Moral Distress and Ethical Dilemmas in the ICU


You notice a nursing colleague in your ICU has missed department meetings, has recently developed a very short temper and does not display the jovial nature they had prior to the pandemic. You are concerned they may be experiencing moral distress. 


Conduct a literature search on the ethical topic of your choice then write a formal paper not to exceed 1200 words. Discuss ALL of the following points with regard to the ethical dilemma you selected:

  1. State the ethical dilemma that exists in the case that the nurse is having to address.
  2. The competing bioethical principles in jeopardy with regard to the dilemma (i.e. autonomy, veracity, beneficence, etc.), and why; 
  3. The applicable laws, covered in the course, that could govern your course of action;
  4. Provisions from the ANA’s Code of Ethics for Nurses that could help arrive at a decision about how to address the ethical dilemma; 
  5. A summary of the course of action you would choose to take. 

This is a formal paper so please submit a paper with a title page, in-text citations, topic headings, and a reference list.  


Moral Distress and Ethical Dilemmas in the ICU

Moral distress has been one of the main ethical issues noted among nurses following the covid-19 pandemic. Nurses often experience stress in clinical practice settings as they are faced with situations involving various ethical dilemmas. Moral distress is a sad, negative state in which a nurse experiences psychological imbalance when making ethical decisions but cannot implement them due to perceived or real institutional constraints. The issue is associated with moral dilemmas and uncertainty, whereby in one, the nurse has two conflicting and morally justifiable causes of action, and in the other, they question the right course of action. This paper presents the ethical dilemma in a case, competing bioethical principles, applicable laws, the American Nurses Association (ANA) code of ethics provision, and the course of action that would be taken in the ethical dilemma.

Case Summary/Ethical Dilemma Related

The case involves a fellow nurse at the intensive care unit. The nurse has developed a short temper and is not as jovial as she used to be before the pandemic. She has also missed several departmental meetings without explanation. The primary concern, in this case, is moral distress. As mentioned earlier, moral distress occurs when a nurse knows the right ethical decision but is restricted by institutional constraints. Exposure to different ethical dilemmas whereby the nurse knows the right course of action to take but cannot implement it is what causes moral distress. Nurses face various ethical dilemmas in critical care units, which have intensified during the covid-19 pandemic. The selected ethical dilemma in the case whereby the nurse must address is the personal health risk ethical dilemma. Before the pandemic, the nurse was all okay and did her duties enthusiastically as opposed to after the pandemic since she is torn between protecting her health and offering services when they are needed most. Robert et al. (2020) note that personal health risk has been a significant ethical dilemma in ICU settings in the Covid-19 era. Therefore, it is worth noting that the ethical dilemma in the case is a personal health risk.

Competing Bioethical Principles in Jeopardy Regarding the Dilemma

Two bioethical principles are competing and in jeopardy concerning this ethical dilemma. These bioethical principles are justice and beneficence. Justice is a bioethical principle stipulating that nurses should act fairly and impartially and make nursing action decisions without showing partiality based on a patient’s economic status, age, religion, or other definitive factors. In this case, justice for the patient is in jeopardy since the nurse is considering personal protection, whereas there is a high need for nursing services. However, even though failure to work during the pandemic era would protect the nurse from the disease, it would cause injustice to humanity since it is when the services are needed the most.

Beneficence is the other bioethical principle that is in question in this case. The ethical principle stipulates that nursing actions or decisions for taking action should aim at promoting good, assisting others, and generally benefiting the patient. Farrell and Haywad (2022) note that during the pandemic, many patients, especially those with Covid-19 pneumonia, were moved to the ICU settings, which was a significant worry for the nurses in these settings contracting the virus. However, if the nurse had chosen not to work for fear of contracting the virus, the principle of beneficence would not have been maintained since the decision would not have benefitted the patients.

Applicable Laws that Could Govern the Course of Action in the Case

As mentioned earlier, in this case, the issue of concern is moral distress, and the ethical dilemma is personal health risk against care provision. Various laws can be applied to govern the course of action in this dilemma. Administrative laws are one of them. According to Guido (2020), administrative laws are the laws enacted by means of decisions of administrative bodies/specific governing bodies. An example of an administrative law that can be applied is the individual nursing practice act, which allows nurses to make decisions autonomously. Similarly, in this case, the nurse may choose the course of action autonomously, given that the individual nursing practice standards act protects them.

The other administrative law governing a course of action is the institutional laws on professional behavior and conduct. In this case, it is evident that the nurse has not been attending department meetings, which is against the institution’s professional conduct. Ideally, attending departmental meetings is a sign of professional conduct. The nurse has not been attending meetings due to moral distress. Therefore, the institutional laws will help the nurse decide on the action.

Provisions from the ANAs Code of Ethics for Nurses that Would Help Arrive at Decisions on Addressing the Ethical Dilemma

The fifth and ninth provisions from the ANA code of ethics for nurses would be instrumental in helping arrive at an ethical course of action in addressing the ethical dilemma. The 5th provision states that nurses owe the same duties to themselves as to others regarding the responsibility to promote health and safety, preserve character wholeness/integrity, maintain competence, and promote personal and professional growth (ANA, 2015). The provision entails duties to self, promotion of personal health, safety and wellness, preservation of character and integrity, and ensuring personal growth. Based on this provision, the nurse should make a decision that will enhance personal safety and wellness, preserve character and integrity, and promote personal growth. In a state of moral distress and a dilemma on personal health risk, the nurse should consider this provision.

The 9th provision states that professional nursing, through its professional organizations, should articulate nursing values and professional integrity and integrate principles of social justice into health and policy (ANA, 2015). The provision also entails asserting nursing values, maintaining professional integrity, and integrating social justice into health and policy. In this case, the nurse experiencing moral distress does not exhibit professional integrity and appropriate nursing values by skipping department meetings and being temperamental. Additionally, offering care services in times of crisis is an issue of social justice. Therefore, this would direct the nurse in deciding on a course of action.

Summary and Course of Action

Based on the bioethical principles, laws, and ANA code of ethics discussed above, the ethical decision in this dilemma continues with work, but looking for ways to address the moral distress issue. Even though personal health may be at risk, the nurse should consider that the services are most needed, especially because there is a crisis and a form of social justice issue. Nurses are expected to uphold nursing values, maintain professional integrity, and contribute to addressing social injustices in health. The course of action supports all these considerations. However, it is essential to seek moral distress help.



American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. to an external site.

Farrell, C. M., & Hayward, B. J. (2022). Ethical dilemmas, moral distress, and the risk of moral injury: Experiences of residents and fellows during the COVID-19 pandemic in the United States. Academic Medicine97(3), S55.

Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson Education, Inc.

Huynh, A.P. & Haddad, L.M. (2022). Nursing Practice Act. In: StatPearls [Internet].

Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Annals of intensive care10, 1-9.

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