Chapter 22: Ethics and Values

7. The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment? a.Scrutinize personal values. b.Call for an ethical committee consult. c.Decline the assignment on religious grounds. d.Convince the family to challenge the directive.

ANS: A Clarifying values—your own, your patients', your co-workers'—is an important and effective part of ethical discourse. Calling for a consult, declining the assignment, and convincing the family to challenge the patient's directive are not ideal resolutions because they do not address the reason for the nurse's discomfort, which is the conflict between the nurse's values and those of the patient. The nurse should value the patient's decisions over the nurse's personal values.

5. A nurse is experiencing an ethical dilemma with a patient. Which information indicates the nurse has a correct understanding of the primary cause of ethical dilemmas? a.Unequal power b.Presence of conflicting values c.Judgmental perceptions of patients d.Poor communication with the patient

ANS: B Ethical dilemmas almost always occur in the presence of conflicting values. While unequal power, judgmental perceptions, and poor communication can contribute to the dilemma, these are not causes of a dilemma. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes.

1. Four patients in labor all request epidural analgesia to manage their pain at the same time. Which ethical principle is most compromised when only one nurse anesthetist is on call? a.Justice b.Fidelity c.Beneficence d.Nonmaleficence

ANS: A Justice refers to fairness and is used frequently in discussion regarding access to health care resources. Here the just distribution of resources, in this case pain management, cannot be justly apportioned. Nonmaleficence refers to avoidance of harm; beneficence refers to taking positive actions to help others. Fidelity refers to the agreement to keep promises. Each of these principles is partially expressed in the question; however, justice is most comprised because not all laboring patients have equal access to pain management owing to lack of personnel resources.

2. The patient reports to the nurse of being afraid to speak up regarding a desire to end care for fear of upsetting spouse and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patient's cause? a.Advocacy b.Responsibility c.Confidentiality d.Accountability

ANS: A Nurses advocate for patients when they support the patient's cause. A nurse's ability to adequately advocate for a patient is based on the unique relationship that develops and the opportunity to better understand the patient's point of view. Responsibility refers to respecting one's professional obligations and following through on promises. Confidentiality deals with privacy issues, and accountability refers to answering for one's actions.

14. Which action by the nurse indicates a safe and efficient use of social networks? a.Promotes support for a local health charity b.Posts a picture of a patient's infected foot c.Vents about a patient problem at work d.Friends a patient

ANS: A Social networks can be a supportive source of information about patient care or professional nursing activities. Even if you post an image of a patient without any obvious identifiers, the nature of shared media reposting can result in the image surfacing in a place where just the context of the image provides clues for friends or family to identify the patient. The ANA and NCSBN states, "Effective nurse-patient relationships are built on trust. Patients need to be confident that their most personal information and their basic dignity will be protected by the nurse." Becoming friends in online chat rooms, Facebook, or other public sites can interfere with your ability to maintain a therapeutic relationship.

1. A nurse is a member of the ethics committee. Which purposes will the nurse fulfill in this committee? (Select all that apply.) a.Education b.Case consultation c.Purchasing power d.Direct patient care e.Policy recommendation

ANS: A, B, E An ethics committee devoted to the teaching and processing of ethical issues and dilemmas exists in most health care facilities. It is generally multidisciplinary and it serves several purposes: education, policy recommendation, and case consultation. It does not have purchasing power or provide direct patient care.

17. A nurse is teaching a patient and family about quality of life. Which information should the nurse include in the teaching session about quality of life? a.It is deeply social. b.It is hard to define. c.It is an observed measurement for most people. d.It is consistent and stable over the course of one's lifetime.

ANS: B Quality of life remains deeply individual (not social) and difficult to predict. Quality of life is not just a measurable entity but a shared responsibility. Quality of life measures may take into account the age of the patient, the patient's ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality.

11. The nurse has become aware of missing narcotics in the patient care area. Which ethical principle obligates the nurse to report the missing medications? a.Advocacy b.Responsibility c.Confidentiality d.Accountability

ANS: B Responsibility refers to one's willingness to respect and adhere to one's professional obligations. It is the nurse's responsibility to report missing narcotics. Accountability refers to the ability to answer for one's actions. Advocacy refers to the support of a particular cause. The concept of confidentiality is very important in health care and involves protecting patients' personal health information.

6. The nurse questions a health care provider's decision to not tell the patient about a cancer diagnosis. Which ethical principle is the nurse trying to uphold for the patient? a.Consequentialism b.Autonomy c.Fidelity d.Justice

ANS: B The nurse is upholding autonomy. Autonomy refers to the freedom to make decisions free of external control. Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care. Consequentialism is focused on the outcome and is a philosophical approach. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.

16. During a severe respiratory epidemic, the local health care organizations decide to give health care workers priority access to ventilators over other members of the community who also need that resource. Which philosophy would give the strongest support for this decision? a.Deontology b.Utilitarianism c.Ethics of care d.Feminist ethics

ANS: B Utilitarianism focuses on the greatest good for the most people; the organizations decide to ensure that as many health care workers as possible will survive to care for other members of the community. Deontology defines actions as right or wrong based on their "right-making characteristics" such as fidelity to promises, truthfulness, and justice. Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible. The ethics of care and feminist ethics are closely related, but ethics of care emphasizes the role of feelings.

