Luke's St. Hospital School of Nursing at Moravian College Bethlehem, Pennsylvania
Spring 2008
"Human beings should keep learning as long as they are ignorant, i.e., as long as they live." (Seneca 4? B.C-A.D. 65)
COURSE TITLE: TERM: CREDIT HOURS:
NURSING 395: Ethical Dilemmas in Health Care Spring 2008 Three
CLASS SCHEDULE: Theory Hours: MON., WED., & FRI: 10:20 a.m. -11:10 a.m. No clinical hours required. FACULTY: Office Location: Building Phone: E-mail: Office Hours: Dr. Maria L. Schantz, PhD, RN, CEN Collier Hall Nursing Complex PPH Science [phone] [e-mail] Mon. Wed. 11:30 a.m. 12:30 p.m. and by appointment No prerequisites required
PREREQUISITES:
REQUIRED TEXTS: Butts, B. & Rich, K. L. (2008). Nursing ethics across the curriculum and into practice (2nd ed.). Boston: Jones and Bartlett Publishers.
American Nurses Association (2001) Code of ethics for nurses with interpretive statements. Silver Springs, MD: American Nurses Association. American Nurses Association (2003) Nursing's Social Policy Statement. (2nd) Silver Springs, MD: American Nurses Association. American Nurses Association (2003) NURSING: Scope and standards of practice. Silver Springs, MD: American Nurses Association
Reeves Library TEXTS on RESERVE: DeWolf Bosek, M. S., & Savage, T. A. (2007). The ethical component of nursing education. Philadelphia: Lippincott Williams & Wilkins. Munson, R. (2004). Interventions and reflection: Basic issues in medical ethics. California: Tomsom/Wadsworth.
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Munson, R. (2003). Outcome uncertain: Cases and contexts in bioethics. California: Tomson/Wadsworth. Volbrecht, R.M. (2002). Nursing ethics: Communities in dialogue. New Jersey: Prentice Hall.
CATALOG/COURSE DESCRIPTION:
This course provides the foundation of ethical theories and bioethics relative to healthcare. The relevance of ethics to decision-making within the healthcare system is explored. Ethical issues that affect healthcare professionals and individuals across the lifespan are analyzed.
STUDENT LEARNING OUTCOMES: At completion of this course the student will be able to: 1. Identify the purposes of ethical theory and its relevance to decision making within healthcare practice. 2. Compare & contrast the three ethical theories of deontology, teleology, and principalism as each theory relates to ethical dilemmas. 3. Use the MORAL ethical decision-making model to address ethical issues inherent within clinical practice and nursing research. 4. Challenge the consistency of his/her ethical worldview. 5. Apply principles of healthcare ethics to justify ethical decisions that affect individuals across the lifespan. 6. Examine and discuss the interdisciplinary role of the nurse as it relates to ethical decision-making. TEACHING METHODS: The predominant emphasis of the course will be on seminar/problem-posing dialogical education and interactive/cooperative group activity learning. To that end, the course will include the following modalities: case studies presentations and discussions; selected movies viewing and critique; and, possibly, guest speakers. Lectures will be used as appropriate. Online format supported by the Blackboard software platform. The URL for Blackboard is http://blackboard.moravian.edu
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METHODS OF EVALUATION 1. Class Participation 10% 2. Final Examination 20% 3. Reflective journals related to case studies 25% 4. Written movie critique using the MORAL ethical decision-making framework as the basis for the critique 20% 5. *Argument Research Paper/Presentation 25% *Students will address an ethical issue across the lifespan such as: Nursing the childbearing family i.e. reproductive technology such as IVF and advanced maternal age or "granny pregnancies"; selective reduction; fetal research/use of embryonic research; mandatory Newborn HIV testing; sperm retrieval from cadavers; human cloning; gender selection; marketing human embryos; eugenic sterilization Nursing care of children i.e. futile pediatric care; children's rights versus paternalism; life versus death decision making; the rights of the adolescent in quality of life cases Nursing care of the adult i.e. HIV test reporting for public protection; right to refuse treatment for self or dependents; right to privacy and confidentiality; clinical trials Nursing care of the elderly i.e. truth telling; competency matters; principles of equality and equal consideration, allocation of transplant organs, scarce medical resources; euthanasia and physician assisted suicide. Scholarly Paper: *Writing Intensive Course: Students who have elected to fulfill Writing Intensive Course Requirements for NUR 360 will be required to submit an 810 page scholarly/research on the assigned topic in addition to the presentation. The paper will follow the same format as the presentation. Students will write a rough draft which will be peer edited. (Final drafts will be reviewed by a member of the Writing Center prior to submission to the instructor). This writing assignment is worth 25% of the total course grade. It must be written in accordance with American Psychological Association (APA) guidelines. Failure to cite sources will result in an automatic 0 (zero). This paper will be typed and grammatically correct. It is critical that spell and grammar checks be done. The paper should be 8-10 pages in length and typed in Times Roman using a 12 point font. An abstract is not necessary.
