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Chapter 1, 2, 3, 4, 5, 7, 9

values

Enduring beliefs or attitudes about the worth of a person, object, idea, or action. People have a small number of these.

value system

Are basic to a way of life, give direction to life, and form the basis of behavior- especially behavior that is based on decisions or choices. Are the way by which people organize their values internally along a continuum from most important to least important.

beliefs (or opinions)

Interpretations or conclusions that people accept as true, They are based nore on faith than on fact. May last briefly. Often judged as correct or incorrect.

attitude

Mental positions or feelings towards a person, object, or idea (e.g., acceptance, compassion, openness). Lasts over time. Jusged as good or bad, positive or negative.

values transmission

Influenced by social traditions; cultural, ethnic, and religious groups; and by family and peer groups.

professional values

Acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers.

5 values essential for the professional nurse are:

altruism, autonomy, human dignity, integrity, and social justice

values clarification

Process by which people identify, examine, and develop their own individual values. A main principle is that no one set of values is right for everyone. Promotes personal growth by fostering awareness, empathy, and insight. An important step to take in dealing with ethical problems.

Which fundamental professional nursing values have not varied over time or across groups?

Human dignity, equality, and prevention of suffering.

True or Fale
The nurse should never assume that the client has any particular values.

True

What are the steps that may help clients clarify their values?

Listing alternatives
Examining possible consequences of choices
Choosing freely
Feeling about the choice
Affirming the choice
Acting with a pattern

ethics

-a method of inquiry that helps people understand the morality of human behavior
-the practices or beliefs of a certain group (ie, medical ethics, nursing ethics)
-the expected standards of moral behavior of a particular group as described in the group's formal code of professional ethics.

bioethics

ethics applied to human life or health (ie, decisions about abortion or euthanasia).

nursing ethics

refers to ethical issues that occur in nursing practice.

Scope and Standards of Practice

A publication by the ANA (2010) which holds nurses accountable for their ethical conduct.

Professional Performance Standard 7

-Of the ANA Scope and Standards of Practice publication relates to ethics.
-The current edition of this standard was significantly expanded to include greater emphasis on nurse advocacy and professional responsibility.

morality (or morals)

-similar to ethics, many use the terms interchangeably
-refers to private, personal standards of what is right and wrong in conduct, character, and attitude.

It is important for a nurse to distinguish between....

morality and law
-laws reflect moral values of a society, however, an action can be legal but not moral.
-action can be moral but illegal.

morality and religion (as they relate to health practices)

moral development

The process of learning to tell the difference between right and wrong and of learning what should and should not be done. Is a complex process that begins in childhood and continues throughout life.

Lawrence Kohlberg (1969) and Carol Gilligan (1982)

Two well-known theorists of moral development.

What is the difference between Kohlberg and Gilligan's theory?

Kohlberg's theory emphasizes rights and formal reasoning;
Gilligan's emphasizes care and responsibility, although it points out that people use the concepts of both theorists in their moral reasoning.

What factors differentiate the three main types of moral theories?

Their emphasis on: a)consequences, b) principles and duties, c)relationships

What are the three moral frameworks?

-Consequence-based (teleological) theories
-Principle-based (deontological) theories
-Relationships-based (caring) theories

Consequence-based (teleological) theories

Look to the outcomes (consequences) of an action in judging whether that action is right or wrong. Ex, utilitariansim

utilitarianism

A consequentialist theory. Views a good act as one that is the most useful-that is, brings the most good and the least harm for the greatest number of people.

utility

Most good and the least harm for the greatest number of people

Principles-based (deontological) theories

Involves logical and formal processes and emphasize individual rights, duties, and obligations. Morality is determined by whether it is done according to an impartial, objective principle.

Relationships-based (caring) theories

Stress courage, generosity, commitment, and the need to nurture and maintain relationships. Judges actions according to a perspective of caring and responsibility. Stress individual rights, promotes the common good or the welfare of the group.

moral principles

Statements about broad, general, philosophical concepts such as autonomy and justice. Provide the foundation for moral rules.

moral rules

Specific prescriptions for actions.

List the moral principles that a nurse must have

autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, responsibility

autonomy

Refers to the right to make one's own decisions. Respecting the client's right to make decisions even when those choices seem to the not to be in the client's best interest.

nonmaleficence

The duty to "do not harm." A complex principle to follow as harm can be intentional as well as unintentional. Unintentional harm occurs when the risk could not have been anticipated.

beneficence

"Doing good." Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons.

justice

Frequently referred to as fairness.

fidelity

To be faithful to agreements and promises. Nurses often make promises and should keep them.

veracity

Refers to telling the truth. In practice, choices are not always clear. The loss of trust in the nurse and the anxiety caused by not knowing the truth, for example, usually outweigh any benefits derived from lying.

accountability

According to the Code of Ethics for Nurses, this means to be "answerable to oneself and others for one's own actions."

responsibility

According to the Code of Ethics for Nurses, this refers to "the specific accountability or liability associated with the performance of duties of a particular role."

