Unit 2

Question 1

Ethics

Answer 1

~Moral principles that govern behavior and conduct
~ANA nursing code of ethics adopted in 1950
~Ethical principles: Autonomy, beneficence, justice, nonmaleficence

Question 2

Autonomy

Answer 2

Patient has the right to make their own decisions including refusing medications, treatments, surgeries, and other medical interventions. The nurse must respect this choice and also advocate for the patient to have autonomy.

Question 3

Beneficence

Answer 3

“Actions guided by compassion” which include keeping the patient safe, assisting them with care, providing them with information to better care for themselves.

Question 4

Justice

Answer 4

Patient has the right to fair and impartial treatment no matter their financial status, insurance carrier, gender identification, culture, ethnicity, religion, etc. this includes being treated fairly by their nurse.

Question 5

Nonmaleficence

Answer 5

Nurses need to ensure they choose interventions that are evidence based and policy driven that have been shown to do no harm or the least amount of harm to the patient. Nurses must keep up their education and skill levels to ensure they can provide safe, EBP interventions.

Question 6

Paternalism

Answer 6

when you assume the right to make decisions for others.

Question 7

Veracity

Answer 7

obligation to tell the truth

Question 8

Fidelity

Answer 8

obligation to keep promises and uphold agreements/contracts

Question 9

Confidentiality

Answer 9

obligation to maintain and observe the privacy of another and maintain strict confidence

Question 10

Advocacy

Answer 10

process in which the nurse helps the patient grow and develop. Critical leadership role.

Question 11

Bioethics

Answer 11

overlapping ethical concerns of theology, life sciences, medicine, laws, biotechnology, philosophy.

Question 12

Ethical Dilemma

Answer 12

Issue with no right or wrong answer
Can’t be solved solely by review of scientific data
Is perplexing – not easily solved
Answer will have a profound effect
Major ethical issues in medicine include: abortion / euthanasia / assisted suicide / organ transplant/ life-saving measures, terminal weans / withholding of food or fluid

Question 13

Utilitarian

Answer 13

do the greatest good for the greatest number of people

Question 14

Deontological

Answer 14

do it because it is the right thing to do

Question 15

distributive ethics

Answer 15

fair and equitable treatment of all

Question 16

virtue

Answer 16

if you act good then you are good

Question 17

morals

Answer 17

a persons standards that govern what actions are or are not acceptable

Question 18

Values

Answer 18

what one believes is important in the way they live

Question 19

Professional values

Answer 19

Altruism, equality, impartiality, justice, fairness, dignity, poise, truthfulness, honesty

Question 20

Regulation of Nursing Practice

Answer 20

State oversight
Defines scope of practice
Regulates practice
Credentialing includes
Licensure
Registration
Certification
Accreditation
Protects the public
Ensures competencies
Suspension / Revocation

Question 21

Impaired Provider

Answer 21

Substance abuse a frequent problem in nursing
Diverting or misuse of controlled substances leads to criminal penalties
Programs to assist in recovery
Intervene according to facility’s policies and procedures
Any nurse that suspects an impaired nurse MUST REPORT IT!

Question 22

Impaired Provider - actions

Answer 22

Any impaired provider must report to their management as well as the Board of Nursing. All employees must consent to getting urine/blood tests if they are suspected of being under the influence. Refusal is automatic termination of employment.

Management can terminate employee or keep them on light duty.

License is usually suspended. Impaired provider program lasts approximately 2 years. Nurse must pay for urine tests, blood work, and counseling. License can be reinstated by BON. Nurse is eligible for re-hire or regular duties in most cases.

In egregious cases – may lose license, face civil or criminal charges.

Question 23

AHA Patient Bill of Rights (1973) (1992)

Answer 23

To protect patient rights.
To give patients autonomy over their healthcare.
Allow them access to healthcare information.
Protect patient privacy and confidentiality.
MH patients NEVER lose their rights! However, they can be overridden if the patient is harming themselves or others.

