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102 Cards in this Set
- Front
- Back
Ethics |
the study of conduct and character |
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Value |
a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior |
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Ethical Dilemmas |
almost always occur in the presence of conflicting values, to resolve ethical dilemmas one needs to distinguish among values, fact, and opinion |
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Deontology |
defines actions as right or wrong |
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Utilitarianism |
Proposes that the value of something is determined by its usefulness |
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Feminist Ethics |
Focuses on the inequality between people |
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Ethics of Care |
Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives |
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Casuistry |
Case-based reasoning |
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Nursing POV |
Nurses generally engage with patients over longer periods of time than other disciplines, patients may feel more comfortable revealing info to nurses |
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Ethics Committees |
usually multidisciplinary and serve several purposes - education, policy, recommendation, and case consultation, any person involved in an ethical dilemma can request access to an ethics committee |
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Quality of Life |
central to discussions about end of life care, cancer therapy, physican-assisted suicide, and DNR (Do Not Resuscitate) |
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Disabilities |
antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges |
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Care at the end of life |
interventions unlikely to produce benefit for the patient |
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Health Care Reform |
Facilitated access to care for millions of uninsured Americans |
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Consensus Building |
an act of discovery in which "collective wisdom" guides a group to the best possible decision |
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Culturally Competent Care: End of Life Decisions |
acknowledgement and respect for cultural differences, willingness to negotiate and compromise when world views differ, being aware of one's own values and biases, using communication skills, knowing cultural practices of patient groups regularly seen, understand that all patients are individuals who may not share the same views as others within their own ethnic group |
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Statutory Law |
reflects decisions made by elected bodies (state legislature), the Nurse Practice Act |
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Civil Law |
Protects the rights of individuals |
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Criminal Law |
Felonies or misdemeanors |
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Regulatory Law |
administrative law, reflects decisions made by State Boards of Nursing, aka the requirement to report incompetent or unethical nursing conduct |
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Common Law |
decisions made by courts when individual legal cases are decided - often having to do with informed consent, patient's right to refuse treatment, negligence, and malpractice |
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Standards of Care |
Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care, best known comes from the American Nurses Association, set by every state |
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Negligence |
the nurse owed a duty to the patient, the nurse did not carry out the duty or breached it, the patient was injured, the patient's injury was caused by the nurse's failure to carry out that duty |
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Patient Protection and Affordable Care Act (PPACA) |
Consumer rights and protections, affordable healthcare coverage, increased access to care, stronger medicare to improve care for those most vulnerable in our society |
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Americans with Disabilities Act (ADA) |
protects rights of people with physical or mental disabilities |
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Emergency Medical Treatment and Active Labor Act |
When a patient presents to an emergency department, they must be treated |
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Mental Health Parity Act as Enacted under PPACA |
Strengthens mental health services |
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Advance directives |
Living Wills, Health Care Proxies/Power of Attorney for Health Care |
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Living Wills |
represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition |
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Health Care Proxies/Power of Attorney for Health Care |
A legal document that designates a person or persons of ones choosing to make health care decisions when a patient is no longer able to make decisions on his or her own behalf |
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Health Insurance Portability and Accountability Act (HIPAA) |
provides protection to individual employees from losing their health insurance when changing jobs by allowing portable health insurance |
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Health Information Technology Act (HITECH) |
Nurses must ensure that no personal health information (PHI) is not inadvertently conveyed via social media |
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Restraints |
Used for patient safety, other efforts did not work, requires written orders |
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Good Samaritan Laws |
limits liability and offers legal immunity if a nurse helps at the scene of an accident |
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Public Health Laws |
the requirement for reporting communicable diseases, school immunizations, and other conditions intended to promote health and reduce health risks |
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The Uniform Determination of Death Act |
