[Solved] Apply Guidos MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48 which is titled, “When Care Appears Medically Inappropriate,” (Guido textbook 7th edition)

Apply Guidos MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48

Assignment Description:

For this week assignment, create a PowerPoint presentation based on the following case studies.

Read the case studies and answer the following questions:

Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48 which is titled, “When Care Appears Medically Inappropriate,” (Guido textbook 7th edition).

• How might the nurses in this scenario respond to the physician’s request?
• How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?

Read the following case study and answer the following questions: “You be the Ethicist”, presented at the end of Chapter 3, p. 41, which starts, “Helga Wanglie…” (Guido textbook).

• What are the compelling rights that this case addresses? Whose rights should take precedence?
• Whose rights should take precedence?
• How might the institutions’ organizational ethics policies have impacted the outcome of this case?
• Leaving any legal issues aside, how would you have used ethical principles to decide the outcome of this case, if Helga Wanglie had continued to survive relying on life-sustaining measure?

Now, examine the same Helga Wanglie scenario from the perspective of health care policy.

• How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?
• Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook, p. 50) assist in this process?
• Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.

M1 Assignment UMBO – 4
M1 Assignment PLG – 4, 6
M1 Assignment CLO – 3, 4, 5

The following specifications are required for this assignment:

• Length: 10 slides minimum; answers must thoroughly address the questions in a clear, concise manner.
• Structure:
  • Title: 1 slide
  • Objectives: 1 slide
  • Guido’s MORAL model: at least 2 slides
  • You be the Ethicist: at least 2 slides
  • Perspective of health care policy: at least 2 slides
  • Conclusion: 1 slide
  • References: 1 slide
  • Additionally, because a good presentation has few words on the slides include a script with the verbiage you would say when presenting; script should be a minimum of 50 words per slide.
• References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least two (2) scholarly sources to support your claims.
• Format: Save your assignment as a Microsoft PowerPoint document and a Word document (.pptx) and (.doc or .docx) or Open Office Impress.
• File Name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module1.pptx”).

Verified Sample Answer

Objectives

Using Guido’s Textbook 7th Edition, the presentation will make use of the Guido’s Moral model to analyses the different case studies and offer various insights. To begin with, the first objective of the presentation is to Resolve dilemma in the case studies using the Guido’s Moral model.

The other objectives include the need to respond to the questions from the “You be Ethicist” case and also respond to questions following the assessment of Helga’s case. The resolution of the case study will make the analysis and answers from the healthcare policy perspective.

Guido’s MORAL model

• The scenario presents a case of an 87-year-old patient in critical care and has been on ventilator care since the time he got admitted to the hospital. The patient’s wishes according to the family would not have been to remain in that state. However, the physician in this case is reluctant to take the patient off the ventilator and orders the nurses to keep it that way (Guido, 2014).
• They might respond to the request by the physician by following the orders that have been given to them by the physician.
• The nurses can also hold a meeting with the family of the patient, provide advice, and listen to the concerns of the family concerning the care that is getting provided to the patient.

• This scenario causes the nurse’s moral distress because their role in patient care has been ignored and the provision of care to meet the wishes of the patient and her family is getting ignored by the physician.
• The moral distress that the nurses in this scenario are experiencing is the reluctance of the physician to address death and failing to follow the wishes of the patient (Guido, 2014).
• They also feel frustrated in a role that is subordinate because they are compelled to follow the orders of the physician.

Positive actions that can be taken

• The positive actions that the nurses can take include practicing collective action and advocating for the right of the patient to refuse treatment and honor the wishes that the patient has concerning her health (Guido, 2014).
• Another positive action would be to take the matter to the ethics committee for determination of what the right decision would be for the patient as care is supposed to be patient-centered.
• The other actions that the nurses can take to prevent moral distress include self-care by accepting what they cannot change and focusing on providing the best care to their patients

You be the Ethicist

• This case study is about a patient that got into a vegetative state but the family is not willing to get her off the life-sustaining measures.
• The argument by the husband, Mr. Wanglie is that God is the one who decides when life ends and thus the patient should stay on life support.
• The healthcare providers are against this decision raising some significant ethical issues

Compelling ethical rights addressed by the case

• The compelling ethical rights that this case addressed include the right of the patients and the families to accept or refuse medical interventions (Pozgar, 2013). Another right is the right of the patient to withdraw informed consent to treatment.
• Another ethical right that gets addressed in this case is the right of the healthcare providers to seek judicial relief from the trust relationship that exists between them and the patient when they feel that the relationship is morally offensive to them.

Right that takes precedence

• The right that takes precedence is the right of the patient and family which in this case, it is the right of the husband who is making decisions on behalf of the patient because the patient cannot make her own decisions.
• Mr. Wanglie is granted this right because he is the husband of the patient which makes him her guardian.

