Common Issues and Ethical Dilemmas Confronting Nurses during Pandemic

COMMON ISSUES AND
ETHICAL DILEMMAS
CONFRONTING NURSES
DURING PANDEMIC
Dr.WillardN.Riveral
Asst.Professor
SchoolofNursingandHealthSciences,
BiliranProvinceStateUniversity

Overview
of ethics
01
Bioethical
principles
02
Ethical
delimmas of
nurses
04
strategies
05
TABLE OF CONTENTS
Ethics in
nursing
practice
03
Self-care
strategies
06

ETHICS DEFINED
Ethics are moral principles that
govern how the person or a group will
behave or conduct themselves.

A branch of philosophy dealing with values
pertaining to human conduct, considering
the rightness and wrongness of actions and
the goodness or badness of the motives and
ends of such actions.

Refers to
systematic rules or principles governing right
conduct. Each practitioner, upon entering a
profession, is invested with the responsibility
to adhere to the standards of ethical practice
and conduct set by the profession.

Its major concerns include the nature of
ultimate value and the standards by which
human actions can be judged right or wrong.

Sample Ethical Questions:
How should we live? Shall
we aim at happiness or at
knowledge, virtue, or the
creation of beautiful
objects?

BIOETHICAL PRINCIPLES
Refer to the four basic principles of health
care ethics when evaluating the merits and
difficulties of medical procedures. Ideally, for
a medical practice to be considered "ethical",
it must respect all four of these
principles: autonomy, justice, beneficence,
and non-maleficence.

Bioethics is an Inherent and Inseparable Part
of Medicine as HCWs has ethical obligation to:
1. Act for the benefit of the patient.
2. Avoid or minimize harm, and
3. Respect the values and
preferences of the patient.

4 Fundamental Principles of Bioethics
1. Beneficence
2. Non-maleficence
3. Autonomy
4. Justice

1. Beneficence
The obligation of physician to act for the
benefit of the patient and supports a
number of moral rules to protect and
defend the right of others, prevent harm,
remove conditions that will cause harm,
help persons with disabilities, and rescue
persons in danger.

2. Non-maleficence
-The obligation of a physician not to harm the
patient
-Based on the principle of Hippocrates “to help
and do no harm,”
-Do not kill, do not cause pain or suffering, do
not incapacitate, do not cause offense, and do
not deprive others of the goods of life.

3. Autonomy
-All persons have intrinsic and unconditional
worth, and therefore, should have the power to
make rational decisions and moral choices, and
each should be allowed to exercise his or her
capacity for self-determination.
-Based on the principles of Immanuel Kant and
John Stuart Mill

4. Justice
There should be an element of fairness in
all medical and nursing decisions and
care. Nurses must care for all patients
with the same level of fairness despite
the individual's financial abilities, race,
religion, gender, and/or sexual
orientation.

7 ETHICAL PRINCIPLES IN NURSING
1. Beneficence
2. Non-maleficence
3. Autonomy
4. Justice
5. Accountability
6. Fidelity
7. Veracity

NURSING ETHICS
- Refers to the values and ethical principles
governing nursing practice, conduct, and
relationships.

ETHICAL CODES
- A set of ethical principles that is shared by
members of the organization, reflects their
moral judgments over time, and serves as a
standard for their professional action
- No code can provide absolute or complete
rules that are free of conflict and ambiguity

NURSING CODE OF ETHICS
- A guide for “carrying out nursing
responsibilities in a manner consistent with
quality in nursing care and the ethical
obligations of the profession.”
- ICN Code of Ethics for Nurses (1900)
- National Code of Ethics for Nurses (ANA,
CAN, PNA)
- Code of Ethics for Filipino Nurses (2004)

Importance of Nursing Code of Ethics
The codes outline how nurses should behave
ethically as a profession, and how they
should decide when they encounter barriers
preventing them from fulfilling their
professional obligations. The codes can also
support nurses in their practice and reduce
their moral distress.

Importance of Nursing Code of Ethics
-It is a succinct statement of the ethical
obligations and duties of every individual
who enters the nursing profession.
-It is the profession’s nonnegotiable ethical
standard.
-It is an expression of nursing’s own
understanding of its commitment to society.

Purposes of Nursing Code of Ethics
-Inform the public about the minimum
standards of the profession and help them
understand professional nursing conduct.
-Provide a sign of the profession’s
commitment to the public it serves.
-Outline the major ethical considerations of
the profession.

Purposes of Nursing Code of Ethics
-Provide ethical standards for professional
behavior.
-Guide the profession in self- regulation.
-Remind nurses of the special responsibility
they assume when caring for the sick.

