Nursing News February 28, 2019

By Moira K. McGhee

Top 5 Ethical Issues in Nursing

When choices need to be made concerning ethical issues, but the “best” course of action isn’t clear and the treatment options aren’t ideal, nurses are often faced with an ethical dilemma.  

In today’s healthcare environment, ethical issues in nursing are becoming increasingly complex. The American Nurses Association developed the Code of Ethics for Nurses to establish the ethical standard for nurses and the ethical obligations and duties of everyone in the nursing profession.  

Applying the nursing code of ethics in difficult patient-care situations guides you through common ethical issues nurses face every day. 

Common Ethical Issues in Nursing

Ethics in nursing is fundamental to the integrity of the nursing profession and ensure better patient outcomes.  

Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below. 

1. Giving Artificial Hydration and Nutrition 

“Artificial hydration and nutrition is the most difficult conversation to have with patients, family and staff,” says Helen Staples-Evans, DNP, RN, NE-BC and Chief Nursing Officer at Loma Linda University Children’s Hospital.  

“Some issues that have caused concerns among nurses are placement of a G-tube in a nursing home patient with end-stage dementia who is no longer eating and not placing a G-tube in a stroke patient based on their Advance Directive that states he/she would never want a feeding tube placed. 

“Not giving artificial feeds and hydration to a dying person is very difficult for the families and staff,” Staples-Evans continued. “Some nurses feel it is ‘starving the person to death.’ This is even worse in the pediatric setting when the parents have made the decision to discontinue life-sustaining treatments and focus on comfort. The discomfort among nurses grows the longer the child is alive and not being fed.” 

2. Providing Futile Care or Agressive Interventions 

Staples-Evans points out that futile care or aggressive interventions, despite seeing the patient’s progressive decline, is another ethical dilemma some nurses face. 

“Nurses see patients who are in multi-organ failure suffering who continue to receive dialysis, mechanical ventilation and other aggressive interventions because the family won’t let go,” explains Staples-Evans. 

Kristie Aylett, APR, Fellow PRSA, is the Public Relations/Communications Consultant for the American Association of Critical-Care Nurses. She says the number one resource accessed on the AACN website in 2018 was related to ethics: a study published in the American Journal of Critical Care about Predictors of Moral Distress in a US Sample of Critical Care Nurses. 

“According to co-author Catherine Hiler, RN, DNP, CCRN-CMC, the intensive care unit is a practice environment where life-sustaining care intersects with end-of-life care. We found high levels of moral distress frequency when nurses deemed that the care being provided was futile, and the highest level of moral distress frequency occurred when the wishes of the patient’s family to continue life support were followed even though the nurse believed that doing so was not in the best interest of the patient.” 

3. The Opioid Crisis 

Ethical issues in nursing also emerge from the opioid crisis. Nurses must adhere to ethical guidelines surrounding the opioid epidemic as they struggle with the dilemma of the best treatment approach for their patients. 

According to Staples-Evans, some of the opioid-related ethical dilemmas nurses face are “fear of giving opioids to individuals at the end of life, because the nurse doesn’t want to be the one to give the ‘last dose,’ and nurses not giving pain medications or advocating for their patients in pain because they’re concerned with addiction.” 

4. Dealing with Noncompliant Patients 

Ethical dilemmas for emergency room nurses sometimes stem from patients brought into the ER who clearly require acute medical care but aggressively decline medical treatment. While a patient has the right to be autonomous, as a nurse, you have an ethical obligation to advocate for needed medical treatment.  

Unfortunately, you can try to administer care and dispense prescribed medications, but the patient has every right to refuse all medical treatment, even if it means they may not survive. Nursing ethics require you to inform your patients of the necessity for medical treatment, but you can’t force them to accept it. 

A common barrier to noncompliance is science versus spirituality. As the Duquesne University School of Nursing explains on its blog, some religions restrict medical interventions, so patients or their family members with strong religious convictions may feel that science-based health care infringes on their religious beliefs and refuse much-needed treatment.  

The ANA’s nursing code of ethics delves into this issue and states that nurses must respect their patient’s religious beliefs, but that doesn’t imply they condone those beliefs. 

5. Anti-Vaccine Dilemmas 

Ethical concerns about autonomy versus beneficence often become a heated debate when addressing childhood immunizations.  

A parent’s autonomy gives them the right to refuse to immunize their children, but not vaccinating potentially poses a public health hazard and could cause previously eradicated diseases to reappear.  

When you’re attempting to overcome the obstacles to vaccination, you must attempt to unearth why a parent is anti-vaccine, provide them with accurate information about the importance of vaccinating and discuss their hesitation. 

Seek Help with Ethical Issues in Nursing 

No matter what type of ethical issues you’re facing, remember there are avenues for assistance, including your nurse manager or your facility’s ethics committee. 

“I tell my nurses to always ask themselves, 'What are the goals of the patient and/or family?' Our role is to help the patient and family meet those goals, not convince them otherwise,” concludes Staples-Evans.  

“They must also ask themselves, 'Will the treatment I'm concerned about meet the goals of the patient and/or family?' If the answer is yes, then the treatment should be continued; if not, the treatment shouldn’t be done.” 

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