CLINICAL PRACTICE
Ethical Decision-Making Frameworks for Charge Nurses
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Joanna Whitfield, MSN, RN
- Last Updated: 05/17/2023
As a charge nurse, you are responsible for making crucial decisions that could impact patient care and outcomes. The nursing profession has an ethical obligation to prioritize ethical decision-making to ensure that patients receive quality care. In this article, we will explore ethical decision-making frameworks that charge nurses can use to navigate challenging ethical scenarios.
The Role of Charge Nurses in Healthcare Delivery
Charge nurses play a vital role in healthcare delivery. They are responsible for overseeing the daily operations of a unit or department, ensuring that patients receive the care they need, and managing the nursing staff. Charge nurses act as the point of contact between patients, healthcare providers, and other departments. They are often the first point of contact for patients and their families, and they play a critical role in ensuring that patients receive the care they need.
Charge nurses often make critical decisions on behalf of patients, especially when there is no physician on site. They must be able to think on their feet and make quick decisions in high-pressure situations. As such, charge nurses need to have an ethical decision-making framework in place to guide their decision-making and actions effectively.
Core Responsibilities of Charge Nurses
The roles of charge nurses are complex and multifaceted. Some of their core responsibilities include:
- Assigning tasks to the nursing staff: Charge nurses are responsible for delegating tasks to the nursing staff, ensuring that each patient receives the care they need. They must be able to assess the needs of each patient and assign tasks accordingly.
- Ensuring smooth communication and collaboration between healthcare providers: Charge nurses must be able to communicate effectively with other healthcare providers, including physicians, other nurses, and support staff. They must be able to collaborate effectively to ensure that patients receive the care they need.
- Managing patient flow and bed assignments: Charge nurses are responsible for managing patient flow and bed assignments. They must ensure that patients are assigned to the appropriate beds and that the unit is operating at maximum capacity.
- Maintaining high-quality patient care standards: Charge nurses are responsible for maintaining high-quality patient care standards. They must ensure that patients receive the care they need and that their needs are met in a timely and effective manner.
The Importance of Ethical Decision-Making in Nursing
At the core of nursing, stands the value of respect for the dignity of human beings, regardless of their background or health status. Nurses are responsible for providing care that is safe, compassionate, and respectful of patients’ rights and needs. Ethical decision-making is necessary as it promotes safety, respect, and human dignity and ensures patients receive appropriate care.
One of the key reasons why ethical decision-making is essential in nursing is that it helps to protect patients from harm. Nurses are often the first point of contact for patients, and they play a critical role in identifying potential risks and hazards. By making ethical decisions that prioritize patient safety, nurses can help to prevent adverse events and ensure that patients receive the best possible care.
Another important reason why ethical decision-making is vital in nursing is that it helps to build trust between patients and healthcare providers. Patients rely on nurses to provide them with accurate information, support, and guidance throughout their care journey. By making ethical decisions that prioritize honesty, integrity, and transparency, nurses can establish strong relationships with patients and their families, which can lead to better health outcomes.
Ethical Theories and Principles in Nursing
As healthcare professionals, nurses are often faced with ethical dilemmas that require careful consideration and decision-making. Ethical theories and principles provide a framework for nurses to make informed and responsible decisions that prioritize patient care and well-being.
In this article, we will explore the three main ethical theories in nursing and the ethical principles that guide clinical practice.
Utilitarianism
The utilitarian theory in nursing promotes decision-making based on the greatest good for the greatest number of people. This theory suggests that nurses should consider the consequences of their actions on both individual and collective levels when making ethical decisions. As a charge nurse, you may be faced with decisions that impact multiple patients or the healthcare system as a whole.
In these situations, it is essential to weigh the benefits and risks of different options and choose the course of action that maximizes the overall well-being of those involved.
For example, if a hospital has limited resources, a charge nurse may need to decide which patients receive priority care. Utilitarianism would suggest that the nurse should prioritize patients who are most likely to benefit from the resources available and who have the greatest need. This decision may not be ideal for every individual patient, but it would promote the greatest good for the greatest number of people.
Deontology
Deontology is a philosophical theory that evaluates the morality of an action based on the action’s inherently moral nature. This theory suggests that nurses should make decisions based on what is right and not on what is best for the collective majority. The golden rule, “Do unto others as you would have them do unto you,” exemplifies this principle.
