Ethical Issues in Nursing: Applying Clinical Decision-Making Framework

This assignment analyzes ethical issues in nursing, focusing on a clinical scenario involving a patient with cardiovascular disease who suffered a stroke. The student reflects on the decision-making processes of the nursing team, including the application of Gillespie and Paterson's Situated Clinical Decision-Making Framework. The assignment addresses the nurse's ethical and legal obligations, the assessment and intervention strategies, and the factors influencing decision-making, such as subjective and objective cues, clinical history, and the need for cultural competence. The student evaluates the strengths and weaknesses of the decision-making process, highlighting the importance of gathering comprehensive patient data, systematic analysis, and evidence-based interventions. The paper also discusses the challenges of communication, cultural competence, and patient involvement in decision-making, providing insights into the complexities of ethical practice in nursing.

Running head: ETHICAL ISSUES
Ethical issues in Nursing
Student Name
University Name
Author Note

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Answer to Question 1:
Most nurses believe their ethical obligation is also evident because their legal
obligation is clear. Many nurses also say their legal obligation either coincides with their
ethical obligation, or decides it. When I was in my placement program as a nursing graduate,
I was delegated under the supervision of RN Amanda Jones who has been associated with the
healthcare organization for the last eleven years. It could be deduced from her experience that
she is among the senior-most registered nurses in the hospital under whom there are
numerous recent registered nurse graduates and enrolled nurses. During the placement
program, I have been part of a nursing team of five people comprising of me, RN Amanda
Jones, EN Sylvia Pratt, Oliver Choi and Chloe Baker. The RN and the EN were the ones who
were delegated to teach us about the nursing codes and the way in which the patient is
provided with care in a professional and practical surrounding. It was crucial for me to gain
an exposure in the practical environment where real-time patients with critical illnesses are
brought in each minute. However, when a patient suffering from cardiovascular diseases was
brought in after suffering from stroke, the competency of the nurses and us that were put to
test. It is because of the incapacity of the individual to clearly distinguish the type of
treatment that is to be provided to the critically ill patient. After observing the subjective cues
of the symptoms that have been experienced by the patient, certain assessments and
examinations were needed to be conducted to understand and infer the root of the problem.
The blood pressure of the subject was found to be 140 mm Hg. However, after conducting a
CT scan, it could be inferred that he had suffered a Concussion on the left side of his brain. It
is because of this reason that mild sedative had been administered and was kept under
observation by me, RN Amanda and Chloe. However, the situation deteriorated further over
the night of the administration and hence, was critical for Amanda and Sylvia to consult the

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doctor again and administer medication with a higher dosage to maintain the medical
condition of the patient.
Answer to Question 2:
From the clinical situation of the patient, it could be inferred that his situation was
critical and needed immediate intervention of the physician and the nursing professionals.
According to the subjective cues, it could be understood that the patient is experiencing
headache and feels dizzy. Upon assessment, it was found that the blood pressure was
extremely high with systolic pressure at 140 mm Hg. Initially the patient was unable to
respond to any of the questions that had been asked by me and Oliver. Upon examining his
blood pressure, it was seen that the systolic pressure was 140 mm Hg. Hence, from this it can
be interpreted that his blood pressure was above the normal level and required immediate
attention. In addition, it was also crucial for the registered nurse to conduct examinations and
assessments such that the root of the issue could be deduced. The initial question of the senior
nurse was to deduce as to how this case could be managed effectively and the required
information that could be gathered to understand the issue of the patient more appropriately
(Flannery, Ramjan & Peters, 2016). The appropriate tests for the patient who is experiencing
symptoms similar to stroke should be taken for a CT scan to produce computed images of the
body by which the areas where hemorrhage is present, could be observed. The decision of the
nurse to undertake the patient for a medical examination was crucial depending upon the
criticality of the medical condition of the patient. In addition, as time passed by, the patient
was feeling breathlessness (Oxelmark et al., 2018). Hence, it was upon the decision of
Amanda to administer oxygen support to the patient after discussing it with the concerned
physician. It was new for me as a graduate to observe the escalation of the medical condition
of the patient and encounter the decision-making ability of the nurse in a distressing time.

