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Ethical & Legal > Ethical & Legal > Flashcards

Ethical & Legal Flashcards

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1
Q

What are MUST haves for whistleblowing?

A
  • adequate documentation to establish wrongdoing
  • presence of unethical or illegal conduct
  • Seek counsel of someone you trust outside of the situation to get an objective perspective
  • Consult with your state nurses association or legal counsel before taking action
  • you are not protected from retaliation by your employer until you blow the whistle
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2
Q

Who do you report your concern to or blow your whistle to?

A

National and/or state agency responsible for regulation of that organization. In the case of criminal activity, to law enforcement agencies as well.

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3
Q

The Joint Commission or the National Committee for Quality Assurance confer protection to whistleblowers. True or False.

A

False. These are private groups. . You must report to a state or national regulator.

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4
Q

The process by which vulnerabilities are identified and changes made to minimize the consequences of adverse patient outcomes and liability is called?

A

Risk management

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5
Q

Nurse practice act is the law within the state or US territory. The state boards of nursing cannot grant exceptions to the acts, waive or expand the acts provisions. True or False

A

True

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6
Q

What are the three categories of nurses defined by Nurse practice acts?

A

1) LPNs and LVNs
2) RNs
3) NPs

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7
Q

What is the objective of risk management?

A

To identify potential hazards and eliminate them before anyone is harmed or disabled

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8
Q

Does Risk management activities include writing policies and procedures?

A

Yes

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9
Q

Written policies and procedures are a requirement of The Joint Commission. True or False

A

True

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10
Q

The policies and procedures must be clearly stated, well delineated and based on practices long time ago. True or False.

A

False. They should be based on current practice.

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11
Q

Who reviews the polices and procedures frequently for compliance and timeliness?

A

Nurse managers

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12
Q

Equal employment opportunities is under which law?

A

Civil Rights Act

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13
Q

Equal Employment Opportunity Act does not apply to any private institutions. True or False

A

False. It applies to private institutions with 15 or more employees.

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14
Q

Legislation regarding sexual harassment at workplaces is under which law?

A

Civil Rights Act

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15
Q

What is the difference between internal and external whistleblowers?

A

Internal whistleblowers report misconduct to a fellow employee or supervisor within the agency. External whistleblower report misconduct to outside persons or entities.

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16
Q

What distinguishes ethics from law?

A

Ethics focuses on the good of an individual and law comprises rules and regulations pertinent to society as a whole.

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17
Q

Nurses experience moral distress occurs when..?

A

two ethical principles compete with each other. E.g., when nurses cannot provide what they perceive to be best for a given patient, financial pressures, limited resources, limits imposed by HCP, disagreements among family members regarding care.

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18
Q

What is the role of ethics committee?

A
  • provide structure and guidelines for potential problems - serve as open forums for discussion
  • functions as true patient advocate by placing patient at the core of committee discussions
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19
Q

Autonomy model of ethics committee is for ____ patients

A

competent patients

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20
Q

Patient-benefit model of ethics committee is for ____ patients

A

incompetent patients. Substituted judgement is used such as what the patient would want if capable making decisions.

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21
Q

Social justice model of ethics committee is for _____

A

whole organization. It considers broad social issues and is accountable to overall institution.

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22
Q

Are standards of care the legal requirement for nursing practice?

A

Yes. They describe the minimum acceptable nursing care

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23
Q

Who develops standards for nursing practice?

A

American Nurses Association (ANA)

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24
Q

Who defines the scope of nursing practice, distinguishes between nursing and medical practice, and establishes education and licensure requirements for nurses?

A

Nurse Practice Act

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25
Q

Who requires accredited hospitals to have WRITTEN nursing policies and procedures?

A

The Joint Commission

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26
Q

Living wills, health care proxies, and durable powers of attorney are all part of?

A

Advance directives

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27
Q

What is Texas Peer Assistance Program for Nurses (TPAPN)?

A

TPAPN provides early identification, support, monitoring, accountability and advocacy to Texas nurses who have an identified substance use and/or mental health condition or related incident, so that they may return to safe nursing practice.

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28
Q

Is TPAPN part of Texas Nurses Association (TNA)?

A

Yes

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29
Q

Addiction is a chronic disease that often involves cycles of relapse and remission. True or false

A

True

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30
Q

_____ is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

A

Addiction

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31
Q

What are the behavioral changes of someone with substance use disorder?

