Chapter 06: Values, Ethics, and Advocacy
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? -Legal obligation -Ethical principle -Professional value -Personal moral
Personal moral Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 103.
A parent teaches a child not to drink and drive; however, the parent does drink and drive. This action results in: -insecurity and a lack of safety. -conflict with society. -a failure to model one's own values. -a disruption in consistency.
a failure to model one's own values. Explanation: Many role models fail to model their own values and, as a result, cause conflict with and confusion in those who look up to them, such as children (not society, in general). The primary result of this action, which is saying one thing and doing another, is not so much insecurity and a lack of safety or a disruption in consistency as it is a failure to reflect one's own values. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 100.
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. -"If you are going to have extramarital sex, please protect yourself by using a condom." -"I can't believe the client is giving that precious infant 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." -"Smoking has been shown to be a risk for many illnesses, including heart disease and cancer."
"I can't believe the client is giving that precious infant 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." Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 100.
Which is a characteristic of the care-based approach to bioethics? -The need for an orientation toward service -The promotion of the dignity and respect of clients as people -The rightness or wrongness of an action independent of its consequences -The need to emphasize the relevance of clinical experience
The promotion of the dignity and respect of clients as people Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Nurses who value client advocacy follow what guideline? -They choose the claims of the client's well-being over the claims of the client's autonomy. -They give priority to the good of the individual client rather than to the good of society in general. -They value their loyalty to an employing institution or to a colleague over their commitment to their clients. -They make decisions for clients who are uninformed concerning their rights and opportunities.
They give priority to the good of the individual client rather than to the good of society in general. Explanation: 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. The nurse would not be demonstrating advocacy if the nurse values the loyalty to an employing institution or to a colleague over the commitment to the client. The nurse demonstrating client advocacy would not choose the claims of the client's well-being over the claims of the client's autonomy. The nurse would not make decisions for clients who are uninformed concerning the client's rights and opportunities. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
An older female client has just informed her family that she does not want to have surgery if the biopsy on a lung mass shows malignancy. Which statement(s), made by family members, violate the concept of feminist ethics? Select all that apply. -"Daddy will want you to have the surgery." -"If it was me who was sick, you would want me to have the surgery." -"Let's find out what your options are before making any decisions." -"Of course you would have the surgery." -"You need to do what the doctor thinks is best for you."
"Of course you would have the surgery." "Daddy will want you to have the surgery." "You need to do what the doctor thinks is best for you." "If it was me who was sick, you would want me to have the surgery." Feminist ethics reflects a full commitment to full personhood for marginalized persons. Older adults, especially older females, are often marginalized. The family may wish to learn about the tumor and need for treatment prior to helping their mother make this decision. The other options infer that the woman is not able to make her own decisions about treatment. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Which statement by the nurse is an example of deception? -"I will administer your pain medication as soon as it is due." -"This injection of procaine will feel like a little pinch." -"I am going to teach you how to give yourself insulin." -"It is important to get out of bed to prevent pneumonia."
"This injection of procaine will feel like a little pinch." Explanation: Telling a client that an injection of procaine will feel like a little pinch is not being truthful, and is defined as a deception. Telling a client that pain medicine will be administered when it is time is being truthful. Telling a client to get out of bed also supports a nursing intervention. Teaching a client how to give an injection is important for the client to take care of himself or herself. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
Which ethical principle refers to the obligation to do good? -Beneficence -Fidelity -Nonmaleficence -Veracity
Beneficence Explanation: 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; however, there will be times when the action may cause "harm" to promote the "good" such as chemotherapy being used to treat and eliminate cancer, but it causes various adverse effects while trying to reach the ultimate goal.. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 102.
When examining values, a nurse notes that one country allows assisted suicide and another outlaws it, making it punishable by imprisonment. Which factors best explain the differences in values between these two countries? -Ethical -Spiritual -Cultural -Economic
Cultural Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 110.
