Final Exam

Question 1

Controversial issues related to technology

Answer 1

Technologies:

i. Availability (not every pt has the opportunity to have PET scans or other scarce tests completed, or receiving an organ)
ii. Cost- some pts cant afford
iii. Patient self-determination
iv. Quality of life pts life with the technology (different for everyone)
v. Technology can both relieve cand cause physical, emotional or spiritual suffering. Balancing benefit over burden
vi. Futile care- some new technological care simply does not help. Why put pt through stress?
vii. Organ/tissue/Procedure/Transplant
1. Allocation of scarce resources- who gets it first?
2. Regarding the donor- how do you determine when death actually occurs?
3. Voluntary informed consent, instead of coercion
4. Risk for forcing pt to donate (coercion)
viii. Coning – making new cells identical via technology. Is it moral?
ix. Stem-cell research. Does Embryonic cell research constitute killing? Is it a slippery slope of treating humans as a commodity?

Question 2

i. Medicine in Hippocrates

Answer 2

iii. Health was a balance between 4 elements ( black and yellow bile, phlem, and blood)
iv. Role of medicine: of medicine was to relieve suffering/reduce effects of disease
v. once disease overpowered body- treatment was withheld
vi. Death is a natural process (medical intervention would prolong suffereing), Mother nature takes its course

Question 3

ii. Modern medicine

Answer 3

vii. health is more holistic (spiritual, emotional, physical, physiological, psychological)
viii.
ix. Role of medicine: focus on preserving, curing the disease- essincially technological power over nature
x. Aggressive medical treatments
xi. Nurses care beyond just curing
xii. Death- can be challenged using life-sustaining measure (life support, meds, intubation, feedings). We challenge Mother Nature. We Play “God”- to some extent.

Question 4

Earth Ethics

Answer 4

• The earth as a whole is so intricately connected to human health.
• Our sense of relationship with the natural world is based in our worldview or cosmology.
• When we destroy the source of our life and sustenance (Earth), our health suffers.
• All things are connected and we belong to a whole universe, not just to a city, culture or nation.
• As a part of the interconnected web of life, what we do to the Earth is what we do to ourselves.
• We cannot have healthy minds or communities without healthy land and environment.
• If we are able to understand we are all a single, sacred, Earth community, we will be able to recognize the interdependence and unity of all in the natural world, and appreciate that all species have an intrinsic right to exist.
• **When we as nurses understand that, as humans, we are only one part of the interconnected Earth community, we recognize that our ethical principles must address the integrity and health of the entire community of life, and we understand the moral imperative to apply principles of beneficence, nonmaleficence, and justice to our treatment of the whole Earth community.
-This does not diminish human rights; rather, it augments human well-being by fostering the rights of humans to live within healthy ecosystems and receive the life-supporting benefits of the natural world.
• We can’t be health if the Earth isn’t healthy-Our manipulation of the natural world for our benefit has disrupted the life system of Earth as well as the human and bioregional communities. These disruptions led to poisoning in the air we breathe; the water we drink, and soil and seas that provide us food.

Question 5

Examples of health problems: related to earth ethics

Answer 5

nature included asthma; autism; toxins in the air, soil, water, and human tissue; drug-resistant organisms.
• Environmentally responsible health care requires awareness and action at an individual, community, and global level.
-(For example: The impact of smoking on asthma and pregnancy asthma outcomes is a link to environmental pollutant to a health concern and taking action to decrease the pollutant. Addressing the source of these toxins requires action at the personal level, such resisting or cessation of smoking; at the professional or local level, such as providing smoking cessation programs at the hospital; or even the global level, joining an organization that promotes tobacco free.

Question 6

• Nurses are positioned to be proactive in addressing the impact of the health care system on the health of the environment.
This includes the consideration such as paying attention to the following:

Answer 6

-How the institution disposes of toxic and other waste
-Unnecessary water and electric consumption
• Nurses can take leadership roles in instituting recycling programs; help develop institutional policies aimed at using energy-efficient, recycled, and environmentally friendly products.

