nursing ethics

child abuse

physical, mental,sexual assaults, physical, emotional, and medical neglect. - nurses are mandatory reporters of child abuse -failing to report suspected child abuse can lead to civil and criminal liability for medical malpractice. -Nurses report suspected abuse to their immediate supervisor and the HCP

Advocacy

pleading in favor of or supporting a case, person, group, or cause. -safeguarding patients' autonomy -acting on behalf of patients -championing social justice in the provision of healthcare. -embrace the promotion of well being and uphold the rights and interests of their patients

The nurse bases individual nursing practice upon commitment to quality patient care and understanding of the nursing role. Under which broad classification of ethical theory does this fall? 1. Applied theories 2. Utilitarian theories 3. Deontological theories 4. Teleological theories

3 Rationale 3: Deontological theories derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed. The nurse makes a commitment to excellence of patient care.

When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse's best defense for applying restraints? 1. Necessity 2. Consent 3. Self-defense 4. Privilege

3 Rationale 3: Self-defense and defense of others may be justifiable to protect oneself and others in the area from harm.

informed consent

An ethical principle requiring that research participants be told enough to enable them to choose whether they wish to participate. -legal and ethical issue of autonomy -respecting a persons autonomy to make personal choices based on the appropriate appraisal of the information about the actual or potential circumstances of a situation. -Physicians responsibility -implied consent is for non risky or invasive treatments. if the patient participates with an action without verbalizing consent.

The hospital ethics committee has decided to move to the relational ethics framework for decision making. What change should the committee members expect from this framework shift? 1. Decisions made will be more practical and action oriented. 2. The number of options for discussion will be reduced. 3. Use of other ethical theories and guidelines will be eliminated.

1

The nurse tells a patient that an immunization "will not hurt at all" when the nurse is aware that the injection will be painful. Which ethical principle has the nurse most clearly violated? 1. Veracity 2. Beneficence 3. Justice 4. Autonomy

1

Deontology

Approach to ethics that judges the morality of an action based on the action's adherence to rules. Described as duty or obligation, because rules 'binds you to your duty'. -focuses on duties and rules. - duty to do something ex: code blue at end of shift, your moral duty is to stay and help even if youre not getting paid

quality of life

Beneficience, nonmaleficence, and respect for autonomy What are the prospects with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds? On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express judgement? Are there biases that might prejudice the providers evaluation of the patients quality of life? what is the legal and ethical status of suicide?

The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years. During the review, the nurse begins to cry and tells the manager, "I just can't do this anymore. I can't sleep because I have such bad nightmares about patients. I can't eat and I've already lost 15 pounds." The nurse manager identifies these findings as being possible signs of which problem? 1. Moral distress 2. Too much focus on the patient 3. Developing incompetence 4. Problems at home

1 Rationale 1: Signs and symptoms of moral distress include powerlessness, guilt, loss of self-worth, self-criticism, low self-esteem, and physiologic responses such as crying, depression, loss of sleep, nightmares, and loss of appetite.

A nurse is frequently tardy to work causing other nurses to have to change their plans to cover the unit. The nurse never thanks those who cover for her and often criticizes the work they did in her absence. If another nurse is tardy, she refuses to stay over to cover. Which ethical theories is this nurse violating? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fidelity 2. Autonomy 3. Beneficence 4. Veracity 5. Paternalism

1, 3

Access to medical records

Clients have a right to read their own records. -helps dispel feelings that the physician was lying about the severity of the illness -helps reassure pts that their care was based on actual medical findings.

The nurse is preparing a patient for a procedure. The patient has signed a consent form but states, "I don't really know anything about this procedure. I wonder if there is something else I could do instead?" How should the nurse proceed? 1. Continue with the preparation as consent may not be revoked. 2. Try to convince the patient to go through with the procedure. 3. Stop the preparation as the patient can revoke consent at any time. 4. Have the patient document the question in writing since the original consent was written.

3

The nursing student began a case study paper by writing, "J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital." What is the significance of this statement? 1. It is incomplete, as the date and time of admission should be included. 2. It is a good description of the patient to begin the paper. 3. It violates Health Insurance Portability and Accountability Act regulations. 4. It is incomplete, as the patient's physician's name should be included.

