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Enduring beliefs or attitudes about the worth of a person, object, idea, or action. People have a small number of these.
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.
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.
Influenced by social traditions; cultural, ethnic, and religious groups; and by family and peer groups.
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
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.
What are the steps that may help clients clarify their values?
Examining possible consequences of choices
Feeling about the choice
Affirming the choice
Acting with a pattern
-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.
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)
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.
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
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.
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.
Statements about broad, general, philosophical concepts such as autonomy and justice. Provide the foundation for moral rules.
List the moral principles that a nurse must have
autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, responsibility
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.
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.
"Doing good." Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons.
To be faithful to agreements and promises. Nurses often make promises and should keep them.
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.
According to the Code of Ethics for Nurses, this means to be "answerable to oneself and others for one's own actions."
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.
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.
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 does client advocacy involve?
Concern for and actions on behalf of another person or organization in order to bring about change.
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
a nurse who works with the multidisciplinary health care team to measure the effectiveness of the case management plan and monitor outcomes
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
the study of population, including statistics about distribution by age and place of residence, mortality, and morbidity
one who is appointed to a position in an organization which gives the power to guide and direct the work of others
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
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.
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
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
nurses identify client problems and then communicate these verbally or in writing to other members of the health team
a role that has traditionally included those activities that assist the client physically and psychologically while preserving the client's dignity
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
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
considered the founder of Planned Parenthood, was imprisoned for opening the first birth control information clinic in Baltimore in 1916
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.
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.
training provided by a health care agency or institution to increase the knowledge of their employees. Inform nurses of the new programs & supplies. Important.
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
a person (or group) who initiates changes or who assists others in making modifications in themselves or in the system
a character in Dickens book, Martin Chizzlewit, who represented the negative image of nurses in the early 1800s
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
Registered nurse and a founder of the American Assembly for Men in Nursing (AAMN). Also founded the National Student Nurse's Association
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.
the establishment and maintenance of social, political, and economic arrangements by which practitioners control their practice, self-discipline, working conditions, and professional affairs
a process by which a person learns the ways of a group or society in order to become a functioning participant
a nurse who helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health
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
a person who engages the advice or services of another person who is qualified to provide this service
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
an occupation that requires extensive education or a calling that requires special knowledge, skill, and preparation
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.
the process of determining and maintaining competence in practice; includes licensure, registration, certification, and accreditation
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.
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
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
consent that is assumed in an emergency when consent cannot be obtained from the client or a relative
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
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)
(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
Homicide, manslaughter, and theft are examples of what segment and type of law?
Criminal law, which belongs to the larger body of public law.
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.
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.)
Internal standards of care
include "the nurse's job description, education, and expertise as well as individual policies and procedures."
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
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).
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.
-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
Good Samaritan Acts
laws designed to protect health care providers who provide assistance at the scene of an emergency against claims of malpractice unless it can be shown that there was a gross departure from the normal standard of care or willful wrongdoing on their part.
(legal) a communication that is false, or made with careless disregard for the truth, and results in injury to the reputation of another
The voluntary practice of validating that an individual nurse has met minimum standards of nursing competence in specialty areas. Certification programs are conducted by the American Nurses Association 9ANA) and by specialty nursing organizations.
True or False. After signing the consent form a patient cannot change their minds and cancel a procedure.
False. The right to refuse continues even after signing the consent. Nurse should notify health provider of the refusal and document it in the chart.
a fact that must be proven that the harm occurred as a direct result of the nurse's failure to follow the standard of care and the nurse could have (or should have) known that failure to follow the standard of care could result in such harm
the negligent acts of persons engaged in professions or occupations in which highly technical or professional skills are employed
Where can one find their state's nurse practice acts?
At the specific state board of nursing's website.
vary among practice settings; may be as an independent or employer-employee relationship
Called the Nurse Licensure Compact (NLC) an agreement between two or more states. It is the mechanism to create mutual recognition among states.
The regulation of nursing is a function of which source and branch of law?
Legislation (statutory Law). Within this, state law, via the nurse practice acts. However, these acts must be consistent with constitutional and federal provisions
the willful or negligent touching of a person (or the person's clothes or even something the person is carrying), which may or may not cause harm
the quality or state of being legally responsible for one's obligations and actions and to make financial restitution for wrongful acts
transferring to a competent individual the authority to perform a selected nursing task in a selected situation; the transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome
What is documented following an informed consent?
-client's concerns or questions -notifcation of health care provider -clients stated understanding -any teaching as a result of nurse-related questions -special circumstances, such as the use of an interpreter (document their full name and title).
