Unit 1 - Ethical Nursing Practice 2

Question 1

____ and the _____ have established guidelines of patients’ rights. These are not legal documents, nurses and hospitals are considered responsible for upholding these rights of patients.

Answer 1

National League for Nursing & American Hospital Association

Question 2

moral principle or a set of moral principles that can be used in assessing what is morally right or morally wrong. Theses principles provide different frameworks for ethical decision-making.

Answer 2

Ethical Theory

Question 3

espouses that what is right and good is what is best for the individual making the decision. An individual’s actions are determined by what is to his or her own advantage. The action may not be best for anyone else involved, but consideration is only for the individual making the decision.

Answer 3

Ethical egoism

Question 4

as fairness principle. Sometimes referred to as distributive ______, and its basic premise lies with the right of individuals to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief. _____ reflects a duty to treat all individuals equally and fairly. All resources within the society ought to be distributed evenly without respect to socioeconomic status. Thus, according to this principle, the vast disparity in the quality of care dispensed to the various classes within our society would be considered unjust. A more equitable distribution of care for the individuals would be favored.

Answer 4

Justice

Question 5

an essential role for the psychiatric nurses. ____ means acting in another’s behalf – being a supporter or defender. Helping clients fulfill needs that, without assistance and because of their illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves. Nurses serve in this manner to protect the clients’ rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that decisions are to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make. Additionally, nurses may act as ____ by speaking on behalf of individuals with mental illness to secure essential mental health services.

Answer 5

Advocacy

Question 6

It is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is based that is the morally decisive factor. Our actions are bound by a sense of duty. Ethical decisions are made out of respect for moral law. For example, “I make this choice because it is morally right and my duty to do so” not because of consideration for a possible outcome.

Answer 6

Kantianism

Question 7

Conduct that results from serious critical thinking about how individuals ought to treat others. __________ reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality.

Answer 7

Moral behavior

Question 8

arises from Kantian duty of respect for persons as rational agents. This viewpoint emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected. ____ presumes that individuals are always capable of making independent choices for themselves. Health care workers know this is not always the case. Children, comatose individuals, and the seriously mentally ill are examples of clients who are incapable of making informed choices. A representative of the individual is usually asked to intervene and give consent. Health care workers must ensure that respect for an individual’s ____ is not disregarded in favor of what another person may view as best for the client.

Answer 8

Autonomy

Question 9

is a situation that requires an individual to make a choice between two equally unfavorable alternatives. Evidence exists to support both moral “rightness” and moral “wrongness” related to a certain action. The individual who must make the choice experiences conscious conflict regarding the decision.
Not all ethical issues are ____. An _____ arises when there is no clear reason to choose one action over another. Ethical dilemmas generally create a great deal of emotion. Often, the reasons supporting each side of the argument for action are logical and appropriate. The action associated with both sides are desirable in some respects and undesirable in others. In most situations, taking no action is considered an action taken.

Answer 9

ethical dilemmas

Question 10

when there is no restriction whatsoever on the individual’s entitlement

Answer 10

Absolute Rights

Question 11

approach to ethical decision making is focused on a way of life and teaching of Jesus Christ. It advances the importance of virtues such as love, forgiveness, and honesty. One basic principle often associated with Christian ethics is known as the Golden Rule: “Do unto others as you would have them do unto you”. All decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated.

Answer 11

Christian Ethics

Question 12

a right on which the society has agreed and formalized into law

Answer 12

Legal rights

Question 13

fundamental guidelines that influence decision-making. The _____ of autonomy, beneficence, nonmaleficence, veracity, and justice are helpful and used frequently by health-care workers to assist with ethical decision-making.

Answer 13

ethical principles

Question 14

refers to one’s duty to benefit or promote the good of others. Health care workers who act in their clients interest are beneficent, provided their actions really do serve the clients best interest. In fact, some duties seem to take preference over other duties. For example, the duty to respect the autonomy of an individual may be overridden when that individual has been deemed harmful to self or others. The difficulty that sometimes arises in implementing the principle of _____ lies in determining what exactly is good for another and who can best make that decision.