3

Categorical Imperative (Kant)

- We should always act in such a way that our moral decisions could be used as a guide for everyone's moral behaviour -follow a unconditional framework of rules , as a guide to know the rightness of actions and ones mora; duties. -ex: if i perform this action, could i will that it should become a universal law for everyone to act in the same way? -ex: For example, any oncology nurse who wishes to perform a procedure on cancer patients without their knowledge must be happy for all other nurses to perform procedures on her (the oncology nurse) without her consent.

Social Justice

-represents the position that benefits and burdems should be distributed fairly among members of a society, or ideally that all members of a society should have the same rights, benfefits and opportunities. - the fair distribution of benefits and burdems among members in a society.

A patient requests that records of her hospitalization for treatment of an infection following an abortion be destroyed as soon as she is discharged. What is the likely outcome of this request? 1. The record will be sealed. 2. The record will be destroyed. 3. The request will be denied. 4. The record will be given to the patient's attorney.

1

In which scenarios would the nurse assume that apparent consent has been provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient follows directions to swallow sips of water as the nurse inserts a nasogastric tube. 2. The patient's family member signed the consent to treat. 3. The patient smiled and held out his arm when the nurse said, "I need to start an intravenous line." 4. The patient voluntarily signed a consent form for an invasive procedure. 5. An unconscious patient is brought to the hospital following a motor vehicle accident.

1, 3 Rationale 1: Apparent consent is given by conduct. This patient is following instructions given to help in the placement of the tube, so conduct would indicate consent. Rationale 2: Depending upon which family member is involved, this situation may be actual consent. For example, a parent signing the consent for a minor child. Rationale 3: Smiling and holding out the arm is an apparent consent to starting an intravenous line. Rationale 4: This is an example of actual consent. Rationale 5: This is a situation of implied consent. The patient is unable to give consent, but would likely give consent if able.

Unrest on the nursing unit has progressed to moral outrage among the nursing staff. Which statements made by the nurse manager to the chief nursing officer indicates an understanding of this issue? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am concerned that the quality of care we are providing will reduce if this unrest continues." 2. "We may experience turnover in staff positions if this tension continues." 3. "I think we need to hire some more unlicensed personnel to shift the direct patient care work off the registered nurses." 4. "This will be a good opportunity to get rid of the unit trouble-makers." 5. "I am going to try to divert this energy by asking the nurses to help rewrite the policy and procedures manual."

1,2

The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as indicating ability to respond appropriately to the ethical dilemmas? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I think nurses and physicians should discuss care decisions with patients and families." 2. "I worked an oncology unit for 10 years before we moved here." 3. "I think that most dilemmas can be solved by taking the option that is most logical." 4. "At my last job, we were required to take ethics training each year." 5. "As long as nurses follow orders and policy and procedures ethical dilemmas are unlikely to arise."

1,2,4

In which ways can the nurse best act as a patient advocate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Participate in continuing education offerings pertinent to the current position. 2. Follow all physician orders precisely and completely. 3. Practice with the patient as priority concern. 4. Educate the patient throughout the hospitalization or other nurse-patient contact. 5. Become active in changing outdated policies or procedures.

1,3,4,5

The nurse discussing the Health Insurance Portability and Accountability Act (HIPAA) says, "I am aware that this act changed the way we handle confidential information." What other provisions of this act should the nurse consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. An anti-fraud and anti-abuse program 2. Establishment of state governments as health care regulators 3. A law preventing portability of health care coverage 4. Tax incentives for preventive care 5. Streamlining of transfer of patient information between insurers and providers

1,5Rationale 1: An anti-fraud and anti-abuse program is part of HIPAA. Rationale 2: The act established the federal government as a national health care regulator. Rationale 3: This act provides for the portability of health care coverage. Rationale 4: There are no tax incentives for preventive care included in this act. Rationale 5: HIPAA was designed to help streamline transfer of patient information between insurers and providers. As part of this streamlining effort, changes to confidentiality also occurred.

In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do? 1. Chart that the child is a victim of child abuse, so that there is a record of the abuse should such behavior reoccur. 2. Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities. 3. Do nothing, because the nurse cannot prove the child was really abused, and saying anything could open the institution to a possible defamation lawsuit. 4. Downplay the child's comments, because children often exaggerate.

