Deck 14: Ethics in Professional Nursing Practice

Question 1

Think about the ethical theories and approaches in this section and the moral conflicts you have experienced in the past. Have you used one of these approaches to resolve a conflict? Which theory or approach have you used?

Answer 1

In the past, I have experienced moral conflicts that have required me to consider different ethical theories and approaches in order to resolve them. One particular conflict that stands out to me is a situation where I had to decide whether to report a coworker for unethical behavior. I found myself torn between the duty to uphold professional standards and the loyalty I felt towards my colleague.

In this situation, I found myself leaning towards a deontological approach, specifically Kantian ethics, which emphasizes the importance of following moral duties and principles. I felt a sense of duty to report the unethical behavior, as it was in line with my professional responsibilities and the ethical standards of the organization. However, I also considered the potential consequences of my actions and the impact it would have on my relationship with my coworker.

Ultimately, I decided to approach the situation from a virtue ethics perspective, considering the character traits and virtues that I wanted to embody. I realized that by reporting the unethical behavior, I was demonstrating integrity and a commitment to upholding ethical standards, which aligned with my personal values.

Reflecting on this experience, I can see how I used a combination of ethical theories and approaches to navigate the moral conflict. I considered the principles of deontological ethics, the consequences of my actions, and the virtues I wanted to embody in making my decision. This experience has taught me the importance of considering different ethical perspectives and approaches when faced with moral conflicts.

Question 2

Has there ever been a time when you have experienced the dilemma of having to make a choice that you know will affect the well-being of another individual? Have you ever experienced moral suffering?

Answer 2

Yes, there have been times when I have experienced the dilemma of having to make a choice that I knew would affect the well-being of another individual. It's never an easy situation to be in, and it often leads to moral suffering. One specific instance that comes to mind is when I had to decide whether to report a coworker for unethical behavior. I knew that by reporting them, it could potentially harm their career and reputation, but I also knew that not reporting them could harm the company and potentially put others at risk. It was a difficult decision to make, and I definitely experienced moral suffering as I grappled with the consequences of my choice. Ultimately, I chose to report the behavior, but it was a decision that weighed heavily on me for a long time. It's never easy to make choices that affect others, especially when it involves moral implications.

Question 3

New nurses have not necessarily developed their own professional boundaries when they begin practice. They may violate a boundary without even knowing they crossed it (Maes, 2003).
What signs might alert you to a potential professional boundary violation or crossing?

Answer 3

There are several signs that might alert you to a potential professional boundary violation or crossing by a new nurse. These signs include:

1. Overstepping personal boundaries: If a new nurse is overly familiar with patients or colleagues, shares personal information inappropriately, or becomes too emotionally involved with patients, it could be a sign of a boundary violation.

2. Lack of respect for privacy: If a new nurse fails to maintain patient confidentiality, shares sensitive information with unauthorized individuals, or accesses patient records without a legitimate reason, it could indicate a boundary crossing.

3. Dual relationships: If a new nurse engages in dual relationships with patients, such as socializing outside of work or accepting gifts, it could be a sign of blurred professional boundaries.

4. Poor communication: If a new nurse struggles to maintain professional communication with patients and colleagues, or if they have difficulty setting appropriate limits and saying no to requests that fall outside of their professional role, it could indicate a boundary issue.

5. Boundary testing: If a new nurse consistently pushes the limits of their professional role, seeks special treatment from patients or colleagues, or disregards policies and procedures, it could be a sign of boundary testing or violation.

It's important for experienced nurses and supervisors to be vigilant for these signs and provide guidance and support to new nurses as they navigate the development of their professional boundaries. Education, mentorship, and open communication can help new nurses understand and uphold the ethical and professional standards expected in their practice.

Question 4

Think about the questions posed in this section in relation to the distribution of scarce healthcare resources using Rawls's veil of ignorance. Then answer the same questions taking your own circumstances into account. Do you come up with the same answers to the questions? Explain your rationale.

Question 5

If the nurse knows of a plan for rational suicide, would the nurse be obligated to intervene? If so, what actions could the nurse take at this point? Does a nurse have the right to try to stop a person from committing rational suicide (to act in the best interest of the patient)? Is a nurse supposed to support the person's autonomous decision to commit rational suicide, even when that decision is morally and religiously incompatible with the nurse's perspective?

Question 6

A patient who is scheduled for knee joint replacement in the morning consented to the surgery after the conference with the surgeon who explained the risks and benefits of the procedure. The patient's right to either authorize or refuse the procedure is an example of which of the following principles?

A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice

Question 7

Which action demonstrates the concept of nonmaleficence?

A) The nurse phones the physician after the patient reports lack of understanding about an upcoming procedure.
B) The nurse administers medication to a patient after performing the five rights of medication administration.
C) The nurse stays with the patient to provide comfort until the patient's family arrives.
D) None of these is correct.

Question 8

In the analysis of a clinical ethical case, the nurse should judge respect for autonomy by asking which of the following questions?

A) Is the patient mentally capable and legally competent?
B) What is the patient stating about preferences for treatment?
C) Is the patient unwilling or unable to cooperate with medical treatment?
D) All of these are correct.
E) None of these is correct.

Question 9

Which of the following reflects the principles of beneficence and nonmaleficence in the analysis of a clinical ethics case?

