Case Analysis Paper Assignment

Case Analysis Paper Assignment

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Your writing assignment requires that you argue for a recommended course of action the nurse should take in a patient case scenario, using the method explained in this document.

Find a specific scenario (case) presenting an ethical dilemma for a nurse to resolve in his/her workplace. The paper should be minimally 2000 words, excluding the works cited. A case may be found in the following ways:

• Find a nurse who holds a position you hope to have after you graduate and ask them to share a case that presented an ethical dilemma to her/him. (make sure to reference them appropriately)
• Find a published case in ethics or nursing textbook.
• Ask your instructor (Stephanie) for a case.
• Create your own ethical case to analyze. This cannot include any of the core content from case discussions in class content on canvas, such as Jehovah’s Witness blood transfusion examples.

Ensure your case is not too similar to the cases provided in our unit 1-3 discussions or to cases presented on any sample papers or sample analyses I provide.

Organize your paper according to the sections described below, inserting into your paper as section headings each of the words in bold font. Also include each of the section letters (A, B, etc.) in bold font. With the exception of section 3, answer the questions in clear, complete sentences (paragraphs where appropriate), and avoid the use of first and second person in all sections except when explaining where you found the case.

PART ONE: THE CASE

(Part One is required only of students taking the course for 2 graduate credit hours or 3 undergraduate credit hours.) A) What is the case that presents an ethical problem to the nurse?  Note that throughout these instructions “nurse” may refer to a nurse practitioner, a non-practitioner RN, or clinical nurse leader. Briefly (in no more than 600 words) describe a particular scenario that leads up to an ethical dilemma/problem for the nurse. (“Ethical dilemma/problem” implies the nurse is in a situation where, because of competing ethically relevant factors, he or she is yet uncertain about the right way to respond—or is pulled to respond in two or more opposing ways.) The case description should focus on the significant data that need to be considered in making an ethical analysis. Typically this includes information about the condition of the patient and about people to be affected by the decision. It may also include information about the belief system of a particular culture or religious group, and relevant laws or institutional policies. (Do not in this section refer to tenets of the Code of Ethics or to any ethical obligations.)

While many persons may be involved in this case, highlight the problem/dilemma that the nurse now faces and must resolve. The whole paper should focus on the question, “What should the nurse do now in order appropriately to respond to the situation he/she faces?” Do not state here (or in any section prior to Part Three) how the case was resolved or what should have happened. Give only the information about the case that leads up to the dilemma, and ensure your analysis focuses on the current dilemma.

1. B) From whom did you learn about such a case?

Identify the general source (employment position of person) from whom you learned about the ethical dilemma described above. Be careful here and throughout your paper to protect confidentiality.

PART TWO: ANALYSIS

(The paper will begin with the ANALYSIS for students taking the course for 2 undergraduate credit hours.)

Throughout this section do not add facts or needless repeat facts already presented in the case description.

1 – Stakeholders and the Wishes/Goals that Matter Most to Each

Identity each person (or group of persons) who has something significant to gain or lose in relation to how the situation is handled. For each identified stakeholder, state the one or two items that the stakeholder would say matters most to him/her/them. If it is unknown what matters most to a stakeholder, state so, indicate possibilities for what could matter most to the stakeholder. If a stakeholder is unconscious or not-yet-reflective, state the most significant benefits and/or harms at stake for him/her.

Examples: (Imagine a case in which a patient, Mr. Roberts, is newly diagnosed with cancer and the patient’s wife pleads with the health care team not yet to reveal the diagnosis.)

Mrs. Roberts: What matters most to Mrs. Roberts is that Mr. Roberts is able to enjoy the upcoming wedding of his daughter, unencumbered with concerns about his health.

Mr. Roberts: It is yet unknown what matters most to Mr. Roberts, whether it be his ability to enjoy the upcoming wedding of his daughter, unencumbered with concerns about his health, or to have nothing hidden to him regarding his new diagnosis.

Do not state what the stakeholders ought to be concerned about. Also, do not include the nurse or any other member of the health care team as a stakeholder unless he or she has something at stake in this case besides his or her concern to do the right thing (fulfill obligations, appropriately care for the patient, etc.).

2 – Opposing General Options

Identify two opposing general options the nurse could take.

Example: There are two general courses of action the nurse could take: 1) Encourage the physician to disclose Mr. Roberts’ diagnosis to him now. 2) Encourage the physician not to disclose Mr. Roberts’ diagnosis to him now.

