Final Exam Review Flashcards
hx nurses were concerned with
loyalty to physicians, punctuality, and obedience
today nursing practice is
autonomous and distinct from medicine with unique ethical challenges
nurses possess
a set of professinoal standards adn framework of legal and ethical guidelines
nursing ethics is needed bc
tech advances, inc complexity of health care, growing sophistications of science and tech (genetics)
professional responsibilities
Have an obligation to serve public interest and the common good
Possess a unique body of knowledge
Have multiple accountabilities
Are trusted to engage in decisions that influence and shape public policy, law, and societal norms
health care professionals need to know the law bc
Failure to understand professional responsibilities and standards puts the nurse at risk of disciplinary or legal action
Complex situations can arise before laws can be made to deal with them
Nurses have legal obligations to their patients
Nurses have corresponding rights
nurses should study ethics bc
Morality and care is at the heart of nursing practice
Nurses practise as part of a team, but with different perspectives
Ethics plays a role in the context of:
-Nurse–client relationships
-Health care policy
-Health care organizations
-Health care system as a whole
the cna code fo ethics for rn’s was first published in
1980
two parts of cna code of ethics for rn’s
nursing values and ethical responsibilities
ethical endeavors
code of hammurabi
1790 BC
justice was strict, eye for an eye
behaviour of women was regulated
class distinctions
hippocratic oath (400BC) principles
Beneficence and nonmaleficence Sanctity of life Competence Professional integrity Privacy and confidentiality
nuremburg code (1947) research principles
Informed consent (autonomy)
Beneficence
Nonmaleficence
early nursing ethics
Had a strong foundation in Christian morality
Focused on obedience, compliance, etiquette, and loyalty to the physician
Were less focused on judgement, reflection, or critical thinking
Part I of the Code is organized around seven values:
Providing safe, compassionate, competent, and ethical care
Promoting health and well-being
Promoting and respecting informed decision making
Preserving dignity
Maintaining privacy and confidentiality
Promoting justice
Being accountable
- providing safe compassionate competent and ethical care
Using speech and body language to demonstrate compassion
Questioning unsafe care
Collaborating with others to provide safe care
Providing care during a natural or human-made disaster
Preventing and minimizing all forms of violence
promoting health and wellbeing
Providing care directed first and foremost to the person, family, or community in their care
Advocating for the least restrictive measures possible for those in their care
Collaborating with others to maximize health benefits
promoting and respecting informed decision making
Providing information needed for informed decisions
Recognizing that individuals may choose to defer to family or community values in decision making
Supporting the right to refuse or withdraw consent for treatment
Respecting the choice to engage in unhealthy lifestyles or treatments
preserving dignity
Relating to all persons with respect
Intervening when others fail to do so
Taking into account a person’s unique values, customs, and beliefs, as well as their social circumstances
Providing care in a discreet manner
Maintaining professional boundaries
Advocating for a dignified and peaceful death
maintaining privacy and confidentiality
Respecting information and adhering to privacy laws
Taking reasonable measures to avoid being overheard when conversing with patients
Taking care not to access information inappropriately
Intervening if others inappropriately access or disclose information
promoting justice
Avoiding discrimination (on any grounds) when providing care
Refraining from judging, stigmatizing, or demeaning behaviours
Refusing to engage in any inhumane or degrading action, and intervening with others do so
Making fair decisions and advocating for fair allocation of resources
being accountable
Practising with honesty and integrity, in accordance with the Code
Practising within the limits of competence
Protecting the safety of others when a colleague is unable to perform his or her duties
Clearly and accurately representing themselves by name, title, and role
Identifying and addressing conflicts of interest
nurses have a role in the provision of social justice, including advocatin for
Policies to address the social determinants of health
Accessible, universal, comprehensive health care services
Environmental preservation
Positive, healthy work environments
The resolution of global health issues
Out of the 185 000 adverse events that occur in Canadian hospitals each year ______ are preventable
70000
patient safety
preventing and mitigating unsafe acts by protecting people from harm (real or potential)
RNAO is concerned with the following 3 key aspects of patient safety for nursing and health care.
Quality care and nursing
Quality work environments
Multi-level accountability
rnao recommendations for pt safety
Amend legislation to have a senior nurse administrator in all sectors responsible for nursing practice.
Managers be a registered nurse especially in direct practice.
Put structures in place for meaningful participation in decision making.
Introduce whistle blower protection at the provincial level to enable health care providers to speak out when safety is being compromised.
Administrators share in the responsibility along with individual nurses in patient safety.
