Chap. 4: Evidence-Based Practice & Ethics
A public health nurse is faced with an ethical dilemma. Which question should the nurse consider first when deciding how to resolve the dilemma? A) "What exactly is the ethical dilemma?" B) "What are the alternative courses of action?" C) "What are the consequences of each alternative courses of action?" D) "How should this dilemma be solved?"
A) "What exactly is the ethical dilemma?" Feedback: A framework is applied in public health ethics inquiry. Three core functions of this inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of alternative courses of action and their consequences, and (3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values.
Application of nursing research results to community health nursing practice is essential. Which of the following must occur first before results can be applied? A) Be informed about research findings B) Demonstrate skill in examining research reports C) Assess abstracts of relevant research studies D) Check if the study was funded by a drug company
A) Be informed about research findings Feedback: Community health nurses have many opportunities to apply the results of other investigator's research, but a necessary prerequisite is that the nurse must be informed about research findings. Critically examining research reports and assessing abstracts are all part of evaluating relevant research studies. However, the nurse needs to know what the research findings are before he or she can evaluate the research. Checking if the study was funded by a drug company might indicate that the results of the study could be questioned due to a conflict of interest.
A community health nurse is working to support programs to encourage preschool immunizations. The nurse is integrating which ethical principle in his or her practice? A) Beneficence B) Autonomy C) Nonmaleficence D) Justice
A) Beneficence Feedback: Beneficence means doing good or benefitting others, such as supporting programs to encourage preschool immunizations. Autonomy means freedom of choice and exercise of people's rights, such as promoting individuals' and groups' rights to and involvement in decision making. Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side effects. Justice refers to treating people fairly, such as ensuring equal access to health care.
Which of the following statements about the impact of research on community health nursing are true? Select all that apply. A) It is important to conduct research to affect public policy. B) Public policy will continue to have a negative effect on the community's health. C) Research will affect the effectiveness of community health nursing practice. D) Research will affect the status and influence of nursing as a profession. E) The impact that research has on community health nursing is negligible.
A) It is important to conduct research to affect public policy. C) Research will affect the effectiveness of community health nursing practice. D) Research will affect the status and influence of nursing as a profession. Feedback: Research has the potential to have a significant impact on community health nursing in three ways: by affecting public policy and the community's health, the effectiveness of community health nursing practice, and the status and influence of nursing as a profession. Community health nurses have been involved in research addressing all three of these dimensions.
A group of students are reviewing for an examination on values. Identification of which of the following as an instrumental value indicates the need for continued study? A) Spiritual salvation B) Confidentiality C) Honesty D) Promise keeping
A) Spiritual salvation Feedback: Spiritual salvation is an example of a terminal value, which refers to end states of existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise keeping, and honesty.
Which of the following research studies would most likely use a quantitative research approach? A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized B) The experience of parents whose children have had serious complications subsequent to immunization C) The experience of parents whose children were not properly immunized and developed a vaccine-preventable illness D) Reasons that parents who practice a particular religion do not have their children properly immunized
A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized Feedback: Quantitative research is helpful in identifying a problem or a relationship between two or more variables, such as type of treatment. A more subjective or qualitative approach is needed to study those areas that need a broader focus or that do not lend themselves to objective measurement. Qualitative research emphasizing subjectivity asks "how" or "why."
Situations in which self-determination should be restricted include which of the following? Select all that apply. A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals C) When it interferes with self-interest D) Self-determination and personal autonomy must never be restricted. E) When self-determination deteriorates into self-interest and poses a major roadblock to equitable care
A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals Feedback: There are two situations in which self-determination should be restricted: when some objectives of individuals are contrary to the public interest or the interests of others in society (e.g., endangering others with a communicable disease) and when a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care.
A nursing instructor is preparing a teaching plan for a class comparing evidence-based practice and critical thinking. Which of the following would the instructor include? A) Evidence-based practice and critical thinking are polar opposites. B) Both involve problem clarification of central concepts. C) Interpretation of accumulated evidence is unique to evidence-based practice. D) Problem exploration is unique to evidence-based practice.
B) Both involve problem clarification of central concepts. Feedback: Evidence-based practice and critical thinking share commonalities including exploring a problem, addressing a purpose or goal, making assumptions, clarifying the problem around central concepts or indicators, accessing data, interpreting accumulated evidence, using reasoning, processing, defining, planning and documenting, acting on the problem, and evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical thinking is an important component of evidence-based practice.
