Chapter 10: Safeguarding Patient Rights

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

Multiple Choice

1. Which of the following best describes a “right”?

a. A legal claim or privilege b. A claim or privilege to which one is justly entitled, either legally or morally c. A claim or privilege that carries no corresponding obligations d. The rights of patients are a grey area open to interpretation

ANS: B

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A Incorrect Rights are not required to be legally based.

B Correct! A right is a claim or privilege to which one is justly entitled, either legally or morally.

C Incorrect A right carries a corresponding obligation. Otherwise, the right loses its meaning.

D Incorrect The rights of patients are explicit and clear through standards contained in professional codes of ethics.

DIF: Cognitive level: Comprehension a. The nurse’s right b. The nurse’s autonomy c. The nurse’s obligation d. The patient’s obligation

2. The nurse is in the process of obtaining informed consent from a patient. Which of the following best describes this process?

ANS: C

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A Incorrect This process does not relate to the nurse’s rights.

B Incorrect This process relates to the patient’s autonomy, not that of the nurse.

C Correct! It is the nurse’s obligation to obtain the patient’s informed consent. The nurse must ensure that all relevant information has been provided so that the patient may exercise the right to make an informed consent.

D Incorrect Although the patient’s informed consent is needed, the patient is not obligated to give it.

DIF: Cognitive level: Comprehension a. The nurse should do nothing. b. The nurse should tell her colleagues to be extra careful when attending to this patient. c. The nurse should confront and challenge the patient about his dishonesty. d. The nurse should report this information to her manager in a private meeting.

3. A patient in the nurse’s care is being investigated for diarrhea. The nurse remembers this patient from another facility and recalls that he was diagnosed as HIV-positive, but the patient denies this to the nurse. How should the nurse proceed?

ANS: D

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A Incorrect This is not the correct action for the nurse to take because it potentially places others, including the patient, at risk

B Incorrect The nurse should not discuss this issue with her colleagues because this would violate the patient’s right to confidentiality. Precautions are already taken in the care of every patient.

C Incorrect Rechecking with the patient for clarification of the situation is acceptable, but challenging and confronting the patient is not, especially because the nurse could be mistaken in her memory.

D Correct! The nurse should report this situation to her manager in a private meeting. In many provinces, statute law requires certain patient information and conditions to be disclosed. For example, many public health laws require public health care professionals to disclose to their local medical officer of health the identity of anyone diagnosed with certain communicable or sexually transmitted diseases, including HIV/AIDS. The nurse’s manager is the most appropriate person to deal with this situation; he or she will also need to take into consideration that the nurse’s recollection may be incorrect.

DIF: Cognitive level: Synthesis a. The nurse must disclose the information to the unit manager. b. The nurse can disclose to the patient’s family in order validate the accuracy of the information. c. The nurse can disclose the information during morning report. d. The nurse must disclose the information if someone is in danger.

4. A patient has requested that certain information remain confidential. Which of the following is an exception to maintaining patient confidentiality?

ANS: D Feedback

A Incorrect In most cases, discussing the matter with anyone violates patient confidentiality.

B Incorrect Disclosure to the family may be necessary only to protect the patient or others from harm. The nurse should seek support from the manager if this situation arises.

C Incorrect Confidential information must not be discussed in any report. If the nurse needs to discuss required information with a particular team member, then this discussion should take place on a one-on-one basis, not during a verbal report, when others can hear what is being said. The nurse must disclose to the patient that this information will be shared.

D Correct! If a patient poses a threat to himself or others, the nurse has an ethical obligation to report the information to the authorities in the institution and to the police. Provincial law also requires disclosure in cases of suspected child abuse.

DIF: Cognitive level: Analysis a. The nurse should give the patient her medical record because freedom of information legislation permits it. b. The nurse should give the patient her medical record because it legally belongs to the patient. c. The nurse should ask the charge nurse to review the chart with the patient. d. The nurse should refer the patient to the physician or the medical records department.

