Ethical Dilemmas Encountered by Nurses in the Workplace

[arlusk]

I am a nursing student and I am working on a project where I need to know some ethical dilemmas that nurses have encountered in the workplace. So what I want to know is what happened and why? What was the outcome? What could have been done differently? And what would you suggest for the future?

Thank you very much for your responses, it will really help me a lot with this project.

[klone, MSN, RN]

I can think of one - it happened with a coworker. A woman came in to our L&D unit, 18 weeks pregnant and PPROMed (preterm premature rupture of membranes). A PPROM at 18 weeks means that the baby is not going to survive, and the mother is at high risk of uterine infection if she continues the pregnancy. It was decided that we would induce labor. The coworker was a staunch Catholic and felt that this was murder, so she refused to take the patient. I ended up taking care of the patient, working through the labor induction process with her, and later helping her deliver her (then dead) infant.

[KelRN215, BSN, RN]

There are so many of them in pediatrics.

-Family who initially wanted to decline treatment for their child's (very treatable) cancer because they didn't want her to go bald. Oncology team threatened to take the case to court but the family eventually relented.

-17 yr old with end stage cancer who wanted to terminate treatment. Mother initially was interested in pursuing further treatment options. Ethics team sided with the child, who was only a few months away from turning 18. Mother eventually agreed that it was time to stop.

-Previously cognitively intact teenager with a rare autoimmune encephalitis sometimes related to ovarian teratomas. Work-up was negative for such but family researched on the internet and decided they wanted to proceed with an oopherctomy, thereby sterilizing her permanently. Case went to court, court sided with the parents since their intention was not to sterilize her but to treat her disease.

-Child with a 100% fatal, terminal disease who was rapidly progressing. Family refused to believe that she wouldn't recover and insisted on a trach/vent. Ethics team sided with the parents because they knew the trach would actually do nothing to prolong her life. Child eventually was declared brain dead and withdrawn from support.

-Jehovah's witnesses and blood transfusions. Adults are free to refuse transfusions for themselves but when it comes to children, it gets messy. Our hospital would, if necessary, get a court order to administer blood products over the parents' objections.

-Pre-implantation genetic testing to create a sibling as a bone marrow or kidney donor.

-HIV and disclosure. (For children who contracted the virus at birth.) I've seen this one many times.

https://allnurses.com/nursing-student-assistance/ethical-dilemmas-nurses-789869.html

[Ruby Vee, BSN]

This sounds like a homework assignment. Shouldn't you be doing your own homework?

[klone, MSN, RN]

Oh, that's another one - HIV+ woman in hospital to give birth, and her partner is not aware of her + status. That one kills me, and it's happened more than a few times n

[arlusk]

It is a homework assignment, but it's a project where I'm supposed to ask other nurses what their experiences are. I promise I'm not cheating, if that's what you think I'm doing. So I'm asking for your personal experiences. I've already done my fair share of looking up ethical dilemmas, but now I'm looking for real life experiences that you experienced nurses have gone through. Sorry I didn't clarify that at all.

[JBudd, MSN]

We get them in the ER all the time, police or EMS brings in someone "under the influence", which makes us legally liable for not putting an impaired person onto the street. Trouble is, pt denies alcohol or whatever and demands to leave. Now, we have a high index of suspicion (odor of alcohol, slurred speech, staggering gait, inability to answer coherently), so we keep them. Sometimes forcibly, either chemical or physically restrained. All before a blood test or breathalyzer to "prove" it. After all, hypoglycemia can do all those things as much as alcohol can.

So much for the right to refuse care, eh? I will keep you for up to 12 hours against your will until you are judged sober enough to be responsible for yourself. You can be held liable (responsible) for actions while drunk (DUI), but not responsible enough to refuse care. We will hold you down, strip off your clothes, tie or lock you up, sedate you..... all to keep you and the people around you safe. If they show none of those symptoms but still are non cooperative (answering a few questions would have gotten this one fellow out the door immediately, instead he threatened/verbally abused, stated he would like to kill the cop that brought him in; ended up with people holding him down etc. etc)you can STILL be held.



[tnbutterfly - Mary, BSN]

Moved to Nursing Student Assistance

[classicdame, MSN, EdD]

elderly pain patient whose adult children want to control the interventions. Not wanting patient to be given "too much" pain medicine so they can communicate better with patient. Who is the patient and what is the dilemma here?

[nurseprnRN, BSN, RN]

Legal client who wants me, a life care planner (look it up), to pad my plan with a lot of Cadillacs when Chevys would be perfectly safe and appropriate, and add a lot of other items that serve only to increase the big bottom number while doing nothing to improve the care or quality of life of the patient. Or to omit aspects of my report that have real impact in patient care plan but could be helpful to opposing counsel.

You will find more (nursing, not in hospitals but quite real) examples in the Ethics in Action columns in the last two or three issues of the Journal of Nurse Life Care Planning, http://www.aanlcp.org