NR 226 Exam 1 Questions and Answers

NR 226 Exam 1 Questions and Answers Deontology defines actions as right or wrong Utilitarianism proposes that the value of something is determined by its usefulness Feminist Ethics focuses on the inequality between people Ethics of Care Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives Professional Nursing Code of Ethics A set of guiding principles that all members of a profession accept Autonomy commitment to include patients in their decisions Beneficence taking positive actions to help others Nonmaleficence avoidance of harm or hurt Justice being fair Fidelity agreement to keep promises How to process an ethical dilemma (7 steps) Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify your own values/opinons. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Step 7: Evaluate the plan. Who can request access to an ethical committee? Any person involved in an ethical dilemma (including nurses, physicians, health care providers, patients, and family members) Issues in healthcare ethics quality of care genetic screening care at the end of life access to care 4 basic principles in the Code of Ethics 1. advocacy 2. confidentiality 3. responsibility 4. accountability an ethical problem has at least one of the following.. (3) 1. unable to resolve solely on scientific data 2. perplexing- cannot easily make decision 3. answer will have a profound relevance for areas of human concern purposes of the ethical committee provide education, recommendations, and case consultation issue: quality of life measures the values/benefits of certain medical interventions (ex. DNR, cancer therapy) issue: genetic screening can alert patient to a condition that is not yet apparent, but will eventually develop issue: futile care medical interventions that are unlikely to produce benefit to the patient (ex. tx to a patient that has no hope/incurable) moral distress describes the anguish experienced when a person feels unable to act according to closely held core values ethics The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large values Personal beliefs about the worth of something, that influences their behavior accountability answering for your own actions magnet recognition the hospital has clinical promotion systems and research and evidence-based practice programs; nurses have professional autonomy over their practice team nursing interdisciplinary team approach developed in response to severe shortage of nursing after World War II- team effort, team leader, care is provided collaboratively total patient care -original care delivery model of Florence Nightingale -RN is responsible for all aspects of care, RN works directly with patient, pt satisfaction is high, care can be delegated, RN can have multiple patients during a shift functional based nursing nurse is assigned to do tasks during shift to multiple patients, ex. one nurse does all assessments, one nurse does all VS, etc. primary nursing -places RNs at the bedside and improves accountability for patient outcomes and professional relationships -RN provides care for the same patients when working -RN develops plan of care and delivers interventions -communication from nurse to nurse -continuity of care case management approach that coordinates and links health care services to patients, streamlining costs and maintaining quality decentralized management decision making is moved down to the level stand, managers and staff are more actively involved responsibility duties and activities that an individual is employed to perform authority legitimate power to give commands and make final decisions specific to a given position 5 rights of delegation right task right circumstance right person right direction/communication right supervisor what are nursing considerations during delegation of task? appropriate patient setting, available resources, other relevant factors civil laws protect the rights of the individual. Damage for civil laws usually involves the payment of a fine. common laws results from JUDICIAL decisions concerning individual cases. Most of these revolve around negligence and malpractice. regulatory law (aka administrative law) defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing. tort a civil wrong made against a person or property intentional tort willful acts that violate another's rights (assault, battery, false imprisonment) assault may be actual, or it may result from a threatened action, such as giving a person an injection or threatening to restrain a patient who has refused a procedure. battery intentional touching without consent false imprisonment an example of which is restraining a patient without justification invasion of privacy the release of a patient's medical information to an unauthorized person slander When one person speaks falsely about another person libel Written defamation of character negligence Conduct that falls below the standard of care malpractice Referred to as professional negligence; below the standard of care informed consent Person's agreement to allow something to happen based on disclosure of risks, benefits, and alternatives proof of negligence -The nurse owed a duty to the patient. -The nurse did not carry out the duty or breached it. -The patient was injured. -The patient's injury was caused by the nurse's failure to carry out that duty. Nursing (ANA definition) the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations why is prioritizing important? because it allows you to see relationships among patient problems and avoid delays in taking action that can lead to serious complications for patient list some of the code of ethics for nurses promotes for, advocates for, and strives to protect the health, safety, and rights of patients ethical dilemma having to choose between 2 conflicting principles, causes distress and controversy values clarification helps you to explore values and beliefs/feelings and decide how to act on personal beliefs and respect the values of others, even if they differ form yours. value formation the development of values begins in childhood and is shaped by experiences informed consent persons agreement to allow something to happen to them based on full disclosure informed consent and MINORS parent/legal guardian -if parent refuses