The topic of opioid addiction is always a sensitive one for me since it destroyed my marriage of 18 years. With that being said, my personal values compare with the National League of Nurses (NLN) by the caring and compassion I give to the patients. In this particular instance of Mr. Logan recovering from a surgical procedure, pain medication is essential for recovery. This would be just cause for a nurse to advocate for the patient. Integrity is a part of the National League for Nursing (NLN) and involves respecting the dignity and moral wholeness with every person without limitation (National League for Nursing [NLN], 2021). My ethical principles align with the American Nurses Association (ANA) because I will serve as the most useful advocate for Mr. Logan’s treatment for his pain (American Nurses Association [ANA], n.d.). I understand addiction, but I am also a woman who has given birth and understands pain as well. If I were faced with an ethical dilemma first, I would evaluate the situation to see if I would be able to discuss my concerns with the physician. If I could not discuss my concerns with the physician who is asking for the order, I would immediately go to my direct supervisor. Working with the military has taught me to handle issues at the lowest level.
In the case study of Mr. Logan, I would not continue to deceive Mr. Logan. I have not worked in this particular setting but deceiving a patient in the first place goes against many expectations provided by the NLN and the ANA. I am the type of person who respects authority, and based on several experiences doctors do not have all the answers, let alone all the right answers.
 Mr. Logan did not receive the appropriate use of a placebo, in my opinion. According to Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center (2017), a placebo works on the brain, such as the perception of pain. It has shown effectiveness with conditions such as pain management (Harvard Health Publishing). The placebo mentioned by Professor Ted Kaptchuk does not incorporate a recent surgery and addiction. Therefore, I do not believe any placebo for pain management should be used after surgery and/or addiction in the beginning.
Any nurse can serve as an advocate to their patients by addressing the issue, which is pain. Approaching the surgeon is an option; however, the physician who gave the order will not be happy. Advocating for any patient requires tough skin. Nurses who carry their emotions on their sleeves, such as me, would have a difficult time given this case study. I would do the best that I could to make sure Mr. Logan received pain medication of some sort regardless of his addiction.
1.      How do your personal values compare with those of the NLN?
As a nurse, respect, caring, integrity, gentleness, kindness, and understanding is my core values. Treating others and my patients with respect and kindness and protecting the integrity of my patients is crucial. As a nurse, cultural awareness, and cultural competency has helped me to deliver effective and quality healthcare services that meet the social, cultural, and linguistic needs of diverse patients. National League for Nursing (NLN) explain that to improve the health of the individual, the community, and the nation at large, nurses must understand the needs of their patients, and commit to protecting the interest of these patients. Nurses must respect and protect the integrity of their patients, recognize the cultural norms associated with the health belief of individuals and provide quality care regardless of the patient’s ethnicity (National League for Nursing, 2021).
1.      Do your ethical principles align with those outlined in the ANA Code of Ethics for nurses?
Ethics in nursing are moral principles that govern how nurses and other healthcare providers will behave or portrait themselves when providing care. As a nurse, I know my job responsibilities and understand the importance of staying within my scope of practice during the patients’ care. Nurses are to advocate for patients and families by protecting their rights and speak out for them during treatment. Nurses must ensure patient safety, facilitate patient autonomy and right when deciding on treatment. Patients have the right to refuse treatment and decide on what kind of treatment they want to receive, and nurses must respect the patient’s opinions concerning their health. Promoting patient safety and making the environment conducive for the patients during hospitalization is very important to me as a nurse.
The American Nurses Association (ANA) provides the code of ethics that helps the nurses to stay and practice within their scope of practice. Nurses must follow the rules and regulations in their respective states to protect ethical values. The code of ethics supports nurses in providing consistently respectful, humane, and dignified care. This code of ethics empowered nurses to advocate for their patients and protect the right of their patients. It provides the ethical obligations, and the responsibilities the nurses must assume when providing care and prompt the nurses to provide quality care in a safe environment. Nurses are obligated to maintain the integrity of the profession, collaborate with team members, and continue to improve their knowledge through continuous education (American Nurses Association, 2015).
1.      What will you do if faced with an ethical dilemma while caring for your patient? See the case study below, Mr. Logan.
