Advocacy Flashcards
Fleming vs. HCA health services story/results?
Family concerned about suicidal patient, called nurse and nurse seemed to not be concerned. Then they came in and tried to get help and didn’t receive specialist help at the advocation of the nurse assessing them.
They left and called again requesting specialist help and came in again and still didn’t receive help.
Client ended up killing himself.
NURSE WAS DEFENDANT AND WAS FIUND GUILTY FOR NOT GRANTING PROPER ACCESS TO CARE.
ANA code of ethics on advocacy?
Provision 1: compassion and respect for everyone
Provision 3: protect health and safety of client.
Provision 8: protect human rights and disparities
Provision 9: articulate nursing values, maintaining integrity. Social justice in nursing and health policy.
Patient rights according to Centers for Medicare and Medicaid services? 8
Right to information
Right to choose (autonomy)
Access to emergency services
Full partner in healthcare decisions
Care without discrimination
Right to privacy
To Speedy complaint resolution
To take on new responsibilities for health
As far as healthcare facilities go, what is one thing that they have to do in regards to right to information?
Post notice of right if patient to obtain information about their own healthcare.
What should the nurse know when it comes to right to information and the INSTITUTION they work for?
They should know the policy on how the client can gain access to their healthcare information.
What is the one engrained exception in regards to client right to receive information about their healthcare?
Chronic cognitively impairing mental illness creates misunderstanding of information can exclude them access.
Common among paranoid schizophrenics
Who are the only people who can decide to exempt patient from access to information based on mental illness?
Psychiatrist or treating PCP
What are some steps that have to be done by PCP or psychiatrist to exempt mentally ill client from information?
Documenting criteria that client met to be excluded
Exclusion as limited as possible
Provide written notice to the patient
ONLY ADDRESSED IF PATIENT REQUESTS ACCESS
What are some barriers to the right to information?
Health literacy
minors
mental illness
What is the nurses role in providing information?
DO NOT DISCUSS PROGNOSIS WITH PATIENT
PROVIDE DISCHARGE INFORMATION
know agency and unit protocols
seek advice from treatment team and work collaboratively with treating physician
What is the provision when it comes to the ANA code of ethics and informed consent?
FACILITATE an informed decision, assists in weighing the benefits, burdens, and available options.
What are the three elements of informed consent as part of the accreditation process through the joint commission?
- hospital policies to outline the informed consent requirement and process
- process must be documented in medical record under hospital policy
- include a discussion of proposed treatment, risks, benefits, likelihood treatment will achieve goal, alternatives, risks of the alternatives.
What are is the definition of informed consent?
the subject has both knowledge and comprehension that consent is freely given without diress or under influence and that the right of withdrawal at any time is communicated to the patient.
What are the diferent types of consent?
Expressed - oral or written (most common)
implied consent - presumed its wanted (emergencies, LIKE DISASTERS) or inferred (patients actions or non-actions), A HEAD NOD IS INFERRED IMPLIED CONSENT
What are the elements of expressed informed consent?
disclosure of info, how much and what?
comprehension/competence/capacity, how much of each is needed and who determines this
voluntariness, persuasion vs. coercion
consent, who determines if it has been given?
CAN BE WITHDRAWN AT ANY TIME
What is included in the duty to disclose information?
name of treatment provider
diagnosis
conflicts of interest - example: piece of equipment being used is part of study
proposed treatment/procedure:
–nature and purpose of consent and procedure
–PROBABLE risks/side effects and consequences - seriousness and frequency involved
–possible and probable benefits of treatment
–feasible alternatives and likelihood of success
–consequences of refusal
What are the elements of a PROBABLE risk/side effect?
most serious - DEATH, RISKS THAT COULD PRODUCE LIFE ALTERING EFFECTS
most frequent - what is likely to occur?
THIS IS ALSO INCLUDED IN MED TEACHING FOR NURSES
What is used to determine what the physician should have told the patient?
Material information - MOST COMMON, WHAT WAS GONE THROUGH IN DISCLOSURE OF INFORMATION IN OTHER CARDS IS EXAMPLE OF MATERIAL INFORMATION
What are some other possible elements of material information?
What would a prudent (reasonable PERSON STANDARD) want to know (60% of states use this) and consider “material” - also known as the objective test - MOST COMMON STANDARD USED
Professional practice standard of disclosure - information that is ordinarily given to patient by a reasonable physician
WHEN LOOKING TO SEE IF MATERIAL INFORMATION WAS PROVIDED, ALLOF THESE STANDARDS CAN BE LOOKED UPON
Is full disclosure a possible standard of disclosure?
