Running head: ETHICAL DECISION MAKING 1

Ethical Decision Making: Pain Management

Madison N. McLuen

Grand Canyon University: NSG-436

April 17th, 2020

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Pain encompasses a variety of complex features and degrees of variation for each

individual person. With the individuality of pain in mind, the nurse plays a vital role in

delivering medications or nonpharmacological management in an ethical and moral stature. An

example of an ethical dilemma surrounding the management of pain would be making the

decision to provide opioids to a patient if they are not physically showing signs of pain from the

nurse’s point of view. This paper will analyze the ethical dilemma surrounding the expression of

pain, a description of the model and moral standards that are used, and how to resolve the issue

that is guided by a specific leadership style.

How we reflect and think about pain exerts an influence on the manner in which we

respond to it (Carvalho et. al., 2018). The relieve of all forms of pain and suffering is the ethical

duty of healthcare providers and nurses and is recognized as a human right. The patient should

be the primary interest, and care management should reflect and be guided by what is in the best

interest of the patient. However, many systems in healthcare fail to hold individuals accountable,

in which many organizations fail to provide holistic care which causes undertreatment of pain

management. As this is an ongoing dilemma, it is the moral duty of the nurse to advocate for the

patient and seek pain management based on the subjective feeling of the patient. The nurse

navigates through standards of care by using advocacy, education, and a supportive approach to

honor the patient’s right to self-determination, autonomy, and dignity (ANA, 2016). All nurses

have an ethical obligation to provide respectful, individualized care to all patients experiencing

pain regardless of the person’s personal characteristics, values, or beliefs. As caretakers and

advocators, we are the ones who have the opportunity to support our patients despite any

prejudice, through navigating our own standards. Nurses should navigate their standard of care
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by identifying their prejudices first, then looking at care through the eyes of their patient, and

what is a safe and health-drive approach for them.

An ethical decision model that can be used to solve the issue is the Six-Step Decision

Making Model. This provides steps for the nurse manager to implement with the nurse on staff.

This includes determining how to define the problem, establish the cause, identify the ethical

components, clarify who is involved, explore the various options, apply ethical and moral rules

such as references to the ANA Code of Ethics, and placing the resolution into action. This model

will help the nurse and nurse manager to identify what is the best form of treatment for this

patient, and what is the “moral” implementation. The nurse is also able to use standards of

practice, which is to provide pain relief on the determination of the patient’s subjective pain

scale, and not their own. Respecting the patient’s autonomy, which means right of self-

determination and freedom of decision making should direct the nurse to proper pain

management. Beneficence is also respected when the nurse has an ethical duty to provide benefit

balanced with risk (Huber, 2019).

Unrelieved pain may leave patients extremely vulnerable, speechless, changed, and even

destroyed. Unrelieved pain can compromise a person’s autonomy and increase vulnerability,

whereas providing pain relief can potentially protect a person’s integrity and promote dignity

(Carvalho et al., 2018). This being said, a solution needs to be made to avoid this and respect the

patient’s health. Education towards the nurse should include how to differentiate pain and ways

to management it. The patient should also be educated on the effects of opioids and pain

medications on their health. Using the ethical model above, a solution is made by ethical

arguments and weighing the “good” benefits. A leadership style that is focused on

communication with a democratic approach would use group discussion with the nurse involved,
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the manager, and the provider making a decision. Teamwork is the focus, which means having

multiple minds critically think through the process is the best approach to finding a solution.

When determining the approach, using the Nursing Code of Ethics will guide the team toward an

approach.

Overall, the most ethical and moral decision is to provide the patient with pain relief

since nurses professionals do not have the complete knowledge on the patient’s individual

perception of pain. Having a “patient-centered” view of pain is more accurate, efficient, safer,

and aligns with core principles of the Nursing Code of Ethics.

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References

American Nurses Association (2016). Code of ethics for nurses with interpretive statements.

Silver Spring, MD: Nursesbooks.org Retrieved

from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-

ethics-for-nurses/coe-view-only/

Carvalho, A. S., Martins Pereira, S., Jácomo, A., Magalhães, S., Araújo, J., Hernández-Marrero,

P., Costa Gomes, C., & Schatman, M. E. (2018). Ethical decision making in pain

management: a conceptual framework. Journal of pain research, 11, 967–976.

https://doi.org/10.2147/JPR.S162926

Huber, D. Leadership and Nursing Care Management. [Pageburstls]. Retrieved

from https://pageburstls.elsevier.com/#/books/9780323389662/