Ethical Dilemmas in Nursing: Navigating Complex Patient Care Scenarios

Stuart Larsen^*
*Correspondence: Stuart Larsen, Department of Medical Sciences, Udine University, Udine, Italy, Email:

Keywords

Ethical dilemmas • Nursing • Patient care

Introduction

Nursing is a profession grounded in the principles of compassion, care and respect for human dignity. However, nurses frequently encounter ethical dilemmas that challenge these principles and require them to navigate complex patient care scenarios. Ethical dilemmas arise when nurses face situations involving conflicting values, making it difficult to determine the right course of action. Understanding and addressing these dilemmas are essential for providing high-quality, patient-centred care while maintaining professional integrity and trust. One of the most prevalent ethical dilemmas in nursing involves the balance between patient autonomy and beneficence. For example, a patient may refuse a life-saving treatment due to personal beliefs, leaving the nurse to respect the patient's autonomy while grappling with the desire to provide beneficial care. Informed consent is a fundamental ethical and legal requirement in healthcare. Nurses play a crucial role in ensuring that patients fully understand the nature, risks, benefits and alternatives of proposed treatments or procedures. Ethical dilemmas can arise when patients are unable to provide informed consent due to cognitive impairments, language barriers, or other factors. Nurses must navigate these situations by advocating for the patient's understanding and collaborating with family members, translators, or legal representatives to obtain valid consent [1].

Literature Review

End-of-life care presents some of the most challenging ethical dilemmas in nursing. Decisions regarding life-sustaining treatments, palliative care and euthanasia involve complex considerations of patient autonomy, quality of life and ethical principles. Nurses often find themselves in the difficult position of supporting patients and families through these emotionally charged decisions while ensuring that the patient's wishes and best interests are respected. Ethical frameworks and palliative care guidelines can help nurses navigate these sensitive situations with compassion and professionalism. Resource allocation is another significant ethical dilemma in nursing, particularly in settings with limited healthcare resources. Nurses may encounter situations where they must prioritize care for patients based on the severity of their conditions, potential outcomes and available resources. This can lead to difficult decisions about who receives certain treatments or interventions, especially in times of crisis, such as during pandemics or natural disasters. Ethical principles, such as justice and equity, guide nurses in making fair and transparent decisions about resource allocation. Ethical decision-making frameworks provide structured approaches for nurses to analyse and resolve ethical dilemmas. These frameworks typically involve identifying the ethical issues, gathering relevant information, evaluating options, considering the consequences and making informed decisions. The use of such frameworks, such as the Four-Box Method or the Nursing Code of Ethics, helps nurses systematically address ethical challenges and make well-reasoned choices [2,3].

Discussion

Effective communication is crucial in navigating ethical dilemmas. Nurses must engage in open, honest and empathetic dialogue with patients, families and healthcare team members to understand different perspectives and values. Active listening and clear explanations help ensure that patients are fully informed and involved in decision-making processes. Moreover, interdisciplinary communication and collaboration enhance the collective ability to address ethical issues and provide comprehensive care. Interdisciplinary collaboration is essential for addressing complex ethical dilemmas in nursing. Nurses, physicians, social workers, ethicists and other healthcare professionals bring diverse expertise and viewpoints to the decision-making process. Collaborative efforts ensure that ethical considerations are thoroughly examined and that decisions are made in the best interest of the patient. Ethical committees and case conferences can also provide valuable support and guidance for nurses facing challenging dilemmas. On-going education and training in ethics are vital for preparing nurses to handle ethical dilemmas effectively. Nursing curricula should include comprehensive ethics education, covering theoretical foundations, practical applications and real-world case studies. Continuing education programs, workshops and simulations help nurses stay current with ethical standards and develop critical thinking and decision-making skills. Ethical competence empowers nurses to navigate complex patient care scenarios with confidence and integrity [4].

