Chapter 6: Values, Ethics, and Advocacy
A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply. Before meals, a boy says a prayer that he learned from his parents. A boy is taken for ice cream to celebrate his good report card. A teenage boy explores religions of friends in hopes of developing his own faith. A boy is taught how to behave in public by his schoolteacher. A teenage girl is punished for staying out too late with her friends. A teenage girl tries alcohol at a party with her friends.
A teenage boy explores religions of friends in hopes of developing his own faith. A teenage girl tries alcohol at a party with her friends. Rationale: The laissez-faire approach to discipline would leave children to explore values on their own and to develop a personal value system from this exploration. This approach often involves little or no parental guidance, and may lead to confusion and conflict for the child. Examples of this form of discipline would be a teenage girl trying alcohol at a party with her friends and a teenage boy exploring religions of friends in hopes of developing his own faith. A child reciting a prayer learned by the parents would not be an example of this method. A child being taken for ice cream to celebrate would not be an example of this method. A child taught how to behave by the school teacher is not an example. A teenager being punished by the parents for breaking curfew is not an example.
Which word is best described as protection and support of another's rights? Advocacy Paternalism Autonomy Ethics
Advocacy Rationale: Advocacy is the protection and support of another's rights. Nurses who value client advocacy make sure their loyalty to an employing institution or colleague does not compromise their primary commitment to the client; give priority to the good of the individual client rather than to the good of society in general; and carefully evaluate the competing claims of the client's autonomy and client well-being. Paternalism is acting for clients without their consent to secure good or prevent harm. Autonomy is respecting the rights of clients or their surrogates to make health care decisions; it is also known as self-determination. Ethics is the formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing.
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. Decide the care for a client who is unable to voice an opinion. Convince the family to choose a specific course of action. Present options about the type of care.
Assist in decision making based on the client's best interests. Rationale: 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 legally 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.
A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision? Beneficence Confidentiality Autonomy Justice
Autonomy Rationale: 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.
The focus of the unit where a nurse works is changing. The nurse has deeply held moral and religious objections to procedures that will be commonly performed on clients on this new unit. Which action(s) should the nurse take? Select all that apply. Resign before the new unit focus is implemented. Discuss the situation with the unit nurse manager. Be careful not to share objections with anyone. Plan to care only for clients who will not have these procedures. Do not compromise the nurse's own personal moral standards.
Discuss the situation with the unit nurse manager. Do not compromise the nurse's own personal moral standards. Rationale: The nurse should discuss this situation with the nurse manager and should not compromise personal moral standards. The nurse can express conscientious objection to participating in activities that violate personal ethical beliefs. The nurse should not plan to care only for clients who will not have these procedures as all nurses on a unit are responsible for care in emergencies. Resigning before the new unit focus is implemented is unnecessary if the nurse can be transferred to a different unit.
A client requests that the nurse allow the client 15 minutes two times a day for prayer during hospitalization. What value does this represent? Foundation value Focused value Free value Future value
Foundation value Rationale: A habitual act is indicative of a foundation value.
Which statement best conveys the concept of ethical agency? Ethical practice requires a skill set that must be conscientiously learned and nurtured. Individuals who enter the nursing profession often innately possess ethical characteristics. Ethical practice is best learned and fostered by surrounding oneself with people who exhibit ethical character. A nurse's understanding and execution of ethical practice is primarily a result of increased years of experience.
Ethical practice requires a skill set that must be conscientiously learned and nurtured. 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 female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "This happens to many women." Which type of ethical approach is the nurse exhibiting? Paternalism Feminist Values clarification Moralizing
Feminist Rationale: A feminist approach is one in which the focus is on specific problems and concerns faced by women. The statement that "this happens to many women" is an example of a feminist approach. Paternalism is action limiting a person's or group's liberty or autonomy that is intended to promote their own good (e.g., if the nurse stated that "I must make all decisions about this client's care for her, as she's not in any shape to do so herself"). Values clarification is a self-assessment process that enables a person to discover the content and strength of the person's own system of values. An example of this would be if the nurse stated, "I feel bad for the client, as no one deserves this." Moralizing is to comment on issues of right and wrong, typically with an unfounded air of superiority. An example of this would be if the nurse stated, "If she was a good girl, this would have never happened to her."
A client rings the call bell to request pain medication. On performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. After a few moments, the nurse returns with the pain medication. The nurse's returning with the pain medication is an example of which principle of bioethics? Fidelity Autonomy Nonmaleficence Justice
Fidelity Rationale: Fidelity is keeping one's promises and never abandoning a client entrusted to one's care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make healthcare decisions. Nonmaleficence is preventing harm from being done to a client. Justice involves meeting the needs of each client equitably and acting fairly.
