Decision Making and Ethical Dilemmas: The Process for Solving an Ethical Dilemma in Nursing
Have you struggled with an ethical dilemma?
Solving an ethical dilemma in nursing involves a structured approach to ensure the decision-making process is thorough, thoughtful, and patient-centered. Here's a step-by-step process that nurses can follow:
1. Identify the Ethical Dilemma: An ethical dilemma is a situation in which a person faces a difficult choice between two or more conflicting ethical principles or values, where any available option could lead to compromising one of those principles. In nursing, ethical dilemmas often involve decisions where the right course of action isn't clear-cut, and nurses must weigh competing factors like patient autonomy, beneficence (doing good), nonmaleficence (avoiding harm), and justice.
For example, a nurse may face an ethical dilemma when deciding whether to respect a patient's wish to refuse life-saving treatment, which could conflict with the principle of preserving life. Ethical dilemmas require careful consideration, often involving discussions with patients, families, and healthcare teams, to reach the best possible outcome for all parties involved.
What to do:
- Clearly define the ethical issue at hand.
- Determine the conflicting values, principles, and obligations. What are the conflicting values, principles and obligations in the example?
- Identify who is affected by the dilemma (patients, families, healthcare team).Who is affected
2. Gather Relevant Information: When dealing with an ethical dilemma, it’s essential to gather relevant information to ensure a well-informed decision.
Here are the key pieces of information to collect:
A. Patient’s Medical Condition:
- Detailed understanding of the patient’s current health status, prognosis, and treatment options.
- Information on how the patient’s condition may progress with or without the proposed interventions.
B. Patient’s Preferences and Values:
- The patient’s expressed wishes, values, and goals regarding their care.
- Advanced directives, living wills, or any previously documented preferences.
C. Family’s Perspective:
- The opinions and concerns of the patient’s family or legal representatives.
- Cultural, religious, or personal values that might influence their preferences.
D. Legal and Institutional Guidelines:
- Relevant laws, hospital policies, and professional codes of ethics that apply to the situation.
- Understanding of the legal rights of the patient, healthcare provider, and family members.
E. Ethical Principles and Professional Standards:
- Consideration of core ethical principles such as autonomy, beneficence, nonmaleficence, and justice.
- Reflecting on nursing and medical codes of ethics that guide professional conduct.
F. Available Resources and Options:
- The range of possible actions or interventions, along with their risks, benefits, and potential outcomes.
- Input from ethics committees, colleagues, or consultants who may have experience with similar cases.
G. Contextual Factors:
- Social, cultural, or environmental factors that could affect the decision-making process.
- The patient’s psychosocial and emotional state, including their capacity to make decisions.
H. Possible Consequences of Each Option:
- The short and long-term impact of each possible decision on the patient, family, and healthcare team.
- Evaluation of unintended consequences, such as harm, mistrust, or emotional distress.
How to identifiy an ethical dilemma.
By gathering and evaluating this information, healthcare providers can navigate ethical dilemmas more effectively and make decisions that are ethically sound and patient-centered.
-Make sure you understand the patient's medical condition, treatment options, and prognosis.
-By this point you should have the perspectives and preferences of the patient and their family.
3. Reflect on Ethical Principles and Theories
- Consider the key ethical principles: autonomy, beneficence, nonmaleficence, and justice.
- Reflect on nursing ethics and professional codes of conduct.
- Apply relevant ethical theories, such as utilitarianism (the greatest good for the most significant number) or deontology (duty-based ethics).
4. Explore Alternatives and Options
- Identify all possible courses of action. What options do you have?
- Evaluate the potential outcomes and consequences of each option.
- Consider the legal, ethical, and professional implications of each choice.
5. Make a Decision
Make a list of pros and cons of each option. Weigh the pros and cons of each option based on the gathered information and ethical considerations.
- Consult with colleagues, ethics committees, or mentors if needed.
- Make a decision that aligns with ethical principles, professional standards, and patient preferences.
6. Implement the Decision
- Communicate the decision clearly to all parties involved.
- Ensure that the chosen action is carried out effectively and compassionately.
- Provide support to the patient and their family throughout the process.
7. Evaluate the Outcome
- Assess the impact of the decision on the patient and other stakeholders.
- Reflect on the process and outcomes to identify any areas for improvement.
- Document the decision-making process and the rationale for the chosen action.
8. Reflect and Learn
- Reflect on the experience to enhance ethical decision-making skills.
- Discuss the case with colleagues to gain different perspectives and insights.
- Use the experience to inform future ethical dilemmas and professional growth.
What would you do?
Example of Applying the Process:
Scenario: A terminally ill patient with severe pain requests an increase in pain medication, but the requested dosage could potentially hasten death.
1. Identify the Ethical Dilemma
- The dilemma is balancing the principles of beneficence (relieving pain) and nonmaleficence (not hastening death).
2. Gather Relevant Information
- Review the patient's medical history, current condition, and prognosis.
- Discuss the patient's pain levels and their understanding of the medication's effects.
- Talk to the patient's family and healthcare team for additional insights.
3. Reflect on Ethical Principles and Theories
- Autonomy: Respecting the patient's wishes.
- Beneficence: Alleviating the patient's pain.
- Nonmaleficence: Avoiding harm, such as hastening death.
- Justice: Fair allocation of resources and treatment.
4. Explore Alternatives and Options
- Option 1: Increase the pain medication as requested.
- Option 2: Seek alternative pain management strategies.
- Option 3: Consult a palliative care specialist for additional input.