Answer 14

beneficence

Question 15

Do no harm to clients, either intentionally or unintentionally. Some philosophers suggest that this principle is more important than beneficence; that is, they support the notion that it is more important to avoid doing harm than it is to do good. In the event, ethical dilemmas often arise when a conflict exists between an individual’s rights and what is thought to best represent the welfare of the individual. Conflict is when psychiatric client refuses antipsychotic medications (consistent with his or her rights), and the nurse must then decide how to maintain client safety while psychotic symptoms continue.

Answer 15

Nonmaleficence

Question 16

a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

Answer 16

Rights

Question 17

one’s duty to always be truthful. Requires health-care providers tell the truth and not intentionally deceive or mislead clients. There are times when limitations must be placed on this principle, such as when the truth would knowingly produce harm or interfere with the recovery process. Being honest is not always easy, but rarely is lying justified. Clients have the right to know about their diagnosis, treatment, and prognosis.

Answer 17

Veracity

Question 18

are personal beliefs about what is important and desirable.

Answer 18

Values

Question 19

this process increases awareness through which individuals identify and rank their own personal values. The process increases awareness about why individuals behave in certain ways. _______ is important in nursing to increase understanding about why certain choices and decisions are made over others and how values affect nursing outcome

Answer 19

Values clarification

Question 20

The greatest-happiness principle. This principle holds that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness. The good is happiness and the right is that which promotes the good. The wrongness of an action is determined by its tendency to bring about unhappiness. An ethical decision based on ____ view looks at the end result of the decision. Action is taken on the basis of the end results that produce the most good (happiness) for the most people.

Answer 20

Utilitarianism

Question 21

Clients have a right to whatever level of treatment is effective and least restricts their freedom. The restrictiveness of psychiatric therapy can be described in the context of a continuum based on severity of illness. Clients may be treated on an outpatient basis, in day hospitals, or through voluntary or involuntary hospitalization. Symptoms may be treated with verbal rehabilitative techniques and move successively to behavioral techniques, chemical interventions, mechanical restraints, or electroconvulsive therapy. However, ethical issues arise in selecting the least restrictive means among involuntary chemical interventions, seclusion, and mechanical restrains.

Answer 21

The right to the least restrictive treatment Alternative

Question 22

based on the writings of St. Thomas Aquinas. It advances the idea that decisions about right versus wrong are self-evident and determined by human nature. The theory espouses that, as rational human beings, we inherently know the difference between good and evil (believed to be knowledge that is given to man from God), and this knowledge directs our decision-making.

Answer 22

Natural law theory

Question 23

Ideas or concepts that give meaning to an individual’s life

Answer 23

Values

Question 24

Steps of making an ethical decision

Answer 24

1. Assessment
2. Problem Identification
3. Plan
4. Implementation
5. Evaluation

Question 25

When making a decision about forced medications.

*The treatment team must determine that _____ criteria be met to force medications without client consent.

Answer 25

3

1. The client must exhibit behavior that is dangerous to self or others
2. The medication ordered by the physician must have a reasonable chance of providing help to the client
3. Clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question.

Question 26

requires healthcare facilities to provide clear written information for every patient concerning his/her legal rights to make healthcare decisions, including the right to accept or refuse treatment.

Answer 26

The Self-Determination Act

Question 27

are passed by the state legislature and in general are concerned with such provisions as

1. Definition of important terms, including the definition of nursing and the various types of nurses recognized
2. A statement of the education and other training or requirements for licensure and reciprocity
3. Broad statements that describe the scope of practice for various levels of nursing.
4. Conditions under which a nurse’s license may be suspended or revoked, and instructions for appeal
5. The general authority and powers of the state board of nursing

Answer 27

The Nurse Practice Act

Question 28

State/Country - Law created by a legislative body, such as county, city, state, or congress. Example of statutory law is the Nurse Practice Act.