The perspective of health care policy

• The organizational ethics policies of the institution would have had a significant impact on the outcomes of the case if they had convinced the family of the irreversible condition of the patient.
• This would have played a significant role in saving the family the costs that come with the use of life-sustaining technologies when there was no hope for the patient recovering.
• They should have stopped the constant transfer of the patient from one hospital to another as it may have contributed to the worsening of the patient’s condition.
• I would have used the ethical principle of beneficence
• I would have used the ethical principle of beneficence by acting for the good of the patient by doing what is best in the interest of the patient (Bester, 2020). I would have supported the life-sustaining measures and advised the family of the patent not to transfer the patient from the hospital to give the patient a chance for a better outcome.

Healthcare policy

• Based on the scenario in the Wanglie case, there is a need for a healthcare policy to be established to manage situations in which a decision needs to get made especially when a patient is in a vegetative state. A policy should get established concerning how long a patient can get placed on life-sustaining measures.
• The policy will have a significant impact on the parties affected by it including the nursing staff and physicians who are likely to support the policy that sets limitations on how long a patient can be kept on life support
• The policy may not be supported by some religious and spiritual groups who also believe that it’s only God that gives and takes life, like Mr. Wanglie.

Framework questions by Malone

• The framework questions that get addressed by Malone have a significant impact on the process of policy creation as they guide the development of the policy.
• The questions help in understanding the various elements that need to be considered when making the policy including the implementation process.
• The questions also help address the specific policy aspects that need to be included in the policy and establishing the contributors to the success of the policy.
• The questions are of significant assistance to the development of the policy.

Proposal

• The issues that have been identified in the policy will require a specific process for effective implementation.
• The proposal will be to carry out a patient education initiative on what the policy entails and the specific directives that concern it.
• The patients would be informed of their rights including the right to refuse treatment if they are impressed with the policy.
• The guidelines require effective communication to have the patients and families informed and obtain informed consent from the patients and the families that in case of such a decision about them, there would be no legal issues against the hospital (Raveesh et al., 2016).

Conclusion

• Healthcare organizations are often faced with ethical dilemmas in the processes of healthcare delivery.
• These issues often arise from the conflicts that arise between the desires of the patients and what the healthcare providers deem as the best course of treatment for the welfare of the patients (Pozgar, 2013).
• The conflicting opinions often cause ethical and legal issues that often lead to conflict in terms of the healthcare providers fulfilling their duties to the patients and respecting the patient’s decision.
• Creating effective policies and proper communication with the patients can assist in preventing some of these issues

References

• Bester, J. C. (2020). Beneficence, interests, and wellbeing in medicine: What it means to provide benefit to patients. The American Journal of Bioethics, 20(3), 53-62.
• Guido, G. W. (2014). Legal and ethical issues in nursing(6th ed.). Upper Saddle River, NJ: Prentice-Hall. (Chapter 3 and 4)
• Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett. (Chapter 1 and 4)
• Raveesh, B. N., Nayak, R. B., & Kumbar, S. F. (2016). Preventing medico-legal issues in clinical practice. Annals of Indian Academy of Neurology, 19(Suppl 1), S15–S20. https://doi.org/10.4103/0972-2327.192886

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Understanding Guido’s MORAL Model and Healthcare Ethics Frameworks

Healthcare professionals face complex ethical dilemmas daily, requiring systematic approaches to navigate challenging situations while maintaining patient care standards. Understanding ethical frameworks in nursing, particularly Guido’s MORAL model, provides healthcare workers with structured methodologies for ethical reasoning in nursing practice.

Understanding Ethical Frameworks in Healthcare

Ethical decision making in healthcare requires more than intuition—it demands systematic approaches that consider multiple perspectives, stakeholder interests, and potential consequences. Healthcare ethics models serve as roadmaps for navigating complex moral terrain in clinical settings.

The Importance of Structured Ethical Reasoning

Research from the American Nurses Association indicates that 89% of nurses encounter ethical dilemmas in their practice, yet only 34% feel adequately prepared to handle these situations systematically. This gap highlights the critical need for comprehensive understanding of nursing ethics frameworks.

Statistical Overview of Healthcare Ethical Challenges:

Challenge Type	Percentage of Nurses Affected	Most Common Settings
End-of-life care decisions	76%	ICU, Palliative Care
Resource allocation	68%	Emergency Departments
Patient autonomy conflicts	62%	All units
Professional boundaries	54%	Long-term care
Informed consent issues	49%	Surgical units

Source: American Nurses Association Ethics Survey 2023

Introduction to Guido’s MORAL Model

Guido’s MORAL model represents a systematic approach to ethical decision making in healthcare, providing nurses with a structured framework for analyzing complex ethical situations. This model breaks down ethical reasoning into manageable components, ensuring comprehensive consideration of all relevant factors.

