This paper presents a Portfolio of exemplars from nursing practice, which explores the professional role of the nurse as an advocate with adult patients, where ethical dilemmas are central.

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1. Introduction

This paper presents a ‘Portfolio’ of exemplars from nursing practice, which explores the professional role of the nurse as an advocate with adult patients, where ethical dilemmas are central.  The paper begins with a brief description of the advocacy and empowerment exemplar, followed by a detailed analysis of the empowerment exemplar with regard to the professional role of the nurse, the legal and the ethical framework.  It critically reflects on the issues that pose conflict and the role of the nursing staff who are faced with an ethical dilemma. The ethical decision making model is also applied to the exemplar presented, to gain a better insight into the possible course of action. The portfolio concludes with an  action plan that can be implemented based on the reflective analysis.

2- Exemplar 1 -Advocacy

Advocacy is defined as : “the process of befriending and where necessary, representing a patient, client, partner or protégé, in all matters where the nurse’s help is needed in order to protect the rights or promote the interests of that person” (cited by Frizell, 2005)

Mrs. A, 59 yr old widow, was admitted with shortness of breath and acute exacerbations of COPD. Doctors suggested Bipap treatment twice in the course of treatment but both the times Mrs A was alert and she refused consent. The daughters were aware of this situation.  When Mrs. A became unresponsive on the fourth day, the daughters agreed with the doctor and Mrs. A. was put on Bipap. As an advocate for Mrs. A, the student nurse and her mentor felt that the treatment was ethically and legally inappropriate.

3. Exemplar 2 - Empowerment

Empowerment is defined by Hokansan (1992) as an interpersonal process between the nurse and the patient which aims at facilitating healthy behaviors.

Ms M, 28 yrs old   separated female was admitted in A&E with severe abdominal pain. She was accompanied by her boy friend and two children. A urine test confirmed pregnancy. Ms M disclosed to the student nurse and the mentor that she was HIV positive but did not want this information passed on to her boyfriend. The mentor tried to convince Ms M to confide in her partner, since it was both ethical and legally binding. The mentor and the student were left in dilemma on the next steps.

4. Analysis

The above exemplar concerned with the issue of empowerment, leads to a conflict in the minds of the student nurse and the mentor on the right course of action. In the above exemplar the student nurse observed the mentor trying to negotiate with the patient to disclose her HIV status to her boyfriend. The mentor tried to convince the patient, but was unable to obtain consent. It was observed that the mentor tried to initiate the dialogue with the patient, and listened to the patient’s concerns as well. However, the patient’s resistance to the nursing staff’s suggestion of disclosing the information, posed a conflict for them. In an effort to choose a course of action, based on ethics, the mentor gave time to the patient to explore her values and become ready to communicate (Daniels, 2004) but it did not help. The situation poses professional, ethical and legal issues for the nursing staff. This is discussed below:

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4.1 Professional Issues

The professional issues facing the nursing staff are explored below.

  • Principle of Autonomy and Fairness (Beauchamp & Childress, 2001)- The nursing staff  had a duty to respect the patient’s autonomy and her decision which could result in harm to another individual, while also upholding their duty to fairness and justice. In the above exemplar, duty to protect the patient’s partner, conflicts with the principle of to autonomy that the patient is entitled to.
  • Principle of Loyalty (Beauchamp & Childress, 2001): They were torn between being loyal to the patient and owing a duty to ...

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