Lecture 14 Flashcards
1
Q
principles Standards of ethics in healthcare includes (6)…
A
1) Autonomy
2) Beneficence
3) Nonmaleficence
4) Justice
5) Fidelity
6) Veracity
2
Q
What is Autonomy?
A
The patients right to make their own (autonomous) healthcare decisions
e.g. respect a patient’s right to refuse a treatment
3
Q
What is beneficence?
A
To promote good; taking positive actions to help others
e.g. taking a patient outside to get some fresh air
4
Q
What is nonmaleficence?
A
To avoid causing harm
e.g. perform multiple checks to avoid medication error
5
Q
What is Justice?
A
To treat fairly and equally
e.g. distribute care equitably among assigned patients
6
Q
What is fidelity?
A
To be faithful/loyal
e.g. keep promises to patients
7
Q
What is a code of nursing ethics?
A
a set of guiding principles that all members of a profession accept
8
Q
what does a code of nursing ethics help professional groups settle?
A
questions about practice or behavior
9
Q
what is The American Nurses Association?
A
establishes ethical standards for the nursing profession in the United States
10
Q
What are the basic principles laid out by the ANA that remain constant(4)?
A
1) Responsibility
2) Accountability
3) Advocacy
4) Confidentiality
11
Q
what is advocacy?
A
refers to thee support of a particular cause; nurses advocate for the health, safety, and rights of patients, including their right to privacy
12
Q
what is responsibility?
A
the willingness to respect obligations and to follow through on promises
13
Q
what is Accountability?
A
The ability to answer for your actions
14
Q
what is confidentiality?
A
HIPPA mandates the protection of patients’ health information
15
Q
what sort of ethical considerations should be made concerning nurses and social networks?
A
nurses should not post pictures of patients even if there are no identifiers
16
Q
why should nurses not become friends with patients?
A
it may cloud a nurse’s ability to remain objective
17
Q
Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle of:
A. autonomy.
B. fidelity.
C. justice.
D. nonmaleficence.
A
D
18
Q
what is the ethical considerations for a nurses values and those of your patients?
A
nurses need to respect their own values as they try to respect those of others whose values differ from theirs
19
Q
The values that an individual holds are reflect what?
A
- cultural and social influences
- values vary among people and develop over time
20
Q
sometimes people have such strong values that they consider them to be (BLANK), not just (BLANK)
A
Facts; Opinions
21
Q
what is a value?
A
a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
22
Q
What is an ethical dilemma?
A
When conflicting values cause distress and controversy
23
Q
The daughter of an intubated patient with terminal cancer does not want her mother to have opioid pain medication due to religious reasons even though she is in severe pain.
This is an example of what?
A
An ethical dilemma
24
Q
To resolve ethical dilemmas, one needs to…
A
distinguish among values, facts, and opinion
25
identifying values as something separate from facts can help you...
find tolerance for others even when there is a big difference between view points
26
what are the theories of ethics(5)?
1) Deontology
2) Utilitarianism
3) Feminist Ethics
4) Ethics of Care
5) Casuistry
27
What is Deontology?
Defines actions of right or wrong based on their "right-making" characteristics.
e.g. fidelity to promises, truthfulness, and justice
28
What is Utilitarianism?
* A system of ethics that proposes that the value of something is determined by its usefulness
* AKA consequentialism because main focus is on the outcome or consequence of an action
29
What is the guiding principle for determining the right action
in utilitarianism?
the greatest good for the greatest number of people is the guiding principle
30
what is Feminist ethics?
focuses on the inequality between people
31
what theories does feminist ethics critique?
conventional ethics such as deontology and utilitarianism
32
What is ethics of care?
* emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
* closely related to feminist ethics
33
what is Casuistry?
* case-based reasoning
* focuses on an intimate understanding of particular situations
* depends on finding consensus more than an appeal to philosophical principle
34
describe using casuistry for solving ethical dilemmas...
consensus building promotes respect and agreement rather than a particular philosophy or moral system
35
What are the steps to processing an ethical dilemma(7)?
1) Ask if this is an ethical dilemma
2) Gather information
3) Clarify values
4) Verbalize problem
5) Identify courses of action
6) Negotiate outcome
7) Evaluate action
36
describe the makeup of an ethics committee and its purposes(4)
* Usually multidisciplinary
* They serve several purposes including:
- Education
- Policy
- Recommendation
- Case consultation
37
Who can request access to an ethics committee?
Any person involved in an ethical dilemma including:
* Nurses
* Physicians
* Healthcare Providers
* Patients
* Family members
38
What are the common professional ethical/bioethical issues that will influence you and the care you give your patients(3)?
