Introduction:
In the healthcare setting, nurses often encounter ethical and moral dilemmas. This assignment presents an ethical dilemma. In this scenario, a patient, Carlos, who is recovering from a gunshot wound, is being discharged home to the care of his sister, Consuela. Carlos is HIV+ and Consuela is unaware of Carlos’ HIV status. Carlos has asked the caregivers in the hospital to not disclose to his sister this diagnosis. The question is whether the nurse should disclose this information to Consuela, and what ethical and moral principles should guide the nurse in making this decision.
Nursing ethics are guided by six ethical principles; beneficence, nonmaleficence, autonomy, justice, veracity, and fidelity (Chitty, 2005, p. 528). The
There is a conflict between Carlos’ right to privacy, and Consuela’s right to know about Carlos’ condition that might be relevant to her safety while providing care for Carlos. The nurse needs to arrange appropriate care for Carlos, minimize any risks to Consuela, and at the same time respect Carlos’ autonomy and right to privacy. Provision 1.4 of the ANA Code of Ethics (ANA 2001, p. 8) describes the obligation of the nurse to respect Carlos’ autonomy in making decisions, and provisions 3.1 and 3.2 (ANA 2001, p. 12) describe the nurses’ role in safeguarding the privacy and confidentiality of the patient. Legally it would be a violation of Carlos’ HIPAA rights to disclose his HIV status to Consuela after his explicit request to not divulge this information (HHS.gov, 2003). The risk of transmission of HIV to Consuela is very low, but still more than zero. Provision 2 of the ANA Code of Ethics states, “The nurse 's primary commitment is to the patient, whether an individual, family, group, or community” (ANA 2001, p. 9), so the nurse may consider Consuela’s rights to be equal with Carlos’ rights. The nurse should not, under the existing circumstances, disclose to Consuela Carlos’ status. However, the nurse still has some things that she can do to advocate on behalf of Consuela before discharging Carlos to her care. These actions will be discussed later in this
Is a compromise available? First of all, the nurse would argue that until Consuela is completely informed, Consuela cannot, in the context of discharge planning, be an eligible caregiver. Consuela cannot give informed consent to care for Carlos because she has not been given all the information necessary to make a properly informed decision. To allow her to take care of Carlos without disclosing his HIV status would be deceitful. Any professional caregiver assigned to care for him would be informed, and would also be adequately trained in standard precautions. Consuela is neither. The nurse should go to the responsible discharge planners and ask that Consuela be removed from the list of eligible caregivers. This would allow Medicaid to revisit the case and perhaps assign an appropriate caregiver. In the absence of a home caregiver, the nurse could argue that Carlos is not, in fact eligible for discharge, and that the safest thing to do would be to allow him to recuperate in the hospital, where he can be guaranteed that he will have appropriate caregivers. At the same time, the nurse should talk with Carlos and continue to encourage him to allow Consuela to be informed of his status. The nurse should not agree to carry out a discharge that allows Consuela to care for Carlos without being informed. To quote Angell from the original case study, “If Carlos insists that his sister not be told, the doctor
Nurses everywhere face problems and challenges in practice. Most of the challenges occur due to a struggle with the use of ethical principles in patient care. Ethical principles are “basic and obvious moral truths that guide deliberation and action,” (Burkhardt, Nathaniel, 2014). Ethical principles that are used in nursing practice include autonomy, beneficence, non-maleficence, veracity, confidentiality, justice, and fidelity. These challenges not only affect them, but the quality of care they provide as well. According to the article, some of the most frequently occurring and most stressful ethical issues were protecting patient rights, autonomy and informed consent to treatment, staffing problems, advanced care planning, and surrogate decision making (Ulrich et. al, 2013). The ethical issue of inadequate staffing conflicts with the principle of non-maleficence.
A nurse’s role in decision making is minimal depending on the place of work residence. Authors Shoni Davis, Vivian Schrader, and Marcia J. Belcheir’s opinion on Ethical decision making in nursing is “a process that involves making an ethical consideration of a patient care situation” (738-749). It seems like nurses can just cite immediately or take a hunch of what is wrong with a patient, but doctors are the ones that actually do the direct diagnosing. There have been many decision making processes and theories. Each has its own unique concepts and terminology, but all have similar components. It identifies good nur...
As mentioned by the Cherry and Jacob (2014), “nursing ethics is a system of principles concerning the actions of the nurse in his or her relationship with patients, patients’ family members, other health care providers, policymakers, and society as a whole”
Since ethical dilemmas are not always easily answered through the use of The Code of Ethics, ethical decision-making models are effective tools that can assist nurses in dealing with ethical issues. Ethical decision-making models provide a framework for working through difficult choices. They seek to define the limits of what is morally acceptable and help clarify the guidelines for making those difficult decisions. Ethical decision making models assist nurses in analyzing situations by focusing on understanding the patient needs, need for responsiveness to circumstantial considerations, and recognizing the uniqueness of each situation.
In this essay the author will rationalize the relevance of professional, ethical and legal regulations in the practice of nursing. The author will discuss and analyze the chosen scenario and critically review the action taken in the expense of the patient and the care workers. In addition, the author will also evaluates the strength and limitations of the scenario in a broader issue with reasonable judgement supported by theories and principles of ethical and legal standards.
