Ethical Dilemmas in Nursing Class 2

Ethical Dilemmas and Decision-Making Process

• The class focuses on ethical dilemmas and tools for decision-making in nursing.
• Marianne Sofronas, RN, PhD, a faculty lecturer at the Ingram School of Nursing, McGill University, teaches this course.

What Keeps Nurses Awake at Night

• This summarizes a video about the factors that concern nurses.
• Key elements include Integrity, Truth, and Commitment.

Content for Class 2

• Normative Ethics: Includes Virtue Ethics, Utilitarianism, Deontology, Principlism, and other paradigms--Narrative Ethics, Relational Ethics, Casuistry, Interpretivism, Feminist Ethics, and Ethics of Care. Relevant screencasts are available on MyCourses.
• Ethical Dilemmas and Decision-Making Process: Includes defining ethical dilemmas, ethical decision-making tools and frameworks, ethical questions, moral distress, moral resilience, moral courage, and moral communities.

What is an ethical dilemma?

• Ethical dilemmas involve choosing a course of action with multiple alternatives and consequences.
• Uncertainty regarding the best alternative often arises due to complex interpersonal and contextual aspects.

Decision-making process

• A commonly considered best alternative aligns with ethical norms and community values.
• Multiple right and wrong alternatives exist.

Other components of ethical dilemmas

• Conflict or opposition between two or more moral values/principles frequently occurs.
• Compromises on well-being and communication difficulties are often present.
• Ethical dilemmas may be difficult for healthcare teams and patients/families to resolve. This was authored by Olsen (2017).

Aligning Values to Practice: Example

• Aligning care with values is important.
• Recognizing and addressing social inequalities in access to healthcare is crucial. This example was presented by Colleen Varcoe.

Ethical Decision-Making Tools & Frameworks

• IDEA Framework
• Canadian Nurses Association (CNA)
• Storch Model
• Community Ethics Toolkit

IDEA: Ethical Decision-Making Framework

• This framework outlines the four main steps in ethical decision-making.
• The cycle of this framework involves: Identifying the facts, Determining the relevant ethical principles, Exploring the options, and Acting.

Canadian Nurses Association (CNA)

• This model for decision-making has ten steps:
  1. Determine who is involved
  2. Describe the issue
  3. Assess the situation
  4. Clarify values
  5. Explore the story and note reactions
  6. Identify ethical principles
  7. Clarify legal rules
  8. Explore options and alternatives
  9. Decide the course of action
  10. Develop an action plan
  11. Evaluate the plan

Storch Model

• This model has three steps: Information and identification, clarification and evaluation, and action and review.
• Key components include Professional codes of ethics, Ethical principles, Social expectations, Legal requirements, Range of actions, and anticipated consequences.

Identifying the ethical question

• Understanding different viewpoints, stakes, and the perspectives of all involved is crucial.
• Important to formulate a good ethical question to avoid broad, yes/no type questions, and be focused on the unique case.

The Ethical Question

• Articulating different values at stake is essential.
• Clarifying perspectives, even those not agreed upon, is needed.
• A well-framed ethical question is open-ended and broadens the analysis. Specific examples include asking what is at stake when, what are the implications?

Case Study (Example)

• Case study: woman stopping life-sustaining therapy.
• Factors to consider, along with ethical issues, include autonomy, benefits, consequences, mental health, and education of the patient.

Encounters with Moral Distress

• Moral Distress includes inadequate nursing staff, patient suffering, patient death with dignity, and the challenges of being a nursing student.

Moral Distress

• Feelings arise when the correct response is known but cannot be acted upon due to institutional or hierarchical constraints, as defined by Jameton (1984).
• It is not moral uncertainty (Jameton 1984) or emotional distress (McCarthy & Deady 2008), but knowing what to do but being able to act differently.

From Moral Distress to Moral Agency

• Nurses have the capacity to engage in deliberate action, understand the moral dimension of practice, and engage in morally relevant actions.

What Nurses Can Do to Address Moral Distress

• Recognizing, reflecting, and reconnecting to their purpose are crucial.
• Supporting personal well-being, restoring integrity, developing ethical competence, speaking up, taking principled actions, and contributing to an ethical practice culture are recommended.

Moral Courage, Resilience, and Communities

• These elements relate to the individual journey of becoming a nurse.

Moral Courage

• Moral courage is an expression of moral agency.

Moral Resilience

• Moral resilience is the ability to maintain integrity and respond to moral complexity, confusion, or setbacks.

Moral Resilience Going Beyond the Individual

• Focuses on resistance and system improvement, moving beyond individual resilience.

Moral Community

• A moral community encompasses a workplace where values are clear, shared, and respected.
• Coherence between professed values and lived reality is necessary.

Class 3 Nursing & the Law

• This class covers professional obligations, civil liability, patient rights, and consent and confidentiality.
• Topics include sources and key concepts of Canadian and Quebec law, patient's rights, nursing legal obligations, legal recourses for patients, malpractice cases, informed consent, capacity, and delegated consent.

This quiz explores ethical dilemmas and the decision-making processes specific to nursing. It covers various ethical theories and paradigms such as Virtue Ethics and Utilitarianism, along with ethical questions and frameworks. Perfect for understanding the complexities nurses face in their profession.