NUR 304 Chapter 22 - Ethics and values in Nursing

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. 5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. 6. 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.

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. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

Which statements properly apply 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. 5. 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.

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. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.) 1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified. 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life.

1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified.

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) 1. Ethics of care pays attention to the context in which caring occurs. 2. Ethics of care is used only by nurses because it is part of the Nursing Code of Ethics. 3. Ethics of care requires understanding the relationships between involved parties. 4. Ethics of care considers the decision maker's relationships with other involved parties. 5. Ethics of care is an approach that suggests a greater commitment to patient care. 6. Ethic of care considers the decision maker to be in a detached position outside the ethical problem.

1. Ethics of care pays attention to the context in which caring occurs. 3. Ethics of care requires understanding the relationships between involved parties. 4. Ethics of care considers the decision maker's relationships with other involved parties.

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.

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. 5. Ethics of care focuses only on understanding relationships.

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? 1. Fidelity 2. Beneficence 3. Nonmaleficence 4. Respect for autonomy

1. Fidelity

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

The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.

1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources.

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's 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 views 4. To allow the patient and the physician private time to resolve the dilemma on the basis of ethical principles

1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations

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? 1. To articulate the nurse's 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 on the basis of ethical principles without regard to personally held values or opinions.

1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations.

Match the examples with the professional nursing code of ethics: a. Advocacy b. Responsibility c. Accountability d. 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. 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.

1. d 2. c 3. a 4. b

Match the following actions (1 through 4) with the terms (a through d) listed below: Terms: a. Advocacy b. Responsibility c. Accountability d. Confidentiality Actions 1. You see an open medical record on the computer and close it so that 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 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

1. d 2. c 3. a 4. b

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

2. Ask the question, Is this an ethical dilemma? 4. Gather information. 1. Clarify values. 3. Verbalize the problem. 5. Identify course of action. 7. Negotiate a plan 6. Evaluate the plan.

When designing a plan for pain management for a patient following surgery, 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. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for oversedation as a side effect of his pain medication

2. Asking the patient to establish the goal for pain control

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. 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.

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 agreement about a definition of usefulness exists 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.

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable.

3. In a diverse community it can be difficult to find agreement on which principles or rules are most important.

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? 1. Yes, because patient privacy would not be violated since 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 on the basis of other comments that you make online about his or her condition and your place of work 4. No, because the principle of justice requires you to allocate resources fairly

3. 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

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 a patient's self-worth. 2. Nurses have a scope of practice that encourages their presence during ethical discussions. 3. Nurses develop a relationship with 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 with the patient that is unique among all professional health care providers.

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 patient 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. Assessing the patient's point of view and preparing to articulate it

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.

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. 2. Agree on a statement of the problem or dilemma that you are trying to resolve. 1. List the actions that could be taken to resolve the dilemma. 6. Negotiate a plan. 3. Agree on a plan to evaluate the action over time.

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: You as the nurse are accountable for the well- being 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.

4. Justice: The greatest question in this situation is how to determine the just distribution of resources. 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. 1. Accountability: You as the nurse are accountable for the well- being of this patient.

What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via a messaging tool in a social media site? 1. Yes, if you remove all patient identifiers before sending 2. No, because the patient's x-ray results should be discussed with a provider 3. Yes, because respect for autonomy means honoring this patient's request 4. No, because health information of any kind should not be shared on social media

4. No, because health information of any kind should not be shared on social media

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 3. Develop and implement a plan to address the problem. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 6. Recognize that the problem requires ethics.

6. Recognize that the problem requires ethics. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 1. List all the possible actions that could be taken to resolve the problem. 3. Develop and implement a plan to address the problem.

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of: A. responsibility. B. accountability. C. competency. D. moral behavior.

B. accountability. Rationale: If a nurse decides to withhold medication, despite a provider's order, the nurse is then accountable for his or her actions, as the nurse made the independent decision because of his or her knowledge of the patient and the patient's situation at that moment in time.

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. Rationale: Sometimes to improve a patient's condition, it is necessary to perform a procedure that will cause pain for the patient. The nurse must weigh the benefits and the risks with the patient in his or her quest to do no harm.

Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the principle of ________?

Nonmaleficence