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Chapter: Medical Surgical Nursing: Critical Thinking,Ethical Decision Making, and the Nursing Process

Ethical Nursing Care

In the complex modern world, we are surrounded by ethical is-sues in all facets of our lives.

Ethical Nursing Care



In the complex modern world, we are surrounded by ethical is-sues in all facets of our lives. Consequently, there has been a height-ened interest in the field of ethics, in an attempt to gain a better understanding of how these issues influence us. Specifically, in health care the focus on ethics has intensified in response to con-troversial developments, including advances in technology and ge-netics, as well as diminished health care and financial resources.


Today, sophisticated technology can prolong life well beyond the time when death would have occurred in the past. Expensive experimental procedures and medications are available for at-tempting to preserve life, even when such attempts are likely to fail. The development of technological support has had an influ-ence on all stages of life. For example, the prenatal period has been influenced by genetic screening, in vitro fertilization, the harvesting and freezing of embryos, and prenatal surgery. In the early stages of life, premature infants are given a chance for sur-vival by the use of technical support. Children and adults who would have died as a result of organ failure are living longer be-cause of organ transplantation. Technological advances have also contributed to an increase in the average life expectancy. These advances in technology, however, have been a mixed blessing. Questions have been raised about whether, and under what cir-cumstances, it is appropriate to use such technology. Although many individuals are afforded a better quality of life, others face


The Inquiring Mind: Critical Thinking in Action

Throughout the critical thinking process, a continuous flow of questions evolves in the thinker’s mind. Although the questions will vary according to the particular clinical situation, certain gen-eral inquiries can serve as a basis for reaching conclusions and de-termining a course of action.


When faced with a patient situation, it is often helpful to seek answers to some or all of the following questions in an attempt to determine those actions that are most appropriate:


·   What relevant assessment information do I need, and how do I interpret this information? What does this information tell me?

·   To what problems does this information point? Have I iden-tified the most important ones? Does the information point to any other problems that I should consider?

·   Have I gathered all the information I need (signs/symptoms, laboratory values, medication history, emotional factors, mental status)? Is anything missing?

·   Is there anything that needs to be reported immediately? Do I need to seek additional assistance?

·   Does this patient have any special risk factors? Which ones are most significant? What must I do to minimize these risks?

·   What possible complications must I anticipate?

·   What are the most important problems in this situation? Do the patient and the patient’s family recognize the same problems?

·   What are the desired outcomes for this patient? Which have the highest priority? Does the patient see eye to eye with me on these points?

·   What is going to be my first action in this situation?

·   How can I construct a plan of care to achieve the goals?

·   Are there any age-related factors involved, and will they re-quire some special approach? Will I need to make some change in the plan of care to take these factors into account?

·   How do the family dynamics affect this situation, and will this have an affect on my actions or the plan of care?

·   Are there cultural factors that I must address and consider?

·   Am I dealing with an ethical problem here? If so, how am I going to resolve it?

·         Has any nursing research been conducted on this subject?


extended suffering as a result of efforts to prolong life, usually at great expense. Ethical issues also surround those practices or poli-cies that seem to allocate health care resources unjustly on the basis of age, race, gender, disability, or social mores.


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