Prince Georges Community College Ethical Dilemma Presentation

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Prince Georges Community College


it is an Ethics presentation Assignment, which am supposed to present in class, based on what the case study is below.

Below is the case study of what the presentation will be talking about. Please used this case study to write the paper

1): Moral Courage with a Dying Patient

Mr. T. is an 82-year-old widower who has been a patient on your unit several times over the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. On admission, his ejection fraction is less than 20%, EKG shows a QRS interval of greater than 0.13 seconds, and his functional class is IV on NYHA assessment.

He has remained symptomatic despite maximum medical management with a vasodilator and diuretics. He tells you, "This is my last trip; I am glad I have made peace with my family and God. Nurse, I am ready to die." You ask about an advance directive and he tells you his son knows that he wants no heroics, but they just have never gotten around to filling out the form. When the son arrives, you suggest that he speak with the social worker to complete the advance directive and he agrees reluctantly. You page the physician to discuss DNR status with the son. Unfortunately, Mr. T. experiences cardiac arrest before the discussion occurs and you watch helplessly as members of the Code Blue Team perform resuscitation. Mr. T. is now on a ventilator and the son has dissolved into tears with cries of, "Do not let him die!"

The presentation should be written in about 15 pages,.

following this lay out

The front pages

The case study alone on a page

Case study in your own small words


Ethical Dilemma ,based on the case study


ANA Code of Ethics based on the case study

Nursing provision based on the case study



Below i will give an attachment that content the (Rubric information for Ethical Dilemma)

And an example for the Ethics presentation

Please follow the rubric information.( 15pages)

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Information organized and placed in a logical sequence (10 1. points) 2. Demonstrated knowledge of ethical dilemma presented by: 2a. Summarized the situation (10) 2b. Explained the ethical dilemma (5) 2c. Solved the problem as a professional RN (15) Responses supported with specific ANA Codes 3. (20) Visual aids professional, visually interesting & aided in understanding material; proper 4. grammar/spelling/punctuation-no more than 2 errors in presentation (10) 5. Maintained eye contact of audience (10) 6. Voice clear & audible (10) Encouraged class participation (5) 7. Reference slide that includes references in APA 8. format (5) Total points possible = 100 Points Awarded Lateral Violence: The Sword in the Workplace NSG 100 INTRODUCTION TO NURSING AS A PROFESSION ETHICS CASE STUDY Case Study – Melissa started on the unit as a new graduate 5 weeks ago. She is still in orientation and has a good relationship with her preceptor. The preceptor has been assigned consistently to Melissa for most of the last 4 weeks, but due to a family emergency has not been unavailable in the last week. Melissa has been assigned a new preceptor for the remainder of her orientation. The new preceptor has not been welcoming, supportive, or focused on the educational goals of the orientation. In fact, this preceptor has voiced to all who will listen her feelings about the incompetence of new BSN graduates. Case Study(continued) – The crisis occurs when Melissa fails to recognize a patient’s confusion as a result of an adverse medication effect. The preceptor berates Melissa in the nurses’ station, makes sarcastic comments in shift report about the “inability of university-educated nurses to recognize the basics,” and informs the nurse manger “that new graduates are a danger to patients.” Melissa tells you that she thinks she should resign and that maybe her previous preceptor was too easy on her. You know her preceptor is an excellent clinician and experienced teacher. What is your advice to Melissa? Case Study in Own Words – Melissa just started her new job five weeks ago as a new nursing graduate. She is given an amazing nursing preceptor (Preceptor A). A family emergency with Preceptor A has occurred, and now Melissa has been assigned to a new preceptor (Preceptor B). Preceptor B is very condescending and derogatory towards Melissa, and as a result, Melissa thinks that her old preceptor was too easy on her. Melissa now wants to resign from her position. – What is occurring in this situation, and what advice should you give to Melissa? Introduction – “Ethics are crucial because moral questions are at the heart of life’s vital issues. Morality is primarily concerned with questions of right and wrong, the ability to distinguish between the two and the justification of the distinction” (Ray, 12) – All nurses should be supportive of each other – Nurses are upheld to the highest of standards Ethical Dilemma – The ethical dilemma in this situation is that Preceptor B is not taking proper responsibly to promote the health care environment. – Preceptor B is using lateral violence against the graduate nurse. – Examples of Lateral Violence – Manipulation – Gossiping – Slander – Preceptor B’s attitude, and behavior is making Melissa feel incompetent at effectively carrying out her nursing duties and properly caring for her patients. – Melissa wants to resign Solution – The first solution to this ethical dilemma is for Melissa to discuss the situation to the nurse manager. – Melissa needs to explain Preceptor B’s behavior to the nurse manager. – Melissa also needs to report the lateral violence to the nurse manager. – “A healthy work environment is primarily the responsibility of the leader. The leader sets the expectations, the tone, and, especially, the level of tolerance for the amount of bullying or unhealthy behaviors in the workplace” (oncnursingnews) ANA Code of Ethics – “The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care” (Code of Ethics for Nurses with Interpretive Statements 23). – The work environment should be free from harassment and other unethical elements – Nurses should work together to main the work environment. Provision 6 guides us to: - The provision states that a nurse must strive to improve the workplace as an ethical environment. The new preceptor is not doing this, therefore Melissa should report her. - Preceptor B is always castigating Mellissa, instead of explaining/teaching. Conclusion – Direct Melissa to the Charge nurse to take further action if the situation was not taken care of – It all relates back to Provision 6. References – Code of ethics for nurses with interpretive statements. (2015). Silver Spring, MD: ANA, American Nurses Association. – Lateral Violence in Nursing Can Take Many Forms. (n.d.). Retrieved July 14, 2017, from – Rae, S. B. (2009). Moral choices: an introduction to ethics. Grand Rapids, MI: Zondervan.
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Ethical Dilemma Presentation

