Chapter 12: Ethical Issues in Leadership, the Organization, and Approaches to the Delivery of Care

Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

Multiple Choice

1. Which of the following organizational activities should be guided by ethical standards?

a. Recruitment practices b. Leadership practices c. Resource allocation d. All are correct

ANS: D

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A Incorrect All of the above should be guided by ethical standards. Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

B Incorrect All of the above should be guided by ethical standards. Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

C Incorrect All of the above should be guided by ethical standards. Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

D Correct! All of the above should be guided by ethical standards. Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

DIF: Cognitive level: Synthesis a. The charge nurse should fire the employee immediately. b. The charge nurse should send the employee home immediately. c. The charge nurse should send the employee for drug testing immediately. d. The charge nurse should suspend the employee with pay immediately.

2. During the night-shift report, the nurse notes that a colleague does not seem to be able to stay awake. Despite prompting, the colleague remains drowsy, and the nurse suspects substance abuse. The nurse reports this to the charge nurse. Which of the following describes the charge nurse’s responsibility?

A Incorrect Firing the employee immediately would be premature and not supportive. Firing is the role of the manager, not the charge nurse.

B Correct! The employee should be sent home immediately after being told the reason for being sent home (that she is unfit for work at this time). The charge nurse notifies the manager, who then has the responsibility to follow up with this nurse prior to the nurse’s return to work, express concern, and offer support, counseling, or medical treatment.

C Incorrect Discussion with the employee must take place prior to drug testing, as the employee may admit to the substance misuse. If necessary, the manager would arrange for drug testing, not the charge nurse.

D Incorrect Discussion with the employee must take place prior to any discipline. If necessary, the manager would be involved with the disciplinary actions, not the charge nurse.

DIF: Cognitive level: Synthesis a. An aging population creates a growing demand on health resources. b. An aging population means more young people are contemplating entering the nursing profession. c. Advances in technology call for increased generalization of practice for new nurses. d. All are correct.

3. Which of the following factor has an impact on nursing shortages?

ANS: A

A Correct! As the population ages, its health care needs increase. An aging population results in a growing demand on health resources.

B Incorrect An aging population means fewer young people are available to potentially enter the nursing profession.

C Incorrect Advances in technology call for increased specialization of practice for new nurses.

D Incorrect All of the above are not correct.

DIF: Cognitive level: Knowledge a. Recruiting nurses from developing countries and offering them a better way of life in Canada b. Booking a table at an international job fair for nurses and discussing opportunities with nurses who attend the fair c. Offering large financial and transition incentives for internationally educated nurses to come to Canada d. Hiring internationally educated nurses through international recruitment agencies

4. Which of the following is the most ethical method for recruiting internationally educated nurses?

A Incorrect This is unethical because developing countries can little afford to lose what resources they have.

B Correct! Booking a table at a job fair is the most ethical method of attracting internationally educated nurses. Recruitments are then voluntary, no incentives are necessary, and the recruiters are not perceived as “poaching.”

C Incorrect Incentives for internationally educated nurses may result in abuse from local nurses who may perceive reverse discrimination.

D Incorrect International recruitment agencies often use aggressive strategies to lure internationally educated nurses away from the developing countries with nursing shortages or promise financial or transition incentives that never materialize.

DIF: Cognitive level: Synthesis a. The nurse should ask another nurse with the same cultural background as that of the patient to care for the patient. b. Nurses must be knowledgeable about all cultures and customs. c. The nurse can identify the patient’s unique cultural practices during assessment and then plan the implementation of care and interventions accordingly. d. Nurses should avoid discussion of unusual customs.

5. Which of the following best describes the expectations of a nurse caring for a patient with a different cultural background?

ANS: C Feedback

A Incorrect The nurse should be able to care for this patient without involving another nurse. It is impossible for nurses to be knowledgeable about the cultural backgrounds and values of all the patients they care for.

B Incorrect It is impossible for nurses to be knowledgeable about the cultural backgrounds and values of all the patients they care for.

C Correct! Nurses should undertake a comprehensive cultural assessment of their patients in an effort to understand their unique values to design a care strategy consistent with their values and beliefs.

D Incorrect Nurses should encourage discussion of customs that are important to the patient.

DIF: Cognitive level: Application a. Language barriers always interfere with care. b. Patients’ food preferences result in less than optimal nutrition. c. Patients’ reluctance to disclose their feelings is an issue. d. There may not be a shared understanding of what is meaningful to these patients and their families.

6. Why are patients and clients from diverse cultural backgrounds at risk?

ANS: D

Feedback

A Incorrect Language barriers can sometimes be an issue, but not always.

B Incorrect Family members may bring outside food to patients, and in most situations, the care is short term, so diet is not a major issue.

C Incorrect This is a generalization and is not appropriate.

