Foundations - Chapter 3: Ethical Responsibilities PDF

CHAPTER 3 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT ETHICAL DILEMMAS SECTION: MANAGEMENT OF CARE Ethical dilemmas are problems that involve more than Ethica...

CHAPTER 3 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT ETHICAL DILEMMAS SECTION: MANAGEMENT OF CARE Ethical dilemmas are problems that involve more than Ethical one choice and stem from differences in the values and CHAPTER 3 beliefs of the decision makers. These are common in Responsibilities health care, and nurses must apply ethical theory and decision‑making to ethical problems. A problem is an ethical dilemma when: ◯ A review of scientific data is not enough to solve it. Ethics is the study of conduct and character, and ◯ It involves a conflict between two moral imperatives. a code of ethics is a guide for the expectations ◯ The answer will have a profound effect on the and standards of a profession. situation and the client. Ethical theories examine principles, ideas, systems, and philosophies that affect judgments ETHICAL DECISION‑MAKING about what is right and wrong, and good and Ethical decision‑making is a process that requires striking bad. Common ethical theories are utilitarianism, a balance between science and morality. deontology, consensus in bioethics, and ethics of care. When making an ethical decision: Identify whether the issue is indeed an ethical dilemma. Ethical principles for individuals, groups of Gather as much relevant information as possible about individuals, and societies are standards of what the dilemma. is right or wrong with regard to important social Reflect on your own values as they relate to values and norms. the dilemma. State the ethical dilemma, including all surrounding Values are personal beliefs about ideas that issues and the individuals it involves. determine standards that shape behavior. List and analyze all possible options for resolving the dilemma, and review the implications of each option. Morals are personal values and beliefs about Select the option that is in concert with the ethical behavior and decision‑making. principle that applies to this situation, the decision maker’s values and beliefs, and the profession’s values for client care. Justify selecting that one option in light ETHICAL DECISION‑MAKING IN NURSING of the relevant variables. Apply this decision to the dilemma, and evaluate Bioethics refers to the application of ethics to health and the outcomes. life. It addresses dilemmas (stem cell research, organ transplantation, gender reassignment, and reproductive Ethics committeesgenerally address unusual or complex technologies [in vitro fertilization, surrogate parenting]). ethical issues. Other ethical dilemmas include abortion and acquired Examples of ethical guidelinesfor nurses are the immunodeficiency syndrome. American Nurses Association’s Code of Ethics for Nurses With Interpretive Statements (2015) and the International Council BASIC PRINCIPLES OF ETHICS of Nurses’ The ICN Code of Ethics for Nurses (2012). Advocacy: support and defend clients’ health, wellness, Moral distressoccurs when the nurse is placed in a safety, wishes, and personal rights, including privacy. difficult situation where the actions taken are different Responsibility: willingness to respect obligations and from what the nurse feels is ethically correct. follow through on promises. Accountability: ability to answer for one’s own actions. Confidentiality: protection of privacy without 3.1 Nursing’sroles in ethical diminishing access to high‑quality care. decision‑making An agent for clients facing an ethical decision. Examples: ETHICAL PRINCIPLES FOR CLIENT CARE Caring for an adolescent client who has to Autonomy: the right to make one’s own personal decide whether to undergo an abortion even though her parents believe it is wrong decisions, even when those decisions might not be in Discussing options with a parent who has to decide that person’s own best interest. whether to consent to a blood transfusion for a Beneficence: action that promotes good for others, child when his religion prohibits such treatment without any self‑interest. A decision maker for health care delivery. Examples: Fidelity: fulfillment of promises. Assigning staff nurses a higher client load than previously because administration has Justice: fairness in care delivery and use of resources. reduced the number of nurses per shift Nonmaleficence: a commitment to do no harm. Witnessing a surgeon discussing only surgical options with Veracity: a commitment to tell the truth. a client without mentioning more conservative measures FUNDAMENTALS FOR NURSING CHAPTER 3 Ethical Responsibilities 11  Application Exercises Active Learning Scenario 1. A nurse is caring for a client who decides not to A nurse is teaching a group of newly licensed nurses about have surgery despite significant blockages of the process of resolving ethical dilemmas. Use the ATI Active the coronary arteries. The nurse understands Learning Template: Basic Concept to complete this item. that this client’s choice is an example of UNDERLYING PRINCIPLES: Define the which of the following ethical principles? ethical decision‑making process. A. Fidelity NURSING INTERVENTIONS: List the steps B. Autonomy of making an ethical decision. C. Justice D. Nonmaleficence 2. A nurse offers pain medication to a client who is postoperative prior to ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Beneficence 3. A nurse is instructing a group of newly licensed nurses about the responsibilities organ donation and procurement involve. When the nurse explains that all clients waiting for a kidney transplant have to meet the same qualifications, the newly licensed nurses should understand that this aspect of care delivery is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence 4. A nurse questions a medication