Chapter 22, Ethics and Values EAQ, EAQ
Beneficence The immunization is a clear effort to provide benefit. Beneficence refers to doing good. Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding healthcare plans.
A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? Fidelity Beneficence Nonmaleficence Respect for autonomy
As per the professional code of ethics, the nurse should keep all information provided by the patient confidential. However, if the information can have an impact on the course of treatment, it should be revealed. In this case, the nurse should discuss the patient's drug use with the healthcare provider, because it could affect the treatment. The nurse should not discuss it with the patient's family members or with colleagues, because that would be a breach of confidentiality.
A patient in the early stages of pancreatic cancer is being treated with chemotherapy. The patient confides in the nurse that he abuses drugs and asks the nurse to keep it confidential. What should the nurse do? Keep it a secret. Discuss it with the patient's family members. Discuss it with colleagues. Discuss it with the healthcare provider if it affects the treatment
Chemotherapy has side effects, but it is a viable treatment option. 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.
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?
Respect the patient's decision and do not schedule counseling. Discuss with the patient the potential benefits of psychological counseling. Respect the autonomy of the patient. The nurse has to respect the autonomy of the patient and her decision. so should not schedule psychological counseling. The nurse should discuss with the patients the benefits of counseling, as a means of advocating for her best health outcome. The family members can be asked for their opinion, but only with the patient's permission. The nurse should not implement any interventions that violate the patient's wishes.
A patient is preoccupied with the feeling that she suffers from breast cancer. She asks the nurse to insist that the healthcare provider perform a mastectomy. Following several tests, the nurse finds that the patient has no symptoms of or risk factors for breast cancer. When the healthcare provider refers the patient to a psychologist, the patient refuses to go. Which nursing interventions are appropriate in this situation? Select all that apply. Respect the autonomy of the patient. Ask family members for their opinion. Schedule psychological counseling irrespective of the patient's wishes. Respect the patient's decision and do not schedule counseling. Discuss with the patient the potential benefits of psychological counseling.
Nonmaleficence refers to the avoidance of harming or hurting others. Bone marrow biopsy is a procedure with a certain risk associated with it. The benefits, however, outweigh the risk. Therefore, performing the biopsy is an act of nonmaleficence. Advocacy refers to supporting patient rights in any given situation. Beneficence means performing actions that may benefit others. Responsibility refers to a willingness to respect and fulfill one's professional obligations.
A patient is scheduled for a bone marrow biopsy. The nurse understands this procedure and knows it would be helpful for an accurate diagnosis of the patient's disease. However, the patient may experience pain and adverse effects from the procedure. Which ethical principle should guide the nurse's actions in this situation? Advocacy Beneficence Responsibility Nonmaleficence
Review the surgical procedure. Explain the risks and benefits of the procedure. Ensure that the patient reads the surgery documents and signs the consent form. Reviewing the surgical procedure and explaining the risks and benefits of the procedure indicate respect for the patient's autonomy. Ensuring that the patient signs the informed consent also indicates respect for her autonomy. The healthcare team should not withhold any information about possible harmful effects. Financial aspects of the surgery are purely subjective issues and vary from one establishment to another.
A patient is scheduled for a mastectomy. Which interventions are performed out of respect for the patient's autonomy? Select all that apply. Review the surgical procedure. Explain the risks and benefits of the procedure. Withhold information about the possible harmful effects. Ensure that the patient reads the surgery documents and signs the consent form. Ensure that the patient makes full advance payment.
Autonomy 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. Autonomy means freedom from external control. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harming or hurting others.
A patient is scheduled for surgery. Before the surgery the patient read the consent form and signed it. This is an example of which principle?
