Study Guide for Dimensions of Professional Nursing EXAM 2

NR 512 Study Guide for Dimensions of Professional Nursing: Nursing Now, Chapter 3: 1. Define Theory and model a. Theory--refers to a speculative statement involving some element of reality that has not been proved. b. Model--a hypothetical representation of something that exists in reality. The purpose of a model is to explain a complex reality in a systematic and organized manner. 2. Why are theories important in nursing? a. They help to explain and direct nursing actions. This also raises nursing from a task oriented job to the level of a profession that uses judgment and knowledge to make informed decisions about client care. 3. What are the 4 key concepts that nursing theories define? a. Client or patient (individual or collective) b. Health c. Environment d. Nursing e. These concepts should be clearly defined, closely interrelated, and mutually supportive. 4. Know the General Systems Theory (open systems and closed systems) a. A widely accepted method for conceptualizing and understanding the world and what is in it derives from a systems viewpoint. b. Rarely used as a nursing model in its pure form, but its process and much of its terminology underlie many nursing models. c. General systems theory, sometimes referred to simply as systems theory, is an outgrowth of an innate intellectual process. This is similar to the process of deductive reasoning in which a single complex thought or theory is broken down into smaller, interrelated pieces. It then puts the parts back together to show how they work individually and then together within the system. d. Open systems are those in which relatively free movement of information, matter, and energy into and out of the system exists. In a completely open system, there would be no restrictions on what moves in and out of the system, thus making its boundaries difficult to identify. e. Closed system prevents any movement into and out of the system. In this case, the system would be totally static and unchanging. Probably no absolutely closed systems exist in the real world, although some systems may tend to be closed to outside elements. 5. Know the Orem Self-Care Model a. A human being able to live life to the fullest through self-care. Assistance in self-care activities to help the client achieve health is the objective in nursing. 6. Know the King Model a. The person participates in a dynamic process to achieve the highest level of functioning. The nursing objective is that the dynamic process meets and identifies with the client’s health care needs. 7. Know the Watson model of Human Caring a. The individual is in a dynamic state of growth and development leading to full potential as a human being. Nursing focuses on the science of caring that helps the clients reach their greatest potential. 8. Know the Neuman Health-Care Systems Model (including stressor and levels of intervention) a. An open system that constantly interacts with the internal and external environment. It features an individual with relatively stable internal functioning of a high state of wellness and identifies the boundary disruption and helps clients in activities to restore stability. 9. Know what Middle Range Theories are a. A set of relatively concrete concepts or propositions that lie between a minor working hypotheses found in everyday nursing research and a well-developed major nursing theory. b. Are less comprehensive and more focused than the major nursing theories but are not as specific or concrete as situation-specific practice theories. c. Generally contain only a few basic ideas or concepts that researchers are attempting to prove or illustrate. They do not have a large number of variables and tend to focus on one or two problems that are linked, like the major theories, to human beings, environment, health care, or nursing. d. Should be socially significant, meaning that they deal with people or populations with health-care conditions. Nursing Now, Chapter 6: 1. Define: a. Values--ideals or concepts that give meaning to an individual's life. b. Morals--the fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development. c. Laws--can generally be defined as rules of social conduct made by humans to protect society, and these laws are based on concerns about fairness and justice. The goal of such is to preserve the species and promote peaceful and productive interactions between individuals and groups of individuals by preventing the actions of one citizen from infringing on the rights of another. d. ethics-- a branch of traditional Western philosophy known as moral philosophy that studies moral behavior in humans and how humans should act toward each other individually and in groups; Ethics, as a system of beliefs and behaviors, goes beyond the law, which has as its primary underlying principle the preservation of society; declarations of what is right or wrong and of what ought to be. e. Ethical code--a written list of a profession's values and standards of conduct. It provides a framework for decision-making for the profession and should be oriented toward the daily decisions made by members of the profession. f. Ethical dilemma--a situation that requires an individual to make a choice between two equally unfavorable alternatives. g. Ethical accountability--To be answerable to oneself and others for one’s own actions. h. Euthanasia--A mode of ending life in which the intent is to cause the patient's death in a single act (also called mercy killing). Patient assisted suicide. i. Autonomy--the right of self-determination, independence, and freedom. It refers to the client's right to make health-care decisions for himself or herself, even if the health-care provider does not agree with those decisions. j. Beneficence--views the primary goal of health care as doing well for clients under their care. In general, the term good includes more than providing technically competent care for clients. Good care requires that the health-care provider take a holistic approach to the client, including the client's beliefs, feelings, and wishes, as well as those of the client's