Ethical Dilemmas in Nursing
Post Conference Activity: Ethical Dilemmas in Nursing
Have you heard this before?
“That’s not how we do it in the real world!”
I am certain you have faced the same challenge I have; nurses who deviate from expected best practices and the students they leave behind.
What comes to mind when you think about ethical dilemmas in nursing?
Is it the 14 year-old who wants to stop receiving chemotherapy treatment after he relapses with acute myelogenous leukemia for the third time or the previously healthy 33 year-old mother of three who has a traumatic brain injury from which she has been left neurologically devastated and the family does not want to withdraw care?
We think of the extreme, but what about the “everyday” ethical dilemmas nurses face? How do these “everyday” dilemmas impact us and the care we give? How do our student nurses respond in these situations? Are we equipping them to handle the day-to-day ethical dilemmas they will face after graduation? Are we facing these challenges with our students or are we perpetuating the problem? How can we teach student nurses when they observe poor practice, like:
- Nurses who label labs at the nurses’ station rather than at the bedside,
- The physician who skips the pre-procedure time-out,
- The patient without their identification band on,
- The experienced nurse who won’t perform bedside handover,
- A narcotic that is prescribed for leg pain, but the nurse administers it for a heachache?
What is the impact of ethical dilemmas on nursing?
The way ethical dilemmas are handled within an organization is referred to as the ethical climate (Victor and Cullen, 1987) (as cited in Lemmenes, Valentine, Gwizdalski, Vincent, Liao, 2016, p. 725). An organization’s ethical climate impacts the Registered Nurses’ response to future ethical dilemmas, organizationational loyalty, job satisfaction, psychological well-being of staff and teamwork. Negative perceptions of an organization’s ethical climate can lead to high nurse turnover and dysfunctional behavior (Lemmenes et al., 2016, p. 725-726).
How can we teach ethical competence?
According to Lechasseur, Caux, Dollé, & Legault (2018, p. 700) the components of ethical competence are ethical sensitivity, ethical knowledge, ethical reflection, ethical decision making, ethical action, and ethical behavior. While there is much work to be done in developing best practices in teaching student nurses to handle ethical dilemmas; their experiences in the clinical setting is priceless. Utilizing Dr. Tanner’s Clinical Judgement Model (noticing, interpreting, responding, reflecting) (Tanner, 2006), we can teach student nurses through “real life” scenarios.
What are practical steps we can take?
Use the clinical time to discuss deviations in practice the students encountered during the day and the moral distress they experience. What did they see? What were they expecting to see? Rather than avoid the topic, talk about the possible outcomes for the patients. How did the student nurse handle the dilemma? Finally what about you? Can you make a difference? Are there concerns you can address with the department leaders. Get to know the nurse leader. Bring your concerns forward and remember to CUS!
Post Conference Activity
Access your FREE GUIDE by clicking HERE. Students can complete this during their day or use this as a journaling exercise.