Question 24

Patient Bill of Rights 1-3

Answer 24

1. You have the right to be treated fairly and respectfully.
2. You have the right to get information you can understand about your diagnosis, treatment, and prognosis from your healthcare provider.
3. You have the right to discuss and ask for information about specific procedures and treatments, their risks, and the time you will spend recovering. You also have the right to discuss other care options. You may lose this right if you’re in the middle of an emergency and don’t have the ability to make sound decisions.

Question 25

Patient Bill of Rights 4-6

Answer 25

4. You have the right to know the identities of all your healthcare providers, including students, residents, and other trainees.
5. You have the right to know how much care may cost at the time of treatment and long term.
6. You have the right to make decisions about your care before and during treatment and the right to refuse care. The hospital must inform you of the medical consequences of refusing treatment. You also have the right to other treatments provided by the hospital and the right to transfer to another hospital.

Question 26

Patient Bill of Rights 7-9

Answer 26

7. You have the right to have an advance directive, such as a living will or a power of attorney for healthcare. A hospital has the right to ask for your advance directive, put it in your file, and honor its intent.
8. You have the right to privacy in medical exams, case discussions, consultations, and treatments.
9. You have the right to expect that your communication and records are treated as confidential by the hospital, except as the law permits and requires in cases of suspected abuse or public health hazards. If the hospital releases your information to another medical facility, you have the right to expect the hospital to ask the medical facility to keep your records confidential.

Question 27

Patient Bill of Rights 10-12

Answer 27

10. You have the right to review your medical records and to have them explained or interpreted, except when restricted by law.
11. You have the right to expect that a hospital will respond reasonably to your requests for care and services or transfer you to another facility that has accepted a transfer request. You should also expect information and explanation about the risks, benefits, and alternatives to a transfer.
12. You have the right to ask and be informed of any business relationships between the hospital and educational institutions, other healthcare providers, or payers that may influence your care and treatment.

Question 28

Patient Bill of Rights 13-15

Answer 28

13. You have the right to consent to or decline to participate in research studies and to have the studies fully explained before you give your consent. If you decide not to participate in research, you’re still entitled to the most effective care that the hospital can provide.
14. You have the right to expect reasonable continuity of care and to be informed of other care options when hospital care is no longer appropriate.
15. You have the right to be informed of hospital policies and practices related to patient care, treatment, and responsibilities. You also have the right to know who you can contact to resolve disputes, grievances, and conflicts. And you have the right to know what the hospital will charge for services and their payment methods.

Question 29

Americans with Disabilities Act

Answer 29

Purpose
Eliminate discrimination
Provides enforceable standards
Has backing of Federal government

Serious mental health disorders fall under the ADA

Question 30

Patient Self Determination Act 1990

Answer 30

Part of Social Security Act
Includes Medicaid and Medicare
Mandates patients be informed of their right to be involved in their medical decisions and care that they receive.
Allows patients to make decisions about their advanced directives and requires that providers carry them out.
Mandates patient advocates be assigned when necessary.
Allows patients to decline care if they wish.

Question 31

Legal Issues in Nursing

Answer 31

HIPPA:
All patients have the right to client confidentiality
Treat all patient information as privileged communication
Exceptions:
SI/HI
Duty to Warn
Suspected Abuse
Patient shares information that could endanger themselves or others

Question 32

HIPAA

Answer 32

Do not discuss private patient data in unsecure locations – tell them to stop. Then report.
Do not share patient data with anyone that is not directly providing care to the patient.
Do not post ANY patient information or pictures EVER!
Duty to Warn: You must tell the a third party if a real threat is made against their life.
You must report an impaired co-worker if you suspect someone of being drunk/drugged on their shift.