A nurse learns to adopt behavior modeled by a charge nurse. What ethical principle or behavior is the nurse most likely to learn through this process? -Standards of practice -Ethical conduct -Decision making -Autonomy
Ethical conduct Explanation: By adopting the professional behavior of the charge nurse, the nurse learns appropriate ethical conduct. Standards of practice are specific, official statements established by an organization to guide practice in a profession; they are not learned by adopting the behaviors modeled by one person. Autonomy relates to respecting the right of another person to make one's own decisions. The nurse is not learning this principle in this scenario. Decision making is the thought process of selecting a logical choice from the available options. The nurse is not choosing from a variety of options in this scenario. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
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? -Advanced practice licensure guidelines -Legal responsibilities -Nursing education principles -Ethical principles
Ethical principles Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 102-103.
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 -Altruism -Human dignity -Social justice
Integrity Explanation: 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. Altruism is a concern for the welfare and being of others. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
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. -Depend on the charge nurse to handle the issue from this point. -Inform the family that the ethical issue has been reported. -Report the issue to the hospital medical director.
Monitor for resolution of the problem. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 114.
What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage? -School administration -Awareness of other cultures -Work -Peers
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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 98.
A client continues to complain of pain despite receiving medication. The family states, "In our culture it is acceptable to complain out loud." What would be the best response by the nurse? -The pain medication should have worked by now. -Describe your home situation to me. -Tell me more about your cultural beliefs. -It is fine to complain out loud.
Tell me more about your cultural beliefs. Explanation: It is important for the nurse to learn about how culture affects the client's behavior. Asking the client to explain the client's cultural beliefs will help the nurse to use a care-based approach. Stating that the medication should have worked or stating that it is fine to complain out loud are not examples of a care-based approach. Also, describing the home situation would not be helpful in this instance. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
Which is the best definition of ethics? -The adherence to formal personal values -The informal, systematic study of moral beliefs -The formal, systematic study of moral beliefs -The adherence to informal personal values
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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 102.
Which action would cause a charge nurse to have concerns about a nurse's moral agency? -The nurse often must stay after shift change to complete documentation. -A family member complained that the nurse was slow answering call lights. -The nurse was seen at a grocery store after calling in sick. -The nurse was unable to pass a required dosage calculation examination.
The nurse was seen at a grocery store after calling in sick. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
Which statements indicate a correct understanding of the tenets of the Code of Ethics for Nurses? Select all that apply. -The nurse has the right to fair compensation for the workload. -The nurse is active in developing a core of research-based principles. -The nurse participates in the advancement of the profession. -The nurse maintains standards of personal conduct. -The nurse holds personal information as confidential.
-The nurse maintains standards of personal conduct. -The nurse is active in developing a core of research-based principles. -The nurse holds personal information as confidential. Explanation: The ANA Code of Ethics states: "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." Standards of personal conduct, developing research, and confidentiality are all tenets of the Code of Ethics for Nurses. Fair compensation and participation in the advancement of the profession are related to the Bill of Rights for Registered Nurses, not the Code of Ethics for Nurses. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 105-106.
Which best defines value clarification? -A process by which people come to understand their own values and value systems -A systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct -An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct -A belief about the worth of something, about what matters, that acts as a standard to guide one's behavior
A process by which people come to understand their own values and value systems Explanation: Value clarification is a process by which people come to understand their own values and value systems. A value is a belief about the worth of something, about what matters, that acts as a standard to guide one's behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. Ethics is a systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
Which scenario is an example of the laissez-faire approach to value transmission? -Teaching children right from wrong and telling them the reason behind a bad action -Telling a child an injection will feel like a pinch before the nurse gives the injection -Allowing a child to decide not to have an intravenous line inserted - Modeling healthy behaviors for adolescents, such as not smoking electronic cigarettes
Allowing a child to decide not to have an intravenous line inserted Explanation: 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 adolescents good behavior. Telling the child about the injection feeling like a pinch is not an approach to value transmission. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 100.
