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Ethics in Nursing

Hutton lecture

Differentiate between responsiblity and accountability. * Responsibility is a state of obligation to do something w/i one's power or control * Accountability is a state where one is subject to the obligation to report, explain, or justify some action
Differentiate between intentional and unintentional torts. * Intentional torts require intent to do harm, but harm isn't necessary for liablity * Unintentional torts require harm, but not intent. * Intentional torts do not require expert witnesses, b/c there is no standard to compare actions to.
List 5 examples of Intentional Torts and 2 examples of Unintentional Torts. Intentional: * assault & battery * defamation of character * invasion of privacy * false imprisonment * fraud Unintentional: * Negligence * Malpractice
What is the threat or attempt to make bodily contact with another person without their consent? Assault
What is the willful, angry, violent, or negligent touching of another person's body or anything attached to that person? Battery
Who might be someone to call when faced with an ethical dilemma, such as the absence of an MD, etc. PCC, ER
The making of derogatory remarks about another person, diminishing their character Slander: defamation of character
Written derogatory remarks about another person Libel: defamation of character
Intrusion by a person into the personal affairs of another individual Invasion of privacy
4 examples of invasion of privacy: * eavesdropping upon a private conversation * unauthorized intrusion on childbirth * taking of photos w/o consent * displaying x-rays/papers w/ the client's name on them
Unjustified detention or prevention of movement of another person w/o proper consent False imprisonment
What type of document can a client sign to relieve health providers from liability when the client is leaving despite the detriment to his/her health? Against medical advice; absence without authority
The willful & purposeful misrepresentation that could cause harm or has caused loss or harm to a person or property Fraud
Performing an act that a reasonable prudent person under similar circumstances would not do: or failing to perform an act that a reasonably prudent person would do under similar circumstances Negligence
A violation of professional duty, a failure to meet standards of care, or a failure to use skills & knowledge of other professionals in the same situation Malpractice
The purpose is to define professional accountability to the public; establishes general & specific guidelines for practice. Standards of care
Who develops standards of care & where might we find these laid out? * Developed by professional organizations & institution policies * Found in textbooks: Kozier, Davis, Lewis
The main purpose of this is to guarantee minimum standards for licensure & credentialing; defines the legal scope of nursing practice. Nurse Practice Act
What to remember about delegation? 1. Nurses can delegate tasks, but not the nursing process (assessment, etc) 2. Nurses must monitor the outcome of the delegated tasks for deviations & whatnot
What tasks can nurses delegate? * bathing * comfort care * V/S * sometimes dressing changes (but must look at & assess)
Who has the power to decide whether nursing students sit for their board exams? State Board of Nursing
List 4 powers of the State Board of Nursing. * examine & license * regulate & define nursing practice * approve nursing educational programs * investigate & discipline nurses
Who can file a complaint to the State Board of Nursing? anyone
Who is liable for a student nurse's errors? * student * instructor * school of nursing
Who must perform as a professional nurse would, up to the point in their experience... and after mastering a skill will be held accountable? student nurse
What statute permits a client to make own health care choices; requires facilities to recognize advance directives, offer to complete an advance directive, & the right to refuse treatment? The Patient Self-Determination Act * health care surrogate * living will
Who may be responsible for ensuring the patient has consented to a medical procedure? the nurse, doctor, health care team
When is consent unnecessary? In emergency situations
Reasons for Negligence that may result in malpractice lawsuits: * improper technique or negligent performance * untimely management of care/ follow-up of complications * failure to act as a pt advocate * failure to use equipment responsibly * failure to follow standards of care * failure to communicate
Reasons for Negligence that may result in malpractice lawsuits: * meds administration errors * failure to assess & continue monitoring * failure to document
6 elements that must be present for a nursing malpractice case to be proven: 1. duty: nurse had responsibility for client 2. breach of duty: standard of care was neglected 3. foreseeability: nurse's act must be correlated directly with injury 4. causation: harm occurred as a result of nurse's action 5. harm/injury 6. damages
List some legal safeguards: * stay up to date on knowledge: nursing journals! * stay w/i legal boundaries * follow agency policies/procedures * use evidence-based practice * evaluate team assignments * develop good rapport w/ HC team * be sensitive to client issues
List some legal safeguards (part 2): * avoid double shifts * complete incident reports on yourself & your colleagues * malpractice insurance * Good Samaritan Act
This provides a defense for those who provide services in an emergency, but does not protect a nurse from a lawsuit, if harm is caused. Good Samaritan Act
Nurses are/are not required to stop in an emergency situation? Authorized to provide ___ life support. are not; basic
Who is required to stop for an emergency? paramedics, firefighters, police officers
Executing physician orders is a legal responsibility of the Nurse Practice Act unless... you anticipate injury will occur if the order is carried out.
