Chapter 6 Fundamentals Nursing

Why promoting self-determination of a client is a concern?

Nurses as advocates must realize that they do not make ethical decisions for their patients. Instead, they facilitate their patients' own decision making.

Why being politically active of a client is a concern?

Nurses must continue to advocate for the health care needs of those least empowered to do so for themselves. Nurses are a powerful block of voters—three million strong—whose potential for influencing health care legislation is growing.

What are the violations of principles?

Paternalism Deception Privacy Confidentiality Allocation of scarce nursing resources Valid consent or refusal Conflicts concerning new technologies Unprofessional, incompetent, unethical, or illegal physician practice Unprofessional, incompetent, unethical, or illegal nurse practice Short staffing and whistle-blowing Beginning-of-life issues End-of-life issues

What does advocacy mean? (key term definition)

Protection and support of another's rights

What is confidentiality? (ATI book)

Protection of privacy without diminishing access to high-quality care.

What does bioethics mean? (ATI book definition)

Refers to the application of ethics to health and life. It addresses dilemmas. Examples Stem cell research, organ transplantation, gender reassignment, and reproductive technologies.

What does Autonomy mean?

Respect the rights of patients or their surrogates to make health care decisions. (F book); The right to make ones own personal decisions, even when those decisions might not be in that persons own best interest (ATI book). Respect rights of patients to make health care decisions. (Power point)

What is Unprofessional, incompetent, unethical, or illegal nurse practice?

Violation of nursing rules

What is The Beauchamp and Childress principle-based approach? (F & ATI book & Powerpoints)

autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, privacy, and confidentiality.

What are the ICN Guidelines to Achieve Purposes of Code of Ethics?

-Study the standards under each element of the code. -Reflect on what each standard means to you. -Discuss the code with coworkers and others. -Use a specific example from experience to identify ethical dilemmas and standards of conduct in the code. -Work in groups to clarify ethical decision making, and reach consensus on standards or ethical conduct. -Collaborate with other professionals to apply standards in practice, education, management, and research.

What are areas of concern for patient advocates?

1) Representation of patients 2) Promoting self-determination 3) Whistle-blowing 4) Being politically active

What is Short staffing and whistle-blowing?

A nurse who goes outside the organization for the public's best interest when it is unresponsive to reporting the danger through the organization's proper channels.

A nurse who provides the information and support that clients and their families need to make the decision that is right for them is practicing what principle of bioethics? A. Autonomy B. Nonmaleficence C. Fidelity D. Justice

A) Autonomy

What is Accountability? (ATI book)

Ability to answer for ones own actions.

What is Beginning-of-life issues?

Abortion as example

What does bioethics mean? (powerpoint definition)

Encompasses a number of fields of "life sciences".

Why representation of a client is a concern?

The nurse is often involved as an intermediary between the patient and the family, especially when the patient and family have conflicting ideas about the management of health care situations.

What does feminist ethics mean? (F Book key term definition)

Type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor.

What is Responsibility? (ATI book)

Willingness to respect obligations and follow through on promises.

How do nurses use advocacy in nursing practice?

-Primary commitment to the patient -Prioritization of good of individual patient rather than society in general -Evaluation of competing claims of patient's autonomy and patient well-being

What does care-based approach mean? (F book)

Approach to bioethics that directs attention to the specific situations of individual patients viewed within the context of their life narrative. Essential to person-centered care.

What are the three paramount human questions?

1) What kind of person should I be in order to live a moral life and make good ethical decisions? 2) What are my duties and obligations to other people whose life and well-being may be affected by my actions? 3) What do I owe the common good or the public interest in my life as a member of society?

What is paternalism?

A nurse acts for a patient without consent to secure good or prevent harm.

What is nursing ethics? (book definition key terms)

A subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments.

