Introduction
In Nursing Course, there are certain situations in which nurses are thrust into various strenuous ethical positions. Important nurses are often placed under moral distress. For instance, one can be aware of the right thing to do but experiences constraints that are institutional and make it nearly impossible to pursue the right course of action. This complex situation not only drives the nurse-patient relationship into an awkward position of spiritual comfort; it otherwise makes it more unattainable to improve the life of a patient. Lines, therefore, have to be drawn in order for nurses to ensure ethical professional standards in order to attain full spiritual care of their clients.

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Therefore, moral dilemma involving the need to opt for two reasonably acceptable options or two honest courses of actions where certain cases arise, nurses have to understand first the severity of the disease before settling for a cause of action. In cancer patients near – end life situations including common ethical predicaments such as artificial nutrition and hydration, truth telling and disagreement of various management plans, would put the clinician in good stead so as to be aware of the pertaining issues and have a subtle way of dealing with such problems.
Organizations also have the culpability to ensure that everything is in place so as to have minimal occurrence and optimal support for staff during their process of resolving difficulties.
The research paper aims at, carrying out a thorough analysis of various ethical dilemmas regarding nursing and health care decision also the implementation of those decisions in practice.

Problem Statement
Ethical Decision Making: Ethical Dilemma
As it might be a prevailing Instance for nurses to focus on the larger ethical issues faced during patient care, more trivial are everyday issues affecting clinical officers like me. Nurses are often required in terms of the ethical dilemma to carefully navigate through the complexities of the healthcare system in which raw data delivery as well as effective communication among the team members is facilitated.

In a qualitative scholarly study 22 nurses caring for patients with terminal cancer illness (Veer, 2012) identified that there are different ways nurses facilitate prognostic information in context of hope. It was determined that whereas there are interdependent nurses that are, they perform different tasks. These include; negotiating, facilitating, coordinating and providing different support for physician’s communications. There is a notable challenge that is associated with this such as they have to ask the physician questions like; “have you two talked about this?” However, as much as this has to be brought up, as a nurse I have to ensure that I do not in any way offend the doctor with my questions or even the phrases. The Author of the case study also concluded that it is necessary to have a more interdisciplinary way or method of communication. Similarly, they have referred to various communication skills and education since the medics have identified some difficulties with discussing prognosis-related information.

Identified are the problems such as patients’ reluctance to accept the prognostic information and hence nurses are accompanied by discomfort with the current process and desire to maintain hope with the patients. I also have in many chances found that generally ethical dilemmas occur when there is inadequate time since there might be “an expanded set of legal rules. These include protocols, clinical guidelines resulting in a strong emphasis on the accountability that understaffed cases lead to increased job pressure so does higher societal demands which have always been associated with moral desires.

Although my situation does not seem much complex, it is a real moral dilemma since the hospital always does its best to maintain the lowest possible cost hence the short listing of various staff personnel. Research on different moral distress situations has explained that moral distress has a more significant effect on experienced nurses more that physicists. It has more negative perception on ethical climate and reports lower satisfaction on quality of affliction. (Gaberson, 2014). Ethical issues are also mostly encountered during a provision of hospice as well as various palliative cares. Hospice has been a routine and has been institutionalized as a form of medical technique resulting to over emphasis on techniques and efficiency. It has, therefore, lead to deviating from its original medical routine (Annie J & Bradshaw M. 1994). Bradshaw reported that most frequent ethical dilemmas in the US are often used as a predicament to the survival of a terminally ill patient. Truthfully, as a Nurse, I have found the study of Mr. Bradshaw as a compelling fact since hesitancy to morphine for fear of respiratory failure and issues related to parental nutrition as well as meeting the expectations of different delirious clients have led to difficult clinical decisions.

In Taiwan, a team of professional training and manpower has demonstrated the distinct lack of solutions pertaining moral dilemma and inescapable effects such as the quality of care of a terminally ill cancer patient. This study entails the most common difficulties particularly relating to palliative care unit, conducted by the NTUH (National Taiwan University Hospital). Apart from confiding this research to an ethical dilemma, it is also asserted that various improvements should be made in which will ensure that the local variety of the car is established ( Burkhrdt, 2008).

Purpose Statement
Ethical Decision Making Model
In this Phase, I utilize the ethical model so as to figure out the principle in which I will be able advocate for changes in the nursing career and necessitate various improvements in nursing practices. Despite various cultural differences, it is seamless that agreed appropriate hospice and palliative care to be given within the framework of principles should always be adhered to.
Major Ethical Principles in the palliative care include or relate to:
1. Autonomy
2. Beneficence, which applies to various therapeutic strategy and decision making such as telling the truth and a choice of medication.
3. Justice- balance between personal need and social resources as it is the selection of place of care

As a nurse, the factors that are upon my responsibility include providing full care to every client. Such factors usually put me under moral distress. Hospital scheduling, therefore, leads to numerous instances of rationing hence more workload. As a leader in the nursing field, I should be able to satisfy all ethical duties without having necessarily an enormous workload. Moreover, in a situation where there is a limited ability to interact on the spiritual level with patients it taken into consideration to be a real difficulty. Since there are different ways in which patients are dealing with their end of life situations, and need spiritual support from nurses. From a Leading nurse perspective, the best way to deal with this is to grant the patient opportunity to guide you into action (O’Brien, 2011). The identification of moral distress, education and work habitat are the interdisciplinary collaboration, and support systems that will decrease moral distress (Anderson & Parker, 2013).

Conclusion
As a Leader, I would include a review of ethical, religious, clinical context in support of all of the positions this would advise the nurses to choose the best option for the patients. The discussion of ethical, religious, and clinical perspectives in support of all the positions broadens the nurses’ horizon and helps them to choose the best option for the patient” Educating the nurses on ethical dilemmas would require me to teach them on reflection. It is a conscious, dynamic process of brainstorming and discussing different analysis of learning from experience this gives the insights into self as well as their practice. When you engage in the process of reflection, you work towards a particular goal that is thoughtfully considering the situations and determine limitations to be addressed. As a leader I will change, the practices of today and opt for a written narrative since it lets one analyze the situation at hand more clearly with depth that otherwise would have been faulty if it were just talked about.