Topic 12 Flashcards
1
Q
Family durability
A
System of support and structure within a family that extends beyond the walls of the household
2
Q
family resiliency
A
ability to cope with expected and unexpected stressors
3
Q
family diversity
A
Uniqueness of each family unit
4
Q
what is the goal of family centered nursing
A
to address the comprehensive health care needs of the family as a unit; and to advocate, promote, support, and provide for the well-being and health of the patient and individual family members.
5
Q
what is the defintion of a family?
A
-The family can be defined biologically, legally, or as a social network with personally constructed ties and ideologies.
-No two families are alike; each has its own strengths, weaknesses, resources, and challenges.
6
Q
what are 5 trends that are threats/concerns for families
A
o (1) changing economic status
o (2) homelessness
o (3) domestic violence
o (4) the presence of acute or chronic illnesses or trauma
o (5) end-of-life care.
7
Q
what are factiors that influence family forms
A
-family caregivers
-poverty
-homelesness
-domestic violence
8
Q
the structure of a family is based on…
A
the ongoing membership of the family and the pattern of relationships
9
Q
rigid family sturctures
A
specifically dictate who accomplishes different tasks and also limit the number of people outside the immediate family allowed to assume these tasks.
10
Q
extremely flexible family structures
A
There is sometimes an absence of stability that would otherwise lead to automatic action during a crisis or rapid change.
11
Q
family nursing is based on the assumption that…
A
all people, regardless of age, are members of some type of family.
12
Q
A nurse can view the family in three ways: as _____, as _____, or as ______.
A
as context, as the patient, or as a system
13
Q
Family as context
A
primary focus is on the health and development of an individual member existing within a specific environment
-Although the focus is on the individual’s health status, assess how much the family provides the individual’s basic and psychological needs.
14
Q
family as patient
A
the family processes and relationships are the primary focuses of nursing care.
-Focus your nursing assessment on family patterns rather than the characteristics of the individual members.
15
Q
family as system
A
Remember that looking at the family as a system requires that you look at the family as context and as patient. These two perspectives are not mutually exclusive. You may use them simultaneously.
-Both family members and family unit
16
Q
family forms
A
patterns of people considered by family members to be included in the family
17
Q
nuclear family
A
Consists of husband and wife (and perhaps one or more children). living as one unit
18
Q
extended family
A
includes relatives (aunts, uncles, grandparents, and cousins), in addition to the nuclear family.
19
Q
single-parent family
A
a family in which only one parent is present to care for the children
-Is formed when one parent leaves the nuclear family because of death, divorce, or desertion, or when a single person decides to have or adopt a child.
20
Q
blended family
A
Is formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation.
-consists of a biological parent, a stepparent, and the children of one or both parents
21
Q
alternative family
A
Relationships include multi-adult households, “skip-generation” families (grandparents caring for grandchildren), communal groups with children, “nonfamilies” (adults living alone), and cohabitating partners.
22
Q
family heath system (FHS)
A
a holistic model that guides the assessment and care for families. It includes five realms/processes of family life: interactive, developmental, coping, integrity, and health.
23
Q
Genetic factors reflect a family’s…
A
heredity or genetic susceptibility to diseases that may or may not result in actual development of a disease.
24
Q
how can acute/chronic illness influence a family?
A
economically, emotionally, socially, and functionally and affects the family’s decision making and coping resources.
25
what is essential to provide individualized patient/family-centered care?
Incorporating the patient's and family's cultural beliefs, values, and communication patterns
26
trauma
sudden, unplanned, and sometimes life threatening event
27
end of life care
the support and care given during the time surrounding death
28
The five areas of family life to include in an assessment are...
interactive, developmental, coping, integrity, and health processes of the family
29
If a patient has been hospitalized or is in a rehabilitation setting discharge planning begins...
with the initiation of care and includes the family
30
Calgary Family Assessment Model
Focuses on interactions among the individuals in the family
-famuly assessment questions include: family structure, developmental assessment, and family functioning
31
Family caregiving
o The routine provision of services and personal care activities for a family member by spouses, siblings, friends, or parents
32
Family caregiving activities include...
include finding resources, providing personal care, monitoring for complications or side effects, providing instrumental activities of daily living and ongoing emotional support and decision making
33
the nurse as an educator
Your focus as an educator may be on the family caregiver, to prepare that person to manage the skills and processes needed to manage the patient's needs within the home.
34
caregiver burden
stress responses experienced during prolonged periods of home care by family caregivers
35
restorative and continuing care: family
-Maintain patients' functional abilities within the context of the family.
-Make sure home environment will accommodate a patient's strengths and limitations.
-Show how to perform aspects of physical care.
