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NURS 3560 - Ethics > Week 2 > Flashcards

Week 2 Flashcards

1
Q

what are the legal & ethical responsibilities of nurses (5)

A
  • follow laws & guiding documents
  • meet entry lvl competencies
  • gain competence in a specific area of practice
  • maintain fitness to practice
  • continuous learning
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2
Q

what is an example of a document that gives direction that is a law

A
  • Regulated Health Professions Act: Practice of Registered Nurses
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3
Q

what is are 2 example of a document that gives us direction that is a regulation

A
  • The Regulated Health Professions Act: College of Registered Nurses of Manitoba General Regulation
  • CRNM Practice Direction: Practice Expectations for Registered Nurses
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4
Q

what is an example of a document that gives us direction r/t ethics

A
  • CNA Code of Ethics for Registered Nurses
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5
Q

what is the regulated health professions act

A
  • an umbrella act (statute) that governs the practice of 21 different health professions, with profession specific regulations
  • sets our consistent rules and processes for all RHP
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6
Q

what is the regulated health professions act

A
  • an umbrella act (statute) that governs the practice of 21 different health professions, with profession specific regulations
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7
Q

what does the regulated health professions act outline (8)

A
  • defines the actions that can be done by a HCP (“reserved acts) –> these pose a risk of harm to the public so must be regulated for public safety
  • limits the performance of reserved acts to HCP
  • defines how professions are designated and governed
  • defines how the profession registers its members
  • restricts the use of titles such as “registered nurse” or “doctor” to people who are qualified
  • establishes the requirements for standards of practice, code of ethics, practice directions, continuing competency programs, professional conduct, a process for managing complaints
  • sets out the process for becoming a regulated profession
  • defines health professions
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8
Q

what is the practice of registered nursing regulation (4)

A
  • defines which reserved acts (actions done by a HCP outlined in the RHPA) that can be performed by registered nurses (scope of practice)
  • defines the scope of practice of nurses
  • describes requirement for licensing
  • describes education required
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9
Q

the college of registered nurses of manitoba general regulation provides detail on: (7)

A
  • the process and requirements to become (and remain) a RN –> licensing requirements
  • the use of title (ex, RN)
  • reserved acts and the circumstances under which a nurse can perform them
  • standards & scope of practice for RN
  • sets out its process for dealing w complaints against a RN
  • manages complaint & discipline process
  • sets Practice Expectations
  • maintains lists of RNs (register)
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10
Q

what is the designated regulator for RNs

A
  • the college of registered nurses of manitoba (CRNM)
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11
Q

what is the CRNM’s primary goal

A
  • to protect the public
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12
Q

as the regulator, the CRNM uses the RHPA, regulation, and code of ethics to: (6)

A
  • establish the process & requirements for practice
  • set the standards for registered nursing education & practice
  • determines entry lvl competencies (things a person needs to be able to demonstrate they know in order to safely practice nursing)
  • approves education programs that prepare students to meet the competencies
  • support nurses to meet the standards thru practice consultants
  • take action when standards are not met
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13
Q

the CRNM sets basic requirements for registered nursing practice, including: (3)

A
  • completion of an accredited program
  • passing the NCLEX-RN exam to demonstrate knowledge of entry lvl competencies for nursing practice
  • meeting standards of nursing practice
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14
Q

what is a competency

A
  • the integrated knowledge, skills, abilities, and judgement required to practice nursing safely and ethically
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15
Q

what are 5 categories of competencies

A
  • professional responsibility and accountability
  • knowledge-based practice (specialized body of knowledge and competent application of knowledge)
  • ethical practice
  • service to the public
  • self-regulation
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16
Q

what is the continuing competence program

A
  • ensures that nurses are using the most current info to guide their practice & are always learning and improving
  • program that every RN must complete
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17
Q

what does the continuing competence program include (9)

A
  • self assessment
  • self-development plan
  • learning goals & plan
  • jurisprudence learning module
  • minimum practice hours
  • documentation of learning activities to meet goals
  • evaluation of impact of learning activities on your practice
  • declaration of completion of various components of program each year
  • multi-source feedback
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18
Q

what is the minimum practice hours requirements

A
  • 1125 practice hours over 5 years

- or 450 hours in past 2 years

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19
Q

what are CRNM practice direction (5)

A
  • minimum expectations for safe, competent nursing practice
  • more detailed than regulations
  • written statements on matters relevant to registered nursing practice
  • articulates the expectations the public can have of a registered nurse & describe how a RN is to practice, at minimum
  • serve as a legal reference to describe reasonable and prudent nursing practive
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20
Q

describe the compliance with practice directions

A
  • is required
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21
Q

what occurs when a pt, family member, colleague, or supervisor feels that a RN is not meeting standards?

