Use of the Ethical Positioning System for Solving Ethical Dilemmas

Tuesday, 10 November 2015: 10:40 AM

Joan Dorman, MSN, RN, CEN
College of Nursing, Purdue University Calumet, Hammond, IN, USA

Use of The Ethical Positioning System for solving Ethical Dilemmas


  It is typical in nursing education to value critical thinking, clinical reasoning, and problem solving as necessary skills. Students practice these throughout their education, and generally feel confident in their ability to arrive at acceptable solutions.

           At some point, however, students and nurses are faced with particular problems for which they do not feel prepared.  These are the ethical dilemmas, so common in today’s healthcare environment.   The associated feelings of powerlessness, faced in these situations, have driven many nurses from the bedside.

 It is apparent that nurses need a framework for systematically examining these dilemmas and reducing the feelings of despair.  It became apparent that the nursing process, which students and nurses use on a daily basis, could be adapted for use in making ethical decisions.  That is how The Ethical Positioning System evolved.

 The tool consists of six steps. The first step involves assessing the situation, including all elements of its context.  Next, the nursing dilemma is stated in a sentence or two. The third step, which is planning, calls for addressing all possible solutions to this ethical dilemma, along with the pros and cons of each choice.  These choices are then evaluated in terms of the applicable ethical principles and the appropriate provisions of the American Nurses Association (ANA) Code of Ethics.  To summarize and conceptualize this stage, all of this data is entered into a diagram, which is step four.  At this point, it is usually clear that one tentative solution exceeds the others.  The nurse then moves on to the final stages, implementation and evaluation.