The nurse should include the family in patient care and decision making to help resolve ethical dilemmas. According to the ethics of care, the nature of relationships between family and patient can help resolve ethical dilemmas. The presumption of good will on the part of all participants will help resolve conflicts and facilitate effective treatment for patients. Strict adherence to confidentiality will help build a trusting relationship with the patient and the family, thereby reducing the ethical conflict. Providing patient-centered decision making will ensure that the nurse adheres to justice and veracity, thereby reducing the risk of ethical conflict. p. 297
A registered nurse is teaching a student nurse about resolving an ethical conflict. Which statement made by the student nurse indicates the need for further teaching? "I should presume good will on the part of all participants." "I should strictly adhere to the confidentiality principle." "I should reduce the involvement of family in patient care." "I should ensure that all treatment provided is patient-centered."
The foundation of the ethics of care is its attention to relationships, as distinguished from other philosophies based more on principles.
According to the philosophy of the ethics of care, which is most important when solving ethical dilemmas? Patients Relationships Ethical principles Code of ethics for nurses
Match the examples with the professional nursing code of ethics: Term Definition Advocacy Responsibility Accountability Confidentiality Definitions 1. You see an open medical record on the computer and close it so no one else can read the record without proper access. 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication.
Advocacy - 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. Responsibility - 4. You tell your patient that you will return in 30 minutes to give him his next pain medication. Accountability -2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. Confidentiality -1. You see an open medical record on the computer and close it so no one else can read the record without proper access.
Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply.) A. Access to health care reflects the commitment of society to principles of beneficence and justice. B. If low income compromises access to care, respect for autonomy is compromised. C. Access to health care is a privilege in the United States, not a right. D. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. E. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. F. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.
A. Access to health care reflects the commitment of society to principles of beneficence and justice. Correct B. If low income compromises access to care, respect for autonomy is compromised. Correct D. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. Correct Justice is the ethical principle that justifies the agreement to ensure access to care for all, but it does not necessarily clarify how to resolve issues of limited resources such as money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficence means "first do no harm." A lack of care because of poor access causes harm (i.e., no preventive services, no early detection, no risk reduction) and therefore is ethically troubling. The principal of fidelity implies that we agree to ensure access to care even for people whose beliefs and behaviors may differ from our own, including drug addicts.
The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (Select all that apply.) A. Ethics of care pays attention to the environment in which caring occurs. B. Ethics of care pays attention to the stories of the people involved in the ethical issue. C. Ethics of care is used only in nursing practice. D. Ethics of care focuses only on the code of ethics for nurses E. Ethics of care focuses only on understanding relationships.
A. Ethics of care pays attention to the environment in which caring occurs. Correct B. Ethics of care pays attention to the stories of the people involved in the ethical issue. Correct Ethic of care focuses on environmental issues affecting care, the narratives of the patients and health care providers, and understanding relationships.
When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy
A. Fidelity Correct Requiring a return to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity.
When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy
A. Fidelity Correct` Fidelity means keeping promises. Keeping the promise in this case includes not just tending to the clinical need but evaluating the effectiveness of the interventions.
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 principals of utilitarianism. This philosophy proposes which of the following? A. The value of something is determined by its usefulness to society. B. People's values are determined by religious leaders. C. The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. D. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider.`
A. The value of something is determined by its usefulness to society. Correct Utilitarianism specifically refers to the greatest good for the greatest number of people, whereas 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.
Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Correct B. To await new clinical orders from the physician C. To limit discussions about ethical principals D. To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues
A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Correct Nursing plays a unique and critical role in the resolution of difficult ethical situations. The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the health care team.
Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following best describes the role of the nurse in the resolution of ethical dilemmas? A. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. B. To study the literature on current research about the possible clinical interventions available for the patient in question. C. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. D. To allow the patient and the physician to resolve the dilemma on the basis of ethical principles without regard to personally held values or opinions.
A. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. Correct A nurse's point of view is essential to full discussion of ethical issues because of the nature of the relationship that nurses develop with patients and the intensity and intimacy of contact with the patient and family.
Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1. List the actions that could be taken to resolve the dilemma. 2. Agree on a statement of the problem or dilemma that you are trying to resolve. 3. Agree on a plan to evaluate the action over time. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5. Take time to clarify values and distinguish between facts and opinions—your own and those of others involved. 6. Negotiate a plan. A. 4, 5, 2, 6, 1, 3 B. 4, 5, 2, 1, 6, 3 C. 5, 4, 2, 1, 3, 6 D. 4, 5, 1, 2, 3, 6
B. 4, 5, 2, 1, 6, 3 Correct This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and health care team to reflect on personal values and then identify the exact nature of the ethical problem, design a plan, and evaluate the success of the plan.
A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy
B. Beneficence Correct The immunization is a clear effort to provide benefit. Beneficence refers to "doing good." Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding health care plans.
A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.) A. Quality of life is measured by potential income, and average income varies in different regions of the country. B. Community values are subject to change, and communities influence definitions of quality C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.
B. Community values are subject to change, and communities influence definitions of quality Correct C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. Correct D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging. Correct Definitions of quality depend on individual experience and value integrated into community standards, but value refers to elements beyond monetary value.
It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (Select all that apply.) A. Average income varies in different regions of the country. B. Community values influence definitions of quality, and they are subject to change over time. C. Individual experiences influence perceptions of quality in different ways, making consensus difficult. D. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. E. Statistical analysis is difficult to apply when the outcome cannot be quantified. F. Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.
B. Community values influence definitions of quality, and they are subject to change over time. Correct C. Individual experiences influence perceptions of quality in different ways, making consensus difficult. Correct D. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. Correct E. Statistical analysis is difficult to apply when the outcome cannot be quantified. Correct A person's average income and whether the person is employed are incorrect answers because income level is not necessarily a determining factor in measuring quality of life, but the ability to do meaningful work usually does influence the definition.
Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? A. Consult a professional ethicist to ensure that the steps of the process occur in full. B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. C. Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. D. List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.
B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. Correct Before proceeding with discussion about any difficult situation, just as in the nursing process, participants take time to gather all relevant information as insurance for reliability and validity during the discussion.
The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? A. Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. B. In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. C. Even when agreement about a definition of usefulness exists in a community, laws prohibit an application of utilitarianism. D. Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.
B. In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. Correct In increasingly diverse communities, ideas of usefulness have become equally diverse.
When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? A. Yes because ethics is essentially a democratic process, with all participants sharing an equal voice B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do C. Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care D. No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department
B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do Correct 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 of the following explain how health care reform is an ethical issue? (Select all that apply.) A. Access to care is an issue of beneficence, a fundamental principal in health care ethics. B. Reforms promote the principle of beneficence, a hallmark of health care ethics. C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
B. Reforms promote the principle of beneficence, a hallmark of health care ethics. Correct C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Correct D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics. Correct Since health care reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Access to care is an issue of justice.
The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? A. Patients B. Relationships C. Ethical principles D. Code of ethics for nurses
B. Relationships Correct The foundation of the ethics of care is its attention to relationships, as distinguished from other more principal based philosophies.
1. The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Even though several ethical principles are at work in this case, what are the principles from highest to lowest priority? 1. Accountability: You as the nurse are accountable for the wellbeing of this patient. 2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver transplant. 3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant. 4. Justice: The greatest question in this situation is how to determine the just distribution of resources. A. 4, 1, 3, 2 B. 2, 4, 3, 1 C. 4, 2, 3, 1 D. 4, 3, 2, 1
C. 4, 2, 3, 1 Correct Understanding the concept of justice helps to enrich the conversation about how to act and lifts the conversation above and beyond the circumstances of the patient. If justice is compromised, respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but unfortunately her commitment to care does not give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case.
Which is the best method of negotiating or processing difficult ethical situations? A. Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. B. Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. D. Medical experts are best able to resolve conflicts about outcome predictions.
C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. Correct Ethics is ultimately an activity of community, resolved successfully through institutional ethics committees and not easily resolved by deference to a single expert or leader.