Question 7

Ok so there was this chart known as the “Earth Chart”- this provides guidance to nurses and others for promoting ethically responsible relationships with Earth and the global community. So if she asks what the nurse can do for the earth/community you could provide this answer) This is on page 354-355.** Here are several examples summarized:

Answer 7

• Respect and care for the community of life, which includes:
  - Respecting Earth and life in all its diversity
  - Securing’s Earth bounty and beauty for future generations
  - Ecological integrity, which includes:
  - Protecting and restoring the integrity of Earth’s ecological systems
  - Advancing the study of ecological sustainability and sharing that wide base of knowledge with others
  - Social and economic justice, which includes:
  - Eradicating poverty
  - Affirming gender equality
  - Upholding the right to all without discrimination
  - Democracy, nonviolence, and peace, which includes:
  - Treating all living beings with respect and consideration
  - Promoting a culture of tolerance, nonviolence, and peace

Question 8

Earth health and human health are intricately interconnected, and nurses need to include ethical considerations of our relationship with Earth into nursing practice. Twenty-first-century health care needs and issues require global consciousness. Nurses need to work individually and collectively both to meet the needs of those affected by global issues such as ware, violence, disaster, famine, epidemics, and displaced persons, and to work as well to prevent the devastation these issues cause.

Answer 8

Earth health and human health are intricately interconnected, and nurses need to include ethical considerations of our relationship with Earth into nursing practice. Twenty-first-century health care needs and issues require global consciousness. Nurses need to work individually and collectively both to meet the needs of those affected by global issues such as ware, violence, disaster, famine, epidemics, and displaced persons, and to work as well to prevent the devastation these issues cause.

Question 9

Health Insurance coverage-past and current

Answer 9

• After WWI, the idea of group practices for physicians began, and the movement for health insurance began to develop.
• President Theodore Roosevelt passed the first form of social insurance, worker’s compensation.
• Through Workers’ Compensation, the cost of injury and damage to workers because of job-related hazards was passed on to industries.
• During this time, the struggle for access to care and control of fees and services escalated.
• 1920s-growth and expansions of the health care industry. Consumerism flowered in direct relationship to the growth of the health care industry.
• As the public became more aware of the availability of modern techniques, the wanted the best available.
• From this demand the health care delivery system developed into a middle-class entity in which many advances were taking place in private care.
• The poor were increasingly underserved.
• By the end of this decade, there was criticism regarding the cost and financing of health care, and the question of equal care for all income levels raised.
• The rich and middle class were accused of having the best care available.
• The poor were viewed as being provided charity care.
• During the Great Depression, government and charity hospitals were overrun with pts. unable to afford health care, causing health care institutions to lose income.
• Continuous rising costs of health care led to development of plans for health insurance for everyone in the 1930s.
• Later on, the need for more payment in order to continue the growth of health care and technologies led to the development of a prepayment insurance plan.
• WWII prompted advances in health services that led to further advancement in technology.
• Between 1946 and 1966, the health care system hit a new wave of expansion in hospitals (development of intensive care, coronary care, respiratory, and physical therapy units).
• Because of the vast technological expansion, the cost of health care increased rapidly
• Insurance industries decided to help society and began to provide third-party coverage for health care. These insurance plans helped pay large hospital and health care bills, and removed incentives from health care institutions to keep their costs down.
• In retaliation, hospitals passed down increased costs to insurance companies, who in turn passed the cost on to the individual insurance subscriber.
• Those that did have health insurance demanded more and better service, which led the system to drive itself through the “supply and demand cycle”
• In 1965 and 1966, Medicare Part A and B were passed, which gave hospitals and other health care institutions a license to spend.
• The health care system got caught up in a whirlwind of spiraling costs that prompted the development of cost-containment mechanisms (Diagnostic Related Groups, case management, and managed care systems)

Question 10

• Standardization and the constraints of health insurance plans

Answer 10

are more defining the care that pts. in the present receive in the health care system.

Question 11

• Medicare Part D drug benefit program

Answer 11

developed in response to the increasing cost of medications for the elderly on fixed incomes. Problem, there are loopholes that limit the its ability to meet the needs of many Medicare recipients.

Question 12

true or false
• Today, nearly 25 million Americans are underinsured, meaning they have very high deductibles or spend 10% or more of their income on medical expenses.

Answer 12

True

Question 13

Health care cont..

Answer 13

• Caring for people with limited or no health insurance results in health care institutions having to provide charity care similar to that which existed in the first part of the twentieth century.
• Limited acces to health care by so many people due to lack of health insurance prompted the passage by the US Congress in 2010 of the Patient Protection and Affordable Health Care Act.

Question 14

Patient Protection and Affordable Health Care Act.

