Nursing is one of the most hectic professions due to the workload. The differing personality and ailments increase the complexity and challenges of the profession. The essence that an error can be fatal increases the pressure of the nurses to make the best decisions at all time. Working as a unit nurse in a public hospital where the ratio of nurses to patients is more than 1:10 resulted in multiple ethical, moral and legal issues. The complex working environment leads to temptations that pressure the nursing management and clinicians with ethical dilemmas and risks of punishment if their decisions are wrong (Cianci, Hannah, Roberts & Tsakumis, 2014). This essay explores the complexity and factors involved in solving the nursing ethical dilemma.
Ethical Dilemma Encountered
However, the most memorable ethical dilemma I had to make was not medical but a social dilemma. A male patient in his 50s required a kidney transplant. The patient was a father of five children and each child was willing to donate a kidney to save the life of their beloved father. The patient and the kids were confident that one of them would pass the cross-match tests. The father was also pleased that his kids were all determined to donate their kidneys. The man life revolved around his children and supportive wife of 25 years.
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However, following the blood tests and cross-match examinations, no child’s blood or antigen matched that of the father. Further tests depicted that the patient was not the biological father of any of the children. I was the nurse mandated to care for the patient; the patient’s wife approached me stating that she knew that patient was not the biological father. She had an affair with the husband’s friend after years of being childless and the husband’s family pressuring her to bear children. The man had refused to consult medication and family counseling arguing that nothing was wrong with him. The woman knew she was fertile thus decided to have children and save her marriage. The wife begged me to lie about the reasons for the mismatch because the children would be devastated and her husband would die if he knew that the children he adored and took pride in were not his. On the other hand, children argued that they could not believe that the test results thus were planning to visit other hospitals to determine the real reason they were incompatible to their father.
Ethical, moral and legal implications utilized to solve the ethical dilemma
According to Marquis and Huston (2017), nurses are placed in situations that expect them to act as agents for physicians, patients, patients’ families, and the organizations due to the conflicting wants, objective and needs (Marquis & Huston, 2017). The balance of successfully playing these roles is difficult considering the laws and organization policies that may be against the nursing virtues or values. The ethical dilemma created in that the nurse has to choose whether to remain silent and risk the patient’s trust if the children undergo the cross-match tests in another hospital. The guilt of bending the rules to preserve the wife’s secret is likely to reduce the guilt in the end.
According to Cianci, Hannah, Roberts & Tsakumis (2013), a single unethical behavior results in the individual justifying or rationalizing to downplay the act and negative consequence caused by the amoral act. The disengagement leads to the nurse to repeat the unethical behavior and feel no guilt at all (Cianci, Hannah, Roberts & Tsakumis, 2014). Based on the ethical dilemma described above, it is vital to employ the ethical frameworks to determine the best possible decision. Utilitarian define ethical decisions based on the decision that lead to the greatest benefits for the most people. Therefore, it would be better to keep the silence and hope that the children will not retake the tests. The family will remain united and nobody will suspect of the wife adulterous life.
Deontological frameworks, on the other hand, claim that people have inherent rights and must access these rights. Using the deontological guidelines, the nurse should tell the truth. However, duty-based deontology, the nurse has an obligation to do or refrain from doing something that may jeopardize the health of the patient. The patient connection with his kids and the warning from the wife that learning of such a deception would worsen his health or kill him. Lastly, intuitionist argues that the decision of a case should depict the relative goals, rights, and duties (Marquis & Huston, 2017). The patient and children need to know the truth but the nurse does not have a right to share the information because doing so would be an intrusion on the patient’s privacy.
In case the patient suffers after revealing the news, the nurse faces legal actions such as respondeat superior and personal liability for the decision to share the depressing news (Marquis & Huston, 2017). The ANA Code of Ethics guideline requires the nurse to seek help if he or she does not have the skills to make the decision but seeking information for instance from the hospital’s therapist may result in slander because of the image creates in regards to the woman (Marquis & Huston, 2017). Therefore, the nurse should engage the wife and try to convince her to consult the therapist on the best way to deal with the situation. Convincing her to reveal the benefits of revealing the secret to her family should be based on the doctrine of doing good. The organization should also have structured approach to solve such problems to ensure that when faced with a similar situation the nurse is able to gather data and analyze different alternatives thus reduce the morality pressure on the unit nurse or physicians.
My Role as a Moral Advocate and Leadership Styles
Moral advocates are expected to defend and speak out on behalf of the patients, their colleagues, and play the role of intermediaries to enhance ethical decisions. Understand and practicing within the Nurse Practice Act scope enables me to know my limits, rights, and channels that nursing advocates can use to improve the health sector. Based on recent surveys as quoted by (Martin, 2014), nurses are disengaged in politics but through collaboration within the health profession, the nurses can influence policymakers. Collaboration enables the nurses to have a higher bargaining power and advocate for change through lobbyists. By playing the role of a whistleblower and participating in the lobbyist groups, it is possible to call for states and the federal government to change or formulate policies that are simple, direct and do not contradict to other regulations. The current nursing and health policies tend to diminish the nurse’s power to engage in decision-making processes. Therefore, when faced with an ethical dilemma as the one discussed earlier, the nurses freeze and do not know how to solve the dilemma without breaking the law.
Leadership styles and self-assessment are essential in making ethical decisions. According to Cianci, Hannah, Roberts & Tsakumis, (2014), leaders opposed to bending rules or entertaining lying even when the lie is aimed at benefiting the organization or the profession influence their subordinates to acquire the principle of veracity and fidelity. The study demonstrated that leaders who condone amoral behaviors diminish the guilt by rationalizing and justifying such acts. I believe that my moral conviction and my determination to enhance ethical behaviors is similar to that of an authentic leader.
References
Cianci, A., Hannah, S., Roberts, R., & Tsakumis, G. (2014). The effects of authentic leadership on followers' ethical decision-making in the face of temptation: An experimental study. The Leadership Quarterly , 25 (3), 581-594.
Edmonson, C., (2015). Strengthening Moral Courage among Nurse Leaders. Online Journal of Issues in Nursing .
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application . Philadelphia, PA: Wolters Kluwer.
Martin, M. (2014). Transcultural Advocacy and Policy in the Workplace. Journal For Nurses In Professional Development , 30 (1), 29-33.
