Ethical Decision Making in Nursing: Uustal's Nine-Step Model
This paper applies Uustal's (1993) nine-step ethical decision-making model to a real clinical dilemma encountered in nursing practice. The scenario involves a child diagnosed with a brain tumor whose parents administered marijuana without physician knowledge or consent. Drawing on virtue ethics, the paper walks through each step of Uustal's framework — from identifying the problem and clarifying personal ethical values to evaluating alternatives, selecting an acceptable course of action, and assessing outcomes. The paper also addresses the role of the American Nurses Association Code of Ethics in shaping nurses' professional duties and guiding morally sound clinical decisions.
- Introduction to the Ethical Dilemma: Clinical scenario involving child, brain tumor, and unauthorized marijuana
- Applying Uustal's Model: Steps One Through Five: Problem identification, personal ethics, alternatives, and consequences
- Applying Uustal's Model: Steps Six Through Nine: Selecting, planning, implementing, and evaluating the ethical action
- The Role of Fundamental Nursing Duties in Ethical Decision Making: ANA code and professional obligations shaping nursing practice
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What makes this paper effective
- The paper grounds an abstract ethical framework in a concrete, real-world clinical scenario, making the application of Uustal's nine steps tangible and easy to follow.
- It explicitly names the ethical theory being used (virtue ethics) and connects it to specific values such as honesty, integrity, and compassion, rather than leaving the ethical stance implicit.
- The paper evaluates multiple alternatives rather than jumping to a single solution, demonstrating systematic ethical reasoning consistent with the model being applied.
Key academic technique demonstrated
The paper demonstrates framework-driven ethical analysis — the practice of using a named, structured decision-making model to organize and justify moral reasoning. By progressing through each of Uustal's nine steps in sequence and explicitly labeling them, the writer shows how a theoretical tool can be applied methodically to a messy real-world situation, which is a core competency in applied nursing ethics.
Structure breakdown
The paper opens by introducing the clinical scenario and identifying it as an ethical dilemma. It then moves systematically through Uustal's nine steps across two main analytical sections, grouping the earlier steps (problem identification, personal ethics, and alternatives) before the later steps (evaluation, implementation, and assessment). A brief concluding section connects the analysis to the broader professional framework of nursing duties and the ANA Code of Ethics.
Introduction to the Ethical Dilemma
Uustal (1993) proposed a decision-making model that offers tangible steps for arriving at a morally acceptable solution when experiencing an ethical dilemma. Generally, nurses are frequently faced with ethical dilemmas that are largely attributed to the nature of their work. One ethical dilemma encountered in a clinical setting involved a child diagnosed with a brain tumor. Before the diagnosis, the child had been severely ill and went several days without eating, which increased the severity of his condition. Even though the physicians were doing their best to save the child's life, the family became extremely worried. As a result, his parents gave him marijuana based on their extensive knowledge of its medical benefits. While the decision proved beneficial in the short term, the child faces the risk of experiencing a recurrence of the brain tumor (James, 2011).
Applying Uustal's Model: Steps One Through Five
Uustal's model of decision-making can be applied to this dilemma by working through its nine steps. The ethical ramifications of the situation include giving an illegal drug to a child, carrying out treatment procedures without physician consent, and a probable erosion of trust in the health care facility and its personnel. Based on Uustal's model, the first step in resolving the issue is identifying the problem — specifically, that a child was given an illegal drug without the doctor's knowledge or consent.
The second step involves clarifying the personal ethical position relevant to the situation. In this case, that position is virtue ethics, which is grounded in values such as self-control, compassion, trustworthiness, integrity, honesty, courage, and prudence. From this perspective, the parents should have notified the physicians and nurses of their decision to give the child marijuana so that health care personnel could evaluate him thoroughly.
Third, several alternatives exist, including holding consultations with the physicians about the marijuana, trusting the physician's judgment and following the existing treatment plan, and transferring the child to a facility where the drug is legally used for medical purposes. Fourth, the most important alternative would be to consult the physicians about the marijuana use, followed — if the physicians disagree — by transferring the child to a hospital where medical marijuana is legalized. The need for consultation is driven by the value of honesty, since the physicians mistakenly believed the child's recovery was due solely to their treatment plan. Fifth, the first alternative would foster cooperation from the hospital's health care team, including the physician, and would enable the child to be monitored appropriately. Transferring the child to another hospital, however, would carry increased risks because of the time required before he could receive further treatment.
References
Dahnke, M. D. (n.d.). The role of the American Nurses Association Code in ethical decision making. Retrieved September 13, 2013, from
James, S. D. (2011, May 5). Montana dad gives cancer-stricken boy marijuana behind doctor's back. ABC News. Retrieved September 13, 2013, from http://abcnews.go.com/Health/montana-father-medical-marijuana-cancer-stricken-toddler-son/story?id=13529490&singlePage=true
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