Healthcare Ethics
Health Care Core Curriculum
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Healthcare Ethics Module Description
 This module emphasizes the use of sound ethical
practices in healthcare.
 Ethical practices and standards include 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.
General Teaching Notes
 The curriculum for this module is broken into 2 parts,
Values and Ethics.
 It is important to discuss with students the definition and
development of values and their own personal values.
General Teaching Notes
 The following statements can help distinguish the difference
between values and ethics and provide guidance throughout
the module.
All human interactions are value-based and guide our
behavior and tell us right from wrong.
Values are essential to ethics. Ethics are concerned with
human actions, and the choice of those actions.
Ethics evaluates those actions, and the values created
them. It determines which values should be pursued, and
which shouldn't.
Ethics is a code of values.
Module Outline and Instructor Resources
 This module consists of 5 competencies.
 Each competency is divided into unit competencies with
learning activities to help students master the competency.
 Each learning activity is explained on the Module Outline and
the resources described
 Choose the learning activities that best meet your classroom
needs.
Module Outline and Instructor Resources
 Find these learning activities and resources on the website or
create your own.
 The Course Outline also has documents that the instructor can
use in teaching the lesson.
 These competencies are listed on the following slide and will
then be addressed throughout the remainder of the power
point.
 On D2L site review the:
 Course Outline
 Module Competencies and the Instructor Notes
Module 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 from other health care employees.
5. Using an ethical decision making model applied to
healthcare situations, describe how ethics influence the
care of clients.
Module Competency #1
Describe dimensions of values as they impact healthcare.
Competency #1 - Describe dimensions of
values as they impact healthcare
Five units and learning activities round out the learning for
this first competency:
1. Define Values
2. The Importance of Values
3. Development of Values
4. Identity of Personal Values
5. Values in Healthcare
6. Professional Values and their impact
Module Competency #1: Values
Unit #1A: Define Values
Recommended Content
 In this unit the student will learn the definition of values. The
definition is “standards that provide the foundation for
making decisions and guiding behavior”.
 The goal is to assist students to understand that beliefs are
chosen freely and all human interactions are value-based.
Tips for presenting materials:
 In our multicultural society we live in a melting pot of values.
Be prepared for differing values around disciplining children,
death and dying, and female roles within the family, for
example.
(see next slide)
Module Competency #1: Values
Unit #1A: Define Values
Recommended Learning Activities
Assignment
Resources
Notes
Personal Core
Values
Worksheet on Website
Present a list of 30 values to
students and have them select the
top 5 most important to their lives.
Have the students answer 3 ethical
questions and relate their answers
back to their values.
Module Competency #1: Values
Unit #1B: Importance of Values
Recommended Content
 Values guide a person’s actions and conveys what they
consider is right and or wrong.
 Values are freely chosen, enduring beliefs or attitudes or
ideals about the worth of a person, object, idea, or action.
 Values are shared by the members of a culture about what is
good or desirable and what is not. Values exert major
influence on the behaviors, decisions, and actions of
individuals and serve as broad guidelines in all situations.
Module Competency #1: Values
Unit #1B: Importance of Values
Recommended Learning Activities
Assignment
Resources
Notes
Small group
discussion
none
Share a time that you had
to make an ethical
decision based on a value
that you hold.
Discuss the range of
values different
communities have around
going to the doctor,
healing, and death.
Module Competency #1: Values
Unit #1C: Development of Values
Recommended Content
 This part of the unit discusses how the values within our lives have
been shaped and formed. We are not born with values but rather
we develop them as we grow. Sociologist Morris Massey from the
University of Colorado at Boulder describes three periods in which
values are developed.

Imprint Period

Modeling Period

Socialization Period
(Changing Minds Organization)
 These periods of development provide a sound basis for the
understanding the development of values. The discussion of these
periods can provide students with a better understanding of where
they are and/or where their siblings and/or children are on the
development scale.
(see next slide)
Module Competency #1: Values
Unit #1C: Development of Values
3 Periods of Value Development , cont.
1. The Imprint Period
 Up to the age of seven, we are like sponges, absorbing everything
around us and accepting much of it as true, especially when it comes
from our parents. The confusion and blind belief of this period can also
lead to the early formation of trauma and other deep problems.
 The critical thing here is to learn a sense of right and wrong, good and
bad.
 This is a human construction which we nevertheless often assume would
exist even if we were not here (which is an indication of how deeply
imprinted it has become).
