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1. Understand and apply relevant legal, regulatory and governance requirements within the context of health and social care settings

Module Title: Ethical and Legal Decision Making in the Context of Nursing

AIMS AND SUMMARY

 This module will introduce students to the underlying principles of healthcare ethics, legislation and social policy. This will include the protection of vulnerable people across the lifespan including those with complex needs. Students will be equipped to recognise ethical challenges relating to people`s choices and decision-making about their health and wellbeing across care settings. Ability to act within the law to help service users, families and carers to manage needs will be explored.

INTENDED MODULE LEARNING OUTCOMES

The intended learning outcomes are that on completion of this module you should be able to:

1. Understand and apply relevant legal, regulatory and governance requirements within the context of health and social care settings

2.    Understand the need to base all decisions regarding care and interventions on people’s needs and preferences particularly for those who lack mental capacity

3.    Analyse the use of ethical frameworks and underpinning health and social care policy within nursing practise

4.   

The student will write a 2000 word (excluding references) essay. Select a service user or child and family  that you  have worked with in your previous practice placements, ideally this would be over a period of time not a one off interaction. Your field leads have also written some case studies for you to utilise should you choose to.The assignment will draw upon relevant ethical theoretical concepts and  healthcare/ social policy underpinning the decisions made in respect of an individual’s care.   Key to this work is an analysis of your (the nurses)  role in supporting decision making  for the people in your care in terms of advocacy and supporting patient’s rights and autonomy. Appropriate references must be evident with national and /or professional guidelines to support your clinical judgements and shared decision making processes.

 ******Please use the attached assignment scenario****

Assignment focus:

The essay needs to clearly focus on one case the student has cared for in clinical practice. The assignment should offer a clear structure that is logical, sequential, and systematically progressive in nature.

The following framework is a guide that you might find useful to organise your assignment. The sub-headings are:

1.       Introduction

2.       Background/ Short case summary

3.       Identification of key ethical issues involved in this person’s/child’s care supported by underpinning theory

4.       Critically analyse the concept of ethical decision making and ethical frameworks. Using a framework interpret and apply current health and social care policy, and law/legislations relevant to your case study and how they are utilised to support rationale in ethical decision making. You should draw on other relevant ethical theories.

5.       Appraise the nurses’ role in this individual’s care acknowledging resources to support decision making- you will do this throughout when critically discussing the decision making process however you may wish to appraise the role of the nurse in general terms separately. 

6.       Conclusion

7.       References

The context and content should reflect a contrast and balance of ideas, and reasoning to support the module learning outcomes:

2. Understand the need to base all decisions regarding care and interventions on people’s needs and preferences particularly for those who lack mental capacity 

3. Analyse the use of ethical frameworks and underpinning health and social care policy within nursing practise 

4. Appraise the role of the nurse in shared decision making in order to support individuals, their families and carers to receive person-centred care

Confidentiality

Please do not breach confidentiality by identifying the name of the person/ child or any family members or the location of the clinical setting. Change personal details to protect confidentiality and state this in your introduction. Any contravention of confidentiality will result in an automatic fail.

Suggested assignment guidelines

Introduction

The introduction begins with a general statement to introduce the main subject area and to set the context for the discussion. The introduction offers the reader a broad background of information into your key ethical challenges and outlines all the ideas you are going to present in the assignment, such as: 

·         A statement/ definition of the importance of the topic and the context ,background of and care delivery

·         Introduce  how you will structure the work linked to the learning outcomes

·         Introduce  the service user/child you have choses

·         Include statements dealing with confidentiality were necessary 

Background  

Background information refers to a concise summary of the clinical & wider detail of this persons’ care which is relevant to the issues that you later discuss, appendix can be used for detailed description.

Physical health

Mental health

Family and other relationships

Social circumstances- employment, religious/spirit ual beliefs, sexuality etc..

Age and development (where appropriate)

 ***BE BRIEF HERE PLEASE, DETAILED INFO CAN GO TO APPENDIX***

Impact of all of the above on ability to make decisions for self.

You may choose to use on of the pre-prepared case studies available to you on Moodle or work with your seminar leader to create your own based on a particular interest or your experience in practice.

 Key ethical challenges

The identification of  the key ethical challenges starts the main body of the assignment where your paragraphs will develop your discussion and ideas to demonstrate your knowledge of the topic, by including relevant evidence, analyse and evaluate  your material, such as:-

Mental capacity- how much input did the person/child have into decision making and why?

What were the challenges to the person/child receiving care in making treatment choices?

Were the individual’s human rights respected and if not, why not?

Was there conflict between treating teams and the person/child and/or family/significant others regarding preferred options for care

Please consider the learning outcomes when writing your report.  Discuss the concept of ethical decision making in the context of nursing. Discuss the use of ethical frameworks and present reasoning for your preferred model (s). 

Utilise your preferred ethical model(s)/princip les from the module as a framework for aiding decision making and identifying key issues regarding this person/child’s treatment. In each step of the framework you should drawing on relevant policy/guideline s and legislation/case law to critically discuss each step of the decision making process- how do they apply and how influential are they (details below) You should also refer to the role of the nurse in each stage of your framework where applicable (see section below).

