Week 5 lecture study Flashcards
What are nurses held to that serves as a guide in their practice?
American Nurses Association Code of Ethics
Ethical
behaving in a way of respect to ones dignity and the rights of individual people using moral principles
Utilitarianism
End goal moral justifies even when the means are not moral
Deontology
both the means & end goal must be ethical and moral
What are the most common ethical concerns in healthcare?
allocation of scarce resources & end of life issues
Bioethics
subcategory of ethics, concerns that occur due to advancing science & technology
–> Stem Cell, cloning, genetic engineering
justice
Fairness. RN is fair when distributing care. All clients being cared for must get justly and equitably care.
Beneficence
doing good, RN does the right thing for client
Nonmaleficence
doing no harm, harm can be classified as intentional and nonintentional
accountability
Taking responsibility for one’s own actions. Take responsibility for all professional & personal consequences that occur due to their actions.
Fidelity
Keeping one’s promise.
Autonomy
Client self-determination. Encourage client to make own decisions w/o judgement or coercion
Veracity
Truthful. RN cannot withhold truth from client.
Recognize ethical dilemmas and take appropriate action:
RN has responsibility to recognize and ID ethical issues affecting staff or clients
Multidisciplinary ethics committees
Understand and apply ethical guidelines - ANA Code of Ethics. World Medical Association’s Code of Ethics
No automatic guidelines for solving ethical dilemma’s
Recognize ethical dilemmas and take appropriate action: problem definition
– clear description of the dilemma & circumstances
Recognize ethical dilemmas and take appropriate action: assessment process
gather facts, opinions, perceptions, collect data
Recognize ethical dilemmas and take appropriate action: ID those involved and available resources
review ethical codes, evidence based practices
Recognize ethical dilemmas and take appropriate action: data analysis
organize and analyze data collected
Recognize ethical dilemmas and take appropriate action: investigate
examine rights, duties, values
Recognize ethical dilemmas and take appropriate action: evaluate the results
measure in terms of effectiveness
Inform client / staff members of ethical issues affecting client care
RN’s responsibility to inform staff and clients of ethical issues that can/do affect care.
Client may ask nurse to do something unethical. RN must inform client they can’t do it for ethical & legal reasons.
Clients may ask for information on ethical actions to choose.
Nurse Practice Act
Outline legal scope of practice
Sets educational requirements
Facility policies govern practice in that particular facility
Standards of care-established by federal, state, professional organizations
Each state has own nurse practice act
Your state of work is most important affecting your care
Practicing beyond limits may lead to charges of violating act
Rules of Conduct
Legally use skills & knowledge to protect safety & comfort of clients
Laws are binding rules of conduct enforced by authority
Laws & ethics can overlap- you have to identify & examine fine lines that separate them.
If a law is challenged as unjust or unfair, usually reflects underlying ethical principle
Clients who feel they have been treated with disrespect or lack of dignity, or that their rights were ignored/violated –more likely to initiate legal action
Evaluate outcomes of interventions to promote ethical practice: things to ask
Is staff knowledgeable about ethics & ethical practice?
Is staff effectively applying ethical principles to their daily practice?
Are clients knowledgeable and informed about ethics & ethical practice?
Were all appropriate professional resources, including code of ethics & professional literature, employed to resolve the ethical dilemmas?
Ethical dilemmas carry what
a great deal of stress
Moral dilemmas call for what
Ethical choices in the face of profound uncertainty
How can moral dilemmas be further complicated?
by psychological pressures and personal emotions
What do many moral dilemmas involve?
choices about justice or fairness when scant recourses must be divided among clients with equal needs
Dilemmas: Beneficence
Beneficence-often occur when providers, client or family members disagree about what course of action is in client’s best interest
Dilemmas: Autonomy
often closely related to beneficence issues especially when family must make decision for what’s best for the client
Dilemmas: Justice
example limited resources being divided fairly
Dilemmas: fidelity
– balancing a client’s privacy against society’s right to be informed. Involves a commitment to veracity.
Dilemmas: values
Encounter many conflicting sets of values. Must establish own ethical belief
Incorporate chosen values into everyday thoughts and actions
informed consent
Clients have the right to knowledgeably consent to or reject all care and proposed treatments.
informed consent: providing the client with what?
enough information to know what the client is getting into if they decide to undergo the proposed treatment or procedure as well as anticipated consequences if consent is refused or withdrawn
informed consent: responsibility
Responsibility for obtaining informed consent rests with the person who will perform the treatment or procedure
informed consent: what is client informed of?
