Professional Foundations in Nursing Flashcards
What is nursing ontology?
The nature of reality in nursing
What is epistemology in nursing?
Our relationship with the truth and knowledge; what we do with our knowledge
Why is ethics needed in health care?
Technological advances, increasing complexity of health care, and growing sophistication of science and technology
What are professional responsibilities of nurses?
Serve public interest and common good, possess a unique body of knowledge, have multiple accountabilities, engage i decisions that influence and shape public policy, law and societal norms
What are the CNA entry to practice competencies of a registered nurse?
Clinician, advocate, coordinator,, communicator, collaborator, professional, educator
Why is it important that health care professionals know the law?
Failure to understand responsibilities and standards puts nurse at risk of discipline or legal action, nurses have legal obligations to their patients, nurses have corresponding rights
What does a code of ethics represent?
A characteristic of a professional body, a public declaration of a professions values and responsibilities, a formal expression of a professions values and responsibilities
What are the 7 principles of deontology?
Providing safe, compassionate, competent and ethical care, promoting and respecting informed decision making, preserving dignity, maintaining privacy and confidentiality, promoting justice, being accountable
What does the CNA code of ethics consist of?
Nursing values and ethical responsibilities, ethical endeavours: respond to and protect the vulnerable
What is the code of Hammurabi?
The first recorded collection of law and ethical codes in which justice was strict, the behaviour of women was regulated, and class distinctions occurred
What was the Hippocratic Oath (400 BC)?
Contains principles found in modern day codes: beneficence and nonmaleficence, sanctity of life, competence, professional integrity, privacy and confidentiality
What was the Nuremburg Code (1947)?
Established after the trials of Nazis accused of human experimentation
Reaffirms that research must be conducted with adherence to the ethical principles of informed consent, beneficence, and nonmaleficence
What did the early nursing ethical codes focus on?
Strong foundation in Christian morality, focused on obedience, compliance, etiquette, and loyalty to the physician, less focused on judgement, reflection or critical thinking
What are the values and ethical responsibilities outlined in the CNA code of ethics?
Providing safe, compassionate, competent, and ethical care, promoting health and well being, promoting and respecting informed decision making, preserving dignity, maintaining privacy and confidentiality, promoting justice, being accountable
What are the ethical endeavours outlined by the CNA code of ethics?
It challenges the profession of nursing to work collectively with others to recognize the diversity of the Canadian population, consider the challenges that influence the health and well being of the world and strive to reduce health disparities due to poverty, homelessness, and vulnerability
What values does the Canada Health Care Act outline?
Public administration, comprehensiveness, universality, portability and accessibility
What functions may clinical ethical committees have?
Consultation, education and policy making
What are some safety rights that patients have?
Right to respect and dignity and the right to be kept safe
What are common causes of adverse events in health care?
Human limitations/ error, communication breakdown, fatigue, workload, complexity of processes, reliance on memory over checklists, systemic problems
What are causes of adverse events in pediatric care?
Medication, unfamiliarity with peds care protocols, miscommunication, lack of coordination of care, lack of scope, depth and focus on documentation
What is one of the most important factors in developing a culture of patient safety?
Leadership: leaders must demonstrate commitment through articulated values and actions
What often precedes errors?
A series of events or misteps
What aspects of safety for nursing and health care is the RNAO concerned about in order to create a safe environment for patients and caregivers?
Quality care and nursing, quality work environments, and multi level accountability
What is ethics?
The philosophical study of morality
What is ethical theory?
The study of the nature and justification of general ethical principles that can be applied to moral problems
What is biomedical ethics?
Explores the ethical questions and moral issues associated with health care
What is nursing ethics?
Focuses on the moral questions within the sphere of nursing practice and relationships
What is applied ethics?
The field of ethics in which these theories and principles are applied to actual moral problems
What is morality?
The tradition of beliefs and norms within a culture or society about right and wrong human conduct
What are non-normative ethics?
The fields of descriptive ethics and meta-ethics: descriptive ethics gather factual descriptions and explanations of moral behaviours and beliefs; meta-ethics analyzes the meanings of terms such as right, obligation, good and cultures
What are normative ethics?
Attempts are made to identify the basic principles and virtues that guide morality
What are ethical dilemmas?
They arise when the best course of action is unclear and when strong moral reasons support each position
What is moral distress?
Results when we are not able to face these issues and deal effectively with them
What are values?
An ideal that has meaning or importance to an individual, group or society
What does the process of value clarification require?
Open discussion, active listening, and mutual respect
Who developed the Socratic method?
Plato and Aristotle
What does the Socratic method provide?
Frameworks and rules to determine right and wrong
What are teleological theories?
They consider outcomes and consequences of decisions and actions
What is the theory of utilitarianism?
There are no absolute rules to judge right and wrong, an action is right if it leads to the greatest good and least harm
Who is the best known deontologist?
Immanuel Kant
What did Kant describe?
The a categorical imperative which is an absolute rule for behaviour that exists in all circumstances
What did W.D. Ross propose?
The mature person intuitively knows what is good
What do ethical principles do?
They serve as a rule to moral conduct and assist in taking consistent positions on specific and related issues; provide a framework for ethical decision making for health care
What were the important principles applied to ethical challenges in health care according to Beauchamps and Childress?
