106 Chapter 22 ETHICS

Morals

Judgement about behavior

Nonmalficence

"Do no harm"

Beneficence

"Doing good" Positive actions to help others Best interest of patient is more important than self-interest

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal views 4. To allow the patient and the physician private time to resolve the dilemma on the basis of ethical principles

1

The nurse is caring for a patient that needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease 3. The social worker should look into enrolling the patient into Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patients poor prognosis are made clear to his family so that they can adopt a palliative approach

1

Which statements properly apply an ethical principle to justify access to health care (select all): 1. Access to health care reflects the commitment to society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised 3. Access to health care is a privilege in the United States, not a right 4. Poo access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics 5. If a new drug is discovered that cures a disease but at a great cost to the patient, the principle of justice suggests that the drug should be made available to those who can afford it

1,2,4

Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life (select all): 1. Community values influence definitions of quality, and they are subjective to change over time 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures 4. Statistical analysis is difficult to apply when the outcome cannot be quantified 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life

1,2,4

The ethics of care suggests that ethical dilemmas can be best solved by attention to relationships. How does this differ from other approaches to ethical problems? (select all) 1. Ethics of care pays attention to the context in which caring occurs 2. Ethics of care is used only by nurses because it is part of the Nursing Code of Ethics 3. Ethics of care requires understanding the relationships with other involved parties 4. Ethics of care is the considers the decision maker's relationships with other involved parties 5. Ethics of care is an approach that suggests a greater commitment to patient care 6. Ethics of care considers the decision maker to be in a detached position outside the ethical problem

1,3,4

Match the following actions (1 through 4) with the terms (A through D) listed below: A. Advocacy B. Responsibility C. Accountability D. Confidentiality 1. You see an open medical record open on the computer and close it so that no one else can read the record without proper access 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the provider and your head nurse and follow agency procedure 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication

1D 2C 3A 4B

When designating a plan for pain management for a patient following surgery, the nurse assesses that the patients priority is to be as free from pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that? 1. Assessing the patient on a numeric scale every 2 hours 2. Asking the patient to establish a goal for the pain control 3. Using alternative measures such as distracting or repositioning to relieve the pain 4. Monitoring the patient for over sedation as a side effect of his pain medication

2

The application of deontology does not always resolve an ethical problem. Which of the following best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best option 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important 4. The focus on consequences rather than the "goodness" of an action makes decision makers uncomfortable

3

What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via messaging tool in a social media site? 1. Yes, if you remove all patient identifiers before sending 2. No, because the patients x-ray results should be discussed with a provider 3. Yes, because respect for autonomy means honoring this patient's request 4. No, because health information of any kind should not be shared on social media

4

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem 2. Articulate a statement of the problem or dilemma that you are trying to resolve 3. Develop or implement a plan to address the problem 4. Gather all relevant information regarding the clinical, spiritual, and social aspects of the problem 5. Take time to clarify values and identify the ethical elements, such a key principles and relationships involved. 6. Recognize that the problem requires ethics

6,4,5,2,1,3

Ethics of care

Alternative view of utilitarianism and deontology, similar to feminist ethics, care-based ethics focuses on understanding relationships, personal narratives and the context in which ethical problems arise. Emphasizes the role of the decision maker.

Accountability

Answering for your own actions

Advocacy

Application of skills and knowledge for the benefit of another person. Nurses can advocate for health, safety, and rights of patients, including right to privacy and right to refuse treatment

Casuistry

Case based reasoning Determine a course of action on the basis of what was done to manage a situation previously.

Value

Deeply held belief about the worth of an idea, attitude, custom, or object that affects choices/behavior

Quality of Life (ethical dilemma)

Deeply personal Quality-of-life measures used to scientifically define value and benefits of medical interventions. Interventions can create a burden for patient and family and must be offset by benefit received from care

Deontology

Defines actions as right or wrong based as adherence to rules and principles such as fidelity to promises, truthfulness, and justice. Examines a situation for the existence of essential right or wrong. Requires a mutual understanding of justice, autonomy, and goodness.

The importance of accountability within nursing

Ensure your professional actions are explainable to your patients. Healthcare institutions exercise accountability by monitoring TJC compliance

Value clarification

Ethical dilemmas almost always occur in the presence of conflicting values. Need to distinguish between fact and opinion

Justice

Fairness and distribution of resources

Fidelity

Faithfulness/agreement to keep promises

Code of ethics

Guiding principles that all members of a profession accept. Key principles: 1. Advocacy 2. Responsibility 3. Accountability 4. Confidentiality

Futile

Interventions unlikely to produce benefit for patient.

Feminist ethics

Looks at the nature of relationships to guide participants in making difficult decisions especially in relationships in which power is unequal. "...concentrate on practical solutions and ask questions about the people involved and their relationships rather than underlying principles."

Confidentiality

Obligation to respect patient privacy. (ie.HIPAA)

ANA code of ethics

Promotes ethical decision making by setting standards for collaborative interpersonal communication

Just culture

Promotion of open discussion

Risks and benefits of social networks within healthcare

Pros: Supportive source of info about patient care or professional nursing activities Emotional support for both nurse and patient (patient can connect with friends and loved ones who cannot be physically present) Cons: Online friendship with a patient can cloud ability to remain objective

Institutional whistle blower

Protections prohibit retaliation against an employee who makes a legitimate report about clinical safety issues.

Nurse autonomy

Relationship between members of healthcare team and the institutions they work for. Policies that accommodate respect for healthcare professionals by finding ways to reassign duties that conflict with religious, cultural, personal beliefs

Ethics

Study of right and wrong

Facts

Supported by objective data

Respecting a patients autonomy refers to

The commitment to include patients in decisions of all aspects of care. *key feature to patient-centered care* Protect patient independence Demonstrate through informed consent With patient, determine plan of care that matches their goals and values

Moral distress

The need to take a specific action while believing that action to be wrong

Utilitarianism

The value of something is determined by its usefulness. Main emphasis is on the outcome or consequence of action. (aka consequentalism) "Greatest good for greatest number of people"

Ethical dilemma

Two opposing courses of action can both be justified by ethical principles

End-of-life care

Variety of opinions about what a "good death" looks like Because views about death/dying are tied into spiritual/cultural beliefs conflicts of end-of-life care are common in healthcare.

Opinions

Views or ideas that are not necessarily based on facts

Responsibility

Willingness to respect one's professional obligations and to follow through. Nurse is responsible for actions, provided care and delegated tasks. Apply work place policies and procedures to provide care.

Autonomy

freedom from external control

In an ethics committee nurses provide

insight about ethical problems at family conferences, staff meetings, or even one-on-one meetings. *Reduce risk for moral distress by promoting discourse even when disagreements or confusion are profound

Clarifying values

is an important and effective part of ethical discourse. Maintain respect and tolerance for differing values