Clinical ethics involves dilemmas that arise when difficult decisions must be

made in clinical practice (What do I do now, 2013). I faced an ethical dilemma

during my fifth day precepting. During this shift, I was supposed to care for three
patients rather than two, like I had been doing in previous shifts. When we received
report, however, we learned that one of our three patients was on airborne precautions
and had tuberculosis. Due to the fact that I had not yet been fitted for a respirator, I
could not provide care for this patient. My nurse said that she would do all of the
patient care, but that she still wanted me to complete the documentation on the patient
so that I could get the feel of caring for three patients. After thinking this through,
though, I realized that I would not be able to document on a patient whom I would
have no interaction with because it would be unethical. I approached my nurse and
had to plainly tell her that I did not feel comfortable documenting on a patient who I
did not personally assess. She said that this patient was on his last week in the
hospital and was healthy, and that most of the documentation could be inferred.
Instead of arguing, I simply said nothing and maintained eye contact. The nurse
noticed my silence, and stated that if I did not feel comfortable, she would do the
documentation. I said thank you, and that put end to the conflict. When analyzing
this dilemma, I decided to use an ethical decision-making model to help. The first
step in this process is to define the ethical dilemma (Toren & Wagner, 2010). This
dilemma could be defined as a choice between obeying my superior and doing the
morally and legally correct thing. Both choices are things that a precepting student
should do. The next step is to clarify the ethical principles and laws involved. In this
case, it involves legality. Nurses are required by the nursing practice act to conduct
complete and accurate documentation and reporting (Campos, 2010). By
documenting on a patient that I was not caring for and could not assess myself, there
would be no way to ensure that it was complete or accurate. The next step is to
identify the alternatives for action (Toren & Wagner, 2010). In this case, my choices
were to document on the patient or to refuse to document on the patient. I feel that an
additional choice could be to document on certain items that I could complete without
seeing the patient. I could have isolated those items and presented them to my
preceptor. The next step is to choose an action. My choice was to confront my
preceptor about my feelings, and to not chart on the patient. The final two steps are
to initiate discussion about unresolved issues and to generalize the solution to other
similar cases. In retrospect, I should have further explained my feelings and
reasoning behind my decision to my preceptor. At the time, I felt embarrassed about
my choice, and didnt feel up to discussing things any more than necessary to get my
point across. I now feel that I should have explained that I feel that, by documenting
on the patient, I would be falsely charting. I think by saying this I would have set
limitations for the future and created a better understanding for my preceptor. As for
the final step, I will definitely use this experience to ease my ethical decision making
process in the future.
Sources:
Campos, N. (2010). The legalities of nursing documentation. Men in Nursing, 40(1),
7-9.

Toren, O., & Wagner, N. (2010). Applying an ethical decision-making tool to a nurse
management dilemma. Nursing Ethics, 17(3), 393-402.
doi:10.1177/0969733009355106
What Do I Do Now? Ethical Dilemmas in Nursing and Health Care. (2013). ISNA
Bulletin, 39(2), 5-12.