Mohawk College Professional Development I (Nursing Ethics) PDF

Week 9 Professional Development I Module 9: Nursing Ethics  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and Mohawk College honours that union by recog...

Week 9 Professional Development I Module 9: Nursing Ethics  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and Mohawk College honours that union by recognizing the Six Nations of the Grand River and the Mississauga’s of the Credit First Nation. We acknowledge that the territories on which Mohawk College and its campuses are situated are governed by the Between the Lakes Treaty, the Dish with One Spoon Wampum Agreement, and the Upper Canada Treaty Agreement. These agreements are binding to this day and represent our mutual commitment to maintain healthy, reciprocal and respectful relationships with the many Indigenous nations and peoples of this area. We acknowledge this and iterate our dedication to inclusivity, to friendship and to valuing the ongoing contributions of Indigenous peoples and communities. Agenda 01 02 03 Housekeeping Learning Outcomes Ethics 04 05 06 Consent & Coming Up Questions? Confidentiality  0 Week 9 1 Housekeeping Questions? Case Scenario Assignment Part B Learning Plan (Part B) Building on Part A (Reflection submitted Week 5) Refer to Canvas for additional instructions Individual Assignment Due prior to start of class next week (Week 10) Late submissions will receive deductions (Astle & Duggleby, 2023) Part B: Individual Learning Plan In Part A of this assignment, you were asked to reflect on the question: How might you manage the situation? Do you have the knowledge and skills needed to manage the situation? When a practice issue occurs that could potentially lead to patient harm, nurses have the professional and ethical responsibility to reflect on what happened and identify any gaps in practice. When a gap in nursing knowledge or skills is identified, a learning plan can help nurses develop an action plan to address specific areas of practice. Learning plans are also an annual quality assurance requirement for all nurses who are registered with the College of Nurses of Ontario. They provide a way for nurses to demonstrate to the public a dedication to excellence in nursing practice and continuing competence. Based on the case scenario and reflection that was written in Part A, students are required to complete an individual learning plan that includes one (1) learning goal and three (3) learning activities. Part B: Individual Learning Plan Step 1: Recall that in Part A you had to answer the question: do you have the knowledge and skills needed to manage the situation described in your case scenario? What gaps did you identify? What knowledge or skill could you gain that would be helpful to manage the situation? This will help you produce a learning goal for yourself. Step 2: Describe how your learning goal aligns with patient safety principles and nursing best practices surrounding patient safety. Include at least one scholarly source that is relevant, reputable, and current. Step 3: Which CNO Code of Conduct principles does your learning goal align with? It should align with a minimum of 2 principles. Describe how your learning goal aligns with the principles identified in the Code of Conduct from the College of Nurses of Ontario Step 4: Describe how your learning goal aligns with with at least three (3) entry to practice competencies for Registered Practical Nurses. Step 5: Identify three (3) specific learning activities you can complete to address your learning goal and provide a timeline on when you intend to complete these activities.  0 Week 9 Learning 2 Outcomes Learning Outcomes 1 2 Discuss ethics as it Explore the ethical values relates to nursing and principles set by the practice College of Nurses Ontario 3 4 Use an ethical decision- Identify ethical making framework to issues in nursing examine ethical dilemmas practice  0 Week 9 Ethics 3 Small Group Activity What is Ethics? Time: 5 minutes Discuss how you define ethics Identify examples of ethical situations (write them down) Be ready to share in large group Understanding Ethics Values: Strong personal beliefs and ideals that a person or group believe to have merit Ethics: Study of the philosophical ideals of right and wrong behaviour based on what one thinks they should or should not do Reflects what matter most to people or professions CNA published a Code of Ethics document for nurses (Astle & Duggleby, 2023) Nursing & Ethics CNA Code of Ethics is a statement of ethical values of nurses and of nurses’ commitments to persons with health care needs and receiving care It’s intended to guide nurses in all contexts of nursing practice, education, administration, research, and policy decision making Nurse are bound to the Code of Ethics to serve and protect the public The code provides guidance for ethical relationships, responsibilities, behaviours, and decision making Should be used in conjunction with professional standards and best practice (Astle & Duggleby, 2023) Ethical Terms Responsibly: The characteristics of reliability and dependability An ability to distinguish between right and wrong Includes duty to perform actions adequately and thoroughly Advocacy: Acting on behalf of another