University of Massachusetts Boston s5

University of Massachusetts Boston College of Nursing and Health Sciences

Course Number: NU 332 Course Title: Legal, Ethical and Health Policy Issues in Nursing Credits: 3 credits, 3 hours of classroom Semester and Year: Level 2, Semester 6 Pre-requisites: Completion of all 100 and 200 level courses, NU 314 Pharmacology, NU 310 Adult Health I, NU 320 Nursing Research, Writing Proficiency Co-requisites: NU 335 Maternity & Women’s Health Nursing (6 credits) NU 345 Mental Health Nursing (6 credits) Faculty: Thomas W. Connelly, Jr., Ph.D., RN Office Telephone: 617.287.6170 E-mail: [email protected] Office Hours: Wednesday: 0700-0800, after class and by appointment Office Location: Science building, 3rd floor, room 301-05

Course Description: This course provides a legal, ethical, and political approach to guide health professionals to socially responsible practice and collaboration within the changing health care environment. In addition, the course conducts critical analyses of contemporary urban health and policy issues affecting individuals across the lifespan. The impact of the complex socio-political environments on how the health care system evolved and is continually reformed is explored. Different health issues and policies including communication, advocacy, and ethical concerns of access, quality, and cost will be examined.

Course Objectives: At the completion of this course, the learner will:

1. Differentiate ethical, legal, and policy approaches to examine issues in nursing, health care and society. 2. Identify the socio-political influences on the development, implementation, and evaluation of selected health policy in the United States. 3. Summarize the effect of current government (local, state, federal) and health care provider group policy on the people/clients across the life span. 4. Explain the effect of government (local, state, federal) and health care provider group laws and regulations on nursing and other health care professions. 5. Analyze literature and research from nursing and other disciplines in articulating and communicating positions about nursing, health and societal issues. 6. Incorporate political awareness, critical consciousness social activism and participation in the policy process into professional role behavior.

1 Topical Outline: Introduction to the course Overview of ethical, legal, policy/political framework Ethical theories Review of relevant nursing documents: ANA Code of Ethics, The Social Policy Statement and the Scope of Nursing Practice Ethical dilemmas in health care/bioethics Major ethical theories and concerns in nursing Decision-making frameworks for analyzing ethical dilemmas Types of laws/rights of patients Avoiding malpractice and other legal risks How a bill becomes a law and the legislative process Regulation, accountability, and professional relationships in nursing The political context of health care Key concepts in public policy The role of the nurse in shaping, implementing and evaluating health policy

Methods of Instruction: Lecture Group discussion/presentations Required readings Written assignments Discussion and critique Educational media

Methods of Evaluation: Class participation 10% ANA Code of Ethics 15% MEDSPUB exam 10% Required reading abstracts 15% Analysis and debate 50%

Required Texts:

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC: Author. Burkhardt, M.A. & Nathaniel, A.K. (2008). Ethics and issues in contemporary nursing (3rd ed.). New York: Thomson Learning (Delmar).

Required References:

American Psychological Association. (2001). Publication Manual of the American Psychological Association (5th ed.). Washington, DC: Author. Hacker, D. (2006). A writer’s reference (6th ed.). Boston: Bedford St. Martin Press. See also: http://Windson.igs.net/~nhodgins/apa_format_guidelines.html

