UCO Nsg 1221-Intro to Nursing, Exam #2
Terms
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- age of viability
- about 20 weeks; point of development when baby can live outside the mother's body
- Taft-Hartley amended in 1974
- allowed nurses in nonprofits to form collective bargaining units
- Standard of best interest
- describes a type of decision made about a client's health care when the client is unable to make the informed decision regarding his or her own care; basis is what health-care providers & the family decide is best for that individual
- Ethical dilemmas arise from
- client care situations, nursing practice, promotion of the profession
- plaintiff
- individual who brings the dispute to the court
- Ethics serve the purpose of
- governing conduct to insure the protection of an individual's rights
- stare decisis
- requires a judge to make decisions similar to those that have been handed down in previous cases if the facts of the cases are identical
- planning includes
- short & long term goals; pt goals are what pt is able/willing to work on
- distributive justice
- requires that all citizens have equal access to all types of health care, regardless of their income levels, race, sex, religious beliefs, or dx
- Quasi-intentional torts
- mixture of unintentional and intentional torts; a voluntary act that directly causes injury or distress without intent to injure or to cause distress.
- 2 types of advance directives
- living will & medical durable power of attorney
- Deontology
- a system of ethical decision making based on moral rules and unchanging principles; ethical absoluteness of principles regardless of the consequences of the decision
- Legal obligations
- those that have become formal statements of law & are enforceable under the law
- Values are derived from
- societal norms, religion, and family orientation & serve as a the framework for making decisions and taking action in daily life
- Confidentiality
- The right of a pt to expect communication with the nurse to remain unshared
- nursing malpractice is based on these four elements
- duty, breach of duty, causation (the "but for" test related to the injury), & damage or injury
- Omnibus Budget Reconciliation Act of 1990
- requires that all hospitals, nursing-care facilities, home health care agencies, & caregivers ask clients about advanced directives & provide information concerning living wills & durable power of attorney (DPOA) to help clients make informed health-care decisions
- NLRB
- National Labor Relations Board, established to supervise implementation of the act
- inductive reasoning
- particular to general
- Veracity
- the principle of TRUTHFULNESS; requires the health care provider to tell the truth and not to deceive or mislead clients intentionally
- Rights
- generally defined as something owed to an individual according to just claims, legal guarantees, or moral and ethical principles
- Who has the responsibility to obtain the informed consent?
- the person who is performing the procedure (not a nurse substitute that has been asked to get a signature)
- most common of the quasi-intentional torts is...
- defamation of character
- Informed consent can only be given by client after the client receives sufficient information on what?
- Treatment proposed, material risk involved or potential complications, acceptable alternative treatments, outcome hoped for, consequences of not having the treatment
- Oklahoma County Pharmacy
- med provisions based on lack of income qualifications
- Most workplace violence is a result of...
- unresolved stress that does not have an acceptable outlet
- major representation for nurses
- Service Employees International Union
- Autonomy is
- the right of self-determination, independence, & freedom; 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
- Medicare part A
- qualification by having paid into social security
- deductive reasoning
- general to particular
- slander
- spoken communciation in which one person discusses another in terms that harm that person's reputation
- Civil law
- generally deal with the violation of one individual's rights by another individual
- decision of arbitrator
- usually binding recommendations that must be accepted by both sides
- non sequitur
- a fallacy in which the conclusion does not follow from the arguments or premise
- Palliative care
- provides pain relief and comfort measures but does not try to prolong the person's life
- advanced directives
- expressed desires about future medical care; best means to guarantee that a client's wishes will be honored
- Moral principles related to nursing practice
- 1. Belief in the worth & dignity of the individual (every individual is worthy of care regardless of age, income,etc) 2. Health care should yeild general social good; may involve risks in order to advance (examples: clinical drug trials, use of placebos, etc)
- critical thinking skills
- ID problem by restating the issue as a declarative statement, gather pertinent data, understand (your) values in context, challenge assumptions & rituals of care, find cause of problem, imagine & explore solution alternatives creatively
- chief goal of ETHICAL decision making process
- determine right and wrong in situations where clear demarcations are not readily apparent
- Nonmaleficence
- requirement that health-care providers do no harm to their clients, either intentionally or unintentionally; protect client from harm
- 43 - 44 million
- uninsured in this country; some travel to foreign countries...where health care is often better
- legal responsibilities for nursing students
- confidentiality (as student you will have to sign waiver of confidentiality), no pt names on reports, no talking in public about pt (have to be very careful), informed consent (nurse may witness signature but it is responsibility of person doing procedure - doctor - to do the counseling). Nurses may witness signature & need to assure that consent form has the right procedure on it. False imprisonment, assault, battery, negligence
- nurses joining unions
- highly charged issue
- Mediation
- A process that allows each party to present his or her case before a mediator, who is an independent 3rd party trained in dispute resolution. The mediator does not act as a decision maker, but rather encourages the parties to come to an agreeement.
