Case study analysis for Nursing (Bioethics)

Assignment Description
Case Analysis Paper Assignment- MSN students
Your writing assignment requires that you argue for a recommended course of action the nurse (or nurse practitioner) should take, using the method explained in this document. To find a case, aim to find a nurse who holds a position you hope to have after you graduate, and ask this nurse to share a case that presented an ethical dilemma to her/him.

Organize your paper according to the sections described below, inserting into your paper as section headings each of the words in bold font. Also include each of the section letters (A, B, etc.) in bold font. With the exception of sections 3 and 4, answer the questions in clear, complete sentences (paragraphs where appropriate), and avoid the use of first and second person in all sections except when explaining where you found the case.
Papers should be APA, minimally 1800 words, excluding the works cited.

PART ONE: THE CASE
A) What is the case that presents an ethical problem to the nurse?

Briefly (in no more than 600 words) describe a particular scenario that leads up to an ethical dilemma/problem for the nurse. (“Ethical dilemma/problem” implies the nurse is in a situation where, because of competing ethically relevant factors, he or she is yet uncertain about the right way to respond—or is pulled to respond in two or more opposing ways.) The case description should focus on the significant data that need to be considered in making an ethical analysis. Typically this includes information about the condition of the patient and about people to be affected by the decision. It may also include information about the belief system of a particular culture or religious group, and relevant laws or institutional policies. (Do not in this section refer to tenets of the Code of Ethics or to any ethical obligations.) Do not state here (or in any section prior to Part Three) how the case was resolved or what should have happened. Also, do not in this section state anything regarding what the nurse ought to do. Rather, give only the information about the case that leads up to the nurse’s dilemma.

B) From whom did you learn about such a case?
Identify the general source (employment position of person) from whom you learned about the ethical dilemma described above. Be careful here and throughout your paper to protect confidentiality.
PART TWO: ANALYSIS
Throughout Part Two, do not add facts to the case or needlessly repeat facts already presented in the case description.
1 – Stakeholders and the Wishes/Goals that Matter Most to Each
Identify each person (or group of persons) who has something significant to gain or lose in relation to how the situation is handled. For each identified stakeholder, state the one or two items that the stakeholder would say matters most to him/her/them. If it is unknown what matters most to a stakeholder, state so, indicate possibilities for what could matter most to the stakeholder. If a stakeholder is unconscious or not-yet-reflective, state the most significant benefits and/or harms at stake for that stakeholder.

Do not state what the stakeholders ought to be concerned about. Also, do not include the nurse or any other member of the health care team as a stakeholder unless he or she has something at stake in this case besides his or her concern to do the right thing (or concern to fulfill obligations, appropriately care for the patient, etc.).

2 – Opposing General Options
Identify two opposing general options the nurse could take.

3 – Specific Ethically Relevant Benefits to be Gained by Option 1
List and number the case-specific ethically relevant “benefits” (goals) that can be achieved by Option 1. For the purpose of this assignment, “benefits” are not limited to the kinds of goods typically considered when considering the principle of Beneficence. Rather, “benefit” refers to anything to be achieved for which there is some ethical reason to care about achieving it. (Ethical reasons do not include reasons merely grounded in satisfying the nurse’s own desire/interest/need.) Typically, each benefit will be a particular way of respecting a person (and the person’s rights) and/or promoting a person’s well-being (flourishing).

To help you pinpoint what is ethically relevant, express each benefit as a succinct phrase beginning with an ‘-ing’ word. If any phrase needs clarification regarding what is ethically relevant, provide the clarification in parentheses, using either a phrase or complete sentence.
Examples of ethically relevant benefits include:
1. Honoring Mr. Roberts’ ethical right to know about his diagnosis
2. Helping Mr. Roberts to maintain trust in his health care providers
3. Satisfying Mrs. Roberts (specifically regarding her wish for Mr. Roberts not yet to know about his newly diagnosed cancer)
4. Appreciating the possibility Mr. Roberts would prefer not yet to know about his cancer (He later may be grateful for having had the opportunity to enjoy his daughter’s wedding without having known about his cancer.)
Other examples include:
• Fulfilling Mr. Jones’ (the patient’s) current wish to ____
• Fulfilling Mr. Jones’ previously stated wish (as communicated in his advance directive) to ____
• Appreciating the possibility (despite what Mr. Jones’ son states) Mr. Jones actually would have wanted ______
• Alleviating the current discomfort Mr. Jones is experiencing
• Eliminating (or diminishing) the risk of discomfort Mr. Jones could experience Do not list general principles or general duties/responsibilities, and do not refer to desires of the nurse to fulfill a duty or to see that patients are appropriately treated. (Examples of what not to include are “fulfilling the nurse’s duty to keep patients safe”; “satisfying the nurse’s desire to avoid harm to Mr. Smith”.)

