Legal and ethical Flashcards
1
Q
what is the study of ideal human behavior and ideal ways of being
A
ethics
2
Q
What kind of process is ethics rather than what?
A
active process rather than a static condition
3
Q
What are ethics an active process of?
A
It is an active process of moral deliberation.
4
Q
What are specific beliefs, behaviors, and ways of being
A
morals
5
Q
morals are what you deem as…
A
right and wrong
6
Q
What is something of worth, something that is highly regarded?
A
values
7
Q
What are rule-based criteria for conduct that naturally flow from the identification of obligations and duties?
A
principles
8
Q
What is a specific domain of ethics that is focused on moral issues in the field of health care?
A
bioethics
9
Q
Why do we primarily need bioethical principles?
A
advancements in technology and medicine. Sig. progress in mid 20th century
10
Q
What is important to consider with resources in bioethical principles?
A
allocation of resources; who gets the resources and who doesn’t
11
Q
What are some examples of issues with research boundaries?
A
- animal testing
- Pregnant women & children
- Human testing
- -> WW2
- -> Tuskegee Study (169 males were given syphillus)
12
Q
What are the 4 key principles for analyzing and resolving bioethical problems?
A
- autonomy
- nonmaleficence
- beneficence
- Justice
13
Q
define autonomy
A
freedom and ability to act in a self-determined manner
14
Q
What does autonomy require?
A
informed consent
15
Q
What does informed consent require? (3 things)
A
- competency
- disclosure, recommendation, understanding of risks and benefits
- voluntary authorization
16
Q
Who is responsible for the actual process of obtaining informed consent?
A
the provider
17
Q
What is the role of the nurse in the informed consent process?
A
just to make sure the patient understands what is going to happen.
18
Q
What do the patient’s have right to do with autonomy?
A
the right to refuse
19
Q
What was the first federal statute of autonomy?
A
the patient self-determination act
20
Q
What did the patient self-determination act require?
A
provide written info regarding the right to make those healthcare decisions to refuse or withdraw treatments at any time, and to write advance directives.
21
Q
What do we have an obligation to do when disclosing information?
A
disclose comprehensive and truthful information
22
Q
What do providers need to disclose about with autonomy?
A
diagnosis and treatment options
23
Q
When is intentional non-disclosure allowed?
A
not disclosing is only legal when it is an emergency in competency, or the patient waves the right to be informed.
24
Q
What needs to be maintained in autonomy?
A
- privacy
- confidentiality
think HIPPA
25
What is the principle used to communicate the INTENTIONAL obligation to do no harm?
nonmaleficence
26
How do beneficence and nonmaleficence differ?
1. Beneficence involves action to help someone.
| 2. nonmaleficence requires intentional avoidance of actions that cause harm
27
What is upholding standards of care in nonmaleficence?
abiding by standards that are specific to one's profession AKA the acceptable and expected care a reasonable person in a profession would provide.
28
What is negligence?
the absence of due care
29
What is imposing a risk of harm with negligence?
imposing an unintended careless risk of harm OR imposing an intentional reckless risk of harm.
30
What is the rule of double effect with nonmaleficence?
intended effects and merely foreseen effects.
| i.e. morphine!! - pain and respiratory depression
31
What does it mean when people take actions to benefit and promote the welfare of other people
beneficence
32
What guides beneficence?
ANA code of ethics
33
What is paternalism?
When the RN makes the decisions based on their own personal beliefs rather than beliefs of the patient.
34
What is a principle in healthcare ethics that refers to fairness?
Justice
35
What does justice involve?
1. treating people equally and without prejudice
2. equitable distribution of benefits and burdens.
3. assuring fairness in biomedical research
36
What are 2 ethical principles in nursing?
1. Human dignity
| 2. Patient advocacy
37
What is the importance of human dignity to a nurse?
nurses are charged with protecting a patient's dignity during all nursing care
38
What kind of role does the nurse often assume with a patient's dignity?
often a patient's nurse is the primary person who guards a patient's dignity during medical procedures.
39
What do nurses do in patient advocacy?
nurses try to identify unmet patient needs and then follow up to address the needs appropriately.
40
What are the 9 principles outlined in the ANA code of ethics?
1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
41
What is the international council of nurses?
a globally accepted document for ethical practice in nursing
42
What are the 4 key principles of the ICN code of ethics?
1. nurses and people
2. nurses and practice
3. nurses and the profession
4. nurses and coworkers
43
What must a nurse be able to differentiate in practice?
personal values and morality from professional values to ensure patient autonomy, nonmaleficence, and justice
44
What must a nurse be able to differentiate in practice?
personal values and morality from professional values to ensure patient autonomy, nonmaleficence, and justice.
45
What must nurses follow in practice?
the board of nursing's legal regulations and standards for practice in his or her state of residence?
46
Who do the legal regulations and standards ultimately protect?
the public
47
What further define the scope of practice for nurses?
1. facility policies
| 2. facility procedures
48
True or false: facility policies and procedures can be more restrictive than those of the state.
true
49
What does scope of practice require?
training and competency - specialized training.
