Final Exam Review Flashcards
hx nurses were concerned with
loyalty to physicians, punctuality, and obedience
today nursing practice is
autonomous and distinct from medicine with unique ethical challenges
nurses possess
a set of professinoal standards adn framework of legal and ethical guidelines
nursing ethics is needed bc
tech advances, inc complexity of health care, growing sophistications of science and tech (genetics)
professional responsibilities
Have an obligation to serve public interest and the common good
Possess a unique body of knowledge
Have multiple accountabilities
Are trusted to engage in decisions that influence and shape public policy, law, and societal norms
health care professionals need to know the law bc
Failure to understand professional responsibilities and standards puts the nurse at risk of disciplinary or legal action
Complex situations can arise before laws can be made to deal with them
Nurses have legal obligations to their patients
Nurses have corresponding rights
nurses should study ethics bc
Morality and care is at the heart of nursing practice
Nurses practise as part of a team, but with different perspectives
Ethics plays a role in the context of:
-Nurse–client relationships
-Health care policy
-Health care organizations
-Health care system as a whole
the cna code fo ethics for rn’s was first published in
1980
two parts of cna code of ethics for rn’s
nursing values and ethical responsibilities
ethical endeavors
code of hammurabi
1790 BC
justice was strict, eye for an eye
behaviour of women was regulated
class distinctions
hippocratic oath (400BC) principles
Beneficence and nonmaleficence Sanctity of life Competence Professional integrity Privacy and confidentiality
nuremburg code (1947) research principles
Informed consent (autonomy)
Beneficence
Nonmaleficence
early nursing ethics
Had a strong foundation in Christian morality
Focused on obedience, compliance, etiquette, and loyalty to the physician
Were less focused on judgement, reflection, or critical thinking
Part I of the Code is organized around seven values:
Providing safe, compassionate, competent, and ethical care
Promoting health and well-being
Promoting and respecting informed decision making
Preserving dignity
Maintaining privacy and confidentiality
Promoting justice
Being accountable
- providing safe compassionate competent and ethical care
Using speech and body language to demonstrate compassion
Questioning unsafe care
Collaborating with others to provide safe care
Providing care during a natural or human-made disaster
Preventing and minimizing all forms of violence
promoting health and wellbeing
Providing care directed first and foremost to the person, family, or community in their care
Advocating for the least restrictive measures possible for those in their care
Collaborating with others to maximize health benefits
promoting and respecting informed decision making
Providing information needed for informed decisions
Recognizing that individuals may choose to defer to family or community values in decision making
Supporting the right to refuse or withdraw consent for treatment
Respecting the choice to engage in unhealthy lifestyles or treatments
preserving dignity
Relating to all persons with respect
Intervening when others fail to do so
Taking into account a person’s unique values, customs, and beliefs, as well as their social circumstances
Providing care in a discreet manner
Maintaining professional boundaries
Advocating for a dignified and peaceful death
maintaining privacy and confidentiality
Respecting information and adhering to privacy laws
Taking reasonable measures to avoid being overheard when conversing with patients
Taking care not to access information inappropriately
Intervening if others inappropriately access or disclose information
promoting justice
Avoiding discrimination (on any grounds) when providing care
Refraining from judging, stigmatizing, or demeaning behaviours
Refusing to engage in any inhumane or degrading action, and intervening with others do so
Making fair decisions and advocating for fair allocation of resources
being accountable
Practising with honesty and integrity, in accordance with the Code
Practising within the limits of competence
Protecting the safety of others when a colleague is unable to perform his or her duties
Clearly and accurately representing themselves by name, title, and role
Identifying and addressing conflicts of interest
nurses have a role in the provision of social justice, including advocatin for
Policies to address the social determinants of health
Accessible, universal, comprehensive health care services
Environmental preservation
Positive, healthy work environments
The resolution of global health issues
Out of the 185 000 adverse events that occur in Canadian hospitals each year ______ are preventable
70000
patient safety
preventing and mitigating unsafe acts by protecting people from harm (real or potential)
RNAO is concerned with the following 3 key aspects of patient safety for nursing and health care.
Quality care and nursing
Quality work environments
Multi-level accountability
rnao recommendations for pt safety
Amend legislation to have a senior nurse administrator in all sectors responsible for nursing practice.
Managers be a registered nurse especially in direct practice.
Put structures in place for meaningful participation in decision making.
Introduce whistle blower protection at the provincial level to enable health care providers to speak out when safety is being compromised.
Administrators share in the responsibility along with individual nurses in patient safety.
Implement 70% fulltime employment for registered nurses in all sectors. Minimize use of agencies and multiple employers.
Create a blame free organizational culture.
Introduce structures within organizations to re-engineer systems for standardization and checks to intercept errors before they reach the patient.
Promote collaborative team practice in work settings.
Support and conduct research on nursing’s contribution to patient safety science and quality health care.
