Describe an example of how you as a professional nurse have used ethical theories or ethical principles in a clinical practice setting
Describe an example of how you as a professional nurse have used ethical theories or ethical principles in a clinical practice setting
Discussion Question:
Please respond to ONE of the following prompts.
- Describe an example of how you as a professional nurse have used ethical theories or ethical principles in a clinical practice setting.
OR
- In your clinical setting, consider the many times and various ways in which you acted as a patient or family advocate. Which model did you follow in advocating for the patient: rights protection model, values-based model, or respect for persons model? Would having used a different model have changed the outcome? Were there also instances when you chose not to be an advocate for a particular patient? What circumstances or events prevented you from serving in this role?
Verified Expert Answer
Describe an example of how you as a professional nurse have used ethical theories or ethical principles in a clinical practice setting
Nurses are critical in the healthcare sector and provide one of the most essential forms of care at all times (Guido, 2020). It is important that nurses ensure that they deliver the best available care. To help the nurses in making sane and informed decisions, different ethical theories and principles can be applied to ensure efficient implementation of the process.Different theories can be used to offer guidelines on the different attributes of care and improve overall patient outcomes (Pozgar, 2020). Theories can also be essential in guiding the correct model of operation in terms of ethics and morality.
In my nursing career, there have been times that I have used ethical theories and principles in a clinical practice setting. Here is an example of how me as a professional nurse used ethical theories or ethical principles in clinical setting; There this patient I was attending to. She was depicting various mental health symptoms which required me to take initiative and ensure that herneeds were met. To better help the patient, I applied the use of the bioethical principle of nursing by ensuring that I exercised beneficence and maleficence.
The patient was not in the right mindset to make decisions but offered suggestions on what she wanted. During the assessment, I made use of beneficence to ensure that all the decisions and practices are in the best interest of the patient. Maleficence was used to ensure that all the measures were taken to prevent or mitigate any form of harm that might affect the patients. All the different principles were implemented while adhering to the Jean Watson theory of caring which requires a nurse to maintain an efficient environment while at the same time improving care delivery.
References
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Prentice Hall. ISBN: 9780134701233.
Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones and Bartlett. ISBN: 9781284144185.
Alternative Answer
There are seven ethical principles nurses keep in mind while providing not only patient care, but in nursing education, nursing leadership, and nursing research roles. These principles include nurses holding themselves accountable, practicing autonomy, presenting as nonmaleficence, demonstrating beneficence, ensuring justice, displaying fidelity, and showing veracity (Faubion, n.d.). Faubion, (n.d.), illustrates that keeping in line with all of these ethical principles can be challenging no matter how long a nurse has been practicing as well highlights that the role a nurse takes on also changes the way nurses display ethical behaviors.
The last five years of my career, I have been in leadership positions. I demonstrated accountability in many ways. The nurses on my team trust that I am available to them throughout the day to guide and assist them in their everyday practice. I need to be approachable in order for the nurses to feel comfortable to ask for help and act as a role model as well. Recently, one of the nurses confided in me that she was very anxious about case managing a patient with a foley catheter with orders for her to complete the first change upon admission to home care services.
I had her come into the office, reviewed the supplies and the process with her, and we went out together to do the admission and catheter change. I hold myself accountable to ensure the nurses are prepared and confident to perform their role. The nurse did very well with the catheter change and did not even show she was nervous! I believe I was there more for moral support than anything else.
When it comes to practicing autonomy, I need to demonstrate this ethical principle everyday as well. I make decisions that affect both the nurses and patients. I use critical thinking skills to help problem solve and assist nurses in the field. The agency I currently work for provides shift nursing for medically complex children and the LPNs working with the patients call to discuss changes in the patient’s status and rely on me to make decisions, for instance.
The nurses will call me with patient data related to respiratory concerns, together with the information they provide I instruct them to start the patient’s sick plan or if there is a need for a more urgent response, I instruct them to send patient out to the ER.
The ethical principles of nonmaleficence and beneficence are two areas, I exhibit, as a leader to keep the nurses and patients safe as well ensure I protect both nurses and patients. I am responsible for making certain the nurses have the PPE and the safe equipment they need to do their job. In addition, when there are weather emergencies, I activate our emergency protocols and identify which patients absolutely need a nurse to visit or work a shift and which patients can be safe at home without a day or two without a nurse.
It is my responsibility to ensure nurses are proactive with patient medication prepours, reviewing the patient’s individualized emergency care plans, and calling to check in on patients. I needed to do this today, ahead of the severe weather warning and the threat of losing power on this Friday.