36
autonomy
Refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and PROTECTING A PATIENTS INDEPENCENCE. Involving patients in decisions about their care is now standard practice.
37
what are providers legally obligated to inform patietns about?
risks and benefits of treatment plans and then to enste that they indtertans and agree with their plan
38
beneficence
doing good, Implies that the best interests of the patient remain more important than self-interest, taking positive actions to help others
39
nonmalefiecence
Avoidance of harm or hurt.
-(not only the will to do good, but an equal commitment to do no harm)
40
justice
refers to fairness
41
fidelity
As a nurse, you keep promises by following through on your actions and interventions.
-also refers to the unwillingness to abandon patientsregardless of the circumstances, even when personal beliefs differ
42
just culture
refers to the promotion of open discussion without fear of recrimination whenever mistakes, especially those involving adverse events, occur or nearly occur.
43
Code of nursing ethics
o A set of guiding principles that all members of a profession accept
o Helps professional groups settle questions about practice or behavior
o Includes advocacy, responsibility, accountability, and confidentiality
44
social networking and nursing
-risk to patient privacy is great
45
Advocacy
refers to the support of a particular cause. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.
46
Responsibility
refers to willingness to respect obligations and to follow through on promises.
47
Accountability
refers to the ability to answer for one's own actions.
48
Standards are set by The Joint Commission and the ANA
Health care facilities have compliance officers who are responsible for making sure that the institution remains in compliance with standards and regulations.
49
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
mandates protection of the patient's personal health information.
50
value
a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior.
51
Ethical dilemmas almost always occur in the presence of...
conflicting values
52
Clarifying values
is an important and effective part of ethical discourse. In the process of values clarification, you learn to tolerate differences in a way that often (although not always) becomes the key to the resolution of ethical dilemmas
53
Deontology
Defines actions as right or wrong based on their "right-making characteristics," such as fidelity to promises, truthfulness, and justice.
54
Utilitarianism
ethics proposes that the value of something is determined by its usefulness. The greatest good for the greatest number of people is the guiding principle for determining right action in this system.
-because its main emphasis is on the outcome or consequence of an action
55
feminist ethics
focuses on the inequality between people
56
ethics of care
Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
57
Casuistry, or case-based reasoning
Turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an "intimate understanding of particular situations." This approach to ethical discourse depends on finding consensus more than an appeal to philosophical principle.
58
what are teh 7 steps that will guide you thorugh an ethical dilemma
Step 1: Ask if this is an ethical dilemma.
Step 2: Gather all relevant information.
Step 3: Clarify values.
Step 4: Verbalize the problem.
Step 5: Identify possible courses of action.
Step 6: Negotiate the outcome.
Step 7: Evaluate the action.
59
Nursing colleagues
listen to the problem, offer alternative actions, and help you articulate the issue. Giving and receiving support from other nurses promotes a positive work environment
60
Nurse leaders
may include a preceptor, charge nurse, manager, educator or advanced practice RN. They may have faces and manages similar situations and so have guidance to offer, They can also access other resources withing the hospital.
61
Members of the interprofessional team
includes physicians, social workers, therapists pharmacists, and chaplains. All may be interacting with the patient or aware of the situation that you are facing. Hearing their perspectives can help you to identify the problem and consider solutions.
62
Consultation services
may include ethics committees and palliative care specialists
63
Professional organizations
often set standards for nursing practice and have web-based resources to help you develop knowledge and skills in ethical analysis
64
Boards of Nursing
can help address questions about scope of practice and competency
65
Ethics committees
-present in majority of hospitals and home health agencies usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation.
66
Quality-of-life measures may take into account...
the age of a patient, the patient's ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality
67
Disabilities Act
bans discrimination against people with physical, mental, or emotional challenges
68
futile
refers to something that is hopeless or serves no useful purpose.
69
If a patient is dying of a condition with little or no hope of recovery...
almost any intervention beyond symptom management and comfort measures is seen as futile. In this situation, an agreement to label an intervention as futile can help providers, families, and patients turn to palliative care measures as a more constructive approach to the situation.
70
health care reform
Facilitated access to care for millions of uninsured Americans
71
Statutory laws (Nurse Practice Act)
include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state.
72
Criminal law (felonies or misdemeanors)
Criminal laws are meant to prevent harm to society and to provide punishment for crimes.
73
Civil law
Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur.
74
The consequences of civil law violations are...
damages in the form of fines or specific performance of good works such as public service.
75
Nursing negligence or malpractice is an example of...
a civil law violation.
76
Common law
results from judicial decisions concerning individual cases.
-Most of these revolve around negligence and malpractice
77
felony
a serious offense that results in significant harm to another person or society in general.
-carry penalties of monetary restitution, imprisonment for greater than 1 year, or death.
