Fundamentals of Nursing-Chapter 22-Ethics and Values

A patient is hospitalized for the treatment of tuberculosis. The patient's friend asked the nurse about the patient's personal health information. However, the nurse refused to give the information. Which principle of the code of ethics has the nurse followed?

1

Advocacy

2

Accountability

3

Responsibility

4

Confidentiality

4

Confidentiality

The nurse has followed the principle of confidentiality. Confidentiality refers to keeping the patient's personal health information private. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the protection of the patient's personal health information. Advocacy refers to the support of a particular cause. Accountability is used while answering about one's actions. Responsibility means a willingness to respect one's professional obligations and follow through on promises.

The night shift nurse is caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take?

1

Give the family the record.

2

Give the patient the record.

3

Allow the family to express concerns.

4

Call the nursing supervisor.

3

Allow the family to express concerns.

Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how best to address their concerns.

A patient suffering from cardiac arrest is brought to the hospital. The patient previously underwent a coronary artery bypass graft (CABG) and angioplasty, and the patient has been chronically ill since then. The patient has requested in writing that not to be resuscitated in case of emergency. What is the term for this request?

1

Living will

2

Implied consent

3

Informed consent

4

Power of attorney

1

Living will

Living wills are written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. Implied and informed consents are types of consent that are given by a patient (or guardian) in case of surgery or treatment. A power of attorney is a legal document that designates a person of the patient's choice to make health care decisions on behalf of the patient when the patient is no longer able to do so.

The American Nurses Association (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 protecting patient privacy. On the basis of this principle, if a nurse participates in a public online social network such as Facebook, could the nurse post images of a patient's x-ray film if all patient identifiers have been deleted?

1

Yes; patient privacy would not be violated as long as the patient identifiers were removed.

2

Yes; respect for autonomy implies that the nurse has the autonomy to decide what constitutes privacy.

3

No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work.

4

No; the principal of accountability requires the nurse to keep the identifiers on the image.

3

No; even though patient identifiers are removed, someone could identify the patient based on other comments about the patient's condition and the nurse's place of work.

Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information. This means that under no circumstance could the nurse post a photo online of a private medical record, including x-rays. The nurse should not share the image online, though the reason is not because the nurse is accountable for keeping the record intact.

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 principles of utilitarianism. Which statement describes utilitarianism?

1

The value of something is determined by its usefulness to society.

2

People's values are determined by religious leaders.

3

The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far.

4

The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or healthcare provider.

1

The value of something is determined by its usefulness to society.

Utilitarianism specifically refers to the greatest good for the greatest number of people, where 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. Utilitarianism is not when values are determined by religious leaders, does not take into account the patient's previous moral life, and does not argue that the best way to determine the solution is to refer the case to the provider.

The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply.

1

Nursing notes can be illegible as long as the nurse can read them.

2

Nursing notes should be maintained properly.

3

Nursing records should be properly preserved.

4

Institutions should maintain complete nursing records.

5

Only basic duties should be recorded in nursing records.

2

Nursing notes should be maintained properly.

3

Nursing records should be properly preserved.

4

Institutions should maintain complete nursing records.

Nursing notes are important because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly, complete nursing records should be properly preserved, because they may be required to show what care was provided. Basic nursing duties, as well as advanced nursing care, should be recorded in the nursing records.

The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. Which would probably cover the nurse in this situation?

1

The nurse's automobile insurance

2

The nurse's homeowner's insurance

3

The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

4

The Patient Care Partnership, which may grant immunity from suit if the injured party consents

3

The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

The Good Samaritan law holds healthcare providers immune from liability as long as they function within the scope of their expertise. Automobile and homeowner insurance would not cover the nurse in this situation. The Patient Care Partnership may grant immunity from suit if the injured party consents, which is not the case in this scenario.

A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy?

1

Inform the patient's spouse about the disease.

2

Do not inform the patient or the family members about the disease.

3

Obtain permission from the patient to inform the patient's spouse about the disease.

4

Obtain informed consent from the spouse to reveal the illness to the patient.

3

Obtain permission from the patient to inform the patient's spouse about the disease.

