NR 395 Week 8 Ethics Course Reflection Paper Example

Reflection: I Came In Thinking Ethics Was About the Big Decisions, and I Am Leaving With a Question About the Word "Refused"

Student Name

College of Nursing, Chamberlain University

NR 395: Ethics, Integrity, and Professional Nursing Trends

Instructor Name

Month Day, Year

Reflection: I Came In Thinking Ethics Was About the Big Decisions, and I Am Leaving With a Question About the Word "Refused"

The Position I Walked In With

When this course opened, I wrote that ethics in nursing was mostly about rare, dramatic moments: withdrawing life support, a patient refusing blood, a family fighting over a feeding tube. I thought the ethics course would prepare me for the one or two times in a career when I would face a genuine dilemma, and that the rest of nursing was clinical skill. I said so with some confidence in my first discussion post, and I defended it in a reply to a classmate who argued that ethics was in everything. I thought her position was true but unhelpful, because if ethics is everywhere it is hard to say what it asks of anyone.

I no longer hold that position, and I can say which week changed it and why.

The Moment It Gave Way

In Week 2, I analyzed a case in which a daughter asked the night nurse to hide her mother's medication in applesauce. My first reading was that the case was about the daughter's request, a big question about deception and consent. As I worked through it, I realized that the most important fact in the case was earlier and smaller: the patient had refused her evening medications for a week, and each refusal had been charted as "refused" without anyone asking why. When I looked more closely at the case, the answer was sitting in the facts: she refused pills from strangers at night but accepted them from a nurse she knew in the morning. The dilemma the daughter brought to the nurse existed because a week of small, ordinary charting decisions had never looked for the reason.

That was the moment my Week 1 position gave way. The big decision in the case was real, but it was built on dozens of small ones, and the small ones were where the ethics actually happened. Each time someone wrote "refused" and moved on, a person's preference was recorded as an obstacle rather than understood as information.

The classmate I had argued with in Week 1 turned out to be right in a way I had not understood. Her point was not that every act is a moral drama. It was that ordinary acts carry moral weight because they add up, and that a nurse who only switches on ethical attention for the dramatic case will have missed most of the chances to prevent it. I wrote to her in Week 3 to say so. Her reply was that she had not fully believed it herself until she read my case analysis, which I take as a sign that the argument in this course worked in both directions.

The Compromise I Am Done Making

The compromise I am done making is writing "patient refused" without a reason. I have done it myself in clinical. Last term I charted "refused" when a patient declined his 0600 blood draw, and I did not ask why; he was asleep and grumpy and I was behind. If I had asked, I might have learned that he had been stuck four times the day before and was afraid of another failed attempt, which was a solvable problem. The Code of Ethics for Nurses describes the patient's right to self-determination as part of the first provision (American Nurses Association [ANA], 2025). A refusal is an exercise of that right, and it deserves the same attention as consent. Charting it without a reason treats it as noncompliance rather than as a decision someone made for a reason.

From now on, when a patient declines something, I will ask one open question before I chart it, such as "Can you tell me what's making you not want it right now?", and I will chart the answer or that the patient did not want to say.

What It Costs Me Now

This change has a cost, and I want to be honest about it. Asking why takes time, and on a busy morning with five patients the time will come from somewhere. Sometimes the answer will create more work: a patient afraid of a blood draw needs a more experienced phlebotomist or a warm compress and a second try, which means a phone call and a delay. Sometimes the answer will be uncomfortable: a patient who refuses because he does not trust the staff is telling me something about the unit, and I will have to decide what to do with it. The easy word "refused" protected me from all of that. Giving it up means accepting more work and more discomfort in exchange for understanding my patients better.

There is a smaller cost as well, which is my own sense of competence. Charting "refused" let me feel that I had done my job: I offered, the patient declined, the box was filled. Asking why makes me responsible for what I hear, and sometimes I will not know what to do with it. I expect to spend the first months of practice asking more questions than I can answer, and to learn to bring those answers to the charge nurse or the provider rather than leaving them in the chart.

What Still Holds, for a Different Reason

One belief from Week 1 survived, though for a different reason. I still think that the dramatic cases matter and that nurses need to be ready for them. But I now think the readiness comes less from studying frameworks than from the habit of noticing small things. The nurse who asks why a patient refuses a blood draw is practicing the same attention that the nurse will need when a family asks for something hard. The frameworks from Week 5 were useful for organizing my thinking about a case, but none of them would have helped the woman in the applesauce case as much as someone asking her, a week earlier, why she would not take her pills.

A Change a Colleague Would Notice

In my next clinical rotation, a colleague reading my charting would see fewer entries that say only "refused" and more that say, for example, "declined 0600 lab draw; states afraid after four attempts yesterday; phlebotomy lead notified; redraw at 0800 with warm pack." My clinical instructor could count those entries in a week. That is the change: small, visible and checkable, and a direct result of a case I first misread as being about something else.

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/