CH. 6 PREP U Values, Ethics, and Advocacy
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?" Explanation: Altruism is a concern for the welfare and well-being of others. Being concerned about: - quality of care - mentoring other professionals - 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.
A charge nurse has implemented staff education on nursing values. The nurse would determine that further education is required when which statement(s) are overheard? Select all that apply. - "I can't believe the client is giving that precious infant up for adoption." - "The gonorrhea test was positive. That's what the client gets for sleeping around." - "If that was my mother, I sure wouldn't agree to a no-code." - "If you are going to have extramarital sex, please protect yourself by using a condom." - "Smoking has been shown to be a risk for many illnesses, including heart disease and cancer."
- "I can't believe the client is giving that precious infant up for adoption." - "The gonorrhea test was positive. That's what the client gets for sleeping around." - "If that was my mother, I sure wouldn't agree to a no-code." Explanation: Being judgmental, as in the options about adoption, gonorrhea, and code-status, does not reflect the values desired in a nurse. Professional nurses do not assume that their personal values are more correct than those of their clients. Nurses are obligated, however, to provide health information such as recommending condom use and smoking cessation.
Which word is best described as protection and support of another's rights?
- Advocacy Explanation: 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.
Which example most accurately depicts the ethical principle of autonomy?
- Describing a surgery to a client before the consent is signed Explanation: Autonomy is the capacity to make an informed, uncoerced decision. Describing a surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision and thus an autonomous one. The nurse changing a dressing on a wound does not require the client to make an informed decision, nor does administering a morning dose of insulin or transporting a client.
A nurse has completed 4 hours of an 8-hour shift on a medical-surgical unit when the nursing supervisor calls. The nursing supervisor directs the nurse to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that the nurse has been busy with client assignments and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem?
- Allocation of scarce nursing resources Explanation: This is a clear example of ethical issues surrounding the allocation of scarce nursing resources and involves distributing nursing care. Advocacy in a market-driven environment and conflicts concerning new technology are not related to the presented situation. Deception is the action of deceiving someone, and the nursing supervisor is not deceiving the nurse.
Which scenario is an example of the laissez-faire approach to value transmission?
- Allowing a child to decide not to have an intravenous line inserted Explanation: A laissez-faire approach to value transmission is one that allows others, especially children, to make decisions without guidance, resulting in a decision that may not be a sound one. Teaching a child about right and wrong behavior is a more active learning strategy, and reflects the moralizing approach to value transmission. Modeling or role modeling is leading (and transmitting values) by example—in this case, not smoking electronic cigarettes to show the adolescents good behavior. Telling the child about the injection feeling like a pinch is not an approach to value transmission.
Which example best describes feminist ethics?
- An approach critiquing existing patterns of oppression and domination in society Explanation: Feminist ethics offer an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guidelines for practice. The care-based approach directs attention to the specific situation of individual clients viewed within the context of their life narratives. The formal study of ethical issues that arise in the practice of nursing describes nursing ethics.
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. Explanation: 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.
Which ethical principle is related to the idea of self-determination?
- Autonomy Explanation: 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.
A nurse is providing care to a client with end-stage cancer. After weighing the alternatives, the client decides not to participate in a clinical trial offered and is requesting no further treatment. The nurse advocates for the client's decision based on the understanding that the client has the right to self-determination, interpreting the client's decision as reflecting which ethical principle?
- Autonomy Explanation: When respecting autonomy, the nurse supports the client's right to make decisions with informed consent. When promoting the client's well-being, the nurse acts in the best interests of the client. Advocacy is linked to the belief that making choices about health is a fundamental human right that promotes the individual's dignity and well-being. Beneficence is reflected by doing good and promoting what will benefit the client. Justice involves treating each client fairly. Fidelity involves being faithful and keeping promises.
Which ethical principle refers to the obligation to do good?
- Beneficence Explanation: Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; however, there will be times when the action may cause "harm" to promote the "good" such as chemotherapy being used to treat and eliminate cancer, but it causes various adverse effects while trying to reach the ultimate goal..
Which ethical principle refers to the obligation to do good?
