Name
University of Phoenix
NSG/426 Integrity in Practice: Ethics and Legal Considerations
Prof. Name
Date
Applying an ethical decision-making model in nursing gives healthcare professionals a structured way to address difficult clinical situations while protecting patient rights, safety, dignity, and quality of life. Nurses must often balance ethical principles, clinical evidence, legal requirements, organizational policies, and patient or family preferences. A systematic approach helps nurses identify the ethical issue, gather relevant information, consider different options, collaborate with the healthcare team, and select an action that best supports patient-centered care.
An ethical decision-making model is a structured framework used to analyze and resolve ethical problems in healthcare. Rather than relying only on personal opinions or intuition, nurses can use an established process to identify the problem, understand the patient’s preferences, evaluate relevant ethical principles, consider possible alternatives, and justify the final decision.
Ethical decision-making is particularly important when patient preferences, family expectations, clinical recommendations, professional responsibilities, and legal requirements do not fully align. Using a consistent framework can improve communication and help healthcare professionals make decisions that are transparent, defensible, and focused on the patient’s best interests.
Healthcare professionals encounter ethical dilemmas in many settings, including hospitals, emergency departments, long-term care facilities, hospice programs, and community healthcare. These situations may involve decisions about informed consent, end-of-life care, confidentiality, treatment refusal, resource allocation, professional boundaries, and patient autonomy.
The major ethical principles used in nursing practice include:
Autonomy: Respecting a patient’s right to make informed decisions about their healthcare.
Beneficence: Taking actions intended to benefit the patient.
Nonmaleficence: Avoiding preventable harm or unnecessary suffering.
Justice: Providing fair and equitable treatment.
Fidelity: Maintaining professional commitments and responsibilities.
Respect for human dignity: Recognizing the inherent value and rights of every patient.
Applying these principles alongside clinical judgment and professional standards helps nurses provide compassionate and ethically appropriate care while maintaining patient and public trust.
The first step in ethical decision-making is recognizing what makes a situation ethically challenging. An ethical dilemma may occur when two or more legitimate values or responsibilities conflict.
For example, a nurse may believe that an intervention would provide additional comfort, while an organizational policy limits that intervention. Similarly, family members may request aggressive treatment even though a competent patient has previously expressed a preference for comfort-focused care.
Nurses should distinguish an ethical problem from a purely clinical problem. A clinical problem may involve determining the correct treatment for a disease, whereas an ethical problem often requires deciding what should be done when competing values, rights, responsibilities, or interests are involved.
Hospice and end-of-life care frequently involve complex ethical decisions because the primary goal is generally comfort, symptom management, and quality of life rather than curative treatment.
A patient receiving hospice care may experience symptoms such as severe pain, fever, respiratory secretions, pressure injuries, anxiety, or other forms of physical and emotional distress. Nurses may experience moral distress when they believe additional interventions could improve comfort but are uncertain whether those interventions are consistent with the patient’s goals of care.
Ethical decision-making in these situations requires careful consideration of the patient’s documented wishes, prognosis, treatment goals, symptom burden, decision-making capacity, and advance care planning.
Ethical dilemmas can also occur when a seriously ill patient arrives at an emergency department without immediately available documentation regarding code status or treatment preferences.
In an emergency, healthcare professionals may need to provide life-sustaining treatment while attempting to determine the patient’s wishes and locate relevant documentation. The appropriate response depends on the clinical circumstances, applicable law, institutional policy, and available evidence regarding the patient’s preferences.
This situation illustrates why advance directives, goals-of-care discussions, and clearly documented code status are important components of patient-centered care. Nurses should communicate relevant information to the healthcare team and follow applicable institutional and legal requirements.
Ethical decisions can affect multiple individuals and groups. Identifying stakeholders helps nurses understand different perspectives before selecting a course of action.
