Chapter 44 - Ethics & Values (Week 4 quiz)

Question 1

_____ are private, personal, or group standards of right and wrong. _____ behavior reflects personal beliefs or religious beliefs

Answer 1

moral; moral

Examples:
Opinion on abortion
GOlden rule “treat others how you want to be treated”

Question 2

______ are a systematic study of right and wrong conduct. Formal process for making consistent moral decisions. It uses specific rules, theories, principles and perspective to inquire into the justification of an individual’s action in a particular situation.

Answer 2

ethics

While morals state this is right/that is wrong, ethics answers the question “What should I do in a given situation?”

Ethics ar rooted in the legal system and reflects political values of society.

Question 3

_______ refers to the application of ethical principles to healthcare. It is concerned with every are of healthcare including direct care of patients, allocation of resources, utilization of staff and medical and nursing research.

Answer 3

bioethics

Question 4

______ ______ is a subset of bioethics. As a nurse you are responsible for deciding the nature and extent of your level of participation in a given ethically challenging situation, you must support clients’ decisions based on their ethical beliefs, and coping with your feelings about the results of decisions made by others.

Answer 4

nursing ethics

Example: Parents bring in 15 year old son who i bleeding internally and needs a blood transfusion. The parents are jehovah’s witness and they believe that blood transfusion are morally wrong. NURSING ETHICS QUESTION is “What do I do in this situation? DO I try to convince them otherwise?”

Question 5

The nurse knows that a physician with Type1 diabetes became hypoglycemic while performing a bedside thoracentesis. The physician resisted assistance and finished the procedure despite being impaired. The nurse is upset by this physician’s behavior. This is an example of nursing ethics.

a. true

b. false

Answer 5

Correct answer: A and B, true and false

This example most directly involves the ethical behavior of the physician, so you might think it is not nursing ethics. However, it could be argued that the nurse has a duty to report impaired practice, perhaps as a whistleblower.

Question 6

Nurses should study ethics because….

Answer 6

1. You will encounter ethical probs frequently at work
2. Ethics is central to nursing
3. Multidisciplinary input is important
4. Ethical knowledge is necessary for prof. competence (we want to conduct our work well and have it stand the test of public scrutiny, we need to be clear about the ethics of our work)
5. Ethical reasoning is necessary for nursing credibility among other disciplines (1-understand your own values as they relate to basic morality and 2-use ethical reasoning to articulate your moral position).
6. Ethical proficiency is essential for providing holistic care (provide support for the spiritual and moral concerns)
7. nurses have a resp. to be advocates for patients
8. Studying ethics will help you to make better decisions (prepares you to analyze moral problems from multiple perspectives rather than relying entirely on your personal values, intuition and emotions.)

(p.1085)

Question 7

________ is the communication and defense of the rights and interested of another.

Answer 7

advocacy

Advocacy includes protecting pt’s legal or moral rights. To advocate for pats in ethical situations you must be able to identify the ethical issues and communicate the pt’s wishes

Question 8

Do you need a medical order or hospital permission to act ethically?

Answer 8

No. Regardless of what others are doing, you should always make the ethical choice. Treat all pts with dignity.

Question 9

What are some sources of ethical problems for nurses?

Answer 9

1.Increased consumer awareness; informed consent
(prof are expected to share knowledge with pt and obtain a truly informed consent, unlike the olden days when people just trusted the doc and did what they were told)

2. Technological advances: we CAN, but should we? (cloning, using stem cells, perform abortions, etc.)
3. Multicultural population: differing ethics (you need to respect variety of belief systems, and you will need to serve as a pt advocate even when the pt’s value system differs from your own)
4. Cost containment: unequal access - (pts are sent home from the hospital while they are still very ill; insurance pmts limits service; pt to nurse ratio has increased
5. Final decision by family and physician
6. Nursing role is to support patient & family
7. Turning off the ventilator/removing from tube feedings
8. Nature of nursing work: moral problems, unique position in organization.
9. Nature of nursing profession - caring vs time spent with pt (less time available with overloaded work); autonomy vs hard choices (we want equal status but prefer to defer dr decide hard choices);

Question 10

______ ______ (or moral agency) for nurses is the ability to base their practice and professional standards of ethical conduct and to participate in ethical decision-making. Simple stated, it means the nurses has choices and are resp for their actions.

Answer 10

ethical agent

ethical agents must:

Know the difference between right and wrong
Understand abstract moral principles
Apply moral principles in decision-making
Weigh alternatives; plan to achieve goals
Decide and choose freely
Act according to choice

Question 11

____ _____ is the Inability to carry out a moral decision. The nurse perceives constraints such as: Physicians; nurse administrators; other nurses, the law; threat of lawsuit.

