Chapter 6 and 7: Ethics and Legal issues

Elements of liability

*-Duty:* Obligation to use due care; Accurate assessment of patients, alert responsible health care professionals to changes in patient, competent execution of safety measures *-Breach of Duty:* Failure to meet the standard of care; failure to note and report than older adult patient assessed as alert on admission is exhibiting periods of confusion, Failure to execute and document use of appropriate safety measures like side rails up and restraints *-Causation:* Most difficult to prove, show failure to meet standard of care actually caused the injury; Failure to use appropriate safety measures and cause patient fall while attempt to get out of bed resulting in fractured hip *-Damages:* Actual harm or injury resulting to the patient; Fractured left hip, pain and suffering, lengthened hospital stay, need for rehab

Torts

*-Intentional* >Act done on purpose or with intent >No harm need be caused Ex: Assault, battery, false imprisonment, invasion of privacy *-Unintentional* >Do not require intent >Require element of harm Ex: Negligence, malpractice, defamation; Communication that's false, Slander; defamation by spoken word, Libel; defamation by print, writing, or pictures

Standards of Care

*-Internal standards:* >Job description >Education >Expertise >Institutional policies and procedures *-External Standards* >Nurse practice acts >Professional organizations >Nursing specialty-practice organizations >Federal organizations and federal guidelines

A client admitted with Hodgkin lymphoma has a handwritten prescription for vinblastine 3.7 mg intravenously (IV) weekly. The nurse interprets the prescription as vincristine 3.7 mg and administers the wrong medication. The client becomes neurovascularly compromised and has a fatal reaction to the medication. The client's family begins a lawsuit against the facility and the nurse's license is suspended by the board of nursing. In preparation for the lawsuit, the nurse meets with the nurse attorney to review the events. Which appropriate statement given by the nurse indicates he has an understanding of the lawsuit?

-"I had a duty and it was my responsibility to get clarification before administering the medication, which I did not."

A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response by the nurse educator would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse?

-"The Scope and Standards of Practice for Professional Ambulatory Care Nursing deals with the professional obligations of a nurse working in the ambulatory setting."

A nurse educator understands that his teaching was effective regarding the Code of Ethics for Nurses when students make which statement?

-"The code is an expression of nursing's own understanding of its commitment to society."

A lawyer is describing the litigation process to a nurse named in a malpractice lawsuit. Which statements by the lawyer accurately describe this process? Select all that apply.

-"The process of bringing and trying this lawsuit is called litigation." -"The opinions of appellate judges are published and become common law." -"Common law is based on the principle of stare decisis." >The process of bringing and trying a lawsuit is called litigation. The opinions of appellate judges are published and become common law. Common law is based on the principle of stare decisis, or "let the decision stand." After a decision has been made in a court of law, the principle in that decision becomes the rule to follow in other similar cases (precedent). The other options listed are not true about the litigation process.

Which statement by the nurse is an example of deception?

-"This injection of procaine will feel like a little pinch."

A nurse is caring for a client with a complete spinal cord injury that has caused paraplegia. The client is very distraught and asks the nurse, "Are they sure, even with therapy, I will never walk again?" Which statement made by the nurse demonstrates veracity?

-"You have a complete injury, which results in a total loss of movement and sensation below the level of injury."

Allocating scarce resources

-A key issue in discussions about access to care -The nursing shortage: >Produces difficult working conditions and affects patients outcomes >Mandatory overtime >Nurses:Patient ratio

Professional Nursing Code of Ethics

-A set of guiding principles that all members of a profession accept -Helps professional groups settle questions standards of practice or behavior -Includes advocacy, responsibility, accountability, and confidentiality

Intergrity

-Acting in accordance with an appropriate code of ethics and accepted standards of practice. When nurse is honest >Provides honest info to patient and public >Documents care accurately and honestly >Seeks to remedy errors made by self or others >Demonstrate accountability for own actions

Deontologic

-Action is right or wrong based on a rule, independent of its consequences

Incident Reports - identify risks

-Agency record of an incident or unusual occurrence (also called unusual occurrence report) -Make all the facts available to agency RISK MANAGEMENT personnel -Contribute to statistical data about incidents -Help health personnel prevent future incidents -Filed according to agency policy - NEVER IN THE MEDICAL RECORD

Informed Consent

-Agreement by the patient to accept treatment or procedure after receiving complete information. -Fundamental right of the client and is based upon principle of autonomy

During a nursing shift, which events warrant completion of an incident report? (Select all that apply.)

