Ethical Considerations in Nursing Research and Practice, Exams of Nursing

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Canadian Fundamentals of Nursing, 6th

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A child's immunization may cause discomfort during administration, but the benefits of protection from disease outweigh the temporary discomforts. Which principle applies to this situation? - ANSBeneficence. (Beneficence means doing or promoting good for others. Commitment to beneficence helps guide difficult decisions. Balancing the risks between the temporary pain of an injection and the extended benefits is an example. Fidelity means being true to one's work. Nonmaleficence means doing no harm. Respect for autonomy means giving allowing patients to choose their own course of care.) A clinical nurse develops a better way to secure an intravenous access device in a patient and wants to see whether it would benefit other patients. Which of the following should be the first step in initiating a study? - ANSReview current literature related to the clinical problem. (Review of the literature is the first step in the orderly research process to determine what is already known about the problem. Recruiting patients occurs later in the process, after the nurse identifies the problem, researches the literature, and designs the study. Experimenting with new nursing procedures that have not been tested or approved is a risk to patients. Surveys are designed to obtain information from large study populations and would not be a first step in the research process.) A new nurse on an orthopedic unit is assigned to care for a patient undergoing skeletal traction. The nurse asks a colleague, "What is the best practice for cleaning pin sites in skeletal traction?" This question is an example of which of the following? - ANSKnowledge-focused trigger. (A knowledge-focused trigger is a question regarding new information available on a topic. A problem-focused trigger is one faced while the nurse is caring for a patient or noting a trend. The PICOT (population, intervention, comparison, outcome, time) format is a way to phrase a question to help clarify the question and the parts. A hypothesis is a prediction about the relationship between study variables.) A nurse is sued for failure to monitor a patient appropriately. Which statements are correct about professional negligence lawsuits? (Select all that apply.) A. The nurse is the plaintiff. B. The person filing the lawsuit has the burden of proof. C. The defendant must prove injury, damage, or loss. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. - ANSB. The person filing the lawsuit has the burden of proof. Correct

D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. Correct (The plaintiff, the person filing the suit, has the burden of proof and must prove that a breach in the prevailing standards of care caused an injury. The nurse would be a defendant in this case. The plaintiff, not the defendant, must prove injury, damage, or loss.) A nurse manager is researching the effects of staff shortages on job satisfaction among new graduates. Which of the following would be the most effective way to gather data? - ANSBy interviewing staff nurses on the unit regarding their perceptions. (A qualitative research study can be carried out effectively, in this case, in order to explore and describe the perceptions of staff nurses about staff shortages and their job satisfaction. Through narrative interviews, the participants' perceptions can be compared, and common characteristics can be discovered. It is difficult to collect data about perceptions or feelings without talking to those involved. Quantitative survey and experimental research involves precise measurements and would not be of use in this study of perceptions. Although obtaining suggestions for possible solutions could be useful, it does not help to identify the problems on this specific unit. The data must be collected first.) A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the following would be appropriate to use? - ANSEvaluation research. (Evaluation research is aimed at finding out how well a program, practice, policy, or procedure is working. A survey is a study of a large group to identify general information, opinions, attitudes, or perceptions. A grounded theory is developed through the collection and analysis of qualitative data. Experimental research involves collecting information about human subjects who are assigned to a control group and a comparison group.) A nurse researcher is designing an exercise study that involves 100 patients who attend a wellness clinic. As the patients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or remain in the traditional program. The nurse plans to measure the patients' self-report of exercise before and 6 months after the program begins. What factor might influence the results of this study in an unfavourable way? - ANSSampling method. (Because the patients at the clinic are allowed their choice of the traditional versus the new exercise program, the sampling in this study is not random sampling.) A nursing student is unsure about the legal liability of using skills associated with placement as a student. Which of the following is true about legal liability for a nursing student? - ANS1. Student nurses, like all other nurses, are accountable for their own actions. Correct

