Nursing Exam 4 Flashcards
1
Q
Autonomy
A
the right to self-determination - to choose and act on that choice (every competent person has the right to decide their own choices)
2
Q
Breach of Duty
A
occurs when a nurse does or does not do, what a reasonable nurse would have done under the same, or similar circumstances
*Nurse’s care fell before the acceptable standard of care
3
Q
Causation
A
Must clearly show the connection between the nurse’s action or omission and the resulting injury to the patient
4
Q
Assault
A
Occurs when a nurse intentionally places a patient in immediate fear of personal violence or offensive contact
*Verbal, must include words expressing an intention to cause harm and some type of action
Ex: If you keep acting like that, I’m gonna restrain you
5
Q
Battery
A
Physical contact/touch (hitting/pushing)
-Committed when an offensive or harmful physical contact is made to the client without his consent, or there is unauthorized touching of a person’s body by another person
6
Q
False Imprisonment
A
The restricting of a person without proper legal authorization (includes any type of unjustified restriction on a person’s freedom or movement
7
Q
What do all religions have in common?
A
Theology
-Discussions and theories related to God and God’s relation to the world
8
Q
What are the core issues of Spirituality?
A
-Faith (lets us trust & be optimistic, gives us purpose in life, allows us to experience sense of self; Ex- putting faith in God to get you through chemo)
-Hope (basic need to achieve, create, & shape our lives; Ex - cling to hope with cancer diagnosis)
-Love (seen through kindness, patience, endurance, and truthfulness
9
Q
What are barriers to spiritual care?
A
-Lack of general awareness of spirituality
-Lack of awareness of your own spiritual beliefs
-Differences in spirituality between nurse and pt
-Fear that your knowledge is insufficient
-Fear of where spiritual discussions will lead
10
Q
What is the standardized spiritual assessment?
A
FICA
11
Q
What does FICA stand for?
A
F- Faiths or beliefs (what are yours?)
I- Importance and Influence
C- Community (spiritual support)
A- Address (is there something nurse can do in regards to spirituality)
12
Q
Grief
A
Internal process a person works through due to a loss
13
Q
Loss
A
Actual or potential situation in which someone or something is no longer present or available to a person (at every stage of life)
14
Q
Bereavement
A
Form of depression accompanied by anxiety in response to loss of loved one
15
Q
Mourning
A
Actions and expressions of bereavement including rituals, symbols, and acions
16
Q
What is an actual loss?
A
Can be identified by others, not just the person experiencing it
*Can SEE you lost something
17
Q
What is a perceived loss?
A
Only identified by the person experiencing it (internal)
*Only person who perceives as loss is the person experiencing it
18
Q
External Loss
A
Actual loss of objects that are important to the person
-Theft
-Destruction
-Disasters (floor or fire)
19
Q
What is an Internal Loss
A
Another term for perceived or physcological losses
20
Q
Physical loss
A
-Injuries (amputation)
-Removal of an organ
-Loss of function (mobility, bladder function)
21
Q
Psychological loss
A
Perceived loss, challenges our belief system
Commonly seen in:
-Sexuality
-Control
-Fairness
-Meaning
-Trust
22
Q
Uncomplicated (Normal/Functioning) Grieving
A
(What we want people to go through)
-Natural response to a loss
-Person may experience a range of feelings, but it decreases over time
23
Q
Complicated (Dysfunctional) Grieving
A
-Maladaptive, usually prolonged or overwhelming
-May become suicidal, workaholic, socially isolated, or demonstrate addictive behaviors
24
Q
Chronic grieving
A
Begins as normal, but continues as long term with little resolution (inability to join normal life)
25
Masked Grieving
Person is grieving, but expressing it through other types of behaviors
26
Delayed grieving
Putting off grieving for periods of time
27
Disenfranchised grieving
You have a connect with the loss that is not socially supported or acknowledged by the usual rites of ceremonies
*Ex: Mistress, children ripped from home (can't go through normal grieving process)
28
Anticipatory grieving
-You are experiencing a loss before it occurs
*May be emotionally unavailable to the dying person
29
What factors influence grief?
