GORDON COLLEGE

College of Allied Health Studies

Tapinac Oval Sports Complex, Donor St., East Tapinac, Olongapo City

DETAILED LEARNING MODULE

Title: Ethico-Moral Consideration in Course Code: NCM 119

Nursing Leadership and Management

Module No. 4 Week: 4

I. Introduction
Welcome to Module 4. This module focuses on the application of professional ethical concepts to
caring for the needs of patients. This module provides a framework for discussing ethical clinical
issues in nursing practice. The biomedical principles and theoretical models, moral obligations,
virtues and values that form the basis of ethical statements are also discussed. This module supports
students in developing their understanding of the right of the nurse to invoke a conscientious
objection with the competing priority of the patient’s right to health care. Thus, you will be given
preparatory work to read about the ethical and moral aspects of nursing practice. You should be
encouraged to record information on the accompanying student learning resources and brainstorm to
answer the questions and other learning tasks.
II. Learning Outcomes
After studying this module, you should be able to:
-enumerate the ethicomoral responsibility of nurses.
-discuss the code of ethics for nurses
-describe each ethico-moral aspects of nursing
-explain how ethical decision-making models and frameworks are incorporated into making ethical
judgments.

III. Topics
Topic
5.1 Ethico-Moral Aspect of Nursing
5.5.1. Code of Ethics for Nurses in the Philippines
5.5.2. ICN Code of Ethics for Nurses
5.5.3. Values in Nursing
5.5.4. Virtues in Nursing
5.5.5. Morality

IV. Teaching and Learning Materials and Resources

-Nursing Leadership and Management Books/E-books -Study Notebook
-Available Open Educational Resources Portal
-Video Clips (e.g. YouTube, Khan Academy, etc.)
-Slides (attached/provided by Instructor)
-Handouts/Notes (attached/provided by Instructor)

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 V. Learning Tasks/Activities
1. Read and review your Ethico-Legal and Moral Considerations lectures. (see slides
attached/provided by your instructor)
2. For Synchronous activity:
 The instructor will discuss and present the topic in the selected online platform.
For Offline/Non-Digital activity:
 The instructor will provide the slides/handout notes/video recordings of the topic via
USB flash drive, CD, or any preferred media.
3. Watch lecture related videos if needed.
 YouTube- Directing - Ethical Issues in Nursing: Introduction: Concepts, Values, and
Decision Making
https://www.youtube.com/watch?v=9VRPMJUyE7Y
 YouTube- Code of Ethics for Registered Nurses
https://www.youtube.com/watch?v=BZ5zgA2rnNA
4. Read supplementary references for the topic.
5. Do a quick check of your knowledge of the concepts of the ethico-moral aspects of nursing.
In your own words, describe the concepts given. Write your own-description down in your
Study Notebook. When you’re done, check the Reading Activity to see how well you did.

READING ACTIVITY:
Overview
Ethical Aspects of Nursing Practice
Respect for the individual is the ethical underpinning of nursing practice, and most nurses use a
combination of ethical morals, values, principles, theories, codes, and laws to guide practice. Ethical
nursing practice necessitates applying moral beliefs and making logical, consistent decisions. Ethics
in nursing requires “the examination of all kinds of ethical and bioethical issues from the perspective
of nursing theory and practice, which, in turn, rest on the agreed core concepts of nursing, namely:
person, culture, care, health, healing, environment, and nursing itself”. By applying ethics, nurses can
determine the best course of action in specific situations. Ethics is an integral part of nursing practice
and involves respect and advocacy for patients and families in all settings.
Ethical Codes
A code of ethics is a formal statement of the rules of ethical behavior for a particular group of
individuals. A code of ethics is one of the hallmarks of a profession. This code makes clear the
behavior expected of its members.
The Code of Ethics for Nurses with Interpretive Statements provides values, standards, and principles
to help nursing function as a profession. The original code was developed in 1985. In 1995 the
American Nurses Association Board of Directors and the Congress on Nursing Practice initiated the
Code of Ethics Project. The code may be viewed online at nursingworld.org Ethical codes are subject
to change. They reflect the values of the profession and the society for which they were developed.
Changes occur as society and technology evolve. For example, years ago no thought was given to do
not resuscitate (DNR) orders or withholding food and fluids. Technological advances have since
made it possible to keep people in a kind of twilight life, comatose and unable to participate in living
in any way, but nevertheless making DNR and withholding very important issues in health care.
Technology has increased knowledge and skills, but the ability to make decisions regarding care is
still guided by the principles of autonomy, nonmaleficence, beneficence, justice, confidentiality,
fidelity, veracity, and accountability.

