Ethical values are essential for nurses to provide a practical and generally accepted approach to guide their motives, actions and intentions. Ethics in nursing practice can be defined as the moral principles governing how nurses conduct themselves in their professional duties. Decision-making is a major component of nursing practice. Nurses are faced with situations where they have to make a decision that is controversial or seems to contradict the interest of the patient. However, in such situations, the nurse must ensure that the decision is consistent with nursing ethical code of conduct and the moral principles guiding nursing practice. According to Liaschenko & Peter (2004), nursing has been viewed as a vocation, calling, profession and recently, as a practice. All the conceptualizations have been associated with a set of moral principles, expectations and ethical guidelines to ensuring that the interest of the patient is prioritized.
The major ethical dilemmas I have encountered in my nursing practice involved a conflict between autonomy and beneficence. Nurses are supposed to adhere to the four ethical principles which include beneficence, nonmaleficence, autonomy and justice. The principle of beneficence stipulates that the nurse should always make decisions and commit to actions which benefit the patient. The principle of nonmaleficence state that the nurse should not commit any harm to the client. The principle of justice asserts that nurses should always uphold fairness in their work. Nurses should never discriminate against their clients or patients. The principle also incorporates cultural competence to ensure that the nurse understands the patient’s specific needs. The principle of autonomy requires nurses to view the patient as a unique individual. The nurse should not impose values and beliefs on the patient. Instead, the patient should be granted room to exercise self-determination and autonomy.
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I encountered a case scenario where a mother was recommended for emergency caesarian section due to fetal distress but she (the mother) was reluctant signing the consent form after being informed about the recommendation, risks involved and the importance of the procedure. In such a situation, I realized that the midwifery-nurse was in a dilemma either to disclose information to the mother on the risks of caesarian section and risk the mother rejecting the procedure, or giving the information as in its factual state to help the mother make an informed decision. The nurse opted for the latter option. Although the mother initially refused to go through the procedure, she was helped by a clinical counselor to prepare mentally for such a case. Fry (21989) argues that the existential phenomenon of human caring shapes the nature of nursing ethics in any phenomena. As a nurse, ethical dilemmas cannot be avoided. The best way is ensuring that the right process is followed to avoid attracting ramifications and legal consequences.
Utilitarianism and deontology serve as the two major theories applying to nursing practice. Utilitarianism explains the role of utility in decision making. When using a utilitarian approach, a nurse should always make a decision that brings happiness (utility) to more people. However, this theory should be applied in a limited manner. In some cases, the nurse has to consider the best interest of the patient which may be against the patient’s views or the views of the family members. The role of the nurse in such a case is explaining the nature of the procedure and the importance to the patient. Deontology focuses on the duty a person has in a given position. For example, nurses have a duty to care. They should ensure that they commit to that call and deliver optimally in their service. Nursing ethics are evolving. However, the concept of human caring remains constant. Therefore, although nursing keeps evolving and presenting new challenges, the four principles of ethical nursing practice takes precedence when faced with an ethical concern or challenge. According to Armstrong (2006), nurses provide patient-centered healthcare by focusing on individual patient needs. Patient-centered care delivery is the heart of nursing practice in the 21 st century. It is coupled to other concepts such as evidence-based practice to ensure that patients get the best quality care possible.
References
Armstrong, A. E. (2006). Towards a strong virtue ethics for nursing practice. Nursing Philosophy, 7 (3), 110–124. https://doi.org/10.1111/j.1466-769x.2006.00268.x FRY, S. Fry, T. (1989). The Role of Caring in a Theory of Nursing Ethics. Hypatia, 4 (2), 87–103. https://doi.org/10.1111/j.1527-2001.1989.tb00575.x
Liaschenko, J., & Peter, E. (2004). Nursing ethics and conceptualizations of nursing: profession, practice and work. Journal of Advanced Nursing, 46 (5), 488–495. https://doi.org/10.1111/j.1365-2648.2004.03011.x
