WEEK 2 Flashcards
Understand ethics in the role of nursing
How can ethics be defined?
Making decisions, choosing right from wrong, acting within one’s individual values–each person has their own set of personal ethics and morals
What are 5 important ethical principals?
Autonomy, beneficence, veracity, fidelity, and justice
Define autonomy
freedom or independence to make own decisions
Define beneficence
actions guided by compassion/kindness
Veracity
telling the truth
Define fidelity
keeping promises or commitments
Define justice
actions are fair and equitable
How would one define altruism?
to do something or act for the sake of benefiting someone
How would one define dignity?
Implies that everyone, regardless of race, religion, sex, gender, or other individual identification, has value and should be respected simply because human beings are all equal.
How would one define integrity?
the quality of being honest and having strong moral principles or moral uprightness
Social justice (aka distributive justice) means what in healthcare?
this principle suggest that regardless of societal status, every person has the right to quality health care
What can happen if a nurse acts in a way that is not consistent with best practice standards and harm is caused to client as a result?
The nurse could be charged with malpractice (or known as professional negligence)
When would a tort be commited?
if an individual carries out OR fails to carry out an act and that results in injury or harm to a client
How can torts be categorized?
intentional or unintentional
Implied consent
consent that is implied by actions
What is an example of implied consent?
A nurse says to a client, “Okay, I am here to give you your flu shot.” The client then rolls his sleeve up, preparing for the shot.
Informed consent
consent that is expressed in writing
What does informed consent require?
providers to educate clients about the risks, benefits, and alternatives to procedures
Why must informed consent by provided?
clients can make well-informed decisions about their health care
Good Samaritan Laws
A nurse decides to act outside of work, these laws protects the nurses from being held responsibe for harm, so long as the nurse is not being willfully negligent and is working within his/her licensure capacity
Define whistleblowing
an act when a person formally reports on illegal, wrongdoing, or unethical practices
What can whistleblowing result in?
It can result in punitive actions against the accused, but can also cause stress, fear of reprisal, and retaliation for the whistleblower
Why are some hesitant to be a whistleblower?
fear or reporting is a huge obstacle, but many laws exist to protect whistleblowers
Define mandatory reporting
legislation mandates that certain officials have a legal duty to report information that can prevent maltreatment and provide safety to another individual. Licensed nurses are mandatory reporters.
Informatics
Defined as the use of technology and information to communicate, manage knowledge, mitigate error, and support decision making
Nursing informatics
defined as the integration of technology and physical devices with nursing knowledge and nursing clinical decision making-making skills
In what year did the ANA designate nursing informatics as its own specialty practice?
1992
What does Healthy People 2020 name health literacy as?
a subheading to the social determinates of health and health care
What are the four elements that the International Council of Nurses (ICN) addresses for the ICN Code of Ethics for Nurses?
Clients and others seeking health care, the practice of nursing, professional responsibilities of the nurse, and global health
The ICN released an updates ICN Code of Ethics for Nurses in 2021. What are some included additional elements?
equity and social justice, climate change and the impact this has on health, the changing roles of technology and social determinants of health, as well as the nurse’s role and responsibility in achieving sustainable development goals as established by the United Nations in 2015.
Define Code of Ethics
Developed by the ANA, this document outlines rules for nurses about client privacy, nursing conduct, and nursing behaviors to protect clients and the profession.
How many provisions does the Code of Ethics for Nurses with Interpretive Standards (aka the Code) have?
9
What does provisions 1 to 3 refer to in the Code?
the fundamental values of the nursing profession and the nurse’s commitment to those that they care for
What are some bullet points from provisions 1 to 3?
The nurse should provide compassionate care and respect for the client.
The nurse should recognize that each client is unique, has worth, and deserves to be treated with dignity.
The nurse should be an advocate for each client’s rights and needs.
The nurse should promote and protect the health and safety of each client.
What does provisions 4 to 6 refer to in the Code?
the duty and loyalty that the nurse is expected to show to their clients and themselves
What are some bullet points from provisions 4 to 6?
The nurse should demonstrate authority, accountability, and responsibility for promoting best practices.
The nurse should promote health and provide the best care they can for each client.
The nurse should maintain competence, practice the accepted values of the nursing profession, and promote a healthy and safe practice environment.
The nurse should adhere to the ethical principles of the nursing profession.
What do provisions 7 to 9 refer to in the Code?
the duty and loyalty the nurse is expected to show beyond direct client encounters and to the nursing profession as a whole
What are some bullet points from provisions 7 to 9?
