Ethics for the Practicing Nurse

Module 3 Title: Shared Healthcare Decision Making and Informed Consent

Date of Module:           June 3 – June 16, 2018

Module Overview:

Have you ever treated a patient while wondering if the patient really understands the risks and benefits of the treatment you are providing?  Do you often find patients are uncertain about their treatment decision?  Many systems in healthcare are designed for efficiency and do not provide the information or time patients need to make informed choices.  Further the process of informed consent may be primarily designed to protect the physician and healthcare organization, not the patient.  (Spatz, Krumholz, & Moulton, 2016)  Nurses are well positioned to serve as patient advocate and educator.  In this module we are going to explore how to better support our patients through shared healthcare decision making and informed consent. 

Learning Objectives

After completing this module, students will be able to:

  1. Identify an ethical dilemma from personal practice and describe what created the dilemma.
  2. Describe the process of shared healthcare decision making.
  3. Describe the elements of informed consent.
  4. Identify two new actions for addressing ethical dilemmas related to share healthcare decision making or informed consent.

Online Learning Course Content

Learning Theory

Learning Theory Overview & Premise

Ethics courses are often designed utilizing a student centered approach with the aim of developing the student’s ability to identify ethical issues, critically think, and formulate actions. (Berry, Borenstein, & Butera, 2011; Bownie & Clarkburn, 2015). I believe using Jerome Bruner’s Constructivist theory and the Problem Based Learning (PBL) theory, which is a Constructivist theory, can help guide me to develop a module that is both student centered and supports the needs of my adult learners.

A main theme of Bruner’s Constructivist theory is learning is an active process that builds on the learner’s previous experience and knowledge, the learner is “constructing” knowledge. (David, 2014). Constructivism is a bottom up approach, always adding new knowledge that when combine with existing knowledge opens up opportunities to see new possibilities. This theory posits that learning is an iterative process of thinking, reflecting, and rethinking done in collaboration with an instructor and peers. (Sadera, O’Neil, & Gould, 2014).

PBL theory uses the principles of Constructivist theory with the addition of a problem as the central focus or trigger for learning. The problem stimulates questions, the search for new information, individual reflection, group dialogue and ultimately a greater understanding of the problem. (Dolmans & Gijbels, 2013; David, 2014). Four phases make up the PBL process. During the first phase students are introduced to the problem and as a group identify learning needs. The students engage in self directed learning activities during phase two. The group comes back together for phase three when learners share their individual learning. During the fourth phase the gathered information is summarized and used to develop a solution to the problem. (Sadera, O’Neil, & Gould, 2014).

References

Berry, R., Borenstein, J., & Butera, R. (2013). Contentious problems in bioscience and biotechnology: a pilot study of an approach to ethics education. Science & Engineering Ethics, 19 (2), 653-668.

David, L. (2014). Constructivism, in Learning Theories. Retrieved on February 17, 2014 at https://www.learning-theories.com/constructivism.html.

David, L. (2014). Problem-based learning (PBL), in Learning Theories. Retrieved on February 14, 2014 at https://www.learning-theories.com/problem-based-learning-pbl.html.

Domans, D. & Gijbels, D. (2013). Research on problem-based learning: future challenges. Medical Education, 47 (2), 214-218.

Downie, R. & Clarkeburn, H. (2005). Approaches to the teaching of bioethics and professional ethics in undergraduate courses. Bioscience Education, 5 (1), 1-9.

Sadera, W., O’Neil, C., & Gould, K. (2014). Pedagogy associated with learning in online environments. Developing Online Learning Environments in Nursing Education (3rd ed.). New York, NY: Springer Publishing Company.

 

Project Management Plan

Ingram Project Plan

Advanced Preparation Assignment

Introduction

Experienced nurses often face ethical dilemmas on a daily basis and as time passes nurses find different ways to deal with the accompanying emotions.  Many nurses normalize the events making them "business as usual".   Activating and reflection questions are one way to "awaken" these experienced nurse's ability to recognize ethical dilemmas.  This activity has two parts. 