5. What should the nurse do if a patient asks to see her medical record?

ANS: D

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A Incorrect Although the patient has the right to his or her information that is contained in the health record, there is an appropriate process that must be followed.

B Incorrect The patient’s record the collection and documentation of the patient’s medical information is the legal property of the physician or the institution.

C Incorrect The charge nurse is not normally authorized to release such information.

D Correct! Although the records themselves do not belong to the patient, the information contained in the records does. However, only the physician or the medical records department may release the information contained in the patient’s medical record to the patient. There is a process to ensure that this is done appropriately and that there is no risk of harm to the patient or others if it is shared. The process depends on whether the patient remains in the hospital or has been discharged from hospital.

DIF: Cognitive level: Application a. To protect health workers from malpractice suits b. To serve as an ethical decision-making framework for the disclosure of information c. To establish rules for the collection, use, and disclosure of personal health information d. To protect hospitals and health authorities

6. Most provinces have enacted legislation regulating access to personal health information. What is the main purpose of information and privacy legislation?

ANS: C

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A Incorrect Legislation does not protect health care professionals from malpractice suits.

B Incorrect Legislation does not provide an ethical decision-making framework.

C Correct! The purpose of information and privacy legislation is to establish rules for the collection, use, and disclosure of personal health information.

D Incorrect The legislation is not designed to protect hospitals or health authorities.

DIF: Cognitive level: Comprehension a. The nurse should immediately disclose the error to the patient and the patient’s family. b. The nurse should inform the physician of the patient’s condition. c. The nurse should discuss the issue with her manager. d. The nurse should discuss the issue with her coworkers so that she feels supported.

7. What immediate action should a nurse take if a medication error results in harm to a patient?

ANS: B

Feedback

A Incorrect When harm occurs, the ethically responsible action is full disclosure of that harm to the patient or family. However, this should not be the nurse’s first action.

B Correct! If harm has resulted from the error then the physician needs to be informed immediately to ensure the appropriate remedial action is taken.

C Incorrect Once the immediate consequences of the error have been addressed, then the ethically responsible action is full disclosure of that harm to the patient or family. However, facilities have different policies regarding the disclosure and documentation of errors, so the nurse should first discuss the issue with his or her manager, who would be most familiar with these policies and also provide the appropriate support and counsel to the nurse.

D Incorrect From the patient safety perspective, it is important to share adverse events with others to minimize the risk of this happening again. This can be done by the manager in manner that respects the confidentiality of the nurse and that of the patient. However, the nurse may be open to be part of this sharing process.

DIF: Cognitive level: Application a. The nurse should call security to restrain the patient. b. The nurse should let the patient go but alert the police. c. The nurse should refuse to give the patient his personal effects. d. The nurse should allow the patient to leave.

8. A competent patient in the nurses’ care becomes angry, insists on leaving against medical advice, and refuses to sign the waiver acknowledging that he has been advised that leaving is not recommended at this time. What should the nurse do?

ANS: D

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A Incorrect In cases involving psychiatric patients of unsound mind, the mental health statutes of most provinces may permit such persons to be prevented from leaving if they pose a threat or danger to themselves or to others. However, the nurse should not attempt to restrain a competent patient or ask security to do so.

B Incorrect If the patient is competent and not at risk of harming others there is no reason to alert the police.

C Incorrect The nurse cannot legally withhold a patient’s personal effects.

D Correct! The nurse should alert the team because others may be able to persuade him to stay. However, ultimately, there is nothing hospital staff can do to prevent a competent patient from leaving. The nurse should give the patient his personal effects and allow him to leave. If a competent patient refuses to sign the waiver, the fact that he is leaving against medical advice should be carefully documented in the chart.

DIF: Cognitive level: Synthesis a. To ensure that everyone with a mental illness will be treated b. To protect the rights of the public c. To protect the rights of the patient d. To outline rights and obligations for health care professionals and patients

9. What is the purpose of a mental health act?

ANS: D

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A Incorrect Not everyone with a mental illness receives treatment.

