Chapter 3 Ethical and Legal Issues

Breach of confidentiality

revealing aspects about a client's case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm.

Ethical Dilemmas

situations that require individuals to make a choice between two equally unfavorable alternatives. Taking no action is considered an action taken.

Beneficence

refers to one's duty to benefit or promote the good of others. -Good care must include a holistic focus that considers the patient's beliefs, feelings, and wishes.

Ethics

A branch of philosophy that deals with distinguishing right from wrong

Values clarification

A process of self-exploration by which people identify and rank their own personal values

Defamation of character: Libel

A written defamation of a person's character, reputation, business, or property rights.

A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? A. Intentional tort B. Malpractice C. Battery D. Assault

ANS: B. Malpractice

A client in a long-term care facility falls out of bed, fracturing his left hip. The side rails on the bed were not raised at bedtime, although this client was identified to be at risk of falling. Which of the following torts has occurred? A. Negligence B. Battery C. Intentional tort D. Slander

ANS. Negligence Negligence occurs when a client is exposed to an unreasonable risk of injury. Raised side rails help decrease the risk of falling out of bed and are a standard of care for clients who have been identified as at risk of falling.

A nurse in a mental health clinic is interviewing a client who has a history of substance use disorder. The client reports his experiences from a previous voluntary hospitalization. Which of the following reported experiences by the client constitutes assault? A. "I was threatened with a shot when I refused to take an oral medication that I knew would make me groggy." B. "I was held down against my will and administered a shot." C. "I was told I had to stay in the facility despite my request to leave." D. "I was exposed as a substance abuser to other clients in a group session."

ANS: A. "I was threatened with a shot when I refused to take an oral medication that I knew would make me groggy." Threatening to medicate clients against their wishes is assault. The tort of assault occurs when a person puts another in fear of nonconsensual contact.

A charge nurse is conducting an in-service training session on ethics to a group of newly licensed nurses. Which of the following situations should the charge nurse include as an example of the ethical principle of veracity? A. A nurse truthfully answers the client's questions about upcoming chemotherapy. B. A nurse stops inserting an NG tube when the client refuses the procedure. C. A nurse provides the same amount of time to all clients regardless of condition. D. A nurse reports an assistive personnel who transfers a client without using a gait belt.

ANS: A. A nurse truthfully answers the client's questions about upcoming chemotherapy. A nurse who truthfully answers the client's questions about treatment, such as chemotherapy, is demonstrating the ethical principle of veracity. Veracity refers to telling the truth and being straightforward and clear with clients about the treatment being delivered.

As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery." The unit manager determines that the nurses are protected under which condition? A. The client is voluntarily committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others. C. The client is involuntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment.

ANS: A. The client is voluntarily committed and poses a danger to others on the unit.

A nurse is called away for an emergency while conversing with a client who is concerned about his medical diagnosis. The nurse returns to the client promptly, as promised. Which of the following ethical principles is the nurse demonstrating? A. Autonomy B. Fidelity C. Nonmaleficence D. Justice

ANS: B. Fidelity The nurse is demonstrating the ethical principle of fidelity by keeping a promise that was made.

A nurse is caring for a client who is receiving treatment at an inpatient alcohol treatment facility. Which of the following actions should the nurse identify as an example of an intentional tort? A. Administering an incorrect dose of benzodiazepine B. Informing the client's family member of the admission without the client's knowledge C. Informing the client that an injection will be administered if the client remains agitated D. Failing to recognize suicide risk, resulting in the client's death

ANS: C. Informing the client that an injection will be administered if the client remains agitated. This is an example of assault. Assault is an intentional tort that is characterized by a threat toward a client that makes the client fearful of harm or unwanted touching.

A nurse is teaching a group of newly licensed nurse managers about the principle of justice. Which of the following statements by a nurse manager indicates an understanding of this teaching? A. "I will refer an unhappy employee to the individual with whom a conflict arose. B. "I will allow staff members to schedule their birthday holidays on alternate days, as long as staffing levels are maintained." C. "I will encourage staff participation in choosing new telemetry monitors for the unit." D. "I will compose staff schedules so that each person works two holidays a year."

ANS: D. "I will compose staff schedules so that each person works two holidays a year." Justice means treating everyone fairly. By scheduling each person to work two holidays per year, the nurse manager is requiring staff members to work an equal share of holidays.

A nurse is caring for a client who refuses to take her prescribed oral medication. The nurse states, "If you don't take this pill, I'm going to give you the medication by injection." Which of the following types of tort has the nurse committed? A. Slander B. Battery C. Negligence D. Assault

ANS: D. Assault The nurse has committed the tort of assault, which is an attempt or threat to touch another person unjustifiably. The nurse threatening to administer an IM injection to the client if she does not take her medication orally is a form of assault.

A nurse is caring for an adult client in the terminal stages of lung cancer who refuses any further treatment. The nurse should provide care that facilitates which of the following outcomes? A. Allows minimal treatment B. Benefits the client's family C. Offers hope for a cure D. Supports self-determination

ANS: D. Supports self-determination The nurse must honor the client's autonomy and ability to make health care decisions. The client has the right to refuse treatment; as the client's advocate, the nurse must support that right.

