Flashcards in Chapter 24 Deck (25):
A nurse educator explains to a new graduate that Ethics is:
a. behaviors concerning moral choices and opinions.
b. behavior according to certain customs or beliefs.
c. a branch of philosophy dealing with right and wrong.
d. a type of thinking where criticism is accepted.
C: Ethics is a branch of philosophy that is concerned with the distinction between right and wrong on the basis of a body of knowledge, not only on the basis of opinions. Behaviors based upon certain customs or traditions that generally reflect personal or religious beliefs relate to morality (behaviors concerning moral choices and opinions) or moral decisions/behaviors. DEFINITION OF ETHICS AND MORALITY
A student nurse did not realize that individuals may differ in their philosophies. The nurse educator explained that philosophies:
a. are a way of looking at the world through rose-colored glasses.
b. are a rational investigation of truths, reality, and human behavior.
c. are an investigation into behaviors and truths but not necessarily into reality.
d. stem from a person’s beliefs, opinions, and principles of bioethics.
B: The rational investigation of the truths and principles of knowledge, reality, and human conduct (behavior) is called a philosophy. Personal philosophies can be a result of a person’s beliefs and values but, bioethics is a type of a philosophy that concerns itself specifically with health care but is not applicable to all philosophies. PHILOSOPHY
When asked about teleology, a nurse educator may provide an example of teleology such as:
a. “Do unto others as you would have them do unto you.”
b. “Murder is always wrong.”
c. “The achievement of a good outcome justifies using less than desirable means to attain it.”
d. “A person’s character must be developed so that he will be predisposed to behave virtuously.”
C: Teleology is an ethical theory that purports that a person must take those actions that lead to good outcomes and that the outcome of this act determines whether is it good or of value. According to teleology, one can use a less than desirable action (means) to attain a good outcome. An example of deontology is to “do unto others as you would have them do unto you.” The statement “murder is always wrong” is an example of relativism, where there are no universal ethics and ethical standards are relative to person, place, time, and culture. Living and behaving virtuously relate to virtue ethics. TABLE 24-1 SELECTED ETHICAL THEORIES
A nurse educator recommends that for some circumstances, making a decision under a “veil of ignorance” may be most appropriate. The nurse educator explains that a “veil of ignorance” pertains to which ethical theory?
a. Justice and equity c. Relativism
b. Deontology d. Virtue ethics
A: An ethical person, according to justice and ethics, chooses the action that is fair to all, including those people who are the most disadvantaged. Therefore, using a “veil of ignorance” regarding who will be impacted by a decision allows for unbiased decision making according to this ethical theory. TABLE 24-1 SELECTED ETHICAL THEORIES
A nurse educator is discussing the topic of virtue ethics. The nurse educator explains that virtue ethics espouses that:
a. people are born virtuous.
b. people’s actions are based on moral rules and unchanging principles.
c. virtues such as truthfulness develop over time.
d. whatever a person thinks is right is.
C: Virtue ethics contends that virtues such as truthfulness and trustworthiness develop over time and that an individual’s character must be developed (not inborn) by nature and habit; therefore, the person will be predisposed to behaving and living virtuously. Action based upon morals and unchanging principles is a characteristic of deontological thinking, and whatever a person thinks is right is an example of relativism. TABLE 24-1 SELECTED ETHICAL THEORIES
A health care organization espouses beneficence, nonmaleficence, fidelity, justice, autonomy, respect for others, and veracity. A nurse employed by the organization understands that these are all examples of which of the following?
a. Philosophies pertaining to nursing
b. Ethical dilemmas
c. Philosophies related to organizational law
d. Ethical principles and rules
D: The ethical principles of beneficence, nonmaleficence, justice, autonomy, respect for others, veracity, and fidelity all concern behaviors and beliefs that influence how nurses make decisions when faced with ethical dilemmas in their practice settings. TABLE 24-2 ETHICAL PRINCIPLES
A staff member asks a nurse manager why the hospital has an ethics committee. The nurse manager explains that a benefit of ethics committees is that they:
a. provide guidance that assists with difficult decisions.
b. are interdisciplinary and provide a way to decide what is wrong and right.
c. provide guidance that assists with decisions concerning ethical dilemmas.
d. provide guidance that assists with decisions related to ethics and nursing practice.
