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What makes nursing a profession? Is it a profession?
-high level of intellectual functioning is required
-nurses use assessment skills and knowledge, have the ability to reason, and make routine judgments based on clients' conditions daily
-nurses are accountable and demonstrate a high level of individual responsibility for the care and services they provide
-"nursing science" continues to grow
-use evidence-based practice
-altruistic profession composed of selfless individuals who place the lives and well-being of clients above their personal safety
-well organized and strong representation: National League for Nursing and American Nurses Association
-Nurse's code of ethics- recognized by other professions as a standard with which others are compared
Important definitions from pages 124-139
Law: formal statement of a society's beliefs about interactions among and between its citizens; a formal rule enforced by society
Ethics: principles or standards of conduct that govern an individual or group
Values: judgment of worth, quality, or desirability based on attitude formed from need or experience; a strong belief held by individuals about something importnant to them
Morals: fundamental standards of right and wrong that an individual learns and interalizes during the early stages of childhood development, based primarily on religious beliefs and societal norms
Code of ethics: written values of a profession that act as a guideline for professional behavior
Ethical dilemma: ethical situation that requires an individual to make a choice between two equally unfavorable alternatives
Autonomy: State of being self-directed or independent; the ability to make decisions for one's future
Justice: fairness; giving people
Fidelity: the obligation of an individual to be faithful to commitments made to self and others.
Beneficence: ethical priniciple based on the beliefs that the health-care provider should do no harm, prevent harm, remove existing harm, and promote the good and well-being of the client.
Nonmaleficence: ethical principle that requires the professional to do no harm to the client.
Veracity: the principle of truthfulness. It requires the health-care provider to tell the truth and not intentionally deceive or mislead clients.
Obligations: demands made on individuals, professions, society, or government to fulfill and honor the rights of others. Obligations are often divided into two categories- moral and legal.
Legal obligations: obligations that have become formal statements of law and are enforceable under the law.
Moral obligations: obligations based on moral or ethical principles but not enforceable under the law.
Rights: just claim or expectation that may or may not be protected by law. Legal rights are protected by law but moral rights are not.
Legal rights: Rights that are based on a legal entitlement to some good or benefits and are enforceable under the legal system with punishment for violations.
Ethical rights: Rights that are based on moral or ethical principles but have no legal mechanism of enforcement.
Basic human rights: Those considerations society deems reasonably expected for all people; right to self-determination, protection from discomfort and harm, dignity, fair treatment, and privacy.
Normative ethics: Questions and dilemmas requiring a choice of actions whereby there is a conflict of rights or obligations between the nurse and the client, the nurse and the client's family, or the nurse and the physician.
Bioethical issues: Issues that deal with the health, safety, life, and death of human being, often arising from advances in medical science and technology.
Utilitarianism: An ethical system that identifies the right action by determining what will provide the greatest good for the greatest number of people
Deontology: ethical system based on the principle that the right action is guided buy a set of unchanging rules.
Slow-code order: Physician's order that the efforts for resuscitation of a client who is terminally ill should be initiated and conducted by at a leisurely pace; the goal of a slow-code order is to allow the client to die during an apparent resuscitation. Slow-code orders are not acceptable practice and do not meet standards of care.
No-code orders: DNR order
Intentional torts: assault, battery, false imprisonment, invasion of privacy, defamation.
Unintentional torts: negligence, malpractice, standards of practice.
Advocacy: Safeguarding the client's rights and supporting their interests.
Explain the ethical theories/systems and their application.
1. Normative ethics: deal with questions and dilemmas that require a choice of actions when there is a conflict of rights or obligations between the nurse and the client, the nurse and the client's family, or the nurse and the physician.
2. Bioethics: Deals with questions concerning life and death, and also questions the quality of life, life-sustaining and life-altering technologies, and biological science.
3. Utilitarianism: Defines good as happiness or pleasure. 2 underlying principles: the greatest good for the greatest number and the end justifies the means.
-Rule utilitarianism: Individual draws on past experiences to formulate internal rules that are useful in determining the greatest good.
-Act utilitarianism: when the situation itself determines whether the act is morally right or wrong.
Deontology: system of ethical decision making based on moral rules and unchanging principles
Ethical theories provide framework for decision-making that can be applied to particular ethical situations.
What are some examples of criminal law and nurses' involvement?
Criminal law provides protection for all member of society.
