Nur 102 Values, Ethics, and Legal Issues Chp 7

The 40-year-old client is admitted for repair of a femoral fracture. The client discloses a history of an addiction to painkillers and asks that the nurse assist in adhering to the recovery from this addiction by not administering any narcotics. As the nurse reviews postoperative prescriptions for the client, the nurse notes that the health care provider has prescribed codeine 30 mg p.o. q6 hours for pain. How does the nurse best approach this situation?

Ask the health care provider to remove this prescription from the client's chart. This example illustrates the principle of fidelity. The client has asked that the nurse assist him or her by not administering any narcotics. Thus, the client has already made wishes known and the nurse does not need to ask again. While it is important to pass this information on to the next nurse, this is not the best choice because verbally passing on client information can cause that information to accidentally be changed or left out during report. Thus, it is important to be proactive and have the prescription discontinued. The nurse should also document the client's wishes in the plan of care.

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?

"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." An advance directive is a written statement identifying a competent person's preferences regarding which medical interventions to use in the event that the client cannot make a decision for themselves concerning terminal care. The other responses are not correct.

Which is the most frequent reason for revocation or suspension of a nurse's license?

Alcohol or drug use A nurse's license may be suspended or revoked for fraud, deceptive practices, criminal acts, previous disciplinary action by other state boards, negligence, physical or mental impairments, or alcohol or drug use. The most frequent reason is alcohol or drug use.

A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?

Assist in decision making based on the client's best interests. One reason an ethics committee convenes is when a client is unable to make an end-of-life decision and the family cannot come to a consensus. In this case, the committee members are there to advocate for the best interest of the client and to promote shared decision making between the client (or surrogates, if the client is decisionally incapacitated) and the clinicians. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.

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

Autonomy Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make healthcare 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.

An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?

Battery The UAP is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to (or held by) that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harm the other party's reputation.

A nurse provides client care within a philosophy of ethical decision-making and professional expectations. What is the nurse using as a framework for practice?

Code of ethics A professional code of ethics provides a framework for making ethical decisions and sets forth professional expectations. Codes of ethics inform both nurses and society of the primary goals and values of the profession. The standard of care for nurses is defined as that of what a reasonable and prudent nurse would do when caring for a same or similar client in the same or similar circumstances. The definition of nursing is the practice of providing care for the sick and infirm. Values clarification is a technique that can often help an individual increase awareness of any values that may have a bearing on lifestyle decisions and actions.

A nurse is involved in ethical decision-making. Place the steps in the order that the nurse would follow to achieve an ethical decision.

Describe the situation and factors associated with the ethical problem. Clarify that the issue is ethical in nature. Identify options and explore short- and long-term consequences. Make the decision. Determine the effectiveness of the decision and implications for the future. In order for the nurse to be confident in ethical decision-making, the steps of the nursing process may be used to help guide ethical decisions: 1) Assess the Situation—recognize and then describe the situation and contextual factors that give rise to the ethical problem; 2) Diagnose (Identify) the Ethical Problem—clarify that the issue is ethical in nature; 3) Plan (Identify and Weigh Alternatives)—identify options and explore the probable short-term and long-term consequences of each for each stakeholder; 4) Implement Your Decision—make the decision and begin to compare the outcome of your action with what you considered and hoped for in advance; 5) Evaluate Your Decision—determine what was learned from this process that will help in the future.

A client states that the client's recent fall was caused by his scheduled antihypertensive medications being mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow?

Document the client's claims and the events surrounding the alleged incident. It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, especially when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.

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 healthcare provider Accountability means that when an error occurs, the nurse takes the proper actions to address it. In this instance, the nurse should fill out an occurrence form for follow-up and notify the provider, as the error may change outcomes in the client's condition. Administering the missed medications with the other evening medications may double up the dose or cause unexpected adverse effects with the other medications. Telling the client that the medication will be administered the following day is not acceptable, as the nurse is suggesting next actions without the provider's knowledge. Documenting in the chart in a narrative about the occurrence does not allow for the health care provider to be notified and aware of a change in the client's condition.

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

International Council of Nurses The American Nurses Association Code of Ethics for Nurses is the main source of the ethical principles that nurses must follow, and this is developed by the International Council of Nurses. The Canadian Hospital Association has not developed standards of ethical practice. Individual state boards of nursing through the department of health professions have laws and regulations that guide practice but not ethical and moral principles. The World Health Organization is a large organization that does not determine ethical practice for nurses.

A registered nurse who has an associate degree would like to obtain a baccalaureate degree in nursing. The nurse works full time and has several family obligations and would like to find a program that fits into that lifestyle. What is the nurse's priority question about an educational program?

Is the program accredited? The most important consideration is whether the program is accredited. Unaccredited programs should be avoided. Cost is important and method of delivery may be very important to this student. They are not as important as whether the program is accredited. NCLEX pass rate is not important in this case as the nurse is already registered.

A home health nurse performs a careful safety assessment of the home of a frail older adult client to prevent harm to the client. The nurse is acting in accord with which principle of bioethics?

Nonmaleficence Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics. An effective advocate is a nurse who is willing to act on behalf of a client and can work well with other members of the healthcare team. A moral is a person's standard of behavior or belief concerning what is and is not acceptable to do. A value is one's judgment of what is important in life.

