Ethics & Issues in Contemporary Nursing

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A novice nurse is stressed due to always being behind with her assignments. She is overheard saying, "No one here worries about checking nasogastric tube placement before they give medications and hang feedings. Skipping that step would save me an extra 30 minutes to be used for charting. If they can do it, so can I." This nurse is experiencing which stage of reality shock?

  • A. loner.
  • B. "rutter."
  • C. change agent.
  • D. "native."
Correct Answer: D

Rationale: The correct answer is D, "native." In this scenario, the nurse is rationalizing skipping a crucial safety step by justifying it with the actions of others, indicating a lack of understanding regarding the importance of the procedure. The "native" stage of reality shock occurs when individuals start to adopt the norms and behaviors of their workplace without questioning or critically evaluating them. This nurse is displaying a mindset of conforming to unsafe practices to fit in with her colleagues, which aligns with the characteristics of the "native" stage.

Incorrect choices:
A: "loner" does not apply as the nurse is not isolating herself but rather seeking to emulate the actions of others.
B: "rutter" does not fit as this stage involves feeling overwhelmed by the demands of the job, not justifying unsafe practices.
C: "change agent" is not relevant as the nurse is not actively seeking to instigate change but rather conforming to existing practices.

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Managers at an acute care facility value the contributions of their aging nursing workforce and make recommendations to accommodate for an aging nursing workforce. They institute for which changes? (select all that apply)

  • A. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit.
  • B. Teamwork and development of new roles such as admission nurse are encouraged.
  • C. Daycare centers for sick children are put into place to prevent the stress of having to find alternative daycare.
  • D. Assistive devices for lifting as recommended by ANA's Handle with Care are made available.
Correct Answer: A

Rationale: The correct answer is A because placing supplies on the nursing unit helps accommodate aging nursing workforce by reducing physical strain from frequent trips to supply rooms. This change supports ergonomic principles and promotes efficiency. Choice B may not directly address the physical challenges of aging nurses. Choice C addresses a different issue unrelated to accommodating aging nurses. Choice D, while important, focuses on one specific aspect of accommodation and may not be as universally beneficial as having supplies readily available.

A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: "To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes." The nurse knows generalizability refers to the:

  • A. conclusion that findings can be generalized from the sample to the entire population.
  • B. fact that the group of steroids used are from the same organic compounds.
  • C. possibility that the subjects were carefully selected and that outside influence is thus suspected.
  • D. fact that the type of bacteria carried by ticks is universal.
Correct Answer: A

Rationale: The correct answer is A. Generalizability refers to the conclusion that findings from a sample can be applied to the entire population. In this case, the purpose of the study is to determine if the positive outcomes of steroid therapy in two randomized placebo-controlled trials for Rocky Mountain Spotted Fever can be generalized to a broader population of patients with the same condition. Choice B is incorrect because generalizability is not about the type of steroids used but about the applicability of study findings. Choice C is incorrect as it refers to selection bias, not generalizability. Choice D is incorrect as generalizability is about the application of findings, not the universality of bacteria types.

A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red yarn around the wrist. The nurse compliments the child's "jewelry," knowing it is believed to prevent:

  • A. mal ojo.
  • B. susto.
  • C. bilis.
  • D. empacho.
Correct Answer: A

Rationale: The correct answer is A: mal ojo. In Hispanic culture, red yarn around the wrist is believed to protect against mal ojo, or "evil eye." This belief stems from the idea that envy or admiration can lead to negative energy being directed at a person, particularly children, causing harm or illness. By complimenting the child's "jewelry," the nurse is acknowledging and respecting the cultural belief in warding off mal ojo.

Summary:
- A: Mal ojo is the correct answer as the red yarn is believed to protect against it.
- B: Susto is a condition related to fright or soul loss, not associated with red yarn.
- C: Bilis refers to bile and is not relevant to the red yarn.
- D: Empacho is a digestive illness, unrelated to the red yarn tradition.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations?

  • A. Blocking
  • B. Filtration
  • C. Empathy
  • D. False assurance
Correct Answer: A

Rationale: The correct answer is A: Blocking. In both situations, the patient's actions are ignored or dismissed, indicating a lack of active listening. Blocking involves avoiding communication by not acknowledging the patient's gestures or needs. The nurse fails to engage with the patient and address their non-verbal cues.

Summary:
B: Filtration is not relevant as it involves selectively presenting information.
C: Empathy is not demonstrated as the nurse is not responding to the patient's non-verbal cues.
D: False assurance is not applicable as it involves giving misleading reassurance, which is not present in the scenario.

A nurse is concerned about a trend in the hospital to regularly "float" nurses to different areas of the hospital based on staff shortage regardless of recent experience in caring for the population on the unit. When deciding to accept a staffing assignment in this situation, the nurse considers a "safe harbor." What is meant by "safe harbor"?

  • A. In an emergency situation, nurses may move patients to one location designated to be areas safe from natural disasters or acts of terrorism.
  • B. Nurses work in teams to care for patients who have no communicable disease and do not pose a safety issue due to infection.
  • C. Horizontal violence is not tolerated and nurses report any form of violence to administration.
  • D. It is written a notice about recurrent staffing issues that allows nurses to continue to care for patients placed in their care but protects their nurse's license while an investigation is conducted.
Correct Answer: D

Rationale: The correct answer is D because "safe harbor" refers to a legal provision that protects nurses when they feel unsafe accepting a staffing assignment due to lack of recent experience or competency. By invoking safe harbor, nurses can continue caring for patients while an investigation is conducted to ensure patient safety and protect the nurse's license. This process allows nurses to voice concerns without fear of reprisal.

Option A is incorrect as it refers to a disaster response plan, unrelated to safe harbor. Option B is incorrect as it discusses patient care teams and infectious diseases, not safe harbor protections. Option C is incorrect because it addresses reporting violence, which is not directly related to safe harbor provisions for staffing assignments.

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