Chapter 22 Potter-Perry Fundamentals Ethics

In a hospital setting, the nurse has arranged an ethics committee meeting with participants from different disciplines to solve an ethical dilemma. Which step of resolving ethical dilemmas is the nurse performing? 1 Gathering all possible relevant information on the case 2 Clarifying one's own values and opinions about the issue 3 Determining whether the situation is an ethical dilemma or not 4 Negotiating the outcome of action for the ethical dilemma

4 The nurse arranges an ethics committee meeting with participants from different disciplines to negotiate the outcome. The nurse does not arrange a committee meeting to gather relevant information. Nor does the nurse arrange a committee meeting to clarify his or her own values and opinions. While determining whether the situation is an ethical dilemma or not, the nurse tries to find a scientific solution but does not arrange a committee meeting.

Refers to the support of a particular cause "nurses ability to help speak up for the patient"

Advocacy

A set of guiding principles that all members of a profession accept

Code of Ethics

HIPAA or Health Insurance Portability and Accountability Act of 1996 is an example of what?

Confidentiality

Main emphasis is on the outcome or consequence of action

Consequentialism

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of A. Autonomy B. Fidelity C. Justice D. Nonmaleficence

D. Nonmaleficence

If you try to make a decision about the ethics of a controversial medical procedure, ________ guides you to focus on how the procedure ensures fidelity to the patient, truthfulness, justice, and beneficence.

Deontology

Acts that are ethical reflect a commitment to standards beyond personal preferences (i.e., standards that individuals, professions, and societies strive to meet). However, when decisions must be made about health care, differing values and opinions among individuals can result in disagreement about the right thing to do.

Ethics

Attention to relationships as distinguished from other more principle based philosophies

Ethics of Care

A bone marrow transplant procedure may offer a chance at cure; but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and full of uncertainty, precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit.

Nonmaleficence

Research suggests that education about safe sex practices reduces the spread of human immunodeficiency virus (HIV). Reducing incidence of HIV is good for a great number of people.

Utilitarianism

A personal belief about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. In some cultures decisions about health care flow from group or family-based discussion rather than independent decisions by one person.

Value

Refers to the ability to answer to ones actions

accountability

The nurse is assessing a patient who has arthralgia. The nurse is preparing a plan for pain management. The nurse monitors the patient's response and revises the plan to reduce the pain. Which statement about the nurse's action is correct? 1 The nurse is showing fidelity. 2 The nurse is advocating for the patient. 3 The nurse is showing responsibility toward patient care. 4 The nurse is following the principle of accountability.

1 Fidelity refers to the agreement to keep promises. The nurse assesses the patient's needs and performs interventions to fulfill them. If the interventions are not found to be effective, the nurse still follows through on the actions and modifies the care plan to reduce the pain. Advocacy, responsibility, and accountability are principles of the codes of ethics. Advocacy is when the nurse speaks up for patient rights. Responsibility refers to a willingness to respect one's professional obligations and follow through on promises. Accountability is when one is answerable for one's actions.

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

1 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.

A patient with leukemia tells the nurse, "I don't want my family to know about my condition; please keep it confidential." The nurse promises to keep the information confidential while caring for the patient and keeps her word. Which ethical concept does this nursing action reflect? 1 Fidelity 2 Justice 3 Autonomy 4 Accountability

1 The ethical concept of fidelity requires the nurse to keep promises. The critically ill patient does not wish to reveal the condition to the family. The nurse keeps the information confidential while caring for the patient and the patient's family. The ethical concept of justice requires the nurse to care equally for all patients. Autonomy refers to the commitment to include patients in decisions about all aspects of their care but does not involve maintaining confidentiality. Accountability refers to the ability to answer for one's actions.

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 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.

Match the examples with the professional nursing code of ethics: 1 You see an open medical record on the computer and close it so 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 primary care 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 patients request. 4 You tell your patient that you will return in 30 minutes to give him his next pain medication.

1 Confidentiality 2Accountability 3 Advocacy 4 Responsibility

When designing a plan for pain management for a postoperative patient, the nurse assess that the patients priority is to be as free of 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. Which principle is used to encourage the nurse to monitor the patient's response to the pain? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

1 Fidelity Pg. 293; Fidelity means keeping promises. Keeping the promise in this case includes not just tending to the clinical need, but evaluating the effectiveness of the interventions.

