Unit I-E Ethics and Values objectives

Justice

You have discovered that your patient is going to be discharged today and they have been too embarrassed to tell anyone that once they get home they are not going to have reliable transportation to be able to make their doctor's appointments. You call the nurse doing the discharge coordination to work on helping the patient make transportation arrangements. Being fair

Autonomy

Your patient, after being informed, has decided she wants to wait on her surgery. You as the nurse don't necessarily agree with the patient but you support her right to make her own choice. Commitment to include patients in decisions

Define "code of ethics," and explain the uses and limitation of a professional code of ethics.

- A set of guiding principles that all members of a profession accept - Helps professional groups settle questions about practice or behavior. - Includes advocacy, responsibility, accountability, and confidentiality Limitations come when you have conflicting views on what the best treatment plan for the patient would be.

What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via a messaging tool in a social media site? 1. Yes, if you remove all patient identifiers before sending 2. No, because the patient's x-ray results should be discussed with a provider 3. Yes, because respect for autonomy means honoring this patient's request 4. No, because health information of any kind should not be shared on social media

Answer: 4. Patient information should not be shared over social media. While the patient does have a right to obtain health records, this is not the best mechanism by which to share the information. Even without specific identifiers, the information could be seen by others and attributed to the patient.

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 3. Develop and implement a plan to address the problem. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 6. Recognize that the problem requires ethics.

Answer: 6, 4, 5, 2, 1, 3. This order reflects a systematic approach to ethical problems, similar to the nursing process

Discuss the role of ethics in professional nursing.

It is the system of moral principles governing nursing conduct.

Explain a nursing perspective in ethics.

Nurses generally engage with patients over longer periods of time than other disciplines. Patients may feel more comfortable revealing information to nurses

Identify some common ethical issues that may be faced by health care professionals.

Quality of life: Central to discussions about end-oflife care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR) Disabilities: Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges Care at the end of life: interventions unlikely to produce benefit for the patient Health Care Reform: Facilitated access to care for millions of uninsured Americans

Identify and explain key steps in the resolution of an ethical dilemma.

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action. pg 300 BOX 22.3

Fidelity

The 86 year old you are caring for has been quite a handful this morning, she is very emotionally needy. You have been with her quite a bit this morning, however, you tell her you will check on her in a ½ hour. When you return in a ½ hour to ask how she's doing, she is surprised you returned. Agreement to keep promises

Nonmaleficence

The doctor has ordered Morphine 10mg IV to be given q2 hours to your patient who has been in severe pain. They have received 2 doses and are now quite lethargic and difficult to arouse. It is time for the 3rd dose and you decide to hold the dose. Avoidance of harm or hurt

example as Nurse as an Advocate

The protection of human and legal rights and the securing care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives.

Discuss the role of values in the study of ethics.

Value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Values clarification - Ethical dilemmas almost always occur in the presence of conflicting values. - To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion.

Beneficence

You are the nurse caring for 4 patients, 1 of those patients is verbally loud and demanding. As the nurse you have done your best to give all 4 of your patients the best care you could, even though you have been stress by the one patient. Taking positive actions to help others

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

Answer: 1, 2, and 4. Access to health care services can be justified through the application of the principles of justice, beneficence, respect for autonomy, and nonmaleficence. While option 3 is an opinion that can be justified with ethical analysis, no justification is offered in this statement, so this option is not correct. Option 5 again describes a point of view, but no ethical principles are described that support this view. Option 6 is incorrect because justice refers to fairness in the distribution of resources and basing access to medication only on income may not be fair

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

Answer: 1, 2, and 4. These statements describe why a single definition for the term quality of life is challenging. Options 3 and 5 are true statements, but they do not explain why the definition of quality of life is difficult to agree on, which is what the question asks for

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) 1. Ethics of care pays attention to the context in which caring occurs. 2. Ethics of care is used only by nurses because it is part of the Nursing Code of Ethics. 3. Ethics of care requires understanding the relationships between involved parties. 4. Ethics of care considers the decision maker's relationships with other involved parties. 5. Ethics of care is an approach that suggests a greater commitment to patient care. 6. Ethic of care considers the decision maker to be in a detached position outside the ethical problem

Answer: 1, 3, and 4. The ethics of care emphasizes attention to the context in which an ethical problem occurs and the relationships between involved parties, including relationships with the decision maker. No approach to ethical problems is exclusive to a single discipline, and no approach is superior to the others nor does any approach demonstrate a higher level of commitment to the patient, so options 2 and 5 are incorrect. Option 6 is true of principle-based approaches such as deontology but not true of the ethics of care.

