Nursing Chapters 5-9

Discuss the relationship between earth health and human health.

-Human health is connected with Earth health.. What we do to Earth, we do to ourselves -Human are only one part of the interconnected Earth community -Relationship with the natural world is based on cosmology (or worldview) -Climate change and poisoning air/water affects human health (ex: asthma, birth defects)

What are ethical and legal obligations to protect the confidentiality of patient information regarding electronic storing and transfer of personal health information?

-Implement safeguards to protect privacy and security of electronic transactions of PHI -Be alert of breaches in confidentiality -HIPAA regulations

Misdemeanor

more serious than infractions (violation of law or agreement), is a criminal offence that carries a potential jail term of less than one year - some states defines a crime that is not a felony or infraction

Unprofessional behavior

not keeping up with the standards expected in a specific positions

Holistic caring

nursing that focuses on healing the whole patient.. Mind, body, spirit, emotion, environment

Statutes

passed by a legislative body (supersedes common law)

Internal Locus of Control

people who believe that they are able to influence or control things that happen to them

External Locus of Control

people who feel that forces outside of themselves direct or rule their lives - whether these be generalized forces such as fate or other persons who are perceived as more powerful

Whistle Blowing

persons who alert the public about serious wrongdoings created or concealed within an organization such as unsafe conditions, incompetence, or professional misconduct. Speaking out about unsafe or questionable practice affecting patient care or working conditions

Nursing skills needed for enabling empowerment include?

-Supportive -Knowledge of social, political, culturally, economic, and environmental factors affecting a person's health choices

What is the ICN codes and declarations of weapons of war and conflict?

-The ICN affirms the ethical responsibility of nurses to eliminate threats to life and health caused by weapons of war and conflict -Calls all nurses to work towards the elimination of these weapons and land mines to prevent consequences

Law

rules developed by governments in order to provide balance in society and protection to its civilians

Ethics

rules of conduct, people's awareness of what is right and wrong, comes within a person's moral values

Watson's theory of human caring

says humanistic aspects of nursing in combination with scientific knowledge "See me as a person" provides the basis for creating a healing relationship with patients

Discuss historical events and patterns of health care delivery that have helped to shape Western systems of health care delivery in the United States.

scientific and medical innovations coincide with the shift from agricultural to industrial economics

medical futility

situations in which interventions are judged to have little or no medical benefit or in which the chance for success is low

Morals

standards of good and evil

Power

the ability to do or act

genetic engineering

the ability to genetically alter organisms for a variety of purposes, particularly to promote their health and strength

cloning

the process of using biotechnology to create a genetically identical copy of a cell or organism, violates the right to one's unique genetic identify, human dignity, integrity

Moral courage

the willingness to stand up for personal core values and ethical beliefs even when we stand alone; reflects a high degree of personal empowerment

Beneficence

to do good

Empower

to facilitate the ability of another person to do, to act, or accomplish something

Precautionary principle

when activity raises threats to human health, precautionary measures taken

Positive Locus:

working harder

Regulations

written by an agency with authority from the legislature (ex: board of registered nursing)

do not resuscitate

written directives placed in the patient's medical record indicating that cardiopulmonary resuscitation (CPR) is to be avoided

palliative care

comprehensive, interdisciplinary, and total care focusing primarily on comfort and support of patients and families who face illness of a chronic nature or who are not responsive to curative treatment

stem cell research

destruction of human embryo, treating human life as a commodity, ownership of biological materials from cells, altering human genetics

Common law

developed through judicial decisions--originally from england

Inappropriate nursing care

discriminating, not abiding to code of ethics

Displaced persons

emergency needs, care and maintenance, ongoing solutions, advocate for those who are suffering (publica awareness, lobby governments, mobilize resources, educational programs for nursing personnel)

Empowerment self-esteem

empowerment requires help self esteem and staying true to yourself

Triage

ethical principle in disaster) done quickly, by experienced person who is aware of resources

Mechanistic view of nature

fix and control

Patient Empowerment

giving patients the authority or power to make decisions

Negative Locus

giving up

Patient teaching

helping patients become better informed about their condition, medical procedures, and choices they have regarding treatment

Ethically appropriate

impartial care/ assistance to every person without being asked, providing emotional as well as technical care

Discuss methods that nurses can use to limit liability.

- File immediate claim and take action to fix mistake-if unresolved can become lawsuit - hospital/health care organization can defend a nurse

Understand what is human trafficking and what is the role of the nurse in combating human trafficking.