-Significance of the loss
-Support system
-Unresolved conflict
-Circumstances of the loss
-Previous loss
-Spiritual care/beliefs and practices
-Timeless of the Death --> Child vs elderly (a lot of life left to live vs got to live a good life)
30
True or False:
90% of people die in expected pattern
True
31
True or False:
Physiological stages of dying are the exact same for every person
False, they can have similarities, but are still unique to every person
32
What are the physiological stages of dying 1-3 months before death
-Client begins to withdraw
-Sleep increases
-Difficult to digest food, liquids preferred
33
What are the physiological stages of dying 1-2 weeks before death
-Reduces BP, changes in pulse, skin color turns paler
-RR may increase or decrease, apnea with sleep
-Congestion - rattling sounding cough
34
What are the physiological stages of dying days to hours before death?
-Surge of energy
-Mental clarity
-Desire to eat
-Talk with family members
-Difficulty swallowing
-Decreased BV, dehydrated
-Gag reflex declines
-Secretions accumulate
-Mucous membranes dry and tacky
-Lips cracked
-Respirations shallow, irregular
-Peripheral circulation decreases, increased perspiration, extremities are cooled, BP decreases, pulse hard to find
-Peristalsis slows, urine output decreases
-Muscles relax, droopy face
-Vision blurs
-Restless and agitated
35
What are the physiological stages of dying moments before death?
-No response to touch or sound
-Cannot be awakened
-Short series of long spaced breaths before breathing ceases entirely and heart stops beating
36
What are the 7 stages of grief?
-Shock
-Denial
-Anger
-Bargaining
-Depression
-Testing
-Acceptance
*DABDA
(Shock and testing were added)
37
What are legal and ethical issues regarding death in health care?
-ADs
-Living will
-Durable Power of attorney (Healthcare Proxy)
-DNR
-Assisted suicide
-Euthanasia
-Autopsy
-Organ donation
38
Post-Mortem:
Why do you elevate HOB ASAP?
To prevent discoloration of face
39
True or False: Post-Mortem
You leave dentures in pts mouth
True: helps to keep their face shape
40
Spirituality
A journey that takes place over time and involves the accumulation of life experiences and understanding
*Attempt to finding meaning in life
41
What was the history of spirituality in the Pre-Christian era
-Caring for sick was an expression of hospitality/charity
-Praying to the God(s) for healing
42
What is the history of spirituality in the early Christian era
-Jesus Christ's primary teaching
-Caring for the sick was honored and respected
-Gradually combined health arts with religious care
43
What is the history of spirituality in the Post-Reformation period in Europe
-Nursing orders flourished
-Nightingale --> spirituality was the heart of human nature and fundamental to healing
-Bringing comfort and relief to the sick and dying - Lady with the Lamp
44
Religion
"The map you take to get to a certain destination"
Involves:
-Beliefs
-Values
-Rituals
-Code of Conduct and Ethics
45
Morals
-Learned from external influences and communicated through various systems
-Good or bad/ right and wrong
-Ex: Treat others the way you want to be treated
46
Moral behavior
Consistent with customs or traditions based on external influences (religious beliefs)
47
Immoral behavior
A person whose behavior is inconsistent with traditional notions (inconsistent with right and wrong)
48
Ethics
The study of more principles and standards, or the process of using them to decide your conduct and actions
-What is right or wrong?
-What actions should be taken in certain circumstances?
*Just because something is accepted does not mean it is ethical
Ex: Is it wrong to steal if I need to feed someone?
-Should we turn off the ventilator on pt?
-Should baby go through surgery even if they will not have a good quality life?
49
What Ethical Principle is used for ethical decision making?
MORAL Model
50
Bioethics
the application of ethical principles to every aspect of healthcare
Ex: Direct care of pts, allocation of resources, utilization of staff, medical/nursing research
51
What does the MORAL Model stand for?
M- Massage the Dilemma
O- Outline the Options
R- Resolve the Dilemma
A- Act by Applying the Chosen Option
L- Look back and evaluate
52
When does moral outrage occur?
When we perceive others acting immorally, it makes us feel powerless
53
When does moral distress occur?