As a nurse, I am obligated to advocate for my patient and protect their right to receive appropriate care. The physician’s behavior is unethical. This type of behavior can jeopardize the patient’s health and destroy the reputation of an organization. It can also result in legal action filling against the physician and the hospital where the physician work. I will let the physician know my opinion about injecting saline as pain medicine. And let the physician know that my scope of practice did not support his action. If the physician insists, I will involve the nurse manager and the higher authority in the setting, to preserve my dignity as a nurse.
a.       Should the nurse continue to deceive Mr. Logan?
No. Deceiving patient is wrong and is not in line with the code of ethics for nurses.  Provision 1 of the Code states that “the nurse is obligated to act with compassion and to respect the dignity and autonomy of each patient” (Epstein &Turner, 2015, p.4).
a.       Is this an appropriate use of a placebo medication?
No, this is not the appropriate use of placebo medication. The code of ethics of the American Medical Association (AMA) forbids the use of a placebo on any patient without the patient consent (Epstein &Turner, 2015). The patient must be informed of voluntarily consent to the placebo.
a.       How can the nurse serve as an advocate for this patient?
Since the nurse has no right to prescribe or change the medication for Mr. Logan, it is appropriate for the nurse to inform the patient that the physician is worried about his struggle with opioid and refused to prescribe the pain medicine that will help him. Informing the higher authorities in the organization will also help the nurse to protect the patient’s right to quality treatment and protect the organization from facing unnecessary legal action.
 I believe my nursing and personal values are similar to those listed in the National League for Nursing (NLN) core values. While working with individuals, patients, or coworkers, I attempt to exude all NLN core values. However, a few I consider to be outstanding are hope, respect, and education. The value of giving hope to patients and families during a time of need is priceless. Being respectful in the manner I care and interact with patients and their families. I believe respect also carries over to diversity. It is essential to respect individual’s values and practices toward their healthcare needs. Because I am naturally curious, it is easy for me to commit to continual education and professional nursing growth.
2.)        The ethical principles outlined in the American Nurses Association (ANA) code of ethics at first glance would be agreeable with my ethical values and most nurses. The theoretical ANA ethics involve the betterment of the nursing profession while promoting the healthcare of the population. The practical application of the ANA ethics can place many nurses in direct conflict with their personal beliefs. An area of conflict for me lies with the required do not resuscitate (DNR) status and its interpretation for HOSPICE patients. This ethical dilemma falls under ANA provision 3, advocating for protecting the patient’s health, rights, and safety, for me (American Nurse Association, 202, Provision 3). I experienced a clinical case review that The individual experienced a fall and received a treatable head injury. Because of the interrupted DNR status, the individual was not transported to the hospital after the fall. Later that day, they began to experience symptoms involving swelling of the brain. The individual died three days after the fall, death certificate listed brain injury as the cause. To me, the ethical issue involved the need for hospitalization and treatment. This individual had a terminal diagnosis of spinal stenosis, which over an undetermined amount of time caused complication and death. It is my opinion the lack of treatment for the accidental injury caused their untimely death. Although the ANA code of ethics seems straightforward in theory, practice and application can be convoluted.
3).        The nurse should answer Mr. Logan’s question with honesty and transparency. At this point, the nurse should provide some education to Mr. Logan, stating concerns with opioid pain medication and the propensity of relapse with his addiction. The nurse should discuss with Mr. Logan’s his desire and need for pain treatment. The nurse should discuss and offer all alternative measures for pain control. Ultimately the nurse should advocate for Mr. Logan’s desire for treatment.   
A.)   The nurse should not deceive Mr. Logan.
B.)     Placebo medications are utilized in controlled clinical trials, where both the control and experimental groups have signed informed consent. This scenario is not appropriate for placebo medication. Alternative pain therapy such as meditation and acupuncture could be therapeutic, with the patients’ knowledge and consent.
C.)    The nurse should make their supervisor aware of the situation. The nurse should also speak with the doctor, advising them of the patients’ questions and responses to the lack of pain control. The nurse should thoroughly document the doctor’s orders, patients’ pain score, and all advocacy measures completed.


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