Implement 70% fulltime employment for registered nurses in all sectors. Minimize use of agencies and multiple employers.
Create a blame free organizational culture.
Introduce structures within organizations to re-engineer systems for standardization and checks to intercept errors before they reach the patient.
Promote collaborative team practice in work settings.
Support and conduct research on nursing’s contribution to patient safety science and quality health care.
All individuals have a right to safe effective care in all sectors in all practice settings.
incident analysis
A structured process that aims to identify what happened, how and why it happened, what can be done to reduce the risk of recurrence and make care safer, and what was learned.
incident mgmt
The various actions and processes required to conduct the immediate and ongoing activities following an incident. Incident analysis is part of incident management.
pt safety incident
An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
harmful incident
A patient safety incident that resulted in harm to the patient. Replaces “adverse event”, “sentinel event” and “critical incident”.
no harm incident
A patient safety incident that reached a patient, but no discernible harm resulted.
near miss
A patient safety incident that did not reach the patient. Replaces “close call”.
rationality
elated to the notion of thinking and reasoning. It is associated with comprehension, intelligence, or inference, especially when an inference or a conclusion can be made from a thought process.
ethics
the philosophical study of morality, is the systematic exploration of what is morally right and morally wrong. The study of ethics enables us to recognize and evaluate the variables that influence our moral decisions, our obligations, our character, our sense of responsibility, our sense of justice, and the nature of the good life.
ethical theory
is the study of the nature and justification of general ethical principles that can be applied to moral problems. Provides more rigorous and systematic approach about how we make decisions about what is right and wrong.
biomedical ethics
explore the ethical questions and moral issues associated with health care.
nursing ethics
focuses on the moral questions within the sphere of nursing practice, the nurse-patient or nurse-client relationship, the moral character of nurses and the nurse as a moral agent.
applied ethics
the field of ethics in which these theories and principles are applied to actual moral problems.
morality
the tradition of beliefs and norms within a culture or society about right and wrong human conduct. It includes non-normative and normative approaches.
morality can be described as
culturally based beliefs and norms about what is right and wrong
a set of rules that are taught to children as they grow up
Canada is a pluralistic society, so it is vital to respect differences and to understand the influence of culture in ethics.
nonnormative ethics
include fields of descriptive ethics and meta-ethics. Descriptive ethics gathers factual descriptions and explanations of moral behaviours and beliefs looking at a wide range of moral beliefs and behaviours: moral attitude, codes, beliefs. Meta-ethics analyzes the meanings of terms such as right, obligation, good, and cultures.
normative ethics
attempts are made to identify the basic principles and virtues that guide morality.
ethical dilemmas
arise when the best course of action is unclear and when strong moral reasons support each position. The involved parties must choose between the most right and the least wrong
moral distress
results when we are not able to face these issues and deal effectively with them.
ethical theories
provide a framework of principles and guidelines to help identify ethical issues and reconcile problems or conflict.
values influence
individual beliefs and opinions
behaviours, rituals, rules, and laws as a collective society
decisions and responses as nurses
values can shift over time, focuses on
quality of life over prolonging life
individual rights over health care decisions
value conflicts arise when
Arise when personal actions or the actions of others are at odds with beliefs
Can arise when professionals disagree on how a situation should be managed
May result in moral distress, so it is important to establish processes to
understand personal values
clarify and articulate values to others
value clarification process requires
open discussion
active listening
mutual respect
teleological theories
consider outcomes and consequences (immediate and long term) of decisions and actions
utilitarianism
used to evaluate decisions such as withdrawal of treatment. The consequences are not only considered in relation to the patient, but also to the family, the health professionals involved, and society.
`
critics argue that utilitarianism
is impossible and impractical for use in daily life
is useless when trying to quantify widely different interests
can lead to injustice, because the greatest good for the majority may bring harm to the minority
w.d ross
A British philosopher who, in an attempt to resolve the problem of conflicting duties in Kantian ethics, developed a more pluralistic theory
His revised theory identified prima facie duties that must override other duties
for example, sanctity of life would have priority over truth telling
according to Beauchamps and Childress (2001), the important principles commonly applied to ethical challenges in health care include:
Sanctity of life Autonomy Nonmaleficence Beneficience Justice Fidelity Veracity
case law
a collection or body of judges’ decisions rendered over centuries of judicial consideration and refinement
statute law
formal rules passed by legislation
doctrine
found in textbooks and journals written by legal scholars and experts. These carry more weight in civil law systems than common law systems
The concept of a “higher law” or “natural law” suggests that:
Humans have the capacity for reason
Humans can judge what is “good” and “just” behaviour
Humans must be treated fairly and consistently
The concept of natural justice is evident in legal and disciplinary hearings in terms of:
The rights of the accused
Due process
civil law deals with
private dispute between two sets of individuals
tort law
civil wrong committed by one person against another, such as causing that other some injury or damage (either to person or property).
