Ethical Dilemmas of Nursing Staff in Health Care

A code of ethics can be defined as "a set of agreed-upon rules and expectations designed for a specific purpose". In fact, it has several functions, including promoting and maintaining ethical standards of professional conduct, nurturing the moral profile of the nursing professional, and encouraging him or her to ask himself or herself questions of a moral nature. The code may also prescribe ethical conduct that is not legally binding, for example, voluntary engagement in ethical behavior involving patient care. It also emphasizes standards of ethical practice that all nurses should adhere to. This paper aims to get acquainted with the ethical dilemmas of nursing staff at the Vlora Regional Hospital on the legal and ethical aspects of nursing in healthcare.

A descriptive, cross-sectional design was adopted to discover the knowledge among 120 nurses at the Vlora Regional Hospital. The non-probability purposive sampling technique was used. A semi-structured questionnaire was self-administered to collect data. The data were analyzed using SPSS software, for descriptive analysis and chi-square test. The study included 120 nurses at the Vlora Regional Hospital, who were surveyed regarding ethical dilemmas in healthcare. The nurses were analyzed according to sociodemographic indicators.

Keywords: Code of Ethics, nursing staff, care, hospial, dilemmas, etc.

Background

Nursing ethics have evolved from 19th-century virtues of obedience and loyalty to a modern focus on patient advocacy and clinical judgment. The first formal Code of Ethics was developed in the 1950s, followed by the American Nurses Association (ANA) guidelines, which establish non-negotiable ethical standards. In contemporary healthcare, nurses face complex situations where competing values create ethical dilemmas- decisions where any choice has significant consequences. Common dilemmas include life-or-death decisions, patient refusal of treatment, cultural or religious conflicts, and inadequate staffing. This study was conducted at the Vlora Regional Hospital in Albania to explore how nursing staff respond to these everyday ethical dilemmas and to assess their knowledge of the legal and ethical aspects of their profession.

Methods

This study utilized a descriptive, cross-sectional design. The researchers employed a non-probability purposive sampling technique to select 120 nurses working at the Vlora Regional Hospital. Data collection was performed using a self-administered, semi-structured questionnaire designed to capture sociodemographic indicators, knowledge of the Code of Ethics, and specific responses to workplace dilemmas. The research was quantitative in nature, with data analyzed using SPSS software for descriptive statistics and chi-square tests. Ethical considerations were strictly followed: the study received approval from the Dean's Office at "Ismail Qemali" University, ensured participant anonymity, and obtained verbal informed consent from all participants in accordance with the Declaration of Helsinki.

Results

The sample was 69.2% female with an average age of 34.6 years. Results showed high occupational stress, with 76.7% feeling stressed on "special occasions" and 17.5% "almost always." While 95% of nurses knew the basic principles of the Code of Ethics, only 12.5% could correctly define "Deontology." Ethical conflicts were common, reported by 70% of staff. Key findings on specific issues included:

1. Euthanasia: 68% view it as a right to a peaceful death and would agree with its application in Albania.
2. Patient Information: 69% believe patients with incurable diseases should not be informed of their condition.
3. Confidentiality: 60% identified telling a patient's relatives about an HIV status as an ethical violation.
4. Resolution: 94% of those facing conflicts resolved them through discussion with colleagues.
5. Departmental trends: The highest levels of concern and stress were reported in the Pediatrics (47%) and Emergency (29%) departments.

Conclusions

The study confirms a strong relationship between ethical decision-making and moral distress in nursing practice. It concludes that while nurses possess a general awareness of ethical codes, there is a lack of deep theoretical knowledge (such as Deontology). Environmental and contextual factors, such as psychological pressure from families and inadequate staffing, act as significant barriers to ethical practice. The author emphasizes that "ethical maturity"- reaching Kohlberg’s post-conventional moral level- is essential for nurses to provide the greatest benefit to patients. Recommendations include developing clear institutional guidelines, involving nurses in ethical thinking throughout their practice, and providing specialized training to help staff manage stress and psychological pressure in high-stakes wards like Pediatrics and Emergency.