Ethical dilemma from your nursing practice

Key Stakeholders

The key stakeholders in this situation are:

The Patient: The individual making the decision about their care.

The Nurse: The primary advocate for the patient, who must balance the patient's wishes with their professional duty.

The Physician/Healthcare Team: The professionals who have a duty to provide beneficial medical treatment.

The Patient's Family: Individuals who are emotionally invested and may disagree with the patient's decision.

The Hospital/Healthcare System: The institution that provides the care and must adhere to legal and ethical standards.

Impact on Key Stakeholders

The Patient: The patient may experience pressure from family and providers to change their mind, which can erode their sense of autonomy. Their decision to refuse treatment could also lead to a decline in their health.

The Nurse: The nurse faces significant moral distress. They may feel a sense of failure if the patient's condition worsens, and they must navigate the challenging task of supporting the patient's decision while also dealing with their own professional and personal beliefs. This can lead to emotional exhaustion and burnout.

The Physician/Healthcare Team: The team may feel frustrated by the patient's refusal of treatment, as they believe they are not being allowed to provide the best care. They also need to ensure the patient's decision is documented as an informed refusal to avoid legal issues.

The Patient's Family: Family members can be devastated by the patient's decision and may disagree with it. This can cause significant conflict within the family and with the healthcare team. They may also feel helpless and unable to influence the outcome.

Sarah, a 35-year-old professional, has been experiencing sleep issues for several months. She reports difficulty falling asleep, frequent awakenings, and feeling unrefreshed in the morning. A sleep study reveals that Sarah spends a lot of time in Stage 1 and Stage 2 sleep but has very limited Stage 3 (N3) sleep and almost no REM sleep. She often experiences hypnic jerks shortly after falling asleep and wakes up frequently, especially after entering Stage 2 sleep.

How might Sarah's limited deep and REM sleep be contributing to her current physical and mental symptoms?

As a helpful reminder:

Stage 1 (Light Sleep): Transition from wakefulness to sleep; muscle activity slows down; may experience sudden muscle contractions (hypnic jerks); easily awakened.

Stage 2 (Light Sleep): Deeper than Stage 1; characterized by sleep spindles and K-complexes; body temperature drops, heart rate slows, and breathing becomes more regular.

Stage 3 (N3, Deep Sleep): Slow-wave sleep (SWS); deepest stage of non-REM sleep; brain waves slow down significantly; difficult to awaken; essential for physical and mental restoration.

REM (Rapid Eye Movement): Dream sleep; brain activity resembles wakefulness; vivid dreaming occurs; rapid eye movements; muscles are temporarily paralyzed; heart rate and breathing become irregular.

Please complete your answer in one short paragraph. Type your answer in the box below and then complete the Academic Honesty Policy declaration to earn the grade. 

Sarah's sleep issues are likely a direct result of her limited deep (N3) and REM sleep. Limited deep sleep prevents her body from undergoing crucial physical restoration, like tissue repair and immune system reinforcement, which would explain why she feels unrefreshed and potentially more susceptible to illness. A lack of REM sleep impacts her mental and emotional health, as this stage is essential for emotional regulation, memory consolidation, and processing daily events. The minimal REM sleep likely contributes to her irritability and difficulty with focus. Since she spends most of her time in lighter sleep stages, she is easily awakened, which further

Sample Answer

Ethical Dilemma: Patient Autonomy vs. Beneficence

A classic ethical dilemma in nursing is the conflict between patient autonomy and beneficence. This occurs when a patient's informed decision about their care conflicts with what the healthcare team believes is in the patient's best interest. For example, a patient with a life-threatening, but treatable, illness may refuse a medically effective treatment. The patient may state that they have lived a full life and do not wish to endure the side effects of the treatment. The nurse and healthcare team, guided by the principle of beneficence, feel a duty to provide life-saving care, creating a conflict with the patient's right to choose.