NR 581 Week 6 Assignment Addressing Ethical Dilemmas Presentation

Student Name

Chamberlain University

NR-581: Foundational Concepts for Advanced Nursing Practice

Prof. Name

Date

Introduction

Ethical dilemmas in healthcare often occur when professionals face conflicting moral principles, limited information, or the need to reconcile ethical duties with legal responsibilities. These challenges are particularly pronounced in end-of-life care, where decisions about treatment, comfort, and autonomy may conflict with family expectations. This discussion examines an ethical dilemma observed in hospice care, focusing on the roles and responsibilities of Advanced Practice Nurses (APNs) and strategies to enhance patient-centered decision-making. The key issue revolves around maintaining patient autonomy while addressing professional, legal, and familial considerations to ensure compassionate and ethically sound care.

Advocacy

Advanced Practice Nurses (APNs) serve as crucial patient advocates, ensuring care that is comprehensive and individualized. Advocacy extends beyond the physical dimensions of care to include cultural, emotional, and spiritual aspects. In end-of-life care, advocacy emphasizes protecting patient autonomy and fostering open communication among patients, families, and healthcare providers. This approach helps to prevent misunderstandings and supports shared decision-making that aligns with patient values and dignity.

Education

Another significant responsibility of APNs is their role as educators for patients and families. They offer evidence-based information about disease progression, treatment options, and ethical considerations. Through clear communication and accessible education, APNs empower patients and families to make informed, value-driven choices during emotionally difficult times. This educational function is particularly vital in end-of-life settings, where understanding medical options supports dignified and peaceful decision-making.

Leadership

Nursing leadership plays an essential role in addressing ethical conflicts. Research indicates that nurses may feel less empowered to influence decisions compared to physicians or advanced providers (Cederquist et al., 2021). Despite these limitations, APNs can demonstrate leadership by guiding interdisciplinary teams, ensuring adherence to ethical principles, and fostering a patient-first culture. Through ethical modeling and collaboration, APNs help build an environment where both patient rights and professional duties are upheld.

Advanced Nursing Role

Ethically challenging situations frequently arise in the care of terminally ill patients. A notable case from a long-term care facility illustrates this complexity. A competent hospice patient who developed Kennedy ulcers—an indicator of approaching death—expressed their preferences regarding care. However, the Power of Attorney (POA) demanded continuous sedation to keep the patient unconscious until death.

Despite the nurse’s efforts to educate the family about the patient’s right to autonomy and the lack of medical necessity for sedation, the provider complied with the POA’s request. The nurse, required to follow orders, administered the sedative, leading to the patient’s death shortly thereafter. This incident underscores the conflict between autonomy and family wishes, raising deep ethical and professional concerns.

Description of an Ethical Dilemma

Stakeholders and Roles

Stakeholder	Role/Responsibility
Long-Term Care Organization	Ensured compliance with ethical and legal standards; maintained institutional integrity.
Provider	Balanced medical judgment with patient preferences and family expectations.
Registered Nurse	Advocated for patient autonomy while executing provider’s orders.
Client (Patient)	Experienced direct impact of end-of-life care decisions.
Power of Attorney (POA)	Exercised decision-making authority, often influenced by emotional stress and personal beliefs.

Impact on Stakeholders

Stakeholder	Impact
Long-Term Care Organization	Risked reputational and legal repercussions if ethical standards were violated.
Provider	Experienced moral distress in balancing ethical and familial pressures.
Registered Nurse	Faced emotional strain and moral conflict in care delivery.
Client (Patient)	Suffered loss of autonomy and possible compromise of quality end-of-life experience.
Power of Attorney (POA)	Endured emotional distress and the psychological burden of end-of-life decisions.

Ethical Analysis

This case challenges several ethical principles:

Autonomy: The patient’s right to self-determination was overridden by the POA’s decision.
Beneficence: Although intended to provide comfort, sedation offered questionable benefit.
Non-maleficence: Administering sedation without medical necessity may have caused harm by depriving the patient of consciousness during their final moments.

According to Nnate (2021), healthcare professionals must balance ethical obligations with patient values, ensuring decisions uphold compassion and respect for human dignity.

Ethical Provisions

Provision	Description
Provision 1	Nurses must treat every patient with dignity, compassion, and respect.
Provision 2	The nurse’s primary responsibility is to the patient.
Provision 3	Nurses are required to advocate for patient rights and safety.
Provision 4	Nurses are accountable for their professional decisions and actions.

Recommendations

Advanced Care Planning

The American Nurses Association (2021) emphasizes that early and comprehensive documentation of patient preferences can prevent ethical conflicts. Effective advance care planning ensures patient autonomy, reduces ambiguity, and promotes ethically consistent care (Smith et al., 2020).

Engagement of Stakeholders

Consistent and transparent communication among all stakeholders—including patients, families, and healthcare teams—helps clarify expectations and reduce conflict. Referring to ethical codes and institutional policies ensures that patient-centered values remain central to all decisions.

Standardized Documentation

Implementing standardized documentation practices for end-of-life decisions enhances transparency and protects healthcare professionals from legal risks. Accurate records not only ensure accountability but also provide valuable references for future ethical care planning.

Conclusion

Advanced Practice Nurses play a crucial role in addressing ethical dilemmas in end-of-life care. Through their combined roles in advocacy, education, and leadership, they balance patient autonomy with professional obligations and family expectations. Upholding ethical standards requires prioritizing patient dignity and informed choice while maintaining open communication among all parties. Proactive measures such as advance care planning and thorough documentation foster compassionate, ethical, and patient-centered end-of-life care.

References

American Nurses Association Center for Ethics and Human Rights. (2021). Nurses’ professional responsibility to promote ethical practice environments (By ANA Board of Directors). American Nurses Association. https://www.nursingworld.org/~4ab6e6/globalassets/practiceandpolicy/nursingexcellence/ana-position-statements/nursing-practice/nurses-professional-responsibility-to-promoteethical-practice-environments-2021-final.pdf

Atkinson Smith, M., Torres, L., & Burton, T. C. (2020). Patient rights at the end of life: The ethics of aid-in-dying. Professional Case Management, 25(2), 77–84. https://doi.org/10.1097/NCM.0000000000000392

Cederquist, L., LaBuzetta, J. N., Cachay, E., Friedman, L., Yi, C., Dibsie, L., & Zhang, Y. (2021). Identifying disincentives to ethics consultation requests among physicians, advanced practice providers, and nurses: A quality improvement staff survey at a tertiary academic medical center. BMC Medical Ethics, 22(1). https://doi.org/10.1186/s12910-021-00613-7

Code of Ethics for Nurses. (2017). American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Nnate, D. A. (2021). Treatment withdrawal of the patient on end of life: An analysis of values, ethics, and guidelines in palliative care. Nursing Open, 8(3), 1023–1029. https://doi.org/10.1002/nop2.777