Exam 2

Question 1

Identify and define the Four Ethical Principlism?

Answer 1

1. Autonomy: One’s ability to self-rule and to generate personal decisions independently. Respect for a patient’s autonomy includes situations such as:
   
   1. Obtaining informed consent for treatment
   2. Facilitating patient choice regarding treatment options
   3. Accepting patients’ refusal of treatment
   4. Disclosing medical information, diagnoses, and treatment options to patients
   5. Maintaining confidentiality.
2. Beneficence: The actions taken by nurses to benefit patients and to facilitate their well–being
3. Nonmaleficence: Refraining from action that might harm others. The injunction to “do no harm” is often paired with beneficence, but a difference exists between the two principles. Beneficence requires taking action to benefit others.
4. Justice: The fair distribution of benefits and burdens. In regard to principlism, it most often refers to the distribution of scarce healthcare resources.

Question 2

Which ethical principle gives patient’s right to either authorize or refuse the procedure?

Answer 2

Autonomy

Question 3

One’s ability to self-rule and to generate personal decisions independently?

1. Obtaining informed consent for treatment
2. Facilitating patient choice regarding treatment options
3. Accepting patients’ refusal of treatment
4. Disclosing medical information, diagnoses, and treatment options to patients
5. Maintaining confidentiality.

Answer 3

Autonomy

Question 4

The actions taken by nurses to benefit patients and to facilitate their well–being?

Answer 4

Beneficence

Question 5

Refraining from action that might harm others. The injunction to “do no harm” is often paired with beneficence, but a difference exists between the two principles. Beneficence requires taking action to benefit others.

Answer 5

Nonmaleficence

Question 6

The fair distribution of benefits and burdens. In regard to principlism, it most often refers to the distribution of scarce healthcare resources.

Answer 6

Justice

Question 7

What do we call the written expression of a person’s wishes about medical care, esp. if critically/terminally ill?

Answer 7

Advanced Directives (e.g. this includes Living Will and Durable Power of Attorney.)

Living Will: written statement about end of life decision making

Durable Power of Attorney: designates a person who is authorized to make healthcare decisions

Question 8

Identify the Four fundamental responsibilities nurses have according to the ICN code of ethics:

Answer 8

1. To promote health
2. To prevent illness
3. To restore health
4. To alleviate suffering

Question 9

Identify behavior that might hinder empathetic communication:

Answer 9

1. Interrupting the patient with irrelevant information
2. Using vocabulary that is either beneath the level of the patient or not understandable to the patient
3. Using language that may be perceived as patronizing or demeaning
4. Using nonprofessional language
5. Reprimanding or scolding the patient
6. Preaching to the patient
7. Providing the patient with inappropriate information
8. Asking questions at inappropriate times or giving patient advice inappropriately

Self-disclosing inappropriately

Question 10

Identify behaviors nursing should exhibit to facilitate empathetic communication:

Answer 10

1. Listening carefully and reflecting back a summary of the patient’s concerns
2. Using terms and vocabulary appropriate for the patient
3. Calling the patient by his or her preferred name
4. Using respectful and professional language
5. Asking the patient what they need and responding promptly to those needs
6. Providing helpful information
7. Soliciting feedback from the patient
8. Using self-disclosure appropriately
9. Employing humor as appropriate
10. Providing words of comfort when appropriate

Question 11

What is the andragogic model and what should the nurse consider when using it in patient education?

Answer 11

Andragogy AKA Adult Learning Theory

Knowles theory of andragogy identified five assumptions that teachers should make about adult learners.

Self-Concept – Because adults are at a mature developmental stage, they have a more secure self-concept than children. This allows them to take part in directing their own learning.

Past Learning Experience – Adults have a vast array of experiences to draw on as they learn, as opposed to children who are in the process of gaining new experiences.

Readiness to Learn – Many adults have reached a point in which they see the value of education and are ready to be serious about and focused on learning.

Practical Reasons to Learn – Adults are looking for practical, problem-centered approaches to learning. Many adults return to continuing education for specific practical reasons, such as entering a new field.

Driven by Internal Motivation – While many children are driven by external motivators – such as punishment if they get bad grades or rewards if they get good grades – adults are more internally motivated.

