Ethical Decision-Making in Nursing: An End-of-Life Case Study
This paper presents a case study examining an ethical dilemma encountered by a nurse in an emergency department involving a 93-year-old patient with advanced Alzheimer's disease. Unable to eat or drink and non-responsive, the patient faces an end-of-life situation in which her family demands feeding tube placement while no advanced directive exists. The paper applies Catalano's (2009) four-step ethical decision-making algorithm to analyze the dilemma, reviews relevant literature on moral distress in nursing, discusses three proposed solutions, and identifies the McAlpine, Kristjanson, and Poroch Ethical Reasoning Tool (ERT) as an instrument for evaluating those solutions. The analysis emphasizes patient-centered care, family communication, and the importance of structured ethical reasoning frameworks in clinical nursing practice.
- Introduction: Overview of nursing ethics and moral conflict in practice
- Problem Statement: Alzheimer's patient, family demands, and nurse's dilemma
- Literature Review: Research on moral distress and ethical decision-making in nursing
- Theoretical Perspective and Case Analysis: Catalano's four-step algorithm applied to the case
- Proposed Solutions: Three options: feeding tube, hospice care, or ECF transfer
- Research Instrument Identification: McAlpine ERT tool for evaluating ethical responses
- Conclusion: Importance of systematic ethics in unique nursing situations
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What makes this paper effective
- The paper grounds its analysis in a concrete, specific clinical scenario — an elderly Alzheimer's patient with no advanced directive — making abstract ethical principles tangible and relatable.
- It draws on a substantial body of peer-reviewed nursing literature to contextualize moral distress, lending academic credibility to the practical case discussion.
- The structured application of Catalano's four-step algorithm provides a replicable analytical framework, showing how theory translates directly into clinical decision-making.
- Three distinct proposed solutions are clearly evaluated against each other, modeling the kind of comparative ethical reasoning expected in nursing practice.
Key academic technique demonstrated
The paper demonstrates applied ethical framework analysis — taking a named theoretical model (Catalano's algorithm) and systematically walking through each step using real case details. This technique shows how abstract decision-making models are operationalized in clinical settings, a core skill in nursing ethics writing at the undergraduate level.
Structure breakdown
The paper opens with a brief introduction situating the problem, followed by a focused problem statement describing the clinical scenario. A literature review synthesizes research on moral distress and ethical decision-making. The theoretical section applies Catalano's algorithm step-by-step to the case. Proposed solutions are then presented and compared. A research instrument (the ERT) is identified and explained. The conclusion synthesizes the broader implications of structured ethical reasoning in nursing.
Introduction
This report describes an ethical predicament encountered by a nurse working in an emergency department. The predicament is analyzed using Catalano's (2009) algorithm for ethical decision-making, and a theoretical perspective is applied throughout the analysis. Several likely solutions to the predicament are discussed, and research instruments for solution evaluation are identified.
There are many moral situations faced by people working in the nursing profession, particularly in relation to a growing technological and scientific environment involving the development of advanced treatment methods and diagnostic equipment (Range & Rotherdam, 2010). Many conflicts arise from the manner in which professionals handle patients in hospital environments or in basic care networks. Workers face difficulty when trying to resolve conflicts due to being overlooked by their leaders or due to a lack of sufficient support while executing their duties and exercising professional autonomy. This can produce feelings of anger, guilt, outrage, sadness, frustration, hopelessness, and impotence toward conflict situations (Corley, 2002).
There are four crucial responsibilities for any nurse: promotion of health, prevention of illness, alleviation of suffering, and restoration of health. These duties require a nurse to promote health, coordinate patient care, administer medication, carry out medical examinations, and perform other essential duties. The nursing process entails assessment, planning, diagnosis, evaluation, and implementation (Parse, 1999).
A working nurse encounters conflict and moral issues in many different situations. It is not possible to separate conflict from a nurse's professional life. Among the many conflicting situations are the absence of consent prior to a procedure, extension of a patient's life without attention to quality of life, questionable or inhumane professional conduct, resource allocation inequalities, and fragmented decision-making. Moral distress can become a persistent burden for nurses given the many conflict situations they face (Lunardi et al., 2009).
Problem Statement
The ethical dilemma encountered by the nurse working in the emergency department involves a 93-year-old patient transferred from an extended care unit. This patient is suffering from Alzheimer's disease. Due to her declining health, she is unable to eat or drink, threatening her life. The patient is also unable to respond to touch or voice and is non-verbal. The physician in charge has concluded that she is unable to thrive. The patient's granddaughter has been granted power of attorney over her grandmother, and there is no advanced directive from the patient. The patient's family insists that their loved one must be taken to the emergency department to receive a feeding tube. The family has been informed that there is a chance their loved one could survive with nutritional support.
The ethical dilemma for the nurse is to identify the patient's right to a dignified death while balancing that right against the desires and wishes of the patient's family members (Heiser, 2014).
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