NURS 2513 Week 1: Introduction to Nursing Ethics, Power, Identity, and Discrimination

Comprehensive flashcard deck for NURS 2513 Week 1 covering foundational ethics concepts, cultural safety, professional codes (CNO/CNA), moral reasoning, Kohlberg's theory, and clinical case applications.

What is the systematic definition of ethics provided in the lecture and study notes?

Ethics is the systematic study of morality, including the principles, values, and standards used to determine whether human actions are right or wrong, good or bad, acceptable or unacceptable.

How is morality defined, and how is it typically formed?

Morality consists of beliefs and values about right and wrong that are often shaped by upbringing, religion, and culture, can be deeply personal, and influence individual behaviour.

How does ethics differ from morality in terms of inquiry and decision-making?

Ethics is the systematic reflection on right and wrong that critically examines and evaluates moral principles to encourage reasoned justification and guide professional decisions, rather than simply accepting personal beliefs.

What are the two distinct meanings of nursing ethics described by Yeo et al.?

(1) The expressed professional moral standards, values, virtues, and principles nurses uphold (such as honesty, fairness, and respect); and (2) a field of study and scholarship analyzing and debating those moral problems.

What fundamental question does ethics ask beyond simply determining what to do?

Ethics asks not only what to do, but why.

What are the six reasons why studying ethics is essential in nursing?

1. Nursing involves vulnerable relationships; 2. Nurses are accountable moral agents; 3. Patients hold diverse values; 4. Competing responsibilities create dilemmas; 5. Professional power can protect or harm; 6. Codes cannot anticipate every situation.

What is the crucial exam distinction between clinical competence and ethical competence?

Clinical competence does not equal ethical competence; a procedure can be technically correct yet unethical if consent, dignity, or patient concerns are ignored.

What is moral reasoning in nursing practice?

Evaluating a situation, considering relevant values and principles, deciding what ought to be done, gathering facts, recognizing conflicts, comparing options, justifying decisions, and reflecting on outcomes.

What defines an ethical dilemma?

A situation where two or more morally significant values, principles, or obligations conflict, such that fully satisfying one may compromise another.

Why is an act such as racial discrimination not considered a genuine ethical dilemma?

Because discrimination is wrong, not an equally defensible alternative or morally valid option.

In the trolley problem, how do utilitarian and deontological reasoning differ?

Utilitarianism may favour redirecting the trolley to reduce total deaths, whereas deontology asks whether deliberately causing one death violates moral duties.

What does changing the identity of the five people on the tracks to escaped prisoners illustrate in the trolley problem?

It tests how assumptions about perceived social worth influence moral judgments.

How should a nurse ethically respond if a colleague dismisses an Indigenous patient's pain?

Assess the patient clinically, consider bias and professional duties, and intervene appropriately rather than assuming the colleague is correct.

How can socioeconomic status create an ethical challenge or barrier in patient care?

A patient may face travel and affordability barriers that prevent them from accessing essential follow-up care.

Give an example of how cultural influences shape ethical nursing care.

A patient may request the active involvement of family members or an Elder in care decisions.

How can geographical location influence ethical healthcare delivery?

Rural patients face geographical disparities, such as having access to fewer healthcare specialists compared to urban populations.

How can professional hierarchy and power negatively impact a patient's care?

A patient may feel intimidated, silenced, or unable to question care decisions or challenge a nurse.

Why might two patients with identical symptoms experience different care outcomes?

Because of structural barriers, systemic discrimination, access barriers, past trauma, or unequal power relationships.

How is power defined in nursing, and when does it become harmful?

Power is the ability to influence decisions, resources, or others' actions; it becomes harmful when used to silence, control, stereotype, or disadvantage vulnerable people.

What is intersectionality as described in the notes?

A framework examining how multiple social identities (such as race, gender, disability, socioeconomic status) and systems of inequality interact simultaneously.

What is the distinction between bias and implicit bias?

Bias is a general tendency or preference influencing judgment, whereas implicit bias consists of automatic associations operating without conscious awareness.

What is the distinction between a stereotype and prejudice?

A stereotype is an oversimplified belief about a group, whereas prejudice is a preconceived judgment or attitude directed toward an individual or group.

How is discrimination defined in the Week 1 study notes?

Unfair treatment of individuals based on their identity or group membership.

What is systemic racism?

Institutional policies, structures, and practices that produce or sustain racial inequity.

What is cultural awareness?

Recognizing cultural differences and examining one's own assumptions and biases.

What is cultural competence?

Developing specific skills, knowledge, and attitudes for respectful cross-cultural clinical practice.

What is cultural humility?

An ongoing process of self-reflection, recognizing power differences, and being open to learning from patients.

What is the central defining feature of cultural safety?

Care that is experienced by the patient as respectful, safe, and free from racism or discrimination, explicitly addressing power imbalances.

Why can a nurse not determine cultural safety based solely on good intentions?

