Course: (2023-24 FA) NURS 516 A - Lgl & Eth Prin to Hlth Care Ldrshp | Moodle

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      Course Announcements from Faculty Forum

      This forum is for general news and announcements sent by your instructor throughout the semester. These announcements will come to students via their EMU email account as well as can be found here.

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      Student Questions & Coffee House Forum
      coffeeThis is a place to ask questions of each other or the faculty; share ah-ha moments, joys, or sorrows as we walk through the semester, or say anything else..

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    • Overview & Learning Activities                                                         

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      Week 1 Objectives & Overview Page

      1. Attend the Zoom orientation on Monday, August 28 at 7pm. Use this hyperlink to get into zoom meeting
      2. Read the following articles after orientation:
      3. Then participate in the discussion forums. Remember, FOR THIS WEEK ONLY - your primary response by Thursday night, and respond to 2 peer's primary posts as well as faculty questions to you by Saturday night. 


    • Forums, Assignments, & Other Assessments                                   

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      Week 1 Forum: Pausing and Reflecting

      After having reviewed some of the resources for reading and watching - consider the following questions.

      • How have the events of the past several years impacted you as a person?
      • HHow have the events of the past several years impacted your role as a leader? Influenced your work? How has it changed you?
      • What work do you still need to process?
      • How might the past 2 years have ethical and/or legal implications?
      • What positive steps have you taken to provide self-care during these times?
      NOTE: This forum is set up as a Q&A forum - which means you can not see other peer's posts until 30 minutes after you have posted your response. After your 30 minute wait - be sure to refresh your screen or log out of the course and come back in.

    • Assignment icon
      Week 1: Forum Grading Rubric Assignment

      Open this assignment to find your grade via the rubric for your participation in the discussion forum this week.

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    • Overview and Learning Activities

      1. Week 1: Learning Outcomes
      2. Readings for this week:
        • Darr - Introduction
        • Grant & Ballard (2011 & 2018) - Chapter 1
        • Makaroff et al., (2014) 
          • Makaroff, K. S., Storch, J., Pauly, B., & Newton, L. (2014). Searching for ethical leadership in nursing. Nursing Ethics, 21(6), 642–658. https://doi.org/10.1177/0969733013513213
      3. Watch this video that describes the key concepts for Week 2.
      4. Respond to the forum questions as well as those of your peers.

    • Forums, Assignments, & Other Assessments                                   

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      Week 2 Forum Questions

      Based on the readings for this week:

      1. Discuss how you would respond to a coworker who states "Aren't ethics and law the same thing? If something is ethical, then it must be legal, right?"
      2. Identify the most exciting learning objective or weekly topic for the semester; what topic or objective do you foresee being the most anxiety producing? In other words, what excites you about the topics in the syllabus - what bothers you as well?
      3. Describe one or two strategies you can start, or continue, in order to become a more ethical leader? 


    • Assignment icon
      Week 2: Forum Grading Rubric Assignment

      Open this assignment to find your grade via the rubric for your participation in the discussion forum this week.

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    • Overview and Learning Activities

      1. Week 3: Learning Outcomes
      2. Readings for this week:
        •  - This was recorded in the Fall 2020 at my home due to the pandemic, and internet connection was spotty. You can disregard the last minute or so with announcements from that semester. If you listen closely you can hear my puppy at the time - playing with her squeeky ball.
        • Darr - chapters 1 & 2
        • Grant & Ballard - chapter 8 (2011) or chapter 3 (2018)
        • Article by Winkler & Gruen (2005) - NOTE: I include this article even though it is getting old. The authors provide an organizational ethic that I believe students need to read about. I will return to this article many times during the semester in order to help students avoid reducing ethics to Principalism.
        • Summaries of the more common ethical perspectives from the excerpt from Five days at Memorial by Fink (2013).
        • Case - "The Case of the Compassionate Committee"
        • Week 3 Reference List
      3. Respond to the forum questions as well as those of your peers.

    • Forums, Assignments, & Other Assessments                                   

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      Week 3 Forum Questions

      1. After reading "The Case of the Compassionate Committee", consider the various ethical standards/perspectives read about this week. Identify 2 or 3 standards that you believe the committee honored by their decision, and describe your rationale.
      2. Similarly, based on the Grant & Ballard readings - what are the legal issues that might be at stake?
      3. Finally - what is your categorical imperative and why? (See Deontology/Kantian ethics description in Darr, 2018, p. 18). When might it be impossible for you to follow your CI and how will you process that situation?



