Chapter Five begins with an overview of the association and differences
between ethical problems, ethical dilemmas, moral distress, moral agency and moral
residue. Two specific tools for nurses to use when confronted with moral issues in
practice are presented: The Mosaic Model for Ethical Decisions by Stephany (2012)
and A Framework for Ethical Decision Making by Oberle and Bouchal (2009). An
open discussion of the strengths of each strategy is presented. The Mosaic Model
differs from other models in that it emphasizes care and caring relationships; keeps the
person in the center; is non-linear and is applicable in many settings. The Framework is
recommended by the CNA (2017). Tt focuses on the client’s best interests; it
encourages reflection; offers items to consider in practice; and is very applicable in a
variety of ethical situations. The aforementioned model and framework are each
presented in a series of five steps. In the Case in Point a client’s decision conflicts with
some members of the health care team. Nurses are encouraged to use the model or
framework presented in this Chapter to sort through the ethical issues in this case.
Keywords: A Framework for Ethical Decision Making, Ethical problems, Ethical
dilemmas, Ethical decision-making models, Ethical decision-making frameworks,
Moral distress, Moral agency, Moral agency violation, Moral residue, The Mosaic
Model for Ethical Decisions.
