Chapter 6: Values, Ethics, and Advocacy

Deontologic theory of ethics

(dust based theory) decisions and actions based on sense of duty- the end result is not what is right or wrong, but the motivation behind the action taken

Bioethics

encompasses a number of fields of "life sciences"

Nursing ethics

formal study of ethical issues that arise in the practice of nursing

Prizing (treasuring)

involves pride, happiness, and public affirmation

Human dignity

respect for inherent worth and uniqueness of individuals and populations

Autonomy

right to self-determination

Ethics

rules, principles, and guidelines that direct conduct based on right and wrong

Values

the belief about the worth of something, belief about what matters, and act as standard to guide one's behavior

Social justice

upholding moral, legal, and humanistic rights

Ethical dilemma

when one is forced to decide between two opposing actions, neither fo which are desirable Taking no action is considered an action

A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? A. the nurse helps the patient prepare a durable power of attorney document B. the nurse gives the patient undivided attention C. the nurse keeps a promise to provide a counselor for the patient D. the nurse competently administers pain meds to the patient

A. the nurse helps the patent prepare a durable power of attorney document

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? a) Human dignity b) Altruism c) Social justice d) Integrity

D. integrity Rationale: integrity is acting in accordance with appropriate code of ethics, human dignity is respect for the worth and uniqueness of individuals, altruism is concern for the welfare of others, and social justice is upholding moral and legal principles

A nurse providing care for three clients on a medical unit, two are more acute than the third. The nurse is making a concerned effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of their shift. Which of the following is the nurse attempting to enact? A. justice B. nonmaleficence C. beneficence D. fidelity

A. justice Rationale: justice is to give each person their due and to act fairly, fidelity is to tell the truth and keep promises, nonmaleficence is avoiding causing harm to patients, and beneficence is benefitting the patient

A home heath nurse performs a careful safety assessment of the home of a frail older adult to prevent harm to the patient. The nurses action reflects which principle of bioethics? A. autonomy B. beneficence C. justice D. fidelity E. nonmaleficence

E. nonmaleficence Rationale: nonmaleficence is making sure you are not causing harm to the patient, autonomy is respecting the patients decisions and allowing them to make their own, beneficence is benefitting the patient, fidelity keeping promises, and justice is acting fairly

Altruism

concern for welfare and well-being of others

Moral resilience

developed capacity to respond well to morally distressing experiences to emerge strong

A student nurse beings 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 accurately describe this concept? (select all that apply) A. advocacy is the protection and support of another's rights B. patent advocacy is primarily performed by nurses C. patients with special advocacy needs include the very young and the older adults, those who are severely ill, and those with disabilities D. nurse advocates make good health care decisions for patient and residents E. nurse advocates do whatever patients and residents want F. effective advocacy may entail becoming politically active

A, C, and F

The foundation for decisions about resource allocation throughout society or group is based on the ethical principle of: A. justice B. autonomy C. confidentiality D. veracity

A. justice Rationale: justice is the foundation for decisions about resource allocation throughout a society, veracity is telling the truth, confidentiality is keeping records confidential, and autonomy is respelling the rights of patients

An employee health nurse is assisting a stressed, working mother with value clarification. Which of the following best defines value clarification? a) A systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. b) A process by which people come to understand their own values and value systems. c) An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. d) A belief about the worth of something, about what matters, that acts as a standard to guide one's behavior.

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

A nurse pulls the curtains before changing the dressing of a surgical wound on the abdomen of a patient. What value is served? A. altruism B. dignity C. freedom D. accountability

B. dignity Rationale: altruism is the concern for the well-being of others, freedom is allowing the patient to make their own decisions, and accountability is documenting nursing care accurately and honestly

A nurse wants to call an ethics consult to clarify treatment goals for a patient who can no longer speak for himself. The nurse believes his dying is being prolonged painfully. The patient's doctor threatens the nurse with firing if the nurse raises questions about the patients care of calls the consult. What ethical conflict is this nurse experiencing? A. ethical uncertainty B. ethical distress C. ethical dilemma D. ethical residue

B. ethical distress Rationale: ethical distress is when you know the right thing to do but finding it is almost impossible to execute because of institutional constraints, ethical uncertainty is when you are unsure if it is an ethical problem, ethical dilemma is when there are two conflicting courses of action, and ethical residue is what nurses experience when they compromise themselves or others

Which statement best conveys the concept of ethical agency?

