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Ethical and Legal Decision Making in the Context of Nursing

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Ethical and Legal Decision Making in the Context of Nursing

Faculty of Health and Life Sciences


BSc (hons) Nursing




Module Title: Ethical and Legal Decision Making in the Context of Nursing


Academic Year: 2020

Cohort: Sept 19











This module guide provides you with information about the module aims, summary, and assessment. It should be read in conjunction with the Module Descriptor found on the Module Information Directory (MID) ( and the 5012NHS Moodle web page.


This 20 credit module will help you to develop the underpinning knowledge essential for delivering safe patient care in a variety of settings and within your field of practice.  The module will run over 8 weeks and you will be expected to undertake the online learning activities and engage in online debates/discussions via Microsoft Teams.  





 This module will introduce students to the underlying principles of healthcare ethics, legislation and social policy. This will include the protection of vulnerable people across the lifespan including those with complex needs. Students will be equipped to recognise ethical challenges relating to people’s choices and decision-making about their health and wellbeing across care settings. Ability to act within the law to help service users, families and carers to manage needs will be explored.




Module Leader

Sally Nuttall


Richard Crossman 210








Hannah Andrews

Scott McEwan (part time)

Carol Drugan (part time)

Jean Parker (part time HPL)

Jill Barr (part time HPL)

Sally Nuttall



CYP- Nikki Murphy

MH- John Parkes

LD – Vicky Sandy-Davies






The intended learning outcomes are that on completion of this module you should be able to:


  1. Understand and apply relevant legal, regulatory and governance requirements within the context of health and social care settings
  2. Understand the need to base all decisions regarding care and interventions on people’s needs and preferences particularly for those who lack mental capacity
  3. Analyse the use of ethical frameworks and underpinning health and social care policy within nursing practise
  4. Appraise the role of the nurse in shared decision making in order to support individuals, their families and carers to receive person-centred care




This module will enable students to understand and apply relevant legal, ethical and policy requirements across the lifespan and in a range of health/social care settings. Content will include:

  • Models of ethical decision making, empowering choice. Imparting information to empower children and young people, mental health service users, learning disabilities service users and adult service users in making decisions.
  • Respecting Human Rights is key to this module and vignettes supporting learning in relation to refusal of treatment, DNA/CPR decision making, organ donation, reasonable adjustments dignity, weighing best interests for incapacitated patients, consent for adults, consent for children.
  • Students will explore examples from clinical practice including recent court cases related to complex ethical and legal decision making pertaining to advocacy, conflict and models of mediation. Resources to support ethical decision making will be highlighted throughout the module.


Due to social distancing restrictions all taught theory and group discussions be will managed via online platforms- a number of online learning resources will be utilised. Lectures will be delivered via narrated PowerPoint where possible and Microsoft Team groups will be used to facilitate online discussions. Module materials will be available on the course Moodle page.




You must stay in the seminar group you have been allocated to and students are not permitted to swap seminar groups.


You must behave in a professional and respectful manner showing consideration for other students and staff. Ground rules will be shared at the module launch.


Engagement will be closely monitored by module team members.


Engagement monitoring is a requirement for all students and is evidence of academic engagement which is vital for success, although this will not be a summative assessment item in module descriptors, poor or erratic engagement will be formally investigated.  If there is no subsequent improvement in engagement a formal record will be made of this and consideration may be given to withdrawing students from their course because of non-engagement.


Moodle (acronym for Modular Object-Oriented Dynamic Learning Environment)

Whilst you are a student at Coventry University module information will be available via the Moodle platform. You may be already familiar with using different virtual learning environments  but  here at Coventry we use Moodle 3 which is also known as a  Virtual Learning Environment (VLE). This provides online support and resources for your course. Moodle provides central space on the web where students and staff can access a set of tools and resources anytime anywhere.  This is used for all our modules.

If you are unfamiliar with Moodle access the following which helps to explain its use.  -‘What is Moodle Explained?’.




We will open up sections on Moodle week by week. Notification of any ‘live’ events will be given to you in with appropriate notice however we are aware that many students will find accessing ‘live’ events challenging.


This module is assessed by an online multiple choice test and an essay.  You must achieve a mark of 60% to pass the multiple choice test and  40% to pass the essay. Please refer to moodle for assessment dates.



% of module mark

Learning outcomes assessed

Examination/assessment Dates:

Classroom based test







2,3, & 4

TBC- look on the assessment tile on moodle

TBC- look on the assessment tile on moodle





Important information:




If you have a disability or medical condition and require ‘reasonable adjustments’ to allow you to fully participate in the module OR reasonable adjustments for the MULTIPLE CHOICE TEST  please discuss these with the module leader so that suitable arrangements can be made.  In the event that the test will take place online the length of time taken to complete the test will be increased by 25%.





You are normally entitled to 1 re-sit of the module subject to approval at the assessment board.  The date of the re-sit will be available on solar after the board have met.


You will be allowed 2 attempts at the test prior to results going to board.