Assignment Part 1

Part 1

Please respond to the following six activating questions by identifying the frequency you experience each scenario in your workplace.  

Do you have concerns that patients, and their families, have not been fully informed about their treatment options?

  • Never
  • Rarely
  • Occassionally
  • Often

Are patients confused about their treatment and its purpose?

  • Never
  • Rarely
  • Occassionally
  • Often

Do you disagree with the patient’s plan of care developed by the provider?

  • Never
  • Rarely
  • Occassionally
  • Often

Have you felt like a medical decision risked the well-being of a patient?

  • Never
  • Rarely
  • Occassionally
  • Often

Do you feel conflicted about administering an ordered treatment?

  • Never
  • Rarely
  • Occassionally
  • Often

Have you worked with a health care professional who you felt was incompetent to help patients make informed medical choices?

  • Never
  • Rarely
  • Occassionally
  • Often

Assignment Part 2

After completing the activating questions go to the course blog to respond to the reflection questions.   

Describe an ethical dilemma you experienced related to either health care decision making or informed consent.  What about the scenario caused the dilemma? How did you respond to the dilemma?

Ethical Dilemmas Reflection Link

Post your response by logging into

https://www.weebly.com/editor/main.php#/

user id = [email protected]

password = Ethics2018

https://ethicsfornurses.weebly.com

Course Readings

Required Course Readings

American Nurses Association. (2015). Code of Ethics for nurses with interpretive statements. Washington, DC: The Association. Available at http://www.nursingworld.org/codeofethics.

Friesen-Storms, J. Bours, G., van der Weijden, T. & Beurskens, A. (2015) Shared decision making in chronic care in the context of evidence based practice in nursing. International Journal of Nursing Studies, 52 (2) 393-402.

Rock, M. & Hoebeke, R. (2014) Informed consent: whose duty to inform? Medsurg Nursing, 23 (3), 189-191.

Optional Course Reading

Cook, W. (2014) Sign here: nursing value and the process of informed consent.  Plastic Surgical Nursing, 34 (1), 29-33.

Web Resources

Resources for Decision Aids and Shared Decision-Making (SDM).

Agency for Healthcare Research and Policy, U.S. Department of Health and Human Services:

Informed Medical Decisions Foundation: http://informedmedicaldecisions.org/

Ottawa Health Research Institute: http://decisionaid.ohri.ca/about.html

Health Dialog:

International Patient Decision Aid Standards (IPDAS) Collaboration:

Healthwise:

Center for Shared Decision Making at Dartmouth/Hitchcock:

Substance Abuse and Mental Health Services Administration (SAMHSA), “Shared Decision Making in Mental Health”:

Mayo Clinic, Shared Decision Making National Resource Center:

US Department of Defense, Military Health System:

Module Assignment

Type & Purpose of Evaluation

            I am proposing three types of evaluation for this module, self reflection, peer feedback and a rubric.  These methods tie together well and enhance student learning.  A self reflection helps the learner identify new knowledge, reflect on that information to consider their reactions and feelings, analyze the usefulness of the information and consider new actions for the future. Peer feedback is a critique of another classmates work designed to enhance learning by exchanging ideas.  Students also benefit from different points of view and experience. (Bonnel & Smith, 2010).  I have designed the reflective journal and peer feedback to be posted on a course Blog site.  Blogs cultivate a learning community.  Through meaningful exchanges students build professionalism, and engage in higher levels of self reflection. (Novakovich, 2016).

            Instructors develop rubrics to provide students guidance in completing assignments and to guide grading those assignments.  This easy to follow evaluation tool also supports instructor feedback, another valuable approach to enhance learning.  I also appreciate that rubrics make grading easier and more consistent.  (Bonnel & Smith, 2010).

