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Flashcards in Weeks 9&10- Ethics Deck (64)
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1
Q

What is ethics?

A
  • a branch of PHILOSOPHY that focuses on the STUDY OF MORAL LIFE
  • addresses ISSUES of HUMAN CONDUCT
  • whether actions are RIGHT or WRONG
  • focuses on DOING GOOD and NOT DOING HARM
2
Q

What is bioethics?

A
  • the study of controversial ethics engendered by advances in biology, biotechnology, law and medicine
3
Q

What are ethical principles?

A

Provide guidance and and direction for one’s decision and actions

4
Q

Some examples of ethical principles.

A
Autonomy
Justice
Fidelity
Non-maleficence
Beneficence
Veracity
5
Q

Autonomy.

A

the respect for individual liberty

6
Q

Justice.

A

the equitable distribution of potential benefits and risks

7
Q

Fidelity.

A

the duty to do what one has promised

8
Q

Non-maleficence.

A

the obligation to do or cause no harm to others

9
Q

Beneficence.

A

the duty to do good to others

10
Q

Veracity.

A

the obligation to tell the truth

11
Q

What is an ethical value?

A

belief or attitude about the importance of a principle (value-what we strive for)

12
Q

What is an ethical dilemma?

A
  • involve moral claims that conflict with others
  • who should decide? what should be done? what is the right choice?
    EX. Consent and capacity to give consent; DNR, euthanasia/assisted suicide; confidenciality, truth telling; resource allocation, med errors
13
Q

What are principles?

A

a fundamental truth or proposition that serves as the foundation for a system of belief or behavior or for a chain of reasoning; about our actions and behaviours

14
Q

What are some examples of influencing factors?

A

Religion
Culture
Law

15
Q

What religious factors and ethical challenges exist?

A
  • religious belief support ethical decisions
  • need to respect religious view of competent adult pt
  • religion provides insight to ones morals, beliefs and ethics
  • ethical conflict when the clients religious belief conflicts with the HCP’s belief
16
Q

Cultural influences.

A
  • shapes values and beliefs (health and illness, pain, suffering, death and dying)
  • will influence making informed decisions
  • individualist vs collectivist approach
17
Q

Legal influences.

A

limits flexibility of decision making

  • determines what is acceptable behaviour based on society’s definition of right and wrong
  • doesn’t address all complexities that surround an ethical question
  • Ethics hold to a higher standard of behaviour
18
Q

What are CNO and CNA’s ethical values?

A
  • Client wellbeing by promoting CHOICE
  • Client choice by promoting & respecting INFORMED DECISIONs & CONSENT
  • PRIVACY and CONFIDENTIALITY
  • SAFE, COMPASSIONATE, COMPETENT & ETHICAL care
  • RESPECT LIFE & PRESERVE DIGNITY
  • Maintain commitments, being TRUTHFUL and ACCOUNTABLE
  • FAINESS & PROMOTE JUSTICE
19
Q

How is consent handled with children or adolescents?

A
  • decision made jointly with HCP, parent, and child

- There is no age of consent; when capable the child should make the decision

20
Q

What is the role of the substatute decision maker?

A
  • Makes decisions when pt is incapable of making those decisions
  • acts on pt wishes or if unknown then acts in the pt’s best interest
21
Q

What is the order of who will be the substitute decision maker, if not designated?

A
  1. Spouse, common-law spouse, partner
  2. Child (if>16) or parent
  3. Parent with right of access only (custodial parents rank ahead of non-custodial)
  4. Sibling
  5. Any other relative by blood, marriage or adoption
  6. The office of the public guardian +trustee
22
Q

What is the western view of what is best in regard to sharing information with the pt?

A
  • more info is best and beneficial to the client
  • autonomy & individual determination
  • value informed consent
23
Q

What are some other view in regards to disclosure?

A
  • may value telling family and then gradually informing the pt
  • consider language barrier and body language barrier
24
Q

What do you need to consider when caring for any pt?

A
  • their perspective, may be different, ASK, never assume
  • legal implication regarding informed decision making creates a barrier in providing culturally competent care
  • collectivist vs individualist
25
Q

What are advanced directives?

A
used when person is no longer able to direct care
EX.  
living will
power of attorney
advantages
limitations
26
Q

Living will.

A

instructive directive; what life-sustains Rx someone wants

27
Q

Power of attorney.

A

proxy directive; says who can make health care decisions if the pt is incompetent; not all provinces recognize living wills

28
Q

What are some advantages to advanced directives?

A

mechanism to communicate wishes; principles of self-determination and fair treatment

29
Q

What are the limitations to advanced directives?

A

often vague; enable to foresee all circumstances

30
Q

What is the ethical decision making process?

A

ASSESSMENT- know the fact; review olives, codes, legislation
PLAN- what is the action plan; what is the least bad opt (no action is an action); involves discussion; use OTTAWA DECISION FRAMEWORK
IMPLEMENTATION- carry out the plan as agreed upon; provide support
EVALUTION- process and outcomes; reassess and consider policy changes

31
Q

There is an ____ need for palliative care due to ___

A

increased need

62% deaths requiring palliative and number of deaths estimated to increased by 33%

32
Q

In ___, ___ began to offer Hospice Palliative care Nursing Certification.

A

2004 CNA

33
Q

Palliative care.

A

a PHILOSOPHY, and an approach to care; not restricted to end of life care, but may be used in conjunction with curative methods

34
Q

Hospice care

A

care that takes place in the last MONTHS of life

35
Q

End of life care.

A

reflects the emphasis on the last DAYS and HOURS of life

36
Q

What are the 5 domains of palliative care.

A
  1. Receiving adequate pain and symptom management
  2. Avoiding inappropriate prolongation of dying
  3. Achieving a sense of control
  4. Reflecting burden
  5. Strengthening relationships with love ones
37
Q

What is WHO definition of palliative care?