- Beneficence Explanation: Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; however, there will be times when the action may cause "harm" to promote the "good" such as chemotherapy being used to treat and eliminate cancer, but it causes various adverse effects while trying to reach the ultimate goal..
Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?
- Care-based ethics Explanation: Central to the care-based approach to ethics is the nurse's relationships with clients and the nurse's "being," or character and identity. Deontology is the study of the nature of duty and obligation. Utilitarianism is the doctrine that actions are right if they are useful or for the benefit of a majority. Principle-based ethics prioritizes goals and principles that exist beyond the particularities of the nurse-client relationship.
Which nursing situation is an example of an ethical dilemma?
- Deciding whether to perform cardiac compressions against a client's wishes Explanation: An ethical dilemma occurs when it is difficult for a decision to be made due to competing ethical principles. If there is no signed do not resuscitate order, then legally cardiac compressions must be started; however, if this is against the client's wishes, the nurse must weigh the ethical principles of beneficence and complying with the law against the ethical principle of autonomy. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope of nursing practice.
A nurse who is caring for a new mother realizes that the woman is not prepared to go home with her newborn after a hospital stay of only 24 hours. However, hospital policy dictates that the mother be discharged. This nurse may be faced with which moral problem?
- Ethical distress Explanation: Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Ethical dilemmas arise when attempted adherence to basic ethical principles results in two conflicting courses of action. The nurse is not uncertain about what is ethical in this case, nor is the nurse merely dissatisfied with an ethical situation.
A hospice nurse is caring for a client with terminal cancer. The family would like the client to continue aggressive therapy to treat the cancer, but the client has voiced to the nurse that no further pursuit of treatment is desired. The nurse speaks to the family about the client's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation?
- Ethical principles Explanation: Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. In this case, the nurse is practicing the ethical principle of autonomy, which is the client's right to self-determination related to choices about care. The nurse's action is not primarily motivated by legal responsibility, nursing education principles, or advanced practice licensure guidelines.
Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when reflecting on the decision-making process and the role it will play in making future decisions?
- Evaluating Explanation: Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance.
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?
- Feminist Explanation: 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 nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle?
- Fidelity Explanation: Fidelity involves keeping promises and being faithful to the promises made. In this case, the nurse tells the client that she will return in 10 minutes and then follows through with the promise. Nonmaleficence involves doing no harm and avoiding actions that deliberately harm a person. Autonomy refers to the right to make one's own decisions. Justice involves treating each person fairly and without judgment.
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 Explanation: 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.
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 Explanation: 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.
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?
- Integrity Explanation: The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the nurse reported the occurrence of the missed medication to the charge nurse. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for self after discharge. Social justice is a concept of fair and just relations between the individual and society and is related to wealth and distribution of goods in a society. Autonomy is the right to self-determination or acting independently and making decisions.
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 Explanation: 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 nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which ethical principle is the nurse attempting to practice?
- Justice Explanation: The ethical principle of justice includes an effort to fairly distribute benefits and to minimize discrimination, even when circumstances make this difficult to achieve. This is demonstrated by the nurse's efforts to fairly distribute the nurse's time and care. Beneficence is the ethical principle of promoting good. Nonmaleficence states that one should not do harm to clients. Fidelity is faithfulness to a person, cause, or belief, demonstrated by continuing loyalty and support.
A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying?
- Laissez-faire Explanation: This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values independently and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn that which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy?
- Limiting visitors due to the client reporting pain Explanation: 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.
Which action most clearly demonstrates a nurse's commitment to social justice?
- Lobbying for an expansion of healthcare resources and benefits to those in poverty Explanation: Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare. Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting care accurately are expressions of the value of integrity.
The nurse has identified an ethical dilemma that has the potential to interfere with a client receiving optimal care. The nurse discussed this issue with the charge nurse on the unit. What action should the nurse choose next?
- Monitor for resolution of the problem. Explanation: Simply reporting the issue does not complete the nurse's obligation in this situation. The nurse should monitor for resolution of the issue, at least to the point where it no longer interferes with client care. The nurse has already reported the issue up the chain-of-command, so further reporting is not necessary at this time. There is no particular reason to inform the family.
