Ch 6 - Values, Ethics, and Advocacy
A client aged 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. The nurse communicates the client's wish to the family and health care team. This is an example of what ethical principle? A. Autonomy B. Nonmaleficence C. Veracity D. Justice
A. Autonomy Autonomy is the ethical principle of respecting the right of clients to make their own decisions about their health care. Nonmaleficence refers to preventing or not causing harm to clients. Veracity refers to telling the truth. Justice refers to fairness and treating clients with equal dignity.
In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value? A. Integrity B. Human dignity C. Altruism D. Social justice
A. Integrity The nurse is demonstrating integrity, which is defined as acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity. Altruism is a concern for the welfare and being of others. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations.
Which statement by the nurse is an example of deception? A. "I am going to teach you how to give yourself insulin." B. "This injection of procaine will feel like a little pinch." C. "It is important to get out of bed to prevent pneumonia." D. "I will administer your pain medication as soon as it is due."
B. "This injection of procaine will feel like a little pinch." Telling a client that an injection of procaine will feel like a little pinch is not being truthful, and is defined as a deception. Telling a client that pain medicine will be administered when it is time is being truthful. Telling a client to get out of bed also supports a nursing intervention. Teaching a client how to give an injection is important for the client to take care of himself or herself.
Which nursing situation is an example of an ethical dilemma? A. Discussing care of a comatose client with the family B. Deciding whether to perform cardiac compressions against a client's wishes C. Administering pain medication as ordered D. Transferring a client to a step-down unit
B. Deciding whether to perform cardiac compressions against a client's wishes An ethical dilemma occurs when it is difficult for a decision to be made due to competing ethical principles. If there is no signed do not resuscitate order, then legally cardiac compressions must be started; however, if this is against the client's wishes, the nurse must weigh the ethical principles of beneficence and complying with the law against the ethical principle of autonomy. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope of nursing practice.
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle? A. Confidentiality B. Conflict C. Paternalism D. Deception
C. Paternalism Making a decision for a client who is confused to prevent an injury is an example of paternalism. Deception occurs when the true nature or reason is concealed and the client is deprived of basic human rights. Confidentiality requires a health care provider to keep a client's personal health information private unless consent to release the information is provided by the client. Conflict is a disagreement or argument and does not represent the example in this question.
Which action most clearly demonstrates a nurse's commitment to social justice? A. Ensuring that a hospital client's diet is culturally acceptable B. Answering a client's questions about care clearly and accurately C. Documenting client care in a timely, honest, and thorough manner D. Lobbying for an expansion of healthcare resources and benefits to those in poverty
D. Lobbying for an expansion of healthcare resources and benefits to those in poverty Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare. Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting care accurately are expressions of the value of integrity.
A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision? A. Justice B. Autonomy C. Beneficence D. Confidentiality
B. Autonomy Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike.
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have: A. moral agency. B. legal obligations. C. personal values. D. ethics.
C. personal values. The only information given here tells us that this nurse has personal values on a particular issues. Personal values are ideas or beliefs a person considers important and feels strongly about. Moral agency is the ability to do the ethically right thing because one knows it is the right thing to do. Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. Legal obligations are behaviors and actions required by law.
To practice ethically, the nurse should avoid: A. reviewing past cases before making decisions about practice. B. allowing an ethics committee to guide the nurse's practice. C. asking the client's family about their views on caring. D. allowing the nurse's own personal judgment to guide practice.
D. allowing the nurse's own personal judgment to guide practice. Personal convictions apply only to situations and decisions pertaining to the individual. In ethical professional practice, nurses should avoid allowing personal judgments to bias their treatment of clients. It is appropriate for nurses to allow an ethics committee, past cases, and the views of clients and their families to guide nursing practice.
Which statement regarding the Code of Ethics for Nurses is most accurate? A. "The code is an expression of nursing's own understanding of its commitment to society." B. "The code enables nurses to provide good care to clients." C. "The code provides nurses with specific guidelines for practice." D. "The code critiques existing patterns of oppression and domination in society."
