ethical issues, legal issues, texas nurse practice act and nurse jurisprudence exam, Delegation & prioritization of client care exam questions and answers|verified for accuracy|GUARANTEED SUCCESS

define terminology commonly used in discussions about ethical issues advance directive- a written statement of a persons wishes about how he or she would like health care decisions to be made if he or she ever loses the ability to make such decisions independently bioethical issues- subjects that raise concerns of right and wrong in matters involving human life (eg euthanasia, abortion) bioethics- ethics concerning life durable power of attorney for health care- a document that allows a person to name someone else to make medical decisions for him or her if he or she is unable to do so. this spokesperson's authority begins only when the patient is incompetent to make those decisions ethics- rules or principles that determine which human actions are right or wrong ethical dilemma- 1. a situation involving competing rules or principles that appear to have no satisfactory solution 2. a choice between two or more equally undesirable alternatives living will- a document that allows a person to state in advance that life-sustaining treatment is not to be administered if the person later is terminally ill and incompetent moral/ethical principles- fundamental values or assumptions about the way individuals should be treated and cared for moral courage- the willingness to do what is right despite the fear of consequences moral distress- feeling of powerlessness to do what is right and ethical moral reasoning- a process of considering and selecting approaches to resolve ethical issues moral uncertainty- a situation that exists when the individual is unsure which moral principles or values apply in a given situation values- beliefs that are considered very important and frequently influence an individuals behavior analyze personal values that influence approaches to ethical issues and decision making what do you value? -clarify your values choosing-what values do i hold important? prizing- dot these work for me? acting on your value choice. this is who i am your values may change overtime consider how your values affect your decision making consider how you bring your own values into your nursing practice apply the 6 basic ethical principles to nursing scenarios Which principle is most important? a. Risk versus benefit - from the patient's perspective 2. How to determine who owns the problem? a. Determine the facts of the case. b. Identify the ethical issues of the situation. c. Consider possible courses of action and their outcomes. d. After a course of action has been taken, evaluate the outcome. Applying ethical principles to nursing scenarios: a. Autonomy - A patient's right to make decisions - self-determination - without outside control. i. Nurses need to respect a patient's right to make decisions about his healthcare. ii. "You have the right to decide about your healthcare." b. Beneficence - Duty to actively do good for patients. i. Nurses need to identify a patient's needs and help meet them ii. "My actions are done to help you." c. Nonmaleficence - Duty to prevent or avoid doing harm, whether intentional or unintentional. i. The nurse must protect patients from coming to harm. ii. "I won't let harm come to you." d. Fidelity - the duty to be faithful to commitments. Loyalty. Follow through. Includes confidentiality. i. The nurse keeps confidential information confidential and follows through on commitments. ii. "I promise ... and I always keep my promises." e. Justice -the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. i. The nurse understands and acknowledges allocation of scarce healthcare resources but also meets each patient's needs consistently regardless of variables. ii. "I will treat you fairly." f. Veracity - the duty to tell the truth. i. Nurses must be truthful to their patients. ii. " I will tell you the truth." discuss resources available to nurses when dealing with ethical issues 1. Resources available to help nurses resolve ethical dilemmas a. ANA Code of Ethics for Nurses b. Patient's Bill of rights - Patient Care Partnership c. Hospital's Ethics Committee discuss current ethical issues nurses may face in healthcare 1. Ethical issues confronting nurses a. Abortion b. Euthanasia --Physician-Assisted Suicide c. Futile Care- medical intervention without reasonable hope of benefit to the patient (ICU, advance directive?) d. Transplantation- who should receive? how are donors solicited? illegal to buy organs i. Deceased patients ii. Fetal tissue- e. In vitro fertilization f. Genetics and genomics g. Allocation of scarce resources Common legal terms advance directive- a document made by a competent individual to establish desired health care for the future or to give someone else the right to make health care decisions if the individual becomes incompetent, examples include living wills and medical powers of attorney defamation- a civil wrong in which an individuals reputation in the community, including the professional community, has been damaged defendant- the person who is being accused of wrongdoing, the