2

Nurses believe that there is a need to change policy for their clinical unit. What is the first step these nurses should take when considering this need for new policy? 1. Determining how many people are affected by the policy 2. Identifying the problem 3. Looking for ethical arguments regarding the policy 4. Finding out who has authority to change the policy

2

The nurse advises a patient to have surgery because, "The doctor knows what is best for you." The nurse is most likely following which ethical principle? 1. Respect for others 2. Paternalism 3. Justice 4. Fidelity

2

The patient demands to see the actual medical record of a hospitalization that occurred 1 year ago. How should the hospital handle this request? 1. Deny the demand; the patient has no legal right to this record. 2. Have the patient come to the hospital to review the original record. 3. Send the patient a copy of the medical record by registered mail. 4. Do not comply with this demand unless the patient provides a subpoena for the record.

2

The patient presents to the emergency department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers? 1. Oral 2. Implied 3. Partial 4. Expressed

2

Prior to surgery, the nurse checks to ensure that the patient has signed an informed consent form. Which ethical principle is the nurse supporting? 1. Beneficence 2. Veracity 3. Autonomy 4. Fidelity

3 Rationale 3: Autonomy is the right to choose what will happen to one's own person. Being informed about the benefits and risks of surgery through informed consent is a direct reflection of the principle of autonomy.

The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review? 1. ANA Code of Ethics 2. State Nurse Practice Act 3. Nurse's Bill of Rights 4. Nightingale Pledge

2 Rationale 1: The ANA Code of Ethics is the document that defines ethical principles for nurses. Rationale 2: The state nurse practice act is the legal guide to define the scope of practice for nurses. Rationale 3: The Nurse's Bill of Rights are references to nurses' rights, not specific legal aspects of nursing practice. Rationale 4: The Nightingale Pledge is the nurses' pledge or commitment to serving their patients derived from the writings of Florence Nightingale.

The hospital administration asks nursing services to assume housekeeping duties from midnight until 6:00 a.m. Nurses are fearful that this is the first step to shifting complete 24-hour-per-day responsibility for housekeeping duties to nursing services. The nurses believe this would take away from their ability to provide quality nursing care to their patients. This scenario is an example of which ethical concept? 1. The MORAL argument 2. Slippery slope thinking 3. Relevance thinking 4. Reluctance model

2 Rationale 2: Slippery slope thinking or arguments suggest that an action will initiate a chain of events that cumulate in an undesirable event later.

In which instance would the nurse accept informed consent from a 13-year-old patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. If the child is consenting to treatment for an emergency surgery 2. If the child is consenting to treatment for a venereal disease 3. Under no circumstances can a 13-year-old give valid consent. 4. When the parents are not readily available 5. The patient is seeking treatment for drug dependency.

2, 5 Rationale 1: A 13-year-old cannot give consent for surgery, even in an emergency. In the case of an emergency, if the parents are not available to give consent, the emergency doctrine applies and surgery would proceed. Rationale 2: The law recognizes a minor's right to provide consent in some circumstances, including treatment for venereal diseases. Rationale 3: In some circumstances minors can give consent for treatment. Rationale 4: An attempt to reach parents must be made even if they are not readily available. Rationale 5: Minors can give consent for diagnosis and treatment of drug dependency, drug addiction, or any condition directly related to drug usage.

A nurse manager has started a dialogue regarding the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements among staff nurses. Which staff nurse statements would the manager evaluate as indicating poor understanding of this document? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "This document describes nursing's own understanding of its commitments to society." 2. "This document is so out of date, they never revise it." 3. "At least the ANA understood that professional ethics are different in different regions of the country." 4. "It is interesting that the ANA first addressed this code over 50 years ago." 5. "This document has established standards by which we should practice."

2,3 Rationale 1: The ANA's Code of Ethics for Nurses with Interpretive Statements is an expression of nursing's own understanding of its commitments to society. Rationale 2: The document has been revised, most recently in 2001. Rationale 3: The statements in the document are inclusive of all nurses and do not change according to region. Rationale 4: This document was first published in 1950, well over 50 years ago. Rationale 5: This document gives direction for those entering the nursing profession about their ethical accountability, sets a nursing standard for ethical practice, and informs the consumer about nursing's ethical standards.

In which instances would the nurse feel comfortable providing care without first obtaining informed consent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient is deaf. 2. The physician feels the disclosure of information required for informed consent might cause the patient to commit suicide. 3. A visitor suffers a cardiopulmonary arrest in the emergency department waiting room. 4. The patient has signed a waiver at the suggestion of the primary nurse. 5. Informed consent was obtained when the patient had the same procedure last week.