A. "The code is an expression of nursing's own understanding of its commitment to society." The Code of Ethics for Nurses provides nurses with a nonnegotiable statement of the ethical obligations of individuals who enter the nursing profession. It serves as an expression of nursing's own understanding of its commitment to society. The feminist ethics approach critiques patterns of oppression and domination in society. Clinical virtues enable nurses to provide good care to clients. The principle-based approach to ethics provides nurses with specific action guidelines for practice.
A nurse cultivates dispositions that enable practicing nursing in a manner in which he or she believes in. This nurse is displaying what essential element of ethical agency? A. Ethical character B. Ethical sensibility C. Ethical valuing D. Ethical responsiveness
A. Ethical character Ethical character is the development or cultivation of virtues such as humility, courage, and integrity to name just a few. The development or cultivation of these virtues allows the nurse to practice in a manner in which the nurse believes in.
Which ethical principle is related to the idea of self-determination? A. Beneficence B. Autonomy C. Nonmaleficence D. Confidentiality
B. Autonomy Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make healthcare decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm.
The nurse has identified an ethical dilemma that has the potential to interfere with a client receiving optimal care. The nurse discussed this issue with the charge nurse on the unit. What action should the nurse choose next? A. Monitor for resolution of the problem. B. Inform the family that the ethical issue has been reported. C. Report the issue to the hospital medical director. D. Depend on the charge nurse to handle the issue from this point.
A. Monitor for resolution of the problem. Simply reporting the issue does not complete the nurse's obligation in this situation. The nurse should monitor for resolution of the issue, at least to the point where it no longer interferes with client care. The nurse has already reported the issue up the chain-of-command, so further reporting is not necessary at this time. There is no particular reason to inform the family.
A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "This happens to many women." Which type of ethical approach is the nurse exhibiting? A. Values clarification B. Feminist C. Moralizing D. Paternalism
B. Feminist A feminist approach is one in which the focus is on specific problems and concerns faced by women. The statement that "this happens to many women" is an example of a feminist approach. Paternalism is action limiting a person's or group's liberty or autonomy that is intended to promote their own good (e.g., if the nurse stated that "I must make all decisions about this client's care for her, as she's not in any shape to do so herself"). Values clarification is a self-assessment process that enables a person to discover the content and strength of the person's own system of values. An example of this would be if the nurse stated, "I feel bad for the client, as no one deserves this." Moralizing is to comment on issues of right and wrong, typically with an unfounded air of superiority. An example of this would be if the nurse stated, "If she was a good girl, this would have never happened to her."
A nursing student states he is able to put himself in his client's shoes. He states he understands the situation of the ill client. This is considered to be an act of: A. assurance. B. sympathy. C. disclosure. D. empathy.
D. empathy. The experience of empathy is an immediate projection of self to the situation of others, causing strong emotional reactions and motivation, and either appropriate caring behavior and/or related reflection.
A hospital owned by a Catholic order of nuns will not allow tubal ligations to be performed. This is considered to be: A. legal obligation. B. personal values. C. personal morality. D. institutional policy.
D. institutional policy. Institutional policies are guidelines developed by health care institutions to direct professional practice. In this scenario, it may also likely reflect the personal morality and values of the institution's personnel as it is run by a religious group. It does not reflect a legal obligation.
While delivering patient care, the home healthcare nurse has the ability to see the whole picture and how various parts are related to the client's diagnosis and problems in the home environment. What skills does the nurse possess that allow her to see the connection of various parts of the situation? A. System skills B. Instrumental skills C. Interpersonal skills D. Imaginal skills
A. System skills Systems skills are those that help a person see the whole picture and how various parts relate.
What is the term for the beliefs held by the individual about what matters? A. Values B. Ethics C. Morals D. Bioethics
A. Values Values are ideals and beliefs held by an individual or group about what matters; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death, as well as questions and concerns regarding quality of life as it relates to advanced technology.
