Exam 3 1020

What is the cause of most ethical dilemmas?

-uncertainty -lack of clarity -conflict regarding the medical facts -goals of therapy -different value systems

Examples of teach-back prompts and questions include:

1. "Tell me in your own words how you will take this medication at home." 2. "Tell me some of the side effects that you should watch for." 3. "When will you call the office regarding your blood pressure?" 4. "Please show me how to request a refill of this medication online."

What are the steps of the teaching process?

1.Gather data about patient's physical and psychological health condition (problems requiring patient management), learning needs, motivation, ability to learn, health literacy, and teaching resources from patient, family, learning environment, medical record, nursing history, and literature. 2.Identify patient's learning needs on basis of three domains of learning. Nursing diagnoses may identify learning needs or conditions that interfere with learning. 3. Establish learning objectives stated in behavioral terms. Identify priorities regarding learning needs. Collaborate with patient about teaching plan. Identify type of teaching method(s) to use. 4. Implement teaching methods. Actively involve patient in learning activities. Include family caregiver as appropriate. 5. Determine outcomes of teaching-learning process. Measure patient's achievement of learning objectives. Reinforce information as needed.

PIE

A PIE note has a specific nursing focus. • P: Nursing problem or diagnosis—Lack of Knowledge related to inexperience with disease condition • I: Interventions that will be used to address the problem—Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves. • E: Nursing evaluation: Patient states, "I'm worried about the blood clot, but I understand how it is being treated." Able to teach back and verbalize that the heparin infusion will be stopped when PT/INR tests are "normal." Also states that he expects to take warfarin for about 6 months until clot in leg dissolves.

Core measures

key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs

What are Good Samaritan Laws?

laws that protect you in the event that you help during an emergency. Protects you as long as you stay within your scope of practice.

A nurse may refuse an assignment when

(1) the nurse lacks the knowledge or skill to provide competent care; (2) care exceeding the Nurse Practice Act is expected; (3) health of the nurse or her unborn child is directly threatened by the type of assignment; (4) orientation to the unit has not been completed and safety is at risk; (5) the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds; or (6) the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient.

What to do when you do not have the skill/competency to perform a task?

*Ask for a different assigment you must inform the supervisor if you do not have the required education or experience to care for the patients assigned to you. You should request and receive an orientation to the unit. Supervisors are responsible to give staff nurses assignments that they can handle safely

Utilitarianism:

A utilitarian system of ethics proposes that the value of something is determined by its usefulness. This philosophy is also known as consequentialism because its main emphasis is on the outcome or consequence of an action. A third term associated with this philosophy is teleology, from the Greek word telos, meaning "end," or the study of ends or final causes. The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Mandatory Reporting:Abuse

Abuse means the willful act or inaction that inflicts injury, confinement, intimidation, or punishment on a child or an adult. Of note in situations of neglect or abuse, the standard of proof to report is that a nurse has a reasonable suspicion that the person may be at risk of harm. Nurses must place the health and safety of the patient above that of the caregiver when making the decision to report

ANA Code of Ethics: Know the principles

Advocacy Advocacy refers to the application of one's skills and knowledge for the benefit of another person. Lawyers are sometimes called "advocates" because they use their expertise to advance their clients' best interests. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment (Harding et al., 2020). Your special relationship with patients provides you with knowledge that is specific to your role as a registered nurse and as such with the opportunity to make a unique contribution to understanding a patient's point of view. Responsibility The word responsibility refers to a willingness to respect one's professional obligations and to follow through. As a nurse you are responsible for your actions, the care you provide, and the tasks that you delegate to others. This responsibility also means maintaining your competence to provide care and seeking guidance when you are uncertain of your skills and knowledge. You also demonstrate responsibility by applying your workplace's policies and procedures to the care you provide. Accountability Accountability refers to answering for your own actions. You ensure that your professional actions are explainable to your patients and your employer. Health care agencies also exercise accountability by monitoring individual and agency compliance with national standards established by agencies such as The Joint Commission (TJC). TJC establishes national patient safety guidelines to ensure patient and workplace safety through consistent, effective nursing practices (TJC, 2021). The ANA promotes ethical decision making by setting standards for collaborative interprofessional communication (ANA, 2015). Confidentiality Patients have the right to keep their personal health information private. Confidentiality refers to the health care team's obligation to respect patient privacy. Confidentiality is a fundamental part of the trusting relationship between a nurse and a patient (Doherty, 2020). Federal legislation known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates confidentiality and protection of patients' personal health information. The legislation defines the rights and privileges of patients for protection of privacy. It establishes fines for violations (USDHHS, 2021). In practice, you cannot share information about a patient's medical condition or personal information with anyone who is not involved in the care of the patient. HIPAA calls this the "right to know." HIPAA also regulates communication of patient information contained in medical records (see Chapter 26).

