Professionalism Chapter 22-24
Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have com- pleted orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."
Answer: 1, 2, 3. Nurses need to be actively involved in their com- munities and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.
Which statements properly apply an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.
Answer: 1, 2, 4. Access to health care services can be justified through the application of the principles of justice, beneficence, respect for autonomy, and nonmaleficence. While option 3 is an opinion that can be justified with ethical analysis, no justification is offered in this statement, so this option is not correct. Option 5 is incorrect because justice refers to fairness in the distribution of resources, and basing access to medication only on income may not be fair.
motivational interviewing
a collaborative, person-centered form of guiding to elicit and strengthen motivation for change
Unintentional Torts (Negligence)
a doctrine that says a person is liable for harm that is the foreseeable consequence of his or her actions
Code of ethics
a guideline to help marketing managers and other employees make better decisions
Durable power of attorney for health care (DPAHC)
a legal document that designates a person or people of one's choosing to make health care decisions when a patient is no longer able to make decisions on his or her own behalf
Sender
a person who transmits a message
Nurse Practice Act
law established to regulate nursing practice
Constitutional Law
law that involves the interpretation and application of the U.S. Constitution and state constitutions
Referent
motivates one person to communicate with another
circular transactional model
includes several elements: the referent, sender and receiver, message, channels, context or environment in which the communication process occurs, feedback, and interpersonal variables
Autonomy
independence
Utilitarianism
idea that the goal of society should be to bring about the greatest happiness for the greatest number of people
Value
A customer's subjective assessment of benefits relative to costs in determining the worth of a product
stereotype
A generalized belief about a group of people
Criminal Law
A law that defines crimes against the public order.
Civil Law
A law that governs relationships between individuals and defines their legal rights.
communication
A process through which you send messages to and receive messages from others.
intentional tort
A wrongful act knowingly committed.
Risk Management
All efforts designed to preserve assets and earning power associated with a business.
Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.) 1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified. 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life.
Answer: 1, 2, 4. These statements describe why a single definition for the term quality of life is challenging. Options 3 and 5 are true statements, but they do not explain why the definition of quality of life is difficult to agree on, which is what the question asks for.
When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip-read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.
Answer: 1, 3, 4. Communication techniques such as assessing the need for adaptive equipment, keeping communication short and direct, and giving the patient time to respond assist the nurse in providing clear, effective communication. Patients may have difficulty with rapid or lengthy explanations. Exaggerated lip movements may be difficult to interpret or demeaning to individuals with hearing deficits.
The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approachesto ethical problems? (Select all that apply.) 1. Ethics of care: pays attention to the context in which caring occurs. 2. is used only by nurses because it is part of the Nursing Code of Ethics. 3. requires understanding the relationships between involved parties. 4. considers the decision maker's relationships with other involved parties. 5. is an approach that suggests a greater commitment to patient care. 6.considers the decision maker to be in a detached position outside the ethical problem.
Answer: 1, 3, 4. The ethics of care emphasizes attention to the context in which an ethical problem occurs and the relationships between involved parties, including relationships with the decision maker. No approach to ethical problems is exclusive to a single discipline, and no approach is superior to the others, nor does any approach demonstrate a higher level of commitment to the patient, so options 2 and 5 are incorrect. Option 6 is true of principle-based approaches such as deontology but not true of the ethics of care.
A nurse is using motivational interviewing with a patient. What outcomes does the nurse expect? (Select all that apply.) 1. Gain an understanding of the patient's health goals. 2. Direct the patient to avoid poor health choices. 3. Recognize the patient's strengths and support the patient's efforts. 4. Provide assessment data that can be shared with families to promote change. 5. Identify differences in patient's health outcomes and current behaviors.
Answer: 1, 3, 5. Motivational interviewing (MI) is a technique used to promote an understanding of the patient's health goals, health outcomes, and current behaviors in a nonjudgmental environment while focusing on the patient's strengths and efforts. The nurse provides a supportive approach to assist the patient in establishing and promoting positive health care changes.
