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Patient Advocacy: Ethical Decision-Making

The patient presented to the healthcare setting is a twenty-five-year-old woman with signs of physical abuse and concussion. She had several injuries on her face and body, claiming that she had been attacked in the evening by a burglar attempting to steal her purse and phone, and she also fell when trying to get away from her attacker. The woman looked exhausted and sleep-deprived, and she noted that she works night shifts to help provide for her family; she has two daughters and is married.

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When asked questions about her injuries, the patient tried to laugh them off and divert the conversation into another direction, only asking if she could get some medication and go home. Any questions about the patient’s husband, such as where did he work and whether he was with the kids when the patient at the hospital, were not answered directly, which caused some suspicion in the healthcare provider.

As the first step in the Bioethical Decision-Making model, the nurse had to identify the ethical issue at hand. Considering both the physical and mental state of the patient, the nurse had suspect domestic violence. It is referred to as partner abuse, specifically physical violence between a male and female partner, which is the most commonly perpetrated by males. From the healthcare perspective, domestic violence is better understood as a chronic syndrome characterized not only by physical violence episodes but also emotional and psychological abuse maintained by perpetrators in order to control their partners (Rakovec-Felser, 2014). Therefore, domestic violence can be referred to as an abuse of power, and the domination, coercion, and victimization of one person by another could lead to negative consequences.

The second stage of the model is gathering and assessing the facts that are relevant to the decision-making. The patient matched several characteristics of a domestic abuse victim, such as increased nervousness, the diminishing of her physical injuries, making up excuses about the injuries or lying about where she got them, and avoiding speaking about her partner. Even though a further psychological evaluation is needed, research evidence suggests that female victims tend to show such characteristics as low self-esteem, submissiveness, insecurity, pacification, as well as social isolation (Pereira et al., 2020).

Besides, the effects of abuse and violence have a profound influence on the health of victims, which enables them to seek healthcare services for health concerns related to their abuse. After communicating with the patient and observing her behavior and demeanor, a nurse made a decision to ask whether the woman was physically abused by her partner and whether she needed help. The patient deliberated to answer the question, stating that she was afraid of telling the truth but admitted to being injured by her husband the previous night. She mentioned that her husband thought that she was at work, but she instead decided to seek health care because of the severe headache. She also said that she would not go to law enforcement to file a report because it would have a negative effect on her daughters’ safety.

The third stage in the process is identifying the individuals who at stake. Before connecting the patient to the law enforcement and domestic violence abuse resources, the nurse had to consider the implications for the patient’s daughters. Because of this, it was necessary to negotiate that the girls were in a safe place and away from the domestic abuser. The fourth step is to identify the values at stake, which included personal freedom, freedom of choice, the concern for others’ health, accountability, and nursing stewardship.

When considering the decision to refer the patient to the law enforcement for her to file a domestic violence report, the nurse had to take into account the risks of the patient being subjected to significant pressure on the part of the alleged abuser as well as consider the overall family implications. It becomes an ethical problem when there are signs of abuse, but the victim refuses to take steps to get away from the toxic domestic environment (Meyer, 2020). Therefore, the patient’s opposition to contacting law enforcement could be an ethical challenge despite her struggling with physical and mental abuse to which she has been subjected.

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The fifth step in the Bioethical Decision-Making model is identifying possible solutions and choosing the appropriate one. When nurses assume the role of patient advocates, it is important than in their decision-making they endure the safety of patients, give them a voice, educate about the implications of the events at hand, protect their rights, as well as connect them to resources that allow for the successful implementation of certain decisions.

Therefore, advocacy does not occur in a vacuum and is rather associated with considering the certain aspects of the environment in which care as well as advocacy processes occur. The most appropriate decision for the nurse in terms of the patient advocacy scenario is to initially treat the patient for her physical injuries and then connect her to the domestic violence resources that the woman can use in order to improve their overall health and wellbeing.

The final step is evaluating the process of decision-making as related to the ethical issue at hand. The ethical decision-making process in the presented scenario was challenged by having to identify the underlying problem behind the patient’s injuries while having very limited cooperation from the patient herself. In the scenario, domestic violence was not a personal matter of that affected only the patient but could also have an adverse influence on her children, which prompted the decision of the nurse to contact the law enforcement and connect the patient to domestic violence resources such as community support groups and advocacy organizations helping victims of abuse overcome the challenges of being mentally and physically abused.

To conclude, the presented scenario shows that nurses deal with cases of domestic violence at some point in their practice because injuries could be significant enough to present to a healthcare facility. The lack of cooperation on the part of the victim is quite common in such situations because the patient was used to being controlled by her partner.

Besides, the patient had also had concerns regarding her children’s safety. It was the responsibility of the nurse to first administer the care for the patient’s injuries and the suspected concussion and then instruct her about the need to call the police and attain support from domestic violence guidance and prevention organizations. The nurse could not have ignored the situations and agreed to stay silent upon the patient’s request because of the risks of further injuries and abuse that could lead to adverse physical and mental health consequences.


Meyer, C. (2020). Breaking the silence: Encouraging domestic abuse reporting. Web.

Pereira, M., Azeredo, A., Moreira, D., Brandao, I., & Almeida, F. (2020). Personality characteristics of victims of intimate partner violence: A systematic review. Aggression and Violent Behavior, 52, 101423.

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Rakovec-Felser Z. (2014). Domestic violence and abuse in intimate relationship from public health perspective. Health Psychology Research, 2(3), 1821.

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