Professional and Ethical Practice Flashcards

A practical nurse is caring for a dying patient who has a valid advance directive refusing resuscitation. The patient's adult children arrive and insist that the nurse initiate CPR when their parent stops breathing, threatening legal action if she does not comply. What is the most appropriate course of action?

Answer: Contact the charge nurse and physician immediately to reinforce the advance directive and document the family's demands

A valid advance directive is a legally binding expression of the patient's autonomous wishes and must be honoured. The practical nurse's ethical and legal obligation is to uphold patient autonomy. The appropriate action is to escalate immediately to the charge nurse and physician, who can explain the directive to the family, and to document all interactions. Complying with the family's demand, suspending the directive, or initiating CPR would violate the patient's legally expressed wishes and constitute a serious ethical and legal breach.

A practical nurse discovers that a colleague has been documenting vital signs without actually taking them, and patients appear clinically stable. The colleague explains they were overwhelmed and promises it will not happen again. What is the nurse's primary professional obligation?

Answer: Report the conduct to the nurse manager immediately, as falsifying documentation poses a direct patient safety risk regardless of current patient stability

Falsifying clinical documentation is a serious breach of professional and ethical standards that directly threatens patient safety, as unmonitored changes in condition could go undetected. Current patient stability does not mitigate the risk or the ethical obligation. Waiting, issuing private ultimatums, or conditioning the report on an adverse outcome all delay necessary action. The nurse has a professional duty under the regulatory framework to report unsafe or unethical practice to the appropriate authority without delay.

A practical nurse working in a long-term care facility is asked by a competent resident to keep secret the fact that the resident is giving away personal possessions to staff members. The nurse suspects the resident may be experiencing financial exploitation. How should the nurse proceed?

Answer: Report the suspicion to the facility's administration and the appropriate regulatory or protective authority, explaining to the resident why confidentiality cannot be maintained in this instance

While confidentiality is a foundational ethical principle, it is not absolute. Suspected abuse or exploitation of a vulnerable person — even one who is cognitively competent — triggers a mandatory reporting obligation in most Canadian jurisdictions and under professional codes of ethics. The nurse must inform the resident that disclosure is necessary to fulfil legal and professional duties, and must report to the appropriate protective authority. Limiting action to internal warnings or requiring the social worker's agreement before reporting does not satisfy the mandatory reporting requirement.

During a home visit, a practical nurse notices that a client consistently defers all health decisions to a family member from a collectivist cultural background, even when the nurse has confirmed the client is cognitively competent and has private moments to express personal views. The nurse believes the treatment plan does not reflect the client's best interests. What is the most ethically defensible approach?

Answer: Explore the client's understanding of the decisions being made and whether the deference reflects a freely chosen cultural value versus coercion, then proceed accordingly

Respecting autonomy requires understanding whether deference is freely chosen or coerced. In collectivist cultures, involving family in decisions can be a deeply held, autonomous value — not a sign of incapacity or exploitation. The nurse must assess whether the client understands the decisions and is choosing deference willingly, or whether coercion exists. Documenting incapacity without evidence, unilaterally excluding family, or immediately escalating to protective services would impose Western individualistic values inappropriately and could harm the therapeutic relationship. Only if coercion is confirmed should protective reporting be considered.

A practical nurse is assigned to care for a patient whose religious beliefs the nurse finds morally repugnant. The nurse is not in a remote or under-resourced setting, and other staff are available. What is the most professionally appropriate action?

Answer: Invoke conscientious objection by privately notifying the supervisor, arranging a seamless transfer of care to another qualified nurse, and ensuring the patient experiences no gap in service

Nurses may exercise conscientious objection when personal moral values conflict with a patient's beliefs or requested care, provided doing so does not abandon the patient and does not interfere with access to care. The ethical pathway is to notify a supervisor discreetly, ensure a qualified replacement is in place before withdrawing, and maintain professional non-judgmental communication with the patient throughout the handover. Refusing without arranging continuity abandons the patient; withholding non-urgent care without a proper handover also violates the duty of care. Suppressing values entirely indefinitely is not a sustainable or required standard.

A practical nurse receives a verbal order by phone from a physician who sounds intoxicated and whose order appears clinically inappropriate for the patient's current presentation. The nurse asks the physician to clarify but receives a dismissive, irritable response repeating the same order. What should the nurse do?

Answer: Refuse the order, document the refusal, and immediately escalate to the charge nurse or medical director while ensuring the patient's safety is maintained

Practical nurses have a professional and legal duty to refuse orders that they have reasonable grounds to believe are unsafe or inappropriate, regardless of who issues them. An order that is clinically inconsistent with the patient's presentation, issued by a provider who may be impaired, meets that threshold. The nurse must refuse the order, document the clinical rationale and the interaction, escalate immediately to the charge nurse or medical director, and ensure the patient continues to receive safe care. Altering a dose without authorization, delaying escalation, or blindly following the order all compromise patient safety and violate the nurse's scope of practice obligations.