    • Assignment icon
      Week 3: Forum Grading Rubric Assignment

      Open this assignment to find your grade via the rubric for your participation in the discussion forum this week.

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    • Overview and Learning Activities

      Week 4: Learning Outcomes

      Activities:

      1. First, complete the readings for this week:
        • Miller (2005) - note, this is a rather old resource but it is the most recent articulation of ethics from an Anabaptist perspective. The inclusion of this reading in no way is meant to "indoctrinate" non-Mennonite students, but rather to help students understand one author's perspective on the roots of Mennonite/Anabaptist ethics - and thus an ethic that influences EMU as a whole. Students from other faith-perspectives would potentially have other ethics values rooted in that faith-perspective.
        • Fowler (2017)
        • Mintz (2020) blog post
        • Bayley (2001)
        • Watch my mini-lecture video presentation.
          . I have also shared the unabridged PPT from that recording.
        • Lantos (1997) - case study for the forum. A few words about this case study. There are two reasons for using the story by Lantos this week:
          • First, as mentioned in the video, the story can help us understand the influence of faith in one's ethical decision-making.
          • Second, we also wish to have you read it as a way to understand and become sensitive to the possibility that people (based on a different faith tradition) might make a decision opposite to one we might make. One way to enhance our ethical sensitivity (see orientation PPT from AACN) is to be able to understand a different perspective and then articulate that perspective as if it were our own. This is also an approach in debate training.  I am not asking you to ultimately agree with the father - but be able to articulate his rationale as if you did agree.

        • Week 4 Reference List

      2. Second - search the internet or elsewhere to find any documents or statements that reflect the core values/ethics of your faith/spirituality perspective.

      3. Third, complete the self-guided values assessment tool from Taproot that is accessed below. You may also utilize the tool from the Center for Ethical Leadership provided. Feel free to generate your own words as you so desire.

      4. Fourth - participate in the forum discussion

      5. Finally - Reminder to make your appointment with your CFO for Week 6 this week; Any ideas about your organization's Ethics Committee schedule?

    • URL icon
      Values Exercise from Taproot URL

      Complete the assigned readings first then do your own self-assessment of values. This is an adapted exercise from Taproot organization - a consulting firm that helps organizations complete root cause analysis investigation of errors, accidents, and environment contaminations. See more info at https://www.taproot.com/live-your-core-values-exercise-to-increase-your-success/

      2 additional steps after you have identified your labels:

      •  Add a verb to each value so you can see what it looks like as an actionable core value.
      • Finally, write your core values in order of priority in your planner, so they are available as an easy reference when you are faced with decisions. 

    • Forums, Assignments, & Other Assessments                                   

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      Discussion Forum Week 4 - Personal & Faith Ethics

      There are three parts to the discussion forum for this week. While each of these could be a day long discussion, the point is to begin the conversation and spend time in personal reflection about the "Words on your own wall": We are looking for you to respond to each question. Given that these are heavy questions, word count is less of a concern this week.

      #1: From the self-assessments:  What surprised you about the results?  What disappointed you? What are those core values or your 'words on your wall'?

      #2 Your Faith Perspective: What did you discover about the influence of your faith with your core values identified in #1? what are the major theological principles/values central to your faith belief system? How do they impact your ethical decision-making? How might/do they conflict with secular ethical principles when you need to make a decision as a leader?

      #3 In regards to the Lantos article/case study:  Assume you were going to defend the father, what ethical values learned over the past 2 weeks would inform the creation of your defense? Once you defend the father - anything else strike you in the author's interpretation of the story & oucome?

      NOTE: The purpose of question #3 is to both understand that being aware of normative perspectives with radically different views builds a leader's competency in effective decision-making; and to understand that conflicting moral views by stakeholders can be credibly defended by a myriad of values in our pluralistic society.


    • Assignment icon
      Week 4: Forum Grading Rubric Assignment

      Open this assignment to find your grade via the rubric for your participation in the discussion forum this week.