B Incorrect The protection of the rights of the public is one aspect of a mental health act, but not the purpose.

C Incorrect The protection of patient rights is one component of a mental health act, but not the purpose.

D Correct! The purpose of a mental health act is to outline rights for patients and obligations for health care professionals in relation to patients with mentally illness, such as admission to and discharge from a mental institution.

DIF: Cognitive level: Knowledge a. Privacy b. Making assumptions made about their needs c. Disrespect from other clients d. All of the above

10. Which of the following issues offer the greatest ethical concerns when nurses care for transgender persons?

ANS: D

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A Incorrect All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

B Incorrect All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

C Incorrect All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

Correct! All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

DIF: Cognitive level: Analysis

TRUE/FALSE

1. A resident in the operating room should be allowed to participate in all aspects of a surgery because the patient signed a general surgical consent form.

ANS: F

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Correct Patients should be informed when residents are to perform a primary role during an operative procedure. A general surgical consent form would not provide this information. In academic hospitals, patients should be informed in some manner that students from all disciplines might be involved in their care.

Incorrect This statement is false.

DIF: Cognitive level: Knowledge

2. A patient in the nurse’s care is unaware of her diagnosis of terminal cancer and asks the nurse about it. The patient’s physician is refusing to give her the diagnosis because he is concerned about her reaction to the news. The nurse should be honest with the patient and tell her what the diagnosis is.

ANS: F

Feedback

Correct Unless she has certain legal qualifications, the nurse is not authorized to tell the patient what her diagnosis is. Giving a diagnosis identifying a disease or disorder is a controlled act that is reserved for certain health care professionals. As an advocate for the patient, the nurse should instead endeavour to influence the physician, stressing the patient’s right to be informed.

Incorrect Unless she has certain legal qualifications, the nurse is not authorized to tell the patient what her diagnosis is. Giving a diagnosis identifying a disease or disorder is a controlled act that is reserved for certain health care professionals. As an advocate for the patient, the nurse should instead endeavour to influence the physician, stressing the patient’s right to be informed.

DIF: Cognitive level: Analysis

3. With the exception of indigenous children, who are covered under the Indian Act, if a physician or the team believes that the decisions of a parent or substitute decision maker put a child at risk and in need of protection, there is an obligation to report this to the Children’s Aid Society (CAS), who will undertake an investigation and determine the child’s need for protection.

ANS: F

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Correct The Indian Act does not address issues related to child welfare. This obligation exists to protect all children in Canada. However, recent cases highlight that to evaluate the best interests of Indigenous children, the uniqueness of their culture, heritage, and traditions and the need to preserve their cultural identity need to be considered.

Incorrect This statement is false.

DIF: Cognitive level: Analysis

4. First responders across Canada are required to initiate cardiopulmonary resuscitation (CPR) efforts on all persons when they receive 911 calls to their homes.

ANS: F

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Correct Historically, first responders were required to initiate resuscitation even on terminally ill persons, even if it was against the wishes of the family, and even if an advance directive from the patient was present. To address this concern, some provinces have introduced a process to ensure that the patient’s/family’s wish not to have CPR is understood, documented, and respected. A medical directive signed by a physician or nurse practitioner, which confirms the existence of a signed DNR (Do Not Resuscitate) order, is accepted by emergency responders in these provinces. Incorrect This statement is false.

DIF: Cognitive level: Knowledge

5. The Indian Act gives the government responsibility and oversight for the Indigenous peoples of Canada with regard to such matters as status, land, administration, resources, and education.

ANS: F

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Correct This paternalistic legislation covers First Nations peoples but excludes the Métis and the Inuit.

Incorrect This paternalistic legislation covers First Nations peoples but excludes the Métis and the Inuit.

DIF: Cognitive level: Knowledge