The unit where a nurse works is undergoing structural changes along with changes in client load and managerial style. The nurse feels disorganized and stressed and is having difficulty sleeping. The nurse wonders if these feelings are related to the changes at work. What next step should the nurse choose in the 4A plan to address this issue? A. Acting to make a change B. Analyzing the risks and benefits of acting to reduce the distress C. Determining the severity of the distress D. Committing to self-care
D. Committing to self-care In this scenario the nurse is Asking if the distress being felt is from changes at work. The next step is to Affirm that distress exists and commit to take care of self. The nurse affirms distress by validating feelings and perceptions with others. The third step is to Assess which includes determining the severity of the distress and analyzing the risks and benefits of acting on the distress. The fourth step is to Act which is implementing strategies to initiate changes to reduce distress.
A nurse knows that the expression "Do not cause harm" refers to which ethical principle? A. Beneficence B. Fidelity C. Justice D. Nonmaleficence
D. Nonmaleficence Nonmaleficence is conducting procedures and interventions in a safe manner so that no harm is caused to the client. Justice is the idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Fidelity is demonstrated by continuing loyalty and support to a client. Beneficence requires that the procedure be provided with the intent of doing good for the client involved.
A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type? A. Shared B. Patient sovereignty C. Clinical D. Paternalistic
A. Shared There are three basic models of healthcare decision making. In the paternalistic model, clinicians decide what ought to be done to benefit the client, inform the client, and the client's role is to comply. In the client sovereignty model, clients or their surrogates, expressing their right to be autonomous, tell the clinician what they want, and the clinician's role is to comply. Most ethicists reject these models in their extremes and recommend a model of shared decision making, which respects and uses the preferences of the client and the expertise/judgment of the clinician. Clinical decision making is the process that results from the use of a healthcare decision-making model.
Which example best describes feminist ethics? A. The formal study of ethical issues that arise in the practice of nursing B. An approach critiquing existing patterns of oppression and domination in society C. A combination of elements of utilitarian and deontologic theories that offer specific action guidelines for practice D. Attention directed to the specific situation of individual clients viewed within the context of their life narratives
B. An approach critiquing existing patterns of oppression and domination in society Feminist ethics offer an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guidelines for practice. The care-based approach directs attention to the specific situation of individual clients viewed within the context of their life narratives. The formal study of ethical issues that arise in the practice of nursing describes nursing ethics.
A client who experienced a cesarean birth rates pain as a 9 on a 10-point scale. The nurse medicates the client for pain. This is an example of the nurse practicing which ethical principle? A. Fidelity B. Beneficence C. Nonmaleficence D. Justice
B. Beneficence Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good. Justice refers to treating clients fairly and impartially. Fidelity refers to keeping one's promises and acting faithfully. Nonmaleficence refers to preventing or not causing harm to the client.
Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing? A. Deontology B. Care-based ethics C. Principle-based ethics D. Utilitarianism
B. Care-based ethics Central to the care-based approach to ethics is the nurse's relationships with clients and the nurse's "being," or character and identity. Deontology is the study of the nature of duty and obligation. Utilitarianism is the doctrine that actions are right if they are useful or for the benefit of a majority. Principle-based ethics prioritizes goals and principles that exist beyond the particularities of the nurse-client relationship.
A charge nurse has implemented staff education on nursing values. The nurse would determine that further education is required when which statement(s) are overheard? Select all that apply. A. "I can't believe the client is giving that precious baby up for adoption." B. "If you are going to have extramarital sex, please protect yourself by using a condom." C. "Smoking has been shown to be a risk for many illnesses, including heart disease and cancer." D. "If that was my mother, I sure wouldn't agree to a no-code." E. "The gonorrhea test was positive. That's what the client gets for sleeping around."
