Chapter 2 Flashcards
Exam 1
What is the first social institution a person knows, which influences your values, norms, and expected behaviors?
family
Example of family structures
*Nuclear with extended family
*Single parent family
*Blended family
*Cohabitational families
*Foster or adoptive families
*Same gender families
a husband, wife, and children PLUS extended family- grandparents, aunts, uncles, or cousins living together
Nuclear with extended family structure
one adult who is divorced, separated, or widowed living with a child or children
Single parent family structure
which one or more parents bring into the union children from a previous relationship
Blended family structure
couples living without the legal bonds of marriage with or without children
Cohabitational family structure
those who take responsibility for children who were not born to them; this may include children from another country or of another cultural, ethnic, or racial group
Foster or Adoptive family structure
include two adults of the same sex living together, some with children; new family formations are emerging, including those who identify as LGBTQ+ orientation
Same gender family structure
High Risk family face what issues?
*living below the poverty level
*living with chronic food insecurities
*single adolescent parent
*unanticipated stressors: ill child, child with special needs
*lifestyle problems: alcoholism, substance abuse, family violence, mental health problems
What is the nurse’s responsibility when carting for a high risk families?
to refer these situations to Social Services; mandatory reporter (elderly, children and special needs adults)
A nurse should take the opportunity to learn about the uniqueness of each person they care for and what else?
about their culture beliefs (especially practices surrounding childbirth)
Ask questions that respect patient’s what?
cultural differences and traditional health practices
In childbearing, “Culture” may include what types of patients?
patients who have been sexually abused, patient who lives in poverty, have low literacy level, identify as LGBTQ+, and have a disability
Since a nurse does not know what they will encounter when they walk into the patient’s room, a nurse should be what?
be flexible, respectful, and have an openness to their communication
the ability to recognize one’s limitations in knowledge and cultural perspective and be open to new perspectives
unbiased care/ competent cultural care
What shapes someone’s worldview about health, illness, and healthcare?
a person’s culture and life experiences
Culturally competent care is what kind of process?
dynamic, lifelong learning process
Examples of barriers to culturally competent care
*linguistic and sociocultural differences *socioeconomic barriers, including lack of health insurance (medical terminology), lack of health knowledge
*reluctance to question health care providers
*ethnic barriers: touch, eye contact, modesty, decision-making, men vs women roles
*spiritual/ religious barriers
*foods
*western vs eastern medicine
What influences the “meaning of giving birth”?
culture
What influences pain-related behaviors and desire for pain management during labor?
culture
This influences women’s behaviors during labor…
culture
Cultural awareness matters in…
pregnancy
ACOG told physicians that their approach to patient’s behavior and beliefs can affect patient communication how?
negatively
C of CULTURE
Consider your own cultural biases and how these affect your nursing care
U of CULTURE
Understand the need to recognize cultural implications in planning and implementing nursing care
L of CULTURE
Learn how to use cultural assessment tools
T of CULTURE
Treat patients with dignity and respect
U of CULTURE
Use sensitivity in providing culturally competent care
R of CULTURE
Recognize opportunities to provide specific culturally based nursing care
E of CULTURE
Evaluate your own previous encounters with patients from other cultures and backgrounds
Refers to the resources available for the family to meet the needs for food, shelter, and healthcare
Socioeconomic status
Insurance, good income, safe neighborhood, value preventive care (future- oriented)
Affluent
Enough to survive or live below poverty level, emphasis on meeting present needs
Working poor or Unemployed
-Infants born to people in low-income groups are more likely to be low birth weight
-May not have insurance, so Medicaid, public clinics, and Women, Infants, and Children (WIC) programs
Poverty
-Conditions in the environments where people are born, live, work, play, worship
-Have major impact on people’s health, well-being, quality of life, and influence health care decisions
Social determinants of health
The most important barrier to prenatal care?
economic stability
Social barriers
*economic stability
*education access and quality
*healthcare access and quality
*social and community context
*neighborhood and built environment
Ratio of who do not have healthcare insurance (preventative care)
1 in 10
Healthcare Access and Quality factors
*NO health insurance
*Systemic barriers: prenatal visits are usually during the day
*lack of transportation
*lack of value of the importance of prenatal care
What can have a major impact on people’s health and well-being?
their relationships and interactions with family, friends, co-workers, and community members
Many people face challenges and dangers they cannot control, what are some examples?
unsafe neighborhoods, discriminations, or trouble affording the things they need
What is impacted when people face challenges and dangers they cannot control?
their health and safety throughout their life
In regards to LGBTQ+ families…
*use gender appropriate terms
LGBTQ+ patients experience what?
