| Course | DNP 661 Ethics and Advanced Nursing Practice |
|---|---|
| Module | Module 4 |
| Paper type | Ethical dilemma exploration paper |
| Length | About 1,065 words, 6 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 661 Module 4
When the Patient Is Your Neighbor: Requests to Prescribe for Family and Friends in a Small Town
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 661: Ethics and Advanced Nursing Practice
Instructor Name
Month Day, Year
When the Patient Is Your Neighbor: Requests to Prescribe for Family and Friends in a Small Town
Introduction
In a town of nine thousand people, a nurse practitioner is never off duty. Within a month of finishing my clinical hours in Safford, I expect to be asked for prescriptions at church, in the grocery store and at family dinners. The requests will come from people I care about, often for real problems and often because the clinic is booked for weeks. Saying no can feel unkind; saying yes can put the person and my license at risk. This paper explores that dilemma, describes the obligations that pull against each other and proposes a policy I can follow.
Three Requests
The first request comes from a neighbor, who stops me in the driveway with a sore throat and asks whether I could "just call in an antibiotic" so he does not miss work. The second comes from a friend at church who has not slept well since her husband died and asks for "something to help," mentioning a sleeping pill her sister takes. The third comes from my brother, whose blood pressure medication ran out while his own nurse practitioner is on leave, and who asks me to send a refill to the pharmacy.
Each request is ordinary. Each also involves a person who would not be in front of me without our relationship, no examination, no record in my clinic's system and, in two cases, a medication with real risks.
The Competing Obligations
On one side is beneficence. My neighbor may well have a bacterial infection, my friend is grieving and not sleeping, and my brother needs his medication. Refusing all three could leave real needs unmet, especially where access is poor.
On the other side are several obligations. Nonmaleficence warns that care without an examination and history risks missed diagnoses, and that a sleep medication for a grieving older woman can cause falls and confusion. Professional guidance for physicians, which nursing ethics texts often draw on, advises against treating family members except in emergencies or for short-term, minor problems, because personal feelings can cloud judgment, sensitive histories may go unasked, and patients may feel unable to refuse or to seek a second opinion (AMA Council on Ethical and Judicial Affairs, 2012). Fidelity to the professional role matters too: the 2025 ANA Code commits nurses to maintain professional boundaries and to keep their primary commitment to the patient's interests, which personal relationships can blur (American Nurses Association, 2025).
The Ethics of Small Communities
Rural practice makes the dilemma sharper. Roberts et al. (1999) describe how clinicians in small communities live with overlapping relationships, where the same people are patients, neighbors, customers and fellow parishioners. These overlaps are unavoidable and not wrong in themselves, but they strain confidentiality and make it harder for patients to refuse a clinician's advice or for clinicians to deliver unwelcome news. Writing about frontier mental health care, the same group noted that clinicians in such settings must often decide case by case which overlaps they can manage ethically and which they cannot (Roberts et al., 1999). The answer to my dilemma therefore cannot be "never interact with patients outside the clinic," which is impossible in Safford. It has to be a set of boundaries I can explain.
Working Through the Cases
I used a simple sequence: collect the facts, list who is affected, name the principles pulling against each other, list the options, choose and justify, and plan how to communicate the decision.
The decisions differ because the facts differ. The neighbor's and the friend's requests involve undiagnosed problems, where the risk of harm is greatest. My brother's request is for a known, stable treatment, the kind of short-term situation where guidance allows an exception, but even there the better choice is to route it through his own clinic.
| Request | Key facts | Options | Decision and reason |
|---|---|---|---|
| Neighbor, antibiotic | No exam; sore throat can be viral or bacterial; clinic has same-day sick slots | Prescribe by phone; refuse; direct to same-day care | Direct him to the same-day slot or urgent care. Prescribing without an exam risks unnecessary antibiotics and a missed diagnosis. |
| Friend, sleep aid | Grief, insomnia, possible depression; medication carries fall and dependence risks in older adults | Prescribe; refuse; help her get seen | Help her book a visit with her own clinician that week and offer the grief group at church. Her symptoms need an assessment no hallway conversation can provide. |
| Brother, refill | Stable condition; known medication; short gap; his own clinician unavailable | Refill once; refuse; ask the covering clinician | Ask his clinic's covering provider to send the refill. If none is available, a single short bridge supply is defensible as a short-term, minor need, documented in a record. |
Communicating a Refusal
The hardest part of this dilemma is not the decision but the conversation. A refusal can sound like distrust or like a nurse practitioner who thinks she is too important to help. I plan to use a short script that names the care, the reason and the alternative: "I care about you, which is why I want you seen properly. I can't prescribe without examining you and keeping a record, but I can get you into the same-day clinic tomorrow morning." Saying the same thing to everyone, and saying it early, makes it a policy rather than a personal judgment.