Answer 28

Statutory law

Question 29

Judge - Derived from decisions made in previous cases. These laws apply to a body of principles that evolve from court decisions resolving various controversies. Example is how different states deal with a nurse’s refusal to provide care for a specific client.

Answer 29

Common Law

Question 30

protects the private and property rights of individuals and businesses. Private individuals or groups may bring a legal action to court for breach of ____. These legal actions are of two basic types: torts and contracts.

Answer 30

civil law

Question 31

violation of civil law in which an individual has been wronged. One party asserts that wrongful conduct on the part of the other has caused harm, and the first party seeks compensation for harm suffered. A _____ may be intentional or unintentional. Example of unintentional _____ are malpractice and negligence actions. Intentional _____ is the touching of another person without that person’s consent. Intentional touching (medical treatment) without the client’s consent can result in a charge of battery, and intentional _____

Answer 31

tort

Question 32

One party asserts that the other party, in failing to fulfill an obligation, has breached the _____, and either compensation or performance of the obligation is sought as remedy. Example is an action by a mental health professional whose clinical privileges have been reduced or terminated in violation of an implied _____ between the professional and a hospital.

Answer 32

contract

Question 33

provides protection from conduct deemed injurious to the public welfare. It provides for punishment of those found to have engaged in such conduct, which commonly includes imprisonment, parole conditions, a loss of privilege (license), a fine, or any combination of these. Example is theft by a hospital employee of supplies or drugs.

Answer 33

Criminal Law

Question 34

Although the codes differ markedly from state to state, most grant certain professionals privileges under which they may refuse to reveal information about, and communications with, clients. In most states privileged communication applies to psychiatrists and attorneys; in some instances, psychologists, clergy, and nurses are also included. In most states, the right to privacy of those records is exempted in civil or criminal proceedings. Strict record-keeping using statements that are objective and nonjudgmental, care plans that are specific in their prescriptive interventions, and documentation that describes those interventions and their subsequent evaluation all serve the bets interests of the client, the nurse, and the institution should questions regarding care arise.

Answer 34

Privileged communication

Question 35

There are exceptions to the laws of privacy and confidentiality. Many states have passed their own variation on the original “____” legislation. Courts have outlined the following guidelines for therapists to follow in determining their obligation to take protective measures:

Answer 35

Exception: Duty to warn
1. Assessment of a threat of violence by a client toward another individual
2. Identification of the intended victim
3. Ability to intervene in a feasible, meaningful way to protect the intended victim
It reasonable for the therapist to notify the victim, law enforcement authorities, and/or relatives of the intended victim. Detailed written documentation of the situation is also essential.

Question 36

all individuals have the right to decide whether to accept or reject treatment or the autonomy to determine what will and will not happen to the persons’ body. A health care provider can be charged with assault and battery for providing life-sustaining treatment to a client when the client has not agreed to it. There are some conditions under which treatment may be performed without obtaining _____

Answer 36

Informed Consent

1. Mentally incompetent to make a decision and treatment necessary to preserve life or avoid serious harm
2. Refuses treatment endangers the life or health of another
3. During an emergency in which a client is in no condition to exercise judgement
4. When the client is a child
5. In case of therapeutic privilege: information about a treatment any be withheld if the physician can show that full disclosure would; hinder or complicate necessary treatment, cause severe psychological harm, or be so upsetting as to render a rational decision by the client impossible.

Question 37

Unless state law is more restrictive, orders for restraint or seclusion must be renewed every _____ hours, for maximum of _____ hours

Answer 37

4, 24

Question 38

In-patient evaluation by a physician, clinical psychologist, or other licensed independent practitioner responsible for the care of the patient must be conducted in _____ hours of initiating restraint or seclusion.

Answer 38

1

Question 39

The ______ included a set of patient rights, one of which is an individual’s right to freedom from restraint and from seclusion except in an emergency situation. Use of seclusion and restraint as a therapeutic intervention for psychiatric patients has been controversial. In addition, an element of moral decision-making is involved when any kind of treatment is coerced, as is often the case with seclusion and restraint.