treatment, sometimes court can intervene on child's behalf informed consent and UNCONSCIOUS -a certain person is legally authorized to make decisions on their behalf -POA **if it's an emergency to save someone's life, can obtain consent after procedure/tx informed consent and MENTALLY ILL they have the right to refuse tx until court legally determines they are incompetent to decide for themselves American's with Disabilities Act (ADA) civil rights statute that protects the rights of physically/mentally ill people. prohibits discrimination and ensures equal opportunity. Emergency Medical Tx and Active Labor Act (EMTALA) --when a patient comes into ER, medical screening needs to be done. If its an emergency, the patient cannot be discharged/transferred until they are stable. --ensures public access to emergency services regardless of ability to pay Mental Health Parity Act (MHPA) forbids insurance plans from putting limits on mental health coverage Patient Self-Determination Act (PSDA) Requires that institutions maintain written policies and procedures regarding advanced directives, the right to accept or refuse treatment and the right to participate fully in health care related decisions Uniform Anatomical Gift Act people over 18 have right to make an organ donation Living Will legal document that expresses client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues Durable Power of Attorney for Healthcare legal document that designates a person to make healthcare decisions for them if they are no longer able to. This person makes choices based on the patient's wishes. Incident Report (occurrence report) -report is completed when an adverse or unusual event takes pace in the OR that may have legal consequences for the staff or patient -confidential -separate from patient's medical record Use of physical restraints a safety strategy that has been used long-term care and hospitals to protect patients from injury Joint Commission's guidelines for the use of restraints (3) 1. only to ensure safety of patient and patients around them 2. when less restrictive interventions are not successful 3. only used with MD's written order Nursing Licensure licensure permits people to offer special skills to the public,and it also provides legal guidelines for protection of the public. when can a license be revoked/suspended? if a nurse's conduct violates provisions in the licensing statute based on administrative laws and rules that enforce the statute Good Samaritan Laws encourage health care professionals to assist in emergencies, and it offers legal immunity if a nurse helps. However, you should only provide care that is consistent with your level of expertise! Public Health Laws the purpose is protection of the public health, advocating the rights of people, regulating financing, and accountability. It includes reporting suspected abuse. If not reported, that nurse may be liable for civil or criminal legal action. Uniform Determination of Death Act -dictates under which circumstances are individuals considered to be dead. 1- CARDIAC STANDARD: indicates that a person is considered to be dead when there is irreversible cessation of circulatory and respiratatory functions 2. WHOLE BRAIN STANDARD: indicates death occurs at the time of irreversible cessation of the entire brain function. Physician Assisted- Suicide statute that stated that a competent individual with a terminal disease could make an oral or written request for medication to end his/her life in a humane and dignified manner. 4 criteria needed to establish nursing malpractice 1- the nurse owed a duty to the patient 2- the nurse did not carry out the duty 3- the patient was injured 4- the nurse's failure to carry out duty caused pt injury what should a nurse do if their assignment is unreasonable? inform their supervisor what is a nurse's responsibility with a doctors order? -nurse must follow the order unless the nurse believes that the order is in error or will harm the patient. - if there is controversy the nurse also needs to inform the supervisor and use the chain of command the scope of nursing practice is legally defined by ___? State Nurses Practice Acts risk management system of ensuring appropriate nursing care that identifies potential hazards and eliminates the harm of others what is the definition of pain? whatever the patient says it is, pain is subjective acute pain -protective mechanism, prevents harm -short duration -A-delta myelinated fibers -localized -limited emotional response chronic pain -no longer a protective pain mechanism -C-fibers; unmyelinated -cancerous vs. noncancerous - 6 months pseudo-addiction shows "drug seeking" behavior and "doctor shopping" that may look like addiction but in fact has not been adequately treated for pain; once given a proper, usually higher dose should fix the problem chronic episodic pain Occurs sporadically over an extended duration inferred pathological pain -musculoskeletal -visceral -neuropathic idiopathic pain chronic pain without known cause gate control theory Some pain messages have higher priority than others. When you feel one pain over another. Can be affected by released endorphins (inhibitory neurotransmitters) **gates can be physiological, emotional, or cognitive neurotransmitters released when cell damage occurs by mechanical, thermal, or chemical stimuli -they spread the message and cause inflammatory response examples of neurotransmitters -prostaglandin -bradykinin -k+ -histamine -substance P phase 1-4 of pain 1- transduction 2-transmission 3-perception 4-modulation unmyelinated fibers C-fibers slow diffused pain myelinated fibers A-delta fibers fast localized pain Physiological factors that influence pain fatigue age genes neurological function Social factors that influence pain attention previous experience family/social support spiritual Psychological factors influencing pain -anxiety -coping style -cultural breakthrough pain Type of pain that occurs between the times when medicine is to be administered, flares mod-sev goal of pain management to anticipate and prevent pain rather than to just treat it. analgesic ladder a guideline for selecting pain-relieving medications according to the severity of the pain and whether agents lower on the ladder have been able to control the pain