person then must defend themselves against the charges, this is the nurse or other health care provider deposition- out of court oral testimony given under oath before a court reporter, the purpose is to enable attorneys to ask questions and receive answers related to the case diversion program- voluntary, confidential monitoring program for nurses whose practice may be impaired due to substance abuse disorder expert witness- a person who has specific knowledge, skills and practice regarding a specific area whose testimony will be allowed in court to prove the standard of care good Samaritan law- a law that provdes civil immunity to professionals who stop and render care in an emergency, care rendered cannot be done so in a grossly negligent manner interrogatory- a process of discovering facts regarding a case through a set of written questions exchanged through the attorneys representing the parties in the case jurisdiction-the courts authority to accept and decide cases may be based on location or subject matter of the case malpractice- improper performance of professional duties, a failure to meet standards of care negligence- failure to act as an ordinary prudent person would when such failure results in harm to another plaintiff- the person who files the lawsuit and is seeking damages for a perceived wrongdoing (patient/family) reasonable care- the level of care or skill that is customarily rendered by a competent health care worker of similar education and experience in providing services to an individual in the community in which the person is practicing standard of care- a set of guidelines based on various types of evidence as to what is reasonable and prudent behavior statutes of limitation- laws that set time limits for when a case may be filed telemedicine- using telecommunication to provide medical info remotely torts- CIVIL wrongs committed by one person against another person or property (includes assault and battery) whistleblower- individuals "on the inside" who reports incorrect or illegal activities to an agency with the authority to monitor or control those activities whistleblower statute- law that protects a whistleblower from retaliation identify 3 major sources of laws Practical advice a. "Mother Rule" -would you feel comfortable telling your mother about what you're doing or thinking about doing b. Fraud or defamation of character—if something feels dishonest, its probably dishonest c. Scope of practice -don't do what's not under your scope d. Invasion of privacy -or breach of confidentiality: don't gossip or talk about patients unnecessarily Sources of laws: 1. Constitutional law- rights, privileges, and responsibilities as set forth by the us constitution including the bill of rights and Medicaid 2. Statutory law- statutes created by legislature can be federal, state, or local. Most common type of law affecting nurses-Nurse Practice Act 3. Administrative law- rules and regulations passed by administrative agencies-BON (federal laws affecting nursing include: HIPAA, americans w/ disablities act, mental health parity act, national organ transplant act) Nurse Practice Acts- -each state has one, -both statues and administrative rules, -qualifications, regulations and monitoring of RNs 1. Criminal law- prosecution and punishment for a crime 2. Civil law - Rights between individuals 3. Common law or Case law- decisions made by judges in court cases explore differences between criminal law and civil law as they pertain to nursing (per ati) Criminal law- is a subsection of public law and relates to the relationship of an individual with the government. violations of criminal law can be categorized as: *a felony: (a serious crime, such as a homicide) *or a misdemeanor: (a less serious crime such as petty theft) Ex. a nurse who falsifies a record to cover up a serious mistake can be found guilty of breaking a criminal law Civil laws- protect the individual rights of people. one type of civil law that relates to the provision of nursing care is tort law. torts can be classified as unintentional, quasi-intentional, and intentional Unintentional torts: (ACTING or FAILING to act as a REASONABLE and PRUDENT person would, resulting in HARM to a person to whom a DUTY was owed.) *Negligence (is the most common)-practice or misconduct that does not meet expected standards of care and places the client at risk for injury Ex. a nurse who fails to implement safety measures for a client who has been identified as at risk for falls *Malpractice-professional negligence Ex. a nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies. Intentional torts: *Assult- the conduct of one person makes another person fearful and apprehensive Ex. threatening to place an NG tube in a client who is refusing to eat *Battery- intentional and wrongful physical contact with a person that involves an injury or offensive contact Ex. restraining a client and administering an injection against his wishes *False imprisonment- a person is confined or restrained against his will Ex. using restraints on a competent client to prevent his leaving the health care facility Quasi-intentional torts: *Defamation- false communication