All individuals have a right to safe effective care in all sectors in all practice settings.
incident analysis
A structured process that aims to identify what happened, how and why it happened, what can be done to reduce the risk of recurrence and make care safer, and what was learned.
incident mgmt
The various actions and processes required to conduct the immediate and ongoing activities following an incident. Incident analysis is part of incident management.
pt safety incident
An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
harmful incident
A patient safety incident that resulted in harm to the patient. Replaces “adverse event”, “sentinel event” and “critical incident”.
no harm incident
A patient safety incident that reached a patient, but no discernible harm resulted.
near miss
A patient safety incident that did not reach the patient. Replaces “close call”.
rationality
elated to the notion of thinking and reasoning. It is associated with comprehension, intelligence, or inference, especially when an inference or a conclusion can be made from a thought process.
ethics
the philosophical study of morality, is the systematic exploration of what is morally right and morally wrong. The study of ethics enables us to recognize and evaluate the variables that influence our moral decisions, our obligations, our character, our sense of responsibility, our sense of justice, and the nature of the good life.
ethical theory
is the study of the nature and justification of general ethical principles that can be applied to moral problems. Provides more rigorous and systematic approach about how we make decisions about what is right and wrong.
biomedical ethics
explore the ethical questions and moral issues associated with health care.
nursing ethics
focuses on the moral questions within the sphere of nursing practice, the nurse-patient or nurse-client relationship, the moral character of nurses and the nurse as a moral agent.
applied ethics
the field of ethics in which these theories and principles are applied to actual moral problems.
morality
the tradition of beliefs and norms within a culture or society about right and wrong human conduct. It includes non-normative and normative approaches.
morality can be described as
culturally based beliefs and norms about what is right and wrong
a set of rules that are taught to children as they grow up
Canada is a pluralistic society, so it is vital to respect differences and to understand the influence of culture in ethics.
nonnormative ethics
include fields of descriptive ethics and meta-ethics. Descriptive ethics gathers factual descriptions and explanations of moral behaviours and beliefs looking at a wide range of moral beliefs and behaviours: moral attitude, codes, beliefs. Meta-ethics analyzes the meanings of terms such as right, obligation, good, and cultures.
normative ethics
attempts are made to identify the basic principles and virtues that guide morality.
ethical dilemmas
arise when the best course of action is unclear and when strong moral reasons support each position. The involved parties must choose between the most right and the least wrong
moral distress
results when we are not able to face these issues and deal effectively with them.
ethical theories
provide a framework of principles and guidelines to help identify ethical issues and reconcile problems or conflict.
values influence
individual beliefs and opinions
behaviours, rituals, rules, and laws as a collective society
decisions and responses as nurses
values can shift over time, focuses on
quality of life over prolonging life
individual rights over health care decisions
value conflicts arise when
Arise when personal actions or the actions of others are at odds with beliefs
Can arise when professionals disagree on how a situation should be managed
May result in moral distress, so it is important to establish processes to
understand personal values
clarify and articulate values to others
value clarification process requires
open discussion
active listening
mutual respect
teleological theories
consider outcomes and consequences (immediate and long term) of decisions and actions
utilitarianism
used to evaluate decisions such as withdrawal of treatment. The consequences are not only considered in relation to the patient, but also to the family, the health professionals involved, and society.
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critics argue that utilitarianism
is impossible and impractical for use in daily life
is useless when trying to quantify widely different interests
can lead to injustice, because the greatest good for the majority may bring harm to the minority
w.d ross
A British philosopher who, in an attempt to resolve the problem of conflicting duties in Kantian ethics, developed a more pluralistic theory
His revised theory identified prima facie duties that must override other duties
for example, sanctity of life would have priority over truth telling
according to Beauchamps and Childress (2001), the important principles commonly applied to ethical challenges in health care include:
Sanctity of life Autonomy Nonmaleficence Beneficience Justice Fidelity Veracity
case law
a collection or body of judges’ decisions rendered over centuries of judicial consideration and refinement
statute law
formal rules passed by legislation
doctrine
found in textbooks and journals written by legal scholars and experts. These carry more weight in civil law systems than common law systems
The concept of a “higher law” or “natural law” suggests that:
Humans have the capacity for reason
Humans can judge what is “good” and “just” behaviour
Humans must be treated fairly and consistently
The concept of natural justice is evident in legal and disciplinary hearings in terms of:
The rights of the accused
Due process
civil law deals with
private dispute between two sets of individuals
tort law
civil wrong committed by one person against another, such as causing that other some injury or damage (either to person or property).
lawsuit process
- Statement of claim
- Statement of defence
- Disclosure of evidence
i. Documentary discovery
ii. Examination for discovery - Pretrial conference
- Trial
- Enforcing judgement
three classes of criminal offences
Indictable offences
Summary conviction offences
Dual procedure (or hybrid) offences
constitution
set of supreme laws that define and regulate the various branches of government, their powers, and restrictions on those powers
Canada’s Constitution includes a charter of rights and freedoms.
charter of rights and freedoms
It sets forth the basic legal and democratic rights of Canadians.
