Unit 8 Ethics & Legal Chapter 11

Question 1

What is Ethics?

Answer 1

Standards of moral conduct in a society

Question 2

What is Beneficence?

Answer 2

Doing good for your patient

In its simplest form, beneficence can be defined as doing good. Nurses demonstrate beneficence by acting on behalf of others and placing a priority on the needs of others rather than on personal thoughts and feelings. PG 499

Question 3

What is Nonmalifience?

Answer 3

Not causing harm to your patient

First, do no harm is the colloquial definition of nonmaleficence. Unlike beneficence, which requires actively doing good, nonmaleficence requires only the avoidance of harm. PG499

Question 4

What is Autonomy, and should you as a nurse respect it?

Answer 4

The patient has the right to choose, for example: “The pt has the right to deny medications due to their autonomy”

A patient who makes independent health care decisions is demonstrating autonomy. Autonomy, or self-determination, is the freedom to make decisions supported by knowledge and self- confidence. PG500

Question 5

What is Justice?

Answer 5

Is being fair to all patients

To do justice is to act fairly and equitably. Although justice may seem easy to achieve, the concept is often challenging to apply in health care. PG501

Question 6

What is Veracity?

Answer 6

Is being truthful to your patients, telling the truth, and being real.

Truthfulness defines the ethical principle of veracity. Honesty promotes unrestricted communication among individuals, demonstrates respect for others, and builds trust. PG500

Question 7

What is Accountability?

Answer 7

Accountability is the willingness to accept responsibility for one’s actions. Accountability is required to provide safe patient care and address potential problems.

Question 8

What is Advocacy?

Answer 8

Advocating for your patient, wanting the best outcome for the patient, and speaking up for them.

Supporting or promoting the interests of others or of a cause greater than ourselves defines advocacy. Patient advocacy is an essential aspect of nursing.PG502

Question 9

What is Fidelity?

Answer 9

BEING FAITHFUL
Keeping promises or agreements made with others constitutes fidelity. In nursing, fidelity is essential for building trusting relationships with patients and their families.

Question 10

What is Confidentiality?

Answer 10

Confidentiality is keeping pt information private / confidential.

Confidentiality is the ethical concept that limits sharing of private patient information. Maintaining the confidentiality of patient information means that its disclosure is limited to authorized individuals and agencies.

Question 11

What is Responsibility?

Answer 11

Responsibility is the concept of being dependable and reliable.

A nurse who is responsible adheres to professional standards of care, complies with institutional policies, meets requirements of continuing education, and follows the orders of physicians and nurse practitioners (NPs).

Question 12

What is Ethical Principles

Answer 12

The study of ethics considers the standards of moral conduct in a society. Personal ethics are influenced by values, societal norms, and practices (Burkhardt & Nathaniel, 2014). Family, friends, beliefs, education, culture, and socioeconomic status influence the development of ethical behavior. Behaviors that are judged as ethical or unethical, right or wrong, reflect a person’s character.

Question 13

Moral Distress

Answer 13

The anguish that healthcare professionals experience when their basic beliefs of what is right
and wrong or ethical principles are challenged

Nurses may suffer moral distress when they are unable to act according to their personal core values or obligations, or when their professional actions do not result in the preferred patient or situational outcome

Moral distress is most often experienced around end-of-life issues. This is especially true when family members insist on care or treatment that is considered futile or unnecessary for a dying patient.

Question 14

Moral resilience

Answer 14

The capacity of an individual to sustain or restore integrity in response to moral complexity, confusion, distress, or setbacks

Question 15

Misdemeanor

Answer 15

A misdemeanor is a crime of lesser consequence that is punishable by a fine or incarceration in a local or county jail for up to 1 year.

Question 16

Felony

Answer 16

A felony is a more serious crime that results in the perpetrator’s being imprisoned in a state or federal facility for more than 1 year.

Examples: Practicing nursing without a license, child abuse, and illegal drug dealing are examples of felonies

Question 17

Assault

Answer 17

Assault is a threat of bodily harm or violence caused by a demonstration of force by the perpetrator.

Question 18

Battery

Answer 18

Actual physical harm caused to another person is ba ttery. The threat to hurt someone is carried out.

Examples
Ba ttery may involve angry, forceful touching of people, their clothes, or anything attached to them

-Performing a surgical procedure without informed consent is an example of bat tery.
-Actions much more subtle, such as inserting an intravenous (IV) catheter or urinary catheter against the will of a patient, also may be classified as ba ttery.

