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Define the dilemma: Use your own words to describe the problem. State it in a way that others can quickly understand your dilemma.

This week is an Advocacy Paper. Choose a patient care situation in which the Registered Nurse should intervene and advocate for the patient. An example of such situation might be when a patient has not been given complete informed consent. Include the following in the paper: Describe the clinical situation concisely and descriptively. It can be an actual situation or a hypothetical one. Apply the Bioethical Decision Making Model to the specific clinical situation that you choose. Address each section of the model in the paper. Conclude with a discussion of nursing advocacy in the clinical setting and the nurse’s role as a patient advocate.
Below is the 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.
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. This should be relevant to the situation.
6. For both #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. The paper should identify facts that you need to clarify. When initially discussing an ethical situation, it is not unusual to not have all 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 to this particular case: beneficence, nonmaleficence, 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.
10. 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 manager’s bookshelf a quarterly series: 2:1. Baltimore, Maryland: Williams & Wilkins. 41-46.

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