NSG 426 Week 3 Applying an Ethical Decision-Making Model

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University of Phoenix

NSG/426 Integrity in Practice: Ethics and Legal Considerations

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Applying an Ethical Decision-Making Model in Nursing

An ethical decision-making model helps nurses and healthcare professionals make patient-centered decisions by balancing ethical principles, legal requirements, clinical evidence, and patient preferences. The primary goal is to protect patient safety, dignity, autonomy, and quality of care while reducing conflicts among patients, families, and healthcare teams.

Applying an Ethical Decision-Making Model in Nursing

Healthcare professionals face ethical dilemmas every day. Nurses, physicians, and other clinicians must make decisions that prioritize patient well-being while complying with professional standards, organizational policies, and legal requirements.

An ethical decision-making model provides a structured framework for evaluating complex situations, considering stakeholder perspectives, exploring alternatives, and selecting the most appropriate course of action. This approach promotes patient safety, supports informed decision-making, and improves collaboration among healthcare teams.

Why Ethical Decision-Making Matters in Healthcare

Ethical decision-making is essential because healthcare providers regularly encounter situations where medical, legal, and personal values may conflict.

Common ethical principles include:

• Patient autonomy

• Beneficence (doing good)

• Nonmaleficence (avoiding harm)

• Justice (fair treatment)

• Fidelity and professional integrity

By applying these principles consistently, healthcare professionals can provide compassionate, evidence-based care while maintaining public trust.

Understanding the Ethical Problem

Many ethical dilemmas arise when clinical judgment conflicts with organizational policies, family wishes, or legal obligations.

Hospice Care Example

One common example occurs in hospice and end-of-life care.

A hospice patient may experience:

• Fever

• Pressure ulcers

• Respiratory secretions

• Severe pain

Although hospice focuses on comfort rather than curative treatment, nurses may struggle when facility policies limit interventions due to care goals or resource constraints. Nurses often feel conflicted between following policy and wanting to provide additional treatments that may improve patient comfort.

Emergency Department Example

Another ethical challenge occurs when a patient arrives at the emergency department without a documented code status.

In these situations:

• Healthcare providers must generally treat the patient as Full Code until verified documentation is available.

• This legal obligation may differ from what clinicians believe would best reflect the patient’s wishes.

• Ethical practice requires balancing patient safety, legal responsibilities, and respect for patient autonomy.

Identifying Key Stakeholders

Effective ethical decision-making requires understanding everyone affected by the decision.

Primary Stakeholders

According to Park (2012), healthcare stakeholders generally include:

• Patients

• Family members and surrogate decision-makers

• Healthcare professionals

• Healthcare organizations and society

Each stakeholder may have different values, expectations, and goals, making ethical decisions more complex.

Case Study: Ethical Decision-Making in Hospice Nursing

A practical example involves a middle-aged patient with advanced multiple-organ cancer receiving hospice care.

Patient Situation

The patient:

• Had terminal cancer

• Received continuous morphine for comfort

• Had a documented Do Not Resuscitate (DNR) order

• Was approaching the end of life

Family Perspective

Although physicians repeatedly explained the patient’s prognosis, the family hoped to change the patient’s status from DNR to Full Code.

Their desire reflected understandable grief and hope rather than medical evidence.

Ethical Challenge

The healthcare team recognized that cardiopulmonary resuscitation (CPR) would likely:

• Cause significant pain

• Provide little chance of meaningful recovery

• Prolong suffering

The ethical dilemma centered on balancing:

• Respect for the patient’s wishes

• Compassion for the family’s emotions

• Professional responsibility to avoid unnecessary harm

Collecting and Analyzing Information

Before making an ethical decision, healthcare professionals should gather comprehensive information.

Clinical Considerations

Evaluate:

• Patient diagnosis

• Prognosis

• Decision-making capacity

• Advance directives

• Code status

• Current symptoms

Family Considerations

Healthcare teams should also assess:

• Family understanding of the illness

• Cultural beliefs

• Religious preferences

• Emotional readiness

• Support systems

Providing education, counseling, and spiritual care often helps families better understand the patient’s condition and participate in informed decision-making.

Developing and Comparing Alternatives

Ethical decision-making requires evaluating multiple options before selecting the most appropriate course of action.

Alternative Approaches

Possible interventions include:

Continue Comfort-Focused Care

• Pain management

• Symptom control

• Frequent repositioning

• Skin care

• Emotional support

Family Support Services

Offer:

• Social work consultation

• Chaplain or spiritual care services

• Grief counseling

• Family meetings with the healthcare team

Interdisciplinary Collaboration

Complex ethical cases should involve:

• Physicians

• Nurses

• Ethics committees

• Social workers

• Chaplains

• Palliative care specialists

Team-based decisions reduce bias and improve patient-centered outcomes.