2 Required Readings:

Aranda, S. (2004). Euthanasia – a clinical and professional issue for nurses. Journal of Advanced Nursing, 47(6), 603-604. Bell, E.A. (1991). Debate: A strategy for teaching critical thinking. Nurse Educator, 16(2), 6-7. Cagle, C.S. (2006). Student understanding of culturally and ethically responsive care: Implications for nursing curricula. Nursing Education Perspectives, 27(6), 308-314. Cameron, M.E., Schaffer, M. & Park, H. (2001). Nursing students’ experience of ethical Problems and use of ethical decision-making models. Nursing Ethics, 8(5), 432-447. Daroszewski, E.B., Kinser, A.G., & Lloyd, S.L. (2004). Socratic method and the internet: Using tiered discussion to facilitate understanding in a graduate nursing theory course. Nurse Educator, 29(5), 189-191. Faulk, D.R. & Ternus, M.P. (2004). Strategies for teaching public policy in nursing. Nurse Educator, 29(3), 99-102. Garity, J. (1995). Creating a professional presentation: A template for success. Journal of Intravenous Nursing, 22(2), 81-86. Garity, J. (2004). Euthanasia – nursing education and research implications. Journal of Advanced Nursing, 47(6), 601-602. Haidinyak, G. (2006). Try a mock trial. Nurse Educator, 31(3), 119-123. Henry, P.R. (2006). Marking groups work in the classroom. Nurse Educator, 31(1), 26-30. Johnson, S.A. & Romanello, M.L. (2005). Generational diversity: Teaching and learning approaches. Nurse Educator, 30(5), 212-216. Kelly, K. (2007). From apathy to political activism. American Nurse Today, 2(8), 55-56. Morrison, C.A. (2003). Named in a lawsuit. Advance for Nurses, 5(5), 32. Tschudin, V. (2004). Euthanasia and nurses. Journal of Advanced Nursing, 47(6), 602-603. Wolf, R. & Donnelly, G. (1993). Public speaking: Content and process evaluation of nursing students’ presentations. Nurse Educator, 18(2), 30-32.

Recommended Readings:

Aiken, T.D. (2004). Legal, ethical, and political issues in nursing (2nd ed.). Philadelphia: F.A. Davis. Bandman, E.L. & Bandman, B. (2002). Nursing ethics through the lifespan (4th ed.). NJ: Pearson Education, Inc. Fry, S.T. & Veach, R.M. (2006). Case studies in nursing ethics (3rd ed.). Boston: Jones & Bartlett Publishers. Harrington, C. & Estes, C. (2004). Health policy: Crisis in the U.S. health care delivery system (4th ed.). Boston: Jones & Bartlett Publishers. O’Keefe, M.E. (2001). Nursing practice and the law: Avoiding malpractice and other legal risks. Philadelphia: F.A. Davis.

3 Other:

1. Disability Statement Any student with a physical or mental impairment that substantially limits that individual in some major life activity and requires an accommodation must provide written documentation of the disability to the Director of the Ross Center for Disability Services. The Director of the Disability Services will make a determination whether or not accommodations are needed. Once this determination is made, the Director will then consult with the faculty member on appropriate accommodation(s). A student with a documented inability is encouraged to register with the Ross Center for Disability Services (Campus Center, 2nd floor, Room 2010, [617-287-4301]).

2. Academic Honesty Statement The health professions have a Code of Ethics and Standards for their members. It is the policy of the College of Nursing and Health Sciences that academic dishonesty or misconduct will not be tolerated. All exercise science and nursing students should familiarize themselves with the policies on Academic Dishonesty and Student Misconduct in the University and College of Nursing and Health Sciences Student Handbooks. Examples of academic dishonesty include, but are not limited to, cheating on exams, submitting written material that is the work of others, or seeking unauthorized use of computer files of a student or faculty member. Misconduct includes, but is not limited to, furnishing false or inaccurate information, disruptive conduct or threat, or damage to university property.

3. Civility in Class Please turn off all cell phones, wireless electronic devices, and pagers. Refrain from disrespectful and distracting behaviors in class including speaking out of turn, laughing inappropriately, or passing notes, etc… while another student is trying to contribute, and especially when the faculty member is lecturing on class content which the majority of students want to hear and take notes on. Students who do not observe civility in class will be asked to leave and/or withdraw from the course.

4. Attendance Classes will begin and end at scheduled times. Attendance will be taken. Multiple absences will be reflected in the student’s final grade and/or the student will be asked to leave or withdraw from the course. Tests or paper assignments in other courses or working does not justify an absence in this course.

5. E-mail Accounts All students are expected to have an e-mail account at the University of Massachusetts Boston. Please note that the University URL server often will not recognize e-mail accounts, because of security reasons, when students forward UMass Boston e-mail messages, especially AOL. All announcements about the course and handouts will be sent with the UMass Boston e-mail account system. There are no exceptions. Please contact customer service, not faculty, if you experience any difficulty in receiving electronic course materials/communications.

