SUBDOMAIN 726.1 – INTRODUCTION TO NURSING
Competency 726.1.8: Principles of Ethics, Bioethics, & Nursing Regulation – The graduate
demonstrates decision-making skills that reflect a professional and ethical framework and
adhere to the guidelines and regulations set by professional and state regulatory bodies.
Nurses are confronted with ethical decisions every day, ranging from decisions about
routine vaccination to issues of death and dying. It is important, therefore, that nurses
know how to analyze a bioethical issue based on nursing ethical values, principles, and
facts in order not only to make ethical decisions about their practice, but also to help
support patients and families as they struggle with ethical decisions.
You will use the following scenario to complete this task:
Matt, a 20-year-old white male, was brought into the emergency department unconscious
with a needle protruding from a vein in his left forearm. It was determined from his lab
work that he had been taking opiates, and a heroin overdose was suspected. After Matt was
intubated and placed on mechanical ventilation, he was stabilized and transferred to the
intensive care unit. Matt’s family was notified, and they rushed to his bedside within a half
hour. After speaking with the physician, the family told the healthcare team that they
wanted to do everything possible to save their son’s life.
An hour later, Matt’s heart stopped, and after a full code, Matt was stabilized but was still
not breathing on his own. Matt’s heart stopped two more times over a span of three hours.
Dark blood was becoming visible in the suctioning canister, but Matt remained in a full
code status, and the family refused to assign him a “Do Not Resuscitate” (DNR) status after
Currently, the physician does not want the patient to have any further resuscitation. EEG
shows no brain activity. The nurse is torn between supporting the family and following
through with the physician’s desires. The nurse manager informs the nurse that she should
do as the physician says. The nurse also dislikes caring for drug abuse patients. The patient
did not have a DNR order on file. If he had a DNR, there would have been an agency policy
to follow it. The hospital also has an ethics committee.
A. Analyze (suggested length of 1-2 pages) the moral aspects/issues found within the
- Provide relevant facts that relate to the aspects/issues.
- Discuss the ownership of the situation.
- Discuss how the five essential nursing values might play into the scenario.
B. Analyze (suggested length of 1-2 pages) two bioethical issues in the given scenario in
terms of a specific ethical theory of your choice.
- Discuss the theory.
- Explain how the chosen theory relates to the given scenario.
- Discuss an applicable law or agency policy.
C. Discuss (suggested length of 1-2 pages) how alternative actions might affect the patient
- Apply the ANA Nursing Code of Ethics to guide these actions.
D. When you use sources, include all in-text citations and references in APA format.
Note: When bulleted points are present in the task prompt, the level of detail or support
called for in the rubric refers to those bulleted points.
PRINCIPLES OF ETHICS, BIOETHICS, & NURSING REGULATION 2
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link
included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in a paper or project, the
submission MUST include APA formatted in-text citations with a corresponding reference
list for any direct quotes or paraphrasing. It is not necessary to list sources that were
consulted if they have not been quoted or paraphrased in the text of the paper or project.
Note: No more than a combined total of 30% of a submission can be directly quoted or
closely paraphrased from sources, even if cited correctly. For tips on using APA style,
please refer to the APA Handout web link included in the APA Guidelines section.
Principles of Ethics, Bioethics, & Nursing Regulation
In the nursing profession, a nurse should possess and demonstrate decision-making skills
that denote an ethical and professional framework. In addition, she should be able to abide by the
regulations and guidelines laid down by the state regulatory and professional bodies. According
to Johnstone (2011), this is founded on the fact that nurses face a wide array of ethical issues on
a daily basis. These vary from end of life decisions and routine vaccinations. In this regard, it is
extremely imperative that a nurse is able to analyze ethical issues on the basis of nursing ethical
facts, principles, and values. This helps the nurse in making ethical decisions regarding their
practice as well as being able to support families and patients in their bid to make ethical
Moral issues/ aspects
Usually, nursing ethical challenges arise in circumstances where decisions need to be
made regarding life-sustaining treatment. In addition, the challenges are experienced in cases
where is a concern for the patient’s best interests. In the case scenario under discussion, the
patient is helpless and it is the family member’s word that counts on behalf of the patient. The
family insists that everything possible to be done to Matt so as to save his life and they have
denied a ‘Do Not Resuscitate’ status. On the other hand, the patient is unable to breathe on his
PRINCIPLES OF ETHICS, BIOETHICS, & NURSING REGULATION 3
own and irrespective of the fact that he is receiving full codes; his heart is stopping regularly for
prolonged periods. Dark blood can be seen from the suctioning canister and the EEG indicates
that there is no brain activity.
There is also an ethical concern where the physician prefers no more resuscitation for the
patient. In this regard, the nurse is torn between adhering to the physician’s desires and
supporting the family. The nurse manager is insisting that the nurse should adhere to what the
physician instructs. Moreover, there is no DNR order on the patient’s file. This is contradictory
and if follow ups were done later concerning the patient’s case, the health care team would be
blamed for not resuscitating the patient considering that there was no DNR order on his file. The
presence of a DNR would act as the basis for an agency policy follow up. The presence of an
ethics committee in the institution implies that the underlying facts would be uncovered within
no time. It is because of this that the nurse is afraid of adhering to what the physician is
instructing. Additionally, the nurse dislikes caring for patients who are drug abusers.