(Changing Minds Organization)
(see next slide)
Module Competency #1: Values
Unit #1C: Development of Values
3 Periods of Value Development, cont.
2. Modeling Period
 Between the ages of eight and thirteen, we copy people,
often our parents, but also other people. Rather than blind
acceptance, we are trying on things like a suit of clothes, to
see how they feel.
 We may be much impressed with religion or our teachers. You
may remember being particularly influenced by junior school
teachers who seemed so knowledgeable--maybe even more
so than your parents.
(Changing Minds Organization)
(see next slide)
Module Competency #1: Values
Unit #1C: Development of Values
3 Periods of Value Development, cont.
3. The Socialization Period
 Between the ages of 13 and 21, we are very largely
influenced by our peers. As we develop as individuals and
look for ways to get away from the earlier programming, we
naturally turn to people who seem more like us.
 Other influences at these ages include the media, especially
those parts which seem to resonate with our the values of our
peer groups.
(Changing Minds Organization)
Module Competency #1: Values
Unit #1C: Development of Values
Recommended Content
As Morris states in the Modeling Period, we copy our parents
and their values. Examples of other learned values include:
 Lifestyle
 Culture
 Religion
 Socioeconomic status
 Rules
 Language
 Education
Module Competency #1: Values
Unit #1C: Development of Values
Recommended Learning Activities
Assignment
Resources
Notes
Small Group
Discussion
None
How has your family
of origin impacted
your values? When
did you first realize
that your values
were different from
others? Give an
example.
Module Competency #1: Values
Unit #1D: Identity of Personal Values
Recommended Content
Students are encouraged to define and identify their own
personal values. What a person values is crucial to self
identification and behavior. It is what motivates a person and
keeps them motivated.
Module Competency #1: Values
Unit #1D: Identity of Personal Values
Recommended Learning Activities
Assignment
Resources
Personal Core Values Website
Notes
Introduction of Value
Message, i.e.
“whatever you do,
do it well”.
Module Competency #1: Values
Unit #1E: Values in Health Care
Recommended Content
 The identification of health care values is discussed within this unit.
The curriculum lists the key health care values as:
Honesty
Integrity
Respect
Responsibility
Accountability
Tips for presenting materials
 Compare and contrast students’ personal values to the key
health values to provide interesting discussion.
(see next slide)
Module Competency #1: Values
Unit #1E: Values in Health Care
 This discussion of key health care values can often lend itself to
discussing the differences between responsibility and
accountability. How closely are they related? Can a person have
one without the other?
 Integrity can loosely be defined as “doing what is right even when
someone is not looking”. What is right for one person, might not be
right for another. Is integrity clear cut or full of gray matter?
 Bringing the discussion back to a person’s own values is crucial to
this part of the module. How are a person’s values tied to the key
health care values. How do they differ? Do they differ? Do people
live by two different sets of values? For example, do you have one
set at home, another at the workplace?
(see next slide)
Module Competency #1: Values
Unit #1F: Professional Values & Their Impact
Recommended Content
 Accountability and confidentiality are two professional values
that that play a large part in a person’s behavior and
performance.
 These 2 values will be discussed in the following 3 slides.
Module Competency #1: Values
Unit #1F: Professional Values & Their Impact
Professional Accountability:
 Professional accountability applies to everyone involved in health care.
 Accountability is a legal obligation; in health care it is also an ethical
and moral responsibility. Within the realm of professional accountability,
there are many factors.
 A healthcare worker’s first priority is accountability.
 A professional healthcare worker has the responsibility to practice
within his/her scope of care, calling upon his/her knowledge and skills
to make decisions in the best interest of the patient.
 The level of responsibility and accountability depends on professional
levels.
** This is what keeps trust in relationships.
(see next slide)
Module Competency #1: Values
Unit #1F: Professional Values & Their Impact
Professional Accountability, cont:
 If you want to be a model of accountability for your team, then here are
the things which you can do to earn your teammates' trust.
1. Think before promising to take a specific task on yourself.
2. It is a good idea not to operate on automatic pilot when asked to take
a project-related responsibility upon yourself, especially if it will involve
much time and effort.
3. You should only make those promises which you are able and willing to
keep.
4. You should only agree to assume responsibilities which you have
committed yourself to do
(Lane)
(see next slide)
Module Competency #1: Values
Unit #1F: Professional Values & Their Impact
Professional Confidentiality:
 Confidentiality means keeping private things private.
 As a healthcare provider, you will probably learn a great deal of
confidential information about your clients.
 You may learn about the resident’s state of health, finances, and family
relationships.
