“Caring practices are central to nursing. What it is to nurse cannot be separated from what it is to care for and about others.”
–Christine A. Tanner, PhD, RN, FAAN, former editor Journal of Nursing Education

Nursing is both a science and an art. Caring behaviors and nurse engagement improve patient outcomes (Swanson, 1999).

Caring gives the nurse a heightened sense of awareness and guides the evaluation of nursing interventions by recognizing subtle changes in the patient’s condition.

Though caring, compassion, and spiritual care are foundational to holistic nursing practice, these “soft skills” are not as easily taught or emphasized in the nursing curriculum.

Can the “Art” Be Taught?

Case studies are a powerful tool to situate and contextualize nursing content to practice.How should the nurse therapeutically respond to a patient who is dying and has lost hope or advocate for a patient whose end of life wishes are not being honored by family?

Case studies that contextualize these ethical and moral dilemmas and allow students to PRACTICE the ethical aspect of the profession can be an effective tool to teach the importance and relevance of the “art” to practice.

My Story

Though there are case studies on the most common med/surg topics from nursing publishers, there was little to nothing on the ethical and moral dilemmas that nurses will encounter after graduation.

Therefore I decided to create my own based on my current clinical experiences and share them so you too can better prepare your students for this aspect of professional practice!

How to Make the “art” pART of Your Curriculum!

Clinical Dilemmas are a BRAND NEW series of case studies that emphasize the importance of the “art” or ethical component of the nursing profession.

I have situated the most common themes of dilemmas in salient scenarios that I have experienced into four general categories:

  1. PATIENT dilemmas. How should the nurse respond when their patient is anxious, lost hope, spiritual crisis or possible drug seeking behavior?
  2. TREATMENT dilemmas. How to support a patient when facing end of life and needs to choose between hospice/comfort care and aggressive medical management
  3. ETHICAL dilemmas. What to do when family members are in disagreement with code status or concern of medical futility
  4. NURSE dilemmas. How to address incivility in practice and academia as well as student burnout

Each study has an emphasis that integrates aspects of caring, spiritual care, nurse engagement/presence, and ethical decision making and its relevance to nursing practice.

 “This powerful collection of clinical reasoning case studies contextualize clinical dilemmas and is a needed resource to teach the art of nursing.”
Barbara Hill, RN, MSN, CNE, CMSRN, Associate Professor
Community College of Baltimore County, Baltimore, Maryland

Clinical Dilemma Structure

I have intentionally made these activities short (2 pages) so they are short and can be completed in 15-20 minutes so they can be easily integrated as an active learning tool in the classroom or clinical post-conference settings.

Each clinical dilemma case study comes complete with:

  • Blank student version (PDF) that can be posted electronically
  • Fully developed answer key (PDF) for faculty that will serve as a guide to student dialogue

Each case study begins with a scenario and the need to identify what data is most relevant and why so the essence of the current problem can be correctly recognized.

These fifteen case studies are derived from situations I have experienced in clinical practice and represent the most common clinical dilemmas a nurse will likely encounter SOONER than later in clinical practice.

Clinical Dilemma Topics

PATIENT Dilemmas
1. Pain Control or Drug Seeking Behavior
2. Anxiety or Spiritual DistressClinical-Dilemmas-PNG
3. Depressed Patient/Loss of Hope
4. Chemotherapy/End of Life

5. Invasive Surgery or Medical Management
6. Dialysis or Hospice
7. LVAD or Hospice
8. Transitioning to Comfort Care

ETHICAL Dilemmas
9. Medical Futility
10. Code Status/Patient Autonomy
11. Remain Intubated/Withdraw Life Support

NURSE Dilemmas
12. Nurse-to-Student Incivility
13. Student-to-Faculty Incivility
14. Faculty-to-Student Incivility
15. Student Burnout


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