Hood mentions, “determining the presence of more than one ethical concern” (Hood, 2013, p. 70), which I felt was the provider asking me to do something she knew was wrong, knowing there were other available resources, and asking me to do something that I had never assisted with or trained to do. After identifying the problem, I needed to identify the morally relevant facts, which takes a closer look at the context of the dilemma (Hood, 2013, p.70). As mentioned before, the doctor seemed at ease knowing what she was doing, telling me the plan, which is a cause of concern for any future outpatient nurse who may possibly work with her, but doesn’t speak up or isn’t aware of her limitations. In this experience, I needed to stop and think to myself, is the choice that I am making legal within my institution and under my scope and license? From there I evaluated the problem, Hood mentions, “examine the ethical norms by reviewing the literature, code of ethics for nursing” (Hood, 2013, p. 70). After encountering that situation and speaking with my manager, I wanted clarification on my job duties as some nurses say it’s a “gray line”, where it depends on your comfort level or the physician you work with in doing things that the nurse possibly shouldn’t be doing. My manager clarified with me that I legally shouldn’t have even offered to go with her
Ethics and integrity are essential parts of the nursing profession since they provide nurses with the capacity for weighing in on the impacts that their actions may have on the profession (Guido, 2014). However, maintaining high levels of ethics and integrity may create significant challenges for nurses some of which impact on their position as healthcare providers. One of the key challenges that nurses experience as part of their profession is increased cases of ethical dilemmas some of which impact on their abilities to make decisions based on the interests of their patients. The nursing code of ethics indicates the need for nurses to ensure that the decisions or actions they take reflect on the interests
To understand ethics in the nursing field, you must first know what ethics is. A general explanation of ethics is the beliefs, values and morals that an individual has. These may not be that same for everyone and some may disagree with each others ethics. Ethics is dealing with what is right and what is wrong everyone has different views regarding what is. A nurse must understand and be clear about ones own beliefs, values and morals, before understanding others and being able to deal with the difference that one will encounter in the nursing field. Ethics in nursing, (Concepts pg.220), “The nurse is someone who has internalized the concept of what it means to be a human being and accepts personal responsibility for relationships with other human beings. A nurse has an obligation to do good and not harm anyone and is committed to providing the same high-quality level of nursing service to all human beings”. Ethics in nursing can be hard to differentiate between the law and the code of ethics. There are committees and groups that are put together to help make the Nursing Code of Ethic...
Ethics are based on one’s character and understanding as to what is right or wrong. Although most people have the general understanding to everyday ethics, it is important for a nurse to be aware of the formal study of ethical issues that appear throughout the profession. In fact, ethics are such a
This case presents a very delicate situation that presents many legal and ethical questions. Do you tell your brother his partner has HIV? I would tell my brother, but the how and when, may vary based on circumstance. From a professional ethical standpoint, it would be unethical to disclose the patient’s HIV status without consent. It would violate the patient’s right to confidentiality, as it is the patient’s choice whom information may be shared with (Beemsterboer, 2010, p. 50). It could also be argued that it is a violation of the principle of nonmaleficence. By providing the patient’s HIV status to people unbound by HIPAA, you are putting the patient at risk of discrimination. This could cause mental anguish or psychological issues, therefore, in essence, inflicting harm on the patient. The most valued application of nonmaleficence is, “One ought to not inflict harm” (Beemsterboer, 2010, p. 42). This would outweigh the ethical argument that you are also preventing harm to your brother, another less important application of nonmaleficence (Beemsterboer, 2010, p. 42). There is one professional ethical principle that I would argue was being applied. This being the principle of paternalism, stating that healthcare providers should do what they deem best for the patient according to their ability and judgment (Beemsterboer, 2010, p. 47). If the patient had a sexual encounter with the brother, and did not inform him of her HIV status, she may be arrested for reckless endangerment according to Pennsylvania law. A case where an HIV-positive person did not disclose their status to their sexual partner was brought before the Pennsylvania Superior Court. According to Pennsylvania law, “Disclosure of HIV status is a defense ag...
The ethical principles that apply to this case include respect for autonomy, beneficence, non-maleficence, veracity, and fidelity. Ethical principles are set to guide nurse’s actions in an ethical situation, therefore it is essential that nurses understand them so they are able to apply them appropriately (Burkhardt et al., 2014).
By establishing a code of ethics the nursing profession provides a framework for judgment calls dealing with these difficult situations. This set of moral principals sets a standard for thinking through ethical problems, which ultimately helps nurses settle these types of issues. These ethical nursing dilemmas usually arise from disagreements in personal values and social issues that regard the decisions or beliefs of patients. The objective is to come to a common understanding which upholds the best interest of the patient while reinforcing the personal values of the healthcare professional.
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
Imagine having the responsibility to choose the “right course of action” in a situation that presents with many different “right actions”. Nurses are faced with this responsibility often; and most times it is not an easy decision process. This situation is known as an ethical dilemma (CNA, 2008). Ethical dilemmas arise in a situation when there are equally compelling reasons for and against two or more possible courses of action, and where choosing one course of action means that something else is relinquished or let go (CNA, 2008). The purpose of this paper is to use the Canadian Nurses Association Code of Ethics (2008), and consider how my own personal morals and values can help guide me through solving ethical dilemmas and also how I, as a future nurse can deal with the negative effects that may arise after an ethical decision is made. Strengthening your moral agency and moral courage as a nurse is also important in the ethical decision making process in order to successfully solve and continue to be able
An important goal of nursing is to “maximize benefit and minimize harm to patients” (Gadow, 1990). It is the nurse who understands the differences between beneficence and the knowledge that patients play a role in decision making. Beneficence is an obligation in the nursing field of ethics. It is the nurse’s duty to understand that decisions may not always be in the patient’s best interest. There are times when nurses are required to make decisions that go against the patient’s wishes, but need to be done for the patients’ well-being. Patients should always be treated with respect and feel like they have the ability to make their own decisions, but nurses should also have the overall well-being of the patient and community in mind. For example, public health programs that include childhood immunizations and vaccinations show goodwill on a community level. The programs weigh the pros and cons of immunizations and vaccinations, but also recognized that harm could be done to a few, but majority of people will benefit (Beauchamp & Childress, 2013). Nursing’s background stems from ethics because of its individual and community