1) Quality of life
2) Genetic screening
3) Care at the end of life
39
the ethical issue of quality of life is central to discussions about...
end-of-life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate
40
How is quality of life measured?(4)
1) Age of patient
2) Patient's ability to live independently
3) Patients ability to contribute to society in a gainful way
4) Other measures of quality
41
what is the definition of quality of life?
quality of life is deeply subjective and difficult to predict
42
describe the capabilities approach:
begins with a commitment to the equal dignity of all people regardless of their class, religion, caste, race, or gender, and is committed to the attainment , for all, of lives that are worthy of that equal dignity
43
what challenges result in moral distress that can characterize the management of care at the end of life?
difficult emotional and spiritual challenges
44
define futile:
* Regular definition: something that is hopeless or serves no purpose
* When used in healthcare discussions: Interventions that are unlikely to produce benefit for a patient
45
if a patient is dying of a condition with little or no hope of recovery, which interventions are futile?
almost any intervention beyond symptom management and comfort measures
46
why would an agreement to label an intervention as futile be benefitial?
an agreement to label an intervention as futile can help providers, families, and patients turn to palliative care measures as a more constructive approach to the situation
47
describe the benefit of HealthCare Reform
Facilitated access to care for millions of uninsured Americans
48
If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of:
A. responsibility.
B. accountability.
C. competency.
D. moral behavior.
B
49
Describe the Nurse Practice Act:
what type of law?
what do they define?
(Statutory Law)
NPA of each state defines:
* The scope of nursing practice and expanding nursing roles
* Sets education requirements for nurses
* distinguishes between nursing and medical practice
50
what is a felony?
a serious offense that results in significant harm to another person of society in general
e.g. misuse of a controlled substance or practicing without a license
51
what are the penalties for felonies?
imprisonment for greater than one year or death; includes monetary penalties
52
what are misdemeanors?
a crime that does not inflict serious harm
e.g. parking in a no-parking zone is a misdemeanor traffic violation (its not really but that's the definition she gives; more like shoplifting an item valued at $50 bucks is a misdemeanor)
53
what are the penalties for misdemeanor crimes?
usually has a penalty of monetary fine, forfeiture, or brief imprisonment
54
what are civil laws?
protects the rights of individuals and provides fair and equitable treatment when civil wrongs or violations occur
e.g. nursing negligence or malpractice
55
what is regulatory law?
AKA administrative law; defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing
56
what is common law?
* result from judicial decisions concerning individual cases
* Most of these revolve around negligence and malpractice
**precidence**
57
what is criminal law?
law that prevents harm to society and provides punishment for crimes (felonies or misdemeanors)
58
Who develops standards that outlines the scope, function, and role of the nurse in practice?
ANA American Nurses Association
59
describe what happens in a malpractice lawsuit
a nurses actual conduct is compared to nursing standards of care laid out by the ANA to determine whether the nurse acted in a way that any reasonably prudent nurse would act under the same or similar circumstances
60
What are Standards of Care?
Legal guidelines for determining nursing practice and identifying the minimum acceptable nursing care
61
who requires accredited hospitals to have written nursing policies and procedures?
The Joint Commission (TJC)
internal standards are specific to the agency and need to be accessible on all nursing units
62
in a lawsuit for malpractice or negligence, a nursing expert may testify to the jury about the standards of nursing care as applied to the facts of the case. what do nurse experts base their opinions on(6)?
* Existing standards of practice established by Nurse Practice Acts
* Federal and state hospital licensing laws
* TJC standards, professional organizations
* Institutional policies and procedures
* Job descriptions
* Current nursing evidence-based literature
63
What is the ADA?
Americans with Disabilities Act: Protects the rights of people with physical or mental disabilities
64
what is a disability as defined by the U.S. Supreme Court?
a mental or physical condition that substantially limits a major life activity
65
describe the relationship between conditions such as HIV and the ADA
the ADA protects healthcare workers in the workplace with disabilities such as HIV and also protects patients with similar conditions from being discriminated against.
66
What is the Emergency Medical Treatment and Active Labor Act?
When a patient presents to the emergency department with an existing emergency condition, the patient cannot be discharged or transferred until after his/her condition is stabilized
67
what is the mental health parity act?
Strengthens mental health services
68
What is the PPACA?
* The Patient Protection and Affordable Care Act: * requires parity in provision of 10 specific services including:
- Mental Health
- Behavioral Health
- Substance Use Services
69
What are 4 stipulations under PPACA?