When we can't act as moral agents, when we are prevented from acting on our moral decisions
*Ex: Growing up believing abortion is wrong, but caring for a pt who needs one
54
Human Dignity
Respect for the inherent worth and uniqueness of individuals and populations (provide it by being considerate, believing them, advocating, privacy, and confidentiality)
55
Informed consent
The right of competent pts to decide whether to agree to a treatment (pt needs to know alternative treatment options, the risks and benefits, treatment info, and provider)
56
Nonmaleficence
Do no harm AND prevent harm
-Does this treatment cause more harm than good?
57
Beneficence
The duty to do good or promote good
-Prevent harm when you can
-Remove harm
-Do no harm
58
Fidelity
Faithfulness; the duty to keep promises
-The same regardless of level of importance
59
Veracity
The duty to tell the truth
-Be culturally sensitive
-Consider the context
60
Justice
The obligation to be fair
-Could be allocating time or resources
61
Professional Code of Ethics
Formal group expectations and standards for professional behavior of the profession
*Not legally binding
62
International Council of Nurses
A guide for action on social values and needs, nursing standards worldwide
63
American Nurses Association
Establishes the ethical standards for the profession, guide fro nurses in ethical analysis and decision making
64
The Patient Care Partnership
Entitles patients to rights:
-Maker their own decisions
-Be active partners in their treatment
-Be treated with dignity and respect
65
The Joint Commission Accreditation Standards
Organizational ethics and individual rights, requires ethics in care, treatment, services, and business
66
Value
A belief about the worth of something
-Behaviors, feelings, knowledge, or decisions, goals, models of conduct, ideas, beliefs (changes around people and experiences you have)
You can value
-An idea
-A person
-A way of doing things
-An object
67
Value neutrality
To understand our own values regarding an issue and be able to become nonjudgmental when providing care to clients
Ex: having a family member who had passed away from an opioid addiction & caring for a patient with an opioid addiction
68
True or False:
Nursing students can for values through education and clinical
True
69
Moralizing
Authoritarian approach "this way is the only way"; unable to make independent choices
70
Laissez-faire
Explore set of values with little guidance "doing your own thing" or discipline
71
Responsible choice
A balance of freedom and restrictions allows them to explore new behaviors and experience the consequences
72
Value Clarification
The process of becoming conscious of an naming one's values
-Allows you to make good decisions and to avoid imposing your views on others
-Positive process of growth that results in awareness, empathy, and insight
-May be done multiple times throughout lifespan as values change
73
Attitudes
Mental dispositions or feelings toward a person, object, or idea
-Our way of responding to situations or things
-Can be positive or negative
74
Beliefs
Something that one accepts as true
-Can be based on faith or facts
-Can be true or false
-Altered based on acquired knowledge and experiences
75
ANA Code of Ethics for Nurses
Focus on the collaboration of healthcare professionals and the community to protect human rights and reduce health disparities
76
American Association of Colleges of Nursing (AACN) values
-Altruism
-Integrity
-Social Justice
77
Altruism
Concern for the welfare and well-being of others (Key of nursing- What do we care about? The well-being of our pts)
78
Integrity
Acting in accordance with an appropriate code of ethics and accepted standards of practice (honesty)
79
Social Justice
Upholding moral, legal, and humanistic principles; treating others fairly regardless of age, race, citizenship, economic status, disability, or sexual orientation (equality)
80
Liability
The person financially or legally responsible for something
-Nurses are legally responsible for their actions --> The nurses owed a "duty of care" and they "breached" that duty
-Cannot be delegated
80
True or False:
Negligence is not a type of malpractice
False, negligence is a type of malpractice
80
Malpractice
-Professional person failed to act in a reasonable manner
-If someone is injured, professional may be held accountable
80
When does Malpractice occur?
-Occurs when a hospital, doctor, or healthcare professional causes injury to a patient through a negligent act or omission
*Could be a result of errors in diagnosis, treatment, aftercare or health management
*Pt must prove that negligence caused injury
81
What is needed to prove that medical malpractice occured?