Name of student

Institutional affiliation

The case study
• Mr. T, an 82 year old widower has been a patient in your unit severally over the past five years. His chronic

heart failure, diabetes and COPD have taken a toll on his body. He also has dyspnea, tachycardia and requires
24-hour oxygen supply in a day his ejection fraction was very low, less than 20% on admission, EKG displays
a QRS interval of greater than 0.13 seconds while his functional class is IV on NYHA assessment.

• When you ask about an advance directive, he informs you his son is aware that he is in no need of any

heroics, although they have never gotten around to filling out the form. On arrival, when you suggest to the
son that he speak with the social worker to complete the advance directive, he reluctantly agrees.

• One pages the physician so he can discuss the do-not-resuscitate status with the son. Mr. T unfortunately

experiences cardiac arrest before the discussion takes place hence you helplessly watch the Code Blue Team
members perform resuscitation on him. While Mr. T is on a ventilator, the son now cries claiming not to let
him die.

Case study in my own small words
• An 82 year old widower named Mr. T has often been a patient in your unit over the past five years. His

airflow blockage has made it difficult for him to breathe, while his heart does not pump blood as it should
therefore suffers from CHF and COPD. Mr. T still continues to be very much symptomatic despite being
under high medication. He is under a maximum medical management. As a nurse he informs you that he is
finally to let himself go; he’s content and glad to have made peace with God and his family. He is ready to
die. When asked for his advance directive to figure out what kind of medical care he wants, he inform you
that his son is already aware of his preferences of not needing any heroics. He adds on saying that they have
never gotten around to filling out the form yet.

• When the son arrives, you ask him to speak to the social worker concerning to finalize the advance directive.
He reluctantly agrees. You page the physician so he can discuss the do not resuscitate status with the son.
Unfortunately, before the discussion takes place, Mr. T experiences a cardiac arrest and you are subjected to
helplessly watch the members of the Code Blue Team perform a resuscitation on him. Mr. T is then placed
on a ventilator while the son seems to be in pain begging not to let his father die.

• The first code of ethics in nursing was formulated in 1950. Code of ethics is applicable in each institution in

different fields. Different professions have different code of ethics depending on the parties involved. Ethics
balances a work station as it is very vital to have a set principle apart from rules and regulations of an
institution. Rules and regulations are a requirement in any profession or working environment, but ethics
have to be set in place to help the individuals in the processes of decision making. It smoothens and makes it
easy for individuals to make decisions where difficult choices have to be made.

• Ethics of an individual are rooted from their education, background and experiences. Nursing professional

ethics are attained through learning and practice in nursing. Ethics are set in place to create a balance state in
a work place or an institution. The ethics help individuals in their daily practice in their set fields. Ethics are
important in decision making as they set a foundation for which a decision is made. Ethics promotes
efficiency in practice regardless of the profession an individual practices. Ethical codes shape ethical
behavior which clarify on what sort of beliefs and values are morally accepted. The code of ethics provides
nurses with a standard to use in making decisions and ethical analysis. Code of ethics acts as non-negotiable
guide for nurses.

