Chapter 06: Ethics in Public and Community Health Nursing Practice

Which of the following is generally considered to be nursing's first code of ethics?

a. Nightingale Pledge

b. Code for Professional Nurses

c. Code of Ethics for Nurses

d. Principles of the Ethical Practice of Public Health

A)

The Nightingale Pledge is generally considered to be nursing's first code of ethics. After the Nightingale Pledge, the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times, until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements. The Principles of

the Ethical Practice of Public Health was approved in 2002.

Which of the following is the first and most crucial step in a generic ethical decision-making process?

a. Assess the context or environment in which the decision must be made.

b. Consider the various ethical principles or theories.

c. Identify the ethical issues and dilemmas.

d. Make a decision and act on it.

C)

The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6) make the decision and take action, and (7) evaluate the decision and action.

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action?

a. Emphasizing that the family must set up a surgical appointment for the wife immediately

b. Assessing the family's current living situation, including insurance and other assets

c. Educating the family concerning the usual treatment and the prognosis of breast cancer

d. Interviewing the family concerning their perspective of the threat to the family's well-being

D)

The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family's cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures, the family, rather than the individual, is the unit of primary concern

The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse?

a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice.

b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment.

c. Talk to the media to see whether a campaign to raise funds for the family can be created.

d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious.

A)

According to Callahan, although the nurse may attempt moral persuasion to change the family's values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family's values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family's decision. Thus, the other answers are not an appropriate action for the nurse to take.