Fundamental of Nursing Chapter 6: Values, Ethics, and Advocacy

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability?

filling out an occurrence report and notifying the health care provider

A hospital owned by a Catholic order of nuns will not allow tubal ligations to be performed. This is considered to be:

institutional policy. Explanation: Institutional policies are guidelines developed by health care institutions to direct professional practice.

The correct definition of ethical distress is:

knowing the correct action, but unable to perform due to constraints

A nurse volunteers to serve on the hospital ethics committee. Which of the following indicates that the nurse knows what the purpose of an ethics committee is?

Assist in decision making based on the client's best interests.

Which of the following nursing situations is an example of the care-based approach to ethics? Select all that apply.

Holding the hand of a dying client Providing a back rub to a client on bed rest Involving the parent in the bed bath of a child

Which of the following statements by the nurse is an example of deception?

"This injection of Novocain will feel like a little pinch."

The nurse is caring for clients in a hospital setting. Which situations encountered by the nurse have a significant ethical component? Select all that apply.

-helping a client make end-of-life decisions -addressing a suspected breach in confidentiality -deciding how to reassign staff in light of budget cuts -deciding when to stop cardiopulmonary resuscitation (CPR) on a client in cardiac arrest

Explanation: End-of-life decisions, resuscitation, allocation of resources, and confidentiality are all affected by ethical principles.

A nurse's choice of continuing education is not an ethical issue.

Explanation: Value clarification is a process by which people come to understand their own values and value systems. A value is a belief about the worth of something, about what matters, that acts as a standard to guide one's behavior.

A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. Ethics is a systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct.

Explanation: An ethical dilemma occurs when it is difficult for a decision to be made. If there is no signed DNR, then legally cardiac compressions must be started.

Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope. (p.98)

The graduate nurse is beginning practice after taking NCLEX. What professional values should the nurse determine are of importance to always incorporate into practice? Select all that apply.

Altruism Autonomy Human dignity Social Justice

Which of the following best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society.

A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This client is utilizing which ethical principle in making his decision?

Autonomy

A nurse who provides the information and support that clients and their families need to make the decision that is right for them is practicing what principle of bioethics?

Autonomy

Which ethical principle is related to the idea of self-determination?

Autonomy

Explanation: Autonomy entails the ability to make a choice free from external constraints.

Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike.

Which of the following nursing situations is an example of an ethical dilemma?

Performing cardiac compressions when a signed Do Not Resuscitate order (DNR) is not available

Explanation: Advocacy is the protection and support of another's rights. If the nurse values client advocacy, the nurse would give priority to the good of the individual client rather than to the good of society in general.

The nurse would not be demonstrating advocacy if the nurse values the loyalty to an employing institution or to a colleague over their commitment to their client. The nurse demonstrating client advocacy would not choose the claims of the client's well-being over the claims of the client's autonomy. The nurse would not make decisions for clients who are uninformed concerning the client's rights and opportunities.

Nurses who value client advocacy follow what guideline?

They give priority to the good of the individual client rather than to the good of society in general.

An illegal immigrant with no health insurance sustained life-threatening injuries following an automobile accident. Which action demonstrates the ethical principle of justice?

airlifting the client to a local trauma center for emergency surgery

To practice ethically, the nurse should:

avoid allowing her judgment to guide practice. Explanation: Personal convictions apply only to situations and decisions pertaining to the individual. In ethical practice, nurses avoid allowing personal judgments to bias their treatment of clients.

Which nursing action demonstrates the principle of fidelity?

filing an incident report after making a medication error

Which action most clearly demonstrates a nurse's commitment to social justice?

lobbying for an expansion of health care resources and benefits

Explanation: Nurses' ethical obligations include acting in the best interest of their clients,

not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large.

Explanation: Altruism, autonomy, human dignity, and social justice are all examples of

professional values. Moralizing is not such an example.

Explanation: Ethics is the branch of philosophy dealing with

standards of conduct and moral judgment. It does not directly address law. It includes, but is not limited to, decision making and competing priorities.

