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181 Cards in this Set
- Front
- Back
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Ch. 21 Values and Ethics
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Accountability
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The ability to answer for one's own actions Acting under standards of the Nurse Practice Act
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Autonomy
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A person's independence. Each person is in control of his/her own person inc. body and mind. Ex. The right to die
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Benificence
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Taking positive actions to help others. Incorporates the negative obligation of "prima non nocere" - "first do not harm" and the positive obligation to do what is good.
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Bioethics
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Ethical considerations of health care issues, guides us in difficult decisions that arise with healthcare
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Code of Ethics
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Set of Ethical Principles accepted by all members of the profession(ANA American Nurses Assoc. and ICN International Council of Nurses)
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Confidentitiality
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A patients record is kept confidential inc. lab tests, diagnosis and prognosis, even HIV
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Consensus of Bioethics
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Equal regard (appreciation) for different points of view
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Consequentialism
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A utilitarian system of ethics proposes that the value of something is determined by its usefulness. The main emphasis is on the outcome/consequence of an action.
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Cultural Values
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Adopted as a result of the social setting in which a person lives
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Deontology
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Immanuel Kant - Actions are right or wrong based on their right-making characteristics such as fidelity to promises, truthfulness and justice. Problem w/babies in NICU must resucitate even if parents say no
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Ethical Dilemma
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Our values guide us through dissent or confusion. Ex. Drinking and driving, asst suicide, reporting med error, removing feeding tube
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Ethic of Care
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Explores the notion that care is a central activity of human behavior. Typically have been "male-biased" in theory and are more about relationships and ethical dilemmas can be more readily solved if we pay attention to relationships and attention to client stories.
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Ethics
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The study of philosophical ideals of right and wrong behavior
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Ethnocentrism
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The belief that one's own culture is superior
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Fidelity
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The agreement to keep promises
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Gender biased
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Gilligan blvd Kohlbergs theory was this. Leaning towards one sex over the other
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Issues in Bioethics
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Quality of life, Genetic Screening, Futile Care (Double mastectomy b/c you have gene), Allocation of Scarce resources (Med technologies and the nursing shortage)
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Justice
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Refers to fairness. Ex. Liver transplant to rich instead of poor
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Nonmaleficence
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The avoidance of harm or hurt
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Nursing Point of View
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Unique and critical, part of the larger picture, we spend one on one time and patient reveals much to us
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Responsibility
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The characteristics of reliability and dependability
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Teleology
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Assoc. w/Utilitarianism comes form the Greek word telosmeaning "end" or the study of ends or final causes
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Value
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A personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Reflect cultural and social influences, relationships and personal needs. Vary among people and change as you age
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Values clarification
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A way to determine your own personal values. A process of self-discovery that helps a person gain insight into values
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Veracity
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Accuracy or conformity to the truth. Always tell the patient the truth
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Ways to understand Pt values
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Structured communication (allow client to elaborate, avoid yes or no and clarify do not judge
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How to process a nursing dilemma?
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#1 Is this an ethical dilemma? #2 Gather info relevant to the case #3 Examine and determine your own values on the issue #4 Verbalize the problem #5 Consider the possible causes of action #6 Negotiate the outcome #7 Evaluate the action
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A childs immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and for society, outweigh the temporary discomforts. This involves the principle of:
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Beneficence
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If a nurse assesses a client for pain and then offers a plan to manage the pain, the principle that encourages the nurse to monitor the client's response to the plan is:
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Fidelity
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The code of ethicsfor nurses is composed and published by:
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The American Nurses Association
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Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to:
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Assess the client's point of view and prepare to articulate this point of view
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Successful ethical discussion depends on people who have a clear sense of personal values. When many people share the same values it may be possible to identify a philosophy of utilitarianism, which propse that:
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The value of something is determined by its usefulness of society
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The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to:
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Relationships
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In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. The nurses point of view is valuable because:
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Nurses develop a relationship to the client that is unique among all professional health care providers
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Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined that the conflict is ethical, a crittcal first step in negotiating the difference of opinion would be to:
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Gather all relevant information regarding the clinical, social, and spiritual apsects of the dilemma so that negotiations agree on the language of the discussion
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Ch. 22 Legal Implications for Nursing Practice
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Administrative Law
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Created by administrative bodies such as State Boards of Nursing. Ex. The duty to report incompetent or unethical nursing conduct to the State Board of Nursing
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Advance Directives
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Can only come into effect when the patient becomes incompetent to make decisions. Determined by a judge
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Americans with Disabilities Act
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Enacted by federal/congress in 1995 to protect the physical and mental rights of handicapped individuals in the workplace
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Assault
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Any intentional threat to bring about harmful or offensive contact Ex. A nurse threatening to give a client a shot or restrain them for an x-ray
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Autopsies
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Consent must be given by (1)decendent, in writing or (2) durable power of atty (3) surviving spouse and ; (4) surviving child, parent, brother or sister in order named. Consent is different in some cultures
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Battery
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Any intentional touching without consent. This can be harmful to the client and cause injury or it can be offensive. Assault always includes battery Ex. A nurse theatens to give a shot but when she actually gives the shot it is battery.