Question 33

Informed Consent

Answer 33

Informed Consent:
Physician must obtain the consent
Nurse may witness the signature
Must be voluntarily given without coercion
The client must have the capacity to understand
Adequate information to make the decision present

Question 34

Implied Consent

Answer 34

– if the patient is incapacitated/not conscious then the physician implies that the patient gives them the consent

Question 35

Impaired Consent

Answer 35

if the patient is under the influence of certain drugs, they are not able to consent. Whenever possible, get the consent before giving pain medications/anesthesia

Question 36

Groups that cannot provide consent

Answer 36

Dependent children
Unconscious or severely injured
Incompetent related to mental illness

Question 37

Informed Outpatient

Answer 37

Check in and out on own decision
Includes PARTIAL HOSPITALIZATION PROGRAM: come into hospital/facility for day treatment and go back home at night

Question 38

Voluntary

Answer 38

Competent patient agrees to admission “terms” but cannot always check out when they want to – requires psychiatrist “ok”
Patient agrees to admission

Question 39

Temporary Emergency

Answer 39

Patient is admitted without consent under 72 Hour Hold initially (Baker-Act)
Requires LEGAL PAPERWORK!
Baker Act: involuntary admission to the facility for short duration. Also called: 72-hour hold. Requires at least 1 medical and 1 other provider/legal/police/state guardian to agree.

Question 40

Involuntary

Answer 40

Physician / Legal Order required up to 6 months in Florida
Requires LEGAL PAPERWORK and JUDGE approval
2 psychiatrists evaluate patient and agree they are a risk to self or others but is unwilling or unable to agree to treatment plan can be involuntarily kept longer duration if:
acute mental illness
poses threat to self or others (Suicidal Ideation / Homicidal Ideation)
severe mental health disability with inability to meet basic Maslow
require treatment but refuse it

Question 41

Long-term involuntary

Answer 41

Inpatient State Hospital (indefinitely)

Question 42

Long term involuntary NGI

Answer 42

Not guilty by reason of insanity involuntary status (indefinitely)

Question 43

Florida Marchman Act

Answer 43

Any person can file a request for Assessment and Stabilization of a person who is a substance abuser who has:
Lost self-control and has impaired judgement due to substance abuse and
Without treatment they pose a real risk to themselves and/or others

Question 44

Behavioral Health Admission Criteria

Answer 44

3 Legal Principles:
Patient has the right to voluntary admission
State government have policing power to protect the public
Parens Patriae: government has the right to intervene on behalf of citizens who cannot act in their own best interests

Question 45

Behavioral Health Treatment Settings

Answer 45

SETTINGS:
Group Therapy
Inpatient
Psychiatric Hospital
Residential Facility
Drug Rehabilitation
Nursing Homes
Partial Hospitalization Program
Intensive Outpatient Program
Private Practice Outpatient
Telehealth / Online / Phone

Question 46

Inpatient Hospital (Public or Private)

Answer 46

Acute care for medical surgical, ICU, ER, behavioral health units

Question 47

Psychiatric Hospital (public or private)

Answer 47

Only offer limited specialty acute and subacute care for specialized MH disorders

Question 48

Residential Facility (public or Private)

Answer 48

Chronic, long term care offering limited medical care and housing for those who cannot function independently

Question 49

Alcohol and drug rehabilitation

Answer 49

Provide drug and alcohol detox, group therapy, up to 30-day stays.

Question 50

Nursing Homes

Answer 50

Provide dementia care and long-term care for more chronic “stable” MH diagnosis but not for acute phases.

Question 51

Partial Hospitalization Program / Intensive Outpatient Programs

Answer 51

“Day program” for 6 or more hours a day during the week to focus on education, individual and group counseling, job training

Question 52

Private Practice Practitioner’s / Telehealth

Answer 52

Brick and Mortar or on-line individual, group, or family therapy paid by insurance or private pay.

