Nursing Principles: Moral Decisions and Ethical Dilemmas Analysis

This essay delves into the core principles of nursing, emphasizing the importance of ethical decision-making in patient care. It presents a scenario involving a firefighter and an elderly man, highlighting the ethical dilemmas nurses face in triage and treatment, irrespective of the patients' backgrounds or social standing. The essay explores key ethical principles such as beneficence, non-maleficence, and justice, along with the significance of the nursing code of ethics. It examines how healthcare disparities, including cultural and linguistic differences, can impact treatment decisions and challenges nurses face. Furthermore, it discusses the role of policy and protocols in shaping ethical practice and explores evidence-based decision-making strategies during triage, emphasizing the use of simulations and experienced mentorship to enhance nurses' skills. The essay underscores the nursing profession's high regard and the necessity to uphold ethical principles in all situations.

Running head: NURSING PRINCIPLES
Moral Decisions and Ethical Dilemmas
Name of the Student
Name of the University
Author’s note

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In the eyes of a layman, a nurse is not a person who is only associated with health care
sector but a nurse is an image of care and affection (Trobec & Starcic, 2015). A nurse is a person
who strives to uplift the health and cares for the betterment of the society at large. Nursing is
regarded as a line of work within the health care sector that concentrates on giving care and
nourishment of individuals, families, and communities so that they can achieve, preserve, or
progress to get optimal health and quality of life (Parahoo, 2014).
In the case that has been presented, on one hand there is a young fire fighter Mr. Jeffers,
who is a brave hero of the society and has been living with a goodwill in the community for a
long time and on the other hand there is an elderly man, Mr. Damascus, who has been a regular
at the hospital with several incidents of headache and different health issues the similarity with
the two cases are that they were both caught up in the same incident and were going through the
same trauma. As a nurse it is the duty to perform similar kind of treatment and give the same
attention to both the people (Holloway & Galvin, 2016).
Nursing is based on virtue of goodness and kindness along with noble behavior and a
strong heart, as the profession deals with human beings who are in need of strength and courage
to deal with the sickness they are suffering form (Holloway & Galvin, 2016). Following ethical
principles provide a fundamental base for the profession of nursing. These philosophies that the
nurse follows are defined as the foundation for any decision that they take keeping in mind the
reflection of consequences and of general moral ideology while taking clinical judgments.
According to Toronto’s four elements of caring responsiveness of the caregiver, attentiveness,
competence and responsibly are imperative for a nurse to purse the process of care giving. In a
case of emergency along with being prompt the nurses are expected to be exceptional caregiver.
Care is significant for human development pertaining to the physical needs at first. People whose

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lives are dependent on the care of a nurse as stated in the code of ethics for nurses, “The respects
the worth, dignity and rights of all human beings irrespective of the nature of the health
problem”.
The most significant and crucial ethical principle that any nurse follows is respect for an
individual and life at large. Hence, a nurse deal with every situation and every patient in an
unbiased way despite the differences in the character of the person a nurse should treat him or
her. Like in this case the fire fighter is a hero of the society where as the other person has been a
petty thief and a roadside criminal who has a history with the police. But regardless of these stark
differences in the character of these people the nurse should treat both of these men in the same
way. Rather the old man should be paid more attention because of his already poor health
condition. His condition has a possibility of aggravating because he is already sick most of the
time.
Some of the primary ethical principles that a nurse has to follow are: inducing the least
damage possible to reach an advantageous outcome of the health of the patient (Cannaerts,
Gastmans, & Casterlé, 2014). Before taking any step a nurse has to contemplate on the idea and
weight the degree of risk. A nurse is expected to think on the toes in understanding a situation
and immediately reacting to help the patient. Fair allocation of resources among the patients is
another important factor that a nurse should keep in mind, as is in the case of the fire fighter and
the old man. Quick examination of the patients is required in the triage area which will give an
insight about the patient who is in more pain and who requires more attention (Cannaerts,
Gastmans, & Casterlé, 2014). If the old man is in more serious condition than the fire fighter
which is highly likely the condition then he should be attained first as his condition may