Which example best describes feminist ethics? -Attention directed 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 -A combination of elements of utilitarian and deontologic theories that offer specific action guidelines for practice -An approach critiquing existing patterns of oppression and domination in society
An approach critiquing existing patterns of oppression and domination in society Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
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? -Confidentiality -Justice -Beneficence -Autonomy
Autonomy Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing? -Deontology -Principle-based ethics -Care-based ethics -Utilitarianism
Care-based ethics Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Which example most accurately depicts the ethical principle of autonomy? -Describing a surgery to a client before the consent is signed -Transporting a client to a scheduled physical therapy appointment -Changing a dressing on a wound as needed -Administering a morning dose of insulin before breakfast
Describing a surgery to a client before the consent is signed Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 101-104.
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? -Implementing -Planning -Diagnosing -Evaluating
Evaluating Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 108.
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? -Justice -Fidelity -Autonomy -Nonmaleficence
Fidelity Explanation: Fidelity is keeping one's promises and never abandoning a client entrusted to one's care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make healthcare decisions. Nonmaleficence is preventing harm from being done to a client. Justice involves meeting the needs of each client equitably and acting fairly. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 103.
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? -Autonomy -Social justice -Altruism -Integrity
Integrity Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards? -World Health Organization -Canadian Hospital Association -International Council of Nurses -Department of Health Professions
International Council of Nurses Explanation: The American Nurses Association Code of Ethics for Nurses is the main source of the ethical principles that nurses must follow, and this is developed by the International Council of Nurses. The Canadian Hospital Association has not developed standards of ethical practice. Individual state boards of nursing through the department of health professions have laws and regulations that guide practice but not ethical and moral principles. The World Health Organization is a large organization that does not determine ethical practice for nurses. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy? -Limiting visitors due to the client reporting pain -Turning and positioning the client every 4 hours -Changing the channel on the television while providing care -Administering pain medication when the pain level reaches 9 on a pain scale of 0 to 10
Limiting visitors due to the client reporting pain Explanation: 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. Administering pain medication and turning and the client every 4 hours are important and necessary interventions for a postoperative client, but this is not advocacy. Changing the channel on the television while providing care also does not promote advocacy. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 112.
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle? -Paternalism -Confidentiality -Deception -Conflict
Paternalism Explanation: Making a decision for a client who is confused to prevent an injury is an example of paternalism. Deception occurs when the true nature or reason is concealed and the client is deprived of basic human rights. Confidentiality requires a health care provider to keep a client's personal health information private unless consent to release the information is provided by the client. Conflict is a disagreement or argument and does not represent the example in this question. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 110.
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? -Client sovereignty -Shared -Paternalistic -Clinical
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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Ethically Relevant Considerations, p. 108.
When analyzing an ethical dilemma according to the ethical framework, what is most important for the nurse to take into consideration? -The relationship between law and values -Standards of conduct -Conflict between competing priorities -Decision-making
Standards of conduct Explanation: Ethics is the branch of philosophy dealing with standards of conduct and moral judgment. It does not directly address law. It includes, but is not limited to, decision-making and competing priorities. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 102.
A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for clients in a long-term care facility. Which nursing action(s) exemplify this principle? Select all that apply. -The nurse follows "medication rights" when administering medicine to clients. -The nurse acts fairly when allocating time and resources to clients. -The nurse performs regular client assessments for pressure injuries. -The nurse keeps promises to provide diligent care to clients. -The nurse provides information to clients to help them make decisions about treatment options. -The nurse arranges for hospice for a client who is terminally ill.
The nurse performs regular client assessments for pressure injuries. The nurse follows "medication rights" when administering medicine to clients. Explanation: The concept of nonmaleficence refers to the avoidance of causing harm. Examples of nonmaleficence include the nurse performing regular client assessments for pressure injuries. Nonmaleficence would also include the nurse following "medication rights" when administering medicine to clients. Providing information to clients to help them make decisions about treatment options demonstrates the ethical principle of autonomy. Arranging for hospice care for a client who is terminally ill demonstrates the ethical principle of beneficence. Keeping promises to provide diligent care demonstrates the ethical principle of fidelity. Acting fairly when allocating time and resources demonstrates the ethical principle of justice. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 103-104-116.
