Minnesota State College and Universities

Health Education-Industry Partnership

HEALTHCARE CORE CURRICULUM

© 2004/2010/2014

 

Module Outline and Instructor Resource

 

Module TitleHealthcare Ethics

 

Credit/Hours:.5 Credit/8 Hours

 

Module Description:

This module emphasizes the use of sound ethical practices in healthcare. Included are ethical practices and standards as they relate to the care of clients/individuals and interactions with peers, colleagues, and team members and family members.  Ethical frameworks are provided for discussion on understanding the types of ethical challenges in healthcare and the difficult decisions that need to be made.

 

Evaluation Method

This module will be graded on a Pass/Fail basis. Assignments/Exams must be passed at 75% or greater. Retests on exams are determined by college and program policy.

 

Competencies:

1.Describe dimensions of values as they impact healthcare.

2.Describe basic principles of professional relationships.

3.Describe aspects of ethical decision making in health care.

4.   Explain how an individual’s diversity, socioeconomic or religious beliefs could lead to potential ethical differences with that of other health care employees.

5.Using an ethical decision making model applied to healthcare situations, describe how ethics influence the care of clients.

 

Module Author:

Diane Gold, MS, RN

Normandale Community College

(952) 487-8452

diane.gold@normandale.edu

 

Revised 2010 by:

Pat Reinhart, RNDede Carr, LDA

NAHHA Coordinator, HCCC Instructor, Nursing Faculty                Dental Assistant Instructor, HCCC Instructor

Minneapolis Community & Technical CollegeMinneapolis Community & Technical College

pat.reinhart@minneapolis.edudede.carr@minneapolis.edu

 

Revised 2014 by:

Pat Reinhart, RN
NAHHA Coordinator, HCCC Instructor, Nursing Faculty

Minneapolis Community & Technical College

pat.reinhart@minneapolis.edu

 

Bonnie Wendt, RN BS

NAR Coordinator
Minnesota Department of Health

Bonnie.Wendt@state.mn.us

 

 

 

Diane Gold, RN, APRN, MS

Consultant
Health Force Minnesota

Dianegold44@gmail.com

 

 

 

 

Sue Field, RN, DNP, CNE

Consultant

Health Force Minnesota

Sue.field@northlandcollege.edu

 


Table of Contents

Module Outline and Instructor Resource

Modules Competencies and Instructor Notes

Instructor Resources

PowerPoints

Learning Activities

Assessment Measurements

Websites

YouTube Videos and Movies

Healthcare Ethics – Vocabulary List

Healthcare Ethics – Boundary Warning Signs

Sample Codes of Ethics

Nursing Assistants Code of Ethic

American Nurses Association Code of Ethics

 


Modules Competencies and Instructor Notes

 

MODULE

COMPETENCY

UNIT

COMPETENCY

RECOMMENDED

MODULE CONTENT

INSTRUCTOR NOTES

1. Describe dimensions of values as they impact health care.

 

1A.  Define values

 

1A. Definition of values:  standards that provide the foundation for making decisions and guiding behavior

  1. Beliefs chosen freely
  2. All human interactions are value-based

 

Review Vocabulary List for Unit

 

 

 

 

 

 

 

 

 

 

 

 

Possible Classroom Discussion: Have students identify society values and those that are important to family and friends

 

 

1B. Discuss the importance of values

 

1B. Values:

  1. Guide actions
  2. Tells us right from wrong

 

 

1C.  Explain how values are developed

1C. Discuss how parents transmit their values, beliefs and attitudes about:

  1. Lifestyle
  2. Language
  3. Rules
  4. Culture
  5. Religion
  6. Education
  7. Socioeconomic status
  8. Passed on from generation to generation
  9. Usually developed early in life

 

 

1D. Identify personal values.

 

1D. Personal Values

  1. Need for identification
  2. Role of values in personal behavior

 

 

 

 

1E. Identify key values in health care.

