Running Head: Ethical Decision-Making: A Professional Nursing Concept
Ethical Decision-Making: A Professional Nursing Concept
Lindsey Butler
Dixie State University
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Ethical Decision-Making
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Ethical Decision-Making: A Professional Nursing Concept
Morality is based on one’s perspective of right and wrong. Each person is raised with
different beliefs, customs, cultural traditions, and values leading to a difference in decisions and
actions. When morals are congruent with the actions taken and decisions made this is known as
ethics. Ethics are especially prominent in nursing practice. The American Nurses Association
(ANA) established a nursing code of ethics. “All nurses in the United States are bound by our
professional code as well as supported by it” (Schroeter, 2014). Choices that do not have a clear
right or wrong answer are called ethical dilemmas. Ethical dilemmas are open for interpretation
with no precise answers, and all cases can be viewed from different perspectives (Stichler, 2013).
Advances in medical technology brings many ethical dilemmas such as a patient’s right
to die or discontinue treatment, DNR status, organ transplantation, costs, perinatal issues, genetic
engineering, and patient autonomy (Alichnie, 2012). Although there is no scientific approach to
solving these problems, there is a systematic process to help nurses make ethical decisions in
behalf of their clients. The systematic process is known as ethical decision-making.
The ethical decision-making model uses ethical principles and theories to make
judgments when two or more values are in conflict (Black, 2014). Ethical principles and theories
delineate a pathway to reach a conclusion during ethical dilemmas. The theory of virtue ethics
and the principle of fidelity provide support and enhance nurses’ ability to surmount ethical
dilemmas. Making a decision amid conflict is not easy; however, virtue theory shapes one’s
actions through the utilization of virtuous instincts.
Importance of Virtue Theory to Nursing
Virtue theory suggests that how a nurse responds to ethical situations is dependent upon
innate virtuous characteristics. According to Schaffer (2009), “virtues are complex, learned
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dispositions that enable individuals to perceive, feel, and act appropriately in response to certain
challenges and circumstances” (p. 85). As nurses establish values, they will respond
appropriately to ethical situations based on the development of virtuous traits. Value system
ethics acts as a guide in business and personal relationships providing integrity in an
organizational practice (Stichler, 2013, pp. 8-9). Virtue ethics helps nurses fulfill their major
role as a patient advocate.
An expectation from ANA’s Code of Ethics for Nurses is to be a patient advocate
(Alichnie, 2012). Advocacy is the act of defending the patient’s rights and concerns in their
vulnerable state by preserving dignity and instilling equality and freedom in an ethical manner.
The nurse, as an advocate, acts on the behalf of the patient to promote holistic healing in an
environment unfamiliar to the client. The responsibility of fighting for the patient is not easy, as
it is not always clear which decision is best or correct. For example, a code of behavior including
honesty, respect and courage are virtues that prepare nurses to advocate their patient's rights.
Nurses that have developed honesty, respect, and courage as part of their character will
already know what to do in an ethical dilemma based on the virtues incorporated into their lives.
Nightingale’s pledge states a nurse’s commitment to do just and right for those they serve
(Alichnie, 2012). For example, a patient that wants to refuse treatment for cancer, yet their
family wants them to continue treatment creates an ethical dilemma. As a patient advocate, the
nurse is a representative of the patient's desires. With the framework of the virtues honesty,
respect, and courage the nurse will do as the client wishes even if that means standing up to the
family or a physician to fight for the patient’s wants. Resnik (2012), in his research, discovered
“virtue-based approaches provide a clear link between natural human desires for happiness and
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self-improvement in moral conduct” (p. 330). As nurses practice virtue ethics they are led to a
desire to continue in good ethical practice.
The virtue theory of ethics decreases moral distress because good moral values act in
accordance with patient’s desires. If the decision goes against the nurse’s beliefs no moral
distress arises because the nurse utilized virtue theory to act with honesty, respect, and courage
allowing the nurse to honor the wishes of the client. Virtue theory portrays an act of fidelity
toward the client and establishes trust.