-An intravenous antibiotic was administered 2 hours late because the IV site infiltrated. -A visitor slipped and fell in the hallway, but was not injured. -A client falls while being transferred from the bed to the chair.

To practice ethically, the nurse should

-Avoid allowing her judgment to guide practice.

Enhancing Ethical Decision-making

-Becoming aware of personal values and ethical aspects of nursing -Becoming familiar with nursing code of ethics -Seeking continuing education to remain knowledgeable about ethical issues in nursing -Respecting the values, opinions, and responsibilities of other health care professionals -Participating in or establishing ethic rounds -Serving on institutional ethics committees -Striving for collaborative practice -Adhere to the Process for Resolving Ethical Dilemmas

The evening nurse received a change-of-shift report from the day nurse. The day nurse's report states, "The client required intubation for respiratory distress this morning, but has been stable all day." The evening nurse collects the following information during the first assessment: Skin flushed. Client lethargic. Temperature 103.0°F (39.4°C). A review of the client's chart reveals that the client's last assessment was done 7 hours earlier. A review of the findings by the nurse attorney determines which facts might be in place regarding liability? Select all that apply.

-Breach of duty has occurred.

Quality of life

-Central to discussions about futile care, cancer therapy, physician-assisted suicide, and DNR

Identify the activities a nurse would use in value processing. Select all that apply.

-Choosing -Acting -Prizing

Altruism

-Concern for others; generosity -Unselfish regard for the welfare of others >Demonstrate understanding of culture, belief, and perspective of others >Advocates for patients, particularly the most vulnerable >Takes risks on behalf of patient and colleagues >Mentors other professionals

Essential Elements of Informed Consent

-Consent must be voluntary -Must be obtained prior to treatment -Patient must be competent with capacity to understand -Patient has the right to withdraw consent at any time. -The nurse witnesses signature only and must establish patient's understanding.

Types of Law

-Criminal law: >Felonies = prison > 1 year and fines >Misdemeanor = < 1 year -Civil law >Contract law >Tort law

When examining values, a nurse notes that one country uses physician-assisted suicide and another country considers physician-assisted suicide as illegal and punishable with imprisonment. How are these two views on physician-assisted suicide affected?

-Culturally

Ways to Minimize Liability

-Delegate appropriately -Protect patients from injury -Report all incidents -Always check any order that is questioned -Know own strengths and weaknesses -Maintain clinical competence

Checklist to ensure informed consent

-Disclosure: Patient informed and has all the info, risks, benefits, alternatives, and no outcome guaranteed -Comprehension: Able to repeat in his own words that he giving consent -Competence: Understands info needed to make this decision, meets above criteria -Voluntariness: Patient voluntarily consenting or refusing

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 can't do it anymore." What ethical problem is the adult child experiencing?

-Distress >Ethical 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 client'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. While the adult child is unhappy, this is not the primary ethical problem.

The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated?

-Duty >Duty refers to an obligation to use due care. The nurse assessed the client and made appropriate interventions and notifications. Breach of duty is the failure to meet the standard of care. An example of breach of duty would be not performing assessments, appropriate interventions, and notifications of the health care provider. Causation is when the breach of duty caused the injury. An example of causation would be failure to perform assessment and appropriate interventions when providing client care, and this caused injury to the client. Damages are the harm or injury that occurred to the client. In this situation, it would be the death of the client.

Feminist ethics

-Ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor

Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when she reflects on the decision-making process and the role it will play in making future decisions?

-Evaluating

Negligence

-Failure to behave in a reasonable and prudent manner -Elements: Duty/Breach of Duty; Cause; Injury -Some Acts of Negligence: >Not properly identifying a patient >Performing an unfamiliar procedure >Medication errors >Failure to use aseptic technique

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?

