NUR 104 HEALTH CARE of interest in our practice;
ETHICS
4. Explain an ethically based rationale for forbidding sexual
BS NURSING / 2nd YEAR relations between patients and health care providers.
Session # 10
LESSON TITLE: Role Fidelity LESSON REVIEW/PREVIEW (10-15 minutes) The
STUDENT ACTIVITY SHEET instructor will let the student answer the following:
Options:
A. Beverage Model
B. Bismarck Model
C. National Health Insurance
LEARNING OUTCOMES: Materials:
Upon completion of this lesson, the nursing student can: 1. Book, pen, notebook, laptop, and projector
List rationale for a profession’s creating a code of ethics;
2. Define disparagement, and state why it is a problem that is
References:
to be avoided in health care practice; and,
Ethics of Health Care: A Guide for Clinical
3. State an ethically based rationale for discouraging conflict Practice Fourth Edition, Raymond S.
Edge, J. Randall Groves
1. This health care model is of nonprofit motive, no need to advertise, no expensive underwriting.
Answer: National Health Insurance
2. Payer is government-run insurance program all citizens pay into.
Answer: National Health Insurance
3. Private not-for-profit health insurance (“sickness funds”) financed jointly by employees and employers through
payroll deductions
Answer: Bismarck Model
4. Health care financed by government and taxed based rather than insurance based
Answer: Beverage Model
5. This health care model is used in Taiwan, Canada and Australia.
Answer: National Health Insurance
MAIN LESSON (20-30 minutes)
The instructor should discuss the following topics. Instruct students to take down notes and read their book about this
lesson (Chapter 7 of their books):
Conflicts of Interest
• Joint-venturing
– Group of individuals join together performing a business venture
– Any commercial relationship between practitioner and a company, in which practitioner has material interest
that could form basis for a conflict of interest, spelled out in a disclosure statement
• Self-referral
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– To self-refer to an establishment in which you do not provide service but have an economic interest is at
least suspect and perhaps unethical
Sexual Misconduct in Health Care Practice
• Sexual Relations
– Between practitioners and patients unethical
– Relationship between practitioner and patient always unequal
– Create emotional factors that interfere with therapeutic relationship and objective judgment • When
practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it is time to end professional
relationship
Scope of Practice
• Role Fidelity
– Requires we remain within scope of clear legitimate practice
– One does not cross line without willful intention
• Nurse-patient Relationship Models
– Bureaucratic model: emphasis on maintenance of social order at expense of individual patient’s welfare
– Physician advocate model: goal is to enhance authority of physician
Impaired Colleagues
• Impaired colleagues place clients at risk
• Behavioral difficulties: absenteeism, illogical decision making, excessive errors
• Question is not whether practitioner has a duty to intervene, but the manner of the intervention •
Health care provider must be confronted
• Made to seek effective assistance
• Treat impaired colleague humanely
Codes of Ethics and Professional Conduct
• Codes of conduct and ethics include:
– Appropriate scope of practice
– Conflicts of interests
– Serving best interest of patients
– Obligations to promote patient autonomy and privacy
– Obligations beyond patients to others in society
– Ethics of research
– Informing on unethical or illegal behavior
• Common Problems with Professional Codes
– Vagueness as to duties and prohibitions and self-regulation and peer enforcement
– Incompleteness as to duties
– Excessive concern with promotion and prestige of profession and financial and business interests
• Gatekeeping
– One looks out for the interests of the profession or of others in a similar practice
– Result of professional obligations and training
– Strong sense of collegiality with others in practice
– Disparaging: talking ill of
Gaming the System
• Practitioner attempting to get around the system
• Willing to lie in the process
• Often done on behalf of patient or at patient’s request
• Health care practitioners’ responsibility to be truthful, keep promises, be fair
• Lying undermines a person’s credibility
• If individual clinician found to be lying, can have harmful effect on entire health care profession •
Gaming can harm other patients
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PHINMA Education (Department of Nursing)
CHECK FOR UNDERSTANDING (15 minutes)
-The instructor will prepare 5-10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.
Multiple Choice
(For 1-10 items, please refer to the questions in the Rationalization Activity)
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS) The instructor
will now rationalize the answers to the students and will encourage them to ask questions and to discuss among their
classmates for 15 minutes.
1. The physician assistant who certifies who certifies that an elderly patient with bunions needs a handicapped
parking stickers, when in fact the severity of the problem does not meet the standard for authorizing the sticker.
