Ch. 11, Ch.22, & Ch. 23 Flashcards
What is Kohlberg’s Theory of Moral Development: Level 1 Preconventional reasoning?
Stage 1: Punishment and Obedience Orientation
Stage 2: Instrumental Relativist Orientation
what is stage 1: Punishment and obedience orientation?
following the rules or be punished
- ex: if a child sasses their parents they will get spanked
what is stage 2: Instrumental relativist orientation?
person avoids punishment
- ex: the parent tells the child to be home at a certain time, the child listens to their parents to avoid punishment
What is Kohlberg’s Theory of Moral Development: Level 2: Conventional reasoning?
- you are looking at how your relationships are affected
- nurses use this to help the patient come up with end of life decision
Stage 3: Good boy- nice girl orientation
Stage 4: Society- maintaining orientation
what is stage 3: Good Boy- Nice Girl Orientation?
wanting approval for being nice
- ex: a child will stay after school and do chores to get the approval of the teacher
what is stage 4: Society- Maintaining Orientation?
the person wants to do the right behavior because they feel like it is their duty
- ex: teenagers avoiding a party that serves alcohol because they think underage drinking is wrong
What is Kohlberg’s Theory of Moral Development: Level 3 Postconventional Reasoning?
Stage 5: Social contract orientation
Stage 6: Universal ethical principle orientation
what is stage 5: social contact orientation?
follow the law even though it is not fair
- ex: the speed limit is 25 mph; you go 25 mph to follow the law
what is stage 6: Universal ethical principle orientation?
the person may not follow the law and is willing to accept the consequences
- ex: if the speed limit is 25 mph, and you go 35 mph, if you get pulled over you won’t care
what are Kohlberg’s Critics?
used all males in this study and people from the United States
- critique: if you repeat this study use women and people from different cultures
what is conventional reasoning?
focuses on relationships
Which of the following are examples of the conventional reasoning form of cognitive development? (Select all that apply.)
A. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her.
B. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son.
C. A teenage girl is encouraged by her peers to engage in shoplifting. She decides not to join her peers in this activity because she is afraid of getting caught in the act. (step 2)
D. A single mother of two children is unhappy with her employer. She has been unable to secure alternate employment but decides to quit her current job. (pre-conventional)
E. A young man drives over the speed limit regularly because he thinks he is an excellent driver and will not get into a car accident. (stage 6)
A. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her.
B. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son.
what is ethics?
what is right and wrong in our behavior
what are morals?
a judgment about behavior
- ex: honesty is the best policy
what is bioethics?
ethics within healthcare
- ex: when we use organ transplants
what is autonomy?
independence
following the patient’s decisions
what are examples of autonomy?
- if a patient is dying and does not want CPR, but the family does, we have to follow what the patient wants
- informing the patients the risk and benefits of treatment (informed consent)
- explaining procedures to the patient before going through treatment (they have the right to refuse)
what is professional autonomy?
when you need to reassign duties when conflict occurs
- ex: if a nurse is against abortion
what is beneficence?
positive actions to help others (good)
- ex: nursing
what is nonmaleficence?
to avoid harm
- ex: if a patient needs a bone marrow procedure, the bone marrow will cure the patient, but the patient will experience pain
what is justice?
fair distribution of resources
- ex: health insurance
- ex: organ transplants
what is fidelity?
being faithful to your promises
what is an example of patients?
when you go into a room and the patient needs to be medicated, you must go back in the room
what is institution?
following policies and procedures
what is yourself?
being able to keep promises to yourself
A patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle of:
A. autonomy.
B. fidelity.
C. justice.
D. nonmaleficence.
D. nonmaleficence
When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient’s priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient’s priority is met. If the nurse’s actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that?