3 – Specific Ethically Relevant Benefits to be Gained by Option 1

List the case-specific ethically relevant “benefits” (goals) that can be achieved by Option 1. For the purpose of this assignment, “benefits” are not limited to the kinds of goods typically considered when considering the principle of Beneficence. Rather, “benefit” refers to anything to be achieved for which there is some ethical reason (in contrast to a reason merely grounded in satisfying the nurse’s own desire/interest/need) to care about achieving it. Typically, each benefit will be a particular way of respecting a person (and the person’s rights) and/or promoting a person’s well-being (flourishing).

Examples of ethically relevant benefits include:

• Honoring Mr. Roberts’ ethical right to know about his diagnosis
• Helping Mr. Roberts to maintain trust in his health care providers
• Satisfying Mrs. Roberts (specifically regarding her wish for Mr. Roberts not yet to know about his newly diagnosed cancer)
• Appreciating the possibility Mr. Roberts would prefer not yet to know about his cancer (He later may be grateful for having had the opportunity to enjoy his daughter’s wedding without having known about his cancer.)
• Fulfilling Mr. Jones’ (the patient’s) current wish to ____
• Fulfilling Mr. Jones’ previously stated wish (as communicated in his advance directive) to ____
• Appreciating the possibility that, despite what Mr. Jones’ son states, Mr. Jones actually would have wanted ___
• Alleviating the current discomfort Mr. Jones is experiencing
• Eliminating (or diminishing) the risk of discomfort Mr. Jones could experience as a result of _____
• Appreciating the possibility Mr. Jones could recover his ability to _____
• Enabling Mr. Jones to have more time to live
• Honoring Mr. Jones’ ethical right not be deceived
• Keeping Ms. Carson safe
• Avoiding irritating Dr. Smith
• Enabling other patients to receive the nursing care they need

To help you pinpoint what is ethically relevant, express each benefit as a succinct phrase rather than as a sentence. Also, do not list general principles or general duties/responsibilities (e.g. the nurse’s duty to keep patients safe), and do not refer to desires of the nurse to fulfill a duty or to see that patients are appropriately treated.

In this section, and throughout your paper, do not use words/phrases such as “autonomy,” “dignity,” “respect”, “advocate,” “justice,” “quality of life,” etc., without clarifying specifically what you mean. Do not use “beneficence” or “nonmaleficence” without indicating the specific benefits or harms you have in mind. Do not use the terms “futile” or “futility” without specifying the goal in relation to which the action would be futile. If you use the word “right,” clarify whether you are referring to a legal right or to a fundamental ethical/moral right, and for any ethical/moral right, to the extent possible, indicate why such a right exists.

4 – Specific Benefits to be Gained by Option 2

List the case-specific benefits that can be achieved by Option 2.

5 – Justified Recommendation of General Option

State which general option is better. (Do not in this section elaborate on actions the nurse can take in line with the general option. Such elaboration belongs in Section 6.) Then justify your claim by explaining why some of the section 3 or section 4 benefits that support your recommended option are so important that, despite the most significant benefits to be achieved by the opposing option, the nurse should pursue the general course of action you claim is better. (Be sure explicitly to mention some of the benefits associated with the opposing option and explain how the considerations you present in support of the recommended option are more important than achieving the benefits of the opposing option.)

If possible, pose objections to the points you make, followed by responses that strengthen your reader’s conviction that your points are valid. Use a format such as: “Some may argue benefits supporting Y [the other option] are more important. . . . [Elaborate.]  Significant as these points are, they are not as important as considerations supporting X . . . [Elaborate].”  (Do not express objections only as questions.)

6 – Sensitivity and Refined Recommendation 

Revisit some of the benefits supporting the opposing option. Explain what (if anything) the nurse can do to help achieve any of these benefits while still following the general recommendation argued for in section 5. (Example: “While being honest with Mr. Roberts about his condition will not satisfy Mrs. Roberts’ desire for the clinicians to postpone disclosing it to him, Mrs. Roberts may become less disappointed with the decision to disclose the diagnosis if the care team  . . .)

Elaborate on the course of action the nurse should take, providing details not yet mentioned in the general recommendation. For example, if the recommended response entails the nurse having a discussion with one or more persons, provide details regarding what the nurse ought to say and how to say it. (You may wish to consider publications on effective communication, such as pp. 52-55, 63-64 of the chapter by Fiona Timmins posted in the E-Reserves.)

