Le001: legal requirements and ethics

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© 2020 Walden University 1

LE001: Legal Requirements and Ethics: Summarize legal mandates and ethical principles to address complex

challenges, manage risk, and advance organizational integrity.

Assessment Rubric

Rubric Criteria

Needs Improvement

Meets Expectations

Exceeds Expectations

Part 1: Principles of Autonomy and Nonmaleficence

Learning
Objective 1.1:

Define the
principles of
respect for
autonomy and
nonmaleficence.

Response does not provide or
provides partial or inaccurate
definitions of the principles of
respect for autonomy and
nonmaleficence.

Response provides two
thorough and accurate
definitions of the principles of
respect for autonomy and
nonmaleficence that apply to
the situation.

Response includes examples
that demonstrate an
understanding of how the
principles of respect for
autonomy and nonmaleficence
can conflict.

Response includes references
to relevant
academic/professional
resources.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

Response includes three
definitions and examples
that demonstrate an
understanding of how the
principles of respect for
autonomy and
nonmaleficence can conflict.

Learning
Objective 1.2
Explain the
prioritization of
respect for

Response does not provide an
explanation or provides a partial
or unclear explanation of which
principle to prioritize or fails to
provide support for reasoning

Response clearly explains
which principle to prioritize
when patients refuse care.

Response provides at least two
relevant examples of

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

© 2020 Walden University 2

Rubric Criteria

Needs Improvement

Meets Expectations

Exceeds Expectations

autonomy and
nonmaleficence.

about which principle to
prioritize.

Response provides an irrelevant
example of information the
hospital would use to determine
whether to prioritize respect for
autonomy or nonmaleficence.

information the hospital would
use to determine whether to
prioritize respect for autonomy
or nonmaleficence.

Response includes references
to relevant
academic/professional
resources.

Response provides at least
three relevant examples of
information the hospital
would use to determine
whether to prioritize respect
for autonomy or
nonmaleficence.

Rubric Criteria

Needs Improvement

Meets Expectations

Exceeds Expectations

Part 2: Clinical Ethics

Learning
Objective 2.1:
Identify conflicting
ethical principles.

Response does not identify, or
one or more responses
inaccurately identify s a
conflicting ethical principle, or
the response does not address
each scenario individually.

Response accurately identifies
one conflicting ethical principle
in each scenario.

Response justifies the
importance of each of the
principles in conflict.

Response includes references
to relevant
academic/professional
resources.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

Response accurately
identifies at least two
conflicting ethical principles
in each scenario and justifies
the importance of each of
the principles in conflict.

Learning
Objective 2.2:

Response does not select or
selects inappropriate actions for
one or more scenarios.

Response selects appropriate
actions to resolve the
conflicting ethical principles in
each scenario.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

© 2020 Walden University 3

Select actions to
resolve conflicting
ethical principles.

Response provides compelling
justification and reasoning to
support the selected action in
each scenario.

Response includes references
to relevant
academic/professional
resources.

Response is written
substantively and thoroughly
related to these topics.

Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations

Part 3: Risk Assessment Framework

Learning
Objective 3.1:

Use the seven-step
risk assessment
framework
described by the
Joint Commission.

Response does not complete or
completed some of the seven
steps incorrectly or fails to
complete all seven steps.

Response accurately
completes each of the seven
steps to illustrate how the
hospital in the scenario might
use a risk assessment
framework.

Response includes a thorough
reflection on the value of the
Joint Commission standards
and their impact on providers
and patients.

Response includes references
to relevant
academic/professional
resources.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

Response is written
substantively and thoroughly
related to these topics.

© 2020 Walden University 4

Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations

Part 4: Impact of Regulatory Guidelines on the Delivery of Care

Learning
Objective 4.1
Explain how
shortages of
healthcare workers
impact the ability to
deliver quality care
and manage risks.

Response does not provide or
provides an unclear or partial
explanation of how shortages of
healthcare workers impact the
ability to deliver quality care and
manage risks for each scenario
provided.

Response includes an
inappropriate explanation of how
to mitigate the impact of
shortages of healthcare workers
on the delivery of quality care
and the management of risk for
each scenario presented.

Response clearly explains how
shortages of healthcare
workers impact the ability to
deliver quality care and
manage risks for each scenario
presented.

Response includes at least one
appropriate explanation of how
to mitigate the impact of
shortages of healthcare
workers on the delivery of
quality care and the
management of risk for each
scenario presented.

Response includes references
to relevant
academic/professional
resources.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

Response provides more
than one appropriate
explanation of how to
mitigate the impact of
shortages of healthcare
workers on the delivery of
quality care and the
management of risk for each
scenario presented.