standards for the determination of death, heart stops beating or brain stops functioning |
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Torts |
Civil wrongful acts or omissions made against a person or property |
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Intentional Torts |
Assault, Battery, False imprisonment (unjustified restraints) |
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Quasi-intentional Torts |
invasion of privacy, defamation of character (slander/libel) |
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Negligence |
conduct that falls below a standard of care |
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Malpractice |
a type of negligence, failure leads to a patient injury |
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Common Negligent Acts |
Failure to assess or monitor in a timely fashion, failure to document the monitoring, failure to notify the health care provider of problems, failure to follow orders, failure to follow the 6 rights of medication administration, failure to convey discharge instructions, failure to ensure patient safety, failure to follow policies and procedures |
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Consent |
Informed consent must be signed, agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal |
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Unemancipated minors may not consent to abortion without one of the following... |
Consent of one parent, self-consent granted by court order, consent specifically given by a court |
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1973 Roe vs Wade |
US Supreme Court ruled that there is a fundamental right to privacy, which includes a woman's right to have an abortion |
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1989 Webster vs Reproductive Health Services |
Some states require viability tests if the fetus is more than 28 weeks |
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Nursing Students |
You are liable if your actions cause harm to patients, as is your instructor, hospital, and institution, you are expected to perform as a professional when rendering care, you must separate your student nurse role from your work as a CNA |
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Malpractice Insurance |
a contract between the nurse and the insurance company that provides a defense when a nurse is in a lawsuit involving negligence or malpractice |
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Short Staffing |
Legal problems occur if an inadequate number of nurses will provide care aka when there is not enough nurses available or nurses are working excessive overtime |
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Floating |
Based on census load and patient acuities nurses will "float" from the area in which they normally practice to other nursing units |
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Health Care Provider's Orders |
Nurses follow orders unless they believe an order is given in error or is harmful |
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Risk Management & Quality Assurance |
a system of ensuring quality nursing care that attempts to ID the potential hazards and eleminate them before harm occurs, 1. identify possible risks, 2 analyze risks, 3 act to reduce risks, 4 evaluate steps taken |
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Occurence Reporting |
serves as a database for further investigation, alerts risk management to a potential claim situation |
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Documentation |
evidence of care received by a patient and establishes support that the nurse acted reasonably and safely |
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TJC's Universal Protocols |
guidelines for preventing mishaps like having surgery performed on the wrong site or undergoing the wrong surgery |
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Professional Involvement |
Becoming Involved in professional organizations and committees that define the standards of care for nursing practice |
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Communication and Nursing Practice |
A lifelong learning process, therapeutic communication promotes personal growth and attainment of patient's health-related goals, patient safety requires effective communication |
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Communication and Interpersonal Relationships |
Communication establishes caring, healing relationships, the ability to relate to others is important for interpersonal communication, communication includes posture, expression, words, and attitudes |
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Developing Communication Skills requires... |
Humility, critical thinking, perserverance, self-confidence, and integrity |
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Thinking is ____________ by perception |
influenced, this includes our senses, our culture, and our education, perceptual bias, and emotional intelligence |
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Levels of Communication |
Intrapersonal, Interpersonal, Small Group, Public, and Electronic |
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Intrapersonal Communication |
self talk |
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Interpersonal Communication |
one on one interaction |
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Small Group |
A small group of people, usually goal directed |
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Public Communication |
interaction with an audience |
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Electronic Communication |
technology between patient and team |
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Verbal Communication |
Vocab, Pacing, Intonation (shouting vs whispering), clarity and brevity, timing and relevance |
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Denotation meaning |
the strict meaning of the word |
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Connotative Meaning |
emotional and imagination associated with a word |
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Nonverbal Communication |
Personal appearance, posture, gait, facial expression, gestures, eye contact, and personal space, sounds |
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Preinteraction Phase |
Occurs before meeting the patient |
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Orientation Phase |
