I.

Ethical decision making (Dula Pacquiao)

A. What is the model?

Ethical decision-making models provide a suggested mechanism for critical thinking and planning
for the resolution of ethical dilemmas. An ethical decision-making model is a tool that can be used
by health care providers to help develop the ability to think through an ethical dilemma and arrive
at an ethical decision.

Nurses encounter ethical dilemmas constantly in our fast-paced healthcare field. Ethical principles
are thus one of the most important aspects of clinical practice. Ethical principles are a set of
standards that help nurses make informed decisions when evaluating the consequences of their
actions.

What are these principles?

Nurses are first and foremost expected to respect all patients equally without discrimination. They
must also give patients autonomy, meaning patients must be allowed to make their own decisions
about treatment even if it isn't in their best interest. And another essential principle of nursing
practice is nonmaleficence, which reminds us to cause no intentional harm to patients. This
includes things like identifying both benefits and risks of medical treatment options.

Each of these main principles of respect, autonomy, and nonmaleficence should be carefully
evaluated when ethical conflicts arise to ensure that decisions do not jeopardize any of these
principles.

B. Who is the proponent?

- Dula F. Pacquiao is the proponent of Cultural Competence in Ethical Decision Making. On

1992, she graduated Doctor of Education (EdD) major in Anthropology of Education at Rutgers
University, New Brunswick, NJ and she had her Master of Arts, Curriculum and Institution in
Nursing on 1997 at Teachers College, Columbia University, NY. On 1968 she graduated Bachelor
of Science in Nursing at University of the Philippines and she is the class valedictorian.

- On 1998-1999, she became the director of Transcultural Nursing Institute and Graduate
program in Nursing at Kean University and on 1992-1998, she became the Assistant professor at
Kean University.

- On 1993- 1998, Ms. Dula became the Board Member and Chair of Education Committee,
NJ. On 1994-1996, she became the Secretary of Transcultural Nursing Society and became the
Chair, Nursing Practice ana Education Committee, National Council of State Boards of Nursing, at
Chicago. On 1995-1996, she became the President of Transcultural Nursing Society and became
a member of NJ commissioner of health, nursing advisory committee and presented certified in
Transcultural Nursing. On 1998, she presents Associate editor, Journal of Transcultural Nursing
and on 1999-2002, Ms. Dula became the Vice President of Transcultural Nursing Society.

C. Assumptions.
1. First it must be understood that "Access to cultural competence care is basic human rights"
-culturally Competent Care is defined as care that respects the diversity of patient populations
and cultural factors that may affect health and healthcare, such as language, style,
communication, beliefs, attitudes, and behaviors.

2. The second assumption made for the model is that in order to provide ethical care, it must be
culturally congruent and competent.
-it must be culturally congruent and competent meaning involves applying knowledge of how
culture influences one's health beliefs, health practices, and communication patterns at each
stage of the nursing process.

3. The third modular assumption is that the "culture of health care organizations and professions
reflect the dominant societal culture".
-a dominant culture is one that has established its own norms, values, and preferences as the
standard for an entire group of people. Preferences and norms are imposed regardless of whether
they contradict what is usual for other members of the group.

4. The fourth assumption is that ethical decision must be made with "awareness of personal,
professional and organizational cultural values and biases as well as understanding their influence
on interactions with others" to be truly competent.
-the ability to recognize the different beliefs, values, and customs that someone has based on
that person's origins, and it allows a person to build more successful personal and professional
relationships in a diverse environment.

5. The fifth assumption states that cultural competence needs to take place on all levels:
practitioner, organizational, societal or community.
- Cultural competence in the workplace to help managers and employee’s better communication
and coordinate with co-workers and clients. This can increase engagement and productivity.

6. The sixth assumption made is that "culturally competent ethical decisions use the -modes of
cultural preservation, accommodation, and repatterning separately or simultaneously"
-Cultural preservation refers to nursing care activities that help people of particular cultures to
retain and use core cultural care values related to healthcare concerns or conditions.
-Culture care repatterning includes those assistive, supporting, facilitative, or enabling
professional actions and decisions that help clients reorder, change, or greatly modify their
lifeways for new, different, and beneficial health care pattern while respecting the clients' cultural
values.

7. Lastly, " application of cultural action modes requires understanding of the values, beliefs, and
lifeways of clients, families, and communities"

-There are certain values considered most important in providing nursing care, these include
patient well-being and patient choice. You are accountable to listen to, understand, and respect
patients' values, opinions, needs, and ethno-cultural beliefs.

D. Critical points of ethical decision-making?

There are three important factors that can influence ethical decision making, which are individual,
organizational, and opportunity factors. All three of these factors can weigh heavily on a person
during the decision-making process, especially in the work place. Many people look to friends or
associates for guidance when making questionable decisions. Sometimes a person may make a
decision based on the opportunity they are put into. Some people make decisions based on their
own moral beliefs and the way they were raised. No matter how a person comes to make a
decision, there are usually three factors that influence a person’s ethical decision-making process.