Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow
Student Elements

Ethics Exercises

Please read each question below and type your response into each corresponding box. When you are finished, fill out your name, e-mail address, and instructor's e-mail at the bottom of this form, and click submit to send a copy to your instructor.

The ANA Code of Ethics now includes the word "patient" instead of the word "client" in referring to the recipients of nursing care.

1:  Do you agree with this change? Why or why not?

Identify two outstanding events in your life that you consider to have been occasions for acting in an ethical way.

2:  Describe the events, your feelings, and the learning processes that took place as a result of these two events. Compare the two events and the hard choices you had to make in each event.

You are the nurse manager in charge of the budget and are told to allocate $10 million to patients for free health care services at a family care clinic where you work. The very generous donor stipulated that a fair and equitable approach to distribution be used and asked for a budget report before the actual distribution was complete.

3:  On what basis would you allocate the money, and what distribution plan would you use for health care services?

Doris Boswell is a 78-year-old female with Alzheimer's disease, rheumatoid arthritis, and type II diabetes mellitus. For the last seven years she has resided at Comfort Rest Nursing Home, but for years before her admittance to the nursing home she lived with her son and his wife. Caring for her became so difficult that her son, John, and his wife could not safely keep her at home any longer. Her son visits every week or as often as possible.

Two years ago, Ms. Boswell developed end-stage renal disease and progressive peripheral neuropathy because of the advancement of her diabetes mellitus. Over time, her dementia has worsened noticeably, but her quality of life remained surprisingly good, despite the presence of her chronic diseases, and her dependence on nursing assistants for feeding and activities of daily living. Although she does not talk, she sometimes cries out in pain.

In the last few months, Ms. Boswell's behavior has changed. She is becoming more irritable by the day and is displaying behavior outbursts when the nurses or anyone else attempt to move her or do anything with her that is not a part of her ordinary daily care. The dialysis treatments have become too burdensome to manage because of her emotional outbursts and resistance.

After a thorough work-up, there was no physical reason for this drastic change in her behavior, so her physician attributed the change to the progression of Alzheimer's disease. Dr. Phillips, her primary physician and medical director of the nursing home, believes that the dialysis is more of a burden than a benefit for Ms. Boswell. Dr. Phillips believes that since he regards Ms. Boswell's quality of life as poor, dialysis treatments are a waste of valuable resources. Without dialysis, Dr. Phillips believes that Ms. Boswell would only live for a month or so. John and the physician discussed the benefit-burden issue, the treatment options, and the outcomes and prognosis of discontinuing dialysis. John was adamant that he wanted his mother to live as long as she could on dialysis, so he told Dr. Phillips that the nursing home administration did not need to worry about money and resources. John informed Dr. Phillips that he would be responsible for the bill and that he had plenty of money. He told Dr. Phillips that his mother would want to live as long as possible.

4:  Put yourself in John's place. What would you need to consider if you had to make this same decision about your mother's future? Please explain.

If you were a school nurse planning a prevention education program for your rural middle school students on alcohol, other drugs, and sex, what would you need to consider before actually beginning your program?

5:  What is the most effective prevention program that could be used? What ethical considerations should be incorporated into program planning? What message do you think adolescents need to hear? What type of relationship do you hope to establish with the students?

A 16-year-old adolescent named Kelly has come to a clinic where you work as a nurse. She has stated that she is at least 12 weeks pregnant but has not told anyone, not even her parents or boyfriend. She is scared of telling her boyfriend for fear of losing him. She wants an abortion, has cash money, and does not want anyone to know about the pregnancy or the abortion. Explore the ethical issues surrounding this situation. Consider the trust-confidentiality-privacy dilemma and the consent dilemma.

6:  Identify specific nursing strategies that you must consider using with Kelly. The clinic is in a state that does not require direct parental involvement but does require consent by someone of legal age.

As a school nurse, you notice that you have a 15-year-old boy named Eric who keeps to himself and never talks to anyone. Lately, his behavior has become what you would note as extreme: not eating in the cafeteria, keeping his head down at all times, and never making eye contact with anyone. He has completely withdrawn from any social interaction at school. The other teens are making fun of him and his behavior, and these actions just seem to make him go deeper into withdrawal. You believe that he is very depressed, and from literature that you have read recently, you gather that he may be at risk for committing suicide.

7:  As a nurse, explore your moral obligations and the specific actions that you would take in this situation.

Greg T. is a 25-year-old man hospitalized with a paranoid delusional disorder. When Greg was admitted, he was very angry and vehemently verbalized that he believed that his ex-mother-in-law had been spreading lies about him around the town and accused her of getting him fired from his last job. When Greg's sister, Rose, visited him at the hospital, he gave consent for you, his nurse, and his psychiatrist to talk with her about his condition. At that time, Rose stated that Greg's ideas about his ex-mother-in-law were delusional thinking and that there was no basis in fact regarding his beliefs. His condition has improved with adjustments of his psychotropic drugs (he is no longer actively exhibiting angry and paranoid behavior), and he is being discharged today. When you are talking with Greg today in preparation for his discharge, he tells you "I'm still not finished with my ex-mother-in-law." You ask him what he means by this statement, and he is evasive but answers with cryptic statements that seem to indicate veiled threats against the woman.

8:  As Greg's nurse, how would you evaluate the duty to warn in this situation? What actions would you take?

9:  Do you believe that Greg should still be discharged today? Please provide a rationale for your answer and discuss what information would be needed to make this decision.

10:  How would you document the events of this situation in Greg's medical record? What would be important considerations in writing a good narrative of the event?

Enter your name, e-mail address, and your instructor's e-mail address to have your results e-mailed to him or her.
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