NSG 426 Week 3 Applying an Ethical Decision-Making Model

NSG 426 Week 3 Applying an Ethical Decision-Making Model

Student Name

University of Phoenix

NSG/426 Integrity in Practice: Ethics and Legal Considerations

Prof. Name:

Date

Applying an Ethical Decision-Making Model in Nursing Practice

Ethical decision-making in nursing ensures that patient safety, dignity, and well-being remain the highest priorities. Nurses frequently encounter situations where legal requirements, organizational policies, patient preferences, and professional ethics conflict. Applying a structured ethical decision-making model helps healthcare professionals make informed, patient-centered decisions while minimizing harm, promoting autonomy, and maintaining professional integrity.

Understanding the Ethical Problem

Healthcare professionals regularly face ethical dilemmas that require balancing clinical judgment, organizational policies, legal obligations, and patient rights. Ethical decision-making becomes particularly challenging when these factors conflict.

One common example occurs in hospice and palliative care. Nurses often care for patients whose treatment goals have shifted from curing illness to providing comfort. Organizational policies or financial limitations may restrict certain interventions, leaving nurses feeling conflicted when patients experience symptoms such as:

• Fever

• Pressure ulcers

• Respiratory secretions

• Severe discomfort

NSG 426 Week 3 Applying an Ethical Decision-Making Model

Although pain management remains a priority, nurses may believe that additional comfort measures could improve the patient’s quality of life. However, policy restrictions or clinical guidelines sometimes limit available interventions, creating moral distress.

Another ethical challenge arises in emergency departments when a patient’s code status is unknown. Until documentation confirms a Do Not Resuscitate (DNR) order, healthcare providers generally initiate full resuscitation efforts to comply with legal standards and protect patient safety. While this decision may appear primarily legal, it also reflects the ethical principle of beneficence by acting in the patient’s presumed best interest.

The Good Samaritan principle further supports healthcare professionals who provide emergency assistance in good faith, reinforcing ethical responsibility while offering legal protection.

Collecting and Analyzing Relevant Information

Ethical decisions should be based on a comprehensive assessment of all stakeholders involved.

According to Park (2012), healthcare stakeholders generally include:

• Patients

• Family members or surrogate decision-makers

• Healthcare professionals

• Healthcare organizations and the broader social environment, including laws, policies, and cultural values

Each stakeholder contributes unique perspectives that influence ethical decision-making.

Hospice Case Example

Consider a hospice patient with advanced multiple-organ cancer. The patient had a valid DNR order and received continuous morphine for pain management. Although physicians repeatedly explained the patient’s prognosis, the family struggled to accept the impending loss and requested changing the patient’s status to Full Code.

Healthcare providers understood that resuscitation would likely:

• Extend life only briefly

• Increase physical suffering

• Reduce the patient’s comfort during the final stages of life

This situation created an ethical conflict between respecting patient autonomy and responding compassionately to the family’s emotional distress.

NSG 426 Week 3 Applying an Ethical Decision-Making Model

The primary stakeholders included:

• The patient

• Family members

• Nurses

• Physicians

• Hospice care team

Supporting families through grief counseling, spiritual care, and honest communication helps reduce ethical conflict while respecting the patient’s wishes.

Developing and Comparing Ethical Alternatives

Ethical decision-making requires evaluating multiple options before determining the most appropriate course of action.

According to Joshi et al. (2017), palliative care addresses not only physical symptoms but also the psychological, social, and spiritual needs of both patients and families. Effective alternatives should therefore prioritize holistic care.

Possible interventions include:

• Providing comprehensive pain management

• Offering spiritual care services

• Increasing patient repositioning and hygiene measures

• Managing respiratory secretions

• Facilitating family counseling

• Encouraging interdisciplinary team discussions

• Consulting ethics committees when appropriate

For example, a terminally ill patient may request an excessive dose of opioid medication to hasten death. Although nurses empathize with the patient’s suffering, intentionally administering a lethal overdose violates ethical and legal standards in most healthcare settings.

Instead, nurses should focus on evidence-based comfort measures while communicating concerns to physicians and supervisors. Collaborative decision-making reduces individual bias and promotes ethically sound patient care.

