Chapter 22 Ethics and Values

Confidentiality

HIPAA mandates. Protection of patients' personal health information. Rights of patients.

Consequential-ism

a utilitarianism system of ethics proposes that the values of something is determined by its usefulness. emphasis is on the outcome or consequence of action.

Value

is a personal belief about the worth of a given idea, attitude, custom or object that sets standards that influence behavior.

Code of Ethics

is a set of guiding principles that all members of a profession accept. a collective statement about a group's expectations and standards of behaviors.

Ethics

is the study of conduct and character. Its concerned with determining what is good or valuable for individuals, groups and society at large

Feminist Ethics

looks to the nature of relationships to guild participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible.

2. Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the principle of ________?

nonmaleficence

Casuistry

or case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an "intimate understanding of particular situations"

Care at the End of Life

patients that suffer from a terminal illness meeting the end stages may see a transplant as a waste of a procedure when it may not increase quality of care.

Responsibility

refers to a willingness to respect one's professional obligations and to follow through. following an agency's policies and procedures.

Justice

refers to fairness.

Autonomy

refers to freedom from external control. Autonomy of patients or Autonomy vs. Self-doubt (toddlers). Informed consent. Respect for providers (their choice to reassignment when there is a conflict with cultural views)

Beneficence

refers to taking positive actions to help others. best interest of the patient.

Accountability

refers to the ability to answer for one's actions. professional actions are explainable to the patient and employer.

Fidelity

refers to the agreement to keep promises.

Nonmaleficence

refers to the avoidance of harm or hurt. this involves not only the will to do good but the equal commitment to do no harm for the patient.

Just Culture

refers to the promotion of open discussion without fear of recrimination whenever mistakes, especially those involving adverse events, occur or nearly occur.

Advocacy

refers to the support of a particular cause. Nurse advocates for health, safety, and rights of patients including their right to privacy and their right to refuse treatment.

Utilitarianism

relies on the application of a certain principle (good and greatest). measures the effect that an act will have.

Adherence to Autonomy

"rightness" such as when a parent refuses to vaccinate a child, but this could cause a breakout of disease.

4. When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle 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

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14. Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. 6. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

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7. The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (Select all that apply.) 1. Ethics of care pays attention to the environment in which caring occurs. 2. Ethics of care pays attention to the stories of the people involved in the ethical issue. 3. Ethics of care is used only in nursing practice. 4. Ethics of care focuses only on the code of ethics for nurses 5. Ethics of care focuses only on understanding relationships.

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12. 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 best describes the role of the nurse in the resolution of ethical dilemmas? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. 2. To study the literature on current research about the possible clinical interventions available for the patient in question. 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. 4. To allow the patient and the physician to resolve the dilemma on the basis of ethical principles without regard to personally held values or opinions.

1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial

15. Match the examples with the professional nursing code of ethics: a. Advocacy b. Responsibility c. Accountability d. Confidentiality 1. You see an open medical record on the computer and close it so no one else can read the record without proper access. 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication.

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3. 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

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13. It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (Select all that apply.) 1. Average income varies in different regions of the country. 2. Community values influence definitions of quality, and they are subject to change over time. 301 3. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5. Statistical analysis is difficult to apply when the outcome cannot be quantified. 6. Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

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11. What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order. 1. Clarify values. 2. Ask the question, Is this an ethical dilemma? 3. Verbalize the problem. 4. Gather information. 5. Identify course of action. 6. Evaluate the plan. 7. Negotiate a plan

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6. The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? 1. Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. 2. In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. 3. Even when agreement about a definition of usefulness exists in a community, laws prohibit an application of utilitarianism. 4. Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.

2. In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism

8. 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 a patient's self-worth. 2. Nurses have a scope of practice that encourages their presence during ethical discussions. 3. Nurses develop a relationship with 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.

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10. 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 principle, 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 obscured or deleted all patient identifiers? 1. Yes, because patient privacy would not be violated since 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 on the basis of other comments that you make online about his or her condition and your place of work 4. No, because the principle of justice requires you to allocate resources fairly

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

5. A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? 1. Seeking out the nursing supervisor to talk with the patient 2. Documenting patient fears in the medical record in a timely manner 3. Working to change the hospital environment 4. Assessing the patient's point of view and preparing to articulate it

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1. 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. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority. 1. Accountability: You as the nurse are accountable for the well-being of this patient. 2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver transplant. 3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant. 4. Justice: The greatest question in this situation is how to determine the just distribution of resources.

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9. Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1. List the actions that could be taken to resolve the dilemma. 2. Agree on a statement of the problem or dilemma that you are trying to resolve. 3. Agree on a plan to evaluate the action over time. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5. Take time to clarify values and distinguish between facts and opinions—your own and those of others involved. 6. Negotiate a plan.

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Moral Distress

Described the anguish experienced when a person feels unable to act according to closely held core values. Occurs when people feel misled or are not aware of their options and do not know when or how to speak up about their concerns.

Disabilities

Integrate those with disabilities into general society and best way to nurture approach and promote equal dignity.

Steps to Resolve Ethical Dilemma

Step 1: Ask the question, Is this an ethical dilemma? Step 2: Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information. Step 3: Clarify values. Distinguish among fact, opinion, and values. Step 4: Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Negotiation requires a confidence in one's own point of view and a deep respect for the opinions of others. Step 7: Evaluate the plan over time.

Ethics of Care

also strives to address issues beyond individual relationships by raising ethical concerns about the structures within which individual caring occurs-structures such as hospitals or universities.

Ethical Dilemma

cause distress and controversy. process ethical issues carefully and deliberately.

Quality of Life

deeply personal. the value and benefits of a medical intervention that effects the persons independence

Deontology

defines actions as a right or wrong on the basis of their "right-making characteristics" such as fidelity to promises, truthfulness and justice.

Teleology

from the greek word meaning "end" or the study of ends or final causes. The greatest good for the greatest amount of people.

The cared-for

to identify the patient.

The one-caring

to identify the person providing care