Ethical Principles and Theories in Nursing Practice

This article discusses the ethical principles and theories in nursing practice, with a focus on ethical dilemmas faced by nurses. It describes a situation where an interdisciplinary team had to make a decision on whether to proceed with a surgical procedure after discovering that the diagnosis was incorrect. The article also provides guidance on ethical decision making in nursing practice.

Running head: Ethical Principles and Theories 1
Seminar 3: Ethical Principles and Theories
Name
Student ID
Institution
Date

Ethical Principles and Theories 2
Seminar 3: Ethical Principles and Theories
The nursing profession is full of ethical dilemmas following its complex and multifaceted
duties, responsibilities, and patient treatment procedures (Goethals, Gastmans, & de Casterlé,
2010 ; Pauly, Varcoe, Storch, & Newton, 2009). Working with different healthcare stakeholders
and especially patients, nurses undergo many instances when they are required to refer to their
nursing ethics in dealing with challenging situations. Indeed, Ulrich, et al., (2010) observe that
every single day of a nurse is full of ethical concerns that demand nurses to not only reconcile
their individual values with those guiding the profession but also those of the patients under their
care. Several reasons explain why most nurses are not in a position to make an informed decision
when faced with an ethical dilemma. These include lack of adequate resources, support, time,
expertise, and the facts informing ethical issues in the nursing (Burston, & Tuckett, 2013).
Even with the national code of ethics in place to guide nurses in their decision making
when faced by a challenging nursing concern, most are the times that nurses will fail to make
correct decisions. In this paper, I will be describing a situation in which I experienced a striking
ethical dilemma using the seven steps of guiding nurses to ethical decision making while
working in an interdisciplinary team in a leading hospital here in Canada during my nursing
practice last long holiday. Having studied the chapter on “Ethical Analysis and Nursing” in our
main course text; “Fundamentals of Nursing” by Potter, Perry, Hall, and Stockert, (2014), I will
also give an opinion as to whether I would approach the same ethical nursing situation
differently or if I would still approach is in the same manner.
The Canadian Nurses Association has been in the frontline in publishing codes of ethics
guidelines meant to guide Canadian nurses’ professionalism (Potter, Perry, Hall, & Stockert,
2014). As primary healthcare providers, nurses are supposed to exploit their professional values

Ethical Principles and Theories 3
in arriving at the most ethical nursing decisions for every patient’ treatment encounter they are
involved in. All healthcare stakeholders including patients and their families have varying values
and beliefs which explains the source of ethical dilemmas. The Canadian Nurses Association
(2017) describes ethical dilemmas in nursing as “situations arising when equally compelling
ethical reasons both for and against a particular course of action are recognized and a decision
must be made…” Failing to address ethical issues may lead to burnout and stress to both the
patients and the nurses. Moreover, nurses may find themselves in legal trouble such as medical
negligence.
During my nursing practice last long holiday in a hospital here in Canada, I built a lot of
professional resilience after dealing with numerous ethical nursing issues especially those of
direct patient care. One nursing situation with striking ethical dilemma concerns occurred when I
was involved in an interdisciplinary team working to deliver a surgical procedure on a 49 year
old woman with acute dysmenorrhea symptoms that had led to uterine fibroids (leiomyomas)
diagnosis. She lived with her husband and a 13 year- old daughter. Her two other children lived
in a town a couple of miles away. She had been diagnosed with mild depression some time back.
The operating room is one room in a hospital that will never lack ingrained ethical
dilemmas with both healthcare providers and their patients diffused in their own worlds on what
ought to be the most optimal course of action. Those relating to surgical procedures ought to be
given priority and addressed accordingly. As we prepared for the procedure ahead by
completing the operating room checklist, we graciously spoke to the patient for moral support
since at that point in time; patients are usually in a panic mode. After scrubbing our patient for an
emergency Total Abdominal Hysterectomy via general anaesthesia at the holding room, we
wheeled her to the theater. The procedure started off shortly after observing the operating room

