The Top 5 Moral Concerns of a Nurse

The Top 5 Moral Concerns of a Nurse All healthcare providers face moral and ethical dilemmas on a daily basis (and some days it can feel like they present themselves hourly). However, what are the top 5 ethical concerns that nursing and healthcare staff face?

1.

Knowledge versus Belief

This dilemma comes about when knowledge gained through training, research or other evidence based practice comes into conflict with the nurses personal beliefs. This may be moral or religious beliefs, or simply something that the individual nurse has come to believe through life experience or socialization.

Related: Balancing Nursing School with Your Life It can be extremely difficult to deal with, particularly if it forces you to confront something that underpins your own belief system. For example, when does medical intervention become ‘going against the will of God’? This may be something that you are not only forced to confront yourself, but an issue that you may find yourself presented with by the distressed family members of one of your patients.

Some people feel very strongly that intervention in certain medical issues is interfering with God’s plan - this is often an extremely emotive issue, and can also be incredibly controversial. It can be very hard to both fulfil legal and moral obligations to provide the best possible care for a sick patient, while also ensuring that the valid religious concerns of the patient’s family are aired and recognized. Although you might morally agree with them, it can be extremely difficult to find a middle ground where spiritual, moral and legal avenues are all equally addressed.

2. Honesty versus Deception It may confuse some people that this is ever an issue that a nurse may have to confront, but there are occurrences of family members wishing to conceal the prognosis from the patient. If they are insistent that revelation of the patient’s

diagnosis will cause the patient harm, it presents a moral and ethical dilemma for the clinical team that is difficult and emotionally draining.

It is crucial that medical and nursing staff balance the physical and emotional needs of their patients, and although full disclosure is required for informed consent for medical procedures and treatment, this can become very complex where a patient is so frail or unwell that they are unable to understand their issues and the choices that they are faced with.

A sadly very common example of this is in disclosing the death of a spouse (or other family member) to a dementia patient. While this is undoubtedly distressing to any individual with health concerns, to a dementia patient, it could mean reliving the pain of learning of the death of a loved one on a daily basis.

In cases such as these, is it perhaps better to gently fend off questions about the whereabouts of the sufferers spouse in order to avoid unnecessary distress?

3.

Resources, and where to use them

Although we all wish that this wasn’t a concern, it is one of the harsh realities of healthcare across all professions.

A patient in a vegetative state still requires a huge amount of care, and there are those who question whether or not the resources required to provide this wouldn’t be better used elsewhere. If there is no realistic prospect of recovery, how do you communicate this to a distressed family who are no doubt praying for a miracle?

Indeed, there are always examples of patients who were deemed to be beyond recovery who suddenly regain consciousness - however, this in itself can mean that they spend a prolonged period of time with life changing physical and mental challenges. This, in turn, can lead to yet more demand on limited healthcare resources, nursing time and facilities. Can this ever lead to a reduction in care for other patients?

4.

Pro-Choice? Pro-Life?

This is, without question, one of the hot button topics not only in nursing but in society in general. It is very rare for there to be middle ground or gray areas with the topic of medical termination of pregnancy, and it can often be divisive and emotive.

As a nurse, how do you provide care for a patient suffering from a medical condition potentially brought on by an abortion if you personally believe that abortion is murder? Is it possible to support a patient through her treatment and care if you feel that strongly about her choices? Many pro-life nurses will be able to relate a story where although distressing, they acknowledge that a termination was the only correct course of action where a patient’s life or mental health was in the balance. If you feel strongly that all abortion is the murder of a child, this kind of scenario can bring about the kind of emotional and mental stress that few people are likely to encounter during their working day.

Equally, as a pro-choice nurse, you may face moral and ethical dilemmas related to late term abortion, and whether or not a patient is using abortion as a method of birth control - some nurses have even encountered women who they believe are being coerced into abortion by abusive or controlling spouses, partners or family members. Again, being confronted with the ugly side of something that you are morally convinced is correct can be very hard to deal with.

This is undoubtedly an area where, even if you are firm in your beliefs, they can be challenged on a daily basis.

Related: Stress Management for Nurses 5.

Patient Freedom of Choice versus Clinical Control

This is an incredibly complex and difficult area of medicine and care that is unlikely to ever be fully settled. What do you do when your patient is determined to make choices and decisions that could result in harm?

At what point does it become ‘right’ to force care onto a patient? For example, if a patient has decided that they wish to stop eating (and this is perhaps more

common than people realize - for example, someone receiving end of life care may decide to forgo food as a method of hastening their death), is it ever right to force feed them? At what point does gentle persuasion to eat become ‘bullying’ that is emotionally and mentally distressing for an already unstable patient?

In Summary These are all complex questions, none of which (technically) have a right or wrong answer. However, as a nurse you will face (or already have faced) all of them. Although you may have very clear cut ideas on where you stand morally and ethically on all of these subjects, there will always be occasions where your beliefs will be challenged.

It is crucial to address your concerns, whether that is with a trusted manager or senior nurse, or with a family member. Although patient confidentiality must always be your priority, talking to someone in general terms about the hard decisions that you face on a daily basis is critical to ensure your own health and well-being. Taking part in continuing professional development in these areas will also help you to deal with issues of these type as they arise, as you will feel more equipped to cope with them, and more prepared when they happen.

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