Chapter 06: ETHICS IN COMMUNITY HEALTH NURSING PRACTICE COPY

Question 1

In which year was the first code of ethics for nursing written?
a.
In 1893, by Lystra Gretter
b.
In 1950, by the American Nurses Association (ANA) House of Delegates
c.
In 1954, by the International Council of Nurses (ICN)
d.
In 2001, by the American Nurses Association (ANA) House of Delegates

Answer 1

A

The Nightingale Pledge, considered nursing’s first code of ethics, was written by Lystra Gretter in 1893.

Question 2

A community health nurse (CHN) is facing an ethical dilemma and is not able to determine which option would have the best outcome. She finally decides to talk to her supervisor and let the supervisor decide which action to take. Ethically, into which category does the CHN’s decision fall?
a.
The decision is appropriate because the supervisor is responsible for the CHN’s choices.
b.
The decision is intelligent because the supervisor has access to resource persons (spiritual leaders, physicians, administrators) who may know of options that the CHN has not considered.
c.
The decision is advisable, but only as an opportunity to further discuss the issue because ultimately the CHN is still responsible for her own choice.
d.
The decision is smart because the supervisor would be more aware of community priorities.

Answer 2

C
Ethically, each CHN is responsible for his or her own decisions. A CHN cannot circumvent ethical accountability by avoiding decision making and relying solely on a supervisor or any external rule or policy to make a decision.

Question 3

Which of the following is the first and most crucial step in the ethical decision-making process?
a.
Assessing the context or environment in which a decision must be made
b.
Considering the various ethical principles or theories
c.
Identifying the ethical concerns
d.
Making a decision and acting on it

Answer 3

C

The first step in the ethical decision-making framework is to carefully identify the ethical issue or dilemma.

Question 4

A CHN has been asked to meet with a couple that recently emigrated from Botswana. The clinic doctor told the man about his wife’s diagnosis of breast cancer, and the couple was about to leave. Although all of the following actions by the CHN might be appropriate, which one is probably the most important action, ethically?
a.
Insisting that the family 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 about breast cancer, including the standard treatment and the prognosis
d.
Interviewing the family to find out about their perception of the threat to the family’s well-being

Answer 4

D
Canada is a country made up of diverse ethnic groups and diverse cultural values. Before any intervention can be made, health care professionals must understand the family’s cultural, psychological, social, communal, environmental, and other contexts because these contexts affect the way issues are perceived and decisions made. Therefore, it is crucial to first interview the family to assess their understanding of the situation before deciding on the next step.

Question 5

A CHN finds that a family has decided not to accept medical intervention for a particular health concern because the intervention could affect the family member’s ability to return to work, and consequently the family’s resources would be drastically reduced. Which of the following actions by the CHN would ethically be most appropriate in this situation?
a.
The CHN should appreciate that the couple has made the decision that they feel is best for their family and take no further action if it is clear that they have made an informed choice.
b.
The CHN should insist that every individual in society has a right to health care and that the family will have to find some way to raise funds for the needed treatment.
c.
The CHN should talk to the social worker on the health care team to see if he or she can convince the couple to agree to the medical intervention.
d.
The CHN should arrange a meeting with the family to discuss the consequences of the couple’s decision.

Answer 5

A
Although the CHN may attempt to change the couple’s thinking through persuasion, in the absence of immediate and grievous harm, there is no ethical requirement to interfere in the family’s decision making. The CHN respects and promotes the autonomy of persons and helps them express their health needs and values and obtain desired information to make informed decisions.

Question 6

A pregnant teenage client asks a CHN to provide information on abortions and a list of health care providers who offer abortion services. The CHN has very strong personal beliefs against abortion that would get in the way of helping the client. What should the CHN do?
a.
Call in another CHN to care for this client.
b.
Explain, from the personal perspective, all the reasons why abortion should be made illegal.
c.
Offer the client a combination of oral contraceptives to induce spontaneous abortion.
d.
Provide information on alternatives to abortion and give the client information on adoption agencies.

Answer 6

A
This creates an ethical dilemma for the CHN. An ethical dilemma is a puzzling moral problem in which a person can envision morally justified reasons for both taking and not taking a certain course of action. If the CHN feels strongly that he or she cannot work with the client in this situation, another CHN should be called on for help, or the client should be referred to other health care providers who can provide the care she needs.

