1. Purpose of the Code of Ethics
a. Common guidelines to use in making ethical decisions
b. Contained in the ANA’s code for nurses
c. The ANA code addresses specific issues and does not confine itself to matters of
etiquette or broad general statements.
d. Nurse obligation is to the patient, Protect patient from unethical or illegal
practices.
2. Steps in making an ethical decision
a. Factors that influence ethical decisions
i. Codes for nurses (nursing standards)
ii. The patients rights
iii. Social and cultural attitudes
iv. Science and technology
v. Legislation
vi. Judicial decision
vii. Funding
viii. Personal religious and philosophical viewpoints
b. Model for ethical Decision making
i. What is the issue?
ii. What alternatives/solutions are possible?
iii. Selection of solution
iv. Justification of the solution
3. Outcome of the Tuskegee Study
a. Even after the U.S Public Hrealth Service in 1945 approved penicillin to treat the
disease, the study continues until 1972 without the men being treated.
b. The Tuskegee Health Benefit Program (THBP) was established to provide
services to the participants and their families.
c. The Tuskegee Study resulted in passage of the National Research Act of 1974 and
the establishment of a Health and Human Services Policy for Protection of
Human Research Subjects.
4. Ethical dilemmas in healthcare
a. Two or more choices are available
b. Difficult to determine which choice is best
c. Available alternatives connot solve the needs of all these involved
d. Each alternative is the dilemma may have both favorable and unfavorable features
e. Ethical dilemmas in healthcare involve issues surrounding professional actions
and patient care decisions.
f. Strategies to resolve & prevent ethical dilemmas
i. Validate feelings and values
ii. Conduct a case analysis
iii. Identify outcomes
iv.
v.
vi.
vii.
Identify short-and-long-term goals
Clarify accountabilities
Follow through
Resolve reactions
5. Principles of ethical behavior
a. Beneficence – to do good
b. Nonmaleficence – to do no harm
c. Autonomy – Patient rights
d. Justice – Equality
e. Distributive Justice – Sharing of resources
6. HIPPA guidelines
a.
7. Actions by a nurse that constitute a crime
a.
8. Definition of Standards of Care
a. A standard or measure of behavior that describes how a nurse is expected to act or
professionally conduct him/herself according to an accepted reasonable practice
of nursing care
b. The degree of care, expertise, and judgement exercised by a reasonable person
under the same or similar circumstances
9. Definition of: delegation, negligence, fraud, malpractice, autonomy, accountability,
veracity, assault, slander, libel
a. Delegation – allowing a delegate to perform a specific nursing activity, skill, or
procedure, that is beyond the delegate’s traditional role and not routinely
performed. Ex: an RN asks a nursing assistant to help a client ambulate in the
hall.
b. Negligence – refers to a failure to exercise that degree of care.
c. Fraud d. Malpractice – identifies professional negligence – lability resulting from improper
practice based on standards of care required by the professional for which the
person has been educated.
e. Autonomy – involves the right of self-determination or choice, independence, and
freedom.
f. Accountability – (responsibility) being obliged to answer for one’s actions and
sometimes, as when certain tasks are delegated, for the actions of others.
g. Veracity – refers to telling the truth or not intentionally deceiving or misleading
clients.
h. Assault
i. Slander
j. Libel
10. Purpose/content of operation consents-especially with children
a.
11. Examples of torts
a. Tort Law - a civil wrong that unfairly causes someone else to suffer loss or harm
resulting in legal liability for the person who commits the tortious act. The person
who commits the act is called a tortfeasor.
b. A tort is a, wrongful act, not including a breach of contract or trust, that results in
injury to another’s person, property, reputation, etc.
c. A civil wrong committed against a person or the person’s party
d. Intentional tort – in which the outcome was planned
i. Example: preventing a client from leaving against medical advice may be
based on concern for the client but interferes with liability and causes
psychological harm.
e. Unintentional tort – an action causing harm to another person or property that was
not intended to happen.
i. Example: negligence (failure to exercise that degree of care)
f. Torts result in physical harm, psychological harm, harm to livelihood, or some
other less tangible value, such as harm to reputation.
12. Good Samaritan laws
a. These laws are meant to encourage anyone to render assistance in an emergency
situation without fear of liability for simple negligence.
13. Nurse’s responsibility regarding child abuse laws
a.
14. What action should the nurse take if questioning a doctor’s order
a.
15. Purpose of documentation
a. If you don’t document, it never happened.
b. Documentation can be used in court as well
16. Where is euthanasia legal in the USA
a. Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington,
Colorado
17. Purpose of nurse practice acts
a.
18. Aim of DRG’s
a.
19. Payers of hospital charges
a.
20. Age group with greatest burden on healthcare
a. Seniors
21. Annual limits vs deductibles
a.
22. Role of lobbyist
a. Lobbying is the process of attempting to influence legislators to take a particular
action.
b. Political action committees (PACs) are organizations and are registered as
political action groups and are free to try to affect the political process.
c. No Non-Profit Organizations
23. ACH act-aim
a.
