Nuft 202 Final exam Flashcards
Accountability is
refers to the ability to answer for ones actions
Health care institutions also exercise this by monitoring individual and institutional compliance with national standards established by agencies such as The Joint Commission TJC.
Advocacy
the support of a particular cause.
Nurses do this to ensure the health, safety, and rights of a patient are being met.
Autonomy
freedom from external control or influence; independence
Beneficence
refers to taking positive actions to help others.
The agreement to act with beneficence implies that the best interests of the patient remain more important than self interest
doing good to others including moral obligation.
Casuistry
case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an “intimate understanding of particular situations”
For instance, the casuist might conclude that a person is wrong to lie in legal testimony under oath, but might argue that lying actually is the best moral choice if the lie saves a life
Code of Ethics
a set of guiding principles that all members of a profession accept.
a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
confidentiality
the act of holding information in confidence, not to be released to unauthorized individuals.
Protection and safety of patient information
Consequentialism
an ethical system that determines the level of goodness or evil from the effect or result of an act
Main emphasis is on the outcome or consequence of action
Deontology
defines actions as right or wrong on the basis of their “right-making characteristics” such as fidelity to promises, truthfulness and justice.
The deontological explains that an act that is not good morally can still lead to something good.
Ethics
the study of conduct and character
Ethics of Care
Strives to address issues beyond individual relationships by raising ethical concerns about the structures within which individual caring occurs (structures such as hospitals or universities)
Fidelity
refers to the agreement to keep promises by following through on your action and interventions
Justice
refers to fairness
the term is most often used in discussion about access to health care resources, including the just distribution of scarce resources
Nonmaleficence
the avoidance of harm or hurt
Examples of nonmaleficence in nursing include holding a medication due to adverse reactions or taking steps to ensure a safe work environment.
Responsibility
a willingness to respect one’s professional obligations and to follow through
Ex. It is the nurses responsibility to report Missing narcotics.
Teleology
Looking at the end result to do good. Thinking about what will happen if we don’t restrain this patient.
from the Greek word telos, meaning “end,” or the study of ends or final causes.
In healthcare, teleological care is a philosophy of care built around the root idea of an end.
their violent behavior, applying a restraint can be an ethical teleological action.
Utilitarianism
idea that the goal of society should be to bring about the greatest happiness for the greatest number of people
measures the effect that an act will have
The utilitarian says that an act is right (moral) if it is useful in “bringing about a desirable or good end.
In this example let us imagine that: A hospital with limited capacity to deal with Covid-19 patients has to decide between admitting a 20 year old patient, who is fit and well, and a 75 year old patient, who has a history of heart disease, to their last available ventilator.
Values
a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn’t have health insurance or enough cash. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority.
1. Accountability: You as the nurse are accountable for the well- being of this patient.
2. Respect for autonomy: This patient’s autonomy will be vio- lated if he does not receive the liver transplant.
3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant.
4. Justice: The greatest question in this situation is how to deter- mine the just distribution of resources.
4,2,3,1
Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the prin- ciple of ________?
Nonmaleficence
A child’s immunization may cause discomfort during administra- tion, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy
2
When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient’s priority is to be as free of pain as possible. The nurse and patient work together to iden- tify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient’s priority is met. Which principle is used to encourage the nurse to monitor the patient’s response to the pain?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy
- Fidelity
A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy?
1. Seeking out the nursing supervisor to talk with the patient
2. Documenting patient fears in the medical record in a timely
manner
3. Working to change the hospital environment
4. Assessing the patient’s point of view and preparing to articu-
late it
Answer: 4
The application of utilitarianism does not always resolve an ethical
dilemma. Which of the following statements best explains why?
1. Utilitarianism refers to usefulness and therefore eliminates the
need to talk about spiritual values.
2. In a diverse community it can be difficult to find agreement
on a definition of usefulness, the focus of utilitarianism.
3. Even when agreement about a definition of usefulness exists in
a community, laws prohibit an application of utilitarianism.
4. Difficult ethical decisions cannot be resolved by talking about
the usefulness of a procedure.
Answer 2
The ethics of care suggests that ethical dilemmas can best be solved
by attention to relationships. How does this differ from other ethical practices? (Select all that apply.)
1. Ethics of care pays attention to the environment in which
caring occurs.