5. Make a Decision
- After evaluating the options, decide to increase the pain medication to a level that relieves pain but carefully monitor the patient's response.
6. Implement the Decision
- Communicate the plan to the patient, family, and healthcare team.
- Administer the medication and closely monitor the patient.
7. Evaluate the Outcome
- Assess the patient's pain relief and overall well-being.
- Monitor for any adverse effects or signs of hastened death.
8. Reflect and Learn
- Reflect on the process with the healthcare team.
- Discuss any challenges and how they were addressed.
- Use the experience to improve future ethical decision-making.
By following this structured process, nurses can confidently navigate ethical dilemmas and provide care that aligns with ethical principles and professional standards.
Here are a few more examples to take note of.
Practical Examples:
- Bedside Conversations: When discussing a patient’s condition at their bedside, ensure curtains are drawn and speak quietly to prevent others from overhearing.
- Phone Conversations: When discussing patient information over the phone, verify the identity of the person you are speaking with and ensure the conversation cannot be overheard by unauthorized individuals.
- Documentation: Always keep patient charts, notes, and other documentation secure. Use coversheets or screen protectors to prevent unauthorized viewing.
By following these strategies, nurses can effectively maintain patient privacy and confidentiality, foster trust, and ensure compliance with legal and ethical standards.
Example of a Reflective Journal Entry:
Date: July 15, 2024
Shift Summary:
Today was a busy shift in the ICU. We admitted two new patients with critical conditions. One patient, Mr. Smith, required immediate intubation.
Significant Events:
- I assisted in Mr. Smith's intubation.
- Managed a family meeting to discuss the care plan for a patient with advanced cancer.
- Encountered a conflict with a colleague over a patient care decision.
Reflections:
- Intubation: I felt confident in my skills during the procedure. However, I need to review sedation protocols to enhance my knowledge.
- Family Meeting: Successfully communicated the care plan, but I could improve my empathy and active listening skills.
- Conflict: The conflict with my colleague was stressful. I need to work on conflict resolution skills and maintaining professionalism under pressure.
Emotional Responses:
- Felt a mix of confidence and anxiety during the intubation.
- Experienced empathy and sadness during the family meeting.
- Felt frustration and defensiveness during the conflict.
Lessons Learned:
- The importance of staying calm and focused during critical procedures.
- Need to enhance communication skills with families.
- Recognize the value of constructive conflict resolution and maintaining a positive team dynamic.
Goals:
- Review sedation protocols this week.
- Attend a workshop on communication skills next month.
- Seek advice from a mentor on conflict resolution strategies.
By incorporating these practices, new nurses can enhance their self-awareness, improve clinical skills, and provide higher-quality patient care. Regular reflection and journaling are valuable tools for continuous learning and professional development.
Take a moment to set up you personal learning plan
Take a moment and start to set up a plan for you and the next 6 months!
Example of a Personal Learning Plan:
Goal: Obtain a Critical Care Nursing Certification (CCRN) within 12 months.
Action Plan:
1. Assess Current Knowledge: Review the CCRN exam content outline and identify areas for improvement.
2. Enroll in Courses: Register for a CCRN review course and schedule study sessions.
3. Study Resources: Gather study materials, including textbooks, online courses, and practice exams.
4. Join Study Group: Form a group with colleagues preparing for the CCRN exam.
5. Mock Exams: Take practice exams to assess knowledge and identify areas needing further review.
6. Exam Registration: Register for the CCRN exam and set a test date.
7. Review and Reflect: Continuously review progress, reflect on learning experiences, and adjust study strategies as needed.
By following these steps, nurses can effectively prepare for lifelong learning and continuous professional development, ensuring they remain knowledgeable and competent in their practice.
How can you learn from a mistake?
Example of Learning from a Mistake: Use this example to choose from a recent mistake go through the steps and see if you can learn from your mistake
Situation: A nurse administers the wrong medication dosage to a patient.
Immediate Actions:
- Acknowledge the Error: The nurse immediately realizes the mistake and remains calm.
- Report and Document: The nurse reports the error to the charge nurse and accurately records it in the patient’s record.
- Assess the Patient: The nurse assesses the patient for any adverse reactions and informs the healthcare team.
Reflect and Learn:
- Self-Reflection: The nurse reflects on the incident, considering factors such as time pressure and distractions during medication administration.
- Seek Feedback: The nurse discusses the mistake with a mentor and receives advice on improving focus and accuracy.
- Root Cause Analysis: The nurse identifies that double-checking procedures were not followed due to rushing.
Improvement Plan:
- Set Goals: The nurse sets a goal to always double-check medication dosages before administration.
- Action Steps: The nurse attends a workshop on safe medication administration and practices double-checking protocols.
Implement Changes:
- Apply Skills: The nurse consistently applies double-checking procedures and stays vigilant during medication administration.
- Monitor Progress: The nurse regularly reviews performance and seeks feedback to ensure continuous improvement.
By admitting mistakes and learning from them, nurses can enhance their professional practice, contribute to a safety culture, and ultimately provide better patient care.
Comment below!
I invite my readers to join a discussion in the blog comment section to share tips and support each other in developing this essential skill.
Share your thoughts and experiences in the comments:
What is a recent ethical dilemma that you’ve come across in nursing?
What is on your 6 month action plan?
When was the last time you admitted to an error? How did you do this?
Any tips or stories you'd like to share with your fellow new nurses?
Ready to embark on this learning journey? Let's make this learning experience interactive and fun!
Share your answers in the blog comments to learn from each other.