24. Professional care models (nursing)
a. Holistic Model – focuses on healing the whole person, involves effects of illness
on the body, mind, emotions, spirituality, religion, and personal relationships.
b. Team Nursing Model – focus on patient centered care and efficient/cost effective
use of available personnel. Divides workers into team, each containing nurses
with different levels of knowledge and skill so each member is used at the level at
which they are capable of performing.
c. Functional Nursing model - Focuses on getting the job done. Divides nursing
into tasks: medication administration, dressing changes, and other treatments,
baths and beds, vital signs.
d. Total Care Nursing Model – Focus: RNs are free to perform patient care. The
nurse provides comprehensive to the assigned patients.
e. Primary Nursing Model – Focus: RN is at the bedside planning and giving
expert care. No time wasted on managing others. Each RN is a primary nurse to
small group of patients and an associate nurse to other patients that he/she helps to
care for.
f. Case Management – focus Is on coordinating all aspects of the care of individual
patients. Involves the use of RNs who do the coordinating. They will ensure
proper utilization of services and resources.
25. IOM and patient centered care
a.
26. First step in research
a. Identify the problem
27. Importance of evidence-based practice
a. EBP uses current research to solve problems while integrating the use of nurse’s
clinical expertise and the clients preference and values. Goal of EBP is to improve
patient care.
28. Purpose of an IRB
a. Institutional Review Board determines whether the question is appropriate, the
means of study fit the question, the study is ethical, and the rights of the patient.
29. Definition of nursing theory
a.
30. Quantitative vs qualitative research
a. Quantitative research refers to a study in which items can be counted or measured
and statistics can be used to analyze the results. Quantitative studies are analyzed
using statistical techniques.
b. Qualitative research frequently used to gain greater understanding of the
experience of the client and family, involves studying phenomena as they
naturally occur. Strives to look at whole picture, and may include interviews,
lengthy observations, and detailed case histories. Analysis of qualitative research
attempts to find themes within the data.
31. Purpose of National Institute of Nursing Research
a.
32. Strategies to control health care costs
a.
33. Steps in enacting a health policy
a.
34. How does informatics equal safety for patients
a.
35. Molloy’s Humanistic Framework
a. Framework consists of 5 concepts of which nursing is in the middle
i. Valuing – to hold in high esteem the inherent worth and dignity of all
individuals
ii. Health – a dynamic state of bio-psycho-socio-spiritual-cultural wellbeing
iii. Environment – the sum total of all internal and external dimensions that
influence human beings
iv. Humanity – a unique human being, functioning as an integrated whole,
reflecting bio-psycho-socio-spiritual-cultural dimensions
v. Nursing – a science and art which focuses on the diagnosis and treatment
of human responses
a. The sub concepts of nursing are:
i. Knowledge – based on the liberal arts and sciences
and incorporates humanity/environment
health/valuing
ii. Responsibility & Accountability – professional
nurses accept responsibility and are therefore held
accountable to maintain Standards of Practice and
adhere to the Code of Ethics of the profession
iii. Leadership/Management – working
collaboratively with individuals and groups to
accomplish professional goals.
iv. Research – a process of inquiry that provides
evidence contributing to nursing’s expanding body
of knowledge
v. Professional Role – provides humanistic health
care to promote health and manage illness for
individuals, families, and communities in
accordance with standards of nursing practice.
36. Nursing in USA today
a.
37. Image
a. Folk image – primary responsibilities, focused on nourishing and nurturing
children, caring for older adults, and caring for aging family members. This image
presents the nurse as a “caring” person who uses common sense to help the sick
individual.
b. Religious image - organized in conjunction with the establishment of the
churches, primary concern focused on care for the sick, poor, orphans, widows,
aged, slaves, and prisoners.
c. Servant image – Change in the role of women, limiting them to their homes.
Duties consisted of bearing children and caring for the homes.
d. Image of Nursing Today - nurses believe that popular attitudes and assumptions
about nurses and what nurses contribute to a clients welfare can greatly influence
the future of nursing.
i. 1970s – derogatory stereotypes
ii. Images can influence the attituded of clients, policy makers, and
politician.
iii. Negative attitudes of nursing may discourage future nurses
38. Organization focused on quality nursing education
a.
39. Primary purpose of research
a. Improve patient care
40. NSNA-what does it do
a.
41. Example of performance based learning
a.
42. Life-long learning-steps
a.
43. Essential features of a caring culture
a. A culture of caring includes the concept of community outreach:
i. Health promotion
ii. Teaching
iii. Using intuition, activism, and concern
b. Assist patients at all aspects of health and illness including death
c. Maintain confidentiality
d. Act as a patient advocate
44. Global Health Concerns
a. Communicable diseases: Covid-19, Hepatitis, HIV/AIDS, Malaria, TB, Neglected
tropical diseases
b. Non-Communicable diseases: Cardiovascular diseases, Mental health, Tobacco,
Diabetes, Traffic accidents, Disabilities
45. Factors related to majority of cases identified in The Joint Commission's Sentinel Event
Database,
a.
46. Culture of Safety
a.