 You are both legally and ethically obligated to keep this information
confidential.
 This means you should not tell anyone other than members of the
healthcare team anything about your residents/patients. Your
residents/patients have to trust you, and talking about them betrays this
trust. Review the HIPAA Law.
(Hegner, Acello, & Caldwell, p. 11)
Module Competency #1: Values
Unit #1F: Professional Values & Their Impact
Teaching Tips
Teaching Tips
 Remind students that if a confidentiality is shared by the patient that if not
reported, could possibly harm the individual, the information must be
shared with the appropriate person. (Example: A patient tells her caregiver
that she has chest pain but does not want anyone else to know since she is
hoping to go home later in the day.)
 However, the caregiver must tell the patient this information could cause
harm and needs to be reported. The patient may not like it, but the
responsibility for this information cannot be lost as it may compromise their
health.
 If this is not conveyed to the patient and the care provider in charge
comes in and tells the patient that he/she knows chest pain is occurring,
the rapport/trust between the caregiver and the individual is broken.
Competency #2
Describe basic principles of professional relationships.
Competency #2 - Describe basic principles
of professional relationships.
Units included in this competency are:
1. Define professional boundaries
2. Identify elements of professional relationships
3. Explain why boundary violations may occur
4. Discuss how to prevent violations of professional boundaries
Module Competency #2: Professional Relationships
Unit #2A: Professional Boundaries
Recommended Content
 This competency offers the instructor(s) opportunity to discuss the
elements of professional relationships with students while providing a
strong emphasis on professional boundaries and boundary
violations.
 The next slide briefly addresses boundaries and why they exist. The
following slide then provides some examples of when a person’s
professional giving of health care might challenge their own belief
system.
(see next slide)
Module Competency #2: Professional Relationships
Unit #2A: Professional Boundaries
Boundaries:
 Are our sense of how we are different from others
 Exist for our protection
 Ensure appropriate behavior and keeps us from offending others
 Enable us to get close with each other without being
overwhelmed.
 Are mutually understood, unspoken physical and emotional limits
of the relationship between the patient and healthcare
providers.
(Fiedler, n.d.)
(see next slide)
Module Competency #2: Professional Relationships
Unit #2A: Professional Boundaries
Personal & Professional Boundaries, cont.
As professionals we see many diverse people every day with different
needs:
 The young gay homeless man
 The African-American mother of three
The Hispanic man who will not tell his family that he is HIV positive
 The Native American female who survives with anyone who will
take care of her.
(Fielder, n.d.)
It’s critical to teach our students that all people, regardless of their circumstances,
deserve to be treated with dignity and respect, and that their privacy and boundaries
must be respected.
(see next slide)
Module Competency #2: Professional Relationships
Unit #2A: Professional Boundaries
Professional boundaries are the limits that:
 Allow for a safe relationship with the client based upon the client's
needs
 Produce consistent & predictable behavior
 Define how power is exercised within the therapeutic relationship
 Protect the client within the relationship.
(College & Association of Registered Nurses of Alberta)
Module Competency #2: Professional Relationships
Unit 2B: Identify Elements of Professional
Relationships
Topics include:
 Within the context of professional relationships, students need to
understand professional boundaries and how they impact the
workplace and the performance of each employee.
 Defining “a safe relationship with a client”. What does that mean and
does the meaning change from person to person?
 At this point in the module, even though ethics has not yet been
discussed, samples of codes of ethics are looked at and evaluated.
(see next slide)
Module Competency #2: Professional Relationships
Unit 2B: Identify Elements of Professional
Relationships
Recommended Content
The in-class discussion and/or learning activities will lend themselves to a
person’s power vs. another person’s vulnerability. The discussion of
professional boundaries cannot take place until students have an
understanding of power vs. vulnerability.
Vulnerability of the elderly and children is often times understood without
question. Discussion around the vulnerability of people with special needs,
including mental health issues, people who are disabled, lack education or
finances.
(see next slide)
Module Competency #2: Professional Relationships
Unit# 2B: Identify Elements of Professional
Relationships
Recommended Learning Activities
Assignment
Resources
Notes
Small Group Discussion
Course Module
and Instructor
Resources
includes 2
examples of
code of ethics
Have employed students share
the code of ethics that they are
working under. Or in small
groups, students might select a
health care profession and
create a code of ethics for their
chosen profession.
Module Competency #2: Professional Relationships
Units #2C: Explain why boundary violations
occur.