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 Ethics
Ethics can be described as a
declaration of what is right, what is
wrong, and what ought to be.
Balancing multiple factors that
protect and support individuals as
well as the needs of a group or
organization often creates a conflict
of interest; these ethical dilemmas
are increasingly common in health
care today. Nurses are confronted
with these difficult situations on a
daily basis and should use ethical
principles to guide patient care. For
this reason, nurses should be
knowledgeable about ethical
principles and proactive in managing difficult situations. The complexity of situations and the
multiple players involved require collaboration among healthcare providers and, in difficult
situations, should involve professional colleagues, ethics committees, and ethicists. Ethical concepts
are defined and applied to ethical dilemmas in this chapter. The American Nurses Association (ANA)
Code of Ethics is provided as an ethical model for the nursing profession. In addition, the roles of
ethics committees and ombudsmen are defined and discussed. Ethical decision-making models and
frameworks are introduced as working tools to assist in ethical judgments.

Morals
The terms morals and ethics are often, incorrectly, used interchangeably. Morals are defined as
“conduct, character, and motives involved in moral acts and include the notion of approval or
disapproval of a given conduct, character, or motive that we describe by such words as good,
desirable, right, worthy, or conversely bad, undesirable, wrong, evil, unworthy”. Morals are ingrained
in one’s consciousness, provide people with established rules of conduct based on societal customs
and habits, and reflect what is right or wrong and good or bad. In comparison, ethics reflects what
actions people should take in a specific situation based on their own morals. Both morals and ethics
are influenced by personal life experiences and value systems. Nurses must maintain moral integrity
and fulfill their moral obligation to patients, regardless of the setting.

Moral Integrity
It refers to quality of character and involves acting consistently with personal and professional values.
Nurses with moral integrity are honest and trustworthy, consistently do the right thing, and stand up
for what is right despite the consequences. In addition, nurses with moral integrity have a sense of
self-worth because they have clearly defined values that are congruent with their actions. Moral
integrity is a positive attribute for nurses in leadership and management positions and is critical to
ethical decision making. Nurse leaders and managers with moral integrity own their own beliefs and
values, respect the beliefs and values of others, and, despite possible differences, avoid compromising
their own moral integrity. When a nurse behaves in a way that is not congruent with professional
moral beliefs, moral integrity is in jeopardy.

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Moral Obligation
An obligation is a duty to or responsibility for another human being. Nurses enter a relationship of
trust with a patient that involves a moral obligation or duty to provide care in a nondiscriminatory
manner. A nurse’s primary commitment is to the recipient of care (American Nurses Association
[ANA], 2015a). Once a nurse-patient relationship has begun, a nurse has a duty to the patient and
cannot abandon a patient in need of care (ANA, 2006). At times, nurses are challenged to balance
professional obligations and personal risks. Although nurses have a moral obligation to care for
patients at all times, situations may arise in which nurses could face potential personal harm.
Therefore, nurses must be able to critically think and analyze certain situations in which the risk may
outweigh the moral obligation to care for a patient. In such cases, it is a nurse’s decision to accept
personal risk that exceeds the limits of his or her moral obligation. The ANA asserts that nurses are
morally obligated to care for patients when the following four criteria are present:
1. The patient is at significant risk of harm, loss, or damage if the nurse does not assist.
2. The nurse’s intervention or care is directly relevant to preventing harm.
3. The nurse’s care will probably prevent harm, loss, or damage to the patient.
4. The benefit the patient will gain outweighs any harm the nurse may incur and does not present
more than an acceptable risk to the nurse. If one or more of these criteria are absent, the nurse must
evaluate the situation and choose whether or not to care for the patient as his or her moral obligation
(ANA, 2006). However, once a nurse accepts an assignment, he or she must fulfill the assignment or
risk being charged with abandonment.