Domains of leaning: Affective

Affective learning deals with learning how to express feelings and emotions and to develop values, attitudes, and beliefs needed toward improving health (Billings and Halstead, 2020). Values clarification (see Chapter 22) is an example of affective learning. The affective domains of learning were developed by Krathwohl, Bloom, and Masia (Krathwohl et al., 1956) The simplest behavior in affective learning is receiving, and the most complex is characterizing. Affective learning includes the following (Wilson, 2021): • Receiving: Learner is passive (not engaged) but is alert and willing to receive information. • Responding: Requires active participation. This refers to a learner's active attention to stimuli, verbal and nonverbal responses, and motivation to learn. • Valuing: Attaching worth and value to the acquired knowledge (e.g., new coping skills) as demonstrated by the learner's behavior through acceptance, preference, or commitment. • Organizing: Developing a value system. Learner internalizes values and beliefs involving (1) the conceptualization of values and (2) the organization of a value system. • Characterizing: Highest level of internalization. Acting and responding with a consistent value system; requires introspection and self-examination of one's own values in relation to an ethical issue or particular experience. • Role-play • Allows expression of values, feelings, and attitudes • Discussion (group) • Allows patient to receive support from others in group • Helps patient learn from others' experiences • Promotes responding, valuing, and organization • Discussion (one-on-one) • Allows discussion of personal, sensitive topics of interest or concern

Disabilities:

Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges

Autonomy

Autonomy refers to freedom from external control. In health care the concept applies to respect for the autonomy of patients. It can also apply to agency respect for the autonomy of health care professionals. A commitment to respect the autonomy of others is a fundamental principle of ethical practice.

Beneficence

Beneficence refers to taking positive actions to help others. The concept of beneficence is fundamental to the practice of nursing and medicine. The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest. It implies that nurses practice primarily as a service to others, even in the details of daily work.

Quality of life:

Central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR)

Domains of learning Cognitive:D

Cognitive learning occurs when an individual gains information to further develop intellectual abilities, mental capacities, understanding, and thinking processes . Bloom's revised taxonomy of six cognitive behaviors is a hierarchy that increases in complexity (Anderson and Krathwohl, 2001; Krathwohl, 2002) (Fig. 25.2). The taxonomy is used to assess learning at a variety of cognitive levels and to then use strategies to promote higher-order thought in students by building on lower-level cognitive skills. Each simpler skill is a prerequisite to mastery of the next more complex one. For example, knowledge or remembering has to be mastered before someone can master the higher level of understanding or comprehension. Each of the cognitive behaviors is divided into subcategories. For example, remembering (formerly Knowledge) includes factual, conceptual, procedural, and metacognitive knowledge • Discussion (one-on-one or group) • Involves nurse and one patient or a nurse with several patients • Promotes active participation and focuses on topics of interest to patient • Allows peer support • Enhances application and analysis of new information • Lecture • Is more formal method of instruction because it is educator controlled • Helps learner acquire new knowledge and gain comprehension • Question-and-answer session • Addresses patient's specific concerns • Helps patient apply knowledge • Role-play, discovery • Allows patient to actively apply knowledge in controlled situation • Promotes synthesis of information and problem solving • Independent project (computer-assisted instruction), field experience • Allows patient to assume responsibility for completing learning activities at own pace • Promotes analysis, synthesis, and evaluation of new information and skills

Know how documentation influences reimbursement in the long term care, home health, and hospital settings

Documentation of patient care by all members of the health care team allows one to determine the severity of a patient's illness, the intensity of services received, and the quality of care provided during an episode of care. Insurance companies use this information to determine payment or reimbursement for health care services. Diagnosis-related groups (DRGs) are classifications based on a patient's primary and secondary medical diagnoses that are used as the basis for establishing Medicare reimbursement for patient care provided by a health care agency. Health care agencies are reimbursed a predetermined dollar amount by Medicare for each DRG. Private insurance carriers and auditors from federal agencies review records to determine the reimbursement that a patient or a health care agency receives (Bauder et al., 2017; Heflin, 2021). Accurate documentation of nursing services provided, as well as the supplies and equipment used in a patient's care, clarifies the type of treatment a patient received and supports accurate and timely reimbursement to a health care agency and/or patient.

What are the legal requirements of charting?

