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Exam 4-DWB > Informed consent > Flashcards

Informed consent Flashcards

1
Q

A health care provider has the duty to do what prior to any procedure

A

disclose all significant information that he/she possesses or reasonably should possess that is material to an intelligent decision by the patient

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2
Q

informed consent may include

A
  • nature of patient’s condition;
  • nature/probability of risk;
  • reasonable expectation of benefits;
  • inability of provider to predict risks/results;
  • irreversibility of a procedure
  • likely result of no treatment;
  • available alternatives including risks and benefits;
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3
Q

Doctrine of informed consent

A
  • a plaintiff was not successful in a claim because the court determined that regardless of the severity fo the potential injury, if the probabiliby that the injury will occur is so small as to be almost non-existent, then the possibility of that injury occurring cannot be considered a material factor
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4
Q

Providers do not have to explain what with informed consent

A

every possibility that may occur but isn’t anticipated by equipment use

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5
Q

provider must only disclose

A

known drug-related events, not predic what might happen

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6
Q

Limits to informed consent

A
  • courts recognize limiting factors;
  • courts acknowledge that the patient’s right to know must be balanced with the recognition tat an undue burden must not be placed on healthcare providers
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7
Q

Limiting factors of informed consent that the court may recognize

A
  • medical matters are complex;
  • communicatio of scientific information by a trained healthcare provider to an untrained pt may be difficult
  • the remote possiblity of risk is almost limitless;
  • there should be a limit to what a provider is held to
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8
Q

Obligaion to give adequate information does not require

A

disclosure of information the healthcare provider reasonably believess patient has

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9
Q

medical consent forms list

A

risks

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10
Q

capacity/incapacity

A

physical ability to make and communicate decisions

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11
Q

competence/incompetencd

A

mental capacity/incapacity

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12
Q

guardian

A

makes decisions patient would make

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13
Q

guardian ad litem

A

makes recommendations for patient in court

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14
Q

conservator

A

makes financial decisions for patient

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15
Q

proxy

A

can be activated/inactivated to act on behalf of patient as needed

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16
Q

self-care directives

A

vary by jurisdiction {i.e. living wills, etc}

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17
Q

differences between legal and ethical responsibility to obtain informed consent

A

ethical: may be to do no harm;
legal: encompasses multiple criteria

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18
Q

In abasence of court decisions/legislation professionals are guided by

A

ethics/personal moral standards

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19
Q

court decisions vary by

A

jurisdiction

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20
Q

when there is a conflict {ethical vs. legal} courts will evaluate

A

wheter a rational basis exists for a decision, and generally consider the public good when deciding an issue

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21
Q

Prevention from deviating from standard

A

goal is to be proficient and up-to-date

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22
Q

Legal issues with deviating from standards

A

failure to keep up with current treatment;

- potential for malpractice suit

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23
Q

Failure to show consern and consideration is considered legal or ethical

A

Both:

  • Ethical: patient has right to self-determination, provider must show concern and consideration to allow that;
  • Legal: potential omission if provider fails to communicate;
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24
Q

Is fialure to communicate/poor communication with the treatment team considered legal or ethical issues

A

legal

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25
Q

Is failure to follow the chain of command considered legal or ethical

A

legal

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26
Q

Is failure to follow/understand institutional policies/procedures considered legal or ethical

A

legal

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27
Q

Is failure to understand/master use of equipment considered ethical or legal

A

legal

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28
Q

Is failure to document appropriately/accurately considered legal or ethical

A

legal

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29
Q

Is failure to obtain informed consent considered legal or ethical

A

legal and ethical

30
Q

Is competency issues considered legal or ethical

A

legal and ethical

31
Q

Practice tips

A
  • know red flag complaints and conditions
  • treat worst thing first;
  • know risk factors that call for screening exams/tests;
  • follow up on diagnostic tests and referrals;
  • revisit unsloved problems until solved;
  • have systems in place for follow up;
  • audit charts;
  • treat every medical opinion as though they are a pt.
32
Q

Trouble spots

A
  • failure to treat in accordance with standards;
  • failure to refer;
  • improper managment/care;
  • delay treatment/care;
  • medication errors;
  • incompatibility/contraindications
33
Q

Ethics

A

branch of philosophy concerned with “doing good” and “right action”

34
Q

ethical lens helps us

A

consider all views and build consensus

35
Q

ethics and morals has what root meanings

A
  • customs;
  • conventions;
  • institutions;
  • laws
36
Q

Morals tend to be associated with

A

values or habits that reflect behavior;

- religious beliefs

37
Q

Ethics tend to be associated with

A
  • critical reflection on our values;
  • personal beliefs and experiences;
  • societal norms;
  • professional guidelines;
  • organizational standards;
38
Q

What role do ethics committees perform

A
  • provide education and consultation on ethical issues;
  • help raise awareness of ethical issues;
  • increase knowledge about ethical issues;
  • provide context and model for moral discourse in complex situations;
  • provide a forum for discourse and consensus building in face of conflicts
39
Q