B. ethical practice requires a skill set that must be conscientiously learned and nurtured

Which action most clearly demonstrates a nurse's commitment to social justice? A. documenting patient care in a timely, honest, and thorough manner B. lobbying for an expansion of healthcare resources and benefits C. answering the clients questions about care clearly and accurately D. ensuring the patients diet is culturally acceptable

B. lobbying for an expansion of healthcare resources and benefits Rationale: social justice is a professional value that encompasses efforts to promote universal access to healthcare

A nurse knows the ethical term "Do not cause harm" is an example of: A. beneficence B. nonmaleficence C. fidelity D. justice

B. nonmaleficence Rationale: beneficence is benefitting the patient, fidelity is keeping promises, and justice is giving a patient their due and treat fairly

A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute? A. providing honest info to patients and the public B. promoting universal access to healthcare C. planning care in partnership with patients D. documenting care accurately and honestly

B. promoting universal access to healthcare Rationale: social justice is upholding legal, moral, and ethical rights

The principle of autonomy by a client is applied in which situation? A. a hospice consultant is ordered by the nurse B. the client has decided to stop chemo C. an order for antibiotics is written in the chart D. the family of the client is discussing care with the physician

B. the client has decided to stop chemo

Which of the following is a characteristic of care-based approach to bioethics? A. the need for orientation toward service B. the promotion of dignity and respect of the clients as people C. the rightness or wrongness of an action is independent of its consequences D. the need to emphasize the relevance of clinical experience

B. the promotion of dignity and respect of the clients as people

A client tells the nurse he doesn't want to have a painful procedure. By respecting and supporting the clients right to make decisions, what is the nurse demonstrating? A. altruism B. confidentiality C. advocacy D. justice

C. advocacy Rationale: advocacy is the protection and support of others rights, altruism is the concern for the well-being of others, confidentiality is keeping things to yourself, and justice is giving everyone their due and acting fairly

Which ethical principle is related to the idea of self-determination? A. confidentiality B. beneficence C. autonomy D. nonmaleficence

C. autonomy

A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches which of the following? A. autonomy B. fidelity C. ethical conduct D. beneficence

C. ethical conduct Rationale: autonomy is allowing patients to make their own decisions, fidelity is keeping promises, and beneficence is benefitting the patient

A nurse is caring for a patient who is a celebrity in the area. A person claiming to be family inquires about the medical details of the client. The nurse reveals the information but later finds out the person was not actually a family member. The nurse has violated: A. veracity B. fidelity C. autonomy D. confidentiality

D. confidentiality Rationale: fidelity is keeping promises, veracity is telling the truth, and autonomy is allowing patients to make their own decisions

A client is scheduled to have an elective procedure and cannot decide if he wants to do it or not. He asks the nurse to help him make the decision because he does not feel that he knows enough about the procedure. Which of the following is the best way to advocate for this patient?

D. facilitate the clients decision by allowing him to verbalize his feelings and providing information to help him assess his options

A nurse incorporates the "five values that epitomize the caring professional nurse" into a home health care nursing practice. Which attribute is best described as acting in accordance with the appropriate code of ethics and accepted standards of practice? A. altruism B. autonomy C. human dignity D. integrity

D. integrity Rationale: autonomy is allowing the patient to decide for themselves, integrity is always doing the right thing and following a code of ethics, altruism is a concern for the welfare of others, and human dignity is respect for the worth and uniqueness of individuals

Choosing

choosing freely from alternatives after careful consideration of the consequences of each alternative

Acting

combining choice into one's behavior with consistency and regularity on the value

An older nurse asks a younger coworker why the new generation of a nurse just isn'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, its a new age and 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.

A. Behaving ethically develops gradually from childhood, made my generation doesn't value this enough to develop an ethical code.

