Fundamentals of Nursing: Ch 22 - Ethics and Values

Ethics

study of conduct and character. It is cocnenred with determining what is good or caluable for indivudals, groups, and society at large.

Autonomy

freedom from external control

protecting patients independence

Beneficence

positive actions to help others

Best interest of the patient remain more important than self interest

Nonmaleficence

avoidance of harm or hurt

Justice

Fairness

just distribution of resources

just culture - promotion of open discussion whenever mistakes occur

Fidelity

agreement to keep promises

unwillingess to abandon patients even when care becomes controversial or complex

Code of Ethics

set of guiding principles all members of a profession accept

Advocacy

support of a cause

Value

personal belief about the worth of a given idea that influences behavior

Culturally competent care during end of life decisions

some cultures depend on family to make decisions for them

Deontology

defines actions as right or wrong based on their "right-making" characteristics like truth, justice.

-how the prcedue ensures fiedeily to the patient

Ex. best plan of care for a child when parents refuse treatment. How to know what to do?

Utilitarianism

the effect an act will have; consequences

-ps. the difference between ultiaiim and deontology is the focus on outcomes. Ultilarisum measures the effect that an will have, deonlogy loos at the presence of principles regadless of outcome

Processing an Ethical Dilemma

set up a conference and come to a consensus with the family or team members; gather info, assess values, make plans, evaluate

Access to care

care for patients who cannot afford prescription

Look at personal ethics

Step ONE to solve ethical dilemma

Ask is this a dilemma?

Step TWO to solve ethical dilemma

Gather relevant info regarding clinical, social and spiritual aspects of dilemma

Step THREE to solve ethical dilemma

Take time to clarify values and distinguish facts and opinion

Step FOUR to solve ethical dilemma

. Verbalize the issue. Agree on statement of problem or dilemma you're trying to solve

Step FIVE to solve ethical dilemma

List actions that could be taken to resolve dilemma

Step SIX to solve ethical dilemma

Negotiate plan

Step SEVEN to solve ethical dilemma

Agree on plan, evaluate action over time

Principles from highest to lowest authority/priority

1. Justice

2. Respect for autonomy

3. Ethics of care

4. Accountability

What best reflects the concept of advocacy?

Assessing the patient's POV and preparing to articulate it

Focus of ethics of care

Pays attention to the environment which caring occurs

Pays attention to the stories of people involved in ethical issues

Understanding relationships

Feminist ethics

Focuses on inequality between people

Ethics of care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives

Casuistry

case-based reasoning

Ethics committees

Multidisciplinary and serve several purposes: Education, policy recommendation, and case consultation

Quality of life

central to discussions about end of life care, cancer therapy, physician assisted suicide, and Do Not Resuscitate (DNR)

Disabilities

Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges

Care at end of life

Interventions unlikely to produce benefit for the patient

Health Care Reform

Facilitated access to care for millions of uninsured Americans

Common law

results from judicial decisions made in courts when individual legal cases are decided

Examples of common law

informed consent, patient's right to refuse treatment, negligence and malpractice

Civil laws

protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur

Example of civil law violation

negligence or malpractice

Responsibility

refers to the willingness to repsct ones profisional obligation and to follow through.

Accountability-

refers to the ability to answer for ones actiosn

1. 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.

4,2,3,1

2. 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 ________?

nonmalefience

3. 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

4. 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

5. 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

6. 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

7. 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.

1,2,5

8. 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

9. 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.

4,5,2,1,6,3

10. 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

11. 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

2,4,1,35,7,6

12. 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

13. 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

14. 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.

1,2,4

15. 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.

1d,2c,3a,4b