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Fundamentals of Nursing Ethics and values

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What are ethics
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The study of conduct and character. It is concerned with determining what is good or valuable for individuals, for groups of individuals, and for society at large.
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What is autonomy
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The ability or tendency to function independently. When applied to politics or government, it refers to freedom from external control. In health care, it refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence.
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What is beneficence
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Taking positive actions to help others. Implies that the best interests of the patient remain more important than self-interest.
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What is maleficence
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to hard or hurt
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What is nonmaleficence
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avoidance of harm or hurt
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What is justice
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fairness; ex. discussions about health insurance, hospital locations and services, even organ transplants
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What is just culture
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the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination
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What is fidelity
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the agreement to keep promises and the unwillingness to abandon patients even when care becomes controversial or complex
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A set of guiding principles that all members of a profession accept and is a collective statement about the group’s expectations and standards of behavior is called a
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code of ethics
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Who established the first code of nursing ethics decades ago
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American Nurses Association (ANA)
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What does the American Nurses Association (ANA) do
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reviews and revises the code regularly to reflect changes in practice, however, basic principles of responsibility, accountability, advocacy, and confidentiality remain constant in professional nursing
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In all professional relationships, WHO, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems
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nurse
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Who is represented by associations and their members and is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
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the profession of nursing
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What is advocacy
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support of a particular cause
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As a nurse you advocate for …
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the health, safety, and rights of patients, including their right to privacy
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What is reponsibility
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a willingness to respect one’s professional obligations and follow through on promises
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A nurse is responsible for …
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their actions and for the actions of those to whom they delegate tasks
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What is accountability
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the ability to answer for one’s actions
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Who establishes national guidelines to ensure patient and workplace safety through consistent, effective nursing practices
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The Joint Commission (TJC)
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Who sets national standards for continuing education and curriculum development for nursing schools
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American Nurses Association (ANA)
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What is the act of keeping information private or secret
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confidentiality
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Who mandates the protection of patients’ personal health information
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Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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What 2 terms shape the practice of health care and distinguish it from other common human relationships
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ethical principles of beneficence and fidelity
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What is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
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value
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When is valued formed
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it begins in childhood and is shaped by experiences within the family unit
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Who plays a role in the formation of values, reinforcing or sometimes challenging family values
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schools, governments, religious traditions, and other social institutions
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What influences value formation
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individual experiences (i.e., the unpredictable twists and turns that occur in life)
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In order to resolve ethical dilemmas one needs to …
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distinguish among value, fact, and opinion
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What is deontology
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defines actions as right or wrong based on their “right-making characteristics” such as fidelity to promises, truthfulness, and justice. It specifically does not look to consequences of actions to determine right or wrong. Instead it examines a situation for the existence of essential right or wrong.
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What does the utilitarian system of ethics propose
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that the value of something is determined by its usefulness
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The philosophy of utilitarianism is also known as
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consequentialism because its main emphasis is on the outcome or consequence of action and teleology meaning the study of ends or final causes
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Who does “the one-caring” identify
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the individual who provides care
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Who does “the cared-for” to refer to
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patient
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What is the ethics of care
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the delivery of health care based on ethical principles and standards of care
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What is a strategy for solving dilemmas and promotes respect and agreement rather than a particular philosophy or moral system itself
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consensus building
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How do you minimize distress caused by an ethical dilemma
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you learn to process ethical issues carefully and deliberately and the process should promote the free expression of feelings and opinions
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Resolving an ethical dilemma differs from the nursing process in that
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it requires negotiation of differences of opinion the resolution of conflicting opinions works best when the following elements are part of the process: 1. the presumption of good will on the part of all participants 2. strict adherence to confidentiality 3. patient-centered decision making 4. welcome participation of families and primary caregivers
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What are the key steps in the resolution of an ethical dilemma
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1: Ask the question, is this an ethical dilemma? If a review of scientific data does not resolve the question, if the question is perplexing, and if the answer will have relevance for areas of human concern, an ethical dilemma probably exists. 2: Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information. 3: Clarify values. Distinguish among fact, opinion, and values. 4: Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. 5: Identify possible courses of action. 6: Negotiate a plan. Negotiation requires a confidence in one’s own point of view and a deep respect for the opinions of others. 7: Evaluate the plan over time.
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Health care institutions establish what kind of committees to process ethical dilemmas
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ethics committees
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Ethics committees are usually multidisciplinary and serve what purposes
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education, policy recommendation, and case consultation
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In order for scientists to develop quality-of-life measures, they take into account the …
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age of the patient, the patient’s ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality
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What is the key to the management of moral distress in the workplace
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engaging in constructive conversation
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What is as important as achieving medical success
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working to ensure dignity and comfort
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The courage and intelligence to act as both an advocate for patients and a professional member of the health care community come from a committed effort to learn and understand what
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ethical principles
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Standards of ethics in health care include …
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autonomy, beneficence, nonmaleficence, justice, and fidelity
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The process of _____ helps you to explore values and feelings and decide how to act on personal beliefs and respect values of others, even if they differ from yours
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values clarification
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______ problems arise in the presence of differences in values, changing professional roles, technological advances, and social issues that influence quality of life
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Ethical
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Who’s point of view offers a unique voice in the resolution of ethical dilemmas
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a nurse’s
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The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn’t have health insurance or enough cash. What principles would be a priority in a discussion about ethics?
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Justice because the first and greatest question in this situation is how to determine the just distribution of resources
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The point of the ethical principal to “do no harm” is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement?
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Nonmaleficence
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A child’s immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation?
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Beneficence
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When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient’s response to the pain?
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Fidelity
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What is the best example of the nurse practicing patient advocacy?
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Assess the patient’s point of view and prepare to articulate it
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Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following?
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The value of something is determined by its usefulness to society
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The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following?
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Relationships
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In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse’s point of view valuable?
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Nurses develop a relationship to the patient that is unique among all professional health care providers
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Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion?
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Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma
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The ANA code of nursing ethics articulates that the nurse “promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient’s x-ray film if you deleted all patient identifiers?
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No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work
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When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote?
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No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do
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Resolution of an ethical dilemma involves discussion with the patient, the patient’s family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas?
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To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations
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A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.)
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1. Community values are subject to change, and communities influence definitions of “quality.” 2. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 3. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.
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Which of the following explain how health care reform is an ethical issue? (Select all that apply.)
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1. Reforms promote the principle of beneficence, a hallmark of health care ethics. 2. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 3. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
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Which is the best method of negotiating or processing difficult ethical situations?
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Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.
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Define veracity
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Conformity to facts; accuracy: “the veracity of the story”. or Habitual truthfulness: “his veracity and character”.