ETHICAL DILEMMA

INTRODUCTION
Ethical dilemmas are complex situations in which mental conflict arises between choosing amongst
diverse paths of action. Nurses are more often caught up in this type of problem regardless of where they
practice and what responsibilities they are seizing, nurses in all stages of the profession have reported
being challenged with ethical dilemmas.
Nursing ethics as defined by the Mosby’s Medical Dictionary (2009), “the values and moral principles
governing relationships in between the nurse and the patient, the patient’s family and other members of
the health profession, and general public. This mean that every one in the setting should be significantly
considered.
Identification of the problem is needed before any ethical quandary is resolved. Commonly, this happens
when nurses are confronted between ethical/cultural practices, medical standards, doctor’s orders and
even family wishes.

REAL EXPERIENCE FROM DUTY

Handling ethical issues should be carried out in a firm and cautious method towards difficulties that can
potentially be unsafe or illegal. One ethical dilemma that I was trapped during the course of my duty was
when a resident was asking for PRN medication outside the medicine indication and considerations.

This resident is beyond 90 years old and is diagnosed with a renal problem and some discomforts associated
with it, with regular episodes of confusions and aggression. This resident as I call her Grandma X has been
ailing about the discomfort she feels during bowel movement.

As per hospital protocol, when a patient has not moved her bowel for 2-3 days, enemas are given in lieu or
in conjunction of the regular oral liquid laxatives that their doctors has already prescribed.

Taking note of her perplexity. Her history states that she always refuses medication. As a nurse being
educated about the Patient’s Rights, we abide on this and can not force a person to take such medications
without their approval or consent.

The argument:
She always complains of difficulty of breathing and swallowing during her bowel movement. This often
happens every morning during her cares. She constantly asks for pain relievers to alleviate the distress every
time she goes to the toilet.

EVALUATION
Nurses learned anatomy and physiology from school, while work related experiences sharpened our
capabilities about conditions of basic type. Being in this field, her straining is probably associated with the
discomforts that she feels in the toilet. Considering her request of pain medication, it is understandable that
too much analgesics may progress her renal problem and that the medication she is asking will not resolve
this discomfort.

Her none compliance with her medication such as taking her Laxol (Laxative) 20mg OD made her not move
daily. And constipation occurs as this does not happen as needed. Her yearning for Paracetamol is only
brought about by the straining.
ANALYSIS AND CONCLUSION
Code of ethics as cited by the Nursing Council of New Zealand (2002), “Promotion of client autonomy
indicates an understanding that the client should normally be allowed to choose his/her own
treatment/care - within the realms of safety.” It is concluded that patient education is highly needed thus
practicing their rights all together is a great and crucial factor.

The rights of consumers and duties of the providers as written by the Health and Disability Commissioner
(July 2012) “Right 5, Right to effective communication, (1) Every consumer has the right to effective
communication in a form, language and manner that enables the consumer to understand the information
provided” This means that I have to give all the means for Grandma X to understand all events that’s
occurring despite her mental infirmities. I need to practice her rights yet give her the best explanation to
exercise beneficence and so that her decision will do her no harm.

By clearly and logically stating, in an age applicable language, I conveyed to her the purposes, benefits,
risks and limitations of the medication in relevance to her reactions. Despite her confusions and agitation,
I was able to relax her and communicate with her the positive factors it could give her.

With a therapeutic tone and touch, she understood that the bowel straining caused her difficulty of
breathing and thus she needs to take her medications as scheduled to optimize her condition. That
Paracatamol could not help her at the moment.

The immediate action was when she was given an enema to induce bowel. She was terribly annoyed with
it but she was able to give her consent prior to the procedure.

ACTION PLAN
It is greatest to know how to communicate best with your patients. The key to a better compliance with
residents in her situation is being clear, calm and logical.

On that instance, it is my strategy to frequently talk to her calmly to lessen her agitation and get her
focused on what is happening. If an intervention is needed, such as morning medications, she will
cooperate.

This has provided me a good learning and experience on how to handle patients and situations like this.
This is a good basis for my future actions and care plan. Nevertheless, patience is the key attitude that a
nurse should posses to overcome this ethical dilemma.

Reference:
Nursing Ethics. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved April 21 2018
from https://medical-dictionary.thefreedictionary.com/nursing+ethics

New Zealand Nurses Organization. (2002). Code of Ethics (revised ed.). Wellington: NZNO Publications.

Health and Disability Commissioner (July 2012). Code of Health and Disability Services, Consumers’ Rights.
Auckland: HDC Publications.