These rights cannot be infringed upon by the government unless it has a justifiable reason.
Any law that breaches the Constitution or a person’s rights is illegal and invalid
charter of rights and freedoms protects
Freedom of religion and conscience Freedom of thought and expression Freedom of the press Freedom of peaceful assembly Freedom of association
Case Law on Consent Reibl v. Hugues (1980)
- Reibl v. Hughes (1980): the plaintiff suffered from a blocked left carotid artery. He was booked for an elective internal carotid endarterectomy, which was performed by the defendant, a neurosurgeon.
- During the surgery, or immediately after, the plaintiff suffered a stroke, which resulted in unilateral paralysis, impotence, and permanent disability. The plaintiff sued the neurosurgeon for the surgeon’s failure to inform him adequately of the risks of the surgery.
- The case reached the Supreme Court of Canada, where the surgeon was held liable for not explaining the risks adequately.
Case Law on Consent Malette v. Shulman (1990)
- The Ontario Court of Appeal handled the Malette v. Shulman (1990) case. The plaintiff had been seriously injured in a motor vehicle accident and rushed to a nearby hospital. She had sustained serious injuries to her head and face and was bleeding profusely.
- The physician on duty in the Emergency department determined that she would need blood transfusions to maintain her blood volume. A surgeon made the same determination and she was barely conscious at the time. She had a card printed in French and signed by the patient identifying her as Jehovah’s Witness with clear refusal of blood transfusion.
- The Court found that informed consent was required and upheld the finding of liability for battery against the physician.
Case Law on Consent Ciarlariello v. Schacter (1993)
- The Supreme Court of Canada reviewed the law of informed consent in a situation in which a patient withdrew consent during a medical procedure.
- The plaintiff was asked to be at the hospital to undergo the first of two angiograms. Her first language was Italian and her daughter took the role of interpreter.
- During her second test, she experience pain and asked them to stop the procedure. The test was stopped. She had suffered some paralysis. She was explained that it would take 5 more minutes to continue and she agreed. She suffered a reaction during the procedure and was left quadriplegic.
- The Court found that informed consent was required and that the physicians were negligent in explaining the risks of the procedure.
expressed consent
a clear statement of consent given by the patient. It is often a written consent.
implied consent
inferred from the patient’s conduct (e.g., holding out his or her arm for an injection).
Ontario’s Substitute Decisions Act (1992)
two methods of providing a substitute decision maker for an incapable person are: The appointment (in advance of becoming incapable) of a power of attorney for personal care An application to the court for the appointment of a guardian
malpractice
involves performing lawful acts in a careless manner or in a manner that does not conform with generally recognized practice standard or standard of care in the nursing profession.
Offences are generally dealt with in civil courts.
duty of care
involve situations in which the patient is receiving services but it can also include personal situations where the nurse is required to place their competencies in their actions.
Latin v. Hospital for Sick Children et al. (2007)
A febrile 14-month-old girl was admitted to a paediatric hospital in January 1998. The triage nurse assessed her as an urgent patient using the triage classification system.
One hour after her arrival, she began a generalized tonic-clonic seizure in the waiting room. She was immediately taken into the treatment room where medical staff attempted to bring her convulsions under control.
She suffered brain damage and extreme permanent disabilities. The child’s family brought a lawsuit against the hospital and the triage and charge nurse on duty as well as against several other on-duty nurses.
It was found that no treatment available could have reversed because of the infectious process in her brain (likely influenza A virus). The court first had to determine the appropriate standard of care owed to the child by the nurses and the hospital. Testimony from experts, hospital policies, academic literature were used in the case. The court found that the triage nurse had not failed to meet the standard of care. The nurse’s assessment and decision-making were carefully reviewed.
Gaudreau v. Drapeau (1987)
There is no general duty to aid a person in need of assistance. What may be clearly moral or ethical imperative may not necessarily be a legal requirement.
Exception: failing to provide the necessities of life to a child, abandoning a child, using skills and knowledge in a legal duty and omission of skills would result in saving a life.
Kolesar v. Jeffries (1974)
A patient who had a spinal fusion was, post-operatively, returned to a surgical unit and the next morning he was found dead. The chart was important in establishing liability because there were no nursing entries from 2200 hours until 0500 hours, when the death was discovered. The absence of nursing documentation allowed the court to infer that “nothing was charted because nothing was done.”
There will likely be a coroner’s inquest if death occurs:
As a result of violence, misadventure, negligence, misconduct, or malpractice
By unfair means
During pregnancy or following pregnancy in such circumstances to which the death could be attributed to the pregnancy
Suddenly and unexpectedly
From disease or sickness for which the person was not treated by a legally qualified medical practitioner
From any cause other than disease
Under circumstances that require investigation
Meyer v. Gordon (1981)
A case in which the newborn suffered severe brain damage ensuing cerebral palsy following a fast delivery. There was a failure to determine the nursing history. Progress of labour was not documented accurately.
Fetal heart rate was checked but poorly documented on the chart.