- Human trafficking is modern day slavery, another form of violence that is often unrecognized -Involves the acquisition , harboring, and trade of people through force, threats, deception, or other forms of coercion with the aim of exploiting them - Nursing responsibility related to victims of trafficking includes recognizing the signs and providing appropriate interventions and support, as well as working toward prevention of this form of violence

Describe what is mind-set and how does it affect expectations regarding nursing practice and ethical stances.

-A set of beliefs or a way of thinking that determines one's behavior, outlook, and mental attitude -Influences how we identify and respond to ethical issues in practice

Describe factors that enhance or block patient empowerment.

-Anxiety and fear -Patient lack of knowledge -Dependency -Apathy -Mistrust -Nurses unwillingness to share decision making power with patient -Limited resources -Control of knowledge about options -Stereotypes that devalue people

Understanding of world class care and how your behaviors impact the patient experience

-At UCLA World Class Practice is World Class Care: In caring for the patients, families and community, we practice within the context of UCLA's mission, vision, and values and we use C-I-CARE as our standard for interacting. -Connect with Compassion by addressing the patients as Mr./Ms. or by the name that they prefer. -Introduce yourself with Integrity by stating your name and your role. -Communicate with Teamwork: what you are going to do, how long it is going to take, and how it will impact the patient.

Nursing care considerations

-Attitudes and values -Knowledge of institutional policies -Communication (help patient/family articulate preference, facilitate communication with others on health care team) -Maintaining the human focus (when medical care deemed futile, nursing care is most essential)

Discuss approaches to fostering empowerment with patients.

-Being a role model -Offering options and developing strategies so patient reaches goals -Mainly support

Identify nursing knowledge and skills basic to empowerment.

-Effective communication -Ability to listen -Self knowledge of personal values and needs for control -Mutual trust and respect -Willingness to accept patients decisions

Describe the role of diversity in empowerment.

-Embracing diversity (variety) is a nursing empowerment requirement. -Our unity is in diversity

Describe nurse attitudes that facilitate empowerment.

-Empowerment is interactive and requires of nurse's self-knowledge of personal values and needs for control, mutual trust and respect, effective communication and reflective listening skills and a willingness to accept patient's decisions regardless of whether the nurses think they are best -A view of the nurse as a partner, facilitator, and resource rather than one who merely provides services for patients

Describe external and internal factors that can influence nursing perception.

-External: health care providers, patients, health care system, family and friends -Internal: ourselves (you)

War and violence

-Guides in codes of Nursing-respect for life and human dignity -Beneficence, justice, nonmaleficence -Advocate prevention of conflict -Work to eliminate threats to life and health caused by violence, weapons of war -Equitable care for ALL VICTIMS

How can nurses enhance patient decision-making capacity?

-Helping patients know who they are -Deep understanding of themselves -Self discovery -Facilitating a patient's self awareness -Identifying personal values -How they experience control

Describe the professional role and how it applies to RN practice at UCLA.

-Our goal is to build functional trust in each other. -The RN assesses patient/family for abnormalities in body/mind/spirit, and then creates a care plan to improve those abnormalities. The RN assesses which member of the care team is the best person to accomplish each task of the care plan (RN is the decider). The RN delegates the work to the care team. All of the nursing work is owned and overseen by the RN. -Functional Trust: Members of the care team trust each other to place the patient's interest first.

Explain the impact on nursing practice of perceptions about nursing from within and from outside the profession.

-Outside perception: loyal soldier perception (physician hold higher ranking than nurse) -Inside perception: nurses are aware of the need to advocate

Application of caring science in 3 key relationships

-Patients/families -Colleagues -Self

Ethical consideration

-Prolonging living or prolonging dying -Values and views regarding what is benefit or burden -Suffering and quality of life -Availability and cost

Discuss nursing role, responsibility, and ethical stance in responding to local, national, and global issues such as disaster, displaced persons, war and violence, epidemics, and toxic chemicals and other pollutants.

-Provide impartial assistance to all victims -Respect cultural customs, religious practices, and other traditions -Respect emotional/ political climate -Advocate for the suffering -Public awareness, lobby governments, resources, educational programs -Ongoing solutions -Care and maintenance -Nurses need to work individually and collectively to meet the needs of those affected by global issues such as epidemic

Verbalize an understanding of the ANA Scope and Standards, ANA Social Policy Statement, Code of Ethics, Section 2725, Title 16 & 22, and the Professional Practice Model and how they all integrate in order to provide excellent patient care.

