Intro to Acute Care (Role, Legal, & Ethics) Flashcards
NCC 621 Module 1a
Integrated approach in which members of a clinical team actively coordinate care and services across disciplines
Interprofessional Patient Care
area of clinical knowledge and related research that is pertinent to patient care
health care discipline
physicians, surgeons, physicians-in-training, medical students, physical assistants
Discipline of medicine
Advanced practice registered nurses–nurse practitioners, nurse anesthetists, clinical nurse specialists; staff nurses and nursing student
Discipline of nursing
Pharmacists, respiratory care practitioners, dietitians, therapists (occupational, physical, speech), social workers, chaplains, child life specialists, case managers, paramedics, emergency personnel
Discipline of allied health professionals
Medical directors, nurse managers, supervisors, health unit coordinators
Discipline of administration
Counsel patients on diet, hygiene, and preventive health care and who diagnose illnesses and prescribe and administer treatment for patients suffering from disease/injury
Attending physicians
makes clinical decisions and provides a broad range of diagnostic, therapeutic, preventive, and health maintenance services
Physician assistant
4 types–nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists (CRNA)
Deliver primary and/or acute care in variety of settings; diagnose and treat common acute illnesses and injuries, perform physical examination, and manage chronic health conditions
Advanced practice registered nurses
Pharmacists; Respiratory therapists; Dietitians; Occupational therapists; Physical therapists; Speech therapists; Social workers; Child life specialists; Case-managers; Emergency medical technicians (EMT) and paramedics
Allied health professionals
distribute medications prescribed by other providers, inform patients about medications, and advise practitioner on selection, dosages, interactions, and side effects
Pharmacists
Respiratory therapists
treat patients of all ages with respiratory illnesses and other cardiopulmonary conditions
Respiratory therapists
applies sciences of foot, nutrition, biochemistry, physiology, food management, and behavior to maintain health status of patients
Dietitians
promote health and wellness to those person who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitations, or participation restrictions
Occupational therapists
help improve patient’s strength and mobility, relieve pain, and prevent/limit physical disabilities
Physical therapists
evaluate, diagnose, and treat speech, language and swallowing disorders in all ages
Speech therapists
assist individuals, groups, or communities to restore, enhance their capacity for social functioning; help prevent and mitigate crisis, and counsel individuals and families to cope with stress
Social workers
promote effective coping through play, preparation, education and self expression activities; provide emotional support for families, encourage optimal development of children
Child life specialists
help patients understand their current health status, what they can do about it, and why those treatments are important
Case managers
provide emergency care to people who have suffered from illness/ injury outside hospital setting, work under protocols
Emergency medical technicians (EMT) and paramedics
Shared mission, purpose, or goal
Essential for interprofessional teams
integrated scheduling, physical proximity of team members, strong interpersonal communication skills; regular opportunities for communication; shared language of communication lack of therapeutic territorialism, and commitment to interprofessional process
Goals for success for interprofessional team
Communication Cooperation (empowerment of team members) Cohesiveness (team sticks together) Commitment (investing in team process) Collaboration (equality in team) Confronts problems directly Coordination of efforts (actions support common plan) Conflict management Consensus decision making Caring (patient-centered outcomes) Consistency (with one another and environment) Contribution
12 C’s of Teamwork
allows team members to share concerns about safety or quality of patient care and to ask questions in attempt to improve understanding of patient care
Open Communication
can provide opportunity for open communication and collaboration between team members
Interprofessional rounds
allows team members to review team performance, identify errors and evaluate them in relation to team function, and provide and receive constructive feedback to improve team performance
Team debriefing
recognizes as a matter of civil liberty, the parent’s right to make decision regarding a child’s education, health care, lifestyle, regiment, religious observation, and discipline
Parental liberty doctrine
The state may intervene against a child’s natural parent/legal guardian and act as parent of any child who is need for protection
State will have the burden of proving that it has not unjustifiably interfered with the parental liberty doctrine
Parent patriae
