final Flashcards
(85 cards)
1
Q
what does beneficence mean
A
to do good
2
Q
beneficence is linked with
A
autonomy
3
Q
beneficence is
A
positive claim right, virtue, duty, patients entitled to benefit from care
4
Q
benevolence
A
not associated with claim right, not required (charity)
5
Q
cognitive resources for thinking about & being beneficent
A
- be aware of difference b/w active & passive approaches to care
- be aware of difference b/w broad & narrow approaches to health (illness vs disease)
- harm –> nonmaleficence (hand-in-hand beneficence)
6
Q
how do you use an active approach
A
check in with clients, being present
7
Q
broad approach
A
holistic, illness (impact of illness on patient)
8
Q
narrow approach
A
disease (list of symptoms, stuff in chart)
9
Q
harm is a doctrine of
A
double effect
10
Q
when is harm ok
A
ok to inflict some harm on patient as long as out weighed by expected benefit (injection, chemo)
11
Q
with regards to harm, the RPN job…
A
make minimal as possible & remove patient from harm setting
- risk of harm not just to patient but to providers to
12
Q
challenges to the benefit/harm balance of beneficence
A
- having a psychiatric diagnosis (benefit = finding out problem, harm = stigma)
- psychiatric treatments (ben = psychosurgery, harm = stock treatment)
- involuntary treatment (harm = all rights taken away)
- harm reduction
- restraints (know how to do it right)
- suicide
- overdiagnosis of mental illness (child w/ ADHD)
- underdiagnosis of mental illness (seniors w/ depression)
- social determinants of health (income, intergenerational trauma)
- there is NEVER enough $$ in mental health care
13
Q
autonomy
A
self-rule
14
Q
paternalism
A
physician makes decision for patient even if patient capable of doing it themselves “doctor knows best”
15
Q
why is autonomy important in our care system
A
- legal reasons: doing things to poeple without permission is illegal
- respect for persons
- shift to patient-centered care
16
Q
how do we know that the patient has autonomy (freedom)
A
to act on their choices; independent, cannot be pressured
17
Q
3 ways patient is autonomous
A
- patient is at liberty
- they are capable of effective deliberation
- they are capable of authenticity (able to think about own goals & impact of choices of self & others)
18
Q
autonomy in a child
A
unable to make medical decision so presumption of autonomy not able
(in BC, no age of medical decision, physician makes decision due to how they are understanding of situation)
19
Q
autonomy in unconscious patient
A
make decision on their behave for safety & well-being of patient
20
Q
what do we do if client can’t make decision for themselves? (not autonomous)
A
- documentation (DNR, advance directives, comfort plans)
- patient has social worker, case worker, ethics comittee, patient advocate, patients family
- limited paternalism (best interest of patient, last resort, hand over autonomy once patient is able to make decisions)
21
Q
describe documentation related to autonomy
A
DNR (CPR), advanced directives (“living will”) = a lot of info about patient preferences, psychiatric advanced directives, comfort pan (not legal document) all documents are NOT legal (BC comfort plan, important), legal proxy decision-maker
22
Q
problems for patient autonomy
A
- illness (not the full person you are - not the best you) –> dependency
- conflict over treatment plans (negotiation & compromise skills)
- cultural differences
- autonomy sexist concept? (women autonomy not as respected as males, masculine outlook of world, women aren’t socialized about making autonomous decisions)
- poor health literacy –> instructions are hard to follow
- patient “noncompliance” –> cause problems… patient chose not to adhere to their treatment plans
23
Q
informed consent
A
voluntary informed choice
ensures the freedom of individuals to make choices about their medical care.
- consent (agree)
- choice (say yes/no)
24
Q
justice elements
A
legal
philosophical (rights & freedoms)
ethical (social justice, distributive justice ($))
25
canada health act
law that funds healthcare
26
5 principles of justice
1. comprehensive (whats covered? - everything thats medically necessary)
2. universality (whos covered? difference b/w provinces, problem = indigenous, metis, Inuit populations not covered)
3. accessibility (can you GET your coverage? waitlists, geography)
4. portability (does your care travel with you?)
