NUR 210 – Ethical Dilemmas in Patient Advocacy

Case Study Analysis Assignment

Assignment overview

Prepare a 1,050–1,400-word case study analysis that examines an ethical dilemma in patient advocacy from the perspective of a registered nurse in a clinical setting. Focus on how professional obligations, patient rights, and organizational constraints interact, and explain how you would advocate for the patient while upholding the nursing code of ethics and relevant legal requirements.

Assignment context

Nurses regularly encounter situations where patient preferences, family wishes, and institutional policies do not fully align. Ethical dilemmas in these situations often involve tensions between autonomy, beneficence, non-maleficence, and justice, and can create moral distress for bedside nurses who are trying to advocate for safe, person-centred care. A structured analysis helps you make sense of these tensions and respond in a way that is ethically defensible and professionally sound.

Assignment instructions

1. Select or use an assigned case

• Use either the case scenario provided in your course site (for example, a conscious patient refusing a recommended treatment, a family demanding non-disclosure of a diagnosis, or a request for potentially futile care) or another instructor-approved scenario that clearly involves an ethical dilemma in patient advocacy.

• Ensure that the case takes place in an RN practice context such as medical-surgical nursing, critical care, long-term care, community health, or emergency nursing.

2. Describe the ethical dilemma clearly

i. Present the situation.

• Summarize the relevant clinical facts, including patient condition, key history, and current treatment plan.

• Identify the main individuals and groups involved or affected (for example patient, family, nurse, physician, social worker, organization).

ii. Identify the dilemma.

• Explain what makes the situation an ethical dilemma for the nurse, such as a conflict between patient wishes and family demands, or between safety concerns and institutional rules.

• Link the dilemma to at least two ethical principles (for example autonomy, beneficence, non-maleficence, justice, veracity, fidelity).

3. Analyse professional and ethical responsibilities

i. Professional standards and codes.

• Discuss relevant standards from a professional nursing code of ethics or similar guideline and explain how they apply to the case.

• Consider duties related to patient advocacy, confidentiality, informed consent, and respect for persons.

ii. Legal and organisational factors.

• Identify any legal requirements or organisational policies that shape what the nurse can or must do in the situation, such as consent policies, documentation expectations, or reporting duties.

• Explain how these factors either support or constrain ethical patient advocacy.

4. Develop an advocacy plan as the RN

i. Immediate actions.

• Describe the steps you would take as the nurse to address the situation in real time, such as clarifying patient preferences, providing information, involving an interpreter, or seeking support from colleagues.

• Explain how you would communicate with the patient and family in a way that is respectful, honest, and supportive of informed decision-making.

ii. Interprofessional collaboration.

• Identify other professionals or services you would involve (for example the attending physician, charge nurse, ethics committee, social worker, spiritual care, legal or risk management staff).

• Explain how collaboration with these team members would help to resolve the dilemma or reduce moral distress.

iii. Protection of patient rights and safety.

• Discuss how your proposed actions respect patient autonomy and promote safety, and how you would proceed if patient preferences differ from the team’s recommendations.

• Describe how you would document your assessments, communications, and advocacy steps in the health record.

5. Reflect on implications for nursing practice

i. Impact on the nurse.

• Consider how the dilemma and your response might influence your sense of professional integrity, moral distress, or resilience as a nurse.

ii. Learning for future practice.

• Identify one or two lessons you would carry forward into similar ethical situations, such as earlier use of ethics consultation, improved communication strategies, or stronger advocacy for policy changes.

6. Academic writing and format requirements

• Length: 1,050–1,400 words, excluding title page and reference list.

• Writing style: Use clear, precise academic language in the third person or first person where appropriate for reflection. Maintain a formal, respectful tone.

• Referencing: Use current APA style for in-text citations and reference list.

• Sources: Include at least four recent scholarly or authoritative sources (2018–2026) that address nursing ethics, patient advocacy, or ethical dilemmas in clinical practice.

