The Nursing Dilemma


Nursing is an activity that involves dealing with another person’s life and it is therefore important that a lot of ethics are integrated in the practice. These ethics normally act as guidelines for the nurses and they are meant to enhance the nurse’s efficiency. As a result of the new technological and infrastructural development, there has been a need to set up new models for care provision .The nurses are therefore expected to adapt to these advancements and be able to adopt the new ethical principles that come with them.

These new ethical principles include beneficence, nonmaleficence, justice, autonomy, veracityand confidentiality. Nonmaleficence principle means that the nurse has a role to protect his or her patient. This principle therefore demands that the nurse cause no harm to his or her patient. The nurse can harm the patient by refusing to take his call; such an action can result into an emotional distress. Other means through which the nurse can harm the patient include a failure by the nurse to give the patient the accurate information or breaking down equipments meant for the patients (Ludwick and Silva, 1999). It is therefore important that the communication system is made efficient and reliable and if possible a backup provided incase of a failure. It is also important that even the machines are assessed so as to ensure that it does not harm the patient.

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Beneficence principles raise the question on as to who between the nurse and the patient has the right to make the decision concerning the health care service that is best for the patient. At times, there is a misunderstanding over what is good between the patient and the nurse, the patient and the organizations, between the patients themselves or between the states that allow interstate practice in care provision (Ludwick and Silva 1999), this is because there is always the battle on as to what is good for each of the parties involved. This ethical principle therefore raises the question about the need to allow the patient to make his or her own independent decision concerning treatment; this also leaves a lot of issues to be raised about who should make the decision in a situation where the patient has a malfunctioning of the brain or if he or she is in a critical condition.

Autonomy means that the individual has the right to make her own independent decision without any interference from others (Ludwick and Silva, 1999). This principle raises the ethical questions concerning the response of the nurses who practice in the states they are allowed autonomy to the withdrawal of that autonomy or vice versa. This also explains if the nurses have thee right to refuse making the independent decisions if they feel less prepared to make such autonomous decisions and if the patients have the right to refuse being given care. The society has also allowed the nurses the power to make autonomous decisions, the question is therefore that, “will the nurses be able to return the favor by increasing their commitment to the society, if the nurses will develop respect to each others autonomy and if this will increase the understanding between the nurses and in the society that they work for” (Ludwick and Silva, 1999).

Justice refers to the equitable distribution of the resources. In health care, it means that the nurse is able to provide for the patients, the kind of care that they know is available for them. Justice in this case is experienced in the availability of enough nurses and finances; Justice raises the issues concerning how to share the services of the few available nurses amongst the many people, it also raises the issue concerning the payment given to the nurses, that is if it is worth it that the nurses work for longer hours and travel to longer distances at no extra pay. One m ay also wonder if it is just to deny patients health care services due to the scarcity of nurses or is it just to have the nurses overworked so as to meet the high demands at no extra pay (Ludwick and Silva 1999).

Confidentiality as an ethical principle implies that the nurse is not allowed to share the information about the patient with any one else unless there is a fact that he or she wants elaborated. The National Council for state boards has developed centralized data base (NURSYS) which contain confidential information about each of the nurses; such information if exposed to the wrong persons may cause some damage to the nurse’s name or reputation. The patients too need confidentiality when dealing with the health providers, this is so because some of them have highly risky diseases that can result in the patients being stigmatized, it is therefore important that the nurse keeps the patients secrets carefully so as to prevent the patients from deciding to stop talking providers as this may put their lives in danger (Grundstein- Amado, n.d).  

Veracity is a principle that encourages both the patient and the nurse to be truthful to one another.  It is important that the patient is truthful with nurse as this will enable the nurse prescribe the best care to the patient. The nurse also needs to be truthful to the patient as this will enable the patient to make the right decision. The ethical issues in this case are that the care givers are normally limited by the regulations of their employers and she may therefore lack the capacity to provide all the necessary information to the patient. Paternalism refers to a practice of treating people in a fatherly manner. This involves helping other people without giving them any responsibilities or rights. Fidelity refers to the strict observance of agreements and promises. It refers to the ability of being able to keep one’s promises for instance the promises to the patients.