Telephone orders: protocol, things to remember: * Must have a second RN verify the order * Must spell out the order * Must read back the order * Must remind physician of patient you are speaking of
When does a nurse question an order? * if the order is ambiguous * if it contradicts normal practice * if it is contradicted by client's condition * if client questions the order
When questioning a doctor's order, what should you keep in mind/prepare to question? * Must have sound reason or know enough to question * Explain why you question the order * NOTIFY MD
3 expectations during your clinical experience that will minimize liability. * Conduct a thorough assessment of your pt at the beginning of your shift * Continue to reassess your pt thru/o shift, esp after med admin or procedures * follow up w/ findings: communication & documentation are essential
When are insulin injections administered? before breakfast
What lab values tell you clearly whether someone is dehydrated or not? BUN-creatinine ratio
Litigation is another word for ____. Who is considered a litigator? * lawsuit * participating lawyers in lawsuits
The result of a trial: a judge renders a ____, while a jury renders a ____. decision; verdict
Skills and learning commonly possessed by members of a profession: legal guidelines for nursing practice standards of care
External standards of care include: * nurse practice acts * professional organizations * nursing specialty-practice orgs. * federal orgs. and guidelines
Internal standards of care include: * job description * education * expertise * individual institution's policies & procedures
Enduring beliefs or attitudes about the worth of a person, object, idea, or action: guide one's behavior Values
Interpretations or conclusions that people accept as true: based more on faith than fact: may or may not be true Beliefs
Mental positions (emotions) or feelings toward a person, object, or idea (such as acceptance, openness, compassion). Attitudes
The right to self-determination... occurs when the nurse respects patient's rights to make decisions about their own health care. Autonomy
A systematic inquiry into the principles of right & wrong conduct, of virtue & of good & evil as they relate to conduct; expected standards of moral behavior of a group described by group; based on a body of knowledge Ethics
Private, personal standards of what is right & wrong in conduct, character, & attitude; may arouse feelings of guilt, hope, shame; use of "ought", "should", "right", "wrong", "good" or "bad" Morality
What word describes truth telling? Veracity
What word means to treat all people fairly & equally Justice
What word means to be faithful to agreements & promises? Fidelity
What word means to "do no harm"? Nonmaleficence
Who establishes the Nursing Code of Ethics? List 7 Moral Principles found within the code. * ANA * Autonomy * Beneficence (promote good) * Nonmaleficence * Veracity * Justice * Fidelity * Value neutrality
What are 3 characteristics of a code of ethics? * shared by members of a group * reflects members' moral judgment over time * serves as a standard for their professional actions
Which statute promotes autonomy? Self-Determination Act
An ____ expresses and defends the cause of another. advocate
Why is the nurse's responsibility as client advocate important? * Clients may be too weak to cut thru hospital bureaucracy to get adequate care * Client may be incompetent & nurse must consider health care surrogate or family's decision-making
What is the overall goal of client advocacy? Describe 3 ways of implementing this goal. * Overall goal: to protect client's rights * INFORM clients about rights: give info relevant to decision-making * SUPPORT client's decisions * MEDIATE b/w client & other health care providers
List 6 steps involved in the ethical decision-making process. * Identify the problem * Gather data * Collaborate with HC team * Discuss options * Make decision * Evaluate effectiveness of decision (reassess)
What is the main function of an ethics committee? The main fxn is to provide a safe place to discuss ethical dilemmas b/w providers, patient, & family
How does one gain access to the ethics committee? * Must first speak to nurse manager about situation * Must request access to speak with the committee
Created by: 2049796