Leadership Roles and Management functions in Nursing theory and application 10th edition Chapter 4

Which statement by a nurse most clearly demonstrates an intuitionist framework for ethical decision making, duty based?

A. "I've got to look at this situation on the basis of its unique characteristics, not by comparing it to other situations."

B. "I'm trying to think of as many different options as I can rather than focusing on those that look most attractive."

C. "I'll make the best decision if I choose the option that comes to mind first rather than overanalyzing the situation."

D. "It's important that I consider the effect of my decision on the organization, not just the people who are directly involved."

A. "I've got to look at this situation on the basis of its unique characteristics, not by comparing it to other situations."

Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine

relative goals, duties, and rights. Consequently, there is a focus on the specific

characteristics of a situation, not its commonalities with other situations. Thinking of as

many options as possible is a good practice for ethical decision making, but it is not

specifically aligned with an intuitionist framework. Similarly, considering the effects on the

organization is not a particular characteristic of this framework. Intuition does not entail

choosing the option that first comes to mind, without any further analysis or consideration

Which statement best describes ethics?

A. The conflict, power, and interdependency associated with the way we live

B. How out lives and relationships are lead in day-to-day circumstances

C. What our conduct and actions should be regarding what is right and good

D. How people make decisions that they see as legally and morally appropriate

C. What our conduct and actions should be regarding what is right and good

Feedback: Ethics is the systematic study of what a person's conduct and actions should be

with regard to self, other human beings, and the environment; it is the justification of what is

right or good and the study of what a person's life and relationships should be, not

necessarily what they are. It is not the study of what people actually do in their daily lives or

how they live but rather what they should do. Ethics is related to legality and morality, but it

is not synonymous with these concepts.

A nurse is facing an ethical dilemma about whether to report a colleague's offensive comment, an action which is likely to jeopardize their relationship. What is a characteristic of this nurse's ethical dilemma?

A. The dilemma can be solved by applying empirical data.

B. The dilemma has no realistic solution.

C. The situation involves two or more undesirable alternatives.

D. The situation involves a breach of the law.

C. The situation involves two or more undesirable alternatives.

Feedback: Ethical dilemmas involve being forced to choose between two or more

undesirable alternatives. Ethical dilemmas are often not amenable to being solved with

empirical data; they involve values and beliefs, not only facts. Most ethical dilemmas do not

involve a breach of the law; legal issues often have a more clear and unambiguous response.

Even though ethical dilemmas are difficult to manage, this does not mean that there is no

possibility of a realistic solution.

The A nurse is applying the ethical principle of justice when providing care for clients. What action best exemplifies this principle?

A. Prioritizing actions that will benefit the largest number of clients

B. Meeting continuing education requirements for license renewal

C. Respecting clients' rights to make decisions about their care

D. Ensuring that time and resources are distributed equitably to clients

D. Ensuring that time and resources are distributed equitably to clients

Feedback: The principle of justice states that equals should be treated equally and that

unequals should be treated according to their differences; this is the principle of equity.

Justice is frequently applied when there are scarcities or competition for resources or

benefits. Meeting requirements for licensure is a legal issue, not a principle of ethics. The

principle of utility involves prioritizing actions that will benefit the largest number of

clients. Respecting clients' rights to make decisions demonstrates autonomy.

The only treatment alternative left for a client diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. Some individuals are arguing that the high cost of the procedure could be better spent providing well-baby screening for 2,000 residents in the service area. What ethical principle is most directly involved in this situation?

A. Paternalism

B. Utility

C. Unethical conduct

D. Maleficence

B. Utility

Feedback: The principle of utility states that what is best for the common good outweighs

what is best for the individual. There is no indication of unethical or maleficent (harmful)

behavior. Paternalism would be characterized by decisions being made without the client

having input

A nurse is applying the MORAL decision-making model to a dilemma involving a colleague's possible dishonesty in documentation. What is the nurse's initial action?

