Chapter 22, Ethics and Values EAQ
Utilitarianism
what study proposes that the value of something is determined by its usefulness; it does not focus on the nature of relationships.
Chemotherapy has side effects, but it is a viable treatment option. Non-maleficence is the avoidance of harm. Therefore explaining to the patient that chemotherapy has side effects but that it is a viable and often effective treatment option, is practicing non-maleficence. Telling the patient that chemotherapy has no side effects and that it will cure cancer may provide false assurance. Stating that starting chemotherapy is the health care provider's decision violates the principle of autonomy.
A patient is in the early stages of pancreatic cancer. The health care provider orders chemotherapy. Which information should be given to the patient per the principle of non-maleficence?
The foundation of the ethics of care is its attention to relationships, as distinguished from other philosophies based more on principles.
According to the philosophy of the ethics of care, which is most important when solving ethical dilemmas? Patients Relationships Ethical principles Code of ethics for nurses
To articulate a unique point of view, including knowledge based on clinical and psychosocial observations Nursing plays a unique and critical role in the resolution of difficult ethical situations The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the healthcare team.
Resolving an ethical dilemma involves discussion with the patient, the patient's family, and participants from all healthcare disciplines. Which describes the role of the nurse in the resolution of ethical dilemmas?
Fidelity refers to the agreement to keep promises. The nurse assesses the patient's needs and performs interventions to fulfill them. If the interventions are not found to be effective, the nurse still follows through on the actions and modifies the care plan to reduce the pain. Advocacy, responsibility, and accountability are principles of the codes of ethics. Advocacy is when the nurse speaks up for patient rights. Responsibility refers to a willingness to respect one's professional obligations and follow through on promises. Accountability is when one is answerable for one's actions.
The nurse is assessing a patient who has arthralgia. The nurse is preparing a plan for pain management. The nurse monitors the patient's response and revises the plan to reduce the pain. Which statement about the nurse's action is correct? nurse is showing fidelity. The nurse is advocating for the patient. The nurse is showing responsibility toward patient care. The nurse is following the principle of accountability.
Justice, because the first and greatest question in this situation is how to determine the just distribution of resources Accountability, respect for autonomy, and ethics of care are not necessarily incorrect answers, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Which principle is the priority in a discussion about ethics?
Autonomy refers to the commitment to include patients in decisions about all aspects of care. The nurse includes the patient by obtaining consent for insulin administration. Advocacy requires the nurse to speak and work in support of the health, safety, and rights of the patient. Accountability refers to the ability to answer for one's actions. The nurse follows nonmaleficence by avoiding hurting patients.
The nurse wants to administer insulin to a patient and obtains consent from the patient before the procedure. Which ethical concept does the nurse adhere to through this action? Advocacy Autonomy Accountability Nonmaleficence
Nonmaleficence is the avoidance of harm or hurt to the patient. The nurse should balance the risks and benefits of patient care to make sure that it causes the least harm to the patient. Nonmaleficence also means choosing those therapeutic approaches that are least harmful for the patient. To keep promises made to the patient is a part of standards of fidelity. Allowing the patient to read the informed consent is a practice of respecting the patient's autonomy.
The senior nurse is teaching a group of student nurses about ethics in the healthcare setting. Which education about nonmaleficence should the nurse provide? Select all that apply. Nonmaleficence means avoidance of harm to the patient. The nurse should balance the risks and benefits of patient care. Nonmaleficence means to keep promises made to the patient. The nurse should allow the patient to read the informed consent. Nonmaleficence means using the therapeutic approaches with the least risk of harm.
Clarifying values Clarifying values involves distinguishing among facts, opinions, and values. The process of clarifying values is an important part of resolving ethical dilemmas. Negotiating a plan requires confidence in one's own point of view and also deep respect for the opinions of others. Verbalizing the problem helps to ensure effectiveness in the final plan and facilitates discussion. Evaluation of the plan over a period of time is helpful for positive outcomes.
