Cebu Doctors University

College of Nursing
Mandaue City

NCM 107
Nursing Leadership and Management

Module 2M:
Ethico Moral Aspects of Nursing
Group 2

Submitted to:
Dr. Armand K. Cuasito, RN. PhDNSc

Submitted by:
Alvarez, Justine Sheene
Ayo, Samantha
Baja, Danica
De los Reyes, Wensie
Eduave, Nina Isobelle
Saldon, Mary Christine
Urbina, Andie Therese
Uy, Angela Faye
Statement of Purpose:
- Nursing ethics is a system of moral principles or moral standards governing the
conduct of nurses which by reason of public approval or practices of the group
has become customary among professional nurses.
- This module will help guide the learner in creating an environment that is both
ethically and morally grounded for him/her to have a cordial relationship with the
family, her associates and fellow nurses, and the society at large.

Objectives:
At the end of this module, the learner will be able to:
1. define the terms related to Ethico-Moral Aspects of Nursing
1.1. ethics
1.2. morals
1.3. nursing ethics
2. cite the importance of the study of ethics
3. understand the guiding principles of the Code of Nurses as adopted by the
International Council of Nurses (ICN)
3.1. nurses and people
3.2. nurses and practice
3.3. nurses and society
3.4. nurses and co-workers
3.5. nurses and the profession
4. relate the guiding principles of the Code of Nurses as to the duties and
responsibilities of nurses in their practice
5. discuss the primary and secondary ethical principles in the practice of nursing
5.1. autonomy
5.2. beneficence
5.3. non-maleficence
5.4. justice
 5.5. veracity
5.6. fidelity
5.7. confidentiality
6. explain common end of-life issues
6.1. euthanasia - voluntary: active or passive - involuntary
6.2. Do Not Resuscitate (DNR) Order
6.3. Advance Directives - Directive to Physician, Family or Surrogate - Medical
Power of Attorney
7. describe what is an ethical dilemma and the steps on how to process it
8. give examples of ethical dilemma encountered in the practice of nursing
9. state the different moral principles applicable in the practice of nursing
9.1. The Golden Rule
9.2. The Two-fold effect
9.3. The Principle of Totality
9.4. The End Does Not Justify the Means
10. discuss ongoing Webinar process of activities
10.1. Proposed Webinar Topic and Title
11. adheres to ethico-legal consideration in performing nursing and leadership roles
12. apply ethical reasoning and decision-making process to address situations on
ethical distress and dilemma.
13. adhere to protocol and principles of confidentiality in safekeeping and releasing
of records and other information
14. adhere to established norms in the practice of nursing
15. demonstrate caring as the care of nursing, love of God: love of country and love
of people
16. project the positive professional image of a Filipino Nurse
17. exemplify compassion, dedication, uprightness, courtesy, and neatness in
performing nursing roles and functions
18. exemplify love for country in service of the Filipino
19. project the positive professional image of a Filipino Nurse
1. define the terms related to Ethico-Moral Aspects of Nursing
1.1 ethics - declaration of what is right & wrong
1.2 - morals - ​a lesson, especially one concerning what is right or prudent, that
can be derived from a story, a piece of information, or an experience.
1.3 - nursing ethics - subset of bioethics which is concerned with the study of
ethical issues that arise in nursing practice

2. cite the importance of the study of ethics

● Helps promote the standard of nursing practice
● Protects values, customs and cultural beliefs
● Guides to avoid overlapping of duties and responsibilities
● Protects confidentiality
● Implement desirable standards

3. Understand the guiding principles of the Code of Nurses as adopted by the

International Council of Nurses (ICN)
● Nurses and People
- The nurse’s primary professional responsibility is to people requiring
nursing care
- In providing care, the nurse promotes an environment in which the human
rights, values, customs and spiritual beliefs of the individual, family and
community are respected
- The nurse ensures that the individual receives accurate, sufficient and
timely information in a culturally appropriate manner on which to base
consent for care and related treatment
- The nurse holds in confidence in people information and uses judgement
in sharing this information
 - The nurse shares with society the responsibility for initiating and
supporting action to meet the health and social needs of the public, in
particular those of vulnerable populations
● Nurses and Practice
- The nurse carries personal responsibility and accountability for nursing
practice, and for maintaining competence abby continual learning
- The nurse maintains a standard of personal health such that the ability to
provide care is not compromised
- The nurse uses judgement regarding individual competence when
accepting and delegating responsibility
- The nurse at all times maintains standards of personal conduct which
reflect well on the profession and enhance its image and public
confidence.
● Nurses and Society
- Collaborative action between the members of the community and
collaborative work
- The nurse shares with society the responsibility for initiating and
supporting action to meet the health and social needs of the public, in
particular those of vulnerable populations
● Nurses and Co-Workers
- The nurse sustains a collaborative and respectful relationship with
co-workers in nursing and other fields
- The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a co-worker or any other
person
- The nurse takes appropriate action to support and guide co-workers to
advance ethical conduct
● Nurses and the Profession
 - The nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management, research
and education
- The nurse is active in developing a core of research-based professional
knowledge that supports evidence -based practice
- The nurse is active in developing and sustaining core of professional
values
- The nurse, acting through the professional organization participates in
creating a positive practice environment and maintaining safe, equitable
social and economic working conditions in nursing

