Choose a patient-care situation in which the RN should intervene and advocate for the patient. An example of such a situation might be when a patient has not been given complete infor

Bioethical  Decision  Making  Model    

1. Define  the  dilemma:  Use  your  own  words  to  describe  the  problem.  State  it  in  a  way   that  others  can  quickly  understand  your  dilemma.  Review          

2. Identify  the  medical  facts:  Describe  the  facts  that  are  relevant  to  the  dilemma.      

3. Remember  that  the  diagnosis  and  prognosis  are  medical  facts.      

4. Identify  the  non-­‐medical  facts  (patient  and  family,  external  influences):     a. Patient  and  family  facts  such  as  culture,  religion,  social,  economic,  the  

existence  of  an  Advance  Healthcare  Directive,  verbal  preferences  made  by   the  patient,  how  the  patient  lived  his/her  life.    

b. Those  that  you  discuss  should  be  relevant  to  the  situation.      

5. External  influences  include:  organizational  policies,  federal  and  state  laws,  practice   acts,  code  of  ethics.  These  should  be  relevant  to  the  situation.        

6. For  both  step  2  or  3,  separate  the  facts  from  the  assumptions:  Sometimes  all   healthcare  professionals  allow  assumptions  to  guide  their  decision-­‐making.  These   must  be  identified  so  that  these  assumptions  do  not  interfere  with  the  process.    

7. Identify  items  that  need  clarification.  Your  paper  should  identify  facts  that  you  need   to  clarify.  When  initially  discussing  an  ethical  situation,  it  is  not  unusual  to  not  have   all  of  the  answers.      

8. Identify  the  decision  makers:  Is  the  patient  an  adult  competent  to  make  their  own   choices?  Is  the  patient  a  child  who  is  old  enough  to  have  a  say  in  the  decision.  If  the   patient  cannot  make  their  own  decision,  who  is  the  decision  maker?  How  was  this   person  selected?      

9. Review  the  underlying  ethical  principles:  Review  which  ones  and  why  they  apply  t   this  particular  case:  beneficence,  nonmaleficience,  veracity,  fidelity,  autonomy  and   justice.    

10. Define  alternatives:  One-­‐Way  to  proceed  may  be  apparent  at  this  point.  However,   sometimes  there  are  different  choices.    They  should  be  addressed  identifying  the   benefits  and  burdens  for  doing  one  thing  versus  the  other.  

  11. Follow-­‐up:    Define  the  process  to  be  used  with  the  chosen  alternative.    

  Reference  Source:  Levine-­‐Ariff,  J.  &  Groh,  D.H.  (1990).  Creating  an  Ethical  Environment.   Nurse  managers'  bookshelf  a  quarterly  series:  2:1.  Baltimore,  Maryland:  Williams  &  Wilkins.   41-­‐61.