week 13 ethics

Question 1

autonomy

Answer 1

• right to self determination
• respect for all persons
• restricted by paternalism
  
  • paternalism
  • maternalism
• ie: informed consent

Question 2

beneficence

Answer 2

• requires positive/kindness action, to act to benefit the patient
• DOING GOOD!
• balancing harms vs benefit
• ex: caring for extremely contagious pts , holding a dying pt’s hand

Question 3

nonmaleficience

Answer 3

• do NO harm
• foundation of healthcare
• doesn’t require taking positive action
• ex: coercing a pt to participate in unwanted chemotherapy

Question 4

veracity

Answer 4

• truth telling
• used language pt understands
• ex: explaining what an advanced directive is

Question 5

fidelity

Answer 5

• keeping promise and avoiding false expectations
• ex: telling a pt I’ll request a consultation

Question 6

justice

Answer 6

• principle of fairness
• giving each what they’re due
• distribution of goods and services

Question 7

legal consideration in nursing

Answer 7

rely on nurse practice act and what the law allows

Question 8

top legal issues for NP’s

Answer 8

employment contract issures

firing / termination issues

improper incident to billing

Question 9

elements of negligence

Answer 9

1. duty of care owed
2. breach of duty occurred
3. breached resulted in injury
4. injury occurred

Question 10

risk management strategies

Answer 10

SHARE

• sense pt needs
• help one another
• respect the dignity and privacy of everyone
• explain what is happening

Question 11

why is EHR a health hazard?

Answer 11

• more steps = more likely for error
• alert don’t work
• security fail
• autofill dangerous
• no provider if it fails

Question 12

social media

Answer 12

don’t respond or give advice to negative post

Question 13

pt’s decisions to sue was based on what communication issues?

Answer 13

• deserting the pt
• devaluing pt and/or family views
• poor delivery of information
• failure to recognize or understand the pt/family views

Question 14

positive behaviors to communication

Answer 14

• managing pt expecatinos
• humor/laughter
• seeking pt’s opinion
• encouraging dialogue with pt
• confirming pt’s understanding of their care
• say “it’s my pleasure” or “You’re welcome” instead of “it’s not a problem” for good tone
• “I understand we did not meet your expectations”

Question 15

informed consent contains

Answer 15

• nature of procedure
• risks/complications
• expected benefits /effects of procedure
• reasonable alternatives/risks/benefits/side effects
• disclosure of conflict of interest (financial/research interests)

Question 16

universal protocols and timeouts

Answer 16

• maximize safety and minimize clinical risk
• 2 pt identifiers, pt confirms correct site, confirmation of procedure
• name of procedure, location, skin prep, anesthesia, description, meds used, how pt tolerated it

Question 17

informed refusal

Answer 17

• I discuss med consequences of refusal with pt
• treatment refusal form acknowledges the medical consequences of refusing the treatment and aware of the risks of not proceeding with tx

Question 18

pt adherence and compliance

Answer 18

• missed appt → f/u with letter to pt that summarizes consequences of f/u failure
• make sure referrals, tests, and other diagnostic studies are completed
• need return receipt 1st class mail
• grade 6 to 8 reading level

Question 19

patient dismissal

Answer 19

• from pt undermining the pt-provider relationship
• chronic tardiness for pt’s that inconveniences/upsets workflows and
• letter sent w return receipt includes: last day the practitioner will give care so pt has emergency care for 30 days, med refills are provided w/in this period, alternative sources of medical care, info on how to get medical records

Question 20

patient handoffs

Answer 20

• checklists! include major dx’s, recent hospitalizations, procedures, meds, allergies, pending lab/diagnostic studies
• limit interruptions (SBAR)
• read back for confirmation

Question 21

electronic mail

Answer 21

DON’T give medical advice through electronic mail (ie: pt has chest pain but im on vacation)

Question 22

respondeat superior

Answer 22

I’m responsible for the employee staff for negligent acts or omissions

Question 23

risk behaviors for suicide

Answer 23

• talking about feeling trapped or in unbearable pain
• talking about being a burden to others
• demonstrating extreme mood swings
• too little sleep or prolonged sleeping
• increasing use of alcohol or drugs
• isolation or withdrawal
• displaying extreme mood swings

Question 24

before prescribing opioids,

Answer 24

• screen for alcohol and brief intervention
• Screener & Opioid Assessment for patients with Pain-Revised (SOAPP-R) = predicts possible abuse in chronic pain pts
• Opioid risk tool - predicts aberrant behavior in pts getting chronic pain management
• CAGE for misuse
• 0-10 numeric pain scale
• educate about overdose
• pain management agreement (safety, freq of refills, 1 pharmacy, random drug tests,

Question 25

patient compliance tools

Answer 25

• random pill counts
• random urine tests
• use of Prescription Drug Monitoring Program (PDMP)
• applies to ALL pts (not just ones we think have drug problem)
• treat everyone same, no discrimination

Question 26

prescribing for family members

Answer 26

• sensitive info - may not share entire story
• blurring of personal and professional boundaries
• ok if
  
  • isolated, rural community
  • innocuous request
  • minor urgent need (suture removal)

Question 27

decision making capacity (DMC)

Answer 27

• ability to communicate a choice
• voluntary choice (no coercion)
• understanding variables involving decision
• ability appreciate personal impact of choices