Ethical and Legal Standards, Patient Centered Care & Evidence Based Practice

Question 1

To do good

Answer 1

Beneficence

Question 2

to do no harm

Answer 2

Nonmaleficence

Question 3

Treated all fairly

Answer 3

Justice

Question 4

Truthful

Answer 4

Veracity

Question 5

A way for citizens to feel safe. Laws regulating professional development

Answer 5

Nurse Practice Act

Question 6

National League of Nursing;

Answer 6

NLN

Question 7

Making sure standards are up to date

Answer 7

Joint Commission

Question 8

Standards of right vs. wrong
Based on a specific group’s standards
Relates to the rights of clients and their families
The development of ethical standards of an individual, community, or a profession

Answer 8

Ethics

Question 9

Distinguishing between right or wrong based on your own personal standards. Focus is more on a social aspect and involves personal awareness of feelings

Answer 9

Morality

Question 10

A set of professional principles and standards designed to help guide professional behavior and relationships through specific nursing beliefs and values

Answer 10

Nursing Ethics

Question 11

Comfort
Teaching & Learning
Communication
Advocacy

Answer 11

Concepts Related to Nursing Ethics

Question 12

Personal ideas about the worthiness of importance of something known through socialization

Answer 12

Values

Question 13

Ideas that one holds to be fact based on experiences and personal knowledge. One’s values often reflect their beliefs.

Answer 13

Beliefs

Question 14

Altruism
Autonomy
Human dignity 
Integrity
Social Justice

Answer 14

5 essential values of nursing

Question 15

Necessary for the nurse to help them maintain client-centered care
Necessary for clients to help the nurse learn their values and distinguish them from their own
Therefore, assists with effective plan of care
Also, helps the nurse know whether values clarification is necessary
**The nurse is to NEVER impose his/her own personal values on a client and must be careful with offering opinions*

Answer 15

Clarifying Values

Question 16

A set of ethical standards and behaviors that are expected in the nursing profession
Help guide nurses in the profession
The 2 major codes the nursing profession follows are the American Nurses Association (ANA) and the International Council of Nurses (ICN)

Answer 16

Nursing Code of Ethics

Question 17

The nurse has certain obligations to address such as the client’s best interests and following facility’s policies

The first step is to consider whether a moral dilemma exists
Maximize the client’s well being.
Balance the clients need for autonomy with family members’ responsibilities for the clients well being.
Support ea. family member and enhance the family support system.
Carry out hospital policies.
Protect other clients’ well-being.
Protect the nurses’s own standards of care.

Become aware of their own values and the ethical aspects of nursing.
Be familiar with nursing codes of ethics.
Seek cont. education
Respect values, opinions, and responsibilities of other healthcare professionals

Answer 17

Ethical Decision Making

Question 18

problem oriented medical record

Answer 18

POMR

Question 19

subjective data
objective data
assessment
plan of care

Answer 19

SOAP

Question 20

subjective data
objective data
assessment 
plan of care
interventions
evaluations
revision

Answer 20

SOAPIER

Question 21

problems
interventions
evalutations

Answer 21

PIE

Question 22

intended to make the client and the clients concerns and strengths the focus of care.

Answer 22

Focus charting

Question 23

only abnormal or significant findings or exceptions to norms are recorded.

Answer 23

CBE-Charting by exception

Question 24

Health Insurance Portability Accountability Act of 1996
privacy and security rule which applies to us all.
Logging off of computers
Can send an email as long as it is encrypted and subject box has “confidential” in it.

Answer 24

HIPPA

Question 25

Population/Patient Problem-Who is your pt? Issue/Intervention-What do you plan to do for this pt? Comparison-Whats the alternative plan? Outcome-What outcome do you seek? Time-What is the time frame? ``` Your PICOT question will fall under one of these types: Therapy/Prevention Diagnosis Etiology Prognosis ```

Answer 25

PICOT Format

Question 26

using one's expertise and knowledge to assist in gathering information related to professional practice. The data collected is a result of best current practices. This process is continuous because old evidence needs to be replaced with updated information.

Answer 26

Evidence based practice

Question 27

Best evidence is from current research Based on nurse's clinical expertise Should reflect clients's preferences, values, needs, interests, and choices

Answer 27

Components of EBP Framework

Question 28

``` Clinical decision making Advocacy Quality Improvement Accountability Professional behaviors ```

Answer 28

Concepts related to EBP

Question 29

Evidence: increased staph infections to wounds noticed per hospital reports Research can be conducted within the facility to determine possible causes Once all evidence is collected and evaluated, changes can be made for improvement

Answer 29

Benefits of EBP

Question 30

Implementing the scientific process All information gathered is OBJECTIVE & FACTUAL The overall goal is to improve client care Careful consideration of funding, participants, ethical/legal issues, and implications for practice

Answer 30

Clinical Research

Question 31

Precision of measurement is used; statistical data collected

Answer 31

Quantitative Research

Question 32

``` Meta-analysis Case study Cohort study Case-control study Randomized control trial ```

Answer 32

Types of Research Studies

Question 33

A group of studies on a given topic are examined, and their results are combined and analyzed as if they were from one large study.

Answer 33

Meta-analysis

Question 34

A case study is specific to one individual, issue or event.