To practice ethically, the nurse should avoid: -allowing the nurse's own personal judgment to guide practice. -reviewing past cases before making decisions about practice. -asking the client's family about their views on caring. -allowing an ethics committee to guide the nurse's practice.
allowing the nurse's own personal judgment to guide practice. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 103.
The foundation for decisions about resource allocation throughout a society or group is based on the ethical principle of: -veracity. -autonomy. -justice. -confidentiality.
justice. Explanation: Justice is the foundation for decisions about ethical resource allocation throughout a society or group, because resources must be allocated fairly and equitably. The other ethical principles listed, veracity, autonomy, and confidentiality, have no direct application to resource allocation within society. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Ethical distress is: -being aware of the principles of right and wrong. -having trouble deciding which of two conflicting ethical principles to follow. -supporting the rights of a client during hospitalization. -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. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 116.
What would be an example of the nurse practicing fidelity? The nurse: -stays with a client during death as promised. -withholds information as requested. -provides continuity of care. -regulates visitors.
stays with a client during death as promised. Explanation: Fidelity requires the nurse to keep promises made and to be faithful to one's commitments. Regulating visitors is a demonstration of the value of privacy. Withholding client's information as requested is an example of maintaining confidentiality. Providing continuity of care is an example of integrity and professionalism. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Which nursing action demonstrates the principle of fidelity? -Treating an uninsured client in the emergency department -Administering a vaccination -Witnessing a client signature on an informed consent -Filing an incident report after making a medication error
Filing an incident report after making a medication error Explanation: Fidelity means being faithful to work-related commitments and obligations. The ethical principle is best demonstrated by the nurse following the employer's policies by completing the incident report following a medication error. Administering vaccines is an example of beneficence; treating an uninsured client in the emergency department is an example of justice; witnessing a client signature on an informed consent is autonomy. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. -Conflict -Compassion -Deception -Trustworthiness -Humility
Trustworthiness Humility Compassion Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
An older adult was just diagnosed with stage 4 pancreatic cancer. The client states, "I am so overwhelmed and I feel like everyone has already decided that I need to be put in hospice care." Complete the following sentence by choosing from the lists of options. The nurse upholds the principle of autonomy by -administering antipyretics for fever -providing emotional support -offering to answer questions the client may have about care and treatment options AND -sharing the plan of care only to the health care personnel assigned to the client -providing the client with the information needed to obtain a second opinion -obtaining routine vital signs
offering to answer questions the client may have about care and treatment options and providing the client with the information needed to obtain a second opinion Explanation: The principle of autonomy upholds the client's right to self-determination; that is, respecting the client's right to make informed decisions about their care. Offering to answer questions pertaining to the client's care options provides the client with the opportunity to make informed decisions. Autonomy is one of the six foundational principles of ethical practice and refers to a competent person's right to make their own choices without intimidation or influence. The nurse can provide the client with the additional provider options because it is the client's right to seek a second opinion. Providing emotional support and administering antipyretics for fever are acts of goodness; thus, they uphold the principle of beneficence. Obtainig routine vital signs is a part of the nurse's responsibilty. It is a means of fulfilling one's commitment to the client; therefore, it fosters the principle of fidelity. The principle of confidentilaity is upheld when the nurse shares pertinent information only to those directly assigned to care for the client. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Table 6-1 Professional Values, p. 101.
Socialization into the nursing profession may have the most significant effect on: -planning. -documentation. -values. -roles.
values. Explanation: Socialization into a culture refers not only to the adoption of practices, such as documentation and planning, and ways of relating to one another (roles) but to the very beliefs that one holds to be most important (values). Because values guide one's practices and roles, the most significant effect of socialization into nursing would be its effect on values. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 98.
