Chapter 07: Application of Ethics in the Community

10. A nurse is applying the principle of distributive justice. Which of the following describes the benefits that will occur through application of this principle? a. Basic needs, material and social goods, liberties, rights, and entitlements b. Taxes, military service, location of incinerators or power plants c. Entitlement to equal rights and equal treatment d. The right to private property and personal assets

A Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. Entitlement to equal rights and equal treatment refers to egalitarianism. The right to private property and personal assets refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

1. Which statement regarding Florence Nightingale's ideas about ethics is correct? a. Nursing is a call to service, and the moral character of persons entering nursing is important. b. Ethical principles are based on the values of the individual nurse. c. Society will dictate the ethical principles to which nurses must adhere. d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.

A Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important. Florence Nightingale did not set up public health centers. Florence Nightingale did not believe that nurses must adhere to society's view of ethical principles. Ethical beliefs are based on the values of the individual nurse, not ethical principles.

9. A nurse is applying the ethical principle of nonmaleficence. Which of the following describes the action that the nurse is taking? a. Administering medications using the "five rights" b. Allowing clients to be active participants in their care c. Providing patient privacy when delivering care d. Referring a client to a physical therapist

A Nonmaleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible. Providing privacy when delivering care demonstrates the client's right to privacy. Allowing clients to be active participants in their care refers to the ethical principle of the right to autonomy. Referring a client to a physical therapist demonstrates the nursing role of referral agent.

16. A nurse is providing care using the idea of "servicing citizens, not customers." Which of the following ideas is being applied by the nurse? a. Ethical tenets of policy development b. Basic concepts of the feminist theory c. Underlying premise of virtue ethics d. Components of distributive justice

A There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed. The basic concept of feminist theory allows us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. The goal of virtue ethics is to enable persons to flourish as human beings. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members.

13. According to Leininger and Watson, what is the moral ideal of nursing? a. Caring b. Advocacy c. Responsibility d. Accountability

A This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice. Advocacy, responsibility, and accountability are not part of the moral idea of nursing proposed by Leininger and Watson.

1. Which of the following are ethical tenets that underlie the core function of assessment? (Select all that apply.) a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations. b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess integrity. c. Service to others over self: a necessary condition of what is "good" or "right" policy. d. "Do no harm": disseminating appropriate information about groups and populations is morally necessary and sufficient. e. Providers of public health services should be competent and available.

A, B, D Service to others over self is an ethical tenet of policy development. Providers of public health services should be competent and available is an ethical tenet of assurance. Competency, moral character, and "do no harm" are the ethical tenets of assessment.

22. The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a chemical spill at a major industrial facility that could produce harmful effects. Which of the following principles is being violated? a. Morality b. Advocacy c. Caring d. Virtue

B Advocacy requires that the community be properly informed, and this was violated in the above scenario. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Caring represents the essence of nursing. Virtue demonstrates behavior showing high moral standards.

18. A nurse believes that all Americans should receive basic health care services. Which of the following core functions supports this belief? a. Assessment b. Assurance c. Policy development d. Advocacy

B Assurance purports that all persons should receive essential personal health services. Assessment refers to systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Advocacy embodies an ethical focus grounded in quality of life.

11. A nurse believes everyone is entitled to equal rights and equal treatment in society. Which of the following principles is being applied? a. Distributive or social justice b. Egalitarianism c. Libertarian view of justice d. Communitarianism

B Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society. Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. The libertarian view of justice holds that the right to private property is the most important right. Communitarianism views that individual rights need to be balanced with social responsibilities; individuals do not live in isolation but are shaped by the values and culture of their communities.

4. What term is used to describe an orderly process that considers ethical principles, client values, and professional obligations? a. Moral distress b. Ethical decision making c. A value d. A code of ethics

B Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations. Moral distress is an uncomfortable state of self when one is unable to act ethically. Values are beliefs about the worth or importance of what is right or esteemed. A code of ethics is a moral standard that delineates a profession's values, goals, and obligations.

3. A nurse who was working in the 1960s used the code of ethics to guide making an ethical decision. Which code of ethics would have been used? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses with Interpretive Statements d. International Council of Nurses (ICN) Code of Ethics for Nurses

B Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the ICN Code of Ethics for Nurses was adopted in 2000.

8. Which ethical principle requires "doing no harm?" a. Respect for autonomy b. Nonmaleficence c. Beneficence d. Distributive justice

B Nonmaleficence refers to doing no harm. Respect for autonomy requires that individuals be permitted to choose those actions and goals that fulfill their life plans unless those choices result in harm to another. Beneficence requires that we do good. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members.

12. Which statement fits with those of the Liberal Democratic Theory? a. One should reject any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties. b. Inequalities result from birth, natural endowment, and historic circumstances. abirb.com/test c. Everyone has a right to private property. d. Government should be limited.

B Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

20. A nurse refers to the Code of Ethics for Nurses or the Public Health Code of Ethics. Which of the following describes why the nurse has referred to this document? a. To provide answers for ethical dilemmas b. To guide professional practice related to ethics c. To increase moral leadership in ethics d. To find a framework for ethical decision making

B These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession. They do not provide answers for ethical dilemmas, only serve as a guide. They do not increase moral leadership, nor do they provide a framework for ethical decision making.

5. A public health nurse is examining several issues within daily practice. Which of the following issues would be considered an ethical dilemma? a. Whether or not to establish a community health center in a rural area b. Allocating resources in a natural disaster c. Deciding to withdraw care on a hospice patient d. Applying the principles of Florence Nightingale in Bangladesh

B When resources are scarce, a dilemma may exist as to how to allocate them. Considering establishing a community health center may be a dilemma, but it probably does not involve ethics. Withdrawing care from a hospice patient would most likely not be an issue encountered by a public health nurse, as this represents community health nursing practice, not public health nursing practice. Applying the principles of Florence Nightingale would not be ethical issue.

2. A community health nurse is applying the Ethical Principles for Effective Advocacy. Which of the following best describes the action(s) of the nurse? (Select all that apply.) a. Act in the health care provider's best interest. b. Keep the client (group, community) properly informed. c. Maintain client confidentiality. d. Carry out instructions with diligence and competence. e. Provide advice to all members of the community.

B, C, D Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy. The nurse should act impartially and offer frank, independent advice, which does not necessarily mean that advice should be provided to all members of the community.

14. A nurse is using the principles of virtue ethics in decision making. Which of the following describes the action that the nurse would take? a. Provide efficient and effective nursing care. b. Identify the meaningful facts in the situation. c. Seek ethical community support to enhance character development. d. Plan ways to restructure the social practices that oppress women.

C According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development. Nurses can demonstrate advocacy when providing efficient and effective nursing care. Identifying the meaningful facts in the situation is part of the ethical decision-making process. Planning ways to restructure the social practices that oppress women is part of the feminist ethics decision-making process.

17. Public health administrators provide part-time translators to a health department serving indigent immigrants. Which of the following best describes what is being addressed? a. Policy development b. Quality c. Assurance d. Libertarian philosophy

C Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Quality refers to providing the best care possible. Libertarian philosophy refers to the view that the right to private property is the most important right.

21. A nurse is demonstrating advocacy in personal nursing practice. Which of the following actions best demonstrates this principle? a. Offering a smoking cessation program b. Screening for hypertension c. Lobbying for health care reform d. Conducting home visits

C Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, and efficient health care for all. This is best accomplished by performing interventions at the population level.

7. There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which of the following actions would the nurse take first? a. Identify all options. b. Determining who arrived first. c. Gather additional information. d. Act and assess decisions made.

C The steps of the ethical decision-making framework are to first identify the ethical issues and dilemmas, then place them within a meaningful context, obtain all relevant facts, reformulate ethical issues and dilemmas if needed, consider appropriate approaches to actions or options, make decisions and take action, and evaluate decisions and action.

2. A nurse is applying the knowledge and processes of ethics to the examination of ethical problems in health care. Which of the following describes the actions of the nurse? a. Values b. Morality c. Ethics d. Bioethics

D Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care. Values are beliefs about the worth or importance of what is right or esteemed. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Ethics is a branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be regarding this life.

6. The growing multiculturalism of American society can contribute to ethnicity conflicts when considering what? a. Providing care to different cultural groups b. Aligning individual values with the cultural norms c. Ethnic groups overburdening the health care system d. The greater community's values being jeopardized by specific ethnic values

D Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture. Providing care to different cultural groups should not produce an ethnicity conflict. Individual alignment with cultural norms would make it less likely that an ethnicity conflict would occur. Ethnic groups using the health care system will not cause it to be overburdened or result in an ethnicity conflict.

15. Which statement about feminist ethics is correct? a. Feminists include only women in their worldview. b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process. c. Feminists believe that men should not be nurses. d. Women's thinking, and moral experiences are important and should be taken into account.

D Feminist theory ascribes to the idea that women's thinking, and moral experiences are important and should be considered. A feminist perspective leads us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. Feminists are women and men who hold a worldview advocating economic, social, and political equality for women that is equivalent to that of men.

19. Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements? a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office. b. The nurse's primary focus is on acute bedside nursing, followed by community health care to promote seamless care. c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient. d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

D Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action. The Code of Ethics for Nurses with Interpretive Statements does not address the practice setting for nursing care. According to the Code of Ethics for Nurses with Interpretive Statements, public health should achieve community health in a way that respects the rights of individuals in the community, not owing duty primarily to the physician. Public health should seek the information needed to implement effective policies and programs that protect and promote health.