Model for Ethical Decision Making
Word count: 1,800 (+10% penalty will apply for non-adherence) – you cannot answer this paper in less than 1800 words. No work will be marked after 1980 words.
The purpose ofthisassignmenttaskis toidentifytheprinciplesofprofessional nursing practice, outlinetheethical andlegal frameworksforprofessional practice and apply the Ethical Decision Making Framework to a complex scenario to establish an ethically and legally sound decision. Remember toincorporate evidenced-basedpracticeinrelationtoquality patientcare.YouMUSTincludeinyourreferencing 4(four)ormore ofthefollowing;
· Health PractitionerRegulation NationalLawAct 2010(WA)
· NMBA Registered Nurse Standards for Practice 2016
· NMBA NationalCode of Conduct for theRegistered Nurse2008
· NMBA Codeof EthicsforRegistered Nurses2008
· NMBA NationalFrameworkfortheDevelopmentof Decision Making Framework: Scopeof Nursing Practice (2007)
· NMBA ProfessionalBoundaries2010
Relevant Acts and Laws relating to the subject and health care practitioners – remember ALL your work must be referenced.
Use theModel for EthicalDecisionMaking (included in your instructions, available on Blackboard) to determine themost favorable outcome of your chosen scenario.
General Instructions
There should be attention to spelling grammar and punctuation, this work is an academic paper and needs to reflect your ability to analyse, reflect and articulate in the written form. Take time to study the marking guide to assist you with your focus. Note that there is no requirement for an introduction or a conclusion. There should be evidence of critical thinking. Citations within text and reference list should conform to APA 6th ed format.
If you feel that you require assistance with your academic writing skills there are many facilities on campus and online to support you. Below is the link to access what is available.
Include a marking guide with your work. Put your name in full on your uploaded document; Surname first.
Using theModel for EthicalDecisionMaking (Kerridge, Lowe and McPhee, p85 2005) to determine themost favorable outcome:
Modelfor EthicalDecision-Making
• Pleaseusetheseheadingswhenwritingyourcasestudy
· The word count provided is only an example – it also shows the weighting of the importance of each section.
1.Clearlystatetheproblem: this should not be any more than 150 words (this is like an introduction)
Considertheproblemwithinitscontext; ethical, medical,socialandlegal considerations.
This should be a very brief summary of the issues as you see it – extract the issues:
o What is the ethical ISSUE-what is the decision about?
o What is the medical condition, just state this in a few lines
o What is the social situation of the patient -is the person dependent, do they have support?
o What appear (prima facie) to be the legal issues? Is it assault; is it the application of an Advanced Directive or informed consent for example?
Example: The medical issues for this patient (Mr S) are; Diabetes type1, depression and Heart Failure. The ethical issue for Mr S is that he is concerned about the lack of autonomy and justice when he is in hospital. Mr S’s social situation is that he lives with his wife and one daughter, he states he is a Catholic. The legal issues for Mr S are namely consent, guardianship and refusal of treatment. These issues will be explored throughout this paper. (80 WORDS – you don’t have to put the word count in each section just at the end of your work – this is just an example for you).
2.Get thefacts: this should not be any more than 350 words
Here you need to find out what are the facts of the case; – what is the medical condition & history, examination, relevant tests (investigations), define the medical condition what is the pathophysiology of the condition/s – use scientific references
o What is the prognosis?
o What are the implications of the condition/s -for example is it acute, chronic, and degenerative? What type of progression or prognosis might be expected?
o Are there any alternative treatments?
o What social factors might have an influence – family input, social interaction
3.Considerthefourprinciples: this should not be any more than 250 words
o You need to define each principle and relate the principle to the patient
o Autonomy: whatarethe patient’spreferences?
o Beneficence:whatbenefitscanbe obtainedforthepatient?
o Non-maleficence:whatarethe risksandhowcantheybeavoided?
o Justice:howarethe interestsofdifferentpartiesto be balanced?
4.Identifyethical conflicts: this should not be any more than 200 words
What are the ethical conflicts? To promote autonomy are we in conflict with beneficence (Autonomy vs Beneficence).
Explainwhytheconflictsoccur relating this to the patient andhowtheymayberesolved.
Ref the NMBA Code of Ethics / ICN Code of Ethics in this section
5.ConsidertheLaw: this should not be any more than 450 words
Identifyrelevantlegal conceptsandlawsandhowtheymightguidemanagement.
