essay on nursing ethical issues

20 Common Examples of Ethical Dilemmas in Nursing + How to Deal With Them

If you are a nurse, chances are you have faced situations where you had to make decisions based on your belief of whether something is right or wrong, safe or unsafe. This type of decision is based upon a system of ethical behavior. It is essential that all nurses develop and implement ethical values into nursing practice. If this sounds familiar, you may be asking, "What are the common examples of ethical dilemmas in nursing?" There are many things that could be considered an ethical dilemma in nursing, and it is important for nurses to know how to address them when they occur. In this article, I will share the 20 most common examples of ethical dilemmas in nursing and offer some insight into handling them.

What Is An Ethical Dilemma In Nursing?

5 main reasons why nurses face with ethical dilemmas in nursing.

1. Patients or their loved ones must make life or death decisions 2. The patient refuses treatment 3. Nursing assignments may contradict cultural or religious beliefs 4. Nursing peers demonstrate incompetence 5. Inadequate staffing

How To Identify Ethical Dilemmas In Nursing?

What are the common examples of ethical dilemmas in nursing, example #1: pro-life vs. pro-choice, ethical dilemma:, how to deal with this ethical dilemma:, example #2: protecting the adolescent’s right to privacy, example #3: empirical knowledge vs. religious beliefs, example #4: parent refuses to vaccinate child, example #5: personal and professional boundaries related to social media, example #6: nurse is instructed to have patient with low literacy level to sign consent for treatment, example #7: end-of-life decision-making, example #8: inadequate resources to provide care, example #9: former patients - to date or not to date, example #10: informed consent, example #11: inadequate staffing, example #12: spirituality vs. science, example #13: patient addicted to prescription pain medication, example #14: duty and compassion do not align with facility safety protocols, example #15: patient does not have an advanced directive, example #16: incompetence among nursing peers, example #17: disclosing the seriousness of medical conditions, example #18: questioning physician orders, example #19: asked to work in a department without training, example #20: beneficence vs. autonomy, 4 consequences of avoiding ethical dilemmas in nursing, 1. nurses can quickly experience burnout., 2. avoiding ethical dilemmas in nursing can lead to legal issues., 3. nurses who avoid ethical dilemmas could lose their jobs., 4. loss of licensure:, my final thoughts.

10 Examples of Ethical Dilemmas in Nursing

When caring for human lives, the decisions you have to make as a nurse are anything but black and white. In addition to taking vital signs and doing dressing changes, there are a realm of tough choices and ethical dilemmas that nurses have to face every day.

Picture this: a nurse finds himself torn between respecting a patient's right to refuse treatment and their deteriorating health. Moral puzzles like these leave even the most experienced nurses scratching their heads and feeling caught between a rock and a hard place. However, understanding how to handle ethical dilemmas isn't just a theoretical exercise. It's a crucial skill that nurses need to have in their toolkits. 

The nursing code of ethics acts as a guide for nurses to help in these decisions, but it can be helpful to see actual examples of ethical dilemmas in nursing and what a nurse should do with each of them. That’s exactly what this article is about. 

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10 common ethical dilemmas in nursing .

While there are many different situations in which a nurse may find themselves dealing with an ethical dilemma, here are 10 common ethical dilemmas in nursing to consider and how a nurse might deal with them:

1. Patient Autonomy vs. Beneficence

Balancing a patient's right to make decisions about their own care with the nurse's duty to promote their overall well-being.

Let's say a patient diagnosed with diabetes refuses to take insulin, despite it being essential for controlling their blood sugar levels and preventing serious complications. 

In dealing with this situation, a nurse should follow the nursing code of ethics and take the following steps:

Respect Autonomy: Respect the patient's right to make decisions about their own care, even if they disagree with those decisions. 

Provide Information: Ensure the patient has accurate and comprehensive information about the treatment, including its benefits, risks, and alternatives. This allows the patient to make an informed decision.

Assess Understanding: Engage the patient in open and non-judgmental communication to assess their understanding of the treatment and the potential consequences of refusing it. 

Collaborative Decision-Making: Engage the patient in collaborative decision-making. Involve them in discussions and explore alternatives that align with their values and preferences. This approach fosters a sense of working together and mutual respect.

Seek Additional Perspectives: If the patient's decision still conflicts with the nurse's professional judgment and poses a significant risk to the patient's health, the nurse should seek guidance from the healthcare team and the nurse manager or supervisor they report to.

Document the Process: Throughout the decision-making process, carefully document all discussions, assessments, and the patient's decisions. This documentation serves as evidence that the nurse has fulfilled their ethical and professional responsibilities.

>> Related: What is Autonomy in Nursing?

2. Confidentiality vs. Duty to Warn 

Struggling with maintaining patient confidentiality while also considering the potential harm to others if vital information is not shared.

Imagine a scenario where a nurse working in a mental health facility becomes aware that a patient with a history of violent behavior has confided in the nurse about their plan to cause harm to their former partner. 

The nurse finds themselves in a challenging ethical dilemma: on one hand, they have a duty to maintain the confidentiality of the patient's personal information, and on the other hand, they have an obligation to protect other people from harm.

To deal with this situation, the nurse should take the following steps:

Evaluate the Severity of the Threat: Carefully assess the level of risk involved in the patient's intentions. Is there an immediate and credible threat to the safety of the potential victim? Consider factors such as the patient's history, current mental state, and access to means for carrying out the harm.

Engage in a Therapeutic Relationship: Explore the underlying issues and reasons behind the patient's harmful intentions. Attempt to address any underlying issues or triggers that may contribute to their behavior and encourage them to seek alternative ways to cope.

Seek Supervision and Consultation: It’s important for the nurse to consult with their supervisor or team members about the appropriate course of action to ensure the safety of the potential victim.

Follow Legal and Ethical Guidelines: Be aware of local laws and regulations regarding the duty to warn or protect. If there is a legal obligation to disclose information in order to prevent harm, the nurse should adhere to those requirements while minimizing the breach of confidentiality to the extent possible.

Document the Process: Document all steps taken, including the patient's disclosure, assessments, consultations, and decisions made. This documentation serves as evidence that the nurse acted ethically, responsibly, and in line with professional standards.

3. End-of-Life Care

Managing the ethical complexities around decisions about withdrawing or withholding life-sustaining treatment, considering the patient's wishes, quality of life, and family dynamics.

For example, consider the situation where a nurse is caring for an elderly patient with a terminal illness. The patient expresses the desire to die a peaceful death without aggressive interventions. However, the patient’s family opposes this and wants “everything medically possible” to be done to save the patient’s life. 

The nurse finds themselves in a complex ethical dilemma, torn between honoring the patient's wishes and respecting the concerns of the family.

Here’s how the nurse might address this situation:

Communication and Education: Engage in open and compassionate communication with both the patient and the family about the patient's medical condition. Discuss the patient’s prognosis, available treatment options, and the potential benefits and downsides of continuing or discontinuing life-sustaining measures. 

Respect for Autonomy: Advocate for the patient's right to self-determination and respect their wishes regarding end-of-life care.

Collaboration and Mediation: Facilitate a respectful and open dialogue, promoting a collaborative decision-making process. The nurse can involve the healthcare team, including palliative care specialists and social workers, to provide support, guidance, and mediation to resolve this situation.

Consider Ethical Decision-Making Frameworks: The nurse should use ethical principles in the nursing code of ethics, such as beneficence, non-maleficence, autonomy, and justice, to analyze the situation and guide their actions. By considering the patient's values, goals, and potential impact on their quality of life, the nurse can advocate for the most ethically appropriate course of action.

Supportive Care: Regardless of the final decision made, the nurse should provide holistic and supportive care to the patient and their family. This includes addressing physical, emotional, and spiritual needs, ensuring optimal comfort, and facilitating open communication to foster a sense of trust and understanding.

4. Resource Allocation

Facing the difficult task of distributing limited resources fairly and ethically among patients, especially during times of scarcity or emergencies.

Consider this scenario: During a severe flu outbreak, a nurse working in a hospital emergency department faces the ethical dilemma of resource allocation. The hospital is overwhelmed with patients and the available resources, such as beds, ventilators, and medications are limited. The nurse must make decisions about which patients receive the resources, balancing the needs of the patients in their care while also considering the needs of other patients in the hospital.

The nurse should manage this situation with fairness and transparency, using the following steps:

Prioritization and Triage: Follow established guidelines and protocols for triaging patients based on the severity of their condition and their likelihood of benefiting from the available resources. This ensures that decisions are made based on clinical needs rather than personal biases.

Open Communication: Maintain open and transparent communication with patients and their families. Explain the challenges faced due to limited resources and the criteria being used for resource allocation. This promotes understanding and trust, even in difficult circumstances.

Collaboration and Consultation: Work collaboratively with the healthcare team, including physicians and hospital administrators, to make informed decisions about resource allocation. Seeking input from multiple perspectives helps ensure fairness and accountability.

Consider Ethical Decision-Making Frameworks: Use the ethical principles of fairness and justice in the nursing code of ethics to guide the nurse’s actions. By considering factors like the potential benefits, risks, and overall impact on patients and the community, the nurse can strive to allocate resources in an equitable and ethical manner.

Advocacy and Support: Advocate for the well-being and rights of their patients, even when difficult decisions must be made. 

5. Informed Consent

Ensuring patients have a clear understanding of the risks, benefits, and alternatives of proposed treatments or procedures before they provide consent.

Here’s an example of how this ethical dilemma could occur: A nurse assists a physician who is rushing to obtain informed consent for a surgical procedure, despite the patient's pain and anxiety. However, the nurse quickly recognizes the patient's limited understanding of the procedure’s implications, raising ethical dilemmas regarding informed consent.

To handle this situation, the nurse should follow these steps:

Ensure Adequate Information: Intervene respectfully but assertively and ask the physician to slow down and provide the patient with complete information about the procedure, risks, benefits, potential outcomes, and available alternatives. 

Clarify Patient Understanding: Speak with the patient and assess their understanding of the information provided. Encourage the patient to ask questions and address any concerns they may have. 

Advocate for Time and Support: If the patient appears overwhelmed or is struggling to comprehend the information, the nurse should advocate for additional time or resources, such as involving a family member or providing educational materials or an interpreter (if appropriate) to support the patient in making an informed decision. 

Document the Process: Document the steps taken to address the concerns related to informed consent. Be sure to include any discussions, explanations provided, patients' questions, and their ultimate decision. Accurate documentation demonstrates the nurse's commitment to upholding ethical standards and professional accountability.

6. Cultural and Religious Beliefs

Navigating conflicts between a patient's cultural or religious values and the standard practices or protocols of healthcare.

