Introduction
Ethics are internationally recognized as a significant aspect of nurses’ work. In their daily activities, healthcare providers are faced with clinical issues and dilemmas related to decisions. Multidisciplinary collaboration can also raise questions on professional conduct and scope of role in providing patient-centered care. Simply defined, ethics are principles and values regarding defect human behavior and the moral norms that are acceptable for a specific occupational group when dealing with ambiguous situation. The rationale for establishing ethical conduct is to prevent and avoid harm to self and others. Nurses need to integrate values from social cultural groups, lived experiences, codes of conducts and court rulings in their daily practice.
Nurses are often confronted with choices that they need to make daily. Ethical issues often arise when the answers are not clear and none of the options is ideal. The nurse may want to make a decision but the institutional restrictions make it impossible to do what they think is best. The results of such mental constraints are moral distress of the professional caregiver, which can further lead to declined patient care and constrained clinical relationships. The central problem is that the nurse thinks that they know what to do in a specific context but are not able or permitted to proceed.
A good grasp of the nurses’ code of ethics can be useful in making decisions that are consistent with the quality of care and the obligation to the profession. However, there is paucity of studies that have been conducted on the topic. The research question for this paper is: For nurses working in a clinical setting, do accurate knowledge and interpretation of the nursing code of ethics, compared to ignorance of the code, result in less instances of moral dilemma? This paper provides a detailed annotation of some of the sources that will be included in writing this topic.
Annotation of Selected Sources
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446–3461. Web.
The background research of this source revealed that there are plenty of studies that have explored the concept of ethical dilemma in nursing practice. Similarly, many researchers have focused on the consequences of such moral issues on the profession. However, from the literature review it was apparent that there is paucity of credible sources that can guide ways of solving the dilemma. Therefore, the objective of the study is to find out the gaps and themes in that can enhance development of decision-making strategies for clinical nurses experiencing ethical dilemmas. This was an integrative review that included published research on related topic from 2000 to 2017.
Various databases were searched including CINAHL, OVID, SCOPUS, and OVID. Thirty-five sources were retained and synthesized using the Garrard’s matrix. Findings indicate that moral dilemmas arise in different circumstances mostly when dealing with end of life, organizational constraints, conflict with physicians and families and policy concerns. The study concluded that there is need for more studies that can compare practices across different settings and the role of nurses.
At the time of the publication, two of the researchers were pursuing their master at Saint Louis University while one was studying at University of Buffalo. This is a scholarly study intended to meet the academicians and professions in clinical setting, especially the nurses. This source is relevant to the current study as it provides evidence on the issues in nursing practice that are most likely to result in ethical dilemma. The information from the study will be integrated in the literature review by explaining how circumstances such as end of life; role confusion or conflict can cause moral distress. The source is also useful in pointing to the common themes on the topic.
Knowledge of the context help to focus the study by identifying a gap that needs to be filled. Compared to all the sources included in this annotation this study has high level of evidence since it is an integrative review that synthesized different credible research findings.
Steck Wilson, M. B., & Rice, J. G., (2018). The Code of Ethics for Nurses with Interpretive Statements. South Carolina Nurses Association.
This article elaborates the Code of Ethics for Nurses with Interpretive Statements (Code) for the American Nurses Association’s (ANA). The code provides the standards for individual conduct as well as the best practices for the entire nursing profession. The obligations stipulated in the code are comprised of provisions which are non-contextual but relevant for various settings. According to Steck et al. (2018) provisions 1-3 of the ANA offer the fundamental values and nurses’ commitment to the patient. From 4-6 concerns loyalty and duty of the profession while 7-9 has provision for the responsibility of nurses beyond the encounters with individual clients.
There are 39 interpretive statements to guide nurses on how they can adhere by the requirements. The source further explains the relevance of the code to nurses in South Carolina who are working with bedridden patients and newly expanded roles. The conclusion is that matters of morals in the profession are urgent and therefore the nursing leadership of SC is continually committed to establishment and the revision of the ANA.
The authors of this study, Wilson and Rice are both registered nurse leaders who hold a doctoral degree. The implication is that they are both experienced and have knowledge that gives them credibility to write on the topic. The paper has also been published by a credible organization which means that it was peer-reviewed to confirm credibility. The primary target audience includes those people who are either pursuing nursing or are already in practice.
The relevance of this source to the current paper is that it gives accurate and objective standards of ethics that can be followed by registered nurses in practice. The interpretation makes it easy to understand the requirements of each provision and its application in real life setting. This source is, thus, important in writing the literature review. Furthermore, the source will be relevant in writing the introduction and defining key terms. It will also aid in relating an ethical dilemma to the applicable code to provide evidence-based recommendations for resolving conflicts. Compared with other sources this paper provides objective information pertaining to the code.
Hyatt, K. (2020). Ethical guidance for nursing decision making. Tennessee nurse extra, 43.
The article starts by defining moral distress as emotional state arising from a situation in which the nurse feels that there is incongruence between the ethically correct action and what is required of them to do in a particular situation. The article then explains some of the virtues in the American Nurses Association including dignity, caring, generosity, moral equality, kindness, respect, prudence, equality and transparency. The article further stipulates the characteristics of what is expected for good nurses including the skills, wisdom, knowledge and integrity as implied by the ANA. The recommendation for nurses during practice are listed to help aid the professionals in a dilemma.
It is expected that the nurse will practice patient-centered care, take responsibility, remain competence, promote prompt responsiveness. Seven principles must guide nurse during their practice including autonomy, beneficence, accountability, veracity, nonmaleficence, and justice. The article elaborates on several requirements for moral conduct with an aim of ensuring that the nurses are not strained emotionally during practice.
The author of this article is an assistant professor of nursing at University of Arkansas of Monticello. She is also a registered nurse who holds a masters degree which shows that her opinion is authentic. Besides, the author has integrated various scholarly sources to back-up the evidences. The target of the article is nurses and students specializing in health sciences. The paper can also be relevant for those interested in legal matters on health.
This source is relevant in writing the introduction and defining some key terms such as moral distress and emotional stress. The article also provides additional information on principles which will be integrated in the literature review. Also, when providing recommendation this article will offer factual information for future researchers to build on. Compared to other sources this paper has a lower level of evidence since it is reliant on expert opinion.
Conclusion
The topic of nursing ethics continues to raise new controversies that affect the performance of nurses due to emotional distress. The current study seeks to add to the current body of research and hopefully fill a knowledge gap. The annotation from the three sources will provide evidence of issues and solutions to the dilemmas that nurses experience daily. Integrating multiple scholarly articles will also provide the wisdom needed by professionals in this field to be competent in dealing with patients, their relatives and the organization that they work. The sources have been selected based on their high levels of credibility and the qualifications of the authors.