Which ethical principle is related to the idea of self-determination? A. Autonomy B. Confidentiality C. Nonmaleficence D. Beneficence

A) Autonomy

A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? A. Fidelity B. Nonmaleficence C. Justice D. Autonomy

A) Fidelity

An emergency department nurse and health care team are caring for a semiconscious child age 2 years with numerous fractures and evidence of cigarette burns. They suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle? A. Nonmaleficence B. Fidelity C. Beneficence D. Justice

A) Nonmaleficence

What does Principle-Based Approach men? (F book key terms)

An approach to bioethics that offers specific action guides. Combines elements of both utilitarian and deontologic theories. The Beauchamp and Childress principle-based approach.

What does ethical dilemmas mean? (ATI book)

Are problems that involve more than one choice and stem from differences in the values and beliefs of the decision makers.

What does Nonmaleficence mean?

Avoid causing harm (F book). A commitment to do no harm (ATI book).

Which of the following statements by the nurse is an example of deception? A. "I am going to teach you how to give yourself insulin." B. "This injection of Novocain will feel like a little pinch." C. "It is important to get out of bed to prevent pneumonia." D. "I will administer your pain medication as soon as it is due."

B) "This injection of Novocain will feel like a little pinch."

Which of the following best describes feminist ethics? A. Attention directed to the specific situation of individual patients viewed within the context of their life narratives. B. An approach critiquing existing patterns of oppression and domination in society. C. The formal study of ethical issues that arise in the practice of nursing. D. A combination of elements of utilitarian and deontologic theories that offers specific action guides for practice.

B) An approach critiquing existing patterns of oppression and domination in society.

What does beneficence mean?

Benefit the patient, and balance benefits against risks and harms (F book). Action that promotes good for others, without any self-interest (ATI book). Benefit the patient (powerpoint).

What is violation of confidentiality?

Breaching that trust by disclosing information about a patient/client to someone who has no right to the information is one of the most serious errors a health care worker can commit.

A nurse fails to communicate a change in the client's condition to the physician. Which element related to proving malpractice has been met? A. Proximate cause B. Damages C. Breach of duty D. Duty

C) Breach of duty

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 of the following is the nurse attempting to enact? A. Beneficence B. Fidelity C. Justice D. Nonmaleficence

C) Justice

A nurse knows the ethical term "Do not cause harm" is an example of: A. Beneficence B. Justice C. Nonmaleficence D. Fidelity

C) Nonmaleficence

Which ethical principle refers to the obligation to do good? A. Veracity B. Fidelity C. Beneficence D. Nonmaleficence

C) beneficence

What are the Characteristics of Care-based approach?

Centrality of the caring relationship. Promotion of dignity and respect for patients as people. Attention to the particulars of individual patients. Cultivation of responsiveness to others. Redefinition of fundamental moral skills to include virtues.

What does the value transmission of modeling mean?

Children learn what is of high or low value by observing parents, peers, and significant others. Modeling may lead to socially acceptable or unacceptable behaviors.

What does the value transmission of moralizing mean?

Children who are taught a complete value system by parents or an institution that allows little opportunity for them to weigh different values. Examples Church or school.

A parent of a high school student age 17 years is allowing the child to make the decision on the college he will attend. When the child requests direction from the parent in making this decision, the parent responds by informing him that he will need to make this decision on his own. This is an example of which type of value transmission? A. Responsible choice B. Moralizing C. Modeling D. Laissez-faire

D) Laissez-faire

A nurse obtains an order for a bed alarm for a confused client. This is an example of which of the following ethical principles? A. Conflict B. Deception C. Confidentiality D. Paternalism

D) Paternalism

What does Bioethics mean? (F book key term definition)

Ethics that encompass all those perspectives that seek to understand human nature and behavior, the domain of social science, and the natural world

Why whistle-blowing of a client is a concern?

Every nurse who witnesses unsafe care has a duty to patients to report it. However, for too long, nurses may have failed to speak up out of fear of retribution.

What does Justice mean?

Give each his or her due; act fairly (F book). Fairness in care delivery and use of resources (ATI book).

What is violations of Conflicts concerning new technologies?

Goes against improving efficient and to communicate more effectively

What is the violation of Valid Consent or Refusal?