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate his or her 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 opinion. 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Pg. 296; A nurse's point of view is essential to full discussion of ethical issues because of the nature of the relationship that nurses develop with patients and the intensity and intimacy of contact with the patient and family.

The nurse may come across many ethical dilemmas. To resolve them, it is important to distinguish ethical problems from other problems. Which are characteristics of an ethical problem? Select all that apply. 1 It cannot be solved solely through literature review. 2 It cannot be easily reasoned with logic. 3 The answer to the problem has profound relevance for patient care. 4 The problem can be solved by critical thinking. 5 The problem involves only hospital management.

1, 2, 3 When solving any ethical dilemma, the first step is to distinguish the ethical problems from other problems. Ethical problems cannot be resolved through literature review only, and they may be difficult to solve logically by the use of reason. The answer to an ethical problem will have a significant influence on patient care. Ethical problems are usually not solved by critical thinking and do not involve only hospital management. They may involve all members of the healthcare team.

A patient is scheduled for a mastectomy. Which interventions are performed out of respect for the patient's autonomy? Select all that apply. 1 Review the surgical procedure. 2 Explain the risks and benefits of the procedure. 3 Withhold information about the possible harmful effects. 4 Ensure that the patient reads the surgery documents and signs the consent form. 5 Ensure that the patient makes full advance payment.

1, 2, 4 Reviewing the surgical procedure and explaining the risks and benefits of the procedure indicate respect for the patient's autonomy. Ensuring that the patient signs the informed consent also indicates respect for her autonomy. The healthcare team should not withhold any information about possible harmful effects. Financial aspects of the surgery are purely subjective issues and vary from one establishment to another.

The nurse is learning about ethics in nursing practice. Which actions should the nurse perform to meet the American Nurses Association (ANA) code of ethics? Select all that apply. 1 Consider the patient as the primary commitment. 2 Strive to protect the health and rights of the patient. 3 Consider personal and professional growth a priority. 4 Contribute to nursing practice and knowledge development. 5 Ignore other healthcare professionals and perform one's own duties.

1, 2, 4 The nurse's primary commitment is to the patient, whether that is an individual, family, group, or community. As per the American Nurses Association (ANA) code of ethics, the nurse should promote, advocate for, and strive to protect the health, safety, and rights of the patient. The nurse should contribute to nursing practice and knowledge development and thus participate in the advancement of the profession. The professional growth of the nurse should continue alongside patient care, but it is not an ethical responsibility. Nurses should collaborate with other healthcare professionals, not just perform their own duties.

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, 2, 4, 5 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.

The nurse is explaining to students the difference between nonmaleficence and beneficence. Which information should the nurse include in the explanation to help the students understand the two concepts? Select all that apply. 1 According to the concept of beneficence, all interventions should consider the patient's best interest. 2 According to the concept of beneficence, maximum priority is given to patients by allowing them to make their own healthcare decisions. 3 According to the concept of nonmaleficence, the healthcare provider should weigh the risks and benefits of the intervention before delivering it. 4 According to the concept of nonmaleficence, the nurse should be loyal and not abandon the patient even when the treatment procedure is complicated. 5 According to the concept of nonmaleficence, the nurse should keep promises by following through on actions and interventions.

1, 3 The principle of beneficence is fundamental to the practice of nursing and medicine. The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest. Nonmaleficence is the avoidance of harm or hurt. According to this concept, the healthcare professional tries to balance the risks and benefits of care while striving to do the least harm possible. 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. According to the concept of fidelity, a healthcare professional should be unwilling to abandon patients even when care becomes controversial or complex. In addition, the nurse should follow through on actions and interventions.

The nurse is explaining to nursing students the difference between nonmaleficence and beneficence. Which information should the nurse include in the explanation to help the students understand the two concepts? Select all that apply. 1 According to the concept of beneficence, all interventions should be undertaken while considering the best interest of the patient. 2 Beneficence means including patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. 3 According to the concept of nonmaleficence, the healthcare professional should weigh the risks and benefits of the intervention before delivering it. 4 According to the concept of nonmaleficence, the nurse should be loyal and not abandon the patient even when the treatment procedure is very complicated. 5 According to the concept of nonmaleficence, the healthcare professional must strive to avoid harm to the patient due to any interventions delivered.

1, 3, 5 The principle of beneficence is fundamental to the practice of nursing and medicine. The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest. Nonmaleficence is the avoidance of harm or hurt. According to this concept, the healthcare professional tries to balance the risks and benefits of care while striving to do the least harm possible. 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. Under the concept of fidelity, a healthcare professional should not abandon patients even when care becomes controversial or complex.

