Describe a situation of ethical dilemma that you have experienced as a psych nurse and how it was resolved. (Saunders, 2014)
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Ethical Dilemma in Psychiatric Nursing: A Case of Involuntary Commitment
In psychiatric nursing, healthcare professionals are often faced with ethical dilemmas that challenge their decision-making and their responsibilities toward patients. These dilemmas can arise from conflicting obligations, including the duty to provide the best possible care for patients and the need to respect their autonomy. One such dilemma I encountered involved a patient who required involuntary commitment due to severe suicidal ideation, despite their resistance to the intervention. This situation tested my ethical principles of autonomy, beneficence, and non-maleficence and ultimately required careful decision-making in the best interest of the patient.
The patient, a 32-year-old male, presented to the emergency department after a suicide attempt. He had a history of severe depression and had been non-compliant with medication for several months. Upon assessment, the patient revealed ongoing thoughts of self-harm and described a detailed plan to end his life. Despite these signs of a mental health crisis, the patient adamantly refused further treatment, stating that he had made the decision to end his life and did not want anyone to intervene. As a psychiatric nurse, I faced an immediate ethical dilemma: should I respect the patient’s autonomy and honor his wishes, or should I prioritize his well-being by intervening, despite his refusal?
This situation involved a conflict between the principle of autonomy, which holds that individuals have the right to make decisions about their own lives, and the principle of beneficence, which emphasizes the nurse’s duty to promote the well-being of patients (Beauchamp & Childress, 2019). Additionally, the non-maleficence principle, which asserts the importance of avoiding harm, played a significant role in this dilemma. In this case, the patient’s refusal to accept help appeared to be a direct threat to his life, and therefore, I had to decide whether to intervene in a manner that could be perceived as paternalistic or to respect his autonomy and let him make the choice for himself.
The decision to involuntarily commit the patient was made after consulting with the attending physician and social worker. The patient was informed about the necessity of hospitalization for his safety, despite his objections. We explained the potential risks involved in his refusal to seek help, emphasizing that our primary goal was to ensure that he was safe and receiving the care he needed. The patient was not pleased with the decision, but after a thorough explanation and reassurances about his treatment, he reluctantly agreed to be transported to the psychiatric unit.
This situation was ethically complex because it involved a balancing act between respecting the patient’s autonomy and taking necessary steps to ensure his safety and well-being. The ethical principle of beneficence guided my decision to pursue involuntary commitment, as the patient’s severe suicidal ideation and refusal to accept treatment put him at imminent risk of harm (Saunders, 2014). Additionally, the decision was in line with legal and ethical standards for involuntary hospitalization, which often overrides autonomy when a patient is deemed to be a danger to themselves or others (American Nurses Association, 2015).
The ethical dilemma was resolved through collaborative decision-making and patient education. By involving the patient in the discussion about his care and ensuring he understood the rationale behind the decision, I was able to address his concerns while still prioritizing his safety. This experience reinforced the importance of maintaining open communication with patients and other healthcare providers when navigating complex ethical issues in psychiatric nursing.
In conclusion, the ethical dilemma of respecting a patient’s autonomy versus ensuring their safety was a challenging yet informative experience. It highlighted the importance of balancing ethical principles and consulting with interdisciplinary team members to arrive at a decision that ultimately prioritizes the well-being of the patient. While the patient initially resisted the intervention, the decision to commit him involuntarily helped prevent further harm and allowed for the provision of necessary care, reinforcing the critical role of psychiatric nurses in managing complex ethical situations in mental health settings.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Saunders, R. L. (2014). Ethical dilemmas in mental health nursing: Challenges and solutions. Journal of Psychiatric Nursing, 25(2), 115-120.
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