**Chapter 22 Ethics Questions Perry/Potter

When a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient's _________.

Autonomy

If a nurse decides to withhold a medication because it might further lower a patient's blood pressure, the nurse will be practicing the principle of A. Responsibility B. Accountability C. Competency D. Moral behavior

B. Accountability

Nurses practice primarily as a service to others, even in the details of daily work

Beneficence

Describe ethical dilemma

existing when the right thing to do is not clear. Resolution requires the negotiation of differeing values among involving in the dilemma They can cause distress and controversy for both patients and caregivers

Refers to the support of a particular cause "nurses ability to help speak up for the patient"

Advocacy

Match the examples with the professional nursing code of ethics: 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 patients request. 4 You tell your patient that you will return in 30 minutes to give him his next pain medication.

1 Confidentiality 2Accountability 3 Advocacy 4 Responsibility

When designing a plan for pain management for a postoperative patient, the nurse assess that the patients 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? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

1 Fidelity Pg. 293; 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.

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? 1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations 2 To study the literature on current research about the possible clinical interventions available for the patient in question. 3 To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Pg. 296; 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.

What is the purpose of an ethic committee in health care institutions?

used to process ethical dilemmas used for education, policy recommendation, and case consultation

Which of the following properly applies an ethical principle to justify access to health care? (select all that apply) 1 Access to health care reflects the commitment of society to principles of beneficence and justice. 2 If low income compromises access to care, respect for autonomy is compromised. 3 Access to health care is a privilege in the United States, not a right. 4 Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

1,2,4 Pg. 298-299; 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, like money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficense means "first do no harm". A lack of care because of poor access causes harm (no preventative services, no early detection, no risk reduction) and is therefore 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.

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? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 Beneficence Pg. 293; Beneficence means "doing well" by taking positive actions. It implies that the best interest of the patient (and society) outweighs self-interest.

The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? 1 Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. 2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. 3 Even when an agreement about a definition of usefulness exist in a community, laws prohibit an application of utilitarianism 4 Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.

2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. Pg. 295; In our increasingly diverse communities, ideas of usefulness have become equally diverse.

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) 1 Ethics of care pays attention to the environment in which caring occurs. 2 Ethics of care pays attention to the stories of the people involved in the ethical issue. 3 Ethics of care is used only in nursing practice. 4 Ethics of care focuses only on the code of ethics for nurses. 5 Ethics of care focuses only on understanding relationships.

2, it's about relationships Pg. 292; All answers are valid concepts, but ethics of care focuses on understanding relationships.

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) 1 Average income varies in different regions of the country. 2 Community values influence definitions of quality, and they are subject to change over time. 3 Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4 The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5 Statistical analysis is difficult to apply when the outcome cannot be quantified. 6 Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

2,3,4,5 Pg. 298; 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.

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in the 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.

2,4,1,3,5,7,6 Pg. 296-297 an important concept in resolving ethical dilemmas is the idea that resolution is more complicated than simply doing what you want--it's about doing what's right, and figuring out what's right requires discourse.

Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 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. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 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.

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? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 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 4 No because the principal of justice requires you to allocate resources fairly

3 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 Comments, photos, etc. on social media are widely distributed and become a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person plus 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? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence Pg. 293; Nonmaleficence is an important concept, but can be difficult to grasp at first. It refers to the balancing the risks and benefits of care while doing least amount of harm and suffering.

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? 1 Nurses understand the principle of autonomy to guide respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers. Pg. 296; A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse.

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? 1 Seeking out the nursing supervisor to talk with the patient 2 Documenting patients fears in the medical record in a timely manner 3 Working to change the hospital environment 4 Assessing the patient's point of view and preparing to articulate it

4 Assess the patient's point of view and prepare to articulate it Pg. 293; All answers are correct behaviors, but 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/her views/wishes heard.

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, list the principles from highest to lowest priority. 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant 4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

4, 2, 3, 1 Pg. 296; Box 22-2 Key steps in the resolution of an ethical dilemma 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, then respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but her commitment to care does not, unfortunately, give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case.

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predicable 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 can 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.

4,5,2,1,6,3 Pg. 296-297; This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and healthcare 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 nurse is working with a terminally ill adult patient. The nurse decides totell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of the processing an ethical dilemma is A. Articulation of the problem B. Evaluation of the action C. Negotiation of the outcome D. Determination of values surrounding the problem

C. Negotiation of the outcome

A set of guiding principles that all members of a profession accept

Code of Ethics

HIPAA or Health Insurance Portability and Accountability Act of 1996 is an example of what?

Confidentiality

Main emphasis is on the outcome or consequence of action

Consequentialism

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of A. Autonomy B. Fidelity C. Justice D. Nonmaleficence

D. Nonmaleficence

If you try to make a decision about the ethics of a controversial medical procedure, ________ guides you to focus on how the procedure ensures fidelity to the patient, truthfulness, justice, and beneficence.

Deontology

Acts that are ethical reflect a commitment to standards beyond personal preferences (i.e., standards that individuals, professions, and societies strive to meet). However, when decisions must be made about health care, differing values and opinions among individuals can result in disagreement about the right thing to do.

Ethics

Attention to relationships as distinguished from other more principle based philosophies

Ethics of Care

Refers to the agreement to keep promises. Refers to the unwillingness to abandon patients even when care becomes controversial or complex.

Fidelity

discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of _________.

Justice

Describes the anguish experienced when a person feels unable to act according to closely held core values

Moral Distress

A bone marrow transplant procedure may offer a chance at cure; but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and full of uncertainty, precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit.

Nonmaleficence

The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Teleology

Research suggests that education about safe sex practices reduces the spread of human immunodeficiency virus (HIV). Reducing incidence of HIV is good for a great number of people.

Utilitarianism

A personal belief about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. In some cultures decisions about health care flow from group or family-based discussion rather than independent decisions by one person.

Value

Refers to the ability to answer to ones actions

accountability

Describe culturally competent care

acknowledge of and respect for cultural differences a willingness to negotiate and compromise when world views differ being aware of ones own values and bias using communication skills to enhance sympathy knowing cultural practices of patients groups regularly seen understanding that all patients are individuals and they may not share the same views as others within their own ethic group

Key steps in the resolution of an ethical dilemma

step 1 ask the questions, is this an ethical dilemma? step 2 gather information relevant to the case step 3 clarify values step 5 verbalize the problem step 6 negotiate a plan step 7 evaluate the plan over time