Considerations when using in pt teaching:

1. Letting learners know why something is important to learn
2. Showing learners how to direct themselves through information
3. Relating the topic to the learners’ experiences
4. Realizing that people will not learn until they are ready and motivated

Basically:

1. Since adults are self-directed, they should have a say in the content and process of their learning.
2. Because adults have so much experience to draw from, their learning should focus on adding to what they have already learned in the past.
3. Since adults are looking for practical learning, content should focus on issues related to their work or personal life.
4. Additionally, learning should be centered on solving problems instead of memorizing content.

Question 12

Identify the reading level for people who have low health literacy skills.

Answer 12

Fifth grade level or below

Question 13

Identify strategies a nurse who engages in patient education activities with many geriatric patients each day should use during the patient education process to accommodate for changes in hearing in the older adult

Answer 13

• Strategies for Hearing
  
  1. Speak distinctly
  2. Do not shout
  3. Speak in a normal voice or lower pitch
  4. Decrease extraneous noise
  5. Face person directly while speaking at a distance of 3 to 6 feet
  6. Reinforce verbal teaching with visual aids or easy-to-read materials

Question 14

Identify the rights of delegation.

Answer 14

1. Right task
2. Right circumstances
3. Right person
4. Right direction and communication
5. Right supervision and evaluation
   * –Can only delegate what is in the job description of the worker. RN remains accountable.*

Question 15

Identify the different TeamSTEPPS (SBAR, CUS)

Answer 15

TeamSTEPPS: (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based framework to optimize team performance across the healthcare delivery system. The core of the TeamSTEPPS framework is comprised of four skills: Leadership, Situation Monitoring, Mutual Support, and Communication.

• SBAR
  
  1. Situation―What is going on with the patient? (ex post op day 1 after appendectomy)
  2. Background―What is the clinical background or context? (ex; pt. history of abdominal pain)
  3. Assessment―What do I think the problem is? (pt is vomiting and little NG output))
  4. Recommendation―What would I recommend? ((do you want us to advance the NG tube?)
• CUS
  
  1. I am concerned
  2. I feel uncomfortable
  3. I think this is a safety issue

Example, “I’m concerned about the medication does that has been ordered. I am uncomfortable giving the dose to this patient because of her renal status. I don’t think it is safe.”

Question 16

Identify an advantage for using SBASR during staff communication?

Answer 16

Significant information regarding a patient’s status or care is communicated from one provider to another using a standardized format.

Question 17

Identify factors nurses should consider when implementing evidence-based practice

Answer 17

• Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization
• Identify an issue and ask the question
• Search for and collect the most relevant and best evidence to answer the clinical question
• Critically appraise the evidence and synthesize the evidence
• Integrate evidence with clinical expertise and patient preferences to make the best clinical decision
• Evaluate the outcome of any EBP change
• Disseminate the outcomes of the change

1. What I PUT
   
   1. Helps resolve problems in the clinical setting
   2. Results in effective patient care and better outcomes
   3. Contributes to the science of nursing through the introduction of innovation to practice
   4. Keeps practice current and relevant by helping nurses deliver care based upon current best research
   5. Decreases variations in nursing care and increases confidence in decision making
   6. Supports Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-readiness since policies and procedures are current and include the latest research
   7. Supports high quality patient care and achievement of Magnet status

Question 18

Identify what PICOT stands for:

Answer 18

1. P: Patient, population, or problem
2. I: Intervention
3. C: Comparison intervention
4. O: Outcome
5. T: Time or time frame (when relevant)
   
   1. In (patient or population), what is the effect of (intervention or exposure) on (outcome) compared with (comparison or alternate intervention)?
   2. For (patient or population), does the introduction of (intervention or exposure) reduce the risk of (outcome) compared with (comparison or alternate intervention)?

Question 19

Questions that will be on exam:

• Identify priorities using SBAR of what needs to be reported first to a health care provider. (ABCs, most critical stuff)
• Identify an advantage for using SBAR during staff communication (short and sweet yet straight the point)
• Identify the primary obligation of all state boards of nursing. (protect the public)

Question 20

Identify how nurses promote the real image of nursing

Answer 20

• Educate the public.
• Describe nurses’ work.
• Make known the agency of the registered nurse (RN).
• Deal with the fear of angering the physician.
• Accept thanks from others.
• Be ready to take advantage of openings to promote nursing.
• Respond to queries with real stories.
• Tell the details.

Question 21

Identify malpractice lawsuits and what are the components required for family to be successful in a lawsuit.