Answer 14

• This law focused on closing existing gaps in health care coverage.
Comprehensive insurance reforms to close the gaps in existing health care coverage
No lifetime limits on dollar value of essential benefits
No retroactive canceling of insurance policies
Not charging higher premiums based on gender or health status
Can’t deny coverage for preexisting conditions
Closing Medicare Part D “donut hole” by 2020
Free preventative care for recommended preventative services
Small business tax credits for offering insurance to employees
Student loans for some health care professions
Increased funding to community health centers
Grants for primary care “Medical Home” teams and school-based clinics
Parents able to keep children on policies until age 26
Increasing Medicare reimbursement for primary care services

Question 15

Health care highlights

Answer 15

• Skyrocketing health care costs can be traced to the advent of health insurance (1930s and later) and the enactment of Medicare and Medicaid (1960s), which removed incentives from health care institutions and physicians to keep costs down, and to public awareness of the availability of medical interventions, which prompted consumers to demand the best care and services available. Difficult decisions emerge with issues of access, cost, and justice.
• Expansion of hospital and other health care services has reached a point of crisis in which out-of-control health care costs have prompted imposition of external controls on institutions and health care providers. Many people have no means of paying for expensive services. Provisions of the Affordable Health Care Act of 2010 address issues related to limited health insurance coverage.

Question 16

• Administrative agencies (e.g. state board of nursing and medicine)

Answer 16

o Have rules and regulations

o Sometimes view as partisan because position on these boards are granted through political appointment

Question 17

• Judicial branch

Answer 17

o Influences health care professions and delivery through the common law system
o Supreme court is considered a nonpartisan entity
• Appointments are important to political parties because of:
• The potential to apply party ideology through the unusual power granted the Court in the United States
• Small number of justices
• Durability of supreme court decisions
• Freedom from special-interest groups
• Justices are appointed for their lifetime
o Examples include: Roe vs. Wade

Question 18

• Legislative Branch

Answer 18

o Issues are decided through the passage of federal or state laws
o Nurses can influence the outcomes of various political issues
o Examples include: Medicare and Medicaid revisions, health insurance reform, issues related to advanced practice nursing, Prescriptive authority, scope of practice, and third party reimbursement

Question 19

Nurses influence on health policy

Answer 19

• Nurses function as citizens, knowledgeable consumers of heath care, professionals whose practice is regulated by government, and advocates for patients
o Because of these roles they are responsible for political involvement
• Political issues of interests to nurses fall into four categories: moral values, professional regulation, the health of individuals in society, distributive justice
• If a nurse identifies a problem and offers feasible solutions, they may not be able to influence legislation
o Can only progress with sponsorship of influential policy makers who believe in the issue
• Nurses are a significant percentage of the voting population so they are in good position to influence political decisions
• Nurses must provide political officials with reliable information to influence policy
• Nurses should carefully review objective data, pertinent research findings, and include a few personal stories
o Cost savings often gets attention
• Agency for Healthcare Research and Quality (AHRQ) was created to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans
o This is a bridge between clinicians, consumers, policy makers, and other health officials

Question 20

Nurses influence on healthcare cont..

Answer 20

• The professional code of ethics calls for nurses to be involved in policy formulation
• Formulation of health policy requires strong leadership and an understanding of policy making
o Nurses must develop the ability to think, teach, research, and act in ways that are relevant to policy
o Must be aware of the impact that policies have on health and on clinical practices
• Nurses are: Most sizable group of health care professionals, perceived favorably by the public, and once nurses become involved in health policy, they usually continue to be active
o But: are relatively new to the political arena, there has historically been a lack of ideological and political unity within the profession, and have fewer funds specifically for intense lobbying
• Nurses have the responsibility to reflect upon problems and potential solutions
• Goals include: maintaining control of nursing practice, making a positive impact on healthcare policy, advocating on behalf of the vulnerable, instituting workplace reforms
• Most of the time the nurses role in the health policy process is an informal lobbyist
o It involves advocating for an issue that is affected by the decisions of policy makers
• Nurses beliefs about lobbying: it is their duty to participate in political activism, or, constrained, subtle, and persistent political activity is more effective in the long term
• Nurses must be aware of trends in the political climate, must access powerful political leaders, and must learn to play the game
• Nurses can become involved by either supporting candidates or running for elected office
o Can become involved in political party organizations
o Involved by district or state nurses’ associations
o Can become actively involved in campaigning for candidates who support their position on various health care issues
• To fulfill the role of advocate, nurses are challenged to become politically active by: knowing and becoming involved with important issues, learning the political process, forming relationships with public officials, and becoming astute in methods influencing health policy