Recommended Content
Some of the characteristics of boundary violations and warning
signs are:
 Secrecy
 Professional privilege
 Role reversal
 Double bind
Students tend to have a difficult time understanding some of these. This is provides
an opportunity to have them role play various situations. A person giving conflicting
cues, a patient/client giving their caregiver money for cares/treatment received.
Other examples may include: asking to go on a date, giving advice on what to do
for their particular difficulty…or calling the patient after their shift is completed or on
a day when they are not working to see how they are doing.
Module Competency #2: Professional Relationships
Units #2C: Boundary Violations
 As our culture continues to become a “ME” culture, another
element of boundary crossing is self-disclosure. It is important
to take ample time within in class to discuss this boundary
violation.
 The following 3 slides provide some thoughts for the instructor
to ponder when planning for this class discussion.
(see next slide)
Module Competency #2: Professional Relationships
Units #2C: Boundary Violations
 Excessive Self-Disclosure – The healthcare worker discusses
personal problems, feelings of sexual attraction or aspects of
his or her intimate life with the client.
 Self-disclosure is not simply providing information to another
person. Instead, scholars define self-disclosure as sharing
information with others that they would not normally know or
discover.
 Self-disclosure involves risk and vulnerability on the part of the
person sharing the information.
(see next slide)
Module Competency #2: Professional Relationships
Units #2C: Boundary Violations
Service Time is Not “Me” Time
 While the rule is not to self disclose, only do so when it
substantiates a point that addresses a client’s needs.
 Don’t use your relationship as an opportunity to vent your
feelings. In fact, the rule of thumb: just listen!
 Active listening places the proper focus on your clients’
needs.
 It also creates an environment of trust. If you talk or share too
much, the client may feel like you’re more of a “friend” versus
a healthcare professional. This will ultimately change the
dynamics of your relationship as a healthcare provider.
(see next slide)
Module Competency #2: Professional Relationships
Units #2D: Boundary Violations
 Inappropriate self-disclosure can create confusion for the patient.
 Self-disclosure is considered problematic:
(a) if it discloses the healthcare worker's current needs or problems.
(b) if disclosure is common, rather than rare event during time with
the client.
(c) when there is no clear connection to the patient's problems or
experiences or is not likely to provide encouragement or support.
(d) it comprises more than a few minutes during the time with the
client.
(e) it occurs despite apparent patient confusion.
Module Competency #2: Professional Relationships
Unit #2C: Prevention of Boundary
Violations
Recommended Content
 When addressing boundary violations in a discussion with
students, helping them recognize boundary “warning signs”
can be the best prevention!
 The next several slides will address boundary “warning signs”.
(see next slide)
Module Competency #2: Professional Relationships
Unit #2C: Boundary Violations
 To avoid boundary violations, it may be helpful to be aware
of “warning signs.” In isolation these do not necessarily
indicate a problem, but if repeated or if several warning signs
are present, the healthcare worker should reevaluate his/her
actions “boundary crossings.” (Minnesota Board of Nursing)
(see next slide)
Module Competency #2: Professional Relationships
Unit #2C: Boundary Violations
The following slides list some “warning signs” that healthcare
workers should be aware of.
 This is not an exhaustive list of warning signs, but should be
instructional for all healthcare workers.
 A healthcare worker in any practice setting will encounter
boundary issues.
 With forethought, planning, communication, and evaluation,
the healthcare worker can take steps to ensure a boundary
issue does not progress to a boundary violation.
(Minnesota Board of Nursing)
(see next slide)
Module Competency #2: Professional Relationships
Unit #2C: Boundary Violations
Warning Signs for Boundary Crossings
* Perception
* Dual relationships
* Time
* Meeting time and place
* Gifts
* Confidentiality
* Forms of address
* Choosing sides
* Personal attire
* Self-disclosure
* Making exceptions
* Touch
* Internal cues
* Communication
* Meeting personal needs
(Minnesota Board of Nursing)
Module Competency #2: Professional Relationships
Unit #2C: Boundary Violations
Interesting perspective on boundaries – food for thought…
 In the article entitled, Professional Boundaries in Nursing, it states
“The violations of professional nursing boundaries are almost always
to make ourselves come across to the patient as the victim.”
 A second quote: "Boundaries are mutually understood, unspoken
physical and emotional limits of the relationship between the
patient and the nurse." (Farber, 1997)
 This advice is appropriate no matter what the gender, political
belief, religion, socioeconomic status, ethnicity or sexual orientation
of the patient or the caregiver.
