Values, Ethics, and Advocacy

Question 1 When an ethical issue arises, one of the most important nursing responsibilities in managing client care situations is which of the following? Be able to defend the morality of one’s own actions. Remain neutral and detached when making ethical decisions. Ensure that a team is responsible for deciding ethical questions. Follow the client and family wishes exactly. Copyright 2008 by Pearson Education, Inc.

Rationales 1 Correct. A nurse’s actions in an ethical dilemma must be defensible according to moral and ethical standards. The nurse may have strong personal beliefs but distancing oneself from the situation does not serve the client. A team is not always required to reach decisions. The nurse is not obligated to follow the client’s wishes automatically when they may have negative consequences for self or others. Copyright 2008 by Pearson Education, Inc.

Question 2 Which of the following situations is most clearly a violation of the underlying principles associated with professional nursing ethics? The hospital policy permits use of internal fetal monitoring during labor. However, there is literature to both support and refute the value of this practice. When asked about the purpose of a medication, a nurse colleague responds, “Oh, I never look them up. I just give what is prescribed orders.” The nurses on the unit agree to sponsor a fund-raising event to support a labor strike proposed by fellow nurses at another facility. A client reports that he didn’t quite tell the doctor the truth when asked if he was following his therapeutic diet at home. Copyright 2008 by Pearson Education, Inc.

Rationales 2 Many medical practices are controversial but not necessarily unethical. The nurse should follow agency policy. Correct. The nurse has an ethical responsibility to act only when actions are safe or risks minimized. This nurse is putting the client at unnecessary risk for medication error. Although some may view nurses’ strikes as unethical, supporting others who are striking is a personal decision. Although a client’s statement in confidence to a nurse may have ethical overtones, it does not automatically constitute an ethical dilemma. Since the nurse is a member of the health care team, principles of confidentiality do not include this nurse. Copyright 2008 by Pearson Education, Inc.

Question 3 Following a motor vehicle crash, the parents refuse to permit withdrawal of life support from the child with no apparent brain function. Although the nurse believes the child should be allowed to die and organ donation considered, the nurse supports their decision. Which moral principle provides the best basis for the nurse’s actions? Respect for autonomy. Nonmaleficence. Beneficence. Justice. Copyright 2008 by Pearson Education, Inc.

Rationales 3 Correct. Autonomy is the client’s (or surrogate’s) right to make his or her own decision. This is not a “do no harm” situation. This is not a “do good” situation. Justice generally applies when the rights of one client are being balanced against those of another client. Copyright 2008 by Pearson Education, Inc.

Question 4 Which of the following statements by the nurse would be most helpful when a nurse is assisting clients in clarifying their values? “That was not a good decision. Why did you think it would work?” “The most important thing is to follow the plan of care. Did you follow all your doctor’s orders?” “Some people might have made a different decision. What led you to make your decision?” “If you had asked me, I would have given you my opinion about what to do. Now how do you feel about your choice?” Copyright 2008 by Pearson Education, Inc.

Rationales 4 Incorrect. This is a judgmental statement. Correct. In values clarification, clients are assisted to think about the factors that influence their beliefs and decisions. Copyright 2008 by Pearson Education, Inc.

Question 5 After recovering from her hip replacement, an elderly client wants to go home. The family wants the client to go to a nursing home. If the nurse is acting as a client advocate, the nurse would perform the following: Informs the family that the client has a right to decide on her own. Ask the primary care provider to discharge the client to home. Suggest the client hire a lawyer to protect her rights. Help the client and family communicate their views to each other. Copyright 2008 by Pearson Education, Inc.

Rationales 5 Informing the family is an intervention without assessment. If the primary care provider sends the client home, the nurse has not acted to assist in resolving or reducing the conflict. If the nurse assists in resolving or reducing the conflict, an attorney may not be needed. Legal action should be a last resort. Correct. A major role of the client advocate is to mediate between conflicting parties. Copyright 2008 by Pearson Education, Inc.

Factors Influencing Moral Decisions Cognitive development Values Moral framework Codes of ethics Copyright 2008 by Pearson Education, Inc.

Cognitive Development Moral decisions require persons to think and reason Reasoning is a cognitive function Ability to make decisions develops over the lifespan Copyright 2008 by Pearson Education, Inc.

Values Enduring beliefs or attitudes about the worth of a person, object, idea, or action May be unspoken or even subconscious Underlie all moral dilemmas Influence decisions and actions including nurses’ ethical decision making Copyright 2008 by Pearson Education, Inc.

Moral Development Process of learning difference between right and wrong Begins in childhood and continues throughout life Moral development theories provide frameworks to view and clarify moral and ethical dilemmas Copyright 2008 by Pearson Education, Inc.

