Chapter

Values, Ethics,
and Advocacy

Multimedia Directory
Slide 24 Understanding Legal and Ethical Issues Video

Copyright 2008 by Pearson Education, Inc.

Learning Outcomes
1.

2.

3.

4.

Explain how cognitive development, values,

moral frameworks, and codes of ethics affect
moral decisions.
Explain how nurses use knowledge of values to
make ethical decisions and facilitate ethical
decision making by clients.
When presented with an ethical situation,
identify the moral issues and principles
involved.
Explain the uses and limitations of professional
codes of ethics.
Copyright 2008 by Pearson Education, Inc.

Learning Outcomes
5. Discuss common ethical issues
currently facing health care
professionals.
6. Describe ways in which nurses can
enhance their ethical decision
making and practice.
7. Discuss the advocacy role of the
nurse.
Copyright 2008 by Pearson Education, Inc.

Pretest
Use your clickers to complete the
following pretest.

Copyright 2008 by Pearson Education, Inc.

Question 1

1.
2.
3.
4.

When an ethical issue arises, one of the

most important nursing responsibilities in
managing client care situations is which of
the following?
Be able to defend the morality of ones own
actions.
Remain neutral and detached when making
ethical decisions.
Ensure that a team is responsible for
deciding ethical questions.
Follow the client and family wishes exactly.
Copyright 2008 by Pearson Education, Inc.

Rationales 1
1. Correct. A nurses actions in an ethical
dilemma must be defensible according to
moral and ethical standards.
2. The nurse may have strong personal
beliefs but distancing oneself from the
situation does not serve the client.
3. A team is not always required to reach
decisions.
4. The nurse is not obligated to follow the
clients wishes automatically when they
may have negative consequences for self
or others.
Copyright 2008 by Pearson Education, Inc.

Question 2
Which of the following situations is most clearly a
violation of the underlying principles associated with
professional nursing ethics?
1.
2.
3.
4.

The hospital policy permits use of internal fetal

monitoring during labor. However, there is literature to
both support and refute the value of this practice.
When asked about the purpose of a medication, a nurse
colleague responds, Oh, I never look them up. I just give
what is prescribed orders.
The nurses on the unit agree to sponsor a fund-raising
event to support a labor strike proposed by fellow nurses
at another facility.
A client reports that he didnt quite tell the doctor the
truth when asked if he was following his therapeutic diet
at home.
Copyright 2008 by Pearson Education, Inc.

Rationales 2
1.
2.

3.
4.

Many medical practices are controversial but not

necessarily unethical. The nurse should follow
agency policy.
Correct. The nurse has an ethical responsibility
to act only when actions are safe or risks
minimized. This nurse is putting the client at
unnecessary risk for medication error.
Although some may view nurses strikes as
unethical, supporting others who are striking is a
personal decision.
Although a clients statement in confidence to a
nurse may have ethical overtones, it does not
automatically constitute an ethical dilemma.
Since the nurse is a member of the health care
team, principles of confidentiality do not include
this nurse.
Copyright 2008 by Pearson Education, Inc.

Question 3
Following a motor vehicle crash, the parents
refuse to permit withdrawal of life support from
the child with no apparent brain function. Although
the nurse believes the child should be allowed to
die and organ donation considered, the nurse
supports their decision. Which moral principle
provides the best basis for the nurses actions?
1.
2.
3.
4.

Respect for autonomy.

Nonmaleficence.
Beneficence.
Justice.
Copyright 2008 by Pearson Education, Inc.

Rationales 3
1. Correct. Autonomy is the clients (or
surrogates) right to make his or her
own decision.
2. This is not a do no harm situation.
3. This is not a do good situation.
4. Justice generally applies when the
rights of one client are being balanced
against those of another client.
Copyright 2008 by Pearson Education, Inc.

Question 4

1.
2.
3.
4.

