Chapter 6: Values, Ethics, and Advocacy

It is time for a nurse to renew licensure. The nurse says, "I need some really easy and quick continuing education hours. I don't understand why we have to do these every year." What is the nurse's coworker's best response?

"Life-long learning is part of the code for nurses."

Which statement by the nurse is an example of deception?

"This injection of Novocain will feel like a little pinch." Explanation: Telling a client that Novocain will feel like a little pinch, is not being truthful, thus a deception. The other choices are true statements and interventions, thus not deception.

A charge nurse has implemented staff education on nursing values. The nurse would determine that further education is required when which statement(s) are overheard? Select all that apply.

"I can't believe the client is giving that precious baby up for adoption." "The gonorrhea test was positive. That's what the client gets for sleeping around." "If that was my mother, I sure wouldn't agree to a no-code."

A nurse's friend states, "I admire you so much. I would love to be a nurse, but I don't think I have the courage." Which response will the nurse make?

"You can work on being more courageous as you learn to be a nurse."

Nurses who value client advocacy follow what guideline?

They give priority to the good of the individual client rather than to the good of society in general.

A nurse demonstrates the professional value known as altruism when caring for clients in a long-term care facility. What nursing action demonstrates this behavior?

A nurse researches the culture of a Muslim client when planning care. The professional value of altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of clients, other nurses, and other healthcare providers. It includes demonstrating an understanding of the cultures, beliefs, and perspectives of others. Altruism is demonstrated by the nurse researching the culture of a Muslim client when planning nursing care. Consulting a client when planning care to determine priorities and helping an older adult client fill out an informed consent form demonstrate the value of autonomy, which is the right to self-determination. Promoting universal access to health care for underserved populations demonstrates the value of social justice.

Which best defines value clarification?

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

Which word is best described as protection and support of another's rights?

Advocacy Advocacy is the protection and support of another's rights. Nurses who value client advocacy make sure their loyalty to an employing institution or colleague does not compromise their primary commitment to the client; give priority to the good of the individual client rather than to the good of society in general; and carefully evaluate the competing claims of the client's autonomy and client well-being. Paternalism is acting for clients without their consent to secure good or prevent harm. Autonomy is respecting the rights of clients or their surrogates to make health care decisions; it is also known as self-determination. Ethics is the formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing.

An illegal immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice?

Airlifting the client to a local trauma center for emergency surgery The ethical principle of justice mandates that clients be treated impartially without discrimination according to age, gender, race, religion, socioeconomic status, weight, marital status, or sexual orientation. An immediate airlift to the local trauma center demonstrates that this client is begin treated impartially. Avoiding causing the client additional harm would demonstrate nonmaleficence. Attempting to help the client obtain health insurance would demonstrate beneficence and advocacy. Telling the client the truth about the client's medical condition and prognosis would demonstrate integrity and honesty (veracity).

A nurse has completed 4 hours of an 8-hour shift on a medical-surgical unit when the nursing supervisor calls. The nursing supervisor directs the nurse to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that the nurse has been busy with client assignments and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem?

Allocation of scarce nursing resources Explanation: This is a clear example of ethical issues surrounding the allocation of scarce nursing resources and involves distributing nursing care. Advocacy in a market-driven environment and conflicts concerning new technology are not related to the presented situation. Deception is the action of deceiving someone, and the nursing supervisor is not deceiving the nurse.

A client is scheduled to have an elective surgical procedure performed but cannot decide whether to go forward with the procedure or cancel it. The client asks the nurse to help make the decision because the client lacks knowledge about the procedure. Which action by the nurse is the best way for this nurse to advocate for the client?

Allow the client to verbalize feelings, and provide information to help the client assess options. Nurses as advocates must realize that they do not make decisions for their clients, but they can facilitate decision making by allowing the client to verbalize feelings and by providing information to help the client assess options. This is not an appropriate time to call in the surgeon or the social worker. Refusing to help the client is not the best example of client advocacy performed by a nurse.