Marking criteria (grading rubric)

Criterion 1: Clarity of the ethical dilemma (25%)

• High distinction: Provides a clear, detailed description of the clinical situation and the ethical dilemma, accurately identifies the main stakeholders, and convincingly links the dilemma to specific ethical principles.

• Credit: Describes the situation and dilemma with adequate detail and links to ethical principles, with minor gaps or areas that could be clearer.

• Pass: Gives a basic description of the situation and dilemma but omits some important details or links to ethical principles.

• Fail: Dilemma is unclear, incomplete, or not clearly ethical in nature.

Criterion 2: Analysis of professional, ethical, and legal responsibilities (30%)

• High distinction: Thoroughly analyses relevant professional standards, ethical codes, and legal or organisational factors, and clearly explains how they apply to the case and shape the nurse’s responsibilities.

• Credit: Addresses key professional, ethical, and legal elements with generally accurate explanations, though some points may be less fully developed.

• Pass: Mentions some standards and responsibilities but with limited depth or incomplete application to the case.

• Fail: Provides little or no analysis of professional, ethical, or legal responsibilities.

Criterion 3: Quality of the advocacy plan (25%)

• High distinction: Presents a specific, realistic advocacy plan that includes concrete actions, clear communication strategies, thoughtful use of interprofessional resources, and careful attention to patient rights, safety, and documentation.

• Credit: Proposes reasonable advocacy steps and team involvement, with some detail on communication and documentation.

• Pass: Outlines general actions but lacks specificity or does not fully connect them to patient rights and safety.

• Fail: Advocacy plan is vague, impractical, or not clearly linked to the dilemma.

Criterion 4: Reflection and implications for nursing practice (10%)

• High distinction: Offers a thoughtful reflection on the impact of the dilemma and response on the nurse, and draws out clear, practical lessons for future practice.

• Credit: Provides a meaningful reflection with at least one implication for future practice.

• Pass: Gives a brief reflection with limited insight.

• Fail: Reflection is superficial or absent.

Criterion 5: Scholarly writing and use of sources (10%)

• High distinction: Writing is well organised, coherent, and largely free of grammatical and spelling errors; sources are current, relevant, and correctly cited in APA style.

• Credit: Writing is clear with minor errors; citations and references mostly follow APA style.

• Pass: Writing is understandable but may contain recurring errors; APA style is inconsistent.

• Fail: Frequent errors or weak structure limit clarity; citation of sources is inadequate or missing.

Many effective analyses start with a concise description of how a patient’s refusal of a recommended intervention places autonomy in tension with the nurse’s duty to prevent harm and promote well-being, then anchor the discussion in the nursing code of ethics and current literature on ethical dilemmas in clinical care (Aydogdu 2022). Strong assignments often show how the nurse can protect patient rights through clear communication, information sharing, and respectful documentation while also engaging the interprofessional team and, when appropriate, an ethics consultation service. Careful reflection on moral distress and professional growth helps to connect the case to the student’s developing identity as a patient advocate.

• How nurses respond when ethical duties and patient wishes collide:

References

• Aydogdu, ALF 2022, ‘Ethical dilemmas experienced by nurses while caring for patients during the COVID-19 pandemic: A scoping review’, Journal of Clinical Nursing, vol. 31, no. 9–10, pp. 1206–1220, doi: https://doi.org/10.1111/jocn.16101

• American Nurses Association 2015, Code of Ethics for Nurses with Interpretive Statements, ANA, Silver Spring, MD, viewed 19 January 2026, https://www.nursingworld.org/practice-policy/nursing-excellence/ethics

• Numminen, O, Repo, H & Leino-Kilpi, H 2019, ‘Moral courage in nursing: A concept analysis’, Nursing Ethics, vol. 26, no. 4, pp. 878–891, doi: https://doi.org/10.1177/0969733017720527

• Peter, E & Liaschenko, J 2023, ‘Moral distress, moral injury, and moral resilience in nursing practice’, Annual Review of Nursing Research, vol. 41, pp. 1–20, doi: https://doi.org/10.1891/0739-6686.41.1