Question 53

Legal Terms

Answer 53

Plaintiff: suing for damages
Defendant: being sued
Civil: Damage to person or property.
Tort: Type of Civil lawsuit that includes:
Negligence: did not follow the standard of care as a nurse. Failed to do something you should have or did something you should not have done. (Example: Failed to call MD for a stat lab result.)
Abandonment: is technically negligence (Example: Nurse leaves in the middle of their shift.)
False Imprisonment: (restraining someone in any way against their will, due to low staffing or for staff comfort, and/or without an order) is a civil tort
Assault and Battery
Malpractice
Criminal: Violation of laws. Includes Misdemeanors and Felonies. Can be accidental or intentional (negligent homicide versus manslaughter)

Question 54

Civil personal injury lawsuit

Answer 54

Medical Malpractice: Improper, illegal, negligent treatment by a professional that led to harm.
Battery with actual physical harm would fall under this type of civil tort.
Malpractice Attorney Must prove 5 things: You had a duty to the patient, there was harm done to the patient, your actions caused the harm, expert testimony from “peers” agrees with defendant, you acted outside of your scope of practice.

Question 55

Intentional Torts

Answer 55

Assault and battery
False imprisonment
Invasion of privacy
Libel and slander
Loss of client property

Any Nurse can serve as a witness in a malpractice case:
May appear as a defendant or member of healthcare provider team in a malpractice or negligence case
Providing testimony as an expert witness

Question 56

Least Restrictive Alternative Doctrine

Answer 56

“Healthcare providers cannot be more intrusive or restrictive of freedom than reasonably necessary to achieve a substantial therapeutic benefit.”
This means that we CANNOT just restrain somebody forcibly without cause – they must be trying to HARM SELF or OTHERS or interfering in medical treatment that would have a negative effect on their health outcomes (like pulling out an endotracheal tube attached to a ventilator)

Question 57

Before we restrain

Answer 57

Before we restrain, we must:
Offer alternatives / try to “talk it out”
Offer seclusion / alone time
Offer PRN medications
Attempt show of force if needed
Chemical restraints only if necessary
Physical restraints only if necessary
Must document everything you tried BEFORE use of involuntary chemical/physical restraints

Question 58

Types of Restraints

Answer 58

Physical, Chemical, or environmental

Question 59

Crises

Answer 59

4 distinct phases – precipitating stressor, anxiety increases as problem cannot be solved easily, all resources (internal and external) are used to resolve the discomfort, the individual reaches a “breaking point.”

How one handles the crisis depends on timing of the crisis, self concept, perception, support, and coping abilities.

Question 60

6 types of Crisis

Answer 60

Dispositional (acute response to external stress), Anticipated (normal life transition that causes loss of control),
Traumatic (leads to feelings of being overwhelmed and defeated),
Maturational/Developmental (unresolved life conflicts), Psychopathology (emotional crisis leading to mental health disorder),
Psychiatric emergency (severely impaired and rendered incompetent)

Nursing diagnosis: Risk for injury, anxiety, fear, spiritual distress, PTSD, ineffective coping.

Question 61

Roberts Crisis Interventional Model

Answer 61

First assess SI/HI
Next establish trust and rapport (yes – it is second in crisis!)
Identify: Maslow! What problems do they have and how well are they coping? Not stable – triage to higher level.
Use therapeutic communication to help them express their feelings.
Explore alternatives to help the person problem solve.
Implement an action plan.
Follow up in 1 month and on anniversaries.

Question 62

Crisis: Suicidal Ideation

Answer 62

Suicidal ideation is a behavior – not a diagnosis.
It can sometimes be prevented!
90% of suicides have a known MH disorder.
90% of survivors DO NOT ATTEMPT IT AGAIN!
1.2 million attempted suicide in 2020 but 3 x that number planned one and 10 times that number seriously contemplated it. 45,979 were successful.
Higher in persons who have experienced physical and sexual violence, child abuse and bullying
2nd leading cause of death ages 10-14 and 25-34. 9th leading cause of death 0 to 65 years of age.
High amount of permanent disability following gunshot, MVA, and asphyxiation attempts.

