1. Information organized and placed in a logical sequence (10 points) Points Awarded 2. Demonstrated knowledge of ethical dilemma presented by: 2a. Summarized the situation (10) 2b. Explained the ethical dilemma (5) 2c. Solved the problem as a professional RN (15) 3. Responses supported with specific ANA Codes (20) 4. Visual aids professional, visually interesting & aided in understanding material; proper grammar/spelling/punctuation-no more than 2 errors in presentation(10) 5. Maintained eye contact of audience (10) 6. Voice clear & audible (10) 7. Encouraged class participation (5) 8. Reference slide that includes references in APA format (5) Total points possible = 100 NSG 100 Case Study in-class Presentations Assignment 1): Moral Courage with a Dying Patient Mr. T. is an 82-year-old widower who has been a patient on your unit several times over the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. On admission, his ejection fraction is less than 20%, EKG shows a QRS interval of greater than 0.13 seconds, and his functional class is IV on NYHA assessment. He has remained symptomatic despite maximum medical management with a vasodilator and diuretics. He tells you, "This is my last trip; I am glad I have made peace with my family and God. Nurse, I am ready to die." You ask about an advance directive and he tells you his son knows that he wants no heroics, but they just have never gotten around to filling out the form. When the son arrives, you suggest that he speak with the social worker to complete the advance directive and he agrees reluctantly. You page the physician to discuss DNR status with the son. Unfortunately, Mr. T. experiences cardiac arrest before the discussion occurs and you watch helplessly as members of the Code Blue Team perform resuscitation. Mr. T. is now on a ventilator and the son has dissolved into tears with cries of, "Do not let him die!" 2): Moral Courage to Confront Bullying Melissa started on the unit as a new graduate 5 weeks ago. She is still in orientation and has a good relationship with her preceptor. The preceptor has been assigned consistently to Melissa for most of the last 4 weeks, but due to family emergency has not been available in the last week. Melissa has been told that she will be precepted by a different nurse for the remainder of her orientation. The new preceptor has not been welcoming, supportive, or focused on the educational goals of the orientation. In fact, this new preceptor has voiced to all who will listen her feelings about the incompetence of new BSN graduates. The crisis occurs when Melissa fails to recognize a patient's confusion as a result of an adverse medication effect. The preceptor berates Melissa in the nurses' station, makes sarcastic comments in shift report abou ...

1. 1.
Information organized and placed in a logical sequence (10
points)
Points Awarded
2.
Demonstrated knowledge of ethical dilemma presented by:
2a. Summarized the situation (10)
2b. Explained the ethical dilemma (5)
2c. Solved the problem as a professional RN (15)
3.
Responses supported with specific ANA Codes
(20)
4.
Visual aids professional, visually interesting
& aided in understanding material; proper
grammar/spelling/punctuation-no more than 2 errors in
presentation(10)
5.
Maintained eye contact of audience (10)
6.

2. Voice clear & audible (10)
7.
Encouraged class participation (5)
8.
Reference slide that includes references in APA
format (5)
Total points possible = 100
NSG 100
Case Study in-class Presentations Assignment
1): Moral Courage with a Dying Patient
Mr. T. is an 82-year-old widower who has been a patient on
your unit several times over the past 5 years. His CHF, COPD,
and diabetes have taken a toll on his body. He now needs
oxygen 24 hours a day and still has dyspnea and tachycardia at
rest. On admission, his ejection fraction is less than 20%, EKG
shows a QRS interval of greater than 0.13 seconds, and his
functional class is IV on NYHA assessment.
He has remained symptomatic despite maximum medical
management with a vasodilator and diuretics. He tells you,
"This is my last trip; I am glad I have made peace with my
family and God. Nurse, I am ready to die." You ask about an
advance directive and he tells you his son knows that he wants
no heroics, but they just have never gotten around to filling out
the form. When the son arrives, you suggest that he speak with
the social worker to complete the advance directive and he