A patient is preoccupied with the feeling that she suffers from breast cancer. She asks the nurse to insist that the healthcare provider perform a mastectomy. Following several tests, the nurse finds that the patient has no symptoms of or risk factors for breast cancer. When the healthcare provider refers the patient to a psychologist, the patient refuses to go. Which nursing interventions are appropriate in this situation? Select all that apply. 1 Respect the autonomy of the patient. 2 Ask family members for their opinion. 3 Schedule psychological counseling irrespective of the patient's wishes. 4 Respect the patient's decision and do not schedule counseling. 5 Convince the patient that counseling by the psychologist would be beneficial.

1, 4, 5 The nurse has to respect the autonomy of the patient and her decision, so should not schedule psychological counseling. However, the nurse should try to convince the patient that psychological counseling would be beneficial. The family members can be asked for their opinion, but only with the patient's permission. The nurse should not implement any interventions that violate the patient's wishes.

The nurse learns that building consensus is the best method for a decision-making process. Which are true statements about consensus building? Select all that apply. 1 Unusual points should be considered respectfully while striving for agreement among the participants. 2 The usefulness of an intervention should be of sole consideration. 3 The nature of relationships should be the only guiding principle for the participants in making decisions. 4 The participants should mainly focus on how just and beneficial an intervention is. 5 Respect for opinions and agreement among participants should form the basis of the decision-making process.

1, 5 Building consensus is essentially an act of discovery, in which collective wisdom guides a group to the best possible decision. It encourages respect for unusual points of view while striving for agreement among all participants. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself. Focusing on just the usefulness of the decision is characteristic of utilitarian philosophy. Focusing on just the benefits and justice of a procedure is characteristic of deontology. Focusing on just the nature of relationships during decision making is associated with the feminist theory.

Which of the following properly applies an ethical principle to justify access to health care? (select all that apply) 1 Access to health care reflects the commitment of 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 Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

1,2,4 Pg. 298-299; Justice is the ethical principle that justifies the agreement to ensure access to care for all, but it does not necessarily clarify how to resolve issues of limited resources, like money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficense means "first do no harm". A lack of care because of poor access causes harm (no preventative services, no early detection, no risk reduction) and is therefore ethically troubling. The principal of fidelity implies that we agree to ensure access to care even for people whose beliefs and behaviors may differ from our own, including drug addicts.

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

2 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.

Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating differences of opinion? 1 Consult a professional ethicist to ensure that the steps of the process occur in full. 2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 3 Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. 4 List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.

2 Before proceeding with discussion about any difficult situation, just as in the nursing process, participants should take time to gather all relevant information to ensure reliability and validity during the discussion.

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 The immunization is a clear effort to provide benefit. Beneficence refers to doing good. Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding healthcare plans.

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

2 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.

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 Beneficence Pg. 293; Beneficence means "doing well" by taking positive actions. It implies that the best interest of the patient (and society) outweighs self-interest.

The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? 1 Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. 2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. 3 Even when an agreement about a definition of usefulness exist in a community, laws prohibit an application of utilitarianism 4 Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.

2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. Pg. 295; In our increasingly diverse communities, ideas of usefulness have become equally diverse.

Which statements explain how healthcare reform is an ethical issue? Select all that apply. 1 Access to care is an issue of beneficence, a fundamental principal in healthcare ethics. 2 Reforms promote the principle of beneficence, a hallmark of healthcare ethics. 3 Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable healthcare causes harm, and nonmaleficence is a basic principal of health care ethics. 5 Access to care is an issue of fidelity, a key principal in healthcare ethics.

2, 3, 4 Because healthcare reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Reform promotes the principle of beneficence, or positive actions to help others; on the opposite end, lack of access causes harm, and nonmaleficence is a basic principle of health care ethics. Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Access to care is an issue of justice, not fidelity.

The nurse is practicing according to the professional nursing code of ethics. Which actions are in accordance with the standards of responsibility? Select all that apply. 1 Protecting the patient's right to privacy 2 Trying to remain competent to practice 3 Being responsible for delegated tasks 4 Being willing to respect professional obligations 5 Supporting the health, safety, and rights of the patients

2, 3, 4 Nurses should strive to remain competent to practice in order to perform responsibly. All nursing interventions are the responsibility of the nurse, including those that the nurse has delegated. The standards of practice involving responsibility include the nurse's willingness to respect professional obligations and keep promises to patients. Protecting a patient's right to privacy and supporting the health, safety, and rights of a patient are standards of advocacy, not responsibility.