A nurse knows that the expression "Do not cause harm" refers to which ethical principle?
- Nonmaleficence Explanation: Nonmaleficence is conducting procedures and interventions in a safe manner so that no harm is caused to the client. Justice is the idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Fidelity is demonstrated by continuing loyalty and support to a client. Beneficence requires that the procedure be provided with the intent of doing good for the client involved.
What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?
- Peers Explanation: In adolescence, peer groups have a major influence on value formation. The attitudes, beliefs, and behaviors that grow out of peer group relationships are powerful. It is generally accepted that the influence of peers exceeds that of school administration, work life, or the awareness of other cultures during this developmental stage.
A nurse believes that abortion is an acceptable option if a pregnancy results from a situation of rape. What is the best description of this belief?
- Personal moral Explanation: A personal moral is a standard of right and wrong that helps a person determine the correct or permissible action in a given situation. Professional values in nursing are a set of beliefs about the worth of things, about what matters, that provide the foundation for nursing practice and guide the nurse's interactions with clients, colleagues, and the public. Ethical principles are a set of specific concepts that guide a person's actions. A legal obligation is something that is required by law.
A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?
- Shared Explanation: There are three basic models of healthcare decision making. In the paternalistic model, clinicians decide what ought to be done to benefit the client, inform the client, and the client's role is to comply. In the client sovereignty model, clients or their surrogates, expressing their right to be autonomous, tell the clinician what they want, and the clinician's role is to comply. Most ethicists reject these models in their extremes and recommend a model of shared decision making, which respects and uses the preferences of the client and the expertise/judgment of the clinician. Clinical decision making is the process that results from the use of a healthcare decision-making model.
A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent?
- Shared decision making Explanation: Shared decision making is recommended by most ethicists and involves considering both the client's preferences and the nurse's expertise to make the best decision. The paternalistic model involves the clinician making the decisions. The client sovereignty model involves the client making all the decisions without input from the clinician. Ethical decision making is that based on a personal or organizational code of ethics.
When analyzing an ethical dilemma according to the ethical framework, what is most important for the nurse to take into consideration?
- Standards of conduct Explanation: Ethics is the branch of philosophy dealing with standards of conduct and moral judgment. It does not directly address law. It includes, but is not limited to, decision-making and competing priorities.
Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem?
- Taking a picture of a client with the nurse's cell phone Explanation: Taking a picture of a hospitalized client is a direct breach of privacy. Documenting care in the client's record is a normal and expected duty of a nurse. While delivering care to a client, the nurse may talk to the client's family while they are visiting the client; this does not reflect a breach of privacy. Participating in a hand-off report is an expected and necessary duty of the nurse and does not reflect a breach of privacy.
A nurse is applying a care-based approach to an ethical dilemma. When integrating this approach, which concept should the nurse keep in mind? Select all that apply. - The caring relationship is essential to the approach. - Clients are people and are to be respected. - Attention is needed to focus on each person's individual situation. - Autonomy and beneficence guide any action. - Benefits to one client typically are benefits to another.
- The caring relationship is essential to the approach. - Clients are people and are to be respected. - Attention is needed to focus on each person's individual situation. Explanation: The nurse-client relationship is central to the care-based approach, which directs attention to the specific situations of individual clients viewed within the context of their life narrative. The care-based approach is essential to person-centered care. Other aspects include the promotion of the dignity and respect of clients as people, and attention to the particulars of individual clients. Autonomy and beneficence reflect the principle-based approach. When applying a principle-based approach, the nurse needs to understand that a benefit to one person may be considered a harm to another.
Which is the best definition of ethics?
- The formal, systematic study of moral beliefs Explanation: Ethics is a formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to human conduct and human flourishing. "Morals" usually refers to personal or communal standards of right and wrong.
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. Explanation: 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).
Which is a characteristic of the care-based approach to bioethics?
- The promotion of the dignity and respect of clients as people Explanation: The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of clients as people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of the criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.
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. Explanation: 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.
Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. - Trustworthiness - Humility - Deception - Conflict - Compassion
- Trustworthiness - Humility - Compassion Explanation: Trustworthiness, humility, and compassion are all examples of professional virtues, as well as cultivated dispositions of character and conduct, that motivate and enable us to be good human beings. Deception and conflict are negative traits that do not exemplify professional virtues.
What is the term for the beliefs held by the individual about what matters?
- Values Explanation: Values are ideals and beliefs held by an individual or group about what matters; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death, as well as questions and concerns regarding quality of life as it relates to advanced technology.
A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating what?
- advocacy. Explanation: Advocacy is the protection and support of another person's rights. Nurses have always been strong client advocates, carefully evaluating the competing claims of the client's autonomy (self-determination) and well-being. Altruism is the principle and moral practice of concern for happiness of other human beings, resulting in a quality of life both material and spiritual. Justice is concerned with moral rightness and fairness. Confidentiality is keeping or one's personal information secret or private.
A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating:
- advocacy. Explanation: Advocacy is the protection and support of another person's rights. Nurses have always been strong client advocates, carefully evaluating the competing claims of the client's autonomy (self-determination) and well-being. Altruism is the principle and moral practice of concern for happiness of other human beings, resulting in a quality of life both material and spiritual. Justice is concerned with moral rightness and fairness. Confidentiality is keeping or one's personal information secret or private.
To practice ethically, the nurse should avoid:
- allowing the nurse's own personal judgment to guide practice. Explanation: Personal convictions apply only to situations and decisions pertaining to the individual. In ethical professional practice, nurses should avoid allowing personal judgments to bias their treatment of clients. It is appropriate for nurses to allow an ethics committee, past cases, and the views of clients and their families to guide nursing practice.
Virtues are defined as...
- cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Explanation: Virtues are human excellences, or cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Values are beliefs about the worth of something, about what matters, that act as a standard to guide one's behavior. Morals are personal or communal standards of right and wrong. Ethical principles are general guides to action, including autonomy, nonmaleficence, beneficence, justice, and fidelity.
A nurse working on a critical care unit was informed by a client with multiple sclerosis that the client did not wish to be resuscitated in the event of cardiac arrest. Now the client is no longer able to express wishes, and the family has informed the health care provider that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve:
- ethical distress. Explanation: The nurse is involved in a situation that involves ethical distress. Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Paternalism is acting for clients without their consent to secure good or prevent harm. Deception and confidentiality can result in ethical problems for nurses when there is a conflict between the client's and nurse's values/interests. In this scenario, the nurse is aware of the client's wishes, but the conflict lies with the family and thus the nurse will experience ethical distress.
A nurse is providing care for a client with cancer. The client's spouse requests that the client not be told that the client is terminal. The nurse complies with this request. The nurse's action is a breach of which ethical principle?
- fidelity Explanation: The principle of fidelity involves the nurse being faithful to the client, who has the right to the truth. By not telling the client, the nurse is not being faithful to the client. Justice is acting fairly. In this scenario, the nurse do not need to recognize any bias or discrimination in the distribution of care. Beneficence is the act of doing of good. The nurse is not doing good by withholding the information. Nonmaleficence means not harming or inflicting the least harm possible to reach a beneficial outcome. The nurse is inflicting harm by not being faithful to the client.
Ethical distress is defined as...
- knowing the correct action but being unable to perform it due to constraints. Explanation: 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.
A nurse working in a critical care unit has experienced personal tragedy, extreme shortage of staff in the work environment, and health issues. The nurse has overcome much of these hardships and is now mentoring other nurses in similar situations. What behavior is this nurse demonstrating?
- moral resilience Explanation: Moral resilience is the developed capacity to respond well to morally distressing experiences and to emerge strong. This nurse has demonstrated that although life issues have been overwhelming, there is an emergence of strength and resilience. Moral distress occurs when you know the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Conscientious objection is the refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's personal and professional ethical beliefs and standards. There is not an ethical dilemma present between the nurse and the workplace.
An older adult was just diagnosed with stage 4 pancreatic cancer. The client states, "I am so overwhelmed and I feel like everyone has already decided that I need to be put in hospice care." The nurse upholds the principle of autonomy by...