A. Think of as many alternatives as possible.

B. Gather as much information about the situation as possible.

C. Engage the colleague in the decision-making process.

D. Perform a critical self-reflection of the nurse's own morals and values.

B. Gather as much information about the situation as possible.

Feedback: The first step of the MORAL decision-making model is to "massage the

dilemma." This involves collecting data about the ethical problem and who should be

involved in the decision-making process. However, this does not necessarily mean that the

nurse must engage the colleague who is the object of the decision. Outlining options

(alternatives) is the second step in the model. It is presumed that a nurse will engage in

self-reflection when addressing dilemmas, but this is not an explicit component of the

MORAL model

A nurse has been asked to stay after a shift and work overtime because three nurses have called in sick. The nurse is reluctant to work the overtime because of a social commitment. Duty-based reasoning would dictate that the nurse:

A. contact the three nurses to remind them of their obligations.

B. base the decision on recent precedents in the health-care organization.

C. work overtime because of the responsibility owed to clients.

D. carefully weigh the effect of the decision on workplace relationships.

C. work overtime because of the responsibility owed to clients.

Feedback: Duty-based reasoning is an ethical framework stating that some decisions must

be made because there is a duty to do something or to refrain from doing something. In this

case, it could be construed that the nurse has a duty to care for clients that supersedes social

activities. Duty-based reasoning would not prioritize the effect on relationships over the nurse's moral duty. Precedents would not necessarily indicate what the nurse's duty is. Duty-based reasoning emphasizes the nurse's own duty, not that of colleagues

A nurse is integrating the Nursing code of ethics when making a decision about the best response to a challenging situation. What information will the nurse be able to obtain from this document?

A. Guidelines that will help the nurse clarify his or her own values

B. Legal guidelines to help the nurse make an ethical decision

C. The principles that are most valued in nursing practice

D. A model that will guide the nurse to make an ethical decision

C. The principles that are most valued in nursing practice

Feedback: A professional code of ethics is a set of principles, established by a profession, to

guide the individual practitioner. It is not, however, a decision-making model or a tool for

clarifying one's own values. Codes of ethics are not legally binding documents

The nurse is faced with a situation that requires ethical decision making. What statement should guide the nurse's action?

A. Only desirable alternatives should be identified when solving ethical dilemmas.

B. Critical ethical decisions should be made quickly so the situation does not worsen.

C. Outcomes are the main criterion for evaluating ethical decision making.

D. Accepting some ambiguity and uncertainty is a part of ethical decision making.

D. Accepting some ambiguity and uncertainty is a part of ethical decision making.

Feedback: Ethical decision makers choose between two or more undesirable alternatives,

and because they can use only the information and resources available at the time, they must

live with some ambiguity and uncertainty. Processes must be considered during ethical

decision making, not only outcomes. The nurse should identify as many alternatives as

possible during the early stages of decision making, not only desirable alternatives. Ethical

decisions often require a careful and methodical approach rather than a quick decision

The principle of autonomy would have the greatest bearing on what clinical situation?

A. A client is unable to afford the treatment that carries the best chance for a cure.

B. A client is discussing a do-not-resuscitate order with the care team.

C. The nurse is caring for two clients in pain and must choose which to treat first.

D. A nurse is considering whether to report a colleague's rough treatment of a client.

B. A client is discussing a do-not-resuscitate order with the care team.

Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and

accepting the responsibility for one's choice. Deciding on resuscitation options involves this

principle because the client's preference is the final determinant on the matter. Situations

involving scarce resources or time are more closely aligned with issues of justice. The nurse's ethical decision making around reporting bad practice align most closely with

duty-based reasoning and beneficence for clients.

The care team is working with a client who has mental illness and who has been deemed a threat to self and others. It may be justified to take away the client's right to:

A. self-determination.

B. beneficence.

C. justice.

D. confidentiality.

A. self-determination.

Feedback: When an individual's impaired decision making poses a threat to self or others, it

may be in the interests of the client and other people to temporarily remove the client's right

to self-determination. That is, to remove the client's right to reject treatment. This is

ultimately an act of beneficence, even though the client may perceive otherwise. Justice is

more closely aligned with the distribution of benefits between people. Confidentiality is

maintained whether or not the client's right to self-determination remains in place

The interdisciplinary team is considering whether to apply the principle of paternalism in the care of a client. What question should guide the team's decision?

A. What interventions are in the client's best interest?

B. Is the client competent to make decisions?

C. What is the client's most likely prognosis?

D. Does the client have strong social or family support?

B. Is the client competent to make decisions?

Feedback: Paternalism can be invoked when a client is unable to make sound decisions for

himself or herself. Consequently, the client's ability to make decisions underlies the

question of whether acting paternalistic is justified or not? The presence or absence of social

and family support does not justify or rule out paternalism. Likewise, the particulars of the

client's prognosis do not determine whether it is appropriate to be paternalistic. The client's

competence decides whether the care team is justified in stepping in to act in the client's

"best interest."