NO
Is the subjective test (PART OF THE REASONABLE PERSON STANDARD) a reliable standard of disclosure? what is it?
the unique informational needs of the particular population determine what is disclosed, NOT USED OFTEN
What are the 3 Cs?
comprehension - the ability to understand and evaluate information in alignment with values, desires, goals - language, hearing ability, reading level
capacity - in a state capable of decision making and communication of that decision - can be task specific for example drinking age, age to get married, etc.. coma, blind, minor BASICALLY A PART OF BOTH COMPREHENSION AND COMPETENCE
competence - the cognitive wherewithal to process input effectively and to reason or deliberate to a valid decision - minors, impaired people (drunk), disease process (TBI, dementia), mental retardation
Three Cs DUMBED DOWN?
comprehension - information improperly received
competence - information improperly processed
capacity - information unable to be received
What are the elements of voluntariness?
Freedom to make decision
The absence of force, threats, manipulation or coercion (real or perceived)
Care with vulnerable populations - children, prisoners, pregnant women, mentally disabled persons, and economically or educationally disadvantaged persons–as “likely to be vulnerable to coercion or undue influence.”
Care not to influence – money, access to care, subordinate relationships
What are some things to know about consent?
Obtained by the person performing the procedure
The act of agreeing to, or refusing, proposed treatment/procedure
An autonomous authorization
Consent (I autonomously agree) vs assent (i agree) - parent (consent) vs. minor (assent)
A patient’s decision that’s contrary to health care provider’s advice does NOT necessarily indicate a lack of comprehension.
Informed refusal
What is the nurses role in informed consent?
The treatment provider should provide information to the patient for the consent.
The nurse’s role is to ensure understanding and to document.
- -Follow hospital procedures/protocols
- -Assess/confirm understanding
- -Refer for additional information as needed (advocate)
- -Act as a witness to the signature
- -Ensure complete documentation and the presence of a consent form in medical record
What are the two exceptions to informed consent?
Emergency –
–provider believes a delay in treatment would result in serious bodily injury or death
–patient is unable to give consent and no one with legal authority to give consent is present
–a reasonable person would consent under the given circumstances
–provider has no reason to believe this particular person/pt would refuse treatment
DISASTER CARE FALL UNDER THESE CIRCUMSTANCES
Non-emergency –
- -Provider believes treatment is necessary and reasonable to save life (court order may be needed)
- -Fact dependent
- -Rare cases decided in court (blood transfusion for jehova witness, usually sides with them, sometimes doesnt)
Describe the issue of social justice and advocacy.
Move beyond advocacy at just the individual level to also include the context in which individuals live
Called to be “activists” to align “’what is’ and ‘what should be’ by becoming engaged in social and political issues that impact the health of the community and society” (Paquin, 2007, p. 2)
example: ANA and involvement of ACA
What is the reality of social justice and patient advocacy?
Politics or ideology often drive “socially just” initiatives
Social justice initiatives may not have a foundation in evidence
Unintended consequences are not accounted for
Social justice often used as a bludgeon to suppress dissent
Absolute equality (justice) is impossible so who ends up shorted?
Social justice movements may stereotype or give preference to certain population groups (white privilege, urban health disparities)
Social justice contrasts individual freedom/personal accountability with lack of control/victimization
TOLERATE DISSENT
Are politics a part of nursing advocacy?
Need knowledge first:
Know yourself
Know your organization/issues
Know the political system
YES THEY ARE
Are politics a part of nursing advocacy?
Need knowledge first:
Know yourself - what you can do in politics
Know your organization/issues
Know the political system
YES THEY ARE
How does a bill become a law?
- Begins as an idea
- Author
- Sponsor
- First Reading
- Committee Hearings
- Vote
- Other house and must pass in identical form
- President (usually will sign or veto)
What is a big way to make changes at a political level as an individual?
Lobby – when “an individual…attempts to influence legislation on behalf of others…” (Aiken, Chapter 4, p. 84)
Generally has a negative connotation because of corruption.
Essential to make changes.
What are some ways to lobby?
Become knowledgeable Vote Write articles or op-eds Write to or meet with a representative Campaign Join professional organizations State Nurses Association Websites Get involved!