Question 7

Some CHNs are disagreeing strongly about the appropriate action to take in relation to a particular family in which one member is ill and the other family members have chosen to continue working at their jobs instead of take time off to care for the ill family member. One CHN states, “It is the wife’s responsibility to care for her ill husband.” Which of the following types of thinking is this CHN applying?
a.
Consequentialism
b.
Deontological ethics
c.
Principlism
d.
Utilitarianism

Answer 7

B

The CHN is focusing on duty with a deontological approach—the moral obligation to engage in certain actions.

Question 8

Some CHNs are disagreeing strongly about the appropriate action to take in relation to a particular family in which one member is ill and the other family members have chosen to continue working at their jobs rather than take time off to care for the ill family member. One CHN states, “The whole family is being affected and will fall apart if they don’t focus on the family’s needs first.” Which of the following types of thinking is this CHN applying?
a.
Communitarianism
b.
Deontological ethics
c.
Principlism
d.
Utilitarianism

Answer 8

D
The CHN is focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress.

Question 9

Some CHNs are disagreeing strongly about the appropriate action to take in relation to a particular family in which one member is ill and the other family members have chosen to continue working at their jobs instead of take time off to care for the ill family member. One CHN asks, “What sort of example does this behaviour set for the community? What if everyone always put their jobs before their families?” Which of the following types of thinking is this CHN applying?
a.
Communitarianism
b.
Deontological ethics
c.
Principlism
d.
Utilitarianism

Answer 9

A
The CHN is focusing on the whole community, with consideration for tradition and the interaction among community members that creates their history and tradition.

Question 10

Some CHNs are disagreeing strongly about the appropriate action to take in relation to a particular family in which one member is ill and the other family members have chosen to continue working at their jobs rather than take time off to care for the ill family member. One CHN states, “But it doesn’t have to be either–or. Perhaps the family members could take turns calling in sick for just 2 or 3 days. That way, they could all help and yet not upset their employers. Wouldn’t that be fair?” Which of the following types of thinking is this CHN applying?
a.
Communitarianism
b.
Deontological ethics
c.
Principlism
d.
Utilitarianism

Answer 10

C
The CHN is focusing on ethical principles such as beneficence (doing good for the ill family member), nonmaleficence (doing no harm, even to the employer), and justice (taking turns and sharing equally).

Question 11

Some CHNs are disagreeing strongly about the appropriate action to take in relation to a particular family in which one member is ill and the other family members have chosen to continue working at their jobs rather than take time off to care for the ill family member. A CHN states, “It’s not up to us; it’s the family’s decision.” Which of the following types of thinking is this CHN applying?
a.
Communitarianism
b.
Deontological ethics
c.
Principlism
d.
Utilitarianism

Answer 11

C
The CHN is using an ethical principle, namely autonomy, in which each person or group can choose actions that synchronize with their values and goals.

Question 12

Three CHNs are disagreeing about the appropriate treatment for Mrs. Mehta, who is probably an excellent candidate for hospice care. The first CHN says that deciding on care, rather than cure, is up to Mrs. Mehta, and no one else can decide for her. The second CHN says that it is the responsibility of the health care team to do what is best for Mrs. Mehta, and if the physician thinks there is still a possibility of cure, then the CHNs should do everything they can to implement the treatment plan. The third CHN says it is not fair for the family to expend all their resources on Mrs. Mehta, who is probably going to die in spite of the care provided by the health care team. Which one of the following conclusions can be drawn from this dispute?
a.
Ethical principles can conflict with each other.
b.
The first CHN is correct because autonomy demands that the patient herself decide.
c.
The second CHN is correct because professional health care providers profess or promise to always do the best for those under their care.
d.
The third CHN is correct because utility demands the maximization of benefit for the majority.

Answer 12

A
One of the criticisms of using ethical principles is that they can conflict in any given situation, and there are no rules to help resolve such conflicts.

Question 13

Having heard several debates about the appropriate thing to do for a specific client, a CHN feels a real need for a rule that would help with decision making. Which one of the following criteria could the CHN apply to this rule for his or her decision making?
a.
The rule absolutely will not get the CHN in trouble with employer.
b.
The rule will gain the support of an expert, such as a spiritual leader.
c.
The CHN would recommend the rule to anyone in a similar situation.
d.
The supervisor would feel comfortable reporting the rule to the administration.