A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as?

Nonmaleficence The principle-based approach to ethics combines elements of both utilitarian and deontologic theories and offers specific action guides for nursing practice. The Beauchamp and Childress principle-based approach to bioethics (2001) identifies four key principles: autonomy (promote self-determination), nonmaleficence (avoid causing harm), beneficence (benefit the patient), and justice (act fairly).

The principle of autonomy by a client is applied in which situation?

The client has decided to stop chemotherapy treatments. The principle of autonomy respects the client's right to make the client's own decisions, and is reflected in the client who decides to stop chemotherapy treatments. The family of a client discussing care does not reflect autonomy, because the client is not making the decisions but the family. An order for an antibiotic is placed by a prescriber and does not reflect the client's right to make the client's own decision about taking the prescribed antibiotic. A hospice consult is placed by the nurse and reflects the nurse's autonomy, not the client's, to make a decision about the client.

A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure?

The nurse ensures that the client's family signs the consent form. The nurse should ensure that the client's family signs the consent form. However, in some states and health care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent form if not in an alert state or unable to communicate. If the client is not in a condition to sign the consent form, a family member may sign the consent form on the client's behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery.

After reporting to work for a night shift, the nurse learns that the unit is understaffed because two RNs called out sick. As a result, each nurse on the unit must provide care for four acute clients in addition to the nurse's regular clients. Which statement is true for this nurse when working in understaffed circumstances?

The nurse is legally held to the same standards of care as when staffing levels are normal. The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite an increased client assignment. Although it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change the nurse's legal position. A nurse has the right to refuse an unsafe client assignment but the nurse is not legally obliged to withhold care.

A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the dosage of atenolol to 12.5 mg. However, because the physician is late for another visit, the physician requests that the nurse write down the order for the physician. What should be the appropriate nursing action in this situation?

The nurse should ask the physician to come back and write the order. The nurse should ask the physician to come back and write down the order. Nurses are discouraged from following any verbal orders, except in an emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.

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. 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 the commitment to the 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 complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report?

To improve quality of care The primary reason to fill out an incident report is to improve the quality of care. Incident reports are not designed to be a means for disciplinary action. Incident reports are designed to identify actual or potential risks that can be iaddressed to improve quality of care. Incident reports are not intended to initiate litigation or document everyday occurrences.

Professional regulations and laws that govern nursing practice are in place for which reason?

To protect the safety of the public Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.

Ethical distress is:

knowing the correct action but being unable to perform it due to constraints. Knowing the correct action but being unable to perform it due to constraints is the definition of moral or ethical distress. Being aware of knowing what is right and wrong is the first step of having an ethical conscience. Supporting a client during a hospitalization is an ethical principle of doing what is right (beneficence) and the focus of client-centered care. An ethical dilemma is a situation in which a person has difficulty deciding which of two or more conflicting ethical principles to follow.

What is the legal source of rules of conduct for nurses?

nurse practice acts Nurse practice acts are examples of statutory law, enacted by a legislative body in keeping with both the federal constitution and the applicable state constitution. They are the primary source of rules of conduct for nurses. Standards of practice, which differ from rules of conduct, are made by agency policies and protocols and by the American Nurses Association. Constitution of the United States is a document that embodies the fundamental laws and principles by which the United States is governed and not nursing practice.

A nurse shows client advocacy by:

offering a hospice consultation to a client who is terminally ill. The definition of advocacy is to ensure that the client's best interests are being met. A hospice consult is an appropriate example. Insisting that a client take a medication does not reflect advocacy for the client because it violates the client's autonomy. Sending a client home with verbal discharge instructions is normal and customary practice and does not ensure that the client's best interests are being met. Refusing to allow a spouse to stay by the client's bedside is not likely to be in the best interests of the client.

A client who is cognitively impaired is scheduled to undergo surgery. The nurse demonstrates understanding of the principle of autonomy and checks the client's health record to ensure that consent has been obtained from which person?

surrogate decision-maker A surrogate decision-maker should be identified to give consent for the client who is cognitively impaired. Infants, young children, people with severe cognitive impairment or cognitively incapacitated, and people in a persistent vegetative state or coma do not have the capacity to participate in decision-making about their health care. For such people, a surrogate decision-maker must be identified to act on their behalf. The surgeon and the nurse are not eligible to give consent for the client.

A nurse is concerned about the practice of routinely ordering an extensive series of laboratory tests for clients who are admitted to the hospital from a long-term care facility. An appropriate entity for addressing this ethical dilemma would be:

the institutional ethics committee. Many healthcare institutions have developed ethics committees, whose functions include education, policy-making, case review, and consultation. These committees are multidisciplinary and provide a forum where divergent views can be discussed without fear of repercussion. Thus, an institutional ethics committee would be an appropriate entity for addressing this ethical dilemma. A client's family would not likely be able to determine whether routine laboratory testing was necessary and therefore ethical and, in any case, would not be objective. The physician and charge nurse would not be objective, either, as they might be implicated in establishing or maintaining this practice. However, the physician and charge nurse could be helpful to the ethics committee by explaining why these tests are necessary and the current and projected care of the client.