Defining attributes are the features of ethical dilemmas that are frequently seen and constantly present in the literature. To differentiate from the other concepts these attributes are helpful. After the literature review, at least five defining attributes are observed within the context of nursing.
- 1-Involvement, engagement, and professional commitment.
The nurses must be involved in the ethical conflicting situations to identify and recognize the dilemmas and possible alternatives with professional commitment and continuous engagement with the patients. Without professional commitment and involvement, it is difficult for nurses to identify the dilemmas as well as solutions in the clinical setting.
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- 2- Equally unwanted options
For the resolution of ethical conflicting situations, there should be two or more two unwanted alternatives available. Nurses have a choice but mostly the consequences will be unwanted.
Nurses must have the ability to select one option from different available options.
- 4-Awareness of options and alternatives
For the awareness of alternatives nurses, must have sound knowledge and experience. On the other hand, if they have deficient knowledge and experience it is difficult to recognize different alternatives.
- 5- Uncertainty of action.
For the nurses, it is difficult to choose because they do not know the actual unwanted outcomes of the choice. Most of the time nurses have inadequate capabilities to know what is right and what is wrong and what can they do. Model case:
The example of an ethical dilemma that has all defining attributes is called a model case of concept analysis by Walker and Avant, (2005) approach. Miss Saira is a cardiac specialized nurse working in the cardiac surgery intensive care unit in one of the tertiary care hospitals in Islamabad for 10 years. During her job course, she has frequently faced an ethical dilemma with patients, families, and other health care workers. She has extensive knowledge and experience about how to deal with dilemmas. Once she was on morning duty and from the outpatient department, a female patient Nasreen was admitted to the ICU with the diagnosis of severe mitral valve stenosis and the surgeon advised urgent surgery for mitral valve replacement. Miss Saira attended to the lady, made her file, checked vital signs, and sent lab samples to the laboratory. She also attached a cardiac monitor and got an ECG. She noticed that Nasreen was very upset and crying. Miss Saira went to her and asked her what the matter was and reassured her. She said that she wanted to share some important information with you that she did not share with the doctor and requested Taira to keep this information confidential. Saira assured her confidentiality after building a trusting relationship with Nasreen. She said, that she is pregnant for the first time and doesn’t want to lose her baby which is why she is worried. Here the nurse faced an ethical conflicting situation about autonomy, beneficence, and nonmaleficence. This is very important to share that information with the dealing surgeon and anesthetist concerning beneficence, and non-maleficence but on the other hand, she will violate the patient’s autonomy, confidentiality, and privacy. It was challenging for her to decide what should do and what should not do. The nurse reassured her and tried to convince her that this surgery was necessary for her to save a life but during surgery, it is difficult to save the baby and it is also very important to share this information with the concerned doctor otherwise for both of you it will have negative consequences. The patient was also reluctant to give consent for surgery, however, after counseling and convincing by Saira, she agreed and allowed that this information would be shared with the doctors and finally, she signed the consent. This was a challenge for the nurse how she will resolve the ethical dilemma without violating the patient’s rights and confidentiality. Moreover, with knowledge and experience, she was able to solve that conflicting situation successfully.
Borderline case:
In the borderline case, some defining attributes are present and some attributes are missing.
Sonia is a registered nurse and working in the cardiac surgery intensive care unit for the last year she doesn’t want to work in the ICU but the administration, it was ordered that she will perform duty there. It is against her wish but she has to do duties in the assigned department. Due to this reason most of the time she did not like to be involved and engaged with the patient’s care. Once she was on duty in the evening shift and assigned a post-operative patient with CABG on the 2nd day. There was an instruction from the surgeon that the patient should be mobilized with assistance but the patient was reluctant to move out of bed because of post-op pain despite pain medications. Sonia asked the patient for his mobilization but he refused to get out of bed because he could not bear the pain so he didn’t want to proceed. She told me that I had no problem and it would lessen my work burden but not be well for me because there would be chances of deep venous thrombosis and pressure ulcers. In this case, some components of ethical dilemma were present but Sonia did not recognize that dilemma because she has the absence of professional commitment due to lack of interest and involvement with patient care.so there were some defining attributes were present and some were missing in this case.
Contrary case:
Mrs. Parveen, a post-op case of mitral valve replacement was discharged from the cardiac surgery intensive care unit and shifted to the cardiac surgery general ward for further post-op observations. Miss Raheela is a 30-year-old registered nurse with a cardiac specialty who works in a government hospital. She has been working in the cardiac surgery general ward for the last 5 years and was assigned to take care of Mrs. Parveen in rehabilitative post-op care. She was an educated lady and easily understood the instructions followed the treatment plan and took medication given by Miss Raheela. When Miss Parveen was in a good mood she told Raheela that she was the best nurse with a professional attitude and sympathy for the patients. She admired the staff and was thankful for her good services. In this contrary case, it has been shown that there is no conflicting situation that will raise an ethical dilemma. Defining attributes, no uncertainty, no problematic situation, and no unpleasant options are seen.
Related case
In the related case, there will be a choice similar to the dilemma but actually, that is no dilemma. The registered nurse Miss Fozia is working in the emergency department having a patient for a blood transfusion. She has different gauge intravenous cannulas from them she has to choose the appropriate cannula through which blood transfusion is carried out smoothly without any interruption. She knows well that for blood transfusion, a suitable cannula is needed. However, after the assessment, it has been noticed that this situation is not related to the dilemma but in fact, the nurse has to choose the right option from different alternatives without decision-making problems and uncertainty to choose the right action.
Antecedents
Antecedents are the causes or the reasons before the occurrence of a situation related to the ethical dilemma. The conflicting situation must be present before the ethical dilemma and availability of alternatives for the resolution of the situation by choosing one possible option from the two or more two unwanted alternatives. The nurses should be able to deal with that dilemma wisely within the ethical boundaries and for the resolution of the dilemma, the nurses must have understanding, command, and professional commitment.
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