Attempting to calm an angry client by using "talk therapy" is an example of which of the following client's rights? a. the right to privacy b. The right to refuse medications c. The right to the least restrictive treatment alternative d. The right to confidentiality

ANS: c. The right to the least restrictive treatment alternative

Nonmaleficence

Abstaining from negative acts toward another; includes acting carefully to avoid harm.

Malpractice

Act or continuing conduct of a professional that does not meet the standard of competence and results in provable damages to the patient

Utilitarianism

An ethical theory that promotes action based on the result that produces the most good (happiness) for the most people

A nurse is discussing with a newly licensed nurse about how to obtain informed consent from a client who is scheduled to undergo an epidural procedure. Which of the following ethical principles should the nurse include in the teaching? A. Beneficence B. Autonomy C. Paternalism D. Justice

B. Autonomy Informed consent is based on the ethical principle of autonomy, which is the right to self-determination, independence, and freedom of choice.

Moral behavior

Conduct that results from serious critical thinking about how individuals should treat others

A nurse is administering medications to a client who is recovering from a stroke and has right-sided paralysis. The nurse places the client's medications on the left side of the mouth and administers pills one at a time. Which of the following ethical principles is the nurse displaying? A. Autonomy B. Nonmaleficence C. Fidelity D. Justice

Correct Answer: B. Nonmaleficence is the duty to do no harm and to protect clients from harm by eliminating threats. These actions taken by the nurse are important for the safety of the client by preventing aspiration.

A charge nurse is discussing ethics with a newly licensed nurse. Which of the following actions should the charge nurse include as an example of beneficence? A. Taking a continuing education course about recognizing risk factors of suicide B. Spending extra time reorienting a client who is experiencing command hallucinations C. Acknowledging and accepting a client's refusal of a psychotropic medication D. Describing the purpose, action, and side effects of a psychotropic medication

Correct Answer: B. Spending extra time reorienting a client who is experiencing command hallucinations. The nurse should include this action as an example of beneficence, which is the duty to act to promote the good of others. Reorienting a client who is experiencing command hallucinations is in the best interest of the client and can protect the client from harm.

Ethical egoism

Decisions are based on what is best for the individual making the decision.

Natural law theories

Do good and avoid evil. Human knowledge of the difference between good and evil directs decision-making.

Christian ethics

Do unto others as you would have them do unto you.

Negligence

Failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances

Values

Personal beliefs about what is important and desirable

Justice

Principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly.

Veracity

Principle that refers to one's duty to always be truthful. Example: Describing the purpose, action, and side effects of a psychotropic medication

Kantianism

Suggests that decisions and actions are bound by a sense of duty

For which of the following reasons may an individual be considered "gravely disabled"? (Select all that apply) a. A person, because of mental illness, cannot fulfill basic needs b. A mentally ill person is in danger of physical harm based on inability to care for self. c. A mentally ill person lacks the resources to provide the neccessities of life. d. A mentally ill person is unable to make use of available resources to meet daily living requirements.

a. A person, because of mental illness, cannot fulfill basic needs b. A mentally ill person is in danger of physical harm based on inability to care for self. d. A mentally ill person is unable to make use of available resources to meet daily living requirements.

Nurse Jones decides to respect the family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism

a. Utilitarianism

The nurse assists the physician with electroconvulsive therapy on his client who has refused to give consent. Which of the following legal actions might the nurse be charged with because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

b. Battery

Nurse Jones decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision?a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism

b. Christian ethics

Which of the following statements is (are) correct regarding the use of restraints? (Select all that apply) a. Restraints may never be initiated without a physician's order. b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents c. Clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. An in-person evaluation must be conducted within one hour of initiating restraints.

b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. d. An in-person evaluation must be conducted within one hour of initiating restraints. Rationale: Staff who are involved in restraint and seclusion are trained and competent to assess the patient at the initiation of restraint or seclusion and every 15 minutes thereafter

A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. Which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

c. False imprisonment

Nurse Jones decides to tell the client of his terminal status because she believes it is her duty to do so. Which of the following ethical theories in considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism

c. Kantianism

Joe is very restless and pacing a lot. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" Which of the following legal actions might the nurse be charged because of this nursing action? a. Defamation of character b. Battery c. Breach of confidentiality d. Assault

d. Assault

Autonomy

emphasizes the status of people as autonomous moral agents whose rights to determine their destinies should always be respected. -Children, comatose individuals, and people with serious mental illness are examples of clients who are incapable of making informed choices. In this instance a representative for the individual should give consent. Example: Acknowledging and accepting a client's refusal of a psychotropic medication

Bioethics

term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

Defamation of character: Slander

the action or crime of making a false spoken statement damaging to a person's reputation.

Right

valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

Invasion of privacy

when a client is searched without probable cause

Avoiding Liability

· Effective communication · Accurate and complete documentation in the medical record · Complying with standards of care · Knowing the client · Practicing within the nurse's level of competence and scope of practice

All clients whom a nurse attends to have the following rights:

· The right to treatment · The right to refuse treatment (including medication) · The right to the least restrictive treatment alternative