Ethical Issues and Moral Principles of Decision Making in Nursing

            Social justice: Social justice is one of the ethical issues that nurses, particularly those at family and community level experience (Butts & Rich, 2019). Working as a women health care nurse practitioners (WHNP) in one of the marginalized communities, I have had experiences of the impact of social injustice, particularly among the expecting women, and had to act to help vulnerable mothers and their babies. Often, these mothers cannot afford high-quality care nor access obstetrician or gynecologists due to their low socioeconomic status, which is not their wish. These impacts their health and babies since most mothers wait for complications to resolve on their own. Expecting mothers were waiting until conditions are worse to seek care, which improves their chances of complications and reduces quality pregnancy outcomes while others gave birth at home, which increased their chances of infecting their babies. A significant number of expecting mothers did not attend any prenatal care visit due to lack of knowledge, particularly the new mothers; inadequate resources include professionals, capital and facilities, and some stated cultural beliefs as a barrier.

           Principle of autonomy: Nurses face ethical dilemmas that call for moral principles of ethical decision making to help inform their actions and care (Butts & Rich, 2019). While working in the emergency department, I came across a Jehovah’s Witness patient who came to the emergency room with massive chronic bleeding. He required a blood transfusion since he had lost a lot of blood, and the bleeding seemed not to cease based on my assessment. However, he refused the blood transfusion citing that his religion did not allow it. He was alert and very competent and was informed of the benefits of blood transfusion, as well as the consequences of refusing the intervention. He insisted that he did not want blood transfusion and was not ready to sign consent. His condition began to deteriorate, and his motor response was alarming. The medical team was torn between respecting his autonomy or obeying the beneficence principle to initiate a blood transfusion to save his life.

           How the situations were resolved: The first situation depicts social injustice, and I had to exploit my legal and ethical responsibilities and duties as a board-certified women health nurse practitioner to help the situation. Thanks to my optimistic view of the situation. I noticed these inequalities and had to make it an opportunity to improve care and provision. I organized a team comprising of four WHNPs and six nurses who understood the situation and began to provide timely, safe, and high-quality and affordable obstetric and gynecologic care to the vulnerable expecting and new mothers. We observed the nursing code of ethics and scope of practice for registered nurses and WHNP throughout our practices and care. I also led the team in the community outreach programs educating expecting and new mothers on healthy habits, practices, and behaviors as well as how to take care of themselves. Besides, the team conducted home visits to enhance the outcomes of mothers and their babies in the community and ensured that mothers receive timely, safe, and quality care as needed. We aimed to venture into prevention and empowerment, which has resulted in reduced cases and significantly improved mothers’ and babies’ health outcomes.

The moral principle of autonomy provides that nurses respect the patient’s decision as long as the patient is alert and competent. The second situation depicts a conflict between autonomy and beneficence. The patient refused to have a blood transfusion even after knowing its benefits to his health and outcome and the consequences of refusing a blood transfusion. He had signed the meaning that we had to respect and support his decision though we did not agree with it (Butts & Rich, 2019). I made sure the patient was comfortable all through and tried other interventions such as administering 20mg/kg of tranexamic acid within three hours, followed by the administration of iron supplements and dietary advice to replenish the lost fluids. The patient was monitored closely, and he finally recovered.

References

Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.

Ethics and Human Rights retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/