IMPORTANT: In this section, and throughout your paper, do not use words/phrases such as “autonomy,” “dignity,” “respect”, “advocate,” “justice,” “quality of life,” etc., without clarifying specifically what you mean. Do not use “beneficence” or “nonmaleficence” without indicating the specific benefits or harms you have in mind. Do not use the terms “futile” or “futility” without specifying the goal in relation to which the action would be futile. If you use the word “right,” clarify whether you are referring to a legal right or to a fundamental ethical/moral right, and for any ethical/moral right, to the extent possible, indicate why such a right exists.

4 – Specific Benefits to be Gained by Option 2
List the case-specific benefits that can be achieved by Option 2. Number them starting with the number following the highest number used in section 3.
5 – Justified Recommendation of General Option
A) State the recommended general option and justify your claim by stating which benefits are most important.
Use this format: Encouraging the health care team to continue Mr. Jones’ life-sustaining treatments (Option 1) is the better option because the most important benefits to be achieved are:
• appreciating the possibility Mr. Jones would have wanted to be kept alive (#2); and
• appreciating the possibility Mr. Jones will soon recover his ability to communicate (#4).

B) Further justify your claim by explaining why the benefits listed in part A are more important than the benefits you’ve listed supporting the opposing option.

Additionally, pose objections to the points you make.
Considering one or more of the benefits that support the opposing option, present one or more robust (well–elaborated) objections to your reasoning that your recommended option is the better option. Present each objection in a distinct paragraph which begins “Objection:”. Follow each paragraph with a paragraph that responds to the objection and which begins with “Response:”. This should strengthen your argument that the section 5 recommended option is the better option.

6 – Sensitivity and Refined Recommendation
Admit how the recommended option is likely to infringe on one or more of the numbered would-be-benefits supporting the opposing option. (You need not address all the benefits supporting the opposing option.) Then explain what could be done—while still following the general recommendation argued for in section 5—either to help achieve this (these) benefit(s) or at least show sensitivity toward the loss of this (these) benefit(s). Example: Being honest with Mr. Roberts about his condition will not satisfy Mrs. Roberts’ desire for the clinicians to postpone disclosing it to him (#3). However, Mrs. Roberts may become less disappointed with the decision to disclose the diagnosis if the care team . . .)
Additionally, elaborate on the course of action the nurse should take, providing details not yet mentioned in the general recommendation. For example, if the recommended response entails the nurse having a discussion with one or more persons, provide details regarding what the nurse ought to say and how to say it. (You may wish to consider publications on effective communication, such as pp. 52-55, 63-64 of the chapter by Fiona Timmins posted in the E-Reserves.)
Do not merely hand off the nurse’s dilemma to someone else! If you think the nurse ought to bring the case to an ethics committee, explain exactly what a nurse serving on the ethics committee ought to say and recommend.
Integration of Literature
(Do not insert the words “Integration of Literature” in your paper.)
• In section 5 (and possibly other sections as well) meaningfully integrate published ethics-related claims into your analysis. Your paper must include at least three references to publications, and at least two of the publications must not include your course texts or readings found in E-Reserves. (Note: The initial submission of your paper should include some—but need not include all—the references your final paper will make to publications.) Integrated literature, while not referring to your specific case, should present a general consideration relevant to your analysis (even if it’s a point with which you disagree and which you criticize in your paper). An example would be a published comment about the clinician’s obligation to “do no harm” and/or about what kinds of situations justify allowing a certain harm.
• Regarding each reference to a published claim, be explicit regarding the reason you make sure a reference. If you agree with the author, include a phrase such as: “As Edison appropriately claims,. . . ” or “Agreeing with the ANA Code of Ethics, which states . . .,” If you disagree with the claim, include a phrase such as: “Contrary to Merton, who claims . . ., it is the case that . . .”
• In addition to the required integration of ethics-related claims, you may integrate relevant published empirical facts, in which case you need not clarify the extent to which you agree with the fact.
• When referring to publications, provide within the body of your paper the author’s name, date of publication, and specific page/section number(s) so that the referred to passage or idea easily can be found.

