Ethical and Legal Standards, Patient Centered Care & Evidence Based Practice Flashcards
To do good
Beneficence
to do no harm
Nonmaleficence
Treated all fairly
Justice
Truthful
Veracity
A way for citizens to feel safe. Laws regulating professional development
Nurse Practice Act
National League of Nursing;
NLN
Making sure standards are up to date
Joint Commission
Standards of right vs. wrong
Based on a specific group’s standards
Relates to the rights of clients and their families
The development of ethical standards of an individual, community, or a profession
Ethics
Distinguishing between right or wrong based on your own personal standards. Focus is more on a social aspect and involves personal awareness of feelings
Morality
A set of professional principles and standards designed to help guide professional behavior and relationships through specific nursing beliefs and values
Nursing Ethics
Comfort
Teaching & Learning
Communication
Advocacy
Concepts Related to Nursing Ethics
Personal ideas about the worthiness of importance of something known through socialization
Values
Ideas that one holds to be fact based on experiences and personal knowledge. One’s values often reflect their beliefs.
Beliefs
Altruism Autonomy Human dignity Integrity Social Justice
5 essential values of nursing
Necessary for the nurse to help them maintain client-centered care
Necessary for clients to help the nurse learn their values and distinguish them from their own
Therefore, assists with effective plan of care
Also, helps the nurse know whether values clarification is necessary
**The nurse is to NEVER impose his/her own personal values on a client and must be careful with offering opinions*
Clarifying Values
A set of ethical standards and behaviors that are expected in the nursing profession
Help guide nurses in the profession
The 2 major codes the nursing profession follows are the American Nurses Association (ANA) and the International Council of Nurses (ICN)
Nursing Code of Ethics
The nurse has certain obligations to address such as the client’s best interests and following facility’s policies
The first step is to consider whether a moral dilemma exists
Maximize the client’s well being.
Balance the clients need for autonomy with family members’ responsibilities for the clients well being.
Support ea. family member and enhance the family support system.
Carry out hospital policies.
Protect other clients’ well-being.
Protect the nurses’s own standards of care.
Become aware of their own values and the ethical aspects of nursing.
Be familiar with nursing codes of ethics.
Seek cont. education
Respect values, opinions, and responsibilities of other healthcare professionals
Ethical Decision Making
problem oriented medical record
POMR
subjective data
objective data
assessment
plan of care
SOAP
subjective data objective data assessment plan of care interventions evaluations revision
SOAPIER
problems
interventions
evalutations
PIE
intended to make the client and the clients concerns and strengths the focus of care.
Focus charting
only abnormal or significant findings or exceptions to norms are recorded.
CBE-Charting by exception
Health Insurance Portability Accountability Act of 1996
privacy and security rule which applies to us all.
Logging off of computers
Can send an email as long as it is encrypted and subject box has “confidential” in it.
HIPPA
Population/Patient Problem-Who is your pt?
Issue/Intervention-What do you plan to do for this pt?
Comparison-Whats the alternative plan?
Outcome-What outcome do you seek?
Time-What is the time frame?
Your PICOT question will fall under one of these types: Therapy/Prevention Diagnosis Etiology Prognosis
PICOT Format
using one’s expertise and knowledge to assist in gathering information related to professional practice. The data collected is a result of best current practices. This process is continuous because old evidence needs to be replaced with updated information.
Evidence based practice
Best evidence is from current research
Based on nurse’s clinical expertise
Should reflect clients’s preferences, values, needs, interests, and choices
Components of EBP Framework
Clinical decision making Advocacy Quality Improvement Accountability Professional behaviors
Concepts related to EBP
Evidence: increased staph infections to wounds noticed per hospital reports
Research can be conducted within the facility to determine possible causes
Once all evidence is collected and evaluated, changes can be made for improvement
Benefits of EBP
Implementing the scientific process
All information gathered is OBJECTIVE & FACTUAL
The overall goal is to improve client care
Careful consideration of funding, participants, ethical/legal issues, and implications for practice
Clinical Research
Precision of measurement is used; statistical data collected
Quantitative Research
Meta-analysis Case study Cohort study Case-control study Randomized control trial
Types of Research Studies
A group of studies on a given topic are examined, and their results are combined and analyzed as if they were from one large study.
Meta-analysis
A case study is specific to one individual, issue or event.
Case study
A longitudinal study follows two groups and measures the outcomes of an exposure group with those of a non-exposure group.
Cohort Study
This study compares individuals with and without a specific condition to identify predictive variables.
