Ch. 11, Ch.22, & Ch. 23 Flashcards
What is Kohlberg’s Theory of Moral Development: Level 1 Preconventional reasoning?
Stage 1: Punishment and Obedience Orientation
Stage 2: Instrumental Relativist Orientation
what is stage 1: Punishment and obedience orientation?
following the rules or be punished
- ex: if a child sasses their parents they will get spanked
what is stage 2: Instrumental relativist orientation?
person avoids punishment
- ex: the parent tells the child to be home at a certain time, the child listens to their parents to avoid punishment
What is Kohlberg’s Theory of Moral Development: Level 2: Conventional reasoning?
- you are looking at how your relationships are affected
- nurses use this to help the patient come up with end of life decision
Stage 3: Good boy- nice girl orientation
Stage 4: Society- maintaining orientation
what is stage 3: Good Boy- Nice Girl Orientation?
wanting approval for being nice
- ex: a child will stay after school and do chores to get the approval of the teacher
what is stage 4: Society- Maintaining Orientation?
the person wants to do the right behavior because they feel like it is their duty
- ex: teenagers avoiding a party that serves alcohol because they think underage drinking is wrong
What is Kohlberg’s Theory of Moral Development: Level 3 Postconventional Reasoning?
Stage 5: Social contract orientation
Stage 6: Universal ethical principle orientation
what is stage 5: social contact orientation?
follow the law even though it is not fair
- ex: the speed limit is 25 mph; you go 25 mph to follow the law
what is stage 6: Universal ethical principle orientation?
the person may not follow the law and is willing to accept the consequences
- ex: if the speed limit is 25 mph, and you go 35 mph, if you get pulled over you won’t care
what are Kohlberg’s Critics?
used all males in this study and people from the United States
- critique: if you repeat this study use women and people from different cultures
what is conventional reasoning?
focuses on relationships
Which of the following are examples of the conventional reasoning form of cognitive development? (Select all that apply.)
A. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her.
B. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son.
C. A teenage girl is encouraged by her peers to engage in shoplifting. She decides not to join her peers in this activity because she is afraid of getting caught in the act. (step 2)
D. A single mother of two children is unhappy with her employer. She has been unable to secure alternate employment but decides to quit her current job. (pre-conventional)
E. A young man drives over the speed limit regularly because he thinks he is an excellent driver and will not get into a car accident. (stage 6)
A. A 35-year-old woman is speaking with you about her recent diagnosis of a chronic illness. She is concerned about her treatment options in relation to her ability to continue to care for her family. As she considers the options and alternatives, she incorporates information, her values, and emotions to decide which plan will be the best fit for her.
B. A young father is considering whether or not to return to school for a graduate degree. He considers the impact the time commitment may have on the needs of his wife and infant son.
what is ethics?
what is right and wrong in our behavior
what are morals?
a judgment about behavior
- ex: honesty is the best policy
what is bioethics?
ethics within healthcare
- ex: when we use organ transplants
what is autonomy?
independence
following the patient’s decisions
what are examples of autonomy?
- if a patient is dying and does not want CPR, but the family does, we have to follow what the patient wants
- informing the patients the risk and benefits of treatment (informed consent)
- explaining procedures to the patient before going through treatment (they have the right to refuse)
what is professional autonomy?
when you need to reassign duties when conflict occurs
- ex: if a nurse is against abortion
what is beneficence?
positive actions to help others (good)
- ex: nursing
what is nonmaleficence?
to avoid harm
- ex: if a patient needs a bone marrow procedure, the bone marrow will cure the patient, but the patient will experience pain
what is justice?
fair distribution of resources
- ex: health insurance
- ex: organ transplants
what is fidelity?
being faithful to your promises
what is an example of patients?
when you go into a room and the patient needs to be medicated, you must go back in the room
what is institution?
following policies and procedures
what is yourself?
being able to keep promises to yourself
A patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle of:
A. autonomy.
B. fidelity.
C. justice.
D. nonmaleficence.
D. nonmaleficence
When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient’s priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient’s priority is met. If the nurse’s actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that?
