CNO - College of Nurses of Ontario Ethical Practice and Conduct Questions and Answers — Questions and Answers
Question 1: A nurse is caring for a client who has decided to refuse a life-sustaining treatment. The client's family is distressed and asks the nurse to persuade the client to change their mind. According to the CNO's ethical values, what is the nurse's primary responsibility in this situation?
- To respect the family's wishes and attempt to influence the client's decision.
- To document the client's decision and withdraw from their care.
- To respect the client's autonomous choice, even if it conflicts with personal or family values. (Correct answer)
- To request an ethics committee consultation to make the final decision.
Correct answer: To respect the client's autonomous choice, even if it conflicts with personal or family values.
The CNO's ethical framework emphasizes the value of client choice. A nurse's primary responsibility is to respect a capable client's autonomous decision, even if it conflicts with their own values or the family's wishes. The nurse should ensure the client is fully informed and their decision is voluntary, but ultimately must uphold the client's right to self-determination.
Question 2: Which of the following actions best demonstrates a nurse's commitment to the principle of 'acting with integrity in the client's best interest' as outlined in the CNO Code of Conduct?
- Sharing details of a client's interesting case with a colleague in the cafeteria.
- Accepting a valuable gift from a grateful client after their discharge.
- Ensuring a client's personal health information is protected and only shared for therapeutic reasons. (Correct answer)
- Performing a procedure without full consent because the nurse believes it is necessary.
Correct answer: Ensuring a client's personal health information is protected and only shared for therapeutic reasons.
Acting with integrity includes protecting client privacy and confidentiality. The CNO Code of Conduct states that nurses must protect the privacy and confidentiality of clients' personal health information. Sharing information without a therapeutic reason, accepting significant gifts that could influence care, and proceeding without informed consent all violate this principle.
Question 3: A nurse notices a colleague consistently failing to perform required safety checks before administering medication. The nurse has informally mentioned it to the colleague, but the behavior continues. According to the CNO Code of Conduct, what is the nurse's next most appropriate action?
- Continue to monitor the colleague and gather more evidence before acting.
- Report the unsafe behavior to the appropriate authority, such as the nurse manager or employer. (Correct answer)
- Confront the colleague again, but this time in a more forceful manner.
- Assume the colleague is just busy and offer to help them with their workload.
Correct answer: Report the unsafe behavior to the appropriate authority, such as the nurse manager or employer.
Principle 6 of the CNO Code of Conduct, 'Nurses maintain public confidence in the nursing profession,' requires nurses to report any error, unsafe behaviour, or unethical conduct to the relevant individuals, such as an employer or CNO, to protect client safety. Ignoring the issue or only addressing it informally is not sufficient when client safety is at risk.
Question 4: A client with limited English proficiency is scheduled for surgery. The surgeon has explained the procedure, but the nurse assesses that the client may not fully understand the risks and benefits. To uphold the ethical value of 'client choice,' what should the nurse do?
- Proceed with the pre-operative checklist as the surgeon has already obtained consent.
- Ask a family member who speaks some English to translate.
- Advocate for the client by requesting a qualified medical interpreter to ensure informed consent. (Correct answer)
- Document the concern in the client's chart and take no further action.
Correct answer: Advocate for the client by requesting a qualified medical interpreter to ensure informed consent.
Informed consent is a cornerstone of the ethical value of client choice. For consent to be truly informed, the client must understand the information provided. The nurse acts as a client advocate by ensuring communication barriers are properly addressed through a qualified medical interpreter, rather than relying on family members who may not be impartial or understand medical terminology.
Question 5: Under which principle of the CNO's Code of Conduct does the accountability to provide inclusive and culturally safe care by practicing cultural humility fall?
- Principle 1: Nurses respect clients' dignity.
- Principle 4: Nurses work respectfully with the health care team.
- Principle 5: Nurses act with integrity in clients' best interest.
- Principle 2: Nurses provide inclusive and culturally safe care by practicing cultural humility. (Correct answer)
Correct answer: Principle 2: Nurses provide inclusive and culturally safe care by practicing cultural humility.
The CNO Code of Conduct is structured around six key principles. Principle 2 is explicitly defined as 'Nurses provide inclusive and culturally safe care by practicing cultural humility.' This principle guides nurses to acknowledge and respond to the unique values, beliefs, and lived experiences of each client.
Question 6: A nurse living in a small, remote community is asked by a close friend to provide ongoing wound care for them at home following a minor surgery, as the local clinic has a long waitlist. According to the CNO's 'Professional Boundaries and Nurse-Client Relationships' standard, what is the most appropriate initial response?
- Refuse to provide any care, as treating friends is always a boundary violation.
- Agree to provide care but insist on being paid to make it a professional arrangement.
- Acknowledge the dual roles, set clear boundaries, and agree to provide care only until another provider is available. (Correct answer)
- Provide the care without any specific discussion about boundaries, as it is a friend in need.
Correct answer: Acknowledge the dual roles, set clear boundaries, and agree to provide care only until another provider is available.
The CNO acknowledges that in limited circumstances, such as in small communities, nurses may need to provide care to family or friends. The standard requires the nurse to acknowledge the dual roles, establish clear professional boundaries, and transfer care to another provider as soon as one becomes available. An absolute refusal may not be appropriate if no other care is available.
CNO - College of Nurses of Ontario Ethical Practice and Conduct Questions and Answers
A nurse is caring for a client who has decided to refuse a life-sustaining treatment.
The client's family is distressed and asks the nurse to persuade the client to change their mind.
According to the CNO's ethical values, what is the nurse's primary responsibility in this situation?