Demerol and Gravol were administered in labour without checking the cervix to ascertain which stage of labour the woman would be receiving narcotic analgesics.
The birth had evidence of meconium aspiration syndrome and the nurses did not document the finding of meconium or the preparation of the proper suctioning equipment on the delivery table.
Patients have the responsibility to:
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Treat others with respect
Disclose information important for safe care
Disclose concerns when they disagree with a plan of care
Notify health care providers if unable to keep appointments
Arrive on time, having followed instructions prior to procedures
Respect the needs of other persons
Communicating a diagnosis is a
controlled act in ontario
Health care providers have a duty to disclose knowledge of
Communicable or sexually transmitted diseases
Suspected child abuse, neglect, abandonment
Intent to harm or kill another person
Gunshot wounds
Elder abuse by a health care professional
In Ontario, protected health information includes:
Physical or mental health information (including patient and family histories).
Identifying a provider of health care to the individual.
Insurance, eligibility, or payment information
Identifying an individual as a donor of any body part or substance.
Identifying an individual’s substitute decision maker.
Two categories exist for admission to a mental health facility:
involuntary and voluntary
Involuntary: when the person
poses a threat to self or others
must be committed for treatment by order of the examining physician
may be detained without consent
Voluntary: when the person
poses no threat, but is choosing admission for treatment
may not be detained without consent
A healthy work culture results in:
Improved client/patient safety
Reduced absenteeism
An improved ability to attract and retain employees
High levels of staff satisfaction
natinal quality institute model
developed with health canada in 2006
The three dimensions of a healthy work environment
Organizational Culture (focused on leadership, creating opportunities, openness, and transparency of processes) Physical Environment (meets and exceeds safety legislation) Health and Lifestyle Practices (encouraging healthy behaviours, work/life balance)
In order to ensure a healthy nursing culture, leaders should:
Address staffing issues Reward effort and achievement Strengthen organizational structures Support nursing leadership and professional development Promote workplace health and safety Ensure a learning environment Promote recruitment and retention
RNAO Healthy Work Environment BPG’s
Developing and Sustaining Nurse Leadership
Collaborative Practice in Nursing Teams
Embracing Cultural Diversity in Health Care
Professionalism in Nursing
Workload and Staffing
Workplace Health and Safety of the Nurse
Prevention of Violence in the Workplace
RNAO: Preventing and Managing Violence in the Workplace
Have policies to prevent, mitigate, and respond to violence Undertake risk assessments Ensure staff awareness Have reporting processes in place Follow up on every incident Provide education to all staff
collective bargaining
process whereby the terms and conditions of employment are negotiated for a set period of time.
Collective bargaining sets terms which may include wages, hours of work, schedules, vacation pay, sick leave.
grievance procedures
A written submission
A meeting with the grievance committee
Binding arbitration
The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.
Denial Anger Bargaining Depression Acceptance
palliative care
not restricted to care during the last months or days of life. Rather, palliative care can be used in conjunction with curative treatments.
hospice care
usually refers to the last months of life and brings with it an association with the place of care as a specialized facility.
end of life care
accurately reflects the emphasis on the last days and hours of life.
nursing role at end of life to
Care for and comfort the patient and family
Alleviate fear of the unknown
Preserve the patient’s dignity and support the family
Respect the role of culture and religion
palliative care aims to
Relieve suffering and improve the quality of living and dying.
Address the physical, psychological, social, spiritual (existential) and practical issues of persons and their families, and their associated expectations, needs, hopes and fears.
Prepare persons and their families for self-determined life closure and the dying process and help them manage it.
Help families cope with loss and grief during the illness and bereavement experience.
Treat all active issues, prevent new issues from occurring and promote opportunities for meaningful experiences, personal and spiritual growth, and self-actualization.
Palliative care extends across the trajectory of life-limiting illness, including care at the point of diagnosis, during treatment and at the end of life, as well as grief and bereavement support.
The Canadian Hospice Palliative Care Association (CHPCA) defines hospice palliative care as an approach to care that aims to:
Relieve suffering and improve the quality of living and dying. Such care approach strives to help patients and families:
1) Address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears;
2) Prepare for and manage self-determined life closure and the dying process; and
3) Cope with loss and grief during the illness and bereavement
Advanced Directives (Living Wills)
Advanced directives come into effect should a person become incompetent or incapacitated.
Advanced directives provide instructions regarding decisions about care and they identify a substitute decision-maker.
Perinatal loss types
spontaneous abortion (< 20 weeks), stillbirth (≥ 20 weeks gestation), or neonatal death (newborn through 28 days of life)
Caring for Older Adults Issues include:
loss of dignity and respect
abandonment by families
clients not wanting to burden their families
clients finding it hard to rely on others
Examples of specific cultural considerations regarding death and dying.
Funeral home visitation may be part of the cultural practice.
A wake at home may be preferred.
A celebration of life, a gathering may be chosen.
Families may wish to prepare the body for burial without delay.