Question 19

Deontology

Answer 19

Deontology is an ethical theory that stresses the rightness or wrongness of individual behaviors, duties, and obligations without concern for the consequences of specific actions

Question 20

Constitutional Laws

Answer 20

Constitutional law is derived from a formal, written constitution that defines the powers of government and the responsibilities of its elected or appointed officials.

Question 21

Which of the following is an Intentional Tort?
A. Assault
B. Malpractice
C. Negligence
D. Alarm reaction

Answer 21

A. Assault

Question 22

Intentional Torts Include…

Answer 22

Assault
* Battery
* Defamation of character
* Libel
* Slander
* False imprisonment
* Invasion of privacy

Question 23

Unintentional Torts Include….

Answer 23

Malpractice and Negligence

Question 24

1. On which ethical theory do nurses implement their care when they act on the basis of the needs of one specific patient rather than the potential consequences to other patients?
   a. Deontology
   b. Autonomy
   c. Utilitarianism
   d. Nonmaleficence

Answer 24

a. Deontology

The ethical theory of deontology focuses on the act rather than on the consequences. Autonomy is an ethical concept that values an individual’s right to make personal decisions. Utilitarianism is an ethical theory that focuses on the consequences of an action and the good of many rather than of an individual. The ethical principle of nonmaleficence asserts an obligation to “do no harm.”

Question 25

2. Which nursing intervention is the best example of patient advocacy?
   a. Collecting blood samples according to the physician’s order each morning
   b. Assessing the vital signs of a patient who is receiving a blood transfusion
   c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain
   d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

Answer 25

c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain

Answer: c
Advocacy requires a nurse to work on behalf of others who may be unable to speak for themselves. When a patient is in pain and the physician or primary care provider is not present, a nurse must advocate for the patient’s needs by initiating contact with the person responsible for addressing an immediate need. In this case, an order for additional pain medication is needed, which requires collaboration with the patient’s physician. Collecting blood samples, assessing vital signs, and assisting a patient with ambulation are primary responsibilities of the nurse that do not require advocacy to meet the patient’s need.

Question 26

3. What action should nurses who demonstrate accountability take if they forget to administer a patient’s medication at the ordered time?
   a. Document the medication as refused by the patient.
   b. Administer the medication as soon as the error is discovered.
   c. Record the medication as given after making sure the patient is okay.
   d. Follow the administration and documentation procedures for medication errors.

Answer 26

d. Follow the administration and documentation procedures for medication errors.

Agency procedures must be followed after every medication error. Care must be taken to adhere to medication administration recommendations and documentation requirements to legally record the incident and provide patient safety. Documenting that the patient refused or already took the medication when that is not factual is illegal and unethical regardless of the patient’s condition. Administering the medication as soon as the error is discovered may not be recommended depending on the medication’s potency and frequency of administration.

Question 27

4. Nursing students are held to which standards by the Code of Ethics for Nurses? (Select all that apply.)
   a. Clinical skills performance equal to that of an experienced nurse
   b. Demonstration of respect for all individuals with whom the student interacts
   c. Avoidance of behavior that shows disregard for the effect of those actions on others
   d. Accepting responsibility for resolving conflicts in a professional manner
   e. Incorporating families in patient care regardless of patient preference

Answer 27

Answers: b, c, d
Nursing students are expected to demonstrate respect, avoid hurting others by their actions, and take responsibility for resolving conflicts in a professional manner, much the same as professional nurses. Student nurses are not required to perform clinical skills at the level of expertise exhibited by an experienced nurse. Involving a patient’s family in care without the patient’s approval indicates a lack of respect for patient autonomy.

Question 28

5. If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take?
   a. Discuss the peer’s actions during group clinical conference
   b. Ignore the initial occurrence and observe if it happens again
   c. Report the actions of the classmate to the clinical instructor
   d. Speak to the peer privately to prevent further occurrences

Answer 28

d. Speak to the peer privately to prevent further occurrences

Answer: d
Alerting the peer who has acted disrespectfully in a private setting is the most professional way to approach this situation. It is never appropriate for a professional to belittle or reprimand a peer in front of others which may be perceived as a form of bullying. Ignoring disrespectful behavior may only perpetuate its occurrence. Seeking help from a clinical instructor would be appropriate if the peer does not respond to the initial intervention from the fellow student.