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy? Limiting visitors due to the client reporting pain Administering pain medication when the pain level reaches 9 on a pain scale of 0 to 10 Changing the channel on the television while providing care Turning and positioning the client every 4 hours
Limiting visitors due to the client reporting pain Rationale: Advocating for clients is a nursing responsibility and is performed with the best interest and welfare of the client in providing safe, competent, and comforting care. Limiting visitors is an example of advocacy. The nurse recognizes that the client is in pain; therefore, limiting the visitors allows for the nurse to advocate for additional measures to allow the client to rest and recover. Administering pain medication and turning and the client every 4 hours are important and necessary interventions for a postoperative client, but this is not advocacy. Changing the channel on the television while providing care also does not promote advocacy.
While providing care to a client, a nurse encounters an ethical problem. The nurse knows the right thing to do, but the facility's policies interfere with the nurse's ability to follow through in doing the right thing. Which condition is the nurse experiencing? Ethical dilemma Moral distress Moral resiliency Ethical agency
Moral distress Rationale: Moral distress occurs when a nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. In an ethical dilemma, two (or more) clear moral principles apply but support mutually inconsistent courses of action. The capacity to recover, adapt, and even thrive in the face of threats, misfortune, or challenging times is termed resilience. Moral resilience is the developed capacity to respond well to morally distressing experiences and to emerge strong. Ethical agency involves the ability to always do the ethically right thing because we know it is the right thing to do.
A parent teaches a child not to drink and drive; however, the parent does drink and drive. This action results in: conflict with society. a failure to model one's own values. insecurity and a lack of safety. a disruption in consistency.
a failure to model one's own values. Rationale: Many role models fail to model their own values and, as a result, cause conflict with and confusion in those who look up to them, such as children (not society, in general). The primary result of this action, which is saying one thing and doing another, is not so much insecurity and a lack of safety or a disruption in consistency as it is a failure to reflect one's own values.
Which nursing action(s) best demonstrate the ethical principle of autonomy? Select all that apply. The nurse reviews best practice standards for procedures commonly performed on the unit. The nurse calls the prescriber when a medication dosage seems too high for the intended client. The nurse checks to ensure an informed consent document is signed prior to transferring the client for a surgical procedure. The nurse completes yearly continuing education requirements. The nurse documents that a client refused a new medication.
The nurse checks to ensure an informed consent document is signed prior to transferring the client for a surgical procedure. The nurse documents that a client refused a new medication. Rationale: Autonomy is respect for the client's right to make health care decisions. Informed consent and right to refuse medications are a part of autonomy. Reviewing standards of practice and checking a medication dosage are related to nonmaleficence. Yearly continuing education is related to keeping the promise to remain competent (fidelity).
A nurse who has worked on a unit for 8 years is conflicted about asking to meet with the charge nurse about staffing ratios. Which question(s) reflect the professional value of altruism in this decision? Select all that apply. "Can I discuss this matter without violating my client's privacy?" "Are my clients receiving equal treatment?" "Am I able to provide safe and efficient care to my clients?" "Am I willing to take this risk to help protect my fellow nurses?" "Will less experienced nurses on the unit learn from my actions?"
"Am I able to provide safe and efficient care to my clients?" "Am I willing to take this risk to help protect my fellow nurses?" "Will less experienced nurses on the unit learn from my actions?" Rationale: Altruism is a concern for the welfare and well-being of others. Being concerned about quality of care, mentoring other professionals, and taking risks to benefit others are examples of altruism. Privacy rights reflect the professional value of human dignity. Fairness and equality reflect the professional value of social justice.
Which statement regarding the Code of Ethics for Nurses is most accurate? "The code critiques existing patterns of oppression and domination in society." "The code enables nurses to provide good care to clients." "The code is an expression of nursing's own understanding of its commitment to society." "The code provides nurses with specific guidelines for practice.
"The code is an expression of nursing's own understanding of its commitment to society." Rationale: The Code of Ethics for Nurses provides nurses with a nonnegotiable statement of the ethical obligations of individuals who enter the nursing profession. It serves as an expression of nursing's own understanding of its commitment to society. The feminist ethics approach critiques patterns of oppression and domination in society. Clinical virtues enable nurses to provide good care to clients. The principle-based approach to ethics provides nurses with specific action guidelines for practice.
Which ethical principle is related to the idea of self-determination? Autonomy Beneficence Confidentiality Nonmaleficence
Autonomy Rationale: 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.