Patient-Care Situation Assignment

During a surgical procedure, the patient expressed her wishes verbally and in a written consent whereby she stated that during the surgical procedure she did not want the doctor to remove any bone. However, after the patient was anesthetized and the surgical procedure commenced, the surgeon attempted to ignore the patient’s wishes. As the surgery was going on, the responsible surgeon explained that there was a need to excise the bone tissue regardless of the patient’s wishes. The healthcare team concurred with the surgeon and this means that the entire team was ready to ignore the patient’s expressed and written consent. However, the circulating nurse acted as the patient’s advocated and emphasized the significance of respecting the patient’s wishes. Accordingly, the healthcare agreed to respect the patient’s wishes and during the surgical procedure, no bone tissue was excised. This is in line with Davoodvand et al (2016) who highlight the importance of nurses remaining alert in situations where the patient is not able to speak. Therefore, it is important for a nurse to give voice to a patient in a situation where the patient cannot speak, just like in the described situation. Patient-Care Situation Assignment

Medical Facts

The patient had a history of degenerative joint disease and osteoporosis. During the current situation, the patient sustained a fall after slipped on ice while walking and fell which fractured her left hip. She was admitted to the hospital via the emergency department and booked for a surgical procedure for repair because the medical assessment established that she was a good candidate for surgery. The patient was scheduled for ORIF with hemiarthroplasty surgical procedure. Before the surgery, the patient informed the medical team that she would not like any of her bone tissue removed.


The dilemma centers on nursing advocacy during a surgical procedure. Nursing advocacy was significant in ensuring patient safety during nurses’ encounters with the healthcare system; particularly the patient was undergoing surgery and hence he was not in a position to act as her own advocate. According to Davoodvand et al (2016) during surgery events, the present nurse is supposed to serve as the patient’s advocate and speak for the patient and at the same time protect the wishes of the patient throughout the surgical procedure. Furthermore, the nursing code requires the nurse present during a surgical procedure to support the cause due to the patient’s susceptibility (Shannon, 2016). As a result, the surgical encounter placed the nurse with the opportunity to act as the patient’s advocate. Patient-Care Situation Assignment

By being the patient’s advocate during a surgical procedure, this gave the patient voice because during surgery the patient decided to put their full trust in healthcare providers. As the patient’s advocate, the nurse should ensure that the provided care focuses on fulfilling the specific wishes of the patient. Moreover, the nurse also acted as an advocate by making sure that the safest procedures were adhered to during the medical procedure. The nurse should also ensure that the surgical procedure should only start after the provision of all correct instructions (Shannon, 2016).

External Influences

State laws and code of ethics are directly applicable to the situation. This is because the situation involved informed consent and the legal dogma of informed consent is ingrained in tort law. Therefore, the surgeon would have breached his duty to the patient by excising the bone tissue because the patient did not consent to this (Judkins-Cohn et al, 2014). Physically, the surgeon would have excised the bone tissue without permission.

The ethics essential in informed consent are founded on the principle of autonomy and self-determination. The code of ethics states that the healthcare provider should seek and get the consent of the patient prior to starting a surgical procedure or any other treatment course. The consent should also be free from imposition. If the patient does not authorize the treatment, this can sum to tort-a common law battery-by the healthcare provider. The common law stipulates that people have the autonomy and self-determination to choose medical treatment (Judkins-Cohn et al, 2014). The organizational policy is also relevant to the situation. This is because the hospital’s policy was that informed consent must be obtained from the patient prior to any medical procedure. Therefore, while the nurse acted as the patient’s advocate during the surgical procedure, the nurse also ensured that the tort law was not breached and at the same time the healthcare team followed the essential code of ethics and set organizational policy. Patient-Care Situation Assignment

Decision Makers

In this situation, the decision maker regarding the treatment of choice is that patient. This is because the patient was competent enough to make a decision regarding his preferred course of treatment. This is because the patient was of sound mind and an adult and hence he is competent ought to decide about his treatment.

Underlying Ethical Principles

Autonomy is the most relevant ethical principle in this situation. The focus of autonomy principle is on the patient’s right of self-determination. According to Ringstad (2016), the principle of autonomy necessitates that there should not be any external constraints and also the patient should have the mental ability to make a decision. In this situation, the patient autonomously made the decision not to have any of the bone tissues removed. The patient also had the mental capacity to make this decision and therefore his autonomy should have been respected by the surgical team. The nurse upheld the patient’s autonomy by acting as her advocate.

The principle of justice is also relevant in this situation. This is because the principle of justice is also based on fairness (Porcino et al, 2014). The selected decision for the patient should be the fairest of all among competing conceptions. Accordingly, in this case the surgical team should have selected the most just decision in accordance with the patient’s will. The nurse upheld the principle of justice y acting as the patient’s advocate because it was ensured that the most just decision for the patient was selected (not to excise the bone tissue).

Alternative Decisions to the Situation

Another alternative decision to the situation was having the bone tissue excised if it was the decision to bring the utmost good to the patient. The principle of beneficence obligates healthcare providers to maximize the potential benefits and minimize the potential harms (Adashi & Cohen, 2017). Therefore, in this situation the alternative decision for the surgical team was to decide the best decision for the patient. This is because the patient was under anesthesia and hence she was fully relying on the healthcare team to make decisions for her. If removal of the bone tissue was the decision carrying utmost benefit and minimum harm, this presents an alternative decision for the team. Patient-Care Situation Assignment


Adashi E & Cohen G. (2017). Ideology v. Beneficence.Journal of Law and the Biosciences. 4(2).

Davoodvand S, Abbas A & Ahmadi F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. J Med Ethics Hist Med. 9(5).

Judkins-Cohn T, Kielwasser-Withrow K, Owen M & Ward J. (2014). Ethical Principles of Informed Consent: Exploring Nurses’ Dual Role of Care Provider and Researcher. 35

The Journal of Continuing Education in Nursing. 45(1).

Porcino A, Page S, Boon H & Marja V. (2014). Negotiating Consent: Exploring Ethical Issues when Therapeutic Massage Bodywork Practitioners Are Trained in Multiple Therapies. International Journal of Therapeutic Massage & Bodywork. 4(7).

Ringstad O. (2016). Patient autonomy in a digitalized world: supporting patients’ autonomous choice. Croat Med J. 57(1): 80–82.

Shannon S. (2016). The Nurse as the Patient’s Advocate: A Contrarian View. Wiley. 46(1). Patient-Care Situation Assignment

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