The study of conduct and character
ethics
Refers to freedom from external control
Autonomy
Refers to taking positive actions to help others
Beneficence
Refers to the avoidance of harm or hurt
Nonmaleficence
Veracity
telling the truth
Fidelity
refers to the agreement to keep promises
Justice
refers to fairness
Determine the proper term of ethics for the following scenario: Nurse Lee tells explains to her patient how to take blood pressure and the medication that will be administered to lower her BP. Also she tells her the side effects and risks of the medication
Autonomy; giving the patient information allows them to make decisions and offers independence
Determine the proper term of ethics for the following scenario: Nurse Nelson has a patient with 9/10 pain and there are no pain meds prescribed. She tells the Dr. and the doctor tells her to administer Demarol IV PRN.
Beneficence
Nurse Nelson is asked to give C.G. Lipitor 5mg PO q2h. Before administering the meds she forgets to do her 3 med checks and just use 2 identifiers. Which ethical term has she violated?
Nonmalefience
Which ethical term states that the interests of the patient is more important than self-interest?
Benefience
Determine the proper term of ethics for the following scenario: Nurse Nelson tells her patient that she will be back in 20 minutes with her Insulin before her morning breakfast. She actually comes back in 20 minutes.
Veracity; telling the patient the truth about when she will be back
Determine the proper term of ethics for the following scenario: Nurse Nelson tells all her patients the same information about the hospital locations and services. Even though F.H. keeps asking for special treatment.
Justice; not giving “VIP” information
Determine the proper term of ethics for the following scenario: Nurse Nelson does not agree with a patient’s lifestyle, but still remains her nurse providing the best possible care upholding the nurse standards
Fidelity; the unwillingness to abandon the patient regardless of different personal beliefs
What is the difference between scope and standard?
Scope is we can do as nurses and standards is the quality of care and level of safety and ethics
What does HIPPA stand for?
Health Insurance Portability Accountability Act
What is the Privacy Rule?
a covered entity that informs patients how their PHI will be used and disclosed and how the patient may access their record
Who is covered under HIPPA?
health plans, health care providers, and health care clearinghouses
What is included in HIPPA?
Patient’s name, contact info. SSN, Dx, and treatments
What are some ways to not violate HIPPA?
Do not share psswds, sign off computers, shred appropriate documents, and do not talk about the patients in the hallway
What are included as Advance Directives?
living wills, power of attorneys and health care proxies
What are Adv. Directives?
they are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over dying process.
Living Wills
represent written documents that direct treatment accordance with a patient’s wishes in the event of a terminal illness or condition. A patient is able to declare which medical procedures he/she wants or does not want when terminally illy or in a persistent vegetative state
Durable power of Attorney/ Health Care Proxy
a legal document that designates a person or people of one’s choosing to make health care decisions when a patient is no longer able to make decisions on his/her own behalf
Is a living wills legally binding? Durable power of attorney?
both
When are living wills and power of attorney enforced?
when the patient has been declared legally competent or lack of capacity to make decisions regarding his/her own health care treatment
TORT
Civil wrongful acts or omissions made against a person or property
How are TORTS classified?
Intentional, Quasi-intentional, and unintentional
Intentional TORT
deliberate acts that violate another’s rights
What are the types of Intentional TORTs
Assault, battery and false imprisonment
What are the types of unintentional TORTs?
Negligence and malpractice
Quasi-Intentional
acts in which intent is lacking but volitional action and direct causation occur such as invasion of privacy and defamation of character
An intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact
Assault
T/F. Actual contact is required for an assault to occur
False, no actual contact is required, a threat is also considered assault
Battery
any intentional offensive touching without consent or lawful justification
If Nurse Nelson threatens to give a patient an injection and gives the patient the injection, what is this considered?
battery
Conduct that falls below the generally accepted standard of care of a reasonable prudent person/ failure of responsibilities
Negligence
When nursing care falls below a standard of care under the nurses recognizance
Malpractice
If a nurse forgets to check medication 3x before administering what is this an example of?
malpractice
If a nurse hangs the wrong IV solution for a patients, what is this an example of?
negligence
What are the common failures of negligence?
failure of ADPIE, failure to notify heal care provider of problems, failure to follow orders, failure to follow 6 rights of med administration
Transferring responsibility for the performance of an activity or task while retaining accountability for the outcome
Delegation
What are the 5 rights of delegation?
- Right Task
- Right Circumstances
- Right Training
- Right Communication
- Right Supervision
What do you not delegate as an RN?
- New admissions
- Patients being discharged
- Transfers in and out
- Patient Teaching
- Unexpected outcomes
- Patients with potential problems
Between the following which patient should you see first?
- physiological vs psychological
- acute vs. chronic
- unstable vs stable
- unpredictable vs predictable
- physiological
- acute
- unstable
- unpredictable
LVN role
- care for stable problems
- differentiate between abnormal and normal
- sterile dressings
- Accu-check
- Perform trache care
- suctioning
- administer enteral feedings
- insert urinary catheter
What can LVNs not do?
- administer blood products
- administer IV Meds
- assess
- nursing diagnosis
UAP role
- standard and unchanging care
- ADLs
- ambulate a stable patient
- ROM
- Routine VS
- Bed making
- I&O
- Specimen collection: Guaiac and urine `
How should you delegate using communication?
provide clear instructions on the procedure itself, what will be accomplished, when it should be completed, and the unique needs of the patient. Make sure whom you delegate the task to has experience
Responsibility as a nurse
willingness to respect one’s professional obligations and to follow through; as a nurse you are responsible for your actions and those to whom you delegate
Accountability as a nurse
refers to the ability to answer for one’s actions; professional actions are explainable to your patients and employer
What is an Incident Report?
any event that is not consistent with the routine, expected care of a patient or the standard procedures in place on a health care unit
Who does an Incident Report go to?
risk-management dept.
What is the purpose of an Incident Report?
helps identify trends in an organization that provide justification for changes in policies and procedures or for in-service programs
Informed Consent
a patient’s agreement to have a medical procedure after receiving full disclosure of risks, benefits, alts, and consequences of refusal
Who is responsible for obtaining the informed consent?
the person responsible for performing the procedure, this does not fall under the nurse
Who signs the consent form for a child?
parents
If an adult is unconscious who signs an informed consent?
the person legally authorized to give it on the patient’s behalf
If there is an emergency and impossible to obtain consent from a patient or authorized person, what is the procedure?
a health care provider may perform a procedure required to benefit the patient or save a life without liability for failure of consent
Primary Health Care
focuses on improved health outcomes for an entire pop. includes: primary care, health education, proper nutrition, maternal and child health care, family planning, immunizations and control of diseases
Secondary Prevention
focuses on early Dx, use of referral services. and rapid initiation of treatment to stop the progress of disease process
Tertiary Prevention
activities directed toward rehab rather than Dx and treatment
Secondary and Tertiary Care
Dx and treatment of illness are traditionally assessed
Good Samaritan Law
encourages health care professionals to assist in emergencies
Good Samaritan Law as a nurse
provides immunity to a nurse who does what is responsible to save a person’s life and is liable for injury that may result from the act
Good Samaritan Law as a citizen
if you do something within accepted standards you are immune from liability as long as you acted without gross negligence