Research Paper on Ethics in ICU Nursing: Balancing Autonomy and Vulnerability

Introduction

Ethics is an emerging issue in the field of nursing, and it has become a significant component in giving health care to patients in the intensive care unit. Critically ill patients are highly vulnerable, and they are dependent on nurses working in the intensive care unit to save their lives. Because of technological advancement and the autonomous nature of the nursing profession, the provision of care at the intensive care unit becomes more complicated by the day (Cerda, Baldwin, Honore, Villa, Kellum, & Ronco, 2016). The extensive use of sophisticated equipment and technology in the modern intensive care units further heightens the complexity for the nurses working in the ICU. They work in environments and situations that require them to make rapid decisions. This condition, therefore, brings the question of ethical dilemmas for the nurses working in the ICU as they are expected to work in strict accordance with the ethical and moral codes governing the nursing profession. This paper investigates the ethical dilemmas experienced by nurses in the intensive care unit while doing their work.

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In the previous years, the standard practice in the intensive care unit was the issue of trying to assist the critical patient by all means possible. If any procedure was deemed to be a way to benefit the patient in the slightest of ways, the procedure was carried out (Avis, Grant, & Foy, 2016). However, things have advanced in the modern era. Today, the issues that mainly affect the ethical decisions taken by intensive care nurses are justification, allocation, and use of health resources. The first dilemma that faces intensive care nurses under these considerations is the principle of autonomy. Under this principle, a patient has the right to make decisions about their lives without any interference from other people (Georgiou, Papathanassoglou, & Pavlakis, 2017). In many instances, critically ill patients are in no position to make any decision about their lives. This decision, therefore, remains in the hands of the ICU nurses. As it is, making decisions on behalf of a patient is against the ethical conduct of nurses. Therefore, it becomes a question of ethical dilemma since the nurse must decide on what to do with the patient and their life.

Secondly, the issue of beneficence is a dilemma faced by nurses in the intensive care unit. This principle is a call for nurses to do well. It requires that nurses protect their patients from harm by promoting good situations for the patients and terminating as well as preventing bad ones. The question of ethical dilemma for the nurses, in this case, arrives when the issue of resources comes to the surface. The patient may not afford the cost of life support, which is vital for the nurse to do well in keeping the patient alive. Different health facilities have different rules that govern the allocation of health resources. Private hospitals have been known to be in the business of generating income. They, therefore, give priority to patients with resources. Under this situation, the obligation of the intensive care unit nurses to observe beneficence is undermined, and they make decisions that are contrary to their professional ethics (Johansson, Wahlin, Magnusson, & Hanson, 2019). The issue of deciding what is suitable for the patient also contradicts with this principle. A patient may be willing to have the nurse terminate their life. The nurse, on the other hand, would be willing to undertake a complicated procedure to save the patient's life, leading to conflict of interest and a dilemma on what is the right action for the nurse to decide.

Thirdly, there is the issue of no maleficence. This requires that a nurse shall not harm a patient. Harm to a patient, maybe intentional or non-intentional. The underlying factor, however, is that the nurse should abstain from doing any harm to a patient. The issue of ending a patient's life is generally considered unethical and immoral. If anything, it has been a question of great dilemma in the field of medicine and nursing. However, it may be the will of some critically ill patients to have the intensive care unit nurse terminate their life (Wiegand, MacMillan, dos Santos, & Bousso, 2015). If the nurse upholds the principle of autonomy, they will go ahead and terminate the life of the patient. In executing this action, they will violate the principle of nonmaleficence since they have harmed the patient by ending their life. Therefore, it becomes a dilemma for the ICU nurse on what action to take in such a scenario.

Lastly, the issue of justice and fairness is another question of ethical dilemma for the intensive care unit nurses in the execution of their duties. These nurses are supposed to observe fairness in giving care to their patients and in distributing resources to the patients. The nurses should be fair irrespective of disparities in the social status of the patients, their economic capacity, ethnical backgrounds, race, or even sexual orientation (Vryonides, Merkouris, Charalambous, Andreou, & Papastavrou, 2017). This principle finds compromise when the nurses are faced by the vise of favoritism, for instance, when one tries to favor a friend or a relative by giving them intensive care over other patients. It also becomes a dilemma when the question of limited resources arise. In such a situation, the nurses are forced to make decisions that compromise the nursing code of conduct.

Conclusion

Ethical dilemmas in the intensive care unit are an aspect of acute concern among ICU nurses. It is, therefore, incumbent for the nursing professionals to come up with a way to address this issue to clear the picture for the nurses on what they are supposed to do when faced by one or many of these dilemmas. This step will be vital in defining the standard code of conduct for the intensive care unit nurses.

References

Avis, E., Grant, L., Reilly, E., & Foy, M. (2016). Rapid response teams decreasing intubation and code blue rates outside the intensive care unit. Critical care nurse, 36(1), 86-90. Retrieved from http://ccn.aacnjournals.org/content/36/1/86.short

Cerda, J., Baldwin, I., Honore, P. M., Villa, G., Kellum, J. A., & Ronco, C. (2016). Role of technology for the management of AKI in critically ill patients: from adoptive technology to precision continuous renal replacement therapy. Blood purification, 42(3), 248-265. Retrieved from https://www.karger.com/Article/Abstract/448527

Georgiou, E., Papathanassoglou, E. D., & Pavlakis, A. (2017). Nursephysician collaboration and associations with perceived autonomy in Cypriot critical care nurses. Nursing in critical care, 22(1), 29-39. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12126

Johansson, M., Wahlin, I., Magnusson, L., & Hanson, E. (2019). Nursing staff's experiences of intensive care unit diaries: a qualitative study. Nursing in critical care. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12416

Vryonides, S., Merkouris, A., Charalambous, A., Andreou, P., & Papastavrou, E. (2017). The ethical dimension of nursing care rationing as it is revealed from existing qualitative research studies. https://ktisis.cut.ac.cy/handle/10488/10198

Wiegand, D. L., MacMillan, J., dos Santos, M. R., & Bousso, R. S. (2015). Palliative and end-of-life ethical dilemmas in the intensive care unit. AACN advanced critical care, 26(2), 142-150. Retrieved from https://www.researchgate.net/profile/Debra_Wiegand2/publication/275363462_Palliative_and_End-of-Life_Ethical_Dilemmas_in_the_Intensive_Care_Unit/links/5a8b081b0f7e9b1a9555a3be/Palliative-and-End-of-Life-Ethical-Dilemmas-in-the-Intensive-Care-Unit.pdf