NR 581 Week 6 Assignment Addressing Ethical Dilemmas Presentation

Grace J.
September 1, 2025September 1, 2025
CU MSN, NR-581

Student Name

Chamberlain University

NR-581: Foundational Concepts for Advanced Nursing Practice

Prof. Name

Date

Introduction

Ethical dilemmas in healthcare arise when professionals face conflicting values, incomplete information, or the need to balance ethical duties with legal obligations. A significant area where these challenges are evident is end-of-life care, where decisions about treatment, comfort, and patient autonomy often clash with family expectations. This discussion explores an ethical dilemma observed in hospice care, emphasizing the responsibilities of advanced practice nurses (APNs) and identifying strategies for improving patient-centered decision-making. The main concern is respecting patient autonomy while simultaneously addressing professional, legal, and family considerations to provide compassionate and ethically sound care.

Advocacy

Advanced practice nurses act as patient advocates, ensuring that healthcare delivery is holistic and tailored to individual needs. Advocacy includes acknowledging not only the physical aspects of care but also cultural, emotional, and spiritual dimensions. In end-of-life care, advocacy particularly involves safeguarding patient autonomy and fostering open communication among patients, families, and providers to avoid misunderstandings and promote shared decision-making.

Education

Another key responsibility of APNs is serving as educators for patients and families. They provide evidence-based information about disease progression, available treatment choices, and ethical considerations related to care. By delivering clear and accessible knowledge, APNs empower patients and their loved ones to make informed choices during critical situations. This educational role is essential in end-of-life care where decisions can be emotionally overwhelming, and clarity is necessary for patient dignity and family peace of mind.

Leadership

Strong nursing leadership is critical when navigating ethical conflicts. Research highlights that nurses often feel less empowered to influence decisions compared to physicians or advanced providers (Cederquist et al., 2021). Despite these challenges, APNs can exercise leadership by guiding interdisciplinary teams, ensuring that ethical principles remain central to decision-making, and promoting a patient-first approach. By modeling ethical practice and facilitating collaboration, they create an environment where both patient rights and professional duties are respected.

Advanced Nursing Role

Ethically complex scenarios are common in nursing practice, especially in caring for terminally ill patients. A case in a long-term care facility illustrates this challenge. A hospice patient, fully competent and able to make personal decisions, developed Kennedy ulcers, signaling impending death. Despite the patient’s ability to express preferences, the power of attorney (POA) insisted on initiating sedative medications to keep the patient unconscious until death.

The nurse attempted to educate the family about the patient’s rights and the absence of a medical basis for sedation. Nevertheless, the provider honored the POA’s request. The nurse, obligated to follow the provider’s orders, administered the medication, and the patient soon passed away. This case highlights the tension between respecting autonomy and addressing family demands, raising serious ethical and professional concerns.

Description of an Ethical Dilemma

Stakeholders and Roles

Stakeholder	Role/Responsibility
Long-Term Care Organization	Maintained compliance with legal and ethical standards; accountable for organizational integrity.
Provider	Balanced clinical judgment with patient wishes and family demands.
Registered Nurse	Advocated for patient rights while carrying out provider’s orders.
Client (Patient)	Experienced the physical and emotional impact of end-of-life decisions.
Power of Attorney (POA)	Exercised decision-making authority, influenced by beliefs and emotional pressures.

Impact on Stakeholders

Stakeholder	Impact
Long-Term Care Organization	Risk of reputational damage and legal repercussions if ethical norms were compromised.
Provider	Faced moral distress balancing patient rights with family preferences.
Registered Nurse	Experienced emotional burden and moral conflict in care delivery.
Client (Patient)	Loss of autonomy and potential reduction in quality of end-of-life experience.
Power of Attorney (POA)	Carried emotional weight and stress of making life-ending decisions.

Ethical Analysis

Several ethical principles were challenged in this case:

Autonomy: The patient’s ability to make decisions was overridden by the POA’s request.
Beneficence: Actions were intended to provide comfort, but the actual benefit was debatable.
Non-maleficence: Sedation without medical justification may have caused harm by depriving the patient of awareness during their final moments.

According to Nnate (2021), healthcare professionals are obligated to balance ethical principles with patient values, ensuring that decisions reflect both compassion and respect for 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 loyalty to the patient.
Provision 3	Nurses are required to protect and advocate for patient rights and safety.
Provision 4	Nurses are accountable for decisions and actions taken in the care process.

Recommendations

Advanced Care Planning

The American Nurses Association (2021) emphasizes that early documentation of patient wishes is essential in preventing conflicts. Comprehensive advance care planning ensures that preferences are recorded and honored, reducing ambiguity and safeguarding patient autonomy (Smith et al., 2020).

Engagement of Stakeholders

Frequent dialogue with all stakeholders—including patients, providers, and family members—clarifies expectations and reduces misunderstandings. Referring to organizational policies and ethical guidelines ensures that patient-centered care is consistently upheld.

Standardized Documentation

Adopting standardized documentation practices for end-of-life care creates transparency, protects healthcare providers from legal disputes, and ensures accountability in clinical decisions. Thorough records serve as both a legal safeguard and a resource for future care planning.

Conclusion

Advanced practice nurses are vital in managing end-of-life ethical dilemmas. By combining advocacy, education, and leadership, they help maintain a balance between patient autonomy and professional responsibilities. Ethical decision-making requires prioritizing patient dignity while addressing the concerns of families and healthcare teams. Proactive strategies, such as advanced care planning and standardized documentation, reduce conflicts and foster compassionate, patient-centered care at the end of life.

References

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

ANA 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