Ownership of the situation
The nurse manager, physician, and nurse are the professionals responsible for the care of
the patient in the scenario under discussion. The nurse manager supports the physician’s desire
but the nurse is torn between the decisions of the two and her wishes considering that there is no
DNR order on the patient’s file. In case the agency or law made follow ups on the case, the
nurse, nurse manager, and physician would be found guilty for failing to resuscitate considering
the absence of a DNR order. It is also worth noting that the family wishes the patient to recover
and, therefore, they want everything possible to be done to the patient (Johnstone, 2011).
Considering that the patient is not in a position to verbalize what he wishes, his family is held
accountable and responsible.
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The health institution where the patient is receiving care is also held responsible for
failing to promote an ethical environment where there are clear guidelines on what should be
done whenever ethical issues arise. It appears that the nurse is unsure on whether she should
follow the physician’s orders and, therefore, seeks the opinion of the nurse manager. Moreover,
it seems that the professionals in the institution fail to include vital information in patient’s file
such as the DNR order. This is a failure on the part of the institution for failing to practice
stringent measures. The issue that the nurse dislikes taking care of drug abuse patients should not
be a concern since all patients should be cared for equally.
Key nursing principles
The professionals in mention should practice altruism where there should be a concern
for the patient and family, and the key purpose should be doing them good. Second, autonomy
denotes that the professionals should be self-determined to do everything possible to ensure the
patient’s survival. In this regard, resuscitation should be continues for as long as possible.
Human dignity implies that the uniqueness of populations and individuals should be respected
and, therefore, regardless of the fact that the patient abuses drugs, equal care should be provided.
The professionals in the mentioned case ought to have integrity where they adhere to the
standards of practice and code of ethics, which stipulate that everything should be done for the
patient so as to support life. Finally, in accordance to social justice, equal treatment should be
provided as guided by the law and accessibility to quality health care should be on an equal
PRINCIPLES OF ETHICS, BIOETHICS, & NURSING REGULATION 5
Principlism is an extremely common ethical approach in the care of patients. It focuses
more on justice, non-malificence, beneficence, and autonomy that are shared by a majority of
ethical theories. Therefore, the best ethical theories’ elements that blend with religious,
individual, and societal belief systems are brought together. Through the incorporation of virtue
ethics, it becomes possible for significant others, patients, and healthcare professionals to place
added weight and value on a specific principles. This results to a rationalized and balanced
decision-making. Principlism forms the foundation where multiple factors are integrated and
situation specific decisions are made possible.
In the case scenario provided, some of the bioethical issues are; should resuscitation be
stopped at this point or should it be continued until the patient recovers or loses his life? Can the
nurse only treat the patient she wishes and disregard patients recovering from drug abuse? Who
should make decisions on behalf of the patient considering that he cannot voice his wishes;
professionals or family? Should the nurse follow what the physician is instructing considering
that there is no such order on the patient’s file?
Relationship between the theory and scenario
While providing care to the patient, the nurse, nurse manager, and physician ought to
practice justice, non-malificence, beneficence, and autonomy. In this regard, the provided care
should encompass fairness; the moral obligation of doing good and implementing practices that
are beneficial to the patient; avoiding patient falls, bruises, and reactive medications; and the
authority to make and implement personal decisions that are useful to the patient (Johnstone,
Law or agency policy
PRINCIPLES OF ETHICS, BIOETHICS, & NURSING REGULATION 6
The Nurse Practice Act is an extremely vital legal laws as it is recognized as the legal and
law authority for the nursing profession. In the mentioned scenario, there is a need for the nurses
to be keen on the ethical and legal dimensions of the practice. This is considering that every
nurse is socialized and educated to respect their nursing license. A nurse should be familiar with
the nurse practice act of the state and update herself about transformations in the nurse licensure
The nurse in the mentioned case should not follow the directives from the physician and
head nurse unless there is a ‘DNR’ order on the patient’s file. The nurse should also care for all
patients irrespective of the conditions they are recovering from. Moreover, she should do all she
can to support the patient’s life and comfort the family.
Alternative actions that can influence patient outcome and ANA Nursing Code of Ethics
So as to ensure the best patient outcomes, there is a need to consider the options that are
likely to produce the most beneficial outcomes and that are associated with the least harm
(utilitarian approach; resuscitating the patient so as to avoid death and complications); the
options that responds to the rights of the majority who are involved (rights approach; the nurse’s,
family member’s, and patient desire for continuing with the treatment until recovery should be
followed); the options that treat people proportionately or equally (justice approach; the nurse
should treat the patient irrespective of his condition); the options that respond to the needs of the
entire community (common goods approach); and the options through which the professionals
become the people they really want to be (virtue approach; the health care team should do all
they can for the patient until he recovers).
After using these approaches, the option that best serves the situation should be selected;
doing all that can be done for the patient. In making a choice, there is a need to consider what
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other community members would say about the decision (Johnstone, 2011). The greatest care
should be a concern when addressing the decision and there should a focus on the stakeholder’s
concern. Afterwards, there should be an evaluation on how the decision turned out and what
lessons were learned from the situation.
While selecting the best alternatives for patient care, the ANA code of ethics should be
adhered to. In regard to the mentioned scenario, the nurse should adhere to respect and
compassion for the inherent uniqueness, worth, and dignity of each individual and as far as all
professional relationships are concerned (Johnstone, 2011). There should be no restrictions
founded on nature of health challenges, personal attributes, and economic or social status. The
key nurse’s commitment is the patient and she should strive for, advocate, and promote the
patient’s safety, health, and rights. The nurse should delegate tasks, promote competence, safety,
and integrity, and participate in advancing the profession through contributions such as
knowledge development, administration, education and practice. This results to better health care
impacts on the patient.
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Johnstone, M. J. (2011). Bioethics: a nursing perspective. New York: Elsevier Health Sciences.