Question 21

Changes in health care economics 1980s to current

Answer 21

The government was the primary mover of cost containment during the early 1980s. Before the 80s there were virtually no incentives to control costs of healthcare for institutions. The government instituted the payment system based on Diagnosis Related Groups (DRGs). Entities such as the Professional Standards Review Organizations (PSRO) and Peer Review Organizations (PROs) were established to require health care providers to develop more efficient standards of practice. In the early 90s the system was in disequilibrium. Large hospitals were cutting costs by eliminating support services and reducing nursing staff. Physicians fearing malpractice litigation resulted in providers ordering a battery of diagnostic tests instead of the tests that they felt were necessary. Employment-negotiated health insurance plans fueled the practice of per spending. Many health care plans have full coverage with no deductible. As a result a large percentage of patients did not pay directly for health care services. Thus, the cost was rendered irrelevant. In 1993, the Clinton administration devised a he alt care proposal that called for universal access to health care through managed competition, which was eventually defeated. This failure was attributed to 4 fundamental factors: 1. Lack of consensus on the question of a right to basic health care for all people’s 2.the strength and energy of those who argued on behalf of individual rights and liberties over the needs of the community. 3 unconstrained powerful interest groups 4. Little or no recognition that substantive reform required a significant challenge to the values that inform and drive health care. As a result of this failure efforts by disparate public and private groups moved towards relieving the problem of health care access. This lead to an establishment of free clinics in all 50 states for un insured or under insured patients. This also generated billions of dollars in health care services. The Children’s Health Insurance Program (CHIP) provides health insurance to children that don’t meet Medicaid guidelines. Oregon enacted laws to provide all citizens with access to basic levels of health care in 1987. In 2006, Massachusetts enacted legislation that requires all citizens to purchase health insurance of face legal penalties. In 2010, Obama signed into law the Patient Protection and Affordable Care Act. The PPACA increased coverage for preexisting conditions and expanded insurance to more than 30 million Americans.
Managed care is a health care system that attempts to clinically and financially control primary health care services in a medical group practice through elimination of redundant facilities and services to reduce costs. We must pay particularly close attention to ethical abuses within a managed health care system. 4 basic rules regulate managed care
1. Relationships are critical in the delivery of health services. They should be characterized by respect, truthfulness, consistency, fairness and compassion
2. Health plans, purchasers, clinicians and the public share responsibility for appropriate stewardship of health care resources
3. All parties should foster an ethical environment for the delivery of effectife and efficient quality health care
4. Patients should be well informed about care and treatment options and all financial benefit issues that affect the provision of care

Side notes
In 1982 there were 32 million uninsured US citizens. In 2010 there were 49.9 million.

pretty lengthy, but here we go.

Question 22

Utilitarian, Libertarian, Communitarian

Answer 22

• Before studying these theories keep in mind they are known as the theories of justice. They were proposed to determine how resources and services should be distributed among society. Due to the fact everyone has different opinions, no single theory will satisfy society.

Question 23

• Utilitarian Theories

Answer 23

• Theory is based on the fact it is good to maximize the “greatest good for the greatest number.”
• Example: Medicare, Medicaid, State Children’s Health Insurance Program
• Favor social programs that protect public health and distribute basic health care in a manner that maximizes the overall benefit.
• The belief is that the outcome of these programs is to maximize utility.
• Problem: Because this theory emphasizes on the good of the overall population before individual rights, social utility might maximize by denying access to health care for some of society’s population.

Question 24

• Libertarian Theories

Answer 24

Proposes that each individual has the right to protect their property and liberty
-This allows individuals to look out for themselves on their own efforts. ( You are not responsible for others around you, just yourself)
-Supports a private citizens or group’s right to own and manage a health care business.
-Pay out of pocket with your own money (Your own property)
–Government would require either donations or volunteers at free clinics because you are voluntarily giving up your property/liberty to others and not being unjustly stripped from them
-Doesn’t classify healthcare as a right, but rather as a commodity that operates on the ability to pay either directly or indirectly through insurance.
-View taxation as unjust because you are violating the person’s right to their own property
-Influences market strategies and managed competition
-For example: This theory would disagree with Obamacare because this is invading individual property in order to look out for others and their needs. Money is being taken away from people out of their own will (invading property) in order to help the needs of others (don’t have that obligation).
• - This proposes the just society (every individual) has the right to protect their property and liberty, allowing citizens to improve their circumstances by their own efforts. (What is meant by that is they get to choose whether or not they want to seek help for their own health or not)
- Market strategies and managed competition are proposals in the US that are influenced by libertarianism.