-Feminist >A feminist approach is one where the focus is on specific problems and concerns faced by women. 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 "the client deserved this"). Values clarification is a self-assessment process that enables a client to discover the content and strength of his or her 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 nurse states to the client that she will keep her free of pain. However, her family wishes to try a treatment to prolong her life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle?

-Fidelity

A child on a pediatric unit hits one of the other children and subsequently has video game privileges revoked for the rest of the day. The next day the same child plays with the other children without any problems in order to avoid losing video game privileges again. According to Kohlberg, the child is demonstrating what stage of development?

-First-level preconventional stage

Liability Elements

-Four elements must be established to prove that malpractice or negligence has occurred: >Duty: obligation to do what a reasonably prudent nurse would do. >Breach of Duty: failure to meet the standard of care >Causation: shows that failure to meet the standard of care caused the injury >Damages: the actual harm or injury resulting to the patient

Good Samaritan Acts

-Guidelines for nurses who choose to render emergency care include: >Limit actions to those normally considered first aid if possible >Do not perform actions which the nurse does not know how to perform >Offer assistance but do not insist >Have someone call or go for additional help >Do not leave the scene until the injured person leaves or another qualified person take over >Do not accept compensation

Principle based approach

-Has both utilitarian and deontologic

During the orientation to the hospital, the staff development educator discusses unit and institutional-based policies. What is the source of the practice rules that result in unit and institutional-based policies?

-Health care institution >The health care institution determines the unit and institutional policies. These policies may vary from institution to institution. Such policies may include clinical procedures, policies specific to the institution, and personnel and employment policies. Unit and institutional based policies are not derived from federal legislation, state legislation, or the board of nursing.

A nurse manager receives negative survey results citing a decrease in the quality of client care. What areas does the nurse manager research as a causative factor in the decrease of quality care delivery? Select all that apply.

-Inadequate staffing patterns -Decreased satisfaction of nurses in the workplace

Selected Nursing Legal Responsibilities

-Informed consent -Delegation -Violence, abuse, neglect (mandated reporters) -Controlled substances -Impaired nurse -Sexual harassment -Death and related issues (DNR)

The nurse beginning practice would like to access the standards for ethical practice. Which organization will the nurse research for these standards?

-International Council of Nurses

Futile care

-Interventions unlikely to produce benefit for the client

Common Ethical Issues

-Issues in the care of HIV/AIDS patients -Abortions -Organ transplantation -End-of-life decisions and DNR orders -Cost containment issues (resource allocation) -Breaches of client confidentiality

Documentation

-Legible -Accurate -Honest

A nurse is called to a deposition for a malpractice charge that has resulted in the death of a client. As the chart is reviewed, the prosecuting attorney questions the nurse about several defaming comments written in the medical record about the client. What charges can be filed against the nurse due to these comments?

-Libel >Libel is damaging statements written and read by others. Since there were defaming comments written in the chart, libel charges could be appropriate. Malpractice, slander, and negligence are not charges in this scenario.

A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit?

-Malpractice >The facility and nurse could be charged with malpractice, which is failing to perform (or performing) an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault).

Who Cannot Provide Informed Consent

-Minor: less than 18 years old. -Mentally ill person deemed incompetent by professionals. -Unconscious patient or one so injured that he/she cannot provide consent. -Patient under the influence of drugs or alcohol.

The nursing student demonstrates the need for further instruction with which statement concerning moral values?

-Moral values give individuals some sense of what is right and wrong."

Impact of HIPAA

-Name cannot be posted on a room door -Charts must be kept in a secure, non-public location -Printed copies of protected health information should not be left unattended in a printer, fax or on counter top. -Access to protected health information should be limited to only those authorized to obtain it

ICN Code

-Nurses and people -Nurses and practice -Nurses and the profession -Nurses and coworkers

An adolescence is in the process of value formation. What does the nurse determine that will be the greatest influence in the child's formation of values in this developmental stage?

