NURS3004: Resolving Ethical Dilemmas in Nursing - A Case Study

This essay reflects on an ethical dilemma encountered during a student nurse's placement in an acute medical ward. The dilemma involved a senior nurse's failure to adhere to contact isolation precautions and proper hand hygiene, potentially endangering patients. The essay employs the MORAL model (Massage the dilemma, Outline the options, Review criteria and resolve, Affirm position and act, Look back and evaluate) to analyze and resolve the situation. The student nurse considered options such as doing nothing, confronting the nurse, or reporting the malpractice to management. Ultimately, reporting the incident to the management was chosen as the most appropriate course of action, balancing patient safety with the student's own security within the workplace. The essay concludes that this approach was effective in addressing the ethical breach and reinforcing the importance of upholding nursing practice standards and ethical codes, while also emphasizing the value of reporting such issues to protect patient well-being and promote a culture of accountability within the healthcare setting.

Solving Ethical Dilemmas in Nursing Practice 1
Solving Ethical Dilemmas in Nursing Practice
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Solving Ethical Dilemmas in Nursing Practice 2
Solving Ethical Dilemmas in Nursing Practice
Ethical Dilemma Scenario
During my placement as a student nurse last holiday in an acute medical ward
of a public hospital, I faced several nursing ethical dilemmas. The most outstanding
one happened when my relationship with the core workers of the institution was put to
test. The nursing dilemma that I found myself in touched on issues concerning the
role of the nurse in safeguarding the safety of patients when their health is put at risk
by the actions of co-workers. According to the code of conduct guidelines, student
nurses work under registered nurse (RN) direct supervision. I was therefore supposed
to work under the instructions of a senior RN in the first week of my placement. The
ward’s superintendent tasked the RN and me to care for patients in the infectious
rooms.
When we started working, I was shocked to see that she entered patients’
rooms that require contact isolation precautions without putting on personal protective
equipment (PPE). Moreover, she extensively neglected appropriate hand hygiene
precautions several times between patients. At one point in time, she gave me a
Panadol to deliver to a patient and upon asking her to accompany me she dismissed
me by stating “Oh, it’s just a Panadol and I have checked it. I have to finish my
nursing notes”.
Solving the Ethical Scenario Dilemma: MORAL MODEL
To resolve this nursing ethical dilemma, I used the MORAL model which is
basically a 5 step ethical decision making model premised on the acronym MORAL:
M- massage the dilemma, O- outline the options, R- review criteria and resolve the
dilemma, A- affirm position and act, and L- look back and evaluate the entire process
as described by Ghazal, Saleem, and Amlani (2014, p.136).

Solving Ethical Dilemmas in Nursing Practice 3
Massage the Dilemma
Since I was still a nurse student and I was yet to be familiar with my fellow
co-workers especially with their personal behaviors and traits, this situation literally
put me in an ethical dilemma. I was torn between abiding by the codes of ethics
guiding the conduct of nurses pertaining the safeguarding of patients’ safety when
their health is at risk out of the actions of co-workers or compromising them to ensure
my safe stay at the acute medical ward. The Nursing and Midwifery Board of
Australia, (2018) and the International Council of Nurses (2012) assert that nurses
have a responsibility of forging and sustaining a collaborative and respectful
relationship with all co-workers in the nursing profession. Moreover, nurses are
expected to safeguard patients' health and safety especially when co-workers endanger
the same.
Outline Options
Option 1- Do nothing by keeping the observation of the malpractice to myself.
This was meant to secure my safe stay and effective completion of my nursing
placement at the hospital. This was prompted by the fact that, I didn’t know the
possible reactions of the nurse and the hospital management against me. In any case,
it was upon the hospital's management to enforce the safety standards of patients.
Option 2- Confront the nurse and make it clear to her that she is contravening
critical patient safety practices that may jeopardize their health outcomes. This option
was in line with the International Council of Nurses (2012) requirements that nurses
ought to take necessary actions to not only guide but also support co-workers to
assume ethical conduct in their practice. This requirement was a formidable defense if
in case the nurse decided to retaliate.