2. Ethics of care pays attention to the stories of the people
involved in the ethical issue.
3. Ethics of care is used only in nursing practice.
4. Ethics of care focuses only on the code of ethics for nurses
5. Ethics of care focuses only on understanding relationships.
Answer: 1,2,5
In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse’s point of view valuable?
1. Nurses understand the principle of autonomy to guide respect
for a patient’s self-worth.
2. Nurses have a scope of practice that encourages their presence
during ethical discussions.
3. Nurses develop a relationship with the patient that is unique
among all professional health care providers.
4. The nurse’s code of ethics recommends that a nurse be present at any ethical discussion about patient care.
Answer: 3
Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma?
1. List the actions that could be taken to resolve the dilemma.
2. Agree on a statement of the problem or dilemma that you are
trying to resolve.
3. Agree on a plan to evaluate the action over time.
4. Gather all relevant information regarding the clinical, social,
and spiritual aspects of the dilemma.
5. Take time to clarify values and distinguish between facts and
opinions—your own and those of others involved.
6. Negotiate a plan.
Answer: 4,5,2,1,6,3
The ANA code of nursing ethics articulates that the nurse “pro- motes, advocates for, and strives to protect the health, safety, and rights of the patient.” This includes the protection of patient privacy. On the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient’s x-ray film if you obscured or deleted all patient identifiers?
- Yes, because patient privacy would not be violated since patient identifiers were removed
- Yes, because respect for autonomy implies that you have the autonomy to decide what constitutes privacy
- No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work
- No, because the principle of justice requires you to allocate resources fairly
Answer: 3
What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order.
1. Clarify values.
2. Ask the question, Is this an ethical dilemma?
3. Verbalize the problem.
4. Gather information.
5. Identify course of action.
6. Evaluate the plan.
7. Negotiate a plan
Answer: 2,4,1,3,5,7,6,
Resolution of an ethical dilemma involves discussion with the patient, the patient’s family, and participants from all health care disciplines. Which of the following best describes the role of the nurse in the resolution of ethical dilemmas?
- To articulate the nurse’s unique point of view, including knowledge based on clinical and psychosocial observations.
- To study the literature on current research about the possible clinical interventions available for the patient in question.
- To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion.
- To allow the patient and the physician to resolve the dilemma on the basis of ethical principles without regard to personally held values or opinions.
Answer: 1
It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (Select all that apply.)
1. Average income varies in different regions of the country.
2. Community values influence definitions of quality, and they are subject to change over time.
3. Individual experiences influence perceptions of quality in dif- ferent ways, making consensus difficult.
4. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures.
5. Statistical analysis is difficult to apply when the outcome cannot be quantified.
6. Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.
Answer: 2,3,4,5
Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply.)
1. Access to health care reflects the commitment of society to
principles of beneficence and justice.
2. If low income compromises access to care, respect for
autonomy is compromised.
3. Access to health care is a privilege in the United States, not a right.
4. Poor access to affordable health care causes harm that is
ethically troubling because nonmaleficence is a basic principle
of health care ethics.
5. Providers are exempt from fidelity to people with drug
addiction because addiction reflects a lack of personal
accountability.
6. If a new drug is discovered that cures a disease but at great cost
per patient, the principle of justice suggests that the drug should be made available to those who can afford it.
ANS: 1,2,4
Match the examples with the professional nursing code of ethics:
- You see an open medical record on the computer and close it so no one else can read the record without proper access.
- You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure.
- A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient’s request.
- You tell your patient that you will return in 30 minutes to give him his next pain medication.
a. Advocacy
b. Responsibility
c. Accountability
d. Confidentiality
ANS: 1d, 2c, 3a, 4b
What are the steps in the process of ethical decision-making?
Step one: ask, is this an ethical problem?
Step two gather information that is relevant to the case
Step three identify the ethical elements in the problem and examine your values
Step four the problem
Identify possible courses of action
DAR notes
Incorporates, data, action and response
The DAR notes address patient concerns, such as a sign or symptom, condition, nursing diagnosis, behavior, significant event, or change in condition
PIE note
A pie note has a specific nursing focus.
P: problem or dx
I: interventions that will be used to address the problem
E: evaluation -evaluate if patient is able to teach back and verbalize the given knowledge
