How difficult patient situations can lead to moral and ethical dilemmas

Healthcare professionals in all disciplines are called upon frequently to deal with unique and difficult patient situations.

As nurses, you spend more time with patients than any other profession and deal with difficult patient situations frequently because of the front line position you hold within healthcare.

Situations can arise from a simple patient question or information from a medical record that gives you pause or concern.

Some scenarios might make you ask:

  • What’s going on here?
  • Why do I feel something’s not right about this?
  • What do I need to do about it?

Other situations are the kind that occur quickly and are identified right away because you intuitively know they are important, potentially serious and need quick action or investigation.

Ethics and morals: Different or the same?

In any difficult patient situation, ethics and morals can come into play. As you look at dilemmas and decisions, you need to distinguish between the ethical and moral ones, even though the two terms often are used interchangeably.

The ethics of nursing practice are clear. In Florence Nightingale’s well-known work,Notes on Nursing,” she wrote that “the very first requirement in a hospital is that it should do the sick no harm.”

As nurses, you follow that rule. It is the basic one you live and practice by. It is what you are taught in nursing programs and what the rules of your employers and professional organizations are built upon.

You understand that nursing ethics are fundamental to the profession and know difficult life-and-death decisions are part of nursing practice.

The American Nurses Association established a Code of Ethics for nurses defined as “a guide for carrying out nursing responsibilities in a manner consistent with quality nursing care and the ethical obligations of the profession … the social contract nurses have with the U.S. public … our profession’s promise to provide and advocate for safe, quality care … that binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations.”

Morals, however, are not guidelines, rules of conduct or codes of behavior. They are not prescribed or imposed on you by schools, churches or professional or business organizations. Morals are personal. They come from within and are based on your beliefs and principles regarding right and wrong.

Although there’s a good deal of information in the literature from ethicists and other experts on the subject, there doesn’t seem to be any clear definitions on how ethics and morals differ.

There is agreement from some that morals and ethics are neither exactly the same, nor completely different. The important thing is both ethics and morals are about doing what is right, and that is why you go to work each day and practice nursing.

Dilemmas you face vs. decisions you make

Healthcare and medicine are complicated. They involve many choices and options you must decide how to handle when faced with difficult patient situations, whether on your own or in concert with patients, families and colleagues.

You can encounter dilemmas in almost any patient care situation. They can arise in …read more

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