-The next ring of the UCLA Professional Practice Model is the Professional RN Role as Decision Maker based on the American Nurses Association (ANA)Code of Ethics, the ANA Standards & Scope of Practice, the California Nursing Practice Act, Title 16 and Title 22. -This ring establishes the expectation that UCLA RN's will meet the required legal regulations and statutes for registered nursing practice in the state of California and the national professional scope and standards of nursing practice. -The State of CA Nursing Practice Act describes the legal requirements for nursing in this state. -According to the our nursing practice act, we help people cope with the difficulties in daily living associated with their actual or potential health or illness problems. What we do requires scientific knowledge and technical skill, includes independent and dependent functions, and things we do ourselves and things we delegate to others. -Independent practice is any part of our work for which the RN alone is responsible. -The nursing condition is the individual's physical, mental, and social response to health and illness and capability of coping with and managing that response. -This is a holistic view of the patient. Where medicine looks at only a small piece of the patient, nursing looks at the effect of illness on the body, mind, and spirit and develops nursing care plans for helping the patient to cope with any abnormalities found in these realms.

Describe trends and challenges of accessibility and financing facing health care delivery systems around the globe.

-The system is challenged to provide for an ever-increasing global population with decreasing both natural and monetary resources -Factors include economics, culture, politics, epidemics, disasters, war and violence, national crises and global travel. -Climate change is a trend that will make accessibility more challenging. Lots of toxins in environment, less clean water, and less clean air

What does it mean to ethically prioritize health care treatment and management of victims during a disaster?

-Triage - (ethical principle in disaster) done quickly, by experienced person who is aware of resources -Separates persons into groups of those who: -Can be saved--need urgent and immediate attention -Can be saved--need urgent/not immediate attention -Need only minor treatment -Have primarily psychological trauma -Are in condition exceeding available resources

Describe what nurses should do when they are disempowered

-Unite with others to challenge unjust, unprofessional, and unethical problems - Advocate for the protection of patient rights, health and safety. - Seek support from colleagues, professional organizations, or the legal system - Become politically active

Military metaphor

-an ethical nurse is like a loyal soldier who follows orders. a. It was associated with obedience to those of higher rank and authority, and respect them. b. Loyalty to patients considered part of being loyal to institutions and to physicians

Legal metaphor

-an ethical nurse is responsible primarily to the patient and advocates for patient rights a. Nurses held legally responsible for their actions and decisions

Western worldview

-humans separate from the natural world, Earth's resources are out here for human use, violence and degradation of much of the natural world -Mechanistic view of nature - fix and control -Little sense of ethical responsibility to other-than-human world -Impact: demotes natural world to collection of objects available for exploitation, violence toward and degrading of much of the natural world, disregard for realities of ecological systems and their capacity to sustain current levels of exploitation/destruction, disruption of human and bioregional communities

Discuss issues and dilemmas related to current technology and to life sustaining interventions.

-may promote conflict between beneficence and nonmaleficence -relieve and cause physical, emotional, or spiritual suffering -issues related to withholding/withdrawing life-sustaining interventions when they are deemed to offer no benefit or have poor outcome: -ideas and beliefs about life, death, and dying -medical futility -advance directives, DNR orders -patient self-determination -nursing care

Disasters

-sudden events of massive proportion resulting in large numbers of victims, displaced persons, material damage, disruption of society, natural technological, and accidental, require both immediate and long-term interventions -Health problems in disaster - need for prompt action, decreased ability of health care system to meet needs (large number of victims, potential language barriers), inadequate supplies and resources (limited infrastructure and transportation, roads), locations may be dangerous to get to

Malpractice

A function of "tort law" derived from common law and now combined with statutory law Also called Professional Negligence Failure to use the level of skill, knowledge and care that other reasonably careful nurses with the same qualifications would use in similar circumstances (the "standard of care"). Harm to patient caused by this failure.

Discuss the meaning of patient empowerment.

A process and outcome that relates to ethical principles and flows from nursings focus on patient advocacy

What are instructions indicating a client's wishes regarding health care interventions or designating someone to act as a surrogate in making such decisions called?