2,3,5 Rationale 1: The fact that the patient is deaf does not remove the requirement to obtain consent. Rationale 2: Therapeutic privilege exists when the health care provider believes the disclosure of information poses immediate and serious harm to the patient. Rationale 3: Emergency situations, such as a cardiopulmonary arrest, constitute an exception to the need for informed consent. Rationale 4: The patient must initiate a waiver; it cannot be suggested by staff. Rationale 5: Prior patient knowledge involves the patient to whom the risks and benefits were fully explained the first time the patient consented to the procedure.

As a result of shared medical decision making, a patient undergoes a surgical procedure that results in paralysis. What must the patient prove to bring a successful malpractice suit based on informed consent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient had no part in the decision to operate. 2. The procedure's known risk of paralysis was not explained to the patient. 3. Since the decision making was shared, no malpractice suit is possible. 4. It was the procedure that caused the harm. 5. That the amount of damage to the patient cannot be determined.

2,4

The patient brings suit against a health care provider. In which ways would the nurse expect this action will affect the confidentiality of the patient's medical record? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The confidentiality of the record will remain intact. 2. The patient's attorney will have access to the information in the record. 3. The record loses confidentiality and is discoverable by any interested party. 4. The record will be released to the defendant's attorney. 5. Only the judge will have full access to the medical record.

2,4

A nurse strongly believes that all newborns should be screened for HIV at birth. Which ethical principle would the nurse cite to support this argument? 1. Informed consent 2. Confidentiality 3. Beneficence 4. Autonomy

3

involuntary commitment

procedure of placing some people with mental illnesses in a psychiatric hospital or another facility based on their potential danger to themselves or others or their inability to care for themselves. Psych emergency- a dr, psychiatrist, clinical psychologist, a licensed clinical swk can admit someone involuntarily in an emergency setting. -Pts are held for 72 hours for observation. -2 psychiatrist must sign off on inpatient psych admission.

What is the principal reason that a higher standard of care may be required for safeguarding mentally ill persons? 1. Mentally ill persons bring more lawsuits than those with no mental illness. 2. The standards of care for mentally ill patients are higher than those for physically ill patients. 3. Mentally ill persons cannot fully appreciate their exposure to potential harm. 4. These patients require more care than do those who are physically ill.

3 Rationale 3: The mentally ill are considered a vulnerable population due to their behavioral and cognitive impairments. Therefore, their judgments and actions may be altered, and they may not be able to recognize the risks of circumstances regarding their care.

A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Every state requires that all sexual contacts of a person diagnosed with AIDS be contacted and treated. 2. AIDS status must be disclosed to any health care provider who has cared for the patient within the last 18 months and to any future health care provider. 3. In general AIDS status is considered confidential. 4. All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department. 5. All babies born in the United States are tested for presence of HIV at birth.

3,4

The hospital has a well-designed, fully functioning ethics committee. What ethical debate topics, concerning the entire social network rather than an individual patient, might now be addressed by this committee? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Do-not-resuscitate orders 2. Autonomy 3. Duplication of services 4. Informed consent 5. Effects of managed care on patient well-being

3,5 Rationale 3: Duplication of services is a topic that concerns the entire social network of provision of health care and is a much broader topic than the typical individual concerns addressed by maturing committees. Rationale 5: The impact of managed care on patient well-being is the kind of broad-based, societal issue that can be addressed by a well-developed mature ethics committee.

A frail 90-year-old resident of a long-term care facility refuses to sign an advanced directive and tells the nurse she "wants everything done" to save her life if she should go into cardiopulmonary arrest. What action by the nurse is ethically and legally indicated? 1. Discuss the situation with the resident's family and plan to follow their wishes. 2. Tell the resident that end of life interventions are generally up to the physician. 3. Tell the resident that everything will be done, but make a do not resuscitation note on the medical record. 4. Support the patient in her wishes but continue education about end-of-life care.

4

The nurse manager has identified high levels of moral distress on the nursing unit. Which change would be helpful in assisting nurses to cope? 1. Relieving the nurses from service on ethics committees 2. Increasing compensation for overtime hours worked 3. Sending nurses home when they exhibit signs of moral distress 4. Encouraging free discussion of ethical concerns

4

The parents of a 17-year-old who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider? 1. Refuse the request pursuant to the provision of the common-law duty to disclose. 2. Refuse the request as it is likely to interfere with the treatment plan. 3. Release the information immediately as parents always can receive information on minor children. 4. Release information only if the patient has signed consent to do so.

