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74 Cards in this Set
- Front
- Back
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Living will
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- A formal legal document that provides written directions concerning medical care that is to be provided in specific circumstances.
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Living will
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- Living wills today are inadequate
- Consist of vague languages, instructions for unwanted treatments |
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Living will
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- Lack of legal penalties for people who choose to ignore to follow the living wills
- Living wills may be legally questionable in regard to authenticity |
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Medical directive
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- Is not a formal legal document but provides specific written instructions concerning the type care and treatments that individuals want to receive if they become incapacitated.
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Medical directive
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- Physicians can use them as a guide to know what the incapacitated patient wants in terms of specific healthcare treatments
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Medical directive: Weakness
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- People cannot possibly anticipate every medical directive that may occur in their future
- People change over time and may change in regard to their future wishes |
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Durable power of Attorney
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- Legal document with the most strength, is a written directive in which a designated person is allowed to make either general or healthcare decision for a patient
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Durable power of Attorney
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- Families and health care providers may experience fear about making the wrong decisions regarding a patient who is incapacitated
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Informed consent
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- Meaningful information must be disclosed even if the clinician does not believe that it the information will be beneficial.
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Informed consent
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- Nurses are often facilitators in informed consent and have a role in terms of patient advocacy, the actual responsibility for ensuring informed consent historically has belong to the physician
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Organ Transplantation and Ethical Issues
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- Moral acceptability of transplanting an organ from one person to another, procurement, and allocation of the organs.
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Organ Transplantation and Ethical Issues
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- 1st ethical issue: is performing transplants playing God?
- 2nd ethical issue: is procurement of organs o Organs donated without the patients consent o After death organs become state property - 3rd ethical issue: Organ allocation o Most debatable issues in health care today because of scarcity of donor organs |
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Organ Transplantation and Ethical Issues
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- Organ black market is thriving due to demand for organs
- U.S. organ donor system is organized so that allocation decision are coordinated by UNOS, and the system is designed to be driven by the principle of justice |
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- 5 Major focus areas of health disparities that are known to affect racial and ethnic groups in all ages:
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o Cardiovascular disease
o Diabetes o HIV infections and AIDS o Cancer screening and disease management o immunizations |
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Conceptions of death
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tradition
Whole brain Higher brain Personhood |
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Tradition
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a Peron is dead when he is no longer breathing and his heart is not beating (Cardiopulmonary)
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Whole brain
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Death is regarded as the irreversible cessation of all brain functions...no electrical activity in the brain, and even the brain stem is not functioning (brain dead)
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Higher brain
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Death is considered to involve the permanent loss of consciousness. Someone in an irreversible coma would be considered dead even though the brain stem continued to regulate breathing and heartbeat (persistent vegetative state)
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Personhood
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Death occurs when an individual ceases to be a person. This may mean loss of features that are essential to personal identify or for being a person
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Active euthanasia:
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occurs when a person takes an action to end a life; including ones own life.
o Eg. Lethal dose of medication such as physician- assisted suicide |
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Passive euthanasia
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a person allows another person to die by not acting to stop death or prolong life.
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- Voluntary euthanasia
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occurs when a person with a sound mind authorize another Peron to take their life or to assist them in achieving death.
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- Nonvoluntary euthanasia
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when a person is not able to express their decision about death
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Terminal sedation
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• When a suffering patient is sedated to unconsciousness…the patient then dies of dehydration, starvation, or some other intervening complication, as all other life-sustaining interventions are withheld
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Rule of double effect
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- The use of high doses of pain medication to lessen the chronic and intractable pain of terminally ill patients even if doing so hastens death
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Rule of double effect:
When the rule is applied |
The act must be good or at least morally neutral
The agent must intend the good effect and not the evil effect which may be foreseen but not intended The evil effect must not be the means of the good effect There must be a proportionally frame reason to risk the evil effect |
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Surrogate decision making
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• Surrogate, or proxy, is either chosen by the patient, is court appointed, or has other authority to make decisions
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Standard of substituted judgment
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• Used to guide medical decisions that involve formerly competent patients who no longer have any decision making capacity.
• Based on assumption that incompetent patients have the exact rights as competent patients to make judgments about their health care |
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Purse autonomy standard (principle of autonomy extended):
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are made on behalf of an incompetent person and are based on decisions that formally competent person made
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Purse autonomy standard (principle of autonomy extended):
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• the persons autonomy continues to be honored when when the person cannot exercise autonomy through normal channels
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Best interest standard:
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based on the goal of the surrogates doing what is best for the patient or what is in the best interest of the patient
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Best interest standard:
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• Applies when the patient who the proxy represents has never been competent, such as a child
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Delegation
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- As licensed professionals, RNs are responsible to the community for providing safe, competent, and effective care for patients in a variety of healthcare settings.
