INTRO TO NURSING Chp 22 ETHICS
Which is the best method of negotiating or processing difficult ethical situations? 1 Defer to an independent arbitrator such as a chaplain when ethical issues arise between dissenting providers. 2 Consult a legal expert to help resolve disputes, since ethical issues usually affect policy and procedure, 3 Seek consensus via the institutional ethics committee to help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions. 4 Defer to medical experts as the ones best able to resolve conflicts about outcome predictions.
Seek consensus via the institutional ethics committee to help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions. Difficult ethical situations are matters for the entire community and resolved most successfully through institutional ethics committees, not by deference to a single expert or leader.
Which is the best example of practicing patient advocacy? 1 Seeking out the nursing supervisor in conflicting procedural situations 2 Documenting all clinical changes in the medical record in a timely manner 3 Working to understand the law as it applies to an error in following standards of care 4 Assessing the patient's point of view and preparing to describe it
Assessing the patient's point of view and preparing to describe it None of these answers is wrong, but advocacy generally refers to the nurse's ability to help speak for the patient.
A patient is scheduled for surgery. Before the surgery the patient read the consent form and signed it. This is an example of which principle? 1 Justice 2 Autonomy 3 Beneficence 4 Nonmaleficence
Autonomy Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Autonomy means freedom from external control. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harming or hurting others.
A patient is in the early stages of pancreatic cancer. The health care provider orders chemotherapy. Which information should be given to the patient per the principle of non-maleficence? 1 Chemotherapy does not have any side effects. 2 Chemotherapy has side effects, but it is a viable treatment option. 3 Chemotherapy will cure the cancer. 4 Starting chemotherapy is the health care provider's decision
Chemotherapy has side effects, but it is a viable treatment option. Non-maleficence is the avoidance of harm. Therefore explaining to the patient that chemotherapy has side effects but that it is a viable and often effective treatment option, is practicing non-maleficence. Telling the patient that chemotherapy has no side effects and that it will cure cancer may provide false assurance. Stating that starting chemotherapy is the health care provider's decision violates the principle of autonomy.
Under which ethical principle is the patient's personal health information protected? 1 Advocacy 2 Nonmaleficence 3 Beneficence 4 Confidentiality
Confidentiality Confidentiality is a principle that is used to keep the patient's personal health information private. Advocacy refers to standing up and speaking on the patient's behalf; it does not involve protecting the patient's health information. Nonmaleficence refers to the act of not hurting or harming the patient; it does not include protection of the patient's health information. Beneficence is performing actions that are beneficial to the patient; however, it does not include protecting the patient's health information.
A patient is hospitalized for the treatment of tuberculosis. The patient's friend asked the nurse about the patient's personal health information. However, the nurse refused to give the information. Which principle of the code of ethics has the nurse followed? 1 Advocacy 2 Accountability 3 Responsibility 4 Confidentiality
Confidentiality The nurse has followed the principle of confidentiality. Confidentiality refers to keeping the patient's personal health information private. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the protection of the patient's personal health information. Advocacy refers to the support of a particular cause. Accountability is used while answering about one's actions. Responsibility means a willingness to respect one's professional obligations and follow through on promises.
Which ethical principles are included in the professional nursing code of ethics? Select all that apply. 1 Advocacy 2 Responsibility 3 Accountability 4 Fidelity 5 Justice
1 Advocacy 2 Responsibility 3 Accountability The professional nursing code of ethics includes advocacy, responsibility, and accountability. Advocacy means to support a patient's cause. Responsibility refers to being answerable for the patient's health condition. Accountability refers to the ability to answer for one's actions. Fidelity and justice are components of ethics but are not part of the professional nursing code of ethics.
A group of researchers is performing a study on the quality of life in elderly patients. Which parameters should be included in the study? Select all that apply. 1 Age 2 Occupation 3 Birthplace 4 Ability to live independently 5 Ability to contribute to society in a meaningful way
1 Age 2 Occupation 4 Ability to live independently 5 Ability to contribute to society in a meaningful way Knowing the patient's age is necessary to confirm the patient as elderly and thus a viable subject in the study. Quality-of-life measures are helpful to define scientifically the value and benefits of certain medical interventions. Quality of life includes some parameters such as the patient's occupation, ability to live independently, and ability to contribute to society in a meaningful way. The patient's birthplace does not affect the quality of life.
How can nurses negotiate differences of opinion and values with patients? 1 Be clear about their values. 2 Emphasize correctness of their values. 3 Negate the patient's values. 4 Ask the patients to accept the nurses' values
1 Be clear about their values. Differences of opinion and values can be resolved by being clear about one's own values. Honesty helps to evaluate the patients' values effectively. The nurses should not emphasize their own values and negate the patient's values. This can adversely affect the nurse-patient relationship. Asking the patients to accept the nurses' values is unethical and undermines the patient's autonomy.
There are seven key steps in the resolution of an ethical dilemma. Which step involves distinguishing among facts, opinions, and values? 1 Clarifying values 2 Negotiating a plan 3 Verbalizing the problem 4 Evaluating the plan over time
1 Clarifying values Clarifying values involves distinguishing among facts, opinions, and values. The process of clarifying values is an important part of resolving ethical dilemmas. Negotiating a plan requires confidence in one's own point of view and also deep respect for the opinions of others. Verbalizing the problem helps to ensure effectiveness in the final plan and facilitates discussion. Evaluation of the plan over a period of time is helpful for positive outcomes.
The nurse is assessing a patient who has multiple myeloma and is in need of a bone marrow transplant. This patient does not have health insurance and cannot pay out-of-pocket for the procedure. Which ethical principle should be discussed regarding the patient's condition? 1 Justice 2 Fidelity 3 Autonomy 4 Beneficence
1 Justice In this case, the principle of justice should be discussed. A major question in this situation is how to obtain financial support for the treatment. Justice involves discussion about health insurance, hospital locations and services, and even organ transplants. Fidelity refers to providing patient care in all circumstances and keeping the promises for further patient care. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Beneficence refers to actions that may be beneficial to others.
Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principles of utilitarianism. Which statement describes utilitarianism? 1 The value of something is determined by its usefulness to society. 2 People's values are determined by religious leaders. 3 The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. 4 The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or healthcare provider.
1 The value of something is determined by its usefulness to society. Utilitarianism specifically refers to the greatest good for the greatest number of people, where goodness is determined primarily by usefulness. The concept is easier to apply in a community where shared values allow for agreement about a definition of usefulness. Utilitarianism is not when values are determined by religious leaders, does not take into account the patient's previous moral life, and does not argue that the best way to determine the solution is to refer the case to the provider.
When an ethical dilemma occurs on the unit, can nurses resolve the dilemma by taking a vote? 1 Yes; ethics is essentially a democratic process, with all participants sharing an equal voice. 2 No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. 3 Yes; ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care. 4 No; most ethical dilemmas are resolved by deferring to the medical director of the ethics department.
2 No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion.
The nurse educator is lecturing a group of nursing students about ethics and values. Which statement made by the student indicates a correct understanding of beneficence? 1 "Avoidance of harm or hurt is beneficence." 2 "Support of a particular cause is beneficence." 3 "Agreement to keep promises is beneficence." 4 "Taking positive actions to help others is beneficenc
4 "Taking positive actions to help others is beneficence Beneficence involves taking positive actions to help others. Agreeing to act with beneficence implies that the best interest of the patient is more important for the nurse than self-interest. Avoidance of harm or hurt is nonmaleficence. Support of a particular cause is advocacy. Agreement to keep promises is fidelity.
The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Which principle is the priority in a discussion about ethics? 1 Accountability, because the nurse is accountable for the well-being of this patient 2 Respect for autonomy, because this patient's autonomy will be violated if the patient does not receive the liver transplant 3 Ethics of care, because the caring thing is to provide this patient the resources for a liver transplant 4 Justice, because the first and greatest question in this situation is how to determine the just distribution of resources
4 Justice, because the first and greatest question in this situation is how to determine the just distribution of resources Accountability, respect for autonomy, and ethics of care are not necessarily incorrect answers, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
The nurse is caring for a patient with a bacterial infection. After administering an antibiotic, the nurse realizes that the wrong dose was given. The nurse immediately informs the patient and the primary healthcare provider. Which principle of the nursing code of ethics has the nurse followed? 1 Advocacy 2 Accountability 3 Responsibility 4 Confidentiality
Accountability The nurse has followed the principle of accountability. Accountability refers to the ability to answer for one's actions. The nurse realizes the mistake and informs the healthcare provider so that corrective actions can be taken. Advocacy means to support and speak for a particular cause on behalf of the patient. Responsibility refers to a willingness to respect one's professional obligations and follow through on promises. The nurse is acting responsibly, but the principle of accountability is more relevant in this situation. Confidentiality is a principle that is followed when one keeps the patient's personal health information private. The nurse is not trying to protect any patient-related information.
The American Nurses Association (ANA) code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes protecting patient privacy. On the basis of this principle, if a nurse participates in a public online social network such as Facebook, could the nurse post images of a patient's x-ray film if all patient identifiers have been deleted? 1 Yes; patient privacy would not be violated as long as the patient identifiers were removed. 2 Yes; respect for autonomy implies that the nurse has the autonomy to decide what constitutes privacy. 3 No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work. 4 No; the principal of accountability requires the nurse to keep the identifiers on the image
No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work. Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information. This means that under no circumstance could the nurse post a photo online of a private medical record, including x-rays. The nurse should not share the image online, though the reason is not because the nurse is accountable for keeping the record intact.
Which principle of health ethics refers to the avoidance of harm or hurt? 1 Justice 2 Autonomy 3 Beneficence 4 Nonmaleficence
Nonmaleficence Nonmaleficence is the act of avoiding harm or hurt to the patient. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Beneficence refers to taking positive actions to help others.
In most ethical dilemmas in healthcare, the solution to the dilemma requires negotiation among members of the healthcare team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy in guiding respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional healthcare providers. 4 The nurse's code of ethics recommends that the nurse be present at any ethical discussion about patient care.
Nurses develop a relationship to the patient that is unique among all professional healthcare providers. None of these options is wrong, but the point of the question is to build confidence and even pride in the value of the special body of knowledge that the nurse acquires about patients as a result of the nurse's unique relationship with them.
Resolving an ethical dilemma involves discussion with the patient, the patient's family, and participants from all healthcare disciplines. Which describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate a unique point of view, including knowledge based on clinical and psychosocial observations 2 To await new clinical orders from the physician 3 To limit discussions about ethical principals 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues
To articulate a unique point of view, including knowledge based on clinical and psychosocial observations Nursing plays a unique and critical role in the resolution of difficult ethical situations The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the healthcare team.