Module Competency #2: Professional Relationships
Units #3: Boundary Violations
Recommended Learning Activities
Assignment
Location
Notes
HCE Competency 2:
Scenarios Personal Professional
Boundaries
Worksheet on
Website
This assignment includes
4 scenarios in which
students evaluate the
situations and whether or
not boundaries are
crossed.
HCE Competency 2
Scenario Red Door
Clinic
This is a scenario
regarding sexually
transmitted diseases and
HIPAA
From Values to Ethics in Competency 3
 Up to this point, the module has addressed the definition and
development of values, personally and professionally. Key
health care values were introduced as well. Professional
relationships, boundaries, boundary violations and their
warning signs were discussed. T
 The ethics will be discussed for the remaining of the power
point.
Competency #3
Describe aspects of ethical decision making in health care
Competency #3: Describe aspects of
ethical decision making in health care
Units in this competency include:
1. Define ethics.
2. Define the code of ethics.
3. Explain the purpose of a code of ethics.
4. Identify steps/framework for ethical decision making.
5. Discuss the difference between legal guidelines and ethical
decision-making.
Module Competency #3: Ethics
Unit #3A: Definition of Ethics
Recommended Content
The module introduces the student to ethics and this can provide for
some lively discussions.
The term ethics has several meanings in common use:
 A method of inquiry that helps people to understand the morality of
human behavior (study of morality)
 The practices or beliefs of a certain group (medical ethics, nursing
ethics)
 The expected standards of moral behavior of a particular group as
described in the group’s formal code of professional ethics.
(Ramont & Niedringhaus)
 Ethics: The study of conduct and character; concerned with
determining what is good or valuable for individuals, for groups of
individuals, professions, and for societies strive to meet. (Potter & Perry)
(see next slide)
Module Competency #3: Ethics
Unit #3B: Code of Ethics
 Code of Ethics: a set of guiding principles that all members of
a profession accept; a collective statement about the
group’s expectations and standards of behavior, reflects the
group’s moral judgments over time, & works as a standard for
their professional actions.
 Codes of Ethics serve as guidelines to assist professional
groups when questions arise about correct practice or
behavior.
(Potter & Perry)
(see next slide)
Module Competency #3: Ethics
Unit #3B: Code of Ethics
 Ethical behavior of the healthcare worker/nursing assistant
includes responsibilities to other caregivers that they work with
as well as ultimately reflecting the care being given, so the
patient is a direct recipient of the caregiver’s Code of Ethics.
 Many students seem to be unaware of what a ‘Code of
Ethics’ is. When asked if their place of employment has a
‘Code of Ethics’ and what is it, they typically will stare straight
ahead.
(see next slide)
Module Competency #3: Ethics
Unit #3B: Code of Ethics
Ethical behavior of the healthcare worker/nursing assistant also
includes responsibilities to the employer. Some of these behaviors are:
 Reporting to work on time
 Reliably fulfilling assignments
 Notifying supervisor when ill
 Working as a team member
 Doing one’s job to the best of his/her ability according to JOB
DESCRIPTION
 Conserving supplies/equipment
Code of Ethics will be addressed on the following slides.
(see next slide)
Module Competency #3: Ethics
Unit #3B: Code of Ethics
Establishment of Code of Ethics
 International, national, state, and provincial nursing
associations have established codes of ethics.
 The American Nurses Association (ANA) established the first
code of nursing ethics decades ago and reviews and revises
the code regularly to reflect changes in practice.
Basic principles remain constant, however:
* Responsibility
* Confidentiality
* Accountability
* Advocacy
(see next slide)
Module Competency #3: Ethics
Unit #3B: Code of Ethics
Origins of Ethical Problems in Healthcare
 Ethical problems in healthcare are due to social and technological
changes and healthcare workers’ conflicting loyalties and
obligations.
 Social Changes: Women’s movement, growing consumerism, large
number of uninsured , high cost of health care, and workplace
redesign under managed care—raise issues about fairness and
allocation of resources (justice).
 Technology: monitors, ventilators, parenteral feedings, (growth of
premature infants), prolong biological life
 Some questions to ask students might be: who should be treated—
everyone, only if they can pay, only those who have a chance to
improve?
(Ramont & Niedringhaus)
Module Competency #3: Ethics
Unit #3C: Purpose of a Code of Ethics
Purposes of a Code of Ethics:
1.
2.
3.
4.
5.
6.
Inform the public about the minimum standards of the profession
and help them understand professional healthcare/nursing
conduct.
Provide a sign of the profession’s commitment to the public it
serves.
Outline the major ethical considerations of the profession.