Answer 34

Case study

Question 35

A longitudinal study follows two groups and measures the outcomes of an exposure group with those of a non-exposure group.

Answer 35

Cohort Study

Question 36

This study compares individuals with and without a specific condition to identify predictive variables.

Answer 36

Case-Control Study

Question 37

This is the strongest type of study. RCT's are designed to illustrate a cause and effect relationship by using a control group and an experimental group.

Answer 37

Randomized Control Trial (RCT)

Question 38

Provide best evidence for EBP. Support nursing as a professional discipline. Define current best practice standards of nursing care.

Answer 38

Implications for Nursing Practice. Three main benefits of clinical research.

Question 39

1. Develop a clinical question (determine the type) - Diagnosis - Etiology - Therapy - Prognosis 2. Retrieve the evidence 3. Evaluate the evidence 4. Apply the evidence

Answer 39

Steps to Developing EBP

Question 40

``` Communication Planning client care Auditing health agencies (The Joint Commission) Research Education Reimbursement (from insurance/government) Legal Record (admissible in court) Healthcare analysis ```

Answer 40

Purposes of Maintaining Client Records

Question 41

document helps clients understand their treatment choices and risks that maybe involved. Not nurses Duty. Can be a witness; Physicians duty

Answer 41

Informed Consent

Question 42

``` Assessments Change in conditions Objective descriptions Statements Nursing action Use of safety equipment Deviations or achievement of outcomes MD notification Procedures Consultations Involvement of family/others Activities ```

Answer 42

What to Document

Question 43

Also referred to as charting, recording or documenting onto a client's chart or clinical record. The main purpose is for effective communication among healthcare professionals.

Answer 43

Nursing Documentation

Question 44

Referred to as POMR or POR; Advantage; Encourages collaboration among healthcare team and care is organized based on problem list Disadvantage: Requires frequent updating Four Components include: 1. Database 2. Problem list 3. Plan of care 4. Progress notes - SOAP - SOAPIER

Answer 44

Problem-oriented medical record

Question 45

Source-oriented Problem-oriented 3. Problems, interventions, evaluations (PIE) 4. Focus charting 5. charting by exception (CBE) 6. Electronic (to be discussed in Class 2)

Answer 45

Documentation Systems

Question 46

Also known as PIE= consists of a formatted flow sheet and progress notes Advantage; Organized flow sheet of information Creates an ongoing care plan Disadvantage: All notes must be reviewed prior to the nurse giving care (time consuming)

Answer 46

Problems interventions evaluations

Question 47

source-oriented Advantages: Easy for healthcare team members to locate different sections of the chart Each disipline's charting is clearly identified Disadvantages: Client information is scattered throughout the chart

Answer 47

Source oriented

Question 48

``` Do's of charting Be prompt Be accurate Be detailed Be neat! Check spelling Chart chronologically Date & Time Use black or blue pen Be objective Record you signature ```

Answer 48

Do's of charting

Question 49

``` Dont's of Charting Forget Falsify Use white out Scribble Chart for someone else Stereotype Wait until the end of the shift Chart ahead of time! ```

Answer 49

Don't's of charting

Question 50

Usually contains 3 components 1. Date and time 2. focus (condition, nursing diagnosis, behavior, etc) 3. progress notes

Answer 50

Focus charting

Question 51

Written in Dar format D=data (what was assessed/found) A=action (what was done about it) R=response (how did the client respond to treatment) Advantage: Client-centered providing holisitic care Provides a framework for nursing progress notes Three components do not have to be in any particular order

Answer 51

Focus charting

Question 52

Admissions (nursing history, initial database, nursing assessment) Care Plans Kardexes Flow sheets (includes graphs, intake and output, med administration, and skin assessment) Progress Notes Discharge/Referral Summaries Long-term Care- requirements for documentation depend on facility policy, federal and state regulations, and professional standards Home Care- documentation must meet standards for Medicare and Medicaid and facilities must maintain: 1. home health certification & plan of care 2. medical update and client info form

Answer 52

Special Considerations for charting

Question 53

``` Used only to document deviation from the expected finding Three components: 1. Flow sheets 2. standards of nursing care 3. Bedside access to chart forms ``` Advantages: Charting is simplistic with no repetition Changes to clients condition stand out Disadvantage: Some nurses are not comfortable with this charting system

Answer 53

Charting by Exception (CBE)

Question 54

Provide citizens with protection from harm. | Mandatory duties to report; unsafe working conditions, child abuse and medical practioner

Answer 54

Nurse Practice Act

Question 55

Protecting is defends another's cause represents clients needs, wishes to others positive experience for nurses & clients

Answer 55

advocacy

Question 56

Navigate complex health care system Educate clients about their rights, health care options -provide info -support client in making informed decisions -work with client who lack decision-making capacity

Answer 56

Advocate's Role

Question 57

Nurse maintains professional boundaries - being client advocate - following through or following up - providing resources - going above and beyond

Answer 57

Four Dimensions of Advocacy

Question 58

Protecting an individual by expressing and defending the individuals cause on his or her behalf. An individual who expresses and defends the cause of another. Whats best for the patient, children, elderly, mentally handicapped, not able to advocate for themselves, next of kin that can

Answer 58

Advocate/Advocacy