person, speaking for someone who cannot do so Recognizes the need for improvement of systems and societal structures to create equity Nurses advocate for eliminating social inequities (Astle & Duggleby, 2023) Ethical Terms Accountability: Grounded in the moral principles of fidelity and respect for the dignity of others Nurses are honest and practice with integrity within their work and interactions Accept responsibility for one’s actions and to answer for anything being done As per CNA; nurses who are accountable… ○ Keep up with professional standards ○ Ensure they have competence to practice ○ Maintain fitness to practice ○ Share their knowledge with other nurses ○ Advocate for comprehensive and equitable mental health care services (Astle & Duggleby, 2023) Principles of Health Care Ethics Health care ethics is the philosophical study of what is morally right and wrong when providing health care services An ethical dilemma is a situation that will often involve a conflict between opposing moral choices There are 4 basic principles of Health Care Ethics ○ Autonomy ○ Justice ○ Beneficence ○ Nonmaleficence (Astle & Duggleby, 2023) Principles of Health Care Ethics Autonomy: Refers to one’s freedom or self-determination Having free choice involving decisions that affect one’s life Nurses respect autonomy by assisting clients achieve their own health goals Autonomy assumes the client is competent and can make rationale decisions Can you think of an example? (Astle & Duggleby, 2023) Principles of Health Care Ethics Beneficence: Promoting someone else’s good, or well-being Helps guide difficult decisions concerning whether the benefits of treatment may be challenged by risks to the patient’s well being The act requires that the best interests of the patient remain more important than any self-interests Can you think of an example? (Astle & Duggleby, 2023) Principles of Health Care Ethics Nonmaleficence: Avoidance of harm or hurt Can be helpful when guiding decisions about new or controversial therapies Nurse will try to balance the risks and benefits of a plan of care while striving to cause the least harm possible Can you think of an example? (Astle & Duggleby, 2023) Principles of Health Care Ethics Justice: All people should be treated in a fair and equal manner Can uphold the principle of justice by being concerned for all clients equally, regardless of their conditions or situations Important to understand Social Justice ○ Equitable distribution of benefits and burdens ○ Promotes the view of broad social change being necessary (Astle & Duggleby, 2023) Ethics in Healthcare Health care teams form professional helping relationships with clients and have developed ethical standards to guide interactions Regulated professions have codes of ethics, provided by various governing bodies (Astle & Duggleby, 2023) Codes of Ethics Relates which values are applicable and what to consider when making ethical decisions as an individual, nurse, or part of a multidisciplinary team Gives guidance for decision-making about ethical matters by providing a set of values that are basic to nursing practice Serves as a means for self-evaluation and reflection regarding ethical nursing practice Helps nurses plan out actions and provides supportive rationale for decisions CNO has a Practice Standard for Ethics* CNA as Ethical Responsibilities (Astle & Duggleby, 2023) Canadian Nurses Association Ethics in Nursing https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-ethics *RNs... but can be applied to RPN role just as equally* 7 Values and ethical responsibilities: 1. Providing safe, compassionate, competent and ethical care 2. Promoting health and well-being 3. Promotion and respecting informed decision making 4. Honoring dignity 5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable (CNA 2017) College of Nurses of Ontario *Please note this document has been removed by the CNO* Ethics in Nursing CNO Practice Standard: Ethics (Refer to Canvas for this document) Describes ethical values that are important to nurses 1. Client well-being 2. Client choice 3. Privacy and confidentiality 4. Respect for life 5. Maintaining commitments 6. Truthfulness 7. Fairness Provides behavioural directives to guide ethical decision making (CNO, 2019) Small Group Activity CNO & Ethics? Time: 5 minutes What does each ethical value mean according to the CNO? How do nurses uphold these values? Be ready to share in large group College of Nurses of Ontario 1. Ethical Well-being Promoting client well-being means facilitating someone’s good health or welfare and preventing or removing harm At times it is difficult to decide what is “good” or optimal in a particular situation In determining the best action, it is necessary to differentiate between the nurse’s and the client’s views of what is beneficial Sometimes it is also difficult to balance potential benefits with the potential harm of a given choice Nurses must use the client’s views as a starting point (CNO, 2019) College of Nurses of Ontario 1. Ethical Well-being Behavioural Directives Nurses demonstrate a regard for client well-being by: Listening to, understanding and respecting clients’ values, opinions, needs and ethnocultural beliefs Supporting clients to find the best possible solution, given