There are seven key steps in the resolution of an ethical dilemma. Which step involves distinguishing among facts, opinions, and values?
Returning to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity.
When the nurse assesses a patient for pain and offers a plan to manage the pain, which principal guides the nurse to monitor the patient's response to the pain? Fidelity Beneficence Nonmaleficence Respect for autonomy
Assessing the patient's point of view and preparing to describe it None of these answers is wrong, but advocacy generally refers to the nurse's ability to help speak for the patient.
Which is the best example of practicing patient advocacy? Seeking out the nursing supervisor in conflicting procedural situations Documenting all clinical changes in the medical record in a timely manner Working to understand the law as it applies to an error in following standards of care Assessing the patient's point of view and preparing to describe it
Difficult ethical situations are matters for the entire community and resolved most successfully through institutional ethics committees, not by deference to a single expert or leader.
Which is the best method of negotiating or processing difficult ethical situations? Defer to an independent arbitrator such as a chaplain when ethical issues arise between dissenting providers. Consult a legal expert to help resolve disputes, since ethical issues usually affect policy and procedure, Seek consensus via the institutional ethics committee to help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions. Defer to medical experts as the ones best able to resolve conflicts about outcome predictions.
Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions. This theory lacks a focus on universal principles. Deontology focuses on providing justice and fidelity to the patient but does not focus on the role of relationships. Utilitarianism proposes that the value of something is determined by its usefulness; it does not focus on the nature of relationships. Consensus in bioethics focuses on bringing about an agreement from all the different points of view but does not emphasize relationships.
Which theory considers the importance of relationships in solving ethical dilemmas but lacks a focus on universal principles? Deontology Utilitarianism Feminist ethics Consensus in bioethics
Deontology
what study focuses on providing justice and fidelity to the patient but does not focus on the role of relationships.
Review the surgical procedure. Explain the risks and benefits of the procedure. Ensure that the patient reads the surgery documents and signs the consent form. Reviewing the surgical procedure and explaining the risks and benefits of the procedure indicate respect for the patient's autonomy. Ensuring that the patient signs the informed consent also indicates respect for her autonomy. The healthcare team should not withhold any information about possible harmful effects. Financial aspects of the surgery are purely subjective issues and vary from one establishment to another.
A patient is scheduled for a mastectomy. Which interventions are performed out of respect for the patient's autonomy? Select all that apply. Review the surgical procedure. Explain the risks and benefits of the procedure. Withhold information about the possible harmful effects. Ensure that the patient reads the surgery documents and signs the consent form. Ensure that the patient makes full advance payment.
Ethics committees are usually multidisciplinary. They have several purposes such as education, case consultation, and policy recommendation. Any person involved in an ethical dilemma can request access to an ethics committee. Patient teaching and patient care are the responsibility of all members of the healthcare team.
Healthcare institutions establish ethics committees to process ethical dilemmas. Which are purposes of ethics committees? Select all that apply. Education Patient teaching Patient care Case consultation Policy recommendation
Be clear about their values. Differences of opinion and values can be resolved by being clear about one's own values. Honesty helps to evaluate the patients' values effectively. The nurses should not emphasize their own values and negate the patient's values. This can adversely affect the nurse-patient relationship. Asking the patients to accept the nurses' values is unethical and undermines the patient's autonomy.
How can nurses negotiate differences of opinion and values with patients?
Beneficence involves taking positive actions to help others. Agreeing to act with beneficence implies that the best interest of the patient is more important for the nurse than self-interest. Avoidance of harm or hurt is nonmaleficence. Support of a particular cause is advocacy. Agreement to keep promises is fidelity.
The nurse educator is lecturing a group of nursing students about ethics and values. Which statement made by the student indicates a correct understanding of beneficence? "Avoidance of harm or hurt is beneficence." "Support of a particular cause is beneficence." "Agreement to keep promises is beneficence." "Taking positive actions to help others is beneficence."