Explanation: Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make health care decisions. Beneficence is the duty to do good and the active promotion of benevolent acts.

Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm.

Explanation: Shared decision making is recommended by most Ethicists and involves the client's preferences and the nurse's expertise to make the best decision.

The Paternalistic model involves the clinician making the decisions and the Patient Sovereignty model involves the patient making all the decisions without input from the clinician.

An employee health nurse is assisting a stressed, working mother with value clarification. Which of the following best defines value clarification?

a process by which people come to understand their own values and value systems

Explanation: The nurse is demonstrating integrity, which is defined as

acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity.

A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the client's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions?

acting in the client's best interest

Which of the following is a characteristic of the care-based approach to bioethics?

the promotion of the dignity and respect of clients as people

A public health nurse is involved in planning a community outreach program for a large assisted living community. Due to the aging population within the community, the program will offer hypertension screening and management. This decision is based on which principle?

utilitarianism

Explanation: Feminist ethics offers an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guides for practice.

The care-based approach directs attention to the specific situation of individual patients viewed within the context of their life narratives. And the formal study of ethical issues that arise in the practice of nursing describes nursing ethics.

What would be an example of the nurse practicing fidelity? The nurse:

stays with the client during his death as promised. Explanation: Fidelity requires the nurse to keep promises made and to be faithful to one's commitments.

A nurse is contributing to the analysis of an ethical dilemma. When analysing the dilemma according to the ethical framework, what is most important for the nurse to take into consideration?

standards of conduct.

Explanation: Values are ideals and beliefs held by an individual or group; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people.

A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death, as well as questions and concerns regarding quality of life as it relates to advanced technology.

Explanation: Holding the hand of a dying client, providing a back rub and involving the parents are all examples of a care-based approach.

The other choices are not reflective of this: Documenting data in the electronic medical record

A nursing student reports to the instructor that a medication due at 9 a.m. was omitted. Which of the following principles is the student demonstrating?

Integrity

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which professional value?

Integrity

Explanation: Telling a client that Novocain will feel like a little pinch, is not being truthful, thus a deception.

The other choices are true statements and interventions, thus not deception.

Which are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply.

Trustworthiness Humility Compassion

Explanation: The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the student reported the occurrence of the missed medication.

The definition of altruism is concern for others, social justice is upholding of principles, and autonomy is the right to self-determination, so those choices are not correct.

Explanation: Fidelity means being faithful to work-related commitments and obligations. The ethical principle is best demonstrated by the nurse following the employer's policies by completing the incident report following a medication error.

Administering vaccines is an example of beneficence; treating an uninsured client in the emergency room is an example of justice; witnessing a client signature on an informed consent is autonomy.

What is the term for the beliefs held by the individual about what matters?

Values

A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibility as being fundamental? Select all that apply.

Alleviating suffering Promoting health Preventing illness Restoring health

Explanation: The ethical principle of justice mandates that clients be treated impartially without discrimination according to age, gender, race, religion, socioeconomic status, weight, marital status, or sexual orientation.

An immediate airlift to the local trauma center demonstrates that this client is begin treated impartially. The other actions demonstrate different ethical principles.

Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?

Care-based ethics Explanation: Central to the care-based approach to ethics is the nurse's relationships with clients and the nurse's "being," or character and identity. Deontology, utilitarianism, and principle-based ethics each prioritize goals and principles that exist beyond the particularities of the nurse-client relationship.

When examining values, a nurse notes that one country uses physician-assisted suicide and another country considers physician-assisted suicide as illegal and punishable with imprisonment. How are these two views on physician-assisted suicide affected?

Culturally Explanation: Daily living is expressed in many traditions and customs; understanding these differences is cultural value orientation.

Explanation: Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare.

Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting them accurately are expressions of the value of integrity.

Which statement best conveys the concept of ethical agency?

Ethical practice requires a skill set that must be conscientiously learned and nurtured.

A client requests that the nurse allow her 15 minutes two times a day for prayer during her hospitalization. What value does this represent?

Foundation value Explanation: A habitual act is indicative of a foundation value.