1) A doctor - pt relationship existed
2) The doctor was negligent
3) Negligence caused injury
4) Injury led to specific damages
5) Failure to diagnose
6) Improper treatment
7) Failure to warn a patient of known risks
82
Negligence
The failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent (careful) manner
Ex: As a nursing instructor, I don't verify you are capable of doing a skill before allowing you to proceed with it
83
Abandonment
When a nurse deserts or neglects a patient with whom they have established a provider-pt relationship without making reasonable arrangements for the continuation of care and without reasonable notice
*Not "I'm sick and the hospital could not find staff to cover me"
*Have to be on shift, walk in, something happens, and you leave your floor and do not come back
84
What is the Bill of Rights?
-First 10 Amendments to the U.S. Constitution
-Identifies and limits the role of government in individuals' lives
-Direct implication in healthcare (Includes rights of nurses and pts, helps with privacy of pts like HIPPA)
85
HIPPA (Health Insurance Portability & Accountability Ace- 1996)
-Protect health insurance benefits for workers who lose or change their job
-Protect coverage to persons with preexisting medical conditions
-****Establish standards to protect the privacy of personal health information (confidentiality)
86
Patient Self-Determination Act 1991
Recognizes the client's right to make decisions regarding his or her own healthcare
-Document presence/absence of AD, provide education of ADs, follow state laws regarding ADs, treat everyone the same
87
True or False:
In emergency situations, we still need to get informed consent
False- we can skip (especially if they cannot find a representative to ask)
88
Durable Power of Attorney (DPOA)
-Identifies a person who will make healthcare decisions in the event the pt is unable to do so
-With POA, they are only making decisions if pt is unable to do so
89
Advances Directive (AD)
Written or oral instructions that explain specific wants by a person regarding their end of life care if they were incapacitated or unable to express their desires
90
Living Will
A written document that provides specific instructions about what a person wants
Ex: "I don't want these to occur... NG tubes, intubation, ICU Care"
91
DNR
Specific physician order, signed by the physician, starting not to compete any type of life supporting measures (CPR)
92
Assisted Suicide
Anyone making something available that allows for the person to end their life
93
Physician Assisted Suicide
When a physician makes pharmacological medication available to a person specifically to end their life
94
Euthanasia
The deliberate ending of someone's life from a terminal or incurable illness
Ex: We euthanize animals all the time
95
Autopsy
The medical examination of a body to determine cause of death
*Only done on specific people (trauma, abuse, recent surgery, in restraints)
96
Organ donation
Donation of the tissue, organs and/or skin
97
Emergency Medical Treatment and Active Labor Act (EMTALA)
Requires healthcare facilities to provide emergency medical treatment to patients who seek healthcare in the emergency department, regardless of their ability to pay, legal status, or citizenship status
-Screening can be used to determine emergency
Ex: If you are having a heart attack or are a gunshot victim, hospital must stabilize you before transferring you
98
Americans with Disabilities Act (ADA) 1990
-Protections against discrimination of individuals with disabilities
-Under ADA, employers are requires to make reasonable accommodations in order for a disable person to perform their job
99
Mandatory Reporting
A legal requirement in state statue or regulation for nurses to report an occurrence or individual, including another nurse, when the public is at risk (even if it is a violation of HIPPA, we have to report it)
Ex: Nurses with substance abuse, any vulnerable population abuse or neglect, any communicable diseases like HIV, gonorrhea, syphilis)
100
Good Samaritan Act
Offer legal protection to people who give reasonable assistance to those who are, or whom they believe to be injured in peril or otherwise incapacitated
Ex: If you stop at a car accident and make a silly decision that accidentally causes harm, you are not legally liable
101
Nursing Practice Act
-Regulate nursing practice to protect the health, safety, and welfare or the general public
-Define the scope of nursing practice
-Approve programs providing licensure nursing education to students
102
Medical malpractice statues
A lawsuit brought against a healthcare provider for damages when there has been death of, injury to, or other loss to the person being treated