discrimination and stress, social isolation, transgender males have unique barriers
Correlated with lower quality of care and is seen in times of overload or stress when the unconscious belief is activated
Implicit bias
What should a nurse do concerning implicit bias?
recognize it exists, as most people are unaware of their biases
The analysis of what is morally right and reasonable
ethical reasoning
The application of ethics to health care
Bioethics
Nurses use what when determining the benefits of any course of action?
ethical theories and ethical principals
People have the right to self-determination. This includes the right to respect, privacy, and information necessary to make decisions based on their personal values and beliefs.
autonomy
Make a decision that produces the greatest good or the least harm.
beneficence
Avoid risking or causing harm to others.
nonmaleficience
All people should be treated equally and fairly regardless of disease or social or economic status.
justice
What may patients conflict with?
nurses’ personal values
used to formulate policies for ethical situations: nurses, doctors, social workers, clergy, and even family members involved
ethics committees
Respectful care for childbearing patients is a what?
human right
When do reproduction conflicts arise?
when a patient’s behavior, or wishes may cause harm to a fetus and/ or is disliked by some members of society
Examples of reproduction conflicts
abortion, substance abuses during pregnancy, and patients refusal to follow advice of caregivers
Example of ethical issues in reproduction
*elective termination of pregnancy
*fetal injury
*infertility treatment (& what to do with the unused embryos?)
*Surrogate parenting
What are the 3 categories determining the law’s view of nursing practice?
*nurse practice acts- set by each state
*standards of care set by professional organizations (TJC, AWHONN, ACOG)
*rules and policies set by the institution employing the nurse
Doing something that should not be done or failing to do something that should be
(ex: withhold meds)
negligence
negligence by professionals in healthcare
(ex: not following policy & procedure)
malpractice
Clients have the right to decide whether to accept or reject treatment options as part of their right to function autonomously; an ethical concept that has been enacted into law.
informed consent
requirements of informed consent
*competence
*full disclosure of information
*pt’s understanding of info
*pt’s voluntary consent
Can the patient make the decision or not regarding their treatment? (Are they medicated, of sound-mind, comotose, cognitively impaired, what is their age?)
A requirement of informed consent: Competence
details of what the treatment entails, the expected results, and the meaning of those results. The risks, side effects, benefits, and other treatment options should be explained to clients. The person also should be informed about the consequences if no treatment is chosen.
A requirement of informed consent: full disclosure of information
the person should comprehend information about proposed treatment. Health care professionals should explain the facts in terms the person can understand. If a client does not speak English, an interpreter is required. A client with hearing impairment should have a sign-language interpreter of the appropriate level to sign all explanations before consent is given. Interpreters should not be family or friends because these people may interpret selectively rather than objectively. Additionally, client confidentiality is compromised when nonprofessional interpreters are used for sensitive information. Nurses should be advocates for the client when they find the client does not fully understand or has questions about a treatment. If it is a minor point, the nurse may be able to explain it. Otherwise, the nurse should inform the physician or other health care provider of the need for clarification.
A requirement of informed consent: Patient’s understanding of information
the client should be allowed to make choices without undue influence or coercion from others. Although others may give information, the client alone makes the decision. Clients should not feel pressured to choose in a certain way, and they should not think their future care depends on their decision.
A requirement of informed consent: Patient’s voluntary consent
-essential for collaborative client care
-the best evidence that a standard of care has been maintained
-It includes nurses’ notes, fetal monitoring strips, electronic data, flow sheets, care paths, consent forms, and any other data recorded on paper, recorded electronically, or both.
-notations in hospital records are the only proof care has been given.
-(when documentation is not present) juries may assume that care was not given.
-should demonstrate thorough initial and ongoing assessments, identification of problems, interventions used, and evaluation of their effectiveness, as well as information reported to other members of the health care team.
documentation
When there is an ethical or legal issue a nurse should relay those issues through the chain of command.. which is?
Nurse –> Supervisor (charge nurse/ nurse manager) and the client’s physician or other health care provider –> administrative channels to the director of nurses, hospital administrator, and chief of the medical staff
The nurse can reduce malpractice liability by maintaining what?
expertise
Nurses are still what when delegating tasks to unlicensed assistive personnel?
legally responsible
Nurses should know & do what about each of the UAPs?
their capabilities; supervise them sufficiently to ensure competence
Measures to lower health care costs continue to directly and indirectly affect nurses’ work. Two measures of special concern are what?
the use of unlicensed assistive personnel (UAP) and brief length of stay (LOS) for clients.
LOS for vaginal delivery
48 hrs
LOS for c-section
about 72 hrs
early discharge complications
UTIs, HAIs, pneumonia, poorly absorbed education/ instructions by new exhausted mothers; missed health issues
