Client Centered Issues

Front 1

Autonomy

Back 1

-autonomy is having freedom to make choices about issues that affect our life and to make decisions about personal goals
-self determination is derived from the principle of autonomy
-in relation to health care, autonomy includes viewing patients as members of a social world, in which health care decisions affect others and are made in conjunction with trusted persons

Front 2

TThreats to autonomy

Back 2

Threatened by factors such as:
-paternalism
-presumption that a person's values, knowledge level, and ways of dealing with issues are consistent with those of the health providers
-greater attention to technology than caring

Front 3

Paternalism

Back 3

-implies well-intended actions of benevolent decision making, leadership, protection, and discipline
-manifests itself in the making of decisions on behalf of patients without their full consent or knowledge

Front 4

Limits on autonomy

Back 4

- justice implies fair, equitable, and appropriate treatment in light of what is due or owed to persons, recognizing that giving to some may deny receipt to others who might otherwise have received these things
-patient autonomy implies the responsible use of freedom, which means considering the needs of family and society as well as our own desires
-justice requires is to ask not only who deserves an intervention, but who is expected to pay for it

Front 5

Nursing Care Considerations

Back 5

Facilitating patient decisions about health care requires nurses to be attentive to:
-patients valuse
-effects of lifestyle and role
-others affected by patients choices
-evaluation of risks, benefits, and economic considerations

Front 6

Informed consent

Back 6

-provides legal protection of a patient's right to personal autonomy
-it gives the patient an opportunity to choose a course of action in regard to plans for health care

Front 7

Legal elements of informed consent

Back 7

-info includes both disclosure and understanding of the essential info: Professional practice standard (the disclosure is consistent with the standards of the profession), reasonable person standard (what a reasonable person in similar circumstances would need in order to make informed decision), subjective standard (what the particular person wants or needs to know)
-consent implies the freedom to accept or reject something

Front 8

Nursing Roles and Responsibilities

Back 8

-verifying that the patient is aware of options and the implication of each
-advocating for the patient to ensure criteria for autonomous decision making is met
-nurse's signature as witness and treatment was explained to the patient's understanding

Front 9

Advance Directives definitions

Back 9

- instructions indicating health care interventions to initiate or withhold, or that designate someone who will act as a surrogate in making decisions in the event we lose decision-making capacity
-to ensure patients have the end-of-life care they prefer, it should be discussed openly and clearly with family, surrogate, and health care professionals and then placed in writing

Front 10

Advance Directives

Back 10

-Legal wills> legal documents giving directions to health providers related to withholding life support if certain condition exists
-Durable power of attorney> allows competent person to designate another as a surrogate or proxy to act on her or his behalf in making health care decisions in the event of the loss of decision-making capability

Front 11

Elements of Decision-making capacity

Back 11

-medical determination related only to whether people have the ability to make decisions about their health
-patient must have the: ability to understand all info, communicate understanding and choices, personal values that guide decision, ability to reason

Front 12

Competence

Back 12

-ability to make meaningful life decisions
-legally, a person must be ruled incompetent be a judge, and this ruling will generally remain in effect for the rest of the patient's life
-a court-appointed guardian becomes the surrogate decision maker

Front 13

Patient self-determination act

Back 13

-1991, federal law required institutions receiving Medicaid or Medicare funding to provide written info to adult patients regarding their rights to make health care decisions
-includes: right to refuse treatment and opportunity to write Advance Directives

Front 14

Nursing role and responsibility

Back 14

- know states statutes that guide and govern advanced directives
-explore patient and family understanding of info received
-be familiar with patients wishes as expressed by their advanced directives
-increase public awareness of advanced directives
-know own values, beliefs, and concerns associated with end-of-life issues

Front 15

Choices concerning life and health

Back 15

-nurses deal with patients present health concern while encouraging change toward healthier living
-nurses may encounter patients who are not willing to follow the treatment plan and make necessary change toward healthier living
-what is an appropriate nursing response to educating or treating these patients?

Front 16

ANA Code of Ethics for Nurses

Back 16

the code requires to provide services with respect for human dignity and to avoid value judgements related to differences in background, customs, attitudes, and beliefs

Front 17

Complementary therapies

Back 17

-people have the right to use modalities other than conventional medicine
-health care professionals need to broaden their knowledge case concerning these modalities on order to discuss their use with patients
-they could not be discontinued because they are not understood within the Western medial framework

Front 18

Confidentiality

Back 18

-people will not disclose info if they are not provided confidentiality
-without accurate info, health care professionals cannot make appropriate decisions regarding treatment plans or care in general
-any breach in confidentiality is a violation of trust that is needed to build the nurse-patient relationship