50
What do many states encourage health care professionals to do in non-employment related emergencies?
stop and render aid in non-employment situations through Good Samaritan statutes
51
Do good Samaritan laws vary from state to state?
yes
52
What do Good Samaritan laws offer?
offer immunity from lawsuit for bystanders who offer aid in emergencies
53
what does immunity cover in Good Samaritan laws?
covers only the scene of the accident and not subsequent care under the supervision of HCPs.
- cannot accept PAYMENT IN ARIZONA!!!!
54
What are professional boundaries?
limits that protect the space between the nurse's professional power and the patient's vulnerabilities
55
What are the underlying concepts of nurse-patient boundaries?
1. power
2. choice
3. trust
56
What are boundary crossings?
short lived, accidental. (grieving or crying with family)
57
What do you need to always clarify with nursing boundaries?
values of the patient!!! "What would you do"
58
What happens in values transmission with nursing boundaries?
"Well if this was my mom then I would do this."
59
What is a situation in which an individual is compelled to choose between 2 actions that will impact the well-being of a sentient being
ethical dillemmas
60
What are the 3 possibilities that create an ethical dilemma?
1. both actions can be reasonably justified as being good
2. Neither action is readily justifiable as good.
3. The goodness of the actions is uncertain
61
Why is ethics hard in nursing?
moral matters are so pervasive that nurses often do not even realize that they are faced with minute-to-minute opportunities to make ethical decisions
62
What is so crucial in ethics?
reflection is crucial to the practice of ethics.
63
What does reflection involve in ethics?
involves stopping to think about what one is choosing and doing before and during one's actions.
64
What are the four topics used to analyze ethical decision making and cases?
1. medical indications
2. patient preferences
3. quality of life
4. contextual features. - loyalty and fairness, family issues, benefits that military families get, provider issues, financial and economic factors, religious or cultural factors.
65
What are ethics committees?
a group of nurses who participate in reflective dialogue with other healthcare professionals. They are part of a team approach to ethical analysis by serving
66
What does an ethics committee usually consist of?
Usually consists of...
1. physicians
2. nurses
3. an on-staff chaplain
4. a social worker, an administrator
5. possibly a legal representative
6. local community representatives
67
What are the goals of the ethics committee?
1. provide support to families in decisions
2. review cases as requested when there is conflict
3. provide assistance in clarifying situations if they are ethical nature
4. Help to clarify what are the main issues that they are encountering --> discuss alternatives, suggest compromises
5. Always try to promote the rights of patients
6. Help the patient and physician compromise on treatment decisions.
7. Promote fair policies and procedures
8. Do not have the right to negate the decisions of family and patients.
68
What is stereotyping and discrimination against older adults based on age?
ageism
69
what is our goal with elder population?
maintaining the patient's dignity when they cannot care for themselves.
70
What is often used to alleviate suffering/quality of life?
euthanasia
71
What is euthanasia?
- -> active euthanasia= intentional or purposeful that HCPs would take to cause immediate death.
- -> passive euthanasia = withholding treatment!!
- -> voluntary euthanasia = physician assisted suicide
72
What is the salvageability principle?
Providers need to respect a person's right to choose a suitable course of medical treatment.
- if the person is salvageable or not??
73
What is the unacceptably low chance of achieving a therapeutic benefit for the patient?
medical futility
74
What is important to know about palliative care:
Not necessarily hospice care; it is done with chronic diseases.
75
Patients have 2 rights, and what are those rights?
1. right to die
| 2. right to refuse treatment
76
What is important to consider the right to die?
1. Is the patient competent?
| 2. Have they already attempted death?
77
What are some ethical/legal dilemmas in critical care?
1. advanced directives
2. DNR
3. family presence and visitation in the ICU
78
What are issues specifically addressed in advance directives?
1. Treatments to refuse
2. The time the directive needs to take effect
3. Hospitals and physicians to be used
4. what lawyers to use
79
What are the 2 types of advance directives ?
1. living will
| 2. durable power of attorney
80
What does the patient self determination act of 1990 require for nurses?
Keep the link between the patient and the provider with
81
What is a psychiatric advanced directives?
1. completed by psych patients that are competent.
| 2. They want to direct their psych care if they lose their decision making capacity
82
What is a surrogate decision makers?
proxy that acts on behalf of the patient. (family, court appointed)
83
What is a surrogate decision makers?
proxy that acts on behalf of the patient. (family, court appointed)
84
If immediate family isn't available who is the surrogate decision maker?
neighbor or someone that has best interest
85
If someone of best interest isn't available who is next surrogate decision maker?
two physicians
86
What are the 3 types of codes?
1. Full code
2. Modified code
3. Do not resuscitate
87
What are modified codes?
- can decide whether they want certain things to be done or not to be done.
- can change their mind as often as the want. --> have to change the code band.
88
What is DNR more commonly referred to as?
Allow natural death
89
What does DNR not mean?
DOES NOT MEAN DO NOT TREAT
90
What is the dilemma of family visitation in code blue situations?
- Pros: decreased legal liability
| - Cons: increased legal liability, trauma to the family, chaotic
91
If a surrogate decision maker is available what 2 questions should you ask?
1. Should mechanical vent be instituted?
| 2. Does the nurse's personal values and morality interfere with this decision?