In a multicultural society, nurses often encounter ethical dilemmas when a patient's cultural or religious beliefs clash with the standard practices or protocols of healthcare. An example is when a nurse is caring for a patient from a cultural background who strongly believes in traditional healing methods and is hesitant to accept Western medicine.

In this situation, the nurse should have a culturally sensitive discussion with the patient and demonstrate respect for diversity. Here are the steps the nurse should take:

Culturally Competent Assessment: Conduct a culturally competent assessment to understand the patient's cultural and religious beliefs, values, and preferences regarding healthcare. This requires active listening, open-mindedness, and avoiding assumptions or stereotypes.

Establish Trust and Rapport: Build a trusting relationship with the patient by acknowledging and respecting their cultural and religious beliefs. This can be achieved through effective communication, empathy, and demonstrating cultural humility.

Collaborative Decision-Making: Engage the patient and their family in collaborative decision-making regarding their healthcare. Respectfully discuss the patient's beliefs and preferences, and explore opportunities to integrate traditional healing practices with evidence-based Western medicine. 

Consultation and Education: If there are concerns about the patient's well-being or the appropriateness of certain traditional healing methods, the nurse should seek guidance from a cultural consultant, interpreter, or healthcare team. 

Advocacy and Liaison: Serve as an advocate for the patient, ensuring their cultural and religious rights are respected within the healthcare system. This may involve facilitating communication between the patient and healthcare providers, ensuring the provision of culturally competent care, and addressing any cultural or religious barriers that may arise.

7. Impaired Colleague

Grappling with the ethical responsibility of reporting concerns about a colleague's impairment due to substance abuse or mental health issues.

This situation might occur when a nurse becomes aware that a nursing colleague is impaired while on duty. The impaired nurse exhibits erratic behavior and smells strongly of alcohol. The nurse who witnesses this behavior finds themselves in a challenging ethical dilemma, torn between their duty to ensure patient safety and their loyalty to their colleague.

Nevertheless, the nurse needs to prioritize patient safety and act professionally by following these steps:

Immediate Concern for Patient Safety: The nurse's primary responsibility is to ensure the safety and well-being of patients. If they observe signs of impairment in their colleague that could compromise patient safety, they should take immediate action.

Reporting: The nurse should report their observations and concerns to the appropriate authority within the healthcare facility, such as the nurse manager or supervisor. This report should be made objectively without personal judgments or assumptions and with a focus on patient safety.

Confidentiality and Professionalism: Maintain confidentiality throughout the reporting process, being mindful not to disclose personal details of the impaired colleague unless necessary for the investigation.

Collaboration and Support: Collaborate with the healthcare team and support the impaired colleague's well-being by encouraging them to seek appropriate help and support, such as employee assistance programs or counseling services. 

Ethical Obligation: Nurses have an ethical obligation to protect the welfare of patients and maintain the standards of the nursing profession. This includes recognizing and addressing impairment issues among colleagues to ensure safe and quality care.

8. Professional Boundaries

Striking a balance between providing compassionate care and maintaining appropriate professional boundaries, particularly when it comes to personal relationships with patients.

In this example, let’s look at a scenario where a nurse develops a close friendship with a patient and begins sharing too many personal details about their own life unrelated to the patient’s healthcare needs.

When the nurse realizes what’s happening, they need to prioritize maintaining professional boundaries and act in the best interest of the patient by following these steps:

Recognize the Boundary Issue: Use personal reflection to recognize when professional boundaries are being crossed or compromised. Acknowledging this ethical dilemma is the first step toward resolving it.

Reflect on the Nurse-Patient Relationship: The nurse should remind themselves of their professional role, the duty of care, and the need to maintain objectivity and professional distance.

Reestablish Boundaries: Take appropriate actions to reestablish and reinforce professional boundaries with the patient. This may involve redirecting conversations back to the patient's healthcare needs, avoiding personal disclosures, and focusing on the patient's well-being.

Seek Guidance and Supervision: If the situation becomes challenging to resolve alone, the nurse should seek help from a supervisor, nurse manager, or experienced nursing team member. Consulting with experienced professionals can provide valuable insights and support in addressing this ethical dilemma.

Continuous Professional Development: Engage in ongoing professional development and education regarding nursing ethics and setting professional boundaries. Staying current on ethical guidelines and participating in discussions and training on maintaining professional boundaries can help prevent future boundary issues with patients.

9. Whistleblowing

Facing the ethical dilemma of reporting concerns about wrongdoing or unethical practices within the healthcare system, despite potential professional and personal repercussions.

An example of whistleblowing would be when a nurse becomes aware that a colleague is stealing controlled substances from the medication supply. The nurse decides to report this to their supervisor because it compromises patient safety and violates professional and legal standards. However, the nurse is worried about their colleague being disciplined and possibly losing their license.

Here are the steps the nurse should follow:

Gather Evidence: Collect factual evidence such as documentation discrepancies in medication records, witnessing the colleague's actions, or capturing any other supporting documentation. 

Consult with Colleagues: Seek advice from trusted colleagues, supervisors, or mentors within the healthcare organization. Discuss the situation and determine the best course of action. It’s important to maintain confidentiality during these discussions to protect both the patient and the nurse making the report.

Follow the Proper Chain of Command: Follow the established reporting channels within their healthcare organization. This typically involves reporting concerns to a supervisor, nurse manager, or a designated ethics or compliance hotline. Ensure that the report is made in writing and contains all relevant details and evidence.

Protection and Confidentiality: Be familiar with the whistleblower protection policies and laws in their jurisdiction. The nurse should ensure that their report is treated confidentially and that appropriate steps are taken to protect them from retaliation.

Documentation: Keep a detailed record of all actions taken, including the date and time of the incident, any conversations or consultations, and copies of the report submitted. This documentation helps demonstrate the nurse's commitment to reporting and acting in accordance with professional and ethical standards.

10. Ethical Use of Technology

Considering the ethical implications of using technology in healthcare, such as maintaining patient privacy and security, avoiding biases in algorithms, and ensuring equitable access to care.

An example of this ethical dilemma could occur when a nurse becomes concerned about potential biases in an algorithm and decides to report this to her supervisor. She recognizes that an algorithm where she works may disproportionately allocate resources based on patient factors such as age, race, and gender, resulting in inequitable access to care.

The nurse should advocate for equitable care by taking these steps:

Investigate and Evaluate: Become familiar with the AI algorithm being used and investigate its development process. Assess whether the algorithm has been validated and tested for biases and fairness. 

Raise Concerns: If the nurse identifies biases or inequities in the algorithm, they should communicate their concerns to the appropriate individuals, such as nurse leaders, healthcare administrators, or the technology implementation team. 

Collaborate for Improvement: Engage in collaborative discussions with the healthcare team, including the nursing supervisor, IT specialists, and data scientists. Work with the team to develop strategies to eliminate biases and ensure equitable use of the technology for all patients.

Promote Patient Advocacy: Advocate for the rights and well-being of the patients who may be affected by the technology. This involves ensuring informed consent and transparency regarding the use of AI algorithms. Patients should have the opportunity to understand and discuss the potential biases and their impact on their care.

Continuous Evaluation: Advocate for ongoing evaluation and monitoring of all AI technology being used in patient care to identify and resolve biases or unintended consequences. 

Ethical dilemmas are common in nursing and can be difficult to deal with. But you don’t have to make the decisions about these issues alone. Seek out the support and input of your nursing colleagues, supervisor, or nurse manager. By doing so, you will feel more comfortable and confident about how to handle the ethical dilemma you find yourself in.

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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Ethical Issues in Nursing: Explanations & Solutions

June 5, 2020

View all blog posts under Articles | View all blog posts under Master of Science in Nursing

Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Nurse managers, in particular, are susceptible to ethical issues in nursing and moral distress because of their leadership and mentoring roles. Nurses and other medical staff look to nurse managers for appropriate and ethical decisions.

Before stepping into a role as a nurse manager, registered nurses (RNs) should understand the role ethical decision-making plays in the day-to-day work. Through Duquesne University’s Master of Science in Nursing program, students explore the foundations of ethical management and leadership from professors with real-world experience. The coursework not only covers the fundamentals of ethical nursing but delves deep into controversial case studies, giving students the chance to examine alternative viewpoints and develop reasoning skills.

For nurse managers, ethical decision-making stems from the American Nurses Association Code of Ethics, which was developed as a guideline for nursing responsibilities “in a manner consistent with quality in nursing care and the ethical obligations of the profession.” Nurse managers help solve ethical issues in nursing through using their leadership qualities to implement the Code of Ethics in their daily lives.

Nurses’ Code of Ethics

ANA adopted its first Code of Ethics in 1950. Since then, it has undergone several revisions to offset advances and changes in research, technology, law and overall challenges in nursing. The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right. ANA said that each of the provisions covers topics important to the challenges of nursing in the 21st century.

“The code is particularly useful in today’s healthcare environment because it reiterates the fundamental values and commitments of the nurse, identifies the boundaries of duty and loyalty and describes the duties of the nurse that extend beyond individual patient encounters,” ANA said in a statement.

Daily, nurse managers face a barrage of decisions and must maintain ethical fortitude to ensure the health, safety and well-being of their patients and staff. They actively work toward resolving ethical issues in nursing that they find in their workplace.

Examples of Ethical Dilemmas in Nursing

The ANA Code of Ethics provides a standard by which nurse managers can assess ethical issues in nursing. However, the way it addresses ethical dilemmas can vary in different situations. One ethical dilemma that can occur in healthcare facilities is when nurses themselves are not properly equipped to complete their duties. Nurses who notice their coworker’s lack of knowledge face an ethical dilemma of whether they should bring the issue to their nurse manager. To help curb this ethical dilemma, nurse managers can work hard to educate their nurses regarding the Code of Ethics as well as educate them regarding the Code of Ethics for their specific medical facility. Nurse managers can also provide regular trainings for their nurses regarding recurring issues.

One example of a common ethical dilemma nurses deal with is establishing boundaries with patients. Nurses and nurse managers devote their careers to helping patients receive the care they need, so it can often be difficult to establish professional boundaries. Patients should not rely on nurses beyond their professional capacity and should not develop romantic relationships with them or offer them gifts. Nurse managers can intervene in situations where ethical and professional boundaries are crossed by either patients or nurses.

Another ethical issue in nursing pertains to patient privacy. Nurses and nurse managers have access to a patient’s records and medical history and cannot ethically or legally release that information to anyone besides the patient. Nurses should have the best interest of patients in mind, understanding that they need to protect their privacy and medical data.