4. When professionals work together to solve ethical dilemmas, nurses must examine their own values. What is the best rationale for this step? a.So fact is separated from opinion b.So different perspectives are respected c.So judgmental attitudes can be provoked d.So the group identifies the one correct solution

ANS: B Values are personal beliefs that influence behavior. To negotiate differences of value, it is important to be clear about your own values: what you value, why, and how you respect your own values even as you try to respect those of others whose values differ from yours. Ethical dilemmas are a problem in that no one right solution exists. It is not to separate fact from opinion. Judgmental attitudes are not to be used, much less provoked.

15. The nurse is caring for a dying patient. Which intervention is considered futile? a.Giving pain medication for pain b.Providing oral care every 5 hours c.Administering the influenza vaccine d.Supporting lower extremities with pillows

ANS: C Administering the influenza vaccine is futile. A vaccine is administered to prevent or lessen the likelihood of contracting an infectious disease at some time in the future. The term futile refers to something that is hopeless or serves no useful purpose. In health care discussions the term refers to interventions unlikely to produce benefit for a patient. Care delivered to a patient at the end of life that is focused on pain management, oral hygiene, and comfort measures is not futile.

3. The patient's son requests to view documentation in the medical record. What is the nurse's best response to this request? a."I'll be happy to get that for you." b."You are not allowed to look at it." c."You will need your mother's permission." d."I cannot let you see the chart without a doctor's order."

ANS: C The mother's permission is needed. The nurse understands that sharing health information is governed by HIPAA legislation, which defines rights and privileges of patients for protection of privacy. Private health information cannot be shared without the patient's specific permission. The nurse cannot obtain the records without permission. The son can look at it after approval from the patient. While talking to the physician or getting an order is appropriate, the patient still has to give consent.

13. A nurse is discussing quality of life issues with another colleague. Which topic will the nurse acknowledge for increased attention paid to quality of life concerns? a.Health care disparities b.Aging of the population c.Abilities of disabled persons d.Health care financial reform

ANS: C The population of disabled persons in the United States and elsewhere has reshaped the discussion about quality of life (QOL). Health care disparities, an aging population, and health care reform are components impacted by personal definitions of quality but are not the underlying reason why QOL discussions have arisen.

10. A nurse agrees with regulations for mandatory immunizations of children. The nurse believes that immunizations prevent diseases as well as prevent spread of the disease to others. Which ethical framework is the nurse using? a.Deontology b.Ethics of care c.Utilitarianism d.Feminist ethics

ANS: C Utilitarianism is a system of ethics that believes that value is determined by usefulness. This system of ethics focuses on the outcome of the greatest good for the greatest number of people. Deontology would not look to consequences of actions but on the "right-making characteristic" such as fidelity and justice. The ethics of care emphasizes the role of feelings. Relationships, which are an important component of feminist ethics, are not addressed in this case.

8. The nurse values autonomy above all other principles. Which patient assignment will the nurse find most difficult to accept? a.Older-adult patient who requires dialysis b.Teenager in labor who requests epidural anesthesia c.Middle-aged father of three with an advance directive declining life support d.Family elder who is making the decisions for a young-adult female member

ANS: D Autonomy refers to freedom from external control. A person who values autonomy highly may find it difficult to accept situations where the patient is not the primary decision maker regarding his or her care. A teenager requesting an epidural, a father with an advance directive, and an elderly patient requiring dialysis all describe a patient or family who can make their own decisions and choices regarding care.

9. A nurse must make an ethical decision concerning vulnerable patient populations. Which philosophy of health care ethics would be particularly useful for this nurse? a.Teleology b.Deontology c.Utilitarianism d.Feminist ethics

ANS: D Feminist ethics particularly focuses on the nature of relationships, especially those where there is a power imbalance or a point of view that is ignored or invisible. Deontology refers to making decisions or "right-making characteristics," bioethics focuses on consensus building, while utilitarianism and teleology speak to the greatest good for the greatest number.

12. A young woman who is pregnant with a fetus exposed to multiple teratogens consents to have her fetus undergo serial PUBS (percutaneous umbilical blood sampling) to examine how exposure affects the fetus over time. Although these tests will not improve the fetus's outcomes and will expose it to some risks, the information gathered may help infants in the future. Which ethical principle is at greatest risk? a.Fidelity b.Autonomy c.Beneficence d.Nonmaleficence

ANS: D Nonmaleficence is the ethical principle that focuses on avoidance of harm or hurt. Repeated PUBS may expose the mother and fetus to some risks. Fidelity refers to the agreement to keep promises (obtain serial PUBS). Autonomy refers to freedom from external control (mother consented), and beneficence refers to taking positive actions to help others (may help infants in the future).

18. The nurse is caring for a patient supported with a ventilator who has been unresponsive since arrival via ambulance 8 days ago. The patient has not been identified, and no family members have been found. The nurse is concerned about the plan of care regarding maintenance or withdrawal of life support measures. Place the steps the nurse will use to resolve this ethical dilemma in the correct order. 1. The nurse identifies possible solutions or actions to resolve the dilemma. 2. The nurse reviews the medical record, including entries by all health care disciplines, to gather information relevant to this patient's situation. 3. Health care providers use negotiation to redefine the patient's plan of care. 4. The nurse evaluates the plan and revises it with input from other health care providers as necessary. 5. The nurse examines the issue to clarify opinions, values, and facts. 6. The nurse states the problem. a.6, 1, 2, 5, 4, 3 b.5, 6, 2, 3, 4, 1 c.1, 2, 5, 4, 3, 6 d.2, 5, 6, 1, 3, 4

ANS: D Step 1. Gather as much information as possible that is relevant to the case. Step 2. Examine and determine your values about the issues. Step 3. Verbalize the problem. Step 4. Consider possible courses of action. Step 5. Negotiate the outcome. Step 6. Evaluate the action.