Analysis of Ethical Issues in Selected case study

Clarification of the ethical dilemma

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In making a healthy decision in health care there are critical steps that should act as a guide to the care providers. The first step is to identify the problem at hand and in doing this the nurse should be able to ask her self if the situation of the patient is serious or not, if the decision to be made is between two goods, two bad or a good and a bad one (Velasquez et al., 2009), she should also be able to consider if the situation refers demands for a solution of what is more legal or what is more efficient. In the case study provided, the nurse is faced with a dilemma in that she wants to help the patient by relieving his pain but at the same time she does not want to give him an overdose as ordered by the doctor. The nurse is therefore experiences a crisis on whether to be nonmaleficent by protecting the patient from the harm of the over dosage or to put her fidelity in question by offering the patient the right amount of medication against the doctor’s instructions.

Collection of additional data

In care giving it is important the nurse is well conversant with the facts about the condition of the patient. This will involve the search for further information concerning that condition. This will enable the nurse to determine if she has enough information as well as the options she has in making a decision. The search for information may involve looking up information from the internet, books or even by consulting the other physicians so as to be well conversant with the condition of the patient. It may also be important that authority is given by the concerned parties before any important decision is made. It is important that the information collected is sufficient enough to allow a proper decision making; failure to do so may result in other complications all together for the patient(Velasquez et al., 2009).

The available options and their advantages and disadvantages

Once the facts have been collected, it may be important t that the available alternative actions are weighed. The options can be one that; will do the patient more good than harm; This will involve an act of paternalism on the part of the nurse since the patient is depending on him or her for help. This implies that the nurse will have to consider giving the patient the medications but in the amounts prescribed by the doctor. This would do the patient a lot of good than harm since the patients need at the moment is to be relieved of the pain. This decision will be of benefit to the patient who would have been relieved of his pain and the doctor too since he will be able to continue with his duties elsewhere once Mr. E has been relaxed by the medication. It is a disadvantage in that it does not respect the rights of the patient to be given the right dosage but instead focuses only on relieving the patient of the pain.

An option that does not violate the rights of all the parties involved will mean the nurse will have to provide the patient with medication to relieve his pain as ordered by the doctor; the nurse would have therefore respected the rights of both the doctor and the patient. But as much as the patient may have been relieved from the pain, this decision violates the rights of the patient and the overdose could result in more complications to the patient.

There are options that aim at treating the parties equally; this therefore means that none of the parties have precedence over the other; the nurse will therefore make a decision that treats the patient, the doctor and herself equally without undermining another’s rights. Such an option is of an advantage to the patient since it will allow him to have the medication and at the right dosage. It may be disadvantageous in that the decision of the nurse to give the nurse the right dosage may not go down well with the doctor and this may even make her lose her job.

The nurse may be forced to consider an alternative that will benefit the whole society and not just an individual; this means that she will have to decide as to whether it is herself, the doctor or the patient if given a priority then more people will be benefited. Such an option is important in the sense that it helps in ensuring continued quality health care to the community at large but n the other hand it may be unfavorable since consideration of the whole community means generalizing the needs of individuals and this may be quite detrimental especially if the patient demands specialized attention.  

Finally the other possible alternative is one that will enable the nurse to be herself by making her own independent decisions. This will mean that the nurse will make the decision based on her own values and beliefs, without considering the patient or the demands of the doctor. This is advantageous since it respects the nurse’s autonomy though it shows lack of beneficence in the delivery of the health care services; this is because the nurse does not consider the importance of others opinions about the decision he or she is making (Kittrell and Black 2007 p. 156).

Decision Making

A critical study of all these approaches will enable the nurse to make a decision that would neither compromise the patient nor herself. It is therefore important that the option that best suits that problem at hand be selected, it may also be important that during this step the nurse puts into consideration what other people are likely to say about her decision(Smith, 1996).  It may be important that a decision that is favorable with more people is made so as to avoid criticism. I would go for the option that will respect the rights of the parties involved. This means that I will give the medication to the patient in the right dosage. This will relieve the patient of the pain and again it will not have interfered with my independence as the in making the right decisions.

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The decision should then be implemented with a lot of care so that none of the parties get hurt in the process. I would therefore give the medication to the patient in the right dosage.


In evaluating the decision made, one assess his or her decision t determine its outcome and if there is any possible lesson he or she has learnt from the situation. I would therefore evaluate the patient’s blood pressure, the level of pain and temperature; if they are in the expected range then I would be able to conclude that my decision had succeeded.


Nursing dilemma is one thing that a number of the nurses are faced with in their daily activities. It becomes quite complicated particularly when the nurse has knowledge about the condition of the patient; but is barred from making the right decision to help the patients simply because he or she has to follow orders from the doctors. It may be important that the nurses are allowed the right to make independent decisions concerning the care to be provided after consultations with those in the senior positions.

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