Ethical Issues in Nursing Practice

This assignment delves into the complex ethical issues encountered by nurses in various practice settings. It analyzes specific dilemmas such as the use of physical restraints on patients, navigating end-of-life care, and upholding patient autonomy. The assignment emphasizes the importance of adhering to codes of ethics, legal frameworks, and best practices to ensure ethical and compassionate nursing care.

Running head: ETHICAL DILEMMA
ETHICAL DILEMMA
Name of the student:
Name of the university:
Author note:

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Introduction:
Ethical dilemma is common occurrence in present day health care. Nurses need to be
knowledgeable about the ethical principles, ethical theories, professional codes of conducts,
codes of ethics and others to ensure safe practice and save themselves form legal obligation
(Preshaw et al., 2016). A case study is chosen where the nurses had provided restraints in the
aggressive patient leading to clashes between beneficence, non-maleficence. Theory of
utilitarianism was also not followed. Several codes of ethics and professional conducts were also
breached. The present assignments will gradually unfold how such occurrences had taken place
and what a nurse in such situation should have done.
Identification of the ethical issues:
In the case study 2, the nurse named Camilla was assigned to care for a patient named Sam who
was suffering from acute abdominal pain. When she was trying to measure his vital signs, she
was prevented by the patient who was quite agitated. He violently pushed the nurse away and
was not cooperating with her. He was answering irrationally and was continuously calling out.
When the team arrived and witnessed his aggressive behaviour and verbal abuses along with his
trying to pull his cannula out, they decided to restrain him. Although Camilla was apprehensive
of the negative outcome that would result from the restraints, yet the nurse in charge Julia
insisted to follow her orders as there was no workforce on the shift to handle the patient
effectively.
The case represented a scenario where the nurse was torn between two ethical situations. On one
hand, she had the duty to maintain the safe practice of the patient to ensure that he gets well and
her interventions have positive outcome on his health. On the other hand, she had to maintain the

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orders of her senior to restrain the patient as he was being a threat to the safety of the staffs on
the ward and also to himself. To prevent any adverse events to occur on the ward, he was
restrained so that his treatment could be continued without any interruption from him. However
to do that, the nurses had to breach the ethical principles of autonomy and dignity as informed
consents were not taken from the patient and his rights and human dignity was not paid
importance to. Hence, here rises an ethical dilemma. The nurse named Camilla was facing
dilemma where she was torn apart between her duties to maintain safe and effective practice for
the patient to make him get well but at the same time was not being able to take informed
consent of the patient for maintaining his dignity and autonomy (due to his aggressive behaviour
and violence exhibited by him).
A clear ethical perspective on the issues:
While working with the patient, there arose many situations for which the nurse was not being
able to initiate her treatments effectively. Measuring the vital signs of the patient was very
important in order to understand the physiological condition of the body (Mertz & Stretch,
2014). Following the vital signs and then determining the treatment requirements were extremely
important to tackle his abdominal pain. The responsibility of the nurse is to provide the safest,
evidence based and person centered care to the patient so that his symptoms are overcome. The
ethical principles of beneficence and non maleficence always guide the nurse to provide the
safest care to patients. The theory of Utilitarianism states that those care practices will be
considered right which has the best outcome on the patient health (Eren, 2014). However, in
order to do so, an uninterrupted care was very important which would ensure quality life.
However, it was not possible as the patient was violent and aggressive and was not allowing the
nurse to actively conduct her assessment which was delaying his process of treatment. Therefore

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the nurses decided to restrain him and contribute his treatment. However, this was an unethical
approach as present healthcare system guidelines instructs the importance of the maintenance of
the principle of autonomy and dignity and asking for the patients’ permission before applying
any interventions or restrains on him (Sinclair, Papps & Maeshall, 2016). This should be kept in
mind also that the patient was not in a stable state of mental health for which he was not being
able to answer rationally and did not understand the negative aspect of his aggression. Still, by
the rulebook, asking for dignity and informed consent are important which were breached by the
Camilla and her senior nurse. Therefore this led to an ethical situation where Camilla was not
being able to understand what actions to take as he was aware that restraints may also have
physical harm to the patient and his aggression could increase. However providing effective care
by restraining was also important.
An alternative perspective to your own:
Critical thinking and proper decision making are two important characters which need to be
possessed by every nurse in her professional practice to ensure that she is providing the best care
to the patient with the best approach that would ensure patient satisfaction. It was indeed true
that the nurse was facing issues in carrying out her assessments of the vital signs. The patient
was aggressive and violent which proposed a threat to the patient and also to the healthcare
professionals. It was very indeed important for the nurse to carry on with the treatment just for
the patient benefits. The principles of beneficence and non maleficence ensure the proper caring
of the patient by the best service (Park et al., 2016). However, it does not necessarily mean that
in order to maintain the two principles, another principle of autonomy and dignity needs to be
avoided. Providing the right to the patient to allow the nurses to carry on the treatment is very
important (Margettic et al., 2014). If a more skilled nurse would have been present in the ward,