You should also try and demonstrate knowledge of other ethical theories and ethical concepts relevant to your case, for example, Utilitarianism and Consequentialism , Deontology/Duty based ethics, Virtue Ethics, ‘Truth Telling’. The concept of Paternalism is always a poignant consideration for many case studies especially when involving vulnerable patients/service users.

 Consider local/national resources available to support ethical practice and professional guidance in relevant areas of practice as outlined in the module or experienced in practice.

health and social policy/

guidelines/

legislation/ case law

As above, throughout the assignment identify which health and social policy and guidelines were relevant to this case and draw on them where relevant. You should also identify and discuss relevant legislation and case law relevant to your case study where appropriate. For example you may NICE Guidelines, NHS Constitution, Person-centred planning, Advance Care Planning, DNACPR, Health and Social Care Act (2012), Codes of Practice  for the MCA,( 2007), Liberty Protection Safeguards, Mental Health Act (1983 & 2007), Children Act (1989 & 2004), Human Rights Act (1998) and the Equality Act (2010).

 Evaluate the impact that current health and social policy/guideline s had on this person/child’s care. 

Show understanding of whether local/national strategies for supporting health/social care in this instance- are they fit for purpose? Are they helpful?

Support all of your points with relevant policy, legislation or documents (reference to support claims).

Appraise the nurses’ role

Consider the role of the nurse within concepts of advocacy, assessment of capacity and professional obligations/duties to do so. You will be referring to this throughout the assignment however it may also be helpful to discuss this in more detail in a separate section just before the conclusion (avoid unnecessary repetition however! Think carefully about your structure- it’s always a good idea to map out your assignment first).

Accountability and Advocacy.

Risk of Paternalism?

Virtue Ethics/The need for nurse to be ethical practitioners/Compassion Fatigue?

Are there limitations to the nurses’ role within decision making? 

How is this relevant to the changing role of the nurse and future standards of education and proficiencies/co mpetencies?

How can conflict best be resolved?

What resources exist to support nurses and others in managing complex ethical, legal and policy issues?

Relate the above to your chosen person/child’s care and reflect on professional/national guidance to support practitioners in your field and draw from other’s where appropriate.

Conclusion

You are not required to add any new information. You are summarising what you have discussed and reiterate some of the key point

RECOMMENDED READING AND REFERENCE MATERIAL PLEASE SEE 203NHS MOODLE SITE WHICH WILL BE UPDATED REGULARLY. WE ARE AWARE THAT THE LIBRARY IS CLOSED AND SOME OF THE RESOURCES ON THIS LIST ARE NOT AVAILABLE AS E-RESOURCES SO HAVE COMPILED AS LIST OF ALTERNATIVES AVAILABLE IN ‘MODULE ESSENTIALS’

Cranmer, P. and Nhemachena, J. (2013) Ethics for Nurses- Theory and Practice.University of Huddersfield: Open University Press

Cuthbert, S. and Quallington, J. (2017) Values and Ethics for Care Practice. Lantern

Griffin, R. and Tengnah, C. (2020) Law and Professional Issues in Nursing, 5th edition.Swansea Univeristy: Sage.         

Herring, J, (2018) Medical Law and Ethics, 7th edition. Oxford. Oxford University Press.

Avery, G, (2016) Law & Ethics in Nursing and Healthcare – An Introduction, 2nd edition. Essex University: Sage

Beauchamp, T., and Childress, J. (2013) 7th edition. Principles of Biomedical Ethics. New York: Oxford University Press

Bradshaw, P., and Bradshaw, G. (2010) Health Policy for Health Care Professionals. London: Sage

Dimond, B. (2016) Legal Aspects of Mental Capacity: A Practical Guide for Health and Social Care Professionals, 2nd ed, Oxford: Wiley-Blackwell Publishing.

Dimond, B. (2011) Legal Aspects of Nursing. England: Pearson Longman

Graham, M. and Cowley, J. (2015) A Practical Guide to the Mental Capacity Act 2005. Jessica Kingsley Publishers.

Selman, D. (2011) What makes a Good Nurse- Why the Virtues are Important for Nurses. London: Jessica Kingsley Publishers.

Seedhouse, D. (2009) Ethics: The Heart of Health Care. Chichester: John Wiley and Sons

Essential Legislation/general policies for Ethical decision making- These are some key resources that should apply to the vast majority of scenarios for you assignment.

Capacity Act Code of Practice File

NHS Long Term Plan (2019) following on from `5 year forward view`URL

NHS Five Year Forward View File

Health and Social Care Act 2012 File

DOLs Code of PracticeFile

MCA GuideFile

Example case study- published articleFile

The Right to ConsentFile

Principles of Consent- RCNFile

Human rights and nursing (copy)File

Health and Social Care Act 2012File

NHS Constitution- The Virtues required for practice!File

Fundamentals of Nursing- BookletFile

NMC Code 2018File

NHS Long term PlanFile

Mental Capacity Code of PracticeFile

Ethics of consent- UKCENURL

Equality Act 2010URL

Human rights Act- Schedule One- The ArticlesURL

Mental Capacity ActURL

Guide to Ethics (including some pros&cons)URL

2019 Amendment o the Mentla Capacity Act in relation to depriving someone of their LibertyURL

British and Irish Legal Information Institute (BAILII)URL


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