Documentation systems need to be flexible enough to allow members of the health care team to efficiently document and retrieve clinical data, track patient outcomes, and facilitate continuity of care. Information in a patient's record provides a detailed account of the level of quality of care delivered. The quality of care, the standards of regulatory agencies and nursing practice, the reimbursement structure in the health care system, and legal guidelines make documentation and reporting an extremely important nursing responsibility. The information you enter into a patient's individual medical record communicates within the patient's integrated health record the type and frequency of patient care delivered and provides accountability for the care you implemented. This information is then available for all members of the health care team in all settings to review. It is necessary to document all the nursing care you provide for each patient, including assessment data, nursing problems or diagnoses, interventions, and evaluation of patient responses, in the health record. Your data enable providers and outside reviewers of the medical record to track a patient's clinical course. In 2008 the Centers for Medicare and Medicaid Services (CMS) implemented a policy under which hospitals are no longer reimbursed for the treatment of 11 specific hospital-acquired conditions (HACs) or preventable adverse events, commonly known as "never events" (CMS, 2020). Four of these preventable adverse events are considered "nurse-sensitive": Stage 3 and 4 pressure injuries, falls with injury, catheter-associated urinary tract infections (CAUTIs), and central line-associated bloodstream infections (CLABSIs)

How do we assess for health literacy?

During your assessment, be alert for patient behaviors that might reflect a literacy deficit, such as having difficulty completing registration forms or health histories, failing to make follow-up appointments, asking few questions during a physical examination, and responding simply "yes" when asked whether explanations are understood. Use health literacy assessment tools to determine the level of a patient's health literacy (AHRQ, 2020b). Examples of these tools include: • The Short Assessment of Health Literacy—Spanish and English (SAHL-S&E) is an instrument consisting of comparable tests in English and Spanish, with good reliability and validity in both languages (Lee et al., 2010). • The Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF) is a seven-item word recognition test to provide clinicians with a valid quick assessment of patient health literacy (Arozullah et al., 2007). The REALM-SF has been validated and field-tested in diverse research settings. Assessing a patient's health literacy level is especially important in planning appropriate patient education approaches

How to talk to patients about organ donation?

Encourage them to notify their family/next of kin about their wishes

How do you speak with a patient when using an interpreter?

Ensure that interpreters are competent in medical terminology and understand issues of confidentiality and impartiality. Do not use a patient's family members to interpret for you or other health care providers. Family members may include their own perceptions or opinions in translation, which can greatly reduce the accuracy of the translated information (Betancourt et al., 2020). When you begin a patient interview with an interpreter present, you should speak in the first person ("I" statements), not the third person (e.g., "tell her," "he said"), and speak directly to the patient, as the interpreter functions as an inconspicuous participant for the conversation. Have the interpreter sit next to or slightly behind the patient. Look at the patient instead of looking at the interpreter and speak in short sentences; then wait for the interpreter to convey them . Avoid using jargon, acronyms, and jokes; attempts at humor are often lost in interpretation. Ask the patient for feedback and clarification at regular intervals. Be observant of the patient's nonverbal and verbal behaviors. At the end of a conversation thank both the patient and the interpreter.

Feminist Ethics:

Feminist ethics critiques conventional ethics such as deontology and utilitarianism. It looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal, or in which a point of view has become ignored or invisible. Writers with a feminist perspective tend to concentrate more on practical solutions than on theory. Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.

Fidelity

Fidelity refers to faithfulness or the agreement to keep promises. As a nurse you have a duty to be faithful to the patients you care for, to the health care agency you work for, and to yourself. If you assess a patient for pain and offer a plan to manage the pain, the standard of fidelity encourages you to initiate the interventions in the plan as soon as possible and to monitor the patient's response to the nursing interventions. Fidelity is honored when we strive to provide excellent care to all patients, including those whose values are different from our own. We recognize a professional duty to apply the same skills and knowledge to the care of patients and families, regardless of their background, lifestyle, or past or present choices. When our need to exercise our own autonomy leads us to remove ourselves from a particular treatment or situation, fidelity demands that we not abandon the patient but instead find an equally qualified professional to provide the care we are unable to provide.

How do we use cultural competence in nursing? Why is it important?

HOW:The goal of delivering cultural care is to utilize research findings to provide culturally specific care that is safe and beneficial to the well-being of the diverse population. WHY:The goal of delivering cultural care is to utilize research findings to provide culturally specific care that is safe and beneficial to the well-being of the diverse population. Can cause the patient to be discriminated. Example: When you provide culturally competent care, you bridge cultural gaps to provide meaningful and supportive care for all patients. Transcultural care is culturally congruent when it fits a person's life patterns, values, and system of meaning. These patterns and meaning are generated by people themselves and not from biased, predetermined criteria.