78
misdemeanor
a crime that, although injurious, does not inflict serious harm.
-o usually has a penalty of a monetary fine, forfeiture, or brief imprisonment.
79
standards of care
Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care
80
The American Nurses Association (ANA) outline...
the scope, function, and role of the nurse in practice.
81
Nurse Practice Acts define
the scope of nursing practice, distinguishing between nursing and medical practice and establishing education and licensure requirements for nurses.
82
In a malpractice lawsuit, a nurse's actual conduct is compared to...
nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.
83
The Joint Commission (TJC) requires
accredited hospitals to have written nursing policies and procedures.
-These internal standards of care are specific to the agency and need to be accessible on all nursing units.
84
Patient Protection and Affordable Care Act (PPACA)
created a new Patient's Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick.
85
PPACA was developed to
increase access to health care.
86
Americans with Disabilities Act (ADA)
prohibits discrimination and ensures equal opportunities for people with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation.
87
The Emergency Medical Treatment and Active Labor Act
provides that if an emergency condition exists, staff must evaluate the patient and may not discharge or transfer him or her until the patient's condition stabilizes.
88
Patients may remain on their parent's health insurance until they are
26 years old
89
Advance directives
legal documents that allow people to choose what medical care they wish to have if they are unable to make those decisions themselves
90
The Patient Self-Determination Act (PSDA)
requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
91
For living wills or durable powers of attorney for health care to be enforced, the patient must
be declared legally incompetent or lack the capacity to make decisions regarding his or her own health care treatment.
92
Living wills
Represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition.
93
A health care proxy or durable power of attorney for health care (DPAHC)
A legal document that designates a person or people of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf
94
the ethical doctrine of autonomy ensures
the patient the right to refuse medical treatment.
95
Cardiopulmonary resuscitation (CPR) is an emergency treatment provided without patient consent. Health care providers perform CPR on an appropriate patient unless
there is a DNR order in the patient's chart.
96
Uniform Anatomical Gift Act
An individual who is at least 18 years of age has the right to make an organ donation. Donors need to make the gift in writing with their signature. In many states, adults sign the back of their driver's license, indicating consent to organ donation.
97
Health Information Technology Act (HITECH)
In conjunction with HIPPA and in response to new technology and social media.
98
Restraints can be used...
(1) only to ensure the physical safety of the patient or other patients
(2) when less restrictive interventions are not successful
(3) only on the written order of a health care provider. The regulations also describe documentation of restraint use and follow-up assessments.
99
Nurses act as Good Samaritans when
providing care at the scene of an accident. All states have Good Samaritan Acts.
100
Public health laws
protect populations, advocate for the rights of people, regulate health care and health care financing, and ensure professional accountability for care provided.
101
Any health care professional who does not report suspected child abuse or neglect may be liable for
civil or criminal legal action
102
The Uniform Determination of Death Act
States that health care providers can use the cardiopulmonary definition or the whole brain definition to determine death.
103
An autopsy or postmortem examination may be requested by
the patient or patient's family
104
The Oregon Death With Dignity Act
Was the first statute that permitted physician-assisted suicide
105
tort
A civil wrong made against a person or property.
106
Intentional torts
are willful/deliberate acts that violate another's rights. These include assault, battery, and false imprisonment.
107
Assault
an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.
108
battery
any intentional offensive touching without consent or lawful justification.
109
results if the health care provider performs a procedure that goes beyond the scope of the patient's consent, what is this considered
battery
110
false imprisonment
occurs with unjustified restraint of a person without a legal reason.
111
Quasi-intentional torts
invasion of privacy
defamation of character
112
nvasion of privacy
the release of a patient's medical information to an unauthorized person such as a member of the press, the patient's employer, the patient's family, or online.
113
Defamation of character
is the publication of false statements that result in damage to a person's reputation.
114
slander
occurs when one speaks falsely about another
115
libel
is the written defamation of character
116
unintentional tort
negligence and malpractice
117
Negligence
is conduct that falls below the generally accepted standard of care of a reasonably prudent person.
118
Malpractice
is one type of negligence and often referred to as professional negligence.
119
Certain criteria are necessary to establish nursing malpractice:
o The nurse (defendant) owed a duty of care to the patient (plaintiff).
o The nurse did not carry out or breached that duty.
o The patient was injured and the nurse's failure to carry out the duty caused the injury.
120
what is the best way for nurses to avoid malpractice
follow standards of care, give competent health care, and communicate with other health care providers.
