Benny Holland, RN, MPH EDHP 501: Curriculum Design April 13, 2014

Curriculum Topic: Nursing Professionalism & Ethics

Audience:

Bachelor of Science in Nursing (BSN) students, senior year

Problem Statement: Nurses provide care to patients within professional guidelines which include legal, moral, ethical, regulatory, and humanistic principles. Failure to demonstrate knowledge, attitudes/behaviors, and skills consistent with these principles can harm patients, patient families, coworkers, the nurse, the nurses family, the community, the nursing profession, and the institution where the nurse practices. A Needs Assessment was conducted on first semester BSN students to evaluate common knowledge of nursing professionalism and ethics (see Appendix A for Needs Assessment instrument). Analysis of the Needs Assessment data indicated over 90% of students lacked sufficient knowledge of nursing professionalism and ethics to provide appropriate responses to questions on the topic. A portion of the National Council Licensure Exam (NCLEX) asks questions designed to evaluate the nursing students comprehension of legal, moral, ethical, regulatory, and humanistic aspects of being a registered nurse and the registered nurse candidate is required to pass the NCLEX for licensure. Avoiding harm to patients, families, communities, and the nursing profession, along with the requirement to pass the NCLEX for licensure as a registered nurse, constitutes a need to educate, train, and verify that all nursing students are proficient in demonstrating professionalism by adhering to these legal, moral, ethical, regulatory, and humanistic principles before graduating from a nursing program. The successful completion of this course will provide BSN students the knowledge, skills, attitudes, and abilities to practice as a registered nurse in the state of Texas.

Curriculum Goals: 1. At the end of this course, all nursing students will have an understanding of the legal, moral, ethical, regulatory, and humanistic principles/issues related to nursing practice.

2. By the end of this course, all nursing students will demonstrate competence in applying legal, moral, ethical, regulatory, and humanistic principles to make decisions appropriate to the standards of nursing practice in the delivery of health care. 3. During this course, all nursing students will experience simulated legal, moral, ethical, regulatory, and humanistic principle dilemmas designed to encourage critical thinking and application of knowledge gained in order to stimulate introspection and consideration of personal values, standards of the nursing profession, and legal requirements of the registered nurse.

Nursing Professionalism and Ethics will be introduced by a guest speaker who is a registered nurse and also a practicing lawyer in Texas. The guest speaker will provide an overview of the major topics the course will cover and how those topics may and are currently affecting the delivery of nursing care today.

Curricular Content Unit 1

Unit Name Legal and Regulatory Aspects of Nursing Unit Summary This unit is designed to provide students with an understanding of the Texas Nursing Practice Act (Nursing Practice Act, Nursing Peer Review, and Nurse Licensure Compact as amended September 2013) and other regulatory aspects of the practicing registered nurse. Included with the didactic content is the need for continual review and future learning to ensure ongoing compliance with the Nursing Practice Act and other regulatory aspects as they evolve. The class will be conducted in the lecture hall; dates and time to be determined. Materials include a copy of the Texas Nursing Practice Act, handout materials related to nursing legal requirements and regulations, and written case studies involving nursing legal and regulatory scenarios to be used in clinical simulation or problem based learning exercises. Activities will consist of quizzes, short narrative responses to case studies, and clinical simulation scenarios. Problem based learning sessions will provide an alternative to clinical simulation scenario activities in the event of simulation laboratory scheduling issues. Unit Essential Questions What is the Nursing Practice Act? Who regulates nursing practice in the Unit Enduring Understanding Students will understand that The Nursing Practice Act is legal requirements for practicing as a registered nurse.

state of Texas? What is the scope of practice of a registered nurse? What are the sanctions for violations of the Nursing Practice Act? What is Nursing Peer Review? What is the Nurse Licensure Compact? What constitutes safe nursing practice? What are Continuing Education Units and how do they affect nursing licensure? What are nursing professional standards of practice?

Nursing practice has defined limits to the delivery of health care as a registered nurse. The Peer Review process is intended to evaluate adverse events related to nursing practice and determine a response to a complaint. The Safe Harbor Act protects nurses from action by the Texas Board of Nursing when place in situations affecting the safe delivery of nursing practice. Compliance with the Nursing Practice Act and other regulatory aspects of nursing is mandatory and enforceable Identify components of nursing standards of practice

Unit Knowledge Expectations Students will know. Where to find and how to use the Texas Nursing Practice Act What is contained in the Nursing Practice Act How to conduct themselves as a registered nurse When and how to invoke the Safe Harbor Act What the scope of practice for a registered nurse permits in the delivery of health care this includes an understanding of other professional scope of practices The requirements of Continuing Education for nursing licensure The scope of practice and standards of practice for registered nurses

Unit Skill Expectations Students will be able to. State specific rules contained in the Nursing Practice Act Identify the date of the current Nursing Practice Act and how to locate it Implement a plan of care within the legal, and regulatory framework of the Texas Nursing Practice Act State when it would be necessary to invoke the Safe Harbor Act State when and why the Peer Review process is implemented and what types of recommendations may result Demonstrate application of the Nursing Practice Act and nursing regulatory requirements during clinical simulation scenarios or problem based learning sessions, and actual clinical experiences State the requirements of Continuing

Education for Texas nursing including the required number of hours and specialized content to comply Demonstrate nursing standards of practice during clinical simulation scenarios or problem based learning sessions, and actual clinical experiences

Unit Assessment At the end of this unit, students will pass a written quiz related to the topics covered containing multiple choice, short answer, and narrative questions with a minimum score of 75%. Scores less than 75% will require remediation with faculty.