Which scenario is an example of the laissez-faire approach to value transmission?

Allowing a child to decide not to have an intravenous line inserted A laissez-faire approach to value transmission is one that allows others, especially children, to make decisions without guidance, resulting in a decision that may not be a sound one. Teaching a child about right and wrong behavior is a more active learning strategy, and reflects the moralizing approach to value transmission. Modeling or role modeling is leading (and transmitting values) by example—in this case, not smoking electronic cigarettes to show the teenagers good behavior. Telling the child about the injection feeling like a pinch is not an approach to value transmission.

A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?

Assist in decision making based on the client's best interests.

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?

Autonomy Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike.

A nurse is providing care to a client with end-stage cancer. After weighing the alternatives, the client decides not to participate in a clinical trial offered and is requesting no further treatment. The nurse advocates for the client's decision based on the understanding that the client has the right to self-determination, interpreting the client's decision as reflecting which ethical principle?

Autonomy When respecting autonomy, the nurse supports the client's right to make decisions with informed consent. When promoting the client's well-being, the nurse acts in the best interests of the client. Advocacy is linked to the belief that making choices about health is a fundamental human right that promotes the individual's dignity and well-being. Beneficence is reflected by doing good and promoting what will benefit the client. Justice involves treating each client fairly. Fidelity involves being faithful and keeping promises.

When examining values, a nurse notes that one country allows physician-assisted suicide and another outlaws it, making it punishable by imprisonment. Which factors best explain the differences in values between these two countries?

Cultural

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

Evaluating Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance.

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle?

Fidelity

The nurse is caring for clients in a hospital setting. Which situations encountered by the nurse have a significant ethical component? Select all that apply.

Helping a client make end-of-life decisions Addressing a suspected breach in confidentiality Deciding how to reassign staff in light of budget cuts Deciding when to stop cardiopulmonary resuscitation (CPR) on a client in cardiac arrest

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

International Council of Nurses

The nurse has identified an ethical dilemma that has the potential to interfere with a client receiving optimal care. The nurse discussed this issue with the charge nurse on the unit. What action should the nurse choose next?

Monitor for resolution of the problem. Simply reporting the issue does not complete the nurse's obligation in this situation. The nurse should monitor for resolution of the issue, at least to the point where it no longer interferes with client care. The nurse has already reported the issue up the chain-of-command, so further reporting is not necessary at this time. There is no particular reason to inform the family.

A nurse shows client advocacy by:

Offering a hospice consultation to a client who is terminally ill The definition of advocacy is to ensure that the client's best interests are being met. A hospice consult is an appropriate example. Insisting that a client take a medication does not reflect advocacy for the client because it violates the client's autonomy. Sending a client home with verbal discharge instructions is normal and customary practice and does not ensure that the client's best interests are being met. Refusing to allow a spouse to stay by the client's bedside is not likely to be in the best interests of the client.

A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Utlimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?

Shared Explanation: There are three basic models of healthcare decision making. In the paternalistic model, clinicians decide what ought to be done to benefit the client, inform the client, and the client's role is to comply. In the client sovereignty model, clients or their surrogates, expressing their right to be autonomous, tell the clinician what they want, and the clinician's role is to comply. Most ethicists reject these models in their extremes and recommend a model of shared decision making, which respects and uses the preferences of the client and the expertise/judgment of the clinician. Clinical decision making is the process that results from the use of a healthcare decision-making model.

A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent?

Shared decision making Shared decision making is recommended by most ethicists and involves considering both the client's preferences and the nurse's expertise to make the best decision. The paternalistic model involves the clinician making the decisions. The client sovereignty model involves the client making all the decisions without input from the clinician. Ethical decision making is that based on a personal or organizational code of ethics.

Which is the best definition of ethics?

The formal, systematic study of moral beliefs Explanation: Ethics is a formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to human conduct and human flourishing. "Morals" usually refers to personal or communal standards of right and wrong.