Chanting may be practiced to assist the spirit to leave the body.
Medical Assistance in Dying (MAiD):
circumstances where a medical practitioner or nurse practitioner, at an individual’s request: (a) administers a substance that causes an individual’s death; or (b) prescribes a substance for an individual to self-administer to cause their own death”
Eligibility for MAiD
Be eligible for services funded by the government.
Be at least 18 years old and mentally competent.
Have a grievous and irremediable medical condition
Make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence.
Give informed consent to receive medical assistance in dying.
Possible Approaches to Increase Organ Donation
Recorded consideration: Staff must document and request of all suitable patients
Required request: Approach all patients on admission
Presumed consent: Patients must opt out if they do not wish to donate
Market strategies: Offer lump-sum payment or funeral expenses
Education and public wide campaigns
Genetic Advances: It is now possible to
Select embryos based on gender
Diagnose complex conditions in utero
Screen newborns for conditions and deficiencies such as sickle cell disease or hypothyroidism
Screen people for inheritable diseases or predispositions such as breast cancer or Parkinson’s disease
Predictive Testing for Inheritable Conditions Pros
Lessens anxiety
Allows for lifestyle changes
Treatment interventions may decrease risk
Others may be identified
Predictive Testing for Inheritable Conditions Cons
Individual reactions are unpredictable
May result in unfair treatment
stem cells have potential use in tx of
Alzheimer’s disease
Parkinson’s disease
Spinal cord injuries
There is controversy regarding fetal tissue because it
is obtained from elective abortions
could encourage pregnancy and abortion for the purposes of donation
In Vitro Fertilization (IVF) used in
damaged or absent fallopian tubes
endometriosis
ovulatory problems
low sperm count
assisted human reproduction act (2004)
A federal statute that recognizes that
- the health and well-being of children is paramount
- benefits must be balanced
- free and informed consent is fundamental
- trade for commercial gain is prohibited
- persons who undergo assistance must not be discriminated against
- diversity in the human genome must be protected
assisted human reproductionact (2004) bans
human cloning
creation of a life form that is a hybrid of a human and another species
assisted technology for the purposes of gender selection
payment of money for surrogacy arrangements
counselling a woman under 21 to become a surrogate
the purchase of embryos, sperm, or ova or advertising sale of such items
Which of the following nursing functions require that nurses have knowledge of current legislation?
- Disposal of syringes used for chemotherapy administration
- Accessing patient information from charts
- Administering narcotics
- All are correct
all are correct
Which of the following issues represent two main areas of ethical debate in nursing practice?
- Access to patient files and documentation
- Family presence and filming in the birthing room
- Nonregulated providers and nursing students participating in care
- Medical Assistance in Dying (MAID) and genomics
Medical Assistance in Dying (MAID) and genomics
Which of the following factors has contributed to growth in the field of ethics in recent years?
- Worldwide population growth
- Declining participation in organized religion
- Growing sophistication in science and technology
- Worldwide nursing shortages
Growing sophistication in science and technology
Which of the following obligation do nurses have in relation to clients’ health information?
- Confidentiality
- Disclosure to family members
- Faxing of records to other institutions
- Legibility of writing
confidentiality
Why should nurses study ethics?
- To avoid incidents of negligence and malpractice
- To have a basis on which to make decisions and be accountable
- So that they can bypass the law if a decision they make has an ethical basis
- To challenge physicians and other health care professionals when nurses disagree with their actions
To have a basis on which to make decisions and be accountable
Which of the following situations is most professionally challenging for a nurse when making ethical decisions?
- Deciding the most appropriate caregiver to assign to a patient
- Calling in sick with the flu when the unit is short-staffed
- When multiple accountabilities to the client, family, colleagues, and the law may be in conflict
- Reporting a colleague who has arrived at work impaired
When multiple accountabilities to the client, family, colleagues, and the law may be in conflict
Emphasis on patient safety has promoted which of the following evolutions in nursing culture?
- Increasing the use of restraints
- Ensuring that side rails on all beds are in the upright position
- The obligation to disclose any harm that may have occurred to patients and families
- Expanding the number of medications that are checked by more than one nurse before administration
The obligation to disclose any harm that may have occurred to patients and families
How has the profession of nursing changed over the past 100 years?
- Nurses are accountable to physicians and ensure that their orders are followed.
- Nurses are more aware of the safety risks in having family members engaged in a person’s care and, therefore, limit their involvement.
- Nurses are critical thinkers and provide evidence informed care.
- Nurses recognize the moral foundation of care and the influence of caring on healing.
Nurses are critical thinkers and provide evidence informed care.
Nurses have which of the following rights, under the Canadian Charter of Rights and Freedoms?
- Privacy, respect, and freedom of expression
- The right to persuade families to allow changes to a treatment plan
- Access to any inpatient file in their facility
- The right to refuse to care for certain groups of patients
Privacy, respect, and freedom of expression
Which of the following represents a dilemma with conflicting ethical and legal issues?