Nursing practice consistent with the Code of Ethics for Nurses includes which actions? Select all that apply. -Assuming responsibility for care with limited collaboration with other healthcare professionals -Empathizing with clients and establishing friendships when appropriate -Protecting the client's right to confidentiality and privacy -Acknowledging that the client is the focus and center of care and remains a part of the treatment team -Delivering culturally safe care
-Delivering culturally safe care -Acknowledging that the client is the focus and center of care and remains a part of the treatment team -Protecting the client's right to confidentiality and privacy Nurses should always deliver culturally safe care, as well as protect the client's right to confidentiality and privacy in healthcare settings. Nurses also should put the client at the center of care and incorporate the client as a part of the healthcare team. As such, nurses must collaborate closely with other members of the healthcare team and include all healthcare professionals caring for the client. Nurses should not cross professional boundaries with their clients by establishing friendships. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
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 which continuing education offerings to take -Deciding when to stop cardiopulmonary resuscitation (CPR) on a client in cardiac arrest
-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 Explanation: There are four basic ethical principles that guide nursing practice: autonomy, nonmaleficence, beneficence, and justice. Many nurses add fidelity, veracity, accountability, privacy, and confidentiality to this list because they play a central role in the tradition of nursing (and medical) ethics and guide the behavior of health care professionals toward clients and their families. End-of-life and CPR decisions often involve the ethical principles of autonomy and nonmaleficence. Allocation of resources in light of budgetary constraints involves the ethical principle of justice. A breach in confidentiality involves the ethical principles of confidentiality and privacy. A nurse's choice of continuing education is not an ethical issue. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 103.
A famous actor with bipolar disorder has been admitted in the mental health unit for treatment. A well known news outlet has offered the nurse several thousand dollars to provide information or a picture of the client. The nurse knows that it is their professional duty and legal responsibility to uphold privacy and confidentiality. For each of the behaviors exhibited by the nurse below, state whether the behavior upholds the principle of privacy or confidentiality. -sharing client information only to the caregivers directly assigned to client care -logging off the electronic health record after documenting assessment information -keeping the door closed while conducting physical assessment -obtaining the client's permission before allowing a student nurse to assist with care -asking the client to sign a medical release form before providing information to the health insurance company
-sharing client information only to the caregivers directly assigned to client care (confidentiality) -logging off the electronic health record after documenting assessment information (confidentiality) -keeping the door closed while conducting physical assessment (privacy) -obtaining the client's permission before allowing a student nurse to assist with care (privacy) -asking the client to sign a medical release form before providing information to the health insurance company (confidentiality) Explanation: Privacy requires the nurse to utilize client information appropriately; that is, limiting access to client information to activities that are only directly related to health care. Upholding privacy includes keeping the door closed while conducting physical assessment and obtaining the client's consent before allowing a student nurse to assist with care. Confidentiality involves protecting client health information from public disclosure. Client information should only be shared with health personnel directly involved in the client's care. This includes controlled access to electronic health records; therefore, the nurse should log off the electronic health record after documenting to avoid unauthorized access to the client's information. If client information needs to be divulged, the nurse should first obtain the client's written permission. An example of this is asking the client to sign a medical release form before providing information to the health insurance. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Examples of Ethical Problems, p. 110.
Which word is best described as protection and support of another's rights? -Autonomy -Paternalism -Ethics -Advocacy
Advocacy Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 112.
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? -Avoiding treating the client so as to not do any additional harm -Filing the paperwork for the client to receive retroactive health insurance -Telling the client honest information about the client's medical condition and prognosis -Airlifting the client to a local trauma center for emergency surgery
Airlifting the client to a local trauma center for emergency surgery Explanation: 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 being 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). Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 99-102-103.
A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply. -A boy is taken for ice cream to celebrate his good report card. -An adolescent boy explores religions of friends in hopes of developing his own faith. -Before meals, a boy says a prayer that he learned from his parents. -An adolescent girl tries alcohol at a party with her friends. -An adolescent girl is punished for staying out too late with her friends. -A boy is taught how to behave in public by his schoolteacher.
