Wilkinson's Fundamentals of Nursing Fifth Edition Chapter 5: Ethics & Values Study Guide

Morals:
- Defined as private, personal, or group standards of right and wrong.
- Moral behavior is conduct in accordance with custom and reflects personal moral beliefs.
Ethics:
- The systematic study of right and wrong conduct.
- A formal process for making consistent moral decisions.

Nursing ethics refers specifically to ethical questions that arise out of nursing practice.
Primary questions for nurses include:
- What will your level of participation be in a given ethically challenging situation?
- Can you support patients’ decisions based on their ethical beliefs?
- What are your feelings about the results of decisions made by others?
Case Study/ClickerCheck:
- Scenario: A provider with Type $1$ diabetes became hypoglycemic while performing a bedside thoracentesis. The provider resisted assistance and finished the procedure despite being impaired. The nurse is upset by the behavior.
- Classification: This is an example of nursing ethics. Although it directly involves the provider’s behavior, it can be argued that the nurse has a duty to report impaired nurses and providers.
- Correct evaluation: True (Correct Answers: $A$ and $B$ in the source material assessment).

Moral Distress:
- The inability to carry out a moral decision.
- Perceived Internal Constraints: These include a lack of sufficient knowledge or socialization issues.
- Perceived External Constraints: These include providers, nurse administrators, other nurses, the law, and the threat of a lawsuit.
Moral Outrage:
- The belief that others are acting immorally.
- Professionals feel powerless because they cannot prevent a ‘wrong.’
- Often leads to the response of ‘whistleblowing.’

Definition: The identification of an unethical or illegal situation and the reporting of such actions to someone in authority.
Scope: Can involve one single person or an entire organization.
Requirements: Necessity for accurate information before taking action.
Considerations: Potential for significant consequences; individuals must ‘THINK before you act.’
Advocacy: The American Nurses Association (ANA) is working to provide protection for whistleblowers.

Consumer Awareness: Increased patient awareness and the requirement of informed consent.
Technological Advances: Navigating the conflict of ‘we CAN, but should we?’
Multicultural Population: Dealing with differing values among patients and staff.
Cost Containment: Ethical dilemmas regarding unequal access to care.
Nature of the Work:
- Ethical problems specific to nurses.
- The unique position nurses hold within healthcare organizations.
Nature of the Profession:
- Caring versus the actual time spent with patients.
- Autonomy versus the avoidance/escape of hard choices.
- Higher pay versus institutional cost effectiveness.
- Professionalism versus the duty of caring.

Developmental Stages: Influenced by theories from Kohlberg and Gilligan.
Values:
- A belief regarding the worth of something.
- Highly prized ideals, customs, conduct, or goals.
- Values are freely chosen and learned through observation and experience.
- They vary from person to person and are subject to change.
Attitudes:
- Feelings toward a person, object, or idea.
- Includes both a thinking component and a feeling component.
- Represents what a person specifically thinks.
Beliefs:
- Something that one accepts as true, although it is not always based on established fact.

Consequentialism:
- Teleology.
- Utilitarianism.
Deontology:
- Formalism.
- Categorical imperative.
Feminist Ethics:
- Values relationships and individual stories.
- Addresses issues from a female perspective.
Ethics of Care:
- The nursing responsibility to care within ethical situations.
- Combines principles with human feelings.
Application Example: A nurse hired to work in hospice daycare believes in establishing relationships with an emphasis on caring. The frameworks applicable here are Feminist ethics and Ethics of care ( $B$ and $D$ ).

Autonomy: Respecting a patient's right to independence and self-choice.
Nonmaleficence: The duty to do no harm.
- Case Example: A stroke patient with right-sided hemiplegia insists on a cup of hot coffee. The nurse does not permit the patient to drink unsupervised. The nurse is prioritizing nonmaleficence (reducing the risk of a burn) over autonomy. Correct Answer: $C$ .
Beneficence: The duty to do good and promote the well-being of others.
Fidelity: Keeping promises and being faithful to commitments.
Veracity: The obligation to tell the truth.
Justice: The duty to be fair.

Guidelines for Decision Making:
- Codes of Ethics for Nurses.
- International Council of Nurses.
- American Nurses Association (ANA) Standards of care.
- Patient Care Partnership.
- The Joint Commission.
Assessment/Analysis/Diagnosis labels:
- Decisional conflict.
- Moral distress.
Implementation Processes:
- Clarify personal values.
- Identify moral dilemmas.
- Use a decision-making model, such as the MORAL acronym.
- Participate on an ethics committee.
- Look for potential compromises and improve decision-making skills.
The MORAL Acronym Steps:
- Step $O$ : Represents ‘Outlining options.’
- Example: A provider explains the impact on an unborn child to a patient refusing a cesarean birth, outlining consequences while listening to the patient's viewpoint. Correct Answer: $D$ .

Applying Ethical Agency: Consider an instance where a client is diagnosed as brain-dead, but the family insists that all care be continued. Nurses must evaluate their ethical agency components to navigate this choice.
Safe, Effective Nursing Care Scenario:
- Context: A CEO purchases new IV start kits to save money, but the needles break during use, injuring several patients. The CEO blames nurse technique.
- Dilemma: The RN asks if they should become a whistleblower. Factors to consider include the history of unsuccessful internal attempts to change the kit and the safety of the patients.