Question 29

6. What nursing intervention is best when a patient is struggling with the decision to abort an abnormally developing fetus discovered during genetic testing in the first trimester of pregnancy?
   a. Recommend additional testing
   b. Refer the patient to an abortion clinic
   c. Listen to the patient’s concerns
   d. Discuss regional adoption agencies

Answer 29

c. Listen to the patient’s concerns

Answer: c
Listening is the best option for the nurse when patients are considering ethical care decisions. Patients often need someone to listen to their verbalized concerns to sort out feelings about the situation and make decisions that are best for them. The patient’s primary care provider is responsible for recommending further testing or making requested patient referrals.

Question 30

7. Making prejudicial, untrue statements about another person during conversation may expose a nurse to being charged with what offense?
   a. Libel
   b. Assault
   c. Slander
   d. Malpractice

Answer 30

c. Slander

Answer: c
Conversation that includes prejudicial and false statements about another person is an example of oral defamation of character or slander. Libel is the written form of defamation of character. Assault is a threat of bodily harm accompanied by a sense of imminent danger. Malpractice is professional negligence caused by unsafe practice.

Question 31

8. What legal consequences may a nurse experience if the nurse is convicted of a crime? (Select all that apply.)
   a. Loss of nursing licensure
   b. Employment affirmation
   c. Monetary penalty
   d. Unit transfer
   e. Imprisonment

Answer 31

Answers: A,C,E
Nurses who are convicted of a crime may have their nursing licenses revoked, be required to pay fines or pay restitution to patients or their families for damages, and be incarcerated for various periods, depending on the severity of the crime. Nurses who commit crimes are most often placed on probation pending the outcome of court proceedings or dismissed from their employment, not affirmed or transferred to work on another unit.

Question 32

9. What is the best way for a nurse to avoid crossing professional practice boundaries with patients?
   a. Spend extensive time with a patient without visitors
   b. Focus on the needs of patients and their families
   c. Intervene in problematic patient relationships
   d. Relay personal stories when unsolicited

Answer 32

b. Focus on the needs of patients and their families

The best way to avoid crossing professional practice boundaries is to focus on the patient’s needs and those of the patient’s family. Nurses should consistently avoid unsolicited self-disclosure of personal information, intervening in patient relationships, and spending excessive amounts of time with one patient. In addition to keeping patients’ secrets, gaining personally from a relationship with a patient and engaging in sexual overtures or sexual behavior with a patient are considered violations of professional boundaries.

Question 33

10. What action should a nurse take if a patient who needs to sign an informed consent form for nonemergency surgery appears to be under the influence of drugs or alcohol?
    a. Contact the physician to see what should be done.
    b. Ask the patient’s spouse to sign the informed consent form.
    c. Request permission to bypass the need for a signed consent form.
    d. Wait to have the informed consent form signed when the patient is alert and oriented.

Answer 33

d. Wait to have the informed consent form signed when the patient is alert and oriented.

When a normally competent patient is assessed to be under the influence of alcohol or drugs, it is the nurse’s responsibility to delay a nonemergency procedure until legal informed consent can be obtained from the patient. Only in the case of an emergency is it possible to obtain informed consent from a spouse or designated power of attorney for a temporarily impaired adult.

Question 34

Libel

Answer 34

Wri en forms of defamation of character are considered libel.

Question 35

Slander

Answer 35

Oral defamation of character is slander. Slander is spoken information that is untrue, causing prejudice against someone or jeopardizing that person’s reputation.

Example

For instance, if a nursing student says that a classmate cheated on an examination despite this being untrue, the student has commi ed slander.

Question 36

Defamation of character

Answer 36

Defamation of character occurs when a public statement is made that is false and injurious to another person

Question 37

What falls under Defamation of Character?
A. Assault
B. Libel
C. Battery
D. Negligence

Answer 37

B. Libel

Question 38

False Imprisonment

Answer 38

Unauthorized restraint or detention of a person is considered false imprisonment. Preventing patients from leaving a health care facility at their request may be considered false imprisonment

To prevent health care providers and institutions from being held liable if a patient chooses to leave a facility when physicians and nurses think that it is in the patient’s best interest to remain hospitalized, the patient is asked to sign an against medical advice (AMA) form. A signed AMA form documents that the patient has chosen to leave the facility when leaving could jeopardize the patient’s condition.