Values
Values are personal beliefs that influence behavior and give meaning and direction to life. Values
evolve over time and reflect ethnic background, family life, cultural beliefs, environment, and societal
norms. As people mature, their value systems may change and grow to encompass personal,
professional, and societal values. Although people are not always conscious of how much value
systems influence decision making, people are constantly making decisions based on values. “Nurses
have a right and duty to act according to their personal and professional values” (ANA, 2015a, p. 20).
Being aware of personal values helps nurses to make clear, thoughtful, and consistent decisions. The
process one goes through to understand personal values is called values clarification.

Values Clarification
Values clarification is the process of reflecting on and analyzing values to better understand what is
important. Self-reflection on personal and professional values requires a readiness and willingness to
take an honest look at personal behaviors, words, actions, motivations, and any congruencies or
incongruencies among them. Values clarification leads to self-awareness. Through self-reflection,
nurses can develop an insight into their value systems, thus enhancing their ability to make value
decisions in nursing practice (Burkhardt & Nathaniel, 2008).

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Values clarification is an ongoing process of becoming self-aware of the personal and professional
values that are important. Nurses must become self-aware to be able to provide nonjudgmental care
to patients and to develop and maintain a nonjudgmental approach to leadership and management.
The nursing code of ethics, discussed later in this chapter, obligates nurses to deliver care with respect
for human needs and values without prejudice. It is difficult to carry out this obligation without self-
awareness.
Values clarification is deciding what one believes is important. It is the process that helps people
become aware of their values. Values play an important role in everyday decision making. For this
reason, nurses need to be aware of what they do and do not value. This process helps them to behave
in a manner that is consistent with their values. Both personal and professional values influence
nurses’ decisions. Understanding one’s own values simplifies solving problems, making decisions,
and developing better relationships with others when one begins to realize how others develop their
values. Kirschenbaum (2000) suggested using a three-step model of choosing, prizing, and acting,
with seven sub-steps, to identify one’s own values. You may have used this method when making
the decision to go to nursing school. For some people, nursing is a first career; for others, it is a
second career. Using the model, the valuing process is analyzed:
1. Choosing. After researching alternative career options, you freely chose nursing school. This
choice was most likely influenced by such factors as educational achievement and abilities, finances,
support and encouragement from others, time, and feelings about people.
2. Prizing. Once the choice was made, you were satisfied with it and told your friends about it.
3. Acting. You have entered school and begun the journey to your new career. Later in your career,
you may decide to return to school for a bachelor’s or master’s degree in nursing. As you progressed
through school, you probably started to develop a new set of values—your professional values.
Professional values are those established as being important in your practice. These values include
caring, quality of care, and ethical behaviors

Virtue
Burkhardt and Nathaniel (2006) list four virtues that are more significant than others and that are
illustrative of a virtuous person: compassion, discernment, trustworthiness, and integrity.
Compassion is a deep awareness of the suffering of another along with the desire to relieve it.
Discernment is possession of acuteness of judgment. Trustworthiness is present when trust is well
founded or deserving. Integrity may be considered to be firm adherence to a code of conduct or an
ethical value. These virtues form the foundation for an ethically principled discipline and have been
endorsed throughout the nursing profession’s history. Nurses who subscribe to these four virtues are
inclined to recall and value that patients also have their own personal values.