- Act utilitarianism
- outlines a method of ethical thinking in which the situation itself determines whether the act is morally right or wrong; views acts as good to the extent that they promote happiness & bad to the degree that they promote unhappiness
- common areas of legal liability for nurses (per textbook)
- Leaving foreign objects inside a client during surgery, failing to follow a hospital standard or protocol, not using equipment in accordance with the manufacturer's recommendations, failing to listen to and respond to client's complaints, not properly documeting phone conversations & orders from physicians, failure to question physician orders when indicated, failing to clarify poorly written or illegible physician orders, failing to assess and observe a client as directed, failing to obtain a proper informed consent, failing to report a change in a client's condition such as vital signs, circulatory status & level of consciousness, failing to report another health-care provider's incompetency or negligence, failing to take actions to provide for a client's safety, failing to provide a client with sufficient & appropriate education before discharge
- 1978 the North American Nursing Diagnosis Assoc recognized what?
- diagnosis of spiritual distress
- What is brain death?
- an irreversable condition that occurs when blood no longer flows to the brain and the brain tissue dies
- Medicare part B
- have to pay for but for certain medical expenses like supplies, O2
- Ethical dilemma
- is a situation that requries an individual to make a choice between two equally unfavorable alternatives
- 1992 NLNAC
- National League for Nursing Accrediting Commission designated critical thinking as mandatory outcome objectives
- Nonfeasance
- a type of negligence that occurs when a person fails to perfom a legally required duty
- does religion = spirituality?
- no
- DNR
- Do Not Resuscitate
- Informed consent / law
- the voluntary permission by a client, or by the client's designated proxy, to carry out a procedure on the client
- Rule deontology
- is based on the belief that standards exist for the ethical choices and judgements made by individuals
- qualities required to be competent
- technical skills, critical thinker, communication
- Nursing code of ethics
- #1. The nurse in all professional relationships practices with compassion & respect for the inherent dignity, worth, & uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of the health problems. # 2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community. #3. The nurse promotes, advocates for, & strives to protect the health, safety, & rights of the patient. #4. The nurse is responsible & accountable for individual nursing practice & determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. #5. The nurse owes the same duties to self as to others including the responsibility to preserve integrity & safety, to maintain competence, & to continue personal & professional growth. #6. The nurse participates in establishing, maintaining, & improving health care environments & conditions of employment conducive to the provision of quality health care & consistent with the values of the profession through individual & collective action. #7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, & knowledge development. #8. The nurse collaborates with other health professionals & the public in promoting community, national, & international efforts to meet health needs. #9. The profession of nursing, as represented by associations & their members, is responsible for articulating nursing values, for maintaining the integrity of the profession & its practice, & for shaping social policy.