Question 39

Invasion of Privacy

Answer 39

Public disclosure of private information, use of a person’s name or likeness without permission, intrusion into a person’s place of solitude, and meddling into another’s personal affairs are examples of invasion of privacy.

Example
Accessing the medical record of a patient for whom a nurse does not have the responsibility of providing care is an example of invasion of privacy.

Question 40

Criminal Law

Answer 40

Criminal law is the body of state and federal laws wri en to prevent harm to the country, state, and individual citizens.

Question 41

What are the types of Statutory Laws

Answer 41

• Intentional torts
• Assault
• Battery
• Defamation of character
• Libel
• Slander
• False imprisonment
• Invasion of privacy
  *Uninterntional Torts
  *Malpractice
  *Negligence

Question 42

Negligence

Answer 42

Creating a risk of harm to others by failing to do something that a reasonable person would ordinarily do or doing something that a reasonable person would ordinarily not do constitutes negligence.

Example
For instance, if water is spilled on a hospital corridor floor, a reasonable person would recognize it as a potential fall hazard, seek to alert others to its presence, and have it cleaned up as quickly as possible.

Question 43

Malpractice

Answer 43

Malpractice may occur when a professional (such as a nurse) acts unethically, demonstrates deficient skills, or fails to meet standards of care required for safe practice.

Examples
- include engaging in sexual activity with a patient;
-calculating medication dosages inaccurately, resulting in a patient’s drug overdose;
- administering penicillin to a patient with a documented penicillin allergy, resulting in the patient’s death from a severe allergic (anaphylactic) reaction.

Question 44

a client asks why a diagnostic test has been ordered and the nurse replies, “i’m unsure but will find out for you”. when the nurse later returns and provides an explanation, the nurse is acting under which principle?

1. nonmaleficence
2. veracity
3. beneficence
4. fidelity

Answer 44

4. fidelity

4: Fidelity means being faithful to agreements and promises. This nurse acted on the clients behalf to obtain needed information and report back to the client.

Question 45

a client with cancer has decided to discontinue further treatment. Although the nurse would like the client to continue treatment, the nurse recognizes the client is competent and supports the clients decision using which ethical principle?
1. justice
2. fidelity
3. autonomy
4. confidentiality

Answer 45

3. autonomy

Question 46

What is the Good Samaritan Act?

Answer 46

All 50 states have enacted Good Samaritan laws offering protection for physicians and other health care professionals who provide emergency care at the scene of a disaster, emergency, or accident

Good Samaritan laws protect health care professionals from charges of negligence in providing emergency care if (1) the care is within the professional’s scope of knowledge and standards of care and (2) no fee is received or charged for services.

Question 47

Advance Directives

Answer 47

Plans put in place (IN ADVANCE) incase the given person cannot make decisions in the future.

-Living Will
-Power of attorney
-Healthcare Proxy

Question 48

Living Will

Answer 48

A living will specifies the treatment a person wants to receive when he or she is unconscious or no longer capable of making decisions independently.

All states recognize the legitimacy of living wills, although individuals need to communicate their wishes with family members and provide copies of their living wills to health care providers and family members as documentation of their preferences. The existence of a signed living will alleviates confusion and may help avoid legal disputes regarding the care of loved ones.

Question 49

Durable power of attorney

Answer 49

A durable power of a ttorney is a legal document that allows a designated person to make legal decisions on behalf of an individual unable or not permi tted to make legal decisions independently.

Spouses, domestic partners, and a orneys are the most common people to be granted power of a orney.

Question 50

Healthcare Proxy

Answer 50

The specific durable power of a ttorney for medical care is called a health care proxy. This document specifies the person who can make health care decisions for an individual who is unable to comprehend information or communicate his or her wishes for any reason.

The health care proxy limits the scope of power of the designated person or people to medical care and treatment decisions.

Question 51

Should Advance Directatives Documents be notorized?

Answer 51

Yes, they are legal documents and must have a witness

It is the responsibility of nurses and other health care providers to document the existence of advance directives in patient’s medical records. If a patient has signed and notarized advance directives, a copy of each document should be placed in the patient’s medical record on admission to a health care facility.

Question 52

Is it the right of the patients Autonomy to change the status of their DNR(Do-Not-Resuscitate) Code?
A. Yes
B. NO

Answer 52

A. Yes

Question 53

Statutory Law

Answer 53

Responsibility
Statutes governing health care, such as provisions for care of the uninsured and the actions that constitute child abuse, originally became law after they were introduced and passed as bills in a legislative body.

