Test 1 Flashcards
What are the MO board of nursing disciplines?
Censure, probation, suspension, revocation
What are the KS board of nursing disciplines?
Denied, limited, revoked, suspended, stay of suspension, private censure, public censure
Censure
Basically a point on your license, if you receive enough you will be disciplined further
Probation
imposes additional terms and conditions to a license
suspension (suspended)
nurse may not practice, but still retains license
revocation (revoked)
nurse may not practice, does not retain license
A license is considered…?
your property
Since a license is property, legally it…?
cannot be taken without due process, is subject to regulation, can be taken/restricted with just cause, and just cause must be proven by the state
State Board of Nursing
Administrative arm of state government and serves as the legal body to oversee the practice of nursing in the state
What does the practice committee do?
Assists the BON in developing strategies to address current and evolving issues r/t nursing and acts as a resource to the public, nurses, employers
What does the executive committee do?
Provide leadership in making decision r/t protocols, operating budget, etc..
What does the education committee do?
Assist the board in safeguarding the health and welfare of the public
What does the licensure committee do?
Assist the board in developing, refining, and monitoring policies and procedures relevant to licensure by examination, endorsement, and renewal
What does the discipline committee do?
guards the public through vigilance of the licensee’s compliance with the Nursing Practice Act.
Where can complaints come from?
Individuals, employers, public entities, nurses, other agencies, the BON
I-M-N-F-M-D?
Incompetency, misconduct, gross negligence, fraud, misrepresentation, or dishonesty
Enabling?
Violating the NPA or assisting and/or enabling another person to violate the NPA
What is NURSYS?
Centralized data bank of regulatory information on nurses, each state reports disciplinary actions to NURSYS
Religious Suffering
Viewed as a dichotomy. It is part of human existence, character and empathy is develops, highest duty to care for the suffering
Philosophical Suffering
It is part of human condition, humans have right to avoid suffering. Drives assisted suicide argument.
Medical Suffering
If there were no suffering, there would be no need for health care
Personal Suffering
Value in being a “wounded healer”, those who suffer can more closely connect with the suffering
Compassion
The antidote to suffering. It is the awareness of the suffering and a wish to relieve it.
Where to Values arise from?
Faith belief, culture, upbringing, society, philosophy, experience
Morals
Outward expression of values
Ethics
Approaches to life events that drive decisions, arise from personal value systems
Ethical dilemma
situation in which an individual is compelled to choose b/w two actions that will generate a quandary
Deontology
Humans have the duty to do the right thing. The duty relies on the action itself, not necessarily the outcome
Teleology
Utilitarianism/Consequentialism the right/wrongness of an action is based on the consequences not necessarily the action itself. Do the most good for the most people.
Nursing ethical principles
Nonmaleficence, beneficence, autonomy, justice, veracity, fidelity, respect/compassion, privacy/confidentiality
Nonmaleficence
do no harm
beneficence
to promote good
autonomy
the right to choose for oneself
justice
the obligation to be fair to all people
veracity
to be truthful in both commission and omission
fidelity
loyalty to another, faithful, to keep promises
respect/compassion
to treat with worth and dignity
privacy/confidentiality
respecting the right for non-disclosure, protecting disclosed information
Nursing code of ethics
respect, primary commitment, promotes/protects the health/safety/right of patient, accountability, owes duties to self, maintain/improve healthcare environments, advances profession, collaboration, responsible for the integrity of the profession and shaping social policy.
Standards of Practice
Assessment, diagnosis, outcomes identification, planning, implementation, evaluation
Implementation (standard of practice)
Prescriptive authority and treatment, Consultation,
Coordination of care, Health teaching and promotion
Standards of Professional Practice
Leadership, resource utilization, evaluation, environmental health, education, quality of practice, R&D, communication, collab, ethics
Aikens Decision making model
collect/analyze/interpret data, state dilemma, consider choices of action, analyze advan/disadvan of each option, make decision
Pro/con of Aikens
Pro - organized, nursing process orientated
Con - no action after decision, no evaluation
ETHICAL decision making model
Examine the dilemma
Thoroughly comprehend possible alternatives
Hypothesize arguments
Investigate/compare/eval arguments for each alternative
Choose the alternative
Act on chosen alternative
Look at the dilemma & examine outcome
What is APRNing?
minimum masters; clinical nurse specialist, midwife, anesthetist, practitioner, cert exam by profession (not state), separate license by state
the 2 measures of appropriate practice
must meet all ongoing requirements of license, meet the legal standard of care for nurses
3 branches of government?
legislative (statutory), executive (administrative), judicial (judicial)
law is organized into 3 categories:
criminal (against society), civil (against individuals), administrative violations (violation of regulations)
Criminal Law
either misdemeanor or felony, government is always prosecutor
Civil Law
Wrongs b/w individuals, wronged person receives damages (payment for restitution or a prohibition of the wrongful behavior
Major areas of civil law:
contracts, employment, torts, business, family, probate, property, etc…
Torts
A civil wrong for which a remedy may be obtained, usually in the form of damages or a breach of a duty that the law imposes on everyone in the same relation to one another
Types of Torts
assault, battery, false imprisonment, trespassing, conversion, negligence, defamation, invasion of privacy, intentional/negligent infliction of emotional distress, misrepresentation, strict liability, products liability
Battery
a harmful, offensive, or non-permitted contact with another, must be intentional
Assault
Apprehension of an imminent harmful contact, words not enough need action also.
False imprisonment
a sufficient act of restraint in a bounded area; patient must believe they are not free to leave and can not leave
Conversion
unauthorized taking or destruction of someone else’s possessions.
