NurseZone.com recently posted a story by RN Debra Wood about the ethical dilemmas nurses face. Often, these come about when nurses want to do what they consider the “right thing,” but aren’t able to do so due to protocol or doctors’ orders. We thought it was an interesting topic and wanted to share the story with you, as we think it might resonate and want your thoughts!
Here are some excerpts from the article:
Carol Pavlish, RN, PhD, FAAN, associate professor at the UCLA School of Nursing in Los Angeles, has studied early indicators of ethical challenges nurses face and has developed some strategies for helping them.
“Challenges primarily had to do with watching patients suffer, which nurses find is unnecessary suffering,” Pavlish agreed. Nursing interventions may increase the patients’ suffering without necessarily improving an outcome.
Pavlish found nurses also were concerned that patients and families were not fully informed about treatment options and their clinical prognosis and whether the patient voice was represented. For instance, advance directives were not being followed because families wanted something else.
Wood then discusses how the work environment impacts ethical dilemmas…
“The hierarchy or work structure do not encourage conversations,” Pavlish added. She is developing models and tools to allow such discussions to take place where everyone can feel comfortable speaking up.
“We are looking for ways that it becomes a community obligation to the patient, with collaboration in answering questions and talking about issues,” Pavlish said. “The work of ethics is dialogue.”
Patient safety and staffing issues also fall into the work environment category. Pavlish found nurses reporting they do not have the time to do what they intended for patients–helping them recover or adapt, or addressing patients’ emotional needs.
“They felt compromised and that some their moral obligations were not recognized by the system,” Pavlish said.
And mentions other ethical concerns…
Cultural diversity and caring for people with different values and traditions, and accepting their rituals, can present challenges in the practice setting, Turner explained. Education can help address this type of scenario.
Access to care and affordable and equitable care present ethical challenges for nurses as they try to make that happen in their communities.
Nurses working in non-acute care settings, such as schools and prisons, have concerns related to bedside nurses but they can differ, Turner explained. For instance, some school nurses are now dealing with the fallout from legal actions in their states that now allow untrained lay people to administer insulin and other medications to students.
Communication is key for helping nurses work through these issues. In fact, having conversations with the health care team and holding family conferences can help ease the ethical conflict, Pavlish reported.
“A lot of the distress people feel, even if they don’t agree, is diminished if they have had an opportunity to communicate their view,” Pavlish added.
Walton made the argument for moral advocacy, speaking up and discussing options early.
“How do we talk about the hard stuff and share and invite our team members,” Walton said. “That can mitigate moral distress.”
Read the entire story here, then tell us, do you agree with the list? What do you think are the top ethical challenges for nurses? Sound off in the comments below!