THeories, metaparadigm and others

Question 1

What is Epistemology?

Answer 1

The study of knowledge

Question 2

Nursing Epistemology can be described as

Answer 2

The study of knowledge in the nursing profession, the patterns of knowing and knowing that develops from them, and the criteria for accepting these knowledge claims

Question 3

What are the 4 patterns of knowing?

Answer 3

Aesthetic, Personal, Empirical & Ethical Knowing

Question 4

What is Aesthetic knowing?
(5) principles (what is the acronym?)
We stand on an _______ standpoint and?

Answer 4

Expressive, Subjective, Unique, Creative & Experiential
Compared to Empirical knowing
It is based on sensing, not analysis
We stand on an evaluative standpoint and envision the outcome of our actions chosen for the situation

Question 5

Empirical knowing is about (2)
and how you use ______

Answer 5

Knowledge (evidence based) test → examining + analysing → legitimise aspects of nursing care

and how we use these knowledge to help patients recover

Question 6

Personal knowing is about
How do you gain personal knowing?

Answer 6

Your experiences as a nurse (with practice), you understand what can happen in certain situations

This is gained by engagement & active empathetic participation

Question 7

Ethical knowing is about (3) components

Answer 7

Right/wrong
good/bad
fair/unfair

The morals in nursing
How do you actually justify your actions?

Question 8

Definition: meta-paradigm?

Answer 8

general concept that defines/identifies the discipline (the uniqueness of the discipline)

Question 9

Fawcett’s meta-paradigm of nursing contains

Keep in mind these are general concepts

Answer 9

Person, Environment, Health and Nursing

Question 10

How did Fawcett view persons?
(2)

Answer 10

• refers to the sick individual
• unique and autonomous
• considered in terms of their physiological, psychological, social, spiritual and cultural selves
• responsible for their health - involved in care planning

Question 11

How did Fawcett view Health?

Answer 11

• a perceived state of well-being
• harmonious connection of the physical, psychological, social and spiritual parts of an
  individual with the environment
• viewed both in normative state and/or process of
  living as well as the process of dying

Question 12

How did Fawcett view the environment? (2)

Answer 12

• comprises internal and
  external factors that act
  on human beings and
  affect their behavior and
  development
• home life, mental state,
  addictions, physical pain,
  chances of relapse,
  rewarding work

Question 13

Fawcett Definition of nursing?

What are the roles of nurses?

What type of care do we cater to our patients?

Ethical and Emotional paradigm!

Answer 13

• process of caring for the health of human beings
• assisting individuals in meeting their needs
• teaching them the basics of caring for themselves
• extends beyond the health care facility to the community and society
• ethical and emotional paradigm

Question 14

What are the 2 types of Nursing theories?

Answer 14

Grand: global emphasis on nursing practice
Middle-range: tested directly

Question 15

Florence Nightingale’s Focus

What does the ________ contribute to? (Think meta-paradigm)

Answer 15

Environment is very important for everyone’s well being
Environmental control can prevent disease and uplift the maintenance of health
- this benefits everyone, especially the sick and poor

Question 16

Virginia Henderson’s Focus

________ focuses on the?
The nurse’s unique function here is to?

Answer 16

Henderson’s needs theory focuses on improving the patient’s independence

According to Henderson, the unique function of the nurse is to
assist the individual (sick/well) in the 14 activities that improves/(or leads to peaceful death)

To help him gain independence as rapidly as possible

Question 17

Dorothy Orem’s Focus

When is the nurse necessary according to Orem?

Answer 17

Orem focuses on self care
The nurse is necessary just when the care patients need is beyond their capacity and ability

In this case, the nurse educates/guides/supports & care for the patient (based on their needs)

Question 18

Calista Roy’s Focus

Answer 18

ADPIE to help patients adapt

Question 19

Patricia Benner’s model

TLDR for each stage

Answer 19

Novice to Expert Model
Novice: zero experience
Advanced beginner: follows rules, unable to prioritize
Competent: 2-3 years experience, able to plan for the long term (able to prioritize and manage contingencies)
Proficient: Speed + Flexibility + Holistic understanding
Expert: deep background and understanding of clinical situations

Question 20

What is Singapore’s strategy to sustain quality healthcare as the demand rises?

