ethical
list common ethical dilemas
- informed consent
- withholding or withdrawing life-sustaining treatment
- organ and tissue transplantation
- confidentiality
- justice in the distribution of health care resources
ANA states that nurses have an ethical obligation to serve as ___________ for patients and to protect their basic rights
an advocate
ethical dilemma warning signs:
• Emotionally charged situation for both patients and family
• Significant change in patient’s condition
• Confusion about facts (families just cannot comprehend bc they're in shock)
• Hesitancy about the correct set of actions
• Deviation from customary practice
• Need for secrecy regarding proposed actions
1. ethical dilemma
2. assess -> context, physical & personal factors
3. healthcare options
4. plan
5. act it out
6. evaluate
List 3 ethical principles and explain (there are 7)
autonomy: pt has right to choose their own care
beneficence: prevent harm and do good
nonmaleficence: do not intentionally harm
justice: fair distribution of healthcare resources
veracity: obligation to tell the truth
fidelity: moral duty to be faithful to commitments
confidentiality: respect individuals autonomy and right to control info about their health
T or F
Nurses have a duty to treat and are required to care for the patients they are assigned for no matter what.
True,
While nurses can switch assignments, they must care for assigned patents and must have someone to cover any breaks and lunches
Which nursing actions indicate an understanding of ethical decisions?
A: Respecting the patient’s wishes and goals
B: Discussing burden versus benefit with the patient
C: Being knowledgeable on relevant ethical principles
D: Discussing potential outcomes of options with the patient
All of the above
Figure 3-1
The nurse is caring for a patient who is unresponsive, unable to communicate, and has no voluntary action or cognition. The condition is considered permanent. The term for this condition is:
A: brain death
B: non–heart beating donor
C: persistent vegetative state
D: terminal condition
C
This is the definition of persistent vegetative state. These individuals are not brain dead and are not necessarily terminal. A non–heart beating donor would be someone with cardiac death. See Table 3-2 for definitions.
The family has decided to withdraw life support. Which actions by the nurse are consistent with this decision?
a: Beginning continuous renal replacement therapy
b: Discontinuing comfort measures
c: Initiating “do not resuscitate” orders
d: Stopping tube feedings
e: Weaning the patient from mechanical ventilation
C, D, E
Withdrawal from life support would include writing DNR orders, stopping tube feedings, and weaning from the ventilator. Comfort measures are always provided even though life support is withdrawn or withheld. Patient comfort is of primary importance. Continuous renal replacement therapy is considered an extraordinary measure.
The critical care nurse must demonstrate characteristics of ethical nursing practice, which include:
a: collaboration
b: compassion
c: disclosure
d: trust
A, B, D
Compassion, collaboration, accountability, and trust are essential characteristics of ethical nursing practice.
The family of a critically ill patient whose care has been deemed futile has decided to withhold treatments. Which action should the nurse take to initiate the family’s wishes?
a: Obtain signatures for “do not resuscitate” orders.
b: Turn the patient every 2 hours.
c: Slowly wean the patient off the ventilator.
d: Refrain from giving the patient medications.
D
To withhold treatment is a decision not to administer selected treatments in cases in which care is considered futile. Withdrawal is a removal of treatments, such as mechanical ventilation. “Do not resuscitate” is a written order not to initiate life-support measures in the event of cardiopulmonary arrest. Turning the patient every two hours is not an example of withholding treatment.
Which nursing actions contain the elements of informed consent?
a: Scheduling time for the patient to meet with the health care provider
b: Ensuring that the patient and family members understand what is to be done (competence)
c: Obtaining voluntary permission for what is to be done
d: Writing the consent on a standardized form
A, B, C
Informed consent is a process, not a form. Competence is essential, along with adequate explanations and voluntary agreement for what is to be done.
The nurse recognizes that this principle guides health care decisions:
A.Autonomy
B.Beneficence
C.Nonmaleficence
D.Justice
A
This guides every other thing. It is their right to have say in care
Nurses have a duty to treat. What are some issues that arise if residents do not care for patinets
abandonment
- unfortunately does occur
moral conflict
Pt arrives to ED post-trauma, vitals are all over the place, doc sees that she is an organ donor. Despite family wishes, the surgical team begins preparing her for organ procurement surgery. TOD is 0247, COD organ procurement. Is this an ethical dilemma?
Yes
Organ procurement cannot be the cause of death.
t or f
the ANA code of ethics is one of the primary obligations of professional nurses is protection of their patients basic rights. this obligation requires nurses to recognize ethical delimas that actually or potentially threaten patients rights and to participate in the resolution of those dilemmas
true
Moral distress occurs when
the nurse knows the ethically appropriate action to take but is unable to act on it or when the nurse acts in a manner contract to personal and professional values
- one of the key issues affecting the work place
- contributes to loss of nurses from the workforce and threatens the quality of patient care
- address it and increase participation in moral decision making-starts with open communication with the health care team, the patient, and the family regarding the patients wishes and ethical concerns
Joint Commission requires formal mechanisms such as... (please explain)
bioethics committees: multi professional team that educates and makes policies
ethics consult: these are hosted to improve process and patient outcomes; used when issues cannot be resolved regarding pt care either family-family-or HCT-family)
Which of the following must be present for informed consent? SATA
a: competence
b: voluntariness
c: coherence
d: disclosure of info
e: POA or healthcare surrogate
A, B, D
Witnessed written document or oral statement in which instructions are given by a person to express the persons instructions concerning life-prolonging procedures.
WHAT IS AN ADVANCED DIRECTIVE?
WITNESSED WRITTEN DOCUMENT OR ORAL STATEMENT VOLUNTARILY EXECUTED BY A PERSON THAT EXPRESSES THE PERSON'S INSTRUCTIONS CONCERNING LIFE-PROLONGING PROCEDURES
WHAT IS A LIVING WILL?
What is the difference in a healthcare proxy and surrogate?
proxy: competent adult who has NOT been expressly designated to make healthcare decisions for incapacitated person; but they are authorized by state law to make healthcare decisions
surrogate: competent adult designated by the patient to make healthcare decisions if the patient becomes incapacitated
essentially the key difference is patient approval/choice
organ procurement cannot be the reason for death. In which case could it mean the removal of life sustaining therapy?
in a person who is brain dead
- complete and irreversible cessation of brain function
permanent, irreversible unconsciousness condition that demonstrates absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment
What is a persistent vegetative state?
Describe the difference in DNR and AND
DNR: do not resusitate
medical order to prohibit CPR and emergency cardiac carets reverse signs of clinical death (irreversible cessation of spontaneous ventilation and circulation). DNR may or may not give AD instructions/wishes
AND: allow natural death
alternate term with less-negative connotations, but essentially means DNR; no extra measures will be used