Key stakeholders may include:
The patient
Family members or legally authorized surrogate decision-makers
Nurses and other healthcare professionals
Healthcare organizations
The broader community and society
The patient should remain central to the decision whenever possible. Family members and surrogate decision-makers can provide valuable information about the patient’s values and preferences, but their wishes should not automatically replace the patient’s known choices.
Consider a middle-aged patient with advanced multiple-organ cancer who is receiving hospice care. The patient has a documented Do Not Resuscitate (DNR) order and receives continuous morphine for comfort while approaching the end of life.
The patient’s family understands that the prognosis is poor, but they continue to hope that the patient’s code status can be changed from DNR to Full Code.
This situation creates an ethical conflict involving patient autonomy, family concerns, beneficence, nonmaleficence, and professional responsibility.
The healthcare team must consider whether CPR would provide meaningful benefit or instead cause additional suffering. For a patient with advanced terminal illness, CPR may result in physical injury, pain, or prolonged suffering without achieving the patient’s previously expressed goals.
At the same time, the family’s request may reflect grief, fear, hope, or difficulty accepting the patient’s prognosis. Ethical nursing practice therefore requires more than simply rejecting the family’s request. The healthcare team should communicate compassionately, explain the clinical situation, and ensure that decisions remain consistent with the patient’s preferences and applicable legal requirements.
Before making an ethical decision, nurses should collect information from clinical, legal, ethical, and patient-centered perspectives.
Important clinical information includes the patient’s diagnosis, prognosis, symptoms, treatment plan, decision-making capacity, and current condition. Nurses should also review advance directives, code-status documentation, prior statements about treatment preferences, and other relevant records.
The healthcare team should also assess the family’s understanding of the illness and explore cultural, spiritual, religious, and emotional considerations. When appropriate, social workers, chaplains, palliative care specialists, and other professionals can provide additional support.
Once the ethical issue and relevant information have been identified, the healthcare team should consider reasonable alternatives rather than immediately selecting one intervention.
For a hospice patient, options may include continuing comfort-focused treatment, improving symptom management, providing additional emotional support, or arranging an interdisciplinary family meeting.
Comfort-focused care may include appropriate pain and symptom management, repositioning, skin care, emotional support, and other interventions consistent with the patient’s goals.
Family support may include social work consultation, spiritual care, grief counseling, and additional communication with physicians, nurses, and palliative care professionals.
The alternatives should be evaluated according to the patient’s preferences, expected benefits and harms, ethical principles, professional standards, applicable laws, and organizational policies.
Complex ethical situations rarely involve nursing alone. Interdisciplinary collaboration allows different professionals to contribute clinical, ethical, psychosocial, legal, and spiritual perspectives.
Depending on the situation, the team may include nurses, physicians, social workers, chaplains, palliative care specialists, case managers, and ethics consultants or ethics committees.
Collaboration can reduce individual bias, improve communication, clarify patient goals, and promote more consistent decision-making. When disagreements remain unresolved, an ethics consultation may provide a structured process for reviewing the situation.
An ethical decision should be supported by clear reasoning rather than personal preference. Nurses should be able to explain how the decision reflects the patient’s values, ethical principles, professional standards, clinical evidence, and applicable legal or organizational requirements.
An appropriate ethical decision should seek to:
Protect patient dignity and safety.
Respect informed choices and autonomy.
Reduce unnecessary suffering.
Promote appropriate patient and family communication.
Support continuity of care.
Maintain professional accountability.
Documentation is also important. The medical record should accurately reflect relevant assessments, patient preferences, discussions, consultations, decisions, and changes in the plan of care according to organizational requirements.
Patient autonomy is a central component of ethical nursing practice. Competent adults generally have the right to accept or refuse recommended healthcare interventions after receiving appropriate information.
Shared decision-making supports autonomy by allowing patients and clinicians to discuss treatment options, benefits, risks, alternatives, and personal preferences. This approach can strengthen communication and help ensure that care reflects what matters most to the patient.
When a patient lacks decision-making capacity, nurses should follow applicable laws and organizational policies regarding legally authorized surrogate decision-makers. The goal should be to determine and honor the patient’s known values and preferences whenever possible.