A) What are the prospects, with or without treatment, for a return to normal life?
B) What physical, mental, and social deficits is the patient likely to experience if treatment succeeds?
C) Is the patient mentally capable and legally competent?
D) What physical, mental, and social deficits is the patient likely to experience if treatment succeeds, and is the patient mentally capable and legally competent?
E) What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits is the patient likely to experience if treatment succeeds?

Question 10

What concept is included in the approach to ethical decision making known as ethical principlism?

A) Autonomy
B) Justice
C) Integrity
D) Autonomy and integrity
E) Justice and autonomy

Question 11

Which behavior reflects the themes in the Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2015)?

A) The nurse phones the physician when the patient states that he does not understand the possible risks of a scheduled procedure.
B) The nurse convinces the patient to go through with a procedure because it is what is best for him.
C) The nurse petitions for free health care for the poor.
D) All of these are correct.

Question 12

Which of the following is a fundamental responsibility of nurses according to the International Council of Nurses?

A) Health promotion
B) Illness prevention
C) Health restoration
D) Alleviation of suffering
E) All of these are correct.

Question 13

During a disaster, a nurse triages rapidly using scarce resources to provide care to the greatest number of people rather than expending resources on a single critically injured person who is unlikely to survive. This type of care is based on which ethical approach?

A) Deontology
B) Utilitarianism
C) Ethic of care
D) Virtue ethics
E) Natural law theory

Question 14

A nurse lies to a patient about the side effects of the medication that she administers to the patient because the patient has stated that she does not want to take anything that might cause her to become drowsy. This action is a violation of the deontological approach because of which of the following reasons?

A) No action can be judged as right if the action does not have the potential to be a universal law.
B) It does not promote the good for the greatest number of people.
C) Lying is morally wrong based on the laws of nature.
D) All of these are correct.
E) None of these is correct.

Question 15

Which question reflects the principles of loyalty and fairness in the analysis of a clinical ethics case?

A) Is the patient's right to choose being respected?
B) Are there problems of allocation of resources?
C) Is there any conflict of interest on the part of the providers or the institution?
D) Is the patient's right to choose being respected, and is there any conflict of interest on the part of the providers or the institution?
E) Are there problems of allocation of resources, and is there any conflict of interest on the part of the providers or the institution?

Question 16

A nurse caring for a patient who is terminally ill and has intractable pain administered pain medication to the patient, a high dose but within the ordered parameters. The patient expired a short time after the medication administration. Which option identifies this situation?

A) Terminal sedation
B) Rule of double effect
C) Active euthanasia
D) Passive euthanasia
E) None of these is correct.

Question 17

A patient is no longer able to make competent decisions. The daughter of the patient talked with the physician about treatment options and chose a treatment based on what the patient had verbalized to the daughter while she was still competent. This type of surrogate decision making is:

A) substituted judgment.
B) pure autonomy standard.
C) best interest standard.
D) traditional standard.
E) None of these is correct.

Question 18

Which of the following is an example of potential boundary violations in the nurse-patient relationship?

A) Acceptance of a gift
B) Neglect
C) Intimacy
D) All of these are correct.
E) None of these is correct.

Question 19

Which of the following options is included as guidelines by the Oregon Nurses Association that relate to the Death with Dignity Act?

A) The nurse is responsible for maintaining support, comfort, and confidentiality.
B) The nurse should administer the medication to end the patient's life.
C) The nurse should discuss end-of-life options with the patient and family.
D) The nurse is responsible for maintaining support, comfort, and confidentiality, and should administer the medication to end the patient's life.
E) The nurse is responsible for maintaining support, comfort, and confidentiality, and the nurse should discuss end-of-life options with the patient and family.

Question 20

The nurse recognizes that patients at the point of care have no option but to rely on nurses. Which of the following best reflects this phenomenon?

A) Required reliance
B) Unavoidable trust
C) Confident dependence
D) Unsupported faith
E) None of these is correct.

Question 21

As the nurse educates families regarding organ donation and transplantation, it is important to consider issues related to organ transplantation. Which of the following is a potential ethical issue related to organ transplantation?

A) Moral acceptability of transplanting an organ from one person to another
B) Organ procurement
C) Allocation of the organs
D) All of these are correct.
E) None of these is correct.

Question 22

Which statement is characteristic of a person who is contemplating rational suicide?

A) The person has made a reasoned choice that seems to make sense to others.
B) The person has an unrealistic assessment of life circumstances.
C) The person is free from severe emotional distress.
D) The person has made a reasoned choice that seems to make sense to others, and the person has an unrealistic assessment of life circumstances.
E) The person has made a reasoned choice that seems to make sense to others, and the person is free from severe emotional distress.

Question 23

Which of the following would be a reason why a physician initiates a do-not-resuscitate order?

A) There is no medical benefit that can come from CPR.
B) The person had a very poor quality of life before CPR.
C) The person's life after CPR is anticipated to be very poor.
D) All of these are correct.
E) None of these is correct.

Question 24

The nurse should educate patients regarding advance directives. Which of the following is a type of advance directive?

A) Living will
B) Residing advocate
C) Power of attorney
D) Power of attorney and residing advocate
E) Living will and power of attorney

Question 25

Which concept guides organ allocation?

A) Justice
B) Medical utility
C) Economic value
D) Economic value and medical utility
E) Justice and medical utility