1. Values, Ethics, and Advocacy

2. 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.
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3. 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.
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5. 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.
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6. 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.
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7. 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.
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8. 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.
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9. 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?”
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10. 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.
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11. 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.
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12. 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.
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13. Factors Influencing Moral Decisions
Cognitive development
Values
Moral framework
Codes of ethics
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14. Cognitive Development
Moral decisions require persons to think and reason
Reasoning is a cognitive function
Ability to make decisions develops over the lifespan
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15. 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
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16. 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
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18. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. Moral Frameworks
Utilitarianism – views a good act as one that brings the most good and the least harm for the greatest number of people
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26. 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
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27. 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
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28. Moral Issues Arouse conscience
Concerned with important values and norms evoke words such as good, bad, wrong, should and ought
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29. 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
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30. Major Moral Principles
Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Veracity
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31. 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
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32. Nonmaleficence Duty to do no harm
Harm may intentional or nonintentional
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33. Moral Principles Beneficence = doing good Justice = fairness
Fidelity = faithful to agreements and promises
Veracity = telling the truth
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34. 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
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35. 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
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36. 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
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37. 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
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38. 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
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39. 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).
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40. 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
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42. 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
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43. 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
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