Components of Guido’s MORAL Model

The MORAL acronym represents five essential steps in ethical decision making:

M – Massage the Dilemma

• Identify the core ethical issue
• Gather relevant facts and context
• Distinguish between ethical and non-ethical problems
• Clarify stakeholder positions

O – Outline the Options

• Brainstorm potential solutions
• Consider alternative approaches
• Evaluate feasibility of each option
• Assess resource requirements

R – Resolve the Dilemma

• Apply ethical principles and theories
• Consider professional guidelines
• Evaluate potential outcomes
• Select the most appropriate course of action

A – Act on the Decision

• Implement the chosen solution
• Communicate with relevant parties
• Document the decision-making process
• Monitor implementation effectiveness

L – Look Back and Learn

• Evaluate outcomes and consequences
• Assess the decision-making process
• Identify lessons learned
• Apply insights to future situations

Theoretical Foundation of the MORAL Model

The MORAL model integrates several ethical theories, including:

• Deontological Ethics: Focus on duties and rights
• Consequentialist Ethics: Emphasis on outcomes and results
• Virtue Ethics: Character-based moral reasoning
• Principlism: Application of biomedical ethics principles

Core Principles of Nursing Ethics

Understanding fundamental ethical principles provides the foundation for applying any ethical framework effectively. These principles guide ethical reasoning in nursing and inform decision-making processes.

The Four Pillars of Biomedical Ethics

Principle	Definition	Application in Nursing
Autonomy	Respect for patient self-determination	Informed consent, patient choice
Beneficence	Acting in patient’s best interest	Promoting health, preventing harm
Non-maleficence	“Do no harm” principle	Risk assessment, safety measures
Justice	Fair distribution of resources	Equitable care, resource allocation

Additional Nursing-Specific Ethical Principles

Veracity (Truthfulness)

• Honest communication with patients and families
• Accurate documentation and reporting
• Transparency in professional relationships

Fidelity (Faithfulness)

• Commitment to professional obligations
• Maintaining confidentiality
• Honoring promises and agreements

Accountability

• Responsibility for actions and decisions
• Professional competence maintenance
• Quality improvement participation

Systematic Approach to Ethical Dilemma Analysis

Developing critical thinking skills for healthcare ethics requires understanding how to systematically analyze ethical situations. This process involves multiple steps and considerations.

Step 1: Problem Identification and Assessment

Key Questions for Assessment:

• What makes this situation ethically problematic?
• Who are the stakeholders involved?
• What values are in conflict?
• What are the immediate and long-term consequences?

Stakeholder Analysis Framework:

Stakeholder	Primary Concerns	Potential Impact
Patient	Autonomy, well-being, dignity	Direct physical/emotional effects
Family	Support, information, involvement	Emotional and financial impact
Healthcare Team	Professional integrity, patient safety	Moral distress, legal liability
Institution	Policies, resources, reputation	Financial and regulatory consequences
Society	Public health, resource allocation	Community health outcomes

Step 2: Information Gathering and Context Analysis

Effective ethical reasoning requires comprehensive information gathering:

Clinical Information:

• Medical history and current condition
• Prognosis and treatment options
• Patient preferences and values
• Family dynamics and support systems

Contextual Factors:

• Institutional policies and procedures
• Legal requirements and regulations
• Cultural and religious considerations
• Resource availability and constraints

Step 3: Ethical Analysis and Option Development

Applying Ethical Theories:

1. Deontological Analysis: What are the duties and obligations?
2. Consequentialist Analysis: What outcomes are most desirable?
3. Virtue Ethics Analysis: What would a virtuous professional do?
4. Care Ethics Analysis: How do relationships factor into the decision?

Practical Application of Ethical Frameworks

Understanding how to apply ethical frameworks in nursing requires practical examples and systematic approaches to common dilemmas.

Case Study Framework for Ethical Analysis

Scenario Development Process:

1. Present the ethical dilemma clearly
2. Identify key stakeholders and their positions
3. Outline relevant ethical principles
4. Apply chosen ethical framework
5. Develop potential solutions
6. Evaluate and select best option
7. Plan implementation strategy
8. Consider follow-up and evaluation

Common Ethical Dilemmas in Healthcare Settings

End-of-Life Care Decisions

• Withholding or withdrawing treatment
• Pain management vs. life prolongation
• Family disagreement with patient wishes
• Resource allocation in terminal care

Patient Autonomy Conflicts

• Competency assessment challenges
• Cultural conflicts with medical recommendations
• Family override of patient decisions
• Advance directive interpretation

Resource Allocation Dilemmas

• Scarce resource distribution
• Cost-effectiveness considerations
• Emergency triage decisions
• Staffing allocation challenges

Professional Guidelines and Legal Considerations

Healthcare ethical decision making occurs within a framework of professional standards and legal requirements that must be understood and integrated into the decision-making process.

