Chapter 6 Values, Ethics, & Advocacy PrepU

A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?

Paternalism -Making a decision for a client who is confused to prevent an injury is an example of paternalism.

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.

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." -Being judgmental, as in the options about adoption, gonorrhea, and code-status, does not reflect the values desired in a nurse. Professional nurses do not assume that their personal values are more correct than those of their clients. Nurses are obligated, however; to provide health information such as recommending condom use and smoking cessation.

Which statement by the nurse is an example of deception?

"This injection of procaine will feel like a little pinch." -Telling a client that an injection of procaine will feel like a little pinch is not being truthful, and is defined as a deception.

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.

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.

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.

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.

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.

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.

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 is managing the care for a postoperative client. How does the nurse demonstrate advocacy?

Limiting visitors due to the client reporting pain -Advocating for clients is a nursing responsibility and is performed with the best interest and welfare of the client in providing safe, competent, and comforting care. Limiting visitors is an example of advocacy. The nurse recognizes that the client is in pain; therefore, limiting the visitors allows for the nurse to advocate for additional measures to allow the client to rest and recover.

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.

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.

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.

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. -Advocacy is the protection and support of another's rights. If the nurse values client advocacy, the nurse would give priority to the good of the individual client rather than to the good of society in general.

A client rings the call bell to request pain medication. On performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. After a few moments, the nurse returns with the pain medication. The nurse's returning with the pain medication is an example of which principle of bioethics?

Fidelity -Fidelity is keeping one's promises and never abandoning a client entrusted to one's care without first providing for the client's needs.

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. -One reason an ethics committee convenes is when a client is unable to make an end-of-life decision and the family cannot come to a consensus. In this case, the committee members are there to advocate for the best interest of the client and to promote shared decision making between the client (or surrogates, if the client is legally incapacitated) and the clinicians. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.

Which nursing situation is an example of an ethical dilemma?

Deciding whether to perform cardiac compressions against a client's wishes -An ethical dilemma occurs when it is difficult for a decision to be made due to competing ethical principles. If there is no signed do not resuscitate order, then legally cardiac compressions must be started; however, if this is against the client's wishes, the nurse must weigh the ethical principles of beneficence and complying with the law against the ethical principle of autonomy.

Which nursing situations are examples of the care-based approach to ethics? Select all that apply.

Holding the hand of a dying client Providing a back rub to a client on bed rest Involving the parent in the bed bath of a child -Nursing interventions related to care and the client demonstrate a care-based approach. Holding the hand of a dying client, providing a back rub, and involving the parents are all examples of a care-based approach. Documenting care provided in the electronic health record is not care-based but part of everyday responsibilities of the nurse. Taking a week of vacation is a personal intervention and not related to the care of a client.

A hospital owned by a Catholic order of nuns will not allow tubal ligations to be performed. This is considered to be:

Institutional policy -Institutional policies are guidelines developed by health care institutions to direct professional practice. In this scenario, it may also likely reflect the personal morality and values of the institution's personnel as it is run by a religious group.

A nurse states to the client that the nurse will keep the client free of pain. However, the client's family wishes to try a treatment to prolong the client's life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle?

Fidelity -In this case, the nurse's promise to keep the client pain-free is the best example of the principle of fidelity means being faithful to one's commitments and promises.

A hospice nurse is caring for a client with terminal cancer. The family would like the client to continue aggressive therapy to treat the cancer, but the client has voiced to the nurse that no further pursuit of treatment is desired. The nurse speaks to the family about the client's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation?

Ethical principles -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. In this case, the nurse is practicing the ethical principle of autonomy, which is the client's right to self-determination related to choices about care. The nurse's action is not primarily motivated by legal responsibility, nursing education principles, or advanced practice licensure guidelines.

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 healthcare provider -Accountability means that when an error occurs, the nurse takes the proper actions to address it. In this instance, the nurse should fill out an occurrence form for follow-up and notify the provider, as the error may change outcomes in the client's condition. Administering the missed medications with the other evening medications may double up the dose or cause unexpected adverse effects with the other medications. Telling the client that the medication will be administered the following day is not acceptable, as the nurse is suggesting next actions without the provider's knowledge. Documenting in the chart in a narrative about the occurrence does not allow for the health care provider to be notified and aware of a change in the client's condition.

A nursing student is preparing for the first time to insert an indwelling catheter in a client. The client asks the student if he or she has have performed the procedure before. What is the best response by the student?

"I have practiced the skill in the lab and my instructor will be present during the procedure." -The student should be honest with the client and not practice deception by stating that he or she has performed the procedure before. The student cannot commit to the client that there will be no issues with the procedures. Portraying confidence is important for the client to feel comfortable with a student performing a procedure for the first time and telling the client that he or she is nervous would not inspire that confidence.

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." -While all of these answers have some merit, the best is to remind the nurse that life-long learning is an expectation of nursing and is part of the American Nurses Association Code for Nurses.

The nurse has been educating a young adult client about living with type 1 diabetes and the importance of adhering to a strict dietary regimen. The client is repeatedly admitted and is not following the prescribed plan. What statement made by the nurse may facilitate values clarification for the client?

"Rank the three most important things in your life." -To facilitate values clarification for this client, first help the client identify basic values and what is most important in the client's life. Having the client complete ranking of important things in life can help the client prioritize when the client is placing low value on health and health behaviors.

Which statement regarding the Code of Ethics for Nurses is most accurate?

"The code is an expression of nursing's own understanding of its commitment to society." -The Code of Ethics for Nurses provides nurses with a nonnegotiable statement of the ethical obligations of individuals who enter the nursing profession. It serves as an expression of nursing's own understanding of its commitment to society.

A nurse is caring for a client who is a practicing Jehovah's Witness. The health care provider prescribes two units of packed red blood cells based on the client's low hemoglobin and hematocrit levels. The nurse states to the health care provider that it is unethical to go against the client's beliefs even though the client's blood counts are very low. What is the best description of the nurse's intentions?

Acting in the client's best interest -Nurses' ethical obligations include acting in the best interest of their clients, not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large. In this case, the nurse is aware of the client's belief that it is wrong to receive a blood transfusion and acts to protect the right of the client to self-determination in care, thus acting in the client's best interest.

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.

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 -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 aged 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. The nurse communicates the client's wish to the family and health care team. This is an example of what ethical principle?

Autonomy -Autonomy is the ethical principle of respecting the right of clients to make their own decisions about their health care.

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.

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 client who experienced a cesarean birth rates pain as a 9 on a 10-point scale. The nurse medicates the client for pain. This is an example of the nurse practicing which ethical principle?

Beneficence -Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good.

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 -Daily living is expressed in many traditions and customs; understanding these differences is cultural value orientation. Because it is primarily culture that determines a society's values, cultural factors best explain the differences in values between these two countries. Although economic, spiritual, and ethical factors may be involved in value formation, a society's value system is most influenced by culture.

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.

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.

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.

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value?

Integrity -The nurse is demonstrating integrity, which is defined as acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity.

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.

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

Peers -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.

A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibilities as being fundamental? Select all that apply.

Promoting health Preventing illness Restoring health Alleviating suffering -According to the ICN Code of Ethics, nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering.

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. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?

Shared -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.

Which nursing action(s) best demonstrate the ethical principle of autonomy? Select all that apply.

The nurse documents that a client refused a new medication. The nurse checks to ensure an informed consent document is signed prior to transferring the client for a surgical procedure. -Autonomy is respect for the client's right to make health care decisions. Informed consent and right to refuse medications are a part of autonomy.

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.

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.