Misdemeanor: minor criminal offense
Felony: major criminal offense
Defendant is the person being accused of the crime
Nurse's involvement: (examples) failure to renew nursing license, illegal diversion of drugs such as narcotics, and intentional and unintentional death
Explain tort law and nurses' involvement
A tort is a wrongful act committed against a person or their property.
A person who commits a tort is called a tort- feasor and is liable for damages to those affected.
the word tort in latin tortus means twisted and is the French word for wrong
torts are classified as unintentional intentional and quasi-intentional
Unintentional torts negligence the omission of an act that a reasonable prudent person would preform.
unintentional torts malpractice a type of negligence for which professionals can be sued. the standard for nurses is what a reasonable prudent person would do in the same situation
Intentional tort a willful act that violates another persons rights or property.
3 requirements that distinguish from malpractice
1. the nurse must intend to bring about consequences of the act
2. the nurses act must be intended to interfere with the client or clients property
3. the act must be a substantial factor in bringing the injury or consequences.
the following are examples of intentional torts
assault and battery. the unjustifiable attempt to touch another person or threat of doing so. battery is the actual harmful or unwarranted contact with another person. without consent
False imprisonment when a competent pt is confined or contained or restrained with intent to prevent leaving the hospital
intentional infliction of emotional distress again 3 criteria are met 1 the conduct exceeds what is usually accepted by society 2. the health care provider's conduct intended to cause mental distress and 3. the conduct actually does produce mental distress.
Client abandonment is another intentional tort
Explain how nurses can prevent lawsuits.
In order to prevent law suits a nurse can:
1) Use effective communication techniques such as SBAR as ineffective communication is one of the leading causes of litigation in nursing.
2) Charting everything in the medical record at the time it happened. This can prevent negligence claims based on "if it isn't charted, it didn't happen".
3) Establishing communication with the patients. If the patient trusts a nurse and can have an open dialogue with him/her it incidence of lawsuits is decreased.
4) Keeping up on current best practices and nursing education and skills training. This can prevent medical error by ensuring that the nurse knows the best practices and is using updated information in his/her own practice.
5) Understanding and recognizing which patients may be prone to initiate law suits. Patients that are dissatisfied with care, have a history of lawsuits, or constantly complain can all be sources of possible new lawsuits.
Describe proper documentation guidelines.
Basically if it's not documented it didn't happen.
For medications, the time, route and dose needs to be documented, as well as the response from the patient. If a medication was not given that needs to be charted as well along with why it wasn't given.
When communicating with the provider, each attempt to reach the provider should be documented as well as the time attempted. If reached, the discussion contents should be documented as well.
When speaking to a provider confirm client details and repeat verbal orders.
Before charting make sure you have the right client. Write legibly and concisely, specific and accurate details, avoid subjective statements, chart interventions provided and client response to interventions, any teaching opportunities should be charted and the response to those teachings.
Explain advance directives and DNR/DNI and the nurse's role.
advance directive is a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. Also the nurse needs to be aware that laws vary from state to state. The nurse should establish a trusting relationship with the patient and patient's family so that she can assist them in making decisions that are in the best interest of the patient. It is also important for the nurse to document any teachings or discussions that took place.
roles of the nurse DNR/DNI: The orders for DNR are legally separate from the advance directive. There should be a written order for a DNR/DNI that needs to be reviewed, evaluated, & reordered. The nurse should know whether there is any law that regulates who should authorize a DNR order for an incompetent client that can no longer make a decision. Hospitals have policies and procedures along with The ANA's published position statement on nursing care and DNR decisions.
What source of law governs nursing practice?
It is The Nurse Practice Act (NPA) that governs the law of nursing.
The NPA is where the practice of nurses are defined and standards are established
NPA sets requirements for licensure and entry to practice
Creates our board of nursing who's job is to oversee the practice of nursing
It is here that grounds for disciplinary actions are identified for example; suspension/revocation of a nurse license
The NPA also provides guidance/framework for the court to base decisions on whether or not a nurse has breached a standard of care
What is informed consent? Can nurses be involved in this?
Informed consent is permission given for a surgery or other procedure after the individual has had the benefits and risks associated with that procedure explained and they acknowledge understanding. The client should receive info on consequences of not getting the particular treatment or procedure, possible complications, alternative treatments and planned outcome as well as what treatment is advised or proposed. The role of the registered nurse is to reiterate or reinforce the physicians teaching, but they are not to be the primary source or only source of information to the client. Two exceptions to informed consent are emergency situations and where the provider feels its medically contraindicated (pg. 182)
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