A, D, E Being judgmental, as in the options about adoption, gonorrhea, and code-status, does not reflect the values desired in a nurse. Professional nurses do not assume that their personal values are more correct than those of their clients. Nurses are obligated, however, to provide health information such as recommending condom use and smoking cessation.
A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle? A. Fidelity B. Justice C. Autonomy D. Nonmaleficence
A. Fidelity Fidelity involves keeping promises and being faithful to the promises made. In this case, the nurse tells the client that she will return in 10 minutes and then follows through with the promise. Nonmaleficence involves doing no harm and avoiding actions that deliberately harm a person. Autonomy refers to the right to make one's own decisions. Justice involves treating each person fairly and without judgment.
The nurse is reviewing charges to clients for surgical procedures and observes different charges dependent upon insurance status. The nurse immediately reports this bias in charges to the supervisor for action. What principle of bioethics is the nurse demonstrating? A. Fidelity B. Justice C. Nonmaleficence D. Beneficence
B. Justice The nurse is seeking to distribute the benefits, risks, and costs of nursing care justly. When recognizing and addressing subtle instances of bias and discrimination, the bioethical principle of justice is being practiced. The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. Beneficence is committing oneself to actively promoting the client's health or well-being. Fidelity is being faithful to the promise that is made to be competent.
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy? A. Changing the channel on the television while providing care B. Limiting visitors due to the client reporting pain C. Turning and positioning the client every 4 hours D. Administering pain medication when the pain level reaches 9 on a pain scale of 0 to 10
B. Limiting visitors due to the client reporting pain Advocating for clients is a nursing responsibility and is performed with the best interest and welfare of the client in providing safe, competent, and comforting care. Limiting visitors is an example of advocacy. The nurse recognizes that the client is in pain; therefore, limiting the visitors allows for the nurse to advocate for additional measures to allow the client to rest and recover. Administering pain medication and turning and the client every 4 hours are important and necessary interventions for a postoperative client, but this is not advocacy. Changing the channel on the television while providing care also does not promote advocacy.
A client is brought to the emergency department by an adult child, who states, "I am unable to care for my parent anymore. Although I would like to, financially and physically I cannot do it anymore." What ethical problem is the adult child experiencing? A. ethical dilemma B. moral distress C. dissatisfaction D. ethical uncertainty
B. moral distress Moral distress is when someone wants to do the right thing but is not able. The adult child brings the parent to the emergency department to maintain the parent's safety, although the child needs to take care of the parent. Dilemma is a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones. The client is not experiencing a dilemma. Uncertainty means a feeling of not knowing what will happen. The adult child is certain that he or she cannot care for the parent. Dissatisfaction implies a sense of dislike for, or unhappiness in, one's surroundings. Although the adult child is unhappy, this is not the primary ethical problem.
Which nursing situations are examples of the care-based approach to ethics? Select all that apply. A. Documenting data in the electronic medical record B. Taking a week's vacation from work C. Holding the hand of a dying client D. Involving the parent in the bed bath of a child E. Providing a back rub to a client on bed rest
C, D, E Nursing interventions related to care and the client demonstrate a care-based approach. Holding the hand of a dying client, providing a back rub, and involving the parents are all examples of a care-based approach. Documenting care provided in the electronic health record is not care-based but part of everyday responsibilities of the nurse. Taking a week of vacation is a personal intervention and not related to the care of a client.
A nurse's friend states, "I admire you so much. I would love to be a nurse, but I don't think I have the courage." Which response will the nurse make? A. "It is more important to be smart than it is to be courageous." B. "I'm not courageous at all." C. "You can work on being more courageous as you learn to be a nurse." D. "You don't have to be courageous to be a nurse."
C. "You can work on being more courageous as you learn to be a nurse." Courage is a virtue of nurses that can be learned or strengthened with work. Courage is a quality nurses should possess. Courage is not less important than being intelligent, compassionate, or humble.
A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee? A. Present options about the type of care. B. Decide the care for a client who is unable to voice an opinion. C. Assist in decision making based on the client's best interests. D. Convince the family to choose a specific course of action.