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    • Week 5: Learning Objectives, Activities, & Other Resources

      Week 5 Objectives

      Activities

      1. Darr - chapters 3 & 5
      2. Grant & Ballard, - chapter 9 (2011) or chapter 11 (2018)
      3. ANA code of ethics in Appendix of Darr text. Or other applicable specialty or discipline-specific codes of ethics.
      4.  Article by Gaudine (2011) 
      5. Read case study for our Zoom session
      6. Please also review the PPT for some additional thoughts and how to prepare for our committee meeting.
      7. Attend our zoom session on Thursday, September 28. Review the Adapted Darr Model. See course zoom link at top of Moodle page.
      8. A single reflective forum post by Saturday midnight. No responses to peers required.


      Additional Resources

      Jonson, Siegler, and Winslade model for Clinical ethical decision making.

      Week 5 References


    • Forums, Assignments, & Other Assessments                                   

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      Week 5 Forum - Reflections on Ethics Committee Conversation

      Reflect on the following:
      • What are some of the key take-aways for you in relation to the process & utilization of ethics committees?
      • What questions are still nagging you about the committee process?
      • What do you believe the best way for an ethics committee to handle the case study presented?
      • What surprised you or challenged you in the readings about ways to create a proactive culture as well as the barriers/ facilitators of accessing the ethics committee (Gaudine et al., 2011) )? Do you have examples or reflections about your organization in regards to ethics committees?
      NOTE - as in some previous weeks, this is a Q&A forum. You will need to wait 30 minutes before seeing responses from your peers.

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    • Remember that this week and Week 7 are "combined" weeks to give you time to construct your paper, edit it, seek out the Grad Writing Coach if desired, and finalize it. Thus, you can work back & forth between your paper and the Week 7 activities including meeting with your CFO.

      Several friendly reminders:

      • Remember that the Guidance Note and assignment upload are at the top of the course page in the toggle called Major Assignments.
      • The paper is due Oct 15 at the end of Week 7. 
      • Finally - Be aware of your audience (that is not me - hint - hint!). First person "I" language is appropriate in this paper!

      May your time of writing your ethical credo this week be a time for reflection and pause (using the words of Dr. Sorrell from the readings in week 2).



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    • Week 7: Learning Objectives, Activities, & Other Resources

      Week 7 Objectives

      Activities

      1. Darr - chapter 6
      2. Grant & Ballard, - chapters 3 (2011) or chapter 9 (2018)
      3. Article by Den Nieuwenboer & Kaptein (2008). NOTE - While this article is getting old, I find the author's theory is helpful - and timeless maybe - in providing an understanding about why legal & ethical financial issues arise.
      4. Ethics Sage blog post - this blog post seems to build on the den Nieuwenboer & Kaptein article about why financial legal/ethical issues occur, but uses another helpful analogy of a "broken window".
      5. Please also review the PPT for some additional thoughts.
      6. After completing all of the readings, formulate a number of questions for your CFO interview. See these hints or suggestions as a starting point
      7. Interview your CFO
      8. Participate in the discussion forum as usual

      Week 7 References


    • Forums, Assignments, & Other Assessments                                   

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      Discussion Forum - Week 6/7 - Financial legal & ethical concerns of your CFO & You

      1. Discuss (be reflective & analytical) your learnings from interviewing your CFO such as but not limited to:

      • What were some of the legal and ethical issues/values/standards that impact their role?
      • What were the highlights/ insights/ new appreciations from your conversation?
      • How can you help them do a better job?
      • How do the comments of the CFO reflect or contradict the readings?

      2. What policies should be in place in your organization to prevent broken window theory or downward spiral situations?

      3. What other learning points or surprises arose from the readings? 


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    • This week we will dig deeper into a leader's role in creating legal & ethical work cultures. We will especially focus on several specific models for creating better work cultures. We will also examine professional codes of ethics in relation to an ethical culture but more focused on an individual professional's responsibility to foster a legal & ethical environment.

      The reading list is a little long today, however, I wanted to provide you with some examples of how nurse leaders have developed programs for creating a more ethical environment. Unfortunately, they are all hospital based but can be applicable with variation in any setting. And could serve as a seed to your MSN capstone project later on. I do recognize that some of the articles are older, but they provide excellent food for thought - and I believe are still excellent models for implementation in 2023.

