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Ethics in Nursing
Hutton lecture
Question | Answer |
---|---|
Differentiate between responsiblity and accountability. | * Responsibility is a state of obligation to do something w/i one's power or control * Accountability is a state where one is subject to the obligation to report, explain, or justify some action |
Differentiate between intentional and unintentional torts. | * Intentional torts require intent to do harm, but harm isn't necessary for liablity * Unintentional torts require harm, but not intent. * Intentional torts do not require expert witnesses, b/c there is no standard to compare actions to. |
List 5 examples of Intentional Torts and 2 examples of Unintentional Torts. | Intentional: * assault & battery * defamation of character * invasion of privacy * false imprisonment * fraud Unintentional: * Negligence * Malpractice |
What is the threat or attempt to make bodily contact with another person without their consent? | Assault |
What is the willful, angry, violent, or negligent touching of another person's body or anything attached to that person? | Battery |
Who might be someone to call when faced with an ethical dilemma, such as the absence of an MD, etc. | PCC, ER |
The making of derogatory remarks about another person, diminishing their character | Slander: defamation of character |
Written derogatory remarks about another person | Libel: defamation of character |
Intrusion by a person into the personal affairs of another individual | Invasion of privacy |
4 examples of invasion of privacy: | * eavesdropping upon a private conversation * unauthorized intrusion on childbirth * taking of photos w/o consent * displaying x-rays/papers w/ the client's name on them |
Unjustified detention or prevention of movement of another person w/o proper consent | False imprisonment |
What type of document can a client sign to relieve health providers from liability when the client is leaving despite the detriment to his/her health? | Against medical advice; absence without authority |
The willful & purposeful misrepresentation that could cause harm or has caused loss or harm to a person or property | Fraud |
Performing an act that a reasonable prudent person under similar circumstances would not do: or failing to perform an act that a reasonably prudent person would do under similar circumstances | Negligence |
A violation of professional duty, a failure to meet standards of care, or a failure to use skills & knowledge of other professionals in the same situation | Malpractice |
The purpose is to define professional accountability to the public; establishes general & specific guidelines for practice. | Standards of care |
Who develops standards of care & where might we find these laid out? | * Developed by professional organizations & institution policies * Found in textbooks: Kozier, Davis, Lewis |
The main purpose of this is to guarantee minimum standards for licensure & credentialing; defines the legal scope of nursing practice. | Nurse Practice Act |
What to remember about delegation? | 1. Nurses can delegate tasks, but not the nursing process (assessment, etc) 2. Nurses must monitor the outcome of the delegated tasks for deviations & whatnot |
What tasks can nurses delegate? | * bathing * comfort care * V/S * sometimes dressing changes (but must look at & assess) |
Who has the power to decide whether nursing students sit for their board exams? | State Board of Nursing |
List 4 powers of the State Board of Nursing. | * examine & license * regulate & define nursing practice * approve nursing educational programs * investigate & discipline nurses |
Who can file a complaint to the State Board of Nursing? | anyone |
Who is liable for a student nurse's errors? | * student * instructor * school of nursing |
Who must perform as a professional nurse would, up to the point in their experience... and after mastering a skill will be held accountable? | student nurse |
What statute permits a client to make own health care choices; requires facilities to recognize advance directives, offer to complete an advance directive, & the right to refuse treatment? | The Patient Self-Determination Act * health care surrogate * living will |
Who may be responsible for ensuring the patient has consented to a medical procedure? | the nurse, doctor, health care team |
When is consent unnecessary? | In emergency situations |
Reasons for Negligence that may result in malpractice lawsuits: | * improper technique or negligent performance * untimely management of care/ follow-up of complications * failure to act as a pt advocate * failure to use equipment responsibly * failure to follow standards of care * failure to communicate |
Reasons for Negligence that may result in malpractice lawsuits: | * meds administration errors * failure to assess & continue monitoring * failure to document |
6 elements that must be present for a nursing malpractice case to be proven: | 1. duty: nurse had responsibility for client 2. breach of duty: standard of care was neglected 3. foreseeability: nurse's act must be correlated directly with injury 4. causation: harm occurred as a result of nurse's action 5. harm/injury 6. damages |