In my role, I need to make sure all the nurses are receiving fair treatment. This means each day I review their caseloads, acuity of the patients and the nurses daily schedule so that one nurse is not drowning while others have a lighter day. It’s my responsibility to arrange and make changes so that it is fair and just for everyone. This is an example of ensuring justice for the nurses on my team.
As far as, fidelity and veracity, I support the nurses on my team by starting out every day with a huddle to discuss their day and any challenges they may face. I can offer support and also be truthful on expectations. For instance, it is not reasonable to give the nurses false hope that they will not get an admission or have unexpected patient visits due to change in status every day. Sometimes, I can’t work out the perfect schedule, but I make every attempt possible to assist with making their work day more manageable and safer.
I know there is always room for growth and improvement with applying the seven ethical principles in my nursing practice. Each day new challenges arise and with them I am faced with an opportunity to advance my skills and my ability to practice all seven ethical principles.
Reference
Faubion, D. (n.d.). 7 main ethical principles in nursing + why they’re important. Nursingprocess.org. Retrieved December 21, 2022, from https://www.nursingprocess.org/ethical-principles-in-nursing.html
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FAQs:
Non-maleficence in nursing example
Non-maleficence is one of the core ethical principles in nursing, which means “do no harm.” It requires nurses to avoid causing harm or suffering to patients, whether intentionally or unintentionally. Here’s an example of how non-maleficence applies in nursing practice:
Example: Medication Administration
- Scenario: A nurse is preparing to administer medication to a patient. The patient has a known allergy to penicillin, and the prescribed medication is a penicillin-based antibiotic.
- Application of Non-Maleficence:
- The nurse reviews the patient’s medical history and allergy information before administering the medication.
- Upon noticing the allergy, the nurse recognizes that administering the medication could cause a severe allergic reaction (e.g., anaphylaxis), which would harm the patient.
- The nurse withholds the medication and immediately contacts the prescribing physician to discuss an alternative treatment.
- The nurse documents the situation and ensures the patient’s safety by advocating for a safer medication option.
- Outcome: By adhering to the principle of non-maleficence, the nurse prevents potential harm to the patient and ensures their safety.
Other Examples of Non-Maleficence in Nursing:
- Preventing Infections:
- A nurse ensures proper hand hygiene and uses sterile techniques during wound care to prevent infections, which could harm the patient.
- Fall Prevention:
- A nurse assesses a patient’s fall risk and implements measures such as bed alarms, non-slip footwear, and frequent monitoring to prevent falls and injuries.
- Safe Use of Restraints:
- A nurse avoids using physical restraints unless absolutely necessary and ensures that restraints are used correctly and for the shortest time possible to prevent physical or psychological harm.
- Accurate Documentation:
- A nurse carefully documents patient information, medications, and treatments to avoid errors that could lead to harm, such as medication overdoses or incorrect procedures.
- Advocating for Patients:
- A nurse speaks up when a physician orders a treatment that may be harmful to the patient, ensuring that the patient’s safety is prioritized.
- Preventing Pressure Ulcers:
- A nurse regularly repositions an immobile patient and uses pressure-relieving devices to prevent skin breakdown and pressure ulcers.
- Monitoring for Adverse Reactions:
- A nurse closely monitors a patient after administering a new medication to detect and address any adverse reactions promptly.
12 Examples of Ethical Dilemma In Nursing
Ethical dilemmas in nursing occur when nurses face situations where they must choose between two or more conflicting values, principles, or courses of action. These dilemmas often involve balancing patient autonomy, beneficence, non-maleficence, and justice. Here are some common examples of ethical dilemmas in nursing:
1. Patient Autonomy vs. Beneficence
- Scenario: A patient with a terminal illness refuses life-saving treatment, but the nurse believes the treatment could significantly improve the patient’s quality of life.
- Dilemma: Should the nurse respect the patient’s autonomy and their right to refuse treatment, or should they advocate for the treatment they believe is in the patient’s best interest (beneficence)?
- Resolution: The nurse should respect the patient’s decision while ensuring the patient is fully informed about the consequences. The nurse can also explore the patient’s reasons for refusal and provide emotional support.
2. Truth-Telling vs. Withholding Information
- Scenario: A patient has been diagnosed with a terminal illness, but their family requests that the nurse not disclose the diagnosis to the patient to protect them from emotional distress.
- Dilemma: Should the nurse honor the family’s request and withhold the truth, or should they respect the patient’s right to know their diagnosis (autonomy)?