1E. Key Healthcare Values:

  1. Honesty
  2. Integrity
  3. Respect
  4. Responsibility
  5. Accountability

 

 

 

1F.  Discuss how professional values impact on performance and behavior

 

 

1F.  Professional values

  1. Confidentiality
  2. Professional   boundaries
  3. Values in relation to clients
  4. Values in relation to other workers
  5. Others: religious; Cultural

 

2. Describe basic principles of professional relationships.

2A.  Define professional boundaries

2A.  Definition:  space between the caregiver’s power and the client’s vulnerability

 

2B. Identify elements of professional relationships

 

 

 

 

2B. Professional Boundaries

  1. Nature of professional
  2. Relationships Boundaries : are the limits that allow  for  a safe relationship with the client based on  the client’s needs
  3. Safe space

2C.  Explain why boundary violations may occur

2C.  Characteristics of boundary violations/warning signs

  1. Role reversal
  2. Secrecy
  3. Double bind
  4. Professional privilege

 

2D. Discuss how to prevent violations of professional boundaries

2D. Violation of boundaries

The challenge

  1. Be aware
  2. Be aware of feelings and behavior
  3. Be observant of the behavior of other workers
  4. Always act in the best interest of the client

Discussion of boundary warning signs attached.

3. Describe aspects of ethical decision making in health care

3A. Define Ethics:

3A. Definition of ethics:

System of rules and principles that guide decision making relating to what is right or wrong

Compare sample codes of ethics from various health professions.  Have students find the EMT code of ethics.

(Links to multiple codes of ethics at this website.

http://www.ahc.umn.edu/bioethics/
resource/links/home.html

 

 

 

 

 

 

 

Have students discuss the business code of ethics from their place of employment

 

3B. Define Code of Ethics

3B. Ethics are dynamic

Code of Ethics: formal guidelines and standards for professional actions

 

3C. Explain the purpose of a Code of Ethics

3C. Purpose of Ethics’ Code:

  1. Promote welfare of client
  2. Ensure high quality of care

 

3D.  Identify 8 guiding principles in ethics

3D. Guiding principles for health care workers

  1. Preserve life

I.  Quality of life

2.  Euthanasia

  1. Do good (beneficence)
  2. Respect autonomy
  3. Uphold justice
  4. Be honest (veracity)
  5. Be discreet (confidentially)
  6. Keep promises (fidelity)
  7. Do no harm (nonmaleficence)

Review Oregon’s Euthanasia law
http://public.health.oregon.gov/Provider
PartnerResources/EvaluationResearch/
DeathwithDignityAct/Pages/index.aspx

 

 

3E.  Identify steps/
framework for ethical decision making

 

 

3E.  Ethical Decision-making

Approaches

  1. Rationale and systematic
  2. Based on ethical  principles and codes not emotions

 

 

3F. Discuss the difference between legal “guidelines” and ethical decision-making.

3F. Laws vs. Ethics

  1. Laws cannot keep pace with ethical dilemmas
  2. Differences state to

state

  1. Biomedical Ethics  
  2. Committee Resources

 

 

 

 

 

 

 

 

 

 

 

4.   Explain how an individual’s diversity, socioeconomic or religious beliefs could lead to potential ethical differences with that of other health care employees.

4A. Identify possible factors that may contribute to ethical differences between employees

4A. Factors that may contribute to ethical differences

Personal issues

  1. Lack of knowledge
  2. Previous experience
  3. Lack of self confidence
  4. Fear of being misunderstood

 

Diversity Issues

  1. Ethnic
  2. Gender
  3. Political
  4. Religious

 

Status Issues

  1. Social
  2. Financial

 

Role play of 1:1 (caregiver to caregiver) to represent personal, diversity and status issues discussed.  To be presented to other class members.

 

5. Using an ethical decision making model applied to health care situations, describe how ethics influence the care of clients.