1) Insurers may not discriminate or deny coverage to patients with mental illness because of pre-existing conditions
2) patients may remain on their parent's health insurance until they are 26 years old
3) currently, admission of a patient to a mental health unit can occur involuntarily or on a voluntary basis
4) If the patient's history and medical records indicate suicidal tendencies, the patient must be kept under supervision
70
What is the Uniform Anatomical Gift Act?
A person 18+ has the right to make an organ donation
71
what is the order a dead persons family is approached to have them consider donating their loved ones tissue or organs?
1) Spouse
2) adult son or daughter
3) parent
4) Adult brother or sister
5) grandparent
6) guardian
72
What is HIPAA?
The Health Insurance Portability and Accountability Act: Provides rights to patients and protects employees
73
what are some rights the HIPAA provides(3)?
1) protects employees from losing their health insurance when changing jobs
2) Protects patients health information and right to consent
3) limits who is able to access a patient's record
74
What is HITECH?
The Health Information Technology Act: Ensures that patient PHI is not inadvertently conveyed on social media
75
what are some attributes of HITECH?
* HITECH expands principles extended under HIPAA, especiall when a security breach of personal health information (PHI) occurs
* Under HITECH, nurses must ensure that patient PHI is not inadvertently conveyed on social media and that protected data is not disclosed other than as permitted by the patient
76
Who sets standards in the use of restraints?
1) The Centers for Medicare and Medicaid Services (CMS)
2) American Nurses Association (ANA)
3) The Joint Commission (TJC)
77
when can restraints be used?
1) to ensure the physical safety of the patient or other patients
2) when less restrictive interventions are unsuccessful
3) only on the written order of a HCP
78
A nurse is caring for a patient who states, “I just want to die.” For the nurse to comply with this request, the nurse should discuss:
A. living wills.
B. assisted suicide.
C. passive euthanasia.
D. advance directives.
D
79
what is PSDA?
The patient Self-Determination Act: Requires health institutions to provide written information to patients of their rights to make decisions; to refuse treatment; formulate advance directives
80
what must happen for living wills or durable powers of attorney to be enforced?
the patient must be declared legally incompetent or lack the capacity to make decisions regarding his or her own health care treatment
81
what should you do to determine whether an advance directive set in another state is honored in your state?
check your state laws
82
what is a living will?
written documents that direct treatment in accordance with the patient's wishes in the event of a terminal illness or condition
83
What is a healthcare proxy or durable power of attorney?
a legal document that designates a person or people of one's choosing to make healthcare decisions when a patient is no longer able to make decisions on his or her own behalf
84
what is required before attaching a DNR order to a patient's medical record?
documentation that the HCP has consulted with the patient and/or family is required before attaching DNR to medical record
85
Who licenses all registered nurses in the states where they practice?
The State Board of Nursing
86
what are good samaritan laws?
laws that limit liability and offer legal immunity for nurses who help at the scene of an accident
* some states require nurses to help at the scene of an accident
87
what happens if you perform a procedure that exceeds your scope of practice and for which you have no training at the scene of an accident?
you are liable for injury that may result from the act
88
what happens if you leave an accident victim without properly transferring or handing them off to a capable person?
you may be liable for patient abandonment and responsible for any injury suffered after you leave them
89
What are public health laws?
Protects populations, advocates for the rights of people, regulates healthcare and healthcare financing, and ensures professional accountability for care provided
90
what happens if a healthcare professional does not report suspected child abuse or neglect?
may be liable for civil or criminal legal action
91
What is the Uniform Determination of Death Act?
states that healthcare providers can use the cardiopulmonary definition or whole brain definition to determine death
92
what is the cardiopulmonary definition of death?
this standard requires irreversible cessation of circulatory and respiratory functions
93
what is the whole-brain definition of death?
this standard requires irreversible cessation of all function of the entire brain, including the brainstem
94
what definitions of death facilitate the recovery of organs from a person for transplant?
either the cardiopulmonary or whole-brain definitions of death
95
who can request an autopsy or postmortem examination?
if the patient's death is not subject to a medical examiner review, consent must be obtained by the patient or patients family
96
what is the priority of consent for autopsy(4)?
1) patient
2) durable power of attorney
3) surviving spouse
4) surviving child, parent, or sibling
97
what is the Oregon Death with Dignity Act?
* the first statute that permitted physician assisted suicide
* states that competent-yet-terminal patients could make oral or written request for medication to end their life in a human and dignified manner
98
what is a terminal disease?
defined as an incurable and irreversible disease that has been medically confirmed and that will, within reasonable medical judgement, produce death within 6 months
99
how does the ANA feel about assisted suicide?