Sanctity of life, autonomy, nonmaleficence, beneficence, justice, fidelity and veracity
What is nonmaleficence?
“first do no harm”
Obliges to act in a way that will prevent or remove harm
What is beneficence?
Obliges individuals to make positive moves that produce good or benefit for others; it is often in conflict with the principle of autonomy
What is fidelity?
Obliges nurses to be loyal, keep their promises and tell the truth to those in their care
What is veracity?
The duty to tell the truth
What does Carol Gilligan’s study of moral development challenge?
The notion that there is one superior way to think about moral problems - that is in terms of abstract and general notions of duty, justice and rights
What is the goal of feminists ethics?
To create a plan or ideology that will end the social and political oppression of women
What are the most important values in providing nursing care according to the CNO?
Client well being, client choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness, and fairness
What did Tommy Douglas and his government introduce?
The first single-payer, universal health care program
What is the Canadian legal system derived from?
English common law
What is common law?
A system based on rules, principles and doctrine developed by English judges that was meant to be applicable to all people in England
What is case law?
A collection or body of judges decisions rendered over centuries of judicial consideration and refinement
What is statute law?
Formal rules passed by legislation
What are the primary sources of common law?
Case law and statue law
What is the secondary source of common law?
Doctrine
What is a doctrine?
They are found in textbooks and journals written by legal scholars and experts, they carry more weight in civil law systems than common law systems
What is a custom?
Principles and rules of a particular trade, the courts will elevate accepted practice the that trade to a rule of law when statutes and the common law are silent on a particular issue
What are the 3 branches of government?
Judicial (courts), executive (queen/ governor general), and parliament (house of commons, queen and senate, legislature)
What is the concept of a “higher law” or “natural law”?
Humans have the capacity for reason, can judge what is good and just behaviour, and must be treated fairly and consistently
What is civil law?
It deals with private disputes between two sets of individuals, and incorporates a body of rules and principles governing relations among individuals, corporations and institutions
What is criminal law concerned with?
The relations between the individual and the state
What is a tort?
A civil wrong committed by one person against another, causing injury or damage
What is a tort in nursing?
Breaching duty of care; some level of damage
What does the criminal code of Canada achieve?
Lists criminal offences, outlines procedures governing arrests, charges, bail, hearings, trials, and sentencing, contains provisions dealing with appeals, and outlines criminal offences
What are the 3 classes of criminal offences in Canada?
Indictable offences, summary conviction offences dual procedure offences
What is the constitution?
A set of supreme laws that define and regulate the various branches of government, their powers and restrictions on those powers
What does the Charter of rights and freedoms accomplish?
It sets forth the basic legal and democratic rights, which cannot be infringed upon by the government unless it has a justifiable reason
What rights are protected by the charter of rights and freedoms?
Freedom of religion and conscience, thought and expression, press, peaceful assemble, and association
What are Canadian mobility rights?
Canadians have the right to enter, remain in and leave Canada, and to move and take up residence in any province
What are Canadian legal rights?
Right to life, liberty and security, not to be arbitrarily detained or imprisoned, and to be informed of the reasons for an arrest
What are Canadian equality rights?
All are equal before the law regardless of race, sex, ethic origin, colour religion, age, mental or physical disability and sexual orientation
What is the notwithstanding clause?
Provides that a law contravening the charter may apply for up to 5 years; it expires after 5 years unless invoked again
What is included in the informed consent and the health care consent act of 1996?
Consent to the nature of treatment, the expected benefits of the treatment, the material risks of the treatment, the material side effects of the treatment, alternative courses of action, the likely consequences of not having the treatment
In health care, what is a lack of consent considered?
Battery, an intentional tort
What happened in the Reibl vs Hugues case (1980)?
The patient was not informed of the risks of the surgery he underwent, had a stroke after surgery and he sued the surgeon for failure to inform him of the risks, leading to the surgeon being held liable for not explaining the risks adequately
What happened in the Malette vs Shulman case (1990)?
The patient was given blood without their consent after the physician found a card saying that she was a Jehovah’s witness, the court found the physician liable for battery
What was the Ciarlariello vs Schacter case (1993)?
The patient withdrew consent during a test, then was now properly informed of the risks of proceeding, then suffered a reaction and was left quadriplegic, the physicians were deemed negligent in explaining the procedure risks
What are conditions of informed consent?
Must be given voluntarily without coercion or pressure, must be fully informed of the risks and benefits of treatment, consent must be specific and given by a legally capable person
What is expressed consent?
A clear statement of consent given by the patient; often written
What is implied consent?
Inferrered from the patient’s conduct; ex. holding out arm for an injection
What makes an adult to be considered competent?
If a patient can appreciate the nature and consequences of the proposed treatment, they are considered capable
What makes a child considered able to consent to treatment?
If the child is mature enough to understand the nature and risks inherent in a procedure, depends on age, maturity, intelligence and intelligence
What are the methods of providing a substitute decision maker under Ontario’s Substitute Decisions Act?
The appointment of a power of attorney for personal care, or an application to the court for the appointment of a guardian
What are the duties of guardians and attorneys for personal care?
Required to determine the incapable person’s wishes and values, best interests and must consult with the family, friends and health care professionals whenever possible