A 46 y/o client has been diagnosed with cancer. He has met with the oncologist and is now weighing the options to undergo chemo or radiation at his treatment. This client is utilizing which ethical principle in making his decision? A. autonomy B. beneficence C. justice D. confidentiality

A. autonomy Rationale: autonomy is allowing the patient to make their own decisions, beneficence is benefitting the patient, justice is acting fairly, and confidentiality relates to privacy

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? A. evaluating B. diagnosing C. implementing D. planning

A. evaluating Rationale: evaluating ethical decisions involve reflecting on the process and evaluating those elements that will be helpful in the future

The nurse is reviewing charges for surgical procedures and observes different charges dependent upon insurance status. The nurse immediately reports the bias in charges to the supervisor for action. What principle of bioethics is the nurse demonstrating? A. justice B. nonmaleficence C. fidelity D. beneficence

A. justice Rationale: justice is acting fairly and giving patients their due, fidelity is to keep promises, nonmaleficence is to avoid harm, beneficence is to promote well-being and benefit the patient

A nurse shows client advocacy by doing which of the following examples? A. offering a hospice consultation to a terminally ill client B. refusing to allow a spouse to stay at the bedside C. insisting that a medication be taken D. sending a client home with verbal discharge instructions

A. offering a hospice consultation to a terminally ill client

Which of the following nursing situations is an example of an ethical dilemma? A. performing CPR when a signed DNR is not available B. discussing care of a comatose patient with the family C. transferring a client to a step-down unit D. administering pain meds as ordered

A. performing CPR when a signed DNR is not available Rationale: all of the other scenarios are all within the ethical scope or nursing practice

A nurse is having lunch in the break room and overhears the other nurses talking about a difficult client in an inappropriate way. The nurses attempt to engage them in a conversation. Which of the following responses by the nurse would best represent behavior that supports the value of human dignity in nursing practice?

A. saying she believes that this discussion is inappropriate and disrespectful to the client and that she does not want to be a part of it

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 this process? (select all that apply) A. people are born with values B. values act as standards to guide behaviors C. values are ranked on a 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

B, C, D,

A nurse who is working in the hospital uses value clarification to help understand the values that motivate parents' behavior. Which examples denote "prizing" in the process of values clarification? (select all that apply) A. a patient decides to quit smoking following a diagnosis of lung cancer B. a patient shows off a new outfit she's wearing after losing 20lbs C. a patient chooses to work a few hours following a stress-related heart attack 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

B, F,

A client rings the bell and requests pain meds. Upon performing the assessment, the nurse says she'll return with the pain meds. The nurse's promise to return with the medication is an example of which principle of bioethics? A. justice B. autonomy C. fidelity D. nonmaleficence

C. fidelity Rationale: fidelity is keeping promises, justice is giving each client their due and acting fairly, autonomy is respecting the rights of the patients, and nonmaleficence is preventing harm from being done to a client

A nursing facility is presenting a lecture on ethics. The correct definition of ethical distress is : A. belief about worth as a standard to guide behavior B. being aware of the principles of right and wrong C. knowing the correct action, but being unable to perform it due to constraints D. supporting the rights of the client during the hospital stay

C. knowing the correct action, but being unable to perform it due to constraints

How do we develop moral resilience?

Cultivating good relationships, refusing to view crises as insurmountable, nurturing a positive view of self and taking care of self, and keeping things in perspective. The most important of these is is accepting that change is a part of living

A nurse may experience ethical distress in which client situation? A. ambulating a patient who had a hip replacement B. turning and position and client every hour C. administering pain meds as ordered D. continuing IV fluids for a patient who wants to die

D.

A nurse obtains an order for a bed alar, for a confused client. This is an example of which of the following ethical principles? A. confidentiality B. conflict C. deception D. paternalism

D. paternalism Rationale: paternalism is choosing an action for the patient because we believe it is in their best interest; acting like a parent

A pediatric nurse is assessing a 5 y/o boy who has dietary modifications related to his diabetes. His parents tell the nurse they want him to value good nutritional habits, so they 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

D. rewarding and punishing

Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem? A. talking to the family of a patient while they are visiting B. participating in a hands off report at the end of a shift C. documenting care in the patients record D. taking a picture of a client with the nurse's cellphone

D. taking a picture with the nurse's cellphone

Care based approach to ethics

The nurse-patient relationship is the central theme, focus on promotion of dignity and respect for patients as people, and considers specific situations of individual patients

Utilitarian theory of ethics

promotes action based on end result that produces the most good (happiness) for the most people (emphasis is on the end result and how people feel about it)

Conscientious objective

refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's professional and personal ethical beliefs and standards

Issues in patient advocacy

representation of patients, promoting self-determination, whistle-blowing, and being politically active

Moral distress

when one knows the right thing to do but personal or institutional factors make it difficult to follow through with the correct actions