The Clear Advance Directive
A patient has a valid and clearly applicable advance directive declining a particular life-sustaining intervention. The patient can no longer communicate. A family member demands that the healthcare team provide the intervention.
What is the nurse’s best initial response?
A. Follow the family member’s request because the patient cannot currently speak
B. Remove the advance directive from the chart until the family resolves the disagreement
C. Verify that the directive is available and applicable, communicate the conflict to the healthcare team, and advocate for the patient’s documented preferences
D. Tell the family member that the family member is no longer permitted to participate in discussions
C. Verify that the directive is available and applicable, communicate the conflict to the healthcare team, and advocate for the patient’s documented preferences
Ethical discernment requires the nurse to recognize the conflict, understand the clinical and ethical context, and use appropriate resources to protect the patient’s expressed preferences. The nurse should remain compassionate toward the family while keeping the patient’s wishes central.
A patient reports significant pain and requests prescribed pain medication. A family member asks the nurse not to administer it because the family member is concerned about possible side effects.
What is the nurse’s best response?
A. Withhold the medication because family members know the patient best
B. Administer the medication without assessing the patient or discussing the concern
C. Assess the patient’s pain, goals, condition, and decision-making ability; evaluate the medication order; educate the patient and family; and honor the capable patient’s informed preference
D. Ask the family member to decide whether the medication should be administered
C. Assess the patient’s pain, goals, condition, and decision-making ability; evaluate the medication order; educate the patient and family; and honor the capable patient’s informed preference
Ethical judgment is inseparable from clinical knowledge. The nurse must combine a clinical assessment with attentiveness to the patient’s pain experience, preferences, potential benefits, and potential risks.
A patient without an advance directive lacks decision-making capacity. The family requests an intervention that the healthcare team believes will not accomplish its intended clinical purpose and may add burden without meaningful benefit.
What is the most appropriate nursing response?
A. Tell the family that its request does not matter
B. Promise the treatment because the family is requesting everything possible
C. Avoid the discussion and wait for another discipline to address it
D. Clarify the patient’s known values and goals, communicate the clinical concern, advocate for a family meeting, and request appropriate palliative-care or ethics support
D. Clarify the patient’s known values and goals, communicate the clinical concern, advocate for a family meeting, and request appropriate palliative-care or ethics support
The nurse should not reduce the situation to “family versus healthcare team.” Ethical discernment requires attention to the patient’s values, clinical circumstances, expected benefits and burdens, family understanding, and available alternatives.
A patient has decision-making capacity and is clearly communicating personal treatment preferences. Family members disagree with the patient and begin arguing in the room.
What should the nurse do first?
A. Ask the family to vote on the treatment
B. Center the capable patient’s expressed preferences, assess whether the patient wants family involvement, and create an environment in which the patient can communicate freely
C. Follow the preference of the loudest family member
D. Delay all care until every family member agrees
B. Center the capable patient’s expressed preferences, assess whether the patient wants family involvement, and create an environment in which the patient can communicate freely
Ethical awareness means recognizing that allowing family conflict to overshadow the patient can undermine the ethical goals of nursing. Ethical judgment should remain attentive to the patient’s voice, experience, relationships, and circumstances.
A patient is medically ready for discharge but does not have stable housing. The nurse is concerned that the patient may be unable to obtain medications, store supplies, attend follow-up appointments, or follow a care plan safely.
What is the most ethically appropriate nursing response?
A. Complete the discharge without raising concerns because housing is not a nursing issue
B. Refuse to discharge the patient independently of the healthcare team
C. Assess specific barriers, communicate safety concerns, involve appropriate resources, and collaborate on the safest feasible discharge plan
D. Tell the patient to return to the emergency department if problems develop
C. Assess specific barriers, communicate safety concerns, involve appropriate resources, and collaborate on the safest feasible discharge plan
Nurses consider social structures that affect health and use professional collaboration and advocacy when social disadvantage creates or worsens health risks.