A community health nurse working with a group of families who come to local community health care center tells them that she is going to be setting up child care so that the families can participate in the various classes being offered by the center. Three months have passed, and the nurse still has not instituted the child care program. The nurse has violated which ethical principle? A) Veracity B) Fidelity C) Justice D) Respect
B) Fidelity Feedback: Fidelity means keeping promises or commitments to foster trust and trustworthiness. By failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow through on what they have said earn their clients' respect and trust. In contrast, when a commitment is not kept, community members may lose faith and interest in participation. Veracity refers to telling the truth, giving clients accurate information in a timely manner. Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by ensuring equal access to health care and not limiting the amount or quality of services due to income level. Respect involves acknowledging clients as valued participants in shaping their own and the community's health outcomes.
Which one of the following statements about cultivating a spirit of inquiry is most accurate? A) It is not very important; research will be performed anyway. B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged. C) It involves "asking the burning clinical question." D) The agency does not have an important role in cultivating a spirit of inquiry.
B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged. Feedback: In order for effective change to occur, current practices must be continually examined, questioned, and challenged. It is very important that the spirit of inquiry is cultivated. "Asking the burning clinical question" is part of the next step of asking the question. The agency does have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a culture that supports it.
After teaching a class on values, which of the following, if stated by the class, indicates the need for additional teaching? A) Some values are descriptive, while others are evaluative. B) Keeping a promise is an example of a terminal value. C) Values persist, remaining relatively stable over time. D) Certain values have more importance than others.
B) Keeping a promise is an example of a terminal value. Feedback: Terminal values refer to end states of existence such as spiritual salvation, peace of mind, or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping promises, and honesty. Some values are descriptive or capable of being true or false, while other values are evaluative, involving judgments of good and bad. Values remain relatively stable over time and persist to provide continuity to personal and social existence. A hierarchical system of values occurs in which certain values have more weight or importance than others.
According to the Institute of Medicine's landmark report, The Future of Nursing, nurses should: Select all that apply. A) work independently from other health professionals to promote the profession of nursing. B) work collaboratively with other health professionals to promote health care. C) attempt to redesign health care. D) improve practices through evidence-based means. E) The Future of Nursing report does not express the importance of evidence-based nursing.
B) work collaboratively with other health professionals to promote health care. C) attempt to redesign health care. D) improve practices through evidence-based means. Feedback: The Future of Nursing highlights the need for nursing to work with other health professionals in "redesigning health care" by "conducting research" and improving practices through evidence-based means.
When working with clients, a community health nurse promotes the clients' self-concept and health promoting behaviors. The nurse is attempting to achieve which outcome? A) A value system B) Prescriptive-proscriptive beliefs C) Individual autonomy D) Values clarification
C) Individual autonomy Feedback: Promoting clients' self-concept and health-promoting behaviors are associated with the value of self-determination that promotes individual autonomy. Value system, prescriptive-proscriptive beliefs, and values clarification are not associated with self-determination. A value system is an organized set of beliefs that guide individual behavior. Prescriptive-proscriptive beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps identify the personal and professional values that guide actions.
After teaching a class on ethical principles, the instructor determines that the class needs additional instruction when they identify which of the following as an ethical principle? A) Respect B) Autonomy C) Morality D) Justice
C) Morality Feedback: Morality is the behavior or judgment that conforms to a standard that is right and good. When judgments involve moral values, conflicts are inevitable. There are seven fundamental ethical principles that guide decision making. These include respect, autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.
After a class discussion on moral evaluations, which characteristic if identified by the class would lead the instructor to determine that the discussion has been effective? A) There is specificity that applies to an individual person. B) A special place is given to a person's own welfare. C) Other values cannot override the moral evaluation. D) They relate to a matter of individual taste.
C) Other values cannot override the moral evaluation. Feedback: Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a preemptive quality, meaning that other values or human ends cannot, as a rule, override them; they possess universality or reflect a standpoint that applies to everyone, such that everyone in principle ought to be able to make and understand, even if some individuals, in fact, do not; moral evaluations avoid giving a special place to a person's own welfare, having a focus that keeps others in view, or at least considers one's own welfare on a par with that of others. Moral evaluations are prescriptive-proscriptive beliefs that have certain characteristics separating them from other evaluations including matters of taste.
Which of the following statements about evidence-based practice has been identified by multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003)? A) We must continue to cling to "the way we've always done it." B) We have spent billions of dollars each year researching new treatments and have translated that knowledge into clinical practice. C) We are not translating the knowledge that we are gaining into clinical practice. D) We have continued to spend more than a trillion dollars a year providing care and do translate that capacity into improved clinical practice.