Case-Control Study
This is the strongest type of study. RCT’s are designed to illustrate a cause and effect relationship by using a control group and an experimental group.
Randomized Control Trial (RCT)
Provide best evidence for EBP.
Support nursing as a professional discipline.
Define current best practice standards of nursing care.
Implications for Nursing Practice. Three main benefits of clinical research.
- Develop a clinical question (determine the type)
- Diagnosis
- Etiology
- Therapy
- Prognosis - Retrieve the evidence
- Evaluate the evidence
- Apply the evidence
Steps to Developing EBP
Communication Planning client care Auditing health agencies (The Joint Commission) Research Education Reimbursement (from insurance/government) Legal Record (admissible in court) Healthcare analysis
Purposes of Maintaining Client Records
document helps clients understand their treatment choices and risks that maybe involved.
Not nurses Duty. Can be a witness; Physicians duty
Informed Consent
Assessments Change in conditions Objective descriptions Statements Nursing action Use of safety equipment Deviations or achievement of outcomes MD notification Procedures Consultations Involvement of family/others Activities
What to Document
Also referred to as charting, recording or documenting onto a client’s chart or clinical record.
The main purpose is for effective communication among healthcare professionals.
Nursing Documentation
Referred to as POMR or POR;
Advantage;
Encourages collaboration among healthcare team and care is organized based on problem list
Disadvantage:
Requires frequent updating
Four Components include:
- Database
- Problem list
- Plan of care
- Progress notes
- SOAP
- SOAPIER
Problem-oriented medical record
Source-oriented
Problem-oriented
3. Problems, interventions, evaluations (PIE)
4. Focus charting
5. charting by exception (CBE)
6. Electronic (to be discussed in Class 2)
Documentation Systems
Also known as PIE=
consists of a formatted flow sheet and progress notes
Advantage;
Organized flow sheet of information
Creates an ongoing care plan
Disadvantage:
All notes must be reviewed prior to the nurse giving care (time consuming)
Problems interventions evaluations
source-oriented
Advantages:
Easy for healthcare team members to locate different sections of the chart
Each disipline’s charting is clearly identified
Disadvantages:
Client information is scattered throughout the chart
Source oriented
Do's of charting Be prompt Be accurate Be detailed Be neat! Check spelling Chart chronologically Date & Time Use black or blue pen Be objective Record you signature
Do’s of charting
Dont's of Charting Forget Falsify Use white out Scribble Chart for someone else Stereotype Wait until the end of the shift Chart ahead of time!
Don’t’s of charting
Usually contains 3 components
- Date and time
- focus (condition, nursing diagnosis, behavior, etc)
- progress notes
Focus charting
Written in Dar format
D=data (what was assessed/found)
A=action (what was done about it)
R=response (how did the client respond to treatment)
Advantage:
Client-centered providing holisitic care
Provides a framework for nursing progress notes
Three components do not have to be in any particular order
Focus charting
Admissions (nursing history, initial database, nursing assessment)
Care Plans
Kardexes
Flow sheets (includes graphs, intake and output, med administration, and skin assessment)
Progress Notes
Discharge/Referral Summaries
Long-term Care-
requirements for documentation depend on facility policy, federal and state regulations, and professional standards
Home Care-
documentation must meet standards for Medicare and Medicaid and facilities must maintain:
- home health certification & plan of care
- medical update and client info form
Special Considerations for charting
Used only to document deviation from the expected finding Three components: 1. Flow sheets 2. standards of nursing care 3. Bedside access to chart forms
Advantages:
Charting is simplistic with no repetition
Changes to clients condition stand out
Disadvantage:
Some nurses are not comfortable with this charting system
Charting by Exception (CBE)
Provide citizens with protection from harm.
Mandatory duties to report; unsafe working conditions, child abuse and medical practioner
Nurse Practice Act
Protecting is
defends another’s cause
represents clients needs, wishes to others
positive experience for nurses & clients
advocacy
Navigate complex health care system
Educate clients about their rights, health care options
-provide info
-support client in making informed decisions
-work with client who lack decision-making capacity
Advocate’s Role
Nurse maintains professional boundaries
- being client advocate
- following through or following up
- providing resources
- going above and beyond
Four Dimensions of Advocacy
Protecting an individual by expressing and defending the individuals cause on his or her behalf.
An individual who expresses and defends the cause of another.
Whats best for the patient, children, elderly, mentally handicapped, not able to advocate for themselves, next of kin that can
Advocate/Advocacy