Answer 11

Moral Distress

If you are confident that you have made a good decision and can express it logically and clearly to others, you can at least enter into a conversation with the nurse admin, physicians, and families about what ought to be done. Then at least you can be comfy knowing you did all you can do.

Question 12

____ _____ is belief that others are acting immorally. The nurse does not participate in the act. The nurse feels powerlessness because he/she cannot prevent a “wrong.” Sometimes the only way to respond is by “whistleblowing.”

Answer 12

Moral outrage

Question 13

What is a whistleblower?

Answer 13

a person who identifies a person or organization that is incompetent/unethical or engaged in an illicit/illegal activity to an agency that can stop the wrongdoing.

PPT:
Identification of an unethical or illegal situation
Can involve one person or an entire organization
Reporting such an action to someone in authority
Need accurate information (never jump to conclusions! always look at the big picture before taking action)
Be aware of the consequences (weigh risks and benefits)
ANA working to protect whistleblowers

Question 14

_____ ______ ______ occurs when the nurse’s ability to perform the essential functions of nursing is diminished by chemial dependence on drugs, alcohol or mental illness.

Answer 14

impaired nursing practice

If a nurse is impaired, they cannot practice nursing

Question 15

T or F: Not acting is a decision you make.

Answer 15

True. If you do nothing when a person has coded, you chose not to act and it is your decision.

See pg1088 paragraph NURSES MORAL PROBLEMS

Question 16

How are values, morals and ethics related?

Answer 16

Ethics are based on a structured set of principles and theories and ethical decision are publicly state i terms of possible alternative behaviors. These decision are influenced unconsciously by our own personal values and morals.

In essence, even though you are respecting someone else and taking their beliefs into consideration, it is impossible not to put your own spin on the situation.

Question 17

What are Factors in Moral Decision-Making?

Answer 17

1. Values (Belief about the worth of something):
   - Highly prized ideals, customs, conduct, goals
   - A full value is freely chosen from a lit of alternatives after thoughtful consideration, cherished and made known to others,
   - Learned through observation and experience
   - Vary from person to person
2. Attitudes (mental dispositions or feelings toward a person, object or idea). They can be cognitive (thinking), affective (feeling), and behavioral (doing).
3. Beliefs (Something that one accepts as true, not always based on fact)

Question 18

Who should your first loyalty be to?

Answer 18

the patient

This is what creates issues… because you may have to go against dr, other nurses, etc.

Question 19

What is the difference between personal and professional values?

Answer 19

These values have the following differences:
● Personal values are those that are part of your own value system that you have chosen. These may include money, friendship, scholarship, or fairness.
● Professional values are those you acquire through socialization into nursing—from teachers, peers, learning, and experiences.

Question 20

What is an example of professional values?

Answer 20

Answer:
Professional values are acquired during your socialization into nursing, and they provide the foundation for your practice.

Examples of these may include those outlined in Table 44-2 (in Volume 1): altruism, autonomy, human dignity, integrity, social justice, equality, esthetics, freedom, truth, service, education, competence, and loyalty, as well as others.

Question 21

Where do we acquire values?

Answer 21

Through social interaction

Question 22

______ _______ means that we attempt to be neutral in a situation by attempting to understand our own values regarding an issue and to know when to put them aside. Becoming nonjudgmental when providing care.

Answer 22

value neutrality

Question 23

T or F: There is no one moral framework to solve all ethical problems.

Answer 23

True.
Moral frameworks are systems of thought theories. It is recommended to use multiple to analyze a situation to enable you to perform a more comprehensive analysis.

Question 24

What is autonomy?

Answer 24

Right to self determination (to choose and act on that choice). It is tied in with respect for human dignity.

We can give autonomy to pts by planning with them, educating them so they can make informed choices and honor their choices, believe their stories about illness and protect those who cannot decide for themselves.

Question 25

What is integrity?

Answer 25

Acting in accordance with an appropriate code of ethics and accepted standards of practice. Includes honesty.

YOu don’t need anyone watching over you for you to do the right thing and act the right way.

Question 26

In _________ , the rightness or wrongness of an action depends on the consequences of the act rather than the act itself.

Answer 26

consequentialism (also called teleology - telos mean end aka end result)

Example: Not punching someone because you don’t want to go to jail

Examples of consequentialism:
*Utilitarianism - value of an action is determined by its usefulness. (Will utilization of this benefit the majority of people involved?) To use: Evaluate every alternative action for its potential outcomes. Make a list of pros and cons. Select the action that benefits the greatest number of people.