4. relate the guiding principles of the Code of Nurses as to the duties and
responsibilities of nurses in their practice
American Nurses Association 2015 Code of Ethics for Nurses:
● The nurse practices with compassion and respect for the inherent dignity, worth
and unique attributes of every person.
- The respect for human dignity. Nurses establish a relationship with their
clients by building trust and provide the care that they need regardless of
their race, gender and social status.
● The nurse’s primary commitment is to the patient, whether an individual, family,
group, community or population
- The plan of care for each client should be unique to them. During the plan
of care, nurses allow the clients to participate in the planning and
implementing their treatment. The plan of care is not only for the client but
also for the client’s family as the continuity of care is in their own homes.
● The nurse promotes, advocates for, and protects the rights, health and safety of
the clientt.
 - The client’s have the right to privacy. The nurses must ensure that all
information must be kept confidential at all times as the need for
healthcare does not justify unwanted intrusion in a client’s life.
● The nurse has the authority, accountability, and responsibility for nursing
practice; make decisions, and take action consistent with the obligation to
promote health and provide optimal care.
- Nurses are responsible for the care that they give to their client. This
includes the care authorized by the physicians, their independent nursing
intervention and health teachings. Nurses are accountable for their own
actions and judgements made with regards to their nursing practice.
● The nurse owes the same duty to self as to others, including the responsibility to
promote health and safety, preserve wholeness of character and integrity,
maintain competence and continue personal and professional growth.
- The duty to self and others. The respect of all human beings is not only for
the client but for the nurse as well. The same duties that they owe to the
clients are owed to themselves. The nurse must take care of
himself/herself in order for them to give proper care to their clients.
● The nurse, through individual and collective effort, establishes, maintains and
improves the ethical environment of the work setting and conditions of
employment that are conducive to safe and health care.
- Nurses must create an environment that supports proper ethical practices.
Head nurses and nurse executives must ensure that all nurses are treated
fairly and equally.
● The nurse, in all roles and settings, advances the profession through research
and scholarly inquiry, professional standards development, and the generation of
both nursing and health policy.
- Participating in research will help nurses gain advanced knowledge that
can help with the development of the nursing profession. Nurses should
 be part of any scholarly activities in order for them to expand their
knowledge that forms both theory and practice.
● The nurse collaborates with other health professionals and the public to protect
human rights, promote health diplomacy and reduce disparities.
- The need for health is a universal right. Nurses collaborate with not only
the physicians but other healthcare professionals in order to give the
clients the optimal care that they need. Nurses dedicate and show their
commitment through their profession by sustaining health so each
individual can live up to their fullest.
● The profession of nursing, collectively through its professional organizations,
must articulate nursing values, maintain the integrity of the profession, and
integrate principles of social justice into nursing and health policy.
- Nurses may emphasize the values of justice and fairness in caring for their
clients. They are responsible for communicating, affirming and promoting
their values not only to their clients but to the community outside of the
hospital setting as well.

5. discuss the primary and secondary ethical principles in the practice of nursing
● Autonomy
○ Essential element of a professional nurse; this means that the person is
reasonably independent and self-governing in decision making and
practice
■ Ex: Informed consent means that the patient fully understands the
risks involved in a surgery. The action of allowing the patient to
decide whether a surgery is to proceed exemplifies autonomy
● Beneficence
○ Doing or producing good
■ Ex: administering an antibiotic as a prophylaxis for
● Non-maleficence
 ○ Our duty is to “do no harm” or preventing harm
■ Ex: raising side rails of a patient bed during a transfer to the
Operating Room
● Justice
○ Fairness and equality
○ Guided by truth and justice; not biased and judgemental
○ Equality: fair for all parties as dictated by reason and conscience
○ Morally good side wins
● Veracity
○ Telling the truth
■ Ex: you tell a pediatric patient that you will inject in 3 seconds and
not surprise them at 2 seconds
● Fidelity
○ Faith to agreement and promises
■ Ex: as a nurse you agree to walk a psychiatric patient every
Tuesday, so you fulfill this promise
● Confidentiality
○ Any information subjecting the patient or client will not be made public or
available to others
■ Complying with HIPAA (Health Insurance Portability and
Accountability Act of 1996) and not sharing any private patient
information to a third party

6. explain common end of-life issues:

