Table of Contents:

1. Ethical Principles 4. Client Advocacy & Cultural

2. Ethical Decision-Making Competence
3. Ethical Resources 5. NCLEX Practice Questions

Ethics

1. Ethical Principles 2. Ethical Decision-Making

Ethics are moral principles and standards that guide Ethical dilemmas:
behavior and decision-making based on what is right
Ethical dilemmas arise when there is a conflict
or wrong rather than on personal opinion. between two or more ethical principles, making it
difficult to determine the best course of action.
Nursing codes of ethics and ethical principles guide

When ethical dilemmas occur, the nurse’s #1 priority =
ethical nursing care:
honoring the client’s wishes and advocating for the
y Codes of ethics are guidelines that promote safe,
client’s rights.
ethical care:
y Emphasize responsibility, accountability,
Ethical dilemma examples:
and advocacy
y Beneficence vs. autonomy: The client’s family wants
y Although not legally binding, violations can result
aggressive treatment when the client’s advance
in disciplinary action.
directive states the client only wants palliative care.
y Beneficence vs. nonmaleficence: Continuing

TABLE 1. ETHICAL PRINCIPLES aggressive, invasive treatment when there is no
chance of recovery
Principle Example y Beneficence vs. autonomy: A client’s religious beliefs
conflict with treatment (a Jehovah’s Witness declines a

Respecting client’s

Autonomy: Respect blood transfusion).
decision to refuse
client’s right to make
treatment, even if Ethical decision-making:
own decisions.
you disagree y Ethical reasoning is a standardized decision-

Beneficence: y Administering analgesics making process for handling ethical dilemmas:
Promote well-being. to alleviate pain y Ethical decision-making mirrors the nursing
process, beginning with assessment of the
y Nonmaleficence: y Double-checking situation.
Prevent harm and medication dosages to
The nurse should first identify the dilemma, gather
minimize risks. prevent error relevant information, and reflect on personal
values and biases.
y Fidelity: Fulfill y Returning to administer
y After identifying the problem, possible actions
promises and pain medication as
and their consequences are considered, and
responsibilities. promised
then the decision is evaluated.
y Veracity: Provide y Explaining diagnosis
truthful and accurate and treatment options
information. honestly
Management of Care

y Justice: Treat all fairly y Providing high-quality

and equally. care regardless of
socioeconomic status

 Autonomy and beneficence: Autonomy is  Fidelity and veracity: Fidelity involves keeping
respected when clients make their own decisions. promises, like returning to give analgesics as promised.
Beneficence is demonstrated by promoting clients’ Veracity means providing truthful and accurate
well-being and acting in their best interest. information to keep clients fully informed.
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2. Ethical Decision-Making, Continued Client advocacy examples:
y Ensuring client’s needs are met
Ethical reasoning example: y Example: Using interpreters
Scenario: A client’s advance directive declines
Communicating client wishes
aggressive treatment, but the family requests it. y Example: Notifying HCP of changes to
advance directives
Application: The nurse identifies the conflict between

Respecting client autonomy
the client’s advance directive and the family’s request
y Example: Advocating to respect client’s treatment
for aggressive care. After gathering information and
decisions, even when others disagree
reflecting on personal values and biases, the nurse
y Protecting client confidentiality
considers actions like following the directive or
y Example: Intervening when private information is
consulting the ethics committee. After taking action,
inappropriately shared
the nurse evaluates the decision’s impact on the
client and family and the ethical issue’s resolution.
Cultural competence:

Cultural competence is an important aspect of client
3. Ethical Resources care and advocacy. To promote culturally competent
Nurses should use ethical resources to guide ethical care, the nurse should:
decision-making to solve ethical dilemmas: y Be aware of personal cultural biases and ensure

Ethics committees: A multidisciplinary team they do not impact client care.
composed of health care professionals from different
Avoid stereotyping clients based on gender,
disciplines, clients, and families consulted to help ethnicity, or religion.
solve ethical dilemmas y Conduct a cultural assessment to determine if

Provide guidance and support to reach a the client has any beliefs, values, or traditions
decision; the committee does not make that may impact their care.
the decision. y Incorporate cultural practices into the
y Organizational policies: Provide detailed care plan.
frameworks for specific ethical issues (informed
consent, confidentiality). Examples of culturally competent care:
y Interprofessional collaboration: Discuss ethical y Supporting a client’s treatment decisions based on
issues with the client’s health care team members religious beliefs
to reach a well-rounded decision. y Example: Jehovah’s Witness clients do not
typically receive blood product transfusions.
4. Client Advocacy & Cultural Competence y Accommodating dietary preferences based on
Advocacy is acting on behalf of the client to ensure the religious beliefs
client’s rights are respected: y Example: Muslims do not typically eat pork or take

Ethical responsibility: Nurses must serve as client medications with pork derivatives.
advocates, protecting client’s rights.