- A 4-year-old child with acute lymphocytic leukemia being removed from the hospital by his parents, who are refusing treatment
- The diversion of patients to hospitals outside of the province
- The wish of a terminally ill patient to end his life
- The withdrawal of ventilation from a patient who has been declared brain dead
-A 4-year-old child with acute lymphocytic leukemia being removed from the hospital by his parents, who are refusing treatment
Which of the following treatments or procedures involves “rationing” in health care? Vaccinations Organ donation Prenatal care Open heart surgery
organ donation
On which ethical principle is informed consent based?
Justice
Veracity
Fidelity
Autonomy
autonomy
Which of the following is a well-known teleological theory? Utilitarianism The Categorical Imperative Relativism Hedonism
utilitarianism
Which of the following ethical principles is the foundation of the nurse–patient relationship? Fidelity Beneficence Justice Autonomy
fidelity
On which of the following occasions might a nurse experience moral distress?
When asked to remain at work for four additional hours after the end of the shift in order to help colleagues
As a result of making a medication error
When a homeless person with a drug addiction refuses a street nurse’s advice to seek treatment for an infected wound
When a patient’s family member files a complaint against the nurse
When a homeless person with a drug addiction refuses a street nurse’s advice to seek treatment for an infected wound
How is the principle of nonmaleficence best described?
To protect the patient
To maintain confidentiality of patient records
To do no harm
To ensure equality in society
to do no harm
Why does feminist theory reject traditional ethical theory?
- Females are intrinsically ethical beings.
- Traditional ethical theories do not address issues of wealth.
- Traditional ethical theory is outdated.
- Widely known ethical theories are based on a male perspective
Widely known ethical theories are based on a male perspective
Which of the following theories was developed by the philosopher Immanuel Kant?
Utilitarianism
Moral obligation
Relativism
Pluralistic utilitarianism
moral obligation
Which of the following is a necessary first step in resolving an ethical dilemma?
Consulting with a lawyer
Referring to the Canadian Nurses Association’s Code of Ethics for Registered Nurses
Obtaining all of the facts relating to a moral controversy
Adhering to hospital policy
Obtaining all of the facts relating to a moral controversy
Why is trust essential to ethical nurse–patient relationship?
Nurses are often acting in the place of a parent.
Nurses are in a position of power, as they are caring for people at their most vulnerable states.
Nurses make decisions for patients while the patients are incompetent.
The Canadian Nurses Association’s Code of Ethics for Registered Nurses states that trust is required.
Nurses are in a position of power, as they are caring for people at their most vulnerable states.
Which of the following was the major issue addressed by the Nuremberg Code?
- Experimentation on human embryos
- Codes of ethics
- The principle of informed consent from research subjects
- The design of research programs
The principle of informed consent from research subjects
Which of the following is the major function of the Canadian Nurses Association (CNA)?
Proposing laws on safe patient–nurse ratios
Recruiting new nurses
Developing standards of education, practice, and ethical conduct
Political lobbying on health care issues
Developing standards of education, practice, and ethical conduct
Does a nurse have an obligation to care for someone with a highly contagious disease?
No; the nurse has the right to ask a colleague to take over care.
Yes; the nurse always has an obligation to give care.
No; the nurse has the right to refuse care.
Yes; the nurse is obligated to give care if protective clothing has been supplied.
Yes; the nurse is obligated to give care if protective clothing has been supplied.
Which of the following is a nurse’s required response when there are limited resources available for giving care?
- Refuse to carry on with the assignment until more nurses are brought in to help.
- Enlist the support of family members to complain to hospital authorities.
- Adjust the nursing priorities to minimize harm to patients, and ensure that leadership is aware of the situation.
- Publicize the nursing shortage through the press
Adjust the nursing priorities to minimize harm to patients, and ensure that leadership is aware of the situation.
How do the principles of beneficence and nonmaleficence guide research?
- Participants must give informed consent.
- The degree of risk should not outweigh the potential gain for humanity.
- Drug companies cannot pay physicians to prescribe experimental drugs.
- All consent forms must be written in the language of the participant.
-The degree of risk should not outweigh the potential gain for humanity.
If a nurse suspects that her client did not give informed consent, what is her responsibility?
- Repeat the information to the client.
- Ignore her suspicion because it is not her responsibility to obtain consent.
- Contact the physician in charge of care to discuss the information with the client again.
- Contact the family of the client to express her concern.
Contact the physician in charge of care to discuss the information with the client again.
When is a nurse required to break confidentiality?
- When a client’s next of kin asks about the diagnosis
- When the parents of a 16-year-old ask why their child spent the night in the emergency department
- When the press asks for an update on a trauma victim
- When a client or others may be harmed
When a client or others may be harmed
When might a hospital ethics committee become involved in the care of a patient?
- When there is a difference of opinion between the family and the treating team regarding the plan of care
- When the client is a high-profile media personality
- When the client is a staff member
- During strike action by nurses
When there is a difference of opinion between the family and the treating team regarding the plan of care
In which of the following areas do clinical ethicists have a role in health care?