If you don't report abuse or neglect:

Health care professionals who do not report instances when they have suspicion of abuse or neglect may be liable for civil or criminal legal action. Some state boards of nursing now require mandatory continuing education on abuse and neglect for license renewal or before obtaining a new nursing license.

Know the legal requirements of mandatory reporting for RN's: abuse, neglect, violence

In most states all nurses are mandatory reporters of abuse or neglect of patients when they have reasonable suspicion to believe an individual is at risk of harm.

Care at the end of life:

Interventions unlikely to produce benefit for the patient

Justice

Justice refers to fairness and the distribution of resources. The term is most often used in discussions about access to health care, including the just distribution of scarce services and resources. Discussions about health insurance, hospital locations and services, and organ transplants generally are among the issues that cite the concept of justice. The term itself is open to interpretation, as people interpret fairness differently. Does the concept of justice mean that health care resources should be available to those who have earned them? Or should they be distributed equally? Should those with a greater need for resources receive more than others? Especially as health care costs continue to rise, the issue of justice remains a critical part of the discussion about health care reform and access to care.

Nonmaleficence

Maleficence refers to harm or hurt. Nonmaleficence refers to the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good but the equal commitment to do no harm . A health care professional tries to balance the risks and benefits of care while striving at the same time to do the least harm possible. A bone marrow transplant procedure may offer a chance at cure, but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and uncertain precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit.

What is the criteria to establish professional negligence or malpractice?

Negligence: is conduct that falls below the generally accepted standard of care of a reasonably prudent person (Furrow et al., 2018). Anyone, including people not in the medical field, can be liable for negligence. Nurses are negligent when they had a duty of care that is breached and their patient is physically harmed. A reasonably prudent nurse under similar circumstances would have provided care differently. The law establishes the standard of care to protect others against an unreasonably great risk of harm (Furrow et al., 2018). Negligent acts, such as hanging the wrong intravenous solution for a patient or applying a warm compress that causes a burn, often result in disciplinary action by the State Board of Nursing and a lawsuit for negligence against the nurse and the employer. Most lawsuits allege negligence. Malpractice is a type of negligence. A person being held liable for malpractice must be a professional. Certain criteria are necessary to establish nursing malpractice: (1) the nurse (defendant) owed a duty of care to the patient (plaintiff), (2) the nurse did not carry out or breached that duty, (3) the patient was injured as a result of the breach in duty, and (4) damages or remedies are allowed under state law to "make the person whole" in the eyes of the court. Even though nurses do not intend to injure patients, some patients file claims of malpractice if nurses give care that does not meet the appropriate standards. Most malpractice and professional licensure claims occur in hospital settings. Common causes of malpractice against nurses include failure to follow the standard of care (e.g., not implementing a pressure injury or fall prevention protocol), failure to communicate important information to another health care provider, failure to document appropriately, failure to assess and monitor a patient, and inappropriate delegation of nursing tasks.

How do you protect patient privacy and confidentiality

Nurses are legally and ethically obligated to keep information about patients confidential. Only members of the health care team who are directly involved in a patient's care have legitimate access to a patient's health record. You discuss a patient's diagnosis, treatment, assessment, and any personal conversations only with members of the health care team who are specifically involved in the patient's care. Do not share information with other patients or with health care team members who are not caring for the patient. Patients have the right to request copies of their medical record and read the information. Each agency has policies that describe how medical records are shared with patients or other people who request them. In most situations, patients are required to give written permission for release of their medical information. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first federal legislation to provide protection for patient records; it governs all areas of patient information and management of that information. To eliminate barriers that potentially delay access to care, HIPAA requires providers to notify patients of privacy policies and to obtain written acknowledgment from patients indicating they received this information. Under HIPAA, the Privacy Rule requires that disclosure or requests regarding health information be limited to the specific information required for a particular purpose (Hebda et al., 2019). For example, if you need a patient's home telephone number to reschedule an appointment, access to the health record is limited solely to telephone information. Of equal importance under HIPAA is the Security Rule, which specifies administrative, physical, and technical safeguards for 18 specific elements of protected health information (PHI) in electronic form (USDHHS, 2020). Nurses are permitted to use health records for data gathering, research, or continuing education as long as records are used as specified and permission is granted from an institutional review board (for research) or appropriate administrative department. When you are a student learning in a clinical setting, maintaining patient confidentiality and adhering to HIPAA are required as part of professional practice. You can review patient health records only for information needed to provide safe and effective patient care. For example, when you are assigned to care for a patient, you need to review the patient's health record and the interprofessional plan of care. You do not share this information with classmates (except for clinical conferences) and do not access the health records of other patients on the unit. Access to an EHR is traceable through user log-in information. It is unethical to view health records of other patients, and breaches of confidentiality will lead to disciplinary action by employers and potentially dismissal from work or nursing school. To protect patient confidentiality, you must ensure that any electronic or written materials you use in your student clinical practice do not include patient identifiers (e.g., name, room number, date of birth, demographic information). Never print material from an EHR for personal use; any information printed must be for professional use only and should not include identifiable information.

