6: Values, Ethics, and Legal Issues Flashcards
Values
standards for decision making that endure for a significant time in one’s life
value system
a learned set of principles and rules organized into a hierarchy
Attitude
one’s disposition toward an object or a situation.
Beliefs
ideas that one accepts as true
Behaviors
actions that can be perceived or noticed
Two ways culture is learned in families
World view
Cultural value orientation
World view
unquestioned framework or predominant set of assumptions through which people view life
Cultural value orientation
a subset of ideas that helps to clarify components of one’s world view: nature time activity relationships
nature orientation
Mastery: one believes that humans are masters of nature and values problem solving and intervention
Subjugation: one believes humans are subjugated to nature and values wonder, awe, or fate and focuses more on safety and survival
Harmony: one believes humans should act in harmony with nature and may value balance
first-level preconventional stage
children learn to distinguish right from wrong and understand the choice between obedience and punishment
Values clarification
a method of self-discovery by which people identify their personal values and their value rankings
values inquiry
a method of examining social issues and the values that motivate human choices
Ethics
a branch of philosophy dealing with standards of conduct and moral judgment
Personal morality
set of beliefs about the standards of right and wrong that help a person determine the correct or permissible action in a given situation
Personal values
ideas or beliefs a person considers highly important and are learned through interactions with social systems as described previously
Professional ethics
values held by a group deemed as having generalizable application and standards of conduct to be upheld in all situations
Institutional policies
guidelines developed by healthcare institutions to direct professional practice
Principles
basic ideas that serve as starting points for both understanding and working through problems
Beneficence
doing or promoting good
nonmaleficence
to avoid doing harm, to remove from harm, and to prevent harm
Autonomy
creating the conditions in which patients can make their own decisions
capacity
mental or physical ability
surrogate decision maker
Someone to act on patient behalf for infants, young children, people who are severely mentally handicapped or incapacitated, and people in a persistent vegetative state or coma
advance directives
verbally participating in healthcare decision making and by employing written documents to specify what interventions patients would or would not want
living will
advance directive that specifies the types of medical treatment patients do and do not want to receive
proxy directive (AKA durable power of attorney for healthcare)
advance directive allows patients to designate another person to make decisions
Justice
the foundation for decisions about resource allocations for societies or groups.
six basic rights for patients
The right to self-determination
ethical values that guide the behavior of healthcare professionals
Veracity: telling the truth
Fidelity: being faithful to one’s commitments or promises
Privacy: appropriately using patient information
Confidentiality: information about a patient be kept private
dilemma
a situation in which:
● Two or more choices are available.
● It is difficult to determine which choice is best.
● Available alternatives cannot solve the needs of all those involved.
● Each alternative may have both favorable and unfavorable features.
Laws
rules or standards of human conduct established by government through legislative bodies and interpreted by courts to protect the rights of citizens
Sources of Law
constitutions, legislative statutes, and common law
Constitutions
foundation of the system of justice
Legislative statutes
laws derived from a legislative body
Common law
evolves from decisions of courts
Civil law
It is the body of law that deals with relationships between private individuals subdivided into contract law and tort law.
Criminal law
public law that deals with the public’s safety and welfare divided into felonies and misdemeanors
Licensure
the legal ability to practice as a nurse in a certain state
Standards of care
comprise the expected level of performance or practice as established by guidelines, authority, or custom
tort
Private wrong for which the law provides a remedy resulting in money damages paid to the victim
crime
Any wrong punishable by the state. Results in prison term, fine, or short jail sentence to punish offender
Assault
the THREAT of touching another person without his or her consent
Battery
the actual carrying out of touching another person without his or her consent
Felony
Premeditated killing (first-degree murder) Impulsive or unintentional killing (second-degree murder; manslaughter, rape, arson, treason, kidnapping, burglary, bribery, child abuse, drug trafficking, fraud, and terrorism)
Misdemeanor
An offense punishable by imprisonment of less than 1 year or a fine of less than $1,000. Does not amount to a felony.
Intentional
Assault and battery Defamation of character Fraud Invasion of privacy False imprisonment
Unintentional
Negligence—mistake or failure to be prudent
Malpractice—negligence in the practice of a profession (e.g., failure to assess a significant change in condition, failure to act appropriately in treating a patient, error in sponge counts, causing a burn, failure to use aseptic technique,
falls, medical errors, misadministration of blood)
Defamation of character
false communication that results in injury to a person’s reputation by means of print (libel) or spoken word (slander)
libel
printed false communication
slander
spoken false communication
Fraud
purposeful misrepresentation of self or an act that may cause harm to a person or property
false imprisonment
Prevention of movement or unjustified retention of a person without consent
four elements of Negligence
duty
breach of duty
proximate cause
damages.