Why is it important to have knowledge of the laws that regulate nursing practice?
Accountability, ensure consistancy with current law, protect the public, protect self from liability.
duty of care established by the presence of an expressed or implied contract
What are the categories of physicians orders that nurses must question to protect themselves legally?
1) Question any order that a client questions
2) Question any order if the client's condition has changed
3)Question and record verbal orders to avoid miscommunication
4) Question any order that is illegible, unclear, or incomplete
the body of law that deals with relationships among private individuals; also known as private law
What is the major difference between civil and criminal law?
The potential outcome for the defendant. If found guilty in a civil action, defendant will have to pay a sum of money. If found guilty in a criminal action, defendant may pay money, be jailed, or executed, if a nurse, could lose his/her license.
law that defines and enforces duties and rights among private individuals that are not based on contractual agreements
Breach of duty
a standard of care that is expected in the specific situation but that the nurse did not observe; this is the failure to act as a reasonable, prudent nurse under the circumstances
Standards of care
detailed guidelines describing the minimal nursing care that can reasonably be expected to ensure high quality care in a defined situation (eg, a medical diagnosis or a diagnostic test). Become legal guidelines for nursing practice. Can be classified into internal and external standards.
What are the 5 steps of a lawsuit?
1. A complaint is filed by the plaintiff against the defendants.
2. A written response is made by the defendants.
3. Both parties engage in pretrail activities to obtain all the facts of the situation.
4. In the trial all relevant facts are presented to a jury or only to a judge.
5. Judge renders a decision, or jury renders a verdict. If outcome is unacceptable an appeal is made for another trial.
a client's agreement to accept a course of treatment or a procedure after receiving complete information, including the risks of treatment and facts relating to it, from the physician
What are the three major elements of informed consent?
1) The consent must be given voluntarily.
2)The consent must be given by a client or individual with the capacity and competence to understand.
3) The client or individual must be given enough information to be the ultimate decision maker.
Legal responsibilities as a nursing student.
I am responsible and liable for my own actions. When I perform duties within the scope of nursing, I am held to the same standard.
involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm
a supposition or system of ideas that is proposed to explain a given phenomenon (ie: theory of gravity)
used for fields of study in which the central focus is performance of a professional role (nursing, teaching, etc)
those that articulate a broad range of the significant relationships among the concepts of a discipline
refers to a pattern of shared understandings and assumptions about reality and the world. paradigms include our notions of reality that are largely unconscious or taken for granted
focus on the exploration of concepts such as pain, self-esteem, learning, and hardiness
a belief system, often an early effort to define nursing phenomena, and serves as the basis for later theoretical formulations
Nightingale's environmental theory
links health w/ 5 environmental factors: pure or fresh air, pure water, efficient drainage, cleanliness, and light, especially sunlight
Peplau's interpersonal relations model
existence of a therapeutic relationship betw the nurse and the client. 4 phases: orientation, identification, exploitation, and resolution
Henderson's definition of nursing
nurse is concerned w/ both healthy and ill. emphasis on independence from, and interdependence w/, other health care disciplines is well recognized. Nurses role= assisting sick or healthy individuals independence in meeting 14 fundamental needs.
Rogers' science of unitary human beings
person=irreducible whole, the whole being greater than the sum of its parts. humans=dynamic energy fields in continuous exchange w/ environmental fields. 4D.
Orem's general theory of nursing*
based on 4 concepts: self-care, self-care agency, self-care requisites(needs), and therapeutic self-care demand
King's goal attainment theory
relationship of personal systems (individuals), interpersonal systems (groups such as nurse-client), and social systems (education, health care, etc)
Neuman's systems model*
based on the individual's relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. reconstitution is the state of adaptation to stressors (atom model) intra=infection, inter=unrealistic role expectations, extra=$ concerns
Roy's adaptation model
the process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create human and environmental integration. 4 modes: physiological, self-concept, role function mode, and interdependence mode.
Leininger's cultural care diversity and universality theory
human caring varies among cultures in its expressions, processes, and patterns. it is largely culturally derived. focuses on what is univeral among cultures and what varies.
Watson's human caring theory
caring=unifying focus for practice. carative factors=clinical caritas processes (10 of them)
Parse's human becoming theory
3 assumptions about human becoming focus on meaning, rhythmicity, and cotranscendence
Cumulative Index to Nursing and Allied Health Literature; database for nursing and health-related literature
Process of delivering educational or instructional programs to locations away from a classroom or site.
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