Chapter 22 EAQ
When an ethical dilemma occurs on the unit, can nurses resolve the dilemma by taking a vote? Yes; ethics is essentially a democratic process, with all participants sharing an equal voice. No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. Yes; ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care. No; most ethical dilemmas are resolved by deferring to the medical director of the ethics department.
No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. Rationale Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion.
Which is the best method of negotiating or processing difficult ethical situations? Defer to an independent arbitrator such as a chaplain when ethical issues arise between dissenting providers. Consult a legal expert to help resolve disputes, since ethical issues usually affect policy and procedure, Seek consensus via the institutional ethics committee to help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions. Defer to medical experts as the ones best able to resolve conflicts about outcome predictions.
Seek consensus via the institutional ethics committee to help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions. Rationale Difficult ethical situations are matters for the entire community and resolved most successfully through institutional ethics committees, not by deference to a single expert or leader.
Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principles of utilitarianism. Which statement describes utilitarianism? The value of something is determined by its usefulness to society. People's values are determined by religious leaders. The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or healthcare provider.
The value of something is determined by its usefulness to society. Rationale Utilitarianism specifically refers to the greatest good for the greatest number of people, where goodness is determined primarily by usefulness. The concept is easier to apply in a community where shared values allow for agreement about a definition of usefulness. Utilitarianism is not when values are determined by religious leaders, does not take into account the patient's previous moral life, and does not argue that the best way to determine the solution is to refer the case to the provider.
The nurse educator is lecturing a group of nursing students about ethics and values. Which statement made by the student indicates a correct understanding of beneficence? "Avoidance of harm or hurt is beneficence." "Support of a particular cause is beneficence." "Agreement to keep promises is beneficence." "Taking positive actions to help others is beneficence."
Rationale Beneficence involves taking positive actions to help others. Agreeing to act with beneficence implies that the best interest of the patient is more important for the nurse than self-interest. Avoidance of harm or hurt is nonmaleficence. Support of a particular cause is advocacy. Agreement to keep promises is fidelity.
How can nurses negotiate differences of opinion and values with patients? Be clear about their values. Emphasize correctness of their values. Negate the patient's values. Ask the patients to accept the nurses' values.
Be clear about their values. Rationale Differences of opinion and values can be resolved by being clear about one's own values. Honesty helps to evaluate the patients' values effectively. The nurses should not emphasize their own values and negate the patient's values. This can adversely affect the nurse-patient relationship. Asking the patients to accept the nurses' values is unethical and undermines the patient's autonomy.
A patient is in the early stages of pancreatic cancer. The health care provider orders chemotherapy. Which information should be given to the patient per the principle of non-maleficence? Chemotherapy does not have any side effects. Chemotherapy has side effects, but it is a viable treatment option. Chemotherapy will cure the cancer. Starting chemotherapy is the health care provider's decision.
Chemotherapy has side effects, but it is a viable treatment option. Rationale Non-maleficence is the avoidance of harm. Therefore explaining to the patient that chemotherapy has side effects but that it is a viable and often effective treatment option, is practicing non-maleficence. Telling the patient that chemotherapy has no side effects and that it will cure cancer may provide false assurance. Stating that starting chemotherapy is the health care provider's decision violates the principle of autonomy.
Under which ethical principle is the patient's personal health information protected? Advocacy Nonmaleficence Beneficence Confidentiality
Confidentiality Rationale Confidentiality is a principle that is used to keep the patient's personal health information private. Advocacy refers to standing up and speaking on the patient's behalf; it does not involve protecting the patient's health information. Nonmaleficence refers to the act of not hurting or harming the patient; it does not include protection of the patient's health information. Beneficence is performing actions that are beneficial to the patient; however, it does not include protecting the patient's health information.
A patient is hospitalized for the treatment of tuberculosis. The patient's friend asked the nurse about the patient's personal health information. However, the nurse refused to give the information. Which principle of the code of ethics has the nurse followed? Advocacy Accountability Responsibility Confidentiality
Confidentiality Rationale The nurse has followed the principle of confidentiality. Confidentiality refers to keeping the patient's personal health information private. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the protection of the patient's personal health information. Advocacy refers to the support of a particular cause. Accountability is used while answering about one's actions. Responsibility means a willingness to respect one's professional obligations and follow through on promises.
Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating differences of opinion? Consult a professional ethicist to ensure that the steps of the process occur in full. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.
Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. Rationale Before proceeding with discussion about any difficult situation, just as in the nursing process, participants should take time to gather all relevant information to ensure reliability and validity during the discussion.
The American Nurses Association (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 protecting patient privacy. On the basis of this principle, if a nurse participates in a public online social network such as Facebook, could the nurse post images of a patient's x-ray film if all patient identifiers have been deleted? Yes; patient privacy would not be violated as long as the patient identifiers were removed. Yes; respect for autonomy implies that the nurse has the autonomy to decide what constitutes privacy. No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work. No; the principal of accountability requires the nurse to keep the identifiers on the image.
No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work. Rationale Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information. This means that under no circumstance could the nurse post a photo online of a private medical record, including x-rays. The nurse should not share the image online, though the reason is not because the nurse is accountable for keeping the record intact.
Which principle of health ethics refers to the avoidance of harm or hurt? Justice Autonomy Beneficence Nonmaleficence
Nonmaleficence Rationale Nonmaleficence is the act of avoiding harm or hurt to the patient. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Beneficence refers to taking positive actions to help others.
The point of the ethical principal to do no harm is to reassure the public that in all ways the healthcare team not only works to heal patients but agrees to do this in the least painful and harmful way possible. Which principle describes this agreement? Beneficence Accountability Nonmaleficence Respect for autonomy
Nonmaleficence Rationale Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care.
There are seven key steps in the resolution of an ethical dilemma. Which step involves distinguishing among facts, opinions, and values? Clarifying values Negotiating a plan Verbalizing the problem Evaluating the plan over time
clarifying values Rationale Clarifying values involves distinguishing among facts, opinions, and values. The process of clarifying values is an important part of resolving ethical dilemmas. Negotiating a plan requires confidence in one's own point of view and also deep respect for the opinions of others. Verbalizing the problem helps to ensure effectiveness in the final plan and facilitates discussion. Evaluation of the plan over a period of time is helpful for positive outcomes.Clarifying values