5. public administration (admin by province, not federal, & be transparent)
27
list 5 things that are not covered in Canada health act
dental care, vision care, prescription drugs, medical equipment, hearing aids
28
healthcare resource allocation
1. societal level (gov raises taxes/cut services OR lower pay, lower expenses, lower pensions (for politicians))
2. institutional level (hard choices re: budget (manager)
3. individual level (RPN: be aware nurses undermine profession
29
what do nurses say about health resources
stop cutting corners, say thats a lie about not enough $, learn about how healthcare is funded & share, defend nursing values, good nursing measured by outcomes with patients, be active in union, vote, report everything
30
what is linked with truthfulness
autonomy
31
why does truthfulness matter
1. legal reasons
2. respect for persons (deontology)
3. shift toward patient-centered care (autonomy in center but need truthfulness, not telling the patient the truth, normal therapeutic privilege (physician not tell truth))
4. trust!!! (therapeutic relationship based on trust (patient needs to trust for them to be truthful, broad public trust in system, following public health guidelines))
32
being truthful not just about
conveying accurate info or giving facts
33
what it means to be truthful
not an absolute value in HC, truth needs to be modified, telling whole truth not required
34
it is justified (acceptable) to withhold the truth when
1. patient doesn't want to know the truth (respecting autonomy, ex: sex of baby)
2. institution has a no new info policy (anything the patient doesn't know, that needs to be heard from physician, ex: test results, discharged (common in BC))
3. necessary to protect patient confidentiality
4. to protect the anonymity of a clinical trial (qts about medication taken, only time you cant tell person about what medication they were given)
35
it is NOT justified (acceptable) to withhold the truth when
1. when a patient's condition is serious
2. when a patient's condition is incurable
3. when the patient's cognitively impaired
36
grey areas of justice
1. disclosing the sex of an unborn child (sex selective abortion)
2. false paternity
3. lying to funding agencies to get resources for patients
4. "lying" to patients with dementia (distraction)
5. what to do about patient delusions
37
why is confidentiality important
legal reasons (patient needs to know laws)
respect for persons (at risk because of psych status)
vulnerability
38
describe why vulnerability is important regarding confidentiality
- body: need privacy = modesty important (closing curtain, talk quietly) may have cultural differences (having mental illness causes issues with modesty, patient in prison don't have much confidentiality due to 24/7 surveillance, involuntary patients)
- information about them: health info needs extra protection, mental health info high risk of sharing
39
confidentiality means
what happens with info
40
privacy means
kind of info
41
in laws/ethics . . .
privacy is patients right
(patient allowed to show you what they want to show, patient allowed to decided how much info they want to share, you have obligation of keep info confidential)
42
confidential is a
positive claim right
43
when is it permitted to share patient info?
1. with the patients permission (autonomy)
2. inside the circle of care (group of individual who responsible for patients care) "need to know"
44
2 kinds of breaches of confidentiality
1. unintentional (WORST! - happen when HC prof not using common sense, being careless, not being aware of surroundings, RPN gossip about patient, think about consequences and stigma)
2. deliberate (certain purposes permitted: duty to warn that overrides duty to protect)
45
damage to patient if unintentional info shared
- unable to buy extended life insurance
- used against them in criminal trial, divorce, child custody, employment status, housing, certain benefits, volunteering, travel, education
46
duty to warm that overrides examples
- food/water borne illness (food poisoning)
- infectious disease (COVID)
- sexual transmitted infections
- suicide
- child abuse (domestic abuse --- chart situation)
- elder abuse
- seizure disorder (vehicles)
- heart conditions (vehicles)
- violent crimes (knife, gun wound, sexual assault)
47
info about patient mental illness is not allowed in ???
police background checks
48
families & confidentiality
- can give w/ permission
- in law, you can only give w/ permission
49
some ppl think confidentiality too strict bc
- research is hard
- detect fraud
- patient needs to be able to access their OWN records
50
technology & confidentiality
- ppl worried about how secure it is
- 2 step-auth
51
why is medical research separate from clinical care
1. different goals = knowledge
2. medical research involves vast amounts of money
3. past harms (ppl been harmed by research in past, need to make up for it, reparation)
4. may care for a patient who is also a research volunteer/participant
52
research ethics board (REB) aspects
- all research studies MUST be approved by board
- protect the participants not researchers
- not made up of researchers but ppl who specialize in ethics
- look at scientific validity & safe guards put in place to protect participants
- no REB for privately funded research
53
RCT aspects
- randomized control trial
- involve comparison
- investigational treatment (experimental drugs)
- existing medication
- placebo (no chemically active substances)
- no intervention (observation)
54
in RCT another characteristic is "what is being compared" which comprises
- investigational treatment vs placebo
- investigational treatment
- placebo
- existing meds
- no intervention
55
comparison is referred to as
arm = how many things are being compared
56
different arms in RCT
- 2 arm RCT
- 3 arm RCT
- 4 arm RCT
57
4 different phases of clinical trial
1. dosage
2. safety
3. efficacy
4. post-marketing
58
dosage
- figuring out optimal dosage of a drug, when does it become toxic?