Importance of Fidelity to Nursing
In addition, fidelity is a key component to any healthy relationship especially a
professional nurse-client relationship. Stichler (2013) refers to “fidelity as being faithful to
commitments and accountable for responsibilities” (p. 8). This principle builds trusting
relationships and helps vulnerable patients to feel more comfortable. Crigger (2009) further
explained the importance of fidelity to the nurse-client relationship:
The principle of fidelity establishes the agent's responsibility to carry out duties carefully
and completely.... Because the patient, who is not as knowledgeable as the nurse, places
her faith and trust in the nurse's special knowledge and advice to make decisions for her
health that are in her best interests. Patients and society give nurses special privileges. For
example, nurses can administer medications, obtain extensive personal information and
examine private body parts as part of our discipline's scope of practice as given by the
society. Therefore, fidelity is deeply related to all activities that a nurse performs in her
professional role (p. 257).
Fidelity emphasizes how much the patients trust in their nurses. The expectation is the nurse will
honor their role by accepting accountability for their actions. The principle of fidelity is a tool for
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nurses as patient advocates and ethical decision making. As nurses honor their fiduciary
relationship, they will be guided to make ethical decisions based on the client’s wants and by
doing tasks they say they will do.
Keeping commitments includes staying true to small and big promises. For example if the
nurse says they will check in the patient in fifteen minutes the nurse needs to check on the patient
in fifteen minutes. Even the small commitment made reduces patient anxiety and increase trust in
the relationship. The patient will connect the small acts of faithfulness to bigger ones in the
future and will look to the nurse for support. On the other hand when a nurse breaks a
commitment, the patient also applies that to shape future relationships. For example, if a nurse
says to a child, “it will not hurt” before giving a shot, the child does not know when the nurse
can be trusted so they chose not to trust nurses. Fidelity also includes maintaining patient
confidentiality. If the confidentiality is broken, the principle of fidelity will be in conflict
Beneficence in Conflict with Broken Confidentiality
The phenomenon of conflict, usually, arises when two or more ethical principles compete
(Resnik, 2012). Competition creates a conflict of interest. For example, due to the legal
perspective of Health Insurance Portability and Accountability Act (HIPPA) laws, a patient
should be able to trust that a nurse will not share any of their personal information or violate
confidentiality. Since licensed nurses have duty to follow HIPPA laws, it is assumed that, as
professionals, they will not to disclose any personal information about their clients.
On the other hand, nurses may break confidentiality by following a different ethical
principle. One principle that comes into conflict with a break in confidentiality is the principle of
beneficence. Beneficence means doing good. Part of the nurse-client relationship is that nurses
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will provide good quality care for the patient. Clients expect nurses to care for them in the best
way possible and do what is right.
However, the principle of beneficence, or do good continually, may at times create a
conflict with confidentiality. For instance, a client diagnosed with suicidal ideation may not want
anyone to know of their condition, and based on the confidentiality agreement the nurse would
honor that request. On the other hand, due to beneficence, the nurse may find it more appropriate
to break confidentiality, and tell someone close to the patient in order to do good and decrease
the patient’s imminent threat of committing suicide. The conflict of principles creates an ethical
conflict.
Nurses have an obligation to perform ethically when providing patient care. According to
ethical and legal principles, one specific obligation is to internalize and accept accountability for
their nursing practice, and the tasks delegated to others. Through legal and ethical actions, the
nurse consequentially becomes a suitable patient advocate. The way to make ethical decisions is
by establishing an ethical framework before dilemmas arise. Virtue theory helps nurses
establish values in their lives and then it becomes instinct to use those values including in ethical
dilemmas. The virtues that are ingrained in nurses act as the moral compass and aid them in their
clinical practice. The ethical principle of fidelity also prompts nurses to make ethical decisions in
nursing practice. The idea of remaining truthful to clients leads nurse to act in accordance with
nursing values established by that nursing code of ethics, and therefore maintains an ethical
practice.
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References
Alichnie, C. (2012). Ethics and nursing. Pennsylvania Nurse, 67(2), 5-26. Retrieved from
http://web.b.ebscohost.com.libproxy.dixie.edu/ehost/pdfviewer/pdfviewer?sid=609715c4
-6066-4d9e-99e0-aaa016aa7d2f%40sessionmgr112&vid=29&hid=127
Black, B. P. (2014). Nursing today: A time of transformation. In Professional Nursing Concepts
and Challenges (7th ed., pp. 30-35). China: Elsevier.
