Prep U chapter 6 Values, Ethics, and Advocacy
Which word is best described as protection and support of another's rights?
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.
Which ethical principle refers to the obligation to do good?
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; it is more binding than beneficence.
A client who experienced a cesarean birth rates pain as a 9 on a 10-point scale. The nurse medicates the client for pain. This is an example of the nurse practicing which ethical principle?
Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good. Justice refers to treating clients fairly and impartially. Fidelity refers to keeping one's promises and acting faithfully. Nonmaleficence refers to preventing or not causing harm to the client.
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?
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.
What would be an example of the nurse practicing fidelity? The nurse:
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.
A nurse is involved in ethical decision-making. Place the steps in the order that the nurse would follow to achieve an ethical decision.
In order for the nurse to be confident in ethical decision-making, the steps of the nursing process may be used to help guide ethical decisions: 1) Assess the Situation—recognize and then describe the situation and contextual factors that give rise to the ethical problem; 2) Diagnose (Identify) the Ethical Problem—clarify that the issue is ethical in nature; 3) Plan (Identify and Weigh Alternatives)—identify options and explore the probable short-term and long-term consequences of each for each stakeholder; 4) Implement Your Decision—make the decision and begin to compare the outcome of your action with what you considered and hoped for in advance; 5) Evaluate Your Decision—determine what was learned from this process that will help in the future.
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?
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.
The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards?
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.
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 physician that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve:
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.
The nurse has an ethical conflict regarding the client's use of marijuana to control symptoms of advanced cancer. Which argument(s) regarding this conflict reflect a utilitarian approach? Select all that apply.
Utilitarian arguments are those that determine rightness or wrongness of an action based on the action's consequences. In this case, that the client experiences reduction of symptoms, that the client will not be driving, and that there is little opportunity for diversion all reflect an utilitarian approach. Deontologic arguments are based on a rule such as legality or specific dosages.
What are standards for decision-making that endure for a significant time in one's life?
Values are standards for decision-making that endure for a significant time in one's life. Beliefs are more likely to be changeable and are not necessarily a long-term foundation for decision-making. 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. A role is a set of responsibilities one takes on in relationship to others.
A nurse shows client advocacy by:
The definition of advocacy is to ensure that the client's best interests are being met. A hospice consult is an appropriate example. Insisting that a client take a medication does not reflect advocacy for the client because it violates the client's autonomy. Sending a client home with verbal discharge instructions is normal and customary practice and does not ensure that the client's best interests are being met. Refusing to allow a spouse to stay by the client's bedside is not likely to be in the best interests of the client.
A hospital owned by a Catholic order of nuns will not allow tubal ligations to be performed. This is considered to be:
Institutional policies are guidelines developed by health care institutions to direct professional practice. In this scenario, it may also likely reflect the personal morality and values of the institution's personnel as it is run by a religious group. It does not reflect a legal obligation.
Ethical Distress is:
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.
Which is a characteristic of the care-based approach to bioethics?
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.
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?
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.
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. Utlimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?
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.
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:
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.
