Ethical considerations within the nurse practice are an important integration. Nurses are constantly facing ethical dilemmas that are the cause of moral distress. This is because they often know what the right thing to do is, but are limited by organizational restraints put in place (Jameston, 1984). Therefore, the nurses are subjected to constant situations of moral distress. Ethical decision-making within the nursing environment is key. Furthermore, the nurse leaders’ approach to nursing challenges is likely to influence the outcomes of such situations.
What Is the Role of Nurses in Ethical Decision Making?
Nurses are supposed to act as moral agents in the course of nursing (Corley, 2002). As such, they are constantly faced with morality issues that need proper approaches to solve them. Because of this peculiar role played by the nurse, acts of moral courage are supposed to benefit the organization, fellow practitioners, and leaders. Jameston (1984) noted that moral dilemmas in the course of care arise where the nurse’s moral values are in conflict with the objectives of the organization. As such, the continued stress on the nurses affects the quality of service provided by the caregiver (Repenshek, 2009).
Nurse leaders play a peculiar role in the moral decision-making process since their decisions move between the clinical and administrative roles of healthcare (Wurzbach, 2008). Therefore, moral distress arising from the lack of a moral action because of conflict with the organizational goals can create situations that will haunt them (Rashotte, 2004). The nurse leader’s inability to look back arises from the concept of moral conviction from which moral acts are born (Wurzbach, 2008). Ethical decisions are the difference between proper care and improper care practices, and can thus remove the possibility of uncertain healthcare methods that would result in misses or near-misses.
How Can Nurses Mitigate Risks for Misses?
Different models have been brought about for the mitigation of risks for misses and near misses. In the example of a research study, for example, the organization is at risk of negative publicity arising from negative research results. Furthermore, the financial stability of the organization can be hampered. Therefore, collaborative approaches to mitigating risks have been developed. For example, in the research exemplar case, the nurse leadership may get into prior agreements with the researcher in order to mitigate the risks arising from potentially damaging research topics (Edmonson, 2010).
The 4As framework was developed for the purpose of alleviating moral distress among nurses and nurse leaders. This was after the discovery that it was necessary to remove the situations of moral distress altogether. In this model, nurse leaders are encouraged to Ask, Affirm, Assess and Act. Nurse leaders will look for signs of distress at the emotional, spiritual, emotional, and behavioral levels (Roberts, 1984). Thereafter, the nurse leader must affirm the presence of such distress and dedicate their resources to resolving such distress and its source. Subsequently, the nurse leader would be able to assess the risks using their superior situational analysis skills and finally act. In this step, moral courage is applied for both the creation of an optimum environment and the best opportunity for maximal success. Any attempt to resist action should be avoided. Quality improvement depends on the nurse leader’s ability to act and counter the causes of moral distress among nurse practitioners.
Corley, M. (2002). Nurse moral distress: A proposed theory and research agenda. Nursing Ethics, 636-50.
Edmonson, C. (2010). Moral Courage and the Nurse Leader. The Online Journal of Issues in Nursing (OJIN).
Jameston, E. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall.
Rashotte, J. (2004). Dwelling with stories that haunt us: building a meaningful nursing practice. Nursing Inquiry 2005, 34-42.
Repenshek, M. (2009). Moral distress: Inability to act or discomfort with moral subjectivity? Nursing Ethics.
Roberts, C. (1984). Will power and the virtues. Philosophical Review, 227-47.
Wurzbach, M. (2008). Moral conviction, moral regret, and moral comfort: Theoretical perspectives. In E. Pinch, & A. Haddad, Nursing and health care ethics: A legacy and a vision (pp. 57-68). Silver Springs, MD: Nurse Books.
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