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Cardiopulmnary definition of death
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Irreversible cessation (stopping) or circulatory and respiratory functions
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Civil Laws
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Protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Violations cause harm to persons or property and usually the damages are paid for by money not imprisonment.
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Common Law
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Created by judicial decisions made in courts when individual legal cases are decided. Ex. Informed consent and the clients right to refuse treatment
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Crimes
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2 types, a felony and a misdemeanor. This happens when a person does something against the law
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Criminal Laws
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Prevent harm to society and provide punishment for crimes Ex criminal conduct is miuse of a controlled substance
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Defamation of Character
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The publication of false statements that result in the damage to a persons reputation
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Durable Power of Attorney for Health Care
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A person who is designated to make health care decisions in behalf of the clients wishes should they be incompetent
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Emergency Medical Treatment and Active Labor Act (EMTALA) 1986
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Enacted by congress to prevent "patient dumping" when a patient comes to the ER he/she must be screened/evaluated within the hospitals capacity before any transfer or discharge.
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Felony
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A crime of a serious nature that has a penalty of imprisonment for greater than one year or even the death sentence
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Fudiciary Relationship
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One in which the nurse was providing services which by nature, causes the client to trust the knowledge, integrity and fidelity of the nurse
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HIPPA Health Insurance Portability and Accountabilty Act
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Protects clients who have preexisting conditions from losing insurance when they change jobs, protects the medical record and access to it, may not copy any of the chart, may not discuss issues in public, no names on charts
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Incident Report
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Tools used in risk management to report an accident or a deviation from policies or prescribed orders involving clients, employees, or visitors.
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Informed Consent
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Process of obtaining permission from a client to perform a specific test or procedure after describing all risks, side effects, and benefits
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Intentional Torts
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Willful acts that violate anothers rights
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Invasion of Privacy
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Breaches of confidentiality, release of pictures or medical records
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Libel
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Written false statement about a person that may injure that person's reputation.
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Living Wills
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Instruments by which a dying person makes wishes known to caregivers; a living will has no legal validity in most states.
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Malice
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Spirit with which the person publishing information knows it is false and publishes it anyway or publishes it with reckless disregard as to the truth or falsity of the statement. Slander: oral and Libel: writing
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Malpractice
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Injurious or unprofessional actions that harm another. Professional negligence
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Mental Health Parity Act
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Mental health benefits must equal that of medical and surgical benefits, clients can be invol or vol admitted and suicidal patients must remain under supervision
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Misdemeanor
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Lesser crime; penalty is usually a fine or imprisonment for less than 1 year.
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Negligence
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Careless act of omission or commission that results in injury to another.
