2.2 Ethical decision-making models in nursing
4 min read•august 9, 2024
Ethical decision-making models guide nurses through complex moral dilemmas. These frameworks, like the , help analyze issues, consider options, and make sound choices aligned with nursing ethics.
Cultural factors add depth to ethical considerations in nursing. Respecting diverse beliefs while upholding core principles requires and humility. Nurses must navigate these complexities to provide ethical, patient-centered care.
Ethical Principles
Fundamental Ethical Principles in Nursing
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- respects patients' right to make their own decisions about their healthcare
- Involves obtaining before procedures
- Allows patients to refuse treatment even if it goes against medical advice
- requires nurses to act in the best interest of patients
- Involves providing care that promotes health and well-being
- Includes educating patients about healthy lifestyle choices
- mandates avoiding harm to patients
- Encompasses careful medication administration to prevent errors
- Involves proper infection control practices to prevent nosocomial infections
- ensures fair and equitable distribution of healthcare resources
- Addresses issues of healthcare access for underserved populations
- Considers resource allocation in situations of scarcity (organ transplants)
Additional Ethical Principles in Nursing Practice
- emphasizes loyalty and commitment to patients
- Involves maintaining patient confidentiality
- Requires following through on promised care and treatments
- stresses truthfulness and honesty in patient interactions
- Includes providing accurate information about diagnoses and prognoses
- Necessitates admitting and disclosing medical errors when they occur
Ethical Decision-Making Models
MORAL Model for Ethical Decision-Making
- M: Massage the dilemma to clarify the ethical issues involved
- Identify the stakeholders affected by the decision
- Articulate the conflicting ethical principles at play
- O: Outline options for addressing the dilemma
- Brainstorm potential courses of action
- Consider both short-term and long-term consequences of each option
- R: Review criteria and resolve
- Evaluate each option against ethical principles and professional standards
- Consult relevant policies, laws, and ethical guidelines
- A: Affirm position and act
- Make a decision based on the most ethically sound option
- Implement the chosen course of action with confidence
- L: Look back and learn
- Reflect on the decision-making process and outcomes
- Identify lessons learned for future ethical dilemmas
Alternative Ethical Decision-Making Frameworks
- organizes ethical considerations into four categories
- Medical indications examine the clinical facts and treatment options
- Patient preferences focus on the patient's expressed wishes and values
- Quality of life evaluates the impact of decisions on patient well-being
- Contextual features consider external factors (family, legal, financial)
- Ethical framework provides a structured approach to analyzing ethical issues
- Identify the ethical problem or question at hand
- Gather relevant information from all involved parties
- Consider applicable ethical principles and professional guidelines
- Evaluate potential courses of action and their consequences
- Make a decision and justify it based on
Ethical Challenges
Common Ethical Dilemmas in Nursing
- occurs when two or more ethical principles conflict
- decisions (continuing life support vs. allowing natural death)
- Balancing patient autonomy with beneficence in cases of treatment refusal
- arises when nurses cannot act according to their ethical beliefs
- Occurs when institutional constraints prevent ethical action
- Can lead to burnout, job dissatisfaction, and turnover among nurses
- Informed consent requires patients to understand and agree to treatments
- Involves explaining risks, benefits, and alternatives of procedures
- Challenges arise with patients who have diminished decision-making capacity
Patient Advocacy and Ethical Responsibilities
- Patient advocacy involves speaking up for patients' rights and interests
- Includes ensuring patients receive appropriate care and resources
- May require challenging unethical practices or decisions by colleagues
- Nurses must navigate complex ethical situations while prioritizing patient welfare
- Balancing family wishes with patient's expressed preferences
- Addressing potential conflicts of interest in healthcare delivery
Cultural Considerations
Cultural Competence in Ethical Nursing Practice
- Cultural competence involves understanding and respecting diverse patient beliefs
- Requires awareness of one's own cultural biases and assumptions
- Necessitates adapting care to align with patients' cultural values
- Ethical decision-making must consider cultural factors
- Some cultures prioritize family decision-making over individual autonomy
- Religious beliefs may influence treatment preferences and end-of-life care
- Nurses must navigate cultural differences while upholding ethical principles
- Using professional interpreters to ensure accurate communication
- Respecting cultural practices while maintaining patient safety standards
- encourages ongoing learning and self-reflection
- Recognizes that cultural competence is a continual process, not an endpoint
- Involves asking patients about their cultural preferences and beliefs
Key Terms to Review (21)
American Nurses Association (ANA): The American Nurses Association (ANA) is a professional organization that represents the interests of registered nurses in the United States. It plays a crucial role in shaping nursing practice and promoting high standards in healthcare. The ANA advocates for ethical standards and provides resources that guide nurses in their decision-making processes, especially when navigating complex ethical dilemmas.