A. Assessing the patient’s pain on a numeric scale every 2 hours
B. Asking the patient to establish the goal for pain control
C. Using alternative measures such as distraction or repositioning to relieve the pain (implementation)
D. Monitoring the patient for oversedation as a side effect of his pain medication
B. Asking the patient to establish the goal for pain control
what is a code of ethics?
guiding principles that all members of the profession accept
what is advocacy?
you are the patient’s voice, but our voice is to benefit the patient
what is responsibility?
following through on your professional obligations
- ex: delegation
- ex: if you need help and following policies and procedures
what is accountability?
to take ownership and being responsible for your actions
- ex: if you caused a medical error, you need to take ownership and fill out an instant report
what is confidentiality?
respecting patient’s privacy
- if confidentiality is violated, the hospital can be fined
what is Health Insurance Portability and Accountability of 1996? (HIPAA)
to protect patient’s personal health information
- the only people who can look at the charts are people who have the “right to know”
- patients must give permission to release medical information to insurance companies
- ex: in the olden days, patient’s names were put on the board, but now it violates HIPPA so they put #’s
If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of:
A. responsibility.
B. accountability.
C. competency.
D. moral behavior.
B. accountability
what are personal values?
comes from families and education
what is values clarification?
your personal values and looking at the values of patients and coworkers
what is deontology?
based on rules
- actions are either right or wrong
- ex: this is the rule: you have to leave within 30 minutes during the change of shift there is no grey area
what is utilitarianism?
focuses on outcomes
- greatest good for the greatest # of people
- ex: if David isn’t disturbing the patient, families, and staff then he can stay on the unit
what is casuistry?
looking at how similar cases managed the same problem
- ex: a nurse leader on the unit would look at how other hospitals dealt when a family member didn’t leave the unit
what is feminist ethics?
when you have power that is unequal in a relationship
- ex: does David have a power over his mom, does the staff have power over David
what is ethics of care?
when you make an ethical decision when engaging in caring relationships
- ex: what is the relationship between David and his mother (if it a positive relationship he can stay)
The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology?
A. The emphasis on relationships feels uncomfortable to decision-makers who want more structure in deciding the best action. (ethics of care)
B. The single focus on power imbalances does not apply to all situations in which ethical problems occur. (Feminist ethics)
C. In a diverse community it can be difficult to find agreement on which principles or rules are most important.
D. The focus on consequences rather than on the “goodness” of an action makes decision-makers uncomfortable (utilitarianism)
C. In a diverse community it can be difficult to find agreement on which principles or rules are most important.
what are the 2 types of ethical problems?
ethical dilemma
moral distress
what is ethical dilemma?
2 opposing courses of action that can be justified by ethical principles
what is moral distress?
taking action, but having the fear of retaliation
- ex: working in a hospital you go into the break room and hear your coworkers make inappropriate jokes. I feel I need to say something, but I’m fearing retaliation
The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution?
1. List all the possible actions that could be taken to resolve the problem.
2. Articulate a statement of the problem or dilemma that you are trying to resolve.
3. Develop and implement a plan to address the problem.
4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem.
5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved.
6. Recognize that the problem requires ethics.
- Recognize that the problem requires ethics.
- Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem
- Take time to clarify values and identify the ethical elements, such as principles and key relationships involved.
- Articulate a statement of the problem or dilemma that you are trying to resolve.
- List all the possible actions that could be taken to resolve the problem.
- Develop and implement a plan to address the problem.
what is the 1st step to resolving an ethical problem?
ask if there is an ethical problem
what is the 2nd step to resolving an ethical problem?
gather all relevant information
(similar to the assessment stage)
what is the 3rd step to resolving an ethical problem?
identifying the ethical elements in the problem and examine your values
what is the 4th step to resolving an ethical problem?
naming the problem
(similar to the diagnosis stage)
what is the 5th step to resolving an ethical problem?
consider possible courses of action
what is the 6th step to resolving an ethical problem?
create an action plan and carry it out
(similar to the implementation stage)
what is the 7th step to resolving an ethical problem?
evaluate the action plan
what are ethics committees?
if you encounter an ethical problem, you can take it to the committee
- it discusses ethical issues and dilemmas
what are the issues of health care ethics?
social media
quality of life
care at the end of life
access to healthcare
with social media what can you not do?
you can’t post any information or pictures and have any online friendship
what is the quality of life?
values and benefits of a medical intervention
- ex: a flu vaccine causes minor pain, but helps avoid getting the flu
what is futile?
unlikely to produce a benefit for the patient
- ex: if a patient is dying in the next couple of days, a flu vaccine would be unnecessary
what is access to healthcare?
looking at the ethical principle of justice
- ex: is healthcare an equal right for everyone
- ex: how will we divide the resources (organ transplants)
What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via a messaging tool in a social media site?