      Reminder that we meet by Zoom on Thursday, October 26 at 7pm to review another case. I will also talk about Assignment #2 at that zoom session. If you attend the Zoom session I am forgoing the reflective forum for that week.

      Week 8 Learning Objectives

      Readings & Forum for Week 8.

      1. Darr - chapter 7 as well as chapter 4 (codes of ethics),  and applicable codes in Appendix B of Darr: Nursing (page 426); Medicine (pp 414, 422); Administrators (pp. 415-421)
      2. Grant & Ballard - chapter 4 (2011) or chapter 10 (2018)
      3. Article by Helft et al., (2009)
      4. Article by Rushton et al., (2021)
      5. Article by Epstein et al (2023)
      6. Watch video on the Hospital of the University of PA program regarding creation of an ethics culture through the shared governance infrastructure. Feel free to skim their article as well.
      7. ANA code of ethics - 2015- document from the California ANA
      8. Read Week 8 case that will be explored in our discussion forum.
      9. Participate in forum discussion for this week. Read case study included below.
      Week 8 References

    • Forum icon
      Week 8 - Legal & Ethical Issues Related to Organizations and Staff Forum

      1. Case Study from American Nurse Regarding Staffing
      If you can – forget that you have read the “Case commentary”:

      • First, identify the legal & ethical standards that apply to this case. Use the Grant & Ballard readings for this week as a basis for the legal issues; and readings especially from Week 2 and this week regarding ethical standards. Provide rationale for which ones you choose;
      • Second, based on a central premise by Darr that calls for primary prevention strategies for fostering an ethical culture - which one of the examples of ethics programs found in the readings this week may have prevented this case. Or consider, which one would best be implemented to prevent similar issues in the future.
      2. Creating an Ethical Culture for Staff in Your Organization
      • What structures are in place at your organization to reduce moral distress? If your organization already has something similar to what is found in the readings - how might that program be enhanced further?
      • Could any of the 4 examples found in the journal readings be effectively implemented in your health care organization? Which one? Why or why not?
      • What does your organization do to assure they follow the various legal mandates for the workplace as read about in Grant & Ballard?



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    • This week we will examine a rather sensitive and sometimes difficult topic - legal and ethical issues related to death and dying. Besides the readings, I provided a PowerPoint presentation by Dr. M. Mahon, from George Mason University. She is a nurse ethicist and has served as Chairperson of the Ethics Committee at the Hospital of the University of Pennsylvania. She has done extensive research in relation to end of life issues. In her presentation she offers another model for ethical decision making that has become quite popular in the clinical literature by Jonson, Siegler, and Winslow. If you want more information about that model, I have referenced the book. We will use that model for working through the case for this week. 

      Learning Objectives for this week

      Learning Activities for this week 

      1. Darr - chapter 10
      2. Review thePowerpoint by Dr. Mimi Mahon, RN PhD
      3. Article by Su et al., (2020) - meta analysis of surrogate decision makers
      4. Article by Robinson (2017) - when surrogates want to keep going
      5. Article by Flaherty & Meurer (2023) - about end-of-life doulas as surrogates
      6. Article/case study entitled "Before He Wakes"from the Hastings Center Report. This case study will be the focus of our zoom discussion, responding to the case based on your learnings from the other readings.
      7. Participate in our synchronous zoom session on Thursday, October 26 at 7pm. See course zoom link at the top of the page. 
        • Be prepared to participate in the following way. In the first half of the session the "committee" will work through the case provided for our meeting using the ethics decision-making model described by Darr on page 45. 
        • In addition, in the second half of the session several other analytical questions will be discussed regarding how your organization handles ethical issues related to death and dying.
        • At the end of the meeting Don will discuss Assignment #2.
      8. Submit a reflection forum response by Saturday October 28. You do not need to respond to your class peers.

      Week 9 References




    • Forum icon
      Forum Week 9 - Reflections on Case Analysis

      Reflect on the following:

      1. Regarding our committee processes:

      • Did we as a committee consider all stakeholder perspectives?
      • Should the committee have made another recommendation?
      • What questions are still nagging you about the case?