The nurse has been navigating a difficult situation that involved an ethical dilemma. Which factors should be considered when assessing the quality of the nurse's ethical problem-solving process? Select all that apply.

A. The number of alternatives that the nurse initially generated

B. The process the nurse used for data gathering is not needed

C. Precedents in the organization involving similar situations were compared to this one

D. The outcomes of the process

E. The process that was used to arrive at a decision

A, D, E

Feedback: Outcomes should never be used as the sole criterion for assessing the quality of

ethical problem solving because many variables affect outcomes that have no reflection on

whether the problem solving was appropriate. Quality, instead, should be evaluated both by

the outcome and the process used to make the decision. Rigorous data gathering enhances

the decision-making process, but this is not the criteria by which the overall process is

gauged. Similarly, precedents can be used to inform decision making but do not constitute

the basis for evaluating the overall process. Generating multiple alternatives aids the

problem-solving process by identifying as many options as possible.

The nurse has applied the MORAL decision-making model to a situation that involved an ethical dilemma. The nurse should complete the process by:

A. leading the implementation plan.

B. evaluating the effectiveness of the decision-making process.

C. disseminating the results of the process to other nurses.

D. reaffirming the nurse's relationships with stakeholders.

B. evaluating the effectiveness of the decision-making process.

Feedback: The final phase of the MORAL decision-making model involves "looking back."

That is, evaluating the decision-making process. This model does not explicitly involve

reaffirming relationships or disseminating the results, even though the model does not

preclude these actions. Implementing the decision precedes the evaluation phase.

Which statement is correct regarding the distinction between legal and ethical obligations in decision making?

A. Ethical controls are much clearer and individualized.

B. Legal controls are clearer and philosophically impartial.

C. Ethical controls are clearer and philosophically impartial.

D. Legal controls are much less clear and individualized.

B. Legal controls are clearer and philosophically impartial.

Feedback: In general, legal controls are clearer and philosophically impartial; ethical

controls are much less clear and individualized

The nurse-manager has learned there is conflict between a nonresponsive client's family members about the best plan of care. The manager recognizes the complex ethics of this situation. What is the manager's best action?

A. Make contact with the hospital's ethics committee.

B. Refer the family to the hospital's spiritual care service.

C. Base a decision on the most recent precedent in the organization.

D. Ask an impartial staff member to mediate.

A. Make contact with the hospital's ethics committee.

Feedback: An ethics committee can bring needed experience, perspective, and insight to

challenging ethical situations. Precedent cannot always be used as a guide because each

situation is unique even if they appear superficially similar. Clients and families often benefit from spiritual care, but this does not help the manager make a good decision.

Mediation can sometimes be beneficial, but this does not release the nurse-manager from

addressing the situation as best as he or she can.

In which situation would the nurse be justified in overriding a client's right to confidentiality?

A. A client does not want her husband to know that she is a client on the unit.

B. An older adult client discloses to the nurse that her son occasionally hits her.

C. A teenage client asks the nurse not to tell her parents that she is pregnant.

D. A client states that he does not want to know the results of his recent diagnostic test

B. An older adult client discloses to the nurse that her son occasionally hits her.

Feedback: Health-care managers are required by law to report certain cases, such as drug

abuse in employees, elder abuse, and child abuse. This is considered a justifiable violation

of confidentiality. The manager is obliged to respect client confidentiality around disclosing

pregnancy, acknowledging a hospital admission, or not wanting to know diagnostic results

The new nurse-manager has committed to modeling the leadership roles associated with applying ethics in the workplace. What is the manager's best action?

A. Ensure nurses are responsible for scrutinizing each other's behavior to monitor for ethical violations.

B. Demonstrate self-awareness about his or her own beliefs, morals, and values.

C. Delegate ethical decision making to staff nurses whenever possible.

D. Ensure that individual rights are always prioritized over collective rights.

B. Demonstrate self-awareness about his or her own beliefs, morals, and values.

Feedback: A core competency for ethical leadership is evaluating one's own values and

beliefs. This form of self-reflection is foundational for providing ethical care and promoting

in others. The balance between individual and collective rights is situation-specific;

individual rights are not always priorities over group interests. The manager must show

leadership in ethical decision making and cannot always delegate this important function to

staff. Ethical nurses are observant for violations, but this should not result in an environment

where each nurse is "scrutinizing" colleagues' practice

Which nurse is experiencing moral distress?

