ethical responsibilities chapter 3

Unit 1 Safe, Effective Care Environment

Section Management of Care

Chapter 3 Ethical Responsibilities

Overview
●● Ethics has several definitions but the foundation of ethics is based on an expected behavior
of a certain group in relation to what is considered right and wrong. It is the study of
conduct and character.

●● Morals are the values and beliefs held by people that guide their behaviors and decision-
making.

●● Ethical theory examines the different principles, ideas, systems, and philosophies used to
make judgments about what is right and wrong and good and bad. Two common types of
ethical theory are utilitarianism and deontology.

●● Ethical principles are standards of what is right or wrong with regard to important social
values and norms. Ethical principles pertaining to the treatment of clients include:

◯◯ Autonomy – Ability of the client to make personal decisions, even when those
decisions may not be in the client’s own best interest.
◯◯ Beneficence – Agreement that the care given is in the best interest of the client; taking
positive actions to help others.
◯◯ Fidelity – Agreement to keep one’s promise to the client about care that was offered.
◯◯ Justice – Fair treatment in matters related to physical and psychosocial care and use of
resources.
◯◯ Nonmaleficence – Avoidance of harm or pain as much as possible when giving
treatments.
●● Unusual or complex ethical issues may need to be dealt with by a hospital’s ethics
committee.

Ethical Decision Making in Nursing

●● Ethical dilemmas are problems about which more than one choice can be made and the
choice made is influenced by the values and beliefs of the decision makers. These are
common in health care, and nurses must be prepared to apply ethical theory and decision
making to ethical problems.

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 Ethical Responsibilities

●● A problem is an ethical dilemma if:

◯◯ It cannot be solved solely by a review of scientific data.

◯◯ It involves a conflict between two moral imperatives.
◯◯ The answer will have a profound effect on the situation/client.
●● Ethical decision making is a process that requires striking a balance between science and
morality. There are several steps in ethical decision making:

◯◯ Identify whether or not the issue is indeed an ethical dilemma.

◯◯ State the ethical dilemma including all surrounding issues and individuals involved.
◯◯ List and analyze all possible options for resolving the dilemma and review
implications of each option.
◯◯ Select the option that is in concert with the ethical principle applicable to this
situation, the decision maker’s values and beliefs, and the profession’s values set forth
for client care. Justify why that one option was selected in light of the previously
mentioned variables.
◯◯ Apply this decision to the dilemma and evaluate the outcomes.
●● The American Nurses Association Code of Ethics for Nurses (2001) and The International Council
of Nurses’ The ICN Code of Ethics for Nurses (2006) are documents commonly accepted by
professional nurses. The Code of Ethics for licensed practical/vocational nurses issued by the
National Association for Practical Nurse Education and Service, Inc., also serves as a set of
standards for nursing practice. Codes of ethics are available through the organizations’ Web
sites.

●● The nurse’s basic code of ethics and principles remains constant. These basic principles
include:

◯◯ Advocacy – Support of the cause of the client regarding health, safety, and personal
rights
◯◯ Responsibility – Willingness to respect obligations and follow through on promises
◯◯ Accountability – Ability to answer for one’s own actions
◯◯ Confidentiality – Protection of privacy without diminishing access to quality care
●● The Uniform Determination of Death Act (UDDA) is a document that can be used to assist
with end-of-life and organ donor issues.

◯◯ The UDDA provides two formal definitions of death that were developed by the
National Conference of Commissioners on Uniform State Laws. Death is determined
by one of two criteria:
■■ An irreversible cessation of circulatory and respiratory functions
■■ Irreversible cessation of all functions of the entire brain, including the brain stem
◯◯ A determination of death must be made in accordance with accepted medical
standards.