Common Ethical Situations for Nurse Managers and Nursing Ethics Examples

Even though nursing is a fast-paced job with new challenges daily, many nurse managers report facing similar ethical dilemmas. A recent study found that the most frequently occurring and stressful ethical situations are protecting patients’ rights, staffing, advanced care planning and decision-making. Exacerbating the problem is the large number of inexperienced nurses entering the field, many who have never faced ethical issues in nursing. Such challenges make experienced nurse managers all the more critical to daily healthcare needs nationwide.

The following are some other examples of common ethical situations that nurse managers face:

• Honesty vs. withholding information. Family members may want to withhold medical information from sick patients to protect their emotions. However, patients have the right to know about their medical conditions. Deciding how to share this information, especially if it goes against the family’s beliefs, can be a touchy situation. ANA advocates for truth telling, or veracity, as a key factor in nurse-patient relationships.
• Science vs. spirituality. Healthcare, which is science-based and results driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guidelines. The ANA Code of Ethics states that nurses should respect the “unique differences of the patient,” including “lifestyle, value system, and religious beliefs.” However, respect for the belief “does not imply that the nurse condones those beliefs or practices on a personal level.”
• Healthcare needs vs. resource allocation. The rising cost of healthcare is increasingly putting nurse managers at odds with budgeting constraints and patient needs. A large number of medical facilities have scarce resources, which puts patients at risk for not getting the care they need. These resources range from medical equipment to healthcare staff. Research suggests that nurse leaders must include staff in the budgeting process so that they can better understand the needs and demands.
• Autonomy vs. beneficence. Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity. ANA explains: “Using ethical principles to arrive at a solution should be done in an atmosphere of caring, respect, openness, and honesty. This process should be based on a sound ethical, decision-making model, using the best evidence-based-practice guidelines available.”

How to Deal With Ethical Dilemmas in Nursing

Nurses undergo many years of education and clinical training before they can become certified nurses, and yet, dealing with real ethical issues in nursing can be far more complex than solving hypothetical issues in textbooks. Nurses can learn how to deal with ethical dilemmas in the workplace through gaining experience and interacting with patients over time. Although nurses have great levels of empathy, it can benefit them to establish professional boundaries with each of their patients at the outset of their careers. Whenever nurses struggle to identify whether something is ethical, they can review the ANA Code of Ethics.

Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges.

Help Avoid Ethical Dilemmas in Nursing

The Duquesne University School of Nursing’s MSN program integrates ethical problem-solving and decision-making to help MSN graduates explore and address ethical issues. Students in each of Duquesne University’s MSN tracks — Adult-Gerontology Acute Care Nurse Practitioner, Family (Individual Across the Lifespan) Nurse Practitioner, Psychiatric-Mental Health Nurse Practitioner, Executive Nurse Leadership and Health Care Management, Forensic Nursing and Nursing Education and Faculty Role — learn how ethics and problem-solving play distinct roles in nursing.

U.S. News & World Report ranked Duquesne University’s online MSN program among the Best Online Graduate Nursing Programs in 2017. If you are interested in advancing your career as a nurse manager, explore how Duquesne University’s Master of Science in Nursing program can help you pursue your professional goals and help you avoid ethical issues in nursing.

Recommended Readings

Family Nurse Practitioners and Professional Liability Insurance

Importance of Nurse Manager Resilience

Using Escape Rooms for Nurse Education

American Nurses Association, View the Code of Ethics for Nurses 

Houston Chronicle , “Legal & Ethical Issues That Health Care Professionals Face” 

Lippincott Solutions, Best Practices for Ethical Nursing Leadership 

Medical Records Info, Top 10 Most Prevalent Ethical Issues in Nursing 

National Center for Biotechnology Information, “Ethical Problems in Nursing Management —A Cross-Sectional Survey About Solving Problems” 

NurseChoice, “4 Common Nursing Ethics Dilemmas” 

Common Ethical Dilemmas in Nursing and their Solutions

Healthcare professionals, including nurses, face ethical dilemmas fairly regularly. Most of the dilemmas are usually serious and very stressful because when faced with a dilemma, a nurse must make a decision, which is easier said than done.

As a nursing student, you might be assigned to write an essay where you identify, analyze, and resolve an ethical dilemma. We have noticed over the years that many students struggle with writing an ethical dilemma nursing essay. If that sounds like you, read this post that comprehensively explores ethical dilemmas in nursing, including their examples and solutions.

In most cases, essays about ethical dilemmas in nursing take the reflective essay approach, where you reflect on real, researched, or imagined clinical scenario or encounter. It could be during your placement, clinical rotations, or shadowing experiences. As you do so, you will borrow from various ethical theories and decision-making models.

If you could use some help, our experienced online nursing essay writers can help you get a bespoke ethical dilemma essay at an affordable fee.

Let's get started with the basics to more advanced concepts.

What is an Ethical Dilemma in Nursing?

An ethical dilemma is a scenario where it is not easy to decide one way or another. Nurses are faced with ethical dilemmas almost every day. They have to make serious and difficult decisions fairly regularly. The decisions can sometimes mean life or death. Therefore, as a student nurse, it is vital to learn about ethical dilemmas nurses face, how to identify them, and how to solve them correctly.

When facing an ethical dilemma, you should always follow the nursing code of ethics . This is because most dilemmas can be solved by following the nursing code of ethics. The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it.

While most dilemmas can be solved by following the code of ethics in nursing, some dilemmas cannot be solved in this manner. The reason is that the nursing code does not guide every ethical dilemma or situation.

If faced with a situation that makes it difficult for you to follow the nursing code of ethics, you should use your judgment to weigh the pros and cons of both decisions to make the right decision.

Examples of ethical dilemmas nurses face regularly include: how to deal with a non-compliant patient, how to deal with a patient that is refusing treatment, and whether to disclose confidential information to help a patient.

Ethical Dilemma Versus Moral Dilemma

The terms ethical and moral are often used interchangeably in speech. However, the two terms do not always mean the same thing. For example, there is a slight difference between ethical and moral dilemmas.

An ethical dilemma involves two morally correct choices, but one is slightly more ethically problematic than the other. In contrast, a moral dilemma is a situation with two morally correct choices, but neither is preferable. For the moral dilemmas, the nurses know the right action yet might be limited to acting by forces outside their control.

As a nurse, you are more likely to face ethical dilemmas than moral dilemmas. Because ethical dilemmas are anticipated, a code of conduct has been created to help you always make the right decision.

Reasons Nurses Face Ethical Dilemmas in Healthcare

There are many reasons why nurses face ethical dilemmas frequently when providing care to patients. The following are the eight main ones:

• Inadequate staffing. When a healthcare facility has fewer staff than it needs to function optimally, nurses sometimes must make a tough decision. They have to decide whether to work longer to care for patients or to prioritize their mental and physical health and work only as much as possible.
• Incompetent peers. As a registered nurse, you will have a big dilemma if you notice a colleague showing incompetence. You will have to choose one of two options – to ignore your colleague's incompetence because they are a friend and they probably will not do it again, or report your colleague to a supervisor to ensure high standards are maintained. This is an ethical dilemma since the former is more ethically problematic than the latter.
• Religious/cultural beliefs. Your religious or cultural beliefs may present an ethical dilemma as a practicing nurse. For instance, you might be given a nursing assignment that contradicts your religious beliefs, e.g., you are asked to clean up the private parts of a male patient after a procedure as a Muslim female nurse (this is forbidden according to Islam). It is easy to see how this situation would present an ethical dilemma.
• Patient refusing treatment. There are occasionally situations when patients refuse treatment. As a nurse, you know what is best for the patient. However, you also know that they have the right to make their own decision. So when a patient refuses treatment, this will always present you with an ethical dilemma – do you insist and look for ways to ensure they get the treatment or grant them their wish?
• Artificial nutrition and hydration. Some patients and older adults do not want to be fed or hydrated using a tube. This presents a huge ethical dilemma for nurses. This is because nurses are trained to care for people who need it. Therefore, they feel bad about it when they see the need to provide artificial nutrition and hydration and get stopped because of a patient's wishes. They feel so bad because they know there is something they can do, yet they are asked not to do it.
• Providing futile care. Being asked by a patient's family to continue providing care despite a patient's continued decline is one of the biggest ethical dilemmas nurses face. This is especially true for critical care nurses. Being trained medical staff, they can see when it is not in a patient's best interest to continue receiving aggressive interventions. However, most of the time, patient families don't want to give up on their loved ones. Therefore, they insist that interventions continue presenting nurses with a big ethical dilemma.
• Opioid crisis. The opioid crisis across the United States presents nurses with several ethical dilemmas. For example, many nurses do not want to give patients opioid pain medications, especially when they believe they risk getting addicted. Now imagine knowing that a patient can benefit from a medication yet at the same time feeling like it could lead to them getting addicted to it
• Anti-vaccine stance. Nurses who do not mind vaccines face a dilemma whenever they interact with those against vaccines. This is because, on the one hand, they know they have to provide care to everyone without discrimination. Yet, on the other hand, they know that people against vaccines pose a serious public health hazard.

Identifying Ethical Dilemmas in Nursing

As evident in the section above, ethical dilemmas can arise virtually anywhere in the nursing world. It is up to you as a nurse to identify dilemmas when they arise and deal with them as expected by the ANA code of conduct. In this section, we are going to focus on how to identify ethical dilemmas in nursing.

Here are the main indicators of ethical dilemmas in nursing.

• Harm potential. When you face a healthcare situation that has the potential to impact a patient negatively, you are most likely facing an ethical dilemma. If it were so easy to spare the patient from the negative impact, the situation wouldn't be a dilemma because this is the option you would take.
• Conflict of interests. When you face a healthcare situation with a conflict of interests between you and the patient or you and the case management team, it is likely an ethical dilemma.
• Uncertainty. This is perhaps one of the biggest indicators of ethical dilemmas and dilemmas. When you face a healthcare situation in which you are unsure what to decide, you are most likely facing an ethical dilemma. Nurses are trained to judge situations and make decisions quickly. When you cannot do these things as a nurse, something is holding you back, and the situation is likely a dilemma.
• Cautiousness. When you face a healthcare situation in which you are cautious about the outcome of the options you can take, you are most likely facing an ethical dilemma. People are cautious when making ethical dilemma decisions because they do not want to see negative consequences (if any) caused by their decision(s).
• Delay. When you have a decision to make at work and keep delaying the decision-making, you are most likely facing an ethical dilemma. People delay making ethical dilemma decisions because they fear the consequences.