Preventative ethics

A
  • integration into daily practice through ethics rounds or opportunities for reflection;
  • opportunity to prevent ethical dilemma becoming a crisis;
  • acceptance of daily ethics rounds in some institutions
40
Q

What is one of the richest professional code of ethics

A

the ANA code of ethics

41
Q

The ANA code of ethics guides us to

A
  • respect persons;
  • help maintain patient’s autonomy;
  • promote patient’s dignity;
  • ensure patient’s safety;
  • should be reflected on and considered every day
42
Q

Autonomy as ethic principles

A

self-rule;

- person’s right to determine what is best for them

43
Q

A patients right to determine what is best for them is based on

A
  • ability to reason;
  • capacity for personal decision making;
  • knowledge of personal goals;
  • self-knowledge
  • ability to act on one’s choices
44
Q

Autonomy assumes

A

no other influences however no one is completely autonomous

45
Q

What can impact one’s ability to act autonomously

A

stress of illness

46
Q

Nonmaleficence

A
  • do no intentional or needless harm;
  • be accountable;
  • advocate for patient/family to prevent unnecessary harm;
  • supervise delegated tasks;
  • max benefit with minimal harm
47
Q

Nonmaleficience possess the professional competence that allows you to

A
  • foresee consequences;

- perform action;

48
Q

Beneficence

A
  • promotion of patient’s good;

- potential conflict with principle of autonomy

49
Q

What is the ultimate goal of nursing and medicine

A

beneficence

50
Q

Boundaries to beneficence

A
  • patients/families wishes;
  • society’s provisions;
  • health and heatlhcare system
51
Q

With beneficence it is important to

A
  • be careful to avoid paternalism;

- promote self-awareness in ourselves and patients;

52
Q

What is the most important thing with beneficence

A

knowing what is right for the patient

53
Q

Veracity

A

truthfulness in support of patient autonomy;

- obligation to tell the truth;

54
Q

Veracity requires

A

factual knowledge and knowledge of patient as an individual;

ongoing reflection

55
Q

Veracity is what part of jusdicious process communication

A

transparency

56
Q

with veracity it is important to consider

A

the vulnerability of patients in need of care;

57
Q

Justice and fidelity

A
  • fairness, both to individuals and in allocating resources;
  • no undue burden on people;
  • faithfulness to professional commitments even if conflicts about allocation of resources
58
Q

What are 2 main ethical frameworks

A
  1. principle orientation to ethical decision making;

2. relational or care-based approach to ethical decision making;

59
Q

Ethical framework: principle orientation to ethical decision making

A
  • ethical principles as overriding guides;

- particulars of situation less important than adherence to principles;

60
Q

Ethical framework: relational or care-based approach to ethical decision making

A
  • particulars of situation more important than principles;

- every situation, patient, family unique

61
Q

CERN helpful guidelines

A
  • Get the story straight before making any decisions.
  • Recognize the ethical principles and apply the theory.
  • Theory as a tool to quickly assess a situation
  • Adhere to unbiased and honest communication.
  • Honesty protects the good of patient and family.
  • Use the notion of preventative ethics.
  • know the kind of pain you are treating
62
Q

CERN guideline for using the notion of preventative ethics

A
  • patient and family education;

- preparation for conversation about end-of-life issues with Md

63
Q

CERN guideline types of pain that can be treated

A
  • emotional pain;
  • physiologic pain;
  • changes in mental status potentially caused by pain treatment;
  • existential distress
64
Q

Ethical dimensions

A
  • listen
  • respect;
  • take other person’s point of view;
  • reflect on challenge vs. inquiry;
  • consider that education of family on intervention may not be sufficient;
  • summarize everything to be sure everyone’s goals and intentions are same
65
Q

Ethical implications of palliative sedation

A
  • goal of medication;
  • apassing;
  • ability to provide the care (i.e. ketamine drip’s success not guaranteed);
  • interventions appropriate execution possible;
  • validation in myself through palliative MD’s assessment after patient’s passing;
  • confirmation of team effort in treating
66
Q

Rule of double effect

A
  • initial inentions must be good;

- may not always acheive best outcome but you are upholding good morals and ethics

67
Q

You are upholding good morals and ethics if

A
  • you are honest;
  • you have a trusting relationship;
  • you have good communication;
  • you express the intended benefits of the intervention;
68
Q

Ethics at end-of-life

A
  • maintain patient relationship;
  • advocate for the patient;
  • alleviate pain;
  • ensure optimal quality of life;
  • provide family-centered care;
  • know how to deal with hope;
69
Q

foundation of relational ethics

A

relationships with patients and families

70
Q

Relational ethics

A
  • unique knowledge about patient d/t privaleged info;
  • must gather extensive info on patient and family in very short time;
  • relatioinships can last over time;

Exam 4-DWB (20 decks)

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