A
  • a complaint can be made
  • CRNM may also initiate an investigation process if it identifies registered nursing practise that falls short of standards
  • there is a specific process that is followed to review and investigate complaints
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22
Q

what type of issues may result in a complaint (4)

A
  • profession misconduct
  • incapacity or unfitness to practice nursing
  • sufferring from ailment
  • conduct unbecoming a registered nurse
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23
Q

describe the complaint process (6)

A
  • must be transparent and fair (objective)
  • hearings open to the public
  • complaints and injury committees must include a public representative –> one of the members must not be a nurse (guards against appearance of bias when it is not only nurses adjudicating nurses)
  • an investigation gathers evidence from the complainant & the nurse
  • complaints investigations and inquiries examine the nurse’s conduct & make determinations based on the Standards of Practice or Code of Ethics
  • committee makes a determination about which standards or values were breached, if any
24
Q

what is professional misconduct

A
  • an act or omission which falls short of what would be proper in the circumstances
  • most serious of the possible charges against a RN
25
Q

what are examples of professional misconduct

A
  • any abuse of a client or health care team member
  • falsification of a record
  • abandonment
  • breaking the law (ex. PHIA)
26
Q

what are examples of professional misconduct

A
  • any abuse of a client or health care team member
  • falsification of a record
  • abandonment
  • breaking the law (ex. PHIA)
27
Q

what is negligence

A
  • conduct that falls below the standard that is considered desirable within the nursing community
  • failing to take the care that a reasonable & prudent HCP would take in order to prevent harm to the pt
28
Q

what are common negligent acts (6)

A
  • medication errors
  • failure to monitor a pt’s condition adequately
  • falls resulting in injuries to a pt
  • pressure injuries from inadequate repositioning
  • failure to remove foreign objects (ex. surgical sponge left in pt after surgery)
  • failure to communicate effectively w other members of healthcare team , including poor handoff (ex. didnt mention low BP)
29
Q

what is the tort of negligence

A
  • a civil wrong that occurs (between individuals, or individuals and organizations) and harm results
  • the person who was harmed (or their family) seeks redress
30
Q

in order to be found negligent, the following elements must be proved by the plantiff (person who was harmed)

A
  • duty of care *
  • breach of duty *
  • foreseeable harm caused by breach (presence of injury/damage) *
  • causation*
  • the pt did not contribute to the negligence and/or accept a risk voluntary
  • = essential element of negligence
  • all of these must be demonstrated to be found guilty of negligent*
31
Q

in order to be found negligent, the following elements must be proved by the plantiff (person who was harmed)

A
  • duty of care *
  • breach of duty *
  • foreseeable harm caused by breach (presence of injury/damage) *
  • causation*
  • the pt did not contribute to the negligence and/or accept a risk voluntary
  • = essential element of negligence
  • all of these must be demonstrated to be found guilty of negligent*
32
Q

describe duty of care r/t negligence

A
  • to be found guilty of the tort of negligence, the nurse must have had a duty to provide care for the pt
  • duty of care is described in law as “the duty to exercise a reasonable degree of skill, knowledge, and care in the treatment of a pt”
33
Q

what is included in duty of care (3)

A
  • a duty to adhere to evidence-informed protocols and procedures that minimize the risks of harm
  • a nurse-pt relationship existed, giving the pt reasonable expectation they would receive care (ex. was the assigned nurse)
  • the nurse is legally required to act in a manner that meets or exceeds the standards of care of a reasonable prudent caregiver or HCP
34
Q

what is involved with the duty of care (5)

A
  • duty to attend to pt (hands & eyes on pt)
  • duty of care & skill (ex. diagnosis & treatment) –> need to be competent to perform the skills required
  • duty to keep adequate and accurate records –> timely, accurate documentation
  • duty to refer or seek out advice of others –> questions, clarify, confirm
  • duty to communicate with others involved in care –> handoffs, effective reports
  • duty to supervise colleagues w less experience –> mentorship and practice support
35
Q

what is breach of duty

A
  • when there is a duty of care, the standard of care that a reasonable, prudent nurse would provide was not met
36
Q

breach of duty is based on evidence from: (4)

A
  • the pts medical record (documentation)
  • organizational policies
  • staffing lvls and policies
  • experts
37
Q

what is injury or harm r/t negligence

A
  • the breach of duty must have caused harm to the pt
  • must be financially compensable harm or damages to the pt
    ex. loss of income or earning potential, property damage, injury, death, disability
38
Q

the degree of harm determines….

