Chapter 22 Notes

Research suggests that education about safe sex practices reduces the spread of human immunodeficiency virus (HIV). Reducing incidence of HIV is good for a great number of people.

Utilitarianism

A personal belief about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. In some cultures decisions about health care flow from group or family-based discussion rather than independent decisions by one person.

Value

Key steps in the resolution of an ethical dilemma

step 1 ask the questions, is this an ethical dilemma? step 2 gather information relevant to the case step 3 clarify values step 5 verbalize the problem step 6 negotiate a plan step 7 evaluate the plan over time

When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

1 Fidelity

Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following? 1 The value of something is determined by its usefulness to society. 2 People's values are determined by religious leaders. 3 The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. 4 The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider.

1 The value of something is determined by its usefulness to society.

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations 2 To await new clinical orders from the physician 3 To limit discussions about ethical principals 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations

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? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 Beneficence

A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.) 1 Quality of life is measured by potential income, and average income varies in different regions of the country. 2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? 1 Consult a professional ethicist to ensure that the steps of the process occur in full. 2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 3 Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. 4 List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.

2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.

When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? 1 Yes because ethics is essentially a democratic process, with all participants sharing an equal voice 2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do 3 Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care 4 No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department

2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do

Which of the following explain how health care reform is an ethical issue? (Select all that apply.) 1 Access to care is an issue of beneficence, a fundamental principal in health care ethics. 2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? 1 Patients 2 Relationships 3 Ethical principles 4 Code of ethics for nurses

2 Relationships

Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.

The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work 4 No because the principal of justice requires you to allocate resources fairly

3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work

The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy to guide respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers.

What is the best example of the nurse practicing patient advocacy? 1 Seek out the nursing supervisor in conflicting procedural situations 2 Document all clinical changes in the medical record in a timely manner 3 Work to understand the law as it applies to an error in following standards of care 4 Assess the patient's point of view and prepare to articulate it

4 Assess the patient's point of view and prepare to articulate it

The patient for whom you are caring 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. What principles would be a priority in a discussion about ethics? 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant 4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

Refers to the support of a particular cause "nurses ability to help speak up for the patient"

Advocacy

When a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient's _________.

Autonomy

If a nurse decides to withhold a medication because it might further lower a patient's blood pressure, the nurse will be practicing the principle of A. Responsibility B. Accountability C. Competency D. Moral behavior

B. Accountability

Nurses practice primarily as a service to others, even in the details of daily work

Beneficence

Refers to the agreement to keep promises. Refers to the unwillingness to abandon patients even when care becomes controversial or complex.

Fidelity

A nurse is working with a terminally ill adult patient. The nurse decides totell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of the processing an ethical dilemma is A. Articulation of the problem B. Evaluation of the action C. Negotiation of the outcome D. Determination of values surrounding the problem

C. Negotiation of the outcome

A set of guiding principles that all members of a profession accept

Code of Ethics

HIPAA or Health Insurance Portability and Accountability Act of 1996 is an example of what?

Confidentiality

Main emphasis is on the outcome or consequence of action

Consequentialism

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of A. Autonomy B. Fidelity C. Justice D. Nonmaleficence

D. Nonmaleficence

If you try to make a decision about the ethics of a controversial medical procedure, ________ guides you to focus on how the procedure ensures fidelity to the patient, truthfulness, justice, and beneficence.

Deontology

Acts that are ethical reflect a commitment to standards beyond personal preferences (i.e., standards that individuals, professions, and societies strive to meet). However, when decisions must be made about health care, differing values and opinions among individuals can result in disagreement about the right thing to do.

Ethics

Attention to relationships as distinguished from other more principle based philosophies

Ethics of Care

discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of _________.

Justice

Describes the anguish experienced when a person feels unable to act according to closely held core values

Moral Distress

A bone marrow transplant procedure may offer a chance at cure; but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and full of uncertainty, precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit.

Nonmaleficence

The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Teleology

Refers to the ability to answer to ones actions

accountability

Describe culturally competent care

acknowledge of and respect for cultural differences a willingness to negotiate and compromise when world views differ being aware of ones own values and bias using communication skills to enhance sympathy knowing cultural practices of patients groups regularly seen understanding that all patients are individuals and they may not share the same views as others within their own ethic group

Describe ethical dilemma

existing when the right thing to do is not clear. Resolution requires the negotiation of differeing values among involving in the dilemma They can cause distress and controversy for both patients and caregivers

What is the purpose of an ethic committee in health care institutions?

used to process ethical dilemmas used for education, policy recommendation, and case consultation