An adolescent boy explores religions of friends in hopes of developing his own faith. An adolescent girl tries alcohol at a party with her friends. Explanation: The laissez-faire approach to discipline would leave children to explore values on their own and to develop a personal value system from this exploration. This approach often involves little or no parental guidance, and may lead to confusion and conflict for the child. Examples of this form of discipline would be an adolescent girl trying alcohol at a party with her friends and an adolescent boy exploring religions of friends in hopes of developing his own faith. A child reciting a prayer learned by the parents would not be an example of this method. A child being taken for ice cream to celebrate would not be an example of this method. A child taught how to behave by the school teacher is not an example. An adolescent being punished by the parents for breaking curfew is not an example. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 100.
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? -Decide the care for a client who is unable to voice an opinion. -Assist in decision making based on the client's best interests. -Present options about the type of care. -Convince the family to choose a specific course of action.
Assist in decision making based on the client's best interests. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 111.
Which ethical principle is related to the idea of self-determination? -Confidentiality -Nonmaleficence -Beneficence -Autonomy
Autonomy Explanation: Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make healthcare decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
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? -Fidelity -Autonomy -Justice -Beneficence
Autonomy Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Promoting Self-Determination, pp. 101-104.
Which nursing situation is an example of an ethical dilemma? -Administering pain medication as ordered -Discussing care of a comatose client with the family -Transferring a client to a step-down unit -Deciding whether to perform cardiac compressions against a client's wishes
Deciding whether to perform cardiac compressions against a client's wishes Explanation: 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. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope of nursing practice. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 113.
Which statement best conveys the concept of ethical agency? -Individuals who enter the nursing profession often innately possess ethical characteristics. -A nurse's understanding and execution of ethical practice is primarily a result of increased years of experience. -Ethical practice is best learned and fostered by surrounding oneself with people who exhibit ethical character. -Ethical practice requires a skill set that must be conscientiously learned and nurtured.
Ethical practice requires a skill set that must be conscientiously learned and nurtured. Explanation: Ethical agency must be cultivated in the same way that nurses cultivate the ability to do the scientifically right thing in response to a physiologic alteration. It is inaccurate to assume that it will passively develop from the presence of other ethical practitioners, or from years of experience. It is not an innate characteristic of personality. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 107.
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 -Paternalism -Moralizing -Values clarification
Feminist Explanation: 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." Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 104.
A nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which ethical principle is the nurse attempting to practice? -Nonmaleficence -Fidelity -Beneficence -Justice
Justice Explanation: The ethical principle of justice includes an effort to fairly distribute benefits and to minimize discrimination, even when circumstances make this difficult to achieve. This is demonstrated by the nurse's efforts to fairly distribute the nurse's time and care. Beneficence is the ethical principle of promoting good. Nonmaleficence states that one should not do harm to clients. Fidelity is faithfulness to a person, cause, or belief, demonstrated by continuing loyalty and support. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 101-104-110.
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? -Moralizing -Laissez-faire -Modeling -Responsible choice
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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 100.
While providing care to a client, a nurse encounters an ethical problem. The nurse knows the right thing to do, but the facility's policies interfere with the nurse's ability to follow through in doing the right thing. Which condition is the nurse experiencing? -Ethical dilemma -Moral distress -Ethical agency -Moral resiliency
Moral distress Explanation: Moral distress occurs when a nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. In an ethical dilemma, two (or more) clear moral principles apply but support mutually inconsistent courses of action. The capacity to recover, adapt, and even thrive in the face of threats, misfortune, or challenging times is termed resilience. Moral resilience is the developed capacity to respond well to morally distressing experiences and to emerge strong. Ethical agency involves the ability to always do the ethically right thing because we know it is the right thing to do. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Ethical Experience and Decision Making, pp. 106-107.
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? -Ethical decision making -Client sovereignty model -Shared decision making -Paternalistic model
Shared decision making Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 17.
Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem? -Participating in a hand-off report at the end of the shift -Documenting the care in the client's record -Taking a picture of a client with the nurse's cell phone -Talking to the family when they visit the client
Taking a picture of a client with the nurse's cell phone Explanation: Taking a picture of a hospitalized client is a direct breach of privacy. Documenting care in the client's record is a normal and expected duty of a nurse. While delivering care to a client, the nurse may talk to the client's family while they are visiting the client; this does not reflect a breach of privacy. Participating in a hand-off report is an expected and necessary duty of the nurse and does not reflect a breach of privacy. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 101-110.