3. agrees reluctantly. You page the physician to discuss DNR
status with the son. Unfortunately, Mr. T. experiences cardiac
arrest before the discussion occurs and you watch helplessly as
members of the Code Blue Team perform resuscitation. Mr. T.
is now on a ventilator and the son has dissolved into tears with
cries of, "Do not let him die!"
2): Moral Courage to Confront Bullying
Melissa started on the unit as a new graduate 5 weeks ago. She
is still in orientation and has a good relationship with her
preceptor. The preceptor has been assigned consistently to
Melissa for most of the last 4 weeks, but due to family
emergency has not been available in the last week. Melissa has
been told that she will be precepted by a different nurse for the
remainder of her orientation. The new preceptor has not been
welcoming, supportive, or focused on the educational goals of
the orientation. In fact, this new preceptor has voiced to all who
will listen her feelings about the incompetence of new BSN
graduates. The crisis occurs when Melissa fails to recognize a
patient's confusion as a result of an adverse medication effect.
The preceptor berates Melissa in the nurses' station, makes
sarcastic comments in shift report about "inability of university
educated nurses to recognize the basics," and informs the nurse
manager "that new graduates are a danger to patients." Melissa
tells you that she thinks she should resign and that maybe her
previous preceptor was too easy on her. You know her preceptor
is an excellent clinician and experienced teacher.
3) Moral Courage with a Family Disruption
Tom has been a clinical nurse on the unit for 3 years and tonight
is charge nurse for a fully occupied 30-bed unit. Even though
two staff members called in sick, the supervisor was able to pull
a RN and a nurse's aid from another unit. In shift report, Tom

4. had heard again in detail about the Host family. This family has
been problematic for the last week, and the staff has complained
constantly about their continuous, frequent requests; rudeness;
and unwillingness to leave the room when the patient in the
other bed requests privacy. The 79-year-old patient in the Host
family has COPD and mild dementia, and currently is
hospitalized because of diagnosis of cerebrovascular accident
(CVA). The CVA has left her with partial paralysis of the left
side and inability to speak. The family expects the nurses to do
everything for the patient, even though the patient is able and
willing to do a number of basic care functions. The crisis occurs
when the son comes to the nurses' station, screaming at the unit
secretary about the staff's incompetence and demanding to see
the nursing supervisor. The charge nurse is in the nurses' station
and is able to address the hostile situation.
While this makes you feel somewhat validated in your
perceptions, you now wonder what you should do with this
information. Afraid of any repercussions, you decide to keep it
to yourself because if you tell anyone, Sue will surely find out
it came from you and then will really get mad at you. Besides,
you need to stay in the nursing program ... you've worked too
hard to get where you are.
4) Student Nurse/Instructor Case Study
You are a student nurse who is assigned to work with an
instructor (Sue) that you have heard 'horror stories' about. You
are really worried about being in her clinical group as she tends
to have 'favorites' ... and based on assignment grades she has
given you in previous terms, you are definitely not one of them.
You go to clinical and all seems to be going okay for the first
few weeks so you assume all of your problems are unfounded.
Then you notice a slight shift in your instructor's demeanor. She
seems to only pay attention to the students who she thinks are
the 'smart ones' of the group. When you have a question about
your patient, she looks at you in disgust and tells you she is
going to send you home for being unprepared. Frightened you

5. will not be able to pass clinical; you stay in your patient's room
or to yourself on the unit and no longer ask any questions of
your instructor. You are so frightened that your instructor will
ask you a question about your patient that you cannot answer;
you stay up all night before clinical 'looking up anything and
everything' so that you won't be caught off guard. During the 5"
week of the term, you overhear some of the staff at the hospital
talking about your instructor in the break room.
This is what you overhear ... • Thoughts that Sue is an
inexperienced clinical instructor ... is she capable of doing her
job? (You know she has been at the nursing program for about 7
years.) • Sue is not able to assist her students perform skills
they have learned in lab ... this does not meet the state board
requirements for a clinical instructor. • Perceptions that Sue
does not adequately supervise her students ... brings to question
is she doing her job and ensuring patient safety • Professional
boundaries are not clear with students ("Sue is more of a friend
than instructor") ... some nurses are saying this is not a new
issue and Sue has been counseled regarding this in the past. •
Sue actually asked one patient if he was 'okay' being taken care
of by one of her students considering the student is 'obviously'
gay. • It is obvious that Sue has favorites ... those are the only
students she talks to and they can do no wrong ... others she just
chews out whenever they ask a question.
5): The case of the Nurse Addict
Judy Boise and Claire Temple had been colleagues for a long
time. They have worked together at the same hospital for 6
years. Since obtaining her divorce however, Ms Temple
personality has changed. She often makes silly comments or
giggles at inappropriate times. At other times, Ms Temples is
very irritable and resorts to taking medication for her nerves.
Ms Boise suspects that her friend is developing a drug
dependence. Her suspicion is confirmed one day when Ms
Temple asks Ms Boise to work for her while she sleeps off the
effects of some medication. Ms Boise confronts her friend with