❏ Euthanasia
- Mercy killing
- Painlessly putting to death those people suffering from incurable or painful
disease
 a. Voluntary​:
- Two willing parties
- Dying individual desires control over time and manner of death

1. Active
- Lethal dose of potassium
- Person directly causes the patient's death (overdose)
- SO decides euthanasia
- Voluntary if SO is the proxy
- Involuntary if SO is not the health care proxy
2. Passive
- Remove respirator
- Not doing extraordinary measures
b. Involuntary
- No consent given by patient

❏ Do Not Resuscitate (DNR) Order

- “No code” or “DNR” for clients who are in a stage of terminal, irreversible
illness or expected death
- “Allow natural death”
- Written, renew every 24 h by doctor
- Do not do CPR
- Does not include stopping feeding or giving meds

❏ Advance Directives
- Legal documents that allow person to specify aspects of care they wish to
receive, should they become unable to make their preferences
 - Legal document that allow you to spell out your decisions about end of life
ahead of time
- Living will
- accept/ refuse med care
a. Directive to Physician, Family or Surrogate
- Living will/ natural death act
- Allows patient to decide the treatments they would like or not
like the future
- Patient documents wishes for treatments or withdrawal of
treatment
b. Medical Power of Attorney
- Patient names another person to make decisions on their
behalf when they are unable to do so
- Patient designates another person as decision maker

7. describe what is an ethical dilemma and the steps on how to process it

An ethical dilemma can be described as being forced to choose between two or more
undesirable alternatives. For example, a nurse might experience an ethical dilemma if
he or she was required to provide care or treatments which are in conflict with his or her
religious beliefs.

Steps on how to process it:

1. Ask, “What is the ethical question?” In identifying the ethical question, the nurse
must look for “shoulds”.
2. Ask about your first gut reaction to the case. This step is essential if you are
going to be able to identify your own values, assumptions, and biases, and set
them side in order to analyze the situation; this also helps to notice if others have
a different reaction from you.
 3. Gather relevant facts, both facts that are already known and facts needed to
determine a justified course of action.
4. Ask, “What are the values at sake for this scenario?” One must consider values
from different perspectives. Know who are the stakeholders (someone who will
be affected by the decision made) and what their perspective are.
5. Ask, “What are the options in this case?” Specifically what can both the nurse
and physician do?
6. Ask, “What should I do?”, “What do I think is the best option based on the values
of the stakeholder?”
7. Ask, “What justifies this choice?” Give reasons to support your decisions based
on the values at sake and be able to respond to objections that come your way.
8. The last step in processing an ethical dilemma is to ask, “How could this ethical
problem have been prevented?” Identify if there are systematic changes that
could have been made to prevent the problem from occurring again.