What should the ethical nurse be able to do?

Explain the rationale behind every action and recognize the standards to which he or she will be held.

What do the Ethical standards of the Joint Commission mandate?

That health care institutions provide ethics committees or a similar structure to write guidelines and policies and to provide education, counseling, and support on ethical issues.

code of ethics

A formal statement of a group's ideals and values.
Is a set of ethical principles that a) is shared by members of the group, b) reflects their moral judgments over time, and c) serves as a standard for their professional actions.

What are the purposes of the Nursing codes of ethics?

1) Inform the public about the minimum standards of the profession and help them understand professional nursing conduct
2) Provide a sign of the profession's commitment to the public it serves.
3)Outline the major ethical considerations of the profession.
4)Provide ethical standards for professional behavior.
5) Guide the profession in self-regulation
6) Remind nurses of the special responsibilty they assume when caring for the sick.

Nurses' growing awareness of ethical problems has occurred largely because of.....

a) social and technological changes and b) nurses' conflicting loyalties and obligations.

Responsible ethical reasoning is....

Rational, systematic, and based on ethical principles and codes rather than emotions, intuition, fixed policies, or precedent.

moral stress

Occurs when what is in the clients best interest may be contrary to the nurse's personal belief system. This is considered a serious issue in the workplace. One step to coping with this is using the 4A's.

What are the 4A's to Rise Above Moral Distress?

Ask, affirm, assess, act. In addition nurses may establish team conferences and use of counseling professionals to express their feelings.

What is an important first step in ethical decision making?

To determine whether a moral situation exists. Criteria is used to determine this.

List the major ethical issues that nurses frequently encounter.

-Responsibility and risk of caring for an AIDS client: Testing for HIV/AIDS in health professionals and clients

-Abortion. Principle of sanctity of life use principle of autonomy and a woman's right to control her own body.

-Organ and tissue transplantation: allocation of organs, selling of body parts, involvement of children as potential donors, consent, clear definition of death, and conflicts of interest between donors and recipients.

-End-of-Life Issues: Euthanasia, assisted suicide, termination of life-sustaining treatment, withdrawing or withholding of foods and fluids.

-Allocation of scare health resources

-Management of personal health information.

advocate

One who expresses and defends the cause of another.

What is the overall goal of the client advocate?

To protect the clients' rights. Inform client of their rights and provide them with the info they need to make an informed decision.

What are the three functions of the advocacy role?

To inform, support, and mediate

What does client advocacy involve?

Concern for and actions on behalf of another person or organization in order to bring about change.

Clara Barton

An "angel" in the Civil War, she treated the wounded in the field. A schoolteacher who volunteered as a nurse during the Civil War. Most notably, she organized the American Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882

Case manager

a nurse who works with the multidisciplinary health care team to measure the effectiveness of the case management plan and monitor outcomes

Dorthea Dix

Tireless reformer, who worked mightily to improve the treatment of the mentally ill. Appointed superintendant of women nurses for the Union forces.

Standards of clinical nursing practice

descriptions of the responsibilities for which nurses are accountable

Demography

the study of population, including statistics about distribution by age and place of residence, mortality, and morbidity

Manager

one who is appointed to a position in an organization which gives the power to guide and direct the work of others

Sojourner Truth

an abolitionist, Underground Railroad agent, preacher, and women's rights advocate, she was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedman's Relief Association after the war

What is Health promotion?

Nutrition, exercise and accident prevention.

What is illness prevention?

Immunizations, prenatal care, prevent stds

How do professional nursing organizations influence nursing practice?

Enhance growth of individuals and allows a collective influence on issues/legislation, improve standard of education.

Factors influencing contemporary nursing practice

Aging, economics, family structure, science, technology, consumer demands, legislation, demography, nursing shortage, telenursing.

Mary Mahoney

Graduated from the New England Hospital for women and children in 1879 as America's First African American Nurse. Constantly worked for acceptance of African Americans in nursing and promotion of equal opportunities

Florence Nightingale

considered the founder of modern nursing, she was influential in developing nursing education, practice, and administration

Patient Self-Determination Act (PSDA)

legislation requiring that every competent adult be informed in writing upon admission to a health care institution about his or her rights to accept or refuse medical care and to use advance directives

Communicator

nurses identify client problems and then communicate these verbally or in writing to other members of the health team

Caregiver

a role that has traditionally included those activities that assist the client physically and psychologically while preserving the client's dignity

Counseling

the process of helping a client to recognize and cope with stressful psychologic or social problems, to develop improved interpersonal relationships, and to promote personal growth