when the nurse and patient meet and get to know each other |
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Working Phase |
when the nurse and the patient work together to solve problems and reach goals |
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Termination Phase |
occurs at the end of a relationship |
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Motivational Interviewing |
a technique that encourages patients to share their thoughts, fears, beliefs, and concerns with the aim of changing their behavior, the interview is delivered in a nonjudgemental, guided communication approach |
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Types of Professional Nurse Relationships |
Nurse-Family Relationship, Nurse-health care team Relationship, Nurse-community relationships |
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Elements of Professional Communication |
appearance, demeanor, behavior, courtesy, use of names, trustworthiness, autonomy and responsibiliy, assertiveness |
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Nursing Process |
1. Assessment 2. Nursing Diagnosis 3. Planning 4. Implementation 5. Evaluation |
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Assessment |
through the patient's eyes: gather info, synthesize, and apply critical thinking - physical & emotional factors, developmental factors, sociocultural factors, gender |
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Nursing Diagnosis |
Many patients experience difficulty with communication, lacking skills in attending, listening, responding, or self-expression, inability to articulate, difficulty forming words, difficulty with comprehension |
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Planning |
Goals & Outcomes - specific and measurable, Setting of priorities, Teamwork and collaboration |
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Implementation |
active listening to convey respect, encourage responses about feelings and ideas, SOLER - Sit facing the patient, open posture, lean toward the patient, Establish and maintain eye contact, and relax |
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Theraputic Communication Techniques |
sharing observations, empathy, hope, humor, and feelings, Using touch and silence, provide information and clarity, validation and summarization, self-disclosure and confrontation |
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Adapt Communication Techniques for... |
those who do not speak your language, patients who cannot speak clearly, the cognitive or hearing impaired, or the visually impaired and unresponsive |
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Evaluation |
nurses and patients need to determine if the plan of care has been successful, if expected outcomes are not met, areas of care need to be modified, nursing outcoms are evaluated to see what strategies and interventions were effective |
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Purpose of Medical Record |
Communication, Legal Documentation, Reimburshment, Research, Education, and Auditing/Monitoring |
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HITECH established... |
provisions to promote the meaningful use of health information technology to improve the quality and lower the cost of health care |
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Confidentiality |
Nurses are legally and ethically obligated to keep all patient info confidential, nurses are responsible for protecting records from unauthorized readers, HIPAA requires that the PHI be limited to the minimum amount of people neccessary |
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Physical Security Measures |
placing computers or file servers in restricted areas or using privacy filters for computer screens visible to visitors |
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Handling and Disposing of Information |
de-identify all patient data, special considerations for faxing, safeguard all information that is printed or extracted for report purposes |
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Guidelines for Quality Documentation |
Factual, Accurate, Complete, Current, and Organized |
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Methods of Documentation |
Narrative (traditional method) and Problem-Oriented Medical Record (care plan, database, problem list, progress notes) |
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Types of Progress Notes |
SOAP(IE) - Subjective, Objective, Assessment, Plan (Intervention, Evaluation) PIE - Problem, Intervention, Evaluation Problem charting (DAR) - Data, Action, Response |
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Charting by Exception (CBE) |
focuses on documenting deviations |
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Admission Nursing History Form |
Guides nurse through a complete assessment |
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Flow Sheets and Graphic Records |
Helps team members see trends over time and decreases amount of time spent writing narratives |
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Standardized Patient Care Summary or Clinical Care Guidelines (CPGs) |
preprinted, established guidelines used for patients that have similar health problems |
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Acuity Rating Systems |
Nurses use acuity ratings to determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours |
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Documentation in the Home Health Setting |
Medicare has specific guidelines for establishing eligibility for home care which establish the cost reimbursement, Documentation is the justification and quality control for reimbursement, nurses need to document all of their serves for payment.
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Telephone Communication |
TOS (telephone orders) VOS (verbal orders), TORB - telephone order read back |
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Nursing Informatics |
The use of information and computer technology to support all aspects of nursing including direct delivery of care, administration, education, and research, also recognized as a specialty area of nursing practice |
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Nursing Clincial Information Systems |
allows nurse to access computerized system info at the patient's bedside, enables the nurse to share the care plan instantly with the patient and check lab results |