Responsibility of Ethical Dilemma

Question: Discuss about the Responsibility of Ethical Dilemma. Answer: Introduction Ethics is coined from a Greek word which means character. In the course of providing patient care, nurses have the responsibility of observing the concept of ethics. The concept of ethics entails giving rational, correct and good care to whoever they are entrusted to. On our daily endeavors, we combat numerous ethical dilemma issues regardless of area of operation. Nurses are faced with ethical decisions when discharging our duties which in most instances affect both our patients and us. Ethical dilemma is regarded as a difficulty whose solution is not satisfactory. Making an ethical decision is very important due to the fact that varied ethical choices on a dilemma can result to different answers which may turn out to be ethically wrong or right decision (Ulrich et al. 2007). Ethics is the art of doing something good without causing any harm. The art of determining what is wrong and what is right may differ from nurse to nurse considering areas of operation, training and the general behavior of the person. Ethical decision making by nurses are coined from the fundamental principles we cover as part of our curriculum where we derive tools and basis of making a decision. Experience, beliefs, and values shape our decisions based on the knowledge acquired. This may therefore result to different decisions being made on similar dilemma (Cathy 2012). In nursing, there are principles that guide our daily routine in anticipation of making our patients feel better. The principle of nonmaleficence requires nurses to evade causing injury and suffering to patients when they are being attended to. Nonmaleficence also requires nurses to report any abuse suspected on the patient. The principle of beneficence advocates for doing good to patients. Nurses are encouraged to concentrate on achieving optimal results by offering outstanding treatment to patients. The principle of autonomy requires patients participation when administering treatment to them. Patients have the right to independence, self-determination and a chance for self-direction. They have the authority to determine what will be happening to them. They have the right to consent or refuse treatment. The nurses are expected to respect the wishes of patients whether they agree with them or not. The principle of justice require nurses to treat all patients equally and fairly. Nurs es must distribute resources to the patients accordingly, giving consideration to patients needs and spending time with patients fairly without favor and bias (Parahoo 2014). Besides ethical principles, deontological and utilitarian ethical theories also guide nurses when discharging duties. Under utilitarian ethics, the means of doing something is justified by previous outcomes. Decisions are made based on benefits achieved for the majority. And deontological ethics gives more importance to obligation or duties carried out by the nurses. Deontological stresses that the means is not justified by the outcome (Conway Gawronski 2013). Nurses encounter numerous ethical dilemma issues in the course of our duties. We tend to feel the family members struggles in trying to make ends meet. Moreover, we spend much of our time taking care of the patients thus understanding their needs. Nurses determine the opinion of the patient on the treatment perception together with the families. The magnitude of the ethical dilemma faced by us determines the number of people who will be directly affected by the decision. Such decisions also tend to affect the psychological well-being of a person thus have a much impact on their life expectancy. For instance, a patient may want to undergo a therapy which prolongs life but will have to live with side effects which on return will totally turn around the lifestyle of the patient. In these kind of scenarios, we can base their decisions on the fundamental principles that guide our operations. Based on my personal experience on the basic principles, my experience in carrying out my duties w as as follows. Situations of doctors reprimanding nurses is common. A one painful ordeal I gone through from my doctor colleague is still fresh in my mind. For surgeries to be conducted on patients, they are given time to prepare psychologically for the possible outcomes of the intended surgery, what it will entail and will be required of the patient. After some surgery are planned, patients are put under the Care of nurses. Patients tend to ask us a lot of questions regarding the operation. An instant arose where when the surgery was about to be performed, the patient asked the doctor in-charge for alternative medication instead of the surgery. Upon learning that from the patient, the doctor turned on me for advising the patient otherwise which led to several questions before the surgery. Such settings put us in dilemma over the right to consent of the patients being abused by the doctors since the patient wanted more information availed before the consenting to the procedure. Some doctors believe that they are right and their decisions towards discharging their duties is above board and no one should question (Parahoo 2014). Pro-life versus pro-choice decisions have direct effect to the nurse involved. Our own values and beliefs forms basis of the position we take in choosing between the two. A patient carried out an abortion which turned out to be harmful and the victim came to the hospital to seek for medication (Cathy 2012). During my training in college, abortion