Advance directives

What are alternative traditions of health care

Alternative medicine is a term that describes medical treatments that are used instead of traditional (mainstream) therapies. Some people also refer to it as "integrative," or "complementary" medicine.

Which ethical principle does empowerment relate to?

Autonomy

Describe the role and ethical responsibility of nursing in addressing local, national, and global environmental issues.

Awareness and action related to source of environmental pollutants: personal, professional, and global Address the impact of health care system on health of environment Nurses are positioned to be proactive in addressing the impact of the health care system on health of the environment Includes attention to the health impact of chemicals found in products used in healthcare institutions, how the institution dispose`s of toxic and other wastes , proper disposal of unused/ outdated medications, impact of antibiotics, hormones, and chemotherapy that get into water and soil Precautionary principle - when activity raises threats to human health, precautionary measures taken

Discuss factors prompting a renewed interest in traditional healing systems Worldwide.

Health care system must address global changes and challenges in developing countries, ex. can tradition methods and systems of the health care system be utilized to promote health and prevent disease, thus reducing burden on the system?

What factors can hinder nursing empowerment.

Job dissatisfaction Low levels of professional commitment Burn-out

Ethical Imperative

Nurses carried physicians orders without questioning them even at the expense of the patients. Nurses transitioned from the soldier metaphor to being the patient advocate.

How does ethical practice in managed care setting direct nurses?

Nursing care considerations: -Provide impartial assistance to all victims -Regularly assess conditions -Respect cultural customs, religious practices, and other traditions -Assure confidentiality to extent possible -Respect emotional and political environment -Attend to critical human needs and dignity beyond the emergency response

Briefly describe factors affecting health care delivery for rural and urban aggregates.

Problems of access to and payment for health care services are of special concern among rural populations and the urban poor Factors:... Rural populations in the united states and abroad often have to do without services because of lack or providers and facilities within a reasonable distance from their homes Many require a day off work for travel and waiting in crowded waiting rooms The urban poor face similar access problems because access requires trips to places they cannot afford, or free clinics Medication may be unaffordable There may be language and cultural barriers

Discuss the nursing role in empowerment of patients.

Requires recognition and acceptance that patients have the ability to discern what they need, to make decisions, and to direct their own destinies

What influences empowerment?

Self esteem, personal values, perceptions, your environment, access to resources, and information

Relate the concept of medical futility to health care decisions.

Situations in which interventions are judged to have little or no medical benefit or in which the chance for success is low

Negligence

The omission to do something that a reasonable person guided by those ordinary considerations that ordinarily regulate human affairs, would do, or doing something that a reasonable and prudent person would not do.

Administrative law

body of law that governs the activities of administrative agencies of government. Government agency action can include rule making, adjudication, or the enforcement of a specific regulatory agenda.

Constitutional law

body of law which defines the role, powers, and structure of different entities within a state, namely, the executive, the parliament or legislature, and the judiciary

Precautionary principle

This principle states "when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically"

Unintentional torts

Torts that occur when an act or omission causes unintended injury or harm to another person

Intentional torts

Willful or intentional acts violate another person's rights or property

Felony

a crime, typically one involving violence, regarded as more serious than a misdemeanor, and usually punishable by imprisonment for more than one year or by death

Precedent

a legal case that established a principle or rule that is used by court or other judicial bodies when deciding later cases with similar issues or facts

Abandonment of the person

a nurse who has accepted a patient care assignment, and is responsible but chooses to abandon or neglect a patient needing immediate care without making arrangements of such care

Plaintiff

a person who brings a case against another in a court of law

genetic screening

a process for determining whether persons are predisposed to certain diseases, and whether couples have the possibility of giving birth to a genetically impaired infant

genetic diagnosis

a process of biopsy of embryos to determine the presence of genetic flaws and gender prior to implantation

quality of life

a subjective appraisal of factors that make life worth living and contribute to a positive experience of living

Citation

a writ issued by a court ordering a person to appear at a specific time and place to do a specific act or to show the court sufficient cause

Paternalism

acting in a fatherly manner by making decision on behalf of patients without their full consent or knowledge

Battery

actual physical impact on another person

Case law

application of "the law" to facts by judges (common law/statutes)

eugenics

based in the belief that some human traits are more desirable for society than others, and that society should weed out what proponents consider to be undesirable traits

Personal empowerment

being true to ourselves and our values - This requires self awareness, self care, growth of personal strength and power

euthanasia

causing the painless death of a person in order to end or prevent suffering