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

Values Explanation: Values are standards for decision-making that endure for a significant time in one's life. Beliefs are more likely to be changeable and are not necessarily a long-term foundation for decision-making. Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. A role is a set of responsibilities one takes on in relationship to others.

A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches the principle of:

ethical conduct. Ethical conduct dictates that a nurse act in a professional, safe, competent manner. Drinking alcohol while at work and behaving inappropriately breaches this principle. Beneficence is acting for the good of the client. Fidelity is keeping promises. Autonomy is respecting one's right to self-determination and making decisions. Although the nurse's intoxication will likely lead to breaches in the principles of beneficience, fidelity, and autonomy, there is no evidence of such breaches in these specific principles in this case.

Ethical distress is:

knowing the correct action but being unable to perform it due to constraints. Knowing the correct action but being unable to perform it due to constraints is the definition of moral or ethical distress. Being aware of knowing what is right and wrong is the first step of having an ethical conscience. Supporting a client during a hospitalization is an ethical principle of doing what is right (beneficence) and the focus of client-centered care. An ethical dilemma is a situation in which a person has difficulty deciding which of two or more conflicting ethical principles to follow.

A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:

personal values. The only information given here tells us that this nurse has personal values on a particular issues. Personal values are ideas or beliefs a person considers important and feels strongly about. Moral agency is the ability to do the ethically right thing because one knows it is the right thing to do. Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. Legal obligations are behaviors and actions required by law.

Which ethical principle refers to the obligation to do good?

Beneficence Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; it is more binding than beneficence.

A nurse believes that abortion is an acceptable option if a pregnancy results from a situation of rape. What is the best description of this belief?

Personal moral A personal moral is a standard of right and wrong that helps a person determine the correct or permissible action in a given situation. Professional values in nursing are a set of beliefs about the worth of things, about what matters, that provide the foundation for nursing practice and guide the nurse's interactions with clients, colleagues, and the public. Ethical principles are a set of specific concepts that guide a person's actions. A legal obligation is something that is required by law.

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 her in the conversation. Which response by the nurse would best represent behavior that supports the value of human dignity in nursing practice?

Saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it Theorists describe the value clarification process as having three steps: choosing, prizing, and acting. In this illustration, the response that best represents a value for human dignity is a response in which the nurse goes through all three stages of the values clarification process; the nurse then concludes that the other nurses' behavior is wrong and prizes the human dignity of the client enough to act against the peers by telling them they are wrong. In the other responses, the nurse either wrongly participates in the inappropriate behavior or avoids addressing it with others.

Which example best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society Feminist ethics offer an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guidelines for practice. The care-based approach directs attention to the specific situation of individual clients viewed within the context of their life narratives. The formal study of ethical issues that arise in the practice of nursing describes nursing ethics.

Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply.

• Trustworthiness • Compassion • Humility Trustworthiness, humility, and compassion are all examples of professional virtues, as well as cultivated dispositions of character and conduct, that motivate and enable us to be good human beings. Deception and conflict are negative traits that do not exemplify professional virtues.

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?

Integrity The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the nurse reported the occurrence of the missed medication to the charge nurse. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for self after discharge. Social justice is a concept of fair and just relations between the individual and society and is related to wealth and distribution of goods in a society. Autonomy is the right to self-determination or acting independently and making decisions.

A nurse knows that the expression "Do not cause harm" refers to which ethical principle?

Nonmaleficence Nonmaleficence is conducting procedures and interventions in a safe manner so that no harm is caused to the client. Justice is the idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Fidelity is demonstrated by continuing loyalty and support to a client. Beneficence requires that the procedure be provided with the intent of doing good for the client involved.

What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?

Peers Explanation: In adolescence, peer groups have a major influence on value formation. The attitudes, beliefs, and behaviors that grow out of peer group relationships are powerful. It is generally accepted that the influence of peers exceeds that of school administration, work life, or the awareness of other cultures during this developmental stage.

