Ethical decision-making.

Abstract

Even though nurses engage in ethical decision-making on a daily basis, few practical resources are available and little is known about how nurses resolve ethical dilemmas in the clinical setting. A descriptive clinical ethical decision-making model has been presented and factors influencing current ethical decision-making skills have been identified. What is known suggests that some nurses do not consider multiple options during ethical deliberations. This may be due to the fact that there is limited time available for ethical deliberations in the clinical setting. In addition, the nurse may be prevented from implementing the chosen option by a variety of yet unidentified and uncontrolled variables. Recommendations In order to increase the amount of time available for ethical deliberation, a pro-active approach must be developed toward ethical issues. Ethics rounds need to be integrated into traditional medical and nursing rounds as a means for identifying ethical issues. Research is needed to describe (1) the process nurses use to resolve ethical situations, (2) the variables influencing decision-making in the clinical setting, and (3) the problems nurses experience during ethical decision-making. The nurse's ability to identify several options may increase as more time is available for ethical decision-making. Traditionally, nurses have identified ethical dilemmas that imply two options. Nurses need to consider ethical issues, concerns, and situations in order to identify multiple options. Ethics discussions, inservice education, and consultations with ethicists would provide the opportunity to critique previously experienced ethical situations and enhance the nurses's decision-making skills for future situations.