Which sources are responsible for the formation of values in an individual? Select all that apply. 1 History books 2 Schools 3 Governments 4 Social institutions 5 Religious traditions

2, 3, 4, 5 Schools, governments, social institutions, and religious traditions play an important role in the formation of values. A value is a personal belief about the worth of a given idea. Values help to set standards that influence behavior. History books are not a source for the formation of values.

When caring for a patient, the nurse is distressed over an ethical dilemma and attempts to resolve it. Arrange in order the steps involved in the resolution of an ethical dilemma. 1. Evaluate the action plan. 2. Gather information about the case. 3. Identify the course of action and draw a plan. 4. Clearly verbalize the ethical problem. 5. Distinguish among facts, values, and opinion.

2, 5, 4, 3, 1 The first step in resolving an ethical dilemma is to gather information relevant to the case from the perspective of the patient, family, institution, and society. Next, the nurse should distinguish among facts, values, and opinion. Verbalizing the problem helps; although it may not be easy, creating a clear statement of the dilemma helps to facilitate discussion and ensure that the final plan is effective. Next, a course of action should be identified and a plan discussed. The implemented plan should be evaluated over time.

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (select all that apply) 1 Ethics of care pays attention to the environment in which caring occurs. 2 Ethics of care pays attention to the stories of the people involved in the ethical issue. 3 Ethics of care is used only in nursing practice. 4 Ethics of care focuses only on the code of ethics for nurses. 5 Ethics of care focuses only on understanding relationships.

2, it's about relationships Pg. 292; All answers are valid concepts, but ethics of care focuses on understanding relationships.

It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (select all that apply) 1 Average income varies in different regions of the country. 2 Community values influence definitions of quality, and they are subject to change over time. 3 Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4 The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5 Statistical analysis is difficult to apply when the outcome cannot be quantified. 6 Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

2,3,4,5 Pg. 298; A person's average income and whether the person is employed are incorrect answers because income level is not necessarily a determining factor in measuring quality of life, but the ability to do meaningful work usually does influence the definition.

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in the correct order. 1 Clarify values 2 Ask the question, Is this an ethical dilemma? 3 Verbalize the problem. 4 Gather information. 5 Identify course of action 6 Evaluate the plan 7 Negotiate a plan.

2,4,1,3,5,7,6 Pg. 296-297 an important concept in resolving ethical dilemmas is the idea that resolution is more complicated than simply doing what you want--it's about doing what's right, and figuring out what's right requires discourse.

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.

3 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.

The point of the ethical principal to do no harm is to reassure the public that in all ways the healthcare team not only works to heal patients but agrees to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care.

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.

3 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.

A registered nurse is teaching a student nurse about resolving an ethical conflict. Which statement made by the student nurse indicates the need for further teaching? 1 "I should presume good will on the part of all participants." 2 "I should strictly adhere to the confidentiality principle." 3 "I should reduce the involvement of family in patient care." 4 "I should ensure that all treatment provided is patient-centered."

3 The nurse should include the family in patient care and decision making to help resolve ethical dilemmas. According to the ethics of care, the nature of relationships between family and patient can help resolve ethical dilemmas. The presumption of good will on the part of all participants will help resolve conflicts and facilitate effective treatment for patients. Strict adherence to confidentiality will help build a trusting relationship with the patient and the family, thereby reducing the ethical conflict. Providing patient-centered decision making will ensure that the nurse adheres to justice and veracity, thereby reducing the risk of ethical conflict.

Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.

The 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 the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work 4 No because the principal of justice requires you to allocate resources fairly

3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work Comments, photos, etc. on social media are widely distributed and become a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person plus people accessing your site could know your actual assignment or put "two and two" together.

The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence Pg. 293; Nonmaleficence is an important concept, but can be difficult to grasp at first. It refers to the balancing the risks and benefits of care while doing least amount of harm and suffering.

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy to guide 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 health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers. Pg. 296; A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse.

Which approaches to ethics focus on the importance of relationships in the decision-making process? Select all that apply. 1 Deontology 2 Utilitarianism 3 Feminist ethics 4 Ethics of care 5 Teleology

3, 4 Ethics of care and feminist ethics are closely related. Both promote a philosophy that focuses on understanding relationships, especially personal narratives. Deontology defines actions as right or wrong based on their "right-making characteristics." A utilitarian system of ethics proposes that the value of something is determined by its usefulness. Teleology is a term associated with the utilitarianism philosophy, which means the end or final output of any intervention.

