Leadership Exam 3

The Scope and Standards of Practice of Nursing Administration Practice (2009)

what document is helpful specifically to the nurse-manager in creating and maintaining an ethical work environment

the master is responsible for the acts of his servants

what does respondeat superior, which is a form of vicarious liability, mean

nonmaleficence

what ethical principle is described here: actions are taken in an effort to avoid harm

beneficence

what ethical principle is described here: actions are taken in an effort to promote good

confidentiality

what ethical principle is described here: keep privileged information private

fidelity

what ethical principle is described here: need to keep promises

veracity

what ethical principle is described here: obligation to tell the truth

paternalism

what ethical principle is described here: one individual assumes the right to make decisions for another

autonomy

what ethical principle is described here: promotes self-determination and freedom of choice

justice

what ethical principle is described here: seek fairness; treat "equals" equally and treat "unequals" according to their differences

utility

what ethical principle is described here: the good of the many outweighs the wants or needs of the individual

statutes (also called statutory law or legislative law)

which source of law is described here: laws that are passed by the state or federal legislators and that must be signed by the president or governor

court decisions (tort law)

which source of law is described here: the courts interpret the statutes and set precedents; in the US, there are 2 levels: trial and appellate

administrative agencies

which source of law is described here: the rules or regulations established by appointed agencies of the executive branch of the government (governor or president)

because of the potential for subjectivity and bias

why are researchers beginning to see the intuitionist ethical framework as inappropriate for an ethical decision-making framework

A (look back)

According the MORAL modeling in solving an ethical issue, the L represents: A. Look back B. Look at other options C. Listing decision D. Looking forward

B. False (Rationale: All nurses must know and understand personal liability, which says every person is liable for his or her own conduct. The law does not permit a wrongdoer to avoid legal liability for his or her own wrongdoing. Any employer may have the legal right to recover or be reimbursed the amount of damages from the negligent employee)

All nurses are covered by respondeat superior, which protects them from malpractice. A. True B. False

-Massage the dilemma: collect data about the ethical problem and who should be involved in the decision-making process -Outline options: identify alternatives and analyze the causes and consequences of each -Review criteria and resolve: weight the options against the values of those involved in the decision. This may be done through a weighting or grid. -Affirm position and act: develop the implementation strategy -Look back: evaluate the decision making

Describe the MORAL decision-making model for ethical problem solving

NO (it functions as a guide to the highest ethical practice standards for nurses)

Is the ANA Code of Ethics legally biding

B

The American Nurses Association Code of Ethics is a legally binding description of the nurse's role that must be followed by all nurses. A. True B. False

A (utilitarian)

The ethical framework that is based on the premise of providing the greatest good for the greatest number of people is known as: A. Utilitarian B. Rights based C. Duty based D. Intuitionist

D. The courts (Rationale: Court decisions are also called tort laws. The courts interpret the statues and set precedents. Most malpractice law is addressed by the courts)

Tort laws are determined by: A. The constitution B. State statutes C. Administrative agencies D. The courts

become so focused on production that they become less humanistic

what do managers who use the principle of utility need to be careful not to do

-Drug abuse in employees -Elder abuse -Child abuse

although confidentiality is a basic ethical principle and is a foundation of both medical and nursing ethics, there are times when disclosure is required by the law, when are those times? (3)

the patient

although nurses have multiple fidelity duties (patient, physician, organization, profession, and self) that at times may be in conflict, the ANA Code of Ethics is clear that the nurse's primary commitment is to who?

prevent a person from coming to harm

because paternalism limits freedom of choice, most ethical theorists believe that paternalism is justified only to what/

-unintentional tort: professional negligence -intentional tort: direct invasion of someone's legal rights

describe intentional vs unintentional torts

says that every person is liable for his or her own conduct

describe personal liability

a duty to do something or to refrain from doing something

describe the basic premise of duty based (deontological) ethical framework

each case weighed on a case-by-case basis to determine relative goals, duties, and rights

describe the basic premise of intuitionist (deontological) ethical framework

individuals have basic inherent rights that should not be interfered with

describe the basic premise of rights based (deontological) ethical framework

provide the greatest good for the greatest number of people

describe the basic premise of utilitarian/consequentialist (teleological) ethical framework

-criminal: beyond a reasonable doubt -civil: based on a preponderance of the evidence -administrative: clear and convincing standard

describe the burden of proof required for a guilty verdict with each of the different types of court cases