Nonmaleficence Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care.
The point of the ethical principal to do no harm is to reassure the public that in all ways the healthcare team not only works to heal patients but agrees to do this in the least painful and harmful way possible. Which principle describes this agreement?
Accountability is being answerable for any right or wrong action. In this case, the student nurse admits that the patient is in pain as a result of the nurse's mistake. Fidelity involves following through on promises. Advocacy is the ethical responsibility to advocate for patient rights. Confidentiality is the ethical responsibility to maintain privacy regarding the patient's condition and information; it is unrelated to the student nurse admitting the mistake.
The registered nurse instructs the student nurse to administer an analgesic to a patient who has undergone appendicitis surgery, but the student nurse forgets to administer the drug and finds that the patient is suffering from severe pain. The student nurse reports the mistake to the registered nurse. Which ethical concept does the student nurse adhere to through this action? Fidelity Advocacy Confidentiality Accountability
No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion.
When an ethical dilemma occurs on the unit, can nurses resolve the dilemma by taking a vote?
Beneficence The immunization is a clear effort to provide benefit. Beneficence refers to doing good. Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding healthcare plans.
A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? Fidelity Beneficence Nonmaleficence Respect for autonomy
As per the professional code of ethics, the nurse should keep all information provided by the patient confidential. However, if the information can have an impact on the course of treatment, it should be revealed. In this case, the nurse should discuss the patient's drug use with the healthcare provider, because it could affect the treatment. The nurse should not discuss it with the patient's family members or with colleagues, because that would be a breach of confidentiality.
A patient in the early stages of pancreatic cancer is being treated with chemotherapy. The patient confides in the nurse that he abuses drugs and asks the nurse to keep it confidential. What should the nurse do? Keep it a secret. Discuss it with the patient's family members. Discuss it with colleagues. Discuss it with the healthcare provider if it affects the treatment
Respect the patient's decision and do not schedule counseling. Discuss with the patient the potential benefits of psychological counseling. Respect the autonomy of the patient. The nurse has to respect the autonomy of the patient and her decision. so should not schedule psychological counseling. The nurse should discuss with the patients the benefits of counseling, as a means of advocating for her best health outcome. The family members can be asked for their opinion, but only with the patient's permission. The nurse should not implement any interventions that violate the patient's wishes.
A patient is preoccupied with the feeling that she suffers from breast cancer. She asks the nurse to insist that the healthcare provider perform a mastectomy. Following several tests, the nurse finds that the patient has no symptoms of or risk factors for breast cancer. When the healthcare provider refers the patient to a psychologist, the patient refuses to go. Which nursing interventions are appropriate in this situation? Select all that apply. Respect the autonomy of the patient. Ask family members for their opinion. Schedule psychological counseling irrespective of the patient's wishes. Respect the patient's decision and do not schedule counseling. Discuss with the patient the potential benefits of psychological counseling.
Nonmaleficence refers to the avoidance of harming or hurting others. Bone marrow biopsy is a procedure with a certain risk associated with it. The benefits, however, outweigh the risk. Therefore, performing the biopsy is an act of nonmaleficence. Advocacy refers to supporting patient rights in any given situation. Beneficence means performing actions that may benefit others. Responsibility refers to a willingness to respect and fulfill one's professional obligations.
A patient is scheduled for a bone marrow biopsy. The nurse understands this procedure and knows it would be helpful for an accurate diagnosis of the patient's disease. However, the patient may experience pain and adverse effects from the procedure. Which ethical principle should guide the nurse's actions in this situation? Advocacy Beneficence Responsibility Nonmaleficence
Autonomy Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Autonomy means freedom from external control. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harming or hurting others.
A patient is scheduled for surgery. Before the surgery the patient read the consent form and signed it. This is an example of which principle?