The nurse should promote the profession of nursing through research and inquiry.
The nurse should participate in the development of standards of practice and policies governing nursing and health care.
The nurse should collaborate with other members of the interprofessional team to protect the rights of all individuals and decrease health disparities.
The nurse should promote the integrity of the nursing profession.
Define nonmaleficence
the ethical principle that refers to the nurse’s obligation to do no harm
What is “the Code” for nursing students?
The Essentials of Baccalaureate Education for Professional Nursing Practice (The Essentials) was created by the American Association of Colleges of Nursing to narrow the list to five professional values and behaviors in nursing (Elliot, 2017).
What are the five values from the Essentials?
Nurses of all practice levels share these same core values, which include altruism, human dignity, integrity, autonomy, and social justice.
Define altruism
To do something, or take action, for the sake of benefiting someone else.
What is an example of being an altruistic nurse?
being an advocate for your client and their best interest
Define human dignity
each individual, regardless of race, religion, gender, sexual orientation, culture, ethnicity, socioeconomic status, or any of our characteristics or personal preferences, has intrinsic value and should be respected and treated equally
What are some examples/aspects of human dignity?
Maintaining client privacy, showing respect, providing culturally competent care, and ensuring confidentially
Define integrity
a nurse demonstrates honesty, even when circumstances challenge the nurse’s character, and it can be difficult to sustain
How does the AACN describe integrity for nurses?
upholding professional standards of the Code, even in difficult times
What is an example of integrity?
the nurse is honest and provides care to clients using the ethical framework that is accepted within the profession
What are the steps in making an ethical decision?
- Is there an ethical dilemma?
- Clearly identify the ethical dilemma
- identify the possible solutions
- apply ethical principles to the solutions
- include all relevant individuals and factors
- decide on a solution
- review the decision
- put the decision into action
What is the Emergency Medical Treatment and Labor Act (EMTALA)?
Ensures that all individuals, regardless of their insurance or financial status, have equal access to emergency medical care
Why was EMTALA enacted?
to direct emergency medical personnel to provide equal care to clients entering the emergency department (ED), regardless of their insurance or financial status
What are the 3 major provisions of EMTALA?
All clients must have a medical screening evaluation (MSE).
If the client is, in fact, experiencing an emergency, the hospital must stabilize the client. If the hospital cannot provide the specific level of care (treatment and management) of the emergency condition, they must transfer the stabilized client to a facility that can.
In the event the client cannot be stabilized in said ED, a physician or another qualified medical professional must verify and sign off transfer, clearly indicating that the benefits of transfer outweigh the risks of transferring an unstable client (Rhodes & Smith, 2017).
What is the Health Insurance Portability and Accountability Act of 1996 (HIPPA)?
a federal law that protects an individual’s identifying private information and personal health information
What is the difference between privacy and confidentiality?
Physical seclusion, protection of personal information and identity, and the ability to make autonomous decisions all refer to privacy.
Not disclosing personal information without the person’s permission is referred to as confidentiality
What is an example of intentional tort?
invasion of privacy, defamation, and assault and battery.
When does assault occur?
when a client is made to feel fearful of harm or offensive contact, such as being threatened with restraints
What is battery?
An act that results in harm or injury to a client, such as illegally restraining a client, touching the client inappropriately, or operating on the wrong body part
This is most often treated as a criminal offense.
What are examples of unintentional tort?
negligence and malpractice
What are some tasks or procedures that would require implied consent?
insertion of a uniary catheter, administration of pain medication, and intiation of an IV site
What are tasks or procedures that would require informed consent?
colonoscopy to screen for colon cancer, scheduled cesarean section, and elective cosmetic surgery
What is a nursing task when receiving informed consent?
Witnessing client signature on the consent form
What are advanced directives?
legal documents in which a client’s decisions related to health care are documented
It is important that nurses promote the development of advance directives with clients
Why are their low rates for advance directive completions?
