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CSULB NURSING COURSE 353 Legal Issues in Health Care

Dr. Eileen Watson

Ethical Decision-Making Abilities: Reflection on Moral Accountability

The instructional/learning module takes place in three parts

PART ONE :Assigned readings. The following required readings and learning activities areassigned one week before the two module lectures:

  • Textbook:

Guido, G. (2010). Legal and ethical issues in nursing (5thed.). New Jersey: Pearson

Hall. Students are assigned to read Chapters 1 and 2.

  • Articles to be Downloaded and read from CSULB Library E-reserve:

Clavreul, G. (2008). A question of nursing ethics.Retrieved from:

Kerr, J.(2008).Ethics and retention. .Advance for Nurses, 5(11), 22

Urlich, et al. (2007)Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science & Medicine, 65, 1708-1719

  • Online-Student Activities
  1. American Nurses Association (ANA) Website:

click on:

  1. Code of Ethics for Nurses With Interpretive Statements (2001) (View Only). Read each of the nine provisions and interpretive statements.

Provisions 1-3 Discuss Fundamental Values of the Professional Nurse

Provisions 4-6 Discuss Duty and Loyalty

Provisions 7-9 Discuss Expanded Duties Beyond Direct Patient Care

  1. Read ANA Position Statements on Ethics and Human Rights
  1. Take the Morality Test on line:

PART TWO: This part includesboth module lecturesand class interaction exercises. Content from chapters one and two in the module required textbook by Guido (2010) are reviewed for clarity and discussion. Throughout learning modules, case scenarios are presented for class discussion to provide the nursing students with an opportunity to apply various ethical principles. Upon completion of the module, the students review and discuss a health care case scenario (in text) using an ethical decision-making model—MORAL MODEL. This exercise provides each nursing student a step-by-step framework for working through an ethical dilemma.

PART THREE Putting It All Together—Post lecture assignments for continuing the learning processes involved in ethical decision-making, moral reasoning, moral judgment, and ethical reflection are suggested. Suggested activities are an ethical reflection homework paper and a class debate on current ethical health care issues.

  • Ethical Reflection Paper

a.You are going to reflect back on an ethical dilemma you have encountered in your student nursing experiences. (This can be as simple as to the type of medication you should give). You will write a scenario explaining the ethical dilemma (do not use names of hospitals or individuals).

b.Then you will identify sections from the American Nurses Association Code of Ethics (2001) in resolving this dilemma—identifying which provisions are most relevant to your scenario.

c.Then using each step of the MORAL MODEL, describe how you worked through the ethical dilemma. How did you resolve it? Include relevant ethical principles when you address resolving the dilemma. Refer back to Guido (2010) Chapter 2 and lecture/discussion activities.

  • Ethical Debate: Class will be divided as evenly as possible for pro/con positions on ethical topics. Be prepared to support position from researching topic—is it legal/illegal…….good/bad……ANA Position. Topics may include:
  1. Medical Futility
  2. Active Euthanasia
  3. Social justice
  4. Abortion
  5. Assisted Suicide
  6. Foregoing Nutrition/Hydration
  7. Advance directives

Additional Instructional/Learning Module Resources

•AACN (2008). Public Policy Position Paper on Moral Distress. Retrieved from:

•AACN (2008). 4 A’s to Rise Above Moral Distress Handbook; 4 A’s to Rise Above Moral Distress Toolkit and Bibliography. Retrieved from:

and

•Aiken, T. (2004). Legal, ethical and political issues in nursing (2nded.). Philadelphia: F.A. Davis

•American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Washington, DC: American Nurses Publishing.

•Bosek, M. & Savage, T. (2007). The ethical component of nursing education: Integrating ethics into clinical experience. Philadelphia: Lippincott Williams & Wilkens

•Butts, J. & Rich, K. (2005). Nursing ethics across the curriculum and into practice. Boston: Jones and Bartlett

•Carmel, S., Werner,p., & Ziedenberg, H. (2007). Physicians’ and nurses’ preferances in using life-sustaining treatments. Nursing Ethics 14(5), 665-674

•Clavreul, G. (2008). A question of nursing ethics. Retrieved from:

•Crain, W. (1985). Kohlberg’s stages of moral development. Theories of development (19 pages). New Jersey: Prentice-Hall.