Moral Model of Ethical Decision Making

Developed by Crisham (1985), the MORAL Model of Ethical Decision Making incorporates the
nursing process and bioethics. Bioethics are ethics applied in the health professions and include such
issues as end-of-life decisions and abortion. The MORAL model is used when nurses encounter
conflicting obligations. The model encompasses five steps, represented by the mnemonic MORAL:
M: Massage the dilemma. Collect relevant data about the ethical circumstance and determine who in
the organization should be involved.
O: Outline available options. Identify alternatives and the impact and consequences of each.
R: Review criteria and resolve. Options must be weighed against values and practical considerations.
This evaluation can be easily accomplished by placing the options on a decision-making grid.
A: Affirm position and act. This step involves developing and implementing the strategy.
L: Look back. Evaluate the decision-making strategy.

In the first step of the model, the nurse must be aware that an ethical dilemma exists. Collecting data
about the ethical conflict solidifies the existence of a problem and helps determine who should be

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involved in the resolution of the ethical dilemma. Health team members must remember that
conflicting values of the patient, nurse, physician, and family may occur. An ethical dilemma exists
because there are reasons to do two opposing actions.

Outlining options, the second step of the MORAL model, must be done with staff involvement.
Available options are weighed against the consequences of the proposed action. They may involve:
•doing nothing.
•scheduling a family conference.
•consulting the ethics committee.
•consulting with an external party, such as an ombudsman.
•referring to the attending physician.

The third step of the model is to review criteria and resolve. To determine a course of action, the
options generated in step two are weighed against practical considerations and the primary values of
those involved in the dilemma. This evaluation can be accomplished by placing the aforementioned
criteria on a decision-making grid. The pluses (+) and minuses (–) in the squares of the decision-
making grid quantify the difficulty of the situation. An ethics committee or an ombudsman can count
the pluses and minuses and make a decision based on the numerics. With a situation as difficult as an
ethical dilemma, this mechanism helps to quantify the available options and make them more
objective.

The fourth step of the model is when the nurse and health care team confirm a decision and intervene.
Several questions by nurses and other team members may surface in this step, such as:
•Are nurses and team members free to state their opinions without consequences?
•Will physicians agree with the interventions recommended by the team?
•Should the team have consulted with an outside party, such as an ethics expert who is not employed
by the hospital?
•Can the nurses and team members reconcile significant differences in their personal values with
those associated with this ethical dilemma?

The last step in the MORAL Model is evaluation. The nurse reviews all actions taken to resolve the
ethical dilemma. If actions taken have remedied the situation, the nurse and ethics committee can
move on to resolve other issues. If the ethical dilemma being evaluated was not resolved, the team
restarts the process by returning to step one.

The ANA Code of Ethics for Nurses, the nursing process, the five-step model offered by Burkhardt
and Nathaniel, the Ethical Positioning System Model, the MORAL Model, and the Improving
Communication – Improving Care framework developed by the AMA can all act as guides for ethical
communication and decision making. Nurses learn and base decisions on the conceptual frameworks
from their education. Evidence shows that an overwhelming majority of student nurses who used an
ethical decision-making model found that the model was helpful in conflict resolution.

Essential Values and Behaviors

Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is
reflected by the nurse’s concern for the welfare of patients, other nurses, and other health-care
providers. The professional behaviors involved with this essential value include: understanding of
cultures, beliefs, and perspectives of others; advocacy for patients, particularly the most vulnerable;
risk taking on behalf of patients and colleagues; and mentoring other professionals. Autonomy is the
right to self-determination. Professional practice reflects autonomy when it respects patients’ rights
to make decisions about their health.