A. A heavy workload prevents a nurse from providing the care that each client requires.

B. The children of a terminally ill client do not want the client's prognosis communicated to the client.

C. A nurse knows that a colleague called in sick to work because the colleague had a social engagement.

D. A nurse witnesses a colleague using a racial slur in a conversation with another nurse.

A. A heavy workload prevents a nurse from providing the care that each client requires.

Feedback: Each of the listed situations has an ethical element. However, moral distress

occurs when the individual knows the right thing to do but organizational constraints make

it difficult to take the right course of action. A nurse who lacks the time and energy to give

clients what they need is likely to experience moral distress. Issues of respect, honesty, and

confidentiality require ethical decision making, but they do not directly involve a disconnect

between the desire and the ability to do the right thing

The nurse is practicing in a challenging environment where ethical and moral issues must often be dealt with. Which statement describes how moral uncertainty occurs?

A. An individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is.

B. An individual witnesses the immoral act of another but feels powerless to stop it.

C. An individual is forced to choose between two or more undesirable alternatives.

D. An individual knows the right thing to do, but organizational constraints make it difficult to take the right course of action.

A. An individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is.

Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or

values apply and may even include uncertainty as to what the moral problem is. Moral

distress occurs when the individual knows the right thing to do but organizational

constraints make it difficult to take the right course of action. Moral outrage occurs when an

individual witnesses the immoral act of another but feels powerless to stop it. Ethical

dilemma is being forced to choose between two or more undesirable alternatives

The nurse-manager is applying the MORAL decision-making model to a decision around a client's plan of care. The manager has engaged all the necessary stakeholders and collected as much data about the situation as possible. What should the manager do next?

A. Identify as many alternatives as possible.

B. Assess the client's values and beliefs.

C. Arrange to meet with the institution's ethics board.

D. Choose the option that best aligns with ethical principles.

A. Identify as many alternatives as possible.

Feedback: The initial step in the MORAL decision-making model involves collecting data

and determining who should be involved in the decision-making process. After this, the

nurse identifies alternatives and then chooses the best option. Engaging with an ethics

committee should take place in the first step when the manager decides who to involve.

Assessing the client's values should take place early in the decision-making process

Which ethical principle is demonstrated when an adult child is legally given the right to make medical decisions for a cognitively impaired parent?

A. Justice

B. Fidelity

C. Paternalism

D. Beneficence

C. Paternalism

Feedback: Paternalism is when one individual assumes the right to make decisions for

another. Justice requires that a person seek fairness, treat "equals" equally, and treat

"unequals" according to their differences. Fidelity involves the need to keep promises.

Beneficence involves actions that are taken in an effort to promote good

A nurse has repeatedly witnessed a physician being dismissive of clients' reports of pain and anxiety. The nurse recognizes that the best action would be to address this behavior with the physician, but the nurse strongly suspects that these concerns would be dismissed. What phenomenon is this nurse experiencing?

A. Ethical universalism

B. Moral conflict

C. Moral outrage

D. Ethical relativism

C. Moral outrage

Feedback: Moral outrage occurs when an individual witnesses the immoral act of another

but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual

is unsure which moral principles or values apply and may even include uncertainty as to

what the moral problem is. Ethical relativism suggests that individuals make decisions based

only on what seems right or reasonable according to their value system or culture. Ethical

universalism holds that ethical principles are universal and constant and that ethical decision

making should not vary as a result of individual circumstances or cultural differences.

Which statements concerning autonomy are true? Select all that apply.

A. It is based on a person's right to make a choice.

B. Its legal equivalent is self-determination.

C. It overrides paternalism but not beneficence.

D. It is a form of personal liberty.

E. It supports the process of progressive employee discipline.

A, B, D, E

Feedback: A form of personal liberty, autonomy is also called freedom of choice or

accepting the responsibility for one's choice. The legal right of self-determination supports

this moral principle. The use of progressive discipline recognizes the autonomy of the

employee. The employee, in essence, has the choice to meet organizational expectations or

to be disciplined further. If the employee's continued behavior warrants termination, the

principle of autonomy says that the employee has made the choice to be terminated by

virtue of his or her actions, not by that of the manager. Ethical situations always differ, so it

is impossible to state that one particular principle always overrides another

Which activity best demonstrates a nursing unit manager's attention to ANA standards for ethics required of that position?

