Reflective Entry 3:"Balancing Compassion and Policy: A Reflective Look at Ethical Dilemmas in Care"

What?

While on placement in a residential care setting, I encountered a situation where a resident with early-stage Parkinson’s wanted to self-administer their morning medication. He had done this independently for years at home and viewed the enforced administration routine in the home as “infantilising.” However, the facility policy required all medication to be administered by staff.

The resident was visibly upset, and I witnessed rising tension between him and the carer. I felt caught between respecting his autonomy and adhering to professional protocol.

So What?

This presented a classic ethical dilemma: autonomy vs. safety and policy vs. person-centred care.

My initial instinct was to side with policy — it seemed safer. But as I reflected, I questioned whether “safety” was being used to override the resident’s dignity. According to the NMC Code (2018), nurses must promote individual choice and independence. Ignoring the resident’s autonomy conflicted with this.

To work through the situation, I used critical thinking to examine assumptions:

• Was the resident cognitively competent?

• Could their physical state allow for safe self-administration?

• Were the staff following policy out of convenience or genuine concern?

I also consulted the Mental Capacity Act (2005) guidance and realised the resident likely had capacity to choose, which changed my perspective. I discussed my observations with the supervising nurse, who agreed to conduct a reassessment of the care plan.

This led to a compromise: supervised self-administration. It wasn’t policy-breaking — it was policy-adjusting through informed, reflective, ethical care.

Now What?

This experience changed my understanding of what it means to be a reflective, thinking practitioner. Reflection is not just about learning after things go wrong — it’s about catching the tension before harm occurs. As Rolfe et al. (2001) stress, reflection must lead to ethical action, not just thought.

I now understand that solving dilemmas in practice isn’t about choosing one side — it’s about negotiating context, ethics, and evidence. This aligns with Atkins & Murphy (1994), who argue that true reflective practice involves emotional awareness and moral courage.

Going forward, I will:

• Use daily reflective notes to track and analyse ethical dilemmas

• Study care policies more deeply to understand why rules exist — and how they can flex

• Build confidence to raise ethical concerns using evidence-based language

• Practice structured ethical reasoning using models like Beauchamp & Childress’ Four Principles (autonomy, beneficence, non-maleficence, justice)

Personal Growth Insight

What felt like a simple conflict turned into a turning point in my development. I realised that being a thoughtful practitioner requires not just knowing the rules — but knowing when to question them thoughtfully. Critical thinking and reflection gave me that ability.

References

• Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user’s guide. Palgrave Macmillan.

• Nursing and Midwifery Council (NMC). (2018). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at: https://www.nmc.org.uk/standards/code

• Atkins, S., & Murphy, K. (1994). Reflective practice. Nursing Standard, 8(39), 49–56.

• Beauchamp, T.L., & Childress, J.F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.

• UK Parliament. (2005). Mental Capacity Act 2005. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents