Test #4: Ethics
What is Deontology? (2)
1. Based on right and wrong- rights of freedom, right to education, right to healthcare?? 2. More black and white , uses rules and principles rather than outcomes, which can be "shades of gray" Nurses must accept decisions of patients, even if they lead to poor outcomes, i.e. pt chooses not to have a blood transfusion and dies
What are some important points to know about values?(6)
1. Belief about the worth of something 2. Highly prized ideals, customs, conduct, goals 3. Freely chosen 4. Learned through observation and experience 5. Vary from person to person 6. Can change
What are Feminist Ethics?
1. Believe Deontology principles are made by med, cold, rules, that devalue feelings of women, caring, compassion, love. 1. Feminists believe more in relationships and stories, rather than universal rules and principles
List some different processes for ethical practice. (6)
1. Clarify your values. 2. Identify moral dilemmas. 3. Use a decision-making model. •M O R A L 4. Look for a compromise. 5. Participate on an ethics committee. 6. Improve your ethical decision making.
What are some of the sources for ethical problems for nurses?
1. Consumer awareness: Informed consent 2. Technological advances: We CAN, but should we? 3. Multicultural population: Differing ethics 4. Cost containment: Unequal access 5. Nature of the work 6. Nature of the profession
What concrete evidence should one have before whistleblowing? (5)
1. How often have these incidents occurred? 2. Over what time period? 3. What are the opinions of other nurses? 4. What is the conclusion of the root cause analysis conducted after each incident? 5. Are there other documented incidentsr?
What is the purpose of The Codes of Ethics for Nurses? (6)
1. Inform the public about the profession's minimum standards. 2. Demonstrate nursing's commitment to the public it serves. 3. Outline major ethical considerations of nursing. 4. Provide general guidelines for professional behavior. 5. Guide the profession's self-regulating functions. 6. Remind us of the special responsibility we assume in caring for the sick.
What are ways that nurses are ethical agents?
1. Know the difference between right and wrong. 2. Understand ethical principles. 3. Apply ethical principles in decision making. •Weigh alternatives; plan to achieve goals. 4. Decide and choose freely. 5. Act according to choice. 6. Consider value neutrality.
What must an ethical agent be able to do?
1. Perceive the difference between right and wrong. 2. Understand abstract ethical principles. 3. Reason and apply ethical principles to make decisions, weigh alternatives, and plan sound ways to achieve goals. 4. Decide and choose freely. 5. Act according to choice (this assumes both the power and the capability to act).
A client rings a 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) Autonomy. c) Nonmaleficence. d) Justice.
A
A nurse is discussing principles in healthcare ethics with the nursing students. Which of the following would be an appropriate example of nonmaleficence? a)To protect clients from a chemically impaired practitioner. b) To preform dressing changes to promote wound healing. c) To provide emotional support to clients who are anxious. d) To administer pain medications to a client in pain.
A
After the nurse informs the surgeon that a chest tube is malfunctioning, the health care provider asks the nurse to reposition the tube and obtain a chest radiograph. The nurse should: a) Inform the surgeon this is not within the safe scope of practice. b) Report the surgeon to the Ethics Committee. c) Report the surgeon to the nursing supervisor. d) Follow the prescription as requested by the surgeon.
A
An employee health nurse is assisting a stressed working mother with value clarification. Which of the following best defines value clarification? a) A process by which people come to understand their own values and value systems. b) A belief about the worth of something, about what matters, that acts as a standard to guide one's behavior. c) An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. d) A systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct
A
The client has right-sided hemiplegia as a result of a stroke (brain attack) and wants a cup of hot coffee. Even though the client is insistent, the nurse does not permit her to drink the coffee unsupervised. This nurse is using the ethical principle of A. Autonomy B. Fidelity C. Nonmaleficence D. Justice
A
What is ethics?
A formal process for making logical and consistent moral decisions. Another way to explain it is a systematic study for right and wrong conduct.
What is a Whistleblower?
A person who reveals information about the practices of others that he or she reasonably believes is corruption; mismanagement; fraud; abuse; illegal; or harmful to the health, safety, and welfare of the general public.
The nurse is caring for a client with end-stage cancer whose health status is declining. A prescription is written by the attending health care provider (HCP) to withhold all fluid, but the health care team cannot locate a family member or guardian. The nurse requests an ethics consultation. Which information is true of an ethics consultation? Select all that apply. a) Persons requesting an ethics consultation may do so without intimidation or fear of reprisal. b) Ethics consultations may prevent poor outcomes in cases involving ethical problems. c) The recommendations of ethics consultants are advisory only. d) Requests for ethics consultations may only be made by the HCP or nurse. e) Ethics consultation is intended to provide legal advice on client care.
A, B, C
The nurse is asked to develop an in-service to explain documents guiding professional nursing practice on the obstetrical unit. One of the documents included is the Code of Ethics. The nurse correctly explains that the Code of Ethics asks nurses to demonstrate which behaviors? Select all that apply. a) Maintain integrity and shape social policy. b) Develop, maintain, and improve health care environments. c) Ask the hospital for fair compensation for work. d) Be responsible and accountable for individual practice. e) Increase professional competence and personal growth.
A, B, D, E
The family of a hospitalized client demonstrates understanding of the teaching about legal documents related to end-of-life care such as "advance directive" and "power of attorney" when they make which statements? Select all that apply. a) "Advance directives give instructions about future medical care and treatment." b) "If people are not capable of communicating their wishes, health care providers and family together can agree on measures or actions that will be taken." c) "Ethics experts agree that the family is the sole deciding factor when the client is competent." d) "Medical power-of-attorney gives primarily financial access to the designee." e) "Medical power-of-attorney or durable power-of-attorney for health care is a document that lists who can make health care decisions should a person be unable to make an informed decision for himself or herself."
A, B, E
How can evaluating help in ethical decision making?
After a situation is resolved, evaluate your decision and the effects of your actions. You should be able to learn from even the worst decision. And when everything goes well, you can file your strategies away to use in similar future situations.
What are values?
Are ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups, or society. You can value an idea, a person, a way of doing things, or even an object (e.g., money). People express their values through behaviors, feelings, knowledge, and decisions. For example, the nurse who values compassion will interact with patients in a sensitive, caring manner.
How has Consumer awareness caused ethical problems in healthcare?
As a result of increased consumer awareness and availability of information online, professionals now are expected to share knowledge with patients and to obtain truly informed consent for treatments. In some cases, consumers are demanding treatment that is not medically needed.
How can a nurse consult reliable sources for ethical decision making?
Attend ethics education programs and discuss issues with healthcare providers, attorneys, ethicists, and clergy to obtain the perspectives of others.
What are attitudes?
Attitudes are mental dispositions or feelings toward a person, object, or idea. Attitudes can be cognitive (thinking), affective (feeling), and behavioral (doing). For example, you might have a positive attitude about cleanliness; that is, you may think it is a good thing (e.g., "The floor is clean. That's nice.") But if you value cleanliness, you would be willing to scrub the floor. You would also wash your hands at appropriate times, bathe regularly, and teach others about hygiene.
A client with metastatic brain cancer is admitted to the oncology floor. According to the Patient Self-Determination Act of 1991 (PSDA), what is the hospital required to do concerning the execution of advance directives? a) Decide on a treatment plan if the client can't. b) Inform the client or legal guardian of his right to execute an advance directive. c)Respect individuals' moral rights. d) Advise clients not to execute an advance directive because it limits treatment options.
B
Which statement is a correct reason for nurses to become culturally sensitive and develop their cultural competency skills? a) It is important to facilitate the process of acculturation for people of different cultures. b) Cultural sensitivity and consideration of client diversity are necessary to provide ethical nursing care. c) The code of ethics challenges nurses to practice in an ethical and caring way. d) There are many subcultures in our country, and it is important to know about these cultures and their practices.
B
What is moral outrage?
Belief that others are acting immorally but you are powerless to stop it ‒Cannot prevent a "wrong" ‒Respond with "whistleblowing"
What are beliefs?
Beliefs are what one accepts as true (e.g., "I believe that germs cause disease and that by washing my hands I remove germs"). Beliefs are sometimes based on faith and sometimes on facts. A belief may or may not be true. Beliefs may or may not involve values.
A group of nursing students are reviewing current nursing Codes of Ethics. Such a code is important in the nursing profession because: a)Nurses are highly vulnerable to criminal and civil prosecution in the course of their work. b) Nurses interact with clients and families from diverse cultural and religious backgrounds. c)Nursing practice involves numerous interactions between laws and individual values. d) Nurses are responsible for carrying out actions that have been ordered by other individuals.
C
A nurse who works on a palliative care unit has participated in several clinical scenarios that have required the application of ethics. Ethics is best defined as: a) The relationship between law and culture. b) Moral values are considered to be universal. c) The principles that determine whether an act is right or wrong. d) The laws that govern acceptable and unacceptable behavior.
C
Two days after the client donated the right lobe of the liver to his father, he tells the nurse, "I was pressured by my family to donate a piece of my liver." What is the nurse's priority intervention in this situation? a) Provide written documentation of conversation to the ethics committee. b) Inform all the surgeons who harvested and transplanted the liver. c) Explore the client's statement obtaining additional, detailed information. d) Notify the supervisor to determine if a psychiatric evaluation is necessary.
C
What does the Code of Ethics for Registered Nurses include? a) Tips for correctly performing a procedure in the hospital environment. b) Bylaws that state clients' rights. c) A code of ethics that states the nurse's obligation and responsibility to the client. d) Regulations stating criteria for nursing licensure
C
Which represents a breach of the nursing Code of Ethics regarding the rights of clients in psychiatric care situations? a) The nurse discusses the client's care with out-of-town family members that the client has formally indicated are allowed to know about the client's hospital care. b) The nurse discusses the client's history and hospital course of treatment with a consulting health care provider (HCP). c) The nurse discusses with peers in the hospital cafeteria the progress of a well-known client being cared for at the hospital. d) The nurse discusses the client's care with the admission coordinator of a retirement home that the client plans to enter after discharge from the hospital.
C
Which of the following actions performed by a nurse will increase the risk of liability? Select all that apply. a) Witnessing a client sign a consent for an ordered medical procedure b) Withholding a medication to clarify the ordered dosage c) Assisting a client on ordered bed rest to walk to the toilet d) Asking unlicensed assistive personnel to assess a client's wound e) Providing information to a unknown caller about a client's diagnosis and treatment
C, D, E
The parents of a preschooler are refusing a blood transfusion to treat severe hypovolemia because they are Jehovah's Witnesses. The parents are aware of the potential consequences of refusing the treatment. The priority intervention for the nurse at this point is to: a) Contact social services and report the parents for abuse. b) Perform the blood transfusion as directed by the physician. c) Notify the hospital ethics committee to overrule the parents decision. d) Pursue obtaining orders for alternative treatments to a blood transfusion.
D
Using the MORAL acronym for making an ethical decision, under which "letter" would the following action fall? The physician explains to the laboring woman the impact on the unborn child of refusing a cesarean birth. A. M B. L C. R D. O
D
What do ethics committees do?
Ethics committees develop guidelines and policies, provide education and counseling, and in the case of ethical dilemmas, review the case and provide a forum for the expression of the diverse perspectives of those involved. Ethics committees usually follow one of three models when discussing a dilemma: the autonomy model, the patient benefit model, or the social justice model.
What does ethics use to justify an individuals choices?
Ethics uses specific rules, theories, principles, and perspectives to inquire into the justification of an individual's actions in a particular situation. It seeks to discover what we "ought" to do in certain circumstances.
How does a nurse use self-knowledge in ethical decision making?
Examine your personal value system. Explore the influences of your religion, cultural beliefs, and personal experiences. This will help you to recognize your comfort zone with specific ethical issues.
What is moral distress?
Inability to carry out a moral decision because of perceived constraints ‒Physicians; nurse administrators; other nurses ‒The law; threat of lawsuit
What is moral agency or ethical agency for nurses?
Is the ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making. Simply stated, it means that nurses have choices and are responsible for their actions.
What is Advocacy?
Is the communication and defense of the rights and interests of another
How does one clarify their values?
It is a process of becoming conscious of and naming one's values (Burkhardt & Nathaniel, 2014). If you are clear about your values, you will be more able to make good decisions and to avoid imposing your values on others. Because each person has his own unique values set, it is important that you appreciate how others' values influence their decisions.
What is value neutrality?
It means that we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients.
What is the MORAL model of ethical decision making?
M- Massage the dilemma- Identify the issue/dilemma, identify gaps in knowledge O- Outline the options R- Resolve the dilemma A- Act by applying the chosen option L- Look back and evaluate plan
What is a good compromise?
One that preserves the integrity of all parties. This means that: 1. The discussions are carried out in a spirit of mutual respect—all viewpoints are respected and considered. 2. The compromise solution itself is ethically sound.
How does one identify moral dilemmas?
Only problems that pose a question between competing and equally valuable interests are true dilemmas.
What are morals?
Private, personal, or group standards of right and wrong. Or, moral behavior, in accordance with custom, reflects personal moral beliefs
What is Autonomy?
Refers to a person's right to choose and ability to act on that choice. It is based on respect for human dignity. You demonstrate respect for autonomy when you treat patients with consideration, believe their stories about the course and symptoms of their illnesses, and protect those who are unable to decide for themselves.
How can sharing help in ethical decision making?
Regularly engage in discussions with the staff on your unit to determine differences in value systems and to collaborate proactively to identify methods to effectively resolve ethical dilemmas. When faced with a difficult ethical decision, seek guidance and support from peers, coworkers, and teachers.
How does a nurse improve their ethical decision making?
Research has found that when faced with ethical dilemmas, nurses tended to use conventions (e.g., rules, procedures) as criteria for decision making rather than clients' personal needs and well-being. A full-spectrum nurse must move from the conventional (rules-bound) to the post-conventional (reasoning) stage of moral development.
How does a nurse use theoretical knowledge in ethical decision making?
Review nursing and other literature for discussion of cases and experiences of other nurses. This will give you a broader view of the problems you may confront and the strategies for managing them. Become familiar with the codes of ethics, the Patient Care Partnership, and ethical frameworks and principles.
What does THINK stand for in whistleblowing?
TALK with an attorney or other legal representation. HAVE concrete and credible evidence of the violation or wrongdoing. INSTITUTE a survival plan, if your job is put in jeopardy or you are fired. NOTE the nature and consequences of the problem—its type, severity, and potential impact. KNOW your reporting options and support systems.
When did the American Nurses Association (ANA) revise their Code of Ethics for Nurses?
The ANA revised their Code of Ethics for Nurses in 2015. It is relevant in many practice settings and reflects current ethical situations.
What did the International Council of Nurses (ICN) do?
The ICN adopted its Code of Ethics for Nurses in 1953. ICN Code has since served as the standard for nurses worldwide. The Code stresses respect for human rights, including cultural rights, the right to life and choice, the right to dignity, and right to be treated with respect.
What is Beneficence?
The duty to do or promote good. You can think of this principle as being on a continuum with nonmaleficence. At one end of the continuum is the duty to bring about positive good, beneficence, at the other end, is the duty to do no harm
What is fidelity?
The duty to keep promises. It is a basic part of every patient care situation. Sometimes the promises are of major significance, such as promising not to share certain information with other members of the healthcare team. At other times it may be only a promise to come back to check the effectiveness of a pain medication or to bring a requested item back to the client's room. The duty to keep a promise is the same regardless of its level of importance.
What is Veracity?
The duty to tell the truth. This seems straightforward, and you may wonder why it even needs discussion. Most nurses would agree that it is not hard to tell the truth, but at times it may be very hard to determine how much of the truth to tell.
How has cost containment caused ethical problems in healthcare?
The emphasis on cutting healthccare costs creates many morally questionable situations. For example, patients are being sent home from the hospital while they are still very ill. On being discharged, they may discover that insurance payments are limited for services outside the hospital, including specialists, home care, and medical supplies (e.g., bandages, walkers).
What does the Patient Care Partnership encourage healthcare providers to be more aware of?
The need to treat patients in an ethical manner and to protect their rights.
What is Justice?
The obligation to be fair. It implies equal treatment of all patients. Questions of justice will become a part of your everyday experience in patient care, from deciding how to allocate your time among patients to larger decisions, such as how to allocate limited healthcare resources.
What is consequentialism?
The rightness or wrongness of the action depends on the consequences of the action. so think risk vs benefits
What does the The Joint Commission Accreditation Standards say in regards to ethics?
The section on organizational ethics requires ethical behavior in care, treatment, services, and business practices. The patient's values, preferences, need for information, and other factors that promote autonomy must be considered in her plan of care. It includes a statement about the need to provide for meeting patient needs in the event care must be denied in the institution. In meeting the patient's needs, you must also consider the organization's legal responsibility.
What is non-maleficence?
The twofold duty to do no harm and to prevent harm. Nonmaleficence refers to both actual harm and risk of harm, as well as to intentional and unintentional harm. In nursing it is rare to find intentional harm, but unintentional harm due to lack of careful planning and consideration does occur (Beauchamp & Childress, 2012). Unintentional harm can also occur because of lack of knowledge, skill, or ability
Why should one talk to an attorney before whistleblowing?
To understand the requirements of whistleblowing in the state. There are usually strict adherence requirements that the whistleblower must follow. Seeking legal advice may provide insight into other options.
How does utilitarianism fall under the heading of consequentialism?
Utilitarianism (principle of utility) falls under this by thinking of it as a risk benefit analysis, i.e giving chemotherapy, giving meds that often will make a pt sick, but benefit is it saves the life. So if an act is "good" it is acceptable, i.e more benefits than risk
How can a student expand their practical knowledge to help in ethical decision making?
While you are still a student, ask to attend either ethical rounds or an ethics committee meeting.
How have technological advances created ethical problems in healthcare?
With every new technology, new issues arise. For example, in vitro fertilization and embryo transfer methods have brought about questions of what should be done with embryos that are not implanted into a uterus. Can they be disposed of? What is their status as persons?
How should nurses ethically work with Multicultural populations?
You will work with patients and colleagues from a variety of cultural backgrounds who probably hold very different sets of values. You will need to respect a variety of belief systems and serve as a patient advocate even when the patient's value system is very different from your own.