Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in EXERCISE 4–3 (Guido textbook). How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
Applying Guido’s MORAL model to the dilemma presented in the case study described in Exercise 4-3 allows for a structured approach to resolving the ethical conflict. The MORAL model provides a comprehensive framework that nurses can use to address moral dilemmas in healthcare settings. In this scenario, the nurse is faced with a request from a physician to administer a medication to a patient that is not medically indicated. This situation raises ethical concerns, as the nurse is obligated to prioritize the well-being of the patient and adhere to ethical principles such as autonomy, beneficence, and non-maleficence.
The first step of Guido’s MORAL model is to establish the moral dilemma. In this case, the nurse must recognize the conflict between following the physician’s instructions and acting in the best interest of the patient. The nurse may feel torn between obedience to authority and the responsibility to advocate for the patient’s well-being.
The second step is to outline the relevant facts. This requires the nurse to gather all pertinent information related to the patient’s condition, the medication in question, and the physician’s rationale for the request. It is essential for the nurse to have a clear understanding of the factual background to make an informed decision.
The third step is to review the ethical principles involved. In this case, the nurse must consider the principles of autonomy, beneficence, and non-maleficence. Autonomy refers to the patient’s right to make decisions about their own healthcare, which may conflict with the physician’s request. Beneficence emphasizes the nurse’s duty to act in the best interest of the patient, which may call for questioning the appropriateness of the medication. Non-maleficence pertains to the nurse’s obligation to do no harm and to prevent harm from being done to the patient.
The fourth step is to identify possible alternatives and their potential consequences. In this scenario, the nurse could discuss their concerns with the physician, seek clarification about the rationale for the medication, and explore alternative treatment options. The consequences of each alternative should be carefully evaluated, taking into consideration the potential impact on the patient’s well-being, the professional relationship with the physician, and the ethical integrity of the nursing profession.
The fifth step is to consider the values and beliefs that may influence the decision-making process. The nurse must reflect on their personal values, professional values, and the ethical standards upheld by the nursing profession. This introspection is critical for ensuring that the decision aligns with one’s own moral compass and professional responsibilities.
The last step is to make a decision and implement the chosen course of action. In this case, the nurse might choose to communicate their concerns to the physician, providing evidence-based information to support their position. The nurse should aim to foster open and respectful dialogue, seeking a resolution that upholds ethical principles and ultimately benefits the patient. If the physician remains resistant, the nurse may consider seeking support from a supervisor or involving the ethics committee to mediate the conflict.
In this scenario, the nurses might experience moral distress due to the challenging ethical situation they are faced with. Moral distress occurs when healthcare professionals are aware of the ethically appropriate course of action but are constrained from acting upon it. The nurses may feel a sense of powerlessness and frustration, as their professional duty to advocate for the patient conflicts with the authority of the physician. Moreover, witnessing potential harm being inflicted on the patient may cause emotional distress and moral unease.
To prevent moral distress, the nursing staff can take several positive actions. Firstly, they could engage in ethical discussions within their team, providing a supportive environment to share concerns and perspectives. This collaboration can help validate their moral concerns and promote understanding among colleagues. Secondly, the nurses could seek educational opportunities to enhance their ethical knowledge and decision-making skills. This can empower them to better navigate ethical dilemmas and feel more confident in advocating for their patients. Finally, the nurses should encourage a culture of ethical awareness and open communication within the healthcare institution. This can include initiatives such as ethics rounds, case conferences, or the establishment of an ethics consultation service to facilitate ethical decision-making and address moral distress.
In conclusion, Guido’s MORAL model provides a structured approach for nurses to resolve ethical dilemmas in healthcare settings. By following the steps of the model, the nurse in this scenario can systematically address the conflict between the physician’s request and the patient’s well-being. This ethical dilemma has the potential to cause moral distress among the nursing staff, but positive actions such as engaging in ethical discussions, seeking education, and fostering an ethical culture can help prevent and potentially resolve moral distress.