ANA held that assisted suicide violates the code of ethics for nurses
100
What is a tort?
a civil wrong made against a person or property
101
how are torts classified?
1) intentional
2) quasi-intentional
3) unintentional
102
what are intentional torts?
willful acts that violate another persons rights including:
* assault
* battery
* false imprisonment
103
what is assault?
an intentional threat toward another person; no contact is required for assault to occur
104
what is battery?
any intentional offensive touching without consent or lawful justification; contact can be harmful or merely offensive to a patients personal dignity
105
if a provider performs a procedure that goes beyond the scope of the patient's consent it is considered...
battery
106
what is the tort false imprisonment?
unjustified restraint of a person without legal reason; requires that the patient be aware of the confinement
107
what are quasi-intentional torts?
* Invasion of privacy
* Defamation of character
108
what is invasion of privacy?
the release of a patient's medical information to an unauthorized person such as a member of the press, patient's employer, the patient's family, or online
109
what is defamation of character?
the publication of false statements that result in damage to a person's reputation
forms of defamation of character:
* Slander
* Libel
110
what is slander?
occurs when one person speaks falsely about another
111
what is libel?
written defamation of character
112
what are unintentional torts?
torts that are unintentional:
* Negligence
* Malpractice
113
what is negligence?
conduct that falls below the generally accepted standard of care of a reasonably prudent person
114
what is malpractice?
a type of negligence; often referred to as professional negligence
115
what is the criteria necessary to establish nursing malpractice?
* The nurse (defendant) owed a duty of care to the patient (plantiff)
* The nurse did not carry out or breached that duty
* The patient was injured and the nurses failure to carry out the duty caused the injury
116
a patient's signed consent form is required for what(5)?
1) admission to healthcare agency
2) invasive procedures such as central line insertions
3) surgery
4) some treatment programs such as chemotherapy
5) participation in research studies
117
informed consent creates a legal duty for the healthcare provider to...
disclose material facts in terms the patient is able to understand to make an informed choice
118
informed consent is part of the HCP-patient relationship. it must be obtained and witnessed when...
the patient is not under the influence of medication such as opioids. it is not the nurses responsibility to get informed consent; nurses responsibility to to witness the consent and make sure that the patient understands
119
In general, Informed consent is what?
An agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal
120
what is the nurses role in informed consent?
the nurse signs as a witness to the consent and that patient voluntarily gave consent, the patients signature is authentic, and the patient appears to be competent to give consent
121
what do you do if the patient denies understanding or you suspect they do not understand the information related to informed consent?
notify HCP or nursing supervisor
122
do patients with mental illness also have to give consent for procedures?
they must also provide consent; they retain the right to refuse treatment unless a court has determined legally that they are incompetent to decide for themselves
123
things to note about nursing students(3):
* You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university.
* You are expected to perform as a professional when rendering care.
* You must separate your student nurse role from your work as a certified nursing assistant (CNA).
124
what is malpractice insurance(3)?
1) A contract between the nurse and the insurance company
2) provides defense when a nurse is in a lawsuit involving negligence or malpractice
3) Nurses are covered by institutions insurance while working
125
A student nurse employed as a nursing assistant may perform care:
A. as learned in school.
B. expected of a nurse at that level.
C. identified in the hospital’s job description.
D. requiring technical rather than professional skills.
C
126
When can a nurse refuse an assignment at work?
1) nurse lacks the knowledge or skill to provide competent care
2) care exceeding the Nurse Practice Act is expected
3) Health of nurse or unborn child is directly threatened by the type of assignment
4) orientation to the unit has not been completed and safety is at risk
5) The nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds
6) the nurses clinical judgement is impaired as a result of fatigue, resulting in a safety risk for the patient
127
The Community Health Accreditation Program (CHAP) requires agencies to have:
guidelines for nurse/patient ratios
128
nurses who float must inform their supervisor of...
any lack of experience in caring for the type of patients on the nursing unit
129
nurses follow HCPs orders unless...
they believe that orders are in error, violate agency policy, or are harmful to the patient
130
what do you do if the HCP confirms an order that you feel is wrong?
inform your direct supervisor
131
make sure all HCP orders are...
in writing, dated, times, and transcribed correctly
132
Occurrence reporting:
* serves as a database for further investigation
* alerts risk management to a potential claim situation
133
what are components of risk management and quality assurance?
* occurrence reporting
* documentation
134
documentation is often the evidence of...
care received by the patient and establishes support that the nurse acted reasonably and responsibly
135
You are about to administer an oral medication and you question the dosage. You should:
A. administer the medication.
B. notify the physician.
C. withhold the medication.
D. document that the dosage appears incorrect.
B