4 6. Class Participation Students are expected to complete assigned readings and participate significantly in class discussion and group work each week. Signing the attendance sheet does not constitute significant participation. Success in this course will not be measured by memorizing facts for a test, but rather by active student engagement and discussion on each week’s class material. Individual student participation should consistently demonstrate one or more of the following levels in each class throughout the course:

 Clearly contributes to the discussion from the ethical, legal, and health policy literature.  Raises questions that are thought-provoking.  Comments reflect synthesis of knowledge form nursing, not personal anecdote or experience.  Demonstrates critical thinking and scientific inquiry.

Please see E-reserve article Socratic Method of Discussion by Daroszewski, et al. to enhance your class participation skills.

7. Evaluation Criteria for Written and Oral Assignments:

Submitted work is to follow the APA guidelines set forth in the Publication manual of the American Psychological Association (5th ed.). In addition, the following criteria will be assessed:

Honesty. Essential criterion. The paper meets University and College of Nursing standards of academic honesty. If this criterion is not met, the remaining of the criteria does not apply. The student will automatically fail the assignment. Briefly, the faculty expects that each student will work individually and that all references will be cited with no evidence of plagiarism from published literature or other work. Responsiveness. The response addresses the question that is asked and addresses each point in the question. Requirements specified in the instructions are met. Logic. The development of the paper flows smoothly from point to point throughout the paper. Materials, such as examples, case studies, etc… are thoroughly integrated into the presentation. Accuracy. Information is accurately presented and referenced. Breadth. An appropriate variety of information from several sources is integrated in the paper to show a breadth of understanding. Depth. Specific information is included to illustrate or otherwise support the point being made to show the depth of understanding. Originality. The paper is presented in the student’s own words and contains an appropriate variety of significant information to show breath of understanding as well as an ability to critically assess and prioritize the literature.

5 8. Access to Healey Library Electronic Reserves All required reading can be downloaded through the Healey Library Electronic Reserve system. To access the articles, follow these steps:

1. Open your internet browser and go to http://www.lib.umb.edu 2. Click on Healey Library Catalog 3. Click on eReserves (under Electronic Resources) 4. Click on Electronic Reserves and Reserve Pages 5. Select Course Reserves, Pages by Instructor 6. Select instructor (Garity) and click on ‘Search’ 7. Click on Course, Nursing 332 8. Enter password: legal 9. Click on one article you would like to download 10. Repeat steps 1-9 to download other articles

9. Helpful Hints In addition to required texts and references, please scan one or more of the following newspapers on a daily or weekly basis for articles relevant to the class discussion topic and/or course assignments: www.bostonglobe.com (this is usually for free near coffee kiosks at UMB) www.ledger.com www.nytimes.com www.wallstreetjournal.com

10. MEDSPUB The MEDSPUB online website provides you with direct access to online learning modules to help you develop and use critical thinking and problem solving skills related to learning important test taking strategies and nursing concepts through content review, tutorials, and assessment, including case studies and practice exams. Please follow the student LOGIN instructions on the website http://www.medspub.com Please use your student UMB email address when registering for the first time. Your access code for this specific course will be emailed separately. If you have any concerns utilizing this site, please contact [email protected] for assistance. This website can be accessed from any computer – in your home, on campus, or elsewhere and is an additional learning resource for this course. The following learning modules for NU 225, 345 and 332 are: . Learning System – RN (see specific modules for Women’s Health or Psychiatry) . Pharmacology . Management (the section on legal and ethical issues – NU 332)

And previous programs: . Nurse Logic . Skill Building . Dosages and Calculations

6 Course Outline:

Week 1 January 30

Course Overview Burkhardt & Nathaniel Chapter 1

Detailed review of the syllabus Rationale for the course and its inclusion in curriculum Social/political/historical forces in shaping nursing Role of the nurse in ethical, legal and health policy issues

Week 2 February 6

Introduction to an Ethical, Legal, Policy/Political Framework Burkhardt & Nathaniel Chapters 4, 5 & 18

Values clarification/development Theories of moral development The relationship between ethics, law, and policy/politics in nursing and health care

Week 3 February 13

Introduction to Ethics Burkhardt & Nathaniel Chapters 2 & 3

Traditional theory of ethics (tautological, deontological, Natural Law, etc…) Ethical principles (autonomy, beneficence, etc…) Ethical conduct rules (veracity, privacy, etc…) Values and morals, obligations and rights: in technology, cultural diversity, family traditions, distribution of resources, health policy, etc…