A
  • Attendance and performance such as arriving late or leaving early, unexplained absences from the unit for extended periods, excessive number of mistakes including medication error
  • secretive, suspicious behavior such as frequent trips to bathroom, wearing long sleeves in warm weather
  • appetite and sleep pattern
  • personality or attitude such as increasing isolation from colleagues
  • mood swings, irritability, or anger such as inappropriate verbal or emotional responses
  • lack of motivation, diminished alertness, confusion, or memory lapses
  • fearful, anxious or paranoid
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32
Q

What are the physical changes of someone with substance use disorder?

A

Bloodshot eyes, abnormal sized pupils, sudden weight loss or weight gain, deterioration of physical appearance, unusual smells on breath, body, clothes

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33
Q

What are the social changes of someone with substance use disorder?

A

Sudden change in friends, hangouts, hobbies, legal problems related to substance use, unexplained need for money or financial problems

34
Q

_____ is a process of change through which individuals improve their health and
wellness, live a self-directed life, and strive to reach their full potential.

A

Recovery

35
Q

What are the 10 guiding principles of recovery from substance use disorder?

A
  1. Is person-driven
  2. Occurs via many pathways
  3. Is holistic
  4. Is supported by peers
  5. Is supported through relationships
  6. Is culturally-based and influenced
  7. Is supported by addressing trauma
  8. Involves individuals, families, and community strengths and responsibility
  9. Is based on respect
  10. Emerges from hope
36
Q

What are the steps to take if you find a nurse with substance use disorder?

A
  • Identification and reporting
  • Intervention
  • Diagnosis and treatment
  • Monitoring
37
Q

What are some of the factors for stress in nursing?

A

Staffing shortages, increased patient acuity and assignment ratios, demands from administrators and physicians, shift rotations, long work hours, workplace bulling and verbal abuse.

38
Q

Often the lack of institutional controls for storing and distributing narcotics facilitates improper removal of drugs from floor stock, waste or even from a patient’s medication supply, for the nurse’s personal use, which is known as ?

A

diversion

39
Q

Three signs to watch in a nurse that could indicate substance use disorder?

A

Behavioral changes, physical signs, and diversion of drugs

40
Q

What are the narcotic discrepancies that could indicate substance use disorder?

A

Incorrect counts, large amounts of wastage, numerous corrections of records, reports of ineffective pain relief from patients, offers to medicate coworkers patients for pain, altered verbal or phone medication orders, controlled substance discrepancies.

41
Q

What are alternative-to-discipline programs (ADPs)?

A

voluntary non-disciplinary opportunities for nurses with substance use disorder

42
Q

Treatment for substance use disorder DOES work for all those who maintain a rigorous relapse prevention program. True or False.

A

True

43
Q

Nurses in recovery can re-enter workplace safely when treatment and monitoring are instituted. True or False

A

True

44
Q

Professional support for relapse prevention include?

A

periodic random drug testing, documented attendance at 12-step programs, professional support groups, individual counseling

45
Q

What does returned to work contract usually include?

A

workplace monitor or supervision, standards for work performance, conditions of employment such as no fully autonomous practice, staffing agencies, or floating, required drug screening, restrictions on practice such as restricted access to controlled substances, limited shift or hours such as no overtime or night shifts

46
Q

When is reporting to Texas Board of Nursing REQUIRED for nurse with substance use disorder?

A

A nurse is suspected of being impaired by chemical dependency or diminished mental capacity
AND
the person believes or suspects that the nurse
committed a practice violation.

47
Q

When is reporting to TPAPN (use TPAPN Referral Form) or Nursing Peer Review (use BON Complaint Form) REQUIRED for nurse with substance use disorder?

A

A nurse is impaired or suspected of being impaired
by chemical dependency or mental illness
AND
there is NO Nursing Practice Act violation.

48
Q

Can you write anonymous referral to TPAPN?

A

Yes. The referral can be anonymous, non-anonymous, or confidential.

49
Q

Who can refer to TPAPN?

A

Onself, 3rd party, or BON

50
Q

What is the focus of participant in TPAPN?

A
  1. Recovery from substance use and/or mental health conditions
  2. Maintenance and demonstration of sobriety and/or mental fitness
51
Q

How long is the participation required in TPAPN?