Justifying the Ethical Decision

Ethical decisions should always prioritize patient welfare while respecting patient rights and professional standards.

Why Ethical Decisions Matter

Appropriate ethical decisions help:

• Protect patient dignity

• Reduce unnecessary suffering

• Respect informed consent

• Improve communication

• Support family involvement

• Maintain professional accountability

Healthcare professionals should avoid actions that create conflicts of interest or compromise clinical judgment.

For example, accepting valuable gifts from patients may not always violate the law, but it can create ethical concerns regarding professional boundaries.

Respecting Patient Autonomy

Whenever possible, patients should participate in decisions regarding their own care.

Shared decision-making improves:

• Patient satisfaction

• Treatment adherence

• Quality of care

• Healthcare outcomes

When patients cannot make decisions independently, legally authorized representatives should help ensure care aligns with the patient’s known values and preferences.

Strategies for Implementing Ethical Decision-Making

Healthcare organizations can strengthen ethical practice by implementing clear policies and education.

Best Practices

Follow Professional Ethical Standards

Healthcare providers should consistently apply ethical principles alongside organizational policies and legal requirements.

Communicate Effectively

Open communication among patients, families, and interdisciplinary teams reduces misunderstandings and ethical conflicts.

Document Thoroughly

Accurate documentation supports transparency and continuity of care.

Seek Ethics Consultation

Complex cases may benefit from formal ethics committee review or consultation.

Maintain Professional Boundaries

Professional relationships should always prioritize patient welfare and avoid conflicts of interest that could impair clinical judgment.

Key Takeaways

Ethical decision-making is a structured process that helps healthcare professionals balance patient autonomy, beneficence, nonmaleficence, justice, and legal responsibilities.

Hospice care prioritizes comfort, symptom management, and quality of life rather than curative treatment.

Interdisciplinary collaboration improves ethical decision-making by incorporating diverse clinical, ethical, and patient-centered perspectives.

Respecting advance directives and documented code status helps ensure care aligns with patient preferences.

Patient and family education, communication, and emotional support are essential components of ethical nursing practice.

Frequently Asked Questions (FAQs)

What is an ethical decision-making model in nursing?

An ethical decision-making model is a structured framework that helps nurses evaluate complex clinical situations, consider ethical principles, assess stakeholder perspectives, and choose the most appropriate course of action.

Why is ethical decision-making important in healthcare?

Ethical decision-making protects patient rights, promotes safe care, supports professional accountability, and helps resolve conflicts involving patients, families, healthcare providers, and organizations.

What are the main ethical principles in nursing?

The core ethical principles include:

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

• Fidelity

• Respect for human dignity

Who are the primary stakeholders in healthcare ethical decisions?

Primary stakeholders typically include:

• Patients

• Family members or surrogate decision-makers

• Healthcare professionals

• Healthcare organizations and society

How should nurses handle ethical conflicts?

Nurses should:

1. Gather all relevant clinical information.

2. Review patient wishes and advance directives.

3. Consult interdisciplinary team members.

4. Consider ethical and legal standards.

5. Document the decision-making process.

6. Prioritize patient-centered care.

What role does palliative care play in ethical decision-making?

Palliative care focuses on relieving physical, emotional, psychosocial, and spiritual suffering while supporting both patients and their families throughout serious illness and bereavement.

Conclusion

Applying an ethical decision-making model enables healthcare professionals to provide safe, compassionate, and patient-centered care. By evaluating stakeholder perspectives, respecting patient autonomy, collaborating with interdisciplinary teams, and following ethical principles, nurses can navigate complex clinical situations with confidence and professionalism. Ethical decision-making ultimately improves patient outcomes, strengthens family support, and promotes high-quality healthcare delivery.

References

Dawn, S. (2013). BMC Medical Informatics and Decision Making, 13(Suppl. 2), S11. https://doi.org/10.1186/1472-6947-13-S2-S11

Joshi, A. Y., Darekar, A. B., & Saudagar, R. B. (2017). Palliative Care Makes a Difference for Patients Dying in Hospital. Research Journal of Pharmacy and Technology, 10(6), 1858–1864.

Park, E. (2012). An Integrated Ethical Decision-Making Model for Nurses. Nursing Ethics, 19(1), 139–159. https://doi.org/10.1177/0969733011413491