      2. Regarding the readings: 

      • identify one area within your organization/department that needs further improvement in relation to the legal and ethical perspectives concerning end-of-life issues. 
      • How might the readings provide beginning answers for improvement? 
      • How might you approach colleagues in your work setting as they express their feelings or beliefs about EOL?  Another way to look at this - how might you respond if they come to you as the nurse seeking personal advice about EOL issues they are experiencing?
      3. What else jump out at you, surprise you or concern you from the week's activities?

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    • Remember that this week and Week 11 are "combined" weeks to give you time to construct your assignment, edit it, seek out the Grad Writing Coach if desired, and finalize it. Thus, you can work back & forth between your paper and the Week 11 activities.

      Several friendly reminders:

      • Remember that the Guidance Note and assignment upload are at the top of the course page in the toggle called Major Assignments.
      • The assignment is due Nov 12 at the end of Week 11. 





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    • Learning Activities for this week 

      As you begin working on this week's readings and questions, be sure to remember to complete the "Prereading" assignment as outlined below. Also, click on this link for the objectives for this week:

      Pre-reading Assignment: Find the consent forms for your organization/department PRIOR to doing the readings. Reflect on them while doing the readings thinking about their ethical and legal implications. 

      Learning Objectives for this week

        1. Darr - chapter 9
        2. Grant & Ballard - chapter 7 (2011); chapter 5 (2018)
        3. Slade (2017) related to shared DM in behavioral health settings
        4. Aversano et al (2022) related to shared DM in oncology
        5. Review the clinical ethical decision-making schematic by Jonson, Siegler, & Winslade
        6. Watch video created by Dr Irma Mahone (see below), former nursing faculty, in which she discusses shared decision making (SDM). This was the focus of her PhD dissertation research. While you watch her zoom follow along with her PPT open as well. She forgot to share her screen when she made the recording. 
        7. Article by Badger et al., (2009) - this article will be the basis of part of our forum discussion.


      Week 11 References


    • Page icon
      Video Presentation by Dr. Mahone re Shared Decision Making Page

      As you watch this video of Dr. Irma Mahone, please open the PPT to follow along with the video. Dr. Mahone forgot to share her screen before she recorded. Thanks

    • Forum icon
      Week 11 Forum - Patient Consents

      Question #1: Based on the Badger et al. (2009) case (try not to read the last page or so) - In one to two sentences fpr each question:

      1. What were the ethical and legal values/ standards/ principles involved with the case read for this exercise? Explain with brief rationale.
      2. What were the cultural & organizational characteristics that resulted in this case? What could be done as an organization to prevent this situation in the future?
      3. What recommendations might an ethics committee make to the practitioners/administrators (assuming this case went to the EC before his death)?
      4. Your reaction to the case - how did you feel deep inside as a health care professional as you read it?
      Question #2:
      1. Reflecting on the readings for this week and your review of your organizational consents, what did you learn about consents in your organization/department? How do they compare or contrast to the legal and ethical standards discussed by Darr and Grant & Ballard?
      2. What could be enhanced in your organization and how could you as an ethical leader do to improve shared decision-making in your organization?

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    • Read this first regarding the week's objectives as well as the environment created this week before starting on the week's activities.

    • Learning Activities for this week 

        1. Be sure to read the objectives link found above before starting
        2. To understand how one organization approached the issue of DEI and racism, read this webpage. I was a member of the MHS board when we began processing the issue of racism and also as we developed this document.
        3. Watch all 3 videos from the National Museum for African American History & Culture. You will find all 3 videos in the hyperlink bu scrolling down the page. Total watching time is 1 hour and 15minutes.These include:
          • Video 1: Howard Ross on "Hidden Bias - Part 1" (45 minutes)
          • Video 2: Jerry Kang on "Immaculate Perception" (14 minutes)
          • Video 3: Vera Myers TED talk - "How to Overcome our Biases" (17 minutes)
        4. Read Bailey et al (2017)regarding structural racism & health inequities
        5. Read Calhoun & Parker (2021) about the experience of a physician of color
        6. Read Lee et al (2021) about leadership roles in diversity & inclusion
        7. Skim the instructor's guide to The Person You Mean to be by Chugh. At least read the preface and introduction, There is a 1 page chapter summary for each chapter of the actual book. Thus, only about 10 page of reading.
        8. Attend the zoom class with our guest speakers on Thursday, Nov 16 at 7pm. See the zoom course link near the top of the Moodle page.
        9. Respond in the reflective forum by Saturday night. No peer response required.