8. give examples of ethical dilemma encountered in the practice of nursing

● . ​Informing client about emotionally impacting information
○ Patient V, a woman, 41 years of age, is in critical condition and is
scheduled for emergency surgery following a severe motor vehicle
accident. You have been informed that her two children have been killed
in the crash. She is almost hysterical and is asking you repeatedly about
the condition of her children as you prepare her for emergency surgery.
Do you tell the mother the truth about her children at this time or wait until
after the surgery?
● To provide life saving measures that are against patient’s wishes
○ A 20-year-old, pregnant, Black Hispanic female presented to the
Emergency Department (ED) in critical condition following a single-vehicle
car accident. She exhibited signs and symptoms of internal bleeding and
 was advised to have a blood transfusion and emergency surgery in an
attempt to save her and the fetus. She refused to accept blood or blood
products and rejected the surgery as well. Her refusal was based on a fear
of blood transfusion due to her belief in Bible scripture. She was not given
any blood products, and despite vigorous care, her condition worsened
within 2 hours. She delivered a stillborn baby, and was transferred to the
ICU where she underwent cardiac arrest and died.
● Truth Telling to Terminally Ill Patients
○ Merry was a 40-year-old mother of two with a history of tumor and hospital
visits; however, her last doctor’s visit in October left her and her family
with shattering news. Doctors diagnosed Merry with metastatic inoperable
tumor. Since Merry last visit, her conditions worsened due to malignancy
and she became a victim of nausea, vomiting, intestinal obstruction and
slothfulness. When Merry came to know of her medical conditions, she
became stubborn and denied treatments the hospital offered her:
exploratory laparotomy, insertion of a urinary catheter, and insertion of
nasogastric tube. The matter of refusal of treatment between the medical
staff and Merry put her family in a hard situation. They encouraged Merry
to agree to take the hospital’s treatments; on the other hand, they also
wanted to respect and honour her autonomous wishes. In due course, the
medical team established a terminal diagnosis for Merry and informed this
to her family. Afterwards, the family asked the consultant to keep this
information from Merry. The consultant agreed and Merry sustained her
stay in the hospital with the trust that she was suffering from a tumor
which can be cured. A week later, the holidays approached, Merry and her
family conversed plans for Christmas as well as her discharge from the
hospital. Though Merry’s family and doctors were well aware of her
prognosis, both groups willingly concealed the truth and let Merry believe
her health condition was not terminal. This created an uncomfortable
 situation for the involved health care professionals involved in this tough
conflict of interest. Eventually, Merry’s disease took control of her life and
she unknowingly passed away one week before her expected Christmas
holiday.
● Case of Suspected Child Abuse
○ You are a nurse in a pediatric unit. One of your patients is a girl, 15
months of age, with a diagnosis of failure to thrive. The mother has stated
that the child appears emotional, cries a lot, and does not like to be held.
You have been taking care of the infant for the two days since her
admission, and she has smiled and laughed and held out her arms to
everyone. She has eaten well. There is something about the child's
reaction to the mother's boyfriend that bothers you. The child appears to
draw away from him when he visits. The mother is very young and seems
to be rather immature, but appears to care for the child. This is the second
hospital admission for this child. Although you were not on duty for the first
admission six weeks ago, you check the records and see that the child
was admitted with the same diagnosis. While you are on duty today, the
child's father calls and inquires about her condition. He lives several
hundred miles away and requests that the child be hospitalized until the
weekend (it is Wednesday) so that he can "check things out." He tells you
that he feels the child is mistreated. He says he is also concerned about
his ex-wife's four-year-old child from another marriage and is attempting to
gain custody of that child in addition to his own child. From what little the
father said, you are aware that the divorce was very bitter and that the
mother has full custody. You talk with the physician at length. He says that
after the last hospitalization he requested that the community health
agency call on the family. Their subsequent report to him was that the
4-year-old appeared happy and well and that the 15-month-old appeared
clean, although underweight. There was no evidence to suggest child
 abuse. However, the community health agency plans to continue following
the children. He says the mother has been good about keeping doctor
appointments and has kept the children's immunizations up to date. The
pediatrician proceeds to write an order for discharge. He says that
although he also feels somewhat uneasy, continued hospitalization is not
justified and the state medical aid will not pay for the additional days.
When the mother and her boyfriend come to pick her up, the baby clings
to you and refuses to go to the boyfriend. She is also very reluctant to go
to the mother. All during the discharge you are extremely uneasy. When
you see the car drive away, you feel very sad. What should you do? Upon
returning to the unit, you talk with your supervisor, who listens carefully
and questions you at length. Finally she says, "It seems as if you have
nothing concrete to act upon and are only experiencing feelings. I think
you would be risking a lot of trouble for yourself and the hospital if you
acted rashly at this time. Accusing people with no evidence and making
them go through a traumatic experience is something I would hesitate to
do."

9. state the different moral principles applicable in the practice of nursing

- The Golden Rule
● Simply stated, the Golden Rule is “Do unto others as you would have
them do unto you.” This is a guiding moral principle that emphasizes
reciprocity in an individual’s actions on the ground that human beings’
innate selfishness cause them to gauge their actions based on how they
would also like to be treated.
- The Two-Fold Effect
● Also known as “Double Effect”, the Two-Fold Effect is an ethico-moral
doctrine that states that each action has both a positive and negative
effect, and that the action may be justified so long as the positive outcome
 outweighs the negative outcome or the negative outcome was not
intended. This principle can often be seen in the healthcare setting
regarding patients with DNR (Do Not Resuscitate) orders, terminally ill
patients, and euthanasia.
● Example: A doctor may choose to provide certain medications to a
terminally ill patient to relieve negative symptoms despite knowing that this
drug might cause the patient’s condition to deteriorate and die sooner.
- The Principle of Totality
● The Principle of Totality expresses that all decisions must acknowledge
and benefit the entirety of a person. This principle is derived from the
philosopher St. Thomas Aquinas. In this doctrine, any action that is
perceived to cause damage to any part of a person, including their
physical, psychological, and spiritual parts, is considered morally wrong.
However, this principle states that one component of a whole may be
sacrificed for the greater good of the entire being.
● Example: The removal of a cancerous tumor is justified because it is seen
to benefit the totality of the human in the long run.
- The End Does Not Justify the Means
● This principle states that anything that results in a good outcome is
morally wrong if dishonest or harmful actions were done to achieve it.
● The key to achieving justified means are through methods that are
transparent, respectful, and empathetic.
● Example: A student nurse falsified data in a nursing research course in
order to meet the prescribed deadline. The end goal was met, but the
action was executed in a dishonest way.

References
Marquis, B. L., & Huston, C. J. (2021). ​Leadership roles and management functions in
nursing: Theory and application​. Philadelphia: Wolters Kluwer Health.
Roussel, L., Thomas, P., & Harris, J. (2020). ​Management and leadership for nurse
administrators.​ Jones and Bartlett Learning.