4

The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, "I'll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot." What action should be taken by the nurse? 1. Remind the patient that the surgery is to remove his lower leg, not just his toe. 2. Check to see if the patient signed consent for the above-the-knee amputation. 3. Continue the transfer, as the patient is not reliable since opioid medications have been administered. 4. Stop the transfer and notify the surgeon of the patient's comment.

4

Which option reflects financial exploitation? 1. The caregiver allows the patient to pay for incidentals necessary for care. 2. The caregiver encourages the elder person who wishes to continue to work in the family business. 3. The caregiver takes the patient's Social Security check to the bank for deposit. 4. The caregiver has the patient sign power of attorney papers by saying they are required by the government.

4

The hospital is forming an ethics committee. Which concept should be central to that committee's function? 1. Most of the committee's work should involve short-term ethical issues. 2. The overriding concern of the committee should be protection of the hospital. 3. Members should be limited to medical staff. 4. The committee should act to provide guidelines for potential problems.

4 Rationale 4: Ethics committees can (1) provide structure and guidelines for potential problems, (2) serve as an open forum for discussion, and (3) function as a true patient advocate by placing the patient at the core of the committee discussions.

The long-term care facility is considering the involuntary discharge of a resident. What should the facility provide the resident prior to making this decision? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A referral to a different long-term care facility 2. Return of the last month's fees 3. Access to a psychiatric evaluation 4. Social work counseling if requested 5. Written notice

4, 5 Rationale 1: The facility does not have to refer the resident to a different facility. Rationale 2: There is no requirement for return of the last month's fees. Rationale 3: There is no requirement that the facility provide access to a psychiatric evaluation. Rationale 4: The resident has a right to social work counseling. Rationale 5: To discharge a resident involuntarily, written notice must be given to the resident, a responsible party, a state agency, or an ombudsman.

ICN Code of Ethics

ICN Code for Nurses is nursing's respect for the life, dignity, and rights of all people in a manner that is unmindful of nationality, race, creed, color, age, sex, political affiliation, or social status. -Adopted by ICN in 1953, with revision in 2012. -4 principle elements: Nurses and people(nurses primary responsibility is to the people requiring nursing care), Nurses and Practice (nurses carry personal responsibility for nursing practice, for maintaining competence by continual learning.), Nurses and the profession (EBP, the nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice), Nurses and Coworkers (the nurse sustains a collaborative and respectful relationship with coworkers in nursing and other fields.) - A guide for action based on social values and needs -globally accepted document for ethical practice in nursing

Contextual Features

Justice and fairness Are there professional, interprofessional, or business interests that might create conflict of interest in the clinical treatment of patients? Are there financial factors that create conflicts of interest in clinical decisions? Are there religious issues that might affect clinical decision? what are legal issues that might affects clinical decisions?

John Rawl's Veil of Ignorance

Justice comes from making decisions that maximize liberty for all people and without considering which outcome will give us personally the biggest benefit. -make justice based decisions from a position free of biases. -2 principles: 1. everyone should be given equal liberty regardless of ther adversities. 2. differences among people should be recognized by making sure the least-advantaged people are given opportunity for improvement.

HIPPA Laws

The Privacy Rule of the Health Insurance Portability and Accountability Act (HIPPA) has brought significant changes to the record keeping, storage, access, and discussion of patient-specific medical information. The HIPPA laws are used for keeping an individual personal information only for themselves and the EMS individuals treating them.

ANA Code of Ethics

The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Nine provisions of the Code describe -ethical values, -obligations, -duties, -professional ideals of nurses: individually, collectively

moral dilemma

a conflict in which you have to choose between two or more actions and have moral reasons for choosing each action -conflicting but morally justifiable courses of action

Ethical Systems ****

a set of moral principles, or values, that are used to guide and shape behavior

Ethical Theory ****

a systematic examination of morals involving critical reflection and analysis about what is right and wrong

Slippery Slope

an idea or course of action which will lead to something unacceptable, wrong, or disastrous.

ethical dilemma

an idividual is compelled to choose between 2 actions that will affect the welfare of a sentient being and both acions are reasonably justified as being good, neither action is good, or the goodness of the action is uncertain. - none of the available options feel right. -ex: a daughter trying to decide whether to withdraw lifesupport from her 88yo mom. It may feel wrong ending her moms life, but it isnt right to allow her mother to suffer with her medical condition.

