Ethical Issues in Nursing Practice Essay

Ethical Issues in Nursing Practice Essay

Park, M. (2009). Ethical issues in nursing practice. Journal of Nursing Law, 13(3), 68-77. doi:10.1891/1073-7472.13.3.68
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Essay Prompt: Identify primary areas for legal and ethical issues faced by oncology nurses in this study (Park, 2009), and strategies they may have developed to work with those ethical issues.Ethical Issues in Nursing Practice Essay

Nurses play a role as advocates to assist patients and families struggling with complex information
and difficult decisions. In particular, the fact that nurses encounter clinical situations that require
ethical judgment highlights the need for nursing staff to gain knowledge and expertise in delivering care in an ethical manner. In this study, through reviewing empirical studies of hospital-based
nurses’ experiences, the author identified the ethical issues that nurses frequently face and the
approaches that they have taken to solving them. The findings can serve to intensify the awareness
of the ethical issues in both clinical and educational areas.
Keywords: ethical issues; nursing practice; education; hospitals
Advances in medical technology allow for better recovery for critically ill patients and
dramatically extend the human life span.Ethical Issues in Nursing Practice Essay
However, while advances bring benefits to patients
and families, they simultaneously raise moral and
ethical issues regarding respect for patient integrity
and autonomy, soaring medical costs, quality care,
and end-of-life decision making (Scanlon & Fleming,
1990; Wright, Cohen, & Caroselli, 1997). As the largest
group of health care providers, nurses are frequently
placed in unique positions to assist patients and
families struggling with complex information and difficult decisions (Briggs & Colvin, 2002). The fact that
nurses encounter clinical situations that require ethical judgment highlights the need for nursing staff to
gain knowledge and expertise in delivering care in an
ethical manner.
Reporting the lack of ethical confidence among
newly graduated nurses, nursing ethics researchers
have emphasizes the importance of having welleducated and well-qualified nurses who know how
to find feasible solutions to ethical problems (Bunch,
2001; Woods, 2005). Although nursing schools have
become more concerned with the ethical development
of their students, researchers point out that education
has not reflected reality and does not prepare newly
qualifying nurses to deal effectively with a variety of
ethical situations in the health care setting ( Woods,
2005). The traditional ethics education has tended
to emphasize the acquisition of philosophical and
theoretical knowledge and has created a gap between
theory and practice ( Woods, 2005). New approaches
are needed for teaching nursing ethics pragmatically.
The nursing ethic as a dynamic standard for nurses’
professional moral behavior should address ethical
issues confronted by nurses (Omery, Henneman, Billet, Luna-Raines, & Brown-Saltzman, 1995). Therefore,
knowledge about specific nursing ethical issues found
in the health care setting and understanding the impact
of these issues on practice will be essential, pragmatic
parts of nursing ethics education. That is, the ethical
issues are subjects that should be dealt with in ethics
education for nursing students before entering in nursing practice. Thus, identifying what issues should be
dealt with in classes is needed.Ethical Issues in Nursing Practice Essay
Researchers have tried to identify ethical issues that
nurses confront in the clinical area since Vaughan’s
(1935) study. The earliest study of ethical issues in
nursing practice (Vaughan, 1935) identified 2,265
ethical issues based on the diaries of 95 nurses that
recorded ethical issues. Since this study, many other
studies have been focused on ethical issues that affect
the profession of nursing and the everyday practice
of individual nurses using qualitative methodologies. In a review study, Christensen (2002) identified
the ethical and legal issues that oncology nurses in
hospitals face: (a) advance directives, ( b) do-notresuscitate orders, (c) documentation and patient
privacy, (d) informed consent, (e) medication errors,
and (f ) pain management. A systematic analysis
Park • Ethical Issues in Nursing Practice • 69
study of nurses’ ethical conflicts identified each main
ethical issue in a particular role or setting (Redman &
Fry, 2000). Examples were (a) harm/good of lifeprolonging aggressive therapies (intensive care unit);
( b) inadequacy of resources for care (administration);
(c) undertreatment, consent, and refusal of treatment
(oncology); (d) disagreement with quality of medical
care (diabetes educators); and (e) protection of child’s
rights (pediatric nurse practitioner). However, a systematic review of ethical issues encountered by nurses
in current practice is rarely found.
The purpose of this study is to review the empirical studies of hospital-based nurses’ experiences with
ethical issues to identify (a) the ethical issues nurses
face and ( b) the approaches they have taken to solving
them.Ethical Issues in Nursing Practice Essay
METHODS
This article reviewed quantitative studies of hospitalbased nurses’ experiences with ethical issues. To be
included in this review, a publication was to have
reported the findings from a research project studying
nurses’ experiences. The integrative review included
the reports of primary research studies that were published in the English language from 1990 and 2007. This
study began with a search of multiple library databases,
including PubMed (MEDLINE), the Cumulative Index
to Nursing and Allied Health (CINAHL), and ISI Web of
Knowledge, to identify research related to ethical issues
that nurses face. Key words used in the search process
were “nursing ethics” and “issue” and/or “problem.”
Additional literature was identified by reviewing the
reference lists of journal articles identified during the
literature review.