The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? A. Yes because patient privacy would not be violated as long as the patient identifiers were removed B. Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work D. No because the principal of justice requires you to allocate resources fairly
C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work Correct Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information.
The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers? A. Yes, because patient privacy would not be violated since patient identifiers were removed B. Yes, because respect for autonomy implies that you have the autonomy to decide what constitutes privacy C. No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work D. No, because the principle of justice requires you to allocate resources fairly
C. No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work Correct Information such as comments and photos on social media is widely distributed and becomes a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person, or people accessing your site could know your actual assignment or put "two and two" together.
The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy
C. Nonmaleficence Correct 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.
In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? A. Nurses understand the principle of autonomy to guide respect for patient's self-worth. B. Nurses have a scope of practice that encourages their presence during ethical discussions. C. Nurses develop a relationship to the patient that is unique among all professional health care providers. D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.`
C. Nurses develop a relationship to the patient that is unique among all professional health care providers. Correct None of these options is wrong, but the point of the question is to build confidence and even pride in the value of the special body of knowledge that a nurse acquires about patients, the result of a unique relationship with them.
In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? A. Nurses understand the principle of autonomy to guide respect for a patient's self-worth. B. Nurses have a scope of practice that encourages their presence during ethical discussions. C. Nurses develop a relationship with the patient that is unique among all professional health care providers. D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.
C. Nurses develop a relationship with the patient that is unique among all professional health care providers. Correct A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse.
What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order. 1. Clarify values. 2. Ask the question, Is this an ethical dilemma? 3. Verbalize the problem. 4. Gather information. 5. Identify course of action. 6. Evaluate the plan. 7. Negotiate a plan. A. 2, 4, 1, 5, 3, 7. 6 B. 2, 4, 3, 1, 5, 6, 7 C. 4, 1, 2, 3, 5, 7, 6 D. 2, 4, 1, 3, 5, 7, 6
D. 2, 4, 1, 3, 5, 7, 6 Correct In resolving an ethical dilemma, it first must be determined that an ethical dilemma exists. Then a systematic approach is needed to gather information, clarify values, verbalize the exact problem, identify a plan, negotiate elements of the plan, and evaluate the plan. ARCVINE
What is the best example of the nurse practicing patient advocacy? A. Seek out the nursing supervisor in conflicting procedural situations B. Document all clinical changes in the medical record in a timely manner C. Work to understand the law as it applies to an error in following standards of care D. Assess the patient's point of view and prepare to articulate it
D. Assess the patient's point of view and prepare to articulate it Correct Seeking out the nursing supervisor, documenting clinical change in the medical record in a timely manner and working to understand the law as it applies to an error in following standards of care are not wrong; but advocacy generally refers to the nurse's ability to help speak for the patient.
A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? A. Seeking out the nursing supervisor to talk with the patient B. Documenting patient fears in the medical record in a timely manner C. Working to change the hospital environment D. Assessing the patient's point of view and preparing to articulate it
D. Assessing the patient's point of view and preparing to articulate it Correct Assessing the patient's point of view and preparing to articulate it best reflects the concept of advocacy because it is standing up for the patient and having his or her views and wishes heard.
1. The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. What principles would be a priority in a discussion about ethics? A. Accountability because you as the nurse are accountable for the well-being of this patient B. Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant C. Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources
D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources Correct Accountability, respect or autonomy and ethics of care are not necessarily wrong, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
Ethics committees are usually multidisciplinary. They have several purposes such as education, case consultation, and policy recommendation. Any person involved in an ethical dilemma can request access to an ethics committee. Patient teaching and patient care are the responsibility of all members of the healthcare team.
Healthcare institutions establish ethics committees to process ethical dilemmas. Which are purposes of ethics committees? Select all that apply. Education Patient teaching Patient care Case consultation Policy recommendation
Be clear about their values. 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.
How can nurses negotiate differences of opinion and values with patients?
To articulate a unique point of view, including knowledge based on clinical and psychosocial observations Nursing plays a unique and critical role in the resolution of difficult ethical situations The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the healthcare team.