Do not merely hand off the nurse’s dilemma to someone else! If you think the nurse ought to bring the case to an ethics committee, explain exactly what a nurse serving on the ethics committee ought to say and recommend.

Integration of Literature (for section 5 and possibly 6):

(Do not insert the words “Integration of Literature” in your paper.)

• Within section 5, meaningfully integrate ethics-related claims of publications, making clear to what extent these claims are (or are not) true, reasonable, etc., and how reflecting on these claims is helpful in determining the better option. (Absolutely avoid “drop quotes,” i.e., simply inserting a quotation of a thinker, without clarifying to the reader your need to share the thinker’s words. If you agree with the author, include a phrase such as: “As Edison appropriately claims,. . . ” or “Agreeing with the ANA Code of Ethics, which states . . .,” If you disagree with the claim, include a phrase such as: “Contrary to Merton, who claims . . ., it is the case that . . .”)
• In addition to the required integration of ethics-related claims, you may integrate relevant published empirical facts, in which case you need not clarify the extent to which the stated fact is reasonable.
• When referring to publications, provide in the body of your paper the author’s name, date of publication, and specific page/section number(s) so that the referred to passage or idea easily can be found.)
• Students taking the course for 2 graduate credit hours or 3 undergraduate credit hours must integrate into their analysis claims/facts from at least five publications, excluding the course texts or publications found within the course’s E-Reserves. (Integration of course texts/readings is welcome, but your paper must also integrate five publications outside of the course text and readings found in the course’s E-Reserves.)
• Students taking the course for only 2 undergraduate credit hours must integrate an ethics-related claim of at least one publication into their analysis. (The publication may be from the course.)

(OPTIONAL) PART THREE: ACTUAL OUTCOME OF THE CASE

If the case you analyze is a real case, you have the option of briefly explaining how the case was actually resolved. (I love to know!)  How the case was actually resolved (how the nurse actually responded) should not be mentioned in any other place of the paper but this section.

WRITING MECHANICS:

1) The paper should be single-spaced (but with a space between each paragraph), 12-point font, 1” (or 1.25”) margins. Please insert page numbers in the upper right hand corner, and provide a list of references immediately after section 6 or after the optional Part Three. You may use any standardized style for citing references (APA or a style found in one of the assigned readings), provided you are consistent and that within the body of your paper you refer to specific page numbers (or specific sections) so that the referred to passage or idea can be easily found.

2) If the source for your case is a publication, while you need to list that publication in your bibliography, it does not count toward the required number of publications to be integrated into your paper.

3) Avoid the use of first and second person. (‘I’, ‘me’, ‘you’)

4) Ensure you use correct sentence structure and grammar (including correct use of apostrophes).

5) Do not use abbreviations without having first indicated the term(s) for which the abbreviation stands.

Before submitting your paper, I strongly recommend having another person (preferably a classmate) look over it and give feedback in terms of how clearly it provides the content asked for in the paper instructions.

Written Case Analysis Grading Guide

(This is only a guide. Some papers may present sections that need to be weighed differently than this guide indicates.)

Students Taking the Course for 2 Undergraduate Credit Hours (1000+ words)  1) STAKEHOLDERS: Author follows paper instructions in identifying each key stakeholder and the key items/goals that matter to him/her. 15% (13.5-15 very good/excellent, 11-13 satisfactory/good, 7.5-10 partially satisfactory, 0-7 poor)     2)  OPPOSING GENERAL OPTIONS: The author clearly states two opposing general courses of action the nurse can take. 5% (4-5 good, 2-3 partially satisfactory, 0-1 poor) 3) and 4) “BENEFITS” TO BE GAINED BY EACH OPTION: Following the paper instructions, the author clearly explains how certain “benefits” will be gained by one option, and other “benefits” will be gained by an opposing option. 25% (22.5-25 very good/excellent; 18.5-22; satisfactory/good, 12.5-18 partially satisfactory, 0-12 poor) 5) JUSTIFICATION OF THE BETTER OPTION: The author provides a clear, robust argument for why a particular option is better. Possible objections are considered and well responded to. 25% (22.5-25 very good/excellent; 18.5-22; satisfactory/good, 12.5-18 partially satisfactory, 0-12 poor) 6) SENSITIVITY & REFINED RECOMMENDATION: The author clearly explains what, if anything, the nurse can do (while following the better option argued for in section 5) to show sensitivity toward some of the “benefits” that support the opposing option. The author appropriately elaborates on the course of action the nurse should take. 15% (13.5-15 very good/excellent, 11-12.5 satisfactory/good, 7.5-10.5 partially satisfactory, 0-7 poor) INTEGRATION OF LITERATURE: The author meaningfully integrates claims of the required number of publications according to the paper instructions, including in the body of the text the specific page number on which the referred to point is found. The author provides an appropriate bibliography of the sources. 15% (13.5-15 very good/excellent, 11-12.5 satisfactory/good, 7.5-10.5 partially satisfactory, 0-7 poor) For any section that fails to abide by any of the relevant “Additional Instructions,” points will be deduced within that section. For example, a deduction of points will occur in each section where there is an occurrence of grammatical errors or inappropriate or ill-defined phrases/terms (e.g., “I feel,” “futile” without reference to a specific goal).