Which social media uses can be implemented with patients and families without violating confidentiality? (Select all that apply.) 1. Social media can be used to provide supportive information. 2. Results such as x-ray results can easily be sent via social media. 3. Family and friends who cannot be present can connect with the patient. 4. All health information can be shared on social media. 5. Social media should never be used with patients and families.
Answer: 1, 3. On the one hand, social media can be a supportive source of information about patient care or professional nursing activities and can provide you with emotional support when you encounter hardships at work. Social media can also be a source of support to your patients, connecting them with friends and loved ones who cannot be physically present. On the other hand, the risk to patient privacy with social media is great. Posting informa- tion or pictures about patients, even without specific identifiers, is a violation of confidentiality.
Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility
Answer: 1, 3. Providing a standardized process, policy, and tool can assist in a predictable, safe transfer of important patient information between health care facilities. Communication and collaboration between the sender and receiver of information enable the staff to validate that the information was received and understood. Requiring a patient visit is not always necessary, and relying on family members to share information does not release staff from their responsibilities. Doing patient transfers on the same day and time has no effect on creating a safe patient transfer.
Which of the following actions, if performed by an RN, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Reviewing the EHR of a family member who is a patient in the same hospital on a different unit 2. Refusing to provide health care information to an older adult's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written order 5. Completing an occurrence report on the unit
Answer: 1, 4. Viewing a family member's electronic health record (EHR) violates the patient's rights provided by HIPAA. A physical restraint can be applied only on the written order of a health care provider based on The Joint Commission and Medicare guidelines.
A patient is in skeletal traction and has a plaster cast due to a frac- tured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to docu- ment and report this to the health care provider because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated tem- perature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to provide patient education about cast care 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition
Answer: 1, 5. The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
You are working on a patient care unit and observe several other nurses who are not following the agency's policy when preparing and administering medications. When you ask them to explain why they are doing this, they state the new medication adminis- tration technology installed on the unit takes too much time to use, so they are using workarounds to get their patient medica- tions administered on time. Which is the best action to take first? 1. Discuss the situation with the nursing manager. 2. Call a colleague who works at another institution to talk about the problem. 3. Look for a position on a different nursing unit. 4. Say nothing and begin your work.
Answer: 1. Alerting the nursing manager is the first step in helping identify a problem that may exist related to medication administra- tion. Speaking up about issues that may create an unsafe patient situ- ation for the hospital and nursing staff can help reduce your legal risk.
Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and health care providers takes precedence over personal views 4. To allow the patient and the health care provider private time to resolve the dilemma on the basis of ethical principles
Answer: 1. The ideal process for resolving ethical problems engages the perspectives of all involved, and nurses, as members of the health care team, have a valuable and unique point of view to share. Option 2 is a strategy that assists in answering a clinical question but does not address ethics. Options 3 and 4 are incorrect because both suggest that the nurse disengage from her own values and critical thinking and follow an action driven by the points of views of others.
A patient states, "I don't have confidence in my doctor. She looks so young." What is the nurse's therapeutic response? 1. Tell me more about your concern. 2. You have nothing to worry about. Your doctor is perfectly competent. 3. You can go online and see how others have rated your doctor. I do that. 4. You should ask your doctor to tell you her background.
Answer: 1. The nurse should respond with a question to elicit more information about the area of concern. Telling the patient to look up the physician online or advising the patient to query the physician directly are ways that the nurse unhelpfully gives advice to the patient.
The nurse is caring for a patient who needs a liver transplant to sur- vive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.
Answer: 1. The principle of justice as it pertains to the distribution of health care resources is the ethical element present in option 1. Options 2, 3, and 4 are all potential strategies for assisting this patient, but they do not address the ethical elements of the case.
Match the following actions (1 through 4) with the terms (a through d) listed below: ___1. You see an open medical record onthecomputerandcloseitso thatnooneelsecanreadthe recordwithoutproperaccess. ___2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the provider and your nurse manager and follow agency procedure. ___3. Apatientattheendoflifewantsto go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. ___4. You tell your patient that you will return in 30 minutes to give him his next pain medication. a. Advocacy b. Responsibility c. Accountability d. Confidentiality
Answer: 1d, 2c, 3a, 4b. Action 1 corresponds with option d. Preventing unnecessary access to a patient's health care information protects the patient's right to confidentiality. Action 2 corresponds to option c, accountability. Accountability refers to taking owner- ship of one's actions, which includes acknowledging errors. Action 3 corresponds to option a, advocacy. Sharing the patient's stated wish with other members of the health care team is an example of using your voice to benefit another person, in this case the patient. Action 4 corresponds with option b, responsibility. By following through on an established plan in caring for the patient, the nurse demonstrates responsibility.
