Running Head: Ethical Dilemma
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Ethical Dilemma
Ariel M. Kinder
Texas Tech University Health Sciences Center School of Nursing
In partial fulfillment of the requirements of
N5327- Evidence for Advanced Practice Nursing
Laura Thomas, PhD, RN, CNE
August 5, 2018
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Nursing Ethical Dilemma
Nursing often encounters ethical dilemmas in the clinical area of work. Some are straight
forward cases while other dilemmas are multifaceted. Being self-aware of your own strengths
and weakness through an ethics self-assessment can give us opportunities to personal reflect on
own ethical behaviors and responses. After taking the American College of Healthcare
Executives (ACHE) ethics self-assessment, I will explore my own strengths and weakness and
develop an improvement plan to address my weaker areas of ethics. In my own nursing career, I
have come across multiple ethical dilemmas with my patients. Using my own ethical dilemma
example, I will apply the evidence-based model application.
The ACHE ethics self-assessment is intended for personal use in evaluating your own
ethical ground and to personal assist in thoughtful ethics-related leadership and actions
(American College of Healthcare Executives, n.d.). My weakness that were identified during the
self-assessment included relationships with both my clinicians and colleagues. With colleagues, I
foster discussions about ethical concerns when they arise, and I encourage the use of
organizational mechanisms: I answered occasionally to. With clinicians, I encourage clinicians to
access ethics resources when ethical conflicts occur, and I encourage resource allocation that is
equitable and is based on clinical needs: I answered almost never to. One way to foster growth
and development about ethical issues is to join a peer group that is open and nondiscriminatory.
Currently, the hospital I am employed with is reinventing their clinical practice council, this
would be a great opportunity for myself to join my follow peers to talk about policies,
procedures, evidence-based practice, and ethical issues. Another way to improve my ethical
skills is to have honest open communication with my practicing physicians about the patients’
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wants and needs. Lastly, continual education on ethics with books or classes will help me
understand and foster growth and development in applying ethics to my daily life.
Ethical Dilemma
Parents of a newborn child, who is 63 days old, presents to the Pediatric Emergency
Department with a fever. The patient has a history of low-birth weight. The newborn child is
unvaccinated. Parents do not believe in medications or lab work for child.
The selection of this ethical dilemma happens very often in the pediatric emergency
department where I am employed. The competing demands of this dilemma are the up rise of
nontraditional care to children including not vaccinating children and the nonuse of medications.
According to WebMD, Austin, Texas is a hot spot for unvaccinated children (2016). The Texas
Health Department also stated that in some Austin schools up to 45% of kindergarteners have
received no vaccines (2018). There are two ethical dilemmas here with this case. One is the not
vaccinating your child and secondly the seriousness around fevers in infants that can lead to
sepsis or death.
Febrile illnesses are very serious in children under the age of three years old but
especially if they are under the age of three months old (American Academy of Family
Physician, 2013). Febrile illness in young infants who have risk factors (low-birth weight and
unvaccinated) have increased risk for developing early on-set sepsis. Applying the Stetler model,
I have consolidated many resources including Children’s Mercy, AAFP, and Academy of
Pediatrics to provide an evidence-based guideline for patients under the age of three months with
risk factors. The recommendation included a full sepsis work-up. The full sepsis evaluation
includes: blood work (complete metabolic panel, complete blood count, and blood culture),
urine, lumbar puncture, and options for respiratory or gastrointestinal panel if indicated by
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examination. The patient shall receive board septum antibiotics like Rocephin, as soon as the
blood culture has been obtained. These patients require inpatient management.
The Centers of Disease Control provides prudent information about the importance of
vaccinating children fully. According to the CDC, vaccines are very safe and effective,
immunizations can save your child’s life, protects others you care about, immunizations can save
your family time and money, and immunizations protects future generations from many diseases
(2015.). Vaccines have eradicated many diseases worldwide. Vaccines provide adaptive
immunity to newborns with whom have very little to no immunity at all when they are born. Not
vaccinating your child puts them and others at risk for developing diseases that are preventable.
The best thing to do in this situation is to educate the parents on the seriousness of a fever
and importance to help locate the infection that is causing the fever. Another important factor is
to advocate for your patient since the patient is unable to speak for themselves. We need to
remain respectful to the parents’ beliefs and values but bring forth concerns for the well-being
and safety of child. During these situations, having open and honest communication with the
family will hopefully help come up with a plan of care that is in the best interest of the child.
Ethical dilemmas occur often and are inevitable to avoid. Knowing your personal
strengths and weakness about ethics will help you respond appropriately in difficult situations.
Also remembering the principles of ethics: autonomy, nonmaleficence, beneficence, and justice
will also be a guiding factor to help resolve the ethical dilemmas that present to you.
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EBP Model Name
Stetler Model
Melnyk, B. M., & Fineout-Overholt, E.
(2015). Evidence-based practice in nursing
& healthcare: A guide to best practice (3rd
ed.). Philadelphia, PA: Wolters Kluwer.
Model Evolution
Summary