Know the responsibilities of nursing students who work in the healthcare settings

Nursing students are liable if their actions exceed their scope of practice and cause harm to patients. Regardless of intent, students are expected to know what they can and cannot do when providing care to patients. If a student harms a patient as a direct result of a lack of action, the student, instructor, hospital or health care agency, and university or educational institution generally share the liability for the incorrect action. Nursing students should never be assigned to perform tasks for which they are unprepared, and instructors should supervise them carefully as they learn new skills. Although nursing students are not employees of a hospital, the agency has a responsibility to monitor their acts. They are expected to perform as professional nurses would in providing safe patient care. Faculty members are usually responsible for instructing and observing students, but in some situations staff nurses serving as preceptors share these responsibilities. Every nursing school should provide clear definitions of preceptor and faculty responsibility. It is equally important that nursing preceptors be aware of state laws applicable to nursing students, faculty, and the educational institution when supervising students.

Narrative note

Patient states, "My leg is so swollen. I'm worried about this blood clot." Is asking questions about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction. Discussed importance of bed rest and the reason for treatment with heparin infusion. Explained need for daily blood tests to check anticoagulation levels. Provided brochure on anticoagulation therapy for DVT. Used teach-back method to validate patient understanding; he is able to describe that the heparin infusion will be stopped when his PT/INR is therapeutic on warfarin and he can expect to take warfarin for about 6 months after discharge until clot is resolved.

What is the education purpose: of health promotion

Primary Prevention As a nurse you are a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home, clinic, or workplace you provide information and skills to help patients adopt healthier behaviors. For example, in childbearing classes you teach expectant parents about physical and psychological changes in a woman. After learning about normal childbearing, the mother who applies new knowledge is more likely to eat healthy foods, engage in physical exercise, and avoid substances that can harm the fetus. An adult with obesity and a family history of diabetes can learn about the effects diabetes has on health and adopt improved diet and exercise habits to avoid development of the disease. Success in patient education is not the ability of a patient to simply recall information that is provided, but also the ability of the patient to incorporate knowledge into everyday life activities in a way that promotes health

Domains of learning: Psychomotor

Psychomotor learning involves the development of manual or physical skills, such as learning how to walk or how to type on a computer (Billings and Halstead, 2020; Wilson, 2021). The simplest behavior in the hierarchy is fundamental (depending on the hierarchical model), whereas the most complex is origination. Psychomotor learning includes the following: • Demonstration • Provides presentation of procedures or skills by nurse • Permits patient to incorporate modeling of nurse's behavior • Allows nurse to control questioning during demonstration • Practice • Gives patient opportunity to perform skills using equipment in a controlled setting • Provides repetition • Return demonstration • Permits patient to perform skill as nurse observes • Provides excellent source of feedback and reinforcement • Assists in determining patient's ability to correctly perform a skill or technique • Independent projects, games • Requires teaching method that promotes adaptation and origination of psychomotor learning • Permits learner to use new skills

Guidelines for quality documentation

Quality nursing documentation enhances efficient, individualized patient care and has five important characteristics: factual, accurate, current, organized, and complete. It is easier to maintain these characteristics in your documentation if you continually seek to express ideas clearly and succinctly by doing the following: • Stick to the facts. • Write in short sentences. • Use simple, short words. • Avoid the use of jargon or abbreviations.

What is the education purpose: of health restoration?

Secondary Prevention Patients recovering from and adapting to changes resulting from illness or injury often seek information about their conditions and need information and skills to help them regain or maintain their levels of health. Nurses who work in home health and rehabilitation settings have the opportunity to educate patients using strategies that promote self-care. However, some patients find it difficult to adapt to illness and become disinterested in learning. As a nurse you learn to identify patients' willingness to learn and motivate your patients' interest in learning (Bastable, 2019). The family often is a vital part of a patient's return to health if a patient chooses to involve them. Family caregivers usually require as much education as patients, including information on how to perform skills within the home. If you exclude a family from a teaching plan, conflicts can occur. However, do not assume that a family caregiver should be involved; assess the patient-family relationship before providing education for family caregivers.