A. Yes, if you remove all patient identifiers before sending
B. No, because the patient’s x-ray results should be discussed with a provider
C. Yes, because respect for autonomy means honoring this patient’s request
D. No, because health information of any kind should not be shared on social media
D. No, because health information of any kind should not be shared on social media
what is constitutional law?
every US citizen has a constitutional right to refuse treatment
what is statutory law?
laws that are civil or criminal
what is civil law (Nurse Practice Act)?
defines nursing and tells us the standards we must meet in each state (different in each state)
what is criminal law?
felonies or misdemeanors
purpose: protect society and punishes people for crimes
- ex: if a nurse steals narcotics
what is administrative law?
regulatory law
you will use this to report nurses who engage incompetent or unethical behavior
what is common law?
judicial decisions
a judge makes a legal decision
- ex: if privacy was an issue, the judge will make the decision based off the “right of privacy” in the constitution
what is case law?
establishes laws based on formal cases
used with malpractice
what is scope of nursing practice?
our boundaries and what nurses can and cannot do
what is standards of nursing care?
knowledge and skill possessed by the nurse
what is the American Nurse Association (ANA)?
who comes up with the standards of care
what is joint commission?
people come to the hospital and inspects the hospital
what is standard of proof?
what a reasonable prudent nurse will do under the same circumstances
what is Emergency Medical Treatment and Active Labor Act?
any patient that goes into the ER or Labor and Delivery must be screened
what is Health Information Technology Act?
you can’t post health information on social media
what is the Americans with Disabilities Act? (ADA)
protecting people with physical and mental disabilities
what is Mental Health Parity and Addiction Equity Act?
all health insurance is required to give coverage to people with mental health and addiction
what is the Patient SELF Determination ACT? (1991)
healthcare organizations must provide written information to patients telling them they have the right to refuse treatment
what is an advance directive?
a legal document that tells people what you want done before/during/after your death
- ex: not wanting to be on a ventilator or feeding tubes
what is a durable power of attorney?
when a person is legally designated to make healthcare decisions if the person is unable to make decisions for themselves
what is do no resuscitate? (DNR)
if they don’t have a pulse or isn’t breathing, you CAN NOT do chest compressions
what is Uniform Anatomical Gift Act?
they would ask you if you are an organ donor if you are over the age of 18
what is the Omnibus Budget Reconciliation Act (1987)
has to do with restraints
- must have a physicians order
when are the only times you can use restraints?
- to ensure patient safety (if they pull out their iv, pulling their feeding tube out)
- trying less restrictive interventions that failed (have a sitter to make sure the patient isn’t getting up, but they still continue to do it)
A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assessing the patient. This action is most likely a violation of which of the following laws?
A. Health Insurance Portability and Accountability Act (HIPAA)
B. Americans with Disabilities Act (ADA)
C. Patient Self-Determination Act (PSDA)
D. Emergency Medical Treatment and Active Labor Act (EMTALA)
D. Emergency Medical Treatment and Active Labor Act (EMTALA)
A nurse received bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient’s medical record. The nurse lists patients’ medical diagnoses on the message boards in the patients’ rooms. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient’s family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)?
A. Discussing patient conditions at the bedside at the change of shift
B. Allowing the nursing student to review the assigned patient’s chart before providing care during the clinical experience
C. Posting medical information about the patient on a message board in the patient’s room
D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
C. Posting medical information about the patient on a message board in the patient’s room
A nurse sends a text message to the oncoming nurse to report that a patient refuses to take medication as ordered. What should the oncoming nurse do? (Select all that apply).
A. Add this information to the board hanging at the patient’s bedside.
B. Tell the nurse who sent the text that the text is a HIPAA violation.
C. Inform the nursing supervisor.
D. Forward the text to the charge nurse.
E. Thank the nurse for sending the information
B. Tell the nurse who sent the text that the text is a HIPAA violation.
C. Inform the nursing supervisor.
A nurse is caring for a patient who states, “I just want to die.” For the nurse to comply with this request, the nurse should discuss:
A. living wills.
B. assisted suicide.
C. passive euthanasia.
D. advance directives.
D. advance directives
A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman’s anemia. The woman’s husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse’s responsibility?
A. Obtain a court order to give the blood.
B. Convince the husband to allow the nurse to give the blood.
C. Call security and have the husband removed from the hospital.
D. Gather more information about the wife’s preferences and determine whether the husband is her power of attorney.
D. Gather more information about the wife’s preferences and determine whether the husband is her power of attorney.
what is the Nurse Practice Act?
purpose: to protect citizens from nurses who are incompetent
- for nurses to be accountable
- to make sure the best care is practiced
what is licensure?
wherever you want to practice you need to take the NCLEX there
what is an enhanced nurse licensure compact?
where you can have licenses in multiple states
what is Informed Consent and Health Care Acts?
