What are the top 5 ethical dilemmas faced by nurses?

  1. 0 I'm working on a project and have to write about ethical challenges faced by nurses. I'm interested in hearing from nurses about ethical challenges they (or a colleague) have faced while on the job. So, what would you consider to be the top 5 ethical challenges of nursing?

    Thanks so much. I love all.nurses.com!
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  3. Visit  sorchgorch profile page

    About sorchgorch

    Joined Jun '09; Posts: 12.

    24 Comments so far...

  4. Visit  Be_Moore profile page
    8
    Personally, my favorite is the 90 y/o with cancer who is found down in the field, intubated, started on pressors, and the family wants us to do "everything" because they are the "most special <insert relationship type> in the world." So they are so special that should his/her pressure tank, we should crank pressors until toes fall off? And should his/her heart stop beating we should break their 90y/o sternum? If that's what love is, I hope no one loves me should I live to be 90!
    LesMonsterRN, fmoore723, NeoNurseTX, and 5 others like this.
  5. Visit  Woodenpug profile page
    0
    Yeah, that's the most common one. Self determination vs. non malefeasence. Of course, true self determination should imply informed consent and therefore no broken bones in a futile cpr effort.
  6. Visit  arelle68 profile page
    0
    She was 96 years old. Her lungs were full of fluid. CHF. Her granddaughter asked me would I please get Morphine for pain. I assessed the pt not to be in pain. I stated perhaps she had anxiety, and went to get Ativan. I noted that the Ativan had been given two hours before. Couldn't give Ativan. Drew up a syringe of Morphine 15 mg as prescribed, and headed back to the pt's room. The granddaughter stated, "I think she just took her last breath." She was still breathing. Very, very shallow. Her heart was beating very rapidly. A flutter. Again, I assessed for breathing. No more. Assessed for pulse. It was gone. Then...I thought about the Morphine in my hand.
  7. Visit  jnrsmommy profile page
    2
    The terminally ill pt who has his DNR paperwork in order, whose wife watched him sign not 3 hours before, after a lengthy discussion about this being his wish. When he passed, having her scream "Do something!" and having to proceed to code him.
    misscherie and tkane like this.
  8. Visit  rachelgeorgina profile page
    0
    beneficence vs non-malfeasance
    patient autonomy vs patient advocacy
    the provision of justice

    i'm a student and just toke ethics and law in healthcare. we did three really interesting assignments:
    1) pt has history of alcohol abuse, currently in remission. pt pregnant and shows no signs of drinking throughout pregnancy whilst monitored by her middie at home. upon birth of the baby, dr. tells mum that baby has fetal alcohol syndrome in order to scare her out of drinking. the baby doesnt have anything wrong with it. mother is exceptionally distressed and proceeds to hysteria. what does nurse do?

    2) pt has Stevens-Johnson Syndrome with uncertain prognosis (50/50 chance). pt arrests, is unconscious vented and needs dopamine to maintain her BP constantly. pt disclosed to family and nurse prior to arrest that she doesnt wish to be kept alive should her become a "vegetable". she also has an advanced care directive stating that should she become terminal, she doesn't wish for life sustaining measures. nurse says to doc that perhaps we should discontinue treatment in accordance with pt and family wishes. doc says no. nurse hangs a bang of normal saline, labels it dopamine, pt arrests and dies. was this ethical?

    3) does mental health legislation (in australia) violate pt autonomy, dignity? and does it enhance and enforce unrealistic stereotypes regarding the mentally ill. do nurses play a part in this?
  9. Visit  Zookeeper3 profile page
    1
    I'll just reiterate whats been stated, end of life care. Our doc's do such a poor job, in the face of families giving false hope because it's easier. As nurses, we paint another picture, we're there for 12 hrs. we know what is going to play out.

    It's ICU or other nurses at the bedside that have the talk, did it last night.... full blown septic shock, on chemo, mets.... maxed on three pressers... "I will keep pounding on her chest, breaking more ribs, until you decide to let her go peacefully and tell me to stop, or until my breaking her ribs, pushing on her chest works no more, either way, the outcome is the same... ... how would she want to die?"

