NURS 3350 Module 4 Assessment: Ethical Dilemma Case Analysis

Assignment Brief: Navigating Ethical Conflicts in Patient Care

Course Code: NURS 3350 – Ethics & Legal Standards in Nursing Practice

Assessment Title: Module 4 Case Study – Ethical Decision-Making & Advocacy

Level: BSN (Bachelor of Science in Nursing)

Length: 1,200 – 1,500 words (excluding title page and references)

Format: APA 7th Edition

1. Context & Purpose

Nurses frequently encounter situations where the “right” course of action is unclear, often due to conflicting values between patients, families, and medical teams. As a patient advocate, you must possess the ability to deconstruct these scenarios using structured ethical frameworks.

This assignment requires you to analyze a complex clinical scenario involving a refusal of care or a disagreement regarding the plan of treatment. You will apply the Four-Box Method (Jonsen et al.) to organize the facts and use the ANA Code of Ethics to justify your proposed resolution. This exercise bridges the gap between theoretical bioethics and real-world bedside practice.

2. Learning Outcomes (CLOs)

• Apply the four principilist ethical frameworks (Autonomy, Beneficence, Non-maleficence, Justice) to a clinical case.
• Analyze the legal and professional implications of patient advocacy in complex scenarios.
• Construct a plan of care that respects patient values while maintaining professional integrity.
• Utilize the Jonsen, Siegler, and Winslade Four-Box Method to resolve clinical ethical dilemmas.

3. Task Instructions

You are to select one of the case vignettes provided in the Module 4 Resources folder (Case A: End-of-Life Withdrawal in Pediatrics OR Case B: Treatment Refusal in Mental Health). Once selected, write a formal paper addressing the following:

Part 1: Introduction (Approx. 150 words)

Briefly introduce the selected case. Identify the primary ethical conflict (e.g., Paternalism vs. Autonomy). Clearly state your thesis regarding the nurse’s primary obligation in this scenario.

Part 2: Application of the Four-Box Method (Approx. 500 words)

Analyze the case data using Jonsen’s four quadrants. Do not just list bullet points; narratively discuss the interaction between these factors:

1. Medical Indications: What is the prognosis? What are the goals of treatment?
2. Patient Preferences: Has the patient expressed specific wishes? Do they have decision-making capacity?
3. Quality of Life: How will the treatment (or lack thereof) impact the patient’s life physically and mentally?
4. Contextual Features: Are there financial, religious, or family pressures influencing the decision?

Part 3: Ethical & Legal Analysis (Approx. 400 words)

Identify which provision(s) of the ANA Code of Ethics for Nurses applies here. Discuss any legal precedents or standards (such as informed consent laws or advance directives) that constrain or guide the decision. Evaluate the power dynamics between the medical team and the patient/family.

Part 4: Proposed Resolution & Reflection (Approx. 300 words)

Propose a concrete course of action. If you were the nurse in this scenario, how would you communicate this resolution to the physician and the family? Reflect on how your personal values might influence your professional judgment in this specific instance.

Part 5: Conclusion (Approx. 100 words)

Summarize the importance of structured ethical reasoning in protecting patient rights.

4. Formatting & Submission Guidelines

• File Type: Submit as a Microsoft Word document (.docx).
• Formatting: Use standard APA 7th Edition styling (Times New Roman 12pt, Double Spaced, 1-inch margins).
• Headings: Use clear subheadings for each section of the analysis.
• References: Minimum of 4 scholarly sources published within the last 5 years, including the ANA Code of Ethics.

5. Grading Rubric

Criteria	Novice (0-69%)	Competent (70-89%)	Proficient (90-100%)
Application of Four-Box Method (30%)	Missing quadrants; analysis is superficial or purely descriptive without connection to ethics.	All quadrants addressed; some analysis of the conflict between medical indications and preferences.	Deep integration of the four quadrants; critical analysis of how contextual features complicate medical facts.
Ethical & Legal Integration (30%)	Fails to cite the Code of Ethics; confuses legal and ethical concepts.	Correctly identifies relevant Code provisions; basic discussion of legal constraints.	Sophisticated synthesis of ANA provisions, legal standards, and bioethical principles (autonomy/justice).
Resolution & Advocacy (25%)	Solution is vague or ignores the patient’s voice; no reflection included.	Proposed solution is logical; reflects on nurse’s role as advocate.	Resolution is actionable, compassionate, and robustly defended; profound reflection on personal vs. professional values.
Writing Mechanics & APA (15%)	Multiple citations errors; poor grammar impedes readability.	Minor APA errors; clear writing with occasional awkward phrasing.	Polished, professional, and scholarly academic tone; flawless APA formatting.

6. Respecting the patient’s refusal of dialysis requires the nurse to prioritize the principle of autonomy over beneficence, even when the medical outcome is likely fatal. Evaluation of the “Patient Preferences” quadrant of Jonsen’s model reveals that the patient has demonstrated capacity and a consistent understanding of the consequences, which legally supersedes the medical team’s desire to treat reversible uremia. Effective advocacy in this instance involves facilitating a family conference to align expectations rather than coercing the patient into compliance. Ongoing documentation of these conversations protects the nursing license and ensures the ethical validity of the decision (Rainer et al., 2018).

7. Recommended Resources 

1. Grace, P. J., & Uveges, M. K. (2022). Nursing ethics and professional responsibility in advanced practice (4th ed.). Jones & Bartlett Learning.(Comprehensive text covering advanced advocacy and ethical frameworks).
2. Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics, 26(3), 646–662.https://doi.org/10.1177/0969733017724354
3. Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446–3461.https://doi.org/10.1111/jocn.14542
4. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.(The definitive guide on the scope of practice and professional expectations).
5. Browning, A. M. (2023). Moral agency in nursing: The courage to lead change. Nursing Administration Quarterly, 47(1), 7–14.https://doi.org/10.1097/NAQ.0000000000000557