family and significant others. k. No maleficence--the requirement that health-care providers do no harm to their clients, either intentionally or unintentionally. l. Justice--the obligation to be fair to all people. The concept is often expanded to what is called distributive justice, which states that individuals have the right to be treated equally regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief. m. Fidelity--the obligation of an individual to be faithful to commitments made to himself or herself and to others. In health care, fidelity includes the professional's faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of the profession. n. Veracity--the principle of truthfulness. It requires the health-care provider to tell the truth and not to intentionally deceive or mislead clients. o. Advance directive--a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. p. Living will--a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. q. durable power of attorney for health care--In case you ever become mentally incapacitated, you'll need what are known as "durable" powers of attorney for medical care and finances. A durable power of attorney simply means that the document stays in effect if you become incapacitated and unable to handle matters on your own. r. Abandonment--Leaving a client without the client's permission; terminating the professional relationship without providing for appropriate continued or follow-up care by another equally qualified professional. 2. Know the process used in ethical decision making a. Gather the facts b. Define the ethical issues c. Identify the affected parties d. Identify the consequences e. Identify the obligations f. Consider your character and integrity g. Check your gut h. Decide the proper ethical action and be prepared to deal with opposing arguments 3. Know the Ethical Systems of Utilitarianism (teleological) and Deontology. How do they approach ethical dilemma decision making? a. Ethical Systems of Utilitarianism--referred to as the ethical system of utility. As a system of normative ethics, utilitarianism defines good as happiness or pleasure. It is associated with two underlying principles: “the greatest good for the greatest number” and “the end justifies the means.” Because of these two principles, utilitarianism is sometimes subdivided into rule utilitarianism and act utilitarianism. b. Rule Utilitarianism--the individual draws on past experiences to formulate internal rules that are useful in determining the greatest good. c. Act Utilitarianism--the particular situation in which a nurse finds himself or herself determines the rightness or wrongness of a particular act. d. Deontology--a system of ethical decision-making based on moral rules and unchanging principles. This system is also termed the formalistic system, the principle system of ethics, or duty-based ethics. A follower of a pure form of the deontological system of ethical decision-making believes in the ethical absoluteness of principles regardless of the consequences of the decision. 4. Know the basics of the Nursing Code of Ethics (From ANA; 2015) a. The nurse practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice. b. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. c. The nurse promotes, advocates for, and protects the rights, health and safety of the patient. d. The nurse has authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to provide optimal care. e. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. f. The nurse, through individual and collective action, establishes, maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care. g. The nurse, whether in research, practice, education, or administration, contributes to the advancement of the profession through research and scholarly inquiry, professional standards development, and generation of nursing and health policies. h. The nurse collaborates with other health professionals and the public to protect and promote human rights, health diplomacy, and health initiatives. i. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. Nursing Now Chapter 7: 1. Define and be able to relate these terms to ethical principles or issues of nursing: a. Active euthanasia--defined as the intentional act of causing the death of a patient experiencing great suffering. b. Passive euthanasia--defined as withdrawing medical treatment with the deliberate intention of causing the patient's death. c. Mercy Killing--the killing of a patient suffering from an incurable and painful disease, typically by the administration of large doses of painkilling drugs. d. Assisted suicide--the suicide of a patient suffering from an incurable disease, effected by the taking of lethal drugs provided by a doctor for this purpose. e. Self-determination Act--(PSDA) is a federal law, and compliance is mandatory. It is the purpose of this act to ensure that a patient's right to self-determination in health care decisions be communicated and protected. f. Abortion--the deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy. g. Genetic Research--Research using human DNA samples, genetic testing or genetic information. h. Confidentiality--a set of rules or a promise that limits access or places restrictions on certain types of information. i. HIPPA--the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. A regulation designed to protect personal information and data collected and stored in medical records. It’s a national standard to be used in all doctor's’ offices, hospitals, and other businesses where personal medical information is stored. It also gives patients the right to view their medical records and request changes if the data is incorrect. j. Breach of Confidentiality--occurs when nurses share information about patients with people that do not have a “need to know” status covered under the patient’s written authorization. Unless otherwise instructed to do so, nurses cannot discuss patient care or diagnosis with family, friends, co-workers, other nurses, insurance providers or financial aid organizations. k. Transplantation of Human Organs--the act of transplanting the human organs of a