What is the term for the beliefs held by the individual about what matters? -Morals -Values -Bioethics -Ethics
Values Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 98.
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: -confidentiality. -altruism. -justice. -advocacy.
advocacy. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 112.
Virtues are: -beliefs about the worth of something, about what matters, that act as a standard to guide one's behavior. -cultivated dispositions of character and conduct that motivate and enable us to be good human beings. -general guides to action, including autonomy, nonmaleficence, beneficence, justice, and fidelity. -personal or communal standards of right and wrong.
cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Explanation: Virtues are human excellences, or cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Values are beliefs about the worth of something, about what matters, that act as a standard to guide one's behavior. Morals are personal or communal standards of right and wrong. Ethical principles are general guides to action, including autonomy, nonmaleficence, beneficence, justice, and fidelity. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches the principle of: -fidelity. -autonomy. -ethical conduct. -beneficence.
ethical conduct. Explanation: 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 beneficence, fidelity, and autonomy, there is no evidence of such breaches in these specific principles in this case. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 105.
A nurse working on a critical care unit was informed by a client with multiple sclerosis that the client did not wish to be resuscitated in the event of cardiac arrest. Now the client is no longer able to express wishes, and the family has informed the health care provider that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve: -deception. -ethical distress. -paternalism. -confidentiality.
ethical distress. Explanation: The nurse is involved in a situation that involves ethical distress. Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Paternalism is acting for clients without their consent to secure good or prevent harm. Deception and confidentiality can result in ethical problems for nurses when there is a conflict between the client's and nurse's values/interests. In this scenario, the nurse is aware of the client's wishes, but the conflict lies with the family and thus the nurse will experience ethical distress. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 110-116.
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 cannot do it anymore." What ethical problem is the adult child experiencing? -moral distress -ethical dilemma -ethical uncertainty -dissatisfaction
moral distress Explanation: Moral distress is when someone wants to do the right thing but is not able. The adult child brings the parent to the emergency department to maintain the parent's safety, although the child needs to take care of the parent. Dilemma is a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones. The client is not experiencing a dilemma. Uncertainty means a feeling of not knowing what will happen. The adult child is certain that he or she cannot care for the parent. Dissatisfaction implies a sense of dislike for, or unhappiness in, one's surroundings. Although the adult child is unhappy, this is not the primary ethical problem. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 106-107.
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? -ethical dilemma -conscientious objection -moral distress -moral resilience
moral resilience Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, Moral Distress and Resiliency, p. 106.
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have: -moral agency. -personal values. -ethics. -legal obligations.
personal values. Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 98.
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? -Sharing what the client did to the nurse last week, though the nurse treats the client with dignity -Saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it -Getting up and walking out of the break room because the nurse's break is over -Laughing and joining in the conversation, though the nurse does not believe the client is that bad
saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it Explanation: 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, pp. 101-102.
A nurse is preparing a client for discharge from the cardiac unit and observes cigarettes in the client's belongings. The nurse asks the client to consider the client's health and that of the client's spouse. This is an example of: -social justice. -moral distress. -ethical dilemma. -values clarification.
values clarification. Explanation: Values clarification is a process that allows an individual to examine and understand what choices to make. Moral distress is the emotional state that arises from a situation when a nurse feels that the ethically correct action to take is different from what the nurse is tasked with doing. An example of this is the nurse taking away the cigarettes out of the client's belongings bag. Ethical distress occurs when a decision is made regarding what one believes to be the right course of action, but barriers prevent the nurse from carrying out or completing the action. The nurse can expect ethical distress if removing the cigarettes from the client's belongings bag. Social justice is a concept of fair and just relations between the individual and society. An example is the selling of cigarettes to those who had a cardiac event. Moral distress, ethical dilemma, and social justice are not reflected in this scenario. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 6: Values, Ethics, and Advocacy, p. 101.
