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
The racial and ethnic composition of the nursing porfession will change to more accurately reflect the population as a while when
The increased numbers of racial and ethnic minorities enrolled in educational programs graduate and begin to practice
Which or the following is a correct statement about the registered nurse population
The rate of aging RNs has slowed for the first time in the past 30 years
Which of the following best describes trends in nursing education
Numbers of rns with bachelor’s and higher degrees are increasing
Despite the variety of work settings available to the rn, data from 2008 indicate that the primary work site for rns is
Acute care hospitals
One important advantage of clinical ladder programs for hospital based rns is that they
Allow career advancement for nurses who choose to remain at the bedside
Which of the following statements is correct about community health nursin
Prevention and community education are the cornerstone of chn
Which of the following is most essential for the nurse entrepreneur to be successful
Excellent time management skills
The major benefit of serving as a military nurse is
The financial support to seek advanced degrees
Which of the following statements explains why the school nurse of today is truly a community health nurse
The school nurse may be called on to a care for a students family members in underserved areas
What has been found about the outcomes of patients cared for in hospitals with a higher percentage of BSN prepared nurses as compared to patients in hospitals with a lower percentage of BSN prepared nurses
Outcomes were better in hospitals with more bsn prepared nurses
Faith community nursing was founded on which of the following premises
Spiritual health is central to a persons well being
One important advantage of the evolution of nursing informatics is that
Informatics nurses are best able to design systems with the needs and skills of nurses who use them
Which of the following nursing roles is not considered an advanced practice role
Community health nurse
NPs are advanced practice nurses who
Can diagnose and treat common and chronic conditions
The clinical nurse leader is a recently proposed role. The responsibilities of the person in this role include which of the following
Oversee and manage care delivery in specific setting
Hospice and palliative care nursing is a rapidly developing specialty in nursing. Which facts have contributed to this growth
Select all that apply
End of life care is largely the responsibility of nurses
End of life needs are expected to increase with the aging population
Hospice and palliative care nurses work in a variety of settings
CNSs may
Select all that apply
Manage an inpatient nursing unit
Develop educational programs for nursing staff
Conduct practice outcomes research
Which early nursing leader founded the first training school for nurses that would later become a model for early nursing education
Florence nightingale
Who was the first educated African American professional nurse
Mary Eliza Mahoney
To which early nursing leader is attributed the founding of the American Red Cross
Clara Barton
What were some of the application requirements of nursing education programs in the 1900s
Female, sensitive, subservient
Which of the following statements best describes how the Chicago worlds fair of 1893 became a pivotal point in the history of nursing education in the United States
The organization today known as the NLN was formed to address issues in nursing education
Which early nursing organization is credited with first recommending state registration for nurses
ICN
Which of the following nursing leaders, because of her work in the Henry street settlement is considered the founder of public health nursing
Lillian wald
Despite the caring efforts of early public health nurses in the Henry street settlement, racial disparity left many people underserved. Which of the following African American public health nurses was instrumental in providing excellent nursing care to underserved families despite these social challenges
Jessie sleet scales
Which one of the following events occurring during the first decade of the 20th century brought sweeping changes to nursing
Nurses had to pass a licensing examination to use the title RN
What was the most significant impact on the profession of nursing made by Mary Breckinridge in here role as a frontier nurse
She demonstrated that nurses could provide primary care in rural settings
Mary Breckinridge established frontier nursing serves. She provided primary care to women and babies and demonstrated that nurses could provide primary care. Which of the following trends in health care delivery that began in the second half of the 20th century continues today
Provision of care to the poor, elderly and disabled through Medicare and Medicaid
Two amendments to the social security act in 1965 designed to ensure access to health care for elderly, poor and disabled Americans were the establishment of
Medicare and Medicaid
A recent trend in nursing has been an increase in the number of men and women with degrees in other fields or other careers applying to nursing programs. What is the single most important reason for this trend
A nursing career provides both job security and meaningful employment
The current appeal to men and women with degrees in other fields is that the nursing can provide job opportunities, economic security, and the opportunity to help others. What specialty of nursing was considered well suited for men at a time when other areas were excluding men from practice
Psychiatric nursing
Because it required physical stamina and strength
When surveyed what is the primary reason given by men for entering nursing
To make a difference
What was the purpose of the hill burton act
Funding for the construction of hospitals
The 1946 hill burton act provided funding for the construction of hospitals. When surveyed which profession was closed by the general public as highest in honesty and ethics
Nurses
Call up polls from 1999-2010 rated nursing as the top profession in honesty and ethics.