-Peers

Liability of Students

-Perform only those activities within the scope of nursing education to date -Students are responsible for their own actions and liable for their own negligence -Students are expected to adhere to same standards of care as registered nurses

Credentialing

-Professional competence is ensured and maintained *>Accreditation:* the process by which educational programs are evaluated and recognized as having met certain standards *>Licensure:* the state determines a candidate meets certain minimum requirements to practice in the profession and grants a license to do so. *>Certification:* the process by which a person meets certain criteria established by a non governmental association and is granted recognition in a specified practice area.

Human dignity

-Respect for the inherent worth and uniqueness of individuals and populations. When nurse values and respects all patients and colleagues >Provides culturally competent and sensitive care >Protects patient privacy >Preserves confidentiality of patients and health care providers >Designs care with sensitivity to individual patient needs

Utilitarian

-Rightness or wrongness of an action depends on the consequences of the action

Legal Considerations and Implications

-Safe nursing practice includes knowledge of the laws that affect nursing practice. -Nurses are accountable for their own actions and obligations. -Provision of safe competent care is the best way to avoid legal problems.

Liability

-Standard to determine negligence or malpractice is what would have been done by a reasonable and prudent professional with similar preparation and experience (applies to students as well).

Nurse Practice Acts are examples of which type of laws?

-Statutory laws

How to Process an Ethical Dilemma

-Step 1: Assess the situation; gather data -Step 2: Diagnose; identify the ethical problem -Step 3: Plan; Identify and weigh alternatives -Step 4: Implement your decision -Step 5: Evaluate your decision

Nursing students in an ethics class have been asked to define "ethics." What would be the best definition of ethics?

-The formal, systematic study of moral beliefs.

A client is being prepared for an elective surgical procedure and the consent form has not been signed. Who should the nurse have obtain consent for the procedure?

-The health care provider performing the surgical procedure >The nurse should inform the surgeon the consent has not been signed. Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study. In this particular case, the surgeon, the client, and a witness, all need to sign the consent form. The nurse's roles are to confirm that a signed consent form is present in the client's chart and to answer any client questions about the consent.

Malpractice - negligence by professional personnel

-The negligent acts of persons engaged in professions or occupations in which highly technical or professional skills are employed -Some examples of malpractice: >When harm results from professional misconduct >Unreasonable lack of skills >Illegal or immoral conduct -23-2

The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice?

-The nurse administers amoxicillin to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest.

A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for clients in a long-term care facility. Which nursing actions best exemplify this principle?

-The nurse performs regular client assessments for pressure injuries. -The nurse follows "medication rights" when administering medicine to clients.

Autonomy

-The right to self-determination >Respect for others >Ability to determine personal goals >Complete understanding of choices >Freedom to implement the choice/plan >Plan care in partnership with patients >Honors right of patient and families to make decisions about health care >Provides info so patients can make informed choices

Beneficence

-To act in the best interest of others >To promote good >To prevent harm or evil >To remove harm or evil

Justice

-To give each his or her due, and act fairly Is health care a "right" or a social good?

Nurses Rights

-To have legal representation; malpractice insurance -To have sufficient orientation to know the policies and procedures and Standard of Care -To exercise professional judgment while carrying out MD orders & question any order that doesn't seem "Right."

Purposes of Professional Codes of Ethics

-To inform the public about the minimum standards of the profession -To help the public understand professional nursing conduct -To provide a sign of the profession's commitment to the public

Social Justice

-Upholding moral, legal, and humanistic principles. Nurse works to assure equal treatment under the law and equal access to quality health care >Supports fairness and nondiscrimination in the delivery of care >Promotes universal access to health care >Encourages legislation and policy consistent with the advancement of nursing care and health care

What are standards for decision making that endure for a significant time in one's life?

-Values

What is the term for the beliefs held by the individual about what matters?

-Values >Values are ideals and beliefs held by an individual or group; 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.

Just info

-Values are ideals and beliefs held by an individual or group; 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.

Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which guideline is true regarding a nurse's role is witnessing a testator's signature?

-Witnesses to a signature do not need to read the will.

