Ethical Dilemmas
A client refuses a prescribed blood transfusion despite understanding the potential consequences. The nurse respects the decision. Which ethical principle is demonstrated?
Autonomy
A nurse promises to return with pain medication in 15 minutes but does not follow through. Which ethical principle has been violated?
Fidelity
A client states, "Nobody listens when I explain my concerns." Which communication technique should the nurse use?
Active listening
Two nurses disagree about break coverage and agree to discuss the issue privately. What is the first step toward resolving the conflict productively?
Identify and clarify the problem.
A unit has 20 clients, but several require frequent assessments and complex interventions. What factor should most influence staffing decisions?
Client acuity
One RN assumes responsibility for all aspects of care for assigned clients during a shift. Which nursing care delivery model is being used?
Total patient care.
A nurse administers pain medication to a client with a terminal illness to relieve suffering. Which ethical principle is primarily demonstrated?
Beneficience
A nurse administers a prescribed medication despite recognizing that the dosage may cause serious harm. Which ethical principle has been violated?
Nonmaleficence.
During handoff, a nurse reports a client's worsening condition using Situation, Background, Assessment, and Recommendation. What communication framework is being used?
SBAR
Two nurses each give up part of their preferred scheduling arrangement to reach an agreement. Which conflict management strategy is demonstrated?
Compromising.
A nurse manager reviews an increase in falls and missed nursing care during evening shifts. What staffing information should be evaluated?
Staffing adequacy, skill mix, client acuity, and workload patterns.
An RN leads a group of nursing personnel who collaboratively care for an assigned group of clients. Which nursing care delivery model is demonstrated?
Team nursing.
A nurse discovers that a colleague documented an assessment that was never performed. Which ethical obligation should guide the nurse's response?
Veracity and professional accountability
A nurse posts a TikTok video describing an unusual clinical situation. The video doesn't mention the client's name, but it includes enough details that coworkers recognize the client. What ethical concern does this raise?
Violation of client confidentiality and privacy.
A nurse says, "I'm fine," but avoids eye contact, crosses both arms, and speaks sharply. What should the receiving nurse recognize?
Incongruence between verbal and nonverbal communication
A nurse agrees to a coworker's preferred assignment to preserve the relationship, despite having a different preference. Which conflict management strategy is demonstrated?
Accommodating.
An experienced RN and a newly licensed RN are assigned to a high-acuity unit. What should the charge nurse consider when distributing assignments?
Individual competencies, experience, client acuity, and available support.
One nurse administers medications to all clients on a unit while another performs treatments. Which nursing care delivery model is demonstrated?
Functional nursing
Two clients need the only available monitored bed. The healthcare team evaluates clinical need, not financial status. Which ethical principle guides this decision?
Justice
A client with advanced dementia has an advance directive declining artificial nutrition. The family requests a feeding tube despite the documented wishes. What should guide the nurse's advocacy?
Respect for the client's previously expressed wishes and autonomy.
A nurse gives discharge instructions using medical terminology. The client nods but cannot explain the instructions afterward. Which communication strategy is most appropriate?
Teach-back using plain language
Two nurses work together to develop a scheduling solution that addresses both individuals' concerns. Which conflict management strategy is demonstrated?
Collaborating.
A unit consistently uses overtime to cover staffing shortages. What long-term concern should the nurse manager evaluate?
Staff fatigue, burnout, turnover, and potential effects on client safety.
A nurse coordinates a client's plan of care throughout hospitalization and serves as the central nurse responsible for continuity of nursing care. Which model is demonstrated?
Primary nursing
A competent client asks the nurse not to disclose a diagnosis to family members. The family demands information. What should guide the nurse's response?
Respect for autonomy and confidentiality
A nurse witnesses a colleague making a medication error. The colleague asks the nurse not to report it because the client has not experienced any apparent harm. What ethical responsibilities should guide the nurse's actions?
Veracity, accountability, and nonmaleficence. The nurse should ensure client safety and follow organizational reporting procedures.
A provider dismisses a nurse's concern about a client who is deteriorating. What should the nurse do to communicate the safety concern effectively?
Use assertive communication supported by objective assessment findings and escalate through the chain of command if necessary
A nurse manager repeatedly avoids addressing tension between two staff members. Their disagreements begin to affect client care. What should the manager recognize?
Avoidance has allowed the conflict to escalate, necessitating intervention.
A nurse manager must reduce staffing expenses without compromising safety. Which approach is most appropriate?
Evaluate acuity, workload, scheduling patterns, skill mix, and quality indicators before adjusting staffing.
A unit experiences fragmented communication because different staff members perform separate tasks for each client. Which nursing care delivery model may contribute to this problem?
Functional nursing
A nurse believes continuing an invasive intervention may do more harm than good. The family insists that everything possible be done. What is the nurse's most appropriate response?
Advocate for a collaborative discussion of goals of care, the client's wishes, and the benefits and burdens of treatment
A nurse is caring for a client who refuses a recommended treatment. The nurse personally disagrees with the decision but recognizes that the client understands the risks and benefits. How should the nurse manage this ethical conflict?
Respect the client's autonomy, provide unbiased information, and avoid allowing personal values to interfere with client-centered care.
A nurse manager notices that staff repeatedly misunderstand verbal shift assignments. What system-level change would best address the problem?
Implement a standardized process for communicating assignments, with opportunities for clarification.
During a disagreement, a nurse states, "You never help anyone on this unit." How should the nurse manager redirect the conversation?
Encourage specific, objective examples and the use of "I" statements instead of accusations.
A unit's client census decreases, but several remaining clients require frequent reassessments and complex interventions. Should staffing automatically decrease?
No. Staffing decisions should reflect client acuity and nursing care needs, not census alone.
A unit has increasing client complexity and concerns about continuity of care. The nurse manager is considering a new nursing care delivery model. What factors should guide this decision?
Client acuity, staff competencies, continuity of care, communication, available resources, and quality outcomes