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According to the framework, it is important to gather subjective and objective cues for the
patient for the nurse to make efficient judgments and take appropriate decisions for the
betterment of the medical condition of the patient (Gillespie, 2010). It is the responsibility of
the registered nurse to know their standards of practice and administer interventions under
their scope of practice. Working beyond their scope of practice does not always generate
positive health outcome for the patient and the nurses should administer interventions for
which substantial evidence is present and has generate positive wellbeing results for the
patient. Hence, in this scenario, it was critical for Amanda to assess the gravity of the
situation and think quickly about the medication and possible treatment for the stroke patient.
It is commendable for her as a registered nurse with years of experience to assess the
situation of the patient and gather the appropriate cues for effective treatment to be started for
the patient. From the situation, it was required for Amanda to judge the situation
appropriately by taking the subjective and objective cues into careful consideration for
improvement in the health condition of the stroke patient. For making an efficient decision
based on the cues gathered and efficient judgments passed, Amanda assessed the clinical
history of the client such that past symptoms and medication of the patient could be known
(Bucknall et al., 2016). It was upon the given information about the patient which deemed to
be critical for the nurse to decide and inform the physician about the patient and the
medications that could be administered to him. Upon administering the medications and
oxygen support, the medical condition of the patient improved for a short while. Hence, the
implementation of the nursing intervention was a success; however, the improvement was
short-lived and the condition of the patient deteriorated further. From administering the same
intervention to previous clients generated positive results that resulted in the improvement of
the condition. After assessing the condition of the patient critically, it is upon the competence
of the nursing professionals to administer the best intervention for necessary improvement in

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the health condition of the patient. Again cultural competence is an important area that is to
be bought to practice by the practitioners on an imperative basis to develop good rapport with
the client. The judgment passed by Amanda, Sylvia and the physician allocated to provide
care to the patient gave me the necessary exposure to efficient clinical decisions to be
undertaken after assessing the condition of the patient. Hence, I am glad that the procedure
for taking a critical decision where the patient is unresponsive due to the deteriorating
medical condition is provided to me.
Answer to Question 3:
For making an efficient decision for the treatment of the patient, it is crucial for the
nursing professional delegated to make an informed decision by gathering the appropriate
cues and judging the situation of the patient. Hence, in the present clinical situation, Amanda
was able to gather critical cues like subjective and objective data for making an informed
decision. Subjective data was gathered in the form of medical history of the patient and the
symptoms that were experienced by the patient (Gunawan & Aungsuroch, 2017). Objective
data was gathered in the form of blood pressure, pulse, heart rate, oxygen saturation level,
urine output, and sodium and calcium levels. It is upon the basis of this information that
Amanda was able to take an informed decision for the clinical intervention and upcoming
treatment choices for the betterment in the health condition of the patient. The system
followed by Amanda and her team for the decision making was systematic as in they had
followed the steps for making an efficient decision for the improvement of the patient, which
is the strength of the decision making model used. The first step was to gather the critical
information about the patient such that an informed decision could be undertaken. It is after
this that a critical analysis of the cues gathered are to be done to understand what went wrong
in the patient for the condition to deteriorate (Chiffi & Zanotti, 2015). This critical analysis

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aspect is another strength of decision making. The time when an analysis is done, it is after
this that an effective and appropriate decision for the patient could be taken. Hence, in the
given scenario, the nursing team had undertaken a systematic approach in coming down to
take a clinical decision for the treatment that could be provided to the patient. The guidelines
that had been set by the organization had been critically followed by the nursing professional
team and worked within their scope of practice by utilizing their previous knowledge and
administering evidence-based nursing interventions for the desired wellbeing outcome for the
patient. The weaknesses were lack of cultural competence, communication gaps between the
professionals, between the professionals and the patient, non-inclusion of patient in certain
aspects of decision making.

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References
Bucknall, T. K., Forbes, H., Phillips, N. M., Hewitt, N. A., Cooper, S., Bogossian, F., &
First2Act Investigators. (2016). An analysis of nursing students’ decision‐making in
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72(10), 2482-2494.
Chiffi, D., & Zanotti, R. (2015). Medical and nursing diagnoses: a critical comparison.
Journal of evaluation in clinical practice, 21(1), 1-6.
Flannery, L., Ramjan, L. M., & Peters, K. (2016). End-of-life decisions in the Intensive Care
Unit (ICU)–Exploring the experiences of ICU nurses and doctors–A critical literature
review. Australian Critical Care, 29(2), 97-103.
Gillespie, M. (2010). Using the Situated Clinical Decision-Making framework to guide
analysis of nurses’ clinical decision-making. Nurse Education in Practice, 10(6), 333-
340.
Gunawan, J., & Aungsuroch, Y. (2017). Managerial competence of first‐line nurse managers:
A concept analysis. International journal of nursing practice, 23(1), e12502.

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Oxelmark, L., Ulin, K., Chaboyer, W., Bucknall, T., & Ringdal, M. (2018). Registered
Nurses’ experiences of patient participation in hospital care: supporting and hindering
factors patient participation in care. Scandinavian journal of caring sciences, 32(2),
612-621.