An employee health nurse is assisting a stressed, working mother with value clarification. Which of the following best defines value clarification?

-a process by which people come to understand their own values and value systems

An RN is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action by the RN is considered negligent if injury results from this action?

-asking the LPN/LVN to teach a new diabetic client how to administer insulin

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability?

-filling out an occurrence report and notifying the health care provider

A nurse is contributing to the analysis of an ethical dilemma. When analysing the dilemma according to the ethical framework, what is most important for the nurse to take into consideration?

-standards of conduct.

Non-maleficence

>Duty to do no harm >Harm may be intentional or non-intentional

Question 7

A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accordance with which of the principles of bioethics? *A.* Autonomy *B.* Beneficence *C.* Justice *D.* Fidelity *E.* Nonmaleficence ANSWER: E Nonmaleficence is defined as the obligation to prevent harm. Autonomy is respect for another's right to make decisions, beneficence obligates us to benefit the patient, justice obligates us to act fairly, and fidelity obligates us to keep our promises

Question 18

A nurse administers the wrong medication a patient and the patient harmed. The physician who ordered the medication did not read the documentation that the patient was allergic to the drug. Which statement is true regarding liability for the administration of the wrong medication? *A.* The nurse is not responsible, because the nurse was merely following the doctor's orders. *B.* Only the nurse is responsible, because the nurse actually administered the medication. *C.* Only the physician is responsible, because the physician actually ordered the drug. *D.* Both the nurse and the physician are responsible for their respective actions. ANSWER: D Nurses are legally responsible for carrying out the orders of the physician in charge of a patient unless an order would lead a reasonable person to anticipate injury if it were carried out. If the nurse should have anticipated injury and did not, both the prescribing physician and the administering nurse are responsible for the harms to which they contributed.

Question 19

A nurse answers a patient's call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to bed and then fills out an incident report. Which statement accurately describe the aspects of this procedure? Select all that apply. *A.* An incident report is used as disciplinary action against staff members. *B.* An incident report is used as a means of identifying risks. *C.* An incident report is used for quality control. *D.* The facility manager completes the incident report *E.* An incident report makes facts available in case litigation (the process of taking legal action) occurs. *F.* Filing of an incident report should be documented in the patient record. ANSWER: B,C,E Incident reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks and are filled out by the nurse responsible for the injured party. An incident report makes facts available in case litigation occur and in some states, incident reports may be used in court as evidence. A physician completes the incident form with documentation of the medical examination of the patient employee, or visitor with an actual or potential injury. Documentation in the patient record should not include the fact that an incident report was filed

Question 1

A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe a characteristic of the development of a personal value system? (select all that apply) *A.* people are born with values *B.* Values act as standards to guide behavior *C.* Values are ranked on continuum of importance *D.* Values influence beliefs about health and illness *E.* Value systems are not related to personal codes of conduct *F.* Nurses should not let their values influence patient care ANSWER: B,C,D A value is a belief about the worth of something, about what matters, which acts as a standard to guide one's behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person's values influence beliefs about human needs, health, and illness; the practice of health behaviors; and human responses to illness Values guide the practice of nursing care. An individual is not born with values; rather, values are formed during a lifetime from information from the environment, family, and culture.

Question 3

A nurse who is working in a hospital setting after graduation from a local college uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply. *A.* patient decides to quit smoking following a diagnosis of lung cancer. *B.* A patient shows off a new outfit that she is wearing after losing 20 pounds. *C.* A patient chooses to work fewer hours following a stress-related myocardial infarction. *D.* A patient incorporates a new low-cholesterol diet into his daily routine. *E.* A patient joins a gym and schedules classes throughout the year. *F.* A patient proudly displays his certificate for completing a marathon. ANSWER: B,F Prizing something one values involves pride, happiness and public affirmation, such as losing weight or running a marathon. When choosing, one chooses freely from alternatives after careful consideration of the consequences of each alternative, such as quitting smoking and working fewer hours. Finally, the person who values something acts by combining choice into one's behavior with consistency and regularity on the value, such as joining a gym for the year and following a low-cholesterol diet faithfully