•Decasterie, B., Grypdonck, M., Vuylsteke-Wauters, M., & Janssen, P. (1997). Nursing students’ responses to ethical dilemmas in nursing practice. Nursing Ethics 4(1), 12-28

•DeCasterle, B., Izumi, S., Godfrey, N., & Denhaaerynck, K. (2008). Nurses’ responses to ethical dilemmas in nursing practice: meta-analysis. Journal of Advanced Nursing 63 (6), 540-549

•Duckett, l., Rowan, M., Ryden, M., Krichbaum, K. et al. (1997). Progress in the moral reasoning of baccalaureate nursing student between program entry and exit. Nursing Research 46 (4), 222-229

•Edmonson, C. (2010). Moral courage and the nurse leader. The Online Journal of Issues in Nursing, 15(3). American Nurses Association

•Fry, S. (1985). Individual vs aggregate good: Ethical tension in nursing practice. International Journal of Nursing Studies, 22(4), 303-310.

•Frye, S. (1989). Teaching ethics in nursing curricula. Nursing Clinics of North America, 24(2), 485-497.

•Ganske, K. (2010, Sept.). Moral distress in academia. OJIN. Online Journal of Issues in Nursing. 15(3), Manuscript 6, pp. 1-11.

•Guido, G. (2010). Legal and ethical issues in nursing (5thed.). New Jersey: Pearson Hall.

•Edmonson, C. (2010). Moral courage and the nurse leader. The Online Journal of Issues in Nursing, 15(3). American Nurses Association

•Fry, S. (1985). Individual vs aggregate good: Ethical tension in nursing practice. International Journal of Nursing Studies, 22(4), 303-310.

•Frye, S. (1989). Teaching ethics in nursing curricula. Nursing Clinics of North America, 24(2), 485-497.

•Ganske, K. (2010, Sept.). Moral distress in academia. OJIN. Online Journal of Issues in Nursing. 15(3), Manuscript 6, pp. 1-11.

•Guido, G. (2010). Legal and ethical issues in nursing (5thed.). New Jersey: Pearson Hall.

•Kohlberg, L. (1981). Essays on moral development, Vol.1; The philosophy of moral devilment. San Francisco: Harper and Row

•Kohlberg, L. & Blatt, M. (1973). The effects of classroom moral discussion upon children’s level of moral judgment. In Recent Research in Moral Development. New York: Holt, Rinehart & Winston

•Kohlberg, L., & Turiel, E. (1971). Moral development and moral education. In C.M. Beck, E. Sullivan (Eds.) (pp. 415-16)Psychology and Educational Practice, Glenview, Ill.: Scott & Foresman

•Murphy, C. (1976). Levels of moral reasoning in a selected group of nurse practitioners. New York: Teachers College, Columbia University. (Unpublished Doctoral Dissertation)

•Numminen, O. & Leino-Kilpi, H. (2007). Nursing students’ ethical decision-making: A review of the literature. Nurse Education Today, 27(7), 796-807

•Psychology Wiki (2011). Kohlberg’s stages of moral development. Retrieved from:

•Rest, J., Turiel, E., & Kohlberg, L. (1969). Level of moral development as a determint of preference and comprehension of moral judgment made by others. Journal of Personality 37, 225-252

•Roell, S. (1982). Moral development levels of university education graduate and undergraduate nursing students.Dissertation Abstracts International 43(3A), 736-737

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•Smith, M. (2009, Sept.). Donald Schon: Learning, reflection and change, The encyclopedia of informal education. Retrieved from:

•Stone, S. (2000, Nov/Dec.). The purpose of a code of ethics and code of conduct for nursing students. . Retrieved from:

• Smith, M. (2009, Sept.). Donald Schon: Learning, reflection and change, The encyclopedia of informal education. Retrieved from:

•Ulrich, c. et al. (2007). Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the Unites States. Social Science & Medicine 65, 1708-1719

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•Winland-Brown, J. & Dobrin, A. (2009, Mar.). A comparison of physicians’ and nurses’ responses to selected ethical dilemmas. (p. 1-19). Retrieved from:

•Wirtz, E. (2007). The moral integrity development of nursing students in two-year colleges. Montana: Montana State University (Unpublished Doctoral Dissertation)