Week 4 February 20 Required Reading Abstracts Due

Continued from Week 3

7 Week 5 February 27 ANA Code of Ethics Assignment Due Position Statements/Ethical Guidelines for Nurses Burkhardt & Nathaniel Appendices A, B, C & D

ANA Code of Ethics* ANA Social Policy Statement* ANA Scope of Nursing Practice* ICN Code of Nursing Ethics Patient’s Bill of Rights, etc… Read only copies available at http://www.nursingworld.org

Week 6 March 5

Ethical Dilemmas Burkhardt & Nathaniel Chapters 6, 11, 16 & 17 and Case Studies

Informed Consent, Genetics, Birth and the biological revolution, Abortion, Sterilization and contraception, Ageism, Sexism, Transcultural and Spiritual Issues, End-of-Life Care: Assisted suicide and Euthanasia, Competence and surrogate decision- making, Confidentiality/HIPPA regulations, Rationing of health care

Week 7 March 12

Continued from Week 6 Burkhardt & Nathaniel Chapters 10 & 11 and Case Studies

Week 8 March 26

Types of Law/Rights of Clients Burkhardt & Nathaniel Chapter 7

Types of law: common, statutory, constitutional, contract Tort law Malpractice Liability/reducing liability Judicial process – civil, criminal http://www.npg.com/npg/1999/index.html

8 Week 9 April 2 MEDSPUB Exam Due

Regulation, Accountability & Professional Relationship Issues Burkhardt & Nathaniel Chapters 8 & 9

Regulation and credentialing Nurse Practice Acts Public vs. Private regulation Nurses’ relationships with other nurses, physicians, subordinates, institutions and other health care professionals

Week 10 April 9

The Political Context of Health Care Burkhardt & Nathaniel Chapters 13, 19 & 20

Definitions of politics Special interest groups Stakeholders Advocacy and the politically active nurse

Week 11 April 16

Key Concepts in Public Policy Burkhardt & Nathaniel Chapters 10, 14 & 15

Definition of policy (historical, cultural, technological, and economic trends The policy process Policy analysis Putting together a policy issues paper Anatomy of a bill How a bill becomes a law Legislation process Nurse’s role in legislation http://www.mccormack.umb.edu/cwpp

Week 12 April 23

Student Debates

Week 13 April 30

9 Student Debates Week 14 May 7

Student Debates

Week 15 May 14

Student Debates

METHODS OF EVALUATION:

MEDSPUB Assignment (10% of course grade)

LEARNING MODULE: Log onto MEDSPUB account (be sure to use your spring activation code) Click on ‘NU 335-345 spring’ then Nursing Management, then Nursing Management Part II Click ‘Tutorial’ and review content areas #3 (Ethical Issues) and #4 (Legal Issues)

EXAM: Log onto MEDSPUB account Click on ‘NU 335-345 spring’ Click on ‘Learning System’ Click on ‘Management 2, 25 Q & A’ Take the exam and print a copy of your score to submit to the faculty. Assessment attempts = 3; Exam pass total = 80%; Tutorial time = none.

Required Reading Abstracts (Healey Library Electronic Reserves):

Select two of these articles (see page 3 of syllabus), read and write-up two abstracts (one paragraph on each, 3-4 sentences) about the major concepts and ideas discussed in the articles that any student or professional nurse should know or could benefit from in their clinical practice. Do not submit the journal’s abstract but rather your own words.

Grading: 15 points:

Use of substantive writing/critical thinking in answering question (10 points) [see page 31 in APA Manual] APA format, grammar, spelling, etc… (5 points) [see pages 10, 40 and 89 in APA Manual]

10 ANA Code of Ethics Assignment

Select one of the nine sections (these will be assigned in class) of the ANA Code of Ethics. Write a one page paper (include a separate title page) answering the following questions:

1. What are the main points/highlights covered in this section of the Code? Use your own words. 2. What did you find most interesting about this section of the Code? 3. What did you learn by reviewing this section of the Code? 4. How will you apply the information and knowledge from this section of the Code to the clinical nursing courses you are currently taking? Be specific about how this section of the Code serves to advance the professional role and practice of the nurse.