Principles of Nursing Ethics

Principles of nursing ethics were formulated to help nurses consistently make the right decisions when faced with ethical situations. There are many principles of nursing ethics, but the main ones are non-maleficence, beneficence, autonomy, and justice. These are the ones that are always integrated into nursing training programs to help nurses make the right decisions whenever they are faced with difficult situations.

1. Nonmaleficence

Nonmaleficence is probably the most well-known ethical principle in the healthcare world. It applies to nurses, doctors, and other medical professionals.

This principle teaches nurses that it is their responsibility to provide care, treatment options, and/or case management in a manner that does not harm the patient. When you internalize this principle as a nurse, you will always choose to provide care and treat patients safely.

Non-maleficence is an important part of providing patients with safe and quality care. Exercising this principle means doing everything possible as a nurse to provide care while ensuring the highest degree of patient safety.

An excellent example of non-maleficence in nursing practice is withholding the administration of a powerful medication until you get confirmation on whether a patient is allergic to it or not. Another example of maleficence in nursing practice is discontinuing medication when you notice signs of adverse reactions.

When a nurse lacks this principle, it can result in dire consequences for patients. More specifically, a lack of nonmaleficence can lead to reduced patient safety. And, of course, this can mean patient injury or even death. Patient injury or death resulting from lack of nonmaleficence can cause mental trauma, job loss, and even legal consequences.

Therefore, it is imperative to internalize and adhere to this nursing principle.

2. Beneficence

Beneficence is another important nursing principle. This principle is characterized by charity and kindness. It is basically all about ensuring your actions are guided by compassion and maximum consideration of the welfare of those you serve.

While some people choose to pursue nursing for the money or job security, most people in nursing are in it out of their love for serving others. Therefore, this beneficence principle is almost always naturally ingrained in the minds of most nurses.

The best way to apply this nursing ethical principle is to always act in the patient's best interest regardless of the circumstances. Practicing this principle regularly will ensure the patient is always cared for in the best way possible. You will also automatically improve positive patient outcomes.

An excellent example of beneficence in nursing practice is offering to sit with a patient to console them after giving them bad news about their situation. Another superb example of beneficence is drawing curtains to protect a patient's and his family's privacy when exchanging final goodbyes.

Lack of beneficence can result in poor nurse-patient relationships and reduced patient safety. When a patient realizes you are not kind or acting in their best interest, they will not be very interested in showing you kindness or respect. This can result in poor nurse-patient relationships and adverse patient outcomes.

As mentioned above, a lack of beneficence can also lead to reduced patient safety. When you don't act in the patient's best interest, it can lead to safety issues such as failure to record vital info, failure to use protective measures when providing care, and medication errors.

It is easy to see how following this principle can make it easier for nurses to provide quality care and make more ethical decisions.

3. Autonomy

Autonomy is a fundamental nursing ethical principle. It recognizes the right of the patient to make their own decisions. Nurses must never forget this right to avoid imposing their will or self-interest on the patient. 

Of course, there is a right way to recognize patients' independence and ability to make their own decisions. This right way involves offering the patient all the necessary information to make the best decisions. This information includes available treatment options and the pros and cons of each option.

Once a nurse has offered a patient all the correct information, they have to respect whatever decisions the patient makes, even if they disagree.

Autonomy is essential in nursing practice because it helps nurses adhere to the patient's wishes. It is also important because it passes responsibility for some major care decisions to the patient they will affect the most.

A good example of autonomy is when a nurse agrees to respect a patient's choice not to get treatment, even if they believe the treatment benefits the patient. Another excellent example of autonomy is a nurse respecting a patient's wish to be seen or attended to by a nurse of the same sex for religious reasons.

When a nurse doesn't practice this ethical principle, they can make decisions that make patients feel disrespected. They can also make decisions that can lead to a breakdown of the nurse-patient relationship. Thus, it is always essential to have this ethical principle in mind.

Justice is a fundamental ethical principle. It is all about nurses showing fairness in the way they provide care. Nurses must provide quality care to patients regardless of their appearance, age, financial history, religious preference, race, and gender.

Even when faced with a situation that involves healthcare for a convicted murderer or any other criminal, a nurse must still offer the best care they can provide.

This nursing ethical principle is crucial because it ensures fairness and equity in nursing. In other words, it provides patients care regardless of who they are. This usually has the effect of making patients feel valued. This, in turn, usually has the effect of enhancing patient outcomes.

A good example of justice in nursing practice is providing care to a known anti-vaccine campaigner when they get COVID or any other vaccine-preventable illness. This is justice and fairness because it allows the person to become well again without considering the negative influence of vaccine use.

A nurse lacking this ethical principle can act in ways that make a patient feel rejected, leading to adverse patient outcomes. It can also lead to unfair prioritization in care provision, resulting in dire consequences for the patient.

By following the nursing ethical principles discussed above and adhering to the ANA code of conduct, you can handle different ethical dilemmas correctly and without serious negative consequences.

Examples of Ethical Dilemmas in Healthcare

Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ethical issue. As long as it impacts healthcare, it falls within nursing practice or medical ethics.

The following are some of the most common ethical dilemmas in nursing.

1. Pro-choice versus pro-life.

The pro-choice versus pro-life dilemma is common in nursing. For example, when a patient wishes to have an abortion because they do not want a baby, yet a nurse is pro-life because of religious beliefs, it becomes a big dilemma.

SOLUTION : Respect the wishes of the patient.

2. Religious beliefs versus science.

This dilemma is common in nursing practice. For example, it can occur when a patient refuses a specific procedure or treatment because of religious beliefs, yet a nurse knows what science says is best in the situation.

SOLUTION : Respect patient autonomy and do as they wish.

3. Beneficence versus autonomy.

As a nurse, you must practice beneficence (kindness and charity). You are also required to respect the patient's autonomy. Now imagine you have been ordered to give a patient medication to ease pain and suffering, yet they insist on not taking it to stay awake and spend their last minutes with their loved ones. This presents a great beneficence vs. autonomy dilemma.

SOLUTION : Obey the patient's wishes as long as they are conscious and can make their own decisions

4. Anti-vaccine stance.

As a nurse, you must follow exactly what the guardian wants for a child unless it is required by law to do otherwise. Now imagine a situation where a parent refuses to let their child get vaccinated, yet you know at the back of your mind that vaccines benefit children. You know what you must do, yet a guardian insists you must not do it. This is a significant ethical dilemma.

SOLUTION : Obey the guardian's wishes for their child.

5. Withholding information versus being honest.

Nurses are ethically expected to be open and transparent with patients. However, there are cases when you may feel as a nurse that explaining the gravity of a situation to a patient will worsen their stress and anxiety. You may, therefore, think it is more appropriate to withhold some information from them. This presents a big dilemma.

SOLUTION: Always be honest, especially when the situation is complex. Patients deserve to know the truth.

6. Limited resources versus healthcare needs.

Nurses occasionally face situations where their resources are not optimal for the people they serve. Remember the COVID-ventilator issue? Doctors and nurses had to decide whom to give ventilators initially at the start of the pandemic when there were not enough ventilators.

SOLUTION: When the resources are limited, choosing patients based on severity is recommended.

7. Questionable orders.

Doctors and other medical professionals are not perfect. They make mistakes from time to time. Therefore, you will have a big dilemma when a doctor prescribes treatment, and you feel it is not the best treatment in the back of your mind. Do you fulfill the doctor's order or intercede and question it?

SOLUTION: When you feel something wrong is about to happen, you should speak up to protect the patient's interest.

How to Address Ethical Dilemmas in Nursing

The best way to address ethical dilemmas is to internalize and follow the nursing ethical principles and the ANA code of conduct. However, not everyone constantly has the time and energy to review nursing ethical principles and the ANA code of conduct.

For this reason, we have shared the tips below to help you correctly address ethical dilemmas in nursing.

1. A Problem Shared Is a Problem Halved

When you feel uneasy about an ethical situation, you should share it with a trusted colleague or a supervisor. Communicating the problem with someone else invites a fresh perspective to the problem and increases the likelihood of arriving at a better decision.

2. Internalize Patient Autonomy

Remembering and recognizing patient autonomy or the right to make their own decisions is always important. It doesn't matter what you think is best for a patient – what they want is what you should do as long as it is legal and within your nursing responsibilities. Of course, you should present the patient with all the information they need to decide. So if you ever have to grapple with an ethical situation that makes you feel like ignoring patient autonomy, you shouldn't do it. You should choose the option that ensures patient autonomy.

3. Respect the Right to Privacy

Every patient has a right to privacy. This means you should treat their information as confidential and only to be shared with them or with persons they approve. It is not in your place to share patient information, especially when it is sensitive. You can only share info when given consent. Therefore, if you ever have a dilemma about sharing information, remember to respect the right to privacy and ask for consent to share info if you think it is necessary.

4. Transparency is Key

You should always be open and honest with patients. Doing this will help you to avoid many ethical situations. It will also make it easy for you to make ethical decisions. Therefore, whenever necessary, please share all the information you can share with patients to help them understand what is happening. Share with them the pros and cons of every treatment or management option. Let them be fully aware of the benefits and risks of everything.

5. Ask Yourself What Is in The Best Interest of the Patient

Whenever you need to make an ethical decision, in addition to all your other considerations, you should ask yourself what is in the patient's best interest. Asking yourself this question will help you act in a way that ensures the patient's best interests are taken into account. It will also force you to involve the patient in decision-making to know what they want or wish for. You can never go wrong by acting in a patient's best interest.

6. Stay Up-To-Date with Ethical Guidelines

Ethical guidelines change regularly. Therefore, to ensure you are always making the right ethical decisions, you should stay up to date with ethical guidelines (both professional guidelines and institution-specific guidelines). It is not always easy to do this, but you can subscribe to nursing blogs that discuss ethical guidelines. This will ensure you always have the latest information you need to make good ethical decisions. You can also stay up to date by enrolling in at least one online ethical nursing training program or course. This will help you to refresh your ethical principles knowledge and to be aware of the latest ethical issues in nursing.

7. Always Do Something as Soon as You Can

When faced with an ethical situation, never do anything and hope the situation will resolve itself. Always do something as soon as possible. This will ensure either the issue is solved or starts getting solved. When you ignore an ethical situation, it has the risk of snowballing and becoming a much bigger issue down the line. Therefore, please do something about an issue whenever you can do it quickly.

8. Negotiating Never Hurts Anybody

One of the best things you can do when facing a nursing ethical dilemma is to negotiate with the parties involved. When you do this respectfully and fairly, you can easily resolve most ethical situations. For example, if a patient refuses a specific treatment for religious reasons, you can convince them to accept it using various persuasion techniques. Of course, you should respect the patient's decision if they insist on a certain stance or position.