· Consider: the Practice Standards – how they apply to the case study ie (NMBA Registered Nurse Standards for Practice 2016).
o How does duty of care apply to the patient?
· How does the Practice Standards relate to the Act?
· You need to use the Acts (legislation) that apply to the case study for example:
o Consent to Treatment – Age of Majority Act
o Human Tissue and Transplant Act
6.Makingthe ethicaldecision:this should not be any more than 250 words
o Clearlystatethe clinical ethicaldecisionand justifyiteg:
o Specifyhowguidingprincipleswere balancedand why (i.e.justifythe decision). Use the information that you have in the Law and Get the Facts section to support your decision. MUST Reference
o Takeresponsibilityforthedecision&providealternativemanagement – reference this!
7. Evaluate the decision and discuss the legal relevance and importance of accurate documentation: this should not be any more than 150 words
· Identify how you would evaluate your decision-what is our fundamental tool for establishing the efficacy/outcome of an action/decision? – here you will research what does the literature say about evaluation – also use the NMBA Registered Nurse Standards for Practice 2016
o State where you would document and why it is a fundamental practice in healthcare. Here you will research what the literature say about evaluation – also use the NMBA Registered Nurse Standards for Practice 2016.
Tip for 7. – Review Kozier and Erb’s Fundamentals of Nursing 2008 Vol 1 – Evaluating p 245 and Documentation and reporting Chapter 15 p255
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Further information:
· A minimum of 18 references are required for this assessment.
· Review the marking rubric when doing your assessment.
· Good luck
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CASE SCENARIOS
SELECT ONE CASE SCENARIO AND APPLY THE MODEL FOR ETHICAL DECISION-MAKING
Case Study 1 Mr. Alphonse
Mr Alphonse Martinez[1] a retired Italian man, married, his wife also retired and they have two grown up sons who still live at home. They are a close family who go to church every Sunday. Mr Alphonse had just recently made an Advanced Health Directive (AHD) that stated if he had another serious heart attack that he was not to be resuscitated. His wife and two sons were opposed to his Advanced Directive and instructed the staff to take no notice of the AHD.
Alphonse has been discharged from the coronary care unit (CCU) and placed in a step-down cardiac ward following his myocardial infarction (MI). While he had been in CCU the staff had felt that he had exaggerated his chest pain. That is, when they asked him to rate his pain from 0 – 10 he sometimes stated that it was 12 or 14. In response staff reacted in a rather disapproving manner.
During the first evening on the cardiac ward Alphonse asked Mark, one of the student nurses on clinical practice, to contact the hospital priest to come and see him and give him the last rites. Mark did so immediately and then went back to sit with Mr Alphonse.
Later Mark’s clinical supervisor (RN) called him to one side and asked why he was sitting with Mr Alphonse. Mark (student nurse) replied that Mr Alphonse was anxious and so he was sitting with him. The RN asked Mark “do you think you could be making him more anxious by sitting with him?” Mark replied that he didn’t think so, and he was only doing so until the priest came.
The RN then asked why the priest was coming, and Mark said that Mr Alphonse had asked for the priest, and so he had contacted him to come. The RN then said to Mark, “did you not think you should have told me what you had done” With that Mr Alphonse’s buzzer went and, turning to go back into the room, the RN and Mark saw Mr Alphonse have a cardiac arrest.
Despite vigorous and sustained effort Mr Alphonse could not be resuscitated.
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Case Study 2 Miss Mary-Jane
Mary-Jane is 14 years old; her parents are newly separated and they both work. She has three younger siblings and Mary-Jane does a lot of the child minding. She has been complaining of abdominal pain, moderate now severe and has some vaginal spotting (bleeding) for the past 24 hours. She presents to the emergency department at her local hospital with her parents who are concerned that their daughter is so unwell. Mary-Jane is looking pale, sweaty, light headed, nauseated and has some stomach bloating. You have taken her base line observations on admission and they are: temperature 37.8C, pulse 118bpm, BP 90/50, Respirations 28bpm, shallow breathing. A possible diagnosis would be an ectopic pregnancy, and to rule this out a pregnancy test is essential. As the student nurse together with the Registered Nurse caring for Mary-Jane consider the legal and ethical issues, one being consent and the other confidentiality, these and others will need to be considered for Mary-Jane.
What are the rules surrounding mandatory reporting of sexual abuse?
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[1]Alphonse Martinez (Hawley, G. (p 212, 2007). Ethics in clinical practice: An interprofessional approach. London. Pearson Education Ltd.