C) We are not translating the knowledge that we are gaining into clinical practice. Feedback: To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend billions of dollars each year researching new treatments, and more than a trillion dollars are spent annually on health care, but "we repeatedly fail to translate that knowledge and capacity into clinical practice."
A community health nurse discovers that a bill in the legislature would eliminate a state law that currently funds child health promotion services for low-income children. Which action at the primary level of prevention would be most appropriate? A) Advocate for amendment to the passed law to allow some funding for children to remain B) Once the bill has been passed, seek private resources to support funding of health promotion services for low-income children. C) Gather a group of health professionals to volunteer to provide the health promotion services eliminated by the passed bill D) Advocate through active lobbying against the bill and gather community support
D) Advocate through active lobbying against the bill and gather community support Feedback: Appropriate activities at the primary level of prevention would include actively lobbying against the bill, garnering community support in favor of the revised bill, and advocating for the clients. Advocating for amendments would be appropriate at the secondary level. Seeking private resources and gathering volunteers to provide the health services would be appropriate at the tertiary level.
A nurse is planning a research study to answer a clinical question. Which of the following would be most appropriate for qualitative research approach? A) Evaluating the reported cases of post vaccination complications after varicella immunization B) Determining the use of complementary and alternative health care by middle-aged adults in rural areas C) Ascertaining the effect of using calming music on older adults with dementia in extended care facilities D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness
D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness Feedback: Qualitative research is used to study those areas that need a broader focus or that do not lend themselves to objective measurement. This type of research emphasizes subjectivity and the meaning of the experiences to individuals. Thus, qualitative research would be most appropriate for assessing the emotional responses and feelings of individuals who require isolation for a communicable illness. Quantitative research would be used to evaluate the reported cases of post vaccination complications, to determine the use of complementary and alternative health care, and to ascertain the effect of calming music.
Which of the following would the community health nurse do first when making an ethical decision? A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's values
D) Clarify one's values Feedback: Clarification of a person's values is the first step in the process of ethical decision making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is the first step in the process of valuing. Identifying isolated values are those which are organized into a hierarchical system where certain values have more weight or importance than others.
Which of the following statements about basic values that guide decision making in community health nursing is true? A) Client empowerment means that the provider must use a paternalistic approach to health care. B) Self-interest does not interfere with self-determination. C) When matters of well-being are considered, the client's preferences and needs should not be considered. D) Equity is not possible in times of limited resources.
D) Equity is not possible in times of limited resources. Feedback: In times of limited technical, human, and financial resources, however, it may be impossible to fully respect the value of equity. Client empowerment is an approach that differs from the paternalistic approach to health care in which decisions are made for, rather than with, the client; instead, it enables patients and professionals to work in partnerships. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care. Well-intended interventions sometimes fall short if they are in conflict with clients' preferences and needs.
A community health nurse obtains a client's informed consent for care demonstrating the understanding that this is derived from which value? A) Self-interest B) Well-being C) Equity D) Self-determination
D) Self-determination Feedback: Informed consent derives from self-determination. Self-interest refers to a deterioration of self-determination in which the person focuses on fulfilling one's own desires without regard for the greater good. Well-being is a state of positive health, the intent of all therapeutic interventions. Equity refers to justice or fair and equal treatment.
Which of the following statements about the steps of the EBP process is most accurate? A) One of the last steps of the EPB process is to search for and collect the most relevant best evidence. B) One of the earliest steps in the EBP process is to disseminate the outcomes of the EBP decision or change. C) It is optional to integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. D) The first step in the EBP process is to cultivate a spirit of inquiry.
D) The first step in the EBP process is to cultivate a spirit of inquiry. Feedback: The steps of the EBP process in order are cultivating a spirit of inquiry; asking the burning question in PICOT format; searching for and collecting the most relevant best evidence; critically appraising the evidence for its validity, reliability, and applicability and then synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluating outcomes of the practice decision or change based on evidence; and disseminating the outcomes of the EBP decision or change.
A community health nurse is applying the value of equity in decision making with clients. Which of the following best describes this value? A) Forming, revising, and pursuing personal life plans B) Promoting clients' health and a sense of well-being C) Fulfilling one's desires over those of others D) Treating similar cases in the same fair fashion
D) Treating similar cases in the same fair fashion Feedback: Equity is defined as the value directing like cases to be treated alike and that all individuals be treated fairly. Self-determination refers to a person's exercise of the capacity to shape and pursue personal plans for life. Well-being involves promoting clients' health and sense of well-being. Self-interest is the fulfillment of one's own desires without regard for the greater good.