Grading: Students in each group will be given the option of whether to receive a group grade or an individual grade. The group will come to a consensus and then notify the instructor of the decision prior to the presentation. Students who are
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Writing Intensive will receive a grade on the paper and not a presentation grade. 6. Tardiness for written assignments: Assignments are expected on or before their due date. The instructor reserves the right to deduct 5 (five) points per day from the grade if assignments are handed in late. The Grading Scale Policy for NUR 360 is as follows: A AB+ B B= 93-100 = 90-92 = 87-89 = 83-86 = 80-82 C+ C CD+ D DF = 77-79 = 73-76 = 70-72 = 67-69 = 63-66 = 60-62 = < 60
NOTE: Students are encouraged to read/review the MC Grades and Quality Points criteria as described in the Moravian College Catalog 2006-2008 pp. 46-47. ATTENDANCE:
Students are expected to attend and be prepared for class. Preparation requires: completion of assignments prior to coming to class and actively participation in class activity. If unable to attend a class, please contact the instructor at least one hour before class via phone or e-mail. Any absence from class must be accompanied by an appropriate written verification of absence (physician/nurse practitioner's note for illness or emergency circumstances). Absences without appropriate written verification will be deemed as unexcused and the instruct reserves the right to deduct 1 (one) point off from the final course grade for each unexcused absence. In addition, there are no commercial breaks built into the course, so once class begins students must stay. If they leave early or wonder out and return, they will be counted absent for that day's work. If there is an unavoidable reason why a student must leave class early, let me know before class begins. If a student must miss class, it is his/her responsibility to get in touch with a classmate for obtaining any notes, handouts or other class items and to have the work done on time. Please, do not phone/e-
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mail/fax me to find out "what we did in class?" ... remember, you are responsible for your assignments. Daily evaluation of attendance and preparation is done according to the following scale: 3: Well prepared for class, excellent performance in terms of quality and quantity; in other words, EXCELLENT. 2: Prepared for class, good performance in terms of quality and quantity; in other words, GOOD. 1: Present class, in but evidence of little or insufficient preparation. 0: ABSENT Classroom Behavior and Etiquette: We must maintain a courteous and productive environment during class. Out of respect for others and in the interest of learning, the use of cellular phones, beepers, etc., is not allowed in the classroom; please make sure they are turned off before coming to class. You are expected to pay attention and to behave properly during class activity as student incivility will not be tolerated. Examples of incivility may include, but are not limited to, use of profane language, inappropriate confrontation with others, violating confidentiality, or misuse of college property. If your behavior is disruptive in any way, you will be asked to leave, will be counted absent for that day, and will earn a zero for that day's work. Sleeping in class is not allowed; if you want/need to sleep, stay home/in your dorm. If you fall asleep during class, you will receive one verbal warning; after the first incident you will be counted absent any time you fall asleep during class, and will earn a zero for that day's work. The course faculty member reserves the right to dismiss the student from the classroom if actions are deemed inappropriate. ACADEMIC HONESTY/PLAGIARISM POLICY: All written assignments must adhere to the APA 5th edition format with proper recognition to another's work. Plagiarism is the intentional use of another's works or ideas as your own. This may range from using another individual's direct words or changing the words slightly (paraphrasing) without the appropriate citation, to
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purchasing Papers from the Internet or a professional writing service. Please consult the Academic Regulations session of the Moravian College Catalog 2007-2008 on p. 46. Violations or suspected violations will incur serious consequences. DISABILITIES: Students with a documented disability who wish to request course accommodations should contact the Director of the Learning Services (Ex. 1510). The syllabus and methods of course delivery are subject to change at the discretion of the instructor. It is within the instructor's discretion to apply qualitative judgment in determining the grades for an assignment or for the course.