5A. Define ethical dilemma

5A. Ethical dilemma: 

  1. Ethical dilemmas occur when different values conflict.

Example: A client’s right to refuse treatment conflicts with the health care worker’s obligation to carry out orders.

 

 

5B. Identify current ethical dilemmas.

 

 

 

 

 

5B. Ethics Dilemmas in the News

aEnd-of-life issues

i.Patient self-determination

ii.Assisted suicide/ euthanasia

iii.DNR orders

iv.Discontinuation of feedings.

v.Legal guardianship

 

  1. Abortion
  2. Genetic testing/ screening
  3. Allocations of organs for transplants
  4. Access to health care
  5. Managed care
  6. Insurance costs
  7. Resuscitation
  8. Stem cell research

Have student bring newspaper/magazine article about controversial bioethical and moral dilemmas to class for discussion.  Identify the ethical issue selected and partner with other students who have selected that ethical dilemma. 

 

 

5C. Discuss the problem solving process as applied to ethical issues in health care utilizing a team approach.

5C. Problem Solving Process

  1. Identify the problem
  2. Gather information:
  3. Identify ethical issues
    • Is there more than one problem
    • Are their competing ethical claims on the nurse?
    • (Conflict of duty)
  4. Any conflict of personal values?
  5. Any conflict of professional values?
  6. Create alternative solutions
  7. Select and act/implement solution
  8. Evaluate and revise as needed- Assess the outcome

Discuss the dimensions of the ethical dilemma by identifying the values involved and then apply the ethical decision making model (problem solving) to determine an approach that can be used to deal with the dilemma.

 

Have a chaplain from the hospital or a member of the ethics committee discuss ethical decision making

 

 

 


 


Instructor Resources
 

INSTRUCTOR RESOURCES – These resources can be found

 

 

 

PowerPoints FOR INSTRUCTORS (on HealthForce MN website)
 

PowerPoint for classroom use:

 

The following PowerPoints contain in-depth background material on the module topics for the instructors’ use or for reading assignments for the students.
 

 

 



Learning Activities

The learning activities can be found on the HealthForce Minnesota Website at: http://www.healthforceminnesota.org/Resources.html

 

 

HCE Competency 1: Accountability
This assignment focuses on the difference between making excuses and taking accountability for ones actions. 
 

HCE Competency 1 Personal Core Values:

The student chooses their highest personal core values and compares their core values to their response to ethical issues. It includes a self-assessment of personal values.

.

HCE Competency 2: Scenario Red Door Clinic

This is a scenario regarding sexually transmitted diseases and HIPAA.
 

HCE Competency 2:  Scenarios Personal - Professional Boundaries:

This assignment includes 4 scenarios in which students evaluate the situations and whether or not boundaries are crossed.

 

HCE Competency 3 Project Medical Ethics Collage. 
In this assignment the students use their creativity to make a collage that involves ethical situations.  The student explain the pictures and their meaning relating it to the ethical situation. * High School (HS) Health Occupations Students of America (HOSA): Can be used for competitive events.

 

HCE Competency 3 Project – Presentation Ethical Situations
In this assignment, students research an ethical issue and either write a letter to a fictitious editor, develop an advertisement poster, or give a persuasive speech
* Can be used for HOSA competitive events.

 

HCE Competency 3 Scenarios Ethical Decisions

In this assignment there are 3 scenarios and students answer questions on ethical issues and professional boundaries. The topics include Home Health Aide, Long Term Care, and Health Care Worker.

 

HCE Competency 4 Ethical and Legal Dilemmas

           This learning activity lists 7 thought provoking ethical and legal questions for discussion.

 

HCE Competency 4 Scenarios Moral Dilemmas. 

This learning activity contains 4 scenarios which involve personnel moral dilemmas.  Students are asked to “think” about what they would do in the situations.  Scenarios include: The Drug Bust, A Pregnant Woman, Concentration Camp, and the Neighbor.