The nurse should include the family in patient care and decision making to help resolve ethical dilemmas. According to the ethics of care, the nature of relationships between family and patient can help resolve ethical dilemmas. The presumption of good will on the part of all participants will help resolve conflicts and facilitate effective treatment for patients. Strict adherence to confidentiality will help build a trusting relationship with the patient and the family, thereby reducing the ethical conflict. Providing patient-centered decision making will ensure that the nurse adheres to justice and veracity, thereby reducing the risk of ethical conflict. p. 297
A registered nurse is teaching a student nurse about resolving an ethical conflict. Which statement made by the student nurse indicates the need for further teaching? "I should presume good will on the part of all participants." "I should strictly adhere to the confidentiality principle." "I should reduce the involvement of family in patient care." "I should ensure that all treatment provided is patient-centered."
In this case, the principle of justice should be discussed. A major question in this situation is how to obtain financial support for the treatment. Justice involves discussion about health insurance, hospital locations and services, and even organ transplants. Fidelity refers to providing patient care in all circumstances and keeping the promises for further patient care. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Beneficence refers to actions that may be beneficial to others.
The nurse is assessing a patient who has multiple myeloma and is in need of a bone marrow transplant. This patient does not have health insurance and cannot pay out-of-pocket for the procedure. Which ethical principle should be discussed regarding the patient's condition? Justice Fidelity Autonomy Beneficence
Ensuring that the patient understands the risks of a medical procedure Including the patient when deciding on care Ensuring that the patient has read and signed an informed consent before surgery Receiving permission from the patient before performing a physical examination Autonomy refers to the patients' right to make their own decisions. The nurse shows respect for a patient's autonomy by ensuring that the patient understands the risks of a medical procedure, by including the patient in all care decisions, by ensuring that a patient has consented to a medical procedure or surgery, and by getting permission from the patient before providing care or completing assessments. When nurses keep promises by following through on interventions, they are acting on the principle of fidelity.
The senior nurse is teaching a group of nursing students about health care ethics. Which are examples of the nurse showing respect for a patient's autonomy? Select all that apply. Ensuring that the patient understands the risks of a medical procedure Keeping promises by following through on any interventions Including the patient when deciding on care Ensuring that the patient has read and signed an informed consent before surgery Receiving permission from the patient before performing a physical examination
The principle of beneficence is fundamental to the practice of nursing and medicine. The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest. Nonmaleficence is the avoidance of harm or hurt. According to this concept, the healthcare professional tries to balance the risks and benefits of care while striving to do the least harm possible. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. According to the concept of fidelity, a healthcare professional should be unwilling to abandon patients even when care becomes controversial or complex. In addition, the nurse should follow through on actions and interventions.
The nurse is explaining to students the difference between nonmaleficence and beneficence. Which information should the nurse include in the explanation to help the students understand the two concepts? Select all that apply. According to the concept of beneficence, all interventions should consider the patient's best interest. According to the concept of beneficence, maximum priority is given to patients by allowing them to make their own healthcare decisions. According to the concept of nonmaleficence, the healthcare provider should weigh the risks and benefits of the intervention before delivering it. According to the concept of nonmaleficence, the nurse should be loyal and not abandon the patient even when the treatment procedure is complicated. According to the concept of nonmaleficence, the nurse should keep promises by following through on actions and interventions.
Trying to remain competent to practice Being responsible for delegated tasks Being willing to respect professional obligations Nurses should strive to remain competent to practice in order to perform responsibly. All nursing interventions are the responsibility of the nurse, including those that the nurse has delegated. The standards of practice involving responsibility include the nurse's willingness to respect professional obligations and keep promises to patients. Protecting a patient's right to privacy and supporting the health, safety, and rights of a patient are standards of advocacy, not responsibility.