9. Talk to Somebody Higher Up

As a nurse, some ethical decisions are not yours; they are above your pay grade. In such a case, they should be referred to somebody higher up, e.g., the nurse manager or the nurse supervisor. Because the manager or supervisor is usually more experienced, they are often in a much better position to handle ethical decisions and teach you what to do when faced with the same situation again.

Consequences of Failing to Address Ethical Dilemmas in Nursing Properly

When you fail to address ethical dilemmas in nursing correctly, there are often negative consequences. The most common negative consequences nurses have to deal with include the following:

1. Loss of License

When you are faced with an ethical decision, you must make sure you act in the way expected of you according to the nursing code of conduct. Failure to act in the manner that is expected of you in the nursing code of conduct can lead to loss of licensure. This is especially true when your decision in an ethical situation is an egregious violation of the nursing code of conduct or the ethical principles of nursing. Therefore, when faced with an ethical decision, it is best to consider the options carefully and to act in the way that is expected of you.

2. Legal Issues

You could face legal issues when you fail to adequately address certain ethical dilemmas in nursing. As a nurse, you have specific responsibilities. You are also expected to adhere to the nursing code of conduct. If you fail to address ethical issues correctly, e.g., you leak confidential information about a celebrity patient for money to the public, you could face legal issues, including a lawsuit and/or criminal charges. Hence it is crucial to think long and hard about some ethical issues before deciding what to do.

3. Job Suspension or Termination

Most hospitals have a code of conduct that nurses and other healthcare professionals must sign when hired. They expect nurses to follow the code to the letter. Most hospitals also expect nurses to follow the ANA code of conduct and to always adhere to the ethical principles of nursing. So when faced with an ethical situation and failing to act correctly, you could end up before the ethics committee of your hospital, and they could recommend your suspension or the termination of your job contract.

4. Stress and Burnout

Ethical situations can cause a lot of stress and mental burnout. They can make it almost impossible for you to continue operating normally. When you ignore them or make the wrong decision, you can potentially make them worse. This can lead to even more stress and even physical burnout. Consequently, it is important to make the right decisions quickly when faced with ethical problems or issues.

5. Negative Patient Outcomes

The worse thing that could happen if you don't address ethical issues correctly is an adverse patient outcome, such as patient deterioration, patient injury, or death. It is always painful for nurses to realize or discover that their decisions caused an adverse patient outcome. It can lead to stress, loss of self-confidence, and so on. Of course, an adverse patient outcome can also lead to legal issues, job suspension, and job loss. So it is best to make the correct decision whenever faced with an ethical dilemma.

Takeaway about Ethical Dilemmas in Nursing Practice

Nursing training is all-rounded in anticipation of all the issues a trained nurse would experience in typical clinical settings. Learning about ethical dilemmas and how to solve them can be a stepping stone toward excellence as a nurse or medical/healthcare practitioner. You will be dealing with many ethical dilemmas in the workplace and an experience on how to solve them can always help you avert adverse situations.

Related Readings:

• List of hot controversial topics for nursing issue papers

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Covid-19: Ethical Challenges for Nurses

• PMID: 32410225
• PMCID: PMC7272859
• DOI: 10.1002/hast.1110

The Covid-19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses' relationships with patients and families. We urge policy-makers to ensure that nurses' voices and perspectives are integrated into both local and global decision-making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic.

Keywords: Covid-19 pandemic; allocation of scarce resources; crisis standards of care; moral distress; nurse-patient-family relationship; nursing ethics; safety of nurses.

© 2020 The Hastings Center.

• Betacoronavirus
• Coronavirus Infections / nursing*
• Ethics, Nursing*
• Health Care Rationing / ethics
• Nurse-Patient Relations / ethics
• Pneumonia, Viral / nursing*
• Safety Management / ethics
• Stress, Psychological / epidemiology

120 Legal and Ethical Issues in Nursing Topics and Examples

James colson dnp, rn.

• May 15, 2024
• Nursing Topics and Ideas

Nursing is a noble profession that demands not only clinical expertise but also a deep understanding of legal and ethical principles. Healthcare practitioners often find themselves at the intersection of patient care and complex legal and ethical dilemmas. This resource serves as a valuable guide for nursing students, educators, and professionals striving to navigate the complex landscape of nursing ethics and legalities.

In this article, we explore Legal and Ethical Issues in Nursing Topics and Examples. We also cover PICOT questions examples, nursing research questions EBP &, nursing research questions examples, and nursing essay topic ideas about legal and ethical issues in nursing.

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Legal and Ethical Issues in Nursing Topics and Examples

Picot questions examples on legal and ethical issues in nursing.

• In nursing practice (P), how does adherence to the ANA Code of Ethics (I) compared to non-adherence (C) affect patient trust and satisfaction (O) within six months (T)?
• In end-of-life care (P), what is the impact of advanced directives (I) compared to no advanced directives (C) on decision-making and quality of life in terminally ill patients (O) over one year (T)?
• In psychiatric nursing (P), how does the use of physical restraints (I) compared to alternative de-escalation techniques (C) influence patient safety and mental well-being (O) within 24 hours (T)?
• In the neonatal intensive care unit (P), what is the effect of parental presence during invasive procedures (I) compared to non-presence (C) on parental stress and infant pain management (O) during hospitalization (T)?
• In emergency nursing (P), how does the implementation of triage protocols for patients with non-life-threatening conditions (I) compared to no triage protocols (C) affect patient waiting times and satisfaction (O) within one month (T)?
• In critical care nursing (P), what is the impact of do-not-resuscitate (DNR) orders (I) compared to full-code orders (C) on patient and family perceptions of end-of-life care (O) during the hospital stay (T)?
• In nursing education (P), how does the incorporation of ethics modules (I) compared to traditional education (C) influence students’ ethical decision-making and moral reasoning (O) over one semester (T)?
• In community health nursing (P), what is the effect of mandatory reporting of child abuse (I) compared to no mandatory reporting (C) on child safety and well-being (O) within one year (T)?
• In maternal-child nursing (P), how does routine testing for substance use during pregnancy (I) compared to no routine testing (C) affect neonatal outcomes and maternal engagement in treatment (O) at birth (T)?
• In nursing leadership (P), what is the impact of ethical leadership practices (I) compared to unethical leadership (C) on staff morale and job satisfaction (O) over six months (T)?

You can also check out PICOT Questions Examples on Health Disparities and Social Determinants of Health

Evidence Based Practice (EBP) Project Ideas Legal and Ethical Issues in Nursing 

• Create an ethics training module to enhance nursing staff’s understanding and application of ethical principles in their practice.
• Develop and implement educational programs for patients and families to promote understanding and completion of advance directives.
• Develop and implement de-escalation techniques training for psychiatric nursing staff, reducing the use of physical restraints.
• Establish protocols and practices that encourage parental presence during invasive procedures in neonatal intensive care units.
• Develop and implement triage protocols for patients with non-life-threatening conditions to enhance patient satisfaction and decrease waiting times in the emergency department.
• Investigate the perceptions of patients and families regarding the use of do-not-resuscitate (DNR) orders in critical care settings.
• Develop ethics modules and integrate them into nursing education programs to enhance students’ ethical decision-making skills.
• Evaluate the effectiveness of mandatory reporting of child abuse in community health nursing to ensure child safety and well-being.
• Implement a protocol for routine testing for substance use during pregnancy and assess its impact on neonatal outcomes and maternal engagement in treatment.
• Create leadership development programs for nursing leaders to enhance ethical leadership practices, improving staff morale and job satisfaction.
• Enhance informed consent procedures to ensure that patients fully understand the implications of medical interventions and treatment options.
• Implement communication training for nurses to foster effective and empathetic communication with patients, particularly in sensitive situations.
• Develop and provide cultural competency training for nursing staff to ensure they can provide culturally sensitive care.
• Implement strategies and protocols to reduce medication errors in nursing practice, focusing on medication administration and documentation.
• Establish rigorous protocols to maintain patient privacy and confidentiality in nursing practice and healthcare settings.
• Develop communication strategies and training programs for healthcare providers to improve conversations about end-of-life care with patients and families.
• Implement policies and training programs to promote inclusive care for LGBTQ+ patients and address their unique healthcare needs.
• Develop policies and procedures to protect nurses who report unethical or unsafe practices, fostering a culture of safety and accountability.
• Investigate and establish ethical guidelines and legal regulations for telehealth practice in nursing.
• Develop education initiatives for healthcare providers to ensure they can effectively educate and respect patients who choose informed refusal of medical treatments.

Nursing Capstone Project Ideas on Legal and Ethical Issues in Nursing 

• Ethical Decision-Making in Nursing Practice.
• Enhancing Staff Morale and Job Satisfaction through Ethical Leadership Practices in Nursing.
• Advance Directives Education for Patients and Families to Promote Autonomy in Healthcare Choices.
• Mandatory Reporting of Child Abuse to Ensure Child Safety and Well-Being in the Community.
• De-Escalation Techniques in Psychiatric Nursing to Reduce Physical Restraint Use.
• Enhancing Family-Centered Care in the NICU.
• Optimizing Triage Protocols in Emergency Nursing to Reduce Wait Times and Enhance Patient Satisfaction.
• Understanding DNR Orders in Critical Care from a Patient and Family Perspective.
• Integrating Ethics Modules into Nursing Education to Foster Ethical Competence in Future Nurses.
• Implementing Substance Use Testing in Maternal Care to Promote Neonatal and Maternal Health.
• Ensuring Patient Autonomy in Medical Decision-Making through Informed Consent Procedures.
• Improving Patient Understanding and Satisfaction with Effective Nurse-Patient Communication.
• Providing Culturally Sensitive Care through Cultural Competency Training for Nursing Staff.
• Reducing Errors in Medication Administration through Medication Safety Initiatives.
• Ensuring Patient Trust by Upholding Privacy and Confidentiality in Nursing Practice.
• Enhancing Compassionate Conversations in End-of-Life Care Communication.
• Promoting Health Equity through Inclusive Care for LGBTQ+ Patients.
• Fostering a Culture of Safety and Accountability with Nurse Whistleblower Protection.
• Ensuring Ethical Telehealth Practice through Telehealth Ethics and Regulations.
• Educating Healthcare Providers on Respecting Informed Refusal and Patient Autonomy.