Question 25

Communitarian Theories

Answer 25

-Places the community at the center of the value system.
-Emphasizes the value of public good and maintains that values are rooted in communal –Believe that human life will be better if collective and public values guide people’s lives.
-Facilities that follow this theory are designed to help members of the community develop their common lives and hence their personal lives.
-Each individual of the community burdens all community members
-Traditions include commitments of equal access to health care and suggests that as long as communal funds are spent, services will be equally available.
- Some people who believe in this theory propose a federation of interlinking community health programs that are democratically administered by citizen-members.
-In this model, each individual program would determine the following:
~Which benefits to provide
~Which care is most important
~ Determine whether expensive services will be included or excluded\
-No one has rights to specific health care treatment and everyone has equal access.
- For example: It’s a team effort, if one goes down, we all go down. Everyone has to look out for each other and be accountable for one another.

Question 26

• Communitarian Theory:

Answer 26

Values are rooted in the communal practices

Question 27

Chapter highlights on theories

Answer 27

• Utilitarian theories are based upon the rule that it is good to maximize the greatest good for the greatest number.
• Libertarian theories propose that the just society protects the rights of property and liberty of each person, allowing citizens to improve their circumstance by their own effort.
• Communitarian theories place the community-rather than the individual, the state, the nation, or any other entity-at the center of the value system

Question 28

Effect of children and elderly of social issues and poverty : POVERTY

Answer 28

Poverty-

• Without health care coverage, the poor often postpone needed healthcare, or cope with public clinics that are often degrading and impersonal.
• Children in poverty are covered under the Medicaid Children’s Health Insurance Program.
• Individuals without coverage must find health care systems that will provide free care, or do without.
• For that reason, many people living below the poverty level do not participate in basic preventative care programs.
• While poverty is detrimental to the health of all individuals living with inadequate resources, it produces a next generation of citizens with more health problems than usual.
• Children living in poverty have a higher incidence of conditions associated with trauma, poor nutrition, drugs, burns, mental illness, and HIV infection.
• Children in poverty are more likely to experience poor nutrition, inadequate exercise, and diseases from environmental factors such as vermin or lead.
• Children in poverty are more likely to grow up with chronic illnesses that require extensive health care resources.

Question 29

Effect of children and elderly of social issues and poverty : HOMELESSNESS

Answer 29

Homelessness-
-The new homeless are often families, single women with children, veterans, and the elderly.
-Their health problems include those resulting from limited access to care, those coincident with homelessness, and those associated with the psychosocial burden of homelessness.
-Health problems resulting from limited access to care include exacerbated or advanced conditions that would have responded to early and thorough intervention.
-Health problems in the homeless include illnesses resulting from: living with inadequate nutrition, warmth, hygiene, safety, and other basic needs.
-Health problems associated with the psychocsocial burden of homelessness are primarily mental illnesses, suicide, assault, and substance abuse which can dull the anxiety of homelessness.
-The percentage of homeless children who have a chronic health problem is well above the rate of children who are not homeless.
Health Promotion Model- views health as the absence of disease and associates common diseases with controllable risk factors.
-the key to improved health is deemed to be the provision of knowledge and skills to individuals.
-An assumption of that model is that people will use slef-determination, individualism, and responsibility to secure adequate housing, employment, and proper nutrition.
-As long as the dominant models for health care delivery inhibit patient’s participation in their own care, poverty and homelessness will contribute to the poor health of American citizens.

Question 30

Effect of children and elderly of social issues and poverty :Increasing elderly population

Answer 30

Increasing Elderly Population-

• People are living longer due to: healthier diets, vaccines, medical advances, and improvements in the environment.
• Health disparities continue to exist, in the US those of higher socioeconomic groups are expected to live 20 years longer than those of low status
• Elder abuse is increasing. 4-6% of elders are victims.
• Vast numbers of elderly are socially isolated, in need of work to survive, and susceptible to economic hardship.
• As people age chronic illnesses, pain, frailties, cognitive problems, and disabilities occur with increasing frequency.
• The assumption in current health care models is that the frail elderly will be cared for at home by friends and family to alleviate strain on the healthcare system.
  