- interest-based bargaining
- 6 steps; reduces power struggles/opposition
- prayer
- consistent across all religions
- health care system type 4
- socialized health system where physicians are state/gov't employees; goal to keep population productive
- critical thinking is
- logical, rational & reflective; must be based on rationales & facts
- Most commonly used alternatives to trial
- mediation & arbitration
- code of ethics
- is a written list of a profession's values and standards of conduct; ethical principles that govern a particular profession
- governance
- arrangement of hierarchy of power
- defining characteristics of spiritual distress
- concerns with the meaning of life & death, anger toward God, concerns about the meaning of suffering, concerns about the person's relationship to God, questions about the meaning of life, the inability to participate in preferred religious practices, seeking spiritual help, concerns about the ethics of prescribed medical regimens, black humor, expressing displaced anger toward clergy, sleep disturbances, and altered mood or behavior
- How are organ donor reciepients chosen?
- Recipients are chosen from the United Network of Organ Sharing, a national computer registry.
- Malpractice
- more serious than mere negligence because it indicates professional misconduct or unreasonable lack of skill in performing professional duties; a type of negligence for which professionals can be sued.
- logical reasoning
- deductive & inductive
- CRIMINAL law classification of offenses
- misdemeanors & felonies
- MCO
- managed care organization
- highly likely times of spiritual need
- at births, death, surgery, ER
- Kevorkian trial verdict
- guilty of second-degree murder; reinforced belief that mercy killing or assisted suicide is always ethically wrong
- main demographics affecting health care delivery
- increasing AGE of population & CHRONIC health problems such as cancer, heart disease Alzheimer's disease, diabetes, COPD, HIV
- methods to prevent litigation
- Impeccable documentation in the chart/medical record, rapport with clients, keep current on nursing skills, knowledge of the client
- health care system type 3
- funded & operated by the government; nat'l health insurance
- National Labor Relations Act (NLRA of 1935)
- granted employees the right to self-organization & to form, & help in the organization of labor unions that could then bargain collectively through representatives
- critical thinking overlaps
- attitude/behavior, technical skills & competencies, interpersonal skills, theoretical & intellectual skills/competencies
- important goal of bargaining unit
- protect employee against arbitrary treatment & unfair labor practices
- common areas of legal liability (as discussed in class)
- Medication errors, failure to properly assess a pt or take an adequate history, failure to observe pt closely & take appropriate precautions, failure to document pertinent information or communicate it to the doctor
- goal of critical thinking
- the resolution of a problem or a method to improve client care
- Interventions / Implementation of Spiritual Care
- listening, being wholly "present", reading Bible with pt, calling a minister, praying with the pt
- Bioethics & bioethical issues
- the ethics of life or in some cases death, questions quality of life, life-sustaining & life-altering technologies, & biological science in general
- Decision making could be assisted by
- professional code of ethics (ANA), health care facility guidelines of IRB & hospital ethics committee, moral principles, professional integrity of faithfulness & committment, belief in the value & validity of scientific truth and scientific method
- Utilitarianism also called teleology, consequentialism, or situation ethics
- referred to as the ethical system of utility; defines good as happiness or pleasure
- Statutory law
- Laws that govern the profession of nursing. Most laws that govern nursing are state-level __________________ because licensure is a function of the state's authority.
- most common violation by nurses of the criminal law
- failure to renew nursing licenses, thereby practicing nursing without a license - a crime in all states
- Moral obligations
- those based on moral or ethical principles but are not enforceable under the law
- health care system type 1
- private approaches predominate; physicians/caregivers & clients have maximum autonomy; clients choose care/service providers
- PPS
- required facilities providing Medicare client services to be reimbursed with fixed-rate system including incentives to reduce LOS
- prejudice =
- bias + stereotype
- Criminal law
- Concerned with providing protection for all members of society. Government imposes punishments appropriate to the type of crime.
- Morals
- fundamental STANDARDS of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development; the "oughts" & "shoulds" of society
- Deontology advantages
- useful in making ethical decision in health care because it holds that an ethical judgement based on principles will be the same in a variety of given similar situations regardless of the time, location, or particular individuals involved; terms used are similar to the legal system
- right to work/open shop collective bargaining unit
- only those employees who desire to be members join the union & pay dues; more chance for conflict between union members & nonmembers
- Betty Neuman & Jean Watson
- only theorists who clearly acknowledged the impact of spirituality in development of their theories
- collective bargaining
- uniting of employees for the purpose of increasing their ability to influence their employer & improve working conditions
- collaborative care =
- complementary care (physician must order, nurse carries out order)
- Ethical decision-making process step 5
- make the decision & act on it
- Common law
- Laws that evolved from the decisions of previous legal cases that form a precedent. Accumulated results of the judgments & decrees that have been handed down by courts.
