Running head: ETHICAL REASONING IN NURSING PRACTICE

Ethical Reasoning in Nursing Practice

Mary Kate Dustin
James Madison University

ETHICAL REASONING IN NURSING PRACTICE

Ethical Reasoning in Nursing Practice

Medication administration is one of the most significant and controversial areas
associated with nursing practice. A medication error is defined by the National Coordinating
Council for Medication Error Reporting and Preventing (2015) as any preventable event that
may cause or lead to inappropriate medication use or patient harm while the medication is in the
control of the health care professional, patient, or consumer (p. 1). Unfortunately, there is a
substantial yearly increase in medication administration errors in both primary and secondary
care locations (Archer, 2015). An average of 450,000 avoidable medication errors are recorded
annually in the United States of America. Roughly 20% of all medication administrations result
in error, and in addition to reported medication mistakes, one to two medication administration
errors per day are unreported (Medication Errors in Hospitals, 2015). According to the Journal
of Clinical Nursing, there are five specific areas where medication errors can occur,
prescription, transcription, dispensing, administering and monitoring patient
condition/documenting (Medication Errors in Hospitals, 2015, p. 3064).
Although medication administration error can occur for numerous reasons, a study by
Biron, Lavoie-Tremblay, and Loiselle (2009) found an average of three to six interruptions per
hour during medication administration; disruptions and distractions are one of the leading causes
of medication errors. With the elderly population quickly increasing, as well as the constant
creation of new medications, the medication demand is expanding (Archer, 2015). Medication
administration errors are an extremely prevalent issue and need to be considered.
Background
While completing a rotation in my nursing clinical, I experienced an ethical situation
regarding a medication administration error. I feared speaking up mainly because of my position

ETHICAL REASONING IN NURSING PRACTICE

as a student. The nurse I had been working with one particular day had been extremely short with
me throughout the shift, making me anxious to approach her. I was assisting the nurse in a
routine medication pass and realized that she had taken the incorrect medication from the
cabinet. The medication she had selected was a pill that the patient was supposed to take later in
the day, rather than the capsule he required at that time. I thought it would be most appropriate if
I remained quiet because I knew the computer would discover the error when she attempted to
scan the wrong medication in. While I was waiting for the nurse to scan in the medication, my
clinical instructor came to find me and told me to follow her to observe someone receive
dialysis. Although I was apprehensive the nurse would be irritated or disregard me, I decided that
the most ethical action to take in my situation was to advocate for my patient. The nurse
examined the medication and realized I was correct, and thanked me. Although I was fearful to
speak up, I know it was the moral action to take. The computer may have caught the mistake, but
as nurses we cannot solely place reliance on technology. An alternative way I could have
countered the situation is by explaining to my clinical instructor what was happening and asking
for her guidance. I may have felt more comfortable or relaxed approaching the nurse with my
instructors encouragement and support.
I experienced moral distress because I felt like it was the equitable action to take to speak
up to the nurse but I was afraid that she would dismiss my observation. Moral distress occurs
when an individual identifies the ethically correct action to take, but feels incapable to do so. I
knew that I should say something regarding the patients medications, but felt powerless and
afraid of the nurse in charge. Patients have six rights regarding medications; they are correct
medication, correct route, correct time, correct client, correct dosage, and correct documentation