  • In reality, family members may not be able to due to geographical distance, or other personal responsibilities.
  • The caregivers often have to help with the finances of the elderly since their fixed incomes cannot cover the basic cost of living as well as health care expenses.

Question 31

) Impediments to intervening with vulnerable groups: victim blaming

Answer 31

Victim Blaming

• Tends to hold the people burdened by social conditions accountable for their own situations and responsible for needed solutions.
  
  • use language such as “she was asking for it” or “he should have quit smoking”
• When there is evidence of personal or system-wide victim blaming, the ethical stance is to treat each person with dignity and fairness while working to change attitudes toward the victim.

Question 32

Impediments to intervening with vulnerable groups: Language of Violence

Answer 32

Language of Violence

• Violence mode that colors speech and actions
• For instance, in healthcare we may say: “attacking” germs, “battling” disease, “plotting strategies” against or “defeating” invasive cells, “suffering defeat,” or “achieving victory.”
• The mindset behind these phrases contradicts the concept of a compassionate approach to healthcare that values nonviolence.
• This type of language can inadvertently lead to victim blaming or encourage futile and dangerous procedures.
• Should instead create a milieu that emphasizes nonviolence.

Question 33

Sexual Harassment and How to Stop : Nightingale

Answer 33

• Nightingale first experienced: earning respect through being a lady
• Def: a form of sex discrimination that violates the Civil Rights act of 1964; “unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature

Question 34

Sexual Harassment and How to Stop : Indicators of harassment

Answer 34

• Indicators:
  o Invasion of space
  o Lack of respect
  o Overtly friendly behavior
  o Sexual suggestive behavior that is planned or intentional
  o Physical or organizational power that supports or protects the harasses while limiting the options of the harassed
  o A sexualized workplace where explicit jokes, innuendos, and pictures are common.
• May sometimes be difficult to identify

Question 35

Sexual Harassment and How to Stop : - Nurses role to stop sexual harassment

Answer 35

• Nurses role to stop sexual harassment:
  o Being assertive: ask person to stop
  o Seeking support from other nurses
  o Documenting each incident
  o Filing a complaint or grievance
  o Initiating legal action
• Nursing leaders role to stop sexual harassment:
  o Develop organization wide-strategies such as
  • Education programs focusing on sexual harassment
  • Written procedures to address sexual harassment issues
  • Investigation of all complaints
  • Counseling for victims

Question 36

Caring for LGBT patients:

Answer 36

• More likely to receive substandard health care. Some health care providers disapprove of LGBT patients choices in life.
  o May not reveal their sexual orientation to providers
• Nurses should be sensitive to creating an environment that encourages open dialogue.
  o Use gender neutral language such as “partner”
  o Assure patients that private information will be kept confidential
  o Ask specific questions about sexual practices
  o Open communication is the key to providing beneficent and comprehensive health care

Question 37

LGBT nurses

Answer 37

• LGBT nurses:
  o May be the largest minority group in nursing (around 100, 000- 200,000 in America)
  o Many remain reluctant to have sexual orientation known due to fear of sexual harassment and discrimination from coworkers, superiors, etc.
  o Not all are given benefits that heterosexual couples have including spousal benefits for life insurance, health insurance, and maternity leave
  o Some states a nurse can lose their license because some consider same-gender relationships to be morally wrong violating the provision of “having a good moral character

Question 38

Barriers to empowerment

Answer 38

• Self-critical, judgmental, and negative thinking are particularly confining for establishing empowerment
• Feelings of powerlessness are associated with job dissatisfaction, low levels of professional commitment, and burnout, which are barriers to quality of patient care
• Nurses are viewed as being loyal soldiers to the facility
• Hierarchical system physician are perceived to be of higher rank than nurses
• Physician is “captain of the ship”

Question 39

Fostering empowerment

Answer 39

• Power- the ability to do or act
• Empowerment- facilitating the ability of another person to do or act; capacity of disenfranchised people to understand and become active participants in the matters that affect their lives
• Intrapersonal, interpersonal, and environmental factors all play a role in empowerment
  o Self esteem
  o personal values and perceptions
  o sense of self in relation to others
  o an environment that allows access to information, resources, and support