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal views 4. To allow the patient and the physician private time to resolve the dilemma on the basis of ethical principles

Answer: 1. The ideal process for resolving ethical problems engages the perspectives of all involved, and nurses, as members of the health care team, have a valuable and unique point of view to share. Option 2 is a strategy that assists in answering a clinical question but does not address ethics. Options 3 and 4 are incorrect because both suggest that the nurse disengage from her own values and critical thinking and follow an action driven by the points of views of others.

The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.

Answer: 1. The principle of justice as it pertains to the distribution of health care resources is the ethical element present in option 1. Options 2, 3, and 4 are all potential strategies for assisting this patient, but they do not address the ethical elements of the case

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

Answer: 1d, 2c, 3a, 4b. Action 1 corresponds with option d. Preventing unnecessary access to a patient's health care information protects the patient's right to confidentiality. Action 2 corresponds to option c, accountability. Accountability refers to taking ownership of one's actions, which includes acknowledging errors. Action 3 corresponds to option a, advocacy. Sharing the patient's stated wish with other members of the health care team is an example of using your voice to benefit another person, in this case the patient. Action 4 corresponds with option b, responsibility. By following through on an established plan in caring for the patient, the nurse demonstrates responsibility.

When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for oversedation as a side effect of his pain medication

Answer: 2. Asking the patient to establish the goal for pain control is a demonstration of respect for autonomy. Assessing, monitoring, and using alternative measures are interventions that address pain but that are not necessarily grounded in the principle of autonomy

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable

Answer: 3. Deontology is an approach to ethics that identifies the correct action as that which is supported by fundamental principles and duties. The disadvantage of this approach is that its application relies on consensus around what the primary duties and principles are. Option 1 describes a limitation of the ethics of care. Option 2 describes a limitation of feminist ethics, while option 4 describes a limitation of utilitarianism.

Bringing the different points of view of the ethics committee members to agreement and harmony is referred to as collective ethics. A. True B. False

Answer: B Rationale: Building consensus brings different points of view to agreement and is an act of discovery in which "collective wisdom" guides a group to the best possible decision.

During the meeting the committee discusses ethical theories such as deontology. Which of the following terms are associated and mean that the value of something is determined by its usefulness? (Select all that apply.) A. Accountability B. Consequentialism C. Advocacy D. Teleology E. Utilitarianism

Answer: B, D, E Rationale: Consequentialism means that the main emphasis is on the outcome or consequence of the action. Teleology is the study of the end or final causes. Utilitarianism means that the value of something is determined by its usefulness and embodies the concepts of consequentialism and teleology

The committee evaluates the impact of relationships on health care. _____________ ethics looks to the nature of relationships to guide participants in making difficult decisions.

Answer: Feminist Rationale: Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible.

Define the role of the nurse as an advocate and be able to identify situations where the nurse is advocating for the patient/ patient family.

to protection of human and legal rights and the securing care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. Nurses are advocates for their patients in several critical ways. They are communicators, liaisons, educators, interpreters and caregivers. A career in nursing entails filling multiple roles while providing quality care and striving for healthy outcomes for all patients. Nurses are knowledgeable about a variety of resources, either within their communities or directly through healthcare organizations, that can assist patients who have difficulty paying for prescriptions and other healthcare services. Nurses can also advocate for their patients by assisting them with the research involved in cost savings. This can include comparing one drug over another or even communicating with physicians to find ways to lower costs.