Which of the following statements by the nurse

would be most helpful when a nurse is assisting
clients in clarifying their values?
That was not a good decision. Why did you
think it would work?
The most important thing is to follow the plan
of care. Did you follow all your doctors orders?
Some people might have made a different
decision. What led you to make your decision?
If you had asked me, I would have given you
my opinion about what to do. Now how do you
feel about your choice?
Copyright 2008 by Pearson Education, Inc.

Rationales 4
1. Incorrect. This is a judgmental
statement.
2. Incorrect. This is a judgmental
statement.
3. Correct. In values clarification, clients
are assisted to think about the factors
that influence their beliefs and decisions.
4. Incorrect. This is a judgmental
statement.
Copyright 2008 by Pearson Education, Inc.

Question 5

After recovering from her hip replacement, an

elderly client wants to go home. The family wants
the client to go to a nursing home. If the nurse is
acting as a client advocate, the nurse would
perform the following:
Informs the family that the client has a right to
decide on her own.
Ask the primary care provider to discharge the
client to home.
Suggest the client hire a lawyer to protect her
rights.
Help the client and family communicate their
views to each other.
Copyright 2008 by Pearson Education, Inc.

Rationales 5
1. Informing the family is an intervention
without assessment.
2. If the primary care provider sends the client
home, the nurse has not acted to assist in
resolving or reducing the conflict.
3. If the nurse assists in resolving or reducing
the conflict, an attorney may not be needed.
Legal action should be a last resort.
4. Correct. A major role of the client advocate
is to mediate between conflicting parties.

Copyright 2008 by Pearson Education, Inc.

Factors Influencing Moral

Decisions
Cognitive development
Values
Moral framework
Codes of ethics

Copyright 2008 by Pearson Education, Inc.

Cognitive Development
Moral decisions require persons to
think and reason
Reasoning is a cognitive function
Ability to make decisions develops
over the lifespan

Copyright 2008 by Pearson Education, Inc.

Values
Enduring beliefs or attitudes about the
worth of a person, object, idea, or
action
May be unspoken or even subconscious
Underlie all moral dilemmas
Influence decisions and actions
including nurses ethical decision
making
Copyright 2008 by Pearson Education, Inc.

Moral Development
Process of learning difference
between right and wrong
Begins in childhood and continues
throughout life
Moral development theories provide
frameworks to view and clarify moral
and ethical dilemmas

Copyright 2008 by Pearson Education, Inc.

Code of Ethics
Formal statement of a groups ideals
and values
Serves as a standard for professional
actions
Provides ethical standards for
professional behavior

Copyright 2008 by Pearson Education, Inc.

Values Clarification
The following steps can help clarify values:
1. List alternatives
2. Examine possible consequences of
choices
3. Choose freely
4. Feel good about the choice
5. Affirm the choice
6. Act on the choice
7. Act with a pattern
Copyright 2008 by Pearson Education, Inc.

Moral Issues
Arouse conscience
Concerned with important values and
norms evoke words such as good,
bad, wrong, should and ought

Copyright 2008 by Pearson Education, Inc.

Moral Principles
Statements about broad, general,
philosophic concepts
Provide the foundation for moral rules
which are specific prescriptions for
actions
Useful in ethical discussions
May be able to agree on principles that
apply
May serve as a basis for the solution to
the problem
Copyright 2008 by Pearson Education, Inc.

Understanding Legal and

Ethical Issues Video

Click here to view a video on legal and ethical issues.

Back to Directory Copyright 2008 by Pearson Education, Inc.

Major Moral Principles

1.
2.
3.
4.
5.
6.

Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Veracity

Copyright 2008 by Pearson Education, Inc.

Autonomy
Right to make ones own decisions
Inward autonomy if individuals have
the ability to make choices
Outward autonomy if choices are not
limited or imposed by others

Copyright 2008 by Pearson Education, Inc.

Nonmaleficence
Duty to do no harm
Harm may intentional or
nonintentional

Copyright 2008 by Pearson Education, Inc.