Which techniques demonstrate a therapeutic response to an adult patient who is anxious? (Select all that apply.) 1. Matching the rate of speech to be the same as that of the patient 2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient 5. Assuring the patient that all will be well
Answer: 2, 3, 4. An adult patient who is anxious is reassured by the nurse who demonstrates good eye contact and a calm presence. Also, when the adult is anxious, remaining supportively present and calm helps the patient to begin to experience less anxiety. Telling the patient that all will be well is false reassurance, and the nurse may escalate the patient's anxiety if the nurse's speech is speeded up to match the patient's speech.
A patient has gone through a number of treatment changes during a shift of care. During the hand-off report, the nurse plans to communicate effectively with the nurse who will be caring next for the patient for which of the following reasons? (Select all that apply.) 1. To improve the nurse's status with the health team members 2. To reduce the risk of errors to the patient 3. To provide an optimum level of patient care 4. To improve patient outcomes 5. To prevent issues that need to be reported to outside agencies
Answer: 2, 3, 4. Effective communication in health care has been linked to a decrease in medical errors and an improvement in qual- ity of care and patient outcomes. The status of the nurse or the prevention of reportable issues is not the focus of communication with patients.
A nurse sends a text message to the oncoming nurse that states, "Mr. Kodro in room 3348-1 refused to take his sertraline hydro- chloride as ordered this morning because he said he was feeling better." What should the oncoming nurse do? (Select all that apply.) 1. Add this information to the board hanging at the patient's bedside. 2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Informthenursingsupervisor. 4. Forwardthetexttothechargenurse. 5. Thankthenurseforsendingtheinformation.
Answer: 2, 3. The Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology Act provide rules about how and with whom nurses can share patient health infor- mation. Sending a text message to another nurse about a patient is a violation of these acts. Report violations of the privacy of patient health information to your supervisor or manager.
A nurse works with a patient using therapeutic communication during all phases of the therapeutic relationship. Place the nurse's statements in order according to these phases. 1. The nurse states, "Let's work on learning injection techniques." 2. The nurse is mindful of biases and knowledge in working with the patient with B12 deficiency. 3. The nurse summarizes progress made during the nursing relationship. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.
Answer: 2, 4, 1, 3. In the therapeutic relationship the nurse begins by understanding the self (preinteraction), then provides intro- ductions, followed by a working phase and finally termination and summarization.
When designing a plan for pain management for a patient follow- ing surgery, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates this action? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for over sedation as a side effect of his pain medication
Answer: 2. Asking the patient to establish the goal for pain control is a demonstration of respect for autonomy. Assessing, monitoring, and using alternative measures are interventions that address pain but that are not necessarily grounded in the principle of autonomy.
A nurse is planning care for a patient going to surgery. Who is re- sponsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager
Answer: 2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.
The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable.
Answer: 3. Deontology is an approach to ethics that identifies the correct action as that which is supported by fundamental principles and duties. The disadvantage of this approach is that its application relies on consensus around what the primary duties and principles are. Option 1 describes a limitation of the ethics of care. Option 2 describes a limitation of feminist ethics, while option 4 describes a limitation of utilitarianism.
A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Documentherfindingsandtreatthepatient. 2. Instruct the mother on safe handling of a 2-year-old child. 3. Contact a child abuse hotline. 4. Discuss this story with a colleague.
Answer: 3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.
A nurse received a bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient's medical record. The nurse lists patients' medical diagnoses on the message boards in the patients' rooms. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of HIPAA? 1. Discussing patient conditions at the bedside at the change of shift 2. Allowing the nursing student to review the assigned patient's chart before providing care during the clinical experience 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
Answer: 3. Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment.