How do you determine if your teaching was effective?

Teach-back is a closed-loop communication technique that assesses patient retention of the information given during a teaching session. To perform teach-back, ask the patient to explain material that was discussed, such as the role of diet and exercise in managing blood glucose levels, or to demonstrate a skill, such as self-monitoring blood glucose. The response allows you to determine the degree to which the patient remembers and understands what was taught or demonstrated. Use nonjudgmental language so that patients do not feel tested (Flanders, 2018). For example, say, "I want to be certain that I taught this well. Can you please describe some symptoms of a stroke?"

What is the education purpose: coping with impaired function

Tertiary Prevention Not all patients fully recover from illness or injury. In addition, patients with preexisting mental illness or those who have lower literacy skills have difficulty understanding patient education (Bastable, 2019). Many patients with impaired function need to learn to cope with permanent health alterations. New knowledge and skills are often necessary for patients to continue activities of daily living. For example, a patient loses the ability to speak after larynx surgery and needs to learn new ways of communicating. Changes in function are physical and/or psychosocial of the patient. In the case of serious disability such as following a stroke or a spinal cord injury, the patient's family (as defined by the patient) needs to understand and accept many changes in the physical capabilities of the patient. The family's ability to provide support results in part from education, which begins as soon as you identify the patient's needs and the family displays a willingness to help. Teach family members to help the patient with health care management (e.g., giving medications through gastric tubes and doing passive range-of-motion exercises). Families of patients with alterations such as alcohol use disorder, intellectual disability, or substance abuse disorder learn to adapt to the emotional effects of these chronic conditions and provide psychosocial support to facilitate the patient's health. Comparing a realistic desired level of health with the actual state of health enables you to identify deficits and needs and then plan effective teaching programs.

Ethics of Care:

The ethics of care and feminist ethics are closely related. Both promote a philosophy that focuses on understanding relationships, especially personal narratives. An early proponent of the ethics of care used the term the one-caring to identify the individual who provides care, and the cared-for to refer to the patient or patients. In adopting this language, the author hoped to emphasize the role of feelings.

What are the purposes of patient education:

The primary goal of patient education is to help individuals, families, or communities achieve optimal levels of health (Miller and Stoeckel, 2019). Patient education through active patient participation and decision making is essential for providing safe, patient-centered care (Quality and Safety Education for Nurses [QSEN], 2020). In addition, providing education about preventive health care helps reduce health care costs for individuals. Patients learn ways to change their lifestyles (e.g., diet, exercise, stop smoking) to prevent chronic disease and reduce the effects of chronic illnesses and associated medical care. Because most patients now know more about their health, they want to be actively involved in their health maintenance. Comprehensive patient education includes three important purposes, each involving a separate phase of health care: health promotion and illness prevention, health restoration, and coping.

Quality of life: What determines?

Very Personal different for each person. During the ethical decision-making process, you will apply the concepts of autonomy, beneficence, nonmaleficence, justice, and fidelity

How do we become culturally competent?

We start by realizing our own cultural attitudes, biases, and then attempt to change these by learning about other cultures. means that professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community . Cultural beliefs, values, and practices are learned from birth, first in the home, then in the church or other places where people congregate, and then in educational and other social settings. This cultural learning applies to both you and your patients. The process of cultural competence in delivering health care services is "a culturally conscious model of care in which a healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of a client" (family, individual, or community)

Restraints: When to use, how to use, what to document, what to assess

When: Restraints can be used (1) only to ensure the physical safety of the patient or other patients, (2) when less restrictive interventions are unsuccessful, and (3) only on the written order of a health care provider what to document:• Record restraint alternatives used and patient's response, patient's current behavior and medical condition, level of orientation, and patient or family caregiver's statement of understanding of the purpose of restraint and consent for application (if required by facility). • Record in nurses' notes and restraint flow sheet the placement and purpose of restraint, type and location of restraint, condition of skin under restraint, time applied, ongoing assessment findings, and time restraint ended. • Record patient's behavior after restraint application. Record times patient was assessed, attempts to use alternatives to restraint and patient's response, times restraint was released (temporarily and permanently), and patient's response when restraint was removed. • Document evaluation of patient learning. • Report any injury resulting from a restraint to registered nurse in charge and health care provider immediately • During hand-off report, note the location and type of restraint, last time assessment was conducted, and findings. assess: If there is abrupt change in perception, attention, or level of consciousness, perform hand hygiene. Assess for respiratory and neurological alterations, fever and sepsis, hypoglycemia and hyperglycemia, alcohol or substance withdrawal, and fluid and electrolyte imbalance.