• Ethical dilemmas are issues nurses come across on almost daily basis. They include situations whereby a

choice between two options must be made and neither of the options is perceived as a responsible solution
ethically. For a solution to become realized, extensive thought and discussion is done as the outcomes of
both options are weighed. Nurses come across situations which call for a comprehensive understanding of

• In the event of an ethical dilemma, a nurse may experience certain conflictions on what to do. The issue may
be morally right but not ethically advisable to a patient. A patient may make a decision and when not in a
position to reencounter such decision a family member may want the different choice.

It thus puts a nurse in a dilemma position because all the people have a say; the nurse is obligated to follow
the wishes of her patient but the family member asks the nurse to choose a different option. It therefore
creates an ethical dilemma for a nurse because a decision needs to be made. Weighing the options by the
patient and the family member may all be justified in their own way therefore a nurse should be able to
follow up on the necessary code of ethics to avoid such situations or solve them.

Ethical dilemma ,based on the case study
• The ethical dilemma in the case study is that the nurse has to make an important decision and the choices
made by the son and Mr. T are not the same. The nurse is required to identify which decision should be
made. According to the case study, Mr. T is willing to die but even though the son had reluctantly agreed
before, when his father experiences a cardiac arrest, his decision immediately changes.

• The nurse had initially talked with Mr. T whereby Mr. T had indicated his wishes to die because he claimed
he had made peace with his family and God. The son was did not have the time discuss on the advance
directive with the physician, and that little time is enough to change his initial decision.

• The nurse should also put into consideration that the advance directive is not put into writing, despite Mr. T

having openly said that the visit was his last. For any direct measures to be undertaken, there has to be a legal
form which lets the nurse sign off on the required areas. Patients may say one thing but mean the other
(Peluso et al., 2018).


The first step the nurse should do is understand the uniqueness of the dilemma. Each situational case is different; no patient is similar to the
other. Mr. T was of sound mind when he stated on his wishes of not requiring acts of heroics. His statement meant that he was willing to
withdraw the medication although the advance directive was not formulated. Mr. T is also a senior citizen who can make his own decisions; if
he were a minor, his statement of willingness to die would not become considered by the nurse. The case study shows different decisions made
concerning the same situation. For Mr. T to make a statement that insinuated his decision to forego the treatment just before experiencing a
cardiac arrest, that should be considered in making the decision regarding do-not-resuscitate order.

This scenario shows a patient who is willing to forego a treatment and a son who does not want the directive upheld. In this case, the family
that is the son, is not willing to let go of his father just yet despite knowing his father’s wishes of not requiring anymore acts of heroism. To
get a directive on the steps to take, the nurse may opt to report this situation to the nurse manager in charge. Seeking advice or help from a
higher power is important in a nursing profession. It is because certain scenarios repeat themselves and people with a longer experience would
help much in determining the seriousness of a situation and the required steps to be undertaken.

The nurse should explain the mental stability state of Mr. T was in as he expressed his wishes to let go of the medication. The medical history
of the patient is also considered to keep record of his state throughout his medication. The nurse should inform her superiors on the situation
as it is; the son’s decision to not wanting his father to die and Mr. T’s decision to be willing to withdraw all the treatment.

ANA code of ethics

The nursing code of ethics addresses both collective and individual nursing intentions therefore, require a demonstration of ethical
competence from each and every nurse in the professional life. The fact that the code of ethics articulates ethical obligations nurses should
follow, it does not necessarily state how those obligations are met. It applies to all nurses, whether volunteering, researcher, educator, clinical
care giver, or other nursing practice forms. Any of those can be termed as practice. The nursing Code of Ethics expresses a nursing
understanding of its responsibility and commitment to the society. The code of ethics contains nine provisions that have relational divisions;
nurse to profession, nurse to self, nurse to nurse, nurse to patient, and nurse-nursing to society. Nurse to nurse, nurse to self and nurse to
patient address the most crucial values and commitments to be met by the nurse. The rest of the provisions address duty and loyalty
boundaries, and dutiful aspects that are beyond one-on-one patient encounters.

Provision 1 states that practices of a nurses should be accompanied by compassion and respect for the inherent worth, dignity and personal
attribute of each individual with no prejudice. The right to and need for health care services is universal, as it surpasses all individual
differences. A nurse establishes relationships with the patient to build trust and...

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