APPENDICES:
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St. Luke's Hospital School of Nursing at Moravian College Bethlehem, Pennsylvania
NUR 360: Ethical Dilemmas in Health Care Spring 2008 TOPICAL OUTLINE Topics Assignments Due Course Introduction General Overview
Intro to Ethical Philosophy, Theories, & Approaches Do Ethical Reflections exercises on pp. 10, 11, 22, and 23 in Butts & Rich Butts & Rich Chap 1
Week Week 1
Date Jan.14, 2008
Jan.16 -18
Readings
Week 2 Jan.21- 23 Intro to Bioethics, Nursing Ethics, and Ethical DecisionMaking Do Ethical Reflections exercises on p. 65 and Case Study on p. 73 in Butts & Rich
Butts & Rich Chap 2
Jan. 25 Week 3
Jan. 28,
Ethics in Professional Nursing Practice
Ethics in Professional Nursing Practice
Butts & Rich Chap 3
* Reflective Journal Due (Topic:Advocacy)
Code of ethics for nurses with interpretive statements
Appendix A
Butts & Rich American Nurses Association (2001)
and The ICN Code of Ethics for Nurses Appendix B DeWolf Bosek & Savage, Chap 8
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Jan. 30, Feb. 1st
Ethics in Organizations and Leadership
With a classmate do Ethical Reflections exercises on pp. 138, 139, 140 in Butts & Rich Do Ethical Reflections exercises on pp. 173, 179, 181 and Case Study on p. 190 in Butts & Rich
Butts & Rich Chap 4
Week 4 Feb. 4- 68 Reproductive Issues and Nursing Ethics
Butts & Rich Chap 5
Feb. 8
** Reflective Journal Due (Topic: Abortion)
Week 5
Feb.11,
Ethical Issues in the Media "The Tuskegee Experiment"
*Group Discussion
Munson, "Outcomes uncertain" : Chap 9 Articles: 1.) "When does life begin? "Scientific myths and Scientific facts" by Dianne N. Irving & 2.) Poverty, facts, and political philosophies" by Peter Singer Prior to class Students will view the movie
Miss Evers' Boys
Available on
Blackboard-- class time will be reserved to discussion related to reaction to film In Addition,
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Feb.13, 15
Race, Gender, and Medicine
With a classmate Do Decision Scenario #s: 1, 2, 3,4, 5, and 6 in Munson, pp.269272
Students will research and bring to class an article related to the issue of Informed consent
Intervention & reflection,
Chap 4
Munson,
Week 6
Feb. 18, Feb. 20, 22
Infant and Child Nursing Ethics
Feb. 22
Week 7
Feb. 25, 27,
Adolescent Nursing Ethics
Feb. 29 Week 8 March 3,5, and 7 Spring Break-- NO CLASSES
With a classmate Do Ethical Reflections exercises, pp. 207, 211, and case study pp. 226-227 Do a lit/internet research on the case of Terri Schiavo and be ready to present it in class With a classmate Do Ethical Reflections exercises on pp. 248, 253, 259, and case study p.270 in Butts & Rich
Butts & Rich Chap 6
Butts & Rich Chap. 7
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Week 9 March 10,12, Adult Health Nursing Ethics With a classmate Butts & Rich Chap 8 do Ethical Reflections exercises on pp. 283, 293, 300, and case study on pp. 305-306 Prior to class Students will view the movie Wit Available on Blackboard-- class time will be reserved to discussion related to reaction to film
March 14
Death & Dying Issues
Week 10 March 17, 19 Gerontological Considerations Ethics and the Nursing Care of Elders With classmate Do Ethical Reflections exercises on pp. 356, 361, 372, 373 Butts & Rich Chap 10
Week 11 March 24 Euthanasia Issues Prior to class Students will view the movie
Guest Speaker-TBA
Million Dollar BabyAvailable on
Do Ethical Reflections exercises on pp. 464,468, and (Read all the cases in this chapter related to the issue of Blackboard-- class time will be reserved to discussion related to reaction to film
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March 26,
Medical Futility Decisions)
Butts & Rich Chap 12
March 28 Week 12 March 31, April 2
Psychiatric/Mental Health Nursing Ethics
***Movie Critique Moral Ethical Critique Due With classmate do Ethical Reflections exercises on pp. 320, 325, 328 With a classmate do Ethical Reflections exercises on pp. 405, 409, 411, 412 Butts & Rich Chap 9
April 4
Community/Public Health Nursing Ethics
Butts & Rich Chap11
Week 13
April 7-9-
April 11
Cases and Guest Speaker TBA International Dilemmas in Health Care
Independent reading and study
Week 14
April 14
**Student Presentations
Possible Research Issues: As assigned by Reproductive groups Control In Vitro Fertilization Gamete Intrafallopian Transfer Freezing
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April 16 ** Student Presentations
Embryos Eugenics Cloning/ Twinning Selective Reduction As assigned by groups
April 18
** Student Presentations
Genetic Control Genetic Screening Genetic Intervention Genetic Therapy
Do-Not- Resuscitate As assigned by groups Directives for Pennsylvania and Student Nurse's home State Good Samaritan Law in Pennsylvania and Student Nurse's home State Euthanasia and Physician Assisted Suicide Active/ Passive Euthanasia Self Administered vs Other Administered Euthanasia Landmark Cases Advanced Directives
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Week 15 April 21 **Student Presentations HIV/AIDS *Responsibility and Confidentiality *HIV Testing *Disclosure Medical Futility *Genetic and Congenital Impairments *Testing for Impairments * Dilemma of Severe Prematurity *Arguments in Favor of Withholding Medical Care from Defective Infants *Social Context
As assigned by groups
April 23
** Student Presentations
As assigned by groups
April 25
**Student Presentations
Clinical Trials * Patient Rights * Impact on Society * Outcomes
As assigned by groups
Week 16
April 28May 3
Final Exam
The Instructor reserves the right to assign additional readings, alter course content and/or course sequence as needed, and use qualitative judgment in determining the grades for assignments and exams.
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