Example of utilitarianism:
Triage situation - you have limited supplies - the victim with the littlest chance of survival may not be treated to allow treatment for those with greatest potential to survive.

Question 27

_______ is almost opposite of utilitarian model. It considers actions to be right or wrong regardless of its consequences. Decisions based on moral rules & unchanging principles.

Answer 27

Deontology

• Includes categorial imperative principle
• treat the person as more important than a goal
• Rules and princples: justice, autonomy, doing good and doing no harm
• Rights and duties - helping someone in need because you have a duty to help, not because it produces pos. consequence.

Important to consider motives: is a parent refusing blood transfusion because of religious beliefs or because they will gain a trust fund if the child dies?

Question 28

T or F: Categorical imperative states that one should act only if the action is based on a principle that is universal.

Answer 28

True.

Lamen’s terms: If you believe that everyone should act in the same way in a similar situation, you take that action.

Question 29

_____ _____ values relationships/stories rather than universal principles. It includes love, relationships, caring, nurturing and sympathy.

Answer 29

Feminist ethics - Addresses female perspective of issues and moves away from typical make reasoning such as principles of fairness, just, and rights.

Question 30

_____ __ _____ directs attention to the specific situations of individual patients, viewed within the context of their life narrative. It emphasizes the role of feelings, but also includes some of the principles that are part of traditional ethics such as autonomy and beneficence (doing good). It includes a responsibility of the nurse to care as a part of their professional behavior.

Answer 30

Ethics of Care

Some ethics of care perspectives:

1. Caring is central force in nursing
2. promote dignity and respect for pt
3. Attend to particulars of individual pt (esp marginalized and disenfranchise people)
4. cultivate responsiveness to others
5. Define moral princ to include kindness, attentiveness, empathy, compassion and reliability.

Question 31

T or F: Discussing a patient in the elevator or cafeteria is okay and does not violate privacy and confidentitiality.

Answer 31

False! You are not maintaining the patient’s trust by sharing their private info with anyone else, esp where it can be overheard by others.

Question 32

_______ is a twofold duty to do no harm & to prevent harm (actual harm/risk for harm/intentional or unintentional harm). Includes lack of careful planning & consideration (such as checking medications).

Answer 32

Nonmaleficence

Nonmaleficence requires critical thinking. Ask yourself if the benefits will outweigh the risks for a patient. Example: getting out of bed after surgery prevents thrombophletis and pneumonia but may cause damage to surgery site and pain to the pt.

Question 33

_______ is the duty to do or promote good.

Answer 33

Beneficence

While nonmaleficence is to do no harm-Beneficence is doing duties to bring good.

1. nonmaleficence…do no harm
2. prevent harm
3. remove harm if inflicted
4. beneficence - DO GOOD

Question 34

______ is treating other like a child. This is harmful! Example: When speaking to a competent pt, you say, “Trust us, we know what is best for you.”

Answer 34

paternalism

p.1096

Question 35

______ (faithfulness) is the duty to keep promises

Answer 35

Fidelity.

The duty to keep a promise is the same regardless of its level of importance. When making promises, don’t give vague statements. Instead say things like, “I will get back to you as quickly as I can.”

p.1096

Question 36

________ is duty to tell the truth.

Answer 36

Veracity

You may not wish to say “Your father has a fatal illness and will die in one month.” Instead you could say, “your father is very ill, and we will do everything we can to help him.” You are still telling the truth.

Question 37

_______ obligation to be fair.

Answer 37

Justice

Offer equal treatment for all pts.

Examples of justice:

1. distributive justice - distr. both benefit and burden fairly
2. compensatory justice - focuses on making amends for wrong doing .
3. Procedural justice - first come first served..

p.1097

Question 38

The patient has right-sided hemiplegia as a result of a stroke and wants a cup of hot coffee. Even though the patient is insistent, the nurse does not permit her to drink the coffee unsupervised. This nurse is using the moral principle of

a. Autonomy
b. Fidelity
c. Nonmaleficence
d. Justice

Answer 38

Correct answer: C

How can you solve/reason through this question?

1. PATIENT SAFETY BEFORE ANYTHING ELSE!
2. Maslow’s - survival ranks higher than emotions/self esteem etc.

Rationale:
While this is a simple example, the nurse is actually decreasing the risk of harm (a burn) by not leaving the patient alone with hot coffee. Note that in this instance, the nurse judged the principle of nonmaleficence to be more important than the principle of autonomy.

Question 39

Professional _______ of ______ are formal statements of a group’s expectations (hospital’s expectation of its staff) and standards for professional behavior generally accepted by members of the profession.