- small # of volunteers, healthy volunteers, can use placebo
- start off w/ low dosage - increase it based on tolerance
59
safety
- larger trial, healthy volunteers, use of placebo
- check that no one is having a severe adverse effect (SAE)
60
efficacy
- drugs can be prescribed after this phase is successful
- statistical measurement not effectiveness of drug
- as big as possible (trial), sick participants, no placebo (few exceptions) (unethical to leave sick participants unmedicated)
61
post-marketing
- need to keep collecting data on the drug (side effects)
- health care providers (physicians) are supposed to give this information to Health Canada (doesn't always happen)
- Canada Vigilance Program (allows public to report side effects of a drug)
62
randomized =
equal chance of a participant being assigned to each arm
63
patients will not be. . .
assigned to a particular arm based on what will benefit them
64
therapeutic misconception
- patients have a false belief that they are receiving something therapeutic
- not about clinical care but the research/knowledge
65
double "blind"
(double anonymized)
- neither the researcher or participant know what is being administered
66
can participants drop out
free to drop out at any time for any reason
67
beneficence in medical research
benefits researchers and the public
68
non-maleficence in medical research
- can't guarantee participants will be free of harm
- unknown risks
69
autonomy in medical research
- informed consent is required
- due to the risks, it is crucial for potential participants to know what they are getting into
- important to tell them as much information as is allowed
- understand it is not for their benefit
70
truthfulness in medical research
- research is an exception to truthfulness
- unable to complete effective research without hiding things
- before the research, the participants are informed that they will be lied to
71
confidentiality in medical research
contents of medical files will be shared outside of the healthcare team as it is now considered evidence (w/ consent of participants)
72
justice in medical research
- all about recruitment (who participated & took the risk, in future, all populations should be apart of clinical trials, research is done on mentally ill, prisoners, racial/ethnic minorities, indigenous people so more privileged populations are protected)
- women should make up 50% of clinical drug trials (especially if drug geared towards women) since they half of population
- women may be kept out of trials due to potential birth defects
73
should dying participants be able to participate in clinical drug trials?
- are typically overprotected
- can help future generations
74
elements of informed consent (element E)
- healthcare provider gives the adult the information a reasonable person would require to make a decision, include info about....
1. condition for which the health care is proposed
2. the nature of the proposed health care
3. the risks and benefits of the proposed health care that a reasonable person would expect to be told about
4. alternative courses of health care
75
RPN integrity aspects
- moral autonomy
- fidelity
- steadfastness
- wholeness
76
moral autonomy
- ability to reject authority
- ur autonomy might conflict with ur pt autonomy, supervisors orders, professional obligations
- sometimes choices won't be acted upon because of institutional pressures
- have the right to not administer medication, use/not use restraints, MAID
- know what choices you can make
77
moral fidelity
staying faithful
- keeping a promise is an act of fidelity
- think about promises you make to yourself and your profession
- think about the future and how you are going to keep those promises
- code of ethics = main example of the promise i have to the public like what kind of things can they do for me, what will they refrain from doing
78
steadfastness
- to be able to withstand pressure
- will be hard because we are going into a challenging profession and tons of pressures from all over = workplace source of pressure, patient source pressure
- keep your values together while experiencing large sources of pressure
- time management & stress management are aspects that influence the ability to make moral decisions
79
wholeness
moral consistency
- across all your different roles, you should be the same moral person
- be accountable for your actions (learn from mistakes! patient's liberty)
80
moral dilemma
faced with ethical dilemma, you don't know what to do (choices)
81
moral distress
you know what to do, but you are being kept from doing the right thing
- face barriers (institutional policies, lack of resources, rigid protocols)
82
moral residue
- aftermath of distress
- carry around the fact that you couldn't do the right thing because of the things affecting it from the moral distress
- moral failure
- impact on both physical & emotional health
83
moral courage
- resilience
- never have to do it alone, always with other support
- how do ppl bounce back
- solidarity with other RPN more important than courage
84
moral injury
- a loss of trust when you witness your peers or leaders act in way that violates ethical expectations (patient liberty (patient freedom being restricted), stigma (lack of respect by doctors))
- what do we do to bring change?
(WE change the system, widespread systemic change)
85
integrity
- important relationship with integrate (combine things into a unified whole)
- having the ability to take everything you have learnt in the course & apply it your practice and your values