Moral Principles
Beneficence = doing good
Justice = fairness
Fidelity = faithful to agreements and
promises
Veracity = telling the truth

Copyright 2008 by Pearson Education, Inc.

Professional Codes of Ethics

Outline the major ethical
considerations of the profession
Provide ethical standards for
professional behavior
Guide the profession in self-regulation
Remind nurses of the special
responsibility assumed when caring for
the sick
Copyright 2008 by Pearson Education, Inc.

Purposes of Professional
Codes of Ethics
To inform the public about the
minimum standards of the profession
To help the public understand
professional nursing conduct
To provide a sign of the professions
commitment to the public

Copyright 2008 by Pearson Education, Inc.

Common Ethical Issues

Issues in the care of HIV/AIDS clients
Abortions
Organ transplantation
End-of-life decisions
Cost-containment issues (resource
allocation)
Breaches of client confidentiality
Copyright 2008 by Pearson Education, Inc.

Enhancing Ethical
Decision-making
Becoming aware of personal values
and ethical aspects of nursing
Becoming familiar with nursing code
of ethics
Seeking continuing education to
remain knowledgeable about ethical
issues in nursing

Copyright 2008 by Pearson Education, Inc.

Enhancing Ethical
Decision-making
Respecting the values, opinions, and
responsibilities of other health care
professionals
Participating in or establishing ethic
rounds
Serving on institutional ethics
committees
Striving for collaborative practice
Copyright 2008 by Pearson Education, Inc.

What is an Advocate?

Copyright 2008 by Pearson Education, Inc.

Advocacy Role
What is
is the
the overall
overall goal
goal of
of
What
being aa clients
clients advocate?
advocate?
being

Copyright 2008 by Pearson Education, Inc.

Values Basic to Advocacy

Client is a holistic, autonomous being
who has the right to make choices and
decisions
Clients have the right to expect a
nurse-client relationship that is based
on shared respect, trust, and
collaboration
It is the nurses responsibility to ensure
client has access to health care
services that meet health needs
Copyright 2008 by Pearson Education, Inc.

Effective Client Advocates

Are assertive
Recognize the rights and values of clients and
families must take precedence when they
conflict with those of health care providers
Are aware that conflicts may arise over issues
Work with community agencies and lay
practitioners
Know that advocacy may require political
action

Copyright 2008 by Pearson Education, Inc.

Post Test
Use your clickers to complete the
following post test.

Copyright 2008 by Pearson Education, Inc.

Question 1

1.
2.
3.
4.

When an ethical issue arises, one of the

most important nursing responsibilities in
managing client care situations is which of
the following?
Be able to defend the morality of ones own
actions.
Remain neutral and detached when making
ethical decisions.
Ensure that a team is responsible for
deciding ethical questions.
Follow the client and family wishes exactly.
Copyright 2008 by Pearson Education, Inc.

Rationales 1
1. Correct. A nurses actions in an ethical
dilemma must be defensible according to
moral and ethical standards.
2. The nurse may have strong personal
beliefs but distancing oneself from the
situation does not serve the client.
3. A team is not always required to reach
decisions.
4. The nurse is not obligated to follow the
clients wishes automatically when they
may have negative consequences for self
or others.
Copyright 2008 by Pearson Education, Inc.

Question 2
Which of the following situations is most clearly a
violation of the underlying principles associated with
professional nursing ethics?
1.
2.
3.
4.

The hospital policy permits use of internal fetal

monitoring during labor. However, there is literature to
both support and refute the value of this practice.
When asked about the purpose of a medication, a nurse
colleague responds, Oh, I never look them up. I just give
what is prescribed orders.
The nurses on the unit agree to sponsor a fund-raising
event to support a labor strike proposed by fellow nurses
at another facility.
A client reports that he didnt quite tell the doctor the
truth when asked if he was following his therapeutic diet
at home.
Copyright 2008 by Pearson Education, Inc.

