Exam 1 Flashcards
Metaethics
Which focus on universal truths, and where and how ethical principles are developed
Normative ethics
Which focus on the moral standard that regulate behaviors
Applied ethics
Focus on specific difficult issues such as euthanasia, capital punishment, abortion and health disparities
Principles
Moral distress, autonomy, beneficence, nonmaleficence, justice, fidelity, veracity
Morals are learned over time and are influenced by life experiences and culture.
Values are usually expressed in terms of right and wrong, hierarchies of importance, or how one should behave
Moral distress
Typically describes as a response to a situation when nurses are faced with an ethical dilemma
Autonomy
Asserts that individuals have the right to make their own decisions
A patient has the right to refuse medical treatment or choose a medical treatment
Beneficence
The doing of good
Even though a nurse may understand that one treatment may benefit them they must adhere to the patients right to autonomy
You should always do what’s good
Get your immunizations so that you dont get others sick. Always go the speed limit
Nonmaleficence
Cute to do no harm
Double effect principle: must be good or at lease morally indifferent, only good effects, favorable balance
Inserting an IV hurts, but its to give fluids/meds. Nurse is not intentionally harming the patient
Justice
Equals should be treated the same
Two diabetic patients receive insulin but one has a diabetic ulcer so that one received wound care
Fidelity
Faithfulness or honoring ones commitments or promises
In making a medication error, you follow policies and procedures to report it
Veracity
Telling the truth or not lying
A dr. Can violate if they do not disclose the entire procedure process
Keeping a cancer diagnosis from a patient because a family member told you to
Theories
Deontology, utilitarianism, virtue, principalism
Deontology
An act was moral if its motives or intentions were good, regardless of the outcome
Determine the right thing to do by gathering all the facts and then making a decision
Washing off drug oil off birds and then setting them free. You are doing good by cleansing them but also washed off the natural oils so they cant survive in the wild
Calling a patients son for him no matter the outcome
Utilitarianism
Moral rightness of an action is determined solely by its consequences
Bring in out out the greatest good for the greatest number of people
Putting people in treatment priority
In triage, the sick or injured are classified by the severity of their condition of determined priority of treatment. Research money is more likely to be on research for a disease that affects a large number of people than for research on disease that only affects a few
Virtue ethics
Emphasizes the character of the decision maker
Tendencies to act, feel and judge that develop through appropriate training but come from natural tendencies
Will instinctively choose to do the right thing due to a persons natural instinct and from past experiences
Principalism
Uses key ethical principles of beneficence, autonomy and justice in resolution of ethical conflicts or dilemmas
Ana code of ethics
The code for nurses is non negotiable and that each nurse has an obligation to uphold and adhere to the code of ethics
The nurse practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, persona attributes or the nature of health problems
Professional ethics overrides personal morals and values
Kohlberg’s stages of moral development
Preconventional
Conventional
Post conventional
Preconventional
The individual is inattentive to the norms of society when responding to moral problems. Self centered approach
- Responds to punishment
- Responds to the prospect of personal reward
In children younger than the age of 9, sone adolescents, and adult criminal offenders
Conventional
Characterized by moral decisions that conform to the expectations of ones family, group or society. It’s the law
- The person makes moral choices based on what is pleasing to others
- Choice on what is desired by the society
Most adolescents and adults
Post conventional
More independent modes of thinking. Knows his/hers own moral values
May sacrifice themselves on behalf of the group
Only a minority of cults achieve this level
Gilligan’s Theory on Moral Development, differences of Gilligan’s research from Kohlberg
The moral person is one who responds to needs and demonstrates a consideration of care and responsibility in relationships
Women view moral dilemma in terms of conflicting responsibility
Women most often exhibited a focus on care, whereas men more often exhibited a focus on justice
Each transition resulted in selfishness and responsibility
Levels:
Orientation to individuals survival
A focus on goodness with recognition of self-sacrifice
The morality of caring and being responsible for others, as well as self
Nurse practice Act- what does this do, and why – for the nursing profession
Defines the practice of professional nursing
Sets the minimum education requirements for licensure, determines legal titles and abbreviations nurses may use, provides disciplinary action
Mandatory laws: requires any person who practices the occupation to be licensed
Permissive laws: protects and limits the use of the title granted in the law but does not prohibit persons from practice the occupation if they do not use the title
Ex. Nurse has a permanent residence in a party state and wishes to work there what are the steps needed to work?