-legal controls are generally clear and philosophically impartial -ethical controls are much less clear and individualized

describe the differences between legal and ethical controls

-Constitution: little direct involvement in the area of malpractice -Statutes: before 1970s, very few state or federal laws dealt with malpractice. Since the malpractice crisis, many statutes affect malpractice -Administrative agencies: some of these agencies, such as the National Labor Relations Board or health and safety boards, can affect nursing practice -Court decisions: most malpractice law is addressed by the courts

describe the involvement of the sources of law with nursing practice

-criminal: incarceration, probation, fines -civil: monetary damages -administrative: suspension or loss of licensure

describe the likely consequences of a guilty verdict for the different types of court cases

individual malpractice insurance

what do many nurses have now due to an increased scope of practice

-ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture -ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences

ethical relativism and ethical universalism are 2 more recent theories of ethical philosophy, describe them

patient is harmed because proper care is not given

explain this component of professional negligence/element of liability: Failure to meet the standard of care must have the potential to injure the patient

the care that should be given under the circumstances (what the reasonably prudent nurse would have done)

explain this component of professional negligence/element of liability: duty to use due care

not giving the care that should be given under the circumstances

explain this component of professional negligence/element of liability: failure to meet standard of care (breach of duty)

the nurse must have reasonable access to information about whether the possibility of harm exists

explain this component of professional negligence/element of liability: foreseeability of harm

actual harm results to patient

explain this component of professional negligence/element of liability: injury

1, 3, 9

generally initial trial courts have ____ judge(s), intermediary appeal courts have ___ justice(s), and the highest appeal courts have ___ justice(s)

value indicator

if a value does not meet all 4 criteria to be a true value, then what is it called

civil court

most malpractice cases are tried in what type of court?

-Decreased independence -Loss of freedom -Interference with ability to make choices autonomously

patient advocacy is necessary because disease almost always results in what 3 things?

-Only cover when on the job -No coverage if employment is terminated, even if the complaint occurred while employed. -Inadequate limits of liability

some nurses count on their employee-provided professional liability policies to protect them from malpractice claims, but these often have limitations, like what?

the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it

strictly speaking, informed consent can be given only after what?

-doctrine of charitable immunity: this holds that a charitable (nonprofit) hospital cannot be sued by a person who has been injured as a result of a hospital employee's negligence; liability is limited to the employee -governmental immunity: provides that the governments cannot be held liable for the negligent acts of the employees while carrying out government activities

the difficulty in interpreting respondeat superior is that many exceptions exist, what are they?

-the previous case must be within the jurisdiction of the court hearing the current case -the court can depart from precedent and set landmark decision

the nurse must avoid 2 pitfalls in determining if stare decisis should apply to a given situation, what are those 2 pitfalls

(1) Incorporates Code of Ethics for Nurses with interpretive statements (ANA, 2001) to guide practice (2) Assures the preservation and protection of the autonomy, dignity, and rights of individuals (3) Maintains confidentiality within legal and regulatory parameters (4) Assures a process to identify and address ethical issues within nursing and the organization (5) Participates on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes (6) Demonstrates a commitment to practicing self-care, managing stress, and connecting with self and others

the revision of the Scope and Standards of Practice of Nursing Administration Practice in 2009 specifically delineate professional standards in management ethics, what are these standards?

tort

what are legal wrongs committed against a person or property, independent of a contract, that render the person who commits them liable for damages in a civil action

incident reports

what are records of unusual or unexpected incidents that occur in the course of a client's treatment

-End-of-life decisions -Technological advances -Health care reimbursement -Access to health care -Provider-patient conflicts regarding expectations and desired outcomes -Withholding of information or blatant lying to patients -Insurance authorizations, denials, and delays in coverage -Medical errors -Patient information disclosure -Patient grievance and appeals processes -Cultural and ethnic diversity and sensitivity -Respect for patient dignity -Inadequate consents -Incompetent health care providers -Complex social problems including AIDS, teenage pregnancy, violence, and poverty -Aging population

what are some common areas requiring nurse-patient advocacy

-assault -battery -false imprisonment -invasion of privacy -defamation -slander

what are some examples of intentional torts

-Practice within the scope of practice -Observe agency policies and procedures -Model practice after established standards -Always put patient rights and welfare first -Be aware of relevant law and legal doctrines -Practice within the area of individual competence -Upgrade technical skills

what are some suggestions to reduce risk for malpractice claims (7)

-Generally cannot be subpoenaed by clients -Do not put in the patient's chart -Do not refer to in the patient's chart -Do provide enough information about the incident or occurrence in the chart so that appropriate treatment can be given

what are some things to know about incident reports

-stare decisis: let the decision stand; uses precedents as a guide for decision making; gives nurses insight into ways that the court has previously fixed liability in given situations -res judicata: a "thing or matter settled by judgment"; applies only when a competent court has decided a legal dispute and when no further appeals are possible; keeps the same parties in the original lawsuit from retrying the same issues that were involved in the first lawsuit

what are the 2 important legal doctrines that frequently guide all 3 courts in their decision making