Examination of the published abstracts and studies
resulted in a decrease of the number of studies included
in the first sampling because studies that did not match
the project criteria were excluded ( n = 25). This study
was limited to hospital-based research and settings in
the United States. Most studies in special clinic areas
dealt with a more specific ethical issue or conflict situation. Therefore, these articles were excluded. However,
this review included the studies done in operating room
areas and collected data from registered nurses in a
local area because the studies dealt with more general
ethical issues encountered by perioperative nurses or
registered nurses with a large sample size. One article
that collected data from directors of nursing in hospitals was included because the directors explained
ethical issues not that they faced but that were faced by
staff nurses. Therefore, through the second review, the
researcher excluded the articles that did not match the
purpose of this project.
This review classified the ethical issues reported by
each study into three categories of the Ethical Issues
Scale (EIS): end-of-life treatment decisions, patient care
issues, and human rights issues. Fry and Damrosch
(1994) developed the EIS in a study of Maryland nurses.
The EIS was validated with a sample of New England
registered nurses currently in practice (Fry & Duffy,
2001). The scale described the full range of ethical
issues experienced by nurses in current practice. The
32-item scale represented three conceptual categories
of ethical issues: end-of-life treatments, patient care,
and human rights (Fry & Duffy, 2001) (see Table 1).
The end-of-life treatment category was defined as
issues about death or the dying process and included 13
issues. The patient care category addressed issues about
how patients receive or do not receive quality nursing
or health care (14 items). The human rights category
was defined as issues concerning the rights of nurse,
patients, and family members (five items). The EIS provides information about the full range of ethical issues
of registered nurses in active practice experience. The
reliability and validity of the EIS have been validated
through a study with a large RN sample ( n = 2,090) and
nurses with expertise in bioethics (Fry & Duffy, 2001).Ethical Issues in Nursing Practice Essay
RESULTS
Twenty-five studies were identified through the first
review process, and 11 studies met the inclusion criteria. All studies used a descriptive research method with
survey instruments. Articles reviewed were classified
into two settings: hospital and operating room. One
article collected data from registered nurses in Maryland; this article was integrated to hospital setting data.
The ethical issues reported in reviewed studies were
divided into three categories (end-of-life treatment
decisions, patient care issues, and human rights issues)
in the EIS. This review described disturbing ethical
issues that were encountered by nurses separated from
the frequent ethical issues. This study identified the
top five frequent ethical issues and disturbing ethical
issues reported in each article and then integrated and
analyzed these issues. Furthermore, this study identified the approaches that nurses have taken to solve the
ethical issues and the resources Ethical Issues in Nursing Practice Essay