C: Ethics committees can be found in many health care organizations today, and they consist of an interdisciplinary group of people who assist in making decisions concerning ethical dilemmas. While these dilemmas may require difficult decisions and judgments about what may be “right” and “wrong” in certain circumstances, they pertain only to ethical dilemmas and not to other types of decisions or concerns. ETHICS COMMITTEES
A nurse is in a situation where there is a conflict between two ethical principles. The nurse must make a decision, but there seems to be no “correct” decision. The nurse is experiencing which of the following?
a. Ethics c. Ethical dilemma
b. Bioethics d. Ethical situation
C: Ethical dilemmas consist of conflict (disagreement or argument) between at least two ethical principles. There are no “correct” answers for ethical dilemmas, but there are a variety of possible solutions. Ethical situations are those in which the question of ethics (right and wrong) comes into play, but they are not necessarily dilemmas. Bioethics are ethics that are specifically related to health care, and ethics, itself, is a branch of philosophy concerned with the distinction between right and wrong based upon a body of knowledge, not just opinions. DEFINITION OF ETHICS AND MORALITY
As a student, you have learned that your duty as a nurse is to do good to others and maintain a balance between those items that may cause harm and those that may cause good. Which ethical principle is this behavior based on?
a. Fidelity c. Beneficence
b. Nonmaleficence d. Veracity
C: The ethical principle of beneficence concerns the duty to “do good” to others and to maintain a balance between benefits and harms. Examples of this would be to provide all patients with caring attention and to treat everyone with respect and courtesy. Nonmaleficence concerns the principle of doing no harm, and veracity deals with the obligation to tell the truth. TABLE 24-2 ETHICAL PRINCIPLES
In a staff meeting, questions have been raised about a colleague’s veracity. You recognize that veracity deals with which of the following?
a. Being first in line c. Having a great deal to do
b. Volunteering to work overtime d. Admitting mistakes promptly
D: Veracity is an ethical principle regarding telling the truth. Admitting to mistakes promptly and offering to do whatever is necessary to correct them is an example of veracity. Being first in line, volunteering to work overtime, and having a great deal to do every day are related to time management and organization, but they are not concerned with telling the truth. TABLE 24-2 ETHICAL PRINCIPLES
A nurse manager at a home health care agency who ensures that all contracts have been completed and payments are timely is displaying the principle of:
a. veracity. c. autonomy.
b. respect for others. d. fidelity.
D: The principle of fidelity concerns the obligation of keeping one’s promise or word. The nurse manager in this example is keeping her word by making sure that all contracts have been completed and payments are made on a timely basis, hence keeping her promise to do so. The ethical principle of autonomy relates to a person’s right to self-determination and respect for individual liberty. An example of veracity would be to refuse to participate in any type of fraudulent activities, and to avoid making paternalistic decisions for others is an example of respect for others. TABLE 24-2 ETHICAL PRINCIPLES
A nurse is attempting to become a more virtuous person as defined by Burkhardt and Nathaniel (2008). The nurse most likely will demonstrate which of the following when providing nursing care?
a. Compassion, discernment, integrity, and trustworthiness
b. Discernment, compassion, understanding, and empathy
c. Trustworthiness, integrity, sympathy, and following the rules
d. Integrity, compassion, understanding, and making the best decision that is fair for all
A: Burkhardt and Nathaniel’s (2008) definition of a virtuous person lists four virtues that are more significant than others: compassion, discernment, integrity, and trustworthiness. Understanding, empathy, and sympathy are all fine attributes, but they do not necessarily contribute to this definition of a virtuous person. Following the rules is an example of deontological thought, and making the best decision that is fair for all is an example of relativism. VIRTUES
A nurse manager is discussing with a colleague the fact that in 2003 the American Hospital Association replaced the Patient Bill of Rights with a document entitled the Patient Care Partnership. Which of the following statements regarding what has been included in the new document is correct?
a. The patient has the right to considerate and immediate care.
b. The patient has the right to have an advance directive concerning power of attorney for business decisions.
c. The patient has the right to review the records of themselves and their family members.
d. The patient has the right to high quality hospital care; a clean, safe environment; and involvement in their own care.