- collective bargaining unit
- union
- Laws
- rules of social conduct to protect society; based on concerns about fairness & justice. Ultimate goal is to promote peaceful & productive interactions between & among the people of that society.
- Welfare rights or sometimes called legal rights
- based on a legal entitlement to some good or benefit; these rights are guaranteed by laws & violation of such rights can be punished under the legal system
- Positive outcomes by/from using nursing process
- more cost effective, saves time/heal faster, improves communication between staff, reassess & document progress, prevents errors & omissions, keeps caregivers on tract, tailors interventions to individual patients, goals for pt in planning phase (short & long term goals) for at least every cause of the problem(s)
- compassion
- Greek word literally means "to feel in one's innards"
- Values
- IDEALS or CONCEPTS that give meaning to the individual's life; beliefs held concerning the worth, the truth, & the desirability of an idea, object, or behavior
- basis of ANA Code of Ethics
- 1. Dignity of the (every) client (including confidentiality & privacy of every pt), 2. professional development, 3. peer accountability (reporting of staff impaired, fatigued)
- health care system type 2
- hybrid system; practitioner & client autonomy; uses tax dollars to pay for health services through government
- Fidelity is
- the obligation of an individual to be FAITHFUL to commitments made to himself or herself and to others; main support for the concept of accountability
- phenomenology
- discipline of philosophy; parallels & is closely related to existentialism, advocating the view that consciousness determines reality & truth in space & time
- slow code order
- instructions for nurses of terminally ill client to merely go through the motions to make the family feel better
- Whose consent is needed to allow for organ donation?
- Consent must come from the patient's legal next of kin, even if the patient has a signed donor card or an organ donation sticker on his or her driver's license.
- Ethical decision-making process step 2
- state the dilemma
- Nursing malpractice
- based on the legal premise that a nurse can be held legally responsible for the personal injury of another individual if it can be proven that the injury was the result of negligence
- Beneficence
- views the primary goal of health care as doing good for clients under their care; do that to BENEFIT the client
- steps of interest-based bargaining
- selection of issues; discussion of interests; generation of options; establishment of standards to measure the options; measurement of the options; development of solutions
- collective bargaining goal
- equalize power between labor & management
- Ethical rights or sometimes called moral rights
- based on a moral or ethical principle; usually do not need to have the power of law to be enforced; in reality are often privileges allotted to individuals or groups
- Ethical decision-making process step 3
- consider the choices of action
- Ethical decision-making process step 4
- analyze the advantages & disadvantages of each course of action
- by 2050
- 1 in 5 people living in Canada or the US will be elderly - estimated 80 million
- CPR
- cardiopulmonary resuscitation
- Ethical situations
- happen every time a nurse intereacts with a client in a health care setting
- Watson: identifies the awareness of clients' & families' spiritual beliefs as . . .
- a responsibility of the nurse
- PRSO
- reviews quality, quantity, cost of hospital care
- principles that underlie ethical dilemmas
- autonomy, justice, fidelity, beneficence, nonmaleficence, veracity, standard of best interest, & obligations
- contract ratification
- contract approved by majority of employees; becomes legally binding on both parties
- veracity exception
- when telling the client the truth would seriously harm the client's ability to recover or would produce greater illness
- Medicade =
- welfare
- Unintentional torts
- negligence (omission of an act that a reasonable & prudent person would perform in a similar situation) or the commission of something a reasonable person would not do in that situation are the primary forms. Also, malpractice.
