A nurse is reinforcing teaching about ethical dilemmas with a newly licensed nurse. Which of the following should the nurse identify as the first step in the ethical reasoning process?

A) Undergoing cardiac catheterization:

Cardiac catheterization is an invasive procedure that involves threading a thin tube (catheter) through blood vessels to the heart. It carries potential risks, including bleeding, infection, and damage to blood vessels or the heart. Therefore, obtaining informed consent is essential to ensure that the client understands the procedure, its risks, benefits, and alternatives before undergoing it.

B) Receiving moderate sedation:

Moderate sedation (conscious sedation) is a drug-induced state of depressed consciousness during which the client remains responsive to verbal commands. While it is less invasive than general anesthesia, it still carries risks, including respiratory depression, hypotension, and allergic reactions. Informed consent is required to ensure that the client understands the potential side effects and complications associated with sedation.

C) Suctioning a tracheostomy tube:

Suctioning a tracheostomy tube is a routine nursing intervention to remove secretions and maintain airway patency. It does not typically require informed consent unless there are specific circumstances or the client's condition warrants additional explanation or consent, such as if the client is at risk for complications or discomfort during the procedure.

D) Inserting a peripheral IV catheter:

Inserting a peripheral IV catheter is a common nursing procedure that typically does not require informed consent unless there are unusual circumstances or the client's condition warrants additional explanation or consent, such as if the client has specific concerns or medical conditions that may affect the procedure.

E) Inserting an indwelling urinary catheter:

Inserting an indwelling urinary catheter is a routine nursing procedure commonly performed to drain urine from the bladder. Informed consent may be required in certain situations, such as if the client lacks decision-making capacity or if the procedure involves specific risks or considerations that require explanation to the client or their legal representative. However, in most cases, informed consent is obtained as part of the general consent for treatment upon admission to the healthcare facility.

A) Asking a staff member from another unit to complete the evaluation: While involving someone from another unit may offer an external perspective, it may not necessarily ensure impartiality. The evaluator should have direct knowledge of the nurse's performance to provide a fair assessment.

B) Focusing primarily on areas that need improvement: This approach may lead to a biased evaluation, as it overlooks the nurse's strengths and positive contributions. A comprehensive evaluation should consider both areas of strength and areas needing improvement to provide a balanced assessment.

C) Discussing the evaluation with the nurse manager: Consulting with the nurse manager about the evaluation could introduce bias, especially if the manager has preconceived notions about the nurse being evaluated. Peer evaluations should aim to be independent of managerial influence to maintain impartiality.

D) Linking the evaluation to predetermined standards: This is the correct approach to ensure impartiality in peer evaluation. By using predetermined standards or criteria, the evaluation process becomes objective and transparent. Evaluators can assess the nurse's performance against established benchmarks, reducing the influence of personal bias.