Justifying Ethical Decisions

Ethical decisions should always prioritize patient welfare while respecting professional standards and patient autonomy.

Healthcare professionals must avoid actions that could harm patients, families, or colleagues. For example, accepting valuable gifts from patients may not always violate legal regulations, but it can compromise professional boundaries and create future conflicts of interest.

Respecting patient autonomy is another essential ethical principle. Patients who possess decision-making capacity should actively participate in their healthcare choices whenever possible.

According to Dawn (2013), patients make higher-quality healthcare decisions when they receive adequate information and support throughout the decision-making process.

When patients communicate their wishes through advance directives or DNR orders, healthcare providers have an ethical obligation to honor those decisions while ensuring informed consent and compassionate communication with family members.

Strategies for Implementing Ethical Decision-Making

Applying ethical principles consistently requires organizational support, professional education, and effective communication.

Healthcare organizations can strengthen ethical practice by implementing the following strategies:

• Provide ongoing ethics education for healthcare staff.

• Encourage interdisciplinary collaboration.

• Consult ethics committees during complex cases.

• Promote patient-centered communication.

• Respect advance directives and informed consent.

• Offer grief counseling and spiritual care services.

• Report ethical concerns promptly through appropriate leadership channels.

• Maintain professional boundaries with patients and families.

Maintaining professional boundaries is particularly important. For example, entering a romantic relationship with a patient may not always constitute a criminal offense, but it violates nursing ethics, impairs professional judgment, and risks compromising patient care.

Similarly, making healthcare decisions without involving competent patients undermines patient autonomy and may damage trust between providers and those they serve.

Why Ethical Decision-Making Matters

Ethical decision-making protects patients, supports families, and strengthens professional nursing practice. A structured ethical framework helps healthcare professionals balance compassion, legal responsibilities, clinical evidence, and patient preferences while reducing moral distress and improving quality of care.

Healthcare teams that consistently apply ethical decision-making models are better equipped to deliver safe, respectful, and patient-centered care across all clinical settings.

Ethical decision-making in nursing involves evaluating patient needs, ethical principles, legal responsibilities, and stakeholder perspectives before selecting the most appropriate course of action.

Hospice nurses frequently encounter ethical dilemmas involving patient autonomy, family expectations, and end-of-life treatment decisions. Structured ethical frameworks help resolve these conflicts while prioritizing patient comfort and dignity.

Patient autonomy, beneficence, nonmaleficence, justice, and professional integrity are the core ethical principles that guide nursing decision-making in clinical practice.

Frequently Asked Questions (FAQs)

What is an ethical decision-making model in nursing?

An ethical decision-making model is a structured framework that helps nurses analyze ethical dilemmas, evaluate available options, consider stakeholder perspectives, and make patient-centered decisions consistent with professional standards.

Why is ethical decision-making important in healthcare?

Ethical decision-making protects patient safety, respects individual rights, promotes professional accountability, and helps healthcare providers resolve conflicts between legal requirements, organizational policies, and patient preferences.

What are the four main healthcare stakeholders?

The primary healthcare stakeholders include:

• Patients

• Family members or surrogate decision-makers

• Healthcare professionals

• Healthcare organizations and society

Each group influences ethical healthcare decisions.

How does patient autonomy influence ethical decisions?

Patient autonomy allows competent individuals to make informed decisions regarding their healthcare. Nurses have an ethical responsibility to respect these decisions, including advance directives and DNR orders.

What are common ethical dilemmas nurses face?

Common ethical challenges include:

• End-of-life care decisions

• DNR and resuscitation conflicts

• Patient confidentiality

• Informed consent

• Professional boundaries

• Allocation of limited healthcare resources

• Conflicts between organizational policy and patient advocacy

References

Dawn, S. (2013). Supporting patient participation in healthcare decision-making. BMC Medical Informatics and Decision Making, 13(Suppl. 2), S11. https://doi.org/10.1186/1472-6947-13-S2-S11

Joshi, A. Y., Darekar, A. B., & Saudagar, R. B. (2017). Palliative care makes a difference for patients dying in hospital. Research Journal of Pharmacy and Technology, 10(6), 1858–1864. https://doi.org/10.5958/0974-360X.2017.00326.2

Park, E. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139–159. https://doi.org/10.1177/0969733011413491