Healthcare providers must accept and support refusal or withdrawal of consent even if they disagree with the patient. Nurse goes against this.

What are the purposes of the Code of Ethics for Nurses?

It is a succinct statement of the ethical obligations and duties of every nurse. It is the profession's nonnegotiable ethical standard. It is an expression of nursing's own understanding of its commitment to society.

What does the value transmission of Laissez-faire mean?

Leave children to explore values on their own & to develop a personal value system. This approach often involves little or no guidance and may lead to confusion and conflict.

What do nurses do that value patient advocacy?

Make sure that their loyalty to their employing institution or colleagues does not compromise their primary commitment to the patient. Give priority to the good of the individual patient rather than to the good of society in general. Carefully evaluate the competing claims of the patient's autonomy (self-determination) and the patient's well-being.

What does ethical dilemmas mean? (F book key term definition)

Situation that arises when attempted adherence to basic ethical principles results in two conflicting courses of action.

What does feminist ethics promote? (F book)

Social policy that reflects a fundamental trust in women and those on the margins. This trust is recognition that all persons deserve the opportunity to make legitimate choices about conditions that affect their lives and are deserving of respect whenever they exercise such facility.

What is advocacy? (ATI book)

Support and defends clients health, wellness, safety, wishes, & personal rights, including privacy.

What is deception?

The knowing and intentional transmission of information to create a false belief in the patient.

What are the theories of ethics? (F book)

Utilitarian- The rightness or wrongness of an action depends on the consequences of the action. Deontologic- An action is right or wrong based on a rule, independent of its consequences.

What is violation of Allocation of scarce nursing resources?

There will not be enough to provide everything that is required.

What is end of life issues?

violation of pain and symptom management, culturally sensitive practices, assisting patients and their families through the death and dying process, and ethical decision making.

What are the 7 Basic Tenets of Bill of Rights for RNs?

1) Practice in a manner that fulfills obligations to society and to those who receive nursing care. 2) Practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 3) Work in an environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses. 4) Freely and openly advocate for themselves and their patients, without fear of retribution. 5) Receive fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. 6) Practice in a work environment that is safe for themselves and their patients. 7) Negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

A nursing faculty is discussing laissez-faire values with students. Which of the following is an example of those values? A. Parents allowing a child to decide not to have an intravenous line inserted B. Modeling healthy behaviors for teenagers C. Telling a child an injection will feel like a pinch D. Teaching children right from wrong

A) Parents allowing a child to decide not to have an intravenous line inserted.

Which of the following nursing situations is an example of an ethical dilemma? A. Performing cardiac compressions when a signed Do Not Resuscitate order (DNR) is not available B. Administering pain medication as ordered C. Transferring a client to a step-down unit D. Discussing care of a comatose client with the family

A) Performing cardiac compressions when a signed Do Not Resuscitate order (DNR) is not available

A nurse is aware that the principle of autonomy is being applied in which situation? A. The client has decided to stop chemotherapy treatments. B. An order for an antibiotic is being written in the chart. C. The family is discussing care with the physician. D. A hospice consult is ordered by the nurse.

A) The client has decided to stop chemotherapy treatments.

Which of the following is a characteristic of the care-based approach to bioethics? A. the promotion of the dignity and respect of clients as people B. the need for an orientation toward service C. The rightness or wrongness of an action is independent of its consequences. D. the need to emphasize the relevance of clinical experience

A) The promotion of the dignity and respect of clients as people.

A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains controlleddrug prescription forms for prescription writing. The physician reports that his wife has chronic back pain and requires pain medication. One day the nurse enters the physician's office and sees him take a pill out of a bottle. The doctor mentions that he suffers from migraines and that his wife's pain medication alleviates the pain. What type of nursephysician ethical situation is illustrated in this scenario? A) Unprofessional, incompetent, unethical, or illegal physician practice B) Disagreements about the proposed medical regimen C) Conflicts regarding the scope of the nurse's role D) Claims of loyalty

A) unprofessional, incompetent, unethical, or illegal physician practice.