Because cultural safety is defined entirely by the recipient of care and whether the patient experiences the environment as respectful and free of discrimination.

Why might historical events such as residential schools cause Indigenous patients to distrust healthcare systems?

Residential schools and colonial policies created lasting intergenerational trauma and institutional harms that are compounded by ongoing discrimination in healthcare.

What specific institutional supports should nurses offer Indigenous patients if requested and available?

Indigenous navigators, Elders, or other cultural and spiritual supports.

What characterized early historical nursing traditions regarding authority and obedience?

They emphasized charity, compassion, and religious service, but were often situated within rigid, obedience-based, gender-subordinated hierarchies.

What key aspects of modern nursing were shaped by Florence Nightingale?

Sanitation, clinical observation, patient welfare, and establishing professional responsibility.

What was the motto of an early Canadian nursing school that illustrated historical subordination?

"I see and am silent."

Which historical research abuses catalyzed the modern focus on informed consent, human dignity, and justice?

Nazi medical experimentation and the Tuskegee syphilis study.

How are spirituality and religion distinguished in the study notes?

Spirituality concerns meaning, purpose, connection, and values (with or without organized religion), whereas religion generally involves organized communal beliefs, teachings, and practices.

What must a nurse do when their personal values conflict with a patient's informed refusal of care?

The nurse must respect the capable patient's informed decision; personal disagreement never permits coercion or abandonment of the patient.

What is the central question and focus of virtue ethics?

Virtue ethics focuses on moral character and asks: "What would a good nurse do?"

What is the central question and focus of deontology?

Deontology focuses on rules, obligations, and moral duties, asking: "What is my duty?" or "What duty or principle applies?"

What is the primary focus of utilitarianism, and what is its main weakness?

It evaluates actions based on consequences, aiming for the greatest overall well-being; its weakness is that aggregate benefit can overlook minority rights and individual dignity.

What is the core question and focus of the ethics of care?

The ethics of care focuses on relationships, empathy, and context, asking: "How can I respond compassionately to this person's needs?"

How is the ethical principle of autonomy defined in nursing?

Respecting a capable patient's self-determination and informed choices, including their right to refuse treatment.

How is the ethical principle of beneficence defined in nursing?

Acting to promote the well-being and health of others, such as providing appropriate pain relief.

How is the ethical principle of non-maleficence defined in nursing?

Acting to avoid causing harm or minimizing preventable harm, such as preventing medication errors.

How is the ethical principle of justice defined in nursing?

Treating people fairly and equitably, allocating resources justly, and actively addressing discrimination.

What is the meaning of veracity in ethical nursing practice?

Communicating the truth honestly and accurately regarding diagnoses, treatment options, and risks.

What is the ethical principle of fidelity?

Remaining loyal to commitments, keeping professional promises, and maintaining trust in therapeutic relationships.

How is integrity defined in nursing ethics?

Acting consistently with professional ethical values, moral principles, and standards of conduct.

What are the six organizing concepts in Yeo et al.'s textbook Concepts and Cases in Nursing Ethics?

Beneficence, autonomy, truthfulness, privacy/confidentiality, justice, and integrity.

What does Lawrence Kohlberg's theory of moral development specifically examine?

It examines why people judge actions right or wrong (the underlying reasoning), rather than only what decision they make.

What characterizes Stage 1 in Kohlberg's theory of moral development?

Punishment and obedience orientation: moral decisions are guided by the desire to avoid punishment (e.g., "I will be punished").

What characterizes Stage 2 in Kohlberg's theory of moral development?

Individual interest and instrumental exchange: moral decisions are guided by self-interest and exchange of favors (e.g., "What's in it for me?").

What characterizes Stage 3 in Kohlberg's theory of moral development?

Interpersonal approval orientation: moral reasoning focuses on pleasing others and being seen as a good person (e.g., "People will think I am good").

What characterizes Stage 4 in Kohlberg's theory of moral development?

Law and order orientation: moral reasoning focuses on obeying laws, following institutional rules, and maintaining social order.

What characterizes Stage 5 in Kohlberg's theory of moral development?

Social contract and individual rights: recognizing that laws are social agreements that may need to be changed if they are unjust.

What characterizes Stage 6 in Kohlberg's theory of moral development?

Universal ethical principles: guided by internalized, universal principles of justice, human dignity, and equality that transcend authority.

How would a Stage 1 nurse versus a Stage 4 nurse justify reporting discriminatory care?

A Stage 1 nurse reports it to avoid punishment or disciplinary action; a Stage 4 nurse reports it because organizational policies and rules require it.

How would a Stage 5 nurse versus a Stage 6 nurse justify reporting discriminatory care?

A Stage 5 nurse reports it to uphold human rights and challenge unjust procedures; a Stage 6 nurse reports it to defend universal human dignity and justice.

What are the primary criticisms of Kohlberg's theory of moral development?