    Being a patient advocate is the toughest part of the job, and the most worthwhile
    sorchgorch likes this.
  10. Visit  zuzi profile page
    0
    Start the investigations and treat the patient or start the hospice???
  11. Visit  Lacie profile page
    0
    Working in chronic dialysis I see many times patients being referred for transplant evaluations. My boss states it's not our or the doctors determination if someone is too old or too ill with other co-morbities to make that decision not to refer. Consider this - 96y/o male with copd on continous O2, in a nursing home and alzhiemers to boot. We referred this patient for kidney transplant evaluation. This means the pt had to also make a 3 hour trip on way to the hospital the transplantation would occur if accepted. #2 scenario - 23 y/o with genetic TTP with 3 associated CVA's and hep C. Has been turned down by 3 other transplant facitilites but again boss insisted so we sent her to another for eval, getting her hopes up only to be turned down once again placing her back into a depression. Is it rational to put these people through all this?
  12. Visit  Vito Andolini profile page
    1
    Quote from Be_Moore
    Personally, my favorite is the 90 y/o with cancer who is found down in the field, intubated, started on pressors, and the family wants us to do "everything" because they are the "most special <insert relationship type> in the world." So they are so special that should his/her pressure tank, we should crank pressors until toes fall off? And should his/her heart stop beating we should break their 90y/o sternum? If that's what love is, I hope no one loves me should I live to be 90!
    How about 89?
    79?
    69?
    09?
    9 months?

    First off, age is not necessarily the deciding factor. Diagnosis isn't either. It is more a matter of what the patient wants and what the family wants. As for pressors until toes fall off - again, there has got to be teaching and lots of it.

    Finding someone down in the field is a lot different, ethically, than a hospitalized patient who crashes or a home care patient who crashes, the way I see it.

    I agree about not wanting to be loved so much that they torture me.

    In answer to OP's question: How about the case of a woman with a very rare pelvic tumor? I recall an attending bringing about 20 med students and house staff into the exam room and each of them stuck their fingers inside of her, trying to learn the feel of this tumor. They hurt her. She was crying. The nurse tried to comfort her. I feel she was gang-raped.

    Yeah, I know everyone has to learn but there's a decent way to go about it. At the time, I was very young and inexperienced, so I did not intervene but if that happened today, I'd step in, block their access to her, and say, as soon as she was obviously becoming restless and uncomfortable, Enough. She's in pain. The rest of you can come back another time. Or I'd let the attending know ahead of time that there was going to have to be a limit to how many students could examine her at once. We'd work it out so I could keep my job and still protect my patient.
    CanuckStudent likes this.
  13. Visit  Vito Andolini profile page
    0
    Quote from Lacie
    Working in chronic dialysis I see many times patients being referred for transplant evaluations. My boss states it's not our or the doctors determination if someone is too old or too ill with other co-morbities to make that decision not to refer. Consider this - 96y/o male with copd on continous O2, in a nursing home and alzhiemers to boot. We referred this patient for kidney transplant evaluation. This means the pt had to also make a 3 hour trip on way to the hospital the transplantation would occur if accepted. #2 scenario - 23 y/o with genetic TTP with 3 associated CVA's and hep C. Has been turned down by 3 other transplant facitilites but again boss insisted so we sent her to another for eval, getting her hopes up only to be turned down once again placing her back into a depression. Is it rational to put these people through all this?
    Does your boss benefit financially for referring them?
  14. Visit  Vito Andolini profile page
    0
    Quote from arelle68
    She was 96 years old. Her lungs were full of fluid. CHF. Her granddaughter asked me would I please get Morphine for pain. I assessed the pt not to be in pain. I stated perhaps she had anxiety, and went to get Ativan. I noted that the Ativan had been given two hours before. Couldn't give Ativan. Drew up a syringe of Morphine 15 mg as prescribed, and headed back to the pt's room. The granddaughter stated, "I think she just took her last breath." She was still breathing. Very, very shallow. Her heart was beating very rapidly. A flutter. Again, I assessed for breathing. No more. Assessed for pulse. It was gone. Then...I thought about the Morphine in my hand.

    And? What's the end of this story?
  15. Visit  Vito Andolini profile page
    0
    Quote from jnrsmommy
    The terminally ill pt who has his DNR paperwork in order, whose wife watched him sign not 3 hours before, after a lengthy discussion about this being his wish. When he passed, having her scream "Do something!" and having to proceed to code him.
    That's the time to just stand one's ground, in a quiet way, reminding her nicely and respectfully that he did not want "something" done, or to do a slow code. You can't blame the wife, who apparently was not really ready to let go or in synch with her husband's wishes. It doesn't mean you have to go full steam just because she screams to do something. You can kind of sit her down, take her hand, remind her that he wanted to be let to cross over, and that he is now in that more peaceful place where he is no longer suffering. That could help with regard to her feelings about him. As for her anger and fear at being left, well, holding hands is good, quietly reminding her that it's all ok, it's all right, everything is all right, etc. (even if you think it isn't, even if you don't believe in Heaven or Hell or eternity - because it's not about our comfort right then, it's about the patient's comfort, the family's comfort) can work wonders. It also could help if a chaplain or family member or friend could be with the wife right then.

    The wife has to face facts sooner or later but she is angry and/or terrified about losing her beloved husband and being cheated out of a father for their kids, the income he used to bring in, her companion, her mate, and on and on. It's no fun becoming widowed, that's for sure. But it is part of life and many of us get to experience it, willingly or not.


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