What moral problem is involved in this situation?
A. Disparagement
B. Gaming the system
C. Gatekeeping
D. None of the above
Answer: B.
Rationale: Gaming the system can be defined as using the rules and procedures meant to protect a system
to, instead, manipulate the system for a desired outcome.
2. The common problems associated with professional codes are as follow EXCEPT?
A. Incompleteness as to duties
B. Vagueness as to duties and prohibitions
C. Excessive concern with prestige of profession
D. None of the above
Answer: D.
Rationale: All of the following are mention are common problems associated with professional code and includes:
vagueness in regard to self- regulation and peer enforcement.
3. One looks out for the interest of the profession or of others in a similar practice is known as?
A. Disparagement
B. Gaming the system
C. Gatekeeping
D. Code of conduct
Answer: C.
Rationale: Gatekeeping function where one looks out for the interest of the profession or of others in similar practices,
comes as a result of our professional obligation and training which lead to a strong sense of collegiality with others in
our practice.
4. Code of conducts and ethics include the following EXCEPT?
A. Serving best interest of patients
B. Ethics of research
C. Incompleteness to duties
D. Appropriate scope of practice
Answer: C.
Rationale: Incompleteness to duties in included in the common problems with professional code of conduct and ethics.
5. What are the ways of a health care professional to avoid disparagement?
A. Offer professional courtesy to others
B. Avoid sexual and conflict of interest
C. Look after the welfare of the profession
D. All of the above
Answer: D.
Rationale: All of the above mention are ways to avoid disparagement thus this will create a harmonious relationship
with your colleagues and build a strong one.
6. Which of the following statement about sexual misconduct is INCORRECT?
A. Between practitioners and patients unethical
B. Relationship between practitioner and patient always equal
C. When practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it is time to
end professional relationship
D. None of the above
Answer: B.
Rationale: Relationship between practitioner and patient is always unequal. Because the nature of the practitioner-
patient relationship places the practitioner in a position of advanage in the critical areas of knowledge , power, status
and personal vulnerability.
7. Sheryl is a respiratory therapy technician in a small town in Michigan. The town has a small hospital and a
small durable medical supply company. She is known locally as an entrepreneur ball of fire and has managed
to become both the head of the hospital respiratory care department and the owner of the small durable
medical supply company. What code of ethics and professional conduct best describe the scenario? A. Role
fidelity
B. Conflict of interest
C. Moral duty
D. Duty to treat
Answer: B.
Rationale: Conflict of interest is a situation in which a person or organization is involve in multiple interest, financial or
otherwise, and serving one interest could involve working against another.
8. What universal principle requires remaining within the scope of legitimate practice. Scope of practice is clear, and
one does not cross the line without willful intention?
A. Justice
B. Autonomy
C. Role Fidelity
D. Veracity
Answer: C.
Rationale: Role fidelity is concerned with promise keeping, integrity and honesty. It also involves meeting the
patient's reasonable expectations (role fidelity) such as being respectful, competent and professional.
9. The nature substance abuse is such that even fine practitioners begin to experience behavioral difficulties such as
EXCEPT.
A. Behaves naturally
B. Absenteeism
C. Illogical decision making
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D. Excessive error
Answer: A.
Rationale: Substance abuse result in negative behavior such as absenteeism, illogical decision making, excessive error
that makes a patient at risk because of imapaired colleagues.
10. An example of conflict of interest where a group of individuals join together to perform a business
venture. A. Self-referral
B. Business partners
C. Joint -venturing
D. Stark law
Answer: C.
Rationale: Joint- venture a commercial enterprise undertaken jointly by two or more paties which otherwise retain their
distinct identities.
LESSON WRAP-UP (10-15 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students
track how much work they have accomplished and how much work there is left to do. This tracker will be part of the
student activity sheet.
You are done with the session! Let’s track your progress.
AL: GROUP ACTIVITY
The instructor will form 6 groups with members depending on the size of the class to answer the given review
exercise. this will be written in a one whole sheet of paper.
On an ethical basis, going beyond your scope of practice, having sexual relations with patients, and self-
referrals are problems. Write a short paragraph for each of these practices using a legitimate moral rationale
indicating why these practices do harm to the professions, the practitioners, and the patients we serve.
Group 1 and 2- Going beyond scope of practice
Group 3 and 4- Sexual relations with patients
Group 5 and 6- Self-referral
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