CH4 Ethical issues

25. Which activity best demonstrates a nursing unit manager's attention to the ethics standards of practice required of that position? A) Membership on the institution's ethic board B) Terminates a staff member for absenteeism C) Assures staff and patients that unit decisions are ethically sound D) Holds membership in the local and state American Nurses Association (ANA)

Ans: A Feedback: ANA standards for ethics related to nurse administrators identifies participants on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes as a criteria measurement. The remaining options while addressing ethical behaviors on the administrator's part are not as directly identified by the ANA.

What does the morale principle of autonomy govern? A) A person's right to make his or her own decision B) The obligation to do good and prevent harm C) Doing what is right and fair D) Truth telling

Ans: A Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for one's choice. None of the other options addresses this concept.

Collecting data about the ethical problem and identifying who should be involved in the decision-making process is accomplished in which phase of the MORAL decisionmaking model? A) Massage the dilemma B) Outline options C) Review criteria and resolve D) Affirm position and act

Ans: A Feedback: Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. Outline options: Identify alternatives, and analyze the causes and consequences of each. Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. Affirm position and act: Develop the implementation strategy.

There are many terms used to describe moral issues faced by nurses, including moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which statement describes how moral uncertainty occurs? A) Occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is B) Occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action C) Occurs when an individual witnesses the immoral act of another but feels powerless to stop it D) Occurs when being forced to choose between two or more undesirable alternatives

Ans: A Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives.

Which factor should be considered when assessing the quality of ethical problem solving? Select all that apply. A) Outcomes B) Decision-making process C) Multiple alternatives D) Data gathering

Ans: A, B Feedback: Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving, because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. If a structured approach to problem solving is used, multiple alternatives are analyzed, and data gathering is adequate, then, regardless of the outcome, the manager should feel comfortable that the best possible decision was made at that time with the information and resources available. The satisfaction of the involved parties is not a reliable factor.

Which characteristic of an organization has influence on the ethical decisions its managers' make? Select all that apply. A) Purpose B) Societal role C) Societal constraints D) Values

Ans: A, B, C Feedback: The manager's ethical obligation is tied to the organization's purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps to define the purposes of various institutions, and the purposes, in turn, help to ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. The organization's societal status should not be considered when making ethical decisions.

Which statement concerning autonomy and the employee is true? Select all that apply. A) It is a form of personal liberty B) Its legal equivalent is self determination C) It is based on a person's right to make a choice D) It is supported by the process of progressive employee discipline

Ans: A, B, C, D Feedback: A form of personal liberty, autonomy is also called freedom of choice or accepting the responsibility for one's choice. The legal right of self-determination supports this moral principle. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has the choice to meet organizational expectations or to be disciplined further. If the employee's continued behavior warrants termination, the principle of autonomy says that the employee has made the choice to be terminated by virtue of his or her actions, not by that of the manager. Therefore, nurse-managers must be cognizant of the ethical component present whenever an individual's decisional capacity is in question. To take away a person's right to self-determination is a serious but sometimes necessary action.

To make appropriate ethical decisions the nurse-manager must have knowledge of what items to assist in making decisions? Select all that apply: 1, 2, 3, 4. A) Organizational processes 1, 2 B) Proven decision-making models 1, 2, and 3 C) Professional approach that eliminates trial and error D) Ethical principles and frameworks

Ans: A, B, C, D Feedback: To make appropriate ethical decisions then, the manager must have knowledge of ethical principles and frameworks, use a professional approach that eliminates trial and error and focuses on proven decision-making models, and use available organizational processes to assist in making such decisions. Knowledge of the involved parties' wishes is not a focus of the decision-making process.

Which term is used to identify a person's feelings of powerlessness to stop unethical behavior in another person or institution? A) Moral conflict B) Moral outrage C) Ethical relativism D) Ethical universalism

Ans: B Feedback: Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture. Ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences

Which member of the health-care team is often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting wants and goals? A) Physicians B) Nurses C) Nurse practitioners D) Social workers

Ans: B Feedback: Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. The nature of the patient contact of a nurse is more direct and involves more time than the other members of the health-care team.

What is the role of the American Nurses Association Code of Ethics and Interpretive Statements? A) Outlines minimum levels of ethical behavior that nurses must maintain B) Functions as a guide to the highest standards of ethical practice for nurses C) Is a legally binding document that directs a nurse's ethical and moral behavior D) Mandates the ethical behavior prerequisite for maintaining a nursing licensure

Ans: B Feedback: The ANA Code of Ethics outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse in order to achieve and maintain the highest standards. The document is not legally binding nor is it a mandate of behavior.