Mrs. Rodriguez, an 80-year-old patient with terminal cancer, has expressed her wish to discontinue aggressive treatment and receive hospice care. However, her family members are divided, with some insisting on continuing all possible treatments. The nurse faces conflicting opinions from the patient and her family regarding end-of-life care, complicating the decision-making process. The nurse facilitates a family meeting, involving a palliative care specialist and a hospital chaplain to mediate the discussion. By emphasizing Mrs. Rodriguez’s expressed wishes and providing emotional support to the family, the nurse helps align the care plan with the patient’s values while addressing the family’s concerns. During a severe influenza outbreak, the hospital faces a shortage of ventilators. The nursing team must decide how to allocate the limited resources among critically ill patients, including a young mother and an elderly man with multiple comorbidities. The nurse must make difficult decisions about who receives life-saving treatment when resources are scarce, raising ethical questions about fairness and justice. The nurse collaborates with an interdisciplinary team, including physicians and ethicists, to develop criteria for ventilator allocation based on clinical indicators, prognosis and ethical guidelines. Transparent communication with patients and families about the decision-making process helps maintain trust and integrity during the crisis. Ethical leadership in nursing is crucial for fostering an environment where ethical dilemmas are recognized, discussed and addressed effectively [5].

Navigating ethical dilemmas in nursing requires a deep commitment to ethical principles, compassion and professional integrity. By understanding common ethical challenges and employing strategies such as ethical decision-making frameworks, effective communication, interdisciplinary collaboration and on-going education, nurses can provide high-quality care even in the face of complex patient care scenarios. Ethical leadership further supports nurses in this endeavour, fostering a culture that prioritizes patient trust, professional integrity and ethical excellence in nursing practice. The team decides to wait for the daughter’s return while managing Mr. Lee’s pain and providing supportive care. This approach respects the ethical principle of obtaining valid informed consent while ensuring the patient’s immediate needs are addressed. Patient autonomy refers to the right of patients to make their own healthcare decisions, while beneficence involves acting in the best interest of the patient. Conflicts arise when a patient's choices or preferences may not align with what the nurse believes is in their best interest [6].

Conclusion

Ethical dilemmas are an inherent part of nursing practice, requiring nurses to balance competing values and make difficult decisions to provide patient-centred care. By understanding common ethical challenges, such as patient autonomy, informed consent, end-of-life care and resource allocation, nurses can develop strategies to navigate these dilemmas effectively. Ethical decision-making frameworks, effective communication, interdisciplinary collaboration and on-going education are essential tools for nurses to uphold ethical principles, maintain professional integrity and foster patient trust. In a profession dedicated to care and compassion, addressing ethical dilemmas with diligence and sensitivity is paramount to delivering high-quality, ethical nursing care.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Eues, Stephanie K. "End-of-life care: Improving quality of life at the end of life."Prof Case Manag 12 (2007): 339-344.

   Google Scholar, Crossref, Indexed at

2. Lorenz, Karl A, Joanne Lynn, Sydney M. Dy and Lisa R. Shugarman, et al. "Evidence for improving palliative care at the end of life: A systematic review."Ann Intern Med 148 (2008): 147-159.

   Google Scholar, Crossref, Indexed at

3. Montgomery, Kathleen E., Kathleen J. Sawin and Verna Hendricks-Ferguson. "Communication during palliative care and end of life: Perceptions of experienced pediatric oncology nurses."Cancer Nurs 40 (2017): E47-E57.

   Google Scholar, Crossref, Indexed at

4. Kenny, Amanda. "Online learning: Enhancing nurse education?."J Adv Nurs 38 (2002): 127-135.

   Google Scholar, Crossref, Indexed at

5. Paice, Judith A, Betty R. Ferrell, Rose Virani and Marcia Grant, et al. "Graduate nursing education regarding end-of-life care."Nurs Outlook 54 (2006): 46-52.

   Google Scholar, Crossref, Indexed at

6. Ferrell, Betty R. "Overview of the domains of variables relevant to end-of-life care."J Palliat Med8 (2005): s-22.

   Google Scholar, Crossref, Indexed at