404--Quiz 1 (ch 3 &4)

Question 1

Ethics

Answer 1

A SYSTEM OF PHILOSOPHY of conduct and principles.

Encompasses a process of determining right from wrong conduct.

Question 2

Morals

Answer 2

Personal PRINCIPLES acquired from life experiences (relationships, religion, culture, etc.).
Not adequate for resolving complex issues arising in clinical settings.

Question 3

Values

Answer 3

Personal BELIEFS about truths and worth of thoughts, objects, or behavior.

Question 4

Autonomy

Answer 4

Ethical principal–RIGHT TO CHOOSE what will happen to one’s own person.

Question 5

Beneficence

Answer 5

Ethical principal–Actions should promote “good” as understood by patient.

Question 6

Nonmaleficience

Answer 6

Ethical principal–One should DO NO HARM.

Question 7

Detriment

Answer 7

Ethical principal–Benefit analysis and concept of double-effect. (ex: Nx gives IM pain meds to relieve pain–inflict some pain to relieve much pain).

Question 8

Veracity

Answer 8

Ethical principal–Individuals should always TELL THE WHOLE TRUTH.

Question 9

Fidelity

Answer 9

Ethical principal–Not promising what cannot be delivered.

Question 10

Paternalism

Answer 10

Ethical principal–Making final decisions for others; negative unless used for advocacy .

Question 11

Respect for others

Answer 11

Ethical principal–Respect the right for people to live and die by their own decisions.

Question 12

Justice

Answer 12

(…for all) Ethical principal–People should be treated fairly and equally. 3 types:
Distributive/social justice
Retributive/correctional justice
Compensatory justice

Question 13

*Ethics Committee definition & function

Answer 13

Provide structure and guidelines for potential problems, serve as an open forum for discussion, and function as a true patient advocate. Mandated by JCAHO.
*“Does NOT determine, rather give RECOMMENDATIONS.”

Question 14

Ethics Committee–composed of who?

Answer 14

Composed of nurses, physicians, clergy, clinical social workers, nutritional experts, pharmacists, administrative personnel, and legal experts.

Question 15

Ethics Committee–structures/models

Answer 15

Autonomy model = Facilitates decision making for patient.
Patient benefit model = Facilitates decision making for INCOMPETENT patients.
Social justice model = Considers broad SOCIAL issues.

Question 16

Professional Code of Ethics

Answer 16

Enumerates standards of integrity, professionalism, and ethical norms.
Minimum standards acceptable for conduct by members of the discipline.
Provides guidelines for professional practice and the discipline’s self-regulation.

Question 17

The Code of Ethics for Nurses with Interpretive Statements

Answer 17

National code of ethics published by the American Nurses Association (ANA).
Gives ethical direction to nurses, sets nursing ethics standard, and informs the public.
It is an expression of nursing’s own understanding of its commitment to society.

Question 18

What Influences Your Ability to Respond to an Ethical Dilemma?

Answer 18

Perception of your level of influence within the health care setting.
Level of clinical expertise and competence
Degree of ethical concern.
Past experience with ethics education.

Question 19

*MORAL Model

Answer 19

Massage the dilemma.
Outline the options.
Resolve the dilemma.
Act by applying the chosen option.
Look back and evaluate the process.

Question 20

*Advocacy Models

Answer 20

Three models employed in clinical setting:
Rights protection model (or autonomy model) = Nx strives to protect the health & rights of the pt; support pt’s decisions.
Values-based decision model = help pt make decisions based on his/her values & beliefs.
Respect for persons model (patient-advocate model) = Nx protects pt’s rights, dignity, & choices; support pt’s individual uniqueness.

Question 21

Moral Distress–definition, causes, benefits.

Answer 21

= When Two Ethical Principles Compete.
Causes:
Financial pressures.
Limited patient care resources.
Disagreement between patient’s family members .
When an action performed violates nurse’s personal beliefs, etc.
Benefits:
Moral distress can serve to energize a person with a feeling of accomplishment and an increased awareness of one’s own beliefs and abilities to handle ethical issues.

Question 22

Initial Moral Distress

Answer 22

Frustration, anger, and anxiety from being prevented from taking correct action.

Question 23

Reactive Moral Distress

Answer 23

Powerless, guilt, loss of self-worth, and depression resulting when nurses are unable to act on their INITIAL MORAL DISTRESS.
Causes moral outrage, burnout, and inability to effectively care for patients.

Question 24

Personal Strategies to Combat Moral Distress

Answer 24

Self-care.
Assertiveness.
Collective action.
Reexamine nursing ethical values.

Question 25

*Therapeutic Jurisprudence

Answer 25

Interdisciplinary study of law as a social force. Aims to understand law's impact on people's emotional and psychological well-being. Challenges nurses to consider the outcome of actions. Acknowledges the fact that "well-being" is a goal of the legal system.

