Situation: An elderly patient, Mr. Jones, is admitted to the hospital with congestive heart failure. His condition is serious, and his doctor recommends aggressive treatment, including intubation and possible ventilator support. However, Mr. Jones, while mentally competent, clearly expresses his wish to forgo such interventions. His adult daughter insists on everything possible being done to save her father, even if it means life support.

Ethical Dilemma: The nurse is caught between respecting Mr. Jones’ autonomy (right to self-determination) and the daughter’s desire to see her father treated aggressively.

Resolution:

1. Gather Information: The nurse would first ensure Mr. Jones understands his condition and treatment options. This may involve a social worker or ethics committee member facilitating a conversation between Mr. Jones and his daughter.
2. Respect Autonomy: The nurse’s primary ethical obligation is to respect Mr. Jones’ right to refuse treatment. The nurse would document his wishes clearly in his medical chart and explain the implications to the daughter.
3. Facilitate Communication: The nurse could help mediate a discussion between Mr. Jones and his daughter, focusing on understanding each other’s wishes and concerns. This might involve exploring alternative options like palliative care to ensure Mr. Jones receives comfort measures.
4. Teamwork: The nurse would collaborate with the doctor, social worker, and potentially an ethics committee to ensure Mr. Jones’ wishes are documented and respected, while also providing support for his daughter during this difficult time.

This is just one example, and ethical dilemmas in nursing can be quite complex. However, the key steps often involve information gathering, respecting patient autonomy, facilitating communication, and working as part of a healthcare team.