FUNDAMENTALS OF NURSING EVOLVE CHAPTER 21 Ethics and Values
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Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:
A. American Nurses Association's (ANA’s) Code of Ethics
B. Nurse Practice Act (NPA) written by stat -
a. This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting.
b. The NPA gives a broad overview of what are appropriate and inappropriate roles of the RN. These rules and regulation are backed by legislative penalties if broken. Following the rules is the basis for licensure for the RN. There are standards of care implied within this act, but specific ethical principles are not discussed.
c. Standards of care, written by field experts, are just guidelines that direct the usual pathway of client management within certain circumstances. Ethical principles are not specifically listed as guidelines. Broad concepts are introduced in most standards of care.
d. The Good Samaritan law deals with the inability of a person to sue a person that stops in "good faith" to try to assist an individual in an accident. However, the professional is held to a higher standard than a layperson when someone does stop to help during an accident. This law has nothing to do with professional issues or standards in the professional setting. -
When describing ethical issues, which statement is correct?
A. Fidelity refers to fairness as equal distribution or random distribution without regard to individual value.
B. Justice is agreement to follow through on a promise that is stated -
c. Beneficence is looking at all aspects of care or management and working with the "good" outcomes despite immediate problems. The temporary pain of an immunization in a child is outweighed by the beneficence (good) in the larger outcome of preventing the disease.
a and b. Both of those statements have reversed the definitions of each concept. Justice is related to fairness and fidelity is related to telling the truth and following one's promises.
d. Maleficence is doing harm or giving hurt. Nonmaleficence is the avoidance of harm or hurt -
Within the professional guidelines for ethical behavior, where the nurse is accountable and responsible, the Health Information Portability and Accountability Act (HIPAA) guidelines support:
A. Privacy of all health care issues
B. The public -
a. HIPAA guides the privacy information transfer. The law requires written consent to copy and transfer parts of the medical record to other facilities or individuals that are requesting information.
b. Public records are open to everyone who will research material that is deemed as public access. Medical records are not public records, which do not fall under the HIPAA guidelines.
c. Information distribution has nothing to do with discrimination or bias, including any bias that might be based upon financial status.
d. Privacy of information again is not based upon age or special needs of the aging population, but the choice of the client to give or withhold permission for distribution of specific medical information -
Which of the following would be an example of a violation of HIPAA laws?
A. Staff calling out a client's name in the waiting room of the physician's office
B. Nurses discussing a client over dinner at the hospital cafeteria
C. Printing -
b. This is a violation of HIPAA guidelines. No information is to be discussed in public for whatever reason. Discussions between nurses in giving and sharing information at report is done behind closed doors and without any attempt to share information as "gossip" when the information is not needed for management of care.
a. This is not a violation. No specific information is given about the condition or reason for the appointment, only that the person is there for a visit.
c. This is not a violation. New copying guidelines require the client's permission to copy information for other referrals and to give access to some insurance companies that might need the information in health care management of this specific issue at this specific time. Not all insurance companies will have access to general knowledge as public information without the consent of the client.
d. This is not a violation. The physician and/or health care team have a right to discuss and plan care for an individual who is under their care. Again, these persons are only those who are assigned to the current health problems and not just anyone who might be nosy. -
A bioethical issue should be described as:
A. The physician's making all decisions of client management without getting input from the client
B. A research project that included treating all the white men and not treating all the black men t - b. The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in the white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early in the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed
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To distinguish an ethical problem from other types of problems encountered, the nurse should be aware that in an ethical problem the:
A. Answer is easily solved but is not the popular one within today's society
B. Professional literature rev - d. Characteristics of an ethical problem include a lack of a logical conclusion, the lack of scientific support for either choice or support for both choices, differences in valuing by staff and client that might result in harm or less than best options, and the answer will include several areas of human concern (no matter what choices are taken, there will be problems).
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After scientific research of the literature and validation that the issue is a dilemma, to solve the dilemma the nurse should next:
A. Do a values clarification
B. Verbalize the problem
C. Negotiate options or outcomes
D. Seek su -
a. In the sequencing of steps to solve the dilemma, once the issue is identified, the nurse should look to see what issues contribute to the dilemma. Asking oneself about one's own values helps to remove the hidden bias in the situation and allows the nurse to look at the situation in a more "neutral position."
b. Verbalization of the problem follows values clarification and is not the next step after identification of the issue. Once the nurse reviews his or her own bias, then confidence can be based upon this "neutral" approach to solving the dilemma.
c. Negotiation of options is the next to the last step in the process.
d. Family input should be a small part of the second step during the information-gathering process, so all relevant facts can be reviewed together. Not involving or getting this input to the solution earlier in the process can result in the lack of satisfaction with the solution of the problem and it may not be in the client's best interests. -
Utilitarian allocation of scarce resources would be described as the:
A. Choosing of who gets what when there is not enough to go around
B. Designation of resources for the greater good of the larger group
C. Distribution of goods base - b. Utilitarian decision making is based upon the theory that the outcome is the emphasis of the action. Therefore the greater good would be more important for the majority rather than focusing upon the smaller group that did not benefit
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When the nurse described the client as " that nasty old man in 354," the nurse is exhibiting which ethical dilemma?
A. Gender bias and ageism
B. HIPAA violation
C. Beneficence
D. Code of ethics violation -
. Stereotyping an "old man" as "nasty"is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client.
b. No names or diagnosis were mentioned to violate the privacy laws.
3. Beneficence refers to taking a positive action to help others. These comments would not be considered positive in nature when describing the client.
4. No ethical violation was noted except the bias stated against the client. The nurse did not say she would not take care of the client or would do him harm. This might be considered slanderous if damages could be proven in a court of law. -
The distribution of nurses to areas of "most need" in the time of a nursing shortage is an example of:
A. Utilitarianism theory
B. Deontological theory
C. Justice
D. Beneficence - c. Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.