Grading: 15 points:

Use of substantive writing/critical thinking in answering question (10 points) [see page 31 in APA Manual] APA format, grammar, spelling, etc… (5 points) [see pages 10, 40 and 89 in APA Manual]

Analysis and Debate of an Ethical Dilemma/Health Policy

This is an integrated group assignment in which students work together to choose an ethical debate topic (a list of potential topics will be provided by the faculty) and research the ethical implications (ethical theory, ethical principles, and ethical rules of conduct) related to the dilemma, integrating health policy aspects and implications. This assignment does not reflect personal anecdote, public opinion polls or talk show commentary; but rather, nursing and health professional opinions on the subject. Groups of five students are required for this assignment. Two students will argue the pro side of an ethical issue and two students will argue the con side. The fifth student will be the moderator of the debate (see moderator role and responsibilities). Students in an individual debate group who believe strongly about an ethical issue, for example pro, should consider arguing the con position, and those who are against the issue should consider arguing the pro position in order that students in the debate groups may develop a more balanced viewpoint of the issue. A class handout of 10-15 nursing references (within the past five years), both pro and con, should be given to the class by each debate group. CINAHL and other data bases are available through the Healey Library. For every non-nursing internet source, provide a nursing reference article. A theoretical framework for presenting the debate will be provided to each student group by the faculty member. Student debates will take place the last four weeks of class. Debate groups are strongly encouraged to utilize creative audiovisuals such as power point (maximum of five slides), overheads, posters, class handouts, etc . . .

11 Helpful hints for this assignment:

 View current televised debate presentations  Read Garity’s article on successful oral presentations  http://www.truthtree.com/debates.shtml  www.toastmasters.org  Please dress for the debate as you would for a professional job interview!

This assignment reflects a group grade and all students are expected to contribute equally to the debate. In the event that any issues/concerns arise during group work, please notify the faculty member promptly.

Role of the Moderator:

Will include, but is not limited to, the following:

Scheduling of short meetings before and after class for each group to decide on a debate topic. Some class time will be allowed to set the groups and the group should plan on meeting at least two times for short meetings (5-10 minutes) prior to the debate.

Coordinating and reviewing articles submitted by each student including moderator to address topic from nursing and allied health points of view. Each student, including moderator, should read and submit short abstracts (one paragraph in own words, not the article’s abstract) on each of the articles relevant to the debate topic to the moderator well in advance. CINAHL should be the major data base used as we are studying nursing ethical issues and most nursing journals have ethical columns or articles on the debate topics.

Coordinating time for each debate group to practice delivering the debate in 45 minutes one or more times (just as students practice to successfully complete physical assessment exams).

Coordinating audio-visual equipment booking with faculty well in advance of debate.

12 Method of Evaluation of an Ethical Dilemma/Health Policy Debate

Criteria Possible Points Comments Points Earned Moderator: Introduces the topic to be debated, provides the structure for the debate and allows for discussion at the end. 15 Pro-side: Describes the ethical dilemma, delineating the variables and ethical principles. Performs a comprehensive review of the literature, summarizing the state of the science. Identifies the health policy aspects of the dilemma and its significance to health care, summarizing the background of the health policy. Describe the factors (internal and external, i.e. 25 stakeholders, special interest groups, etc…) and the ethical implications that should be upheld or may be violated in the specific or proposed health policy. States the legal issues at the state and/or federal level that should be upheld or may be violated, outlining each step of the process and the ethical/legal implications. Con-side: Describes the ethical dilemma, delineating the variables and ethical principles. Performs a comprehensive review of the literature, summarizing the state of the science. Identifies the health policy aspects of the dilemma and its significance to health care, summarizing the background of the health policy. Describe the factors (internal and external, i.e. 25 stakeholders, special interest groups, etc…) and the ethical implications that should be upheld or may be violated in the specific or proposed health policy. States the legal issues at the state and/or federal level that should be upheld or may be violated, outlining each step of the process and the ethical/legal implications. Presentation is clear, consistent and concise. Respectful of time allocation. Maintains eye contact with audience, manages personal nervousness and speaks audibly. 20 Debate materials (AV, case illustrations, handouts, etc…) were suitable given the nature of the content. Reference list provided. APA format followed. 15 TOTAL 100 TWC 2008