- offering to answer questions the client may have about care and treatment options - providing the client with the information needed to obtain a second opinion The principle of autonomy upholds the client's right to self-determination; that is, respecting the client's right to make informed decisions about their care. Offering to answer questions pertaining to the client's care options provides the client with the opportunity to make informed decisions. Autonomy is one of the six foundational principles of ethical practice and refers to a competent person's right to make their own choices without intimidation or influence. The nurse can provide the client with the additional provider options because it is the client's right to seek a second opinion. Providing emotional support and administering antipyretics for fever are acts of goodness; thus, they uphold the principle of beneficence. Obtainig routine vital signs is a part of the nurse's responsibilty. It is a means of fulfilling one's commitment to the client; therefore, it fosters the principle of fidelity. The principle of confidentilaity is upheld when the nurse shares pertinent information only to those directly assigned to care for the client.
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:
- personal values. Explanation: The only information given here tells us that this nurse has personal values on a particular issues. Personal values are ideas or beliefs a person considers important and feels strongly about. Moral agency is the ability to do the ethically right thing because one knows it is the right thing to do. Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. Legal obligations are behaviors and actions required by law.
What would be an example of the nurse practicing fidelity? The nurse:
- stays with a client during death as promised. Explanation: Fidelity requires the nurse to keep promises made and to be faithful to one's commitments. Regulating visitors is a demonstration of the value of privacy. Withholding client's information as requested is an example of maintaining confidentiality. Providing continuity of care is an example of integrity and professionalism.
Which statement by the nurse is an example of deception? A. "I will administer your pain medication as soon as it is due." B. "It is important to get out of bed to prevent pneumonia." C. "This injection of procaine will feel like a little pinch." D. "I am going to teach you how to give yourself insulin."
C. "This injection of procaine will feel like a little pinch." Explanation: Telling a client that an injection of procaine will feel like a little pinch is not being truthful, and is defined as a deception. Telling a client that pain medicine will be administered when it is time is being truthful. Telling a client to get out of bed also supports a nursing intervention. Teaching a client how to give an injection is important for the client to take care of himself or herself.
Ethical distress is defined as...
Knowing the correct action but being unable to perform it due to constraints.
A famous actor with bipolar disorder has been admitted in the mental health unit for treatment. A well known news outlet has offered the nurse several thousand dollars to provide information or a picture of the client. The nurse knows that it is their professional duty and legal responsibility to uphold privacy and confidentiality. For each of the behaviors exhibited by the nurse, click to specify whether the behavior upholds the principle of privacy or confidentiality.
Privacy: - keeping the door closed while conducting physical assessment - obtaining the client's permission before allowing a student nurse to assist with care Confidentiality: - sharing client information only to the caregivers directly assigned to client care - logging off the electronic health record after documenting assessment information - asking the client to sign a medical release form before providing information to the health insurance company Privacy requires the nurse to utilize client information appropriately; that is, limiting access to client information to activities that are only directly related to health care. Upholding privacy includes keeping the door closed while conducting physical assessment and obtaining the client's consent before allowing a student nurse to assist with care. Confidentiality involves protecting client health information from public disclosure. Client information should only be shared with health personnel directly involved in the client's care. This includes controlled access to electronic health records; therefore, the nurse should log off the electronic health record after documenting to avoid unauthorized access to the client's information. If client information needs to be divulged, the nurse should first obtain the client's written permission. An example of this is asking the client to sign a medical release form before providing information to the health insurance.
The nurse strives to uphold human dignity when providing care to clients. Which behaviors by the nurse would best exemplify this value? Select all that apply. - Protects the privacy of the client - Maintains confidentiality - Promotes universal healthcare - Provides culturally competent care - Demonstrates accountability
Protects the privacy of the client Maintains confidentiality Provides culturally competent care Explanation: Human dignity is defined by the right of a person to be valued and respected for one's own sake, and to be treated ethically. The nurse is exemplifying this by protecting privacy, maintaining confidentiality, and providing culturally competent care. Promoting universal health care would better exemplify the value of social justice and, in any case, would not be appropriate an appropriate action when providing care to clients. Demonstrating accountability is not a human dignity issue but is a core concept in the overall nursing care of a client.