What are the basic principles of ethics? (ATI book)

Advocacy, Responsibility, Accountability, Confidentiality.

What does Veracity mean?

Commitment to tell the truth (ATI book).

Which of the following is a characteristic of the care-based approach to bioethics? A. The rightness or wrongness of an action is independent of its consequences. B. the need to emphasize the relevance of clinical experience C. the promotion of the dignity and respect of clients as people D. the need for an orientation toward service

C) the promotion of the dignity and respect of clients as people

A nurse who provides the information and support that clients and their families need to make the decision that is right for them is practicing what principle of bioethics? A. Fidelity B. Autonomy C. Nonmaleficence D. Justice

B) Autonomy

Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing? A. Principle-based ethics B. Care-based ethics C. Utilitarianism D. Deontology

B) Care-based ethics

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? A. Moralizing B. Feminist C. Paternalism D. Values clarification

B) Feminist

A nursing student is studying the principle of autonomy. Which example most accurately depicts this principle? A. transporting a client to a scheduled physical therapy appointment B. describing surgery to a client before the consent is signed C. administering a morning dose of insulin before breakfast D. changing a dressing on a wound as needed

B) describing surgery to a client before the consent is signed

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability? A. documenting in the chart a narrative note about the occurrence B. telling the client that the medication will be given the following morning C. filling out an occurrence report and notifying the health care provider D. administering the medication with the other evening medications

C) filling out an occurrence report and notifying the health care provider

A nurse shows client advocacy by: A. insisting that a medication be taken. B. refusing to allow a spouse to stay by the bedside. C. offering a hospice consultation to a client who is terminally ill. D. sending a client home with verbal discharge instructions.

C) offering a hospice consultation to a client who is terminally ill.

What should nurses do to commit ethical conduct?

Cultivate the virtues of nursing. Understand ethical theories that dictate and justify professional conduct. Be familiar with codes of ethics for nurses and standards for professional nursing conduct.

The nurse is managing the care for a post operative client. How does the nurse demonstrate advocacy? A. Turning and positioning the client every four hours B. Administering pain medication when the pain level reaches 9/10 C. Changing the channel on the television while providing care D. Limiting visitors due to client complaining of pain

D. Limiting visitors due to client complaining of pain

Which of the following nursing situations is an example of the care-based approach to ethics? Select all that apply. A. Providing a back rub to a client on bed rest B. Taking a week's vacation from work C. Involving the parent in the bed bath of a child D. Documenting data in the electronic medical record E. Holding the hand of a dying client

E) Holding the hand of a dying client A) Providing a back rub to a client on bed rest C) Involving the parent in the bed bath of a child

A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for clients in a long-term care facility. Which nursing actions best exemplify this principle? A. The nurse follows "medication rights" when administering medicine to clients. B. The nurse acts fairly when allocating time and resources to clients. C. The nurse arranges for hospice for a client who is terminally ill. D. The nurse keeps promises to provide diligent care to clients. E. The nurse performs regular client assessments for pressure ulcers. F. The nurse provides information to clients to help them make decisions about treatment options.

E) The nurse performs regular client assessments for pressure ulcers. A) The nurse follows "medication rights" when administering medicine to clients.

What does the value transmission of Responsible choice mean?

Encourages children to explore competing values and to weigh their consequences. Also support & guidance are offered as children develop a personal value system.

What is nursing ethics? (powerpoint definition)

Formal study of ethical issues that arise in the practice of nursing. Analysis used by nurses to make ethical judgments.

What is violation privacy?

Invasion of privacy

What does Fidelity mean?

Keep promises (F book). Fulfillment of promises (ATI book).

What does ethical conduct mean?

Nurses committed to high-quality care base their practice on professional standards of ethical conduct as well as professional values.

What does the value transmission of Rewarding and Punishment mean?

Rewarding is children are rewarded for demonstrating values held by parents. Punishment is children are punished for demonstrating unacceptable values.

What is Unprofessional, incompetent, unethical, or illegal physician practice?

pretty self explanatory.