1.

Describe inter- and intraprofessional mechanisms to resolve practice

discrepancies, including ethical, unsafe, and/or illegal care practices.

Describe a situation involving an ethical dilemma that is encountered during

clinical hours. Analyze the dilemma and present concepts involved. Explain how
the dilemma was resolved, and what could or should have been done differently.
Utilize research to defend what could or should have been done differently based
on evidenced based mechanisms of resolution.

Clinical ethics involves dilemmas that arise when difficult decisions must be
made in clinical practice (What do I do now, 2013). I faced an ethical dilemma
during my fifth day precepting. During this shift, I was scheduled to care for three
patients rather than two, like I had been doing in previous shifts. When we received
report, however, we learned that one of our three patients was on airborne precautions
and had tuberculosis. Due to the fact that I had not yet been fitted for a respirator, I
could not provide care for this patient. My nurse told that she would do all of the
patient care, but that she still wanted me to complete the documentation on this
patient so that I could still get the feel of caring for three patients. After thinking this
through, though, I realized that I would not be able to document on a patient whom I
would have no interaction with because it would be unethical. I approached my nurse
and had to plainly tell her that I did not feel comfortable documenting on a patient
who I did not personally assess. She said that this patient was on his last week in the
hospital and was healthy, and that she would verbally tell me what to write for the
assessment. Rather than debate the issue, I simply said nothing and maintained eye
contact. The nurse noticed my silence, and stated that if I did not feel comfortable,
she would do the documentation. I said thank you, and that put end to the ethical
conflict. When analyzing this dilemma, I decided to use an ethical decision-making
model to help. The first step in this process is to define the ethical dilemma (Toren &
Wagner, 2010). This dilemma could be defined as a choice between obeying my
superior and doing the morally and legally correct thing. Both choices are things that
a precepting student should do. The next step is to clarify the ethical principles and
laws involved. In this case, it involves legality. Nurses are required by the nursing
practice act to conduct complete and accurate documentation and reporting (Campos,
2010). By documenting on a patient that I was not caring for and could not assess
myself, there would be no way to ensure that it was complete or accurate. The next
step is to identify the alternatives for action (Toren & Wagner, 2010). In this case,
my choices were to document on the patient or to refuse to document on the patient. I
feel that an additional choice could be to document on certain items that I could
complete without seeing the patient. I could have isolated those items and presented
them to my preceptor. The next step is to choose an action. My choice was to
approach my preceptor and explain my feelings, and to not chart on the patient. The
final two steps are to initiate discussion about unresolved issues and to generalize the
solution to other similar cases. In retrospect, I should have further explained my
feelings and reasoning behind my decision to my preceptor. At the time, I felt
embarrassed about my choice, and didnt feel up to discussing things any more than
necessary to get my point across. I now feel that I should have explained that by

documenting on the patient, I felt that I would be falsely charting. I think by saying
this, I would have set limitations for the future and created better understanding for
my preceptor. As for the final step, I will definitely use this experience to ease my
ethical decision making process in the future.
Sources:
Campos, N. (2010). The legalities of nursing documentation. Men in Nursing, 40(1),
7-9.
Toren, O., & Wagner, N. (2010). Applying an ethical decision-making tool to a nurse
management dilemma. Nursing Ethics, 17(3), 393-402.
doi:10.1177/0969733009355106
What Do I Do Now? Ethical Dilemmas in Nursing and Health Care. (2013). ISNA
Bulletin, 39(2), 5-12.