The University takes very seriously any attempt to cheat in coursework or examinations by any student and if a case is proven this can result in expulsion form the University.  Cheating refers to plagiarism, collusion; taking unauthorised materials into an examination (this list is not exhaustive). Please refer to the essential information within your Student Handbook.





“The University wants you to do your best. However we know that sometimes events happen which mean that you can’t submit your coursework by the deadline – these events should be beyond your control and not easy to predict.  If this happens, you can apply for an extension to your deadline for up to two weeks, or if you need longer, you can apply for a deferral, which takes you to the next assessment period (for example, to the resit period following the main Assessment Boards). You must apply before the deadline.

You will find information about the process and what is or is not considered to be an event beyond your control at       













Submission date:

 TBC- please check on moodle


Assignment Brief:                  

The student will write a 2500 word (excluding references) essay. Select a service user or child and family  that you  have worked with in your previous practice placements, ideally this would be over a period of time not a one off interaction. Your field leads have also written some case studies for you to utilise should you choose to.The assignment will draw upon relevant ethical theoretical concepts and  healthcare/ social policy underpinning the decisions made in respect of an individual’s care.   Key to this work is an analysis of your (the nurses)  role in supporting decision making  for the people in your care in terms of advocacy and supporting patient’s rights and autonomy. Appropriate references must be evident with national and /or professional guidelines to support your clinical judgements and shared decision making processes.


Assignment focus:

The essay needs to clearly focus on one case the student has cared for in clinical practice. The assignment should offer a clear structure that is logical, sequential, and systematically progressive in nature.


The following framework is a guide that you might find useful to organise your assignment. The sub-headings are:

  1. Introduction
  2. Background/ Short case summary
  3. Identification of key ethical issues involved in this person’s/child’s care supported by underpinning theory
  4. Critically analyse the concept of ethical decision making and ethical frameworks. Using a framework interpret and apply current health and social care policy, and law/legislations relevant to your case study and how they are utilised to support rationale in ethical decision making. You should draw on other relevant ethical theories.
  5. Appraise the nurses’ role in this individual’s care acknowledging resources to support decision making- you will do this throughout when critically discussing the decision making process however you may wish to appraise the role of the nurse in general terms separately.
  6. Conclusion
  7. References





The context and content should reflect a contrast and balance of ideas, and reasoning to support the module learning outcomes:


  1. Understand the need to base all decisions regarding care and interventions on people’s needs and preferences particularly for those who lack mental capacity
  2. Analyse the use of ethical frameworks and underpinning health and social care policy within nursing practise
  3. Appraise the role of the nurse in shared decision making in order to support individuals, their families and carers to receive person-centred care




Please do not breach confidentiality by identifying the name of the person/ child or any family members or the location of the clinical setting. Change personal details to protect confidentiality and state this in your introduction. Any contravention of confidentiality will result in an automatic fail.


Suggested assignment guidelines







The introduction begins with a general statement to introduce the main subject area and to set the context for the discussion. The introduction offers the reader a broad background of information into your key ethical challenges and outlines all the ideas you are going to present in the assignment, such as:

·        A statement/ definition of the importance of the topic and the context ,background of and care delivery

·        Introduce  how you will structure the work linked to the learning outcomes

·        Introduce  the service user/child you have chosen

·        Include statements dealing with confidentiality were necessary







Background information refers to a concise summary of the clinical & wider detail of this persons’ care which is relevant to the issues that you later discuss

  • Physical health
  • Mental health
  • Family and other relationships
  • Social circumstances- employment, religious/spiritual beliefs, sexuality etc..
  • Age and development (where appropriate)


Impact of all of the above on ability to make decisions for self.


You may choose to use on of the pre-prepared case studies available to you on Moodle or work with your seminar leader to create your own based on a particular interest or your experience in practice.




 Key ethical challenges

The identification of  the key ethical challenges starts the main body of the assignment where your paragraphs will develop your discussion and ideas to demonstrate your knowledge of the topic, by including relevant evidence, analyse and evaluate  your material, such as:-

  • Mental capacity- how much input did the person/child have into decision making and why?
  • What were the challenges to the person/child receiving care in making treatment choices?
  • Were the individual’s human rights respected and if not, why not?
  • Was there conflict between treating teams and the person/child and/or family/significant others regarding preferred options for care


Please consider the learning outcomes when writing your report.  Discuss the concept of ethical decision making in the context of nursing. Discuss the use of ethical frameworks and present reasoning for your preferred model (s).


Utilise your preferred ethical model(s)/principles from the module as a framework for aiding decision making and identifying key issues regarding this person/child’s treatment. In each step of the framework you should drawing on relevant policy/guidelines and legislation/case law to critically discuss each step of the decision making process- how do they apply and how influential are they (details below) You should also refer to the role of the nurse in each stage of your framework where applicable (see section below).


You should also try and demonstrate knowledge of other ethical theories and ethical concepts relevant to your case, for example, Utilitarianism and Consequentialism, Deontology/Duty based ethics, Virtue Ethics, ‘Truth Telling’. The concept of Paternalism is always a poignant consideration for many case studies especially when involving vulnerable patients/service users.