Unit 2 Unit Name Moral and Ethical Aspects of Nursing Unit Summary This unit is designed to provide students with an understanding of the moral and ethical aspects of practicing as a registered nurse. Included with the didactic content is the need for continual reflection on personal values and responsibilities, including religious and cultural beliefs, as well as the responsibilities of a registered nurse in the role of patient advocate. The class will be conducted in the lecture hall; dates and time to be determined. Materials include: Ethics and Issues in Contemporary Nursing, 4th Edition, (ISBN-10: 1133129161), Chapters 1-9; handout materials related to nursing morals and ethics, and case studies involving nursing moral and ethical scenarios to be used in clinical simulation or problem based learning exercises. Activities will consist of quizzes, group responses and short narrative responses to case studies, and clinical simulation scenarios. Problem based learning sessions will provide an alternative to clinical simulation scenario activities in the event of simulation laboratory scheduling issues.

Unit Essential Questions What is accountability in regards to nursing practice? How does a nurse make justifiable moral and ethical decisions

Unit Enduring Understanding Students will understand that Nurses accept responsibility for their own actions and behaviors Personal values and altruism factor into moral and ethical decision making

How does a nurse distinguish between legal and ethical situations and address them appropriately What is the difference between personal, social, and professional relationships and where and when these boundaries apply? What is the difference between legal and ethical considerations when obtaining informed consent? What is HIPAA and how can a nurse protect a patients privacy, confidentiality, and security at all times?

Nurses must maintain high standards of honesty, integrity, and respect at all times Nurses must ensure boundaries are maintained between social and therapeutic relationships with patients and other professionals Legal and ethical requirements can both apply to situations where a nurse must make appropriate decisions in the best interest of the patient The patient has a right to privacy, confidentiality, and security at all times

Unit Knowledge Expectations Students will know. Understands the nurses role and responsibility in the provision of care to their patients Understands the nurses role and responsibility as patient advocate Theory and process for making justifiable moral and ethical decisions Responsibility of registered nurse as honest, respectful, and compliant with regulations Understands the importance of maintaining appropriate professional boundaries with patients and other professionals between social and therapeutic relationships. Supports clients in making informed decisions related to health care Understands the nurses responsibility to maintain patient privacy, confidentiality, and security during all communications

Unit Skill Expectations Students will be able to. Demonstrate accountability for their own actions and behaviors during clinical simulation scenarios and during actual clinical experiences in provision of nursing care Demonstrates ability to assess the patients wishes and rights and factors them into nursing care decisions during clinical simulation scenarios and during actual clinical experiences State and demonstrate understanding of the theory and processes involved with making justifiable moral and ethical decisions Demonstrates honesty, integrity, and respect in dealing with other professionals during clinical simulations and actual clinicals Demonstrates appropriate boundaries between social and therapeutic relationships with clients and other professionals during clinical simulations and actual clinicals

Demonstrates ability and understanding of the difference between ethical and legal requirements in obtaining informed consent from clients during clinical simulations and actual clinicals Demonstrates ability to recognize situations with the potential to compromise patient privacy, confidentiality and security and make appropriate ethical and legal decisions to maintain them during clinical simulations and actual clinicals

Unit Assessment At the end of this unit, students will pass a written quiz related to the topics covered containing multiple choice, short answer, and narrative questions with a minimum score of 75%. Scores less than 75% will require remediation with faculty.

Unit 3 Unit Name Humanistic Aspects of Nursing Unit Summary This unit is designed to provide students with an understanding of the humanistic aspects of practicing as a registered nurse. Included with the didactic content is the need for continual awareness of the personal values of others, including religious, ethnic, and cultural beliefs, as well as the responsibilities of a registered nurse in the role of patient advocate. The class will be conducted in the lecture hall; dates and time to be determined. Materials include: Ethics and Issues in Contemporary Nursing, 4th Edition, (ISBN-10: 1133129161), Chapters 11, and Chapters 16-20; handout materials related to nursing morals and ethics, and written cases involving humanistic principle scenarios to be used in clinical simulation or problem based learning exercises. Activities will consist of quizzes, short narrative responses to case studies, and clinical simulation scenarios. Problem based learning sessions will provide an alternative to clinical simulation scenario activities in the event of simulation laboratory scheduling issues.