2. The institution where a student is placed has no responsibility to monitor the actions of a student.
3. It is the nursing instructor's role to inform patients that they are being cared for by a student nurse
4. Usually faculty members are responsible for instructing and observing students; however, there are some situations in which staff nurses may share these responsibilities. Correct
5. Nursing students should never perform tasks they have not been taught; instructors should supervise all new skills that are being performed. Correct A patient can be admitted to a mental health facility and treated without his or her consent under which of the following circumstances? - ANSThe patient has threatened to harm himself or herself or others. (police officers (or other authorized parties) may bring the patient to a health care facility for examination and treatment without the patient's consent. The next of kin cannot override a patient's autonomy. Although a psychotic episode may have potential untoward effects, the patient must be the one to consent to treatment.) A patient who is confused is left alone in bed with the side rails down and the bed in a high position, and the patient falls and breaks a hip. In legal terms, what has occurred? - ANSNegligence A researcher gives a subject full and complete information about the purpose of a study. This is an example of which of the following? - ANSInformed consent. (Informed consent implies that the research subjects are given full and complete information about the purpose of the study, procedures, data collection, potential harms and benefits, and alternative methods of treatment. Confidentiality rules guarantee that any information the subject provides will not be reported to people outside the research team. Bias is any personal opinion or judgement that may be interjected into the results. Anonymity means that the subject's name and identifying information would not be disclosed during the research study.) Advance care planning (ACP) - ANSAdvance care planning (ACP) is a multidimensional process that involves health care providers in discussion with patients to ensure that they clearly understand their illness, its trajectory, and available treatment options. ACP includes the expression and comprehension of a patient's beliefs and values and the translation of these beliefs and values into medical decisions. During the ACP process, patients can also identify surrogate decision makers who can act if they become unable to make their own health care decisions. Despite its benefits, ACP remains an underutilized tool in health care. After researching the scientific literature and confirming that an issue is an ethical dilemma, which of the following should the nurse do next? - ANSPerform a values clarification

An advanced-practice nurse in the community has completed a research project showing that follow-up care for women who have experienced gestational diabetes is not adequate. As a member of an interdisciplinary team, the nurse writes a policy guiding follow-up standards for all postpartum women. In effecting change, the nurse would be involving which principle? - ANSSocial justice. (The concept of social justice is also related to a concern for equitable distribution of resources, like the principle of justice, but goes beyond this, encouraging the nurse to seek ways to effect a change in the larger health care system and societal structure in order to create greater equity for all. In this example, the nurse is moving toward this in the actions of writing a policy. Autonomy is the ability to operate independently. In this case, the nurse is working as part of an interdisciplinary team and not focusing on upholding a patient's autonomy. Ethics of care is a philosophy of care not specifically referred to here.) An operating room nurse is talking with colleagues during a meeting. She asks, "I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical patients? What does the P represent in this example of a PICOT question? - ANSSurgical patients. (Surgical patients are the patient population of interest (P) in the PICOT (patient population, intervention, comparison, outcome, time) question. The intervention is the cleaning of the skin, and the comparison of interest is between chlorhexidine use and povidone-iodine use. Operating room nurses are not an element of the PICOT question.) Assault defined - ANSAssault is the threat to engage in harmful or offensive contact. Battery defined - ANSBattery is the actual unlawful touching of another, whether threat of harm is included or not. Civil tort - ANSA civil tort is a civil wrong committed against a person or property. An example of a tort involving property would be to lose the patient's dentures by misplacing them. Ethical dilemmas often involve a conflict of opinion. Once the nurse has determined that the dilemma is ethical, which of the following would be a critical first step in negotiating the difference of opinion? - ANSGather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. (The process of resolving ethical dilemmas is similar to the nursing process. The first step is gathering all relevant information. Then the group will proceed through assessment, planning, implementation, and evaluation.)

hen the nurse describe a patient as "that nasty old man in 354," the nurse is exhibiting which of the following? - ANSGender bias and ageism If the nurse assesses a patient for pain and then offers a plan to manage the pain, which principle encourages the nurse to monitor the patient's response to the pain management plan? - ANSFidelity. (Fidelity means keeping the promises that are made. If the nurse offers to manage pain, then the nurse needs to follow through and ensure that the pain is controlled. Beneficence means taking positive actions to help others. Nonmaleficence means doing no harm. Respect for autonomy means allowing patients to choose their own care.) In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? - ANSNurses develop a relationship with the patient that is unique among all health care providers. (Nurses generally interact with patients over longer intervals of time than do health care providers in other disciplines. Because nurses are often involved in personal care, patients and families reveal information not always shared with physicians or others.) It may seem redundant that health care providers pledge to "do no harm" to patients. The purpose of this oath is to reassure the public that the health care team will work to heal patients with as little pain and harm as possible. Which principle underlies this pledge? - ANSNonmaleficence. (Nonmaleficence means not causing harm. Beneficence means providing the best care possible. Accountability refers to answerability for one's actions. Respect for autonomy means allowing patients to choose their own course of care.) Most litigation involving hospital care is related to which of the following situations? - ANSThe nurse follows an order that is incomplete or incorrect. Nurses agree to be advocates for their patients. The practice of advocacy calls for the nurse to do which of the following? - ANSAssess the patient's point of view, and prepare to articulate this point of view. (As an advocate, the nurse needs to understand the patient's point of view and then be prepared to verbalize that point of view to others involved in the patient's care. Understanding the law, seeking advice from a manager, and ensuring that prescribers' orders are completed correctly can all help in advocacy, but they are not themselves acts of advocacy.) Nurses are bound by a variety of laws. Which of the following descriptions of types of law is correct? - ANSStatutory law is created by elected legislatures, such as the provincial or territorial legislature that defines the nursing practice act.

