Ethical dilemma is a condition where there may be opposite but equally morally lawful perspective to resolving a dilemma, it is also called moral dilemma (McDonald & Then, 2019, p. 25). This assignment aim is to reflection on an ethical dilemma which I encountered during my second year nursing placement as a student nurse in Hampstead Rehabilitation Centre in brain injury ward. In the following paper I will explain the scenario and I will also explain the why and how it is ethical issue for me. As well as, the paper describes about that how I worked through ethical aspects and issue and resolving ethical dilemma. Thus, in this paper to discuss the ethical issue and will be evaluated and interrogated with the ICN code of ethics, moral principles, code of conduct and ethics, and standard of nursing practice. Lastly, dilemma of the scenario will be solved using moral decision making framework that is ‘moral model’.
During my 2nd year, 2nd semester placement, I was assigned to the Hampstead Rehabilitation centre and I was working under my RN. To maintain the privacy and confidentiality of patient I will use ABC in this assignment. As the ABC had brain injury and has dementia as well. So, patient refused tablet coloxyl with senna and nurse gave medicine by hiding in the yoghurt. As the nurse was lying to the patient and didn’t respect the patient right and decisions. Moreover, I was observing at that time and I felt surprised that nurse didn’t maintain safe practice and breach professional nursing practice by not following the 10 rights of medication (right to refuse) and protocols. According to Nursing and Midwifery Board of Australia, (2019), nurse have to follow standard 2, 3 and 6 which is maintain the capability of nursing practice and provide safe, appropriate and responsive quality nursing practice and respect the dignity of the patient. Tablet coloxyl with senna which is for the softening the bowel and help in passing the bowel movement (Mims Australia, 2019).
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In the given scenario, nurse was just only focusing on duty and assigned work and nurse didn’t maintain the protocols, policy and rights of medication while giving medication and failed to delivering quality of nursing care to the patient (Government of South Australia, 2019). On that stage, as a student nurse, it was an ethical dilemma for me and I think that should I have to disclose with this situation with someone or I have to maintain good therapeutic relationship with my buddy nurse or I have to remain silent as somehow it is good for the patients health because patient haven’t used her bowel from 5 days. As well as, I also think that should I have to give reason about safe medication administration and how it is important to respect patient decision or can I give advice to the staff that is experienced and working here from 20 years.
Use of ICN code of Ethics for nurses
The code of ethics for nurses is an element which helps nurses as well as student nurse to make ethical decisions and to solve ethical dilemma while providing standard and quality of nursing care to the peoples (Waubra Foundation, 2019). According to International Council for Nurses (ICN code of ethics), (2012), element 1 and 2 aims that nurses require and obligate to provide safe and quality care to the patient. As well as, nurses are accountable and responsible for maintaining continual learning, policies and protocols (Nursing and Midwifery Board of Australia, 2019). In this scenario, nurses didn’t follow rights of medication administration and didn’t respect patient decision as well (Department on Disability Services, 2016). Additionally, nurse didn’t follow any protocols during procedure which means she didn’t work within scope of nursing practice and didn’t follow the codes and conduct of nursing practice. According to the element 4 of the ICN code of ethics for nurses, aims that it is the duty of co-workers and who ever assigned with the patient, as I was assigned so it is my ethical duty and responsibility as well to report the situation if I witnessed anything wrong or unsafe practice which helps in providing safe practice to the patient (International Council for Nurses, 2012).
Use of Moral model
I am using moral model to assist my discussion and resolve the ethical dilemma. Moral model is very important to make the ethical decision that help the nurses as well as student nurses on assisting and addressing the ethical issue and to resolve ethical issues looked by RN’s and student nurses (Yamamoto, 2011, pp. 599-603).
M – The ‘M’ defines the massage the dilemma. This is the 1st step which includes growing a full understanding of the ethical conflict after collecting important information and analyzing about the issue where error occurs (Yamamoto, 2011, pp. 599-603). According to scenario, as I have encountered an ethical dilemma should I keep good nurse-student therapeutic relationship as I don’t like to do something that will harm my placements and results or should I deliver safe practice and high quality nursing care to the patient. Thus, to solve this ethical dilemma, I analyzed the condition and discuss standards of nursing practices and ICN code of ethics and code of conduct for nurses in Australia to make my decision in this profession as a student nurse.
O – The ‘O’ stands for outline options. This is the 2nd step of moral model. In this, nurses who perceive the dilemma need to acknowledge the conflict included in the issue. After acknowledging the conflict, nurse can then analyze how to solve the problem (Crisham, 1985, p. 44). According to scenario, after analyzing I think about the 5 options they are: 1. Report to the facilitator and have a discussion about the issue. 2. Report to the manager and have a discussion about the situation. 3. Report to the team leader and have a discussion about the issue. 4. Have a meeting with the buddy nurse and discuss about the situation. Remain silent and not to do anything about the issue as the medicine is good for the patient’s condition and helps in bowel movement.