Unit Enduring Understanding Students will understand that Unit Essential Questions What are the dimensions of patient Patients, families, and communities centered nursing care? have unique preferences and values; need coordinated and integrated care; How do cultural, ethnic, spiritual, and require information, communication, socioeconomic backgrounds of and education; expect physical patients, families, and communities comfort and emotional support; need affect the delivery of nursing care? involvement of family and significant What are the concepts of pain, other to ensure seamless transition palliative care, and quality of life? from professional care to home How does the continuum of care affect Values opportunities to learn about nursing? diverse cultures, ethnicities, and religions Understands the impact of personal attitudes, values and beliefs when delivering nursing care to diverse patients Provides patient centered care to individuals and groups with different values than their own Appreciates the role of nursing and acknowledges personal values and beliefs about the management of pain, and end-of-life issues The continuum of care is essential to restoring well-being to patients, is accessed through a variety of settings and at many different times Unit Knowledge Expectations Students will know. How to show respect for and encourage expression of patient values, preferences, and needs How to appreciate and value the patients knowledge and understanding of their own health and symptoms How to show respect for and Unit Skill Expectations Students will be able to. Communicates patient values and needs to health care team members during clinical simulations and actual clinicals States where to seek information sources on behalf of the patient when needed Demonstrates patient inclusion in

encourage input of the patient in health care decisions during clinical health care decisions simulations and actual clinicals Awareness of diverse cultural, ethnic, Demonstrates sensitivity when spiritual, and socioeconomic providing nursing care to diverse backgrounds of commonly cultural, ethical, spiritual, and encountered individuals and groups socioeconomic patients during clinical simulations and actual clinicals Understands pain as a subjective measure of patient discomfort Demonstrates understanding of pain management, palliative care, hospice Understands the roles of palliative care, and end-of-life issues during care and hospice in end-of-life clinical simulations and actual situations clinicals Understands patient and family rights Demonstrates understanding of as well as the implications of end-ofdelivery of nursing care across the life issues and legal instruments continuum of the health system during Understands the various delivery clinical simulations and actual methods of care across the health clinicals systems continuum of care and how they may be accessed Unit Assessment At the end of this unit, students will pass a written quiz related to the topics covered containing multiple choice, short answer, and narrative questions with a minimum score of 75%. Scores less than 75% will require remediation with faculty.

Course and Faculty Evaluation A course and faculty evaluation survey will be provided to each student at the end of this course. The completion of the evaluation is encouraged and requested, but is not mandatory, is anonymous, and will not be considered in the grading for this course. The course and faculty evaluation will be used to assess the curriculum for future additions, changes, or modifications to the course delivery, content, activities, and assessments.

Appendix A Nursing Professionalism and Ethics Needs Assessment

Please provide your best answer to each of the following questions. This is an evaluation survey, not a test. This instrument has no effect on your grade or acceptance into the nursing program.

1. An old classmate from high school is a patient in your facility. She/He is due to be released that afternoon and asks if you could give her/him a ride home, since it will be about the end of your shift. She/He suggests plans to stop and get something to eat together and go over old times. You should. a. Refuse the request in order to maintain your professional relationship with the patient, in spite of your past acquaintance. b. Agree to provide the ride home, but decline the invitation to dinner. c. Explain it would be inappropriate for you to permit patients as passengers in your personal vehicle and suggest an alternative solution to assist the patient in getting home. d. Ask your nurse supervisor for permission or advice in this situation. 2. You are working as a nurse in the hospital and receive a phone call related to a patients status. You have had the patient under your nursing care for 2 days. The caller has identified herself as the patients sister and asks if she has the correct nurse taking care of her sibling. She goes on to explain she is from out of town and hasnt seen her sibling in years. She wants to make sure the sibling is doing well enough for an unannounced, surprise visit this afternoon. What should you tell the caller? a. You are not permitted to share information with your patients sister over the phone. If she would like to come to the hospital, you will be happy to assist her. b. Without sharing any pertinent health information, provide the patients sister with enough information to decide if the surprise visit is an option. c. Do not acknowledge whether the patient is present or not and explain you are not permitted to provide patient information to her. d. Answer the callers questions in the interest of providing social support for your patient. 3. A doctor walks onto your floor of the hospital and orders you to assist her/him with a procedure on one of your patients. The procedure is not commonly performed in a patients room unless it is an emergency. You are unsure if performing the procedure is in your patients best interest. What should you do? a. Comply with the doctors orders and assist with the procedure. As a nurse, you are required to follow doctors orders and assist when requested.

b. Refuse to assist the doctor since you do not have any written orders for the procedure to be performed in the patients room. c. Ask the doctor to help you understand the rationale for the procedure and why the procedure is being performed in the patients room. If the rationale is sound, proceed. If the rationale is unsound, seek more clarification before proceeding. d. Notify your nurse supervisor of the doctors intentions to perform the procedure in the patients room. A total of 20 survey questions related to nursing professionalism and ethics are on the needs assessment survey tool. Only 3 questions are provided here as an example of the needs assessment instrument.