Question 20

A nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true? *A.* Students are not responsible for their acts of negligence resulting in patient injury. *B.* Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. *C.* Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor. *D.* Most nursing programs carry group professional liability insurance unnecessary. ANSWER: B Student nurses are responsible for their own acts of negligence if these result in patient injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision. Most nursing programs require students to carry personal professional liability insurance

Question 8

A professional nurse committed to the principle of autonomy would be careful to: *A.* Provide the information and support a patient needed to make decisions to advance one's own interests *B.* Treat each patient fairly, trying to give everyone his or her due *C.* Keep any promises made to a patient or another professional caregiver *D.* Avoid causing harm to a patient ANSWER: A The principle of autonomy obligates nurses to provide the information and support patients and their surrogates need to make decisions that advance their interests. Acting with justice means giving each person his or her due, acting with fidelity involves keeping promises to patients, and acting with nonmaleficence means avoiding doing harm to patients

Question 5

A professional nurse with a commitment to social justice is most apt to: *A.* Provide honest information to patients and the public *B.* Promote universal access to health care *C.* Plan care in partnership with patients *D.* Document care accurately and honestly ANSWER: B

Question 11

A state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication. This is an example of what type of law? *A.* Public law *B.* Private law *C.* Civil law *D.* Criminal law ANSWER: D Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Public law regulates relationships between people and the government. Private or civil law includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry

Question 10

A student nurse begins a clinical rotation in a long-term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements reflect a correct understanding of advocacy? Select all that apply. *A.* Advocacy is the protection and support of another's rights. *B.* Patient advocacy is primarily done by nurses. *C.* Patients with special advocacy needs include the very young and the elderly, those who are seriously ill, and those with disabilities. *D.*Nurse advocates make good health care decisions for patients and residents. *E.* Nurse advocates do whatever patients and residents want. *F.* Effective advocacy may entail becoming politically active. ANSWER: A,C,F Advocacy is the protection and support of another's rights. Among the patients with special advocacy needs are the very young and the elderly, those who are seriously ill, and those with disabilities; this is not a comprehensive list. Effective advocacy may entail becoming politically active. Patient advocacy is the responsibility of every member of the professional caregiving team-not just nurses. Nurse advocates do not make health care decisions for their patients and residents Instead, they facilitate their decision making. Advocacy does not entail supporting patients in all their preferences

Question 2

Five-year-old Bobby has dietary modifications related to his diabetes. His parents want him to value good nutritional habits and they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission? *A.* Modeling *B.* Moralizing *C.* Laissez-faire *D.* Rewarding and punishing ANSWER: D When rewarding and punishing are used to transmit values, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Through modeling, children learn what is of high or low value by observing parents, peers, and significant others. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Those who use the laissez-faire approach to value transmission leave children to explore values on their own (no single set of values is presented as best for all) and to develop a personal value system.

Question 15

If review of this patient's record revealed that she had never consented to the eye surgery, of which intentional tort might the surgeon have been guilty? *A.* Assault *B.* Battery *C.* Invasion of privacy *D.* False imprisonment ANSWER: B Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Battery is an assault that is carried out. Every person is granted freedom from bodily contact by another person unless consent is granted. The Fourth Amendment gives citizens the right of privacy and the right to be left alone; a nurse who disregards these rights is guilty of invasion of privacy. Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonmernt

Question 9

Janie wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. She believes his dying is being prolonged painfully. She is troubled when the patient's doctor tells her that she'll be fired if she raises questions about his care or calls the consult. This is a good example of: *A.* Ethical uncertainty *B.* Ethical distress *C.* Ethical dilemma *D.* Ethical residue ANSWER: B Ethical distress results from knowing the right thing because to do but finding it almost impossible to execute because of institutional or other constraints (in this case, fear of losing her job). Ethical uncertainty results from feeling troubled by a situation but not knowing if it is an ethical problem. Ethical dilemmas occur when the principles of bioethics justify two or more conflicting courses of action. Ethical residue is what nurses experience when they seriously compromise themselves or allow themselves to be compromised

Question 14

Jean's attorney was careful to explain in her defense that Jean had specialty knowledge, experience, and clinical judgement and had met certain criteria established by the nongovernmental association, as a result of which she was granted recognition in a specified practiced area. What is this sort of credential called? *A.* Accreditation *B.* Licensure *C.* Certification *D.* Board approval ANSWER: C Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area. Nursing is one of the groups operating under state laws that promote the general welfare by determining minimum standards of education through accreditation of schools of nursing. Licensure is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. State board of approval ensures that nurses have received the proper training to practice nursing.

