CHN Chapter 6: Advocacy, Ethical, and Legal Considerations

Which statement provides the best definition of ethics?

a. Universally held theory on how the world evolved

b. A set of rules that apply only to health care professionals in the practice setting

c. Values, norms, moral principles, virtues, and traditions that guide human conduct

d. A specialized area of philosophy

Answer is c. Values, norms, moral principles, virtues, and traditions that guide human conduct

Jack, 14 years old, presents at the community health nurses office requesting an initial immunization series. His parents have never immunized him because they do not believe in immunization. Jack's parents did not sign the immunization consent form sent home from school. What does this situation present for the nurse?

a. Something that never happens in Canada

b. An issue for feminist decision-making

c. An ethical dilemma

d. A course of action that is easily decided and recognized

Answer is c. An ethical dilemma

What is an example of social control?

a. Smoking cessation program

b. Influenza immunization clinics

c. Request to stay at home when ill with the flu

d. Seatbelt law

Answer is d. Seatbelt law

Which scenario represents the principle of reciprocity in ethical decision-making about public health interventions?

a. All stakeholders are involved with developing policy on how to manage a particular infectious disease

b. An individual is committed under the Mental Health Act to protect and prevent harm to others

c. A person who is exposed to a communicable disease is provided instructions on how to quarantine at home

d. The public health department is providing financial compensation to a person who is quarantined

Answer is d. The public health department is providing financial compensation to a person who is quarantined

What does the concept of social justice assume?

a. There is a limit to collective action

b. All societies experience broad, systematic oppression and inequities

c. The individual is valued over the collective

d. It is better to benefit the few than the disadvantaged many

Answer is b. All societies experience broad, systematic oppression and inequities

Which situation has undergone medicalization?

a. Menopause

b. Breast cancer

c. Homosexuality

d. Hyperthyroidism

Answer is c. Homosexuality

What statement is congruent with capacity building?

a. Equitable sharing of rights, roles, and responsibilities among institutions and individuals

b. Just or fair treatment of all individuals, including equitable access to meet health needs

c. Democracy and civil rights defining a social state in which all have equal rights

d. Strengthening of individual and institutional core skills, capabilities and knowledge

Answer is d. Strengthening of individual and institutional core skills, capabilities and knowledge

What term describes the way that nurses approach their practice and reflect on their ethical commitment to their clients and colleagues?

a. Committed ethics

b. Situational autonomy

c. Empowering a community

d. Everyday ethics

Answer is d. Everyday ethics

What nursing action best demonstrates professional responsibility and accountability?

a. Respecting a client's wishes not to inform her boyfriend that she has gonorrhea

b. Keeping a confidential client's repeated statements that she wants to kill her husband

c. Documenting home visit notes in a timely and thorough manner

d. Protecting the identity of a child who reveals that she has been abused

Answer is c. Documenting home visit notes in a timely and thorough manner

Which Canadian Community Health Nursing Standard of Practice is being used when advocating for appropriate resource allocation?

a. Facilitating access and equity

b. Practice setting safety

c. Empowering communities

d. Maintaining professional boundaries

Answer is a. Facilitating access and equity

Which statement reflects the World Health Organization's (2013) definition of empowerment?

a. A professional process in which communities are allowed to become self-directed

b. A static process that provides people with power

c. A nurse-driven process whereby people are given what they need

d. A process where people and communities move toward increased control

Answer is d. A process where people and communities move toward increased control

Who should develop an advanced directive?

a. A physician working in the palliative care setting

b. A person who is terminally ill and needs one to clearly spell out how his or her estate will be divided

c. An individual who wants to stipulate what medical treatments he or she will accept or reject

d. A nurse working with a client who is incapable of making choices

Answer is c. An individual who wants to stipulate what medical treatments he or she will accept or reject

Melanie is a nurse doing home visits. What must she recognize as she builds relationships with her clients?

a. Sharing her attitudes, beliefs, and values regarding health

b. The client's attitudes, beliefs, and values regarding health

c. Using the power in the relationship to meet her personal needs

d. Maintaining a distant and clinical boundary

Answer is b. The client's attitudes, beliefs, and values regarding health

What must be considered when nurses assist clients to make informed choices?

a. The benefits of the intervention but not the risks

b. Legally binding paperwork

c. The exchange of information and respect for the individual's autonomy

d. The benefits of the risks, negligence, and autonomy

Answer is c. The exchange of information and respect for the individual's autonomy

Kennedy is a community health nurse that has been working with a lesbian, gay, transsexual, and bisexual (LGTB) youth group in a large urban centre. Kennedy is lobbying his co-workers to change the nursing intake form to have more gender-neutral language, such as "Do you live with a partner?" What standard of practice is the nurse trying to uphold?

a. Professional responsibility and accountability

b. Facilitating access and equity

c. Building individual/community capacity

d. Promoting health

Answer is c. Building individual/community capacity

Anne-Marie, a recent nursing graduate, is really enjoying developing relationships with her clients. Anne-Marie tells her mentor that she works hard to meet the needs of her clients and has been using the strategy of meeting one client for coffee in the afternoons. How should the mentor respond to AnneMarie?

a. "Tell me more about how this strategy is helping to meet your needs?"

b. "It sounds like the nurse-client relationship has moved into a personal relationship."

c. "I use a more distant and clinical approach with my client relationships."

d. "This is a great nursing strategy that you should share with the rest of the nurses."

Answer is b. "It sounds like the nurse-client relationship has moved into a personal relationship."