Clients often feel that an advance directive is not necessary until a serious illness occurs. Health care literacy rates and English as a second language can also contribute to low completion rates
What are the two types of advanced directives?
living will and durable power of attorney for health care
Define living will
a document where a client can clearly state which life-sustaining treatment(s) they wish to have performed if they become incapacitated and are unable to make decisions for themselves
Define durable power of attorney for health care
a client can appoint an individual to make health care decisions on their behalf if they are unable to do so
Which of the following would be included in advanced directives?
living will, durable power of attorney for health care, organ donor form, and do not intubate (DNI) order
What are some reportable conditions according to the CDC?
anthrax, botulism, chlamydia, foodborne disease outbreak, hepatitis A-C, HIV, influenza, measles, rubeola, tuberculosis, zika virus
What are some anesthesia-related sentinel events?
anesthesia medication error
airway management event
What are some care management related sentinel events?
client fall
restraint related event
pressure injury
What are some criminal related sentinel events?
assault
false imprisionment
What are some environmental sentinel events?
fire
What are some product or device sentinel events?
failure of intravenous infusion device
What are some protection sentinel event?
client elopement
infant abduction
self-harm
What are some suicide sentinel events?
Suicide while receiving care
suicide within 72 hr of discharge
What are some surgical or invasive procedures sentinel events?
wrong procedure
wrong site
wrong client
The ANA’s Standards of Practice
authoritative statements of the competent level of nursing practice that all nurses are expected to perform regardless of the client or health care setting.
What is included in the Nursing: Scope and Standards of Practice are the Standards of Professional Nursing Practice,
these categories are Standards of Practice, which provide a narrative of what competent nursing care should involve when utilizing the nursing process, and the Standards of Professional Performance, which provide a description of competent behavior exhibited by the professional nurse
What does the Standards of Professional Performance include?
ethics
culturally sensitive practice
effective communication with clients and members of the health care team
collaboration with clients and stakeholders
professional leadership
continuing education
evidence-based practice
maintaining quality nursing practice
evaluations of self and peer nursing practice
correct utilization of resources
practicing effectively in a safe environment
When can falsification of health records occur?
Doesn’t document a client assessment
Doesn’t document communication with members of the interprofessional team
Documents inaccurate assessment data
Documents care, events, assessments, or activities that did not actually occur
What is collaborative health care?
a client-centered approach in which members of different health care professions come together and work toward a common goal of improving or restoring a client’s health.
What is the interprofessional teamwork and collaboration model?
Team structure: Identify who is on the team or who should be included in the team.
Communication: Utilize strategies to communicate effectively among the identified team.
Leadership: Identify strategies to effectively lead teams and support the team’s use of these strategies.
Situation monitoring: Encourage team members to be aware of and understand the teams’ performance and the impact it has on the clients’ outcomes.
Mutual support: Support the team by providing feedback to assist them to function better as a team (distribute workload, manage conflict).
What is closed-loop communication?
the use of standardized terminology and procedures to ensure that messages between the sender and the receiver are received, clarified, and correctly interpreted
Define I-SBAR-R
Standardized communication tool that delivers uniform information via the acronym I-SBAR-R, meaning introductions, situations, background assessment, recommendation and readback.
I-SBAR-R
Introductions: Give your name and client care role, ask the receiver for their name and client care role.
Situation: Describe what is currently happening to the client that needs to be addressed.
Background: Provide pertinent clinical background.
Assessment: Give a brief evaluation of the situation.
Recommendation: Give suggestion(s) for care.
Read back/Repeat: Summarize, allow time for questions, and repeat or reread information, as needed.
Define transcribing prescriptions
Upon receiving a provider’s prescription (order) for a client, verify or read back the information, and then document the information correctly in the client’s EHR.
right client, right medication, right dose, right time
Define incivility
Behaviors in the workplace that negatively affect others such as gossiping, spreading rumors, rudeness, or refusing to help a coworker.
It can be peer to peer (see also: lateral violence), supervisor to employee (vertical), and includes behaviors meant to harm, humiliate or distress another.
Define clinical information system
a computer system that allows for instant retrieval of client information either directly or from data networks.
What are some examples of clinical information systems?
This can range from barcode scanning, documenting, and medication administration to arm band scanning by ancillary personnel for procedures such as venipuncture lab draws.
Define electronic health record?
Systemic, digitized documentation system used to improve medical records. A computerized, real-time form of a client’s paper chart that can be shared between members of the interprofessional team; includes information such as the medical history, diagnosis, allergies, and diagnostic testing results.
What is the HIPPA privacy rule?
protected health information (PHI) as, “any information held by a covered entity for healthcare that can be linked to an individual”. The Privacy Rule requires that unique client identifiers (e.g., Social Security number, date of birth), which can link a client to their PHI, be coded for the purpose of transmission.
What is the HIPPA security rule?
specifically addresses the use and disclosure of electronic PHI. The Security Rule was developed as a direct response to the increased use of cellular phones and personal technology by health care workers, which are subject to being lost, stolen, or hacked.