Ethical practice also includes maintaining appropriate professional boundaries. Nurses should avoid relationships or situations that could create conflicts of interest or interfere with objective clinical judgment.
For example, accepting expensive or inappropriate gifts from patients or families may create boundary concerns even when the action does not necessarily constitute a criminal or legal violation. Nurses should follow their employer’s policies and professional standards when determining whether a gift or relationship is appropriate.
Maintaining professional boundaries protects both patients and healthcare professionals and reinforces public confidence in nursing.
Healthcare organizations can support ethical nursing practice through education, clear policies, interdisciplinary communication, and access to ethics consultation.
Nurses can strengthen ethical decision-making by consistently applying professional ethical standards, communicating openly with patients and families, documenting important discussions, and seeking assistance when a situation becomes especially complex.
A practical approach is to ask:
What is the ethical issue?
What does the patient want?
Does the patient have decision-making capacity?
What clinical facts and evidence are available?
What ethical principles apply?
Who are the relevant stakeholders?
What legal and organizational requirements apply?
What reasonable alternatives exist?
What are the potential benefits and harms of each option?
Who should be consulted before a final decision is made?
This structured approach helps nurses move from recognizing an ethical conflict to developing a defensible, patient-centered plan.
Ethical decision-making provides nurses with a systematic way to address difficult healthcare situations. It requires more than identifying an ethical principle; nurses must consider patient preferences, clinical circumstances, potential benefits and harms, legal requirements, professional responsibilities, and the perspectives of relevant stakeholders.
In hospice and end-of-life care, the patient’s goals, advance directives, code status, symptom burden, and quality of life should be carefully considered. Family members should receive compassionate communication and appropriate emotional support while the healthcare team remains focused on honoring the patient’s rights and preferences.
Interdisciplinary collaboration, accurate documentation, effective communication, and ethics consultation can further strengthen ethical practice and support safe, compassionate, patient-centered care.
An ethical decision-making model is a structured process that helps nurses identify ethical problems, gather relevant information, apply ethical principles, consider alternatives, and select an appropriate course of action. It promotes consistent, patient-centered decisions in complex clinical situations.
Ethical decision-making helps protect patient autonomy, dignity, safety, and rights while supporting professional accountability. It also helps nurses address conflicts involving patients, families, healthcare professionals, organizational policies, and legal requirements.
The primary ethical principles include autonomy, beneficence, nonmaleficence, justice, fidelity, and respect for human dignity. Nurses apply these principles according to the circumstances of each patient and the standards governing professional practice.
Primary stakeholders may include the patient, family members or legally authorized surrogate decision-makers, nurses, physicians, other healthcare professionals, healthcare organizations, and society. The patient’s values and preferences should remain central whenever they can be determined.
Nurses should identify the ethical issue, gather relevant clinical information, review the patient’s preferences and advance directives, consider applicable ethical and legal standards, communicate with the patient and family, collaborate with the interdisciplinary team, document the process, and seek an ethics consultation when appropriate.
Palliative care focuses on relieving suffering and improving quality of life for patients with serious illness. It can address physical symptoms as well as emotional, psychosocial, and spiritual concerns while supporting patients and families during serious illness and end-of-life care.
Applying an ethical decision-making model in nursing helps healthcare professionals navigate complex situations in a structured, transparent, and patient-centered manner. By identifying the ethical problem, gathering relevant information, considering stakeholder perspectives, evaluating alternatives, and applying principles such as autonomy, beneficence, nonmaleficence, and justice, nurses can make decisions that respect patient rights and professional responsibilities.
Ethical nursing practice is especially important in hospice and end-of-life care, where treatment decisions may involve difficult questions about comfort, code status, advance directives, family expectations, and quality of life. Effective communication, interdisciplinary collaboration, accurate documentation, and appropriate ethics consultation can help nurses manage these challenges while maintaining compassionate and evidence-based care.
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