or communication with careless disregard for the truth with the intent to injure an individuals reputation Libel-defamation with the written word or photographs Ex. a nurse documents in a clients health record that a provider is incompetent Slander- defamation with the spoken word Ex. a nurse tells a coworker that she believes a client has been unfaithful to the spouse discuss the components of negligence as applied to nursing practice (ati) Malpractice (professional negligence) *malpractice is the failure of a person with professional training to act in a "reasonable and prudent manner": a person who has average judgment, foresight, intelligence and skill that would be expected of a person with similar training and experience Elements necessary to prove negligence w/ an example of a fall risk client: 1. Duty to provide care defined by a standard: care that should be given or what a reasonably prudent nurse would do Ex. the nurse should complete a fall risk assessment for all clients upon admission, per facility protocol 2. Breach of duty by failure to meet standard: failure to give the standard of care that should have been given Ex. the nurse does not perform a fall risk assessment during admission 3. Foreseeability of harm: the knowledge that failing to meet the standard has the potential to cause harm to the client Ex. the nurse should know that failure to take fall-risk precautions can endanger a client at risk for falls 4. Breach of duty has the potential to cause harm (combines elements 2&3): failure to meet the standard has the potential to harm-relationship must be provable Ex. if a fall risk assessment is not performed, the client risk for falls is not determined and the proper precautions are not put in place 5. Harm occurs: occurrence of actual harm to the client Ex. the client falls out of bed and breaks his hip identify common categories of negligence in nursing practice Malpractice a. Definition: Professional negligence. When doing the act required the person to have special education. b. Common causes of malpractice claims: i. Failure to document ii. Medication errors iii. failure to provide a safe enviorment iv. Patient falls v. Equipment failure vi. Failure to assess, monitor, and obtain assistance vii. to communicate adequately viii. Failure to report c. Important documentation: i. Patient's condition on admission and discharge ii. Assessment after incident, physical and mental condtion iii. Patient's non-compliance with medical directives iv. Patient complaints or v. Note exactly what the patient says and admits to vi. Discharge instructions d. Who has liability in a claim? i. The nurse-personal liability ii. The supervisor-supervisory liability iii. The institution-institutional liability iv. The student-student liability explain how standards of care and nursing practice acts are used in determining negligence and malpractice nurses base practice on established standards of care or legal guidelines for care. these standards of care can be found in the following: *the nurse practice act of each state *published standards of nursing developed by professional organizations- ANA, ACCN, oncology nurses society etc *accrediting bodies (the join commission) *originally mandated quality assurance programs *sentinel event reporting *failure mode and effects analysis *NPSG * health care facilities policies and procedures -Standards of care guide, define and direct the level of care that should be given by practicing nurses. they are also used in malpractice lawsuits to determine if that level was maintained -Nurses should refuse to practice beyond the legal scope of practice and/or outside of their area of competence regardless of the reason -Nurses should us the formal chain of command to verbalize concerns related to assignment in light of current legal scope, job description, and area of competence explore various laws and how they impact the practice of nursing good Samaritan laws - which vary from state to state, protect nurses who provide emergency assistance outside of the employment location. the nurse must provide a standard of care that is reasonable and prudent - state laws vary as to when an individual may begin practicing nursing. some states allow graduates of nursing programs to practice under a limited license whereas some states require licensure by passing the NCLEX before working discuss considerations nurses use when participating in the informed consent process 1. Informed consent a. Physician explains risk, benefits, and options b. Physician obtains "informed consent." c. Nurse's role is to witness a signature and clarifying questions d. Criteria for informed consent: mentally competent adult, client understands exactly what they are consenting to, they understand the risks, alternatives, and the outcomes, and the consent is written provide examples of actions nurses can take to reduce their risk of being sued nurses can avoid being liable for negligence by doing the following: *following standards of care *giving competent care *communicating with other health team members *developing a caring rapport with clients *fully documenting assessments, interventions, and evaluations