-criminal -civil -administrative

what are the 3 different types of court cases

-Utilitarian/consequentialist (teleological) -Rights based (deontological) -Duty based (deontological) -Intuitionist (deontological)

what are the 4 most commonly used ethical frameworks

-the constitution -statutes -administrative agencies -court decisions

what are the 4 sources of laws

(1) The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. (2) The nurse's primary commitment is to the patient, whether an individual, family, group, or community. (3) The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. (4) The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. (5) The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. (6) The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. (7)The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. (8) The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. (9) The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

what are the 9 revisions of the new Code of Ethics for Nurses

-Duty to use due care (defined by the standard of care) -Failure to meet standard of care (breach of duty) -Foreseeability of harm -Failure to meet the standard of care must have the potential to injure the patient -Actual patient injury

what are the components of professional negligence/elements of liability

-Freely chosen from alternatives after due reflection -Be prized and cherished -Consciously and consistently repeated (pattern) -Positively affirmed and enacted

what are the four characteristics that determine a true value

scope of practice

what defines the procedures, actions, and processes that are permitted for the licensed individual

-increasing technology, regulatory pressures, and competitiveness among health care providers -national nursing shortages -reduced fiscal resources -spiraling costs of supplies and salaries -public's increasing distrust of the health care delivery system and its institutions

what forces ensure that ethics will become an even greater dimension in management decision making in the future

ethical frameworks (they do not solve the ethical problem but assist individuals in clarifying personal values and beliefs)

what guide individuals in solving ethical dilemmas

defamation

what intentional tort is described here: Communicating to a third party false information that injures a person's reputation

assault

what intentional tort is described here: Conduct that makes a person fearful and produces a reasonable apprehension of harm

battery

what intentional tort is described here: Intentional and wrongful physical contact with a person that entails an injury or offensive touching

false imprisonment

what intentional tort is described here: Restraint of a person's liberty of movement by another party who lacks the legal authority or justification to do so

moral/ethical dilemma

what is described as being forced to choose between 2 or more undesirable alternatives

the nurse, physician, and employing organization are all held liable

what is joint liability

role model ethical behavior

what is perhaps the most important thing a manager can do to create an ethical work environment

applied ethics

what is the application of normative ethical theory to everyday problems

Nurse Practice Act

what is the body of Alabama law that mandates the Board of Nursing to set out the scope of practice and responsibilities for RNs and LPN's

-libel: written defamation -slander: spoken defamation

what is the difference between libel and slander

-teleological: decisions are based on what provides the greatest good for the greatest number of people -deontological: judges whether the action is right or wrong regardless of the consequences

what is the difference between teleological and deontological

open communication (more personal relationships between nurse and patient)

what is the major recommendation by the Joint Commission to decrease malpractice claims

respect for people

what is the most basic and universal ethical principle

to protect the patient and the nurse

what is the primary purpose of law and legislation related to nursing

ANA Code of Ethics

what is the set of principles to guide the practitioner; it outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse

ethics

what is the systemic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are

moral/ethical dilemma

what is this an example of: a nurse required to provide care or treatment that is in conflict with his/her own religious beliefs

self-determination

what legal right supports the moral principle of autonomy

internal conflict and burnout

what may result when personal and organizational values do not mesh

moral uncertainty/moral conflict

what occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

moral distress

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

- The procedure to be performed -The risks involved -Expected or desired outcomes -Expected complications or side effects that may occur as a result of treatment -Alternative treatments that are available

when it comes to the guidelines for informed consent, the person(s) giving consent must fully comprehend what? (5)

defendant

which element of malpractice is defined here: a professional who is alleged to have caused harm

reasonable and prudent

which element of malpractice is defined here: average judgment, foresight, intelligence, skill with similar training and experience

malpractice or professional negligence

which element of malpractice is defined here: failure of a person with professional training to act in a reasonable and prudent manner

plaintiff

which element of malpractice is defined here: injured party

negligence

which element of malpractice is defined here: omission to do something that a reasonable person would do

utilitarian/consequentialist (teleological) (the end justifies the means)

which ethical framework is this an example of: a manager might decide to use travel budget money to send many staff to local workshops rather than to fund one or tow people to attend a national conference

utilitarian/consequentialist (teleological)

which ethical framework suggests that the end can justify the means

administrative agencies

which source of law are state boards of nursing an example of

statutes

which source of law are the 51 Nurse Practice Acts representing the 50 states and the District of Columbia an example of

constitution

which source of law is described here: highest law in the US; interpreted by the US Supreme Court; gives authority to other 3 sources of law