Hiring and disciplining health care personnel
Purchasing and choosing new equipment
Consulting with professionals and educating families
Developing and maintaining adequate record keeping systems
Consulting with professionals and educating families
Why do professional bodies require a code of ethics?
- Because they serve society as a whole.
- Ethical considerations only affect professional people.
- The law does not protect the rights of the individual.
- University programs require the study of ethics.
Because they serve society as a whole.
The legal system of Quebec is principally based on which of the following systems of law? French common law English common law English civil law French civil law
french civil law
What is statute law?
A set of rules developed by a professional association of lawyers
Unwritten laws based on doctrine
A set of written rules passed by a parliament or regulatory body
Law that is described in the civil code
A set of written rules passed by a parliament or regulatory body
The draft version of a proposed law is known as which of the following? A code A statute A charter A bill
a bill
What are the three branches of the Canadian government? Political, legal, and fiscal Judicial, executive, and legislative Judicial, civil, and political Democratic, economic, and fiscal
Judicial, executive, and legislative
What is the primary source of law in Quebec? Statute law Jurisprudence The Civil Code Criminal law
The Civil Code
How is the concept of due process best described?
The process by which legislation is passed
The payment of fines in a timely manner
A feature of justice that ensures fair treatment for all
A feature of the civil code
A feature of justice that ensures fair treatment for all
Which areas of law are governed by civil law? Property, family, tort, and negligence Assault and burglary Business fraud and treason Tax evasion and insurance fraud
Property, family, tort, and negligence
What is an examination for discovery?
Disclosure of the jury list
Disclosure of relevant evidence by both parties in a lawsuit
Cross-examination of a key witness
Disclosure of all of the defendant’s relevant documents
Disclosure of relevant evidence by both parties in a lawsuit
Which of the following is a guaranteed legal right under Canada’s Charter of Rights and Freedoms?
- Detention without charge
- The requirement that no Parliament will continue for more than 5 years
- Free mobility between provinces
- Presumption of innocence
Presumption of innocence
How can a decision made by the Supreme Court of Canada be overturned?
By petition from the provincial appeal court
By a change of law in Parliament
By request from the Governor General
By appointing a new judge
By a change of law in Parliament
What is the primary purpose of the governing bodies of the nursing profession?
To monitor the education of nurses
To protect the public
Their contribution to federal drug legislation
To act as legal counsel for nurses
To protect the public
What is the purpose of an enacted legal definition of nursing?
- It allows greater access to the profession.
- It enables allied health professionals to perform nursing tasks.
- It draws a distinction between nursing and other professional practices.
- It holds nurses more accountable for their actions.
It draws a distinction between nursing and other professional practices.
What regulatory role does the Canadian Nurses Association have?
- None
- Outlining educational guidelines for entry to practice
- Initiating inquiry procedures for alleged nurse incompetence
- Providing political influence in health care policy
none… The Canadian Nurses Association promotes and supports nursing regulations in each province or territory; it promotes professional practice and supports the interests of the profession but does not have a regulatory function of its own.
How do regulatory bodies promote the welfare of the public?
By charging annual professional fees for registration
By ensuring public representation on their councils or boards
By defending members involved in litigation
By setting and enforcing practice standards
By setting and enforcing practice standards
What conflict exists for a nurse who hears about the poor practice of a colleague from a patient?
- Loyalty to a colleague versus the need to protect the public
- The duty to report professional misconduct versus patient confidentiality
- Patient confidentiality versus the colleague’s right to be presumed innocent
- Loss of promotion opportunities versus patient safety
The duty to report professional misconduct versus patient confidentiality
When must the provincial or territorial association inform a nurse when a complaint is lodged?
- After submission of all relevant documents by the complainant
- After an interview with the nurse’s direct supervisor
- Immediately on receipt of the complaint
- Prior to the final decision of the investigating committee
-Immediately on receipt of the complaint
A nurse forgets to renew her registration with the regulatory body and continues to work 3 months after her licence to practise as a nurse expires. What charge could the nursing regulatory body bring against this nurse?
- Late fees and an advance payment of next year’s fees
- Professional incompetence
- No charge
- Professional misconduct
professional misconduct
Which of the following term describes an individual touching another without consent? Assault Battery Intention to harm Assumed implied consent
battery
Informed consent is based on which of the following ethical principles? Integrity Beneficence Veracity Autonomy
autonomy
Which of the following is an example of implied consent?
The client withdraws his arm when the nurse is about to give an injection.
The client signs the surgical consent form.
The client offers his arm to have his blood pressure taken.
The client discharges herself from the hospital.
The client offers his arm to have his blood pressure taken.
our client is undergoing urinary catheterization. The catheter does not pass easily, and the client asks you to stop. What is this an example of? Reduced competence Informed consent Implied consent Withdrawal of consent
withdrawal of consent
What is proxy consent to treatment?