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The professional behaviors involved with this essential value include: planning care in partnership
with patients; honoring the right of patients and families to make decisions about health care; and
providing information so patients can make informed choices. Human dignity is respect for the
inherent worth and uniqueness of individuals and populations. In professional practice, human
dignity is reflected when the nurse values and respects all patients and colleagues. The professional
behaviors involved with this essential value include: providing culturally competent and sensitive
care;
protecting patients’ privacy; preserving the confidentiality of patients and health-care providers; and
designing care with sensitivity to individual patient needs. Integrity is acting in accordance with an
appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional
practice when the nurse is honest and provides care based on an ethical framework that is accepted
within the profession. The professional behaviors involved with this essential value include:
providing honest information to patients and the public; documenting care accurately and honestly;
seeking to remedy errors made by self or other; and demonstrating accountability for own actions.
Social justice is upholding moral, legal, and humanistic principles. This value is reflected in
professional practice when the nurse works to ensure equal treatment under the law and equal access
to quality health care. The professional behaviors involved with this essential value include:
supporting fairness and nondiscrimination in the delivery of care; promoting universal access to
health care; and encouraging legislation and policy consistent with the advancement of nursing care
and health care.

Virtue Ethics
Virtue ethics focuses on virtues, or moral character, rather than on duties or rules that emphasize the
consequences of actions. Take the following example: Norman is driving along the road and finds a
crying child sitting by a fallen bicycle. It is obvious that the child needs assistance. From one ethical
standpoint (utilitarianism), helping the child will increase Norman’s personal feelings of “doing
good.” The deontological stance states that by helping, Norman is behaving in accordance with a
moral rule such as “Do unto others....” Virtue ethics looks at the fact that helping the person would
be charitable or benevolent. Plato and Aristotle are considered the founders of virtue ethics. Its roots
can be found in Chinese philosophy. During the 1800s virtue ethics disappeared, but in the late 1950s
it reemerged as an Anglo-American philosophy. Neither deontology nor utilitarianism considered the
virtues of moral character and education and the question: “What type of person should I be, and how
should I live”. Virtues include such qualities as honesty, generosity, altruism, and reliability. They
are concerned with many other elements as well, such as emotions and emotional reactions, choices,
values, needs, insights, attitudes, interests, and expectations. To embrace a virtue means that you are
a person with a certain complex way of thinking. Nursing has practiced virtue ethics for many years.

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 6. Now, read, analyze, and answer the learning tasks below.

TASK 1. ASSESSING YOUR UNDERSTANDING

Instructions: Using the table below, provide a more inclusive explanation of the common ethical
principles. Fill-in reflection and experience which are necessary to understand many of the ethical
principles in the context of health care and nursing practice. (see rubrics for scoring)
Ethical Principle Example in Nursing Practice
Autonomy
Respect for Others
Beneficence
Nonmaleficence
Fidelity
Veracity
Confidentiality
Justice
Paternalism
Utilitarianism
Privacy
Deontology
Principlism

TASK 2. APPLYING YOUR KNOWLEDGE

Instructions: Briefly answer the following discussion questions. (see rubrics for scoring)
Scenario: Ralfa is in the hospital. She is a 47-year-old woman who has metastatic breast cancer and
does not want her family to know that she is at the end-of-life and is dying. Ralfa has low energy, and
her fatigue level now taxes her coping mechanisms, which are normally excellent; she does not feel
that she can deal with her family’s grief. Ralfa’s daughter has been discharged from the Air Force
and is returning home from an overseas deployment. The family has planned a surprise party for
Ralfa in the hospital when her daughter arrives back home and has invited many of her friends and
family members. Ralfa’s nurse is conflicted because she practices under the principle of
utilitarianism and is aware of her patient’s desire for privacy as well as the party planned by the
family. Ralfa does not know about the party and her family does not know about her prognosis.
Discussion Questions
1. Define and state the limitations of utilitarianism, privacy, and veracity
2. What would a person of utilitarian thought do in this case?
3.What about the unwritten nurse-patient agreement as it relates to beneficence?
4.How does this pose a conflict for a nurse practicing the ethical principle of utilitarianism?
5. Are your values regarding veracity stronger or weaker than your desire to cause no harm to Ralfa’s
feelings (nonmaleficence)?