was regarded as a crime only if performed a recognized medical doctor to save the life of the mother. It was very difficult for me to attend to the patient since she had committed a punishable crime by the law. All in all, irrespective of the patients deeds, we are expected to attend to patients without bias. I did find myself in situation where I was supposed to report the case to the police which can lead the patient to be charged in the court of law for procuring abortion. Consequently, I was supposed to treat her and save her life. On the same note, an injured thief who apparently engaged the police in a gun battle and got shot in return did put me in a difficult situation. Treating him was to save his life and when I could have reported the matter to the police, the thief could have ended up in prison. The dilemma arose where I was to save the life of the thief and again put him in trouble by reporting the incident to the authorities. Care provision to persons with disability was a daunting task I did come across. In an attempt to recover, persons with disability problems who wish to walk do harm themselves in the process of trying to walk without supervision of a nurse. My desire to help the patient walk by promoting independence left the patient vulnerable to falling down which at times complicated the situation further. The situation aggravated more when it was a newborn with mental or physical disabilities. I encountered confusion in breaking the news to one patient that they not be able to walk again. Convincing a person that their normal life they used to enjoy before is now history is quite challenging. Convincing that accident victim that for them to survive, their dear legs will have to be amputated so as to be prepared to embrace disability was quite intriguing. Giving a child a chance to survive meant that I did compromise my personal feeling by causing pain in order to meet the overall goal which was t o make the child walk and overcome the mental status. However, this is ethical, we face the dilemma of balancing the two acts. Life principle supports the opinion of prolonging life if the current quality is poor. Furthermore, in comparing control and freedom, patients does not have a right to making decisions or pushing us to carry out a procedure on them which may turn out to be negative. I faced a challenge in convincing my patient who did not want to eat a diet I prescribed to her which was very important for her recovery. Additionally, the patient wanted me to inject her with drugs that cut weight rapidly but in real sense, rapid loss of weight over a short period of time results to adverse effect on the patients life (Cathy 2012). Careful and absolute reasoning was required from me to convince the patient on the negative effects of the intended action as much she was fighting obese. It was a hill task explaining to the patient why she needed to be patient and take the meals genuinely so that she could reduce the sugar level in the blood instead of seeking shortcut over her obese problem. On that fateful day, we received an accident victim, a cyclist, who was knocked by a speed car. It was a daunting challenge to explain to the family the procedure which was to be undertaken on the patient. With his condition, his right hand was supposed to be amputated since he was brought late into our hospital and the arm was already rotting from inside. And for him to survive and live long, amputation was the only viable option. The feeling of losing a hand is daunting but for the wellbeing of the victim, it was to go. The family members insisted on telling the patient that whatever procedure they are about to undergo was painful and had a total lifestyle change which he will live with to the grave. In an attempt to treat the patient, drug prescription to the patient caused fatigue, sweating accompanied by diarrhea. Passing such information to him did pose a real challenge to me and was in a dilemma. The same patient was also to undergo scanning. Under the principle of nonmalefice nce which prevent nurses from harming patients, we often find themselves inflicting pain to patients in order to relieve them of their misery by administering an injection. A balance between beneficence and nonmaleficence must be closely adhered to in care provision. The benefit of getting care from us must outweigh discomfort the patient is subjected to. Resource distribution is one of the major challenges that affect our daily routine operations. After intensive evaluation of a patients probability of survival, I found that despite putting the patient under medication, oxygen or Intensive Care Unit (ICU), the chances of the patients survival was very minimal but the family still insisted on further treatment. In such a scenario, I was in total dilemma of saving other patients from the same machine and resources available from which the other patient was deemed not to survive. In times of emergency, we are at a cross road to take care of our daily routine and to attend to the patients at the emergency wing. I used to have a schedule to give medication to patients at a particular time, yet during that time, another emergency arises, these double tasks used to put me in a fix to make valid decision on who to attend to. Failure to attend to both at the right time will lead to serious consequence which may even cost a life which I was di rectly responsible for negligence which is punishable by the code of conduct of our operations. Making decisions on personal beliefs and work experience compared to acquired knowledge in the