- Receive an explanation of the procedure or treatment
- Receives the names and qualifications of people performing and assisting in the procedure
- Receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort
- Receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing
- Knows that he/she has the right to refuse the procedure/treatment without discontinuing other supportive care
- Knows that he or she may refuse the procedure/treatment even after the procedure has begun
what are some ways of informed consent as an RN?
- you must obtain informed consent from the patient
- if the patient does not speak English, an interpreter must explain the procedure (families cannot be interpreters)
- need to be able to witness the consent and look if the patient is coerced (done voluntarily) and is capable of giving consent
- must be present in the room when signing
what are some ways of informed consent as an RN? pt. 2
- if the patient does not understand the procedure, you must call the doctor and let them explain the procedure again
- an exception to this rule is if it is an emergency the law is the patient wants to be saved
- emancipated minors can sign their own sent (less than 18) if they have been married/divorced/widowed, if they served in the military, and needs to meet a court order
what is the Good Samaritan Law?
if you provide first aid when helping someone who got into a car crash, you are covered under the Good Samaritan law (can’t be sued)
- must provide care within your knowledge and experience
- must continue care until a medical person has relieved you
what is public health laws?
as an RN you are a mandated reporter for child/elder abuse, domestic violence, and communicable/infectious disease
what is the Uniform Determination of Death Act?
determines the actual care of death
A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits?
A. Family member
B. Surgeon
C. Nurse
D. Nurse manager
B. Surgeon
A home health nurse notices significant bruising on a 2-year-old patient’s head, arms, abdomen, and legs. The patient’s mother describes the patient’s frequent falls. What is the best nursing action for the home health nurse to take?
A. Document her findings and treat the patient.
B. Instruct the mother on safe handling of a 2-year-old child.
C. Contact a child abuse hotline.
D. Discuss this story with a colleague.
C. Contact a child abuse hotline
what is torts?
civil wrongful act for omission (not do something- giving a patient medication) against a person or property
what is intentional?
assault and battery
what is assault?
make a threat against someone
what is battery?
to touch someone without consent
what is assault and battery?
to threaten someone and to touch someone without their permission
-ex: “if you don’t eat your dinner, I will give you this injection”
what is false imprisonment?
restraining somebody without a legal reason
- ex: using restraints
- ex: if a patient wants to sign out of the hospital
what is Quasi-intentional?
an act in which a person may not mean to harm the person but did
what is invasion of privacy?
releasing a person’s health information to someone who is unauthorized
- the only people who are authorized are the ones who have the right to know
- ex: to the press, patient’s employer, their families, online (email, text messages)
what is defamation of character?
making false statements or lies about a person that damages their reputation
what is slander?
oral communication: saying false statements about that person
- ex: telling people your patient had gonorrhea, as a result, they had fewer customers at their business
what is libel?
written, be very objective in charts
- ex: false statements in a medical record
what is unintentional torts?
the person is harmed and the person inflicting that harm should’ve known this
what is negligence?
when your conduct falls below the standard of care
- ex: a reasonable prudent nurse who is hanging an IV would make sure they scan the IV bands, check the physician’s order, and check the medication record
what is malpractice?
all 4 of these elements must be present, if one of them is missing they can sue you
what is duty of care?
must be assigned to this patient
you are responsible for this patient
what is breach of duty?
not following policies and procedures when handing out medication
what is injury?
if an injury is not present, you can’t sue that healthcare provider
- ex: the nurse who hung the wrong medication, the injury would be the 16 year old dying
what are damages?
making the person whole in the eyes of the court
can sue for physical, and emotional damage (loss of work, loss of wages)
what are common sources of negligence?
- Failure to assess and/or monitor, including making a nursing diagnosis
- Failure to observe, assess, correctly diagnose, or treat in a timely manner
- Failure to use, calibrate, or replace equipment required to safely care for the patient
- Broken equipment needs a tag and be sent to engineers
- Failure to document care and evaluation of care provided to the patient in a timely manner
- Failure to notify the healthcare provider of significant changes in a patient’s status
- Failure to respond to or correctly implement new and existing orders
- Failure to follow the seven rights of medication administration
- Failure to convey discharge instructions to the patient, his or her family, or providers who are assuming responsibility for the patient
- Failure to ensure patient safety, especially patients who have a history of falling, are sedated or confused, are frail, are mentally impaired, get up in the night, or are uncooperative
(side rails up, bed locked in low position and call bell in reach) - Failure to follow policies and procedures
- Failure to properly delegate and supervise
You are about to administer an oral medication and you question the dosage. You should:
A. administer the medication.
B. notify the physician.
C. withhold the medication.
D. document that the dosage appears incorrect.
B. notify the physician.
A patient is in skeletal traction and has a plaster cast due to a fractured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient’s toes have become pale and cold but forgets to document this because one of the nurse’s other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.)