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Ethical responsibilities

The Nurse’s Role in Ethical Decision Making

Nurse’s Role Examples
An agent for the client facing an ethical • Caring for an adolescent client who has to
decision decide whether or not to undergo an abortion
even though her parents believe it is wrong
• Discussing options with a parent who has to
decide whether or not to consent to a blood
transfusion for a child when their religion
prohibits such treatment
A decision maker in regard to nursing • Assigning staff nurses a higher client load than
practice recommended because administration has cut
the number of nurses per shift
• Witnessing a surgeon discuss only surgical
options with a client without informing the client
about more conservative measures available

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 Ethical Responsibilities

Chapter 3: Ethical Responsibilities

Application Exercises

1. Match the ethical principle with the correct example.

Justice A. A client decides not to have open heart surgery despite

significant blockages.
Autonomy B. A nurse offers pain medication to a client who is
postoperative prior to ambulation.
Beneficence C. A nurse takes a client outdoors in a wheelchair after lunch
as promised.
Nonmaleficence D. All clients waiting for a kidney transplant have to meet the
same qualifications.
Fidelity E. A nurse questions a medication prescription as being too
extreme in light of a client’s advanced age and unstable
condition.

2. Which of the following entities has a code of ethics that may be used to guide nursing practice?
(Select all that apply.)
The American Hospital Association
The American Nurses Association
The International Council of Nurses
The National Association for Practical Nurse Education and Services, Inc.
The Federation of Associations of Regulatory Boards

3. Which of the following is an ethical dilemma?

A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment.

B. A nurse is overheard telling an older adult client that if he doesn’t stay in bed, she will have to
place him in a restraint.
C. A family has conflicting feelings about the initiation of nasogastric tube feedings for their
father, who is terminally ill.
D. A client who is terminally ill is hesitant to name her spouse on her durable power of attorney
form.

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Ethical responsibilities

Chapter 3: Ethical Responsibilities

Application Exercises Answer Key

1. Match the ethical principle with the correct example.

D Justice A. A client decides not to have open heart surgery despite

A Autonomy
B Beneficence
E Nonmaleficence
C Fidelity
significant blockages.
B. A nurse offers pain medication to a client who is
postoperative prior to ambulation.
C. A nurse takes a client outdoors in a wheelchair after lunch
as promised.
D. All clients waiting for a kidney transplant have to meet the
same qualifications.
E. A nurse questions a medication prescription as being too
extreme in light of the client’s advanced age and unstable
condition.

NCLEX® Connection: Management of Care: Advocacy

2. Which of the following entities has a code of ethics that may be used to guide nursing practice?
(Select all that apply.)
The American Hospital Association
X The American Nurses Association
X The International Council of Nurses
X The National Association for Practical Nurse Education and Services, Inc.
The Federation of Associations of Regulatory Boards

The American Nurses Association, the International Council of Nurses, and the National
Association for Practical Nurse Education and Services, Inc., are associations that advocate
for high quality nursing care through published codes of ethics. The American Hospital
Association is dedicated to serving hospitals and other types of facilities that provide health
care and services. It does not have a code of ethics for nurses. The Federation of Associations
of Regulatory Boards protects the public by promoting effective regulation across disciplines
and jurisdictions inside the United States. It also does not have a code of ethics for nurses.

NCLEX® Connection: Management of Care: Client Rights

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 Ethical Responsibilities

3. Which of the following is an ethical dilemma?

A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment.

B. A nurse is overheard telling an older adult client that if he doesn’t stay in bed, she will have to
place him in a restraint.
C. A family has conflicting feelings about the initiation of nasogastric tube feedings
for their father, who is terminally ill.
D. A client who is terminally ill is hesitant to name her spouse on her durable power of attorney
form.

Making the decision about initiating tube feedings is an example of an ethical dilemma. It
cannot be solved solely by a review of scientific data. It is not easily solved. The answer will
have a profound effect on the situation/client. A nurse who may be impaired is a legal issue.
A nurse who threatens to restrain a client has committed assault, and it is a legal issue. The
selection of a person to make health care decisions on a client’s behalf is a legal decision.

NCLEX® Connection: Management of Care: Ethical Practice

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