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A HISTORY OF NURSING ETHICS

The Nuremberg trials at the close of WWII offered disturbing questions. How can “good” people in traditionally honor-bound professions become complicit in some of the worst violations of humanity in history? What happens when individual professionals are not held to account by their peers, professions, and society as a whole? The trials showed how moral individuals within organizations can engage in morally “wrong” functions. “I was just following orders,” complicit healthcare providers, doctors, and nurses claimed.

Morality refers to principles that help determine what is “right” and what is “wrong.” Ethics is the related field that puts these principles to work to:
apply moral principles to choose “right” actions,
conduct relationships in an ethical manner, and
manage situations where a “right” action is clear but for some reason not possible.

Using what we have learned this week- read the ethical dilemma below and explain your response and actions:

Nurse Is Instructed to Have Patient with Low Literacy Level to Sign Consent for Treatment

Scenario: Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she notices he seems confused and is unsure where or how to sign the paperwork.

Ethical Dilemma: It is common for nurses to be the ones to get signatures on consent forms, especially for procedures like the one described in this scenario. When faced with a situation like the one here when the nurse is not sure that the patient understands what he is being told or if he can read, the decision of whether to delay a busy schedule to have the doctor come back and talk to the patient or explain to the best of her knowledge and get the patient’s signature may seem difficult to make.

Now that you have read the ethical dilemma below WHAT IS THIS PERSON FOCUSING ON EMOTIONALLY? What are the ASSOCIATED ETHICAL PRINCIPLEs AT PLAY IN THIS SCENARIO? WHAT ARE THE IMPLICATIONS OF THE NURSE’S ACTIONS? explain your responses and your current actions.

Sample Answer

Analyzing the Nurse’s Ethical Dilemma

Emotional Focus:

The nurse, Gloria, is likely experiencing a conflict between her professional duty and her moral obligation. She may feel a sense of urgency to adhere to the physician’s instructions and maintain the schedule. At the same time, she may feel a sense of responsibility to ensure that Mr. Isaacs fully understands the procedure and consents to it knowingly. This internal conflict can lead to feelings of stress, anxiety, and uncertainty.

Full Answer Section

Associated Ethical Principles:

Autonomy: This principle emphasizes the patient’s right to self-determination and the ability to make informed decisions about their own healthcare. In this case, Mr. Isaacs’s autonomy is at risk if he does not fully understand the procedure and its implications.
Beneficence: This principle requires healthcare providers to act in the best interests of their patients. While the colonoscopy may be medically necessary, it is important to ensure that the patient understands the potential risks and benefits.
Non-maleficence: This principle requires healthcare providers to avoid causing harm. If Mr. Isaacs undergoes the procedure without fully understanding the risks, he may experience unnecessary harm or distress.
Justice: This principle requires fair and equitable treatment of all patients. In this case, it is important to ensure that Mr. Isaacs receives the information and support he needs to make an informed decision.

Implications of the Nurse’s Actions:

The nurse’s decision will have significant implications for Mr. Isaacs’s well-being. If she proceeds with obtaining his signature without ensuring his full understanding, she may violate his autonomy and potentially expose him to harm. On the other hand, delaying the procedure to obtain informed consent may disrupt the hospital’s schedule and potentially inconvenience other patients.

Course of Action:

To address this ethical dilemma, Nurse Gloria should prioritize the patient’s best interests. She should:

Communicate Clearly: Use simple language and avoid medical jargon to explain the procedure to Mr. Isaacs.
Assess Comprehension: Ask open-ended questions to determine if Mr. Isaacs understands the information.
Involve a Medical Interpreter: If language barriers exist, arrange for a qualified interpreter to assist with communication.
Consult with the Physician: Discuss Mr. Isaacs’s limited understanding with the physician and advocate for additional explanation or a delay in the procedure.
Document the Situation: Clearly document the steps taken to ensure informed consent, including any concerns or limitations.

By taking these steps, Nurse Gloria can uphold ethical principles and protect the patient’s rights.

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A HISTORY OF NURSING ETHICS

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Analyzing the Nurse’s Ethical Dilemma

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