Answer 13

C
One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated in the same way. Principlism suggests that the CHN examine the context and make the decision that could be morally justified within that context.

Question 14

A man is bleeding profusely and screaming, perhaps out of fear, “I’ve got a right to see a doctor. I’m hurt. Someone has to take care of me!” Ethically, which one of the following premises could justify such a demand?
a.
All hospitals receive provincial/territorial funding, and all employed adults pay taxes; so, all adults have a right to what their tax money has purchased.
b.
Saving an individual’s life improves society and upholds tradition.
c.
Our society believes that all persons should be treated equally and that basic needs, such as being saved from death, if possible, should be met.
d.
The man has a property right to his own body, and government is responsible to ensure that property rights are protected.

Answer 14

C
The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society, and that government’s role is to ensure that this happens—at least on a basic level. Therefore, the man does have the right to emergency care.

Question 15

Most of us believe that everyone should receive his or her fair share, that one should always be fair, and that each person should be allowed maximum liberty to make decisions about the self. Which one of the following does such an approach not take into account?
a.
The needs of society as a whole
b.
The inconsistent desire or need for a share of resources
c.
The predisposition in some people for a need to be taken care of
d.
Insufficient resources to give everyone a fair share

Answer 15

A

All of these principles of justice focus on the individual, which ignores the needs of society as a whole.

Question 16

A physician refuses to order pain medication for a drug addict who was severely injured in a car accident. When the CHN requests medication to be used p.r.n., the physician states that the client’s suffering from the pain of his injuries will build character. Which ethical theory is the physician using (or misusing)?
a.
Consequentialism
b.
Communitarianism
c.
Virtue ethics
d.
Utilitarianism

Answer 16

C
Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly have cared about enabling the injured addict to learn from his experience and possibly become addiction-free.

Question 17

Which one of the following is the central, most important concept or action in nursing today?
a.
Adapting to the use of computers and other technological advances
b.
Caring
c.
Distinguishing nursing care from medical care
d.
Seeking evidence-based outcomes

Answer 17

B

Since the mid-1980s, nurses have written about caring being the essence of nursing—the ethical ideal.

Question 18

Gilligan and Noddings both believe in the morality of responsibility in relationships. They emphasize connection. Which term is used to describe this belief?
a.
A distributive justice approach
b.
A feminine ethic
c.
A principled approach
d.
Virtue ethics

Answer 18

B
Because Gilligan and Noddings believe in the morality of responsibility in relationships that emphasized connection and caring as a moral imperative, their approach has been called a feminine ethic.

Question 19

Which of the following outcomes needs to occur in order to claim that advocacy has been truly successful or effective?
a.
Audiences agree with a CHN who is advocating a change.
b.
Legislators discuss appropriate legislation to better allocate resources.
c.
People demand that the disenfranchised be better treated.
d.
Systematic social changes are made to improve quality of life.

Answer 19

D
Advocacy is the application of information and resources to effect systematic changes in a community in order to reduce death and disability and improve quality of life. Although all of the above might be helpful, only when systematic social changes are made to improve quality of life can advocacy be considered effective.

Question 20

Which of the following methods is the best way to determine if a CHN has been effective in assessing community health needs and planning and implementing appropriate interventions?
a.
Asking the CHN about the basis for the interventions and the CHN’s perception of their effectiveness
b.
Examining the community’s morbidity and mortality rate
c.
Reassessing community health needs to determine if they have been met
d.
Systematically surveying community residents regarding their perception

Answer 20

B
Although all the above information is helpful, the outcome of appropriate advocacy should be decreased morbidity and mortality.

Question 21

Which one of the following is probably the first step in resolving any ethical conflict?
a.
Evaluating desirable outcomes
b.
Obtaining all relevant information
c.
Recognizing ethical issues and dilemmas
d.
Reviewing ethical principles and theories

Answer 21

C
Ethical decision making begins with identification of the ethical issues and dilemmas. Those concerned cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas.

Question 22

Much ethical debate has revolved around issues in acute health care, for example, the continuation or withdrawal of medical treatment. In such a specific situation, which of the following is usually the dominant issue?
a.
Doing what is best for the community
b.
Doing what is best for the family
c.
Obeying legal mandates
d.
Upholding the client’s autonomy

Answer 22

D
In acute care settings, in the case of a specific issue, where primary ethical principles usually are applied, client autonomy is the dominant or most crucial principle.