Professional and Ethical Practice Flashcards

A PN observes a colleague consistently documenting medications as administered when the patient "refused anyway," stating that charting refusals "takes too long." The colleague is known to be under significant personal stress. What is the PN's most appropriate first action?

Answer: Document personal observations and report the concern through the facility's established chain of command

When patient safety is at risk due to falsified documentation, the PN must act promptly. The correct first step is to document specific observations and report through the facility's chain of command (charge nurse, manager), which initiates the proper investigation process. Speaking privately with the colleague (A) risks being perceived as collusion and delays addressing an ongoing patient safety issue. Reporting directly to the regulatory body (C) may be appropriate eventually but bypasses institutional processes that should occur first. Waiting for an ethics committee (D) introduces dangerous delay when patients may be actively harmed. The colleague's personal stress, while unfortunate, does not alter the PN's professional obligation.

A substitute decision-maker (SDM) holding power of attorney for personal care for a resident with advanced dementia instructs a PN to withhold all information about the resident's declining condition from adult children who visit regularly. The PN knows the resident had clearly expressed, while capable, that 'family should always be kept informed.' What is the PN's most appropriate response?

Answer: Seek clarification on the scope of the SDM's authority and consult with the interdisciplinary team and, if needed, ethics resources before restricting family communication

An SDM's authority is limited to making healthcare decisions in the incapable person's best interest — it does not automatically extend to controlling what general condition information other family members receive. The resident's previously expressed values are relevant context but do not constitute a legally binding directive that a PN can independently act upon to override an SDM (B). Blindly complying (A) without examining the scope of authority may violate the resident's interests. Unilaterally refusing and documenting it as misconduct (D) is an overreach without proper consultation. The professionally sound approach (C) is to seek clarification through the team and, if needed, ethics or legal resources, before restricting communication.

During a home care visit, a competent patient newly diagnosed with insulin-dependent diabetes mellitus tells the PN, 'Don't tell anyone — I'm a long-haul truck driver and I can't lose my job. I know I'm supposed to report it but I need the income.' What is the PN's most appropriate course of action?

Answer: Explore the patient's concerns, provide education about reporting obligations and the safety risks to the public, document the conversation thoroughly, and escalate through the care team and duty-to-warn protocols if the patient refuses to self-report

This scenario triggers duty-to-warn considerations because there is an identifiable, serious safety risk to third parties (the public). In Canada, insulin-dependent diabetes may trigger mandatory provincial reporting requirements for commercial vehicle operators, and new-onset IDDM poses real risk while driving large commercial trucks. Confidentiality (A) cannot be maintained when there is a concrete third-party safety risk of this magnitude. Immediately contacting transport authorities (B) is premature — proper process requires education, documentation, and care team consultation first. Encouraging self-report alone (D) is insufficient given the severity and immediacy of potential harm. Option C follows the ethical and legal framework: educate, document, and escalate appropriately.

Shortly after a palliative patient's death, the family offers the PN who cared for her a piece of valuable jewelry, saying, 'She always said you were special to her and would have wanted you to have this.' The PN is concerned that refusing will deepen the family's grief. What should the PN do?

Answer: Decline the gift respectfully, explaining that professional standards prohibit accepting gifts of significant value, and suggest meaningful alternatives such as a letter of commendation to the facility

Provincial practical nursing regulatory standards and codes of ethics consistently prohibit accepting gifts of significant monetary or personal value from patients or families, as this creates real or perceived conflicts of interest and compromises professional boundaries. The PN's discomfort with the family's grief does not override professional obligations (A). Accepting and redirecting (B) still constitutes acceptance of the gift and does not resolve the boundary issue. A $50 threshold (D) is not an established standard in Canadian practical nursing regulatory guidelines — this is a common but inaccurate assumption. The appropriate response (C) is a compassionate but clear decline, paired with a meaningful alternative that still honors the family's wish to express gratitude.

A PN realizes they have accidentally entered a client's mental health session notes into another client's chart. Before the error can be corrected, the supervisor says, 'Just delete it and add it to the right chart — no one will notice and it saves paperwork.' What is the PN's most appropriate response?

Answer: Refuse to delete the erroneous entry; draw a single line through it with initials, date, and a brief notation that it was entered in error, then create a properly dated late entry in the correct chart and file an incident report

Deleting or obscuring documentation in a health record constitutes falsification — a serious professional and legal violation regardless of who instructs it. Correct procedure requires drawing a single line through the error (never scribbling it out), adding initials, the date, and a brief note (e.g., 'entered in error'), then completing a properly dated late entry in the correct chart. Following the supervisor's instruction (A) does not exempt the PN from personal professional accountability. A personal log (C) does not fulfill the obligation to report the incident through the facility's formal incident reporting system. Immediately escalating to the regulatory body (D) is premature — the PN should first correct the records properly, complete an incident report, and escalate further only if the supervisor's conduct represents a pattern of directing misconduct.

Moments before a patient is transported to the OR for an elective laparoscopic cholecystectomy, she tells the PN, 'I've changed my mind — I don't want to go ahead today.' The surgeon tells the PN, 'She's just pre-op anxiety — take her in, we'll sort it out in there.' The patient looks directly at the PN and asks, 'What should I do?' What is the PN's most appropriate immediate action?

Answer: Stop the transport to the OR, clearly communicate the patient's withdrawal of consent to the entire surgical team, and advocate for the patient to have adequate time and privacy to discuss her concerns before any decision is made

A patient retains the absolute right to withdraw consent at any point, including immediately before a procedure — this is a foundational principle of Canadian healthcare law and patient rights. The PN's role as patient advocate requires them to stop the process immediately and ensure the withdrawal of consent is formally recognized by the entire team. Deferring to the surgeon's opinion that the patient is 'just anxious' (A, B) dismisses the patient's autonomous decision and could expose all team members to liability for assault or battery if the procedure proceeds. Telling the patient that the signed consent is irrevocable (D) is factually and legally incorrect. The PN must act decisively and immediately (C), even under significant pressure from senior team members, to protect the patient's fundamental rights.