Ethical Principles and Theories 4
routine by cutting the skin. After a few moments we reached the uterine lining and to our
amazement, the uterus showcased normal physiology with absolutely no traces of fibroids.
Being an emergency booking and bearing the complexity of such an operation, confusion
and conflicts filled the whole operating room. However, upon consultation, it was agreed that a
further exploration be done before closing the womb. As opposed to the earlier diagnosis report,
it was established that the cause of the dysmenorrhea symptoms was indeed due to ovarian cysts.
Ovarian cysts which could result from pelvic infections has the potential of causing
hydrosalpinges which is responsible for major menstrual cycle disturbances, dysuria,
infertility ,dyschezia, dyspareunia, and postcoital bleeding (Wallace, Keightley, & Gie, 2010).
To this end, this too needed to be removed there and then.
Though prior consent had been secured from the patient’s husband with regard to the
removal of the uterine fibroids, the husband was hesitant to give new consent for the removal of
the ovarian cysts. Larsson, Sahlsten, Segesten, & Plos, (2011) observe that this is one of the
greatest barriers to comprehensive surgical procedures. However, being an emergency and
already the operation being in great progress, the cyst had to be removed immediately regardless
of what his opinion was. Schenker and Meisel (2011) observe that the advantages of moving
right ahead with such a procedure far outweigh time-lags of waiting for an informed consent
from a family member. Even with complexities that come with a Total Abdominal Hysterectomy
such as surgical injuries to major organs such blood vessels, and the bladder; excessive bleeding;
urinary tract infections; anesthesia and post operation blood clots, the operation was overly
successful and no further complications were reported. The patient was later stabilized at the
post-anaesthetic recovery room (PARU) where upon recovery to her senses was briefed on the
surgical procedures done on her. Though she showcased disappointment, she later came to terms

Ethical Principles and Theories 5
with the situation bearing the gravity of health challenges she would have undergone if the cyst
wasn’t removed.
In analyzing this ethical dilemma in accordance with the seven steps as discussed in
chapter 7 of the book “Canadian Fundamentals of Nursing” by Potter, Perry, Hall, and Stockert,
(2014), I recognize and state that this situation constitutes a nursing ethical dilemma. There is a
conflict between healthcare practitioners as to whether to proceed with the surgery after the
discovery that indeed it is not the uterus that has a problem but the ovaries. Secondly, there is a
dilemma as to whether to continue with the surgery with or without the new consent of the
husband bearing in mind that this is a reproductive surgery that necessitates that both the
husband and his wife should consent to such effect.
After recognizing and stating the problem informing the ethical dilemma, we gathered
and checked the patients’ relevant information that could help us move ahead with the new
surgical procedure. In doing so, we reviewed the patient’ s laboratory tests and results, family
arrangement with regard to birth control, ultrasound results as well as the availability of blood
just in case she needed to be added. Thirdly, we identified relevant factors that could possibly
give us motivation to continue or bar us from the same. These included our professional codes of
ethics, personal values as well as those of the patient and her family. At my personal level, I
thought that since I am a devoted Christian and it is God’s purpose for us to preserve and protect
life, then we had an obligation to do so.
This possibly could not have been the values and beliefs for the rest of the
interdisciplinary team or of the patient and her family. Under her anesthesia condition she could
not voice her opinion yet we needed an argent urgent decision. Pauly, Varcoe, Storch, and
Newton, (2009) observe that all healthcare practitioners’ codes of ethics encases them with the