Provide general guidelines for professional behavior.
Guide the profession in self-regulation.
Remind healthcare workers of the special responsibility they
assume when caring for the sick.
(Ramont & Niedringhaus)
(see next slide)
Module Competency #3: Ethics
Unit #3: Code of Ethics
Recommended Learning Activities
Assignment
Resources
Notes
Compare sample
Codes of Ethics from
various health
professions
Two samples of
codes of ethics
available in Module
Outline and
Instructor Resources
Students to research
Code of Ethics from
a healthcare
profession that they
are interested in.
Code of Ethics
Students create their
own Code of Ethics
for a profession that
interests them
Module Competency #3: Ethics
Unit #3D: Guiding Principles
Recommended Content
The module addresses 8 guiding principles of ethics and asks the student
to identify them. These guiding principles are:
1. Preserve life
2. Do good (beneficence)
3. Respect autonomy
4. Uphold justice
5. Be honest (veracity)
6. Be discreet (confidentiality)
7. Keep promises (fidelity)
8. Do no harm (nonmaleficence)
(see next slide)
Module Competency #3: Ethics
Unit #3D: Guiding Principles
Recommended Learning Activities
Assignment
Location
Notes
Review vocabulary
list
On website and in
Module Outline and
Instructor Resources
Document
Class Discussion
Review Oregon’s
‘Death with Dignity
Act’
Death with Dignity
Act
Class Discussion
Module Competency #3: Ethics
Unit #3E: Framework for Ethical Decisionmaking
Recommended Content
 This unit helps students to understand a rational and systematic method to
make decisions. The key is to identify the ethical principles and code to be
used, rather than emotion.
 On the following slide, let’s take a brief look at ethical theory, ethical
dilemmas and ethical decision-making.
(see next slide)
Module Competency #3: Ethics
Unit #3E: Framework for Ethical Decisionmaking
 Ethical theory examines the different philosophies, systems, ideas, and
principles used to make judgments about what is right and wrong and
good and bad. For example:
 A person who believes that life is sacred may not be able to sanction the
removal of life support services on a client with a severe head injury.
 A person who believes that life begins as conception may not support the use of
birth control methods that prevent implantation (intrauterine devices, morning
after pill).
 Ethical dilemmas occur when the choice available include only
undesirable alternatives.
 Ethical decision-making is the use of a systematic approach that enhances
decision-making and subsequent satisfaction with the decision. (Marquis & Huston)
(see next slide)
Module Competency #3: Ethics
Unit #3E: Framework for Ethical Decisionmaking
Three characteristics of an ethical problem:
 The existence of a conflict of values
 Obligations, loyalties, interests, or
 Needs in a patient care situation, such as
 Disagreement about treatment between health professionals and patients or
health care team members and patients’ families and
 Ethical principles or values are at stake, such as respect for patient autonomy,
doing the least harm, or the values of caring and patient advocacy; and the
situation involves the feelings and values of all key persons involved in the
situation. (Davis, Aroskar, Liaschenko, & Drought)
(see next slide)
Module Competency #3: Ethics
Unit #3E: Framework for Ethical Decisionmaking
Following are 10 steps to follow when making an ethical decision.
1.
Review the overall situation to identify what is going on.
2.
Identify significant facts about the client, including the medical, social
history, decision-making capacity, existence of an advance directive for
treatment.
3.
Identify the parties or stakeholders involved in the situation or affected by
the decision(s) that is made.
4.
Identify relevant legal data
5.
Identify specific conflicts of ethical principles or values
(Davis, Aroskar, Liaschenko, & Drought)
(see next slide)
Module Competency #3: Ethics
Unit #3E: Framework for Ethical Decisionmaking
6.
Identify possible choices, their intent, & probable consequences to the
welfare of the client/clients as the primary concern.
7.
Identify practical constraints, i.e., legal, organizational, political, economic.
8.
Make recommendations for action that are determined to be ethically
supportable recognizing that the possible choices often have positive and
negative aspects.
9.
Take action if your are the decision-maker and implementer of the decision(s)
made.
10.
Reviews and evaluate the situation after action is taken in order to determine
what was learned that will help in resolution of similar situations in client care
and related policy development.
(Davis, Aroskar, Liaschenko, & Drought)
Module Competency #3: Ethics
Unit #5: Framework for Ethical Decisionmaking
Recommended Learning Activities
Assignment
Resources
Notes
HCE Competency 3
Scenarios Ethical
Decisions
Worksheet on
Website
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.