She can practice on her former state and her new state
The NLC allows an RN to have one license (in the state of residency) yet practice in other compact member states without an additional license in the state of employment. Importantly, the nurse is subject to the nurse practice act in the state where she or he is practicing, not to that of the state of licensure. A single license for each nurse and110the concomitant reduction of state barriers provide better protection for the public through improved tracking of nurses for disciplinary purposes and information sharing.
Delegation – know the 5 rights, and be able to apply them
- Right task: Is the task appropriate for delegation in a specific care situation?
- Right circumstances: Is delegation appropriate in this case? Consider the patient’s health status, care delivery setting, complexity of the activity and delegate’s competency, and available resources, and determine any other relevant factors.
- Right person: Can the nurse can verify that the person delegated to do the task is competent to complete this task?
- Right direction/communication: Has the RN given clear, specific instructions? These include identifying the patient clearly, the objective of the task, time frames, and expected results.
- Right supervision/evaluation: Can the RN or other licensed nurse provide supervision and evaluation of the patient and the performance of the task?
Informed Consent- what is this, and what is the nurse role? When might the legality of informed consent be question
Consent must be given voluntarily, by an individual with the capacity and competence to understand, must be given enough information
Completeness: quality of info
Competency: the capability of the patient
Voluntariness: freedom the patient has
The nurse is to make sure they understand and if not then get the provider to explain. They can witness the signing but can not give any information on the procedure
Confidentiality, the nurse role, and in what circumstances do nurses need to break confidentiality
Legal and ethical concern: protection of private information gathered about a patient during provision of care
Protected by state and federal statues, but there are exceptions and limitations
Have the need to report suspected abuse or neglect of a child, gunshot wounds, communicable diseases, and threats
HIPAA requires everyone in the health field to follow protocol
Patient Self Determination Act- what is this …
Patients have to consider and document life-prolonging treatment options
Advanced directives
Ethical principle of autonomy
Must provide written info on rights under state law; ensure institutional compliance; provide education, document on medical record
Elements of malpractice- what must be present in order for a patient to claim malpractice occurred
Occurs when a professional fails to act as a reasonably prudent professional would have acted under the same circumstances
Civil not criminal cases
Professional negligence may occur: Negligence is the failure to act as a reasonably prudent person would have acted in the same circumstances. For example, a person parks his car on a hill and does not engage the parking brake.
Commission: doing something that not have been done
Omission: failing to do things that should have been done
Standard of care: basic minimum level of prudent care based on the ethical principle of non-maleficence (do no harm)
Prevailing: is ascertained through expert witness testimony, documents (national standards of practice), patient record, and other pertinent evidence
Cause of action:
The nurse has assumed duty for patient
The nurse breached the duty of care by failing to meet standard of care
The failure of the nurse caused an injury
The injury is proved
Captain of the ship: physicians are overall in charge of patient care
Respondeat superior: acts of employees to their employer
Contributions of Nightingale, Barton, Wald, Sanger
Barton (angel of the battlefield): set up field hospital for the wounded and dying in culpeper, virginia.
Founded American Red Cross
Widespread public education in home care and hygiene
Nightingale: school-modeled training schools in America
Data collection on morbidity and mortality n British medical system
She established training schools for nurses
Sanger: safe contraception and family planning
Immigrant women
Wald: sought finances and formalized public health
Treated minor illnesses, education and prevented disease transmission
Community health nurses
Common focus was to prevent disease and management of illness
Trends in nurse and health care worker populations, to include foreign born nurses who come to the US for work.
Critical in policy decision making
Need to be aware of cultural differences
Shortages caused the need for recruitment from other countries
Trends in population age groups, and what affects it will have on the future of nursing
Doctoral prepared and mastered are mainly over the age of 50
Changes in demand due to the increasing age of the American population and a greater degree of illness
Internal causes: salary issues, long hours, increased responsibility and significant responsibility
External causes: again population, greater patient acuity, multiple options for women
Origins of nursing care
The origin of nursing care began in the 1800’s during the wars. They needed women to help the men “strength” with their wounds.
Nursing image
Rated the highest in honesty and ethics
Economic and job security
Appeal as strong
Johnson and Johnson campaign: to enhance the image of the nursing profession
Telehealth and nursing
Information technology refers to technology that is used to communicate, store, mange, retrieve, and process information.
Cause less time to be spent with the patient which could result in dissatisfaction for patients and families
It should never take place of human-human interaction
Executive
with the authority to administer the nursing practice act
Legislative
with authority to adopt rules necessary to implement the act (note that rules are different from laws, which are made by the state’s legislative body)
Judicial
with authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure
Which of the following could eventually change the historical status of nursing as a female-dominated profession
More male graduates of basic nursing programs entering the workplace