Answer 20

The 3 beyonds
Healthcare → Health
Hospital → Community
Quantity → Value

Question 21

What are the nursing initiatives in place to increase the nursing workforce?

Answer 21

1. Expanding nursing intake
2. Enable nurses to expand professional capabilities (specialize/further studies)
3. Training opportunities such as community nursing
4. supporting mid-career entrants (PCP)
5. Utilizing technology to ↑ patient care

Question 22

Describe: Autonomy

Answer 22

The principle of self-governance
Freedom to make choices to issues that affect one’s life
Respecting a client’s rights values and choices is synonymous to
respecting the person’s autonomy

Informed consent is a method that promotes and respects a
person’s autonomy
For a client to make a autonomous decision and action,
he or she must be offered enough information and options
to make up his/her mind to make a decision free from cohersion
or external/internal influences

2 related deratives
Privacy - requires avoid intruding the personal space of the patient
In healthcare, patients lose a great deal of privacy.
Small considerations like seeking permission before touching
someone can go a long way towards protecting privacy and
respecting patient autonomy

Confidentiality - confers an obligation to protect the personal
information collected on the patient. This means being vigilant and
holding conversations away from the ears of people who do not
need to know about the patient as well as keeping patient’s
records in a safe and protected area

Question 23

Justice

Answer 23

Promotion of equity, fairness in every situation a nurse encounters
E.g. ensure fair allocation of resources
appropriate staff to patient ratio: to ensure patient care is not
compromised

How about distributive justice?

The application of principle: justice focuses primarily on the fair
distribution of goods and services

Question 24

Beneficence

Answer 24

Doing good for the patient - helping one to gain what is beneficial to them
Groundwork for the trust patients place in nurses

Objective vs Subjective

Question 25

Non-maleficence

Answer 25

Doing no harm So what constitutes as harm?

Question 26

Fidelity

Answer 26

Keeping one's promise Requirement to actively uphold one's end of the patient clinican relationship and all that in it involves This principle requires healthcare providers to maintain their promise implicit in the relationship like maintaining confidentiality, acting in the best interest of the patient, being honest, educating the patient and being responsive to the needs of the patient Society has granted nurses the right to practice nursing through the process of licensure and certification The process of licensure is one that ensures that no one can practice within the domain of nursing as defined by society and the profession. Thus to accept licensure and become legitimate members of the profession mandates that nurses uphold the responsibilities inherent in the contract

Question 27

Veracity

Answer 27

Truth telling Derived largely from Beneficence Patients cannot act in their interest unless they are fully informed of their medical condition Hence, a patient's pursuit of QoL is hampered by not knowing the relevant facts of his/her health

Question 28

Confidentiality + Is the duty of confidentiality absolute?

Answer 28

Patient-client relationship? Duty of confidentiality is not absolute For confidentially to be breached, there needs to be strong grounds It will be voided in the case of self harm & risk of harm to others

Question 29

Ethical dilemma is defined as

Answer 29

A situation that requires a choice between 2 equally unfavourable alternatives

Question 30

Moral distress is defined as

Answer 30

Occurs when one knows the right thing to do but constraints make it impossible to pursue the right course of action

Question 31

Why Mental Capacity Act?

Answer 31

The proliferation of this new demographic profile (gradually aging population) raises a host of pressing issues, particularly that of rising incidences of dementia among the aged This act was designed to provide a regulatory framework whereby a person who does not have the capacity to make a decision for him/herself because of an impairment of, or disturbance in the functioning of, the mind or brain may appoint someone to do so on his/her behalf

Question 32

TLDR? protects against?

Answer 32

Protects those who lack the capacity to make decisions from being taken advantage of

Question 33

What approach did the MCA use to guide decision making? Which ethical principle can be affected due to this approach?

