chapter 21 Flashcards
which healthcare profession promotes advocacy
nursing
what must nurses learn to advocate
the system in which patient care occurs
- learn the reason for and patient’s expectations for the visit
when does the nursing assessment begin and end
begin at the first interaction with patient
continue through entire patient contacte period
where does the word advocacy come from
the Latin word advocate
meaning “to call to one’s aid”
what does it mean to advocate
come to his or her aid OR give voice to his or her concerns
- protect patient privacy
- ensure that patient has a voice in decision making
- protect patient from unethical and illegal practice
where is advocacy mentioned in nursing
the ANA, Code of Ethics for Nurses with Interpretive Statements (2001)
CNA, Code of Ethics for Registered Nurses (2002)
Who was the earliest nurse ethicist
Myra Levine
what did Myra Levin do
describe every interaction between a nurse and patient as a MORAL INTERACTION
what can the nurse do for a patient
run interference
- educate patient and remove barriers so patient achieves desired goals
who is in control of a hc situation, why
the nurse
- has information the patient does not have
- knows what the patient has to do and where he/she has to go
what two traits do nurses use for moral interactions
respect and competency
who gets the final decision
the patient
what two types of goals are there in helathcare
goals created by hc provider AND patient
goals created by hc provider and not endorsed by patient
what can a nurse do between a hc doctor and patient
facilitate a conversation
how can the nurse conduct research regarding advocacy
library
internet
personal contacts
what does the nurses actions depend on (2)
standard of care
patients wishes and communicating with patient
how does the nurse advocate for a patient
providing patient with necessary information
facilitating decision making y talking with patient
what are the three parts of the therapeutic relationship between nurse and patient
allowing patient to
- speculate
- think out loud
- use nurse as sounding board
what are some ways the nurse can advocate by avoiding preventable harms (at a minimum) (3)
maintaining competence in area of practice
using critical thinking skills
promoting health and safety of patients
what do individual acts of the nurse avoid
iatrogenic illness
- those caused by medical treatment or health care staff
what is advocacy of the patient based on (3)
autonomy
beneficence
non-maleficence
what do many patients, especially elder patients NOT do
question physician authority
describe nurse anchor
- assigned to 73 yr old women with wound on foot
- believes that patient needs pain medication before dressing changes
- Dr.Carney tells patient he will hurry so that wound does not hurt very much, but does not give pain medication
what does advocacy require
analyze situation
decide what actions give patient a voice and advance his/her interests
describe student nurse baker
- with 3 year old boy in playroom
- med. student wants to perform examination on boy even though the playroom is considered a safe place and exam free zone
who coined the phrase doctor nurse game
stein
what is the doctor nurse game
describes deference on behalf of the nurse to the authority of the physician
- the nurse makes it seem like the physician has arrived to the conclusion
- nurses have a “fear” of physicians
What did savage, in 1995 say
that doctor nurse game is effective for patient advocacy
what is affected by the quality of nurse-physician relationships (2)
nurse job satisfaction
patient outcomes
what do new graduates believe causes anxiety
interacting with physicians
what is required for a nurse a physician on behalf of the patient
moral courage
why would the nurse NOT speak up
out of fear of the physician (verbal abuse)
out of concern for their relationship with the physician
what is one way a non-charge nurse can get the outcome they desire and believe is right
follow the chain of command in nursing structure
what four relationships impact patient care
relationships among
nurses, student nurses, physicians, medical students
what 3 factors result in complex issues in ehalthcare
hierarchy
gender
personalities
what is used as an excuse for the lack of civility in healthcare
the intensity of work
what 3 things should ensure effective communication and functional relationships
- respectful language
- professional decorum
- diplomacy
describe nursh ash
orthopedic resident is changing patients dressing when he contaminates sterile gloves
nurse ash must inform the physician of the contamination and tell him to change his gloves
what are two reasons the physician did not change his gloves
did not notice