The nurse is practicing according to the professional nursing code of ethics. Which actions are in accordance with the standards of responsibility? Select all that apply. Protecting the patient's right to privacy Trying to remain competent to practice Being responsible for delegated tasks Being willing to respect professional obligations Supporting the health, safety, and rights of the patients
1, 5 Building consensus is essentially an act of discovery, in which collective wisdom guides a group to the best possible decision. It encourages respect for unusual points of view while striving for agreement among all participants. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself. Focusing on just the usefulness of the decision is characteristic of utilitarian philosophy. Focusing on just the benefits and justice of a procedure is characteristic of deontology. Focusing on just the nature of relationships during decision making is associated with the feminist theory.
The nurse learns that building consensus is the best method for a decision-making process. Which are true statements about consensus building? Select all that apply. Unusual points should be considered respectfully while striving for agreement among the participants. The usefulness of an intervention should be of sole consideration. The nature of relationships should be the only guiding principle for the participants in making decisions. The participants should mainly focus on how just and beneficial an intervention is. Respect for opinions and agreement among participants should form the basis of the decision-making process.
It cannot be solved solely through literature review. It cannot be easily reasoned with logic. The answer to the problem has profound relevance for patient care. When solving any ethical dilemma, the first step is to distinguish the ethical problems from other problems. Ethical problems cannot be resolved through literature review only, and they may be difficult to solve logically by the use of reason. The answer to an ethical problem will have a significant influence on patient care. Ethical problems are usually not solved by critical thinking and do not involve only hospital management. They may involve all members of the healthcare team.
The nurse may come across many ethical dilemmas. To resolve them, it is important to distinguish ethical problems from other problems. Which are characteristics of an ethical problem? Select all that apply. It cannot be solved solely through literature review. It cannot be easily reasoned with logic. The answer to the problem has profound relevance for patient care. The problem can be solved by critical thinking. The problem involves only hospital management.
Be clear about personal values. Maintain cultural competence. Attempt to resolve differing opinions. Being clear about personal values helps the nurse to determine the differences between the nurse's own values and those of the patient and to attempt to resolve the differences. Maintaining cultural competence is an important part of the nurse's commitment to nursing practice. Attempting to resolve differing opinions by understanding and negotiating is an essential part of commitment to nursing practice. Values reflect the characteristics of the patient; the nurse should not ask the patient to change. Ignoring the patient's values is not advisable; instead, the nurse should respect the patient's values. Making all patients follow the same values is also not advisable as different factors and backgrounds influence the values of patients, which should be respected.
The nurse understands that values are an important part of life and may differ from one person to another. Which measures should the nurse adopt to ensure ethical nursing care when dealing with the values of a patient? Select all that apply. Ask the patient to change values. Be clear about personal values. Maintain cultural competence. Make all patients follow the same values. Attempt to resolve differing opinions.
Because healthcare reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Reform promotes the principle of beneficence, or positive actions to help others; on the opposite end, lack of access causes harm, and nonmaleficence is a basic principle of health care ethics. Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Access to care is an issue of justice, not fidelity.
Which statements explain how healthcare reform is an ethical issue? Select all that apply. Access to care is an issue of beneficence, a fundamental principal in healthcare ethics. Reforms promote the principle of beneficence, a hallmark of healthcare ethics. Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Lack of access to affordable healthcare causes harm, and nonmaleficence is a basic principal of health care ethics. Access to care is an issue of fidelity, a key principal in healthcare ethics.
The ethical principle of justice ensures that all patients receive equal treatment irrespective of financial status or cultural practices. Veracity involves being truthful and honest with the patient, not providing equal treatment. Advocacy requires the nurse to speak and work in support of the rights of the patient. Providing the same treatment for all patients does not indicate advocacy. Beneficence involves caring for the patient irrespective of personal feelings regarding the patient.
While caring for different patients in a clinical setting, the nurse ensures that all patients receive the same treatment irrespective of their financial status or cultural practices. Which ethical principle is the nurse adhering to? Justice Veracity Advocacy Beneficence
