Ethical models: facilitating clinical practice.

Modern health care presents significant dilemmas in nursing practice. Nurses are often entangled in the web of conflicts between the principles of autonomy, beneficence, and justice in managing the health care concerns of individuals, nurses, and the health care team. However, to achieve resolution the nurse needs an ethics model with which to determine appropriate care practices. According to the concept of autonomy, each individual has the fundamental right of self-determination in health care decisions. At the same time, the nurse strives toward beneficent care for individuals through the delivery of health care. Tension between these two principles generally is minimal. It is only when conflicts exist between the autonomous patient and the beneficent nurse that ethical problems surface. At these times, respect for individual freedom and the interest in doing good are juxtaposed. Nurses may have difficulty determining which actions best serve the purpose and interests of each party to the issue, or which issues, if any, must be regarded as fundamental obligations. For nurses to provide patient care within an ethical framework, clinical practitioners need (1) knowledge of basic rights and ethical principles; (2) conceptual models as ways of thinking about ethical dilemmas; and (3) opportunities to explore and resolve clinical dilemmas.