Question 12

Newly hired nurses in a busy suburban hospital are required to read the state Nurse Practice Act as part of their training. Which topics are covered by this act? Select all that apply. *A.* Violations that may result in disciplinary action *B.* Clinical procedures *C.* Medication administration *D.* Scope of practice *E.* Delegation policies ANSWER: A,D Each state has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes nurses vulnerable to charges of violating the state Nurse Practice Act. Nurse Practice Acts also list the violations that can result in disciplinary actions against nurses. Clinical procedures are covered by the health care institutions themselves. Medication administration and delegation are topics covered by the board of nursing. Laws governing Medicare reimbursement are enacted through Federal legislation.

Question 4

The American Association of Colleges of Nursing identified five values that epitomize the caring professional nurse. Which of these is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice? *A.* Altruism *B.* Autonomy *C.* Human dignity *D.* Integrity ANSWER: D The American Association of Colleges of Nursing defines integrity as acting in accordance with an appropriate code of ethics and accepted standards of practice. Altruism is a concern for the welfare and well-being of others. Autonomy is the right to self-determination, and human dignity is respect for the inherent worth and uniqueness of individuals and populations.

Question 13

Those bringing the charges against Jean are called: *A.* Appellates *B.* Defendants *C.* Plaintiffs *D.* Attorneys ANSWER: C The person or government bringing suit against another is called the plaintiff. Appellates are courts of law, defendants are the ones being accused of a crime or tort, and attorneys are the lawyers representing both the plaintiff and defendant.

Question 16

What must be established to prove that malpractice or negligence has occurred in this case? *A.* The surgeon who performed the procedure called the nurse's action pure negligence, saying that the patient could have been saved. *B.* The fact that this patient should not have died - she was a vibrant grandmother of 10 who had walked three quarters of a mile the morning of her surgery and had sung in her church choir the day before. *C.* The nurse intended to harm the patient and was willfully negligent. *D.* The nurse had a duty to monitor the patient's vital signs, failed to do so, the patient died, and it was Jean's failure to do her duty that caused the patient's death ANSWER: D Liability involves four elements that must be established that malpractice or negligence has occurred: duty breach of duty, causation, and damages. Duty refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse-patient relationship. Breach of duty is the failure to meet the standard of care. Causation, the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) actually caused the injury. Damages are the actual harm or injury resulting to the patient.

Question 6

When an older nurse complains to a younger nurse that nurses just aren't ethical anymore, which reply reflects the best understanding of moral development? *A.* "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." *B.* "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" *C.* "Ethics is genetically determined ... it's like having blue or brown eyes. Maybe we're evolving out of the ethical sense your generation had." *D.* "I agree! It's impossible to be ethical when working in a practice setting like this!" ANSWER: A The ability to be ethical, to make decisions, and to act in an ethically justified manner begins in childhood and develops gradually

Question 17

When the attorney representing the patient's family calls Jean and asks to talk with her about the case so that he can better understand her actions, how should Jean respond? *A.* "I'm sorry, but i can't talk with you. You'll have to contact my attorney. *B.* Answer the attorney's questions honestly and make sure that he understands her side of the story. *C.* Appeal to the attorney's sense of compassion and try to enlist his sympathy by telling him how busy it was that morning. *D.* "Why are you doing this to me? This could ruin me!" ANSWER: A One of the cardinal rules for nurse defendants is: Do not discuss the case with anyone at your agency (with the exception of the risk manager), with the plaintiff, with the plaintiff's lawyer, with anyone testifying for the plaintiff, or with reporters