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Nurse Practice Acts
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Statutes enacted by the legislature of any state that delineate the legal scope of the practice of nursing within the geographical boundaries of the jurisdiction. Each of the 50 states
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Nursing Malpractice
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(1) Nurse owed a duty to the client (2)the nurse did not carry out that duty (3)the client was injured - adverse reaction (4)the nurses failure to carry out the duty caused the injury Ex. The nurse left the side rail down and the nurse fell out of bed
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Occurrence Report
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Same as an incident report
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Patient Self-Determination Act (1991)
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Requires that hospitals provide information to patients about their rights to formulate advance directives and refuse treatment
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Public Health Laws
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Required to report suspected abuse and neglect, communicable dieases (STD's) required immunizations
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Reasonably Prudent
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In a malpractice case, if you are ever sued, an expert witness will come and testify what a reasonably prudent nurse with your same background and expertise would have done, knowing your state Nurse Practice Act, your state laws, the hospitals policies and procedures. So, it is crucial that you practice under and within these standards of care
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Regulatory Law
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Same as an administrative law. Law created by administrative bodies such as State Boards of Nursing when they pass rules and regulations.
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Right to Refuse Treatment (Patient Autonomy)
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If competent you can refuse tube feedings, blood transfusions. Minors are innocent third parties and decisions of their parents will be overridden
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Risk Management
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System of ensuring appropriate nursing care.
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Slander
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Utterance of a false statement about another that harms that person's reputation.
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Standards of Care
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Minimum level of care accepted to ensure high quality of care to clients. Standards of care define the types of therapies typically administered to clients with defined problems or needs.
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Statutory Law
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Of or related to laws enacted by a legislative branch of the government. Law created by elected State legislature and US Congress EX Nurse Practice Act (state) and Americans with Disabilities Act 1995 (federal-congress)
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Tort
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Act that causes injury for which the injured party can bring civil action.
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Uniform Determination of Death Act (1980)
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Adopted by most states and provides that either the cardiopulmonary definition or whole brain definition may be used to determine death
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Unintentional Torts
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Includes negligence and malpractice
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Whole-brain standard definition of death
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Irreversible cessation of all functions of the entire brain, including the brain stem
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The Nurse Practice Acts are an example of:
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Statutory law
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The scope of nursing practice, the established educational requirements for nurses, and the distinction between nursing and medical practice is defined by:
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Nurse Practice Acts
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The clients right to refuse treatment is an example of:
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Common law
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The most common sources of client injury are:
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Medication errors and falls
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This act allows an individual who is at least 18 years of age to make an anatomical gift or organ donation:
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Uniform Anatomical Gift Act. It must be in writing and signed by the donor (driver's license accepted) and MD who certifies death cannot be involved in the removal or transplantation of the organs.
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When the nurse stops to help in an emergency at the scene of an accident, if the injured party files suit and the nurse's employing institution's insurance does not cover the nurse, the nurse would probably be covered by:
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The Good Samaritan laws, which grant immunity from suit if there is no gross negligence.
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The legal definition of death that facilitates organ donation is cessation of:
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Functions of the entire brain
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Even though the nurse may obtain the client's signature on a form, obtaining informed consent is the responsibility of the:
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Physician
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The nurse's malpractice insurance covers the nurse for incidents that occur:
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While the nurse is working within the scope of his employment
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The nurse is obligated to follow a physician's order unless:
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The order is in error, violates hospital policy, or would be detrimental to the client
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Common Negligent Acts in Nursing
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Med errors, IV therapy resulting in infiltration or phlebitis, burns, falls, failure to use aseptic technique, errors in surgical counts, failure to give accurate reports, failure to accurately monitor a clients condition, failure to notify MD of a clients change in condition
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Ch. 23 Communication
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Active listening
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Listening attentively with one's whole being—mind, body, and spirit
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Assertiveness
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Comprises respect for others, respect for yourself, self-awareness, and effective, clear and consistent communication
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Autonomy
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The ability to be self-directed and independent in accomplishing goals and advocating for others
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Channels
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Means of conveying and receiving messages through visual, auditory, and tactile
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Communication
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Means by which people interact
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Connotative
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The interpretation of a word's meaning influenced by feelings, thoughts, or ideas. Ex. "serious" may mean near death to family, while serious to a nurse describes the nature of the illness
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Denotative
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Individuals use a common language share the denotative meaning Ex. "food" has the same meaning for everyone who speaks English
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Empathy
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Ability to understand and accept another person's reality
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Environment
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Physical circumstances in which a person works or lives; can increase the likelihood that certain illnesses will occur (e.g. some kinds of cancer and other diseases are mo re likely to develop when industrial workers are exposed to certain chemicals or when people live near toxic waste disposal sites).