clients’ personal beliefs, and different decision-making styles Using their knowledge and skill to promote clients’ best interests in an empathetic manner Promoting and preserving the self-esteem and self-confidence of clients Maintaining the therapeutic nurse-client relationship (CNO, 2019) College of Nurses of Ontario 2. Client Choice Client choice means self-determination and includes the right to information necessary to make choices and consent or refuse care Clients know the context in which they live and their values and beliefs As a result, when they have the necessary information, they can decide what is best for themselves Clients who are not competent in all areas of their lives may still be capable of making sound decisions in some areas and need the opportunity to do so When a client is incompetent, the nurse needs to work with the substitute decision maker (CNO, 2019) College of Nurses of Ontario 2. Client Choice In Ontario, legislation and common law require that the wishes of clients or substitute decision makers be respected There are limits; clients do not have the right to choose to endanger the safety of others or their choice may be restricted by policies There may be situations in which clients request nurses to perform an act that is illegal By exploring the implications of the request and providing education, nurses have a better chance of preventing a practice that carries considerable risk of harm Consideration of clients wishes may be difficult when their beliefs and values differ from those of the nurse (CNO, 2019) College of Nurses of Ontario 2. Client Choice Behavioural Directives Nurses demonstrate regard for client choice by: Respecting clients even when their wishes are not the same as the nurses Following clients’ wishes within the obligations of the law and the standards of practice Following substitute decision makers’ directives if clients are not capable of making decisions Exploring the clients’ rational for their decisions Supporting informed decision making and advocating for clients to acquire information (CNO, 2019) College of Nurses of Ontario 3. Privacy & Confidentiality Privacy is limited access to a person, the person’s body, conversations, bodily functions or objects associated with that person Because people have different beliefs and values about privacy, these need to be identified by the clients Nurses need to provide care that maintains the dignity and privacy of clients and should not unnecessarily access a client’s privacy Confidentiality involves keeping personal information private Clients have the right to confidentiality and nurse make an implicit promise to maintain it Relevant information is only shared with those directly involved in the care of the client (CNO, 2019) College of Nurses of Ontario 3. Privacy & Confidentiality Cont’d… At times, nurses may learn information which, if not revealed, will result in serious harm to the client or others Nurses need to consult with the health care team and report information to the person or facility affected. Eg. Nurses are obligated to report suspected child abuse, elder abuse, gun shot wounds, stabbings etc. (CNO, 2019) College of Nurses of Ontario 3. Privacy & Confidentiality Behavioural Directives Nurses demonstrate regard for privacy and confidentiality by: Keeping all personal and health information confidential Informing clients or substitute decision-makers that other health team members will have access to client information Informing client or SDM’s that client information may be used for other purposes such as research or quality improvements Refraining from collecting information that is unnecessary for the provision of care Protecting clients’ physical and emotional privacy (CNO, 2019) College of Nurses of Ontario 4. Respect for Life When a client’s wishes conflict with a nurse’s personal values, and the nurse believes that they cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation If no other caregiver is available, the nurse must provide the immediate care required The nurse may have to leave a particular place of employment in order to adhere to their personal values (CNO, 2019) College of Nurses of Ontario 4. Respect for Life Behavioural Directive Nurses demonstrate regard for respect for life by: Identifying, when possible, clients’ values about respect for life and quality of life Respecting clients’ or substitute decision-makers values and following their wishes within the obligations of the law and standards of practice Advocating for palliative measures when active treatment is withheld Providing dignified, comfortable care for a dying client (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to Clients Nurses have an obligation to maintain commitments that they assume as regulated healthcare professionals Maintaining commitments means keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health team and quality practice settings (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to Clients Behavioural Directives Nurses demonstrate a regard for maintaining commitments to clients by: Putting the needs and wishes of clients first Identifying when clients’ needs and wishes conflict with those of family or others and encourage further discussion Identifying needed