A. Assessing the patient’s pain on a numeric scale every 2 hours
B. Asking the patient to establish the goal for pain control
C. Using alternative measures such as distraction or repositioning to relieve the pain (implementation)
D. Monitoring the patient for oversedation as a side effect of his pain medication
B. Asking the patient to establish the goal for pain control
what is a code of ethics?
guiding principles that all members of the profession accept
what is advocacy?
you are the patient’s voice, but our voice is to benefit the patient
what is responsibility?
following through on your professional obligations
- ex: delegation
- ex: if you need help and following policies and procedures
what is accountability?
to take ownership and being responsible for your actions
- ex: if you caused a medical error, you need to take ownership and fill out an instant report
what is confidentiality?
respecting patient’s privacy
- if confidentiality is violated, the hospital can be fined
what is Health Insurance Portability and Accountability of 1996? (HIPAA)
to protect patient’s personal health information
- the only people who can look at the charts are people who have the “right to know”
- patients must give permission to release medical information to insurance companies
- ex: in the olden days, patient’s names were put on the board, but now it violates HIPPA so they put #’s
If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of:
A. responsibility.
B. accountability.
C. competency.
D. moral behavior.
B. accountability
what are personal values?
comes from families and education
what is values clarification?
your personal values and looking at the values of patients and coworkers
what is deontology?
based on rules
- actions are either right or wrong
- ex: this is the rule: you have to leave within 30 minutes during the change of shift there is no grey area
what is utilitarianism?
focuses on outcomes
- greatest good for the greatest # of people
- ex: if David isn’t disturbing the patient, families, and staff then he can stay on the unit
what is casuistry?
looking at how similar cases managed the same problem
- ex: a nurse leader on the unit would look at how other hospitals dealt when a family member didn’t leave the unit
what is feminist ethics?
when you have power that is unequal in a relationship
- ex: does David have a power over his mom, does the staff have power over David
what is ethics of care?
when you make an ethical decision when engaging in caring relationships
- ex: what is the relationship between David and his mother (if it a positive relationship he can stay)
The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology?
A. The emphasis on relationships feels uncomfortable to decision-makers who want more structure in deciding the best action. (ethics of care)
B. The single focus on power imbalances does not apply to all situations in which ethical problems occur. (Feminist ethics)
C. In a diverse community it can be difficult to find agreement on which principles or rules are most important.
D. The focus on consequences rather than on the “goodness” of an action makes decision-makers uncomfortable (utilitarianism)
C. In a diverse community it can be difficult to find agreement on which principles or rules are most important.
what are the 2 types of ethical problems?
ethical dilemma
moral distress
what is ethical dilemma?
2 opposing courses of action that can be justified by ethical principles
what is moral distress?
taking action, but having the fear of retaliation
- ex: working in a hospital you go into the break room and hear your coworkers make inappropriate jokes. I feel I need to say something, but I’m fearing retaliation
The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution?
1. List all the possible actions that could be taken to resolve the problem.
2. Articulate a statement of the problem or dilemma that you are trying to resolve.
3. Develop and implement a plan to address the problem.
4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem.
5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved.
6. Recognize that the problem requires ethics.
- Recognize that the problem requires ethics.
- Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem
- Take time to clarify values and identify the ethical elements, such as principles and key relationships involved.
- Articulate a statement of the problem or dilemma that you are trying to resolve.
- List all the possible actions that could be taken to resolve the problem.
- Develop and implement a plan to address the problem.
what is the 1st step to resolving an ethical problem?
ask if there is an ethical problem
what is the 2nd step to resolving an ethical problem?
gather all relevant information
(similar to the assessment stage)
what is the 3rd step to resolving an ethical problem?
identifying the ethical elements in the problem and examine your values
what is the 4th step to resolving an ethical problem?
naming the problem
(similar to the diagnosis stage)
what is the 5th step to resolving an ethical problem?
consider possible courses of action
what is the 6th step to resolving an ethical problem?
create an action plan and carry it out
(similar to the implementation stage)
what is the 7th step to resolving an ethical problem?
evaluate the action plan
what are ethics committees?
if you encounter an ethical problem, you can take it to the committee
- it discusses ethical issues and dilemmas