Ethical Issues and Dilemmas Discussion

Ethical Issues and Dilemmas Discussion

Summarize the moral/ethical issue in the article

Eren (2013) discusses some of the ethical issues that psychiatric nursing personnel face in the course of delivering their professional services in an in-patient setting. It notes that the cognitive deficiencies experienced by psychiatric patients makes it difficult for them to question how nursing personnel address their medical needs. The author’s particularly note that psychiatric nurses rely on human relationships to provide professional care. In fact, the major components of the professional services they offer include worry, attention, forbearance and protection as part of human relationships. The issue then becomes, how psychiatric nursing personnel should associate with patients with cognitive deficiencies who are unable to make or question ethical decisions. Addressing this issue would require that psychiatric nurses conceptualize their ethical awareness in terms of making decisions about what or morally right and wrong for their inpatients (Eren, 2013). Ethical Issues and Dilemmas Discussion


Describe the moral and ethical dilemmas surrounding the issue

The ethical dilemma is whether there are moral issues with regards to making decisions about the care of cognitively deficient patients who may not appreciate the decision, its implications, and outcomes. The issue is cause by five factors. The first factor is insufficient personnel that force psychiatric nurses to consider minimalistic options so that they will always select the fastest option to allow them handle more patients. The second factor is excessive workload that force psychiatric nurses to consider the easier options that reduce their workload regardless of ethical implications. The third factor is unfavorable working conditions that limit the decisions and care options available to nursing personnel. The fourth factor is lack of supervision whereby psychiatric nurses are left to use their discretion to make care decisions without oversight that would question ethical issues. The final factor is lack of in-service training that leaves nursing personnel unaware and unfamiliar with how to make the best decisions on ethical issues. The article specifically mentions psychiatric nurses who handle in-patients experience problems concerning the ethics of their practice to include neglect, careless and rude behavior, disrespect of patients’ dignity and rights, bystander apathy, lack of proper communication, stigmatization, intimidation and authoritarian attitude, physical intervention when restraining the patient, manipulating reactive emotions, and acting without permission. Other problems include disrespecting privacy, lack of clarity and dishonesty, exposure to unhealthy conditions, violating confidence (Eren, 2013). In this respect, the ethical issue presented in the article is how to handle psychiatric patients in an in-patient setting, especially when they have cognitive deficiencies.

Analyze the ethical issue and compare them to the state health laws and regulations in your state. State of Michigan

Michigan State health laws and regulations assign specific responsibilities to psychiatric nurses on how to handle psychiatric patients with cognitive and intellectual disabilities. Chapter 330 of the mental health code Department of Mental Health Act 271 of 1945 mentions that every professional psychiatric decision should be guided by the intention to offer professional help to the patient. Irrespective of a patient’s cognitive capacity, a psychiatric nurse is expected to always consider the patient’s best interests and care outcomes. This implies that in addition to protecting the patient’s rights within an inpatient setting, the nurse must observe the code of ethics as a fundamental guide for professional practice roles that include management, research, education and care irrespective of the patient’s cognitive capacity (Legislative Council – State of Michigan, 2018).  Ethical Issues and Dilemmas Discussion

Outline the process of ethical decision making you would use to address this ethical dilemma

Every psychiatric nurse must understand that every ethical decision should be guided by professional principles. This requires that the patients be respected without discrimination, given them autonomy, and not caused intentional harm. These principles of respect, autonomy and nonmaleficence should guide all decision. When making an ethical decision to address the present dilemma, the psychiatric nurse should follow six important steps. The first step should entail describing the scenario using factual information in terms of what and why as well as whether an apparent solution exists. The second step is to describe the criteria for making the decision, such as existing policies and principles as well as the patient’s values and principles as they relate to the decision. The third step is to identify the individual best qualified to make the decision in terms of responsibility. The fourth step is to determine whether the decision should be made individually or collectively. The fifth step is to identify the persons who will receive the most benefits from the decision. The final step is to determine how the decision should be implemented (Bitter, 2014; Ruggiero, 2015). Observing the six steps as described improves the psychiatric nurse’s capacity to address the ethical dilemma.


Bitter, J. (2014). Theory and practice of family therapy and counseling (2nd ed.). Belmont, CA: Brooks/Cole.

Eren, N. (2013). Nurses’ attitude toward ethical issues in psychiatric inpatient settings. Nursing Ethics, 21(3), 359-373. doi: 10.1177/0969733013500161

Legislative Council – State of Michigan (2018). Chapter 330, Mental Health Code, Department of Mental Health Act 271 of 1945. Retrieved from

Ruggiero, V. (2015). Thinking critically about ethical issues (9th ed.). New York, NY: McGraw-Hill Education. Ethical Issues and Dilemmas Discussion


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