D: The Bill of Rights was developed to assure that the health care system would be fair and meet patient needs. It provided patients with a guide to addressing problems with their care and encouraged them to participate in staying healthy or getting well. In 2003, The American Hospital Association replaced the Bill of Rights with the Patient Care Partnership. This booklet informs patients of what to expect during their hospital stay. It discusses their right to high quality hospital care; a clean, safe environment; involvement in their own care; protection of their privacy; help when leaving the hospital; and help with billing claims. PATIENT RIGHTS
A student nurse asks a nurse educator about the origins of nursing practice. The nurse educator would most likely respond that nursing practice:
a. evolved from Florence Nightingale’s work in the Korean War.
b. has been strongly influenced by religion and tradition.
c. evolved from meeting the needs of society.
d. has been influenced by a concern for the welfare of society and the needs of individual providers.
C: Nursing practice has evolved from a variety of influences and experiences such as the needs of society (to help provide health-related care for the sick) and has been greatly influenced by religions and women (not tradition). While the seminal work of Florence Nightingale had a major impact upon the profession, it was her initial work in the Crimean War (not Korean) that stimulated substantial changes in the way the sick and injured were cared for. A concern for the welfare of others as a group or as individuals (not providers) has also contributed to the foundations of nursing practice. HISTORICAL AND PHILOSOPHICAL INFLUENCES ON NURSING PRACTICE
Nurses who clarify their values based on the three-step process espoused by Raths, Harmin, and Simon (1978) will be involved in which of the following?
a. Choosing, acting, and evaluating c. Assessing, choosing, and acting
b. Choosing, prizing, and acting d. Assessing, acting, and prizing
B: The three-step process espoused by Raths, Harmin, and Simon (1978) in their classic work Values and Teaching is choosing (beliefs that are chosen freely without coercion), prizing (beliefs that are chosen are cherished), and acting (chosen beliefs are demonstrated consistently through behavior). VALUES CLARIFICATION
A group of nursing students in a class on nursing ethics begin to share their personal beliefs about truth and ideals. These personal beliefs are examples of the student’s:
a. relativism. c. morals.
b. teleology. d. values.
D: Values are personal beliefs concerning the truth of ideals, standards, principles, objects, and behaviors that give meaning and direction to one’s life. Teleology maintains that people must take the course of action that leads to good outcomes, and relativism concerns the belief system that there is no set of universal ethical standards. Morals, or morality, relates to behaviors according to certain customs or traditions and usually reflects one’s personal or religious beliefs. VALUES AND VALUES CLARIFICATION
During an ethics class, students discuss the fact that questions such as “Is it right?”, “Is it fair?”, and “Who gets hurt?” would be components of which of the following?
a. Ethical principles c. Ethics test
b. Values clarification d. Patient rights
C: These questions are all part of an ethics test administered at the Center for Business Ethics at Bentley College (Bowditch and Buono, 1997). Decision makers are taught to ask themselves these questions when making decisions. AN ETHICS TEST
A family member asks a nurse why the cost of health care is so high. The nurse would be correct in responding that some significant contributing factors may be related to which of the following?
a. Cost containment and the nursing shortage
b. HMOs and Medicare
c. Ethical dilemmas and expensive procedures
d. Cost containment and technology
D: Two factors that have contributed to increased costs in health care are cost containment (such as set fees for services as seen in Medicare, Medicaid, and HMOs) and the use of sophisticated technology and treatment procedures (e.g., ICU equipment, robotics, and prosthetics). While the nursing shortage is a serious concern, it does not necessarily significantly impact the increased costs of health care. COST CONTAINMENT AND ISSUES RELATED TO TECHNOLOGY
A nurse manager is employing strategies to enhance the development of an ethical and socially responsible workplace environment, such as:
a. written organizational codes of conduct and communication reinforcing ethical behaviors according to the tort law.
b. training programs in ethics and encouraging confrontation and arguments related to ethical deviation.
c. written organizational codes of conduct and leadership by default.
d. ethics hotline and training programs in social constructs.