List some legal safeguards: | * stay up to date on knowledge: nursing journals! * stay w/i legal boundaries * follow agency policies/procedures * use evidence-based practice * evaluate team assignments * develop good rapport w/ HC team * be sensitive to client issues |
List some legal safeguards (part 2): | * avoid double shifts * complete incident reports on yourself & your colleagues * malpractice insurance * Good Samaritan Act |
This provides a defense for those who provide services in an emergency, but does not protect a nurse from a lawsuit, if harm is caused. | Good Samaritan Act |
Nurses are/are not required to stop in an emergency situation? Authorized to provide ___ life support. | are not; basic |
Who is required to stop for an emergency? | paramedics, firefighters, police officers |
Executing physician orders is a legal responsibility of the Nurse Practice Act unless... | you anticipate injury will occur if the order is carried out. |
Telephone orders: protocol, things to remember: | * Must have a second RN verify the order * Must spell out the order * Must read back the order * Must remind physician of patient you are speaking of |
When does a nurse question an order? | * if the order is ambiguous * if it contradicts normal practice * if it is contradicted by client's condition * if client questions the order |
When questioning a doctor's order, what should you keep in mind/prepare to question? | * Must have sound reason or know enough to question * Explain why you question the order * NOTIFY MD |
3 expectations during your clinical experience that will minimize liability. | * Conduct a thorough assessment of your pt at the beginning of your shift * Continue to reassess your pt thru/o shift, esp after med admin or procedures * follow up w/ findings: communication & documentation are essential |
When are insulin injections administered? | before breakfast |
What lab values tell you clearly whether someone is dehydrated or not? | BUN-creatinine ratio |
Litigation is another word for ____. Who is considered a litigator? | * lawsuit * participating lawyers in lawsuits |
The result of a trial: a judge renders a ____, while a jury renders a ____. | decision; verdict |
Skills and learning commonly possessed by members of a profession: legal guidelines for nursing practice | standards of care |
External standards of care include: | * nurse practice acts * professional organizations * nursing specialty-practice orgs. * federal orgs. and guidelines |
Internal standards of care include: | * job description * education * expertise * individual institution's policies & procedures |
Enduring beliefs or attitudes about the worth of a person, object, idea, or action: guide one's behavior | Values |
Interpretations or conclusions that people accept as true: based more on faith than fact: may or may not be true | Beliefs |
Mental positions (emotions) or feelings toward a person, object, or idea (such as acceptance, openness, compassion). | Attitudes |
The right to self-determination... occurs when the nurse respects patient's rights to make decisions about their own health care. | Autonomy |
A systematic inquiry into the principles of right & wrong conduct, of virtue & of good & evil as they relate to conduct; expected standards of moral behavior of a group described by group; based on a body of knowledge | Ethics |
Private, personal standards of what is right & wrong in conduct, character, & attitude; may arouse feelings of guilt, hope, shame; use of "ought", "should", "right", "wrong", "good" or "bad" | Morality |
What word describes truth telling? | Veracity |
What word means to treat all people fairly & equally | Justice |
What word means to be faithful to agreements & promises? | Fidelity |
What word means to "do no harm"? | Nonmaleficence |
Who establishes the Nursing Code of Ethics? List 7 Moral Principles found within the code. | * ANA * Autonomy * Beneficence (promote good) * Nonmaleficence * Veracity * Justice * Fidelity * Value neutrality |
What are 3 characteristics of a code of ethics? | * shared by members of a group * reflects members' moral judgment over time * serves as a standard for their professional actions |
Which statute promotes autonomy? | Self-Determination Act |
An ____ expresses and defends the cause of another. | advocate |
Why is the nurse's responsibility as client advocate important? | * Clients may be too weak to cut thru hospital bureaucracy to get adequate care * Client may be incompetent & nurse must consider health care surrogate or family's decision-making |
What is the overall goal of client advocacy? Describe 3 ways of implementing this goal. | * Overall goal: to protect client's rights * INFORM clients about rights: give info relevant to decision-making * SUPPORT client's decisions * MEDIATE b/w client & other health care providers |
List 6 steps involved in the ethical decision-making process. | * Identify the problem * Gather data * Collaborate with HC team * Discuss options * Make decision * Evaluate effectiveness of decision (reassess) |
What is the main function of an ethics committee? | The main fxn is to provide a safe place to discuss ethical dilemmas b/w providers, patient, & family |
How does one gain access to the ethics committee? | * Must first speak to nurse manager about situation * Must request access to speak with the committee |