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peer 1: The code of ethics in the American Nurses Association (ANA) sets the standards of care for how a nurse should perform while delivering patient care. These ethics include autonomy, beneficence, justice, and nonmaleficence. The code of ethics may not always have a clear vision, and may cause not only ethical dilemmas, but may also cause moral compromise. 

           Autonomy in nursing allows the patient to make decisions for themselves. Every person in their right state of mind, not under a 10-13 status, can make decisions for their treatment. They can refuse treatments and medications to their own wishes. This is not always what is best for treating their underling illness, however. One example is that a patient may have a low hemoglobin but may also have religious beliefs that hinder them from receiving blood products. Nurses cannot force this patient to get blood. We must respect the patient’s wishes. 

           Ethical nursing also carries the values of nonmaleficence, which means to not cause harm. Nurses are trained to continue assessing the patient for changes and act accordingly to prevent harm. One example of this would be if a patient is on vasopressors and the blood pressure drops. The nurse would increase the dose to maintain a safe blood pressure compatible with life. To do nothing could cause harm. 

           Ethical dilemmas related to these values do occur. Imagine a patient comes to the hospital for help. They told the provider that they wanted everything done and to not let them die. Despite the treatment they received, the patient kept getting worse. The patient is now on a vent, has at least three vasopressors running, and is on CRRT. The patient no longer needs sedation because they are not over breathing the vent, they have no cough, no gag reflex, no response to pain, and pupils are fixed and dilated. The doctors and family have made the decision to withdrawal care. There is clearly an ethical dilemma here to consider. In the article, Nursing Ethical Considerations, the author talks about palliative care in ICU patients, and how morally challenging the principle of nonmaleficence is difficult to uphold” (Haddad, 2023). This is especially true in this case considering the care team is not upholding the code of ethics of autonomy or nonmaleficence by withdrawing care. On the other hand, by continuing treatment they are delaying the inevitable at the expense of suffering. 

           Nurses need to consider every situation as its own situation. No two situations are the same. In the case above, what should nurses do to ensure patient care is delivered to the patient’s wishes? This is where beneficence comes in. Beneficence is to act in high moral standing with love and kindness. Essentially, it means to do what’s right. According to the textbook, Ethics and Issues in Contemporary Nursing, the author states, “Upon entrance into the profession, nurses make an implicit moral commitment to uphold the values and moral obligations expressed in their code.” (Burkhardt, 2020, pg. 87). In this dilemma it may be morally correct to allow this patient to rest in peace, then to try and keep them alive. 

peer2:  Ethical Dilemma: Physical Restraint Use as Standard of Practice in ICU Settings

Ethical dilemmas regarding physical restraint in critical care settings pose significant challenges for nurses. These dilemmas involve the tension between promoting patient autonomy and ensuring patient safety. This is an ethical dilemma. The ethical principles in contention are autonomy and beneficence. Autonomy is in contention because patients may want to refuse physical restraint, asserting their right to make decisions about their care. Beneficence is also in contention as nurses have a responsibility to prioritize patient safety and prevent harm. 

In the critical care setting, nurses often justify the use of restraints for patient safety. While this is often the case, it is important to review each patient’s needs independently. As intravenous sedation and mechanical ventilation become standard practices in critical care, the use of physical restraints has also become normalized (Via‐Clavero et al., 2018). Importantly the question must be asked, are physical restraints always necessary? Many nurses disagree with this standard of care and believe that sedation alternatives and early restraint discontinuation she be the goal. Their use has been associated with several short- and long-term physical and psychological harms, such as skin, neurological or cardiovascular injuries, increased risk of nosocomial infection, delirium, and posttraumatic stress disorder at ICU discharge (Via‐Clavero et al., 2018).

A nurse’s perception of the need for physical restraint use in the ICU can be influenced by a variety of factors, including their beliefs, attitudes, knowledge, training, and the situational factors they encounter in their work environment. These factors can shape nurses’ understanding of the benefits and risks associated with physical restraint use, as well as their willingness to advocate for alternative methods that promote patient safety and well-being without the use of physical restraints. An empowered nurse would review the patient’s case carefully, considering the patient’s clinical condition, level of cooperation, presence of family members, workload, availability of alternative solutions, and the potential use of chemical restraints or weaning from mechanical ventilation.

The ANA Code of Ethics is involved in this ethical dilemma as it guides nurses in promoting patient autonomy and advocating for their patients (Ye et al., 2019). Specifically, Provision 3 of the ANA Code of Ethics states that nurses must advocate for the protection of patients’ rights, including their right to informed consent and autonomy (Gurney et al., 2017). Additionally, Provision 2 of the ANA Code of Ethics emphasizes the importance of maintaining patient safety and acting in the best interest of the patient. Thus, by adhering to the principles outlined in the ANA Code of Ethics, nurses can navigate these ethical dilemmas by engaging in open communication, advocating for patient autonomy, and ensuring patient safety.

Notably, lessons can be learned from this ethical dilemma regarding physical restraint. One lesson is the importance of open communication and collaboration between healthcare professionals and patients or their advocates. This allows for a thorough understanding of the patient’s perspective and enables shared decision-making. Another lesson is the need for ongoing education and training for nurses to ensure they are equipped with the knowledge and skills to explore alternatives to physical restraint and implement evidence-based practices that promote patient safety while respecting autonomy. 

In the field of nursing, ethical decision-making is crucial for providing optimal patient care. Nurses must navigate complex situations and weigh the potential benefits and risks to make ethically sound decisions. Overall, addressing ethical dilemmas regarding physical restraint requires a comprehensive approach that considers the perspectives of both patients and healthcare professionals, promotes open communication and collaboration, and adheres to ethical principles such as autonomy and beneficence

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