medical school usually put us at a fix as we execute our duties. During our practical, I was taught how to perform a procedure from the medical school but when it came to practical application at work place, such learned technique were sometimes in applicable. One patient of mine did believe that transfusion is wrong from their religious perspective but failure to do so as a medical practitioner was to lead to death. At that point, I was faced with the dilemma of saving a life or upholding the religious belief of the patient. The empathy to save a life was contradicting the patients family religious belief. Conversely, by policy, I was required to listen the patients point of view and also the obligation to offer quality service to the patient. Coming to a mutual agreement with the patient and the family to accept the transfusion against the belief and tradition was a really tough exercise. Eventually, the patient and the family accepted the procedure and the life was saved. Organizational policies do also form part of our distress at work. In our organization it was mandatory for the patient to pay fifty percent of the medical expenses which was to be incurred on the patient before discharging treatment to the patient. A patient was brought who really needed urgent attention since she was involved in a fight and had a knife wound. I juggled between saving the life of the patient and upholding the policy of the hospital. If the I could have gone ahead to save the life of the patient without down payment, I was to lose the job as per the policy and a failure to do so will also result in loss of life. On the other hand, when the patient was due for operation, there must be a signatory from the family of the patient to approve of the intended surgery. The problem arose when there was no close family member so sign for the recommended procedure. It was disastrous when the family members of the patient were absent and I went ahead to be the sole signatory of the procedure which may have turned out to be unsuccessful and there is loss of life. Violence and workplace bullying of the nurses is one of the challenges we face. In effective communication between us and doctors is one of the major dilemmas. Work structure and hierarchy inhibit proper communication among the doctors and us. The management used to give orders which should be followed irrespective of our feelings and opinions on the said action. A difficulty in communication used to arise where patients were not ready to disclose the right information about their health status which may eventually result in wrong diagnosis. If the diagnosis goes wrong, we are charged with negligence yet it was the patients fault of giving wrong information in anticipation of their treatment. On the other hand, some patients are very violent and abusive. I have been assaulted in the process of giving care to patients who have psychiatric problems. We therefore find themselves in situations where our safety is compromised while giving care. We face indecisive whether to abandon the pa tient or help them recover. With the growth in information and technology and increased access to information, I once found myself in awkward moment in prescribing drugs to a patient. Since a lot of information is available on the online platform, patients usually research on the internet various diagnosis they are suffering from and remedies to such illness. Research conducted reveal that a good number of people are not existing well but are just surviving as a result of self-medication. When they go hospitals, they already know the medications they are supposed to take towards recovery (Ulrich et al. 2007). Giving alternative medication left me embarrassed since the patient had already known what she actually wanted. Technology has therefore enabled people to treat themselves thus barely surviving serious illnesses. The decision to give the patient what she wanted and I prescribing what is right for her always turned out to be ugly. Another dilemma I faced in the medical facilities was in the area of genetics and genomics. A patient researched about his genomics on the internet and upon coming the hospital, I was the one attending for him. Being my first month of working, I was not well conversant with genetics and genomics. I ended up being embarrassed in front of other patients since he was shouting what I was doing there if I could not attend to him promptly and accurately. Due to the rising population and lack of enough trained nurses, institutions such as schools, community outreach centers and prisons have to cope with quacks to meeting the much needed health attendance. The most dominated area is the admission of insulin to inmates, students and others in the society. Qualified nurses like me find ourselves in uncompromising situations where the untrained care givers does not uphold the accepted code of conduct in the medical profession ((American Nurses Association 2009). Many homes for the elderly are also understaffed leading to deaths since constant care cannot be accessed by the elderly. At their age, old people are prone to variety of diseases which if not watched closely, they end up passing away. The few staffs feel the burden and dissatisfaction of not offering our services when it is most needed. Some people also operate clinics with no proper qualification jeopardizing the whole profession with wrong diagnosis and carrying out illegal abo rtions which usually end in deaths which could have been prevented. Operations of the back-street clinics have also resulted in the thriving