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First Published in
1976 to help apply
research findings to
practice
The original model
has undergone three
revisions
1st revision was in
1994, the use of
research on
knowledge utilization
2nd revision was in
2001a, this was about
the integration of
emerging concepts of
EBP
3rd revision was in
2001b, was about
clarifying and
highlighting critical
concepts
The 2001 revision
became integrally
related to concept of
evidence-based
nursing practice (the
use of research
findings and QI to
substantiate practice)
Key Model Steps

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There are five progressive
categories to the Stetler Model
1.Preparation- defining and
affirming a priority need,
reviewing the context in which
use would occur, and initiating
a search for relevant evidence,
especially research
2.Validation- assessing the
body of evidence, appraising
the documents, summarizing
evidence that related to the
identified needs
3.Comparative
evaluation/decision
making- making decisions the
body of summarized evidence
by applying set criteria
4.Translation/applicationconverting findings into the
type of change,
recommendation, or
application, putting a plan into
action, and enhance adoption
and actual implementation with
evidence-based change plan
5. Evaluation- evaluating the
plan in terms of the degree to
which implemented and
whether the goals for using the
evidence were met
Primary Practice
Setting

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Individual
practice and/or
Hospital Setting
Advanced-level
practitioners
integrate into
their practice
Help improve
current
practice, policy,
or procedure
Changing a
colleague’s way
of thinking
Key Model
Application
Considerations

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Model assumes
both formal and
informal research
findings
May require
reasoned
variation to best
fit patients’
circumstances
and preferences
Requires
integration of
clinical expertise
and judgement
with best
available external
evidence
Research findings
may be used in
multiple ways
(clinical
procedure or
behavioral
interventions but
also conceptually
to change how
one thinks about
the patient or
issue)
Requires an
RU/EBP
competent
individual
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The Iowa Model of Evidence-Based
Practice
Dontje, K. J. (2008). Evidence-based practice:
Understanding the process. Topics in Advanced
Practice Nursing, 7(4). Retrieved from
https://www.medscape.com/viewarticle/567786_4
6

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Systematic multi-step
process with feedback
loops.
First developed in
1994 by Marita G.
Titler, PhD, RN, FAAN
and her collegaues.
Originally used at the
University of Iowa
Hospitals and Clinics
to guide nurses and
other disciplines to
improve patient care.
Revision in 2002.
The model is
currently being
reviewed and may be
updated soon.
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1. Trigger- identify a problemfocused or knowledge-focused
trigger that will initiate the
need for change.
2. Review and critique
relevant literature
3. Identify research
evidence that supports a
change in clinical practice
4. Implement a change in
practice.
5. Monitor the outcomes
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Can be used by
nurses and
other clinicians
in a
multidisciplinary
healthcare
team.
Helps decision
making in
clinical and
administrative
practices that
affect patient
outcomes.
Recognized for
its applicability
and ease of use
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Based on the
problem-solving
steps in the
scientific process.
Important to
identify the issue
as a priority
problem for the
organization.
Highlights the
importance of
considering the
entire healthcare
system using
research to guide
practice
decisions.
It is important to
adequately frame
a clinical
question. The
PICO model can
be utilized.
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References
American College of Healthcare Executives. (n.d.). About ACHE- Ethics Self-Assessment.
Retrieved August 5, 2018, from http://www.ache.org/newclub/career/ethself.cfm
Center for Disease Control and Prevention. (2015, February). Vaccines & Immunizations.
Retrieved from https://www.cdc.gov/vaccines/index.html
Children's Mercy. (n.d.). Febrile Infant. Retrieved August 6, 2018, from
https://www.childrensmercy.org/Health_Care_Professionals/Medical_Resources/Evidence
_Based_Practice/Febrile_Infant/Febrile_Infant/
Dontje, K. J. (2008). Evidence-based practice: Understanding the process. Topics in Advanced
Practice Nursing, 7(4). Retrieved from https://www.medscape.com/viewarticle/567786_4
Hamilton, J. L., MD, & John, S. P., MD. (2013). Evaluation of Fever in Infants and Young
Children. American Academy of Family Physician,87(4), 254-260. Retrieved August 6, 2018.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in Nursing &
Healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer.
Olive, J. K., Hotez, P. J., Damania, A., & Nolan, M. S. (2018, June 12). The state of the
antivaccine movement in the United States: A focused examination of nonmedical
exemptions in states and counties. Retrieved August 6, 2018, from
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002578
WebMD. (n.d.). Unvaccinated Kids Create Risk of U.S. 'Hot Spots'. Retrieved from
https://www.webmd.com/children/vaccines/news/20180614/unvaccinated-kids-create-risk-ofus-hot-spots