Neuromuscular blockade administration to end suffering: an ethical dilemma

Critical care nurses face ethical issues every day in relation to end-of-life decisions. This article presents a case study involving the administration of a neuromuscular blocking agent prior to removing a patient from the respirator. The decision to use a paralyzing agent caused an ethical conflict between the nurse and physician. The article discusses ethical principles in relation to end-of-life decisions from the nurse, physician, and family's perspective. Whatever the belief, critical care nurses must consider the belief's of the patient and family while trying to maintain their own convictions.     

Male nurses and the protection of female patient dignity

Nurses need to be aware of their professional, legal and ethical responsibilities towards patients. Male nurses in particular face problems in their practice as a result of their gender and the stereotypes associated with male nurses. Such stereotypes can act as a barrier to their duty of care. This article examines the challenges associated with male nurses carrying out intimate, physical care. It discusses the ethical, legal and professional issues that male nurses should consider in relation to maintenance of patient dignity during nursing care provision, particularly in relation to female patients.     

Critical care nurses, ethical decision-making and stress

Considerable attention has focused on describing ethical issues that critical care nurses face in their practice; however, less attention has been directed at describing the process of ethical decision-making. Systematic research linking aspects of ethical-decision making and stress is lacking. This cross-sectional study examines the relationship between selected aspects of ethical decision-making, stress and selected nurse characteristics. Sixty-one critical care nurses completed the Nurse's Ethical Decision Making—ICU Questionnaire and the Health Professions Stress Inventory. Findings revealed that nurses who selected the patient advocacy model had significantly higher nurse autonomy scores, that perceived anxiety had a negative association with nurse autonomy, and that workplace restrictions and stress were related.     

Nursing students' experiences of ethical issues in clinical practice: A New Zealand study

Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately.     

Legal and ethical issues confronting oncology nursing

OBJECTIVES: To identify and summarize the legal and ethical issues found in the multiple settings in which oncology nurses practice. DATA SOURCES: Lexis, Medline, Westlaw, federal and state laws, government documents, and nursing and medical textbooks. CONCLUSIONS: Oncology nurses face many legal and ethical dilemmas when delivering care. The best defense against litigation is to be knowledgeable about the specific issues found in each setting, the impact these issues have on practice, and requisite risk reduction practices. IMPLICATIONS FOR NURSING PRACTICE: With the advent of new technology, changing state and federal laws, and new court decisions, the ethical and legal issues nurses will encounter when taking care of cancer patients will not remain the same. Continuing education will be essential if nurses are to remain current, lower their legal liability, and deliver quality care.     

Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long‐acting intramuscular injections: A qualitative study

The ethical issues experienced by mental health nurses in administering antipsychotic depot and long‐acting intramuscular injections (LAI) were explored in the present study. Mental health nurses face ethically‐difficult situations when administering these medications. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical issues involved in performing the procedure. Purposive and snowball sampling was used to select eight participants from two mental health hospitals. Semistructured interviews were carried out to collect data. A thematic analysis was conducted on the data. The four main themes that emerged from the analyses were: (i) lack of alternatives; (ii) safety; (iii) feeling uncomfortable; and (iv) difficulty maintaining the therapeutic relationship. The findings suggest that mental health nurses face ethical challenges in administering LAI. The findings raise much needed awareness of the need for mental health nurses and nurse educators to consider the ethical issues experienced while performing the procedure. There is a need for nurse education providers and organizations to provide opportunities for mental health nurses to address their ‘lived experiences’. Educational courses are needed to equip mental health nurses with the technical and critical thinking skills to administer safe and effective antipsychotic depot and LAI.     

The nursing shortage and ethics: up front and personal

In times of crisis it is often that values and beliefs and, subsequently, our ethics are challenged. Authors in OJIN have addressed some of the ethical issues that nurses face in relation to crises in health care. For example, P. J. Maddox (1998) addressed ethical issues surrounding economic constraints and scarce resources. In this current issue of OJIN, Cheryl Peterson (2001) writes of the ethical dilemma nurses face in trying to comply with the Code for Nurses with Interpretive Statement, 1985 in light of the present nursing shortage. We invite you to read these and the other OJIN articles on the shortage and then submit to this column a story about how the nursing shortage has ethically affected you or your patients/clients.     