Mary Breckinridge

a nurse who practiced midwivery in England, Australia, and New Zealand, founded the Frontier Nursing Service in Kentucky in 1925 to provide family-centered primary health care to rural populations

Standards of Professional Performance

Describe behaviors expected in the professional nursing role. Quality of Practice, Education, Professional Practice Evaluation, Collegiality, Collaboration, Ethics, Research, Resource Utilization, Leadership

Professionalism

a set of attributes, a way of life that implies responsibility and commitment

Margaret Sanger

considered the founder of Planned Parenthood, was imprisoned for opening the first birth control information clinic in Baltimore in 1916

Telecommunications

The transmission of information from one site to another, using equipment to transmit information in the forms of signs, signals, words, or pictures by cable, radio, or other systems

Lavinia L. Dock

a nursing leader and suffragist who was active in the protest movement for women's rights that resulted in the U.S. Constitution amendment allowing women to vote in 1920

What is nursing?

Nursing is caring. An art and a science. Health promoting, maintaining & restoring.

Benners stage II

Advanced beginner

Which events influenced modern day nursing?

The role of women as subservient caregivers, religious values - love thy neighbor, war - created need, societal attitudes - image and visionary leadership - positive image.

Name the 4 areas of nursing practice

Promoting health & wellness, preventing illness, restoring health and care for the dying.

In-Service Education

training provided by a health care agency or institution to increase the knowledge of their employees. Inform nurses of the new programs & supplies. Important.

Professionalization

the process of becoming professional; acquiring characteristics considered to be professional

Diagnostic Related Groups (DRGs)

system to classify diagnoses into similar groups and is used to determine the amount of Medicare payment to a health care provider

Benners stage V

Expert

Change agent

a person (or group) who initiates changes or who assists others in making modifications in themselves or in the system

Sairy Gamp

a character in Dickens book, Martin Chizzlewit, who represented the negative image of nurses in the early 1800s

Benners stage III

Competent, 2-3 years

Harriet Tubman

known as "The Moses of Her People" for her work with the Underground Railroad. During the Civil War she nursed the sick and suffering of her own race

Continuing Education (CE)

formalized experiences designed to enlarge the knowledge or skills of practitioners

Luther Christman

Registered nurse and a founder of the American Assembly for Men in Nursing (AAMN). Also founded the National Student Nurse's Association

Consumer

an individual, a group of people, or a community that uses a service or commodity

Linda Richards

First trained nurse in America. Known for introducing Doctor's orders and nurse's notes. Initiated practice of nurses weating uniforms. Credited for pioneer work in psychiatric and industrial nursing.

Leader

a person who influences others to work together to accomplish a specific goal

Patient

a person who is waiting for or undergoing medical treatment and care

Governance

the establishment and maintenance of social, political, and economic arrangements by which practitioners control their practice, self-discipline, working conditions, and professional affairs

Socialization

a process by which a person learns the ways of a group or society in order to become a functioning participant

Teacher

a nurse who helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health

Client advocate

an individual who pleads the cause of clients' rights

Benners stage IV

Proficient - 3-5 years

Lillian Wald

founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing

Client

a person who engages the advice or services of another person who is qualified to provide this service

Fabiola

This Roman woman spent her wealth nursing the sick and poor. she provided FIRST FREE HOSPITAL IN ROME about 370 AD.

Knights of Saint Lazarus

an order of knights that dedicated themselves to the care of people with leprosy, syphilis, and chronic skin conditions

Profession

an occupation that requires extensive education or a calling that requires special knowledge, skill, and preparation

What is restoring health?

Direct care, diagnostic, consult, teaching and rehab

What attributes contribute to the profession of nursing?

A well defined body of knowledge, a service orientation, research, code of ethics, autonomous/regulates itself, has professional organization for governance.

What is the nurse practice act?

Statewide list of legal acts of professional nursing. To protect the public.

Benners stage I

Student, no experience

Assault

an attempt or threat to touch another person unjustifiably

Credentialing

the process of determining and maintaining competence in practice; includes licensure, registration, certification, and accreditation

Contract law and tort law are examples of what body of law?

Private law (civil law).

Damages

if malpractice caused the injury, the nurse is held liable for damages that may be compensated

What are the three criteria necessary for a profession or occupation to obtain the right to license its members?

1) There is a need to protect the public's safety or welfare.
2) The occupation is clearly delineated as a separate, distinct area of work.
3) A proper authority has been established to assume the obligations of the licensing process, for ex, in nursing, state boards of nursing.

What three groups of people cannot provide consent?

1) minors or adult who has the mental capacity of a child and who has an appointed guardian 2) persons who are unconscious or injured in such a way that they are unable to give consent 3)people with mental illnesses who have been judged by professionals to be incompetent.

