Choose a patient-care situation in which the RN should intervene and advocate for the patient. An example of such a situation might be when a patient has not been given complete informed consent.
Include the following in your paper:
Bioethical Decision Making Model
1. Define the dilemma: Use your own words to describe the problem. State it in a way
that others can quickly understand your dilemma. Review
2. Identify the medical facts: Describe the facts that are relevant to the dilemma.
3. Remember that the diagnosis and prognosis are medical facts.
4. Identify the non-‐medical facts (patient and family, external influences):
a. Patient and family facts such as culture, religion, social, economic, the
existence of an Advance Healthcare Directive, verbal preferences made by
the patient, how the patient lived his/her life.
b. Those that you discuss should be relevant to the situation.
5. External influences include: organizational policies, federal and state laws, practice
acts, code of ethics. These should be relevant to the situation.
6. For both step 2 or 3, separate the facts from the assumptions: Sometimes all
healthcare professionals allow assumptions to guide their decision-‐making. These
must be identified so that these assumptions do not interfere with the process.
7. Identify items that need clarification. Your paper should identify facts that you need
to clarify. When initially discussing an ethical situation, it is not unusual to not have
all of the answers.
8. Identify the decision makers: Is the patient an adult competent to make their own
choices? Is the patient a child who is old enough to have a say in the decision. If the
patient cannot make their own decision, who is the decision maker? How was this
person selected?
9. Review the underlying ethical principles: Review which ones and why they apply t
this particular case: beneficence, nonmaleficience, veracity, fidelity, autonomy and
justice.
10. Define alternatives: One-‐Way to proceed may be apparent at this point. However,
sometimes there are different choices. They should be addressed identifying the
benefits and burdens for doing one thing versus the other.
11. Follow-‐up: Define the process to be used with the chosen alternative.
Reference Source: Levine-‐Ariff, J. & Groh, D.H. (1990). Creating an Ethical Environment.
Nurse managers’ bookshelf a quarterly series: 2:1. Baltimore, Maryland: Williams & Wilkins.
41-‐61.
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Week 7 Advocacy Paper
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Week 7 Advocacy Paper
The first section of the paper is called the introduction, yet the paper does not have a
heading that is labeled introduction. In this section, you would start with an introductory
paragraph. A well-written essay is similar to a trip. The introduction section is the planning stage
where you determine the place, time, and method of travel. You might also include the order of
the trip and stages of travel. Here is where you will introduce what your paper will be about. A
well-written introduction tries to get the reader to finish the rest of the paper. Use this to
complete your advocacy paper. Write this in third person. Explain what your paper is going to
include. Make sure to explain you will be using the Bioethical Decision Making Model to
address this situation.
Define your Dilemma
In this section you will describe your ethical dilemma. You may have to review what an
“ethical dilemma” includes. Make sure to explain the specific ethical principles involved in this
dilemma. Why does this situation include an ethical dilemma? Make sure you are not just
describing a clinically challenging situation, but a situation that actually includes an ethical
dilemma. This will be a specific situation, not a general situation. This can be an actual situation,
or a hypothetical situation. Either way, you will describe the situation in detail.
Identified Medical Facts
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In this section, you will describe the medical facts that are relevant to this specific
situation. You will include diagnosis, prognosis, diagnostics, etc. Make sure to support your
information.
Identified Non-Medical Facts
In this section, you will describe the non-medical facts. What patient and family
influences are involved? Address facts related to culture, religion, social, economic, AD
existence, and patient verbalized preferences.
External Influences
In this section, write about external influences related to professional standards and
policies, federal and state laws, state nurse practice acts, and the ANA Code of Ethics. The
information here should be directly related to your ethical dilemma. Make sure to support your
information with valid resources.
Identification of Assumptions
In ethical dilemmas, there may or may not be associated assumptions. These are
important to identify and acknowledge so they do not interfere with the process. These are
assumptions the healthcare team makes.
Items Needing Clarification
There may be additional items that need clarification. Often, when dealing with an ethical
dilemma, there may be answers that are not readily available.
Identification of the Decision Makers
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Is the patient a competent adult and capable of making their own decision? Is the patient
a child? Does the child have a voice? If the patient is not the decision maker, who is the decision
maker? How did this person become the decision maker? Make sure to support your information.
Review of Underlying Ethical Principles
Again, in this section, you will describe the underlying ethical principles involved in this
ethical dilemma. How do the principles of beneficence, nonmaleficence, veracity, fidelity,
autonomy, or justice apply to this situation? There must be at least two for it to be an ethical
dilemma.
Alternatives for Addressing This Ethical Dilemma
Once you apply the BDMM, there may be a clear choice. But then again, there may be an
alternative. In this section, describe in detail the different choices that may be appropriate. Make
sure to include both benefits and burdens in the alternative(s).
Define the Process for the Alternative
In the section, explain what the process would be for the defined alternative. An ethical
dilemma is when the correct or best choice is not obvious. You have described an ethical
dilemma in your paper and explained the choice made in that particular scenario. Now, pick a
different choice and explain the process and how the scenario would have unfolded if this choice
was made.
Conclusion
End with a conclusion where you summarize your paper and repeat the primary points.
Remember that a well-written essay is like planning a trip. The introduction is the planning
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stage; the body is the journey. The conclusion allows you the opportunity to reflect on where the
journey has taken you. This is similar to reviewing the pictures you took on your trip and
remembering the important places and experiences. Explain the benefit of using the BDMM and
your experience using it for this situation.
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References
American Nurses Association. (2015). Code of ethics for nurses with interpretive
statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/codeof-ethics-for-nurses/coe-view-only/
Butts. J., & Rich, K. (2016). Nursing ethics. Across the curriculum and into practice. (4th ed.).
Jones & Bartlett Learning. https://online.vitalsource.com/books/9781284099096
Pozgar, G. (2016). Legal and ethical issues for health professionals. (4th ed.). Jones & Bartlett
Learning. https://online.vitalsource.com/books/9781284089530
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