Module Competency #3: Ethics
Unit #3F: Legal Guidelines vs. Ethical
Decision-making
Recommended Content
As the famous saying goes. “Which came first the chicken or the egg?”. Laws
and ethics can be viewed in the same way. For example, there were
abortions being performed, ethical dilemma, and then the laws pertaining to
abortion came into being.
Module Competency #3: Ethics
Unit #5: Framework for Ethical Decisionmaking
Recommended Learning Activities
Assignment
Location
Notes
HCE Competency 3
Project Medical
Ethics Collage.
Worksheet
on Website
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.
HCE Competency 3
Project –
Presentation Ethical
Situations
Worksheet
on Website
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
Competency #4
Explain how an individual’s diversity, socioeconomic or religious beliefs
could lead to potential ethical differences with that of other health
care employees
Module Competency #4: Explain how an individual’s
diversity, socioeconomic or religious beliefs could lead to
potential ethical differences with that of other health care
employees
Units included for this competency include:
 Identify possible factors that may contribute to ethical
differences between employees
Module Competency #4: Diversity
Unit #4A: Ethical differences between
employees
Recommended Content
 Ethical differences between any two people can be
drastically different and can may times cause tension,
arguments, broken relationships and be the beginning of an
ethical dilemma.
 The curriculum address 3 factors in which these differences
may develop.
 Personal issues
 Diversity issues
 Status issues
(see next slide)
Module Competency #4: Diversity
Unit #4A: Ethical differences between
employees
 Ethical differences may come about due to personal issues.
Personal issues are broken down into the following.
 Lack of knowledge – people often times fear what they don’t
understand
 Previous experience – if a person’s previous experience is a
negative one, why would their next experience be any different
 Lack of self confidence – a lack of knowledge in the area
 Fear of being misunderstood – if a person is pro-choice does that
mean they support abortions? Maybe not.
(see next slide)
Module Competency #4: Diversity
Unit #4A: Ethical differences between
employees
 The second factor that contributes to ethical differences
between employees is diversity issues.
 The 4 areas of diversity that the curriculum addresses are:
1. Ethnic
2. Gender
3. Political
4. Religious
 It is safe to say that these areas need no explanation and yet
can provide for hot and interesting discussion among the
students.
(see next slide)
Module Competency #4: Diversity
Unit #4A: Ethical differences between
employees
 The third and finally factor that may contribute to ethical
differences between employees is status issues.
 Two part of status issues need to be addressed and they are:
 Social – everyone desires to be accepted, liked and even loved
 Financial – often times a person’s self worth is directly related to
how much money they have or how much money it looks like
they have.
Module Competency #4: Diversity
Unit #1: Ethical differences between
employees
Recommended Learning Activities
Assignment
Location
Notes
HCE Competency 4
Ethical and Legal
Dilemmas
Website
This learning activity
lists 7 thought
provoking ethical
and legal questions
for discussion.
Review Oregon’s
‘Death with Dignity
Act’
Death with Dignity
Act
Class Discussion
Competency #5
Using an ethical decision making model applied to health care
situations, describe how ethics influence the care of clients
Competency #5: Ethical Decisions
Unit #5A: Ethical Dilemmas Definition
Recommended Content
Ask.com defines an ethical dilemma as “a situation wherein moral
precepts or ethical obligations conflict in such a way that any possible
resolution to the dilemma is morally intolerable. In other words, an ethical
dilemma is any situation in which guiding moral principles cannot
determine which course of action is right or wrong.”
The following slide also addresses the issue of ethical dilemmas.
(see next slide)
Competency #5: Ethical Decisions
Unit #5A: Ethical Dilemmas Definition
 Responsible ethical reasoning is rational and systematic; should be based
on ethical principles and codes rather than on emotions, intuition, fixed
policies, or precedent. (Precedent is an earlier similar occurrence.)
 Good decision is in client’s best interest and preserves the integrity of all
involved.
 The healthcare worker must weigh competing factors when making ethical
decisions because of the ethical obligations to clients, the employing
agency, and to physicians.
 Because several people are involved in ethical decision-making,
communication and compromise are important skills for all health
professionals.
 Integrity-preserving compromises are likely collaborative decision-making.
(Ramont & Niedringhaus)
(see next slide)
Competency #5: Ethical Decisions
Unit #5B: Current Ethical Dilemmas
 Over the course of time as value and ethics have changed, society
continues to be presented with ever changing ethical dilemmas. For
example, were abortions an ethical dilemma before Roe vs. Wade?