Theft(also criminal), coercion, borrowed and damaged, borrowed without consent
Misrepresentation
misleading someone else, who relies on your expertise, in order for you to achieve personal gain of some kind.
infliction of emotional distress, intentional or not
behavior causes severe emotional suffering to the patient or family member and accompanies physical harm
defamation
a published, untrue statement about someone that damages their reputation, includes both slander (spoken) and libel (written)
conflict
opposing action of incompatibles, a fight
types of conflict
intrapersonal, interpersonal, intragroup, intergroup
destructive conflict
feelings of anger/frustration, judgemental actions, parties do not have needs met, refuse to deal with issues
constructive conflict
win-win solutions, open communications, needs being met, opposite of destructive
Conflict process
5 stages: potential opposition/incompatibility, congnition/personalization, intentions, behavior, outcomes
Stage 1: Potential opposition or incompatibility
Antecedent conditions: communication, structure, personal values
Stage 2: Cognition and personalization
Perceived or felt conflict
Stage 3: Intentions
Conflict handling intentions: competing, collaborating, compromising, avoiding, accommodating
Stage 4: Behavior
Overt conflict: Party’s behavior and other’s reactions
Stage 5: Outcomes
Increased or decreased group performance
Avoiding
Least assertive, least cooperative. conflict may grow as it is not addressed; diplomatically postpones an issue til a better time
Accommodating
high cooperative/low assertiveness. Individuals may neglect own needs; better ideas mean better rewards. Use this when outmatched and losing
Competing
high assertiveness, low cooperation. pursue own needs over groups; when an important/unpopular action needs to occur
Compromising
mid assertive/cooperation. when collaborating and competing fail, temp solution; difficult for everyone to compromise
Collaboration
high assertive/cooperation. Inefficient, unwise decisions; generates more solutions, more win-win
Core principles of communication
Makes others the focus
Pay attention to detail
Effective communication can be learned
What makes people feel valued?
Emotional engagement, effective listening, giving feedback, positive nonverbal messages
What makes you a good communicator?
Skill(not talent), finding common ground, keeping it simple, being interested, being inspiring, being congruent (trust).
Communication up?
Dominant or passive-aggresive boss: both should be prepared, informed, offers solutions, available, professional
Communication down?
Abandon business-speak, pick language carefully, know when to hold/share
Methods of communication?
video/phone conference, voicemail, email/text, inperson
Best mode of communication?
Either in person or audio/video conference with graphic and text support
Standards for HIT (health information technology)
HIPAA, HHS, AACN, there are no tele-health skills or certifications (HHS working on this)
Negligence
Unintentional TORT. Harm occurs d/t carelessness. Malpractice is negligence. Negligence is when Standard of Care is violated.
Gross Negligence
Excessive and/or deliberate carelessness
Negligence per se refers to:
self-evident negligence, violation of a specific statute/regulation (harm from violation to a person the statute intended to protect)
4 Elements of negligence:
Duty, breach, causation, harm
Duty?
Starts when you assume care of the patient, volunteering, providing care related to nursing expertise
What duties do we owe to patients?
protect, report when needed/required, obtain necessary medical care, educate, monitor to level needed, assess, advocate, basically the LEGAL standard of care
What is the legal standard of care?
The average degree of skill, care, and diligence exercised by members of the same profession under the same or similar circumstances. Licensure = minimum
SOC = average skill
Breach (of duty)
violation of SOC: failing to fulfill a duty, omitting a duty, or performing a duty below standard
Who/what determines duty, breach, and SOC?
fed/state law, regulatory agencies, nursing orgs, other orgs, policies/procedures, education, nursing/experts/literature
Federal/state laws r/t SOC
Determine legal definitions, each state different
Regulatory agencies r/t SOC
Fed agencies: Medicare, HIPAA
Nursing orgs r/t SOC
Define professional minimum SOC. ANA establishes general SOC. Specialty orgs establish specialty SOC
Other orgs r/t SOC
AMA, american diabetic association, AHA
Policy/procedures/guidelines r/t SOC
Establishes the nursing standard of care within your facility, must know these, includes printed instructions for meds/equip/supplies
Education/Literature r/t SOC
Level of education determines legal parameters of practice. Literature cited by P/P can be used to establish SOC in each agency
Nurse experts r/t SOC
Nurses who lead the field, have expertise in a certain area, can establish benchmarks, can testify in court
The COURTS
fed/state CIVIL courts determine if SOC is met with: nurse expert, fact witness, any sources for SOC.
Fed/state CRIMINAL court penalize nurses who violate CRIMINAL laws
Causation
Even if nurse does absolute best, if SOC is not met then negligence occurs only if it results in harm to a patient. 2 types of causation: direct/proximal
Direct Causation (but-for)
the nurse’s action was a substantial factor to cause damages
Proximal causation (foreseeability)
there is a “more likely than not” chance that the nurse’s action caused the harm and the nurse could/should have foreseen that their actions would result in harm to the patient; an unbroken chain of events flowing form the breach
Harm
harm that occurs to the person as a consequence of negligent action. can be physical, emotional, economic
So.. back to malpractice/professional negligence… this only occurs WHEN:
SOC not met AND: A duty existed AND The duty was breached AND The breach CAUSED Harm to occur Even if unintentional
State BON can discipline malpractice if:
sued or not in civil court, found liable in civil court, crimes committed or “no contest” pleas, or breach of the NPA even if patient is not involved
Even if BON doesn’t discipline
A nurse can still be sued and/or prosecuted for a crime
Can the nurse be prosecuted in criminal court, sued in civil court, and disciplined by BON all at the same time?
OF COURSE