In 2002 which major American corporation partnered with nursing to design a media campaign to promote the image of nursing
Johnson and Johnson
In 2003 Johnson and Johnson began a $20 mil campaign - campaign for nursings future - to enhance the image of nursing, to recruit new nurses and educators and to retain nurses
In 2003a shift in population growth is expected to place stress on nursing resources. Which age group is expected to experience the greatest population growth in the next decade
Older than 85 years old
People older than 85 years, known as the “very old,” represent the fastest-growing segment of the total population
In which practice area was the first clinical nurse specialist role developed
Psychiatric nursing
In the 1960s
Which of the following was an unsuccessful attempt by the American medical association to alleviate the nursing shortage of the time
Creation of the registered care technician
There first trained nurse in the United States graduated in 1873 and later became the supervisor of the boston training school. Who was the nurse
Linda Richards
During the Great Depression, staffing of hospitals changed with an impact lasting to the current day. What was this change?
The employment of graduate nurses in hospitals
What was the most important influence of war on nursing?
Nurses were able to perform medical procedures during war.
Florence Nightingale is often credited as being the first nurse researcher. This designation is based on
her use of data on the morbidity and mortality of soldiers in hospitals in Scutari
The nursing profession is responsible for improving its own image. The most effective avenue for changing the image of nursing is to
have nurses appear and behave professionally and explain what nurses do in each patient interaction.
The diversity of the population entering the health care system is a challenge for nurses because
ethnic minority group nurses are approximately 12% of nurses.
Biomedical technology involves the use of complex machines or devices in patient care situations. Because of the highly technological environment in which nurses work, it is important that nurses
use human touch and words of reassurance frequently to convey caring.
Margaret Sanger, as a nurse and activist, worked on the Lower East Side of New York City in the early 1900s with immigrant women. What was the focus of her work?
Safe contraception and family planning for women
Nursing practices during the Civil War advanced the cause of professional nursing. The move toward formal education and training was supported by (Select all that apply
a proposal by Dr. Samuel Gross in 1869 that large hospitals develop training schools for nurses. c. reports of inadequate conditions in hospitals reported by social reformers after the Civil War. d. lobbying by the United States Sanitary Commission for the creation of nursing schools. e. the appointment of Dorothea Dix as Superintendent of Women Nurses of the (Union) Army.
Historically, one solution that attempted to correct the shortage of RNs was to increase the supply of nurses. Means of increasing the supply of nurses included (Select all that apply.)
use of “traveling nurses.”
c.
development of associate degree programs.
d.
importation of nurses from English-speaking countries.
Provisions of the Affordable Care Act include (Select all that apply.)
b.
children up to age 26 being allowed to stay on parents’ insurance.
c.
disallowing denial of coverage for children and teens’ preexisting conditions.
d.
the right to appeal coverage decisions.
e.
recommended preventative services without out-of-pocket cost to consumers.
Which of the following situations is an example of moral distress
You hear nurses in the lounge making off color jokes about a patient. You are afraid to speak up for fear of retaliation
According to kohlbergs theory of moral development, adolescents who shoplift are operating in which level of moral development
Preconventional
According to kohlbergs theory of moral development, individuals who act because it is the rule of society are operating in which level of moral development
Conventional
Flight 93, hijacked on September 11, 2001, crashed into the Pennsylvania countryside because some of the passengers decided to try to take control of the plane and prevent it from being used as a weapon of mass destruction against structures in Washington, D.C. They decided to act despite grave danger to themselves. This is an example of which level of Kohlberg’s theory of moral development?
Postcnventional
According to kohlbergs theory, which of the following is true of moral development
Participating in decision making promotes moral reasoning
Gilligans theory on moral development differed from kohlbergs theory because gilligan considered which population not addressed by kohlbergs
Women
Which of the following ethical theories is illustrated by the example of following the golden role, do unto others as you wish them to do unto you
Deontology
Which of the following ethical theories is illustrated by the example of triage in disaster nursing
Utilitarianism
Respecting the right of a patient with terminal cancer to refuse chemotherapy is based on a belief in the ethical principle of
Autonomy
Respecting an elderly woman’s decision to stray in her own home is based on a belief in the ethical principle of
Autonomy