 Consider local/national resources available to support ethical practice and professional guidance in relevant areas of practice as outlined in the module or experienced in practice.





health and social policy/


legislation/ case law

As above, throughout the assignment identify which health and social policy and guidelines were relevant to this case and draw on them where relevant. You should also identify and discuss relevant legislation and case law relevant to your case study where appropriate. For example you may NICE Guidelines, NHS Constitution, Person-centred planning, Advance Care Planning, DNACPR, Health and Social Care Act (2012), Codes of Practice  for the MCA,( 2007), Liberty Protection Safeguards, Mental Health Act (1983 & 2007), Children Act (1989 & 2004), Human Rights Act (1998) and the Equality Act (2010).

 Evaluate the impact that current health and social policy/guidelines had on this person/child’s care.

Show understanding of whether local/national strategies for supporting health/social care in this instance- are they fit for purpose? Are they helpful?

Support all of your points with relevant policy, legislation or documents (reference to support claims).



Appraise the nurses’ role

Consider the role of the nurse within concepts of advocacy, assessment of capacity and professional obligations/duties to do so. You will be referring to this throughout the assignment however it may also be helpful to discuss this in more detail in a separate section just before the conclusion (avoid unnecessary repetition however! Think carefully about your structure- it’s always a good idea to map out your assignment first).

Accountability and Advocacy.

Risk of Paternalism?

Virtue Ethics/The need for nurse to be ethical practitioners/Compassion Fatigue?

Are there limitations to the nurses’ role within decision making?

How is this relevant to the changing role of the nurse and future standards of education and proficiencies/competencies?

How can conflict best be resolved?

What resources exist to support nurses and others in managing complex ethical, legal and policy issues?

Relate the above to your chosen person/child’s care and reflect on professional/national guidance to support practitioners in your field and draw from other’s where appropriate.




You are not required to add any new information. You are summarising what you have discussed and reiterate some of the key points.



CU Harvard



No less than 20 relevant references.




Instructions for submission:

An electronic copy of your coursework should be submitted through turnitin on the 5012NHS  Moodle page. Please follow the instructions on the Moodle page.


  • There will be a draft submission area for you to check your essay for plagiarism.
  • Please ensure that you keep an electronic copy of your coursework in case of query.
  • Submission date for this coursework can be found on Moodle
  • Front Sheet: only put your student identification number (S.I.D) and the essay title on your front sheet to allow for anonymous marking.
  • Format: Third person
  • Font: Ariel 11
  • Spacing 1.5


Tutorial Support:  Via Seminar lead

Available online via Microsoft Teams or arranged separately with your ‘seminar/group’ lead



‘Penalties may be applied for exceeding any word limit set. Your tutor will advise you whether any word limit is a guideline, or whether your ability to write within the word limit is actually part of the assessment of the piece of work concerned. If the limit set is a maximum, or a minimum, then a penalty of 10% of the mark for that piece of work will be applied to those pieces of work that exceed, or are below, the requirement by 10% or more. Please note, the word count is calculated from all words included from the beginning of the text (does not include the front sheet) to the start of the reference list’.




None identified




Cranmer, P. and Nhemachena, J. (2013) Ethics for Nurses- Theory and Practice. University of Huddersfield: Open University Press

Cuthbert, S. and Quallington, J. (2017) Values and Ethics for Care Practice. Lantern

Griffin, R. and Tengnah, C. (2020) Law and Professional Issues in Nursing, 5th edition. Swansea Univeristy: Sage.         

Herring, J, (2018) Medical Law and Ethics, 7th edition. Oxford. Oxford University Press.





**** There are a large number of essential policies and legislation located in ‘Module Essentials on Moodle******

Recommended reading

Avery, G, (2016) Law & Ethics in Nursing and Healthcare – An Introduction, 2nd edition. Essex University: Sage

Beauchamp, T., and Childress, J. (2013) 7th edition. Principles of Biomedical Ethics. New York: Oxford University Press


Bradshaw, P., and Bradshaw, G. (2010) Health Policy for Health Care Professionals. London: Sage


Dimond, B. (2016) Legal Aspects of Mental Capacity: A Practical Guide for Health and Social Care Professionals, 2nd ed, Oxford: Wiley-Blackwell Publishing.


Dimond, B. (2011) Legal Aspects of Nursing. England: Pearson Longman

Graham, M. and Cowley, J. (2015) A Practical Guide to the Mental Capacity Act 2005. Jessica Kingsley Publishers.


Selman, D. (2011) What makes a Good Nurse- Why the Virtues are Important for Nurses. London: Jessica Kingsley Publishers.

Seedhouse, D. (2009) Ethics: The Heart of Health Care. Chichester: John Wiley and Sons




Journal of Medical Ethics

Clinical Ethics






Websites – PLEASE SEE MOODLE. Up to date resources are in the Learning outcomes document for the le

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