resources and support to enable clients to follow their wishes Making all reasonable efforts to ensure client safety and well-being is maintained during any job action (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to Oneself Nurses need to recognize and function within their value system Nurses’ values may differ from those of others however they must provide ethical care while at the same time remaining committed to their values (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to Oneself Behavioural Directives Nurses demonstrate a regard for maintaining commitments to themselves by: Clarifying their own values in client situations Identifying situations where a conflict of their values interferes with care of clients Exploring alternative options for treatment and seeking consultation when values conflict Recognizing their physical and mental limitations and the impact their own health has on the ability to provide safe, effective and ethical care (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to the Nursing Profession Being a member of the profession brings with it the respect and trust of the public Nurses have a duty to uphold the standards of the profession, conduct themselves in a manner that reflects well on the profession and to participate in and promote the growth of the profession Nurses have a commitment to help regulate nursing to protect the public’s right to quality nursing services Nurses have an obligation to participate in the effective evolution of self-regulation Self regulation is a privilege, and each nurse is accountable for the responsibilities that accompany that privilege (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to the Nursing Profession Behavioural Directives Nurses demonstrate regard for maintaining commitments to the nursing profession by: Promoting the goals of the profession in a manner that meets the needs of clients’ Conducting themselves in a way that promotes respect for the profession Participating in the Reflective Practice requirements of CNO’s Quality Assurance Program Following standards and practice expectations of the profession Being accountable for their actions and behaviours Cooperating with regulatory functions (CNO, 2019)  College of Nurses of Ontario 5. Maintaining Commitments to Quality Practice Settings Nurses are best able to provide quality care when the environment supports quality professional nursing practice, is effective in implementing change and responds to nurses’ concerns All nurses need to advocate for quality practice settings To promote quality workplaces, CNO identifies 7 key characteristics that support quality professional practice: 1. Professional development systems 2. Leadership 3. Organizational supports 4. Response systems facilities and 5. Equipment 6. Communication systems 7. Care delivery processes (CNO, 2019) College of Nurses of Ontario 5. Maintaining Commitments to Quality Practice Settings Behavioural Directives Nurses demonstrate regard for maintaining commitments to quality practice settings by: Continually evaluating the workplace environment to identify opportunities for improving the quality of care Being honest with their dealings with the setting and respecting its philosophy and policies Making those in authority aware of concerns within the setting Exploring solutions within the setting that will meet the needs of clients and others Advocating for nursing input into policies relating to client care (CNO, 2019) College of Nurses of Ontario 6. Truthfulness Truthfulness means speaking or acting without intending to deceive Truthfulness also refers to providing enough information to ensure the client is informed Omissions are as untruthful as false information Health professionals believe that clients have the right to and will benefit from full disclosure Honesty builds trust, which is essential to the therapeutic relationship between nurses and clients (CNO, 2019) College of Nurses of Ontario 6. Truthfulness Behavioural Directives Nurses demonstrate a regard for truthfulness by: Discussing client’s questions about their diagnosis with the health care team and advocating for clients’ right to receive the information Assessing clients’ readiness for information Answering clients’ direct questions Using professional judgement Explaining to clients their right to information and assisting them to understand it Considering family when they do not want the client to have information (CNO, 2019) College of Nurses of Ontario 7. Fairness Fairness means allocating health care resources on the basis of objective health-related factors The Canadian Health Act provides access to health care for all Canadians Health care resources are limited, yet there are more options available This makes decisions about who receives care and what kind of care they receive more difficult Nurses might prioritize an individual client’s needs according to the critical nature of that need Nurses could also look at who will benefit most from the care they can give (CNO, 2019) College of Nurses of Ontario 7. Fairness Behavioural Directive Nurses demonstrate regard for fairness by: Being clear about how their own values relate to the demands of fairness Discussing resource allocation issues with the appropriate authority and