Minor who has been made free of parental control–usually automatically emancipated when they become pregnant or have children of their own, regardless of age
Emancipated minor
allows minor to demonstrate requisite capacity and maturity to make independent decisions with regard to health care
Takes into consideration age of minor, nature of situation, ability of minor to understand medical procedure in question and laws of state in which minor resides
Mature minor
presumption under US law that a minor is someone younger than 18 is immature and may not make their own decisions regarding healthcare
Immature minor
Allows parents and children 14 years or older to refuse medical treatment for a life-threatening condition; preventing parents from being charged with medical neglect if decision to refuse such treatment is made jointly, in good faith, by parents and child who is older than 14
Virginia legislature
Abraham’s Law
Allow parents and children to have autonomy regarding decision related to medical treatment, even if it contradicts conventional wisdom
If parents can demonstrate that they are advocating for their position based on reasonable information and a plan of treatment that they truly feel is in the best interest of the child, courts will often side with parents
Courts will often side with children even if their decisions conflict with those of the parent under the mature minor doctrine if court finds the child is sufficiently informed about diagnosis and treatment alternatives and reasonably understands consequences of decision
Parker Jensen Cancer Case
Decision making for oneself, not commonly applied to children
Consent
Parent is fully informed of purpose, benefits, and risk for child and is asked for permission to perform procedures or enroll child in study
Permission
Self-determination by which child having been fully informed or informed to extent of their ability to understand participates in decision making
May be simple expression of opinion or may be involved discussion of all aspects of tissue
Assent
If child can write a their own name, can be as young as 6 or 7 years
Youngest age a child can assent
Holds that HCPs must not share confidences between themselves and a patient/parent with others without patient’s or parent’s express permission
If HCP believes that the patient in danger of self-harm or harm to another, then information must be shared appropriately to prevent such injuries
Must report disclosures of illegal activity
Confidentiality
Obtaining informed parental consent or permission without undue influence/coercion
Responsibility of research study investigator
Verify that consent is legitimately obtained and that consent protocols are followed
May not advise or direct decision to participate
HCP’s responsibility in research study
If parent is not present, but available by telephone, then obtain permission with third-party “auditory witness”
Emergency Procedures with parent available on the phone
Determine if child is mature enough and able to understand condition and make decision as a mature minor
Emergency procedures without parent available, but minor is awake
two licensed medical professionals may make a declaration that life-saving car is needed
should be committed to writing in a patient’s medical record
Emergency procedures without parent available and unconscious minor
Matched by height, weight, ABO, and serology status; less problematic ethical issues
Cadaver donors
Sibling has 1:4 chance of being a perfect match with identical twin being best match; there is emotional cost
Live donor transplantation
Some states require parental permission to provide any kind of education related to sexuality or birth control
Other states have laws that allow children of a particular age (14 or 16 years) to consent to their own health care
Reproductive decision making
male fertility preservation
minors must provide consent for procedures and storage of reproductive tissue
Cryopreservation of spermatoza
female fertility preservation before treatment with radiation therapy
minors must provide consent for procedures and storage of reproductive tissue
cryopreservation of oocytes &/ embryos, ovarian transposition
- helping pediatric patient achieve developmental appropriate awareness of condition
- telling pediatric patient what to expect with clinical management
- assessing understanding and factors influencing response
- soliciting expression of pediatric patient’s willingness to accept proposed
Four components of assent
Allows patients and/or surrogates to designate desired medical interventions under applicable circumstances
advanced directives
If unresolved, ethics consult should be obtained–> then legal counsel is next step
Court system may be required to determine patient’s next best therapeutic plan
Refusal of Care
Medical interventions that are unlikely to produce any significant benefit to patient
HCPS have moral duty to refuse to provide therapeutic option that may harm a patient and social duty to conserve resources
Futile/Inappropriate Care
Deliberate intervention undertaken with intention of ending a life to relive intractable suffer
