Legal and ethical reasoning is challenging for many nurses because it may cross a difficult path towards moral distress, which may cause significant harm to nursing practice. It is essential that nurses consider the impact of moral distress and how it might influence their activities in the workplace environment. This requires an analysis of the problem or situation that has contributed to moral distress and how it might be managed in the workplace environment. Lack of compliance with the law may contribute to ethical consequences and moral distress that must be explored at the practice level so that nurses are able to receive support and guidance regarding these dilemmas to protect themselves.
It is not surprising that nurses who exhibit moral distress are vulnerable to these conditions, (Gallagher, 2011). At the same time, the concept of moral courage is worthy of discussion because it provides a framework for nurses to exercise sound and reasonable judgment that will impact their practice settings in different ways, as well as support the continued growth and expansion of nurses’ level of guidance and respect in managing situations in the workplace setting. For example, when breaches of confidentiality occur and nurses bear witness to these events, they are likely to face moral dilemmas as they attempt to make an ethically responsible decision. This issue is important because it reflects the challenges of addressing the importance of maintaining confidentiality in a manner that will impact the nursing staff, and instead of moving away from handling the situation, these circumstances may be helpful in learning lessons that will impact future ethical dilemmas (Pauly et.al, 2012).
When nurses are unable to place the desired amount of focus on a specific ethical dilemma such as confidentiality, moral distress is likely to occur; therefore, it is important to develop an understanding of why confidentiality was breached to begin with (Ulrich et.al, 2010). Nurses must be able to openly communicate regarding these issues so that they are able to come out of these situations with lessons learned (Ulrich et.al, 2010). When breaches of confidentiality occur, it is important to conduct an ethical dialogue as early as possible, whereby the nurse who is witness to the behavior is able to express her views in a safe and confidential environment and also obtain further guidance regarding how to proceed with a similar situation in the future (Ulrich et.al, 2010). It is the responsibility of nurses to address these problems as they arise and to not let them build up over long periods of time, particularly if there are legal risks involved (Ulrich et.al, 2010).
In general, nurses must have a safe environment in which to express their views regarding the situation and to address ethical consequences and broken policies. In these instances, nurses may be able to shift the culture towards a more ethically-friendly environment where decisions are made that have reasonable and responsible outcomes. Patient confidentiality must be protected at all times, and when a breach in trust is observed, this breach must be addressed in a timely manner in a safe environment where information may be shared without risk of consequences. If laws are broken, it is imperative that nurses are able to share what they know with the authorities or other leaders so that they are able to alleviate some of the moral distress that they might have. The ability to share information in this manner is enlightening and appropriate for nurses and patients.
Recommendations
In an effort to resolve the ethical dilemma in question, a number of recommendations are proposed that will enable nurses to contribute to the ethical discussion, to alleviate moral distress, and to recognize that narrative inquiry is an option available to discuss the dilemma in a confidential manner, perhaps through an interview that addresses the incident in greater detail to obtain the nurse’s account of the events that have taken place (Jackson et.al, 2011). A dialogue regarding the matter that is only available to those with direct knowledge of the situation so as to protect confidentiality might be helpful in enabling nurses to discuss their feelings regarding the dilemma and how their own level of moral distress has impacted their work and/or their perceptions of the situation and those involved in the behavior.
Addressing the serious nature of the matter before an ethics committee is also another option to explore the nature of the dilemma and its potential consequences. This committee is designed to make decisions regarding breaches of conduct and confidentiality that have led to broken policies and/or systems (Kinlaw, 2012). Targeted questions must be asked during the ethics committee session in order to make a decision that is in the best interest of the victims and other involved parties, and nursing input in a confidential manner is an essential contributor to this process (Kinlaw, 2012). The use of an ethics committee is also likely to be favorable because it enables the nurse to share an experience in a manner where trust is likely to occur and to achieve greater reflection on the situation and how it might have a lasting impact on nurses (Kinlaw, 2012). Nonetheless, expressing one’s views of the situation is important to the discovery of the truth so that the committee is able to make an informed and responsible decision regarding the matter.
Finally, an educational reminder or intervention might be suitable for the situation to promote a learning experience and an opportunity to ask questions regarding the appropriate protocol for sharing confidential information with the appropriate persons. This process requires an environment in which nurses feel comfortable so that they are able to alleviate moral distress and provide information regarding breaches of confidentiality that attempt to identify the facts of the case to make an informed decision.
- Gallagher, A. (2011). Moral distress and moral courage in everyday nursing practice. Online Journal of Issues in Nursing, 16(2).
- Jackson, D., Peters, K., Hutchinson, M., Edenborough, M., Luck, L., & Wilkes, L. (2011). Exploring confidentiality in the context of nurse whistle blowing: Issues for nurse managers. Journal of nursing management, 19(5), 655-663.
- Kinlaw, K. (2012). The healthcare ethics committee as educator. Guidance for Healthcare Ethics Committees, 155.
- Pauly, B. M., Varcoe, C., & Storch, J. (2012, March). Framing the issues: moral distress in health care. In Hec Forum (Vol. 24, No. 1, pp. 1-11). Springer Netherlands.
- Toren, O., & Wagner, N. (2010). Applying an ethical decision-making tool to a nurse management dilemma. Nursing ethics, 17(3), 393-402.
- Ulrich, C. M., Hamric, A. B., & Grady, C. (2010). Moral distress: A growing problem in the health professions?. The Hastings Center Report, 20-22.