- Resolution: The nurse should advocate for the patient’s right to know their diagnosis while providing support to both the patient and their family. Open communication and counseling can help address the family’s concerns.
3. Resource Allocation
- Scenario: Two patients need the same life-saving equipment (e.g., a ventilator), but only one is available. One patient is elderly with multiple comorbidities, while the other is a young, otherwise healthy individual.
- Dilemma: How should the nurse decide who receives the resource? Should they base the decision on age, prognosis, or another factor?
- Resolution: The nurse should follow institutional policies and ethical guidelines for resource allocation, which often prioritize factors like likelihood of survival and medical need.
4. Cultural or Religious Beliefs vs. Medical Recommendations
- Scenario: A patient refuses a blood transfusion due to religious beliefs, even though it is medically necessary to save their life.
- Dilemma: Should the nurse respect the patient’s religious beliefs, or should they prioritize the patient’s physical well-being (beneficence)?
- Resolution: The nurse should respect the patient’s beliefs while exploring alternative treatments that align with their values. In some cases, legal or ethical consultation may be necessary.
5. End-of-Life Care
- Scenario: A patient with a terminal illness requests to stop all life-sustaining treatments, but their family insists on continuing aggressive care.
- Dilemma: Should the nurse honor the patient’s wishes for a peaceful death (autonomy), or should they comply with the family’s demands?
- Resolution: The nurse should advocate for the patient’s wishes while providing emotional support and counseling to the family. Legal documents like advance directives can help clarify the patient’s preferences.
6. Confidentiality vs. Duty to Warn
- Scenario: A patient confides in the nurse that they plan to harm themselves or someone else.
- Dilemma: Should the nurse maintain patient confidentiality, or should they break confidentiality to protect the patient or others (duty to warn)?
- Resolution: The nurse is ethically and legally obligated to report the threat to prevent harm, even if it means breaking confidentiality.
7. Vaccine Refusal
- Scenario: A parent refuses to vaccinate their child due to personal beliefs, despite the nurse’s explanation of the benefits and risks.
- Dilemma: Should the nurse respect the parent’s autonomy, or should they prioritize the child’s health and public safety (beneficence and justice)?
- Resolution: The nurse should provide evidence-based education to the parent and explore the reasons for refusal. If the refusal poses a significant risk, the nurse may need to involve child protective services or public health authorities.
8. Nurse’s Personal Beliefs vs. Patient Care
- Scenario: A nurse is asked to assist with a procedure (e.g., abortion or sterilization) that conflicts with their personal or religious beliefs.
- Dilemma: Should the nurse participate in the procedure despite their beliefs, or should they refuse and potentially compromise patient care?
- Resolution: The nurse should communicate their concerns to their supervisor and seek alternative arrangements to ensure the patient’s care is not compromised.
9. Informed Consent in Emergencies
- Scenario: A patient is unconscious and requires emergency surgery, but there is no time to obtain informed consent from the patient or their family.
- Dilemma: Should the nurse proceed with the surgery to save the patient’s life (beneficence), or should they wait for consent, risking the patient’s health?
- Resolution: In emergencies, the principle of beneficence takes precedence, and the nurse should proceed with life-saving treatment under the doctrine of implied consent.
10. Whistleblowing
- Scenario: A nurse observes a colleague engaging in unsafe or unethical practices, such as medication errors or patient neglect.
- Dilemma: Should the nurse report the colleague (whistleblowing), potentially risking their relationship and workplace dynamics, or should they remain silent to avoid conflict?
- Resolution: The nurse has an ethical obligation to report the behavior to protect patient safety. Most institutions have policies to protect whistleblowers from retaliation.
11. Pain Management in Substance Use Disorders
- Scenario: A patient with a history of substance abuse is in severe pain, but the nurse is concerned about the risk of addiction if opioids are prescribed.
- Dilemma: Should the nurse prioritize pain relief (beneficence), or should they avoid prescribing opioids to prevent potential harm (non-maleficence)?
- Resolution: The nurse should collaborate with the healthcare team to develop a balanced pain management plan, possibly incorporating non-opioid alternatives and close monitoring.
12. Discharge Against Medical Advice
- Scenario: A patient insists on leaving the hospital against medical advice, even though they are not fully recovered and may harm themselves.
- Dilemma: Should the nurse respect the patient’s autonomy and allow them to leave, or should they try to prevent the discharge to protect the patient’s health (beneficence)?
- Resolution: The nurse should educate the patient about the risks of leaving and document the refusal of care. If the patient is deemed incompetent, legal intervention may be necessary.