- Good care requires
- that the health-care provider take a holistic approach to the client, including the client's beliefs, feelings, & wishes as well as those of the client's family & significant others
- Informed consent
- is permission granted by a person based on full knowledge of the risks and benefits of what is being done
- mediator
- neutral 3rd party used to bring sides together for a settlement
- Justice is
- the obligation to be fair to all people regardless of race, sex, marital status, medical diagnosis, social or economic status, religious beliefs, personal attributes, or the nature of the health problem
- 14.6% of gross domestic product in US
- total expenditures on health
- Moral behavior
- is often manifested as behavior in accordance with a groups norms, customs, or traditions
- euthanasia
- literally "good" or peaceful death
- last sense to be lost by the dying
- hearing
- Intentional tort
- assault & battery, false imprisonment, abandonment, intentional infliction of emotional distress
- DNR orders / law
- DNR = do not resusciate. DNR orders are legally separate from advance directives. For the health-care professional to be legally protected, there should be a written order for a "no code" or a DNR order in the client's chart.
- Principles of Care Assessment
- senses, presence (full attention), intuition, respect, interpretation, trust
- Spiritual Distress
- "disruption in the life principle that pervades a person's entire being & integrates & transcends one's biological & psychosocial nature"
- NLRA ammended in 1947
- Taft-Hartley Act or Labor Management Relations Act (LMRA); excluded nurses in non-profits from organizing & striking
- tort
- wrongful act committed against a person or his or her property independent of a contract; word derived from latin "tortus" (twisted) & is French for injury or wrong
- Ethical decision-making process step 1
- critical thinking process of rational examination of all information available; collect, analyze, and interpret the data
- elective abortion
- voluntary termination of a pregnancy before 24 weeks of gestation, performed solely on mother's own decision
- false imprisonment concerns
- restraints must be ordered; released ~ q 2hr or per facility policy & procedures; must not cause injury to skin; may not put into mental facility against pts wishes
- Paternalism
- Health care providers' making a unilateral decision that disregards the client's wishes. Implies that the providers alone know what is best for the client
- Obligations
- demands made on an individual, a profession, a society, or a government to fulfill and honor the right of others
- anger is part of grief process
- pt may not be nice / usual self during this time
- Medicare part D
- medication coverage
- Normative ethics or normative decisions
- deal with questions and dilemmas that require a choice of actions when there is a conflict of rights or obligations between the nurse and the client, the nurse and the client's family or the nurse and the physician
- Rule utilitarianism
- the individual draws on past experiences to formulate internal rules that are useful in determining the greatest good
- libel
- written communication in which a person makes statements or uses language that harms another person's reputation
- burden of proof in civil cases
- responsibility of plaintiff
- Option rights or sometimes called basic human rights
- rights that are based on a fundamental belief in the dignity and freedom of humans; freedom of choice and the right to live their lives as they choose (example: type of clothing)
- Criteria is used to select an organ donor reciepient
- degree of need, how long they've been on the waiting list, & certain medical criteria, such as blood type compatibility, tissue matching, & body size
- code of ethics provides
- a framework for decision making for the profession
- NURSING PROCESS
- assessment, diagnosis or analysis, planning, implementation, evaluation
- Arbitration
- allows a neutral third party to hear both parties' positions and then make a decision or ruling on the basis of the facts & evidence presented
- defendant
- an individual accused of a crime in the criminal law system
- Ethics
- declarations of what is right or wrong, why we should adhere to certain principles
- spirituality defined
- integrative energy, capable of producing internal human harmony or holism; sense of coherence; entails a sense of transcendent reality; solitude, compassion, empathy, living fully. A part of every person; Maslow's highest heirarchy is spiritual
- Durable Power of Attorney for Health Care
- DPOAHC; designated person to make health-care decisions for someone in case they become unable to make decisions for themselves
- W.H.O. says about the U.S.
- spends more per person on health care than any other country, yet quality of care ranks 37th in world
- 1991 Supreme Court NLRB ruling
- defined 8 separate bargaining units for health-care providers
- stem cells
- the very early cells present in the developing fetus that have not yet begun to differentiate; all the cells are identical and contain all the genetic material needed to reproduce an identical individual
- closed shop or agency shop
- all employees pay membership dues whether they belong to the union or not