TASK 3. CASE ANALYSIS

Instructions: Briefly answer the following discussion questions. (see rubrics for scoring)

Scenario: Over the past several weeks, you have noticed that your closest friend, Rafaela, has been
erratic and has been making poor patient-care decisions. On two separate occasions, you quietly
intervened and “fixed” his errors. You have also noticed that he volunteers to give pain medications
to other nurses’ patients, and you see him standing very close to other nurses when they remove
controlled substances from the medication distribution center. Today you watched him go to the
center immediately after another colleague and then saw him go into the men’s room. Within about

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20 minutes his behavior had changed completely. You suspect that he may be taking controlled
substances. You and Rafaela have been friends for more than 20 years. You grew up together and
went to nursing school together. You realize that if you approach him, you may jeopardize this close
friendship that means a great deal to you.

1. Using the MORAL ethical decision-making model, devise a plan to resolve this dilemma.

Rubrics
Features 5 4 3 2 1
Focus/Analysis All key aspects Only modest Some potential Adequate in Weak
The single identified and abstraction connections parts; gaps in progression of
controlling point is related beyond facts; missed the logical ideas
made with an overly development
awareness of the derivative
task about a specific
topic.
Task achievement Fully addresses Sufficiently Presents a Presents Arranges
Fulfillment of the all parts of the addresses all clear position relevant ideas information and
task being task parts of the task but there may but some may ideas but an
presented by the be a tendency be inadequately unclear
activity. that the developed progression
supporting
ideas may lack
position
Relevance/ The task makes The task makes The task makes The task makes The task makes
Connections appropriate some unclear or undistinguishab no connections
Relation of the task connections appropriate inappropriate le connections between the
to the between the connections connections between the purpose and
concepts/ideas purposes and between the between the purposes and features of the
features of the purposes and purposes and features of the ideas/concepts
ideas/concepts features of the features of the ideas/concepts
ideas/concepts ideas/concepts

Guidelines:
The following instructions shall apply:
1.Free medium to use. You can convert your answer sheet in the following format:
a. Picture/Image b. PDF file c. Microsoft Word
2. Submit your answer to our Google Classroom and use your GC domain google account.
3. You may also use the GC Academic Assistance Desk for the submission of accomplished modules.
4. At a minimum, you must cite the journal, textbook, article, and other reading materials. Make sure
to cite any references you use. Use APA style (6th edition) for proper citation format for your
references.

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 VI. References (Online Sources/EBooks)

Jones, R. A. P. (2007). Nursing leadership and management: theories, processes, and practice. F A
Davis.

Kelly, P. (2010). Essentials of nursing leadership & management (2nd ed.). Delmar Cengage
Learning.

Korniewicz, D. M. (2015). Nursing leadership and management: the advanced practice role.
DEStech Publications, Inc.

Marquis, B. L., & Huston, C. J. (2012). Leadership roles and management functions in nursing:
theory and application. Wolters Kluwer Health/Lippincott Williams & Wilkins.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:
theory and application. Wolters Kluwer Health.

Tappen, R. M., Weiss, S. A., & Whitehead, D. K. (2001). Essentials of nursing leadership and
management. F.A. Davis Co.

Weiss, S. A., & Tappen, R. M. (2015). Essentials of nursing leadership and management. F.A.
Davis Company.

Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2010). Essentials of nursing leadership and
management. F.A. Davis.

Online Sources

(2020). Retrieved 3 September 2020, from

http://nursing.iugaza.edu.ps/Portals/55/LN_nsg_ldrshp_final.pdf

(2020). Retrieved 30 September 2020, from

https://juniperpublishers.com/jojnhc/pdf/JOJNHC.MS.ID.555747.pdf

YOU HAVE COMPLETED MODULE 4. WELL DONE!

It’s now time for you to discuss your insights and reflections with your
classmates in the Online Discussion. Coordinate with your Lecturer for
the final details and clarifications of the topic. Before Online Session,
make sure you have organized your ideas in your Study Notebook at
hand. In addition, be ready for an online quiz!

Once you have completed, you may proceed to Module 5.

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