Each state’s legislature passes laws referred to collectively as a nurse practice act (NPA). The NPA defines the scope of nursing practice in the state. Ma ers pertaining to licensure, accreditation of schools and colleges of nursing, and professional roles are outlined in a state’s NPA.

It is the responsibility of all nurses to become familiar with the NPA in the state of their employment and to adhere to the laws that govern practice.

Question 54

4 D’s of Negligence

Answer 54

Duty: It must be proved that the nurse or other health care provider owed a duty of care to the accusing patient.
* Dereliction: There must be evidence that the nurse’s actions did not meet the standard of care required or that care was totally omi ed.
* Damages: Actual injury to the accusing patient must be evident.
* Direct cause: A causal relationship must be established between harm to the accusing patient and the actions or omi ed acts of the nurse.

Question 55

American Nursing Association (ANA)

Answer 55

Transfer of responsibility

Adherence to Principles of Delegation
Appropriate delegation by RNs seeks to ensure patient safety and meet nursing standards of care. The ANA (2013a) Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP) and Scope of Nursing Practice Decision-Making Framework (Ballard, et al., 2016) clearly delineate the basic nursing responsibilities related to delegation. The document is supplemental to each state’s NPA. Additional information on delegation is found in Chapter 12. All nurses must become familiar with and adhere to their specific state or jurisdictional requirements for delegation to prevent patient injury and legal action.

Question 56

NCSBN Scope of Nursing
Practice Decision-Making
Framework

Question 57

The Nurses responsibility to… (Advance Directives)

Answer 57

It is the responsibility of nurses and other health care providers to document the existence of advance directives in patient’s medical records.

Question 58

DNR DO NOT RESCITATE

Answer 58

the wri tten DNR order must be renewed on a regular basis, similar to that of an order for antibiotic therapy or narcotic medication administration.

Question 59

Licensure

Answer 59

Licensure of nurses seeks to ensure professional competence.

The laws of each state and Canadian province or territory require graduates of accredited nursing schools and colleges to pass the National Council Licensure Examination (NCLEX) before beginning professional practice

Question 60

Standards of Care

Answer 60

Standards of care are the minimum requirements for providing safe nursing care. Federal and state laws, rules and regulations, accreditation standards, and institutional policies and procedures are used to formulate nursing standards of care.

The ANA identifies standards for safe practice and regularly releases policy statements and current practice information to guide and update the standards of care for nurses. Each state’s board of nursing establishes accreditation standards for schools and colleges of nursing that must be met

Question 61

Good Samaritan

Answer 61

STAY IN YOUR SCOPE OF PRACTICE , DO NOT PROVIDE CARE OUTSIDE OF YOUR SCOPE (SURGICAL INCISIONS,ETC

PROTECTS HEALTH CARE PROF AIDING PEOPLE IN TIMES OF NEED WHEN WORKING IN YOUR SCOPE OF PRACTICE

All 50 states have enacted Good Samaritan laws offering protection for physicians and other health care professionals who provide emergency care at the scene of a disaster, emergency, or accident (Fig. 11.3).

Question 62

Uniform Determination of Death

Answer 62

The Uniform Determination of Death Act of 1981 identified a comprehensive and medically sound basis for declaring a person dead. As a result, most states have enacted laws establishing two criteria for death: (1) all spontaneous respiratory and circulatory function stops or (2) all brain function, including that of the brainstem, ends. If brain death has been established, organ procurement for donation may take place.

Continue doing CPR until and Id’d professional comes to verify the death

Question 63

Medical Aid in Dying and Euthanasia

Answer 63

Euthanasia occurs when a person who willingly requests to die is injected with a lethal drug dosage by another individual.

Medical aid in dying is when a person who is mentally competent with a prognosis of 6 months or less to live causes his or her own death by self-administering prescribed medication.

Both actions typically occur when the person requesting assistance to die is suffering unbearably; experiencing excruciating, chronic pain; or facing certain death as a result of a terminal illness.

Question 64

Which of the following nursing situations best reflects accountability?
1.The nurse takes the oncology nursing certification examination.
2.The nurse files an incident report regarding a medication error.
3 .The nurse assesses the client for the possible cause of his pain.
4.The nurse tells the client, “I don’t know but I will find out for you.”

Answer 64

2.The nurse files an incident report regarding a medication error