A

Minimum 1-5 years

52
Q

What abstinence is required for participation in TPAPN?

A

Abstinence from all abusable drugs including alcohol

53
Q

What are the four types of social peer support provided by volunteer nurse advocates?

A
  1. Emotional: empathy and camaraderie
  2. Informational: to support health and wellness
  3. Instrumental: mentoring
  4. Affiliational: connection to community supports, activities, and events
54
Q

What are the consequences of non-adherence to TPAPN?

A

New or updated evaluation, Increased length of
participation, Additional workplace monitoring, Additional drug testing, Additional treatment, Additional practice restrictions, Discharge and referral to BON

55
Q

If the patient is unable to make health care decisions for himself/herself when this power of attorney expires, the authorized agent continues to make decisions until the time the patient is able to make health care decisions for himself/herself. True or False

A

True

56
Q

Who can sign as witness to power of attorney document?

A

A person who is not appointed agent by that document, not related by blood or marriage, not entitled to or have claim against any portion of the patient’s estate upon patient’s death, not the attending physician or an employee of the attending physician, not involved in providing direct patient care to the patient, not an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility.

57
Q

Why is documentation important?

A

If you don’t document then it is assumed that the care was not given.

58
Q

When does the best documentation occur in nursing?

A

Immediately after the assessment of patient or a procedure when recall is freshest.

59
Q

In addition to Advance Directions, what are the two other types of directives provided by Texas laws?

A

The Medical Power of Attorney and the Out-of-Hospital Do-Not-Resuscitate Order

60
Q

The do not resuscitate wish must have a valid physician order for enforceability. True or False.

A

True

61
Q

What are the most enforceable types of advance directives in healthcare?

A

Durable power of attorney for healthcare (DPAHC) or medical durable power of attorney (MDPA)

62
Q

Do not resuscitate directives must be ordered by the ______ and must be in the patient’s medical record.

A

physician

63
Q

The states do not have the right to impose legal requirements on decisions for the discontinuance of therapy for incompetent patients. True or False.

A

False

64
Q

What is Patient Self-Determination Act (PSDA) of 1990?

A

It encourages all people to make choices and decisions now about the types and extent of medical care they want to accept or refuse should they become unable to make those decisions due to illness.

65
Q

What does Patient Self-Determination Act (PSDA) mandate?

A

Patients must be asked about existence of advance directives and must provide patients with educational materials about their rights under state law.

66
Q

What are the advantages of safe harbor?

A
  • protects the nurse from employment retaliation and negative employment consequences
  • gets management’s attention to and assistance with the resolution of the concern or issues involved
  • the nurse advocates for the patient and challenges a physician’s order.
67
Q

What is the difference between Safe Harbor and Incident Based Peer Review?

A

Safe harbor is initiated by RN, LVN, or APN and Incident Based Peer Review is initiated by facility, association, school, agency, or any other setting that utilizes the services of nurses.

68
Q

Incident based peer review results from the actions of a nurse that did or could cause harm to patients. True or False.

A

True

69
Q

Safe harbor is initiated ____ (prior to/after) accepting an assignment or engaging in requested conduct.

A

prior to

70
Q

A ______ is defined as the application of a physical force, mechanical device, chemicals, or seclusion to limit freedom of movement.

A

restraint

71
Q

The Joint Commission has identified that miscommunication is frequently associated with _____ Events

A

Sentinel

72
Q

Which department facilitates staff communication to prevent risk to patients?

A

Risk Management

73
Q

It is following through on your actions and interventions, and unwillingness to abandon patients regardless of the circumstances, even when personal beliefs differ.

A

Fidelity

74
Q

It is fairness, just distribution of scarce resources, ensuring that all people receive resources equally.

A

Justice

75
Q

It is the will to do good, commitment to do no harm, balance the risks and benefits of care while striving to do the least harm possible.

A

Non-maleficence

76
Q

It is taking positive action to help others, best interests of the patient remain more important than self-interest.

A

Beneficence

77
Q

It is freedom from external control, commitment to include patients in decisions about all aspects of care, acknowledge and protect a patient’s independence.

A

Autonomy

78
Q

It is the willingness to respect one’s professional obligations and to follow through.

A

Responsibility

79
Q

It is the ability to answer for one’s actions.

A

Accountability

80
Q

It is the support of a particular cause, advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.

A

Advocacy

Ethical & Legal (1 decks)

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