You can also check out Capstone Project Ideas on Healthcare Quality Improvement

Nursing Research Paper Topics on Legal and Ethical Issues in Nursing

• Exploring the Influence of Adherence to the ANA Code of Ethics on Patient Trust and Satisfaction.
• Analyzing Advanced Directives and End-of-Life Decision-Making Over a Year.
• Evaluating De-Escalation Techniques to Reduce Physical Restraint Use in Psychiatric Nursing.
• Assessing Stress and Pain Management in Neonatal Care with Parental Presence during Invasive Procedures.
• A Comparative Study of Patient Satisfaction and Waiting Times in Emergency Nursing Triage Protocols.
• Investigating Do-Not-Resuscitate Orders in Critical Care from a Patient and Family Perspective.
• The Impact of Ethics Modules on Nursing Students’ Decision-Making in Ethical Education.
• Ensuring Child Safety and Well-Being through Mandatory Reporting of Child Abuse in Community Health.
• Examining the Effects of Routine Substance Use Testing in Maternal Care on Neonatal Outcomes and Maternal Engagement.
• A Longitudinal Study on Staff Morale and Job Satisfaction in Ethical Leadership Practices in Nursing.
• Comparing Informed Consent Procedures to Analyze Patient Understanding and Autonomy.
• Strategies for Effective Nurse-Patient Communication to Improve Patient Understanding and Satisfaction.
• Assessing the Impact of Cultural Competency Training on Patient Satisfaction in Cultural Competency in Nursing.
• Reducing Medication Errors in Healthcare with Medication Safety in Nursing Practice.
• Maintaining Patient Trust in the Digital Age through Privacy and Confidentiality in Nursing Practice.
• Compassionate Conversation Strategies in End-of-Life Care Communication in Healthcare.
• Promoting Health Equity and Addressing Unique Healthcare Needs through Inclusive Care for LGBTQ+ Patients.
• Fostering a Culture of Safety and Accountability in Healthcare with Nurse Whistleblower Protection.
• Establishing Ethical Guidelines for Telehealth Practice in Telehealth Ethics and Regulations.
• Educating Healthcare Providers on Patient Autonomy and Respecting Informed Refusal.

Nursing Research Questions Examples on Legal and Ethical Issues in Nursing

• How does adherence to the ANA Code of Ethics affect patient trust and satisfaction in nursing practice?
• What is the impact of advanced directives on end-of-life decision-making and patient quality of life?
• Can de-escalation techniques effectively reduce the use of physical restraints in psychiatric nursing and enhance patient safety and mental well-being?
• How does parental presence during invasive procedures in neonatal care influence parental stress and infant pain management?
• What are the effects of implementing triage protocols in emergency nursing on patient waiting times and satisfaction?
• How do do-not-resuscitate (DNR) orders impact patient and family perceptions of end-of-life care in critical care settings?
• Can the integration of ethics modules into nursing education enhance students’ ethical decision-making and moral reasoning?
• Does mandatory reporting of child abuse effectively ensure child safety and well-being in the community?
• What is the effect of routine testing for substance use during pregnancy on neonatal outcomes and maternal engagement in treatment?
• How do ethical leadership practices in nursing influence staff morale and job satisfaction?
• What are the impacts of enhancing informed consent procedures on patient understanding and autonomy in medical decision-making?
• Can improved nurse-patient communication lead to better patient understanding and satisfaction in nursing practice?
• How does cultural competency training for nursing staff affect patient satisfaction and the provision of culturally sensitive care?
• What strategies and protocols can effectively reduce medication errors in nursing practice, specifically in medication administration and documentation?
• How can rigorous protocols be established to maintain patient privacy and confidentiality in nursing practice and healthcare settings?
• How can healthcare providers be trained to improve communication and conduct compassionate conversations about end-of-life care with patients and families?
• What policies and training programs can effectively promote inclusive care for LGBTQ+ patients and address their unique healthcare needs?
• What policies and procedures can protect nurses who report unethical or unsafe practices, fostering a culture of safety and accountability in healthcare?
• What ethical guidelines and legal regulations should be established for telehealth practice in nursing to ensure ethical telehealth services?
• What educational initiatives can effectively educate healthcare providers on respecting informed refusal, ensuring patient autonomy and respect for their choices?

You can also check out Nursing Research Paper Topics on Interprofessional Collaboration in Healthcare

Nursing Essay Topic Ideas on Legal and Ethical Issues in Nursing 

• Adherence to the ANA Code of Ethics in Nursing Practice makes an Ethical Nurse.
• Empowering Patients in End-of-Life Decision-Making through Advance Directives.
• Exploring De-Escalation Techniques in Psychiatric Nursing.
• Fostering Family-Centered Care by Allowing Parental Presence in Neonatal Care.
• Enhancing the Patient Experience with Triage Protocols in Emergency Nursing.
• A Complex Perspective of Do-Not-Resuscitate Orders on End-of-Life Care.
• The Role of Ethics Modules in Nursing Education.
• Mandatory Reporting of Child Abuse in Ensuring Child Safety.
• Improving Neonatal Outcomes and Maternal Engagement.
• Staff Morale and Job Satisfaction as Key to Ethical Leadership in Nursing.
• Empowering Patient Autonomy through Informed Consent in Healthcare.
• Effective Nurse-Patient Communication.
• Providing Culturally Sensitive Care in Cultural Competency in Nursing.
• Reducing Errors and Ensuring Patient Safety with Medication Safety in Nursing.
• Privacy and Confidentiality in Nursing Practice.
• Strategies for Healthcare Providers in Compassionate End-of-Life Care Conversations.
• Addressing Healthcare Disparities with Inclusive Care for LGBTQ+ Patients.
• Promoting a Culture of Safety and Accountability through Nurse Whistleblowers.
• Navigating the Future of Nursing Practice with Telehealth Ethics and Regulations.
• The Intersection of Autonomy and Patient Choices.
• The Legal and Ethical Dilemma in Assisted Suicide in Nursing Practice.
• Navigating Patients’ Rights and Legal Responsibilities in Healthcare.
• The Impact of Healthcare Policies on Ethical Nursing Practice.
• Balancing Privacy and Patient Safety.
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Legal and Ethical Issues in Nursing Essay Examples

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Navigating legal and ethical issues in nursing is an indispensable aspect of the profession. Nurses must not only provide exceptional patient care but also adhere to strict ethical standards and legal guidelines. These resources are designed to assist nursing students, educators, and practitioners in addressing and resolving complex ethical dilemmas and legal challenges. The capstone project ideas, PICOT questions examples, evidence-based practice project ideas, research paper topics, and research questions in this article are valuable resources for nursing students and professionals seeking dedicated to the critical domain of legal and ethical issues in nursing. 

1. What are the 7 nursing ethics?

There are many ethical principles that guide nursing practice; foundational ethical principles include respect for autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity (tell the truth).

2. What are the 10 ethics in nursing?

The 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

3. What are the 9 code of ethics for nurses?

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity. 

4. What are the top 5 ethical issues in healthcare?

Do-not-resuscitate orders, doctor and patient confidentiality, malpractice and negligence, access to care, physician-assisted suicide.

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• Ethical Competence in Nursing Practice: Competencies, Skills, Decision-Making by Anne J. Davis
• Legal and Ethical Essentials of Health Care Administration by George D. Pozgar
• Ethical Dilemmas and Nursing Practice by Anne J. Davis and Mary Rockwood Lane

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A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study

1 Department of Nursing, Chung-Ang University, Seoul 06974, Korea; rk.ca.uac@83sseno

Sungkyoung Choi

2 Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 06974, Korea; [email protected]

Sujeong Kim

3 Department of Family Health Nursing, College of Nursing, The Catholic University of Korea, Seoul 06974, Korea; rk.ca.cilohtac@usmik

Nurses deal with ethical decisions as they protect patients’ rights, but a consensus on effective approaches to nursing ethics education is lacking. The “four topics” method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students’ perspectives on and experiences of a case-centered approach to nursing ethics education using the four topics method. This qualitative study consisted of two phases. First, we delivered case-centered nursing ethics education sessions to nursing students using the four topics method. Then, we conducted two focus group discussions that explored students’ perspectives on and experiences of nursing ethics education. Data were analyzed using conventional content analysis. Four themes were identified: the importance of ethics education as perceived by nursing students, problems in current nursing ethics education, the experience of case-centered nursing ethics education using the four topics approach, and suggestions for improving nursing ethics education. The case-centered approach using the four topics method is effective in enhancing nursing students’ nursing ethics ability. It is crucial to understand that nursing students would like to set up their own ethical standards and philosophy. Continuous efforts to encourage students’ participation and to provide ethical reflection opportunities during clinical practice are needed to better connect theory with clinical practice.

1. Introduction

Nurses have a responsibility as advocates for patients’ rights; as a consequence, nurses confront ethical quandaries daily [ 1 , 2 ]. As the healthcare system becomes more complex and demands for high-quality nursing care increase, nurses struggle to solve multi-faceted ethical challenges [ 3 , 4 , 5 ]. Nurses with low ethical sensitivity have difficulties making moral decisions in clinical settings [ 6 ], and thus, find it hard to advocate for patients [ 7 , 8 ]. More than half of U.S. nurses experience ethical dilemmas and moral distress several times a month [ 9 ], and 48% of nurses have considered leaving their position due to moral distress in a national survey conducted in New Zealand [ 10 ]. Common ethical dilemmas for nurses, for instance, includes the inability to provide the best quality care to patients due to limited resources, reduced costs, and unsafe staffing levels; carrying out physicians’ orders that a nurse considers professionally unnecessary; and the use of life support technologies to inappropriately extend life in critical care units [ 9 , 11 , 12 ]. The moral distress was found associated with low job satisfaction, burnout, and high turnover rates for nurses [ 1 , 13 , 14 , 15 ], thereby hindering them from providing high-quality patient care [ 16 ]. Although ethical dilemmas can create negative outcomes, ethical issues in nursing practice have received little attention.

Moral distress among nurses can decrease through training [ 17 , 18 , 19 ]. Education and training programs may be provided to enhance nurses’ ethical sensitivity and improve their understanding of decision-making processes in conflict situations [ 13 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Ethics education can enhance ethical sensitivity and awareness [ 21 , 27 , 28 ] as well as the ability to analyze ethical issues critically [ 29 ]. In particular, studies have indicated that providing ethics education to prepare nursing students is important before the newly graduated nurses enter clinical environments where ethical conflicts commonly occur [ 30 ]. Although the importance of nursing ethics education has been recognized, there is still a lack of understanding regarding it [ 31 , 32 ]. Courses related to ethics in the nursing education curriculum are insufficient [ 33 ], and there is a lack of educational materials [ 15 ] for nursing students. Further, there is a dearth of information regarding effective teaching methodologies to improve moral decision-making skills for nursing students [ 34 , 35 , 36 ].

