Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 6 Values, Ethics and Advocacy

A nurse caring for patients in the intensive care unit develops values from their experiences when forming a personal code of ethics. Which statements correctly guide this process? Select all that apply.

a. People are born with values.

b. Values act as standards to guide behavior.

c. Values are ranked on a continuum of importance.

d. Values influence beliefs about health and illness.

e. Value systems are not related to personal codes of conduct.

f. Nurses should not let their values influence patient care.

b, c, d. A value is a belief about the worth of something, about what matters, that acts as a standard to guide our behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person’s values influence beliefs about human needs, health, and illness; the practice of health behaviors; and human responses to illness. Values guide the practice of nursing care. An individual is not born with values; rather, values are formed during a lifetime from information from the environment, family, and culture.

The parent of a young school-age child wants them to learn about healthy dietary choices related to diabetes. Which method of value transmission would be most helpful?

a. Depriving the child of their favorite toy when they consume foods not on their diet

b. Lecturing the child on the merits of healthy and unhealthy food choices

c. Allowing the child to experiment and discuss the outcomes on their blood glucose

d. Offering healthy meals and snacks and acting as a role model for healthful eating

d. Through modeling by observing parents, peers, and significant others, children learn what is of high or low value. When punishment is used to transmit values, children create negative associations with those values. Using lecturing and moralizing modes of value transmission, usually taught by parents or an institution (e.g., church or school), offers little opportunity for the child to weigh different values. Using a laissez-faire approach to value transmission, where no single set of values is presented as best, is not appropriate for a young child; this approach could permit permanent consequences of diabetes to develop.

A nurse who is working in a hospital setting uses value clarification to help patients understand the values that motivate patient behavior. What patient actions help the nurse determine if they demonstrate “prizing” during this process? Select all that apply.

a. They stop smoking after a diagnosis of lung cancer.

b. They show off a new outfit that after losing 20 lb.

c. They choose to work fewer hours following a myocardial infarction.

d. They adopt a low-cholesterol diet.

e. They join a gym and schedule classes throughout the year.

f. They proudly display a certificate for completing a marathon.

b, f. Prizing something you value involves pride, happiness, and public affirmation, such as losing weight or running a marathon. When choosing, you choose freely from alternatives after careful consideration of the consequences of each alternative, such as quitting smoking and working fewer hours. Finally, the person who values something acts on the value by combining choice and behavior with consistency and regularity, such as joining a gym for the year and following a low-cholesterol diet faithfully.

A nurse incorporates the “five values that epitomize the caring professional nurse” (identified by the American Association of Colleges of Nursing) into their home health care practice. Which attribute best reflects agreement with the code of ethics and accepted standards of practice?

a. Altruism

b. Autonomy

c. Human dignity

d. Integrity

d. The American Association of Colleges of Nursing defines integrity as acting in accordance with an appropriate code of ethics and accepted standards of practice. Altruism is a concern for the welfare and well-being of others. Autonomy is the right to self-determination, and human dignity is respect for the inherent worth and uniqueness of individuals and populations.

A nurse caring for patients in the city-run health clinic expresses a commitment to social justice. Working toward which action best exemplifies this attribute?

a. Providing honest information to patients and the public

b. Promoting universal access to health care

c. Planning care in partnership with patients

d. Documenting care accurately and honestly

b. The American Association of Colleges of Nursing lists promoting universal access to health care as an example of social justice. Providing honest information and documenting care accurately and honestly are examples of integrity, and planning care in partnership with patients is an example of autonomy.

Nursing students are discussing the care-based approach to ethical practice. What actions will the students ensure are included in the discussion? Select all that apply.

a, Understanding that the needs of the many prevail versus the needs of the few

b. Promoting the dignity and respect of patients as people

c. Attending to the individual attributes of each patient

d. Cultivating responsiveness to others and professional responsibility

e. Understanding that moral skills include kindness, attentiveness, compassion, and reliability

b, c, d, e. A care-based approach, essential to thoughtful, person-centered care, directs attention to the specific patient situation, viewed within the context of their life narrative. The care-based approach includes the following characteristics: centrality of the caring relationship; promotion of patient dignity and respect; attention to patient particulars; cultivation of responsiveness to others; professional responsibility; and redefinition of fundamental moral skills like kindness, attentiveness, empathy, compassion, and reliability. An action is right or wrong based on a rule, independent of its consequences, such as “the needs of the many outweigh the needs of the few.”