team members Advocating for input into policies and procedures about the use of resources Advocating for adequate resources to provide safe, effective and ethical nursing care Demonstrating a willingness to explore alternative ways of providing care that continue to value clients’ well-being (CNO, 2019) Break Time… Please enjoy a 5-minute break Ethical Frameworks Understanding Ethical Framework? The practice of nursing frequently will present you with ethical dilemmas. To understand and be able to process ethical dilemmas it is important to have an ethical framework. An ethical framework starts with a set of core values. (i.e. CNO) (CNO, 2019) Ethical Frameworks Consideration of ethical issues is an essential component of providing care Nurses encounter ethical conflict, uncertainty or distress in their everyday practice The Ethical Framework for Nurses in Ontario, Section 1, Guidelines for Professional Behaviour, describes the ethical values that are most important to the nursing profession in Ontario To make decisions about ethical situations, nurses need to be aware of their personal values They need to be knowledgeable of clinical situations and ethics, and they require the ability to think through a problem (CNO, 2019) Ethical Dilemmas Ethical Dilemmas A conflict between two sets of values, both are good, but neither of which can be fully served Cause distress or confusion about the best course of action for the patient and/or the nurse i.e. a client refuses treatment for cancer can cause conflict between values of client choice, client well-being, and respect for life (CNO, 2019) Ethical Dilemmas A code of ethics provides guidelines for ethical behaviour but cannot give answers or rules When faced with an ethical dilemma: ○ Carefully consider the four principles of health care ethics ○ Collect as much information about the situation as possible ○ Consider all possible options to resolve the dilemma (CNO, 2019) Ethical Dilemmas How to Analyze Ethical Dilemmas: ○ Determine whether the issue is an ethical dilemma ○ Gather all the information relevant to the case ○ Examine and determine your own values on the issues ○ Verbalize the problem ○ Consider possible courses of action ○ Reflect on the outcome ○ Evaluate the action and outcome (CNO, 2019) Ethical Dilemmas Types of Ethical Dilemmas: Nurses may experience ethical uncertainty when faced with a situation in which they are unsure of what values apply or even where the moral problem is They may also experience ethical distress when they know the “right” thing to do, but various constraints make doing the “right” thing difficult Above all, nurses need to choose ethical interventions that meet the needs of clients (CNO, 2019) Small Group Activity Ethical Dilemmas? Time: 10 minutes Within your small groups; work through the Ethical Dilemma noted on the next slide Answer the accompanying questions Be ready to share in large group Small Group Activity A competent 85-year-old man in a long-term care facility has been taking walks along a busy highway every day. He always says that he could not bear to live without his walks. Recently, the nurses have noticed that his gait has become unsteady, and they are concerned about his safety during his walks along the busy road. They are afraid that he may fall into the traffic. Questions: 1. What ethical principles are in conflict? 2. What CNO ethical values need to be upheld? 3. What are your values on this situation? 4. What are possible courses of action? Resolving Ethical Conflicts Working through and understanding ethical situations are an ongoing part of care It is not always possible to find a resolution to a conflict that satisfies everyone At these times, the best possible outcome is identified in consultation with the client and the health care team works to achieve that outcome As with other aspects of care, documenting the discussions and decisions is necessary (CNO, 2019)  0 Week 9 4 Consent & Confidentiality Consent Nurses have an ethical and legal obligation for obtaining consent CNO Consent Practice Guideline addresses consent under two acts ○ Health Care Consent Act, 1996 (HCCA) ○ Substitute Decisions Act, 1992 (SDA) Practice Guideline does not address consent under the Mental Health Act Practice Guideline does not address consent for Medical Assistance in Dying (CNO, 2017) Obtaining Consent Nurses are accountable for obtaining consent Consent is informed if; ○ The person received the information about the treatment in order to make a decision ○ The person received responses to their request for additional information The information share must include: ○ Nature of the treatment ○ Expected benefits of the treatment ○ Material risks and side effects of the treatment ○ Alternative course of action ○ Consequences of not having the treatment (CNO, 2017) Health Care Consent Act Health Care Consent Act (HCAA) Goals include promoting individual authority and autonomy, facilitating communication between health care practitioners and their clients, and ensuring family members can participate when a client is incapable Consent to treatment involves an ongoing process that can change at any time Health care practitioners have no authority to make treatment decisions on behalf of clients, except in an emergency