Fundamentals of Nursing P&P Chapter 22

Casuistry

(care based reasoning) focuses on "intimate understanding of particular situations"

Which ethical principles are included in the professional nursing code of ethics?

- Advocacy - Responsibility - Accountability

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in 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

The nurse understands that values are an important part of life and may differ from one person to another. Which measures should the nurse adopt to ensure ethical nursing care when dealing with the values of a patient?

- Be clear about personal values. - Maintain cultural competence. - Attempt to resolve differing opinions.

Major Issues in Health Care Ethics

- quality of life - disabilities - care at end of life - health care reform

Which is the best example of practicing patient advocacy?

Assessing the patient's point of view and preparing to describe it

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?

Fidelity

There are seven key steps in the resolution of an ethical dilemma. Which is the second key step in the resolution of an ethical dilemma?

Gather information relevant to the case.

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 principle, 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 obscured or deleted all patient identifiers?

No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work

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?

Nurses develop a relationship with the patient that is unique among all professional health care providers

Autonomy

Refers to freedom from external control

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 best describes the role of the nurse in the resolution of ethical dilemmas?

To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations

A patient has difficulty in breathing. The nurse provides oxygen therapy to the patient, after which the patient feels better. Which principle is involved in this situation?

beneficence

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?

- According to the concept of beneficence, all interventions should be undertaken while considering the best interest of the patient. - According to the concept of nonmaleficence, the healthcare professional should weigh the risks and benefits of the intervention before delivering it. - According to the concept of nonmaleficence, the healthcare professional must strive to avoid harm to the patient due to any interventions delivered.

Professional Nursing Code of Ethics

- Advocacy - Responsibility - Accountability - Confidentiality

A group of researchers is performing a study on the quality of life in elderly patients. Which parameters should be included in the study?

- Age - Occupation - Ability to live independently - Ability to contribute to society in a meaningful way

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.)

- Community values influence definitions of quality, and they are subject to change over time. - Individual experiences influence perceptions of quality in different ways, making consensus difficult. - The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. -Statistical analysis is difficult to apply when the outcome cannot be quantified.

The senior nurse is discussing ethical dilemmas with colleagues. Which statements are true about ethical dilemmas?

- Ethical dilemmas should be processed carefully to reduce distress and controversy. - An ethical dilemma cannot be resolved solely through scientific data. - Resolving ethical dilemmas is similar to the nursing process.

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.)

- Ethics of care focuses only on understanding relationships. - Ethics of care pays attention to the stories of the people involved in the ethical issue - Ethics of care pays attention to the environment in which caring occurs

Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply.)

- If low income compromises access to care, respect for autonomy is compromised - Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics - Access to health care reflects the commitment of society to principles of beneficence and justice

A patient has advanced pancreatic cancer and treatment is no longer viable. The healthcare provider plans for palliative care to improve the patient's quality of life. The nurse in charge has been asked to take measures to relieve the patient's pain. Which nursing interventions are helpful to attain a high standard of fidelity?

- Monitor the patient's response to the pain medication. - Bring the patient pain medication when promised. - Follow up on actions and interventions regularly.

A patient is scheduled for a mastectomy. Which interventions are performed out of respect for the patient's autonomy?

- Review the surgical procedure. - Explain the risks and benefits of the procedure. - Ensure that the patient reads the surgery documents and signs the consent form.

Which elements are necessary for the resolution of conflicting opinions?

- Strict adherence to patient confidentiality - Patient-centered decision making - Presumption of good will on the part of all participants - Participation of families and primary caregivers

Steps in the Resolution of an Ethical Dilemma

1: Ask if this is a dilemma 2: Gather data 3: Clarify values 4: Verbalize the problem 5: Identify courses of action 6: Negotiate a plan 7: Evaluate the plan over time

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, what are the principles from highest to lowest priority? 1. Accountability: You as the nurse are accountable for the wellbeing of this patient. 2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver transplant. 3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant. 4. Justice: The greatest question in this situation is how to determine the just distribution of resources.

4, 2, 3, 1

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable 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 could 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

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?

Assessing the patient's point of view and preparing to articulate it

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?

Beneficence

When the nurse assesses a patient for pain and offers a plan to manage the pain, which principal guides the nurse to monitor the patient's response to the pain?

Fidelity

When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's 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?

Fidielity

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?

Justice, because the first and greatest question in this situation is how to determine the just distribution of resources

The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why?

In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism.

A patient is diagnosed with breast cancer. The healthcare provider educates the patient about the treatment options. The healthcare provider recommends and highly favors chemotherapy; however, the patient chooses to undergo surgery. Which is the most appropriate intervention?

Prepare the patient for surgery.

Deontology

defines actions as right and wrong on the basis of their "right making" characteristics - fidelity to truth, promise, and justice

Feminist ethics

focuses on the nature of relationships to guide participants in making difficult decisions

Utilitarianism

measures the effect that an act will have - Does it serve the greater good? - consequentialism - teology

Ethics of care

the delivery of health care based on ethical principles and standards of care - related to feminist ethics