A patient with brain cancer questions whether they should agree to palliative radiation treatments despite possible memory loss, or enjoy their remaining time with friends and family. What is the most appropriate response by the nurse?

a. “I can’t advise you. This is such an individual decision.”

b. “If you receive the radiation, might you live a bit longer?”

c. “What does your family think you should do?”

d. “What is most important to you with the time you have left?”

d. Advocacy is the protection and support of another’s rights. The nurse assesses the patient’s goals and advocates to support their wishes. Nurses do not make ethical decisions for patients; rather; the nurse facilitates patient decision making by interpreting and providing information, encouraging verbalization of feelings, and facilitating communication with family, primary nurse, health care provider, or clergy.

A hospice nurse is caring for a patient with end-stage cancer. Which action demonstrates the nurse’s commitment to promoting the patient’s autonomy?

a. Competently administering pain medication

b. Giving undivided attention when listening to patient concerns

c. Keeping a promise to obtain a counselor

d. Supporting the patient in obtaining a durable power of attorney

d. The principle of autonomy obligates nurses to provide information and support patients’ and their surrogates’ need to make decisions that advance their interests. Acting with justice means giving each person their due, acting with fidelity involves keeping promises to patients, and acting with nonmaleficence means avoiding doing harm to patients.

A patient with an advanced directive and do-not-resuscitate order is sobbing and reporting severe pain. The nurse contacts the provider, who refuses to increase the medication dose due to the patient’s hypotension. What actions would the nurse take next? Select all that apply.

a. Lodge a complaint with the state board of nursing

b. Consult with the ethics committee

c. Contact a different health care provider

d. Speak with the nurse manager

e. Request a palliative care consultation

b, d, e. Ethical distress results from knowing the right thing to do but finding it almost impossible to execute due to institutional or other constraints (in this case, the nurse fears inability to collaborate with the provider). The nurse uses available resources such as seeking guidance from the nurse manager, attempting to secure a palliative care consult, and consulting the ethics committee. The state board of nursing does not regulate medical practice. The nurse does not circumvent the patient’s health care provider.

A nursing student is on clinical rotation in a long-term care facility. Which action best reflects the student acting as advocate?

Telling the health care team that a patient clearly stated they do not want to be transported to the hospital

a. Avoiding input in care conferences, as patient advocacy is primarily

b. performed by the health care provider

c. Assisting the primary nurse in making good health care decisions for patients and residents

d. Deferring to whatever decisions patients and residents want

a. Advocacy is the protection and support of another’s rights. Among the patients with special advocacy needs are the very young and the very old, those who are seriously ill, and those with disabilities. Patient advocacy is the responsibility of every member of the professional caregiving team—not just nurses. Nurse advocates do not make health care decisions for their patients and residents; rather, they facilitate patient decision making. Advocacy does not entail supporting patients in all their preferences.

At an interprofessional meeting, nurses discuss appropriate uses for an organizational ethics committee. Which referral do the nurses identify as appropriate?

a. Giving input into policies affecting work life balance

b. Providing interprofessional input on clinical care

c. Determining if the patient’s cultural beliefs are valid

d. Advising the board of nursing on policy for licensure

b. The Joint Commission mandates that accredited facilities have a mechanism for addressing ethical problems. Health care institutions often have multidisciplinary ethics committees who provide case review and consultation and participate in education, policy making, quality, and (in some cases) research. Nurses contribute unique knowledge about the patient and family, interpret technical facts, identify appropriate decision makers, represent the patient’s best interests, and help ensure the course of action is justified by sound ethical principles. Nurses play an important role in policy making, identifying needed policies to address ethical concerns or suggest needed modifications of existing policies. The human resource department focuses on employee policy; the health care team cannot judge or force a patient to reevaluate their cultural beliefs and observances.

A patient with dysphagia has been admitted with a third episode of aspiration pneumonia in less than a year. The health care provider insists that for safety, the patient must have a feeding tube placed. The patient declines the tube and later asks the nurse if they should reconsider. What is the most appropriate nursing response?

a. “The feeding tube will prevent aspiration and is the safest option for you.”

b. “You could swallow thickened liquids and puréed foods more easily.”

c. “Tell me your understanding of what may happen without the feeding tube.”

d. “You said cooking and dining with your family is important, and I understand your decision.”

c. The nurse assesses the patient’s understanding of the cause and consequences of aspiration and pneumonia. The nurse can provide further information on pneumonia and sepsis if needed, while supporting the patient’s decision. The patient has already declined treatment; therefore, the nurse assesses whether the patient understands the decision before discussing the intervention. The nurse may suggest safer swallowing options or consultation with a speech therapist after assessing the patient’s knowledge.