The operating room (OR) nurse plays a crucial role in the surgical team, ensuring patient safety, maintaining sterile environments, and providing critical support during procedures.
The responsibilities come with numerous ethical considerations that can pose dilemmas and require careful navigation.
What are the most common ethical considerations for an OR nurse, the associated dilemmas, and examples of how these considerations manifest in practice?
Let’s examine how ethics plays a role in OR nursing.
The importance of ethics
Ethics is a fundamental component of the nursing profession, guiding nurses in their practice to ensure they provide care that respects the dignity, rights, and values of patients.
The American Nurses Association first published its Code of Ethics back in 1926. Today, nurses can read the code, along with interpretive statements, on the ANA website.
Ethical principles in nursing include autonomy, beneficence, non-maleficence, justice, and confidentiality. These principles help nurses make decisions that uphold the best interests of patients and maintain the integrity of the nursing profession.
In the OR, the stakes are particularly high. The environment is fast-paced, and decisions often need to be made quickly, with significant consequences for patient outcomes. OR nurses must balance the demands of their technical responsibilities with the ethical imperative to advocate for and protect their patients.
This dual role makes a strong ethical foundation essential for OR nurses.
Common ethical considerations
Through their work, OR nurses encounter various ethical considerations. Here are some of the most likely, and what types of dilemmas can arise.
Patient autonomy
Explanation: This refers to the right of patients to make informed decisions about their own healthcare. It includes the right to accept or refuse treatment based on their values and preferences.
Ethical dilemma: In the OR, respecting patient autonomy can be challenging when patients are under anesthesia and unable to make decisions or communicate their wishes. An OR nurse must ensure that patients’ informed consent has been obtained before surgery and that their wishes are respected during the procedure.
Example: An OR nurse discovers a discrepancy in the surgical consent form while preparing a patient for surgery. The form indicates the patient consented to a different procedure than what is planned. The nurse faces an ethical dilemma: proceed with the planned surgery to avoid delays, or halt the procedure to verify the patient's consent, potentially causing logistical complications but upholding the patient's autonomy.
Beneficence and non-maleficence
Explanation: Beneficence involves promoting the well-being of patients, while non-maleficence means avoiding harm. OR nurses must balance these principles to ensure the benefits of a surgical intervention outweigh the risks.
Ethical dilemma: OR nurses often face situations where the potential benefits of a surgery must be weighed against the risks of harm. Deciding whether to proceed with a surgery that carries significant risks can be ethically challenging, particularly if the patient’s outcome is uncertain.
Example: A patient with multiple comorbidities is scheduled for a high-risk surgery. The surgical team is divided on whether to proceed, given the potential for serious complications. The OR nurse must advocate for the patient's best interests, considering both the possible benefits and the risks of harm, and ensure that all ethical considerations are communicated to the surgical team.
Confidentiality
Explanation: Confidentiality involves protecting patients' private health information. OR nurses must ensure that patient information is disclosed only to those directly involved in their care and not shared inappropriately.
Ethical dilemma: Maintaining confidentiality can be challenging in the OR, where multiple team members need access to patient information to provide care. Balancing the need for effective communication with the requirement to protect patient privacy is a critical ethical consideration.
Example: During a surgery, an OR nurse overhears a discussion about a patient's sensitive health information. The nurse notices that some non-essential personnel are within earshot. The ethical dilemma involves deciding whether to interrupt the procedure to address the confidentiality breach or handle the situation discreetly afterward without disrupting the surgery.
Justice
Explanation: Justice in nursing refers to fairness in the distribution of healthcare resources and ensuring that all patients receive equitable care. OR nurses must advocate for fair treatment and allocation of resources.
Ethical dilemma: In the OR, situations may arise where resources are limited, and decisions must be made about which patients receive priority for surgical interventions. These decisions can be ethically complex, particularly when patients have similar levels of need.
Example: An OR nurse is part of a team deciding between two patients requiring immediate surgery but only one operating room is available. One patient is a young child with a high chance of recovery, while the other is an elderly patient with multiple health issues. The ethical dilemma revolves around ensuring justice and fairness in making a decision that prioritizes one patient over the other.
Informed consent
Explanation: Informed consent is a patient's right to understand the risks, benefits, and alternatives of a proposed treatment or procedure and to make a voluntary decision to proceed or not. OR nurses play a crucial role in verifying that informed consent has been obtained.
Ethical dilemma: Verifying informed consent can be challenging when there is pressure to proceed with surgery, especially in emergencies. OR nurses must ensure that patients or their legal representatives have been fully informed and have given consent without coercion.
Example: A patient scheduled for surgery is unconscious and unable to provide consent because of an emergency situation. The OR nurse must ensure that the legal representative is contacted and informed appropriately. The ethical dilemma involves balancing the urgency of the situation with the requirement to obtain proper consent, potentially delaying life-saving treatment.
Ethical considerations in practice
For an OR nurse, considering ethics in their daily practice can be a common occurrence. Here are two examples of challenges that are presented.
Example 1: Emergency surgery and patient autonomy
A middle-aged patient is brought into the OR for emergency surgery after a car crash. The patient is unconscious and unable to provide informed consent.
The medical team decides to proceed with the surgery to save the patient’s life. However, upon reviewing the patient's medical records, the OR nurse discovers a "Do Not Resuscitate" (DNR) order. The ethical dilemma revolves around respecting the patient's previously stated wishes versus the immediate need to perform life-saving surgery. The nurse must quickly consult with the surgical team and possibly the patient’s family or legal representative to navigate this ethical challenge.
Example 2: Allocation of limited resources
In a hospital experiencing a surge in patients because of a natural disaster, the OR staff is overwhelmed, and resources are scarce.
Two patients require immediate surgical intervention, but only one operating room is available. One patient is a young man with a high chance of recovery, and the other is an elderly woman with a lower chance of survival. The OR nurse faces the ethical dilemma of advocating for fair and just allocation of resources, considering factors such as age, potential outcomes, and overall health.
This situation requires careful ethical deliberation and collaboration with the surgical team to make a decision that upholds the principle of justice.
Ethics in the OR
Ethics for the OR nurse and surgical team is crucial for several reasons. The operating room is a high-stakes environment where decisions made in seconds can have profound consequences.
OR nurses must navigate complex situations, balancing the need for rapid action with the ethical principles of patient care. They serve as patient advocates, ensuring the patient's voice is heard and respected, even when the patient cannot speak for themselves.
Ethics also plays a vital role in maintaining trust in the healthcare system. Patients and their families must trust that healthcare professionals will act in their best interests, respect their autonomy, and protect their confidentiality. OR nurses, through their adherence to ethical principles, help build and sustain this trust.
Moreover, ethical practice in the OR ensures the integrity of the nursing profession. It reinforces the commitment of nurses to uphold the highest standards of care, fosters professional accountability, and contributes to a culture of ethical excellence within healthcare institutions.
Ethical dilemmas require careful deliberation, collaboration, and a strong commitment to the principles of nursing ethics. By navigating these challenges with integrity and compassion, the OR nurse upholds the trust placed in them by patients and contributes to the overall quality and ethical standards of healthcare.