Part 1

After reading the required course articles write a reflective journal entry and post your journal entry on the course blog page.  You will need to address each of the following topics in your entry:

  1. Write – briefly describe healthcare decision making and informed consent
  2. Reflect – what are your reactions?  What are your feelings?
  3. Analyze – identify one benefit and one challenge of each (healthcare decision making and informed consent)
  4. Personal action plan – what steps are you going to take on the basis of what you have learned?

Part 2

Provide feedback to two of your peers.  Peer feedback should include a new insight or learning you gleaned and how you might use that learning in the future

Assignment Rubric

Refection Journal Grading Rubric

Reflective Journal Link

Post your response by logging into

https://www.weebly.com/editor/main.php#/

user id = [email protected]

password = Ethics2018

https://ethicsfornurses.weebly.com

Module Evaluation

Please provide feedback on your experience  with this module by answering the following five questions.

The course module provided an appropriate balance between instruction and practice.

  • Never
  • Sometimes
  • Frequently
  • Always

The course module was effectively organized.

  • Never
  • Sometimes
  • Frequently
  • Always

The instructor provided me with useful feedback on my writing.

  • Never
  • Sometimes
  • Frequently
  • Always

How satisfied are you with your effort on this course module?

  • Unsatisfied
  • Somewhat satisfied
  • Satisfied
  • Very satisfied

Please identify area(s) where you feel this course module could be improved.

Module References

References

American Nurses Association. (2015). Code of Ethics for nurses with interpretive statements. Washington, DC: The Association. Retrieved on April 23, 2018 at http://www.nursingworld.org/codeofethics.

Bonnel, W. & Smith, K. (2010). Teaching technologies in nursing and the health professions. New York, NY: Springer Publishing Company.

Cook, W. (2014) Sign here: nursing value and the process of informed consent.  Plastic Surgical Nursing, 34 (1), 29-33.

Friesen-Storms, J. Bours, G., van der Weijden, T. & Beurskens, A. (2015) Shared decision making in chronic care in the context of evidence based practice in nursing. International Journal of Nursing Studies, 52 (2) 393-402.

Garrity, M. (2013). Developing nursing leadership skills through reflective journaling: a nursing professor’s personal reflection. Reflective Practice, 14 (1), 118-130.

Helyer, R. (2015). Learning through reflection: the critical role of reflection in work-based learning (WBL). Journal of Work-Applied Management, 7:1, 15-27.

Northern Illinois University, Faculty Development and Instructional Design Center. Reflective Journals and Learning Logs. Retrieved fromhttps://www.niu.edu/facdev/_pdf/guide/assessment/reflective_journals%20and_learning_logs.pdf

Novakovich, J. (2016). Fostering critical thinking and reflection through blog-mediated peer feedback. Journal of Computer Assisted Learning, 32 (1), 16-30.

Raterink, G. (2016). Reflective journaling for critical thinking development in advanced practice registered nurse students. Journal of Nursing Education, 55 (2), 101-104.

Rock, M. & Hoebeke, R. (2014) Informed consent: whose duty to inform? Medsurg Nursing, 23 (3), 189-191.

Sadera, W., O’Neil, C., & Gould, K. (2014). Pedagogy associated with learning in online environments. Developing Online Learning Environments in Nursing Education (3rd ed.). New York, NY: Springer Publishing Company.

Stefano, G. D., Gino, F., Pisano, G. & Staats, B. (2014). Making Experience Count: The Role of Reflection in Individual Learning. Harvard Business School NOM Unit Working Paper No. 14-093; Harvard Business School Technology & Operations Mgt. Unit Working Paper No. 14-093. Available at SSRN:https://ssrn.com/abstract=2414478 or http://dx.doi.org/10.2139/ssrn.2414478

Zori, S. (2016). Teaching critical thinking using reflective journaling in a nursing fellowship program. Journal of Continuing Education in Nursing, 47 (7), 321-329.