Running head: BENCHMARK – ETHICAL DECISION MAKING 1

Benchmark – Ethical Decision Making

Kiana Woods

Grand Canyon University: NSG-436

August 7, 2019
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Introduction

Regardless of the specialty, nurses may encounter difficult circumstances where they

question the ethicality and morality of how a situation is handled or of the interventions that they

are responsible to perform. More specifically, in an intensive care environment, nurses are often

faced with the various ethical dilemmas that may arise when caring for unconscious, heavily-

sedated, or intubated patients. Once a client’s airway, breathing, and circulation have been

declared stable, pain control is usually a top priority on the nurse’s to-do list. But, if a patient is

unable to report, rate, and explain something as subjective as their own pain, how should the

nurse address the need of providing pain-relief for this patient? During this assignment, the

following will be discussed: an analysis of the ethical dilemma, my personal stance on the issue,

appropriate ethical standards that could be applied to the dilemma, how nurse leaders could

navigate to ensure patient safety, relevant ethical decision models, and possible solutions to the

problem.

The Ethical Dilemma and My Stance

As said by the American Association of Critical-Care Nurses, “Many adult patients in the

ICU cannot self-report pain as a result of an altered level of consciousness, the administration of

sedative agents, and/or mechanical ventilation.” (AACN, 2014, para. 3). Because of these

barriers, the absence of self-reporting makes assessing and treating pain in critically ill patients

much more challenging. Considering these circumstances, a possible ethical dilemma may arise.

Being that nothing is more reliable than a patient’s report of their pain, without it, the nurse runs

the risk of either over-medicating or under-medicating their patient. If a nurse does not see a

change in the patient’s vitals or other physical cues that they may be experiencing pain, he/she

may assume that the patient does not need their “as needed” dose of pain medication. On the
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other hand, a nurse may assume that their patient is in more pain than they really are and

administer medications that are not necessarily needed. I believe that it is better to provide pain-

relief measures whether we are sure if patient is in pain or not. My belief is supported by

evidence found in an International Journal of Health Sciences study, where it is said that:

“Appropriate pain management has been shown to be associated with better overall patient

results, shorter length of hospitalization, and reduced cost of care.” (Avasrah, O’Neill,

Abdalrahim, Sutary, & Kharabsheh, 2014, para. 2).

Appropriate Ethical and Moral Standards

When assessing the nature of an ethical dilemma and when searching for a possible

solution, it is important to understand which ethical and moral standards are relevant to the

situation. Ethical principles such as, autonomy, beneficence, nonmaleficence, and justice should

be used to guide health care professionals when providing pain management for intubated

patients (Bernhofer, 2016). These core principles will encourage health care staff to consider the

patient’s right to choose, their duty to do good and avoid doing bad, as well as their

responsibility to be just and fair when planning pain-relief measures for the client. In addition,

the following principles stated in the American Nurses Association’s Code of Ethics for Nurses

can be applied to this ethical dilemma: acting to provide optimal care, considering the patient’s

best interests, and practicing with compassion (American Nurses Association, 2015).

How the Nurse Leader Could Navigate the Standards to Provide Safe Client Care

“Inadequate pain assessment and management have been associated with increased

morbidity and mortality rates within the critical care settings (Avasrah et al., 2014, para. 2). As a

leader in the health care environment, nurse leaders oversee processes, are responsible for

decision-making, and influence others through insight and effective communication (Arkansas
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State University Academic Partnerships, 2016). It is also their responsibility to decrease the

critically-ill patient’s risk of morbidity and mortality while promoting and providing patient

safety. In order to fulfill that duty, the nurse leader can encourage and provide the health care

facility with evidence-based research to support the use of adequate pain management measures.

Models, Skills, Standards, and Morals to Resolve the Dilemma

To resolve the dilemma, there are various decision models, skills, standards, and morals

that can be considered. Specifically, the DECIDE model, a decision-making model that is useful

for managerial and clinical situations, can be used (Huber, 2018, pg. 62). The acronym DECIDE,

stands for the following: D- define the problem, E-establish desirable criteria, C-consider all

alternatives, I-identify the best choice, D-develop and implement an action plan, E-evaluate

(Huber, 2018). When starting with step “D”, the problem can be defined by how the dilemma

can lead to the violation of the following ethical principles: autonomy, beneficence,

nonmaleficence, and justice. With this tool, we are provided an outline for finding a resolution

while incorporating any relevant moral and ethical standards that may be violated with the

present ethical dilemma.

A Possible Solution and How My Leadership Style Influenced My Decision-Making Process

A possible solution that can be utilized in the critical care setting is a standard pain-

management protocol where all intubated, highly sedated, or unconscious patients will receive a

minimum amount of pain medication. Additional pain medication can be given as needed to

patients who show signs of pain that are seen by various means of observation, tools, and

assessments. The use of the DECIDE model as well as influence from my leadership style, led

me to this possible resolution. According to “The Leadership Compass Self-Assessment”

completed in topics one and two, my leadership style includes traits like: being just, objective,
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analytical, and thorough. With that in mind, there is an understandable alignment between my

leadership style and my objective and just solution of providing all ICU patients with some sort

of pain relief.

When the task at hand conflicts with a nurse’s personal values and beliefs, it is likely that

the nurse will experience an ethical dilemma. Ethical dilemmas occur in all areas of the health

care field and effect every health care worker differently. With a specialty area like the intensive

care unit, nurses may experience ethically-questionable circumstances as they care for patients

with altered levels of consciousness. In this case, a question arises as to how the nurse should

provide pain-relief to the patient without violating any ethical or moral standards. By analyzing

the dilemma, reflecting on your own personal beliefs, reviewing relevant decision models,

ethical standards, and ways to promote patient safety, a solution can be reached.
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References

American Association of Critical-Care Nurses (AACN). (2014). Assessing pain in the critically

ill adult. Retrieved from http://ccn.aacnjournals.org/content/34/1/81.full

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver

Spring, MD: Author. Retrieved from

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur

ses/Code-ofEthics-For-Nurses.html

Arkansas State University Academic Partnerships. (2016, Oct. 12). The role of nurse leaders.

Retrieved from https://degree.astate.edu/articles/nursing/the-role-of-nurse-leaders.aspx

Avasrah, S., O'Neill, T., Abdalrahim, M., Sutary, M., & Kharabsheh, M. (2014). Pain

Assessment and management in critically ill intubated patients in jordan: a prospective

study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257364/pdf/ijhs

8-3-287.pdf

Bernhofer, E., (October 25, 2016) "Ethics and Pain Management in Hospitalized Patients" OJIN:

The Online Journal of Issues in Nursing Vol. 17 No. 1