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Ethical decision making model has three components namely knowledge, skill, and attitude. When an ethical dilemma is presented to nurse both nursing and ethical knowledge are activated . The initial primary concern of the nurse is to understand the nature of the nursing problem. When the nursing problem is clarified, the nurse proceeds to consider the ethical aspects of the case( Harasym ,2013). .
The basic steps in the skills component of the model are problem identification , information gathering and decision making, planning for treatment and management and observed clinical behaviors. The final step can be influenced by the individual and context factors as conflicts, nature of family support system and available resources. While making ethical decisions, nurses identify the most appropriate nursing intervention which can be altered by contextual factors including the preferences of the patient or family and quality of life. Justifications for nursing and ethical decisions are based on a variety of factors as probabilities, theory, principles, law, professional codes, beliefs, values, guidelines, consequences, outcomes of comparable cases, and prior experiences. The model provides a framework to foster understanding of ethical reasoning (Harasym ,2013).
The right decision in nursing requires enough sensitivity to ethical issues and failure to handle ethical issues in caring may result in neglecting ethical principles of nursing . In workplaces where nurses constantly receive many different messages, ethical messages can be overlooked and the ethical leader can bring ethics to the attention of employees through frequent contacts and ethical messages (Esmaelzadeh,2016) .
Ethical sensitivity is an element that enables the identification of ethical challenges, emotional and mental perceptions of vulnerable situations of patients and awareness of ethical outcomes of decisions made by others. Ethical sensitivity is defined as an attention to the ethical values involved in a conflict-laden situation and a self-awareness of one’s own role and responsibility in a situation. It is a personal predisposition guiding ethical decision making and involves cognitive capacity, including feelings, ethical awareness, skills and inter-relational process (Esmaelzadeh,2016) .
Nursing ethical sensitivity is defined and measured in at three different ways: identification of numbers of ethical issues, recognition of the rare characteristics of situations and persons receiving care and attitudes to issues such as the restraints using and forced medication administration. Ethical sensitivity requires nurses to recognize patients’ needs by learning and interpreting their verbal and non-verbal behaviors (Esmaelzadeh,2016) .
Ethical sensitivity development creates an attitude and ethical response in nurses which enables providing effective and ethical care for patients. Ethical sensitivity is particularly important for nurses as ethical care providers and this leads to ethical decision making that favors the patients (Esmaelzadeh,2016) .
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