What is the HIPPA breach notification rule?
covers the process of reporting and responding to a breach of PHI
Breaches should be reported as soon as possible, but no more than 60 days from discovery of the breach and the facility must notify the client of a potential breach via mail
What is the HIPPA enforcement rule?
includes compliance and investigations, the administration of financial penalties for violations of HIPAA rules, and procedures for the investigation of these violations.
What are some patient health identifiers?
Names
All geographical data smaller than a state
Dates (other than year) relating to an individual
Telephone number
Social Security numbers
etc.
What does PHI mean?
protect health information
What are the five pillars of meaningful use of electronic health records?
ensure privacy and security
improve population health
improve safety and quality
engage patients and families
coordinate care
What is an adverse drug event (ADE)?
injury caused from a medical intervention that is linked to a medication
What is a medication error?
a preventable error capable of causing harm or death to a client under the care of a health care provider
What is true of medication errors?
The mortality rate due to medical errors is comparable in magnitude to deaths from chronic lower respiratory illnesses, the third biggest cause of mortality, second only to cardiovascular disease and cancer
Define bioethics
refers to the application of ethics to health and life
It addresses dilemmas like stem cell research, organ transplantation, gender reassignment, and reproductive technologies (in vitro fertilization, surrogate pregnancy) also, abortion and acquired immunodeficiency syndrome
What are some examples of when a nurse is an AGENT for clients facing an ethical decision?
caring for an adolescent client who has to decide whether to undergo an abortion even though their parents believe it is wrong
discussing options with a parent who has to decide whether to consent to a blood transfusion for a child when their religion prohibits such treatment
What are some examples of when a nurse is a DECISION MAKER for health care delievery?
assigning staff nurses a higher client load than previously because administration has reduced the number of nurses per shift
witnessing a surgeon discussing only surgical options with a client without mentioning more conservative options
Moral Distress
occurs when the nurse is positioned in a difficult situation where the actions taken are different from what the nurse identifies as ethically correct
often heightened in times of crisis, disaster, or tradegy
What are some examples of quasi-intentional torts?
breach of confidentiality
defamation of character
Negligence issues that prompt most malpractice suits include FAILURE TO:
follow professional and facility-established standards of care
use of equipment in a responsible and knowledgeable manner
communicate effectively and thoroughly with clients
notify the provider of a change in the client’s condition
complete a prescribed procedure
How can nurses avoid liability for negligence?
follow standards of care
giving competent care
communicating with other health team members and clients
developing a caring rapport with clients
fully documenting assessments, interventions, and evaluations
being familiar with and following a facility’s policies and procedures
What organization mandates the use of computerized databases to expedite the accreditation process?
The Joint Commission
What are the purposes of medical records?
communication
legal documents
financial billing
education
research
auditing
What are the documentation formats?
flow charts
narrative documentation
charting by exception
problem-oriented medical records
electronic medical records
flow charts
show trends in vital signs, blood glucose levels, pain level, and other frequent assessments
narrative documentation
records information as a sequence of events in a story-like manner
charting by exception
standardized forms that identify norms and allows selective documentation of deviations from those norms
problem-oriented medical records
organized by problem or diagnosis and consist of a database, problem list, care plan, and progress notes
SOAP, PIE, and DAR
DAR
focus charting
Data, Action, Response
What are the reporting fomats?
change of shift report
telephone reports
telephone or verbal prescriptions
transfer (hand-off) reports
incident reports (unusual occurences)
Change-of-shift report
nurses give this report at the conclusion of each shift to the nurse assuming responsibility for the clients
Formats include: face-to-face, audiotaping, or presentation during walking rounds in each client’s room (unless the client has a roommate or visitors present in order to continue practicing confidentiality)
telephone reports
useful when contacting the provider or other members of the interprofessional team
Is it best to avoid telephone or verbal prescriptions?
Yes, but are sometimes needed in emergencies and at unusual times
transfer (hand-off) reports
include demographic information, medical diagnosis, providers, an overview of health status (physical and psychological), plan of care, recent progress, any alteration that might become an urgent or emergent situation, directives for any assessments or client care essential within the new dew hours, most recent vial signs medication and last doses, allergies, diet, activity, specific equipment or adaptive deice (oxygen, suction, wheelchair) advance directives and resuscitation status, discharge plan (teaching), and family involvement in care and health care delivery.