Why is it important for community health nurse to be aware of social justice and everyday ethical and legal concerns?

a. Because it will assist nurses in gaining the capacity to reflect critically on the multiplicity of ethical and legal dimensions inherent in community health nursing

b. Because they can assist their clients in preparing for legal cases for medical malpractice

c. Because ultimately nursing will be intertwined with the legal system

d. Because it will assist nurses in building resistance to reflect critically on the multiplicity of ethical and legal dimensions inherent in community health nursing

Answer is a. Because it will assist nurses in gaining the capacity to reflect critically on the multiplicity of ethical and legal dimensions inherent in community health nursing

Which of the following statements about social justice is true?

a. Social justice strives to apply justice to medical groups

b. Social justice is the foundational moral justification for public health as a social institution

c. Social justice work does not require consideration of the socioenvironmental context

d. Social justice work involves the perspectives of only medicine and nursing

Answer is b. Social justice is the foundational moral justification for public health as a social institution

Given the current emphasis on obesity in Canadian society, a large body size in women has come to symbolize self-indulgence and moral failure, which in turn may lead women to question their sense of self and right to good healthcare. This is an example of an ethical implication of which community health nurse standard of practice?

a. Health maintenance, restoration, and palliation

b. Capacity building

c. Professional responsibility and accountability

d. Prevention and health protection

Answer is d. Prevention and health protection

Which ethical principle for public health interventions stipulates that the full force of governmental authority and power should not be used unless less-coercive methods are unavailable or have failed?

a. Harm principle

b. Reciprocity

c. Least restrictive or coercive means

d. Transparency

Answer is c. Least restrictive or coercive means

What term best describes the most common ethical orientation in public health nursing practice that embraces the World Health Organization's perspective on empowerment?

a. Advocacy

b. Capacity building

c. Transparency

d. Reciprocity

Answer is a. Advocacy

Which of the following options below correctly describes the cycle of oppression?

a. Stereotype, oppression, biased information, prejudice, discrimination

b. Oppression, stereotype, biased information, prejudice, discrimination

c. Prejudice, biased information, oppression, discrimination, stereotype

d. Biased information, stereotype, prejudice, discrimination, oppression

Answer is d. Biased information, stereotype, prejudice, discrimination, oppression

Which community health nursing standard of practice is demonstrated when a nurse adheres to regulatory standards, federal and provincial or territorial professional standards, laws, codes of ethics, and institutional policies?

a. Capacity building

b. Professional responsibility and accountability

c. Professional relationships

d. Health maintenance, restoration, and palliation

Answer is b. Professional responsibility and accountability

There are four key elements that must be proved to make a finding of negligence. Which of the following is one of the four elements?

a. That the standard of care was breached

b. That the nurse took money from that client

c. That the nurse and the client did not have a professional relationship

d. That there was no harm caused

Answer is a. That the standard of care was breached

Which of the following is part of the ten defining attributes of social justice

a. Equality

b. Disabling environments

c. Empowerment

d. Ethical practice

Answer is d. Ethical practice

Discus three issues faced by community health nurses who provide care in community settings, and provide a practice example for each issue

- Many community settings were not designed for the purposes of caregiving (e.g., apartment buildings without elevators to carry equipment).

- CHNs must adapt their practice to a variety of community venues (e.g., immunizing children in a church gym versus a clinic environment).

- There may be risks to CHNs due to violence, tobacco smoke, pets, ergonomic issues, and physical conditions (e.g., aggressive farm dogs that are not used to visitors).

- Travelling in both urban and rural settings can be an issue for CHNs as a result of inclement weather, driving conditions, becoming stranded, collisions, and communication (e.g., breaking down in a isolated rural area between home visits).

- Providing care in the home can have social and ethical implications (e.g., the assumption that clients all have a telephone and can phone for assistance)

Compare and contrast health promotion with prevention and health protection.

Provide an example from community health nursing practice

Health promotion is a mediating strategy between people and their environments, a positive, dynamic, empowering, and unifying concept that is based in the socioenvironmental approach to health. The nurse may be involved in facilitating community action, assisting in the development of skills, and increasing client knowledge and control over the determinants of health (e.g., facilitating a community to develop a drop-in recreation centre for adolescents)

Prevention and health protection involves a variety of strategies that seek to minimize the occurrence of diseases and their consequences. The nurse may be involved in education, direct services, disease surveillance, immunization, risk reduction, outbreak management, and social marketing (e.g., working at a sexually transmitted infection clinic)

Discuss the potential moral harm that community health nurses need to be aware of when planning activities as part of a health promotion program.

- influencing individuals to conform to social norms

- becoming unwitting agents of social control

- becoming unwitting agents of medicalization

- creating adversarial relationships between groups of clients-those who activity enhance their health and those who do not

- viewing clients who do not enhance their health as morally weak and inferior

- compromising respect for the inherent worth of clients regardless of behaviour and situation

List the four key elements that must be proven to make a finding of negligence.

- That there was a relationship between the person bringing the claim and the person being sued

- That the defendant breached standard of care

- That the plaintiff suffered harm

- That he harm suffered was caused by the defendant's breach of the standard of care

List and discuss the four ethical principles for public health interventions.

- Harm principle: the only purpose for which power can be rightfully exercised over nay member of a civilized community, against his will, is to prevent harm to others

- Least restrictive or coercive means: the full force of governmental authority and power should not be used unless less-coercive methods are unavailable or have failed

- Reciprocity: if a public action is warranted, social entities are obligated to assist individuals in meeting their ethical responsibilities; compensation must be given

- Transparency: all relevant stakeholders should participate in decision-making in an accountable and equitable fashion that is free of political interference or coercion.