Ethical Principles and Theories 6
responsibility of advancing safe, quality , ethical care that enhances human dignity. This was
enough to permit us move ahead with the procedure despite hesitation of being granted informed
consent by the husband.
Fourthly, developing a list of alternative options to evade the dilemma gave us an
opportunity to deliberate as a team on the benefits and downsides of various causes of action.
Fifthly, we tested the various alternative causes of action. In doing so, we considered different
tests in a bid to be on the safe side in case of being adversely implicated for medical negligence
(Fry, Johnstone, & Fletcher, 2008). Sixthly, upon successful testing of options and reflecting on
all the other facets above, we made a decision to remove the ovarian cysts. Letting the cysts stay
would have meant more healthcare challenges to the patient and her family.
Lastly, we reflected on the outcomes and whether a better option was available than the
one we had engaged in. Since the patient was in an anaesthesia condition, she obviously could
not give the consent we desperately needed and therefore the husband had to undergo thorough
explanation of the detriments of an ovarian cyst and why it was important for it to be removed.
Judkins-Cohn, Kielwasser-Withrow, Owen, & Ward, (2014) insist that patients and their families
must give their consent in any type of surgical procedures after being thoroughly briefed of
alternatives. As such, after the husband understood the healthcare implication of the ovarian
cysts, he gave his consent and the procedure moved ahead smoothly knowing that the team had
bleached no procedures.
If I were in the same ethical situation again, I think I would make the same decision
again. Nothing would change. Like it has been enshrined in the nursing code of ethics [CNA,
2017] that nurses can make healthcare decisions that are in the best interest of their patients
regardless of the patients’ and family’s opinion, then this was the best decision the

Ethical Principles and Theories 7
interdisciplinary team in this scenario could have made. DeKeyser Ganz and Berkovitz, (2012)
assert that the various codes of ethics of different healthcare professionals give them the
opportunity to disagree to agree on their contradicting ideas at first. Indeed, comprehending the
ethical dilemma at hand, allowing practitioners to reflect on the individual and professional
ethical frameworks by and large advantages patients to make informed healthcare decisions
(Schenker, Fernandez, Sudore, & Schillinger, 2011).

Ethical Principles and Theories 8
References
Burston, A. S., & Tuckett, A. G. (2013). Moral distress in nursing: contributing factors,
outcomes, and interventions. Nursing ethics, 20(3), 312-324.
Canadian Nurses Association (2017). Code of Ethics for Registered Nurses. [Retrieved, from]
https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-
secure-interactive. Accessed 13/9/2018
DeKeyser Ganz, F., & Berkovitz, K. (2012). Surgical nurses’ perceptions of ethical dilemmas,
moral distress, and quality of care. Journal of advanced nursing, 68(7), 1516-1525.
Fry, S. T., Johnstone, M. J., & Fletcher, M. (2008). Ethics in nursing practice: a guide to ethical
decision making. The Canadian Nurse, 99(4), 20.
Goethals, S., Gastmans, C., & de Casterlé, B. D. (2010). Nurses’ ethical reasoning and
behaviour: a literature review. International Journal of Nursing Studies, 47(5), 635-650.
Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., & Ward, J. (2014). Ethical principles
of informed consent: Exploring nurses’ dual role of care provider and researcher. The
Journal of Continuing Education in Nursing.
Larsson, I. E., Sahlsten, M. J., Segesten, K., & Plos, K. A. (2011). Patients’ perceptions of
barriers for participation in nursing care. Scandinavian Journal of Caring Sciences, 25(3),
575-582.
Potter, P., Perry, A.G., Hall, A.M., & Stockert, P.A. (2014). Canadian Fundamentals of Nursing
(5th Ed.). (Ross-Kerr, J.C., M.J. Wood, Astle B. J. & Duggleby W., Eds.). Toronto,
Canada: Elsevier.
Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral
distress and ethical climate. Nursing ethics, 16(5), 561-573.

Ethical Principles and Theories 9
Schenker, Y., Fernandez, A., Sudore, R., & Schillinger, D. (2011). Interventions to improve
patient comprehension in informed consent for medical and surgical procedures: a
systematic review. Medical Decision Making, 31(1), 151-173.
Schenker, Y., & Meisel, A. (2011). Informed consent in clinical care: practical considerations in
the effort to achieve ethical goals. JAMA, 305(11), 1130-1131.
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010).
Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced
nursing, 66(11), 2510-2519.
Wallace, S., Keightley, A., & Gie, C. (2010). Dysmenorrhoea. The Obstetrician &
Gynaecologist, 12(3), 149-154.