Resolution of the Case Show
The CNS calls a team meeting. She asks the members to work toward a consistent message that can be given to GB’s family because the contrasting views are clearly creating confusion. This request results in careful review of the clinical aspects of the case, including the most recent magnetic resonance imaging (MRI) scan, and brings the team to an agreement that the patient’s prognosis is poor and a second opinion from an outside neurosurgeon is not necessary to confirm this. The social worker has an opportunity to ask questions and is thus assured that the team was unaware of the daughter’s educational background and economic status and are not basing their care on these factors. The CNS then moves forward to establish a mutually acceptable plan of care. In a subsequent family meeting, the team explains the patient’s prognosis to the patient’s daughter using layman’s terms and simple pictures to clarify the growth of the tumor and its position. After addressing the family’s questions, the CNS presents two options—withdrawing intensive care interventions or continuing to provide this care with the DNR order in place. She explains that the team has met separately to consider carefully the daughter’s request for transfer GB and determined that the risks of such a plan outweigh potential benefits. The CNS ends the meeting with the family by offering them additional time to discuss their options and ask any further questions. After several days, the family elects to withdraw the ventilator and initiate comfort measures. Oct 19, 2016 | Posted by admin in NURSING | Comments Off on Ethical Decision Making Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Nurse managers, in particular, are susceptible to ethical issues in nursing and moral distress because of their leadership and mentoring roles. Nurses and other medical staff look to nurse managers for appropriate and ethical decisions. Before stepping into a role as a nurse manager, registered nurses (RNs) should understand the role ethical decision-making plays in the day-to-day work. Through Duquesne University’s Master of Science in Nursing program, students explore the foundations of ethical management and leadership from professors with real-world experience. The coursework not only covers the fundamentals of ethical nursing but delves deep into controversial case studies, giving students the chance to examine alternative viewpoints and develop reasoning skills. For nurse managers, ethical decision-making stems from the American Nurses Association Code of Ethics, which was developed as a guideline for nursing responsibilities “in a manner consistent with quality in nursing care and the ethical obligations of the profession.” Nurse managers help solve ethical issues in nursing through using their leadership qualities to implement the Code of Ethics in their daily lives. Nurses’ Code of EthicsANA adopted its first Code of Ethics in 1950. Since then, it has undergone several revisions to offset advances and changes in research, technology, law and overall challenges in nursing. The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right. ANA said that each of the provisions covers topics important to the challenges of nursing in the 21st century. “The code is particularly useful in today’s healthcare environment because it reiterates the fundamental values and commitments of the nurse, identifies the boundaries of duty and loyalty and describes the duties of the nurse that extend beyond individual patient encounters,” ANA said in a statement. Daily, nurse managers face a barrage of decisions and must maintain ethical fortitude to ensure the health, safety and well-being of their patients and staff. They actively work toward resolving ethical issues in nursing that they find in their workplace. Examples of Ethical Dilemmas in NursingThe ANA Code of Ethics provides a standard by which nurse managers can assess ethical issues in nursing. However, the way it addresses ethical dilemmas can vary in different situations. One ethical dilemma that can occur in healthcare facilities is when nurses themselves are not properly equipped to complete their duties. Nurses who notice their coworker’s lack of knowledge face an ethical dilemma of whether they should bring the issue to their nurse manager. To help curb this ethical dilemma, nurse managers can work hard to educate their nurses regarding the Code of Ethics as well as educate them regarding the Code of Ethics for their specific medical facility. Nurse managers can also provide regular trainings for their nurses regarding recurring issues. One example of a common ethical dilemma nurses deal with is establishing boundaries with patients. Nurses and nurse managers devote their careers to helping patients receive the care they need, so it can often be difficult to establish professional boundaries. Patients should not rely on nurses beyond their professional capacity