Question 26

*Slippery Slope Argument

Answer 26

Suggests that an action will initiate a chain of events culminating in an undesirable event later in time. Does not establish the relevant contingencies. Decision-making models assist nurses in avoiding slippery slope arguments. Fear that what is correct decision now will be incorrect later.

Question 27

Public Health Act of 1944

Answer 27

Consolidated all existing public health legislation under one law and became the major piece of health legislation for the country. It provides funding for nursing education and funding for all levels of disease prevention: primary, secondary, and tertiary.

Question 28

Early leaders of public health in the U.S. include:

Answer 28

Lillian Wald Dorothea Dix Mary Breckenridge

Question 29

Services provided by public health nurses:

Answer 29

``` Monitoring of health status Disease case identification Community education Community organization Development of policies Enforcement of health regulations Participation in organized education sessions Evaluation of the effectiveness of programs as implemented Participation in research ```

Question 30

Fastest-growing field of nursing

Answer 30

Home Health Care

Question 31

The most commonly seen diagnoses of home care patients

Answer 31

diabetes, essential hypertension, heart failure, chronic ulcers, and osteoarthritis

Question 32

Omnibus Budget Reconciliation Act of 1986

Answer 32

Sets strict criteria for qualifications for home health care aides who have a predominant role in direct, hands-on contact with patients.

Question 33

Patient Self-Determination Act of 1990

Answer 33

States that agencies receiving federal funds must inquire whether patients admitted for their services have a living will or special DIRECTIVES. If not, the agency must provide assistance in completing such directives.

Question 34

Outcome and Assessment Information Set (OASIS)

Answer 34

Home health agencies must use OASIS. Under OASIS, home health agency must continue to comply with physicians' orders. Initial assessment visit must be conducted by a registered nurse to determine the immediate care and support needs of the patient and to determine eligibility. Comprehensive assessment must include a review of all medications the patient is currently using to identify any potential adverse effects and drug reactions. Comprehensive assessment must be completed within 5 days after the start of care, must include a review of all medications the patient is using in order to identify any adverse effects/reactions, and must be updated and revised frequently. Electronic reporting of data is also required.

Question 35

Standing Orders

Answer 35

Because of the relative isolation, written standing orders are necessary in case of emergencies or unexpected patients. Home health nurses must honor contracts made with patients, whether written or oral agreements.

Question 36

Contract Law

Answer 36

Medicare and Joint Commission (JC) standards require that a home health care agency accept patients based on a reasonable expectation that a patient's medical, nursing, and social needs CAN BE MET BY THE AGENCY in the patient's residence. Contracts include both written and oral agreements. Contracts include advertised services as well as signed formal contracts.

Question 37

Abandonment

Answer 37

is to be avoided, and is defined as the unilateral termination of the professional relationship without affording the patient reasonable notice and health care services.

Question 38

Refusal of Care

Answer 38

A patient can withdraw consent for treatment at any time. Verbal consent is adequate. Refusal of care is dependent on informed consent and patient education must be documented in agency records.

Question 39

Parish Nursing

Answer 39

Parish nursing, also referred to as health and faith nursing, is the specialization of nursing based on the health and healing traditions found in many religions. The spiritual dimension is central to this practice.

Question 40

Occupational Health Nursing

Answer 40

An area of practice influenced by a variety of federal and state laws, particularly workers' compensation laws, mandatory reporting laws, and occupational safety and health laws Nurses in this setting face higher risk of personal liability than do nurses in other settings. Occupational nurses have responsibilities in a variety of areas, including adequate and rapid assessment of patients and communications with other health care providers who are not frequently at the work site. Occupational health nurses may also have accountability for the actions of people other than health care providers who render first aid assistance at the work site.

Question 41

Occupational Safety and Health Act of 1970 (OSHA)

Answer 41

The main governing occupational nursing practice; administered through the Department of Labor.

Question 42

School Health Nursing

Answer 42

School nurses provide a variety of health services depending on the needs of the children served in the school district. School health nurses face many of the same liability issues that occupational nurses face.

Question 43

Correctional Nursing

Answer 43

Correctional nursing is providing care for a person from the time of arrest and entry into the system through transfer to other facilities, to the final release of custody.

Question 44

Disaster Nursing

Answer 44

Disaster nursing is when a nurse either volunteers or is compensated for aid given during a disaster.

Question 45

Ethical Issues in Public and Community Nursing

Answer 45

Valuing the unique knowledge of patients Balancing diminishing resources while maintaining quality Supporting the empowerment and autonomy of patients If personal beliefs conflict with legislation, does it result in substandard care for patients? Medical procedures used to collect evidence in the prison system

Question 46

Ethics Committee--goals

Answer 46

Promote the rights of patients. Promote shared decision making between patients and health care provider. Promote policies that achieve quality patient-centered care. Enhance the ethical tenor of health care professions and institutions.

Question 47

Home Health Care--requirements

Answer 47

To be covered by either private insurance or public assistance, the services must be: Medically indicated. Ordered by a qualified health care provider. Necessary to maintain or improve health care of the recipient.