deceased person into the body of a living person who is in dire need of them. This affects the donor, the donor’s family, the medical/nursing personnel, and the recipient and his or her family. This is the only health care field in which the actions taken by a group of medical professionals in one part of the country affect their counterparts in another part of the country. l. Choosing recipients of Human Organs--One of the most difficult ethical issues involved in organ transplantation is the selection of recipients. Because fewer organs are available than the numerous people who need them, the potential ethical dilemmas are great. Important criteria for ranking potential recipients include stage of disease process, length of time spent waiting, tissue and blood type compatibility, size matching, and geographic proximity to the donor. Nursing Now Chapter 8: 1. Know the Good Samaritan Act. a. A law that exempts from legal liability persons, sometimes only physicians, who give reasonable aid to strangers in grave physical distress. 2. Know and be able to identify what negligence is. a. Failure to use reasonable care, resulting in damage or injury to another. 3. Know what HIPPA is and in what circumstances a nurse may breach confidentiality. a. See definitions above. b. A nurse may breach confidentiality by talking about a patient and their situation in unsafe areas such as elevators, the dining room, and the hall. They can also breach by not shutting down their computers or closing charts, but discussing a patient with someone not included in the care, or by discussing the situation at home or in another public place. Any instance where the patient’s confidentiality is compromised is considered a breach. 4. Know about laws and the responsibility to the healthcare provider related to Domestic Violence and Child Abuse. a. Anyone in health care is considered a mandated reporter. In other words, if a health care worker suspects abuse, they’re required by law to notify child protective services or the proper authorities. 5. Define a. Assault--the unjustifiable attempt to touch another person or the threat of doing so. b. Battery--actual harmful or unwarranted contact with another person without his or her consent. c. Invasion of Privacy--a violation of a person's right to protection against unreasonable and unwarranted interference with one's personal life. To prove that invasion of privacy has occurred, the client must show that (1) the nurse intruded on the client's seclusion and privacy, (2) the intrusion is objectionable to a reasonable and prudent person, (3) the act committed intrudes on private or published facts or pictures of a private nature, and (4) public disclosure of private information was made. d. False Imprisonment--occurs when a competent client is confined or restrained with intent to prevent him or her from leaving the hospital. e. Intentional Torts--generally defined as a willful act that violates another person's rights or property. Intentional torts can be distinguished from malpractice and acts of negligence by the following three requirements: (1) the nurse must intend to bring about the consequences of the act, (2) the nurse's act must be intended to interfere with the client or the client's property, and (3) the act must be a substantial factor in bringing about the injury or consequences. f. Quasi-Intentional Torts--a mixture of unintentional and intentional torts. It is defined as a voluntary act that directly causes injury or distress without intent to injure or to cause distress. g. professional negligence--The doing of something which a reasonably prudent person would not do, or the failure to do something which a reasonably prudent person would do, under circumstances similar to those shown by the evidence. 6. Define a. Criminal--A person who has committed a crime. b. Contract--a written or spoken agreement, especially one concerning employment, sales, or tenancy, which is intended to be enforceable by law. c. Federal Laws related to health care provider licenses--May cover statutory law, which are laws written and enacted by the US Congress. These laws hold not just in the city and state you live in, but the entire country. d. Civil Laws related to health care provider licenses--generally deal with the violation of one individual's rights by another individual. The court provides the forum that enables these individuals to have their disputes resolved by an independent third party, such as a judge or a jury of the defendant's peers. Examples are tort law, contract law, treaty law, and tax law. 7. Be able to identify appropriate and inappropriate things for a nurse to chart about patients and their care. a. If it isn’t charted, then it didn’t happen. Chart vitals immediately. Only chart what is pertinent to the patient and their care, and only the facts. No personal opinion. 8. DEFINE a. DNR--A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. b. Assault--to make a physical attack on. c. Battery--the crime or tort of unconsented physical contact with another person, even where the contact is not violent but merely menacing or offensive. d. Libel--a published false statement that is damaging to a person's reputation; a written defamation. e. Slander--the action or crime of making a false spoken statement damaging to a person's reputation. f. Advanced Directives--a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. g. Right to Choose--the right of a patient to have a procedure done or medication to be taken; i.e. the right of a woman to have a legal abortion if she chooses to do so. h. Confidentiality--a set of rules or a promise that limits access or places restrictions on certain types of information. The act of keeping information secret or confidential. i. Informed consent--permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. j. Implied consent--consent which is not expressly granted by a person, but rather implicitly granted by a person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's silence or inaction). NOTE: You may be given a patient scenario and must relate and apply the above terms in the scenario.