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Feedback
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In communication theory, information produced by a receiver and perceived by a sender that informs the sender about the receiver's reaction to the message. Feedback is a cyclical part of the process of communication that regulates and modifies the content of messages.
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Interpersonal Communication
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Exchange of information between two persons or among persons in a small group
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Interpersonal Variables
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Factors within both the sender and receiver that influence communication
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Intrapersonal Communication
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Communication that occurs within an individual (e.g., a person who talks with the self silently or who forms an idea in the mind).
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Message
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Information sent or expressed by the sender in the communication process
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Metacommunication
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Communication that includes not only what is said but also the relationship of those involved in the interaction. It is a message that conveys the sender's attitude toward the self, the message, and the attitudes, feelings, and intentions toward the listener
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Nonverbal communication
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Communication using expressions, gestures, body posture, and positioning rather than words
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Pacing
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Conversation set at the correct speed
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Perceptions
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Person's mental image or concept of elements in the environment, including information gained through the senses.
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Perceptual biases
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Human tendencies that interfere with accurately perceiving and interpreting messages from others
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Phases of the helping relationship
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nurse client relationship, nurse family relationships, nurse health team, nurse community
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Public communication
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Interaction between one person and a large group of people
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Receiver
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Person to whom the message is sent during the communication process
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Referent
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Factor that motivates a person to communicate with another individual
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Sender
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Person who initiates interpersonal communication by conveying a message
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Small-group communication
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Interaction that occurs when a small number of persons meet together
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Sympathy
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Concern, sorrow, or pity felt for the client, generated by the nurse's personal identification with the client's needs
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Therapeutic communication techniques
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Specific responses that encourage the expression of feelings and ideas and convey the nurse's acceptance and respect
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Transpersonal communication
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Interaction that occurs within a person's spiritual domain
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Verbal communication
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Sending of messages from one individual to another or to a group of individuals through the spoken word
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7 basic elements to communication
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(1) Referent, (2) Sender and Receiver, (3) Messages, (4) Channels, (5) Feedback, (6) Interpersonal Variables and (7) Environment
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Communication is not the message that was intended but rather the message that was received. The statement that best helps explain this is:
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Contextual factors, such as attitudes, values, beliefs, and self-concept, influence communication
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The nurse demonstrates active listening by:
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Assuming a relaxed posture and leaning toward the client
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The nurse builds helping, caring relationships by:
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Establishing trust and demonstrating empathy
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The statement that best explains the role of collaboration with others for the client's plan of care is the professional nurse:
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Collaborates with colleagues and the clients family to provide combined expertise in planning care
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"I'm not sure what you mean, sicker than usual. What is diff now?" What therapeutic technique is the nurse using?
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Clarifying
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"We've talked a lot about your medications, but let's look more closely at the trouble you are having in taking them on time." The nurse is using what therapeutic technique?
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Focusng
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"If I were you, I'd put your mother in a nursing home." The nurse is using the nontherapeutic technique:
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Giving personal opinions
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When working with an older adult, the nurse should remember to avoid:
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Shifting from subject to subject
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A nurse should consider zones of personal space and touch when caring for clients. If the nurse is taking the clients nursing history, she should:
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Be 18" to 4 feet from the client
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Ch. 24 Client Education
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Affective Learning
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Acquisition of behaviors involved in expressing feelings in attitudes, appreciations, and values
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Analogies
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Comparisons made between things otherwise unalike.
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Cognitive learning
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Acquisition of intellectual skills that encompass behaviors such as thinking, understanding, and evaluating.
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Compliance
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Person's fulfillment of the prescribed course of treatment
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Functional illiteracy
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Inability to read or comprehend above a fifth-grade level.
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Learning
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Acquisition of new knowledge and skills as a result o f reinforcement, practice, and experience.
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Motivation
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Internal impulse that causes a person to take action.
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Psychomotor Learning
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Acquisition of ability to perform motor skills.
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Reinforcement
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Provision of a contingent response to a learner's behavior that increases the probability of the behavior recurring.