Finding and applying adequate education methods to ethics regarding healthcare is a demanding task for nurse educators [ 37 ]. The four topics method, a structured framework that facilitates systematic identification of clinical ethics problems in four broad topics (medical indications, patient preferences, quality of life, and contextual features), is a way to assist ethical decision-making in healthcare settings [ 38 ]. Several studies found the method to be a useful tool in making ethical decisions in clinical settings [ 39 , 40 , 41 ]. The four topics method breaks away from the authoritative decision-making process, leading to higher-level decisions [ 42 ]; furthermore, it provides a systematic way of thinking from an ethical perspective [ 40 ]. Nurses’ better understanding of the decision-making process using the four topics method will enable them to consider a patient’s case from various ethical perspectives. Although the four topics method has been used in medical education studies, there is little information about its effectiveness in nursing ethics education. Therefore, it is necessary to evaluate this method and determine the requirements that need to be revised when applying this method to the nursing field. The purpose of this study was to describe nursing students’ perspectives on and experiences of a case-centered approach to nursing ethics using the four topics method.

2. Materials and Methods

2.1. study design.

This is a qualitative study that aimed to explore nursing students’ experiences of ethics education using the four topics method, and we conducted it in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 43 ]. The research team consisted of four researchers: two with a Ph.D. in Nursing and two with a Ph.D. in Public Health focusing on medical law and bioethics. All researchers had experience in qualitative research. This study consisted of two phases. First, we delivered four nursing ethics educational sessions to nursing students using the four topics method. Then, we conducted focus group discussions (FGD) that explored students’ perspectives of nursing ethics education.

2.2. Participants

The participants included university seniors who (1) were in their fourth year of their Bachelor of Science in nursing (BSN) program, (2) attended university in Seoul and Gyeonggi, and (3) understood the purpose of the study and agreed to participate in the study. We determined that at least one year of clinical practice experience in various clinical settings would be needed to analyze the cases provided in educational sessions. In Korea, nursing students starts their clinical practice in their third year of the BSN program; thus, we only included seniors, who are in their fourth year as participants. The exclusion criteria for the FGD were students who dropped out or were absent from the education program or did not participate in the presentation. Using convenience sampling through an online advertisement and snowball sampling, 10 nursing students from three universities in Seoul, South Korea, were recruited for this study. In July 2019, we used Facebook to recruit participants, who were asked to recommend colleagues interested in participating. All nursing students who participated in educational sessions agreed to participate in FGDs, and no one dropped out.

2.3. Educational Sessions

The four educational sessions lasted two hours each and took place for the 10 participating nursing students between 6 August and 21 August 2019. The course instructor was a researcher with a Ph.D. in medical law and bioethics, and the instructor did not attend the same school as the study participants. The main topics of each educational session are presented in Table 1 . In the first two educational sessions, the instructor delivers lectures including ethical principles, ethical decision-making processes, issues regarding nursing ethics, and the case analysis method using four topic method. After the two lectures, students had about a week to prepare a team presentation. Students were divided into two teams (each team consisted of five students) and each team selected one case out of two possible cases: Case 1 was about an artificial abortion and Case 2 involved terminating life support for a person with brain death. Nursing students analyzed the cases themselves using the four topics method including a set of specific questions that helped identify various conditions and linked them to underlying ethical principles: beneficence, non-maleficence, autonomy, and justice [ 38 , 41 ]. In the remaining two educational sessions, students presented their activities and discussed their opinion. The presentation consisted of the results based on an analysis of cases, determining the legal and ethical issues involved, seeking alternatives and evaluating each alternative, and selecting alternatives and providing strategies for implementation. Students were encouraged to discuss as many alternatives as possible without judgment or criticism.

Description of the educational sessions.

2.4. Data Collection

Data were collected in August 2019. Two FGDs (each team consisting of five participants) were conducted in a private meeting room. The moderator, who was educated and experienced in doctoral-level qualitative research, used a semi-structured interview guideline developed for this study. The moderator used open-ended questions and targeted probes to guide the FGD while allowing participants to talk freely about their experiences related to nursing ethics education. Interview questions were as follows: (1) Experiences regarding ethics in clinical practice: “Have you experienced any ethical situations or problems in clinical practice?” (2) Experiences about the current nursing ethics education: “What form should nursing ethics education have?”, and “Have you ever felt that nursing ethics education was insufficient while attending university or participating in clinical practice sessions? Please tell me in detail the reasons.” (3) Questions regarding a case-centered approach using the four topics: “Please tell me your experiences in this type of education, in particular using a case-centered approach utilizing the four topics,” “What is your most beneficial application of the four topics to analyze the case?”, “What was your most difficult application of the four topics to analyze the case?”, “What is different about this educational sessions compared to previous nursing ethics education?” (4) Questions regarding improvements in nursing ethics education: “What strategies could be implemented in nursing ethics education that would provide a better learning experience for nursing students?” Participants were encouraged to describe specific experiences from previous education and from the intervention sessions. The FGDs were conducted in Korean. The first FGD lasted two hours and the second one lasted two hours and 10 min. All FGDs were audio-recorded and the first author reviewed the transcripts against the audio files for accuracy.

2.5. Data Analysis and Trustworthiness

FGDs were transcribed verbatim in Korean, and the data were analyzed using conventional content analysis. Interview transcripts and field notes were used for data analysis. The first author extracted and coded significant words and phrases. Each student’s response in the interviews was coded appropriately. For example, the statement “I know all of the so-called ethical theories, but in reality, I don’t know how I can use those things in clinical settings” was coded to “did not know how to apply the ethical theories and principles to clinical situation.” The codes were then grouped together as subthemes and the subthemes were further grouped into overarching themes by two researchers. Subsequently, the research team reexamined the codes and engaged in multiple discussions to verify the identified subthemes and themes. We retained the words used by participants to maintain the original meanings. The quotes were selected by the research team during meetings.

To assure trustworthiness, member checking and external auditing were performed [ 44 ]. The final categories were reviewed by two nursing students who had participated in the focus group; to establish credibility (or internal consistency) of the study findings, they were asked whether their intended meaning was maintained, and they confirmed that it had been. Additionally, the study findings were reviewed by one nursing student who met the inclusion criteria but did not participate in this study, and the student answered that she mostly agreed with the study findings and had similar experiences. The finalized coding book and study findings was peer-reviewed by an external researcher who has experience in qualitative research but was not involved in the research process, to assess the accuracy (or validity) and to evaluate whether the interpretations and conclusions were supported by the study data.

2.6. Ethical Considerations

The study was approved by the institutional review board of Chung-Ang University (No. 1041078-201906-HRSB-192-01). Participants were informed about the study’s purpose and methods, after which they provided written informed consent. They were also informed that their participation was voluntary, and the data collected would remain confidential. Participants had the right to withdraw from the study at any time without penalty.

3.1. General Characteristics of the Participants

A summary of participants’ demographic characteristics is provided in Table 2 . Of the 10 nursing students who participated in the study, 7 were female, with a mean age of 23.0 years (±1.41). Most (8 out of 10) participants had taken ethics courses previously and identified themselves as religious.

Participants’ demographic characteristics.

Note. G = group; P = participant.

3.2. Results from Focus Group Discussions

Content analysis of the data identified four main identified themes and 13 subthemes ( Table 3 ). The four themes included: (1) the importance of ethics education as perceived by nursing students; (2) problems in current nursing ethics education; 3) the experience of case-centered nursing ethics education using the four topics method; and (4) suggestions to improve nursing ethics education.

Major themes and subthemes.

3.2.1. Theme 1: Importance of Ethics Education as Perceived by Nursing Students

Participants mentioned the importance of acquiring ethical knowledge before starting clinical practice. Without ethical knowledge, students would not even recognize ethical issues in clinical settings, let alone have the basic knowledge to judge ethical issues. One participant said, “I know what is unethical. Behaviors can vary but there seems to be a huge difference between when I know and when I don’t” (G1, P1). Most participants also noted that they encountered various ethical dilemmas and experienced moral distress during clinical practice, which created confusion regarding values. Participants resolved to make efforts to ensure that unethical judgments were not routine when they became nurses. Participants agreed that ethical awareness is critical to growth as a nursing professional. They wanted to learn about nursing ethics through discussion with others; based on their learning, they would like to create their own criteria of ethical judgments and nursing philosophy. One student said, “As specialized professionals, we have to have our own ethical principles to establish professional values. We are nursing professionals who care for people’s lives” (G2, P1).

3.2.2. Theme 2: Problems in Current Nursing Ethics Education

Participants acknowledged that nursing ethics education was neglected in comparison with other subjects in the curriculum; few nursing ethics courses were offered for credit. A participant said: “credits. […] are concentrated on the subjects that can be considered as major” (G1, P1). Further, when ethics education was available, courses were structured with fixed answers, which led to difficulty in developing critical thinking. One student said, “[…] correct answers? […] as if there are fixed answers. [For ethics], it seems that such an educational method cannot cultivate students’ ability to think” (G1, P3). Given the high student-to-teacher ratio, the instructor could not facilitate all students’ discussions, and participants felt that they lacked the opportunity to think for themselves because they had to focus on passing the course. They mentioned that course contents were not memorable because students did not think and learn for themselves. Participants pointed out the lack of student motivation and voluntary participation, which made it difficult for interested students to share their thoughts in group discussion. Participants also noted that they did not know how to apply the ethical theories and principles learned in the classroom to clinical settings. Students had difficulty in recognizing and judging ethical issues in clinical practice, and they perceived a gap between theory and practice.

3.2.3. Theme 3: Case-Centered Nursing Ethics Education Using the Four Topics Method

Participants acknowledged that they reviewed cases more objectively by using the four topics method. A student said that “(By using the four-topics chart) we could discuss issues within a certain framework. Summarizing and organizing analysis results were somewhat helpful” (G2, P5). However, participants mentioned that some of the questions presented in the four topics chart were difficult to apply to the given cases. Students agreed that analyzing ethical cases using the four topics method was useful because it made them think in new ways: “I found raising various questions and giving answers according to the four-topics chart to be good practice because by doing so, we could answer questions that we had never considered” (G2, P4). Through the case analysis conducted in this study, participants had an opportunity to consider others’ perspectives and ethical values. One participant said, “I believe it is good because we can know how much value each person puts in the four-topics chart” (G1, P2). Applying ethical theory and principles to cases and analyzing them using the four topics method helped them identify the values they personally find important.

