Quiz 2 material Flashcards
Privacy and Informed Consent
Informed consent
Agreement to a procedure or action based on understanding of fact and possible consequences of such actions
What does true informed consent imply?
- Consents is given by someone who has capacity for giving it; competency is established (parent, legal guardian, mature minor)
- Full comprehension of procedure (what, purpose, risks, benefits, complications, what happens in absence of treatment)
Right to Refuse
Consent involves the right or refusal; must be cognicent of the implications.
Limitations on refusal of therapy
- Preservation of life is patient does not have a terminal disease (comes in from a car accident)
- Protection of minor dependents (parent refusal can be overridden)
- Protection of public health (ebola and refusing quarantine is not acceptable)
Constraints on Informed Consent
- Coercion
- Manipulation
- Offers and rewards
- Influence
- Medical paternalism
Consent is Research/Clinical Trials
- Codified in federal law
- Specific requirements mandated
- Risks, risks v benefits, subject selection, data collection/monitoring, privacy and confidentiality, purpose of research, expected duration, ability to opt out
Vulnerable populations in research
- Federally protected
- Pregnany women and their fetuses
- Neonates
- Prisoners
- Children and adults who cannot provide informed consent
Respect for Persons
Acknowledging patient’s right to autonomy in making decisions and choices about participation; protecting those with diminished autonomy
Beneficence
Obligation to do no harm, maximizing possible benefits while minimizing possible harms assoiciated with research.
Justice
What is considered fair, due or owed to persons; for example, genetic mutations, or variations should not preclude individuals from equal access to employment or health care insurance
What is the Patient Self Determination Act (PSDA)?
It requires health care institutions receiving Medicare/Medicaid funding to ask patients whether they have an advanced directive.
No coercion, just a question.
Designed to facilitate conversation.
Offer help and information about creating one.
Enacted in 1991.
What are Advanced Directives?
- Living will: snapshot of your opinions on different scenarios
- Durable power attorney of health care (DPA) - strictly related to medical decisions
- Power of attorney - general ability to take care of financials
How does Health Literacy Relate to Informed Consent?
Make sure the patient/families actually understand what they are signing and what it entails.
Teach-back; can you tell me what you understand.
Low health literacy affects nearly half of the US population.
Informational Privacy
Communication of protected information to others
Physical privacy
Regards personal space
Decisional privacy
Regarding personal choices
Proprietary privacy
Regards bodily tissues
Communication
Process of imparting or exchanging information in meaningful, clearly understood ways between communicators.
Consists of mindfulness and effective listening.
Confidentiality
Principle requiring one to protect and secure personal information of others and see what it is only shared with those who have a need and right to know.
What protects health information?
HIPAA
Required disclosure
- Third party payers or other health care providers
- Law enforcement
- Threats to public health/safety
- Suspected abuse
- Specifict threats to harm self or others
- Subpoenas for legal proceedings
Considerations in sharing PHI
- Is there a right or need to know?
- What outcomes might occur if information is not shared? Is shared?
- Is it based on fact, assumption or opinion?
- Is there a safety concern involved?
- Does it create potential for bias?
Paradigms: Right Vs. Right Dilemmas
- Truth vs. loyalty
- Invidual vs community
- Short term vs. long term goals
- Justice vs mercy
Mandatory Reporting
- Child abuse or neglect
- Suspected elder abuse
- Certain disease
Nurse-Nurse Relationship
- Horizontal violence and workplace bullying
- Walking wounded
- Nurses who feel put down; bullied
- Can create a hostile work environment
- Behavioral characteristics seen in nurses dealing with unresolved stress
Professional Boundaries in Nursing
- Disclosure of personal information
- Health related disclosure
- Mandatory reporting to state board of nursing
Nurses and Social Media
The risk for crossing professional boundaries increases as lines and moral spaces become blurred.
Can cause line crossing and an invasion of moral space and possibly a violation of privacy.