A. Maintains current licensure

B. Terminates a staff member for absenteeism

C. Refers complex dilemmas to the institution's ethics board

D. Assures staff and patients that unit decisions are ethically sound

C. Refers complex dilemmas to the institution's ethics board

Feedback: ANA standards for ethics related to nurse administrators identifies participants on

multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and

outcomes as a criteria measurement. The remaining options, although addressing ethical

behaviors on the administrator's part, are not as directly identified by the ANA

A nurse has applied for a management position in a new organization. How can the manager best prevent intrapersonal conflict related to ethical issues in this role?

A. Determine whether nurses in the organization are required to follow a code of ethics

B. Become familiar with the nurse practice act in the jurisdiction where the organization is located

C. Identify a mentor in the organization who maintains high ethical standards

D. Clarify his or her own values and beliefs and compare to those of the organization

D. Clarify his or her own values and beliefs and compare to those of the organization

Feedback: The likelihood of intrapersonal conflict resulting from disagreement between a

manager's values and those of the organization is reduced if the manager clarifies his or her

own values and those of the organization. A mentor cannot necessarily help a manager do

this because values are personal. All nurses must follow a code of ethics, so this is not a

variable. Becoming familiar with the nurse practice act is beneficial, but this legislation does

not address ethical issues and values.

The managers of a hospital unit have been approached by a nurse educator who wants to conduct research into a particular nursing intervention. In order to ensure that the rights of clients who may participate are protected, the managers should:

A. discuss the educator's values, beliefs, and ethics.

B. compare the study methodology to the code of ethics.

C. refer the educator to the institutional review board.

D. ask the hospital ethics committee to approve or deny the application.

C. refer the educator to the institutional review board.

Feedback: Institutional review boards (IRBs) are primarily formed to protect the rights and

welfare of research subjects. They are the main gatekeepers for research that takes place in

the institution. Ethics committees more often deal with specific situations involved in client

care. Discussing the educator's values and beliefs is insufficient to protect the rights of

participants. There may be some benefit in comparing the research proposal to the code of

ethics, but ultimately, this is within the jurisdiction of the IRB

policies in a long-term care facility specify that immobile residents should be repositioned at least every 2 hours. Despite this, it is well known that many residence endure long periods without being repositioned. How should the nurse best interpret this situation?

A. It is necessary for the nurses at the facility to review the code of ethics

B. There is a need for actions to address this theory-practice-ethics gap

C. The nurses at the facility are experiencing intrapersonal conflict that affects their practice.

D. The nurses at the facility should apply the MORAL decision-making model to address this

B. There is a need for actions to address this theory-practice-ethics gap

Feedback: Theory-practice-ethics gaps exist when there is incongruence between what

nurses know they should or must do and what they actually do. Intrapersonal conflict is

internal discontent resulting from inconsistency between what should be done and what a

nurse can realistically do. However, there is no evidence that this is the case. Reviewing a

code of ethics is unlikely to bring about meaningful change without the addition of other

incentives. The MORAL decision-making model guides ethical decision making but does

not address these gaps between what should be done and what is actually done.

A nurse has recognized that many older adult clients on the unit do not receive enough nutrition because they are unable to feed themselves independently. What action by a manager would be most likely to resolve the nurse's moral distress?

A. Providing a reference so the nurse can seek new employment

B. Acknowledging and validating the nurse's observation

C. Hiring more nursing assistants to help feed these clients

D. Arranging to have the clients' diets changed so they are more nutrient-dense

C. Hiring more nursing assistants to help feed these clients

Feedback: Moral distress occurs when the individual knows the right thing to do but

organizational constraints make it difficult to take the right course of action. In this case, the

nurse knows what needs to be done (the clients need assistance with feeding) and arranging

for more employees to do this function would remove the organizational constraint.

Validation is of no value if it is not followed up by action. Changing the clients' diets is not

helpful if they cannot be fed the new diet. Helping the nurse seek employment elsewhere

does not benefit the clients and may not relieve the nurse's moral distress

A nurse-manager is discussing a proposed change in practice to the interdisciplinary team. What question by the manager best reflects a utilitarian perspective?

A. "Have we asked clients and families what they think?"

B. "How many people will this benefit?"

C. "Does our code of ethics address this?"

D. "Are the benefits greater than the risks?"

B. "How many people will this benefit?"

Feedback: Utilitarianism prioritizes the greatest good for the largest number of people. For

this reason, a question about how many individuals would benefit would be more indicative

of utilitarianism than issues related to consulting clients, weighing risks and benefits, and

consulting the code of ethics