Which ethical framework would most likely be used to arrive at the nurse's decision to work overtime in spite of previous social plans? A) Utilitarianism B) Duty based C) Rights based D) Intuitionism

Ans: B Feedback: The duty framework says that some things should be done just because there is a duty to do them or refrain from doing them. Utilitarianism states that the good of the many outweighs the wants or needs of the individual. The remaining options are not relevant to the situation.

Protecting patient confidentiality respects the client's right to A) self-esteem B) self-defense C) self-determination D) self-incrimination

Ans: C Feedback: Confidentiality is a foundation of both medical and nursing ethics, and it respects the client's right to self-determination. While the other options are worthy of respect, they are not associated with confidentiality.

Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A) Ethical controls are clearer and philosophically impartial B) Ethical controls are much clearer and individualized C) Legal controls are clearer and philosophically impartial D) Legal controls are much less clear and individualized

Ans: C Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.

Which statement regarding the MORAL decision-making model is true? A) It is a problem-solving model B) It does not include an evaluation step C) The identification and analysis of multiple alternatives for action is required D) The decision is arrived upon with only the involvement of the decision maker

Ans: C Feedback: MORAL is a decision-making model that is useful in clarifying ethical problems, and it requires the identification and analysis of multiple alternatives for action. The other options are not true statements regarding this decision-making model.

Which ethical principle associated with an adult child is legally given the right to make medical decisions for a cognitively impaired parent? A) Justice B) Fidelity C) Paternalism D) Beneficence

Ans: C Feedback: Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat ìequalsî equally, and treat ìunequalsî according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good.

Much of the difficulty people have in making ethical decisions results from a lack of formal education about problem solving. Research at the University of Pennsylvania found what percentage of the nurses and social workers reported having no ethics training? A) 15 B) 20 C) 25 D) 30

Ans: C Feedback: Research done at the University of Pennsylvania found that nearly 25% of the nurses and social workers reported having received no ethics training.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a leadership role? A) Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramifications B) Identifies outcomes in ethical decision making that should always be sought or avoided C) Uses established ethical frameworks to clarify values and beliefs D) Role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard

Ans: D Feedback: A leadership role is role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard. Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramification, identifies outcomes in ethical decision making that should always be sought or avoided, and uses established ethical frameworks to clarify values and beliefs are examples of management functions.

Which statement regarding ethical decision making is true? A) Outcomes are the basic criterion for evaluating ethical decision making B) Only desirable alternatives are identified when solving ethical dilemmas C) Critical ethical decisions are made quickly so the situation does not worsen D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Ans: D Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. The remaining options are not true statements regarding the ethical decision-making process.

Which statement best describes ethics? A) How our lives and relationships are led in our reality B) How people make decisions they see as legally and morally appropriate C) The conflict, power, and interdependency associated with the way we live D) What our conduct and actions should be regarding what is right and good

Ans: D Feedback: Ethics is the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are.

Which ethical framework involves an individualized decision-making framework? A) Duty based B) Rights based C) Utilitarian D) Intuitionist

Ans: D Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of people. Duty based is a duty to do something to refrain from doing something. Rightsbased individuals have basic inherent rights that should not be interfered with.

The practice of allocating organs for transplantation based on a person's ìworth to societyî is an example of what ethical principle for decision making? A) Autonomy B) Beneficence C) Utility D) Justice

Ans: D Feedback: Justice: Seek fairness, treat ìequalsî equally, and treat ìunequalsî according to their differences. Autonomy: Promotes self-determination and freedom of choice. Beneficence: Actions are taken in an effort to promote good. Utility: The good of the many outweighs the wants or needs of the individual.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a management function? A) Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision making C) Accepts that negative outcomes occur in ethical decision making despite highquality problem solving and decision making D) Identifies outcomes in ethical decision making that should always be sought or avoided

Ans: D Feedback: Management function identifies outcomes in ethical decision making that should always be sought or avoided. Leadership roles include the following: Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings; accepts that some ambiguity and uncertainty must be a part of all ethical decision making; accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making

What is an ethical dilemma? A) A problem that can be solved using empirical data B) A situation that has clearly delineated facts for decision making C) A problem that when handled effectively has a mutually agreed-upon solution D) A situation that requires choosing between two or more undesirable alternatives

Ans: D Feedback: The most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives. The problem is not generally solved with a solution that is mutually satisfying nor does it lend itself to empirical or delineated facts.

The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect? A) Unethical conduct B) Maleficence C) Paternalism D) Utility

Ans: D Feedback: The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficence behavior on the part of the insurance company. Paternalism would be characterized by the insurance company making treatment decision without the patient having input.