6. her suspicions. Ms Temple acknowledges that she has been
taking cocaine but asks Ms Boise not to tell other nurses about
the nature of her problem. Ms Boise promises not to tell. The
next day, however Ms Boise finds Ms Temple asleep in a chair
in an empty room when she should be taking care of a patient.
6): Brandon and Marilyn Case Study
Justin Tyme - a registered nurse joins the unit after
successfully completing new employee and unit orientation. He
had worked for 10 years in a similar unit at St Elsewhere but
grew tired of the 2 hour daily commute. He is thrilled to be
working closer to home. The staff is ecstatic as the unit has
been shorthanded and the census is high. The staff likes
working with Justin. He is friendly fellow and frequently bri ngs
hot donuts and a huge thermos of Peets coffee for the staff. He
is always willing to help with lifting and turning patients and
often in the first one to respond to patients lights. Justin does
not always follow through on his observations and physician
orders; he often misses giving routine meds. The staff has taken
to routinely double checking Justin's orders and the following
shift often dispenses the missed meds. One morning, Dr. Tauk
comes in to review the speech consult he ordered the day before
on his patient, Mrs. Dee Phagia, prior to ordering her a diet. Dr
Tauk cannot find the consult and asks Charity N. Able RN to
locate it and call him. Charity discovers that the order had never
been placed.
On follow up, Charity discovers not to her surprise- that Justin
was the nurse who noted the order. Charity does not talk to the
manager but does point out the error to Justin who feels terrible
about it. Over the next month, Justin continues to make
intermittent "small" mistakes which cause no harm to patients
and the staff continues to cover. Today, Dr. L. Ovin comes in
and notices that her patient, Mr. hart is in atria fibrillation. She
orders stat IV digoxin and cancels the scheduled diagnostic
procedures. Mr Hart remains in atria fib and as you review his

7. chart, you discover that Justin missed the last two routine
digoxin doses.
7): Shyla and Gloria Case Study
Mrs. Lyons was a 27 year old woman who recently gave birth
prematurely to a set of twins. The infants were doing well but
Ms Lyons hemorrhaged and required emergency surgery
resulting in a hysterectomy. Severe loss of blood dropped her
hemoglobin to 6.0. Because the patient and her husband were
Jehovah's witnesses, they refused blood transfusions as
treatment for the low hemoglobin level. Chris Moore was the
nurse caring for Mrs. Lyons after her surgery. Although he did
not personally believe that patients should refuse blood
transfusions, especially new mothers with dependent infants, he
supported the rights of others to decide their health care in
accordance with their religious beliefs. Shortly after admission
to Mr. Moore's unit, Mrs. Lyon's hemoglobin began to drop. It
was suspected that the patient was hemorrhaging from an
unknown site in her body. Vasoactive drug therapy was begun
to help maintain adequate perfusion of her body tissues and her
cardiac output was constantly monitored. Mr. Lyons remained at
his wife's bedside and supported her repeated desire not to be
transfused, even though to not do so might result in his wife's
death. Over the next 24 hours, Ms Lyons drifter in and out of
consciousness and remained very close to death despite a slight
rise in her hemoglobin level. As Mr. Moore was leaning over
the patient, adjusting the IV tubing, he heard Mrs. Lyons
whisper, "Please I don't want to die-- please don't let me die."
Mr. Moore quickly asked Mr. Lyons if he heard what his wife
said. He was on the other side of the room and had not heard his
wife's word. Even though the nurse believed that his wife was
apparently changing her mind about receiving blood products,
Mr. Lyons was reluctant to believe this and did not want to
reserve her previous decisions. Mr. Moore knew that the patient
condition required a rapid response to avert her death

8. 8): Claudia and Nicole Case study
Sarah was promoted to nurse manager because of her excellence
in delivering patient care and recognizing leadership ability.
She was a preceptor excellent charge nurse, outstanding patient
advocate and chair of the practice council. Sarah has been a
medical surgical nurse for over 10 years and loves the variety of
patients under her care. She only recently completed her BSN
degree and earned her certification in medical surgical nursing.
When Sarah was in her position for less than 3 months, her
immediate supervisor moved to another stated because of his
wife's promotion. This person had been a mentor, confidant, and
recognized leader in the organization. Sarah tried to make the
best of the situation and follow the direction of her new
supervisor. However, right from the beginning, she found this
person to be very focused on the negative.
As an optimistic person, Sarah found this approach counter to
her basic instinct about people. Every time she tried to discuss
this approach, her director would say she was naive and that the
staff was taking advantage of her good nature. The director used
several of her recent projects failures to justify her position.
However Sarah understood that these disappointments had been
the results of staff illness and institutional reorganization. The
crisis point was reached when the director told her to get rid of
two staff members who were the most vocal in their
dissatisfaction with the reorganization. These individuals are
excellent clinical nurses, well-liked by staff and each has over
12 years of seniority in the organization. Sarah knew that the
director did not like these nurses for reasons unrelated to
reorganization and their performance.
Lateral Violence: The Sword in the Workplace
NSG 100 INTRODUCTION TO NURSING AS A PROFESSION