103
Criminal Law
Wrongs or offenses against society; violation of a law; laws vary state to state
104
Felony
Crime punishable by more than 1 year in jail (ex: Murder, suicide, rape/sexual assault, stealing drugs and equipment)
-May lose licensure (most of the time), right to vote, hold public office, possess firearms
105
Misdemeanor
Less than a year in jail (Ex: assault, battery, petty theft)
-May lose licensure
-Does not have to be nursing related crimes -- DUIs, punching someone in a bar, etc
106
Tort Law
Wrongs done to one person by another person that do not involve contracts
-Classified as quasi-intentional torts, intentional torts, or unintentional torts
107
Unintentional Tort
negligence or malpractice
108
Quasi-Intentional Tort
Defamation of Character
-Libel: written or published form of defamation of character (physical)
-Slander: verbal form of defamation of character (words)
109
Fraud
False statements, falsifying documents, concealing information that should have been disclosed
110
Florence Nightingale (1860)
Focused on cleanliness and the environment
111
Peplau
Theory of Interpersonal Relations
-You need to have communication with your pts
112
Virginia Henderson (1955)
Nursing Need Theory (14 needs)
-Created because she had 14 needs
113
Dorothy Johnson (1968)
Behavioral System Model
-Focused on behavior function
114
Dorothea Orem (1971)
You need to be able to fulfill biological, psychological, developmental, or social needs to be healthy
115
Imogene King (1971)
Patient Environment and nurse-pt relationship is part of the nurse for meeting goals towards good health
116
Betty Neuman (1972)
Reduce stress of patient
117
Sr. Callista Roy (1979)
Viewed individual as a set of interrelated systems who strives to maintain the balance between these various stimuli
118
Jean Watson (1979)
Caring Theory
-You need to be caring and humanistic
119
Assumptions
Ideas that we take for granted - Concepts or statements that are presumed to be true, don't plan to test them
120
Phenomena
Aspects of reality that you can observe - Subject matter, what makes them unique
121
Concepts
Mental image or symbol of phenomenon - form these through observation or experiences; use them to find similarities, differences, organize, and categorize; can do this from simple to complex or from concrete to abstract
Ex: Mental image of what I believe everyone is going through
122
Theoretical definition
Pain is an unpleasant experience associated with potential tissue damage
123
Operational definition
Specifies what you deserve (pain is the pts verbal statement that he is in pain)
124
Paradigm
The world view or ideology of a discipline (how we see things) --> Our broadest cinceptual framework
125
What are the 4 major concepts frequently interrelated and fundamental to nursing?
Person
Health
Environment
Nursing
126
Nursing Paradigm
Looks at the entire person
-Look at physical, psychological, spiritual, and social health changes
127
Medical Paradigm
Focuses on identifying and treating disease
128
True or False:
Doctors treat, nurses care
True
129
Are Grand Nursing Theories Broad of Narrow?
Broad
Ex: Everybody should care and everybody should be clean
130
What are Mid Range Theories?
Narrower and more specific than Grand Nursing Theories
-Help design our educational programs, help with protocols and procedures in the hospital
(Teach us how to care and clean)
131
Practice theories
Most specific, focus on a specific situation; used for goals and outcomes
Ex: Only focus on CHF pts
132
Inductive Reasoning
(What we typically do)
-Go from specific to general
-Gather separate pieces on info, recognize a pattern, and form a generalization about the pt
*I have data, now I need to conclude what the problem is
133
Deductive reasoning
-Goes from general to specific
Ex: You receive a call from the ER that you will be receiving a new pt with a kidney infection, you know that pt may arrive with possible symptoms
*I see the problem, now I need to gather data to support the problem
134
Quantitative
-Gather objective data (labs, vitals, etc)
-Surveys, census, chart audit
-Yes or no questions
-Reported as #s
-Generalize the results to a similar population
135
Qualitative
-Subjective data from a small # of subjects
-Open-ended interviews, may perform observations or complete written questionnaires
-Identifies themes
-Research is about sharing the "lived experience"
136
What are barriers to Research for Nurses
-Hesitancy to change nursing practice
-Lack of knowledge or nursing research
-Negative attitudes towards research
-Lack of support from the employing institution
-Study findings that are not ready for the clinical environment