business of substandard drugs which put the life of people in danger. And in an incident of a problem, the whole industry is marred in the unfortunate occurrence tarnishing our good reputation. Research conducted by American Nurses Association (2009) reveals that, we, nurses face unconducive work environment. In most hospitals and care giving organization, there is usually staffing problems and the safety of the patient. Due to staff shortage, we do not get time to exercise full responsibility in meeting the emotional needs of the patients, helping them adapt and recover. Failure to perform such vital processes always leave us unsatisfied to our call to attend to the patients fully resulting them living in stress since we have not met moral obligation as required. Recently, cases of leaking confidential reports are on the rise. A number of the nurses who are entrusted to uphold the confidentiality of a patients medical records are leaking the said records for monetary gain. Bribery allegations once rocked our department. One of my colleague allegedly accessed and leaked medical records of my patient to the ill-motive people who were destined to have medical records of their allies to gain a mileage on him based on his medical condition. Politicians and the business community access the records for uncouth completion environment. Some nurses also abuse the code of the profession and engage in selling of drugs meant for patients to make extra cash. Patients being diagnosed with compromised drugs is also taking shape. In-house treatment by nurses tend to go against the ethics of the treatment. Due to low pay in some countries, nurses engage in off-hospital service delivery which at the day of the compromise the quality of health provision which i s unethical by nature. Casterle et al. (2008) notes that ethical dilemma was also common when dealing with children. Balancing the wishes of the patient and the familys values, beliefs and wishes often pose a challenge in effective service delivery to the sick as much there is dire need to uphold the work ethics without compromising the outcome. However, much expectation is required of us by the parents, our ultimate obligation is the patient. Privacy issues tend to be controversial where we cannot reveal all the medical information to the parents of the patient since by law, minors have some basics to privacy. There are some information that the minor may not want the parents to be told, therefore, we exercises this constitutional mandate and the policy of the hospital to protect the minor. Biases to honest information on the exact condition of the patient do arise severally. The family of the patient may choose to deliberately reserve truthful information with a primary goal of protecting the patient stress related to the emotional wellbeing of their patient. At this point, we have the headache of whether to pass the truthful information to the patient or side with the family. Making decision on what information to share, when and how to share did pose a real dilemma to me. It is considered one of the toughest responsibilities nurses have to put up with. Ethical dilemma is quite diverse. Nurses grappling with a lot of responsibilities is also considered an ethical dilemma since the standard mode of operations is not observed. We face shortage of working equipment, drugs and burden on the number of patients to attend to. In state of affairs where we do not have adequate time to relax and write report on the patients progress, then the working conditions is unethical which some of us barely recognize and acknowledge as part of the problem. Sometimes, work burden becomes more until we feel like quitting the job after professional burnout and moral distress. According to Jeanette (2015) patient care ethics code at Johns Hopkins Hospital spells out the hospitals values as confidentiality, patient autonomy and obeying cultural traditions. The hospital went further to articulate the manner of application of the values from scarce supplies allocation to compulsory flu vaccination. In another setting, Kimmel Cancer Center, has programs for th e nurses to counter distress as they handle cancer patients who visit the facility for a long period of time. Conclusion In nursing, ethical dilemmas come daily which require decision making. Experiences, values and personal beliefs and medical principles acquired from school by us plays a crucial role in our decision making in the course of our duty. Our commitment to those we care for in the society include but no limited to ethical care, providing competent and safe services to patients. Often, we have been frustrated in delivering our professional obligation in a manner we deem acceptable to the code of ethics. Regularly, ethical distress arise from the barriers encountered during the ethical practice. Circumstances such as observing beneficence and nonmaleficence, technological advancement, unfavorable working environment, organizational policies, comparing freedom and control, pro-life and pro-choices forms the fundamental ground for unethical behaviors to thrive. However, as we face the challenges of balancing between ethics and quality service delivery, we should remain focused to main goal in meeting the patients needs without watering the code of ethics in the industry. Bibliography Cathy, F., 2012. Major Ethical Dilemmas in Nursing. University of Alabama Parahoo, K., 2014.Nursing research: principles, process and issues. Palgrave Macmillan. Conway, P. and Gawronski, B., 2013. 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