and should not develop romantic relationships with them or offer them gifts. Nurse managers can intervene in situations where ethical and professional boundaries are crossed by either patients or nurses. Another ethical issue in nursing pertains to patient privacy. Nurses and nurse managers have access to a patient’s records and medical history and cannot ethically or legally release that information to anyone besides the patient. Nurses should have the best interest of patients in mind, understanding that they need to protect their privacy and medical data. Common Ethical Situations for Nurse Managers and Nursing Ethics ExamplesEven though nursing is a fast-paced job with new challenges daily, many nurse managers report facing similar ethical dilemmas. A recent study found that the most frequently occurring and stressful ethical situations are protecting patients’ rights, staffing, advanced care planning and decision-making. Exacerbating the problem is the large number of inexperienced nurses entering the field, many who have never faced ethical issues in nursing. Such challenges make experienced nurse managers all the more critical to daily healthcare needs nationwide. The following are some other examples of common ethical situations that nurse managers face:
How to Deal With Ethical Dilemmas in Nursing Nurses undergo many years of education and clinical training before they can become certified nurses, and yet, dealing with real ethical issues in nursing can be far more complex than solving hypothetical issues in textbooks. Nurses can learn how to deal with ethical dilemmas in the workplace through gaining experience and interacting with patients over time. Although nurses have great levels of empathy, it can benefit them to establish professional boundaries with each of their patients at the outset of their careers. Whenever nurses struggle to identify whether something is ethical, they can review the ANA Code of Ethics. Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges. Help Avoid Ethical Dilemmas in NursingThe Duquesne University School of Nursing’s MSN program integrates ethical problem-solving and decision-making to help MSN graduates explore and address ethical issues. Students in each of Duquesne University’s MSN tracks — Adult-Gerontology Acute Care Nurse Practitioner, Family (Individual Across the Lifespan) Nurse Practitioner, Psychiatric-Mental Health Nurse Practitioner, Executive Nurse Leadership and Health Care Management, Forensic Nursing and Nursing Education and Faculty Role — learn how ethics and problem-solving play distinct roles in nursing. U.S. News & World Report ranked Duquesne University’s online MSN program among the Best Online Graduate Nursing Programs in 2017. If you are interested in advancing your career as a nurse manager, explore how Duquesne University’s Master of Science in Nursing program can help you pursue your professional goals and help you avoid ethical issues in nursing. Recommended ReadingsFamily Nurse Practitioners and Professional Liability Insurance Importance of Nurse Manager Resilience Using Escape Rooms for Nurse Education SourcesAmerican Nurses Association, View the Code of Ethics for Nurses Houston Chronicle, “Legal & Ethical Issues That Health Care Professionals Face” Lippincott Solutions, Best Practices for Ethical Nursing Leadership Medical Records Info, Top 10 Most Prevalent Ethical Issues in Nursing National Center for Biotechnology Information, “Ethical Problems in Nursing Management —A Cross-Sectional Survey About Solving Problems” NurseChoice, “4 Common Nursing Ethics Dilemmas” What are the roles of the nurse in ethical decision making?Nurses' ethical decision-making is defined as a sequential process consisting of professional accountability and moral components, such as moral sensitivity, judgment, motivation, and behavior [18]. Professional accountability is defined as taking responsibility for one's judgment and actions [19].
What is the role of the registered nurse in the clinical decisionNurses assess their patients, work with their colleagues, communicate with patients and their families, and identify patient health requirements. They can base their decisions on research and data. They can use critical thinking skills to identify when a patient's treatment needs to be adjusted.
What is the role of ethics in decisionEthical decisions generate and sustain trust; demonstrate respect, responsibility, fairness and caring; and are consistent with good citizenship. These behaviors provide a foundation for making better decisions by setting the ground rules for our behavior.
What is the role of the professional nurse in managing ethical conflicts?Nurses must foster the organizational conditions, practices, and norms that identify and explore ethical issues. They must develop analytical and decision-making skills and actively participate in resolving ethical concerns.
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