Professional Nursing Standards

American Nurses Association Code of Ethics:

• Provision 1: Compassion and respect for human dignity
• Provision 2: Primary commitment to patient
• Provision 3: Advocate for patient rights
• Provision 4: Authority and accountability
• Provision 5: Self-care and personal integrity

International Council of Nurses Code of Ethics:

• Nurses and people
• Nurses and practice
• Nurses and profession
• Nurses and co-workers

Legal Framework for Healthcare Ethics

Key Legal Considerations:

Legal Aspect	Relevance to Ethics	Nursing Implications
Informed Consent	Patient autonomy	Ensure understanding
Confidentiality	Privacy rights	HIPAA compliance
Advance Directives	End-of-life wishes	Honor patient preferences
Mandatory Reporting	Public safety	Balance confidentiality
Professional Licensure	Competence standards	Maintain qualifications

Developing Critical Thinking Skills for Healthcare Ethics

Building ethical reasoning capabilities requires systematic skill development and ongoing practice.

Essential Critical Thinking Components

Analytical Skills:

• Problem identification and definition
• Information gathering and evaluation
• Assumption identification and testing
• Logical reasoning and inference

Evaluative Skills:

• Option assessment and comparison
• Consequence prediction and analysis
• Value clarification and prioritization
• Decision quality evaluation

Creative Skills:

• Alternative solution generation
• Innovative approach development
• Perspective-taking and empathy
• Collaborative problem-solving

Practice Strategies for Ethical Reasoning

Individual Development:

• Regular ethics literature review
• Case study analysis practice
• Reflection on personal values
• Continuing education participation

Team-Based Learning:

• Ethics committee participation
• Peer consultation and discussion
• Interdisciplinary collaboration
• Quality improvement projects

Measuring Ethical Reasoning Competency

Assessment Methods:

Method	Purpose	Frequency
Self-assessment	Personal reflection	Monthly
Peer evaluation	Collaborative feedback	Quarterly
Case analysis	Skill demonstration	Ongoing
Ethics education	Knowledge update	Annual
Professional development	Competency maintenance	Continuous

Building Ethical Decision-Making Capacity

Developing organizational and individual capacity for ethical decision making requires systematic approaches and ongoing commitment.

Organizational Ethics Infrastructure

Ethics Committees:

• Policy development and review
• Case consultation services
• Education and training programs
• Quality improvement initiatives

Ethics Consultation Services:

• 24/7 availability for complex cases
• Multidisciplinary expertise
• Documentation and follow-up
• Outcome evaluation and improvement

Individual Professional Development

Competency Building Strategies:

• Formal ethics education programs
• Mentorship and coaching relationships
• Professional organization participation
• Continuing education requirements

Self-Care and Moral Resilience:

• Recognition of moral distress
• Coping strategy development
• Support system utilization
• Work-life balance maintenance

Technology and Future Considerations

Healthcare technology advancement creates new ethical challenges requiring updated frameworks and approaches.

Emerging Ethical Challenges

Artificial Intelligence in Healthcare:

• Algorithm bias and fairness
• Decision-making transparency
• Human oversight requirements
• Privacy and data security

Telemedicine and Remote Care:

• Access and equity issues
• Professional boundary maintenance
• Quality and safety standards
• Regulatory compliance

Future Directions in Healthcare Ethics

Trends and Developments:

• Personalized medicine ethics
• Global health equity considerations
• Environmental sustainability
• Social determinants of health

Preparation Strategies:

• Ongoing education and training
• Technology literacy development
• Ethical framework adaptation
• Collaborative policy development

Conclusion: Integrating Ethical Reasoning into Professional Practice

Ethical decision making in healthcare requires more than good intentions—it demands systematic approaches, comprehensive understanding, and ongoing commitment to professional development. Guido’s MORAL model and other ethical frameworks provide structured methodologies for navigating complex situations while maintaining focus on patient welfare and professional integrity.

The integration of ethical reasoning into daily practice requires:

• Systematic approach to ethical analysis
• Comprehensive understanding of ethical principles
• Practical application of ethical frameworks
• Ongoing professional development
• Collaborative decision-making processes

By developing these capabilities, healthcare professionals can confidently address ethical dilemmas while maintaining the highest standards of patient care and professional integrity.

Key Takeaways for Professional Practice

1. Systematic Approach: Use structured frameworks for consistent ethical analysis
2. Stakeholder Consideration: Include all relevant parties in ethical decision-making
3. Principle Integration: Apply core ethical principles to guide reasoning
4. Continuous Learning: Maintain ongoing education and skill development
5. Collaborative Practice: Engage colleagues and ethics resources as needed