Supporting sexual activity in long-term care

Although nurses in almost every long-term care facility face daily challenges involving issues related to residents' sexual lives, guidelines for ethically supporting sexual activity are rare and inadequate. A decision-making framework was developed to guide care providers in responding to the sexual expression of residents in long-term care. The framework recommends that nurses should weigh the documented substantial benefits of having a sexual life against harm to the resident and others, and against offence to others. This article illustrates the use of this ethical decision-making framework by using the example of nurses supporting a resident's expression of his sexuality. It is suggested that nurses use this framework to guide their practice when related ethical issues arise.     

Understanding the ethical issues in infertility nursing practice.

Nurses are actively involved in planning and providing nursing care to infertile individuals and couples in a variety of health care settings. Infertility is a health problem with ethical and physical, psychological, and social dimensions. Rather than evaluating the ethical advantages and disadvantages of each reproductive technology, the author suggests that the ethical issues that face nurses in caring for infertile individuals be assessed from the standpoint of possible harm to the individual and family. From this perspective, a lack of accurate information about treatment outcomes appears to be a serious ethical issue and one that nurses can, in part, remedy.     

Ethical challenge in community health nursing

Community health nurses frequently face situations involving ethical conflicts, but little research has been carried out in this area. This paper, based on a study of dilemmas defined by 30 practising community health nurses in urban and rural British Columbia, Canada, presents an analysis of the situations that contain the most serious ethical conflicts for nurses working in the community. Although issues related to client's rights, nurses' interactions with colleagues and the system, and nurses' rights were explored, nurses in the study reported that situations involving high-risk parenting provided the most serious ethical challenges. Strategies to help nurses caring for such vulnerable clients are described. As well, this paper offers some discussion on implications for community health nursing practice and education in light of current changes and challenges.     

Preparing for practice: students' reflections on their final clinical experience.

Nursing students in their last clinical experience before graduating often encounter stressful situations and face unique challenges. To help students prepare for their transition into practice, both faculty and nurses in the clinical setting need a thorough understanding of what nursing students are thinking and feeling as they near the end of their academic program. This study was conducted to explore the cognitive and emotional responses of baccalaureate nursing students during their final clinical experience. Thirty-two senior nursing students wrote "thinking-in-action" reflections weekly during a 6-week period in the last semester of their nursing program. Reflections were analyzed using qualitative methods; seven themes emerged: being aware of human vulnerability, feeling the weight of registered nurse (RN) responsibility, recognizing limits, evaluating self, seeing the patient/family perspective, confronting ethical issues, and facing reality versus expectations. These findings help nurses in education and practice more fully understand the issues that students face in preparing for practice and may lead to strategies to smoothen the stressful transition from being a student to becoming an RN.     

Heart transplantation from an ethical perspective

Ethical issues in health care have increased during the past two decades, primarily in response to rapidly evolving advanced technologies. This increase in ethical dilemmas has been most felt by nurses because they are the primary health care providers to whom patients and family members turn for support, counseling, and empathy. Heart transplantation is an area of health care that evokes numerous ethical issues. Ethical beliefs must be examined from the aspects of everyone involved: the patient, family members, and health care providers. Some aspects of the transplantation process also warrant special consideration such as transplantation, lack of a viable support system for patients, and cultural issues. Future projections include a growth in the number and types of ethical dilemmas as technology continues to evolve, populations become more diverse and older, and the health care delivery systems continue to employ a more diverse group of health care providers. This article has attempted to give nurses some insight and guidance about the ethical issues currently being encountered. The article has also included the need for future education of nurses and society.     

