Running head: ETHICAL ISSUE

Ethical Issue
Harpreet Kaur
California State University, Stanislaus

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Ethical Issue
Data

According to Florence Nightingale, nursing is not merely based on scientific knowledge

and technical skills, but on human values as well (Rassin, 2008). An ethical issue involves a
conflict in these values. For nursing, the core values are autonomy, beneficence, nonmaleficence, fidelity, justice, and paternalism (Beauchamp and Childress, 2009). Autonomy is
respecting an individuals decision on a choice of action. Based on the Patient Self
Determination Act, competent patients may make their end of life decision or choose a durable
power of attorney, who may make this decision on their behalf. Beneficence is the core principle
of patient advocacy; it is a desire to aid others and do good (Beauchamp and Childress, 2009). It
requires healthcare providers to perform actions that provide benefit to others and balance the
pros and cons of those actions (Byrd & Winkelstein, 2014). Similarly, non-maleficence, the core
of medical oath, aims to avoid damage and harm. Fidelity denotes to an obligation of following
up on a promise that the nurse has made to the patient. In addition, it refers to avoid engaging in
situations where decisions or actions may be influenced by personal interests or financial matters
(Byrd & Winkelstein, 2014). Justice infers that all patients have the right of equal and fair access
to the resources, including distribution of costs, benefits, and risk, without any discrimination
(Byrd & Winkelstein, 2014). Paternalism occurs when a healthcare professional makes a
decision about continuing or withholding a treatment based on his or her belief of patients
interest. These decisions include diagnosis, therapy, and prognosis (Butts & Rich, 2008). The
author observed the violation of fidelity due to an ethical dilemma. According to Ong, Yee, and
Lee (2012), an ethical dilemma is choosing from two or more ethically appropriate options or
from inappropriate courses of action, when one choice precludes choice of the other.

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Ethical Dilemma

On November 14, 2014, the author witnessed an ethical dilemma in the telemetry unit in
Memorial Medical Center while providing care for a patient diagnosed with Endocarditis of the
Mitral Valve. Other diagnosis for the patient included: Acute Respiratory Distress, Sepsis, and
Acute Renal Failure. The patient was scheduled to have a surgery for repair of tricuspid and
mitral valve on November 15, 2014. RS was known on the unit for constantly being on the call
light, asking endless questions, and consistently demanding things like coffee, water, snacks, etc.
Once anyone went in her room, it took a while to come out. This was hard for the nurse to
balance, as she had three other patients to take care of and doctors to round with. Additionally,
she was behind on charting and passing medications. The ethical dilemma occurred as a result of
RS anxiety about her surgery and becoming short of breath. She was worried that having
diarrhea again would prevent her from having the surgery. In addition, she wanted to know if her
husband could take shower in the patients shower room in the hallway and if he could receive a
guest lunch tray. The nurse had promised her that she would come and answer any questions that
she had; however, she knew that going in the RSs would be time consuming and she needed to
stabilize the patient with hyperkalemia first. Consequently, RS was not receiving full justice.
Although her situation was not as critical, she still deserved to be treated with equal approach. In
addition, violation of fidelity occurred as the nurse was not following up on her promise.
Choices of Action and their Advantages/Disadvantages
The nurse could ask either the charge nurse or another Registered Nurse (RN) to assist
RS. She could give them a brief report on her and inform them about her situation. The
advantage of this action is that it would allow the nurse to have sufficient time to catch on
charting, pass medications, and assist the patient with hyperkalemia. The disadvantage of this

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choice might be that the charge nurse or the RN might perceive the primary as being incompetent
for not managing her time effectively. Another action the nurse could take is to have the student
nurse assist RS. The student nurse could ask the nurse about information and communicate it
back to the patient. The advantage of this is the same as the one mentioned before. The
disadvantage of this action is that RS might not perceive the student as not an actual nurse.
The patient might not listen to her.
Performed Action
The action taken was a combination of the potential choices. The charge nurse and the
student assisted RS together. The charge nurse called the respiratory therapist for the breathing
treatment and answered the questions regarding lunch and shower for the husband. The student
nurse administered the anti-anxiety medications with the charge nurse. Also, the student nurse
asked the primary nurse about the loose stool concern and communicated it to the patient. RS
was relieved to know that she would still have the surgery because she was receiving
medications for the loose stools. In fact, her loose stools were not actually a concern because
they were not as loose as before. While the student and charge nurse assisted RS, the primary
nurse stabilized the other patient. As RS was no longer anxious, she was not on the call light as
much that allowed time for the nurse to catch up on the medications and charting. Afterwards,
the nurse explained the situation to RS and clarified why she could not assist her previously.
The author was satisfied with the outcome. The interventions allowed the patient to calm
down. She thanked the nurse and the author for their assistance. No conflict or arguments
occurred. Because of this experience, the author is likely to recognize future ethical issues and
contact appropriate resources for assistance.

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References
Butts, J. B., & Rich, K. L. (2008). Nursing ethics across the curriculum and into practice (2nd
ed., p. 48). Sunbury, MA: Jones and Bartlett.
Byrd, G., & Winkelstein, P. (2014). A comparative analysis of moral principles and behavioral
norms in eight ethical codes relevant to health sciences librarianship, medical
informatics, and the health professions. Journal of the Medical Library Association:
JMLA, 102(4), 247-256.
Ong, W., Yee, C., & Lee, A. (2012). Ethical dilemmas in the care of cancer patients near the end
of life. Singapore Medical Journal, 53(1), 11-16.
Rassin, M. (2008). Nurses' professional and personal values. Nursing Ethics, 15(5), 614-630.