9. ETHICS CASE STUDY
Case Study
Melissa started on the unit as a new graduate 5 weeks ago. She
is still in orientation and has a good relationship with her
preceptor. The preceptor has been assigned consistently to
Melissa for most of the last 4 weeks, but due to a family
emergency has not been unavailable in the last week. Melissa
has been assigned a new preceptor for the remainder of her
orientation. The new preceptor has not been welcoming,
supportive, or focused on the educational goals of the
orientation. In fact, this preceptor has voiced to all who will
listen her feelings about the incompetence of new BSN
graduates.
Case Study(continued)
The crisis occurs when Melissa fails to recognize a patient’s
confusion as a result of an adverse medication effect. The
preceptor berates Melissa in the nurses’ station, makes sarcastic
comments in shift report about the “inability of university-
educated nurses to recognize the basics,” and informs the nurse
manger “that new graduates are a danger to patients.” Melissa
tells you that she thinks she should resign and that maybe her
previous preceptor was too easy on her. You know her preceptor
is an excellent clinician and experienced teacher. What is your
advice to Melissa?
Case Study in Own Words
Melissa just started her new job five weeks ago as a new
nursing graduate. She is given an amazing nursing preceptor
(Preceptor A). A family emergency with Preceptor A has
occurred, and now Melissa has been assigned to a new preceptor
(Preceptor B). Preceptor B is very condescending and

10. derogatory towards Melissa, and as a result, Melissa thinks that
her old preceptor was too easy on her. Melissa now wants to
resign from her position.
What is occurring in this situation, and what advice should you
give to Melissa?
Introduction
“Ethics are crucial because moral questions are at the heart of
life’s vital issues. Morality is primarily concerned with
questions of right and wrong, the ability to distinguish between
the two and the justification of the distinction” (Ray, 12)
All nurses should be supportive of each other
Nurses are upheld to the highest of standards
Ethical Dilemma
The ethical dilemma in this situation is that Preceptor B is not
taking proper responsibly to promote the health care
environment.
Preceptor B is using lateral violence against the graduate nurse.
Examples of Lateral Violence
Manipulation
Gossiping
Slander
Preceptor B’s attitude, and behavior is making Melissa feel
incompetent at effectively carrying out her nursing duties and
properly caring for her patients.
Melissa wants to resign

11. Solution
The first solution to this ethical dilemma is for Melissa to
discuss the situation to the nurse manager.
Melissa needs to explain Preceptor B’s behavior to the nurse
manager.
Melissa also needs to report the lateral violence to the nurse
manager.
“A healthy work environment is primarily the responsibility of
the leader. The leader sets the expectations, the tone, and,
especially, the level of tolerance for the amount of bullying or
unhealthy behaviors in the workplace” (oncnursingnews)
ANA Code of Ethics
“The nurse, through individual and collective effort,
establishes, maintains, and improves the ethical environment of
the work setting and conditions of employment that are
conducive to safe, quality health care” (Code of Ethics for
Nurses with Interpretive Statements 23).
The work environment should be free from harassment and other
unethical elements

12. Nurses should work together to main the work environment.
Provision 6 guides us to:
The provision states that a nurse must strive to improve the
workplace as an ethical environment. The new preceptor is not
doing this, therefore Melissa should report her.
Preceptor B is always castigating Mellissa, instead of
explaining/teaching.
Conclusion
Direct Melissa to the Charge nurse to take further action if the
situation was not taken care of
It all relates back to Provision 6.
References
Code of ethics for nurses with interpretive statements. (2015).
Silver Spring, MD: ANA, American Nurses Association.

13. Lateral Violence in Nursing Can Take Many Forms. (n.d.).
Retrieved July 14, 2017, from
http://www.oncnursingnews.com/publications/oncology-
nurse/2017/march-2017/lateral-violence-in-nursing-can-take-
many-forms
Rae, S. B. (2009). Moral choices: an introduction to ethics.
Grand Rapids, MI: Zondervan.