ETHICAL AND PROFESSIONAL NURSING (Pre-Test)

1. All of the following exemplifies the concept of ethical dilemma, except: 8. A patient refuses to be admitt. To facilitate appropriate decision-making, you willl
a. Distribution of scarce resources first:
b. Paternalism a. explain first the he is required to be admitted for recovery
c. DNR order b. let the patient go home
d. none of these c. tell the client of the conseqences for the decision
2. When the nurse finished performing foot care on the client, she was requested to come d. let the patient sign a "home against medical advise" form - if the question is
back to change linen. The nurse changed the linen as requested by the client. The nurse is "what is the legal requirement"
demonstrating which of the following ethical rules? 9. A nurse who is sued for unprofessional conduct by the BON shall suffer for the
a. Justice following sanctions except:
b. Fidelity - keeping promises a. reprimand
c. Non maleficence b. revocation of her certificate of registration - if convicted only
d. Beneficence c. suspension of certificate of registration
3. The morning shift is over and the outgoing nurse was about to leave the unit when d. write a letter of explanation
the relative of the client called because the client fell out of bed. The nurse hurriedly went 10. Bioethical principles should always guide our practice, except in:

to the client's room to attend to the client. Which of the following ethical principles a. emergency situations
illustrates the action of the nurse? b. ethical dilemma
a. Autonomy c. conducting research
b. Justice d. none of the above
c. Non maleficence

d. Beneficence

4. Which of the following ethical priciples states that "there is always exemption to the

rule"?

a. divine command

b. beneficence

c. utilitarianism

d. law of epikia

5. Which of the following is paramount in the ethical nursing?

a. every nursing activity has an ethical aspect

b. the welfare of the patient is ultimate

c. nursing is safe practice

d. the purpose of nursing is to promote well-being

6. Doing our duty despite circumstances is reflective of which ethical principle?

a. utilitarianism

b. hedonism - pleasure principle

d. deontology

c. telelogical - "utilitarianism"

7. You submitted together with your nursing licensure examination application from a fake

Related Nursing Experience documents. You are liable for which of the following illegal

acts?

a. forgery of documents

b. misrepresentation - misdimeanor can also be the answer

c. incompetence - serious lack of skills

d. perjury - lying in court

 ETHICS IN NURSING

Ethics Example:

- moral principles that govern conduct of a person or group. (code of ethics) • In the event of mass casualty incident, the triage nurse prioritizes those with

- governs professional interactions severe conditions (red tag) over those with black, yellow, and green tags.

B.) Hedonism - action is ethical if it brings pleasure or minimizes pain

BRANCHES OF ETHICS Example:

1.) PROFESSIONAL ETHICS (Code of Ethics) • A terminal cancer patienrt is allowed to select his meals and activities that he

- values and principles introduce to an individual in a professional organization. likes for the entire day.

- it guides the professional action. • Administering Narcotics RTC

PROFESSIONAL ETHICS is our RESPONSIBILITY to our:

• Patient DEONTOLOGY

• Co-workers - from the word "deos" which means duty

• Employer - duty bound ethics

• Other members of the society - The end does not justify theh means

Example: - focuses on the nature of the act rather than consequences

• An RN must always ACT in accordance with the Code of Ethics of the nursing Example:

profession. • Any form of Euthanasia is considered unethical in deontology.

2. ORGANIZATIONAL ETHICS (Business Ethics)

-- values and principles that arise in a workplace DIVINE COMMAND

-- studies appropriate business policies and practices - religion/faith based a supreme being guides actions.

-- being fair to all workers Example:

Example: • Catholic and Islamic faith believes in sanctity of life, hence, abortion is gravey

• Employes must provide appropriate benefits for all employees fairly. condemed.

3. CLINICAL ETHICS • Blood transfusion is declined by a patient who is a member of the Jehova's

-- practical discipline that provides structured approach in resolving ethical issues witness

in clinical practice

-- decision-making regarding the care of the patient Bioethics

Example: -- application of ethics in life sciences (life biology)

• Resolving ethical dilemma -- ethics applied in health care

4. SOCIAL ETHICS BIOETHICAL PRINCIPLES

-- collection of vaues and behavior of a given culture or group A. Beneficence

Example: B. Non-Maleficence

• "Do not do unto others, what you do not want others to do unto you" C. Autonomy

5. PERSONAL ETHICS D. Justiice/Fairness

-- morality OTHER ETHICAL PRINCIPLES

-- personal belief of right and wrong E. Veracity

F. Fidelity

ETHICAL THEORIES G. Confidentiality & Anonymity

CONSEQUENTIALISM

- an action is judged by its outcome 1.) BENEFICENCE

TYPES - do good/ acts of kindness

A.) Utilitarianism - "end justifies the means" - obligation to perform acts that benefit the patient

- for limited resources (scarce) -mother of all bioethical principles.