Question 63

Suicide Protective Factors

Answer 63

Effective coping and problem-solving skills
Reasons to live, goals, find joy in life
Strong cultural identity
Feeling connected and supported by others
Feeling connected to the community
Availability of quality community resources
Availability of quality healthcare resources
Low access to lethal means of suicide
Cultural, religious, spiritual objection to suicide

Question 64

Suicide Risk Factors

Answer 64

Talking about being a burden
Being isolated
Increased anxiety
Talking about feeling trapped or in unbearable pain
Increased substance use
Looking for a way to access lethal means
Increased anger or rage
Extreme mood swings
Expressing hopelessness
Sleeping too little or too much
Talking or posting about wanting to die
Making plans for suicide

Question 65

Anger

Answer 65

A learned emotional response to internal or external stressor
Normal in threat / trauma response (fight or flight)
Can be positive or negative
Can lead to social change when directed by a group
Can lead to aggression and violence
Creates physical symptoms due to epinephrine, norepinephrine, cortisol release

Question 66

Aggression

Answer 66

Behavior intended to threaten or injure a victim’s security or self-esteem
Aims to inflict pain, injury, vengeance on objects/living entities
It is usually designed to punish and frequently accompanied by bitterness, meanness, ridicule, vindictiveness, and hostility.
Often about “control”

Question 67

Violence

Answer 67

Objectionable act that uses force resulting in injury or death.
Most people can restrain themselves from becoming violent except when their life is threatened.
Highest risk for violence is somebody that has a history of being violent.

Question 68

Anger Management

Answer 68

Be vigilant assessing for potential for violence
Anger can manifest in facial expressions, speech, irritability, clenched jaw, fists, yelling, easily offended, short fuse, defensive responses, passive-aggression, stone silence, impulsivity, pacing, argumentative, suspicious, paranoid, outbursts.
Greatest risk: previous history of violence
Use De-Escalation Techniques

Question 69

De-Escalation Techniques

Answer 69

Show of force: All of the staff and often security line up in a “wall formation” to show the patient that they are outnumbered, and that resistance is futile. This can make patients VERY aggressive, so it is a last resort.
Remember to review your Restraints worksheet.

Nursing Process:
Assess the patient: Are they escalating?
Diagnose the Issue: why are they angry/aggressive/violent – is there a trigger
Plan: What is the best approach for this patient?
Implement: Approach the patient and try to assist them, help them work through their issues and teach them better ways of managing their feelings through Socratic questioning and role playing.
Evaluate: Is this plan working? Is this excalating? Do we need to reevaluate.

Question 70

Emotional Intelligence

Answer 70

Being self-aware: Understand how you come across to others. Understand how to assertively get what you need.
Self Regulation: Able to regulate your own emotions even under stress, listen to the facts, weigh the pros and cons, consider the options and make well thought out statements.
Motivation: The ability to understand, use, and manage your emotions in positive ways.
Social Skills: The ability to communicate effectively, to negotiate and defuse conflict and get along with others using compromise.
Empathy: The ability to empathize with others and see the bigger picture from their “eyes”.

Question 71

Assertiveness Training

Answer 71

Important for everyone but especially helpful for individuals with certain mental health diseases.
Builds emotional intelligence, interpersonal skills, self-concept, self-respect, and self-worth without interfering with other’s rights.
Assertive people are able to express their needs and thoughts in a direct and honest manner while respecting the rights of others.
People are not born assertive. Like everything, it must be learned.

Question 72

Assertiveness Training Techiques

Answer 72

Therapist must interview and test the client to understand their nature and why they behave as they do.
Therapist will use role play to understand how the client deals with real life situations and help the client understand how to be assertive in these situations.
Therapist will concentrate on improving both verbal and non-verbal communication and help change the way the client is perceived by others.
Therapist will teach the client assertive communication techniques to use as “homework” and then the patient can report on these weekly