was anxious to complete the dressing
what are ethical issues embedded in (3)
clinical context where there are sociopolitical forces of
- power
- institutional culture
- professional codes
how could issues in healthcare be described as
grey not black or white
what is an ethical uncertainty
question of whether a problem is an ethics problem
- usually when there are two unpleasant options
what did jameton, 1984 do (3)
describe ethical issues as
uncertainty
dilemma
distress
how can nurses describe their feelings about a bad situation
articulate with “is not right”
AND
decide what is right
describe nurse hunt
home health care nurse
- caring for Mr.Dash who had a stroke
- realized that Mr.Dash has not been taking his antihypertensive and anticoagulant medications
- Wants to inform the physician of his 230/150 blood pressure but Mr.Dash says no
describe nurse gorrell
caring for 82 yr old man with myocardial infarction and experiencing left heart failure
- has DNR
intern is running blood test for patient regardless of the DNR, bc the physician wants to know the potassium levels
nurse gorrell believes this is unfair as it will cause the patient pain, discomfort, and extra money
what is a CQI commitee
continuous quality improvement committee
- addresses palliative care for dying patients
- both groups perspectives are listens to and mutually agreeable policy is enacted
what did Mallik and Rafferty, 2000, conclude in their bibliometric analysis of patient advocacy
nurses use advocacy to empower themselves
what did Foley, Minick, and Kee (2002) find
nurses learn advocacy in a haphazard manner dependent on situations
- there are three methods of learning advocacy
what are the 3 ways nurses learn advocacy
- identifying how the nurse learned to stand up for others,i n the past
- watching how other nurses advocate
- gaining confidence with experience, validation, and mentoring
what are the main roles of the ANA and CNA
advocate for health and welfare of citizens
advocate for special patient populations
advocate for advancement of nursing
what represents the professions expectations for ANA members
1991 ANA Code of Ethics for Nurses With Interpretative Statements
what does the 2001 ANA code discuss (2)
client patient interests
workplace issues
what is the goal of nursing
having a work environment that is conducive to optimal performance
what 2 things are critical to a nurses performances
and what 2 things must a nurse do?
staffing and worload determination
priortize and delegate tasks
what two events does a nurse have to shift time and attention
- too many patients
- too many acutely ill patients
how can nurses adocate change
advocate for change
- increase number of nurses
- decrease patient census
- refer acute patients to better staffed units
what group are nurses part of for advocacy
UAN, AFL-CIO
United American Nurses
merged with
The American Federation of Labor and Congress of Industrial Organizations
what key issues affect patient health (3)
staffing
workload
delegation
what issues affect nurse safety and health
workplace violence
sexual harassment
avoidance of hazardous materials and situations
where does workplace violence occur
emergency department
psychiatric unit
what is a source of conflict between nurses and administrators
mandatory overtime
- usually in times of nursing shortages
what does fatigue lead to
errors
- that is why nurses should RESIST mandatory overtime
what is a conundrum in nurses
nurses will risk their lives to save their patients with overtime
what is an operative issue in healthcare
nurse judge whether they are capable of providing care during their shift
during mandatory overtime, their judgement is unnecessary and they must remain on teh unit
if they leave, they are accused of patient abandonment
what should each institution have
a definition on patient abandonment
- the nurses should have input into the transferring of care
what ethical principle is important for identifying unsafe situations
non maleficence
what are three important issues for discussion in nursing
educational preparation
entry level for practice
socialization
what are some workplace issues that should be addressed in facilities employing nurses
needle less intravenous systems
latex allergy management
work related disability benefits
what should be threeo focuses of advocacy for NURSES
on going education through in services
formal education with tuition reimbursement
paid release time to attend conferences
what did the ANA have 84 statements regarding in 2004
blood borne and airborne disease ethics and human rights social causes and health care drug and alcohol abuse nursing education, practice, research consumer advocacy and workplace advocacy use of unlicensed assistive personnel