Answer 33

Paternalistic approach - to make decisions for the best interests for the patient This may affect the autonomy of the individudal

Question 34

What are the 5 principles for the purposes of the MCA?

Answer 34

1. To assume capacity unless proven otherwise 2. Bad decisions does not equate to inability to make decisions 3. To not treat as unable to make a decision unless all practicable steps fails 4. To make decisions in the best interest of the patient 5. Before the decision is made, it must be achieved effectively in a way that is less restrictive of the person's rights and freedom of action

Question 35

What is the key derivative ethical principle in the MCA?

Answer 35

The key derivate ethical principle from autonomy is the respect for persons

Question 36

What are the other ethical principles related to the MCA?

Answer 36

Justice Beneficence Non-maleficence

Question 37

As a whole, is the MCA based on good ethics?

Answer 37

The MCA is well anchored by principle of ethics, and serves to promote respect for and protection of those who suffer from loss of mental capacity

Question 38

What are the safeguards to prevent abuse of the MHCT Act?

Answer 38

The safeguards to prevent abuse are 1. Mentally disordered persons may only be detained in psychiatric institutions designated by the Minister for Health (psychiatric wards can be designated as psychiatric institutions) 2. It is to be inspected regularly by visitors appointed by the Minister for Health 3. Only medical practitioners that have been designated by name or office in writing by the Director of Medical Services may sign an order for admission and detention 4. There are penalties for improper reception or detention of mentally disordered persons 5. A Magistrate's order is required if the period of detention exceeds 6 months

Question 39

Describe the LPA process

Answer 39

The donor >21 years old and mentally capable to make decisions can establish a LPA (Advance planning) The donee will have to meet certain criterias 1. >21 years old 2. not declared bankrupt 3. duty to act in the best interest of the donor 4. trustworthy, reliable and competent to make decisions Can be a family member, relative or a trusted friend Both signs and registers LPA @ the Office of the Public Guardian Certificate issuer can be 1. Lawyer 2. Practicing Psychiatrist 3. Accredited Medical Practitioner

Question 40

Principle of the double effect, what is it?

Answer 40

1. Action is not itself morally evil 2. Bad consequences must not be intended 3. Good consequences is intended 4. The good consequences must be proportionate to the bad consequences

Question 41

How do you explain the procedure to the patient with regards to respecting the person's autonomy as a right? Think Autonomy

Answer 41

Self-governance To make decisions for self To information that will aid informed decisions Provide ample time (prevent feelings of coercion) Understandable words and language Documentation

Question 42

What is needed to make a informed decision/consent? Think the process of explaining to the patient

Answer 42

Comprehensive discussion on need for alternatives benefits/risks and complications Documenting the discussion

Question 43

Who are the non autonomous persons?

Answer 43

Childrens/stress/sedation/persons with limited mental capacity

Question 44

Patients seeking medical care: registration process involves

Answer 44

Providing personal data for medical purposes She consents to the collection, use and disclosure for medical care But does not cover purpose outside for which the personal data was provided

Question 45

What did Madeleine Leininger talk about in culture?

Answer 45

She said that understanding a person's culture involves understanding the person as a whole

Question 46

List henderson's 14 needs

Answer 46

1 Breathe normally. 2 Eat and drink adequately. 3 Eliminate body wastes 4 Move and maintain desirable postures 5 Sleep and rest. 6 Select suitable clothes-dress and undress 7 Maintain body temperature within normal range by adjusting clothing and modifying environment 8 Keep the body clean and well groomed and protect the integument 9 Avoid dangers in the environment and avoid injuring others 10 Communicate with others in expressing emotions, needs, fears, or opinions 11 Worship according to one’s faith 12 Work in such a way that there is a sense of accomplishment 13 Play or participate in various forms of recreation 14 Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities

Question 47

define ethics

Answer 47

Ethics are moral principles that guide a person’s behavior and choices.