| Course | NUR-3420 Contemporary Nursing Practice |
|---|---|
| Module | Module 4 |
| Paper type | Ethical dilemma analysis |
| Length | About 1,117 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Bachelor of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 3420 Module 4
The Donor Who Needs the Payment: An Ethical Analysis of Frequent Paid Plasma Donation
Student Name
Bachelor of Science in Nursing, Thomas Edison State University
NUR-3420: Contemporary Nursing Practice
Mentor Name
Month Day, Year
The Donor Who Needs the Payment: An Ethical Analysis of Frequent Paid Plasma Donation
Every week I screen donors who rely on the payment from plasma donation. Most of them are healthy, eligible and well informed, and the payment is simply part of their budget. A smaller group raises a harder question. This paper analyzes one composite case from that group: a donor in their forties who has donated twice a week for three years, whose total protein has drifted toward the lower limit of the center's procedure, and who told me during screening that missing a donation means missing a utility payment. The donor met every eligibility requirement on the day in question. The dilemma is whether, and how, a nurse should act when a person is eligible to do something that may be slowly costing them, and when money is the reason they keep doing it.
The Facts of the Case
The donor, whom I will call R., had a total protein value within range at every visit for the past year, but the values showed a slow decline over six months. R. reported feeling more tired than usual and attributed it to a second job. Federal rules allow a donor to undergo plasmapheresis no more than twice in a seven-day period, with a gap of at least two days, a limit written into 21 C.F.R. § 640.65, and R. had donated at that maximum frequency for most of the past three years. The center's procedure defers a donor whose total protein falls below a fixed threshold, so R. was eligible. When I mentioned the trend, R. said they could not afford to slow down and asked me not to put anything in the record that would cause a deferral.
Two facts make this a genuine dilemma rather than a policy question. First, R. was eligible, so the procedure did not tell me to do anything. Second, the request not to document was a request I could not grant, while the larger request, to be allowed to keep donating at the maximum frequency, was one I had no authority to refuse.
The Ethical Principles in Tension
Beauchamp and Childress (2019) describe four principles that structure most clinical ethics analysis: respect for autonomy, nonmaleficence, beneficence and justice. Each applies here and they do not point the same way. Respect for autonomy supports R.'s right to decide how to use their own body and how to balance health against money, provided the choice is informed and voluntary. Nonmaleficence asks whether continuing at this frequency is causing harm that R. may not fully appreciate. Beneficence asks what I can do to promote R.'s good beyond simply avoiding harm. Justice asks a wider question about who bears the burden of supplying plasma and whether the system relies on people with few other options.
The evidence on harm is real but limited. In a randomized trial, Haugen et al. (2025) assigned 120 male donors to high-frequency donation, regular-frequency donation or a control group and found that frequent plasmapheresis substantially reduced total serum protein and immunoglobulin G, with larger reductions at higher frequency and a return toward baseline after donation stopped. The authors reported only mild adverse events and called for research on long-term effects. The trial does not show that R. is being harmed, but it supports the concern that sustained donation at the legal maximum lowers protein and antibody levels, and that the effect is reversible with rest.
The Professional Standard
Under the current code of ethics, the nurse owes primary loyalty to the person receiving care, and at a donor chair that person is the donor (American Nurses Association, 2025). Its first provision centers respect for each person's dignity, and that respect extends to choices a nurse would not make personally. The same code makes each nurse answerable for personal practice decisions, and truthful records are part of that answerability. Honest documentation is not a choice the donor can waive. Recording the protein values and the fatigue is part of the record the center relies on and part of my accountability under my license.
The code also speaks to justice. Its later provisions ask nurses to work for health in the wider community and to address the social conditions that affect it. Farrugia et al. (2014) argue that paid plasma collection is ethically defensible because patients with immune deficiencies and bleeding disorders depend on plasma-derived therapies and unpaid systems have not supplied enough plasma to meet the need. Their argument centers the patients who receive the therapies. It does not resolve the question of what is owed to individual donors whose financial need may shape their choices, and that is the question at R.'s chair.
Options and a Decision
I considered three options. The first was to say nothing beyond what the procedure required, which respects autonomy in a thin sense but ignores both the trend and R.'s fatigue. The second was to ask the center physician to defer R. on clinical grounds, which might protect R.'s health but would override a decision R. was entitled to make and would remove income R. said they needed, possibly causing a different harm. The third was to document accurately, explain the trend in plain language, and give R. the information to make an informed decision, while referring the fatigue to the center physician for evaluation.
I chose the third option. I recorded the values and R.'s report of fatigue, explained that protein values had been falling and that research suggests levels recover with a longer gap between donations, and asked whether a schedule of one donation a week for a month was workable. R. said it was not, at least not that month. I respected that answer, made the physician referral, and gave R. the center's information on community assistance programs, which R. had not known existed. I also flagged the case to our quality nurse, not as a complaint about R., but as an example of a trend that the procedure's single threshold cannot see.
Reflection
This case taught me that respecting autonomy is not the same as staying silent. R.'s choice was theirs to make, but it could only be an informed choice if someone told them what the numbers were doing. It also showed me the limit of a nurse's power in a system built on payment. I could inform, document and refer; I could not change the economics that brought R. to the chair twice a week. That limit is a reason to take policy seriously in the modules ahead, since the most useful response to R.'s dilemma may be a procedure that tracks trends over time rather than a single cutoff on a single day.
