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102 Cards in this Set

  • Front
  • Back

Ethics

the study of conduct and character

Value

a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior

Ethical Dilemmas

almost always occur in the presence of conflicting values, to resolve ethical dilemmas one needs to distinguish among values, fact, and opinion

Deontology

defines actions as right or wrong

Utilitarianism

Proposes that the value of something is determined by its usefulness

Feminist Ethics

Focuses on the inequality between people

Ethics of Care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives

Casuistry

Case-based reasoning

Nursing POV

Nurses generally engage with patients over longer periods of time than other disciplines, patients may feel more comfortable revealing info to nurses

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

Quality of Life

central to discussions about end of life care, cancer therapy, physican-assisted suicide, and DNR (Do Not Resuscitate)

Disabilities

antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges

Care at the end of life

interventions unlikely to produce benefit for the patient

Health Care Reform

Facilitated access to care for millions of uninsured Americans

Consensus Building

an act of discovery in which "collective wisdom" guides a group to the best possible decision

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

Statutory Law

reflects decisions made by elected bodies (state legislature), the Nurse Practice Act

Civil Law

Protects the rights of individuals

Criminal Law

Felonies or misdemeanors

Regulatory Law

administrative law, reflects decisions made by State Boards of Nursing, aka the requirement to report incompetent or unethical nursing conduct

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

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

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

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

Americans with Disabilities Act (ADA)

protects rights of people with physical or mental disabilities

Emergency Medical Treatment and Active Labor Act

When a patient presents to an emergency department, they must be treated

Mental Health Parity Act as Enacted under PPACA

Strengthens mental health services

Advance directives

Living Wills, Health Care Proxies/Power of Attorney for Health Care

Living Wills

represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition

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

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

Health Information Technology Act (HITECH)

Nurses must ensure that no personal health information (PHI) is not inadvertently conveyed via social media

Restraints

Used for patient safety, other efforts did not work, requires written orders

Good Samaritan Laws

limits liability and offers legal immunity if a nurse helps at the scene of an accident

Public Health Laws

the requirement for reporting communicable diseases, school immunizations, and other conditions intended to promote health and reduce health risks

The Uniform Determination of Death Act

standards for the determination of death, heart stops beating or brain stops functioning

Torts

Civil wrongful acts or omissions made against a person or property

Intentional Torts

Assault, Battery, False imprisonment (unjustified restraints)

Quasi-intentional Torts

invasion of privacy, defamation of character (slander/libel)

Negligence

conduct that falls below a standard of care

Malpractice

a type of negligence, failure leads to a patient injury

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

Consent

Informed consent must be signed, agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal

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

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

1989 Webster vs Reproductive Health Services

Some states require viability tests if the fetus is more than 28 weeks

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

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

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

Floating

Based on census load and patient acuities nurses will "float" from the area in which they normally practice to other nursing units

Health Care Provider's Orders

Nurses follow orders unless they believe an order is given in error or is harmful

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

Occurence Reporting

serves as a database for further investigation, alerts risk management to a potential claim situation

Documentation

evidence of care received by a patient and establishes support that the nurse acted reasonably and safely

TJC's Universal Protocols

guidelines for preventing mishaps like having surgery performed on the wrong site or undergoing the wrong surgery

Professional Involvement

Becoming Involved in professional organizations and committees that define the standards of care for nursing practice

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

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

Developing Communication Skills requires...

Humility, critical thinking, perserverance, self-confidence, and integrity

Thinking is ____________ by perception

influenced, this includes our senses, our culture, and our education, perceptual bias, and emotional intelligence

Levels of Communication

Intrapersonal, Interpersonal, Small Group, Public, and Electronic

Intrapersonal Communication

self talk

Interpersonal Communication

one on one interaction

Small Group

A small group of people, usually goal directed

Public Communication

interaction with an audience

Electronic Communication

technology between patient and team

Verbal Communication

Vocab, Pacing, Intonation (shouting vs whispering), clarity and brevity, timing and relevance

Denotation meaning

the strict meaning of the word

Connotative Meaning

emotional and imagination associated with a word

Nonverbal Communication

Personal appearance, posture, gait, facial expression, gestures, eye contact, and personal space, sounds

Preinteraction Phase

Occurs before meeting the patient

Orientation Phase

when the nurse and patient meet and get to know each other

Working Phase

when the nurse and the patient work together to solve problems and reach goals

Termination Phase

occurs at the end of a relationship

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

Types of Professional Nurse Relationships

Nurse-Family Relationship, Nurse-health care team Relationship, Nurse-community relationships

Elements of Professional Communication

appearance, demeanor, behavior, courtesy, use of names, trustworthiness, autonomy and responsibiliy, assertiveness

Nursing Process

1. Assessment 2. Nursing Diagnosis 3. Planning 4. Implementation 5. Evaluation

Assessment

through the patient's eyes: gather info, synthesize, and apply critical thinking - physical & emotional factors, developmental factors, sociocultural factors, gender

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

Planning

Goals & Outcomes - specific and measurable, Setting of priorities, Teamwork and collaboration

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

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

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

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

Purpose of Medical Record

Communication, Legal Documentation, Reimburshment, Research, Education, and Auditing/Monitoring

HITECH established...

provisions to promote the meaningful use of health information technology to improve the quality and lower the cost of health care

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

Physical Security Measures

placing computers or file servers in restricted areas or using privacy filters for computer screens visible to visitors

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

Guidelines for Quality Documentation

Factual, Accurate, Complete, Current, and Organized

Methods of Documentation

Narrative (traditional method) and Problem-Oriented Medical Record (care plan, database, problem list, progress notes)

Types of Progress Notes

SOAP(IE) - Subjective, Objective, Assessment, Plan (Intervention, Evaluation)


PIE - Problem, Intervention, Evaluation


Problem charting (DAR) - Data, Action, Response



Charting by Exception (CBE)

focuses on documenting deviations

Admission Nursing History Form

Guides nurse through a complete assessment

Flow Sheets and Graphic Records

Helps team members see trends over time and decreases amount of time spent writing narratives

Standardized Patient Care Summary or Clinical Care Guidelines (CPGs)

preprinted, established guidelines used for patients that have similar health problems

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

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.

Telephone Communication

TOS (telephone orders) VOS (verbal orders), TORB - telephone order read back

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

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