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with proper experiences and skill, she should have found out other ways to handle the situation
and thereby take an effective decision rather than deciding for restraining on the patient. Over the
years, various evidence based journals have been published may procedures which help in
handling aggressive patient thereby making their conditions stable (Hughes & Lane, 2016).
Researchers convey that restraints should be the last resort only when the other techniques for
managing aggression fail. Ensuring open communication, developing a culture of positive
attitudes, giving the scope to the patient to express his anger, refraining from having judgmental
attitudes, smoothing the situation without pressuring the patient for proper behavior and many
others help in such situation. Establishing decision-making protocol and acknowledging and
dealing with conflicts quickly help in tackling the situation (Mohler & Meyer, 2014). The
rationale provide by the nurses for applying restraints cannot be held valid. If the nurses really
are following the principle of beneficence as well as non maleficence for the patient along with
following the ethical theory of utilitarianism, still their activity for not asking for consent cannot
be justified as restraints as rightly said by Camilla will cause physical harm and will increase his
aggression. Therefore if another nurse would have been in the area, she would have applied the
human factor for situation awareness and correct decision-making and apply evidence based
strategies by which he could be stabilized following which consent would have been taken.
Requirement to respect human dignity and human rights:
Human dignity can be defined as the sense of self worth and self respect which includes the right
to fill basic needs of food, safety and shelter. In the healthcare environment, human dignity
mainly remains focused on the importance of privacy, respect and autonomy. Care should be
always taken by healthcare professionals that their practices should never erode the human
dignity. Modesty is one of the traits of human dignity and simple activities like lowering of voice

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when talking, helping them to walk, educating them about their health and the interventions,
asking for their permission before applying interventions, before feeding, bathing and others
increase patient satisfaction (Luo, 2014). Over the years, social activist researchers have found
out through researches that every human being recognizes the need to have some measure of
control over their bodies or what happens to their bodies and even over how their destinies
unfold. Therefore, healthcare professionals do not keep any human beings restrained to bed. This
not only affects their mental health like creating depression, anxiety, frustration and others and
even exacerbates aggression in case of psychotic patients. Besides, it also leads to physical harm,
bruises, fractures and others. Just like the case study, researchers have also found out that less
time and inadequate staffing act as some of the biggest barriers which nurses face when the
condition of preserving patient dignity arises. In rush hours, nurses do not get time for address
each patient as individual. Stress, fatigue, lack of concentration and also burnout may hamper the
patient’s dignity (Eclock & Lewis, 2016). In this case as well, Julie advised Camilla to apply
restraints without trying her best to calm down the situations as staffs were less in number.
Therefore, it is extremely important for every nurse to develop professional knowledge,
dedication as well as clear vision to see every patient as another human being and thereby try to
keep the dignity intact by proper critical thinking and decision making skills.
An important ethical theory studied in this unit:
A debate can be established on the use of the ethical theory of utilitarianism. This theory states
that an intervention or care can be termed as sufficient and proper only when the outcomes of the
interventions has the best impact on the patient making the patient happy and live proper quality
life. This theory mainly instructs to implement strategies which bring happiness for the people
(Luo, 2016). Nurses treat patients with the goal that their intervention would help them overcome