D Correct! Nurses should engage in actions that respect and empower cultural identity and make attempts to understand the values of patients and clients with different cultural backgrounds.

DIF: Cognitive level: Analysis a. Feeling competent and confident in one’s own discipline b. Being willing and able to work with others in the joint evaluation, planning, and care of the patient c. Believing that oneself and fellow professionals in one’s discipline can make an important contribution to care d. Recognizing that other disciplines also have important contributions to make

7. What does the term “multidisciplinarity” mean with respect to the levels of team functioning?

ANS: D

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A Incorrect This phrase describes unidisciplinarity.

B Incorrect This phrase describes interdisciplinarity.

C Incorrect This phrase describes intradisciplinarity.

D Correct! This is the correct definition of multidisciplinarity.

DIF: Cognitive level: Knowledge a. Translation by family members during decisions about cancer treatment b. Translation by family members to assist the patient to eat c. Translation by family members when culturally appropriate comfort measures are being provided d. Translation by family members to help identify subtle signs of discomfort in the patient

8. Patients’ family members are an important aspect of care, and family-centred care is an important model of care. Which of the following is an example of inappropriate family involvement in the care of a patient involving a language barrier?

ANS: A

Feedback

A Correct! Family translation during important treatment decisions should be a last resort. Translation for significant care issues, where possible, should be performed by professional translators to avoid coercion and to ensure that any consent or refusal of treatment by the patient is informed.

B Incorrect Family translation to assist with the patient’s mealtime is appropriate.

C Incorrect Family translation during the provision of comfort measures is appropriate.

D Incorrect Family translation to help identify subtle signs of discomfort in the patient is appropriate.

DIF: Cognitive level: Synthesis a. Respecting the racial, ethnic, cultural, and socioeconomic diversity of clients and families b. Designing health care that is flexible, culturally competent, and responsive to the needs and wish of the client and family c. Listening to family members because they may note important changes in the patient’s condition that may not be readily apparent to the team d. All are correct

9. Which of the following elements best describe family- and patient-centred care?

ANS: D

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A Incorrect These are all important elements of family- and patient-centred care.

B Incorrect These are all important elements of family- and patient-centred care.

C Incorrect These are all important elements of family- and patient-centred care.

D Correct! These are all important elements of family- and patient-centred care.

DIF: Cognitive level: Analysis a. Wake the daughter up, let her know it was inappropriate of her to sleep on the bed as now it will have to be remade. Because it is late, permit her to sleep on the chair beside her father’s bed. b. Wake the daughter up, and tell her she has to go home because visitors are not allowed during the night. c. Let the daughter sleep, and inform the staff that the bed linen needs to be changed in the morning. d. Let the daughter sleep, and meet with the manager in the morning about changing the rules to be more family centred and patient centred.

10. A nurse on a rehabilitation unit does rounds at the beginning of a night shift and discovers that the daughter of an older gentleman, who is recovering from hip surgery, is sleeping on a vacant bed in his room. What should she do as it is not hospital policy to allow visitors during the night?

ANS: D Feedback

A Incorrect Allowing visitors at night might not be the policy, but this approach is against the principles of family- and patient- centred care and contravenes ethical standards.

B Incorrect Allowing visitors at night might not be the policy, but this approach is against the principles of family- and patient- centred care and contravenes ethical standards. The daughter is also at risk of travelling late at night.

C Incorrect This is respectful of the needs of the daughter and her father in the short term.

D Correct! This is the respectful approach that recognizes the needs of the patient and family and the important role families play in supporting the emotional needs of the patient. In this scenario, the nurse is meeting the standards of the CNA Code of Ethics by advocating for the greater good.

DIF: Cognitive level: Analysis

TRUE/FALSE

1. Organizational ethics deals with those values that establish standards and influence how the organization is perceived both internally and externally.

ANS: T

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Correct The ethical culture of the organization influences its image and reputation, establishes the legitimacy of its role in society, and clarifies what the organization stands for.

Incorrect This statement is true.

DIF: Cognitive level: Knowledge

2. Distributive justice refers to the perception that processes have been fair and inclusive regardless of the outcome.

ANS: F

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Correct Distributive justice refers to such outcomes as allocation of resources, salaries, benefits, and work conditions, whereas procedural justice refers to the perception that processes have been fair and inclusive, regardless of the outcome.

Incorrect This statement is false.

DIF: Cognitive level: Knowledge

3. Nursing leaders are solely responsible for ensuring sound ethical practice and a healthy work environment.

ANS: F

Feedback

Correct Nurses share accountability with leaders in ensuring sound ethical practice, a healthy work environment, and staff satisfaction to create a culture and climate conducive to positive patient care outcomes.

Incorrect This statement is false.

DIF: Cognitive level: Comprehension

4. It is best practice when the nursing team explores ethical issues related to the patient/client and determines the best course of action.