A

“Care that aims to relieve client suffering and improve the quality of living and dying.
- address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears. “

38
Q

Advanced care planning.

A

establishes a set of relationships, values, and processes for approaching end of life decisions; it is specific to a pt’s goals, values, age, culture,and medical condition

39
Q

Is an advance care plan adequate for consent?

A

NO, do not replace informed consent.

40
Q

What are the important elements of advice care planning?

A
  • clarifying the pt’s understanding of their illness
  • interpreting the situation and treatment options
  • understanding the pt’s values, and goals of care
  • nomination of substitute decision maker
41
Q

What is the role of the palliative care nurse?

A
  • COMMUNICATION OF GOALs of care and treatment through EVIDENCE BASED information
  • INTEGRATE the client and family in the SHARED DECISION MAKING process and RESPECT the individual needs and concerns
  • IMPLEMENT a standardized and individualized PLAN OF CARE
  • create a THERAPEUTIC REL’N
42
Q

Define quality of life.

A

individual perception of their position in life in the context of the culture and value systems in which they live and in relation to there goals, expectations, standards and concerns (WHO, 1997)

43
Q

What is the role of the palliative care nurse?

A
  • COMMUNICATION OF GOALs of care and treatment through EVIDENCE BASED information
  • INTEGRATE the client and family in the SHARED DECISION MAKING process and RESPECT the individual needs and concerns- the persons
  • IMPLEMENT a standardized and individualized PLAN OF CARE
  • create a THERAPEUTIC REL’N
44
Q

What are 5 components of QOL?

A
  • the persons physical health
  • psychological state
  • level of independence
  • social rel’n
  • personal beliefs
45
Q

What aspect of QOL guides decisions?

A

personal definitions

46
Q

Palliative paradigm shift.

A

From cure and length to QOL; can have good QOL with significant symptoms, highly subjective, affected by a variety of aspects or domains

47
Q

What domains are QOL affected by?

A

socioeconomic, demographic, lifestyle factors, physical and mental health

48
Q

What are some nursing perspectives of QOL?

A
  • determined by the quality of interpersonal rel’n
  • depends on the clients perspective
  • finding meaning in experiences
  • sense of wellbeing evolves rom ability to choose a course of action
49
Q

What affect can perspective of health and symptoms have?

A
  • varying impact of degree of distress
  • perceived and aural body functioning or distress
  • ability to perform normal ADL’s including life responsibilities
50
Q

What must the nurse do when treating underlying cause of symptoms or side effects?

A
  • coaching for expected side effects
  • need good communication between client & HCP
  • teach proper medication management
51
Q

Nursing care for health and function issues includes…

A

comfort, rest, pain and symptom management and promoting optimum functioning

52
Q

What contributes to life satisfaction, peace of mind, control and goals?

A
  • ability to adjust goals leads to improve QOL
  • emotional wellbeing related to self-care abilities
  • body image and self esteem
53
Q

How does spirituality or religiosity, compassion and care effect the pt?

A

provides hope, sense of well-being, a sense of a meaning full life; significant factors for adaptation to chronic illness

54
Q

How does spirituality affect health?

A

improves health and decreases depressison

55
Q

What are some psychological and spiritual issues interventions?

A
  • Informational and emotional support
  • Communicate respect, listen to their story
  • Enhance positive view of oneself
  • Enhance sense of control- health teaching
  • Spirituality: Referral to clergy
    display compassion to understanding suffering and pain; Ask if religion is important to the client or usual ways to manage difficult times
56
Q

What are some socioeconomic interventions?

A
  • Types of support, finances, employment, coping
  • Other expenses: Transportation; Alternative therapies; Affording medications
  • Loss of work, early retirement particularly amongst those with a disability
  • Being productive is a key factors to enhancing QOL
  • Referral to support groups, employment resources
  • May need a referral to a social worker
57
Q

What are some family issues involving partner relationship, social network/ roles interventions?

A

QOL affects the family and spouse reel’s; focus on family happiness, gratifying relationships, what is the family structure and degree of supportive interactions; understand what illness mean s to the family

58
Q

What are some family issues involving partner relationship, social network/ roles interventions?

A

QOL affects the family and spouse reel’s; focus on family happiness, gratifying relationships, what is the family structure and degree of supportive interactions; understand what illness mean to the family

  • involve family in planning and decision making; involve siblings in an age appropriate manner
  • address care giver burden
59
Q

What are the aspects of QOL in children with type 1 diabetes?

A
  • Increased glucose control = good QOL
  • Adolescents tend to have adjustment problems after initial diagnosis
  • At risk for depression, eating disorders, family conflict
60
Q

Where the aspects of QOL in clients with type 2 diabetes?

A
  • Good glycemic control = good QOL
  • Adherence to treatment regimen = good QOL
  • Quality teaching regarding self-management skills leads to good adherence
61
Q

What are the aspects of QOL in children with type 1 diabetes?

A
  • Increased glucose control = good QOL
  • Adolescents tend to have adjustment problems after initial diagnosis
  • At risk for depression, eating disorders, family conflict
62
Q

What the aspects of QOL in clients with type 2 diabetes?

A
  • Good glycemic control = good QOL
  • Adherence to treatment regimen = good QOL
  • Quality teaching regarding self-management skills leads to good adherence
63
Q

What are the aspects of QOL in cancer patients?

A
  • Looks at the effects of key symptoms on QOL with Breast cancer
  • May experience pain, fatigue and depression
  • These symptoms together with chemo, decreased social support tent to = poor QOL
64
Q

What are the aspects of QOL in stroke survivors?

A
  • Independence with ADLs = good QOL

- Increased severeity of impairment, aphasia, unable to return to work=poor QOL