Students Taking the Course for 2 Graduate Credits or 3 Undergraduate Credit Hours (2000+ words)

 PART ONE  1) CASE: Author clearly presents a case that leads to an ethical dilemma to the nurse/NP, and clearly identifies information (events, laws or institutional policies, etc.) relevant to the dilemma.  10% (9-10 very good/excellent, 7.5-8.5 satisfactory/good, 5-7 partially satisfactory, 0-4.5 poor)

2) SOURCE: Author clearly identifies from whom he/she learned about such a case. 5% (4-5 good, 2-3 partially satisfactory, 0-1 poor)

PART TWO

1) STAKEHOLDERS: Author follows paper instructions in identifying each key stakeholder and the key items/goals that matter to him/her. 10% (9-10 very good/excellent, 7.5-8.5 satisfactory/good, 5-7 partially satisfactory, 0-4.5 poor) 2)  OPPOSING GENERAL OPTIONS: The author clearly states two opposing general courses of action the nurse can take. 5% (4-5 good, 2-3 partially satisfactory, 0-1 poor) 3) and 4) “BENEFITS” TO BE GAINED BY EACH OPTION: Following the paper instructions, the author clearly explains how certain “benefits” will be gained by one option, and other “benefits” will be gained by an opposing option. 20% (18-20 very good/excellent, 15-17 satisfactory/good, 10-14 partially satisfactory, 0-9 poor) 5) JUSTIFICATION OF THE BETTER OPTION: The author provides a clear, robust argument for why a particular option is better. Possible objections are considered and well responded to. 20% (18-20 very good/excellent, 15-17 satisfactory/good, 10-14 partially satisfactory, 0-9 poor) 6) SENSITIVITY & REFINED RECOMMENDATION: The author clearly explains what, if anything, the nurse can do (while following the better option argued for in section 5) to show sensitivity toward some of the “benefits” that support the opposing option. The author appropriately elaborates on the course of action the nurse should take. 15% (13.5-15 very good/excellent, 11-13 satisfactory/good, 7.5-10 partially satisfactory, 0-7 poor)     INTEGRATION OF LITERATURE: The author meaningfully integrates claims of the required number of publications according to the paper instructions, including in the body of the text the specific page number on which the referred to point is found. The author provides an appropriate bibliography of the sources. 15% (13.5-15 very good/excellent, 11-13 satisfactory/good, 7.5-10 partially satisfactory, 0-7 poor)    For any section that fails to abide by any of the relevant “Additional Instructions,” points will be deduced within that section. For example, a deduction of points will occur in each section where there is an occurrence of grammatical errors or inappropriate or ill-defined phrases/terms (e.g., “I feel,” “futile” without reference to a specific goal).  

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Grading Guide for Initial Paper Submission

(for MSN students and students taking the course for 3 undergraduate credit hours)

You will not earn any credit on your initial submission if you do not identify the source of the case.

5 points = good/satisfactory in following all instructions for all questions. 4.5 points = one significant weakness in following instructions; 4 points = two significant weaknesses in following instructions; 3 points = three significant weaknesses in following instructions; 2 points = four significant weaknesses in following instructions; 1 point = most of paper does not follow instructions; 0 = none or almost none of the paper follows instructions.

Section 6 and the integration of literature will not be evaluated on the initial submission.

Note:  Please do not assume that earning full credit on your draft implies little need for revisions. Prior to submission, check your final paper not only against instructor comments but also against the paper instructions. (You may need to revise your paper in ways beyond the revisions the instructor suggests when providing comments on your initial submission.)