It privileges justice-based reasoning over care-based reasoning and has been questioned regarding cultural and gender generalizability.

What is the primary role distinction between the CNO and the CNA?

The CNO is Ontario's regulatory body setting enforceable standards for public protection; the CNA is a national association offering ethics guidance and advocacy.

What are the seven CNO ethical values emphasized in the Week 1 lecture?

1. Client well-being; 2. Client choice; 3. Privacy and confidentiality; 4. Respect for life; 5. Maintaining commitments; 6. Truthfulness; 7. Fairness.

What are the six principles of the CNO Code of Conduct?

1. Respect client dignity, autonomy, rights; 2. Provide inclusive, culturally safe care through humility; 3. Provide safe, competent care; 4. Work respectfully with the team; 5. Act with integrity in client interest; 6. Maintain public confidence.

Which CNO Code of Conduct principle is directly applicable when addressing discrimination against an Indigenous patient?

Principle 2: Provide inclusive and culturally safe care through cultural humility.

What are the seven core values of the CNA 2017 Code of Ethics?

1. Safe, compassionate, competent and ethical care; 2. Health and well-being; 3. Informed decision-making; 4. Dignity; 5. Privacy and confidentiality; 6. Justice; 7. Accountability.

Which revised focus areas are emphasized in the newer CNA 2025 Code of Ethics?

Dignity/autonomy; relationships/humanizing care; integrity/accountability; truth and reconciliation; social justice; competent practice; and privacy/confidentiality.

Why can ethical codes not automatically solve every clinical conflict?

Codes cannot anticipate every complex clinical situation; nurses must still apply judgment, critical reasoning, and moral justification.

What is the contractual model of the nurse-patient relationship?

A relationship where the nurse and patient negotiate shared expectations, care values, and family involvement, fostering mutual trust and patient agency.

What is the patient advocate model of the nurse-patient relationship?

A model where the nurse actively defends individual patient rights, clarifies options, and speaks up when the patient's voice or concerns are ignored.

What is the social justice advocacy model?

Advocacy that extends beyond individual bedside care to challenge institutional inequalities, access barriers, discriminatory policies, and systemic racism.

What are the four core steps of the nursing ethical decision-making framework?

1. Assess; 2. Plan; 3. Implement; 4. Evaluate.

What is descriptive ethical analysis in Yeo et al.'s framework?

Identifying the objective facts of the case, missing information, stakeholders, policies, power relationships, and contextual dynamics.

What is conceptual ethical analysis in Yeo et al.'s framework?

Clarifying the meaning of key concepts and terms involved in a case, such as autonomy, racism, equity, dignity, and consent.

What is normative ethical analysis in Yeo et al.'s framework?

Determining what ought to be done by weighing moral duties, values, principles, available options, and ethical consequences.

Why is ethical decision-making described as iterative rather than strictly linear?

Because acquiring new clinical information or patient perspectives often requires returning to earlier stages to reassess and revise the plan.

In the case of an Indigenous man whose pain is minimized by staff, what is the central ethical issue?

The violation of justice, beneficence, and human dignity caused by discriminatory dismissal and stereotyping of the patient's pain.

In the Indigenous pain dismissal case, what should the nurse do during the Implement step?

Deliver appropriate pain interventions, advocate for medical assessment, communicate safety concerns, escalate if necessary, and offer desired cultural supports.

What is the central ethical conflict when a 34-year-old Indigenous woman refuses an emergency C-section?

The conflict between respecting the woman's informed choice and autonomy versus the medical team's beneficence and obligation to prevent harm to the fetus.

Under Ontario law, what right does a capable adult retain regarding emergency medical interventions?

A capable adult has the legal right to refuse treatment, even if that refusal could result in serious harm or death; clinical urgency does not void capacity.

Does refusing a recommended life-saving procedure indicate that a patient lacks decision-making capacity?

No; treatment refusal alone is never proof of incapacity. A formal capacity assessment must be justified by legitimate clinical reasons.

How should a nurse handle a family's request to conceal a nursing home placement from a patient with memory difficulties?

Do not automatically conceal the truth; evaluate the patient's capacity, involve the patient in discussions, and address the family's underlying fears.

What should a nurse do upon discovering a colleague is diverting hospital medication due to personal financial hardship?

Respond with personal compassion, but never conceal the diversion; adhere strictly to safety, reporting, and diversion policies while directing them to support.

What ethical principles must guide the distribution of a scarce vaccine supply?

Justice, beneficence, non-maleficence, and equity—prioritizing those facing high exposure, severe illness risk, and systemic access barriers.

What is moral distress, and how does it differ fundamentally from an ethical dilemma?

Moral distress occurs when a nurse knows the ethically right action but feels institutionally constrained from taking it, whereas a dilemma involves conflicting ethical obligations.

What ethical breach occurs if a nurse obtains a consent signature from a sedated patient?

It violates informed consent, autonomy, and legal standards because sedation impairs decision-making capacity.