Resolving an ethical dilemma involves discussion with the patient, the patient's family, and participants from all healthcare disciplines. Which describes the role of the nurse in the resolution of ethical dilemmas?
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.
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."
Fidelity refers to the agreement to keep promises. The nurse assesses the patient's needs and performs interventions to fulfill them. If the interventions are not found to be effective, the nurse still follows through on the actions and modifies the care plan to reduce the pain. Advocacy, responsibility, and accountability are principles of the codes of ethics. Advocacy is when the nurse speaks up for patient rights. Responsibility refers to a willingness to respect one's professional obligations and follow through on promises. Accountability is when one is answerable for one's actions.
The nurse is assessing a patient who has arthralgia. The nurse is preparing a plan for pain management. The nurse monitors the patient's response and revises the plan to reduce the pain. Which statement about the nurse's action is correct? nurse is showing fidelity. The nurse is advocating for the patient. The nurse is showing responsibility toward patient care. The nurse is following the principle of accountability.
In this case, the principle of justice should be discussed. A major question in this situation is how to obtain financial support for the treatment. Justice involves discussion about health insurance, hospital locations and services, and even organ transplants. Fidelity refers to providing patient care in all circumstances and keeping the promises for further patient care. 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 actions that may be beneficial to others.
The nurse is assessing a patient who has multiple myeloma and is in need of a bone marrow transplant. This patient does not have health insurance and cannot pay out-of-pocket for the procedure. Which ethical principle should be discussed regarding the patient's condition? Justice Fidelity Autonomy Beneficence
Justice, because the first and greatest question in this situation is how to determine the just distribution of resources Accountability, respect for autonomy, and ethics of care are not necessarily incorrect answers, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Which principle is the priority in a discussion about ethics?
The principle of beneficence is fundamental to the practice of nursing and medicine. The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest. Nonmaleficence is the avoidance of harm or hurt. According to this concept, the healthcare professional tries to balance the risks and benefits of care while striving to do the least harm possible. 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. According to the concept of fidelity, a healthcare professional should be unwilling to abandon patients even when care becomes controversial or complex. In addition, the nurse should follow through on actions and interventions.
The nurse is explaining to students the difference between nonmaleficence and beneficence. Which information should the nurse include in the explanation to help the students understand the two concepts? Select all that apply. According to the concept of beneficence, all interventions should consider the patient's best interest. According to the concept of beneficence, maximum priority is given to patients by allowing them to make their own healthcare decisions. According to the concept of nonmaleficence, the healthcare provider should weigh the risks and benefits of the intervention before delivering it. According to the concept of nonmaleficence, the nurse should be loyal and not abandon the patient even when the treatment procedure is complicated. According to the concept of nonmaleficence, the nurse should keep promises by following through on actions and interventions.
Trying to remain competent to practice Being responsible for delegated tasks Being willing to respect professional obligations Nurses should strive to remain competent to practice in order to perform responsibly. All nursing interventions are the responsibility of the nurse, including those that the nurse has delegated. The standards of practice involving responsibility include the nurse's willingness to respect professional obligations and keep promises to patients. Protecting a patient's right to privacy and supporting the health, safety, and rights of a patient are standards of advocacy, not responsibility.
The nurse is practicing according to the professional nursing code of ethics. Which actions are in accordance with the standards of responsibility? Select all that apply. Protecting the patient's right to privacy Trying to remain competent to practice Being responsible for delegated tasks Being willing to respect professional obligations Supporting the health, safety, and rights of the patients
1, 5 Building consensus is essentially an act of discovery, in which collective wisdom guides a group to the best possible decision. It encourages respect for unusual points of view while striving for agreement among all participants. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself. Focusing on just the usefulness of the decision is characteristic of utilitarian philosophy. Focusing on just the benefits and justice of a procedure is characteristic of deontology. Focusing on just the nature of relationships during decision making is associated with the feminist theory.