lawsuit process
- Statement of claim
- Statement of defence
- Disclosure of evidence
i. Documentary discovery
ii. Examination for discovery - Pretrial conference
- Trial
- Enforcing judgement
three classes of criminal offences
Indictable offences
Summary conviction offences
Dual procedure (or hybrid) offences
constitution
set of supreme laws that define and regulate the various branches of government, their powers, and restrictions on those powers
Canada’s Constitution includes a charter of rights and freedoms.
charter of rights and freedoms
It sets forth the basic legal and democratic rights of Canadians.
These rights cannot be infringed upon by the government unless it has a justifiable reason.
Any law that breaches the Constitution or a person’s rights is illegal and invalid
charter of rights and freedoms protects
Freedom of religion and conscience Freedom of thought and expression Freedom of the press Freedom of peaceful assembly Freedom of association
Case Law on Consent Reibl v. Hugues (1980)
- Reibl v. Hughes (1980): the plaintiff suffered from a blocked left carotid artery. He was booked for an elective internal carotid endarterectomy, which was performed by the defendant, a neurosurgeon.
- During the surgery, or immediately after, the plaintiff suffered a stroke, which resulted in unilateral paralysis, impotence, and permanent disability. The plaintiff sued the neurosurgeon for the surgeon’s failure to inform him adequately of the risks of the surgery.
- The case reached the Supreme Court of Canada, where the surgeon was held liable for not explaining the risks adequately.
Case Law on Consent Malette v. Shulman (1990)
- The Ontario Court of Appeal handled the Malette v. Shulman (1990) case. The plaintiff had been seriously injured in a motor vehicle accident and rushed to a nearby hospital. She had sustained serious injuries to her head and face and was bleeding profusely.
- The physician on duty in the Emergency department determined that she would need blood transfusions to maintain her blood volume. A surgeon made the same determination and she was barely conscious at the time. She had a card printed in French and signed by the patient identifying her as Jehovah’s Witness with clear refusal of blood transfusion.
- The Court found that informed consent was required and upheld the finding of liability for battery against the physician.
Case Law on Consent Ciarlariello v. Schacter (1993)
- The Supreme Court of Canada reviewed the law of informed consent in a situation in which a patient withdrew consent during a medical procedure.
- The plaintiff was asked to be at the hospital to undergo the first of two angiograms. Her first language was Italian and her daughter took the role of interpreter.
- During her second test, she experience pain and asked them to stop the procedure. The test was stopped. She had suffered some paralysis. She was explained that it would take 5 more minutes to continue and she agreed. She suffered a reaction during the procedure and was left quadriplegic.
- The Court found that informed consent was required and that the physicians were negligent in explaining the risks of the procedure.
expressed consent
a clear statement of consent given by the patient. It is often a written consent.
implied consent
inferred from the patient’s conduct (e.g., holding out his or her arm for an injection).
Ontario’s Substitute Decisions Act (1992)
two methods of providing a substitute decision maker for an incapable person are: The appointment (in advance of becoming incapable) of a power of attorney for personal care An application to the court for the appointment of a guardian
malpractice
involves performing lawful acts in a careless manner or in a manner that does not conform with generally recognized practice standard or standard of care in the nursing profession.
Offences are generally dealt with in civil courts.
duty of care
involve situations in which the patient is receiving services but it can also include personal situations where the nurse is required to place their competencies in their actions.
Latin v. Hospital for Sick Children et al. (2007)
A febrile 14-month-old girl was admitted to a paediatric hospital in January 1998. The triage nurse assessed her as an urgent patient using the triage classification system.
One hour after her arrival, she began a generalized tonic-clonic seizure in the waiting room. She was immediately taken into the treatment room where medical staff attempted to bring her convulsions under control.
She suffered brain damage and extreme permanent disabilities. The child’s family brought a lawsuit against the hospital and the triage and charge nurse on duty as well as against several other on-duty nurses.
It was found that no treatment available could have reversed because of the infectious process in her brain (likely influenza A virus). The court first had to determine the appropriate standard of care owed to the child by the nurses and the hospital. Testimony from experts, hospital policies, academic literature were used in the case. The court found that the triage nurse had not failed to meet the standard of care. The nurse’s assessment and decision-making were carefully reviewed.