Question 40

Personal Empowerment

Answer 40

urses must serve as credible models of empowerment for others
- Personal Integrity- implies an ability to be honest with and care for ourselves, as well as the needs of others
o We must attend to our own needs and self-actualization first before we can help a patient with theirs
o Yet, nurse still work long hours, consume large amounts of caffeine and sugar to boost energy
- Nurses must attend to factors that influence or thoughts, feelings, actions, and reactions in the present circumstance.
- Empowerment involves taking ownership of our inner lives and recognizing that we have ful control over our thought, feelings, and actions
o Old thinking can be updated with new knowledge
o Questioning the origin of particular thoughts can reveal ideas that were true at that time but are no longer true
o Ownership of feelings involves investigating the internal source of the message, rather than blaming other persons or situations for our feelings.
o When experiencing a lack of control- we should identify both internal and external barriers to having control, whether we want control, and explore what we need to do and are willing to risk in order to gain control.
- An empowered person decides to be accountable for personal responses, makes plans, considers options, develops strategies for change, and acts on plans by doing what is necessary to succeed.
- A victim waits and hopes for something or someone else to change, makes excuses for not taking action, blames people, places, or things for the situation, and is trapped and unaware of options
- Moral courage- higher degree of personal empowerment; the willingness to stand up for personal core values and ethical beliefs, even when we stand alone
o Willing to do what is right even when faced with what is right even when faced with ridicule, social rejection, shame, unemployment

Question 41

Professional Empowerment

Answer 41

• Can be affected by the professional arena, including personal attitudes and self- concept; the structural and functional interrelatedness of health care systems; political, economic, and social forces; and interactions with patients and colleagues.
• Empowered nurses are more likely to initiate and sustain independent behaviors that increase work effectiveness.
  o Factors that have a positive impact include access to structures of information, support, and resources
  o Empowerment facilitates job satisfaction, nurse retention, and better patient care
  o Nurse can address social and economic constraints on nursing through their involvement in professional organizations and by being politically active (ex. institutional boards or committees)
  o Bringing up concerns to these committees

Question 42

Whistle Blowing

Answer 42

• When every effort has been made to have the situation corrected, but the danger still persists
  o May include negligence, professional misconduct, or incompetence, or other factors that may endanger patients or staff
  o Considered a last resort in advocating for the patient)
  o Suggestions:
  • Determine if you are personally and professionally ready to take action
  • Consult a lawyer
  • Contact your states nurses association of whistle blower legislation
  • Use a journal to document instances that have given you concern
  • Fill out “assignment despite objection” forms when working in unsafe situations
  • Speak only the truth
  • If you decide to go outside, make sure you send your mail with a return receipt
  • Be professional and not personal

Question 43

Barriers to empowerment

Answer 43

• Empowerment involves a willingness to take risks and move beyond that which is known, and perhaps comfortable, to the unknown. It requires a change in self-perception often.
• Paternalistic attitudes and sociocultural role expectations within the health care system have fostered reliance on health care providers to determine needs of patients.
• Other barriers include: patient lack of knowledge of resources or strategies that promote empowerment, dependency, apathy, mistrust, being labeled by staff, and the nurse’s unwillingness to share decision-making power with patients.
• Social, cultural, economic, or political factors can present barriers such as: limited resources, control of knowledge about options, locking people into traditional roles and expectations, social labeling that stereotypes and devalues certain people or behaviors, and restriction of access to resources.

Question 44

Fostering empowerment

Answer 44

-Nurses being role models of self-empowerment
-a belief that patients have the right and ability to make their own choices regarding their health
-giving patients opportunities for choice regarding small as well as major decisions
-They may need education, practice, and nurturing through the decision making process
-Providing support is big. For example: accepting the patient for who they are.
-becoming politically and socially active regarding health care issues affecting vulnerable populations.
-develop strategies to enhance a patient’s ability to acquire knowledge
-Facilitating empowerment requires that nurses learn to relinquish their power and embrace the patient as an equal partner. Self-awareness, respect for others, and effective communication skills serve as foundations for the process.
Empowerment requires both knowledge about and availability of resources, support, and opportunities for choice.
Nurses can facilitate empowerment by: working directly with patients and through addressing social, political, and environmental factors affecting empowerment of individuals and communities.

Question 45

You guys don’t forget to go over the NPA on your own!!

Answer 45

OK