Client must be fully informed regarding treatment, tests, surgery, and risks & benefits prior to giving informed consent
informed consent: refusal
Client must be told they have the right to refuse the treatment or procedure without having other care/support withdrawn and that they may withdraw consent after giving it.
informed consent: carrying out procedure without informed consent
Carrying out a procedure without informed consent may be grounds for charges of assault and battery.
Elements of informed consent
Description of treatment or procedure
Description of inherent risks and benefits with frequency or regularity
Explanation of potential for death or serious harm or discomforting adverse effects during or after treatment/procedure.
Explanation & description of alternative treatments/procedures
Name & qualifications of person who is going to perform the treatment or procedure
Discussion of possible effects of not undergoing the treatment or procedure
Explanation of alternative treatments or procedures
Must disclose specific consequences that are particularly significant for the client if they exist
Who can sign or appropriate person to provide informed consent
Must be from an adult client who is mentally competent
Informed consent: next of kin
Next of kin may sign if adult is deemed incompetent, unconscious, can’t be obtained
- People who may sign legal guardian, parent, legally appointed representative, clients durable power of attorney
- Some situations where the above doesn’t exist then courts have guardianship and right to give informed consent if client can’t
informed consent: emancipated minor
May consent to their own care/treatment
Only minors that are emancipated or married may give their own informed consent
Except in cases of pregnancy or sexually transmitted infections
what is the exception to informed consent?
emergency situations
responsibility of informed consent: nurse
Verification & witnessing
May provide information within scope of practice & knowledge base
Cannot substitute their own knowledge for the providers
Witnesses only doesn’t obtain actual consent
Nurse: by witnessing informed consent, you attest to…
By witnessing you attest to: client voluntarily consented, client’s signature is authentic, client is competent to give consent
Responsibility of informed consent: provider
Provide complete information, potential risks, benefits, who will perform, possible alternatives including their risks & benefits
Responsibility of informed consent: client/representative
Must give consent voluntarily & without coercion
Must ask questions & clarify until fully certain
Clarification of consent
The nurse is not providing informed consent.
The nurse is ensuring that the client/representative signs the form.
Witnessing the consent form is just one of many important tasks for RNs
Information technology uses
Bar code patient identifiers
Bar codes for billing supplies, medications
Automated provider orders systems
Electronic medical records
Instant access to information i.e. facility policies
Analysis
Current information i.e. standards of care, evidence based practices
risks of information technology
breaches of privacy, hacking, crashes
advantages of information tech
Reduce risk of misinterpretation
Record of each person who entered/viewed client record
Offer standardized input, mandatory charting fields, flow charts, care plans
Disadvantages of information techn
Use of incorrect prompt/phrase can give misleading assessment
Prompt isn’t descriptive then need for typing out assessment
Need for back up records
Ensuring completeness
Need all members to know how to use the system
information technology: verification
Nurse’s have the responsibility of verifying providers orders.
–> They insure it is complete & appropriate and carried out in a timely manner
–> Nurse’s review an order for completeness, question orders that a client questions, question an order that doesn’t seem appropriate, question orders that aren’t clear.
–>The nurse is responsible for following up on any questionable orders.
Why are telephone orders and verbal orders strongly discouraged?
may lead to serious error
- Full documentation is a must including the reason for the phone call.
- Must read the order back to provider to confirm. Some facilities require two nurses hear & confirm the order.
Applying a Knowledge of Facility Regulations When Accessing Client Records
Mandated by law for facilities to have policies, procedures & educational activities related to accessing, viewing, and use of medical records & information.
HIPAA mandates safeguards to insure confidentiality, integrity, and availability
Applying a Knowledge of Facility Regulations When Accessing Client Records: safegaurds
Primary safeguard is the signature code. Limits access to records
Policies for specific information such as HIV status
Software automatically records date & time of every entry and each correction including name of anyone who modifies a record.
utilizing online resources
Responsible for identifying online resources in a complete and accurate manner before using with a client/staff.
Website that have url with .org, .edu, and .gov are generally reliable and accurate but may not be as current as needed.
Merck Manual, American Cancer Society, American Heart Association, CDC, WHO