What is Informatics? Understand that competence in informatics is different from computer competency

You need to be knowledgeable in the science and application of nursing informatics. Nursing informatics is the specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing and informatics practice (American Nursing Informatics Association, 2021). Nursing informatics is recognized as a specialty area of nursing practice at the graduate level. Nurses who specialize in informatics have advanced knowledge in information management and demonstrate proficiency with informatics to support all areas of nursing practice, including QI, research, project management, and system design (American Nursing Informatics Association, 2021). Through the application of nursing informatics, technology is put to practical use to enhance bedside care and education. It offers an efficient and effective nursing information system that facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in patient care decision making.

Focus charting

a documentation system that replaces the problem list with a focus column that incorporates many aspects of a patient and patient care; the focus may be a patient strength or a problem or need; the narrative portion of focus charting uses the data (D), action (A), response (R) format

What to avoid when documenting: opinion, assumptions, abbreviations

a. Use clear concise words b. Use exact measurements when possible

Nurses have the legal duty to provide care to protect public health. These laws include reporting suspected:

abuse and neglect of a child, older adult, or victim of domestic violence; reporting communicable diseases; ensuring that patients in the community have received recommended immunizations; and reporting other health-related issues to protect public health.

Clinical decision support systems

computerized programs used within the health care setting to support decision making

Bloom's Taxonomy

create, evaluate, analyze, apply, understand, remember

Nurses provide insight about ethical problems at

family conferences, staff meetings, or even in one-on-one meetings. As a member of a health care community, regardless of your work setting, you can reduce the risk for moral distress by promoting discourse even when disagreements or confusion are profound. You will find it helpful when engaged in these conversations to assume that all the participants want to do good, even if they may have different ideas about what that means.

Mandatory Reporting: Neglect

in most states, neglect means a pattern of conduct by a person with a duty of care to provide services that maintain the physical and/or mental health of a child or vulnerable adult (Adigun et al., 2020). It may also be a one-time act that is a clear and present danger to another's health, welfare, or safety. Neglect does not usually require that a nurse intentionally acts to harm a patient; rather, the nurse knew or should have known that neglect would occur under the circumstances.

If the patient has difficulty recalling the material or demonstrating a skill:

modify and repeat the content and reassess retention. Also, take ownership of the teaching experience by responding, "I must not have explained stroke symptoms very well. Let me try again." Patient understanding is confirmed when the patient can accurately restate the information in own words

Ethics committees are usually:

multidisciplinary and serve several purposes: education, policy recommendation, and case consultation.

moral distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

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. As a strategy for solving dilemmas, consensus building promotes respect and agreement rather than a particular philosophy or moral system itself.

What is informed consent?

permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.

Deontology

proposes a system of ethics that is perhaps most familiar to health care practitioners. Deontology defines actions as right or wrong based on their "right-making characteristics," such as fidelity to promises, truthfulness, and justice. Deontology depends on a mutual understanding of justice, autonomy, and goodness. But it still leaves room for confusion to surface.

Resolving an ethical dilemma is similar to:

the nursing process in its methodical approach to a clinical issue. It differs in that it requires negotiation of differences of opinion and clarity about situations that are confusing and not easily solved by appealing to the usual ethical principles. •A process for resolving ethical dilemmas that respects differences of opinion and all participants equally helps health care providers resolve conflict about right actions. •These seven steps will guide you through assessment, planning, implementation, and evaluation of an ethical dilemma.

Campinha-Bacote's Model of Cultural Competency

• Cultural awareness is the process of conducting a self-examination of one's own biases toward other cultures and the in-depth exploration of one's cultural and professional background. It also involves being aware of the existence of documented racism and other "isms" in health care delivery. • Cultural knowledge is the process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups. In acquiring this knowledge, health care professionals must focus on the integration of three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence. • Cultural skill is the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient's presenting problem, as well as accurately conducting a culturally based physical assessment. • Cultural encounter is a process that encourages health care professionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. A cultural encounter aims to modify a health care provider's existing belief about a cultural group and to prevent possible stereotyping. • Cultural desire is the motivation of a health care professional to "want to" (and not "have to") engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters..

How do you know when a patient is ready to learn?

