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Course Outcomes
Outcome 7:
Demonstrate professional standards of moral, ethical, and legal conduct into the care of persons,
families, groups, communities, and populations.
Activities & Reflection (Synthesis):
Nurses are in a position in which it is not uncommon to face ethical dilemmas. Through my BSN
coursework, however, I have obtained the tools needed to have more confidence as I deal with
difficult situations that call for moral, ethical, and legal knowledge application. The key concept
to remember when addressing an ethical dilemma is the first provision of the ANA Code of
Ethics for Nurses (2001), which states that "The nurse, in all professional relationships, practices
with compassion and respect for the inherent dignity, worth, and uniqueness of every individual,
unrestricted by considerations of social or economic status, personal attributes, or the nature of
health problems" (web). When the nurse puts the patient first and is non-discriminatory, he or
she is setting herself up to make good decisions related to patient care.
I have learned about various tools that we as nurses have available in order to make ethical
decisions as well. Nurses can consult the ANA Code of Ethics (ANA, 2001), or consider key
ethical principles and theories. For instance, the principles of autonomy (self-determination),
beneficence (promotion of good), non-maleficence (preventing harm), justice (doing what is
right and fair), fidelity (being faithful), and veracity (truth) can be applied to many ethically
demanding situations (Black, 2011). However, there are times when several ethical principles
apply, and may even conflict with each other. When this occurs, the nurse must weigh the
different alternatives and suggest what he or she believes to be the best option. When a situation
like this is encountered, it is wise to involve an ethics committee and collaborate to make an
ethically sound decision (Black, 2011).
In our coursework, there was an assignment in which a case of an ethical dilemma was
presented. In this case, the principle of beneficence contradicted the principle of autonomy. Mary
Tilghman (n.d.) explained that she was the RN on duty during the night when a Jehovah's
witness patient in DIC was bleeding to death, and had verbally expressed her wish that she
would rather die than receive blood (as cited in Black, 2011). Based on the principle of
autonomy, she should not be given blood. However, in the spirit of beneficence, when she was
unconscious and her husband was told that she would die without a transfusion, his verbal
consent (after she became unconscious) was enough rationale (in the eyes of the doctors) in order
to administer life-saving transfusions. This is an example of an assignment that offered the
opportunity to analyze an ethical dilemma, discuss which ethical principles applied, and make
recommendations to address the dilemma. When putting the patient's wishes first, there is a
strong case for autonomy, although the beneficence of saving her life also applies. There were
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multiple assignments in which I analyzed different ethical dilemmas, discussed them with fellow
students, and/or wrote a recommendation to address an ethical dilemma.
Nurses must ensure that care is given in a way that is within the scope of practice and protects
the nurse from litigation. I have been told many times that if I don't chart something, it is as if I
didn't do it. Therefore, it is important for me as a nurse, as well as for all nurses, to practice
according to policy, record care provided, and ensure that care given is within the nursing scope
of practice and compliant with the state's Nurse Practice Act. My nursing policy and ethics
course has helped me to understand more specifics on the policies that I must follow, and how to
respond to ethical dilemmas in a way that promotes patient safety and helps me to maintain
integrity in my own practice.
It is important to treat each patient the way that I would want to be treated. In order for patients
to feel respected, and to develop a therapeutic relationship with each patient, it is important to
understand the patient and to draw upon the expertise of nursing theorists. In my Professional
Nursing Course, I wrote a paper on Peplau’s Nursing Theory. This paper helped me to gain
insight into the patient’s perspective, and how to facilitate healing and positive communication
through Peplau’s nursing theory (which focuses on understanding patients through relationships).
Please see the attached document, Nursing Theory Paper, to read more.
I have completed a transcultural nursing course as well. This course offered insight on how to
deal with ethical dilemmas and take cultural considerations into account in order to provide
culturally-competent care. Learning about different cultures and specific cultural assessment
strategies has assisted me to learn how to better care for different cultures, and to understand
different rationales for unfamiliar healthcare philosophies which may lead to ethical dilemmas.
As I read the story of Lia Lee, in The Spirit Catches You and You Fall Down, I learned that in
order to provide ethical care, it is essential to provide culturally competent care. For instance,
due to cultural barriers that went much deeper than language, a Hmong girl was taken from her
loving parents. The story was complicated, and both sides had good intentions, but a
questionable, and possibly unethical decision was made to temporarily separate a child from her
parents. This problem could have been avoided through cultural competence. Additionally, this
girl's health outcomes may have been much better if cultural competence had not been lacking.
Therefore, culturally competent nursing care is essential in order to provide ethical care to many
different cultures, and different cultures may have different reasoning or principles to apply to
ethical dilemmas. Please see my analysis of the book The Spirit Catches You and You Fall Down
by clicking on the attachment Transcultural Nursing Final Paper.
I will continue to act ethically as a practicing nurse. I have multiple tools, from facility-specific
ethics committees and codes of conduct, to national standards such as the ANA's Code of Ethics
for Nurses (2001). The knowledge that I have obtained through the BSN program is valuable,
and helps me to offer a rationale for my own ethical beliefs. I can still uphold my personal
beliefs while putting the patient first, although I don't force my beliefs on patients. However, my
ethical beliefs and standards help me to have the courage and soundness of mind to address
ethical dilemmas, offer insight to difficult situations, and have faith that a positive outcome can
be reached. I will treat patients with the same level of respect and compassion as if they were my
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own grandmother, grandfather, brother, sister, father or mother. Caring is the heart of nursing,
and as a caring nurse I will strive to provide ethical care.
References
American Nurses Association [ANA]. (2001). Code of ethics for nurses with interpretive
statements (web). Retrieved from http://www.nursingworld.org/mobile/code-of-ethics
Black, B.P. (2011). Professional nursing: Concepts and challenges (7th ed.). St. Louis,
MO: Saunders Elsevier.