Solving Ethical Dilemmas in Nursing Practice 4
Option 3- Report the malpractice to the management for appropriate action to
be taken against the nurse. This might have jeopardized her performance rating as a
senior nurse but definitely, it was critical in putting the management on high alert
about what was happening in the wards.
Review Criteria and Resolve the Dilemma
Option one allowed me to evade the possible reprimand and workplace abuse
from fellow co-workers but inevitably allowed the compromise on patients’ safety.
Option two gave me an opportunity to support and guide the senior nurse to practice
safely and under the confines of ethical conduct, even though there was a possibility
of reprimand. Option three gave me an opportunity to share with the management the
malpractices happening in the wards for appropriate action to be taken. This option
secured me from possible workplace abuse. Alternative three seemed appropriate to
me since it presented a ‘win-win' situation in which I was secure from possible
workplace abuse, and the patients' safety requirements were bound to be addressed.
Besides, the senior nurse was bound to be summoned to ask her to change her
behavior.
Affirm Position and Act
I approached the management one morning and reported the matter to the
acute medical ward superintendent. Surprisingly, my observations were well received
and I was promised that action would be taken to avert the situation. I was assured
that the management would take stern action against whoever tried to abuse me for
reporting such critical patients' safety breaches. Indeed Aitamaa, Leino-Kilpi, Puukka,
and Suhonen, (2010, pp.469-482) assert that one of the most fundamental roles of the
codes of ethics in the nursing profession constitutes the active support and guidance
between co-workers to uphold best nursing practices as well as reporting the same to

Solving Ethical Dilemmas in Nursing Practice 5
management when it really necessitates. Moreover, Kangasniemi, Pakkanen, and
Korhonen (2015, pp.1744-1757) observe that being ethical during practice helps
elevate the patients’ trust and confidence in the nursing service provision.
Look Back and Evaluate
Due to her senior position, the best approach was to report her to the
management for action to be taken from there. This action shielded me from possible
workplace abuse and intimidation besides helping restore confidence in patients that
their health and safety was assured. De Casterlé, Izumi, Godfrey and Denhaerynck
(2008, pp.540-549); Erdil, and Korkmaz, (2009, pp.589-598.) observe that when
student nurse dares to confront senior RNs directly, it can cause conflicts, lack of trust
and further compromise on patient safety.
Moreover, by reporting her, it further reinforced my stern of observing nursing
practice standards, codes, and ethics besides allowing me a chance not to compromise
on my personal beliefs and values. Patients in rooms that require contact isolation
precautions require high safety standards and compromising on guidelines such as not
putting on PPE or not observing appropriate hand hygiene can really compromise on
their health (Trick, et al., 2009, pp.2003-2009). As such reporting, the case was the
most appropriate action to take to prevent further safety compromise besides securing
my safe stay at the facility.

Solving Ethical Dilemmas in Nursing Practice 6
References
Aitamaa, E., Leino-Kilpi, H., Puukka, P. and Suhonen, R., 2010. Ethical problems in
nursing management: the role of codes of ethics. Nursing ethics, 17(4), pp.469-482.
De Casterlé, B.D., Izumi, S., Godfrey, N.S. and Denhaerynck, K., 2008. Nurses’
responses to ethical dilemmas in nursing practice: meta‐analysis. Journal of advanced
nursing, 63(6), pp.540-549.
Erdil, F. and Korkmaz, F., 2009. Ethical problems observed by student nurses.
Nursing ethics, 16(5), pp.589-598.
Ghazal, L., Saleem, Z. and Amlani, G., 2014. Resolving ethical dilemma: An
application of a theoretical model. Khyber Medical University Journal, 6(3), p.135.
Available at: http://ecommons.aku.edu/pakistan_fhs_son/65
International Council of Nurses, 2012. The ICN Code of Ethics for Nurses. Available
At https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=12&cad=rja&uact=8&ved=2ahUKEwiS5c
Oxk7DeAhWrzoUKHcEICEUQFjALegQIAhAC&url=http%3A%2F
%2Fbioetika.sam.lt%2Fget_file.php%3Ffile
%3DbnBTYXk1V2hZcVdkbTJWbXlKZVpsWjFrYk1PVXltdlR4cHh3MnBtZHg2Un
Z4cDJTblo5a1oyNmprcGFYbTUyWm1LRnF4bWZVYlpPYXJuSE1rcDNHcFclMk
ZLbHRhZFlaV2ViWiUyQlhvNWVhYW1USGFwdVNsNCUyQlYxSm1ibmN6RWI
4U0NtclBKcHNlUmFaMXRwR21leDZHZG1jaW9iTWxuajVuVXg1dWJ6Slp2bW5
Sdw%3D%3D&usg=AOvVaw1DlON-g4PEbJoaigpM5OTm
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in
nursing: an integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.
Nursing and Midwifery Board of Australia, 2018. Code of Ethics for Nurses in
Australia Available from

Solving Ethical Dilemmas in Nursing Practice 7
https://www.google.com/search?q=Code+of+Ethicsfor+Nurses+in+Australia&ie=utf-
8&oe=utf-8&client=firefox-b-ab
Trick, W.E., Weinstein, R.A., DeMarais, P.L., Tomaska, W., Nathan, C., McAllister,
S.K., Hageman, J.C., Rice, T.W., Westbrook, G. and Jarvis, W.R., 2009. Comparison
of routine glove use and contact‐isolation precautions to prevent transmission of
multidrug‐resistant bacteria in a long‐term care facility. Journal of the American
Geriatrics Society, 52(12), pp.2003-2009.