moral distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. -nurses may feel pressure to do something that conflicts with their values -critical, frequently ignored problem in healthcare. Causes -Multiple or dual expectations -Inability to act according to moral integrity

Medical Indications

beneficence and nonmaleficence, what is the patients medica; problem, acute, chronic, critical, reversible? what are the goals of treatment? probablitiy of success of various treatment options? how is the pt benefited by medical and nursing care? how can harm be avoided?

ethics committee

committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases. -promote the rights of patients -promotion of shared decision making between patients , or their surrogates -promotion of fair and equitable policies and procedures that maximize the likelihood of achieving appropriate and acceptable quality patient-centered care -enhance the ethical tenor of health care professions and health care institutions

Institutional Review Board (IRB)

committee of administrators, scientists, and community members that reviews proposals for research involving human participants. This group review serves an important role in the protection of the rights and welfare of human research subjects. The purpose of IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research.

Nonmaleficence

duty to do no harm. healthcare workers are encouraged to do good (beneficience), if for some reason they can't do good, they are required to at least do no harm. -intentional avoidance of actions that cause harm. -avoid negligent care and harm when deciding whether to provide or withhold or withdraw treatment

health inequalities/disparities

inequalities or differences in healthcare access and treatment that result in poor health outcomes for persons and populations. -racial and ethnic minorities suffer serious health disparities in access to care and health outcomes.

Distributive Justice

perceived fairness of the amount and allocation of rewards among individuals

Utilitarianism

promotes the greatest good (happiness or pleasure) and to produce the least amount of harm (unhappiness, suffering, pain) possible in a situation. (greatest good for the greatest number of people who may be affected by an action. ) Rule utilitarian-certain rules such as do not kill, do not break promises, and do not lie, when followed usually create the best consequences for most people. -seeks the greatest happiness for all Act utilitarian- each action in particular circumstance should e chosen based on its likely good consequences rather than on following an inherently moral, universal rule. -which course of action will bring about the greatest happiness, or the least harm.

Patient Preferences

respect for autonomy Has the patient been informed of benefis and risks, understood the information, and given consent? Is the patient mentally capable and legally competent, is there evidence of legal incapacity? If mentally capable, what preferences about treatment is the patient stating? if incapacitated, has the patient expressed prior preferences? who is the appropraite surrogate to make decisions? is the patient unwilling or unable to cooperate with medical treatment, if so, why?

Madison Vs Harrison

states recognize the mature minor generally a teenager between 14-17 who is able to understand thw nature and consequences of the proposed therapy. -obtaining valid informed consent when dx and tx of infectious, contagious, or communicable diseases -dx and tx of drug dependency, drug addiction, or drug usuage -obtaining birth control -tx during pregnancy

Kantian Ethics

the belief that people should be treated as ends and never as means to the ends of others -Balance rights of individuals with rights of populations and communities •Respecting autonomy while protecting safety -Each rational being is ethically bound to act only from a sense of duty .•Consequences of an action are irrelevant. •There are two types of duties: hypothetical imperative and categorical imperative

civil commitment

the involuntary confinement of a person judged to be a danger to the self or to others, even though the person has not committed a crime.

Paternalism

the overriding of a person's actions or decision-making (autonomy) for his own good. acting in ways they believe promotes a patients wellbeing (beneficience). ex: a nurse avoids telling a pt that her BP is elveated because the nurse believes this information will upset the pt and further elevate the BP. Elderly people may not remember the date, time, or peoples names, but they may still have the capacity to make decisions.

veracity

the whole truth should be told -give as much info as possible to patients/family - do not use medical jargon, if a patient cant understand the truth, then the truth is hidden.

Moral Courage

the will to stand up for what is right, regardless of personal cost. ex: confronting or reporting a peer who is stealing and using drugs at work -confronting a physician who ordered questionable treatments not within reasonable standard of care -confronting administrators regarding unsafe practices or staffing patterns, -reporting another nurse for exploitation of a patient or family member (posting a pic or story of a pt on social media)

Beneficence

to do good. -performing deeds of mercy,kindness,friendship,charity -people take actions to benefit and promote the welfare of other people. protect and defend the rights of others, prevent harm from occuring to others, remove conditions that will cause harm to others, help persons with disablities, rescue persons in danger. -Provision 2.1 code of ethics- to have theri patients' interests and well being as their primary concern.

Ethical Decision Making models

•Medical indications •Patient preferences •Quality of life •Contextual features