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deteriorate faster than the firefighter who is comparatively physically fit and strong than Mr.
Damascus (Lewis, Shanahan & Andrus, 2014).
Another important principle is to determine in which order the patents are to be treated.
Like in this case the nurse appointed should understand who is in more pain and start treating
that person first; overlooking any of characteristic of the patient, incurrence covered by the
person or the reputation of the person (Trobec & Starcic, 2015).
Along with these principles a nurse also has some of the secondary ideologies that he or
she should follow like being truthful, sympathetic and approachable. A nurse can help a person
recover from his or her current state by just being friendly and kind. Another important ethical
principle that a person in the nursing profession should follow is to respect privileged
information (Parahoo, 2014).
The way health care disparities impact treatment decision
The health care disparities can impact decision making. For instance, the socio-cultural
difference between provider and patient can lead to communication barrier which impact the
decision of the treatment and healthcare outcomes. The health care providers often engage in
stereotyping, clinical uncertainty, biases and prejudices which are the prime causes of ethnic and
racial disparity in healthcare. Linguistic diversity also leads health-care disparity that impact
treatment decision. For example: A person who is form an Indian origin who is not fluent in
English may have an issue with communication as discussed in the above situation. In another
situation if a nurse is biased towards the race or religion of a person then the process of treatment
can also be hampered, spontaneous attention or correct triage in the process of treatment may not

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be provided. These all fall against the code of ethics stated by the American Nursing
Association.
How Policy/ Protocols challenges Moral Ethics of Nurses
The ethical challenges that Nurses face are related to protection of rights of the patients,
staffing patterns, surrogate-decision making, consent to treatment and advanced care planning.
For instance, if the policy of the hospital or the organisation the nurse is associated with suggest
that a person who has insurance should be served with priority. On the other hand there are a
case which is much severe than the person with insurance then the position of a nurse becomes
questionable owing to who should be served with priority (Epstein & Turner, 2015).
The EB decision making strategies during triage
Triage is an essential concept in nursing some of the performance improvement markers
as indicated in the ESI (emergency severity index) are: safety, effectiveness, patient-
centeredness, timeliness, efficiency and equity (Mirhaghi et al., 2015).
The triage of the patients in departments of Emergency and accidents will require rapid
decision making by the nurses during the triage. The nurses can make these decisions with the
help of their experience and knowledge. The triage decision making skills can be developed by
making extensive usage of simulations, decision rules and reflection of emergency nurses. The
acquisition of skill in triage decision making involves practice and registered nurses must be
mentored by the clinical educators and the experienced nurses before they get involved in
triaging patients during emergency. Nurses can experience the process of decision making during
the triage process by using simulations of triage which are developed from cases of “real triage’’.
These simulations can be followed by verbal protocols so that nurses can get opportunities to

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retrospect and explore the process of decision making by reflection. Experienced nurses can
make use of presentation and decision riles to train registered nurses. The clinical information,
the sequence of processing the information and the rules applied for combination of information
which can lead to a decision during the triage stage for an individual patient can be understood
by experiencing the process of triage decision making (Epstein & Turner, 2015).
Nursing is a profession that has been respected and is regarded as of high esteem. It is the
principles that the profession follows which develops the image of a care giver and hence these
principles must be followed at any situation and any cost.

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Reference List:
Cannaerts, N., Gastmans, C., & Casterlé, B. D. D. (2014). Contribution of ethics education to the
ethical competence of nursing students: educators’ and students’ perceptions. Nursing
ethics, 21(8), 861-878.
Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online
Journal of Issues in Nursing, 20(2).
Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. John Wiley
& Sons.
Lewis, L., Shanahan, M., & Andrus, V. (2014). Nurses leading the way: A holistic view of
excellence. Journal of Nursing Administration, 44(9), 441-443.
Mirhaghi, A., Heydari, A., Mazlom, R., & Hasanzadeh, F. (2015). Reliability of the emergency severity
index: meta-analysis. Sultan Qaboos University Medical Journal, 15(1), e71.
Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Trobec, I., & Starcic, A. I. (2015). Developing nursing ethical competences online versus in the
traditional classroom. Nursing ethics, 22(3), 352-366.