References
American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
21 C.F.R. § 640.65 (2024). Plasmapheresis. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-F/part-640/subpart-G/section-640.65
Farrugia, A., Penrod, J., & Bult, J. M. (2014). The ethics of paid plasma donation: A plea for patient centeredness. HEC Forum, 27(4), 417-429. https://doi.org/10.1007/s10730-014-9253-5
Haugen, M., Nissen-Meyer, L. S. H., Strand, T. A., & Magnussen, K. (2025). The effect of plasma donation frequency on total serum protein, immunoglobulin G and donor safety: A non-inferiority randomized controlled trial. Vox Sanguinis, 120(12), 1205-1215. https://doi.org/10.1111/vox.70105
Reading the NUR 3420 Module 4 assignment instructions
In most terms the fourth module of NUR-3420 centers on ethics, and the written work asks you to describe an ethical dilemma from practice, analyze it with a recognized framework and the ANA code of ethics, and explain what you did or would do. Thomas Edison State University keeps the exact directions in the Moodle classroom, so confirm whether your section wants a specific decision model, a set number of scholarly sources, or a reflection section at the end. A dilemma means two or more defensible actions that cannot all be taken, so a case where the right answer is obvious will not meet the assignment. The paper should name the principles in conflict, cite the code by provision, and show how you weighed the options before deciding.
How the NUR 3420 Module 4 example is put together
The example starts with the person at the center of the dilemma and states the question in one sentence. A facts section separates what the procedure required from what was left to the nurse's discretion and cites the federal frequency limit. In the principles section, autonomy, beneficence, nonmaleficence and justice are each tested on the case, and a single randomized trial is described by design, finding and weakness. The professional standard section paraphrases the ANA code and sets a published argument for paid plasma beside it, so both sides of the wider debate appear. The decision section compares three options and explains why two were rejected. A short reflection draws one lesson about autonomy and one about policy, which points forward to later modules.
Reading the NUR 3420 Module 4 grading rubric
In a professional practice course, ethics papers tend to earn their marks through the clarity of the dilemma, the accuracy and depth of the ethical analysis, the use of the ANA code, the quality of the decision and its justification, and writing and APA style. The analysis row tends to carry the most weight, and it rewards papers that apply each principle to specific facts and admit where principles conflict. Mentors also check that the code is cited by provision and paraphrased correctly, and that any outside evidence is reported accurately. A decision that ignores the strongest counterargument will usually lose points even if it is reasonable. The reflection, where required, is graded on insight rather than length, so one honest lesson outweighs a page of general statements.
Common NUR 3420 Module 4 mistakes, and how to avoid them
Students often lose marks by choosing a situation that is a policy violation rather than a dilemma, such as a colleague charting care that was not given; that is a reporting duty, not a choice between goods. Another frequent problem is listing the four principles in a paragraph each without connecting them to the facts. Quoting the code at length also costs points, since it uses space without analysis. Watch for a decision that appears from nowhere: walk the mentor through the options you rejected. Keep patient details composite and remove anything identifying. If the dilemma involves a coworker, describe roles rather than names. If you want a dilemma paper built on a case from your own unit, send the directions and the desk can draft one.
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 Thomas Edison 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.
More NUR 3420 and Bachelor of Science in Nursing sample papers
- NUR 3420 Module 1: Professional Introduction
- NUR 3420 Module 2: Scope of Practice Paper
- NUR 3420 Module 3: Peplau Theory Application
- NUR 3420 Module 5: Health Policy Analysis
- NUR 3420 Module 6: Professional Development Plan
- NUR 4280 Module 1: Leadership Style Self-Assessment
- NUR 4102 Module 2: Delegation Paper: The Five Rights and the Problem of Missed Care
- NUR 4190 Module 5: Evidence Synthesis Paper
- NUR 4450 Module 6: Competency Portfolio Narrative
NUR 3420 Module 4 questions, answered
Where can I find a free NUR 3420 Module 4 sample paper?
The complete dilemma paper is above, title page first and reference list last, annotated sheet by sheet. The case is a composite plasma donor, so use the structure and replace the facts and setting with a dilemma from your own practice.
Which edition of the ANA Code of Ethics should NUR-3420 papers cite?
Use the current edition, published in 2025 and available online from the American Nurses Association. It keeps nine core provisions familiar from earlier editions and adds language on the nurse's own well-being and global health, so check provision numbers against the 2025 text before citing.
What counts as an ethical dilemma for this assignment?
A dilemma exists when two or more actions are each supported by an ethical principle and you cannot do all of them. Respecting a patient's choice while worrying it will harm them is a classic example. A clear rule violation is not a dilemma, because the right action is already defined.
Do I have to use Beauchamp and Childress's four principles?
Most mentors accept the four principles because they are widely taught, but some sections ask for a specific decision-making model. Read your directions. If a model is named, use it as the structure and bring in the principles where they fit.
Can my dilemma come from a non-hospital job?
Yes, and settings outside the hospital often produce clear dilemmas because policies are thinner and nurses work with more independence. Explain the setting in a few sentences so the mentor understands the rules that apply, then analyze the case the same way you would a bedside dilemma.