As a charge nurse, you may encounter situations where the right decision is not the most popular or the most practical. For example, if a patient requests a treatment that is not medically necessary, deontology would suggest that the nurse should respect the patient’s autonomy and right to make decisions about their own health, even if it is not in the best interest of the collective majority.
Virtue Ethics
Virtue ethics focuses on the personality traits of an individual, emphasizing the development of good character qualities to make ethical decisions. This theory suggests that nurses should consider virtues such as compassion, wisdom, and integrity when making ethical decisions. By cultivating these virtues, nurses can develop a moral compass that guides their actions and decisions.
As a charge nurse, you may be called upon to make difficult decisions that require empathy, critical thinking, and sound judgment. Virtue ethics would suggest that you approach these decisions with a focus on the well-being of the patient and a commitment to doing what is right, even if it is not easy or popular.
Ethical Principles in Nursing Practice
In addition to ethical theories, several ethical principles guide clinical practices in nursing. These principles provide a framework for nurses to deliver safe, effective, and compassionate care to patients.
Autonomy: Autonomy means patients have the right to make their decisions in matters concerning their health. As a charge nurse, you must respect a patient’s autonomy in decision-making. This may involve providing information, answering questions, and supporting the patient’s choices, even if they differ from your own.
Beneficence: Beneficence focuses on doing good for others and preventing harm. Charge nurses need to consider the benefits of their actions and their consequences on patient outcomes. This may involve providing treatments, administering medications, and advocating for the patient’s needs.
Non-maleficence: The principle of non-maleficence prohibits actions that may cause harm to others. Nurses should avoid harm when administering care or providing advice to patients. This may involve carefully monitoring patients for adverse reactions, providing clear instructions, and taking steps to prevent errors.
Justice: Justice demands objectivity and fairness in allocating resources and prioritizing care to ensure that all patients receive quality care, regardless of their social or economic status. Charge nurses may be called upon to make decisions about resource allocation, triage, and patient care that promote fairness and equality.
Common Ethical Dilemmas Faced by Charge Nurses
Allocation of Limited Resources
Charge nurses are often confronted with challenging situations – one of which is the allocation of limited resources. In such situations, charge nurses need to consider the ethical principles of justice and non-maleficence. Furthermore, they need to assess the patient’s needs based on their medical status, the severity of their condition, and the available resources.
Patient Autonomy and Informed Consent
Patients have the right to make their decisions on matters concerning their health. Charge nurses need to uphold this right by providing patients with adequate information to make informed decisions. Patients must be aware of the potential benefits, side effects, and risks associated with any treatment or procedure.
Confidentiality and Privacy
Patient data must be kept confidential to maintain ethical standards. Charge nurses need to ensure that the patient’s medical records and personal information are kept confidential, adhering to HIPAA regulations.
End-of-Life Care and Decision-Making
End-of-life care poses ethical dilemmas for charge nurses. They need to consider patients’ autonomy rights and ensure that their dignity is maintained until their last breath. In these situations, charge nurses need to collaborate with healthcare providers, family members, and patients to ensure the end-of-life care is consistent with the patient’s values and cultural beliefs.
Ethical Decision-Making Frameworks for Charge Nurses
The Four A's of Ethical Decision-Making
The Four A’s is a decision-making framework that charges nurses can use to navigate ethical dilemmas. The framework includes awareness, alternatives, analysis, and application.
First, start by being aware of the ethical scenario and its underlying implications. Secondly, identify the alternatives for resolving the issue. Thirdly, perform an analysis of the alternatives in terms of their potential effects and consequences. Lastly, apply the best ethical alternative.
The Nursing Process Model
The nursing process model is a systematic problem-solving technique that involves assessing, diagnosing, planning, implementing, and evaluating the nursing care for patients. Applying this model helps charge nurses to make ethical decisions while providing high-quality patient care.
The Ethical Decision-Making Matrix
The ethical decision-making matrix provides charge nurses with a framework for analyzing ethical dilemmas. The matrix includes seven steps, which are: defining the ethical dilemma, gathering information, identifying the stakeholders, clarifying the values, identifying the options, ranking the options, and resolving the ethical dilemma by taking action.
The Collaborative Decision-Making Model
The collaborative decision-making model involves healthcare providers, patients, and family members’ collaboration to arrive at an agreed decision in ethical dilemmas. The model involves mutual respect, trust, and open communication.
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