Answer 39

professional code of ethics

Nursing code of ethics is on page 1098 in box 44-1
MAKE SURE YOU READ IT! was in PPT

Question 40

T or F: NUrsing codes are legally binding.

Answer 40

False! They are not, however, they often exceed legal obligations. The board can reprimand a nurse who does not practice within the ethical boundaries set forth.

Question 41

What are the names of the three organizations that have developed long-standing codes to guide nurses’ ethical decision-making?

Answer 41

1. ICN (Int’l Council for Nurses) - World wide standard code ; guide nurses with everyday choices.
2. ANA (American nurses association) - Standards of Care; All aspects of clinical care; Integration of ethical provisions in all areas of practice. Box 44-3 p 1099
3. CNA (Canadian Nurses Association) -Code of ethics for RN: Primary values Box 44-2 p1099

Question 42

_____ _____ _______ has a list of rights of the patient and gives them an explanation of what they can expect once admitted.

Answer 42

Patient Care Partnership

Expectations for hospitalized & extended care patients Box 44-4
p.1100

Question 43

List each of the six ethical principles and its definition.

Answer 43

Answer:
These are the six ethical principles:
● Autonomy is an individual’s right to choose and the ability to act on that choice.
● Nonmaleficence is the duty to do no harm.
● Beneficence is the duty to promote good.
● Fidelity is the obligation to keep promises made.
● Veracity is the duty to tell the truth.
● Justice is fairness and equal treatment.

Question 44

What is values clarification?

Answer 44

Answer:
Values clarification is the process of becoming more conscious about and naming what one values or considers worthy.

A values clarification process does not tell you what your values OUGHT TO BE; it helps you discover what they are?

Question 45

How can you clarify your own values?

Answer 45

Think of a scenario like caring for a drug addict who is in the ER to get drugs.

Ask yourself questions such as:
Could I take care of this person? Does their sitiuation bother me? Could I provide the same quality as my other patients?

See p.1102 table 44-4 Values Clarification

PPT says STUDY IT!

KC Says:
What are the steps in values clarification?

Answer:
The three steps in values clarification involve choosing, prizing, and acting:
1. Beliefs are chosen:
● Freely (allows you to cherish your choice)
● From alternatives
● After considering all consequences (assures the alternative is right for you)
2. Beliefs and behaviors that are chosen are prized:
● With pride (feeling good about your choice)
● With public affirmation
3. Beliefs are acted upon:
● By incorporating the choice into one’s own behavior
● With consistency and repetition

Question 46

A _____ or _____ dilemma requires a choice to be made between 2 equally undesirable actions.

Answer 46

Ethical or moral dilemma (DI = Two = between two options that both have a yucky outcome)

Question 47

The ethical decision making models can help you careful consider several perspectives, guide your reasoning, and explain the reasons for your final action. One of the easiest to remember is the MORAL model.

What does each letter stand for? Describe it.

Answer 47

MORAL stands for the following:
● Massage the dilemma:
Identify and define the dilemma, consider a 360 degree viewpoint- Does everyone involved understand the situation clearly? Is there any other option available? Is it what the pt wants? Have the family consulted with clergy? etc)

● Outline the options:
Include options, consequences of decisions, the state of emergency, the basis for decision. Ethics committee/clergy parties are consulted to help dr/pt/families understand opposing viewpoints.

● Resolve the dilemma:
Carefully review the issues and options. Apply basic moral principles (autonomy, beneficence/nonmaleficence,fidelity, veracity)

● Act by applying the chosen option.

● Look back and evaluate:
How well did it work? how are all parties feeling now? Were you an effective advocate.

Knowledge Check 44-13

Question 48

Using the “MORAL” acronym for making an ethical decision, under which “letter” would the following action fall? The physician explains to the laboring woman the impact on the unborn child of refusing a cesarean birth.

a. M
b. L
c. R
d. O

Answer 48

The letter “O” in the “MORAL” acronym represents the step of outlining options. The physician would explain to the patient all of the consequences and options of either having or not having the C-section, and listen to the patient for her viewpoint.

Question 49

Why is advocacy so important?

Answer 49

1. You have special knowledge that the pt does not have
2. One aspect of your role is to defend pt’s autonomous decisions.
3. nurses have special relationships with pts.
4. to inform and ask about advanced directs to ensure we do what the pt wants.
5. TO build a relationship

Question 50

Tips for improving your ethical decision -making…

Answer 50

1. Read literature for discussion of cases and experiences
   of nurses
2. examine your personal value system.
3. attend ethical rounds or an ethics committee meeting
4. Consult reliable sources (attorneys, ethicists, , etc
5. Share - engage in discussions, consult with peers coworkers and teachers.
6. eValuate - evaluate your decisions and actions

Question 51

A physician has requested privileges to admit and monitor patients at the community hospital. A license check by the hospital administrator reveals that there have been four judgments against the physician for unsafe medical practice. The hospital ethics committee will meet to discuss granting privileges to him. Which of the following models will the ethics committee most likely follow as they review the physician’s case?