      Week 12 References


    • Forum icon
      Week 12 Reflective Forum - due by Saturday night

      1. Reflect on your experience prior to and during our Zoom session. Questions to consider:

      • What new insights or perspectives did you obtain?
      • Something from the readings struck you as interesting?
      • Something our guest said that got you thinking more deeply?
      2. Identify several ways you can enhance  your ethical stewardship as a leader as you work with staff or clients in regards to racism, diversity, equity, and inclusion.

      3. Other thoughts, questions, insights?

      IMPORTANT NOTE: As in some previous weeks, this forum is set up as a Q&A forum. This means you must submit your response before you can see the response of other students. If you wish to see other student's posts you will need to wait 30 minutes before they can be seen.



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    • In Week 14 we will examine the ethics of diversity begun in Week 12. However, now we move to examining law and ethics from a global perspective. You will have the opportunity to learn about 5 different global perspectives on ethics by choosing at least 3 of the 5. I would encourage you to read the related article first, then watch the video to find commonalities. As well, be considering how the different perspectives have areas of commonality and difference between each other as well as our understanding of ethical values in the US.

      Because we had a zoom session in Week 12, I chose to show video recordings from the past 2 years in lieu of scheduling another zoom session and arranging for guest speakers.

      After learning about at least 3 perspectives, then participate in the forum discussion with your peers. 

      Please note: These articles are not exhaustive on the topic of the particular cultures, but rather a sampling. There is much literature on the topic, but these articles were near the top of the search results based on relevance. Their intent is not to fully describe the legal & ethical perspective of a particular culture (for it is impossible and inappropriate to totally generalize a culture based on 1 view), but rather to provide a taste of the issues.


      Readings & Forum for Week 14.

      1. See the individual sections for each of the 5 cultures. Read the attached article and then watch the video.
      2. Participate in the class forum.

    • Ethics from a First Nations Perspective

      1. Lowe & Struthers (2001) - Native American culture and nursing. Click on this link to get to this article by one of our guests - Dr. John Lowe. After you click, you will be asked to log into the library system using your Royal Username & password. Then on the left side, click on the command "Check for full text" then it will open another page in which you should see the article.
      2. Presentation by Dr. John Lowe.


      Ethics from an African Perspective

      1. Haegert (2002) - Ubuntu: An African Ethic
      2. Watch this video below with Jan Emswiler & Kajungu Mturi:


      1.  


      Ethics from a Hispanic & Muslin Perspectives

      1. Latin American ethic & culture by del Rio (2010). Read especially page 137 to the end of the article.
      2. Culturally sensitive care to patients who are Muslim by Hammoud et al (2005)
      3. Zoom recording from 2019 - Hispanic and Muslim speakers


      Ethics from a Chinese Perspective

      1. Contemporary Confucianism as an ethic - Lin Hang (2011)
      2. Chinese Ethical Perspective PPT - by Dr. Yang, 2016 Guest Speaker. Video not available


      Week 14 References



    • Forum icon
      Week 14 Forum - Law and Ethics from a Global Perspective

      FIRST: Reflect on the readings as well as the Zoom recordings. Questions to consider:

      • What new insights or perspectives did you obtain?
      • Something from the readings struck you as interesting?
      • Something one of the speakers said that got you thinking more deeply?
      • How might this experience influence your ethical stewardship as a leader as you work with staff or clients from diverse cultures?
      • Other thoughts, questions, insights?
      SECOND: Given that we could not meet with our guests live, what is a question that you would have asked the guest speakers based on their presentation (one question per each guest)?


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    • As we wrap up the NURS 516 course, I wish you well in your future leadership endeavors.

      Learning Activities for this week 

      1. Kouzes & Posner (1992). This is a gem!
      2. Storch et al (2013) article on ethical nursing leadership.
      3. Markey et al. (2022) article on ethical leadership.
      4. Participate in a closing zoom session on Thursday, December 14 at 7pm. Use course zoom link found near the top of the course page. Come prepared to discuss the following:
        • A brief description of your final paper;
        • What stood out to you from the readings;
        • How your leadership will be different as a result of this semester:
        • Name one goal for the future as an ethical & transformational leader;
        • What do you wish we had taken the time to talk about

      Week 16 References




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