Malpractice
Negligence on the professional’s part
To prove malpractice, four elements are necessary:
● A duty to the plaintiff
● A failure to meet the standard of care, or a breach of duty,
which may be an act of omission
● Causation (i.e., that the breach of duty produced the injury
in a natural and continuous sequence)
● Damages, which require a physical, emotional, financial, or
other injury to the patient
plaintiff
the person bringing suit
defendant
the person being sued
Breach of duty
failure to conform to the standard of practice, thus creating a risk for a person that a reasonable person would have foreseen
Proximate Cause
Causation must be proven for the courts to find negligence
res ipsa loquitur (“the thing speaks for itself”)
When it is obvious that the patient’s injury resulted from someone’s negligence but it is impossible to prove who was at fault
Liability
denotes legal responsibility to pay damages
respondeat superior (“let the master answer”)
The hospital, clinic, or community nurse service may be held responsible for a nurse’s negligence
active euthanasia
deliberately hastening a person’s death and is considered murder
Terminal sedation
legally and ethically permissible to provide analgesia to a level that produces light sedation, even though this is likely to hasten death somewhat secondary to resulting immobility
Good Samaritan laws
legal im- munity for healthcare professionals who assist in an emergency and render reasonable care under such circumstances
Act of omission
neglecting to do something that a reasonably prudent person would do
Commission
doing something that a reasonably prudent person would not do
A nurse is working in an organization that prescribes and supports Plan B (“the morning after pill”) as a form of contraception. In analyzing her role and moral values, the nurse should consider which of the following?
Select all that apply:
a. Is she affirming the patient’s desires?
b. Is she upholding the ethics of the profession?
c. What are the nurse’s beliefs/biases related to this medication?
d. What are the consequences and alternatives of giving or not giving this medication?
a. Is she affirming the patient’s desires?
b. Is she upholding the ethics of the profession?
c. What are the nurse’s beliefs/biases related to this medication?
d. What are the consequences and alternatives of giving or not giving this medication?
A patient with esophageal cancer is no longer able to consume foods by mouth and is now fed via a gastric feeding tube. She is withdrawn and states, “My family used to have big dinners with friends, family, lots of laughter, and loud conversation.” Which of the patient’s values are apparent and best describe her behavior?
a. Independence and individuality
b. Family role
c. Socialization
d. Human nature
c. Socialization
A nurse is caring for a patient with necrosing leg ulcers. The nurse assesses that these are related to venous stasis, but when asked, the patient reports that “there is a man shooting lasers through the floor of her apartment.” In order to progress with wound treatment, what must the nurse understand about resolving value conflicts?
Select all that apply:
a. It is necessary to establish common ground about therapy goals.
b. Further exploration of the patient’s belief system may be needed to identify beliefs related to care.
c. The nurse may need to answer patient questions related to care.
d. The nurse may need to examine his or her values related to mental health and care goals.
a. It is necessary to establish common ground about therapy goals.
b. Further exploration of the patient’s belief system may be needed to identify beliefs related to care.
c. The nurse may need to answer patient questions related to care.
d. The nurse may need to examine his or her values related to mental health and care goals.
A nurse in the transplant ICU is caring for a teenager following a liver transplant as a result of a Tylenol overdose. The patient also superseded another ICU patient (reformed alcoholic) who subsequently died without the transplant. The patient is now noncompliant with treatment, stating that she just wants to die. The nurse questions the principles of healthcare ethics in this case. Which principle would be most in question?
a. Beneficence
b. Nonmaleficience
c. Autonomy
d. Justice
d. Justice: patient is not willing to receive medical therapies to support the transplanted liver after another patient died waiting to receive the same organ
A nurse fails to observe and document a patient’s change in neurologic status, ultimately resulting in the patient’s death from a stroke. Which type of malpractice is most relevant?
a. Fraud
b. Breach of duty
c. Negligence by commission
d. Battery
b. Breach of duty: failure to conform to the standard of practice
assisted suicide
Providing the client with a means to end life, but not the direct action that results in death
brain death
Irreversible cessation of heart and lung functions or an irreversible loss of all functions of the entire brain
community-based no code order
Document that requires the signatures of the primary physician or nurse practitioner and the client or legal surrogate and allows emergency medical personnel, if called, to provide care and support to client and family without resuscitation
confidentiality
Practice of keeping client information private
do not resuscitate (DNR) orders
Orders not to provide resuscitation in the event of a cardiopulmonary arrest
fidelity
Being faithful to one’s commitments and promises
negligence
Failure to do something that a reasonably prudent person would do, or doing something that a reason- ably prudent person would not do
no code order
Order not to provide resuscitation in the
event of a cardiopulmonary arrest
privacy
Patient confidentiality
resuscitation
Act of reviving after apparent death or unconsciousness
veracity
Principle of telling the truth, essential to the integrity of the client-provider relationship