 Some of the current health care ethical dilemmas are that of end of life
care , genetic testing, quality vs quantity of life, organ donation, final
trimester abortions, etc.
Tips for presenting materials
Clearly not all of today’s ethical dilemmas can be discussed, however being
sensitive to a person’s race, religious beliefs, political beliefs, etc. is of the utmost
importance. It is also important to remember that this is not a political science class.
(see next slide)
Module Competency #5: Ethical Decisions
Unit #2: Current Ethical Dilemmas
Recommended Learning Activities
Assignment
Location
Notes
HCE Competency 5
Scenarios Bioethical
Case Studies
Website
This learning activity contains 6
scenarios with questions to
answer regarding bioethical
issues. Topics include DNR,
HIV, Labor, Medication,
Immunizations and Anorexia.
Grey’s Anatomy
Ethical Dilemma
YouTube
Video
Class Discussion
Module Competency #5: Ethical Decisions
Unit #5C: Problem Solving
Recommended Content
The problem solving process can be broken down into 10 steps. They are as follows:
1. Identify the problem
2. Gather information
3. Identify ethical issue
4. Is there more than one problem
5. Are there competing ethical claims
6. Any conflict of personal values?
7. Any conflict of professional values?
8. Create alternative solutions
9. Select and act on solution
10. Evaluate and revise as needed
Module Competency #5: Ethical Decisions
Unit #3: Problem Solving
Recommended Learning Activities
Assignment
Location
Notes
HCE Competency 5:
Scenarios Ethical
Case Study
Website
This learning activity
contains 4 short
scenarios in which
students answer
questions surrounding
the scenarios.
This completes the
curriculum for
Healthcare Ethics.
(see next slide)
What to do now?
 You’ve now been introduced to Health Care Ethics.
 Presented were key points found on the instructor resource
outline and several possible learning activities to use.
 You received tips on teaching the material, along with areas
to be sensitive to with students.
 Now, click on the “Assessments” tab and complete the
Healthcare Ethics Self Assessment.
 You are invited to go to the website to preview additional
learning activities, PowerPoints, assessments, etc.
 You are encouraged to use the instructor learning resource
module outline to make notes on which online resources
would benefit you and your teaching style.
Accessing HealthForce Minnesota
To access the HCCC curriculum go to:
1. www.healthforceminnesota.org/Curriculum.htm
2. Click on Health Care Core Curriculum
3. Click on Curriculum (Password Protected)
A. Password: HCCC
4. Select desired module to view
“This workforce solution was funded by a grant awarded by the
U.S. Department of Labor’s Employment and Training
Administration. The solution was created by the grantee and
does not necessarily reflect the official position of the U.S.
Department of Labor. The Department of Labor makes no
guarantees, warranties, or assurances of any kind, express or
implied, with respect to such information, including any
information on linked sites and including, but not limited to,
accuracy of the information or its completeness, timeliness,
usefulness, adequacy, continued availability, or ownership.”
This work by the Health Professions Pathways (H2P) Consortium, a
Department of Labor, TAACCCT funded project is licensed under
a Creative Commons Attribution 3.0 Unported License.
This power point created by:
Dede Carr, BS, CDA, LDA
Pat Reinhart, RN
References
 College of Registered Nurses of British Columbia (CRNBC). (2011). Practice
standard principles. Retrieved from
https://www.crnbc.ca/Standards/ClientRelationships/Pages/Default.asp
 Hegner, B.R., Acello, B., & Caldwell, E. (2004). Nursing assistant: A nursing
process approach (9th ed.). Clifton Park, NY: Thompson Delmar Publishing
 Lane, A. (2009). The importance of accountability. Retrieved from
http://EzineArticles.com/3471801
 Potter, P.A. & Perry, A.G. (2009). Ethics and values. In P.A. Potter & A.G.
Perry (Eds.). Fundamentals of nursing (7th ed.) (pp. 313-342). St. Louis, MO:
Elsevier, Mosby
 Ramon, P.R. & Niedringhaus, D. M. (2008). Legal and ethical issues of
nursing. Fundamental nursing care (2nd ed.) (pp. 25-44). Upper Saddle River,
NJ: Person Prentice Hall
 Weiss, T.C. (2009, July 21). Certified Nursing Assistant Code of Ethics.
Retrieved from http://www.disabled-world.com/disability/caregivers/cnacode-ethics.ph
You have completed
Heath Care Core Curriculum
Healthcare Ethics
Congratulations!!!
Complete the “Self Assessment” found
under “Assessments”.