National League of NursingNational League of Nursing

The Voice of Nursing Education

Getting Started


Managing Complexity: Using the Monologue of Doris Smith to Understand Situational Decision Making

Printer friendly version of this teaching strategy

Getting Started

This teaching strategy focuses on assessing expectations, coordinating and managing care, and making situational decisions with older adults.  The strategy enhances the student’s human flourishing and nursing judgment. 

1.  Provide the learners with the ACE.S framework and discuss communication techniques when assessing function and expectations in older adults. 

2.  Using the ACE.S framework, ask the learners to discuss a situation where they were unsure how to balance the expectations of the patient with the institution’s protocol and safety guidelines when caring for the older adult. 

3.  Play or read the Doris monologue.  This activity can take place in lecture, seminar, or in pre or post conference for clinical.
     - Download the monologue 

4.  Review the ANA’s Code of Ethics for Nurses with Interpretive Statements with the students. 

The Code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. Discuss the ethical responsibilities of nurses when providing care to older adults. 

5.  Discussion Questions:  Use the following to facilitate a discussion with your students: 

  • What are your concerns for Doris?  What are your concerns for the nurse giving report?
  • What is the cause of the concern?
  • What else do you need to know about Doris?
  • What are you going to do about it?
  • What do you think Doris is experiencing?
  • Discuss the issues related to the IV line for Doris.
  • Consider the possible outcome if the nurse does nothing in this situation.
  • Consider the possible outcomes if the nurse takes action. What are the risks and benefits to Doris? To the nurse?
  • What steps should be taken to resolve this ethical dilemma?
  • Discuss how nurses can determine if a patient is cognitively intact in making care decisions.