Rationales 2
1.
2.

3.
4.

Many medical practices are controversial but not

necessarily unethical. The nurse should follow
agency policy.
Correct. The nurse has an ethical responsibility
to act only when actions are safe or risks
minimized. This nurse is putting the client at
unnecessary risk for medication error.
Although some may view nurses strikes as
unethical, supporting others who are striking is a
personal decision.
Although a clients statement in confidence to a
nurse may have ethical overtones, it does not
automatically constitute an ethical dilemma.
Since the nurse is a member of the health care
team, principles of confidentiality do not include
this nurse.
Copyright 2008 by Pearson Education, Inc.

Question 3

1.
2.
3.
4.

Following a motor vehicle crash, the parents

refuse to permit withdrawal of life support from
the child with no apparent brain function.
Although the nurse believes the child should be
allowed to die and organ donation considered,
the nurse supports their decision. Which moral
principle provides the best basis for the nurses
actions?
Respect for autonomy.
Nonmaleficence.
Beneficence.
Justice.
Copyright 2008 by Pearson Education, Inc.

Rationales 3
1. Correct. Autonomy is the clients (or
surrogates) right to make his or her
own decision.
2. This is not a do no harm situation.
3. This is not a do good situation.
4. Justice generally applies when the
rights of one client are being balanced
against those of another client.
Copyright 2008 by Pearson Education, Inc.

Question 4

1.
2.
3.
4.

Which of the following statements by the nurse

would be most helpful when a nurse is assisting
clients in clarifying their values?
That was not a good decision. Why did you
think it would work?
The most important thing is to follow the plan
of care. Did you follow all your doctors orders?
Some people might have made a different
decision. What led you to make your decision?
If you had asked me, I would have given you
my opinion about what to do. Now how do you
feel about your choice?
Copyright 2008 by Pearson Education, Inc.

Rationales 4
1. Incorrect. This is a judgmental
statement.
2. Incorrect. This is a judgmental
statement.
3. Correct. In values clarification, clients
are assisted to think about the factors
that influence their beliefs and decisions.
4. Incorrect. This is a judgmental
statement.
Copyright 2008 by Pearson Education, Inc.

Question 5

After recovering from her hip replacement, an

elderly client wants to go home. The family wants
the client to go to a nursing home. If the nurse is
acting as a client advocate, the nurse would
perform the following:
Informs the family that the client has a right to
decide on her own.
Ask the primary care provider to discharge the
client to home.
Suggest the client hire a lawyer to protect her
rights.
Help the client and family communicate their
views to each other.
Copyright 2008 by Pearson Education, Inc.

Rationales 5
1. Informing the family is an intervention
without assessment.
2. If the primary care provider sends the client
home, the nurse has not acted to assist in
resolving or reducing the conflict.
3. If the nurse assists in resolving or reducing
the conflict, an attorney may not be needed.
Legal action should be a last resort.
4. Correct. A major role of the client advocate
is to mediate between conflicting parties.

Copyright 2008 by Pearson Education, Inc.

Resources
Audio Glossary
Bioethics Resources on the Web: National
Institutes of Health
This site provides information and links to
bioethical information.
The American Journal of Nursing
American Journal of Nursing article on pain relief
of dying patients
Nursing Ethics: Your Source for Nursing Ethics
This site offers information on nursing issues and
links to various associated Web sites on ethics.
Copyright 2008 by Pearson Education, Inc.

Resources
The American Nurses Association: Center for Ethics and
Human Rights
This site defines ethics and its role in nursing and health
care.
Nursing World: Risk Versus Responsibility
Developed by the American Nurses Association to define
nondiscriminatory care
International Centre for Nursing Ethics
This site offers news, an on-line journal, and links to specific
nursing issues.
Notes on Informed Consent in Health Care
The author provides a synopsis and the mechanism to
obtain informed consent.
Copyright 2008 by Pearson Education, Inc.