INTEGRATION OF LITERATURE: The author meaningfully integrates claims of the required number of publications according to the paper instructions, including in the body of the text the specific page number on which the referred to point is found. The author provides an appropriate bibliography of the sources. 15% (13.5-15 very good/excellent, 11-13 satisfactory/good, 7.5-10 partially satisfactory, 0-7 poor)
For any section that fails to abide by any of the relevant “Additional Instructions,” points will be deduced within that section. For example, a deduction of points will occur in each section where there is an occurrence of grammatical errors or inappropriate or ill-defined phrases/terms (e.g., “I feel,” “futile” without reference to a specific goal).

Sources to reference and integrate within the paper:
American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Washington, DC: Author. (ISBN: 978-1-55810-599-7)

Post, LF, Blustein J (2021). Handbook for Heath Care Ethics Committees (3rd Edition). Baltimore, MD: The Johns Hopkins University Press. (ISBN 978-1-4214-4234-1)

I interviewed the Nurse (RN) and these are the nurses responses (case study) along with my opposing general options to majority of the rubric key points in part 1 and 2. I ran out of time to write the paper as the intructions and rubric requested.
PART 1
1) Case: Chief complaint: 34-year-old female patient with dissociative disorder. Shortness of breath, malaise, chronic anemia, Hemoglobin level of 3, Respiratory distress related to decreased Hgb and low blood volume caused the need for intubation, history of Chronic kidney disease, history of kidney transplant however kidneys weren’t working due to Acute kidney injury, due to labs showing increase BUN, and Cr., WBC were low.
Next of Kin: Patient’s mother, who is a Jehovah’s witness, who stated patient does not take any blood products which causes confusion due to patients Past medical history of kidney transplant. Patient had inability to communicate due to intubation and sedation.
 “Nurses had uncertainty about blood products being allowed to be administered or not because of the patient’s history revealing a kidney transplant.”
 Some Jehovah witness won’t take whole blood but will take some blood that is derived from blood products.

2. Source: MICU-ICU Registered Nurse, RN

PART TWO:
1) STAKEHOLDERS
Stakeholder 1: next of kin, mother
Stakeholder 2: patient, unsure of her wish’s d/t sedation and intubation & needed to be evaluated competent by psych.
Stakeholder 3: Bioethics committee – there mediate and make sure things are ethical and legal.
2) OPPOSING GENERAL OPTIONS:
Option 1: Honor the wishes of the Next of Kin, mother by not giving the patient blood products.
Option 2: Give the patient products.
3) and 4) “BENEFITS” TO BE GAINED BY EACH OPTION: (could add more) follow directions.
– Option 1: morally the mother will believe the pt will be condemned by her god, pt will carry around guilt and suffer from depression if she was to receive the blood products, receiving moral distress, struggling with her spirituality and/or relationship with her god.
– Option 2: by administrating blood products the pts hemoglobin would increase thus sustaining her BP and allowing the pt to be removed off of life support, it would also help recovery from her AKI acute kidney injury (prerenal), decrease her need for possible dialysis.
5) JUSTIFICATION OF THE BETTER OPTION:
Option 1 is the better option both legally & ethically, no harm was done, although she took longer to recover, she did so. Honored wishes didn’t cause any moral distress, anxiety, depression, failure to thrive and did not allow the pt to come to any conflicts with her religious beliefs with her god.
Possible objections: A possible objection is the pts wishes are not compatible scientifically for sustaining her life. (COPY & PASTE FROM CASE the reason blood is need) refer back to option 2
6) SENSITIVITY & REFINED RECOMMENDATION: (I did not complete) follow assignment directions.

INTEGRATION OF LITERATURE: (I did not complete) follow assignment directions.
Sources to reference and integrate within the paper:
American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Washington, DC: Author. (ISBN: 978-1-55810-599-7)

Post, LF, Blustein J (2021). Handbook for Heath Care Ethics Committees (3rd Edition). Baltimore, MD: The Johns Hopkins University Press. (ISBN 978-1-4214-4234-1)

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