B: Some strategies and programs that enhance the development of an ethical and socially responsible workplace are training programs in ethics and social responsibility (not social constructs), encouraging confrontation related to ethical deviations, widespread communication reinforcing ethical behaviors (has nothing to do with tort law), leadership by example (not default), and formal mechanisms for monitoring ethics (i.e., ethics hotlines, ethics programs). CREATING AN ETHICAL WORKPLACE
The 2006 annual Gallup Poll on professional honesty and ethical standards stated that:
a. nurses, pharmacists, and elementary school teachers were ranked highest.
b. clergy and nurses were ranked in the middle.
c. nurses were ranked number one.
d. policemen and clergy were ranked highest.
C: According to the 2006 annual Gallup Poll results on the perceptions of professional honesty and ethical standards, nurses were rated to have high ethical ratings (84%). Of the 21 categories polled, other professions listed in the high percentile were pharmacists (73%), veterinarians (71%), doctors (69%), dentist (62%), and engineers (61%). NURSE-PHYSICIAN RELATIONSHIP
You are working in the Labor and Delivery Department. One of your patients is ready to deliver and is being rushed to the delivery room. The patient’s regular physician is not available so another doctor will be doing the delivery. You ask the doctor if the patient’s husband can come into the delivery room. The doctor immediately asks whether the patient is a private patient or on public assistance. Stunned by the question, you respond that the patient is on public assistance. The doctor then tells you that the husband cannot go into the delivery room. Which ethical principle has been violated
a. Justice c. Beneficence
b. Fidelity d. Nonmaleficence
A: Justice is the principle of fairness that is served when an individual is given that which he is due, owed, deserves, or can legitimately claim. All patients must be treated fairly, regardless of economic or social background. The patient and her husband are being treated unfairly because they are recipients of public assistance. TABLE 24-2 ETHICAL PRINCIPLES
Today is the first day of your leadership clinical. You are assigned to work with one of the nurse managers. After receiving report, you decide to do a room check, greeting each patient with the name he prefers to be called. You introduce yourself to each patient and ask if there is anything she needs. You are practicing which ethical principle?
a. Justice c. Nonmaleficence
b. Beneficence d. Autonomy
B: Beneficence is the duty to do good to others and to maintain a balance between benefits and harms. This principle is practiced when you provide all patients, including the terminally ill, with caring attention; treat every patient with respect and courtesy; and become familiar with your local, state, and governmental laws regarding organ donations. By greeting each patient with the name he prefers to be called, you are demonstrating respect. By asking whether she needs anything, you are providing caring attention. TABLE 24-2 ETHICAL PRINCIPLES
A patient approaches you as you are about to leave to attend a mandatory. The patient asks if you would be able to answer some questions about his medication. You politely tell the patient that you have to attend a mandatory meeting and promise to talk with him when you return in an hour. Once you return from the meeting, you complete your assigned nursing care, chart on the patients, and leave for home. While watching your favorite TV program that evening, you remember that you never returned to discuss the medications with the patient who had approached you that morning. Which ethical principle have you violated?
a. Autonomy c. Veracity
b. Fidelity d. Justice
B: Fidelity is the principle of promise keeping, or the duty to keep one’s promise or word. While you were not lying to the patient and had all intentions of talking with him, you failed to keep your promise. TABLE 24-2 ETHICAL PRINCIPLES
You are passing medications on a mental health unit. One of the patients refuses to take her morning medications stating, “That medicine makes me feel weird.” You see the patient’s breakfast tray and question the charge nurse on whether it would be wrong for you to crush the medication and mix it into the patient’s applesauce without the patient’s knowledge. Which ethical principle would you be violating?
a. Autonomy c. Fidelity
b. Beneficence d. Veracity
A: Patients have the right to refuse to take their medications. By mixing the medication with the patient’s applesauce, you would be violating the patient’s right to autonomy. Autonomy involves respect for an individual’s right to self-determination and respect for individual liberty.
TABLE 24-2 ETHICAL PRINCIPLES