Nurses who are new to practice can best contribute to nursing research by doing which of the following? - ANSAssisting with data collection. (A nurse who is new to practice has not developed the experience required for research but can begin at the less complicated level of data collection. An experienced researcher is more qualified to identify problems for formal research, although input from all levels of nursing is valuable. Nurses with doctoral-level training are typically prepared for obtaining financial backing. A Canadian Nurses Association position paper cites a master's degree as qualification for preparing nurses to implement research- based change in nursing practice.) Relational ethics suggests that ethical dilemmas can best be attended to by focusing on attention to which of the following? - ANSRelationships. (Relational ethics focuses on the role of relational context or the experience of the relationships in shaping moral decisions.) The best way for a nurse to avoid being liable for negligence might be to do which of the following? (Select all that apply.) - ANS- Follow standards of care.

• Give safe, competent care in a caring manner.
• Document assessments, interventions, and evaluations as soon as possible after performing them. The experience of "moral distress" is captured by which of the following statements? - ANSMoral distress occurs when inconsistency exists between a nurse's beliefs and values and how he or she is able to act. The foundation of research is which of the following? - ANSScientific method. (The scientific method is the foundation of research and is the most reliable and objective of all methods of obtaining knowledge. Documentation, critical thinking, and evidence are not the foundations of research.) The nurse involved in scientific research effectively analyzes the information collected and determines a course of nursing action by doing which of the following? - ANSUsing critical thinking. (Critical thinking involves analyzing the data, learning, and problem solving to come up with a course of action. Tradition limits the ability to learn new ways and overlooks what research has to offer. The advice of experienced practitioners may limit research because experience may mean doing things the same way they have been done for years. Using personal opinion overlooks the objective data that are available.) The nurse must follow standards of care to avoid potential litigation such as negligence suits. Which of the following describe a potential nursing malpractice situation? (Select

all that apply.) - ANS1. Failure to question a health care provider about the appropriateness of a patient order. Correct

2. Failure to make a nursing diagnosis. Correct
3. Failure to properly use medical equipment ordered for patient monitoring. Correct
4. Failure to follow the "seven rights" of medication administration. Correct
5. Failure to provide discharge instructions. Correct The nurse notes that the health care unit keeps a list of patients' names at the front desk in clear view so that health care providers can more efficiently locate patients. The nurse knows that this action is a violation of which of the following? - ANSCommon law tort relating to invasion of privacy. The nurse recognizes which correct interpretation of advance-directive provisions? - ANSA proxy directive allows an appointed person to make health care decisions when the patient is in an incapacitated state. The nurse researcher obtains informed consent from participants in a study primarily for which reason? - ANSTo ensure that the study subjects understand their roles in the study. (The conduct of research must meet ethical standards in which the rights of human subjects are protected. The research participants must be told about the study's purpose and procedure and their roles in the study. The researcher is always legally responsible for his or her actions. Control of variables is related to the study design, not to informed consent. Confidentiality is part of the ethical nature of research but is not the focus of informed consent.) The nurse researcher who obtains new knowledge regarding a procedure can most effectively share the information with the nursing profession by doing which of the following? - ANSCommunicating the research findings in a professional journal. (Publication of research results provides other nurses with the scientific background of the study before they apply its findings in practice. Study subjects and setting should be similar in order to replicate a study. Nurses should not change from accepted to unproven ways of providing care without careful research and collaboration with colleagues. Experimenting with new nursing measures is inappropriate and may place a patient at risk.) The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a quality improvement project with the plan, do, study, act (PDSA) model. Which of the following is an example of the "do" step of that model? - ANSImplement a new skin care protocol on all medical units. (The "do" step consists of selecting an intervention on the basis of a data review, implementing the change, and studying the results of the change. The "plan" step includes reviewing the available data to understand existing practice conditions or