A Personal Policy
1. I will not prescribe for family, friends or neighbors outside a documented clinical visit, except for a single short bridge supply of a stable, previously prescribed, non-controlled medication when the person's own clinician cannot be reached.
2. I will never prescribe controlled substances, sleep medications or antibiotics outside a visit.
3. I will offer a concrete alternative every time: a same-day appointment, the covering clinician or urgent care.
4. When I do provide a bridge supply, I will document it and notify the person's own clinician.
5. I will review this policy with my collaborating physician or mentor during my first year of practice.
Conclusion
Prescribing for people we know is a small dilemma that repeats constantly, which is why it deserves a deliberate answer. Beneficence pulls toward helping; nonmaleficence, professional boundaries and the realities of small-town relationships pull toward caution. A written policy, explained warmly and applied consistently, lets me care for the people around me without making them patients I have not properly seen.
References
AMA Council on Ethical and Judicial Affairs. (2012). AMA Code of Medical Ethics' opinion on physicians treating family members. AMA Journal of Ethics, 14(5), 396-397. https://doi.org/10.1001/virtualmentor.2012.14.5.coet1-1205
American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/
Roberts, L. W., Battaglia, J., & Epstein, R. S. (1999). Frontier ethics: Mental health care needs and ethical dilemmas in rural communities. Psychiatric Services, 50(4), 497-503. https://doi.org/10.1176/ps.50.4.497
Roberts, L. W., Battaglia, J., Smithpeter, M., & Epstein, R. S. (1999). An office on Main Street: Health care dilemmas in small communities. The Hastings Center Report, 29(4), 28-37. https://doi.org/10.2307/3528064
Reading the DNP 661 Module 4 assignment instructions
The posted syllabus places Assignment 3 in Weeks 11 to 14, when DNP 661 turns to ethical decision making across medical contexts. Its title, a topic exploration, suggests an in-depth look at one dilemma rather than a broad survey, and the details of length, required sources and format are in Canvas. Expect to choose a dilemma relevant to your advanced practice role, describe it with enough specifics to analyze, identify the principles and obligations in tension, review what professional guidance and the literature say, apply a decision-making process and reach a justified position. Dilemmas from your own setting usually produce richer papers than famous cases already analyzed in every textbook. Choose one where reasonable clinicians might disagree, so the analysis has real work to do.
Inside the DNP 661 Module 4 example
The paper introduces the dilemma through the writer's own situation and then gives three specific requests of increasing difficulty. A section sets beneficence against nonmaleficence, professional guidance on treating family and the boundary duties in the 2025 code. Because the setting is rural, a further section draws on literature about overlapping relationships in small communities. A decision table applies the same steps to all three requests and reaches different answers for each, with reasons. The paper then addresses how to communicate a refusal and closes with a numbered personal policy and a short conclusion. Four sources ground the analysis, including the professional code and two articles on rural ethics.
Where the marks sit in the DNP 661 Module 4 rubric
Ethics papers in DNP courses are typically scored on how clearly the dilemma is defined, the identification of competing principles, the use of course decision-making approaches, engagement with professional codes and literature, the justification of the position taken and scholarly writing. A dilemma earns the most when it is specific and the competing obligations are both given weight. Applying a structured decision process step by step shows method. A position that varies with the facts of each case shows judgment rather than rule following. Practical implications, such as a policy or plan, show the analysis can guide practice. Accurate paraphrase of codes and guidance matters more than quoting them.
DNP 661 Module 4 help with common mistakes
A common weakness is choosing a dilemma with only one defensible answer, which leaves nothing to analyze. Pick a situation where both sides carry real weight. Another is listing principles without showing how they apply to the facts. Avoid treating guidance written for physicians as binding on nurse practitioners; say how it informs your reasoning. Keep personal details of family and friends changed. A dilemma you have actually faced makes the best paper; outline it for the desk and a draft can follow. Before submitting, check that each decision in your analysis follows from facts you stated earlier. Read the course's decision model again and use its steps by name.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 661 Module 4 questions, answered
Where can I find a free DNP 661 Module 4 sample paper?
The exploration above is a complete DNP 661 Assignment 3 sample on requests to prescribe for family and friends, with a decision table for three cases and a written personal policy.
What is the Ethical Dilemma Topic Exploration in DNP 661?
It is the third assignment in ASU's DNP ethics course, an in-depth analysis of one ethical dilemma during the unit on ethical decision making across medical contexts.
Can nurse practitioners prescribe for family members?
Professional guidance generally advises against it except in emergencies or for short-term, minor problems, and state rules and employer policies may set further limits.
How should I choose an ethics dilemma for a DNP paper?
Choose a specific situation from your setting where reasonable clinicians could disagree, so the paper has competing obligations to weigh.
Do I need a decision-making model in the DNP 661 dilemma paper?
Using a structured process from the course, applied step by step, usually strengthens the analysis and shows how you reached your position.