A
  • the size of the award

- more harm = more money

39
Q

what is causation

A
  • the injury or harm must be caused by the nurse’s action or inaction
  • a clear link must be demonstrated
40
Q

describe the requirement of absence of contributory negligence and/or voluntary assumption of risk r/t negligence

A
  • the pt’s conduct may be partially or completely defeat their claim if the pt did something to contribute to the harm they experienced
  • or if the pt provided informed consent to the event that cause harm
41
Q

describe an imp consideration r/t absence of contributory negligence and/or voluntary assumption of risk

A
  • there can still be a finding of negligence even if it is demonstrated that the pt contributed to the harm or voluntary assumed the risk
  • the degree to which the pt contributed impacts on the extent or amt of damages paid out
42
Q

see slides for examples of criminal negligence, not much point memorizing this for an open book exam

A

…

43
Q

preventing complaints & legal action requires: (3)

A
  • meeting standards (the minimum acceptable care (ex. freq of assessments, evidence-informed interventions)
  • communication (oral, written, timely & effective reports)
  • documentation (clear, timely of everything assessed & done)
44
Q

what are the purposes of documentation (6)

A
  • communicate client health info with other members of the care team
  • provide continuity of care –> ensure each shift knows what happened previously
  • demonstrate how care met standards
  • hold nurses accountable for compliance w professional standards of care
  • provide quality assurance thru chart audits; accreditation
  • facilitate research (allows the connection of various factors, illness, pt condition, care provided, etc., to outcomes)
45
Q

in the context of a nursing negligence lawsuit, documentation provides: (4)

A
  • a chronological record of events ( from admission to discharge, including plans, assessments, interventions)
  • evidence to show that nursing process was reasonable & prudent (demonstrates rationale for care decisions)
  • evidence of compliance w professional nursing standards
  • evidence of the “bigger picture” of communication
46
Q

what is the most reliable defense against allegations of negligence and violation of nursing standards

A
  • the medical record (documentation)
47
Q

what is the most reliable defense against allegations of negligence and violation of nursing standards

A
  • the medical record (documentation)q
48
Q

the frequency and amount of documentation is dictated by: (4)

A
  • facility/agency policy & procedure
  • complexity of health problems & pt situation
  • degree to which pt’s condition puts him at risk (more acute = more documentation)
  • degree of risk involved in the treatment of care (higher risk interventions need more detail)
49
Q

what does the acronym FACT stand for r/t documentation

A 
college documentation guidelines suggest the following principles should guide documentation: 
Factual 
Accurate 
Complete 
Timely
50
Q

describe the Factual aspect of documentation

A
  • descriptive
  • objective
  • directly observed or measured
51
Q

describe the Accurate aspect of documentation

A
  • exact measurements

- as precise as possible

52
Q

describe the Complete aspect of documentation

A
  • all appropriate or relevant info including status changes, interventions, pt’s response, communication w pt, family & team
53
Q

describe the timely aspect of documentation

A
  • as close to when it happened as possible to ensure a clear record of what happened when
54
Q

what are 3 examples of errors in documentation

A
  • info required for care & treatment of pt is omitted from record (ex. allergy or assessment not recorded)
  • incorrect/inaccurate/vague info recorded in chart (wrong dose of drug, wording unclear)
  • HCP fail to read the chart (info present but not acted upon)
55
Q

what are rules for documenting (15)

A
  • write legibly
  • write accurately (with clarity, without error, or ambiguity)
  • record concisely
  • record events chronologically (or ASAP after they occur)
  • regular entries
  • person involved in events records entry (only chart what you do)
  • entries signed by person who wrote them w designation
  • write in permanent ink
  • use uniform & professional terms
  • avoid abbreviation
  • record date & time
  • use uniform system of recording throughout facility
  • do not leave blank spaces
  • correct errors opening and honestly (cross out but leave visible, date and time, initial)
  • avoid editorial comments

NURS 3560 - Ethics (7 decks)

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