Ethical Dilemma In Nursing

One of the most challenging moral/ethical dilemmas to resolve occurs when the patient’s autonomous choices conflict with the nurse’s duty to look out for the patient’s best interests. The scenario presented to me describes a conflict between a patient who refuses to bathe and a nurse whose duty is to provide the patient’s care. Because of the patient’s physical condition and inability to get out of bed, they require a two-person bath involving lifts. The patient refuses to bathe at the time scheduled putting the nurse in a difficult position, as the equipment and personnel are only available at a certain times. The nurse is unable to postpone the time resulting in the patient’s upset and ultimately refusal to bathe. In my paper, I will discuss
I believe this situation could and should have been avoided. If the nurse had established a therapeutic relationship with the patient from the beginning of care, the issue could have been identified before the dilemma was presented. In the event that a nurse’s personal value system conflicts with the professional (CNO/CNA) value system, guidelines can be implicated to help nurses work through ethical dilemmas. One guideline presented by CNO provides the following steps: the first is to identify issues at hand, conflicting values, and resources available. The second step is to identify options and develop a plan of approach. The third step is to implement the plan and then the fourth step is to review, discuss, and evaluate the process often with a fellow college or nurse manager (CNO, 2009). When the patient, nurse and ethical standards do not match, a breakdown in the therapeutic relationship between the nurse and patient occurs. In order to resolve the differences between the nurse’s value framework and those of the patient, the nurse must meet the needs of the patient even if it goes against their personal values. The nurse must consider client well-being and client choice in the situation. According to CNO, client well being involves listening to, respecting and understanding the patient, supporting your patient to find the best possible outcome, minimizing risks and maximizing the
When recourses are not available to provide ideal care for the patient, nurses can collaborate with fellow colleges and nurse managers to adjust priorities and minimize harm and maximize care (CNA, 2008). As I stated previously, there are Nursing Care Guidelines available provided by CNO to aid nurses to work through ethical situations. The best resource for the patient is his/her nurse. That is why it is of the utmost importance to provide the client with as much information about their care as possible. This will allow the patient to make an informed decision regarding their care. One possible solution to this situation could be rescheduling the patient’s bath for a different time or a different day. Because there are only a certain amount of staff and lifts available, this would undoubtedly inconvenience other colleagues as well as other patients scheduled for baths. This solution would be beneficial in maintaining client autonomy and maintaining their heath care needs. Another solution would be to accept the client’s decision to not bathe. This would also preserve client’s autonomy but ultimately could cause potential health concerns for the patient and communication breakdown within the patient-nurse