Ethical issues after the disclosure of a terminal illness: Danish and Norwegian hospice nurses' reflections

This research explored the ethical issues that nurses reported in the process of elaboration and further disclosure after an initial diagnosis of a terminal illness had been given. One hundred and six hospice nurses in Norway and Denmark completed a questionnaire containing 45 items of forced-choice and open-ended questions. This questionnaire was tested and used in three countries prior to this study; for this research it was tested on Danish and Norwegian nurses. All respondents supported the ethics of ongoing disclosure to terminally ill patients based on ethical principles embedded in their country's Patients' Rights Acts. Truth, as an intrinsic value, proved foundational to patient autonomy, the most frequent ethical principle these nurses reported to justify their ethical position on information disclosure to terminally ill people. Telling the truth about a diagnosis was not the end of ethics in hospice care, but rather the beginning because what occurs ethically in dealing with prognosis issues became central to these hospice nurses, the patients and their families. Coupled with truth-telling, compassionate interaction and care become extensions of patients' rights.     

Japanese nurses' perceptions about disclosure of information at the patients' end of life

Information disclosure at the end of life is one of the most debated ethical issues in Japan. This paper, using data from a larger questionnaire survey in which 147 Japanese nurses participated, describes nurses' perceptions about this issue. The nurses perceived that non-disclosure of impending death information to patients was the norm in Japan due to its traditional values. This non-disclosure of information has various impacts on clinical nurses. Tension was evident between the Japanese traditional concepts supported by some nurses and the shift toward Western cultural and ethical values supported by other nurses. The nurses confronted uninformed patients who became suspicious, isolated, angry, or died unprepared for their life's ending. The nurses were placed in the middle between the patient and the family, as nurses became keepers of family secrets, or between nurses' ethical obligations to the patient and those of the institution. The nurses had the belief that at the patient's end of life, it is important to change health professionals' attitude from curing to caring.     

Ethical perspectives in neuroscience nursing practice.

The role of neuroscience nurses in relation to ethical issues has become increasingly complex. Knowledge of ethical principles and theories assists the nurse in the development of a theoretical basis for resolution of ethical issues or concerns. Additionally, the nurse must possess information regarding practice codes or standards as well as legislative requirements. The nurse must act as an advocate for the patient and society through active participation in institutional ethics committees and legislative forums.     

Ethical dilemmas and moral distress in oncology nursing practice

Although ethical values and principles guide oncology nursing practice, nurses often are challenged to fulfill every professional core duty and responsibility in their everyday practice. Nurses commonly encounter clinical situations that have ethical conflicts, and they often have difficulty recognizing and articulating them. Unresolved conflicts can cause feelings of frustration and powerlessness, which can lead to compromises in patient care, job dissatisfaction, disagreements among those in the healthcare team, and burnout. This article reviews the ethical principles and values individual nurses bring to their practice as well as those basic to the profession of nursing. This article also discusses ethical conflicts in oncology practice and describes how nurses, especially students and novice nurses, may react to such situations with moral uncertainty or distress. In addition, a process for analyzing and resolving ethical problems in clinical situations is outlined. Increasing awareness and dialogue about ethical issues is an important first step in the process. Additional resources in the clinical setting may encourage nurses to actively participate in ethical decision making and take deliberate action as moral agents.     

Ethical issues in clinical research. Informed consent and risks versus benefits in the treatment of primary hypertension

Clinical research involves a number of ethical issues for the nurse researcher and clinician. When new treatments, such as experimental drugs, are used in patient care, the issues of informed consent to treatment and the balancing of risks and benefits may be especially difficult to resolve. By understanding the functions and elements of informed consent, nurses can assist their patients to ask for and to comprehend the information they need to be truly and fully informed about treatment choices. Likewise, assessing the risks and benefits of an experimental treatment option, such as an experimental drug for the treatment of primary hypertension, may be important to the long-term health of patients. Nurses assist patient decision making and the assessment of relevant risks and benefits by being fully informed about the planned research and by applying knowledge of ethical principles to patient care. When nurses incorporate this type of ethical reflection and moral skill into nursing practice, they meet minimal moral obligations to patients.     

Ethics on the job: a survey. Staffing issues

In this fourth installment of our series on ethical issues, we'll examine how patient care is affected when there just aren't enough nurses to go around. We'll look at how nurses are coping with that situation, and how UAPs now factor into the mix.