 

HCE Competency 4 Project – Presentation Ethical Dilemma Topics
In this learning activity, students choose an ethical dilemma topic and develop a PowerPoint presentation. *HS HOSA competition event*
 

HCE Competency 5: Scenarios Ethical Case Study
This learning activity contains 4 short scenarios in which students answer questions surrounding the scenarios.

 

HCE Competency 5 Scenarios Bioethical Case Studies
This learning activity contains 6 scenarios with questions to answer regarding bioethical issues.  Topics include DNR, HIV, Labor, Medication, Immunizations and Anorexia.

 

HCE Competency 1 2 3 4 5 Ethics Bowl Game

This is a PowerPoint game with questions on each slide.  Students can play this in the classroom to review the material for the module.

 

 

Assessment Measurements
 

 

 


Websites
 

 

 

http://science.education.nih.gov/supplements/nih9/bioethics/default.htm

 

 

 

YouTube Videos and Movies
 

 

 

 


Healthcare Ethics – Vocabulary List

 

  1. Autonomy: respect for the value, worth, dignity and decision making power of each individual. The right to make one’s own decision
  2. Beneficence: quality of doing or producing good; to implement actions that benefit clients and their support persons
  3. Bioethicsethics as applied to life
  4. Boundaries: safe space between a professional’s power and a client’s vulnerability
  5. Caring: to show compassion through interpersonal relationships
  6. Code of ethics: set of rules governing one’s ethical principles; formal guidelines and standards for professional actions.
  7. Confidentiality: Principle of medical ethics that private patient information cannot be revealed to another party without the patient’s written permission
  8. Ethical dilemma: situations where there are no clearly correct answers; choice between two equally unfavorable alternatives
  9. Ethics: system of rules and principles that guide decision-making relating to what is morally right or wrong; ethics provides a standard of conduct or code of behavior.
  10. Euthanasia: “mercy killing” performs action that results in the death of a client to alleviate suffering with belief of no hope for recovery
  11. Fidelity: being faithful to one’s commitments/promises.
  12. Honesty: fairness and straightforwardness of behaviors/actions ; truthful
  13. Integrity: adherence to a code of values/principles
  14. Justice: fair and equitable treatment for all regardless of sex, marital status, diagnosis, social status, economic standard, culture or religion.
  15. Morals: personally held beliefs, opinions and attitudes that guide our actions. Personal standards of right or wrong
  16. Nonmaleficence: the duty to do no harm; bases of most codes of nursing ethics.
  17. Quality of life: focuses on clients physical and mental functioning; usually judged by the person to whom it applies
  18. Role duty: pattern of behavior expected as part of one’s position
  19. Socialization: the process by which individuals learn the knowledge, skills, and accepted behaviors of their social group or society.
  20. Values: standards that provide the foundation for making decisions and guiding behavior; ideas of life, customs, and ways of behaving that society regards as desirable
  21. Veracity: the ability to tell the truth; essential to the integrity of a relationship.

 


Healthcare Ethics – Boundary Warning Signs

 

 

 

Perception: The nurse should ask: Is this what other nurses would do?  How would this appear to others (peers, family, superiors)?  How does this appear to the client?

 

Time: The nurse should consider the quality and quantity of time spent with the client.  Does it vary from that spent with other clients?  Is the nurse spending “off duty” time with the client?

 

Meeting time and place: Is the location of the interaction appropriate to the relationship?  Would you provide nursing service to other clients in this location?  If there is a legitimate, therapeutic need to meet an unusual time, has it been made known to others and documented?

 

Gifts: Does the gift giving create a sense of obligation on the part of the recipient?  Is this a routine part of the nurse’s practice regardless of the age or gender of the client?  Is the gift of a personal nature, given to one nurse, or a general gift given to a group of caregivers?  Does the facility have a policy regarding gifts.

 

Forms of address: Has there been a change in the way the client is addressed or how this client is addressed in relation to others?

 

Personal attire: Has the nurse’s style of dress changed with more attention paid to personal appearance?