9 Provisions of Nursing Code of Ethics (ANA)
1. The nurse practices with compassion and
respect for the inherent dignity, worth,
and unique attributes of every person.
2. The nurse’s primary commitment is to
the patient, whether an individual, family,
group, community, or population.

3. The nurse promotes, advocates for, and
protects the rights, health, and safety of the
patient.
4. The nurse has authority, accountability,
and responsibility for nursing practice;
makes decisions; and takes action consistent
with the obligation to provide optimal
patient care.

5. The nurse owes the same duties to self as
to others, including the responsibility to
promote health and safety, preserve
wholeness of character and integrity,
maintain competence, and continue personal
and professional growth.

6. The nurse, through individual and
collective effort, establishes, maintains, and
improves the ethical environment of the
work setting and conditions of employment
that are conducive to safe, quality health
care.

7. The nurse, in all roles and settings, advances the
profession through research and scholarly inquiry,
professional standards development, and the
generation of both nursing and health policy.
8. The nurse collaborates with other health
professionals and the public to protect human rights,
promote health diplomacy, and reduce health
disparities.

9. The profession of nursing, collectively
through its professional organization, must
articulate nursing values, maintain the integrity
of the profession, and integrate principles of
social justice into nursing and health policy.

Ethical challenges are common in clinical
nursing practice, and an infectious environment
could put nurses under ethical challenges more
easily, which may cause nurses to submit to
negative emotions and psychological pressure,
damaging their mental health.

Ethical Dilemmas of Nurses
During Pandemic

1. Nurses’ Safety, Role, and Moral Distress
-The safety of nurses is a pressing ethical issue, as they
were asked to work under circumstances that put them
at risk to their overall health and well-being.
-The lack of full protection raises ethical questions
about the extent of their duty, lack of personal
protective equipment, and risk of failure of personal
protective equipment.

2. Resource Allocation
Nurses were also facing moral distress because
they were under prolonged pressure to keep up
the resources needed to provide safe and high-
quality nursing care.

3. Nurse-Client Relationship
Nurses were also challenged to restrict many
COVID-19 patients from having end-of-life
communication with their families.

Moral and ethical dilemmas faced by health care
workers (HCW)
Dilemma 1 – How to balance my ethical duty to care
for my patient against genuine concerns of
contracting COVID-19 and spreading it to my family?

workers (HCW)
Dilemma 2 – Should I retain ventilatory support for a
critical patient who is unlikely to survive or use the
ventilator for a less critical patient with better
prognosis?

workers (HCW)
If I have some respiratory symptoms and I think I may have been exposed,
should I open up about my symptoms and stay at home, risking social and
workplace discrimination, or continue to go about my work as usual,
risking my colleague’s health, till my test comes positive? How do I balance
my physical and mental health care needs against the call of duty in these
testing times?

Active Control and Planning
Develop appropriate nursing plans for COVID-
19 patients and hold regular case-based
seminars to contain the risk of infection,
increase the recovery rate of patients, give
better care to them, and improve self-
confidence and sense of accomplishment in
clinical practice.

Seek Support
-From the government, society and hospitals.

Specialize Your Nursing Skills
-Gain knowledge and nursing skills on COVID-
19, which could improve your clinical practice
and ability on infectious diseases.
-Build nursing strategies with critical thinking
and choose effective modes to enhance your
clinical decision-making ability.

Increase Your Research Ability
-Improve the ability of solving problems.
-Research findings of COVID-19 may be
effectively applied to nursing practice, which
could verify the research problems by clinical
results.

Improve Management Skills
-Participate in formulating nursing plans and
focus on nursing COVID-19 patients to gain
more experiences in making plans, directing
medical operations, coordination, and
organization.

WHEN IN DOUBT…
Consult the ethics committee before making any
major decisions. Often, other resources are
needed when making major ethical decisions.

Catharsis and Staying Focused
-Focus on nursing jobs.
-Increase communications with colleagues, or
make more contacts with family members and
friends.

Engage in Relaxing Activities
-Try developing some hobbies during
spare time, to release pressure and
anxiety accumulated during the
process of nursing.
-Listen to music or watch movies
during rest days.

Stay Healthy
-Keep dehydrated
-Get plenty of sleep
-Take balanced diet
-Exercise regularly

REFERENCES
https://www.karger.com/Article/FullText/509119
https://nurse.org/education/nursing-code-of-ethics/
https://journals.sagepub.com/doi/full/10.1177/0969733020944453
https://www.dovepress.com/ethical-challenges-of-nurses-in-covid-19-
pandemic-integrative-review-peer-reviewed-fulltext-article-JMDH
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653013/

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