A dying client tells the nurse that he doesn't want to see his family because he doesn't want to cause them more sadness. Which action by the nurse is most appropriate?

Help the client clarify his values. Explanation: Values clarification is a method of self-discovery by which people identify their personal values and value rankings. The client's value of family may be obscured because of his overwhelming need to protect his family.

The nurse beginning practice would like to access the standards for ethical practice. Which organization will the nurse research for these standards?

International Council of Nurses

Explanation: Ethical agency must be cultivated in the same way that nurses cultivate the ability to do the scientifically right thing in response to a physiologic alteration.

It is inaccurate to assume that it will passively develop from the presence of other ethical practitioners, or from years of experience. It is not an innate characteristic of personality.

A parent of a high school student age 17 years is allowing the child to make the decision on the college that will be attended. When the child requests direction from the parent in making this decision, the parent responds by stating, "you will need to make this decision ony our own." What type of value transmission is the parent displaying?

Laissez-faire

Explanation: An ethics committee will meet when a client is unable to make an end-of-life decision and the family cannot come to a consensus.

The committee members are there to advocate for the best interest of the client. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.

A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing her judgments based on her expertise. Which of the following types of health care decision making does this represent?

Shared decision making

Altruism is a concern for the welfare and being of others.

Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations.

Explanation: Teleology, also known as utilitarianism, is ethical decision-making process based on final outcomes and what is best for the most people.

The choice that benefits many people justifies harm that may come to a few. The nurse did not display veracity, nonmaleficence, or autonomy in this scenario.

Nursing students in an ethics class have been asked to define "ethics." What would be the best definition of ethics?

The formal, systematic study of moral beliefs. Explanation: Ethics is a formal inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to human conduct and human flourishing. "Morals" usually refers to personal or communal standards of right and wrong.

Explanation: According to the ICN Code of Ethics, nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering.

The need for nursing is universal.

Explanation: 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 and 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.

Explanation: This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values on his own and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict.

Through modeling, children learn which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.

An oncology client in an outpatient chemotherapy clinic asks several questions regarding his care and treatment. The nurse explains the clinic's routine, typical side effects of the chemotherapy, and ways to decrease the number of side effects experienced. Which characteristic is the nurse demonstrating?

Veracity Explanation: Veracity means telling the truth, which is essential to the integrity of the client-provider relationship.

Explanation: Autonomy, also known as self-determination, is respecting the rights of clients or their surrogates to make health care decisions. The nurse would provide the information and support the client's and family's need to make the decision that is right for them, including

collaborating with other members of the health care team to advocate for the client. Nonmaleficence is the avoidance of causing harm. Justice is giving each individual their due and acting fairly. Fidelity is the keeping of promises.

A nurse shows client advocacy by:

offering a hospice consultation to a client who is terminally ill. Explanation: The definition of advocacy is to ensure that the best interests are being met. A hospice consult is an appropriate example.

A nurse is of the Catholic faith and votes pro-life. He is considered to have:

personal values. Explanation: Personal values are ideas or beliefs a person considers important and feels strongly about.

Explanation: Trustworthiness, humility, and compassion are all examples of professional virtues, as well as cultivated dispositions of character and conduct that motivate and enable us to be good human beings.

Deception and conflict are negative traits that do not exemplify professional virtues.

Explanation: When an untoward occurrence occurs, the nurse will be considered to be accountable when the proper actions are taken.

In this instance, an occurrence form is filled out for follow-up, and the provider is notified.

Explanation: The ANA Code of Ethics for Nurses is the main source of the ethical principles that nurses must follow and this is found with the International Council of Nurses and the . 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 nursing student is studying the principle of autonomy. Which example most accurately depicts this principle?

describing surgery to a client before the consent is signed Explanation: Describing surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision, thus an autonomous one. The other choices are not reflective of client decision making.

A nursing student states he is able to put himself in his client's shoes. He states he understands the situation of the ill client. This is considered to be an act of:

empathy. Explanation: The experience of empathy is an immediate projection of self to the situation of others, causing strong emotional reactions and motivation, and either appropriate caring behavior and/or related reflection.