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- Contributing factors leading to delegation barriers
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o Not having had educational opportunities to learn how to work with others effectively
o Not knowing the skill level and ability of nursing assistive personnel to simplify the work place and turnover of patients o Nurses are apprehensive in delegating takes because of fear of endangering their own licensure o Nursing shortages places inexperienced nurses at helm o Ineffective communication o Lack of effectively using institution resources |
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Right Task
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- One that is delegable for a specific patient
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Right Circumstance
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- An appropriate patient setting, available resources, and consideration of other relevant factors
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Right Person
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- The right person is delegating the right task to the right person to be performed on the right person
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Right Direction and Communication
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- A clear, concise description of the task, including objectives, limits and expectations
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Right Supervision and Evaluation
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- Appropriate monitoring, intervention, and as needed, feedback
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Statutory Law
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- Enforces law
- Ever changing rules and regulations created by the US Congress, state legislators, local governments, and constitutional law |
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Statutory Law
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o Statutes
Rights, privileges, or immunities secure and protected for each citizen by the US constitution |
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Administrative Law
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- Civil
- The regulatory process is itself governed by statutory law called administrative procedure acts at both federal and state levels. - These acts provide that before regulations can be adopted a published notice of the proposed rules and where they are available must occur |
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o When rules are adopted they become administrative law within a set period of time
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3 steps
• Proposal of regulations • Consideration of proposed regulations • Adoption of regulations with or without changes |
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Case Law
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- Criminal
- Is established from court decisions, which may explain or interpret the other sources of law. |
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Case Law
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- Common law that defines legal rights and obligations
- Based on precedent, meaning a ruling in one case that is then subsequently applied to later similar cases |
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Negligence suit
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- Failure to act as a reasonably prudent person would have acted in specific situation
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- Criteria for liable in malpractice suit
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Nurse owes a duty to a patient and breaches an ordinary standard of care known by laypersons, and the patient is harmed
Does not involve expert witness |
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Malpractice suit
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- Failure of a professional to use such care as a responsibly prudent member of the profession would use under similar circumstances , which leads to harm
o Involves expert witness |
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- Criteria for liable in malpractice suit
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– To have a duty of care
– To have breached the duty of care – To have caused harm |
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Breach of information suit
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• Patients must be informed of their privacy rights.
• Patients must be informed as to who will see their records and for what purpose. • Patients have the right to inspect and obtain a copy of their medical records. |
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Breach of information suit
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• Personal data may not be used for marketing
• Valid authorization to release health information must contain certain information, such as a copy of the signed authorization given to the patient, in understandable language, and how the patient may revoke authorization. • Although information may be used for research purposes to assess outbreak of a disease, all individual identifiable data must be removed. |
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Breach of consent suit
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• Medical standard or what are regarded as material risks
• What a reasonable patient would need to know • What a particular patient needs to know |
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Board of Nursing and disciplinary choices
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- Denying a license
- Imposing a fine - Issuing a reprimand - Placing restrictions on a license - Suspending or revoking a license |
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Board of nursing primary obligation
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- Obligation to protect safety of public
- Set standards of practice and delegation - Discipline - Alternative programs - Nurse Practice Act – Nursing process – Measurement criteria |
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Nursing Licensure
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• Mandatory licensure
• Endorsement • National Council of State Boards of Nursing (NCLEX) |
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Age Related Changes: Cognitive, Visual and Hearing
Cognitive Changes: |
• Changes in encoding and storage of information
• Changes in the retrieval of information • Decreases in the speed of processing information |
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Age Related Changes: Cognitive, Visual and Hearing
Visual Changes: |
• Smaller amount of light reaches the retina
• Reduced ability to focus on close objects • Scattering of light resulting in glare • Changes in color perception • Decrease in depth perception and peripheral vision |
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Age Related Changes: Cognitive, Visual and Hearing
Changes in Hearing: |
• Reduced ability to hear sounds as loudly
• Decrease in hearing acuity • Decrease in ability to hear high pitched sounds • Decrease in ability to filter background noise |
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Domains of Learning: Cognitive
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encompasses the intellectual skills of knowledge acquisition, comprehension, application, analysis, and evaluation
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Domains of Learning:Psychomotor
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refers to learning skills and performance of behaviors or skills
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Domains of Learning: Affective
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• Affective learning requires a change in feelings, attitudes, or beliefs
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Andragogy Model of Learning
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“The art and science of helping adults learn”
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Andragogy Model of Learning
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• Letting learners know why something is important to learn
• Showing learners how to direct themselves through information • Relating the topic to the learners’ experiences • Realizing that people will not learn until they are ready and motivated |
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Self-Efficacy
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- If a person believes he or she is capable of performing a behavior
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o Four methods for enhancing efficacy expectations:
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Performance accomplishments
Vicarious experience or modeling Verbal persuasion Interpretation of physiological state |
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Health Belief Model
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“Widely used frameworks in research and programs related to health promotion and patient education
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- According to HBM likelihood of acting in response to health threat dependent upon six factors:
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• Person’s perception of the severity of the illness
• Person’s perception of susceptibility to the illness • Value of the treatment benefits • Barriers to treatment • Costs of treatment in physical and emotional terms • Cues that stimulate taking action toward treatment of illness |
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Nursing Process
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- Assessment
- Diagnosis - Planning - Implementation - Evaluation |
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Patient Education Process
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- Process begins with assessment, negotiation of goals, and objectives, planning, intervention, and evaluation
- More Specifically Assessment, Planning, implementation, Evaluation |
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o Assessment
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Goal of nurse is the process of patient education which is to assist the patient in obtaining the knowledge, skills, or attitude that will help them develop behaviors to meet their needs and maximize their potential for positive health outcomes
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• Questions of Assessment
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What information does the patient need?
o What attitudes should be explored? o What skills does the patient need to know? o What factors may be barriers? o Is the patient likely to return home? o Can the caregiver handle the care? o Is the home situation appropriate? o What kinds of assistance will be required? |
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Patient Education Process
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- Readiness
- Health Literacy - Assessing the readability of Patient Education materials |
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o Planning
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Nurse responsible for guiding the process through the use of goals and objectives
Objectives for patient education are stated as behavioral objectives • performance • conditions • Criteria Learning objectives should be specific, measurable, and attainable |
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o Implementation
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Learning activities need to be consistent with learning objectives
Using varied learning activities can make learning more fun and more effective Examples include lecture, demonstration, practice, games, simulation, role play, discussion, and self-directed learning |