C. Assist in decision making based on the client's best interests. One reason an ethics committee convenes is when a client is unable to make an end-of-life decision and the family cannot come to a consensus. In this case, the committee members are there to advocate for the best interest of the client and to promote shared decision making between the client (or surrogates, if the client is legally incapacitated) and the clinicians. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.
Which example most accurately depicts the ethical principle of autonomy? A. Transporting a client to a scheduled physical therapy appointment B. Changing a dressing on a wound as needed C. Describing a surgery to a client before the consent is signed D. Administering a morning dose of insulin before breakfast
C. Describing a surgery to a client before the consent is signed Autonomy is the capacity to make an informed, uncoerced decision. Describing a surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision and thus an autonomous one. The nurse changing a dressing on a wound does not require the client to make an informed decision, nor does administering a morning dose of insulin or transporting a client.
Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when reflecting on the decision-making process and the role it will play in making future decisions? A. Diagnosing B. Planning C. Evaluating D. Implementing
C. Evaluating Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance.
A nurse believes that abortion is an acceptable option if a pregnancy results from a situation of rape. What is the best description of this belief? A. Professional value B. Ethical principle C. Personal moral D. Legal obligation
C. Personal moral A personal moral is a standard of right and wrong that helps a person determine the correct or permissible action in a given situation. Professional values in nursing are a set of beliefs about the worth of things, about what matters, that provide the foundation for nursing practice and guide the nurse's interactions with clients, colleagues, and the public. Ethical principles are a set of specific concepts that guide a person's actions. A legal obligation is something that is required by law.
Which is a characteristic of the care-based approach to bioethics? A. The rightness or wrongness of an action independent of its consequences B. The need to emphasize the relevance of clinical experience C. The promotion of the dignity and respect of clients as people D. The need for an orientation toward service
C. The promotion of the dignity and respect of clients as people The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of clients as people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of the criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.
An illegal immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice? A. Filing the paperwork for the client to receive retroactive health insurance B. Avoiding treating the client so as to not do any additional harm C. Telling the client honest information about the client's medical condition and prognosis D. Airlifting the client to a local trauma center for emergency surgery
D. Airlifting the client to a local trauma center for emergency surgery The ethical principle of justice mandates that clients be treated impartially without discrimination according to age, gender, race, religion, socioeconomic status, weight, marital status, or sexual orientation. An immediate airlift to the local trauma center demonstrates that this client is being treated impartially. Avoiding causing the client additional harm would demonstrate nonmaleficence. Attempting to help the client obtain health insurance would demonstrate beneficence and advocacy. Telling the client the truth about the client's medical condition and prognosis would demonstrate integrity and honesty (veracity).
A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying? A. Modeling B. Moralizing C. Responsible choice D. Laissez-faire
D. Laissez-faire This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values independently and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn that which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.
A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent? A. Ethical decision making B. Client sovereignty model C. Paternalistic model D. Shared decision making
D. Shared decision making Shared decision making is recommended by most ethicists and involves considering both the client's preferences and the nurse's expertise to make the best decision. The paternalistic model involves the clinician making the decisions. The client sovereignty model involves the client making all the decisions without input from the clinician. Ethical decision making is that based on a personal or organizational code of ethics.
A client continues to complain of pain despite receiving medication. The family states, "In our culture it is acceptable to complain out loud." What would be the best response by the nurse? A. Describe your home situation to me. B. It is fine to complain out loud. C. The pain medication should have worked by now. D. Tell me more about your cultural beliefs.
D. Tell me more about your cultural beliefs. It is important for the nurse to learn about how culture affects the client's behavior. Asking the client to explain the client's cultural beliefs will help the nurse to use a care-based approach. Stating that the medication should have worked or stating that it is fine to complain out loud are not examples of a care-based approach. Also, describing the home situation would not be helpful in this instance.
