Chapter 6: Ethics in Community Health Nursing Practice Flashcards
- In which year and by whom 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
ANS: A
The Nightingale Pledge, considered nursing’s first code of ethics, was written by Lystra
Gretter in 1893.
- A community health nurse (CHN) facing an ethical dilemma is not able to determine which
option would have the best outcome. She talks to her supervisor and lets the supervisor decide
which action to take. Into which ethical 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.
ANS: 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.
- What 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
ANS: C
The first step in the ethical decision-making framework is to carefully identify the ethical
issue or dilemma.
- A CHN has been asked to meet with a couple who 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
is 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
ANS: 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 are made. Therefore, it is crucial to first
interview the family to gain clarity around the cultural context of the situation.
- A CHN finds that a family has decided to refuse 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.
ANS: 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
- 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.
ANS: 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.
- A team of CHNs disagree about the appropriate action to take in relation to a family with an
ill family member who 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.” What type of thinking is this CHN applying?
a. Consequentialism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: B
The CHN is focusing on duty with a deontological approach—the moral obligation to engage
in certain actions.
- A team of CHNs disagree about the appropriate action to take in relation to a family with an
ill family member who have chosen to continue working at their jobs instead of 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.” What type of thinking is this
CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: 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.
- A team of CHNs disagree about the appropriate action to take in relation to a family with an
ill family member who 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?” What
type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: 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.
- A team of CHNs disagree about the appropriate action to take in relation to a family with an
ill family member who have chosen to continue working at their jobs instead of 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?” What type of
thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: 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).
- A team of CHNs disagree about the appropriate action to take in relation to a family with an
ill family member who have chosen to continue working at their jobs instead of 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.”
What type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: C
The CHN is using an ethical principle, namely autonomy, in which individuals or groups can
choose actions that synchronize with their values and goals.
- A team of CHNs disagree about the appropriate treatment for Mrs. Mehta, who is likely 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. What 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.
ANS: 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.
- After hearing the debates about an appropriate course of action for a specific client, a CHN
expresses a desire for a rule that would help with decision making. What 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 the 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.
ANS: 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.
- A man, bleeding profusely and screaming, perhaps out of fear, cries out “I’ve got a right to see
a doctor. I’m hurt. Someone has to take care of me!” What ethical premise 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.
ANS: 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.
- 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. What 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
ANS: A
All of these principles of justice focus on the individual, which ignores the needs of society as
a whole.
