The Ethics Committee: A Role-playing
Exercise
Jan Buttler and Candice Knight, Nursing Two members of the nursing faculty show how students can be taught
not only ethics, but also how nursing professionals actually contribute
to the resolution of real ethical dilemmas.
Ethical Issues in Health and Physical
Education
Sally Custer, Physical Education and Recreation A professor of physical education notes that people don't
often think
of her discipline as one that deals with issues of ethics and values, then
lists just some of the issues that do, in fact, arise routinely in her
courses.
The Ethics Committee: A Role-Playing
Exercise
by Jan Buttler and Candice Knight, Nursing
Trends in Nursing is a course designed to help the student nurse
move into
the "real world" of professional nursing. In this course students
explore the historical, philosophical and legal aspects of nursing practice.
They examine contemporary issues facing nursing and the influence of societal
trends on nursing practice.
Because of the advances in modern medicine and the expansion of scientific
knowledge, nurses are faced with complex ethical issues on a daily basis.
Hospitals have created ethics committees to resolve issues and share the
responsibility for their resolution. In order to expose the students to
the difficulties these committees face and to reinforce the need for
decision-making
models to help nurses make ethical decisions, we divide the class into small
groups and ask them to function as ethics committees. They are asked to
resolve a case study using a decision-making model discussed in class.
The Decision-making Model
The decision-making model that we teach is similar to a crisis-intervention
process, which takes into account legal as well as ethical issues. This
is a seven-step process:
· Gather facts, including who the decision makers are and whether they
follow situational, end-
result ethics or legalistic, duty ethics.
· State the problem.
· List alternative solutions.
· State ethical principles, laws, consequences, advantages and
disadvantages
from the decision-
maker's viewpoint for each alternative.
· Assist decision makers to choose a solution based on their ethical
position.
· Provide emotional support for all affected persons.
· Evaluate the decison-making process and its results.
Case Studies
Two patients on the unit have the same last name and are in adjacent rooms.
Seconal is prescribed for one and Nembutal for the other. The evening
nurse switches their medications. She discovers her error after the second
patient swallows the capsule and remarks that he had had a yellow capsule
the night before. The nurse has made two other medication errors in the
past year and has been warned that if another occurred she would be
dismissed.
She is the sole support of three children and needs to work. How should
she decide what to do? What should she do?
A 42-year-old woman is pregnant for the first time. Her physician has
recommended
that she have an amniocentesis to find out if the baby has any birth defects
such as Down's syndrome. Her church opposes this procedure and teaches
that a woman is to obey her husband. Her husband is not religious and tells
her he wants the amniocentesis done. She has told the office nurse of her
quandary. How might the nurse help her decide what to do?
A 28-year-old part-time janitor has just found out that she is pregnant
for the fourth time. She has had three prior abortions. She has decided
to leave the man with whom she lives because he beats her. She is a new
convert to a religion that is strongly opposed to abortion. Her job pays
too little to support her and a baby and she says that she is morally opposed
to "going on welfare." Her only support system is her mother,
who lives in a nearby town. She has come to a health center. How might a
nurse counselor help her decide what to do?
Two men on the same hospital unit have a cardiac arrest within moments of
each other. The first arrest is a bitter 80-year-old man with many health
problems. The other is a 42-year-old editor of the local newspaper, a husband
and father of five children. There is only one cardiopulmonary resuscitation
cart. The physician who is present is asked to decide who to resuscitate
first. How might she reason out the answer?
Conclusion
At the conclusion of this exercise the students expressed a great deal
of respect for ethics committees. They all agreed that it is impossible
to completely understand the difficulty involved in resolving an ethical
dilemma until one is exposed to the decision-making process. Each year this
exercise proves to be a valuable learning experience for the students.
Ethical Issues in Health and Physical
Education
By Sally J. Custer, Health and Physical Education
We don't always think of Health and Physical Education as a discipline
involving
ethical issues. In fact, the issues in the discipline go well beyond the
obvious ones of encouraging fair play and stressing safety. Below is a list
of some of the topics I deal with in my Health and P.E. classes each time
I teach them.
Prevention and Care of Athletic Injuries: Includes study
of bone and muscle movements, measures (such as taping) to prevent athletic
injuries, and other topics such as heart attack, heat stroke and heat
exhaustion.
Ethics/Values Topics:
The use of ergogenic aids to enhance performance in athletic competition
Whether or not to use injured athletes in competition; issues of faulty
equipment and dangerous weather; legal liability and negligence; acts of
omission and commission
Exercise Physiology and Body Mechanics: Explores the effects
of exercise and nutrition on the human body, and examines the benefits of
both aerobic and anaerobic activities as well as exercise programs.
Ethics/Values Topics:
The use of human subjects for research in exercise science
Drugs and sports (e.g. anabolic steroids)
First Aid & CPR: Acquaints students with emergency
first aid procedures and cardiopulmonary resuscitation.
Ethics/Values Topics:
Administering first aid procedures to victims with diseases
(AIDS, tuberculosis,
etc.)
Citizen response to and involvement in emergency situations
Elements of Physical Fitness: Explores basic concepts of
physical fitness to provide students with a means for self-evaluation with
the goal of developing and maintaining fitness.
Ethics/Values Topics:
Problems facing overweight and obese people
Fraud and quackery in diet; nutrition and exercise programs; and cures
for disease
Special fitness problems facing the elderly, often complicated by
socioeconomic
circumstances
Whose responsibility is it to care for the elderly?
Lifeguard Training: Introduces lifesaving techniques.
Students
successfully completing the course are certified in Advanced Lifesaving,
C.P.R., and Standard First Aid.
Ethics/Values Topics:
Preventive lifeguarding: discipline and control at public
facilities; alcohol
and drug use at public
facilities; appropriate use of police assistance with patrons;
sexual misconduct
at public facilities
A Teachable Moment in Nursing of Adults
II: Renal Diseases/Multi-System Involvement
By Rosalia Hamilton, Nursing
Mr. Sisco, a 36-year-old engineer, has just been admitted to your unit with
a diagnosis of an AIDS-related pneumonia. He is very thin and emaciated;
has frequent diarrhea; frequent cough; white patches on his tongue and buccal
surfaces; reddened, purplish patches in the axilla and groin; decreased
urinary output; and a distended abdomen. As you enter the room he says,
"I'm so sick. I just want to die."
· How will you carry out your assessment?
· How will you organize your care considering the issues of autonomy,
beneficence, maleficence, justice?
· How will you prioritize nursing diagnosis?
· How will you respond to his verbal statement?
· What case management principles are applicable?
· What nutritional interventions are appropriate?
· Which pharmacotherapeutics do you expect will be ordered?
· Which growth and development aspects are affected by changes caused
by illness?
· What kinds of universal precautions should be imposed?
· What educational needs does this client exhibit?
· How will you assist him in completing the Advance Directive form?
· What are your professional responsibilities when assigned to care
for this client?
· What personal issues do you need to clarify in order to provide
care that is humane, compassionate and caring?
· What diagnostic studies do you anticipate will be necessary in order
to diagnose the cause of the symptomatology?
· What treatments do you anticipate will be utilized?
· What clinical syndromes/events can ensue as a result of the organ
system involvement exhibited by this client?
· How will you assess for AIDS-related cognitive and behavioral
changes?
· For which psychosocial, cultural and spiritual aspects do you need
to assess?
· What kinds of referrals should be made?
By using this method, the preponderance of content that is laden with ethics
and values is addressed. The case method also serves to emphasize the value
of incorporating the teaching of ethics content areas throughout courses
and programs so that students will be equipped to address these issues in
the workplace and in their personal lives.