Answer 39

Patient Self-Determination Act

Question 40

The deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means. Health-care workers may be charged with false imprisonment for restraining and secluding against the wishes of the client anyone having been admitted to the hospital voluntarily.

Answer 40

False Imprisonment

Question 41

are sought when an individual manifest behavior that is clearly and imminently dangerous to self or others. Time limited – _____ hours. At that time the court may decide that the client may be discharged, or, if deemed necessary, and voluntary admission is refused by the client, an additional period of involuntary hospitalization may be ordered.

Answer 41

Emergency Commitments

- 72

Question 42

Court ordered mechanism used to compel a person with mental illness to submit to treatment on an outpatient basis.

Answer 42

Involuntary outpatient commitment

Question 43

condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs such as food, clothing, shelter, medical care, and personal safety. Inability to care for oneself cannot be established by showing an individual lacks the resources to provide the necessities of life. Rather, it is established by showing that the individual’s inability to make use of available resources. A guardian, conservator, or committee is appointed by the court to ensure the management of the person and his or her estate.

Answer 43

Gravely Disabled Client

Question 44

• Filled out by police officer, social worker, or mental health professional to bring someone to the hospital for evaluation
• Must be able to document evidence that the person has intent to hurt themselves or others

Answer 44

Pink Sheet

Question 45

• Once the person is brought to the ER, the ____ sheet no longer has power to hold them, the person can leave the hospital
• If we need the person to remain against their will for evaluation and/or admission, then a _____ sheet is required
• Need to renew after _____ hours
• The original form, not a copy, must remain with the patient as they are admitted from the ED or outpatient setting to an inpatient bed (BHU, ICU, MCU)
• It is very important that inpatient floors know that a blue sheet is in effect and that the original is in the patient record on the admitting floor
• There have been incidents when a patient has been held past the 72 hours without an evaluation and renewal of the blue sheet, obviously, this creates legal issues

Answer 45

• pink
• blue
• 72

Question 46

The failure to exercise the standard of care that a reasonable prudent person would have exercised in a similar situation; any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregardful of others rights.

Answer 46

Negligence

Question 47

is a special form of negligence applicable only to professionals. _____ is an instance of negligence or incompetence on the part of a professional. To succeed in a _____ claim, a plaintiff must also prove proximate cause and damages.

Answer 47

MalpracticE

Question 48

revealing aspects about client’s case or even for revealing that an individual has been hospitalized, if that person can show that making this information known results in harm.

Answer 48

breach of confidentiality

Question 49

shared information is detrimental to the client’s reputation, the person sharing the information may be liable. Involves communication that is malicious and false.

Answer 49

Defamation of character

Question 50

when information is in writing

Answer 50

libel

Question 51

oral defamation

Answer 51

slander

Question 52

is a charge that may result when a client is searched without probable cause.

Answer 52

invasion of privacy

Question 53

is an act that results in a person’s genuine fear and apprehension that he will be touched without consent.

Answer 53

assault

Question 54

is the unconsented touching of another person.

Answer 54

battery

Question 55

Confining a client against his or her wishes, and outside of an emergency situation, the nurse may be charged with false imprisonment.

Answer 55

false imprisonment

Question 56

An obligation or willingness to accept responsibility. This is an initial step needed to change behavior.

Answer 56

Accountability

Question 57

the examination of one’s own reasoning or thought processes

Answer 57

metacognition

Question 58

Therapeutic relationships are _____ oriented

Answer 58

goal

Question 59

getting acquainted and establishing _____ is the primary task in relationship development. _____ implies special feelings on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

Answer 59

rapport

Question 60

To show _____ is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior.

Answer 60

respect

Question 61

refers to the nurse’s ability to be open, honest, and real in interactions with the client. To be real is to be aware of what one is experiencing internally and to allow the quality of this inner experiencing to be apparent in the therapeutic relationship

Answer 61

Genuineness

Question 62

the ability to see beyond outward behaviors and to understand the situation from the client’s point of vie

Answer 62

Empathy

Question 63

gestural component of the spoken work

Answer 63

paralanguage

ex. pitch, tone, rate, pauses, etc.