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R – The ‘R’ defines for review criteria and resolve which is 3rd step of moral model. This step aims to find the moral standard and explain a course of activity most balance with those standard (Crisham, 1985, p. 44). This is a key step in creating a moral judgment which will resolve the dilemma with using Gibbs Reflecting Cycle (Crowe Associated, n.d.).
Along with the all options I think that option 1: The discussion about the issue with the facilitator put me in safe side and provides me a support during my placement. To perform the responsibilities properly as a student nurse I think that she is the appropriate person to help me out from that situation as she was allocated there to help us. She can communicate and discuss with the manger by maintaining privacy and confidentiality of the patient and nurse as well. Option 2 and 3: having discussion with the team leader and manager also help me put in safe side but as I am a student nurse it’s better to talk with the allocated facilitator first. Option 4: Having discussions with the buddy nurse may occur issues between us as she was experienced and may harm in my placement as well. Option 5: Not doing anything about this issue breach the standard 4 of ICN code of ethics for nurses in Australia and as a student nurse I have ethical duty as well to deliver safe practice and quality care to the patient.
After analyzing all the 5 options, I will go with the option 1, report to the facilitator about the incident and discuss with her as it will help to put me in safe side and resolve my ethical issue during my placement. If any ethical issues I will encountered again during my placement, I will go with this option.
A – This ‘A’ stands for affirm position and act which is 4th step of moral model. The ‘A’ step of the moral proceeds to act on individual’s knowledge. To solve the ethical dilemma while developing moral judgment, using moral principles are essential for moral action (Yamamoto, 2011, pp. 599-603). According to the scenario, nurse hide that medicine in food to treat the patient from constipation and following the duties, nurse give the coloxyl senna to the patient which means ‘doing good’ and she is following ethical principles of beneficence (McDonald & Then, 2019, pp. 21-22). On the other hand, while giving that drug, she didn’t follow hospitals protocols and didn’t respect patient right and decision and didn’t follow standards of nursing practice. Additionally, it considered ‘doing harm’ which means that nurse breaches the ethical principles of non-malificience (McDonald & Then, 2019, pp. 21-22). Related to the scenario, as I chose option 1: have a discussed with facilitator, after discussed with her, she put my thoughts and concerns with the manager. Moreover, manager decided that to give training about the 10 medication rights and also decide to held a survey to observe the nurses as she was experienced there from 20 years and she is following 5 medication rights only.
L – This ‘L’ defines as look back and it is last step of moral model. In this step RN’s review on their understanding and involve evaluation for success and to recognize the nurse’s effective activities and development (Crisham, 1985, p. 44). Lastly, the ethical dilemma that I have encountered, resolved through the analyzing of ICN code of ethics, moral principles, standards of nursing practice, and with the support of my facilitator. This ethical dilemma aware and acknowledge me about the importance of using ICN code of ethics for nurses, standard of nursing practice and moral principles in this profession for safe and professional practice. Thus, moral model helps in decision making process enable nurses to respond to ethical dilemma in their own practice.
To conclude, this essay is all about the ethical issue which I encountered during my nursing placement. As a student nurse I think that not respecting the patient right, views, values and opinions may breach the safe and professional practice. By using moral model and ICN code of ethic, moral principles, and standards of nursing, after analyze that, rather than remaining silent it is better to discussed with the facilitator. With the help of facilitator, she put my concerns to manager and she provides training about the safe medication administration to all the staffs. Lastly, I acknowledge that to solve ethical dilemma, I need to be confident and use policies and protocols and use my theoretical knowledge in practice to solve the ethical issues and to deliver quality and safe practice to the patient.
- Crisham, P. (1985). MORAL: How Can I Do Whatʼs Right? Nursing Management (Springhouse), 16(3), 44.)
- Nursing and Midwifery Board of Australia. (2019). Registered nurse standard for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx.
- International Council for Nurses. (2012). The ICN code of ethics for nurse. Retrieved from https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf.
- Waubra Foundation. (2019). Code of ethics for nurses in Australia. Retrieved from https://waubrafoundation.org.au/resources/code-ethics-for-nurses-australia/.
- Yamamoto, M. (2011). “Dilemmas Faced by Nurses Regarding the Physical Restraint of Elderly Patients with Dementia in Japan,” International Journal of Clinical Medicine, 2 (5), 599-603. https://file.scirp.org/Html/13-2100197_8779.htm. (Moral model 2011)
- Crowe Associated Ltd. (n.d.). Gibbs reflective cycle. Retrieved from https://www.crowe-associates.co.uk/coaching-tools/gibbs-reflective-cycle/.
- McDonald, F., & Then, Shih-Ning. (2019). Ethics, law and health care: A guide for nurses and midwives (Second ed.). (p. 25).
- McDonald, F., & Then, Shih-Ning. (2019). Ethics, law and health care: A guide for nurses and midwives (Second ed.). (pp. 21-22).
- Department on disability services. (2016). The rights of medication administration and management. Retrieved from https://ucedd.georgetown.edu/DDA/documents/NursingRTMarch2016.pdf.
- Mims Australia. (2019). Coloxyl with senna. Retrieved from https://www-mimsonline-com-au.ezproxy.flinders.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&searchKeyword=coloxyl&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=720001_2.
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