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their phase of ailment and distress and give them a healthy life to make them happy. While
Camilla was trying to provide the best care plan, she could not do so because of the violence she
faced. In order to forcefully apply interventions and make him safe from threats, the patient was
restrained. Applying restraints is a breach of the ethical theory of utilitarianism as making the
patient feels bondage can never make him happy and in turn gave negative impacts on him. With
the long term goal of the patient’s happy and healthy life, the nurses beached the short term goal
of maintaining immediate happiness of the patient by applying restraints as they never thought
about how the patients self image and self respect can be hampered making him unhappy
(Chehab, 2017). Consequentialism which is the theory of ensuring interventions with the best
outcomes to be the appropriate one is also not followed here. Julie never thought of the physical
and mental impacts that would result from restraints and hence her activity also beached theory
of consequentialism.
Principles of health care ethics:
Beneficence states that nurses should provide interventions which ensure safety of the patients
and should have the best outcome (in comparison to other options). Non maleficence ensures
interventions which would give no suffering to the patient. It is seen that both the principles
clashed among themselves. In order to develop the health of the patient and to keep him safe
from any self harm, restraints were put. Providing restraints helped them to conduct assessments
of the patient and thereby develop an understanding of his condition to develop care plan with
the bets interventions (Bollig, Gjengaegdal & Rosland, 2016). However to do so, non
maleficence was not maintained. The application of medical restraints harmed the patient more
causing him mental as well as physical suffering which is strictly against the principle of non-

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maleficence. Hence, nurses should be more concerned and develop critical thinking ability to
ensure proper decision making in stressful situations.
Profession’s codes of ethics/ professional conduct & professional standards:
The Nursing and midwifery Board of Australia has provided with a set of codes of ethics which
nurses should maintain in their practice to ensure best health of patients without getting engaged
in ethical and legal obligations. However among the 8 codes of ethics, code 1, 2, 5 and 6 were
not maintained. The nurses did not value quality nursing for the patient and did not exhibit
respect and kindness for self as well as others. Nurses also did not value informed decision
making as his permission was not taken before restraining him. The code 6 of maintaining a
culture while providing care may seem to have been taken care of as they tried to put restraint on
him for protecting him form self harm ("Code of Ethics for Nurses in Australia", 2017).
However they missed out the part of the mental and physical harm which the patient may have
due to restraints which would hamper his safety.
Professional codes of conduct proposed by NMBA were also not followed. Code 1of maintaining
a safe care was not followed ("Standard of practice, Nursing and midwifery board of Australia",
2017). Code 3 of maintaining laws in profession was not followed as breaching of human rights
leads to legal obligations. Code 7 of maintaining informed decision making was also not
followed. Hence, it is extremely important for all nurses to abide by the codes to ensure safe
practice free from dilemma and legal obligations.
Recommendations for professional practice:
Every nurses when gets tangled in ethical dilemma, should utilize critical thinking skills and
decision making skills to ensure that the steps they take are in compliance with the ethical

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principles and theories. Maintain of the human rights and dignities are important to overcome
legal obligations. They should follow the professional codes of conduct and codes of ethics to
ensure that their interventions abide by them. Restraints should always be considered as the last
resort on different options in interventions. Nurses should follow various evidence based journals
so that they can understand the most modern techniques which are applied to handle such
patients and treat them effectively (Kusmaul, Bern-King & Bonifas, 2017).
Conclusion:
Due to unavailability of workforce on the ward, Julie’s advice made Camilla apply medical
restraints to maintain safety of the patient and also other staff members without his informed
consent. This resulted in ethical dilemma as there was a clash between the principles of
beneficence and non-maleficence. Moreover, the true sense of utilitarianism was also not
followed. Professional codes of conduct and codes of ethics were also breached by the
application of restraints on the patients. Nurses in such situations have to develop the human
factors of decision making skills, critical reasoning skill and situation awareness so that they can
apprehend the situations correctly. Moreover they should go through different evidenced based
journals to remain informed about the modern care suggested by researchers in the recent years.
This would help them to provide care to patients which would ensure patient satisfaction.

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Bollig, G., Gjengedal, E., & Rosland, J. H. (2016). Nothing to complain about? Residents’ and
relatives’ views on a “good life” and ethical challenges in nursing homes. Nursing
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Chehab, M. (2017). Moral Distress: What Is Next?. Pediatric Critical Care Medicine, 18(8),
814-815.
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Elcock, S., & Lewis, J. (2016). Mechanical Restraint: Legal, Ethical and Clinical Issues. In The
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Kusmaul, N., Bern-Klug, M., & Bonifas, R. (2017). Ethical Issues in Long-term Care: A Human
Rights Perspective. Journal of Human Rights and Social Work, 2(3), 86-97.
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