Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice Assignment

Summative Assessment

The summative assessment will be a 2000-word problem-based essay.

Students will be presented with a selection of ethical scenarios after completion of the formative quiz. Students will need to select one of the ethical scenarios to write for the summative assessment.

There is no template for the summative assessment, however, the essay should consist of the following sections (with suggested word count):

1. Introduction: Provide an introduction to the scenario and make links to the importance of law and ethics in nursing practice. Outline the ethical dilemma and conflicting ethical principles or professional and legal aspects (300 words)

2. Main Body – evaluation and analysis of the situation: you should then discuss this scenario from an ethical standpoint taking into account relevant legal and/or professional issues as appropriate that must include relevant references from the academic literature to support your writing. Please use an ethical framework, such as the four bioethical principles, to structure your discussion. You may also wish to consider philosophical theories of deontology, utilitarianism and values-based care as appropriate (1200 words)

3. Conclusion: Summarise the key legal and ethical points from the essay (200 words)

4. Action Plan: Reflect on how this learning will inform your future practice (300 words)

5. References: following APA 7th guidelines

Students will be marked on their ability to fulfil the module learning outcomes (see rubrics on following page). Key to fulfilling the learning outcomes will be criticality which will have been discussed with students in lectures and tutorials. Being ‘critical’ means being able to synthesise sometimes conflicting evidence in a systematic and balanced manner. The aim of this synthesis is to recommend a particular course of action as a logical consequence of your analysis. It is likely there will be no right or wrong solutions to some or even most of the scenarios we will discuss, just a better or worse argument for or against particular actions.

However, there is a lot of evidence to support decision making and it would be very rare to be faced with an entirely unique situation, so the student needs to be able to demonstrate that they know where the ‘jumping off’ point is. In most cases this will involve following local policy and legal and/or professional guidelines, so the student will need to be able to cite these in the assessment.

Please note: in accordance with the SNB code, any cases discussing patients must be anonymised, and have Students will be marked on their ability to fulfil the module learning outcomes (see rubrics on following page). Key to fulfilling the learning outcomes will be criticality which will have been discussed with students in lectures and tutorials. Being ‘critical’ means being able to synthesise sometimes conflicting evidence in a systematic and balanced manner. The aim of this synthesis is to recommend a particular course of action as a logical consequence of your analysis. It is likely there will be no right or wrong solutions to some or even most of the scenarios we will discuss, just a better or worse argument for or against particular actions.

However, there is a lot of evidence to support decision making and it would be very rare to be faced with an entirely unique situation, so the student needs to be able to demonstrate that they know where the ‘jumping off’ point is. In most cases this will involve following local policy and legal and/or professional guidelines, so the student will need to be able to cite these in the assessment.

Please note: in accordance with the SNB code, any cases discussing patients must be anonymised, and have no identifiable information (including name, age and clinical area the patient attended).

Guidance on the assessment

Choose ONE of the scenarios listed in this workbook to write for your summative assessment. Some points you may want to consider with regards to the scenarios might be:

1. Why is the scenario an ethical dilemma?
   • What are the ethical principles in conflict here?
   • Are there any nursing values at stake here?
   • Are there any cultural or societal norms to be considered?

2. What frameworks could be used to decide on the course of action?
   • How would ethical theories view this scenario? Would any ethical theories be useful in deciding what to do next?
   • How could the bioethics principles be applied to the scenario in deciding the next course of action?
   • Are there legal aspects that need to be considered in this scenario?
   • What are the professional implications of this scenario?

3. What do you think are the key points you will take away from this discussion for future practice?

4. Scenario 3 – Mrs Devi
   
   Mrs Devi is the mother of a five-year-old child named Shalini. Shalini does not have any medical history or allergy history. Mrs Devi received a letter from the Health Promotion Board reminding her that her children should receive mandatory vaccinations. Mrs Devi has self-scheduled a childhood immunization appointment at the polyclinic. During the appointment, the attending nurse noticed that the child did not receive any vaccination since birth. The nurse explained the Singapore National Childhood Immunization Schedule (NCIS) and measles and diphtheria vaccines are compulsory by Singapore law. The nurse also explained to Mrs Devi the benefits, side effects, and importance of vaccines. However, Mrs Devi still refused to vaccinate Shalini as she strongly believed that vaccines could cause serious side effects, despite the nurse’s explanation. During the conversation, Mrs Devi revealed that nurses should respect her rights and her decision not to vaccinate her children. Additionally, Mrs Devi also said that all children in Singapore are vaccinated, which is enough to protect her children from measles and diphtheria as herd immunity has developed in the community.

5. Scenario 4 – Mr Ahmad

   Mr Ahmad, an 82-year-old man with a history of moderate dementia, is brought to the emergency department (ED) with a high fever, confusion, and agitation due to a serious urinary tract infection (UTI). His cognitive function has noticeably declined, and the nurses suspect that the infection has worsened his dementia symptoms. While he is usually able to recognize his family members and participate in simple conversations, today, he appears disoriented, struggles to recall where he is, and repeatedly expresses a desire to leave. Despite medical advice that he requires IV antibiotics and close monitoring, Mr Ahmad insists on being discharged against medical advice. However, the attending nurses and doctors believe he lacks the capacity to make an informed decision about his care. His agitation escalates when staff attempt to persuade him to stay, leading him to raise his voice and try to remove his IV line. His family members, who are usually involved in his care, seem exhausted and frustrated. When the medical team seeks their input, they respond dismissively, saying, “Just do what you think is best, we can’t handle this anymore.” However, they do not provide formal consent for Mr Ahmad to stay, nor do they attempt to convince him to remain in the hospital.

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