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Return Demonstrations
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Demonstrations performed by the client after he or she has first observed the teacher and then practiced the skill in mock or real situations.
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Self-efficacy
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Term that refers to a person's perceived ability to successfully complete a task.
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Teaching
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Implementation method used to present correct principles, procedures, and techniques of health care
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A client must learn to use a walker. Acquisition of this skill will require learning in the:
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Psychomotor domain
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The nurse should plan to teach a client about the importance of exercise:
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When the clients pain medications are working
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A client newly diagnosed with cervical cancer is going home. The client is avoiding discussion of her illness and postoperative orders. In teaching the client about discharge instructions, the nurse should:
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Provide only the information the client needs to go home
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The school nurse is about to teach a freshman-level health class about nutrition. To achieve the best learning outcomes, the nurse should:
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Develop topics for discussion that require problem solving
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A nurse is going to teach a client how to perform a BSE. The behavioral objective that would best measure the client's ability to perform the BSE is:
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The client will perform the BSE on herself before the end of the teaching session
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A client who is having chest pain is going for an emergency cardiac catheterization. The most appropriate teaching approach in the situation is the:
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Telling approach
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The nurse is teaching a parenting class to a group of pregnant adolescents and has given the adolescents baby dolls to bathe and talk to. This is an example of:
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Role playing
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An older adult is being started on a new antihypertensive medication. In teaching the client about the medication, the nurse should:
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Allow the client time to express himself or herself and ask questions
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A client must learn to administer a SUBQ injection. The nurse knows the client is ready to learn when the client:
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Expresses the importance of learning the skill
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A client who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. The best teaching method would be:
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Demonstration
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Ch. 26 Self Concept
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Body Image
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Mental picture of one's body internally and externally.
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Identity
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Component of self-concept; sense of continuity and sameness; one's persisting consciousness of being oneself, separate, unique, and distinct from others.
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Identity Confusion
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Form of self-concept disturbance in which a person does not maintain a clear consciousness of a consistent and continuous self; sense of fragmentation or distortion.
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Role Ambiguity
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State in which a person has unclear role expectations and feels unable to predict the outcomes of behavior.
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Role Conflict
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State in which a person experiences incongruent or incompatible expectations within one role or between two or more simultaneously held roles.
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Role Overload
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State in which a person has more roles or more responsibilities within a role than are manageable.
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Role Performance
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Way in which an individual perceives his or her competency in carrying out significant roles.
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Role Strain
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Generalized state of frustration or anxiety produced by the stress of role conflict and ambiguity.
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Self-concept
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Complex, dynamic integration of conscious and unconscious feelings, attitudes, and perceptions about one's identity, physical being, worth, and roles; how people perceive and define themselves.
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Self-esteem
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Feeling of self-worth characterized by feelings of achievement, adequacy, self-confidence, and usefulness.
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Sick Role
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The expectations of others and society regarding how one should behave when they are sick
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When a nurse is caring for a client after mastectomy, interventions to promote physiological stability and pain control are necessary. In addition, the nurse also needs to design nursing interventions directed toward improving her:
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Self concept
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Developing self through modeling, imitation and socialization is a self concept developmental task during the ages of:
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1 - 3 years
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The following involves the internal sense of individuality, wholeness, and consistency of a person over time and in various circumstances:
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Identity
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Adolescents are at risk for body image disturbance. An acurate statement about body image is that:
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Body image includes actual and perceived perceptions of one's body
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Certain behaviors become common or are avoided, depending on whether they are approved and reinforced or discouraged and punished. This process is called:
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Reinforcement-extinction
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When an individual internalizes the beliefs, behavior, and values of role models into a personal, unique expression of self, the process is called:
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Indentification
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An individuals identity is affected by stressors throughout life, but the age group that is particularly vulnerable to stressors because of it being a time of great change is:
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Adolescents
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When a person does not maintain a clear, consistent, and continuous consciousness of personal identity, it results in:
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Identity confusion
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The nurse asks the client, "How do you feel about yourself?" The nurse is assessing the clien's:
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Self esteem
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Increasing a clients self-awareness is achieved:
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Through establishing a trusting relationship that allows the client to openly explore thoughts and feelings
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