A. Failure to document a change in assessment data
B. Failure to provide discharge instructions
C. Failure to provide patient education about cast care.
D. Failure to use proper medical equipment ordered for patient monitoring
E. Failure to notify a healthcare provider about a change in the patient’s condition
A. Failure to document a change in assessment data
E. Failure to notify a healthcare provider about a change in the patient’s condition
what is termination of pregnancy?
some states require a viability test for abortion (heartbeat law) if you hear a heartbeat, you can’t have an abortion
- depending on the state a minor needs a parent’s consent
what is death with dignity or physician- assisted suicide?
the ANA says if nurses engage in assisted suicide this violates the code of ethics
what is nursing workforce issues?
when you start clinical, you need to have malpractice insurance
- you cannot go into a room if you are unprepared in clinical
- as a tech you need to work in your job description
- ex: if you are a nursing student who learned how to given an Iv and have a job as a tech, you cannot give an injection even if you learned how to
what are staffing and nurse-to-patient ratios?
- if the RN-to-patient ratio is unsafe you need to notify the supervisors
- working excessive overtime
- need to float (care within your scope of practice)
- ex: if you work in labor and delivery and they tell you to go up the intensive care unit, they tell you, you are taking care of a patient who is on a ventilator, but it is not in your knowledge or experience you need to speak up
what are nursing assignments?
when given an assignment you can’t handle, you need to notify your supervisor if you are not comfortable with it
- ex: as a new grad they give you a patient who is very complexed you need to speak up
what is patient abandonment?
refusing to proving care for a patient after developing a relationship with them
only acceptable if you have:
- lack of knowledge
- if the care exceeds the Nurse Practice Act
- if your health is in jeopardy or if you are pregnant
- religious reasons: abortion is against your moral beliefs
- if you are fatigued
what is nurse delegation?
the nurse retains the responsibility
A student nurse employed as a nursing assistant may perform care:
A. as learned in school.
B. expected of a nurse at that level.
C. identified in the hospital’s job description.
D. requiring technical rather than professional skills.
C. identified in the hospital’s job description.
You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first?
A. Call the nursing supervisor to discuss the situation.
B. Discuss the problem with a colleague.
C. Leave the nursing unit and go home.
D. Say nothing and begin your work.
A. Call the nursing supervisor to discuss the situation.
what is performance improvement?
puts emphasis on human performance
- ex: if there is a problem with the IV pumps, you can setup an in-service class on how to teach the nurses how to use the IV pumps
what is risk management?
reducing the risks or lawsuits
what is a never event?
a preventable error
examples:
- patient falls
- a patient getting a urinary infection from a catheter
- getting pressure sores (turning the patient ever 2 hours)
what is quality improvement?
puts emphasis on the work process
- ex: there is a problem with the IV pumps, you would want to use the work process or use the EHR to use this
what is occurrence reporting? (incidence reports)
purpose: provide a database that goes to risk management to decrease the risk
if any situation occurs, you must go into the computer and fill out an occurrence report
examples:
- if a patient falls
- if somebody did not follow a physician’s order
- a complaint (patient/family member/ healthcare employer)
- errors
- if a product on the unit is malfunctioning
Which of the following actions, if performed by a registered nurse, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.)
A. Reviewing the electronic health record of a family member who is a patient in the same hospital on a different unit
B. Refusing to provide health care information to a patient’s child
C. Reporting suspected abuse and neglect of children
D. Applying physical restraints without a written order
E. Completing an occurrence report on the unit
A. Reviewing the electronic health record of a family member who is a patient in the same hospital on a different unit
D. Applying physical restraints without a written order
what are Nurse Experts?
they have expertise in that certain area
- ex: you are involved in a patient fall and the family is going to sue, they will get a nurse expertise (fall prevention) can’t have a conflict of interest so they will get a nurse outside of the hospital
what is professional involvement?
to help yourself, you need to be involved in professional organizations and need to be involved in committees in the hospital
- for an interview, a good goal to say you have is that “I like to serve on a hospital committee”
need to make sure all your policies and procedures are evidence-based, bring it up to you manager if they are not