Values Beliefs Attitudes Interpretations or conclusions that people accept as true Based on faith Lasts only briefly Mental positions or feelings toward a person, object, or idea Lasts over time Copyright 2008 by Pearson Education, Inc.

Values Clarification Process by which people identify, examine, and develop their own individual values No one set of values if right for everyone Promotes personal growth by fostering awareness, empathy, and insight Copyright 2008 by Pearson Education, Inc.

Values Clarification Choosing (cognitive) – beliefs chosen Prizing (affective) – chosen beliefs prized and cherished Acting (behavioral) – chosen beliefs affirmed to others, incorporated into one’s behavior, and repeated consistently Copyright 2008 by Pearson Education, Inc.

Ethics Method of inquiry that helps people to understand the morality of human behavior Practices or beliefs of a certain group Expected standards of moral behavior of particular group Copyright 2008 by Pearson Education, Inc.

Moral Development Process of learning to tell difference between right and wrong Learning what ought and ought not to be done Complex process that begins in childhood and continues throughout life Copyright 2008 by Pearson Education, Inc.

Moral Frameworks Utilitarianism – views a good act as one that brings the most good and the least harm for the greatest number of people Copyright 2008 by Pearson Education, Inc.

Code of Ethics Formal statement of a group’s ideals and values Serves as a standard for professional actions Provides ethical standards for professional behavior Copyright 2008 by Pearson Education, Inc.

Values Clarification The following steps can help clarify values: List alternatives Examine possible consequences of choices Choose freely Feel good about the choice Affirm the choice Act on the choice Act with a pattern Copyright 2008 by Pearson Education, Inc.

Moral Issues Arouse conscience Concerned with important values and norms evoke words such as good, bad, wrong, should and ought Copyright 2008 by Pearson Education, Inc.

Moral Principles Statements about broad, general, philosophic concepts Provide the foundation for moral rules which are specific prescriptions for actions Useful in ethical discussions May be able to agree on principles that apply May serve as a basis for the solution to the problem Copyright 2008 by Pearson Education, Inc.

Major Moral Principles Autonomy Nonmaleficence Beneficence Justice Fidelity Veracity Copyright 2008 by Pearson Education, Inc.

Autonomy Right to make one’s own decisions Inward autonomy if individuals have the ability to make choices Outward autonomy if choices are not limited or imposed by others Copyright 2008 by Pearson Education, Inc.

Nonmaleficence Duty to do no harm Harm may intentional or nonintentional Copyright 2008 by Pearson Education, Inc.

Moral Principles Beneficence = doing good Justice = fairness Fidelity = faithful to agreements and promises Veracity = telling the truth Copyright 2008 by Pearson Education, Inc.

Professional Codes of Ethics Outline the major ethical considerations of the profession Provide ethical standards for professional behavior Guide the profession in self-regulation Remind nurses of the special responsibility assumed when caring for the sick Copyright 2008 by Pearson Education, Inc.

Purposes of Professional Codes of Ethics To inform the public about the minimum standards of the profession To help the public understand professional nursing conduct To provide a sign of the profession’s commitment to the public Copyright 2008 by Pearson Education, Inc.

Common Ethical Issues Issues in the care of HIV/AIDS clients Abortions Organ transplantation End-of-life decisions Cost-containment issues (resource allocation) Breaches of client confidentiality Copyright 2008 by Pearson Education, Inc.

Enhancing Ethical Decision-making Becoming aware of personal values and ethical aspects of nursing Becoming familiar with nursing code of ethics Seeking continuing education to remain knowledgeable about ethical issues in nursing Copyright 2008 by Pearson Education, Inc.

Enhancing Ethical Decision-making Respecting the values, opinions, and responsibilities of other health care professionals Participating in or establishing ethic rounds Serving on institutional ethics committees Striving for collaborative practice Copyright 2008 by Pearson Education, Inc.

What is an Advocate? Figure 5-2 When there is a need for ethical decisions or client advocacy, many different persons contribute to the final outcome. (A. Ramsey/PhotoEdit). Copyright 2008 by Pearson Education, Inc.

Advocate One who expresses and defends the cause of another Protect clients’ rights Informs clients about their rights Provides information they need to make informed decisions Supports clients in their decisions Intervenes on client’s behalf Copyright 2008 by Pearson Education, Inc.

Values Basic to Advocacy Client is a holistic, autonomous being who has the right to make choices and decisions Clients have the right to expect a nurse-client relationship that is based on shared respect, trust, and collaboration It is the nurse’s responsibility to ensure client has access to health care services that meet health needs Copyright 2008 by Pearson Education, Inc.

Effective Client Advocates Are assertive Recognize the rights and values of clients and families must take precedence when they conflict with those of health care providers Are aware that conflicts may arise over issues Work with community agencies and lay practitioners Know that advocacy may require political action Copyright 2008 by Pearson Education, Inc.