The nurse learns that building consensus is the best method for a decision-making process. Which are true statements about consensus building? Select all that apply. Unusual points should be considered respectfully while striving for agreement among the participants. The usefulness of an intervention should be of sole consideration. The nature of relationships should be the only guiding principle for the participants in making decisions. The participants should mainly focus on how just and beneficial an intervention is. Respect for opinions and agreement among participants should form the basis of the decision-making process.
It cannot be solved solely through literature review. It cannot be easily reasoned with logic. The answer to the problem has profound relevance for patient care. When solving any ethical dilemma, the first step is to distinguish the ethical problems from other problems. Ethical problems cannot be resolved through literature review only, and they may be difficult to solve logically by the use of reason. The answer to an ethical problem will have a significant influence on patient care. Ethical problems are usually not solved by critical thinking and do not involve only hospital management. They may involve all members of the healthcare team.
The nurse may come across many ethical dilemmas. To resolve them, it is important to distinguish ethical problems from other problems. Which are characteristics of an ethical problem? Select all that apply. It cannot be solved solely through literature review. It cannot be easily reasoned with logic. The answer to the problem has profound relevance for patient care. The problem can be solved by critical thinking. The problem involves only hospital management.
Be clear about personal values. Maintain cultural competence. Attempt to resolve differing opinions. Being clear about personal values helps the nurse to determine the differences between the nurse's own values and those of the patient and to attempt to resolve the differences. Maintaining cultural competence is an important part of the nurse's commitment to nursing practice. Attempting to resolve differing opinions by understanding and negotiating is an essential part of commitment to nursing practice. Values reflect the characteristics of the patient; the nurse should not ask the patient to change. Ignoring the patient's values is not advisable; instead, the nurse should respect the patient's values. Making all patients follow the same values is also not advisable as different factors and backgrounds influence the values of patients, which should be respected.
The nurse understands that values are an important part of life and may differ from one person to another. Which measures should the nurse adopt to ensure ethical nursing care when dealing with the values of a patient? Select all that apply. Ask the patient to change values. Be clear about personal values. Maintain cultural competence. Make all patients follow the same values. Attempt to resolve differing opinions.
Autonomy refers to the commitment to include patients in decisions about all aspects of care. The nurse includes the patient by obtaining consent for insulin administration. Advocacy requires the nurse to speak and work in support of the health, safety, and rights of the patient. Accountability refers to the ability to answer for one's actions. The nurse follows nonmaleficence by avoiding hurting patients.
The nurse wants to administer insulin to a patient and obtains consent from the patient before the procedure. Which ethical concept does the nurse adhere to through this action? Advocacy Autonomy Accountability Nonmaleficence
Nonmaleficence 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.
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?
Accountability is being answerable for any right or wrong action. In this case, the student nurse admits that the patient is in pain as a result of the nurse's mistake. Fidelity involves following through on promises. Advocacy is the ethical responsibility to advocate for patient rights. Confidentiality is the ethical responsibility to maintain privacy regarding the patient's condition and information; it is unrelated to the student nurse admitting the mistake.
The registered nurse instructs the student nurse to administer an analgesic to a patient who has undergone appendicitis surgery, but the student nurse forgets to administer the drug and finds that the patient is suffering from severe pain. The student nurse reports the mistake to the registered nurse. Which ethical concept does the student nurse adhere to through this action? Fidelity Advocacy Confidentiality Accountability
Ensuring that the patient understands the risks of a medical procedure Including the patient when deciding on care Ensuring that the patient has read and signed an informed consent before surgery Receiving permission from the patient before performing a physical examination Autonomy refers to the patients' right to make their own decisions. The nurse shows respect for a patient's autonomy by ensuring that the patient understands the risks of a medical procedure, by including the patient in all care decisions, by ensuring that a patient has consented to a medical procedure or surgery, and by getting permission from the patient before providing care or completing assessments. When nurses keep promises by following through on interventions, they are acting on the principle of fidelity.