prescription as too extreme in light of the client’s advanced age and unstable status. The nurse understands that this action is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence 5. A nurse is instructing a group of newly licensed nurses about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the newly licensed nurses identify as an ethical dilemma? A. A nurse on a medical‑surgical unit demonstrates signs of chemical impairment. B. A nurse overhears another nurse telling an older adult client that if he doesn’t stay in bed, she will have to apply restraints. C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill. D. A client who is terminally ill hesitates to name their partner on their durable power of attorney form. 12 CHAPTER 3 Ethical Responsibilities CONTENT MASTERY SERIES  Application Exercises Key 1. A. Fidelity is the fulfillment of promises. The nurse has not 3. A. Fidelity is the fulfillment of promises. Because donor made any promises; this is the client’s decision. organs are a scarce resource compared with the numbers B. CORRECT: In this situation, the client is exercising of potential recipients who need them, no one can promise their right to make their own personal decision about anyone an organ. Thus, this principle does not apply. surgery, regardless of others’ opinions of what is B. Autonomy is the right to make personal decisions, “best” for them. This is an example of autonomy. even when they are not necessarily in the person’s C. Justice is fairness in care delivery and in the use best interest. No personal decision is involved of resources. Because the client has chosen not with the qualifications for organ recipients. to use them, this principle does not apply. C. CORRECT: Justice is fairness in care delivery and in the D. Nonmaleficence is a commitment to do no harm. use of resources. By applying the same qualifications to all In this situation, harm can occur whether or not potential kidney transplant recipients, organ procurement the client has surgery. However, because they organizations demonstrate this ethical principle in choose not to, this principle does not apply. determining the allocation of these scarce resources. NCLEX® Connection: Management of Care, Ethical Practice D. Nonmaleficence is a commitment to do no harm. In this situation, harm can occur to organ donors and to recipients. The requirements of the organ 2. A. Fidelity is the fulfillment of promises. Unless the nurse has procurement organizations are standard procedures specifically promised the client a pain‑free recovery, which and do not address avoidance of harm or injury. is unlikely, this principle does not apply to this action. NCLEX® Connection: Management of Care, Ethical Practice B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. In this situation, the nurse is delivering 4. A. Fidelity is the fulfillment of promises. The nurse is not responsible client care. This principle does not apply. addressing a specific promise when they determine C. Justice is fairness in care delivery and in the use of the appropriateness of a prescription for the client. resources. Pain management is available for all clients who Thus, this principle does not apply. are postoperative, so this principle does not apply. B. Autonomy is the right to make personal decisions, D. CORRECT: Beneficence is action that promotes good even when they are not necessarily in the person’s for others, without any self‑interest. By administering best interest. No personal decision is involved when pain medication before the client attempts a potentially the nurse questions the client’s prescription. painful exercise like ambulation, the nurse is taking a C. Justice is fairness in care delivery and in the use of specific and positive action to help the client. resources. In this situation, the nurse is delivering NCLEX® Connection: Management of Care, Ethical Practice responsible client care and is not assessing available resources. This principle does not apply. D. CORRECT: Nonmaleficence is a commitment to do no harm. In this situation, administering the medication could harm the client. By questioning it, the nurse is demonstrating this ethical principle. NCLEX® Connection: Management of Care, Ethical Practice 5. A Delivering client care while showing signs of a substance use disorder is a legal issue, not an ethical dilemma. B. A nurse who threatens to restrain a client has committed assault. This is a legal issue, not an ethical dilemma. C. CORRECT: Making the decision about initiating enteral tube feedings is an example of an ethical dilemma. A review of scientific data cannot resolve the issue, and it is not easy to resolve. The decision will have a profound effect on the situation and on the client. D. The selection of a person to make health care decisions on a client’s behalf is a legal decision, not an ethical dilemma. NCLEX® Connection: Management of Care, Ethical Practice Active Learning Scenario Key Using the Active Learning Template: Basic Concept UNDERLYING PRINCIPLES: Ethical decision-making is a process that requires striking a balance between science and morality. NURSING INTERVENTIONS Identifying whether the issue is an ethical dilemma Gathering as much relevant information as possible about the dilemma Reflecting on one’s own values as they relate to the dilemma Stating the ethical dilemma, including all surrounding issues and individuals it involves Listing and analyzing all possible options for resolving the dilemma with implications of each option Selecting the option that is in concert with the ethical principle that applies to this situation, the decision maker’s values and beliefs, and the profession’s values for client care Justifying the selection of one option in light of relevant variables NCLEX® Connection: Management of Care, Ethical Practice FUNDAMENTALS FOR NURSING CHAPTER 3 Ethical Responsibilities 13