• Describe for me any physical discomfort or anxiety you may be feeling. • Assess patient's ability to attend to questions raised during assessment.

Teaching Methods Based on Patient's Developmental Capacity - Young or middle adult

• Encourage participation in teaching plan by setting mutual goals. • Encourage independent learning. • Offer information so adult understands effects of health problem.

Teaching Methods Based on Patient's Developmental Capacity - Adolescent

• Help adolescent learn about feelings and need for self-expression. • Use teaching as collaborative activity. • Allow adolescents to make decisions about health and health promotion (safety, sex education, substance abuse). • Use problem solving to help adolescents make choices.

Teaching Methods Based on Patient's Developmental Capacity - Infant

• Keep routines (e.g., feeding, bathing) consistent. • Hold infant firmly while smiling and speaking softly to convey sense of trust. • Have infant touch different textures (e.g., soft fabric, hard plastic)

What patient findings might cause you to postpone a scheduled teaching session?

• Pain, fatigue, depression, anxiety, or other physical or psychological symptoms that interfere with the ability to maintain attention and participate: In acute care and rehab settings a patient's physical condition can easily prevent a patient from learning. • Patient's developmental level, which influences the selection of teaching approaches (see Box 25.6). Consider age-appropriate abilities. • Sensory deficits, such as visual or hearing loss, that can affect a patient's ability to understand or follow instruction Patient's reading level: This is often difficult to assess because patients who are functionally illiterate are often able to conceal it by using distractors such as not having the time to read or not being able to see the print.

SOAP Note—Used By All Health Care Disciplines

• S: Subjective—Patient states, "My leg is so swollen. I'm worried about this blood clot. Do you know how they are going to treat it?" • O: Objective—Patient asking question about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction. • A: Assessment—Patient lacks knowledge regarding anticoagulation therapy, seeking information about therapy. • P: Plan: Discussed importance of bed rest and the reason for treatment with heparin infusion. Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves.

What are the SPEAK UP initiatives?

• Speak up if you have questions or concerns. If you still do not understand, ask again. It is your body, and you have a right to know. • Pay attention to the care you get. Always make sure that you are getting the right treatments and medicines from the right health care professionals. Do not assume anything. • Educate yourself about your illness. Learn about the medical tests that are prescribed and your treatment plan so you can make informed decisions. • Ask a trusted family member or friend to be your advocate (adviser or supporter). • Know about your new medicine(s) and why you take them. Medication errors are the most common health care mistakes. • Use a hospital, clinic, surgery center, or other type of health care organization that you have researched or checked carefully. • Participate in all decisions about your care. You are the center of the health care team.

Teaching Methods Based on Patient's Developmental Capacity - School-age child

• Teach psychomotor skills needed to maintain health. (Complicated skills such as learning to use a syringe take considerable practice.) • Offer opportunities to discuss health problems and answer questions.

Teaching Methods Based on Patient's Developmental Capacity - Older adult

• Teach when patient is alert and rested. • Involve adult in discussion or activity. • Focus on wellness and person's strength. • Use approaches that enhance patient's reception of stimuli when there is a sensory impairment (see Chapter 49). • Keep teaching sessions short.

Teaching Methods Based on Patient's Developmental Capacity - Toddler

• Use play to teach procedure or activity (e.g., handling examination equipment, applying bandage to doll). • Offer picture books that describe story of children in hospital or clinic. • Use simple words such as "cut" instead of "laceration" to promote understanding.

Teaching Methods Based on Patient's Developmental Capacity - Preschooler

• Use role-play, imitation, and play to make learning fun. • Encourage questions and offer explanations. Use simple explanations and demonstrations. • Encourage children to learn together through pictures and short stories about how to perform hygiene.

How do you educate a patient with a language barrier?

• When you and the patient do not speak the same language, use trained and certified health care interpreters to provide health care information.

•Values clarification

•Ethical dilemmas almost always occur in the presence of conflicting values. •To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion.

What are futile interventions in the end of life?

•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.

Malpractice Insurance

•The insurance company pays for costs, attorney's fees and settlement, and other related fees generated in the representation of the nurse. •Nurses employed by health care agencies generally are covered by insurance provided by the agency; however, it is important to remember that the lawyer is representing your employer and not you. The insurance provided by the employing agency only covers nurses while they are working within the scope of their employment. •Nurses are also investigated by the State Board of Nursing or Nursing Commission to determine whether the alleged breach in care is a violation of civil regulations associated with their nursing license. Without individual insurance coverage, the nurse will be required to personally pay all costs and attorney fees incurred by him or her in the defense against these claims.