ETHICAL REASONING IN NURSING PRACTICE

(Six Rights of Medication Administration, n.d.). In my situation, two of the six patient rights
regarding medication administration were compromised; correct medication and correct time.
Methods/Findings
James Madison University has created eight key questions that can be utilized as a
framework in the decision making process. The eight key questions are fairness, outcomes,
responsibilities, character, liberty, empathy, authority, and rights.
Fairness is how to balance interests; outcomes relate to what can achieve the best goal for
myself and others; responsibilities are what duties apply to the situation; character is what
reflects the person I want to be; liberty is how does respect for personal autonomy apply;
empathy is what would I do if someone I cared about was involved; authority is what do
authorities expect me to do; and rights are what rights apply in the situation (James Madison
University, n.d.). As a whole, the eight keys questions are prompts for ethical and moral
decision-making.
Regarding my situation, fairness was applied because I wanted to be fair to everyone
involved; especially to the patient. Outcomes relates well to my situation because I wanted the
best possible outcome for my patient, which is why I decided to speak up regarding the
medication error. I also wanted the best outcome for myself, and I knew what the morally right
decision was for me to make. Responsibilities apply to my situation because my duty as a student
nurse is to be a patient advocate; I needed to stand up for the patient and his rights. Character
applies because I know the nurse I want to be would always advocate for patients rights. Liberty
applies because a patient has a right to personal autonomy, freedom, and consent regarding his
medications as well as his treatment; in my situation my patient had the right to receive the
correct medication. Empathy applies because if I thought of the patient as someone I love or

ETHICAL REASONING IN NURSING PRACTICE

deeply care about, I would say something because I want to stand up for my loved ones
wellbeing and safety. Authority applies because I know my teachers expect me to do what is
morally right. Rights apply because all patients have six medication rights (stated previously).
Provision three of the American Nurses Association (ANA) code of ethics states The nurse
promotes, advocates for, and strives to protect the health, safety, and rights of the patient
(American Nurses Association, 2015). This provision specifically relates to my situation because
I advocated for my patient when necessary. The ANA code of ethics contains direction that can
guide individuals actions in the nursing field.
Conclusion
Through my experience I have learned the importance of ethical reasoning. Looking back
on my experience, I can see how detrimental it could have been if I remained silent. Nurses
should always be patient advocates and push for patient rights as well as autonomy. If every
nurse made an effort to speak up, the growing 450,000 medication errors could decrease. What I
have learned about ethical decision-making will assist me to be a superior nurse. I hope that
others can learn from my experience. Even in a situation where you feel powerless or afraid to
speak up, use the eight keys questions and take the most moral choice you can.
Going forward in life, I can now see the importance of the eight key questions. They
create a framework that will help me, as well as others to make the most honorable and moral
decisions we can make.

ETHICAL REASONING IN NURSING PRACTICE

References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Retrieved from http://www.nursingworld.org/ethics/code/protected_nwcoe303.html
Archer, A. (2015). Medication errors: an unacceptable gamble. Nursing & Residential
Care, 17(7), 393-397.
Biron AD, Lavoie-Tremblay M & Loiselle CG (2009) Characteristics of work interruptions
during medication administration. Journal of Nursing Scholarship, 41, 330336.
James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in action.
Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml
Medication errors in hospitals: a literature review of disruptions to nursing practice during
medication administration. (2015). Journal of Clinical Nursing, 24(21/22), 3063-3076.
doi:10.1111/jocn.12944
National Coordinating Council for Medication Error Reporting and Prevention. (2015). About
Medication Errors.
Six Rights of Medication Administration. (n.d.). Retrieved from
http://itdc.lbcc.edu/cps/nursing/vn225/nv225_passing_medi/passing-medi-notes.html

ETHICAL REASONING IN NURSING PRACTICE

Comments
1. Introduction paragraph was written well! Only change to make is 6th line from the
bottom "..distractions are on" I think you meant to put "one.
I changed the word on to one in the first paragraph.
2. Second paragraph- moral distress would relate more to your ethical situation than moral
dilemma
I rewrote a sentence in the second paragraph and said I experienced an ethical
3.

situation rather than a moral dilemma.

Analyze "liberty"-what does liberty have to do specifically with your situation?
I added to my definition of liberty and talked about how patients have the right to

the correct medication, which is why I decided to speak up.

4. Connect the conclusion with the introduction
I added more to my conclusion to connect it to my introduction, for example If
every nurse made an effort to speak up, the increasing 450,000 medication errors
could decrease.