salutation when no authorized person is available to make the decisions A person’s wishes about treatment, admissions or personal assistance services may be expressed orally, in writing, in any other form, or they may be implied. (CNO, 2017) Substitute Decisions Act Substitute Decision Act (SDA) Deals with decision-making about personal care or property on behalf of incapable persons Concerned with persons who need decisions made on their behalf on a continuing basis Involves formal appointment of a decision-maker through a Power of Attorney document (CNO, 2017) Substitute Decisions Act Substitute Decision Act (SDA) – Major Features: An individual may designate a specific person to make decisions about their personal care or treatment if they become incapable A Power of Attorney for personal care comes into effect when the person who granted it becomes mentally incapable, unless it states otherwise A person under statutory guardianship may apply to the Consent and Capacity Board (CCB) for a review of a finding of incapacity (CNO, 2017) Obtaining Consent When the Client in not Capable: 1. Assess Capacity 2. Provide Emergency Treatment of Crisis Admission 3. Inform the Client that a Substitute Decision-Maker will Make Decisions 4. Identify a Substitute Decision-Maker 5. Obtain Consent from the Substitute Decision-Maker (CNO, 2017) Confidentiality Nurses have an ethical and legal responsibility to maintain confidentiality and privacy of client health information Ontario’s privacy legislation supports and extends the College of Nurses of Ontario’s standards on nurses’ responsibility to maintain confidentiality Two provincial legislation acts ○ Personal Health Protection Act , 2004 (PHIPA) ○ Quality of Care Information Protection Act, 2016 (QOCIPA) (CNO, 2022) Confidentiality Personal Health Protection Act , 2004 (PHIPA) Governs health care information privacy in Ontario Sets consistent rules for the management of personal health information and outlines client’s rights regarding their personal health information Balances a client’s right to privacy with the need of individual organizations providing the health care to access the information (CNO, 2022) Confidentiality Quality of Care Information Protection Act, 2016 (QOCIPA) Provides broad protection to quality-of-care information produced by a health care facility or for a governing body Promotes open discussion of adverse events, peer review activities and quality of care information, while protecting the information from being used in litigation or accessed by clients (CNO, 2022) Confidentiality Scenario Your client with an acquired brain injury has been stabilized and is being transferred to another hospital for continuing care. The client is unconscious. Her husband is aware of the transfer but does not know it is happening today. You tried to reach him by telephone, without success. Before the client is transferred, you want to share information about the care she received and the current plan of care with the nurse who will receive her. The client’s cost for this transfer is being covered by private insurance, so you also need to share personal health information with the insurance company. How much information can you share, and with whom, under these circumstances? What are the main issues? (CNO, 2022) Confidentiality Scenario There are two issues of consent in this scenario: 1. The first is sharing personal health information with the receiving hospital nursing staff. These nurses are members of the health care team; therefore, there is implied consent for the sharing of information with them to provide health care. You can, therefore, share her personal health information. You may call the nurse and talk about the plan of care and transmit a copy of the pertinent information from the health record to the receiving facility in a way that ensures the security of the files. (CNO, 2022) Confidentiality Scenario 2. The second is the sharing of the client’s personal health information with the insurance company. Express consent is required because this disclosure is not to a custodian and is not required to treat the client. Because the client is incapable of providing this consent, her husband (the substitute decision- maker) must provide express consent either in writing or verbally, before you share information. Since you cannot reach him, you may arrange her transfer. Once you obtain express consent from the husband, you may provide the information to an insurance company staff member. (CNO, 2022) References Astle, Duggleby, Potter, Perry, Stockert & Hall. (2023). Potter and Perry's Canadian Fundamentals of Nursing (7th edition). Toronto: Elsevier Canada College of Nurses of Ontario. (2019). Ethics. https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf College of Nurses of Ontario. (2017). Practice Guideline: Consent. https://www.cno.org/globalassets/docs/policy/41020_consent.pdf  0 Week 9 5 Coming Up… Coming up… Ensure you have completed 1 hour of asynchronous work for Module 9 Prepare for Module 10 (Week 10) ○ Review module objectives ○ Begin required readings and activities and come prepared to engage in lecture Part B Assignment: Learning Plan ○ Refer to Canvas for Assignment Instructions ○ Due: November 15th at 7:00pm  0 Week 9 6 Questions