Fear of “slipper slope”
AAP does not support idea
Euthanasia
Set of ethical criteria for evaluating the permissibility of acting when one’s otherwise legitimate act will cause negative effect that one would normally be obliged to avoid
Action having foreseen harmful effects partially inseparable from goof effect is justifiable upon satisfaction of following (nature of act is itself good or at least morally neutral)
Doctrine of Double Effect (DDE)
Judgment made on behalf of a non-competent patient based on what the person would have decided had he/she been competent
Substituted judgement
Has origins in family law; surrogate decision maker must determine the highest net balance among available options; weighing positive against negatives
Can be difficult to apply
Best interest
provide care that benefits the patient
Beneficence
avoid harming the patient
Nonmaleficence
individuals should decide what constitutes their own best interest
Autonomy
provides services fairly without bias from factors irrelevant to medical situation
Justice
provide direct patient care by collecting and analyzing data to appropriately manage care
Clinician
engages in shared planning and intervention with other health care professionals to attain desired patient goals
Consultant/Collaborator
teaches patients, families, peers, and communities about a variety of health care issues
Educator
Uses research process to provide evidence-based patient care–research/scholarships–you need to be able apply research to your patient population
Researcher
State board of nursing
Certificate vs MSN vs DNP
Licensure
Non-governmental agency that validates an individual has met certain predetermined standards set by individual’s profession
Determines if you are safe to practice as an NP; required for licensure
Certification
Process of validation of required education, license, and certification
Usually carried out by hospital or clinical practice site
Admitting privileges are determined by hospital
Credentialing
Authorizing a HCP scope and content of patient care services
Privileging
legal provisions set up by individual state nurse practice acts
i.e. what would be considered appropriate for HCP to do?
Scope of practice
evolve out of scope of practice
establish minimal levels of acceptable performance
*important for malpractice claims
*would another NP at your same level do the same things you did?
Standards of practice
ability of NP to prescribe medications to clients is dependent on state nurse practice acts
state practice dictates the level of prescriptive authority allowed
DEA has ruled that NP’s may obtain registration numbers
Prescriptive authority
Legal responsibility that a NP has for actions that fail to meet the standard of care, resulting in actual or potential harm to a patient
Liability
damaging one’s reputation as a result of information being shared without patient’s permission
Invasion of privacy
failure of a NP to render services with the degree of care, diligence, and precaution that another member of same progression under similar circumstances would render to prevent injury to someone else
*asked to perform a task outside of their job description
Malpractice
MInor who has been determined by certain set of circumstances or by a court to be given status as an adult–don’t require parental consent
Being in military service, being financially independent of parent and living on their own, being married
Emancipated minor
Minor can consent for medical decision regardless of parental consent, in regards to sexual health, STIs, mental health services, perinatal/prenatal services, immunizations, substance use disorders, care after rape/assault
Minor legal exception
respect for persons; self-reliance or self-determination
Autonomy
clinician decides what is best for the patient
i.e. futile care–meaning if there are contraindications for medical intervention that may prolong their suffering
Paternalism
following through, faithlessness, commitment to keep promises
Fidelity
Doing no harm or as LITTLE harm as possible
I.e. putting a PICC line, but trying to limit the blood loss as much as possible
Non-maleficence
Telling the truth
Veracity
Equal distribution of goods, services, benefits, and burden
Impartiality
Justice
Exists an ethically “right” and ethically “wrong” choice
Taking controlled substances that are not legally prescribed to you is an ethically wrong choice
Ethical problem
Exists two ethically “right” choices
Usually develop when values among parties are discrepant
i. e. offering a particular treatment modalities that may or may not have good outcomes, may be an ethical problem
i. e. offering ECHO in patient that might be progressing to brain death while another clinician thinks it is worth a shot
Ethical Dilemma
Obtain relevant facts
Identify ethical issues from facts
Determine who is affected
Identify the alternatives available to person who must resolve dilemma
Identify likely consequences of each alternative (con/pon)
Decide appropriate action then evaluate effectiveness of decision
Resolving Dilemmas