ANA Code of Ethics: The ANA Code of Ethics is a foundational document that outlines the ethical principles and guidelines for nursing practice in the United States. It serves as a framework for ethical decision-making and professional conduct, emphasizing the nurse's commitment to patient care, respect for human dignity, and advocacy for social justice. This code plays a crucial role in guiding nurses through ethical dilemmas and shaping their professional identity.
Autonomy: Autonomy is the right of individuals to make their own choices and decisions regarding their personal lives and healthcare. It emphasizes respect for a person's ability to govern themselves, which is crucial in ensuring that patients participate actively in their care, including decision-making processes about treatments and interventions.
Beneficence: Beneficence is the ethical principle that emphasizes the moral obligation to act for the benefit of others, promoting good and preventing harm. In healthcare, it guides professionals to prioritize patient welfare, fostering an environment where patient needs and well-being take precedence over other interests.
Cultural Competence: Cultural competence is the ability of healthcare professionals to understand, respect, and effectively interact with individuals from diverse cultural backgrounds. This skill is essential in delivering ethical and effective nursing care, as it ensures that the unique values, beliefs, and practices of patients are recognized and integrated into their care plans.
Cultural Humility: Cultural humility is an approach to understanding and engaging with individuals from diverse cultural backgrounds that emphasizes self-reflection, lifelong learning, and an openness to learning from others. This concept goes beyond cultural competence by recognizing the power imbalances in society and the importance of being aware of one's own biases while valuing the perspectives of others. By fostering a mindset of humility, healthcare professionals can build more trusting relationships with patients and collaborate effectively across different disciplines.
Deontology: Deontology is an ethical theory that emphasizes the importance of following rules or duties in moral decision-making. It asserts that actions are morally right or wrong based on their adherence to a set of principles, regardless of the consequences that may follow. This approach focuses on the intrinsic morality of actions, guiding professionals to uphold their ethical obligations consistently.
End-of-life care: End-of-life care refers to the support and medical care provided during the time surrounding death, focusing on the needs and comfort of patients who are nearing the end of their lives. This type of care emphasizes the importance of managing pain, providing emotional support, and ensuring that patients’ wishes regarding treatment and life-sustaining measures are respected. It intersects with ethical decision-making and common dilemmas faced in nursing as healthcare providers must navigate complex choices about treatment options and patient autonomy while considering the best interests of both the patient and their family.
Ethical Advocacy: Ethical advocacy involves promoting and defending the rights and interests of patients while adhering to ethical principles and professional standards in nursing. It emphasizes the nurse's role in ensuring that patients receive appropriate care, are informed about their options, and are supported in making decisions about their health. This practice is closely connected to ethical decision-making models that guide nurses in navigating complex situations involving patient care and rights.
Ethical Dilemma: An ethical dilemma occurs when a person faces a situation in which they must choose between two or more conflicting moral principles, each of which has valid support but leads to different outcomes. This often involves a choice that challenges a person's values, beliefs, or professional obligations, making the decision-making process particularly complex. Ethical dilemmas are common in nursing and healthcare settings, where practitioners must balance patient care, professional ethics, and legal considerations.