121
Informed consent
Agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal
122
The nurse's signature as a witness to the consent means...
that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent
123
If patients deny understanding of a procedure or you suspect that they do not understand what should the nurse do
notify the health care provider or nursing supervisor
124
Malpractice Insurance
A contract between the nurse and the insurance company
Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance
Nurses covered by institution's insurance while working
125
A nurse may refuse an assignment when...
o (1) the nurse lacks the knowledge or skill to provide competent care;
o (2) care exceeding the Nurse Practice Act is expected;
o (3) health of the nurse or her unborn child is directly threatened by the type of assignment;
o (4) orientation to the unit has not been completed and safety is at risk;
o (5) the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds; or
o (6) the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient.
126
Nurses who float must inform the supervisor of
any lack of experience in caring for the type of patients on the nursing unit. They should request and receive an orientation to the unit.
127
Nurses follow health care providers' orders unless...
hey believe that the orders are in error, violate agency policy, or are harmful to the patient
128
risk management and quality assurance
A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs
129
what are the steps involved in risk management and quality assurance
o Identify possible risks
o Analyze risks
o Act to reduce risks
o Evaluate steps taken
130
Occurrence reporting
provides a database for further investigation in an attempt to determine deviations from standards of care and corrective measures needed to prevent recurrence, as well as to alert risk management of a potential claim situation
131
A nurse's documentation is often...
the evidence of care received by a patient and establishes support that the nurse acted reasonably and safely.
132
Never events
are preventable errors, which may include falls, urinary tract infections from improper use of catheters, and pressure ulcers.
133
Necessary losses
As people age, they learn that change always involves a necessary loss. They learn to expect that most necessary losses are eventually replaced by something different or better.
134
Maturational losses
form of necessary loss and includes all normally expected life changes across the life span. Maturational losses associated with normal life transitions help people develop coping skills to use when they experience unplanned, unwanted, or unexpected loss.
135
Situational losses
Sudden, unpredictable external events
136
Stages of grief
denial
anger
bargaining
depression
acceptance
137
Attachment Theory
-Numbing: protects the person from the full impact of the loss
-Yearning and searching emotional outbursts of tearful sobbing and acute distress
-Disorganization and despair" endless examination of how and why the loss occurred or expressions of anger at anyone who seems responsible for loss
-Reorganization: Accepts the change, assumes unfamiliar roles, acquires new skills, builds new relationships, and begins the separate himself or herself from the lost relationship without feeling that he or she is lessening its importance
138
Grief Tasks Model
accepts the reality of the loss, experience the pain of grief, adjusts to a world in which the decrease is missing, emotionally relocated the deceased and moves on with life
139
Dual Process Model
loss oriented and restoration oriented
140
Denial
the person cannot accept the fact of the loss.
141
Anger
The person expresses resistance or intense anger at God, other people, or the situation
142
Bargaining
The person cushions and postpones awareness of the loss by trying to prevent it from happening
143
Depression
The person realizes the full impact of the loss
144
Acceptance
The person incorporates the loss onto life
145
Perceived losses
is uniquely defined by the person experiencing the loss and is less obvious to other people.
146
Normal (uncomplicated) grief
common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death.
147
anticipatory grief
A person experiences this grief before the actual loss or death occurs, especially in situations of prolonged or predicted loss like caring for patients diagnosed with dementia or ALS.
148
Disenfranchised grief
People experience this grief when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance.
149
Ambiguous loss
a type of disenfranchised grief, occurs when the lost person is physically present but is not psychologically available, as in cases of severe dementia or severe brain injury.
150
what are the types od complicated grief
chronic, exaggerated, delayed, masked
151
complicated grief
a person has a prolonged or significantly difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future.
152
chronic grief
A person with this grief experiences a normal grief response except it extends for a longer period of time.
153
exaggerated grief
A person with an this grief response often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these individuals.
154
delayed grief
A person's grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss.
155
Masked grief
when a grieving person behaves in ways that interfere with normal functioning but is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution
156
School-age children and grief
understand the concepts of permanence and irreversibility but do not always understand the causes of a loss.
157
Young adults and grief
undergo many necessary developmental losses related to their evolving future.
158
For older adults the aging process leads
to necessary and developmental losses
159
Health promotion
Focus on coping and optimizing health
160
Palliative care focuses on
the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness.
161
the primary gial of palliative care is...
to help patients and families achieve the best possible quality of life.
162
Hospice care
o A philosophy and model for the care of terminally ill patients and their families at the end of life. It gives priority to managing a patient's pain and other symptoms; comfort; quality of life; and attention to physical, psychological, social, and spiritual needs and resources.
o Manage pain, provide comfort, ensure quality of life
o Adheres to patient wishes
163
what are things a nurse should implement in end of life care
-therapeutic ocmmunication
-manage symptons
-promote dignity and self-esteem
-maintain a comfortable ans peaceful enviroment
-promote spiritual comfort and hope
-protect against abandonment and isolation
-support the grieving family