Unethical conduct

may be addressed in nurse practice acts. Unethical conduct includes violation of professional ethical codes, breach of confidentiality, fraud, or refusing to. care for clients of specific socioeconomic or cultural origins

What legal concepts are implicit in the role of nurse as Provider of Service?

liability, standards of care, and contractual obligations

What are the laws and strategies in place to protect nurses against litigation?

-Good Samaritan acts (protect nurses when assisting at the scene of an emergency)
-Providing safe, competent practice by following the nurse practice act and standards of practice
-Accurate and complete documentation
-Professional liability insurance
-Carrying out a physician's order
-The incident report

Statutory law

a law enacted by any legislative body

Slander

defamation by the spoken word, stating unprivileged (not legally protected) or false words by which a reputation is damaged

What is the type of malpractice that results from ignoring a client's complaints?

Failure to observe and take appropriate action.

Name the 4 functions of the law in nursing

Framework (for what is legal), Differentiates (scope), Est. boundaries (of individual nurse actions), Maintain standard of practice (accountability)

6 elements that must be present for malpractice to be proven

duty, breach of duty, forseability, causation, harm/injury, damages

Civil action

deals with the relationship between individuals in society

Implied consent

consent that is assumed in an emergency when consent cannot be obtained from the client or a relative

Harm

the client or plaintiff must demonstrate some type of harm or injury (physical, financial or emotional) as a result of the breach of duty owed the client. The plaintiff will be asked to document physical injury, medical costs, loss of wages, "pain and suffering," and any other damages

Mandated reporters

a role of the nurse in which he or she identifies and assesses cases of violence against others, and in every case the situation must be reported to the proper authorities

Name 4 sources of law in US

Constitutional (US), Legislation (state/statutory), Administrative (boards), Common law (court decisions)

Injury

(Harm) the client or plaintiff must demonstrate some type of harm or injury (physical, financial or emotional) as a result of the breach of duty owed the client. The plaintiff will be asked to document physical injury, medical costs, loss of wages, "pain and suffering," and any other damages

What is whistle blowing?

Reporting unprofessional or unsafe behavior.

Homicide, manslaughter, and theft are examples of what segment and type of law?

Criminal law, which belongs to the larger body of public law.

Tort

a civil wrong committed against a person or a person's property

External standards of care

consist of: Nurse practice acts; Professional organizations (ie, ANA); Nursing specialty-practice organizations (ie, Emergency Nurses Association, Oncology Nursing Society); Federal organizations and federal guidelines (ie, The Joint Commission and Medicare.)

Changes in what two areas have led to questions being raised about the state-based model of nursing licensure?

Health care delivery and telecommunications technology advances.

What us the legal purpose for defining the scope of nursing practice, licensing requirements, and standards of care?

Protection of the public.

Criminal law

deals with actions against the safety and welfare of the public

True or False. Nurse practice acts differ from state to state.

True. (Although similar, the acts may differ in their scope of practice definition and in licensing and license renewal requirements.)

Common law

the body of principles that evolves from court decisions

Internal standards of care

include "the nurse's job description, education, and expertise as well as individual policies and procedures."

Unprofessional conduct

one of the grounds for action against the nurse's license; includes incompetence or gross negligence, conviction of practicing without a license, falsification of client records, and illegally obtaining, using or possessing controlled substances

What are some examples of tort law applicable to nurses?

Negligence, malpractice, invasion of privacy, and assault and battery.

What are four specific areas of HIPAA that pertain to nurses?

1) Electronic transfer of information 2) Standardized numbers 3) The security rule 4 ) The privacy rules

Duty

the nurse must have (or should have had) a relationship with the client that involves providing care and following an acceptable standard of care

Mutual recognition model

a new regulatory model developed by the National Council of State Boards of Nursing (NCSBN), which allows for multistate licensure

What identifying information is protected under HIPAA that may not be initially perceived as health information?

Social security number, name, address, phone number, website address, fingerprints, and age (if over 89).

Impaired nurse

a nurse whose practice has deteriorated because of chemical abuse

Guidelines for nurses who choose to render emergency care:

-Limit actions to those normally considered first aid, if possible
-Do not perform actions that you do not know how to do
-Offer assistance, but do not insist
-Have someone call or go for additional help
-Do not leave the scene until the injured person leaves or another qualified person takes over
-Do not accept any compensation

What four types of invasion must the client be protected from?

-Use of the client's name or likeness for profit, without consent.
-Unreasonable intrusion
-Public disclosure of private facts
-Putting a person in a false light

What are the three separate, interdependent legal roles of the nurse?

provider of service, employee or contractor for service, and citizen

competent adult

A person over 18 who is conscious and oriented.

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