Crigger, N. (2009). Towards understanding the nature of conflict of interest and its application to
the discipline of nursing. Nursing Philosophy: An International Journal for Healthcare
Professionals, 10(4), 253-262. doi:10.1111/j.1466-769X.2009.00412.x
Ohio Nurses Association. What do I do now? Ethical dilemmas in nursing and health care.
(2013). ISNA Bulletin, 39(2), 5-12. Retrieved from
http://web.b.ebscohost.com.libproxy.dixie.edu/ehost/pdfviewer/pdfviewer?sid=609715c4
-6066-4d9e-99e0-aaa016aa7d2f%40sessionmgr112&vid=27&hid=127
Range, L. M., & Rotherham, A. L. (2010). Moral distress among nursing and non-nursing
students. Nursing Ethics, 17(2), 225-232. Retrieved
http://www.ncbi.nlm.nih.gov/pubmed/20185446
Resnik, D. (2012). Ethical virtues in scientific research. Accountability in Research, 19(6), 329343. doi:10.1080/08989621.2012.728908
Schaffer, M. (2009). A virtue ethics guide to best practices for community-based participatory
research. Progress in Community Health Partnerships: Research, Education, and Action,
3(1), 83-90. doi:10.1353/cpr.0.0053
Schroeter, K. (2014). Do you use your professional code of ethics?. Journal of Trauma Nursing,
21(3), 87-88. doi:10.1097/JTN.0000000000000049
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Stichler, J. F. (2013). Ethical considerations in healthcare design and construction. Health
Environments Research & Design Journal (HERD). pp. 5-9. Retrieved
http://connection.ebscohost.com/c/editorials/90503906/ethical-considerations-healthcaredesign-construction
Theory Essay
Theory Essay
Criteria
Introduction
view longer
description
Importance of
Ethical theory
to nursing
Importance of
an ethical
principle and
importance to
Ratings
The student provides a
reasonable description
of the major topic areas
in the introductory
paragraph
10 pts
The student provides an
unreasonable description
of the major topic areas in
an introductory paragraph
6 pts
The student does not
describe any major
topic areas in an
introductory
paragraph
0 pts
10 / 10 pts
The student provides a
credible and wellsupported justification of
the importance of ethical
theory to nursing
25 pts
The student provides
a plausible
justification of the
importance of ethical
theory to nursing
15 pts
The student does not
justify or provides an
implausible justification
of the importance of
ethical theory to nursing.
5 pts
25 / 25 pts
The student provides a
credible and wellsupported justification of
the importance of ethical
principle to nursing.
25 pts
The student provides
a plausible
justification of the
importance of ethical
principle to nursing
15 pts
The student does not
justify or provides an
implausible justification
of the importance of
ethical principle to
nursing.
5 pts
25 / 25 pts
The student provides a
precise summary of an
ethical principle that
would be in conflict if
confidentiality were
broken.
25 pts
The student provides a
reasonable summary of
an ethical principle that
would be in conflict if
confidentiality were
broken
15 pts
The student provides an
imprecise summary or no
summary at all of an
ethical principle that
would be in conflict if
confidentiality were
broken
5 pts
25 / 25 pts
The student cites more
than 5 professional,
scholarly sources in the
paper that are less than
10 years old.
10 pts
The student cites 3-5
professional, scholarly
sources in the paper
that are less than 10
years old.
6 pts
The student cites less
than 3 professional,
scholarly sources or
sources that are older
than 10 years old in the
paper
0 pts
10 / 10 pts
nursing
Ethical
principle in
conflict with
broken
confidentiality
Professional,
Scholarly
Sources
Pts
Overall
holistic
view longer
description
Exemplary
5 pts
Meets Standards
3 pts
Unacceptable
0 pts
5 / 5 pts
Ethical Decision-Making
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Theory Essay
Criteria
Total Points: 100
Ratings
Pts