3.2.4. Theme 4: Suggestions to Improve Nursing Ethics Education

Participants suggested that small group education would encourage active participation, especially in a Korean cultural setting where people dislike standing out by asking questions or giving individual opinions. Participants said that the case-centered approach was helpful and suggested using cases with various ethical topics for learning several points of view. A student mentioned, “If they were real cases, I could focus better, and I could have opportunities to think about them. I wish there are some things we can remember and feel more closely” (G2, P3). They added that simple-to-complex cases need to be appropriately distributed throughout ethics education. Participants emphasized that they need opportunities to learn about ethical issues during clinical practice by sharing experiences and discussing how nurses should approach and resolve ethical problems. Through this process, students want the opportunity to think and exchange opinions on their own. Participants also stated that different evaluation methods should be used for nursing ethics education; that cultivating students’ critical thinking skills is essential; and that, particularly, students’ attitudes and participation in discussions should be included as evaluation items. One participant said, “If possible, rather than examining the students’ answers, the nursing ethics course should evaluate the level of participation in discussion and the opinions the student expresses, as well as how deeply the student participates in the course of drawing such answers and whether the student has the ability to use this tool properly” (G1, P4).

4. Discussion

In this qualitative study, we explored nursing students’ perspectives and experiences of ethics education to better understand current educational approaches and to present strategies for improvement. Consistent with a study by Escolar-Chua [ 26 ], our participants indicated that they encountered nursing ethics issues and moral distress during their clinical practice. Such experiences lead nursing students to imagine themselves as nurses in the future, recognize moral distress, and think about how to deal with it. Given that negative experiences in clinical practice can be impediments to staying in the nursing profession, nursing ethics education and trainings should be provided to nursing students to enhance their ethical competence, which is needed to surmount moral distress [ 26 ]. In particular, professional ethics are fundamental to the nursing profession [ 32 ], and obtaining professional competence is the most important factor in the formation of professional ethics and professionalism in students [ 25 ]. Notably, participants recognized nursing ethics education as a crucial component of professionalism and would like to create their own ethics standards and philosophy of nursing through nursing ethics education. Therefore, nurse educators need to consider providing opportunities to their nursing students for learning professional ethics and professionalism during their ethics courses.

Some issues related to current nursing ethics education need to be improved; nursing students struggled to develop critical thinking skills because the ethics education they had previously focused on lectures and did not provide enough opportunity to think for themselves and exchange their opinions with other students. In addition, nursing students had difficulties in applying theory learned in the classroom to clinical practice. To address the limitations of current nursing ethics education and to enhance students’ ability to appropriately respond to ethical concerns, it is important to develop both theory education and clinical ethics education around the ethical concerns that students may have [ 23 ]. For instance, learning activities analyzing ethical issues that students may observe or experience during their clinical practice could provide them with opportunities to apply their knowledge and skills learned from classroom education to clinical settings. Consequently, these efforts connecting theory to practice could help nursing students make ethical decisions when they enter a clinical environment after graduation. Moreover, discussion of actual situations in a systematic way can allow nursing students to realize their values and resolve ethical issues in practice [ 26 , 29 ]. Therefore, further work is needed to develop various ethical cases, ranging from simple to very complex, based on actual nurses’ experiences. In ethics education, the role and function of teachers can contribute to the development of professional ethics in students [ 25 ]. In Choe et al.’s study [ 34 ] on improving bioethics education, a priority was the enhancement of quality and competence in educators. Teachers should not enforce their own ethical standards and philosophy on nursing students, but should try to develop their competence through continuous education and training.

Analyzing ethical cases using the four topics method was determined to be useful by nursing students because the method guides students to analyze cases and provides direction for discussion. This finding is consistent with previous studies that established the four topics chart as a useful checklist [ 39 ]. In addition, the four topics chart made participants think in new ways. Participants mentioned that after internalizing the concepts of the four topics approach, they would be able to apply those perspectives to solve ethical issues in their work as nurses. However, nurse educators should not simply present the four topics chart as action guidelines or case analysis checklists [ 45 ], and when applying the four topics chart to nursing ethics education, some of the questions it contains should be revised considering the nursing context.

The findings of our study indicate that small group education, the case-centered approach, a connection between classroom education and clinical practice, and different evaluation methods could improve current nursing ethics education. Previous studies have also reported the use of a case-centered approach and small group discussion as the most effective ways to teach an ethics course [ 21 , 46 ]. For ethics development, interpersonal interactions with peers through discussion were highly effective [ 25 ]. However, there are some difficulties in small group education, such as managing the quality of discussion in small groups within a large class [ 21 ] and lack of student participation, as our participants also emphasized. Therefore, effective teaching methods for a large class [ 21 ] and strategies to motivate students’ participation should be developed to better implement the case-centered approach.

This is the first study to explore students’ experiences and perception of current nursing ethics education and case-centered nursing ethics education using the four topics method; however, it has some limitations. First, there were few participants, and they came from a limited geographic area; therefore, caution is needed in generalizing or interpreting results of this study to other nursing students. Further studies are needed to expand the target population. Second, researchers’ perceptions and intentions may result in an interpretation bias regarding participants’ responses. As mentioned in the methods section, we tried to assure trustworthiness of the study by member check, and external auditing. Third, this study examined the consequence of using the four topics method using only a qualitative method based on students’ perspectives and experiences. Therefore, future research should conduct a well-designed experimental study to identify the effects of the modified four-topic method for nursing ethics education based on our study results. Despite these limitations, this study provides useful information for the improvement of nursing ethics education.

5. Conclusions

Nursing students should be prepared to solve ethical issues before working in clinical settings. The study shows that a case-centered approach using the four topics method could be useful for nursing students as the structured framework of this method helps students to understand and analyze cases; this method would be helpful to train them to apply theory to specific situation. However, further research using an experimental study design that applies the modified four-topic method to the nursing field is needed to confirm our findings. Continuous efforts such as encouraging students’ active participation, using small group education, and providing ethical reflection opportunities during clinical practice will be needed to implement effective nursing ethics education that can connect the classroom and the clinic.

Acknowledgments

The authors would like to thank all participating nursing students who took the time to complete interviews and made this study possible.

Author Contributions

Conceptualization, W.L. and A.M.; methodology, W.L.; software, W.L.; validation, W.L. and A.M.; formal analysis, W.L. and A.M.; investigation, W.L. and A.M.; resources, W.L.; data curation, W.L.; writing—original draft preparation, W.L., S.C., S.K., & A.M.; writing—review and editing, W.L., S.C., S.K., and A.M.; visualization, A.M.; supervision, W.L.; project administration, W.L.; funding acquisition, W.L and A.M. All authors have read and agreed to the published version of the manuscript.

This research was supported by the Chung-Ang University Research Grants in 2019 and the Korea National Institute for Bioethics Policy (KoNIBP) awarded by the 2019 Bioethics Policy Research Program.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Ethical and Practical Failings of the Death Penalty

This essay about the death penalty argues that it is fundamentally wrong due to ethical, practical, and systemic issues. It highlights the violation of human rights, the risk of wrongful executions, and the failure of the death penalty to deter crime effectively. Additionally, it points out the significant economic burden it imposes on the judicial system and the deep-seated biases and inequalities in its application. The psychological impact on those involved in its administration is also discussed. The essay concludes that abolishing the death penalty in favor of more humane and effective approaches to justice would uphold the dignity of human life and contribute to a more equitable society.

How it works

One of the most contentious issues in the fields of criminal justice and human rights is still the death penalty. Many contemporary nations are debating the morality, effectiveness, and ramifications of the death penalty despite its historical roots. There are many reasons why the death sentence is inherently immoral, ranging from moral conundrums to pragmatic issues.

Human rights are inherently violated by the death sentence, which is one of the strongest grounds against it. The idea that each and every person has the right to life and dignity is the foundation of human rights.

By its inherent nature, the death penalty completely violates human rights. The state-approved, irreversible act of terminating a life creates a risky precedent that diminishes the value of human life. Furthermore, there is a serious possibility of erroneous executions. Since new information is frequently discovered too late, there is not always a guarantee that someone on death row will remain acquitted. This is evidence that legal systems are imperfect. Due to the death penalty’s irreversible nature, any errors made after an execution made cannot be corrected, leading to an unjust and tragic loss of life.

In addition to the moral arguments, the death penalty fails to serve as an effective deterrent to crime. Numerous studies have shown that the death penalty does not significantly reduce crime rates compared to life imprisonment. The assumption that harsher punishments lead to lower crime rates oversimplifies the complex social, economic, and psychological factors that drive criminal behavior. Instead, a more rehabilitative approach to justice, focusing on prevention, education, and social support, has proven to be more effective in reducing crime in the long term. By addressing the root causes of criminal behavior, society can foster an environment where crime is less likely to occur, rather than relying on the fear of capital punishment.

The economic burden of the death penalty also raises significant concerns. Contrary to popular belief, the process of prosecuting and executing a death sentence is far more costly than sentencing an individual to life imprisonment without parole. The extensive legal proceedings required to ensure a fair trial, including numerous appeals and lengthy trials, place a substantial financial strain on the judicial system. These funds could be better allocated to crime prevention programs, victim support services, and other areas that contribute to the overall well-being of society. By diverting resources away from the costly death penalty process, communities can invest in initiatives that have a more profound and positive impact on public safety and justice.

Furthermore, the application of the death penalty often reveals deep-seated biases and inequalities within the judicial system. Studies have shown that factors such as race, socioeconomic status, and geography can significantly influence who is sentenced to death. Minority groups and those from disadvantaged backgrounds are disproportionately represented on death row, highlighting systemic injustices. This disparity not only undermines the principle of equal justice under the law but also perpetuates cycles of discrimination and inequality. A justice system that claims to be fair and impartial cannot condone a practice that so blatantly reflects and reinforces social biases.

The psychological impact of the death penalty on those involved in its administration also warrants attention. Executioners, prison staff, and even judges and jurors can experience severe emotional and psychological distress as a result of their participation in the process. The act of taking a life, even in a legal context, can lead to long-term mental health issues and moral injury. These often-overlooked consequences further illustrate the pervasive harm caused by capital punishment, extending beyond the individuals directly affected by its implementation.

In conclusion, the death penalty is an inadequate form of punishment in contemporary society due to a number of ethical, practical, and structural problems. It infringes upon fundamental human rights, is a poor deterrent to crime, causes heavy financial costs, and exacerbates social injustices. It also causes psychological damage to those who carry out its implementation. Society may respect human life and strive toward a more just and equitable system for all by doing away with the death penalty and concentrating on more compassionate and successful methods to justice.

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