- action is ethical because it is Greatest Good for the Greatest number" - GOAL: To improve patient's condition

- it is conclusively unethical
 Requisites of Informed Consent
Example:
a. Full Disclosure
• A nurse holds the hands of a dying patient.
b. Competence of the patient/family
• Nurse provides holistic care to a patient.
* Voluntary

2.) NON-MALEFICENCE
Full Disclosure
- DO NO HARM "primum non-nocere"
• Risk/Benefit Ratio
- obligation to protect patient from all of injury/harm
-Assumption of Risk - patient is aware of the consequences
- GOAL: To prvent injury/harmm
• Ailment Disclosure
Example:
-Prensent illness only
• A nurse conducts skin testing before administering a prescribed antibiotic
• Prognosis
• A nurse avoids drug errors by remembering 10 rights of drug administration
• Alternatives
• DO NOT ASSIST IN:
• Assurance of Confidentiality and Anonymity
- Abortion
NOTE: Information within client's understanding
- Suicide
*include credentials, costs
- Euthanasia

- Experiments on UNINFORMED subjects

Competence

• Sound mind
3.) AUTONOMY
- no mental illness/ developmental problem
- allowing patients to make a rational choice
- no psychological problem
- promoting patient's right to self-determination
- not under the influence
- GOAL: Protect client's involvement and best interest in his/her care
• Legal age
LIMITATIONS of AUTONOMY:
- 18 years old and above
• Threat of Public Harm
• Has "free will" (voluntary)
a. communicable diseases
- no coercion (force)
b. acts of violence - eg. terrorism
- no undue influence (bribe)
• Emergency/Near-death
If patient is incompetent
*Patient-waiver
a.) Parent (single), spouse (married)
Examples of Appllication of Autonomy:
b.) Legal guardian
• Informed consent
c. next kin - "available relative"
• Living will/ Advance directives

• Blood/Organ donation
ADANCE DIRECTIVES

• "living will"
STANDARD OF BEST INTEREST
• CONTENT: contains the client's wishes regarding his/her care.
- It is a decision based on what the healthcare providers or family believe is best
• Should be attached to: CHART - legal record
for the patient's health care when the patient is unable to make an informed
• Takes effect ONLY when client is:
decision.
A. unable
- PATERNALISM occurs when there is deliberate limiting of patient's autonomy.
B. unresponsive cardio-pulmonary arresh (-) RR; (-) HR

C. incompetent
INFORMED CONSENT
TYPES OF ADVANCE DIRECTIVES
• Who obtains the INFORMED CONSENT?
1.) Do Not Resuscitate (DNR)
- Physician, MD, Surgeon - Surgery
• written by the Physician upon patient's request
• What is the role of the nurse in INFORMED CONSENT?
• NO heroic/lifesaving measurs once the client's RR//HR ceases
- Witness
• Narcotics/Pain Reliver can be given except Epi since it is a lifesaving drug
- Ensure that consent is signed
Liability for NOT FOLLOWING DNR: Exemptions to Confidentiality:

• Battery - unconsented touching • Medico-Legal

2.) Health Care By Proxy/ Durable Power of Attorney - eg: Rape, abuse, harassment

• Patient assigns a family member or person (a proxy) to make the decision on • Communication within the Health Team

• Communicable disease

4.) VERACITY -Case finding, contact tracing

-- Truth-telling or honesty regardless of client reaction • Claims

-- APPLICABLE FOR: both the patient & healthcare worker -Insurance (HMO, PhilHealth)

Example:

• An MD discloses the true diagnosis to the patient despite objection from family. 1. Mass COVID-19 Immunization - Beneficence

2. Refusal to assist in induced abortion - Non-maleficence

5. JUSTICE 3. Abiding by the principle of privileged communication - confidentiality

-- Fair and equal treatment of clients regardless of color, race, religion. 4. Being with the patient until his/her last breath - beneficence

BASIS: 5. Obtaining informed consent - autonomy

a.) Egalitarian Theory - fair opportunity rule 6. Rending care to patient suffering fom thermal burns - beneficence

- equality 7. Fighting for patient's right without violating other client's/provider's right - autonomy

b.) Utilitarianism - "prioritization" 8. Remembering the right of drug administration - Non-maleficence

- equity 9. Not leaving duty without endorsement - Fidelity

TYPES OF JUSTICE 10. Not accepting gifts or any form of tip from any patient - Justice

a.) Distributive Justice 11. Patient provides the accurate description of his/her symptoms - Veracity

- equal distribution of scarce resources 12. Health providers must be VERY DISCREET in providing information -

- promotion of equity Confidentiality

- in favor of the poor/disadvantaged 13. Ensure continuity of care even if client refuses participation in research - Fidelity

b.) Procedural Justice 14. Opposing EUTHANASIA - Non-maleficence

- promoting unbiased, fair decision-making - "due process" 15. Favoring the socially disadvantaged or medically incapacitated - distributive justice

- arbitration (settlement outside the court) 16. Performing triage during mass casualty incidence - Distributive

- collective bargaining (negotation for humane working conditions) 17. Creating of DSWD and PhilHealth - Justice

c.) Retributive Justice

- people deserve to be treated the way they treat other ETHICAL DILEMMA

- "criminl acts" Why is there an ethical dilemma?

d.) Restorative Justice • There is no clear right/wrong answers

- promotes repair of harm done Example:

• Decisions with "TWO-FOLD" or DOUBLE EFFECT : choice between 2 unfavorable

6. FIDELITY options

-- keeping promises/ being loyal STEPS IN DECISION MAKING

Example: solution for Ethical Dilemma

• A nurse fulfills a promise to come back to a patient after a while. 1.) Assess: Gather data top clarify problem

2.) Alternatives: List all possible choices

7. CONFIDENTILITY 3.) Analysis: Analyze each choice/option

-- ALL INFORMTION obtained must be kept in strictest privacy. 4.) Application: Application of Ethical Principle (considered as the standard)

-- ACCESS: patient & members of the health team 5.) Action: make the final decision

If not solved:

8. ANONYMITY • RN: accountable for his/her actions/decisions

-- protecting client's identity

OTHER ETHICAL PRINCIPLE

A.) Totality

• Principle: The whole is greater than the sum of its parts

B.) Paternalism

• Principle: Deciding everything for everything for the patient - due to the

knowledge that the decision is best for the patient.

C.) Epikia

• Principle: Exeption to the general rule

D.) Stewardship

• Principle: Medical professionals are legally in charge to take care of their

patients.