The registered nurse instructs the student nurse to administer an analgesic to a patient who has undergone appendicitis surgery, but the student nurse forgets to administer the drug and finds that the patient is suffering from severe pain. The student nurse reports the mistake to the registered nurse. Which ethical concept does the student nurse adhere to through this action? 1 Fidelity 2 Advocacy 3 Confidentiality 4 Accountability

4 Accountability is being answerable for any right or wrong action. In this case, the student nurse admits that the patient is in pain as a result of the nurse's mistake. Fidelity involves following through on promises. Advocacy is the ethical responsibility to advocate for patient rights. Confidentiality is the ethical responsibility to maintain privacy regarding the patient's condition and information; it is unrelated to the student nurse admitting the mistake.

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 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.

Under which ethical principle is the patient's personal health information protected? 1 Advocacy 2 Nonmaleficence 3 Beneficence 4 Confidentiality

4 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 admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? 1 Seeking out the nursing supervisor to talk with the patient 2 Documenting patients fears in the medical record in a timely manner 3 Working to change the hospital environment 4 Assessing the patient's point of view and preparing to articulate it

4 Assess the patient's point of view and prepare to articulate it Pg. 293; All answers are correct behaviors, but assessing the patient's point of view and preparing to articulate it best reflects the concept of advocacy because it is standing up for the patient and having his/her views/wishes heard.

The patient for whom you are caring 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. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority. 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is 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, 2, 3, 1 Pg. 296; Box 22-2 Key steps in the resolution of an ethical dilemma Understanding the concept of Justice helps to enrich the conversation about how to act, and lifts the conversation above and beyond the circumstances of the patient. If justice is compromised, then respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but her commitment to care does not, unfortunately, give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case.

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predicable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1 List the actions that can be taken to resolve the dilemma. 2 Agree on a statement of the problem or dilemma that you are trying to resolve. 3 Agree on a plan to evaluate the action over time. 4 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5 Take time to clarify values and distinguish between facts and opinions--your own and those of others involved. 6 Negotiate a plan.

4,5,2,1,6,3 Pg. 296-297; This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and healthcare team to reflect on personal values and then identify the exact nature of the ethical problem, design a plan, and evaluate the success of the plan.

Arrange the key steps in resolving an ethical dilemma in the correct order. 1. Clarify values. 2. Negotiate a plan. 3. Verbalize the problem. 4. Gather information. 5. Evaluate the plan over time. 6. Ask a question. 7. Identify possible courses of action.

6, 4, 1, 3, 7, 2, 5,

When a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient's _________.

Autonomy

If a nurse decides to withhold a medication because it might further lower a patient's blood pressure, the nurse will be practicing the principle of A. Responsibility B. Accountability C. Competency D. Moral behavior

B. Accountability

Nurses practice primarily as a service to others, even in the details of daily work

Beneficence

A nurse is working with a terminally ill adult patient. The nurse decides totell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of the processing an ethical dilemma is A. Articulation of the problem B. Evaluation of the action C. Negotiation of the outcome D. Determination of values surrounding the problem

C. Negotiation of the outcome

Refers to the agreement to keep promises. Refers to the unwillingness to abandon patients even when care becomes controversial or complex.

Fidelity

discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of _________.

Justice

Describes the anguish experienced when a person feels unable to act according to closely held core values

Moral Distress

The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Teleology

Key steps in the resolution of an ethical dilemma

step 1 ask the questions, is this an ethical dilemma? step 2 gather information relevant to the case step 3 clarify values step 5 verbalize the problem step 6 negotiate a plan step 7 evaluate the plan over time

Describe culturally competent care

acknowledge of and respect for cultural differences a willingness to negotiate and compromise when world views differ being aware of ones own values and bias using communication skills to enhance sympathy knowing cultural practices of patients groups regularly seen understanding that all patients are individuals and they may not share the same views as others within their own ethic group

Describe ethical dilemma

existing when the right thing to do is not clear. Resolution requires the negotiation of differeing values among involving in the dilemma They can cause distress and controversy for both patients and caregivers

What is the purpose of an ethic committee in health care institutions?

used to process ethical dilemmas used for education, policy recommendation, and case consultation