Answer 21

Malpractice is the failure of a professional to use such care as a reasonably prudent member of the profession would use under similar circumstances, which leads to harm (doing the wrong thing)

To be successful they need to prove:

1. Duty owed to the patient
2. Breach of the duty owed the patient
3. Foreseeability
4. Causation
5. Injury or harm
6. Damages

Examples: https://verdictvictory.com/blog/top-10-largest-medical-malpractice-lawsuits/

1. $25 Million | Misdiagnosed Heart Condition

When a cardiologist gave a positive report to a Virginia man after a checkup, the doctor took him off his heart medications and told him over-the-counter drugs would be fine to treat his condition. Months later, the man suffered a debilitating heart attack and has since undergone seven surgeries and requires a heart transplant within the next five years.

2. $31 Million | Oxygen Starvation

In 1998, a Florida mother received too much medication during her induced labor. The drugs compromised her child’s oxygen supply, leading to cerebral palsy. The case was settled nearly 14 years later. Due to a cap on medical malpractice awards, the women received only $15 million of the $31 million settlement.

3. $74.5 Million | Negligence & Falsified Medical Records

In California, doctors failed to properly deliver a baby. The doctor in charge chose not to perform an episiotomy, did not use forceps during the delivery and failed to assess contractions. As a result, the infant now suffers from cerebral palsy. The hospital refused to accept fault for negligence and even falsified medical records in an attempt to cover up their wrongdoings.

Question 22

Identify how nurses can avoid errors in their profession:

Answer 22

1. Manage stress
2. Adhere to standards of care
3. Work in environments that encourage examination of incidents
4. Change systems to lower the risk of malpractice

Question 23

What are the roles of the nurse for an informed consent?

Answer 23

1. Facilitating informed consent for patient care as a part of providing patient-centered care
2. Advocate for patient
3. Witness to patient signature

Question 24

Identify the different types of euthanasia and the definitions.

Answer 24

1. Active euthanasia: occurs when a person takes an action to end a life (including one’s own life). Can include a lethal dose of medication.
2. Passive euthanasia: means a person allows another person to die by not acting to stop death or prolong life. An example of this type of euthanasia is withholding treatment necessary to prevent death at a point in time
3. Voluntary euthanasia: Occurs when a person with a sound mind authorizes another person to take his or her life or to assist in achieving death. Also includes the taking of one’s own life.
4. Nonvoluntary euthanasia: Occurs when persons are not able to express their decision about death.
5. A blending of these types of euthanasia can occur, such as voluntary active, nonvoluntary active, voluntary passive, and nonvoluntary passive.

Question 25

Identify the different types of death and the definitions

Answer 25

1. Traditional: A person is dead when he is no longer breathing and his heart is not beating (cardiopulmonary)
2. Whole-brain: Death is regarded as the irreversible cessation of all brain functions…no electrical activity in the brain, and even the brain stem is not functioning (brain death)
3. Higher brain: Death is considered to involve the permanent loss of consciousness. Someone in an irreversible coma would be considered dead, even though the brain stem continues to regulate beating and heart beat (Persistent vegetative state)
4. Personhood: Death occurs when an individual cease to be a person. This can mean loss of features essential to personal identity or for being a person.

Question 26

Identify different defense mechanisms individuals use when under stress and the definitions

Answer 26

Question 27

Identify examples of therapeutic conversation

Answer 27

It is beneficial for the patient and is a positive interaction.

1. Talking with patients at eye level enhances communication.
2. The use of therapeutic communication techniques enhances nurse–patient relationships and helps to achieve positive outcomes.

Examples: pg 47-49; pretty much everything we did in the process recording excerise

Question 28

Identify the 3 domains of learning and the definitions

Answer 28

1. Cognitive learning encompasses the intellectual skills of knowledge acquisition, comprehension, application, analysis, and evaluation (Theory)
2. Psychomotor learning refers to learning skills and performance of behaviors or skills (Lab)
3. Affective learning requires a change in feelings, attitudes, or beliefs (Clinical)

Question 29

Describe empathetic communication.

Answer 29

1. Listening carefully and reflecting back a summary of the patient’s concerns
2. Using terms and vocabulary appropriate for the patient
3. Calling the patient by his or her preferred name
4. Using respectful and professional language
5. Asking the patient what they need and responding promptly to those needs
6. Providing helpful information
7. Soliciting feedback from the patient
8. Using self-disclosure appropriately
9. Employing humor as appropriate
10. Providing words of comfort when appropriate