 

Making exceptions: What is the therapeutic purpose in making exceptions in helping a client or family member?  Another type of exception to note would be the nurse who changes assignments to care for the client.

 

Internal cues: Learning to recognize and trust internal cues is important.  A nurse should seek guidance in a situation that raises questions in his or her mind.  When in doubt, check it out.  Nonverbal behavior, the nurse’s or the client’s may provide helpful insight.  Does the nurse become defensive if questioned about the interaction with the client?

 

Meeting personal needs: In addition to recognizing that the client’s needs must come first, the nurse should be aware of his or her own social and emotional needs and take affirmative steps to have those needs met away from work.  Thoughts such as “I only feel appreciated at work” or “Only I can help this client” indicate the nurse may be meeting his or her needs through the client.

 

Dual relationships: The nurse enters a nurse-client relationship in order to provide the client with nursing services.  Nursing services would not include, for example, dating, babysitting or entering a business relationship with clients.

 

Confidentiality: In the course of a nurse-client relationship, a nurse may become aware of information that is not related to the purpose of the relationship.  The nurse should maintain confidentiality by not using or sharing this information unless doing so is for a legitimate therapeutic purpose.

 

Choosing sides: Is the nurse taking sides with the client against the client’s significant others?  The nurse should ask: “What is the value in taking sides?”  How can the nurse assist the client in looking at all sides of the issue to utilize his or her own problem solving skills.

 

Self-disclosure: While professionals want to be perceived as caring, self-disclosure is rarely helpful or necessary.  The nurse should consider what client need is served by the self-disclosure and determine whether personal issues shared with the client are brief, resolved and related to what the client is experiencing.

 

Touch: Touching is an integral part of many nursing interventions.  Touch may be a component of another action, e.g. checking a blood pressure, or may be therapeutic in and of itself.  Touch, however should not be used indiscriminately.  The nurse should be clear in his or her own mind why touch is called for and communicate this to the client.

 

Communication: It is the responsibility of the nurse to establish and maintain boundaries and to communicate this to the client.  Another aspect of communication is whether the nurse is able to communicate to others the nature of the relationship with the client.  Is the nurse keeping secrets with or about the client?  Does the nurse fail to document or report negative information about the client?

 

Be prepared: The nurse should consider his or her practice setting and be aware of boundary issues which may arise in that setting to consider in advance how to address these concerns.  Nurses should ask themselves questions such as “How often have I raised ethical judgment calls, questions and concerns to other nurses?”  “What are the facility policies regarding establishing, maintaining and communicating boundaries and how are staff made aware of the policies?”  “What nursing function am I providing by my actions?”  “How do I set boundaries for my sexual attraction to a client or a client’s attraction to me?”

 

Similarly the caregiver should know his or her resources both for personal guidance and for making appropriate referrals for clients.  The caregiver cannot be all things to all people and should not attempt to be so.

This is not an exhaustive list but should be instructional to all caregivers.  Any caregiver in any practice setting will encounter boundary issues.  With forethought, planning, communication and evaluation, the caregiver can take steps to ensure a boundary issue does not progress to a boundary violation.

 

 

 

 

Sample Codes of Ethics

Nursing Assistants Code of Ethic

 

No matter what setting you work in, all Nursing Assistants must adhere to a code of ethics. 

The following apply to all Nursing Assistants:

 

Know the behaviors that may result in termination of your Nursing Assistants job: abuse of any kind, theft, insubordination, neglect of duties, altering or falsifying records, and working under the influence of drugs or alcohol, breaching confidentiality.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

American Nurses Association Code of Ethics

  1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

 

  1. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.

 

  1. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

 

  1. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.

 

  1. The nurse owes the same duties to self as to others, including the responsibility serve integrity and safety, to maintain competence, and to continue personal and professional growth.

 

  1. The nurse participates in establishing, maintaining and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

 

  1. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.

 

  1. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

 

  1. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping policy.