1) Social justice
2) Patient benefit
3) Autonomy
4) Privilege to practice

Answer 51

Answer:
1) Social justice

Rationale:
The social justice model focuses more on broad social issues involving the entire institution than it does on a single patient issue. The autonomy model is useful when a patient is competent to decide; it emphasizes patient autonomy and choice as the highest value. The patient benefit model assists in decision making for the incompetent patient by using substituted judgment. There is no privilege to practice model.

Question 52

There has been an accident involving two busloads of school children. The accident victims have been transported to the local emergency department (ED). The ED nurse is triaging the children to determine who will receive treatment first. Which moral framework does this process illustrate?

1) Teleology
2) Utilitarianism
3) Deontology
4) Categorical imperative

Answer 52

Answer:
2) Utilitarianism

Rationale:
Utilitarianism states that the value of an action is determined by its usefulness. When using this framework, the action that results in the most benefits for the greatest number of people involved is preferred. Teleology is a synonym for consequentialism. Deontology theory considers an action to be right or wrong independent of its consequences. The categorical imperative is a principle established by Immanuel Kant, which states that one should act only if the action is based on a principle that is universal.

Question 53

___________ is the systematic study of right and wrong conduct in situations where there are issues of values and morals.

Answer 53

Answer:

Ethics

Question 54

Based on Gilligan’s theory of moral development, compared to men, which of the following statements would a woman be more likely to use in ethical reasoning? “We shouldn’t lie to the patient because

1) it is against agency policy.”
2) the patient might lose trust in us.”
3) lying disrespects the principle of veracity.”
4) we might be sued by the patient.”

Answer 54

Answer:
2) the patient might lose trust in us.”

Rationale:
In Gilligan’s theory, females develop morally by paying attention to community and to relationships, whereas males tend to process dilemmas through more abstract ideals or principles. Concern about losing the patient’s trust reflects that the person is paying attention more to the nurse–patient relationship than to rules and principles. Agency policy reflects a rule-following orientation, which is an early phase in Kohlberg’s theory. Veracity is a moral principle, and is more reflective of male reasoning in Gilligan’s theory. Fear of a lawsuit reflects a legal perspective rather than an ethical perspective.

Question 55

The healthcare team meets with the family of a man with documented brain death. They discuss discontinuing advanced life support, including mechanical ventilation. For several days the wife of the patient has been agonizing over this decision. She says, “I don’t know what to do. I know there is no hope for him, and it would be kind to let him go; but I just don’t see how I can say goodbye forever.” Which of the following nursing diagnoses should be used?

1) Moral Distress
2) Decisional Conflict
3) Death Anxiety
4) Spiritual Distress

Answer 55

Answer:
2) Decisional Conflict

Rationale:
Decisional Conflict should be used when the patient is uncertain about which course of action to take. The person may verbalize distress and uncertainty and may delay decision making.

This woman has not made a moral decision, so she cannot be experiencing Moral Distress, which occurs when the person has made a moral decision but is unable to carry out the chosen action. The woman cannot be experiencing Death Anxiety, because she is not the one who is about to die. Spiritual Distress is the impaired ability to experience and integrate meaning and purpose in life through a connectedness with self, others, music, literature, nature, and/or a power greater than oneself. This woman did not express concerns of a spiritual nature.

Question 56

A pregnant adolescent is in hypertensive crisis, and will likely die unless the obstetrician performs surgery to deliver the baby immediately. However, the baby is not mature enough to survive outside the uterus. The obstetrician believes that there is no good choice: either he risks harm to the mother or harm to the baby. This situation describes which of the following?

1) Moral dilemma
2) Moral distress
3) Whistle-blowing
4) Values conflict

Answer 56

Answer:
1) Moral dilemma

Rationale:
An ethical dilemma is a situation in which a choice must be made between two equally undesirable actions. There is no clearly right or wrong option. Moral distress occurs when a person makes but is unable to carry out a moral decision—no decision has been made in this scenario. A whistle-blower is specifically defined as a person who identifies an incompetent, unethical, or illegal situation, or actions of others, in the workplace and reports it to someone who may have the power to stop the wrong. There is no values conflict because the value that the obstetrician is struggling with (probably sanctity of life) applies to both the mother and the baby.