- A decision made by the medical team to treat in the best interests of the client
- The written consent to treatment signed by the client
- Consent given by a third party designated by the client
- A decision made by the court to treat the client
Consent given by a third party designated by the client
Under what circumstances can a health care professional proceed with treatment without consent?
- In an emergency, when no advance directives or proxy (substitute decision maker) is available
- When the family instructs the team to continue treating
- When the family cannot reach consensus on a treatment plan
- When the benefits of treatment outweigh the risks
-In an emergency, when no advance directives or proxy (substitute decision maker) is available
Which of the following is an example of malpractice?
- Ignoring the principles of asepsis when providing wound care
- Not stopping to assist at the scene of an accident
- Refusing to work overtime
- Practising without a valid nursing licence
Ignoring the principles of asepsis when providing wound care
What is a nonintentional tort?
A premeditated crime
An act of goodwill
An action resulting in no permanent harm to the victim
A nurse administering an antibiotic that the client is allergic to
A nurse administering an antibiotic that the client is allergic to
What is a breach of duty of care?
- Calling in sick on a frequent basis
- Falsifying nursing documentation after the unexpected death of a patient
- Accessing medication for personal use
- Neglecting to medicate a patient for pain in a timely manner
-Neglecting to medicate a patient for pain in a timely manner
What is contributory negligence?
- The negligence of a professional against a plaintiff
- The extent to which a plaintiff is responsible for damage or harm
- When a person consents to the procedure that ultimately results in harm damage
- The negligence of an institution toward an individual
The extent to which a plaintiff is responsible for damage or harm
Why does the law consider nursing documentation so important?
- It is an expected standard of care.
- Families and clients need to be able to read nursing notes.
- It is the only written evidence of the care a patient has received.
- It allows nurses to reflect on their day
-It is the only written evidence of the care a patient has received.
What is the goal of palliation?
- Prolonging life
- Promoting a quality dying process and a dignified death
- Controlling pain
- Hastening the end of life
Promoting a quality dying process and a dignified death
How is assisted suicide defined in the law?
- Mercy killing
- An act that results in the immediate death of a terminally ill patient
- Aiding a competent but physically incapable person in taking his or her own life
- The withdrawal of life-supporting therapies
-Aiding a competent but physically incapable person in taking his or her own life
What is an advance directive?
- A legal will
- Instructions for funeral arrangements
- A directive for palliative care
- A document specifying a person’s instructions for care, should he or she become incompetent
-A document specifying a person’s instructions for care, should he or she become incompetent
Canada’s voluntary approach to organ donation is based on which of the following ethical principles? Beneficence Nonmaleficence Justice Autonomy
Beneficence
What legislation was changed to facilitate MAID?
- Consent legislation across Canada
- Nursing and Regulated Health Professions Acts across the country
- The Canada Health Act
- The Criminal Code
the criminal code
What were some of the goals of the Human Genome Project?
To create an online database for researchers and to apply genetic knowledge into clinical practice
What is in vitro fertilization?
- A fertilization method that guarantees multiple births
- A fertilization method that ensures conception of a child of a specific gender
- Fertilization that occurs outside the body
- Fertilization of a surrogate mother
Fertilization that occurs outside the body
What is gestational surrogacy?
- The implantation of embryos after cryopreservation
- A pregnancy assisted by donor insemination
- The bearing of a child by an individual for another person or couple
- The donation of an embryo from one individual to another
-The bearing of a child by an individual for another person or couple
At what gestational age is a fetus generally thought to be viable? 20 weeks 24 weeks 18 weeks 23 weeks
24 weeks
Which of the following ethical issues is associated with the resuscitation of an infant of 23 weeks’ gestational age?
- The disapproval of the health care team
- The risk of contracting an infection in the neonatal intensive care unit
- The high risk of severe impairment
- The parents’ relationship with the health care team
The high risk of severe impairment
How is a right defined?
An obligation to ensure the safety of caregivers
A need to protect the safety of patients
A law ensuring freedom of speech
A claim or privilege to which one is justly entitled, morally or legally
A claim or privilege to which one is justly entitled, morally or legally
Which of the following situations would require a nurse to break confidentiality?
- The nurse examines a young child and suspects abuse.
- The parents of a 17-year-old client demand to know the results of her toxin screening.
- A new mother discloses that her husband is not the father of her child.
- The local press calls to confirm the presence of a child in the hospital.
-The nurse examines a young child and suspects abuse.
In the context of the client–health care professional relationship and patient safety, which of the following is an example of disclosure?
- The sharing of a fellow patient’s diagnosis
- The sharing of a personal experience
- The sharing of a client’s details to aid the police with their inquiries
- The process by which the health care professional informs a client of an adverse event
-The process by which the health care professional informs a client of an adverse event
Which of the following ethical principles apply when a nurse is required to give care in a situation that is ethically conflicting?
- Justice, beneficence, and nonmaleficence
- Autonomy, veracity, and fidelity
- Justice, autonomy, and veracity
- Beneficence, veracity, and fidelity
Justice, beneficence, and nonmaleficence