problems to identify the need for change. The results of the change are evaluated in the "study" step. The "act" step is the incorporation of the findings into current practice.) To distinguish an ethical problem from other types of problems encountered, the nurse should be aware that which of the following statements about ethical problems is true? - ANSThe answer is not determined by logical deduction. (The characteristics of an ethical problem include the lack of a logical conclusion, lack of scientific support for either choice or support for both choices, differences in valuing by staff and the patient that might result in harm or in options that are less than the best, and an answer that involves several areas of human concern.) Values clarification is a process that involves which of the following? - ANSAppraising one's personal values that arise from careful reflection. When many people share the same values, it may be possible to identify a philosophy of utilitarianism. Which of the following statements is a principle of utilitarianism? - ANSThe value of something is determined by its usefulness to society; this concept is also known by the guiding principle of "greatest good" for the greatest number of people. (According to a utilitarian system of ethics, the value of something is determined by its usefulness for the greatest number of people.) When the nurse signs a form as a witness, the nurse's signature shows which of the following regarding the patient? - ANSThe patient has signed that form and the witness saw it being done. (indicates only that the person signing the form was indeed the person whose name was on the form. The witness does not have to know whether the patient was fully informed or not. The witnessing agent is indicating no judgement about the level of cognitive function of the patient by signing as a witness. The nurse should assess for coercion, but the signature of the witness is not an acknowledgement of having performed such an assessment. If the witness feels that someone is forcing a patient to sign, however, then the witness may refuse to sign, and the contract is then void (unless a different witness signs).) Which of the following are true regarding advance care planning? (Select all that apply.)

• ANSA. It includes the expression and comprehension of a patient's beliefs and values. Correct B. It is a multidimensional process that involves health care providers. Correct C. The patient's family is not included in this planning.

D. Patients can also identify surrogate decision makers, should they become unable to make their own health care decisions. Correct E. The number of unwanted medical interventions is increased. F. This approach remains underutilized in health care. Correct Which of the following could be a barrier to nursing research? - ANSShortage of professional nursing staff. (Shortage of staff could mean less time and personnel to conduct and participate in research. Nursing teams that have teamwork skills can aid research. The desire to change is an incentive for research. Pressure from higher levels in the organization is also an incentive for research.) Which of the following is a priority goal for nursing research? - ANSImproving patient care. (Quality patient care is always the primary focus of nursing practice. Cost control would be a benefit but is not the primary focus. Research is not about technology; many "old" procedures can be improved through research. Although research is a professional function of nursing, it is not done to serve the profession.) Which of the following represents utilitarian allocation of scarce resources? - ANSDistribution of resources to achieve the greater good of the larger group. Which of the following sets forth ethical principles for professional nursing practice in a clinical setting? - ANSCode of Ethics for Registered Nurses of the Canadian Nurses Association. (The Code of Ethics is an ethical guide embodying professional values and standards established by nurses and the Canadian Nurses Association to maintain the highest standards for the nurse's conduct in practice. The code gives a broad overview of the appropriate and inappropriate roles of the registered nurse. Standards of care written by field experts are guidelines that direct the usual pathway of patient management under certain circumstances. Good Samaritan laws are laws that prevent an individual from suing another person who tries in "good faith" to assist that individual in an accident.) Which of the following statements concerning informed consent is correct? - ANShe goal of informed consent is to protect the patient's right to autonomy. (The patient's right to autonomy is the basis of informed consent. Informed consent applies to all treatments, not just those related to surgical procedures.) Withdrawal of food and hydration at the end of life is an ethical issue that nurses may face, particularly if a patient is near death or in a vegetative state. Which of the following

is an accurate statement that the nurse could reveal to the patient's family? - ANSIt is appropriate to withhold food and fluids only after careful examination of the patient's status because artificial hydration may not be benefiting the patient. (The research literature related to withdrawing food and fluids at the end of life is not conclusive enough to support either withdrawing or not withdrawing food or hydration. Rather, a clinician's decision should be based on the goals of care of the patient and family and a careful assessment of the patient's comfort. At the end of life, when the body is shutting down, individuals may lose their desire for food and fluids. Force- feeding can sometimes harm a patient.) You are a nurse researcher interviewing senior oncology nurses, asking them to describe how they deal with the loss of a patient. The analysis of the interviews yields common themes describing the nurses' grief. This is an example of which type of study?

• ANS Qualitative study. (A qualitative study involves inductive reasoning to develop generalizations or theories from specific observations or interviews. Historical research establishes facts and relationships concerning past events. Correlational research is exploration of the interrelationships among variables of interest without any intervention by the researcher. An experimental study involves the use of tightly controlled subject groups, variables, and procedures to eliminate bias and ensure that findings can be generalized to similar groups of subjects.)