Ethical reasoning: Ethical reasoning is the process of evaluating and making decisions based on ethical principles and moral values. It involves critical thinking to analyze situations, weigh options, and determine the best course of action that aligns with ethical standards. In nursing, this type of reasoning is crucial as it guides practitioners in making decisions that impact patient care, respect patient rights, and uphold professional integrity.
Fidelity: Fidelity refers to the ethical principle of being faithful and loyal to commitments and obligations, particularly in the context of healthcare. It emphasizes the importance of maintaining trust in the nurse-patient relationship and upholding promises made to patients. In nursing, fidelity involves adhering to professional standards, following through with care, and honoring the wishes of patients while ensuring their safety and well-being.
Four-box method: The four-box method is an ethical decision-making model that helps healthcare professionals, especially nurses, to systematically analyze complex ethical dilemmas by organizing relevant information into four distinct categories. This model promotes a structured approach, allowing for thorough evaluation of the clinical situation, the patient's wishes, and the ethical principles involved, which can lead to more informed and responsible decisions in nursing practice.
Informed Consent: Informed consent is the process by which a patient voluntarily agrees to a proposed medical treatment or intervention after being fully informed of its risks, benefits, and alternatives. This concept is crucial in promoting patient autonomy and ensuring that individuals have the right to make educated decisions regarding their healthcare.
International Council of Nurses (ICN) Code of Ethics: The International Council of Nurses (ICN) Code of Ethics is a foundational document that outlines the ethical principles and standards that guide nurses in their professional conduct and decision-making. It emphasizes the commitment of nurses to uphold human rights, deliver quality care, and advocate for health equity while providing a framework for ethical practice in diverse settings.
Justice: Justice in healthcare refers to the ethical principle that emphasizes fairness and equity in the distribution of benefits and burdens among individuals and communities. It highlights the importance of treating individuals impartially and ensuring that everyone has access to necessary resources and opportunities, particularly in nursing and research contexts.
Moral distress: Moral distress occurs when an individual knows the ethically appropriate action to take but feels powerless to take that action due to external constraints. This can happen in healthcare settings where professionals face conflicts between their moral beliefs and institutional policies or practices, leading to feelings of frustration and helplessness. Understanding this concept is crucial as it connects deeply with ethical decision-making models, fundamental ethical principles, and the common dilemmas nurses face in their practice.
Moral Model: The moral model is an ethical decision-making framework that emphasizes the role of moral principles and values in guiding the actions of healthcare professionals. It suggests that decisions should be based on what is considered right or wrong, focusing on ethical duties and obligations, and often involving the consideration of patient rights, justice, and beneficence. This model helps nurses navigate complex situations by providing a structured approach to evaluating ethical dilemmas in patient care.
Non-maleficence: Non-maleficence is the ethical principle in healthcare that emphasizes the obligation to not inflict harm intentionally. It serves as a foundational concept in nursing, guiding practitioners to make decisions that prioritize patient safety and well-being. This principle connects deeply with how nurses approach ethical decision-making, navigate common dilemmas in practice, and uphold the standards of professionalism in their roles.
Utilitarianism: Utilitarianism is an ethical theory that emphasizes the greatest good for the greatest number, proposing that the best action is the one that maximizes overall happiness or utility. This principle is vital in various contexts, including decision-making in nursing, where practitioners often face dilemmas that require balancing the needs of individual patients with those of the wider community. Understanding utilitarianism helps nurses navigate complex ethical situations by evaluating potential outcomes and prioritizing actions that yield the highest benefit for patients and society.
Veracity: Veracity refers to the obligation to tell the truth and provide accurate information, especially in healthcare settings. It underscores the importance of honesty in communication between healthcare providers and patients, fostering trust and integrity in the professional relationship. This principle is essential for informed decision-making, which ultimately affects patient outcomes and ethical practice in nursing.