The nurse has an ethical conflict regarding the client's use of marijuana to control symptoms of advanced cancer. Which argument(s) regarding this conflict reflect a utilitarian approach? Select all that apply.

The client experiences significant reduction of cancer symptoms when using marijuana. The client is homebound and will not be driving. There is little opportunity for any other persons to divert or use the marijuana the client obtains. Explanation: Utilitarian arguments are those that determine rightness or wrongness of an action based on the action's consequences. In this case, that the client experiences reduction of symptoms, that the client will not be driving, and that there is little opportunity for diversion all reflect an utilitarian approach. Deontologic arguments are based on a rule such as legality or specific dosages.

Which action would cause a charge nurse to have concerns about a nurse's moral agency?

The nurse was seen at a grocery store after calling in sick. The only option with an ethical component possibility is the nurse being seen at the grocery store after calling in sick. It may be that the nurse had no other choice but to go to the grocery store, even if sick, but it would cause the charge nurse to be suspicious. The other options do not reflect an ethical issue because they did not lead to other unethical behaviors, just job performance issues.

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 about what matters; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death, as well as questions and concerns regarding quality of life as it relates to advanced technology.

Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?

Care-based ethics Central to the care-based approach to ethics is the nurse's relationships with clients and the nurse's "being," or character and identity. Deontology is the study of the nature of duty and obligation. Utilitarianism is the doctrine that actions are right if they are useful or for the benefit of a majority. Principle-based ethics prioritizes goals and principles that exist beyond the particularities of the nurse-client relationship.

Which example most accurately depicts the ethical principle of autonomy?

Describing a surgery to a client before the consent is signed Autonomy is the capacity to make an informed, uncoerced decision. Describing a surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision and thus an autonomous one. The nurse changing a dressing on a wound does not require the client to make an informed decision, nor does administering a morning dose of insulin or transporting a client.

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

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 in which the focus is on specific problems and concerns faced by women. The statement that "this happens to many women" is an example of a feminist approach. Paternalism is action limiting a person's or group's liberty or autonomy that is intended to promote their own good (e.g., if the nurse stated that "I must make all decisions about this client's care for her, as she's not in any shape to do so herself"). Values clarification is a self-assessment process that enables a person to discover the content and strength of the person's own system of values. An example of this would be if the nurse stated, "I feel bad for the client, as no one deserves this." Moralizing is to comment on issues of right and wrong, typically with an unfounded air of superiority. An example of this would be if the nurse stated, "If she was a good girl, this would have never happened to her."

A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying?

Laissez-faire Explanation: This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values independently and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn that which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.

A nurse working in a critical care unit has experienced personal tragedy, extreme shortage of staff in the work environment, and health issues. The nurse has overcome much of these hardships and is now mentoring other nurses in similar situations. What behavior is this nurse demonstrating?

Moral resilience Moral resilience is the developed capacity to respond well to morally distressing experiences and to emerge strong. This nurse has demonstrated that although life issues have been overwhelming, there is an emergence of strength and resilience. Moral distress occurs when you know the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Conscientious objection is the refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's personal and professional ethical beliefs and standards. There is not an ethical dilemma present between the nurse and the workplace.

Which is a characteristic of the care-based approach to bioethics?

The promotion of the dignity and respect of clients as people The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of clients as people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of the criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.

A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating:

advocacy. Advocacy is the protection and support of another person's rights. Nurses have always been strong client advocates, carefully evaluating the competing claims of the client's autonomy (self-determination) and well-being. Altruism is the principle and moral practice of concern for happiness of other human beings, resulting in a quality of life both material and spiritual. Justice is concerned with moral rightness and fairness. Confidentiality is keeping or one's personal information secret or private.

To practice ethically, the nurse should avoid:

allowing the nurse's own judgment to guide practice. Personal convictions apply only to situations and decisions pertaining to the individual. In ethical professional practice, nurses should avoid allowing personal judgments to bias their treatment of clients. It is appropriate for nurses to allow an ethics committee, past cases, and the views of clients and their families to guide nursing practice.