Focus on vulnerable clients: Extra care should be
taken to advocate for vulnerable populations such as
children, older adults, and individuals with cognitive
impairments.
Management of Care

 Ethical dilemmas: Ethical dilemmas arise when two or  Cultural competence: To promote culturally
more ethical principles conflict and are resolved through competent care, nurses should assess personal
ethical reasoning by first gathering information and cultural biases; avoid stereotyping; and conduct
examining personal biases. a cultural assessment to understand the client’s
 Client advocacy: Protecting client rights and acting on values, beliefs, and traditions.
the client’s behalf is client advocacy. Extra care should be
taken to advocate for vulnerable populations, including older
adults, children, and clients with cognitive impairments.

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5. NCLEX Practice Questions

A family asks the nurse to withhold

a terminal diagnosis from a client. The Correct:
nurse should: 2. Informing the client about the diagnosis upholds
veracity, which requires the nurse to provide truthful
1. withhold the diagnosis from the client and accurate information.
2. inform the client about the diagnosis
3. ask security to remove family from the unit Incorrect:
4. wait for the client to ask about the diagnosis 1 & 4. Withholding the diagnosis from the client or waiting for
the client to ask violates veracity.
Hint: 3. Asking security to remove the family is unnecessary and
Only one option upholds the ethical principle will likely escalate the conflict.
of veracity.

The nurse feels uncomfortable Correct:

providing aggressive care to a terminally 4. Reviewing the client’s medical history and advance
ill client. The nurse should first: directive follows the ethical reasoning process, which
begins with identifying the dilemma and gathering
1. consult the ethics committee relevant information.
2. provide aggressive care as ordered
3. request a different client assignment Incorrect:
4. review the client’s medical history and 1. Consult the ethics committee only after gathering
advance directive information.
2. Providing aggressive care might violate client beneficence;
Hint: the nurse should first assess the situation.
Only one option follows the steps of 3. Requesting a different client assignment does not solve the
ethical reasoning. ethical dilemma.

A Muslim client with malnutrition refuses

to eat because a meal tray contains pork.
The nurse should: Correct:
1. Apologizing and offering a new meal without pork
1. apologize and offer a new meal without pork demonstrates client advocacy by honoring cultural
2. encourage the client to eat the rest of the beliefs and promoting client rights.
Management of Care

meal, avoiding the pork

3. explain that the client must eat the meal for Incorrect:
proper nutrition 2 & 4. Encouraging the client to eat the rest of the meal or
4. remove the pork and ask the client to eat the removing the pork are not the most culturally sensitive
remaining food actions.
3. Explaining that the client must eat the meal ignores the
Hint:
client’s concern.
Only one option demonstrates appropriate
client advocacy by honoring cultural beliefs.

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  Allowing a competent client to refuse treatment  Protecting client’s rights and acting on their behalf
is an example of _____ (which ethical principle?). describes client _____. Extra care should be taken
Repositioning a client to promote comfort is an to advocate for vulnerable populations, including
example of _____ (which ethical principle?). children, _____ adults, and clients with
_____ impairment.
 Administering analgesics on time as promised is
an example of _____ (which ethical principle?).  To promote culturally competent care, nurses
Providing a client with accurate information should assess personal cultural _____, avoid
about their diagnosis is an example of _____ _____, and conduct a cultural _____ to understand
(which ethical principle?). the client’s values, beliefs, and traditions.

 Ethical dilemmas are conflicts between two or

more ethical _______. Nurses should apply ethical
reasoning by first gathering ______ and examining
personal _______.

Answers: 1. autonomy, beneficence 2. fidelity, veracity 3. principles, information, biases 4. advocacy, older, cognitive 5. biases, stereotyping, assessment

References:

Astle, B., Duggleby, W., Potter, P. A., Stockert, Perry, A. G., & Hall, Huston, C. J. (2024). Leadership roles and management functions in
Management of Care

A. M. (2024). Potter and Perry’s Canadian Fundamentals of nursing: Theory and application (11th ed.). Wolters Kluwer.
Nursing (7th ed.). Elsevier.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (Eds.). (2023).
Callahan, B., Hand, M., & Steele, N. (Eds.). (2023). Nursing: A Fundamentals of nursing (11th ed.). Elsevier.
concept-based approach to learning (4th ed., Vol 2).
Waddell, J. I. & Walton, N. A. (2020). Yoder-Wise’s leading and
Pearson.
managing in Canadian nursing (2nd ed.). Elsevier.
Berman, A. B., Snyder, S. J., & Frandsen, G. (2021). Kozier & Erb’s
fundamentals of nursing: Concepts, process, and practice
(11th ed.). Pearson.
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