Learning
Objective 4.2
Explain how
revenue and
resource
constraints may
limit the ability to

Response does not provide or
provides an unclear or partial
explanation of how changing
reimbursement rules for
Medicare impacts the ability to
deliver quality care and manage

Response clearly explains how
changing reimbursement rules
for Medicare impacts the ability
to deliver quality care and
manage risks for each scenario
presented.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

© 2020 Walden University 5

deliver quality care
and manage risks.

risks for each scenario
presented.

Response makes an
inappropriate explanation
regarding how to mitigate the
impact of changing
reimbursement rules for
Medicare on the delivery of
quality care and the
management of risk for each
scenario presented.

Response makes at least one
appropriate explanation
regarding how to mitigate the
impact of changing
reimbursement rules for
Medicare on the delivery of
quality care and the
management of risk for each
scenario presented.

Response includes references
to relevant
academic/professional
resources.

Response provides more
than one appropriate
explanation regarding how to
mitigate the potential impact
of changing reimbursement
rules for Medicare on the
delivery of quality care and
the management of risk for
each scenario presented.

Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations

Part 5: Is healthcare a right or a privilege?

Learning
Objective 5.1:

Analyze whether
healthcare is a
right or a privilege.

Response does not provide or
provides an unclear explanation
of whether healthcare is a right
or a privilege.

Response chooses incorrect or
irrelevant citations or does not
provide citations.

Response provides a logical
justification for whether
healthcare is a right or a
privilege.

Response appropriately cites
from relevant
academic/professional
resources to support the
justification.

Response demonstrates the
same level of achievement
as “Meets,” plus the
following:

Response is written
substantively and thoroughly
related to these topics.

Answer ALL questions strictly as they are asked below and follow the Rubric attached. ALL questions should be answered to exceed expectations as on the rubric.


Part One:
 Principles of Autonomy and Nonmaleficence

· An 83-year-old diabetic male, Mr. Jones, is brought into the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle. Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department. The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact.

· Does the father have autonomy to make this decision? Why or why not?

· Discuss the principle of nonmaleficence as it relates to actions of the providers. (1–2 pages)


Part Two:
 Clinical Ethics

· Clinical ethics requires grasping ethical issues, such as informed consent, truth-telling, confidentiality, end-of-life care, treatment futility, pain relief, and patients’ rights to self-determination. For each hypothetical situation described below, identify the conflicting ethical principles involved, and select at least one appropriate action to resolve conflicting ethical principles in each case. (2–3 paragraphs for each topic)

· An elderly patient suffers cardiac arrest and enters the intensive care unit. Her son insists that “everything possible” be done for her, and yet, she slips into a coma and is nonresponsive for months. As a healthcare administrator who oversees the organization, what steps would you recommend to address the son’s concerns?

· You are a healthcare administrator reviewing statistics on lab tests ordered and realize that a few physicians account for the majority of orders of a certain very expensive lab test. You do a bit of research and realize that these physicians have relationships with the manufacturers of this testing equipment. What are your next steps?   Please write a brief policy statement about conflicts of interest in the organization. 


Part Three:
 Risk Assessment Framework

· A hospital finds that hypodermic needle-stick injuries have increased over the last year and, when they conduct an audit, they find evidence that there is wide variation in practice from unit to unit. Some rooms have sharps boxes and others do not, the sharps boxes are of different sizes, and there is variation in how often they are emptied.

· Using the seven-step risk assessment framework described by the Joint Commission (available at 

7 Steps to Comply with Joint Commission

) outline each of the steps to illustrate how a hospital might use a risk assessment framework to manage the risk of needle-stick injuries. (2 pages)

· Note: Registration is required to access the link referenced above.

· Once the seven steps have been outlined, write an email to the Director of Nursing about your concerns and recommendations.


Part Four:
 Impact of Regulatory Guidelines on the Delivery of Care

· You are a nursing supervisor in a small rural healthcare facility. Explain how each of the following scenarios will challenge your ability to deliver quality care and manage risks; discuss specific regulatory guidelines that may apply and explain your approach to mitigating each. Write out the following information as a report you will present to the administrative leadership about the negative implications of these issues.

· A shortage of three certified nursing assistants (CNAs) due to influenza and one registered nurse (RN) scheduled leave for a family wedding (2–3 paragraphs)

· Changing reimbursement rules have a negative impact on revenue that will potentially eliminate the budget for planned renovation to the patient rooms equipped with a winch to lift patients over 200 lbs. (2–3 paragraphs)


Part Five:
 Is healthcare a right or a privilege?

· Provide your opinion about whether healthcare in the U.S. should be is a right or a privilege. Apply ethical standards and state and federal laws to support your position.  Write your position as though you are sharing it through a blog post or letter to the editor of a local paper.  (1–2 pages)

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