NUR09722 Ethical Decision-Making in Nursing: Covert Medication Dilemma in Psychiatric Care, Singapore

University Singapore University of Social Science (SUSS)
Subject NUR09722: Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice

Purpose of the Assignment

To demonstrate critical understanding of the implementation and appraisal of a decision-making process using legal and ethical frameworks with application to current and future practice as a nurse.

Summative Assessment

The summative assessment will be a 2000-word problem-based essay.

Students will be presented with a selection of ethical scenarios after completion of the formative quiz. Students will need to select one of the ethical scenarios to write about for the summative assessment.

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There is no template for the summative assessment; however, the essay should consist of the following sections (with suggested word count):

1. Introduction (300 words)

  • Provide an introduction to the scenario
  • Make links to the importance of law and ethics in nursing practice
  • Outline the ethical dilemma and conflicting ethical principles or professional and legal aspects

2. Main Body – evaluation and analysis of the situation (1200 words)

  • Discuss the scenario from an ethical standpoint
  • Consider relevant legal and/or professional issues
  • Include relevant references from academic literature
  • Use an ethical framework (e.g., the four bioethical principles) to structure the discussion
  • May consider philosophical theories:
    • Deontology
    • Utilitarianism
    • Values-based care

3. Conclusion (200 words)

  • Summarise the key legal and ethical points from the essay

4. Action Plan (300 words)

  • Reflect on how this learning will inform your future practice

5. References

  • Follow APA 7th guidelines

Assessment Guidance

Students will be marked on their ability to fulfil the module learning outcomes. Key to fulfilling the learning outcomes will be criticality, which means:

  • Being able to synthesise sometimes conflicting evidence in a systematic and balanced manner
  • Recommending a particular course of action as a logical consequence of your analysis

Note: In accordance with the SNB code, any cases discussing patients must be anonymised, and have no identifiable information (including name, ag,e and clinical area the patient attended).

Scenario 1 – Ms Wong

Ms Wong is a 40-year-old lady who was admitted to a psychiatric unit due to a new onset of psychosis. She was brought in by her brother to a psychiatric emergency department due to shouting and screaming at home, paranoia against neighbours, and not sleeping for about 4 days.

Upon admission to the unit, she was:

  • Not engaging
  • Irrelevant in speech
  • Not forthcoming when questions are asked
  • Actively responding to auditory and visual hallucinations
  • Gesticulating in the air
  • Talking to herself
  • Mumbling to herself

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She strictly refuses to take her medications, which are:

  • Metformin 850mg for her type 2 diabetes
  • Risperidone 2mg
  • Haloperidol 1.5mg as an antipsychotic drug

Her condition was deteriorating as she had been refusing to take her medication. Some nurses from the unit decided to serve her covert medication; however, this approach was met with differing views from the nursing team.

Guidance on the Assessment

Choose ONE of the scenarios listed in this workbook to write for your summative assessment. Some points you may want to consider:

1. Why is the scenario an ethical dilemma?

  • What are the ethical principles in conflict here?
  • Are there any nursing values at stake here?
  • Are there any cultural or societal norms to be considered?

2. What frameworks could be used to decide on the course of action?

  • How would ethical theories view this scenario?
  • Would any ethical theories be useful in deciding what to do next?
  • How could the bioethics principles be applied to the scenario?
  • Are there legal aspects that need to be considered?
  • What are the professional implications of this scenario?

3. What do you think are the key points you will take away from this discussion for future practice?

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