How difficult patient situations can lead to moral and ethical dilemmas

By | 2019-05-28T17:04:46-04:00 May 28th, 2019|0 Comments

Healthcare professionals in all disciplines are called upon frequently to deal with unique and difficult patient situations.

As nurses, you spend more time with patients than any other profession and deal with difficult patient situations frequently because of the front line position you hold within healthcare.

Situations can arise from a simple patient question or information from a medical record that gives you pause or concern.

Some scenarios might make you ask:

  • What’s going on here?
  • Why do I feel something’s not right about this?
  • What do I need to do about it?

Other situations are the kind that occur quickly and are identified right away because you intuitively know they are important, potentially serious and need quick action or investigation.

Ethics and morals: Different or the same?

In any difficult patient situation, ethics and morals can come into play. As you look at dilemmas and decisions, you need to distinguish between the ethical and moral ones, even though the two terms often are used interchangeably.

The ethics of nursing practice are clear. In Florence Nightingale’s well-known work,Notes on Nursing,” she wrote that “the very first requirement in a hospital is that it should do the sick no harm.”

As nurses, you follow that rule. It is the basic one you live and practice by. It is what you are taught in nursing programs and what the rules of your employers and professional organizations are built upon.

You understand that nursing ethics are fundamental to the profession and know difficult life-and-death decisions are part of nursing practice.

The American Nurses Association established a Code of Ethics for nurses defined as “a guide for carrying out nursing responsibilities in a manner consistent with quality nursing care and the ethical obligations of the profession … the social contract nurses have with the U.S. public … our profession’s promise to provide and advocate for safe, quality care … that binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations.”

Morals, however, are not guidelines, rules of conduct or codes of behavior. They are not prescribed or imposed on you by schools, churches or professional or business organizations. Morals are personal. They come from within and are based on your beliefs and principles regarding right and wrong.

Although there’s a good deal of information in the literature from ethicists and other experts on the subject, there doesn’t seem to be any clear definitions on how ethics and morals differ.

There is agreement from some that morals and ethics are neither exactly the same, nor completely different. The important thing is both ethics and morals are about doing what is right, and that is why you go to work each day and practice nursing.

Dilemmas you face vs. decisions you make

Healthcare and medicine are complicated. They involve many choices and options you must decide how to handle when faced with difficult patient situations, whether on your own or in concert with patients, families and colleagues.

You can encounter dilemmas in almost any patient care situation. They can arise in any setting at any time, from an ordinary interdisciplinary discussion or family meeting to a patient care plan to a differential diagnosis, diagnostic or treatment choice.

You have all dealt with difficult patient situations and know it can be upsetting and unnerving, causing you to feel everything from vague stress to near panic. There’s no question the times we live in can bring you more difficult patient situations to deal with than ever before.

Even when the dilemma — and the ultimate decision on how to handle it — is one that involves no hospital or nursing ethic, it can become a moral choice for you if you believe the decision was the wrong one.

What you do in difficult patient situations is important

“Every day, nurses support each other to fulfill their ethical obligations to patients and the public, but in an ever-changing world there are increased challenges,” according to the American Nurses Association’s Code of Ethics.

When you encounter situations in which a decision is not what you consider the right one or the moral one, you indeed are challenged.

The ultimate importance of how moral dilemmas are handled and decisions are made cannot be overstated. Nor can what these decisions mean for you as the nurse and the patient.

Dilemmas and decisions are crucial, and no discussion of them would be complete without examining the moral distress they can cause and the moral courage you need to overcome that distress.

Take these courses to learn more about nursing ethics:

Everyday Ethics for Nurses
(7.3 contact hrs)
This course provides an overview of bioethics as it applies to healthcare and nursing in the U.S. It begins by describing the historical events and forces that brought the bioethics movement into being and explains the concepts, theories, and principles that are its underpinnings. It shows how ethics functions within nursing and on a hospital-wide, interdisciplinary ethics committee. The course explains the elements of ethical decision-making as they apply both to the care of patients and to ethics committees. The course concludes with a look at the ethical challenges involved in physician-assisted suicide, organ transplantation, and genetic testing.

Pain Management and Ethics: What’s the Right Thing to Do?
(1 contact hr)
Healthcare professionals in most disciplines encounter patients with pain every day. Whether responsible for making assessments, prescribing treatment, or managing care, the professional must continuously make decisions on how to care for a patient with pain. In the current climate of escalating opioid abuse, it may seem that the struggle to determine “the right thing to do” is even more complex. Often the right answer is blurred by the subjective nature and experience of pain itself. Adding new legal restrictions and guidelines to many analgesic agents (most often opioids) further complicates how patients are scrutinized and treated for their pain. Because the treatment of pain has historically always been a moral endeavor, please join a discussion with a pain management expert to look at how ethics, values, and teamwork may contribute to better care for patients with complex pain management issues.

Nursing Ethics, Part 5: The Process of Ethical Decision Making
(1 contact hr)
The principle of well-being, or beneficence, doing good and preventing harm, obliges the nurse to promote the health and safety of patients in decisions made by and for them. The principle of equity, or justice, requires that patients be treated fairly and equally in the decision-making process. This module will further explore these principles and discuss methods of determining decision-making ability in borderline cases.


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About the Author:

Eileen Williamson, MSN, RN
Eileen Williamson, MSN, RN, continues to write and act as a consultant for Before joining the company in 1998, Eileen was employed by North Shore-Long Island Jewish Health System in New York (now Northwell Health System) where she held a number of leadership positions in nursing and hospital administration, including chief nurse at two of their System hospitals. She holds a BSN and an MSN in nursing administration and is a graduate fellow of the Johnson & Johnson University of Pennsylvania Wharton School Nurse Executives program. A former board member and past president of the New Jersey League for Nursing, a constituent league of the National League for Nursing, Eileen currently is a member of the Adelphi University, College of Nursing and Public Health Advisory Board.

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