The senior nurse is teaching a group of nursing students about health care ethics. Which are examples of the nurse showing respect for a patient's autonomy? Select all that apply. Ensuring that the patient understands the risks of a medical procedure Keeping promises by following through on any interventions Including the patient when deciding on care Ensuring that the patient has read and signed an informed consent before surgery Receiving permission from the patient before performing a physical examination
Nonmaleficence is the avoidance of harm or hurt to the patient. The nurse should balance the risks and benefits of patient care to make sure that it causes the least harm to the patient. Nonmaleficence also means choosing those therapeutic approaches that are least harmful for the patient. To keep promises made to the patient is a part of standards of fidelity. Allowing the patient to read the informed consent is a practice of respecting the patient's autonomy.
The senior nurse is teaching a group of student nurses about ethics in the healthcare setting. Which education about nonmaleficence should the nurse provide? Select all that apply. Nonmaleficence means avoidance of harm to the patient. The nurse should balance the risks and benefits of patient care. Nonmaleficence means to keep promises made to the patient. The nurse should allow the patient to read the informed consent. Nonmaleficence means using the therapeutic approaches with the least risk of harm.
Clarifying values 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.
There are seven key steps in the resolution of an ethical dilemma. Which step involves distinguishing among facts, opinions, and values?
No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do. 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.
When an ethical dilemma occurs on the unit, can nurses resolve the dilemma by taking a vote?
Returning to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity.
When the nurse assesses a patient for pain and offers a plan to manage the pain, which principal guides the nurse to monitor the patient's response to the pain? Fidelity Beneficence Nonmaleficence Respect for autonomy
Assessing the patient's point of view and preparing to describe it None of these answers is wrong, but advocacy generally refers to the nurse's ability to help speak for the patient.
Which is the best example of practicing patient advocacy? Seeking out the nursing supervisor in conflicting procedural situations Documenting all clinical changes in the medical record in a timely manner Working to understand the law as it applies to an error in following standards of care Assessing the patient's point of view and preparing to describe it
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.
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.
Because healthcare reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Reform promotes the principle of beneficence, or positive actions to help others; on the opposite end, lack of access causes harm, and nonmaleficence is a basic principle of health care ethics. Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Access to care is an issue of justice, not fidelity.
Which statements explain how healthcare reform is an ethical issue? Select all that apply. Access to care is an issue of beneficence, a fundamental principal in healthcare ethics. Reforms promote the principle of beneficence, a hallmark of healthcare ethics. Purchasing healthcare insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. Lack of access to affordable healthcare causes harm, and nonmaleficence is a basic principal of health care ethics. Access to care is an issue of fidelity, a key principal in healthcare ethics.
Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions. This theory lacks a focus on universal principles. Deontology focuses on providing justice and fidelity to the patient but does not focus on the role of relationships. Utilitarianism proposes that the value of something is determined by its usefulness; it does not focus on the nature of relationships. Consensus in bioethics focuses on bringing about an agreement from all the different points of view but does not emphasize relationships.
Which theory considers the importance of relationships in solving ethical dilemmas but lacks a focus on universal principles? Deontology Utilitarianism Feminist ethics Consensus in bioethics
The ethical principle of justice ensures that all patients receive equal treatment irrespective of financial status or cultural practices. Veracity involves being truthful and honest with the patient, not providing equal treatment. Advocacy requires the nurse to speak and work in support of the rights of the patient. Providing the same treatment for all patients does not indicate advocacy. Beneficence involves caring for the patient irrespective of personal feelings regarding the patient.
While caring for different patients in a clinical setting, the nurse ensures that all patients receive the same treatment irrespective of their financial status or cultural practices. Which ethical principle is the nurse adhering to? Justice Veracity Advocacy Beneficence
Deontology
what study focuses on providing justice and fidelity to the patient but does not focus on the role of relationships.
Utilitarianism
what study proposes that the value of something is determined by its usefulness; it does not focus on the nature of relationships.