Hepatitis B is a sexually transmitted disease, and the patient may be unwilling to reveal the information about the disease to the spouse. Thus, the nurse should request consent from the patient to let the spouse know about the illness. The patient's spouse should not be informed about the illness without the patient's consent. The nurse should abide by the patient's right to be informed about the disease. The nurse must obtain the patient's consent to inform family members about the disease. Obtaining informed consent from the spouse to reveal the illness to the patient is an inappropriate nursing action.

A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility?

1

Obtain a court order to give the blood.

2

Coerce the husband into giving the blood.

3

Call security and have the husband removed from the hospital.

4

Abide by the husband's wishes and inform the healthcare provider.

4

Abide by the husband's wishes and inform the healthcare provider.

Adult patients such as those who are Jehovah's Witnesses are able to refuse treatment for personal religious reasons.

The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act (HIPAA)?

1

Discussing patient conditions in the nursing report room at the change of shift

2

Allowing nursing students to review patient charts before caring for patients to whom they are assigned

3

Posting medical information about a patient on a message board in the patient's room

4

Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3

Posting medical information about a patient on a message board in the patient's room

Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment, which violates the Health Insurance Portability and Accountability Act (HIPAA)

The nurse is floated to work on a nursing unit where the assignment is beyond the nurse's capability. Which is the best nursing action to take first?

1

Call the nursing supervisor to discuss the situation.

2

Discuss the problem with a colleague.

3

Leave the nursing unit and go home.

4

Say nothing and begin work.

1

Call the nursing supervisor to discuss the situation.

Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

When an ethical dilemma occurs on the unit, can nurses resolve the dilemma by taking a vote?

1

Yes; ethics is essentially a democratic process, with all participants sharing an equal voice.

2

No; an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do.

3

Yes; ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care.

4

No; most ethical dilemmas are resolved by deferring to the medical director of the ethics department.

2

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.

Which ethical principles are included in the professional nursing code of ethics? Select all that apply.

1

Advocacy

2

Responsibility

3

Accountability

4

Fidelity

5

Justice

1

Advocacy

2

Responsibility

3

Accountability

The professional nursing code of ethics includes advocacy, responsibility, and accountability. Advocacy means to support a patient's cause. Responsibility refers to being answerable for the patient's health condition. Accountability refers to the ability to answer for one's actions. Fidelity and justice are components of ethics but are not part of the professional nursing code of ethics.

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?

1

Justice

2

Autonomy

3

Beneficence

4

Nonmaleficence

2

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.

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?

1

Beneficence

2

Accountability

3

Nonmaleficence

4

Respect for autonomy

3

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 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?

1

"Avoidance of harm or hurt is beneficence."

2

"Support of a particular cause is beneficence."

3

"Agreement to keep promises is beneficence."

4

"Taking positive actions to help others is beneficence."

4

"Taking positive actions to help others is beneficence."

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.

How can nurses negotiate differences of opinion and values with patients?

1

Be clear about their values.

2

Emphasize correctness of their values.

3

Negate the patient's values.

4

Ask the patients to accept the nurses' values.

1

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.

Which is the best example of practicing patient advocacy?

1

Seeking out the nursing supervisor in conflicting procedural situations

2

Documenting all clinical changes in the medical record in a timely manner

3

Working to understand the law as it applies to an error in following standards of care

4

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

4

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.

There are seven key steps in the resolution of an ethical dilemma. Which step involves distinguishing among facts, opinions, and values?

1

Clarifying values

2

Negotiating a plan

3

Verbalizing the problem

4

Evaluating the plan over time

1

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.

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?

1

To articulate a unique point of view, including knowledge-based on clinical and psychosocial observations

2

To await new clinical orders from the physician

3

To limit discussions about ethical principals

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 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.

Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating differences of opinion?

1

Consult a professional ethicist to ensure that the steps of the process occur in full.

2

Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.

3

Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process.

4

List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.

2

Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.

Before proceeding with discussion about any difficult situation, just as in the nursing process, participants should take time to gather all relevant information to ensure reliability and validity during the discussion.

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?

1

Accountability, because the nurse is accountable for the well-being of this patient

2

Respect for autonomy, because this patient's autonomy will be violated if the patient does not receive the liver transplant

3

Ethics of care, because the caring thing is to provide this patient the 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

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 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?

1

Justice

2

Fidelity

3

Autonomy

4

Beneficence

1

Justice

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.