Ethical Dilemma Nursing Essay Example

Nurses are faced continuously with moral and ethical dilemmas along with other things. Throughout nursing school and in practice we are taught how to handle these dilemmas and what it takes. Nurses are taught to, “use their moral reasoning based on their beliefs and values when faced with ethical dilemmas.” (Barlow et al., 2017). I have faced a handful of ethical dilemmas throughout my clinical experience but there was one situation that stands out above all of them. It was more than just an ethical dilemma it would also fall under as moral distress. 

During my 2nd semester of clinical I was assigned to the ortho unit at Macon Navicent. I had a patient who had essentially broken every bone in her body… she had a brain bleed, both arms were broken, liver laceration, internal fixation with a wound vac on 1 leg, and external fixation on the other. She was in between surgeries as they were doing a surgery every couple days to allow the body to rest. When it was time to pull her medications, my instructor printed all SCHEDULED medications to allow me to review them. Once we pulled everything from the pixus my instructor told me to explain all the medications to her. That is when I realized I had pulled heparin AND enoxaparin to be given subcutaneous. We realized that 1 of the 2 had been scheduled and the other wasn’t discontinued as it should have been. Neither medication had instructions or notes about which should be used but they both scheduled to be given at 9:00 AM. This was a medication error that my instructor had caught and waited for me to figure out. We informed the patients nurse and she stated that it was okay and to just give both since they were ordered. I knew that wouldn’t be safe because giving 2 blood thinners to a patient with so many injuries would double her risk of bleeding or other potential complications. So there I was in the middle of an ethical dilemma. The ethical issues I faced were related to miscommunication between interprofessional teams and could directly impact the patients safety to physical health and life.

Ethical Options

An ethical dilemma is when you are faced with 2 or more undesirable options. I was now placed in a situation where I needed to plan of what to do. I had a couple options of potential routes I could take. I could give my patient both medications or withhold both medications. If I don’t give both medications I would be going against the doctors order and but on the other hand If I give both medications there is a good chance she would bleed out as both medications were SubQ and did the same thing.However, it didn’t just stop at that I needed to determine how to fix this; inform the nurse and let the call only be her decision not mine, call the pharmacy or contact the provider. 

The Code of Ethics for Nurses with Interpretive Statements Provision 3 states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” (pg. 7), this statement is a guideline that supports that which ever option is chosen needs to promote and advocate for the patient. ….

Ethical Arguments

The 2 important ethical principles that can be applied to this situation and are in conflict would be nonmaleficence and beneficence. If I used to act with nonmaleficence to support a decision it would mean to act in a way to do harm. This would align with my option to withhold both medications since giving could potentially hurt the patient. On the other hand to act with beneficence is to promote good and if I were to use act with beneficence in this dilemma my option would be administer both medication because the patient is not mobile and at a severe risk for blood clots. Both ethical principles are at conflict when choosing what is best for the patient. Findings from the published article, Nurses’ contributions to the resolution of ethical dilemmas in practice, found that, “Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others” (Barlow et al., 2017) Meaning that when placed in an ethical dilemma these were the 4 main themes that nurses must sift through during ethical decision making.

Ethical Decision

Using the advice from my instructor and what I thought would benefit the patient the most in this situation was to withhold both medications. Since I couldn’t do good for the patient, I decided to at least not do harm. I informed nurse of the situation, contacted the pharmacy, and contacted the doctor for clarification of which medication needed to be given. As a student nurse I know I don’t have a lot of authority, but I felt a sense of responsibility and by taking this course of action I felt like I was promoting nonmaleficence through preventing potential harm to her. “Nursing students feel torn between the conflicts of whether to provide ethical care or accept unethical practices, stay silent about patient care neglect or confront and report it, provide ethical and quality care or adapt to the culture due to lack of autonomous decision making.” (Albert et al., 2020) highlights how student nurses struggle with ethical decision making especially because we feel like we won’t make the right one since we are so inexperienced.