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Practical & ethical dilemmas are part of
everyday nursing practice
There is no absolute formula to solve
conflict butthere is guidelines:
1. Maintain attentiveness to personal
values
2. Clarify obligation (ااازاام
) لت
3. Determine the nature of the problem
4. Weigh the alternatives thoughtfully
5. Develop solutions that recognize each
person as an autonomous
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Attention to personal values
Attention to personal integrity (نااهها
زا )
Appeals to conscience () ضامير
Integrity is required for us such as pt. welfare
in our primary obligation
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Attentiveness to personal values means:
making your primary loyalty to your pt
seeking to do the right thing
It referred to “Appeals to conscience” which
means personal and subject belief founded on
prior judgment of rightness or wrongness.
Recognize the nurse as a person and encourage
ethical autonomy, this enables us to act in ways
that are rational, free from coercion ( ) اجابارor
manipulation and consistent with personally
held values and principles
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Nurses’ primary responsibility is the patient
By following code of ethics you fulfill
maintaining integrity, loyalty to patient,
obligation to society, profession & yourself
Maintain fidelity, faithful to promise and meet
each patient need
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By maintaining employment & payment
services
We have both Legal & moral obligation to the
institution
When the institution focus on bottom line of
economics rather than pt. welfare conflict
arise
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Inevitable ( ) محتوامconflict situation:
When nurses whose primary loyalty to pt
are employed by institutions that eliminate
important programs
Employ poorly-qualified staff or inadequate
number of staff
Ill-equipped to meet the needs of pt
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Is the problem moral uncertainty, distress, or
outrage
Nurse should match between pt. welfare &
needs of the institution
Code of ethics should be very specific
regarding judgment of accepting delegation&
responsibility
Refuse assignment is Unethical
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In assigning a nurse to float to unfamiliar
setting or in accepting the assignment is
unethical on number of levels:
We must not abandon pt in need of care
if there is no one else available to care
for pt.
We are obligated to give care “ only the
type of care for which we are prepared
and competent”.
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E.g., nurse temporally assigned to specific
units can be asked to give basic,
supportive nursing care but, should not be
asked to perform technical tasks for which
they are unprepared to do so because its is
both ethically wrong and legally risky
accepting assignment must be guided
by the principles of nonmaleficence and
beneficence
If not competent seek additional
information or knowledge, seek help
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Conflicts arise when the institution demand
for loyalty are inequitable () ظالااام
Conflict :( altruism ( ) اياثارand self-sacrificing)
Sacrificing issues of self-interest in favor of
institutional interest
E.g., nurses are willing to skip meals and
breaks and complete work after clocking out
Consistently repeated, self sacrificing is self-
defeating and harmful to both nurses and pt
Altruism has a damaging effect( flowing
from poor self-esteem)
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Incidence report:
“a document, geared towered institutional goal
in which institutions discourage nurses from
talking to pt about mistakes that have been
made and demanding the nurse to complete
incidence report”
To prevent litigation (اءيااا
) داعوى قاضا ها
Kept for the use in the event of hospital needs
a legal defense
Used in firing or disciplining workers
Used in recognizing service to prevent further
incidents
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Relationship with Other Nurses
• Loyalty is a natural product of long-term close
working relationship
• It is productive, enhance unity, strengthenen
pt. welfare and care.
• It may be Harmful (blind)
• Blind loyalty may lead to confused sense of
obligation, it might cover up a coworkers
incompetent practice, illegal drug use or other
actions that have the potential to harm present
or future pts
• So, Nurses should balance loyalty to nurses,
profession, and obligation to the pt.
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Autonomy and accountability are valuable
component of nursing care
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Nurse & physician work are complementary
Conflict resulted :
When nurses try to ask or question the Dr.
order
Advance nursing practice (Independency)
which were once the sole domain of
physician
Nurses are employees but, physicians are not
Gender role in society (obey physician)
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Spectrum of urgency
Low urgency-end…………………High urgency-end
Low urgency-end: the problems are minor
and may be resolved at a leisurely pace
Situations in which there is little risk of
serious harm
Situations in which there is a significant
time available to examine all aspects of the
situation
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High urgency-end: the urgent problems
that require quick solutions and immediate
actions
Emergencies in which life-saving actions
must be carried out at once
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If medical care constitutes incompetent,
unethical, or illegal practice, the nurse is
clearly obligated to disobey order
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Delegation
Nurse has moral obligation to ensure that each
pt, receive excellent care, respect value of each
pt, high quality of nursing care
Evaluate the knowledge and skills expertise of
the individual to whom the care is assigned,
monitor
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Avoid traditional method of disciplining
(punishment)
by enhancement of self-discipline “ a
process by which the rules are internalized
and became a part of the individuals
personality”. Be a role model for following
the rule
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Ethically & legally prohibited
It protect against work place
discrimination
Violate ethical principle of Justice
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Discrimination or unequal
treatment in legislation,
administration
Exploitation ( ) انت هازtaking advantage
of another person to gain unfairly
Making false statement about
people or their work that aren’t fair
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It can be
Racial
Disability
Sexual
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Racial discrimination
Unlawful act to refuse hiring or
discharging any individual because of the
person's race, color, religion, sex, or
national origin.
Unlawful acts include discrimination in
terms of compensation or payment,
condition of employment ,or privileges of
employment
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Discriminatory practice outcomes:
Disparate treatment:
When individual is treated differently by a
superior or by organizational policies
Disparate impact:
When employer consistently apply policies
that appear to be fair to all employees but,
actually adversely affect one group
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Discrimination against persons with
disabilities:
The people with disabilities must not excluded
from job opportunities unless they are
unqualified or unable to perform the job
The practice of requiring medical examination
before employment is prohibited except for
drug testing
Medical examination may be done only after
job has been extended
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