What outcome demonstrates the effective use of silence as a therapeutic communication technique? 1. The nurse feels like there was enough time to be therapeutic when communicating with the patient. 2. The patient states a preference to talk with another staff member. 3. The patient perceives having gained insight into the issue after the conversation. 4. The patient was able to drift off to sleep more easily.
Answer: 3. The effective use of silence provides that patient an opportunity to think and gain insight. Often the patient feels compelled to break the silence and is prompted to talk.
A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood. 2. Convince the husband to allow the nurse to give the blood. 3. Call security and have the husband removed from the hospital. 4. Gather more information about the wife's preferences and determine whether the husband has her power of attorney for health care.
Answer: 4. Adult patients such as those with specific religious objections are able to refuse treatment for personal religious reasons. Because this patient is unresponsive, it is important for the nurse to better understand the patient's preferences and know if the woman has a power of attorney for health care before fol- lowing the husband's wishes. However, there needs to be clear direction on who can make the decision.
A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assess- ing the patient. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act(HIPAA) 2. Americans With Disabilities Act(ADA) 3. Patient Self-Determination Act(PSDA) 4. Emergency Medical Treatment and Active Labor Act(EMTALA)
Answer: 4. EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.
A nurse prepares to contact a patient's health care provider about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old woman who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 p.m. yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days." 2. "The patient reported feeling very nauseated after her dose of levofloxacin an hour ago." 3. "Is it possible to make a change in antibiotics ,or could we give her a nutritional supplement before her medication?" 4. "The patient started to complain of nausea yesterday evening and vomited several times during the night."
Answer: 4S, 1B, 2A, 3R. The nurse describes the patient's complaint of nausea and vomiting to the physician (Situation). Specific patient demographic information and reason for admission with current symptomology are provided (Background). The physician is informed of the patient's complaint of nausea after receiving levofloxacin (Assessment). The physician is asked about making a change in the antibiotic or providing a nutritional supplement be- fore medication administration (Recommendation).
The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.) 1. Validate health care needs through verbal discussion with the patient. 2. Compare actual and expected patient care outcomes with the patient. 3. Provide support through therapeutic communication techniques. 4. Complete a nursing history using verbal communication techniques.
Answer:4,1,3,2. The correct order for the nurse to communicate with the patient is to first complete the history (part of assessment), then corroborate findings through a validation process. After this, the nurse would use therapeutic communication to address needs, and finally would complete an evaluation process to see whether the actual outcomes matched the expected outcome.
The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution? 1. List all the possible actions that could be taken to resolve the problem. 2. Articulate a statement of the problem or dilemma that you are trying to resolve. 3. Develop and implement a plan to address the problem. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. 5. Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. 6. Recognize that the problem requires ethics.
Answer:6,4,5,2,1,3. This order reflects a systematic approach to ethical problems, similar to the nursing process.
Using a systematic approach similar to the nursing process pro- motes resolution of ethical issues. While the specific ethical issues nurses face evolve and change over time, the values and obligations remain constant.
Key points Chapter 22
You apply fundamental concepts such as autonomy, justice, fidelity, and beneficence to ethical decision making.
Key points Chapter 22
Beneficence
Doing good or causing good to be done; kindly action
active listening
Empathic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy.
Ethics of Care
Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
Malpractice
Failure by a health professional to meet accepted standards
Different states have different laws that affect care at the beginning and end of life that do not always align with nursing standards. For example, although some states have laws that allow assisted suicide, the American Nurses Association (ANA) believes that helping patients end their lives is against the nursing code of ethics.
Key Points Chapter 23
A variety of guidelines affect nursing practice in the workplace and address issues such as patient-to-nurse ratios, nursing assignments, delegation, and the supervision of nursing students in clinical agencies.
Key Points Chapter 23
Constitutional law gives patients the right to refuse treatment, and your state's Nurse Practice Act, a statutory law, defines the scope of nursing practice and the standards you must meet within that state to ensure safe, evidence-based, and competent nursing practice.
Key Points Chapter 23
Federal statutes are typically linked to Medicare and Medicaid reimbursement, are intended to enhance patient safety, and greatly influence nursing practice. For example, the Patient Self-Determination Act (PSDA) requires health care institutions to provide information to patients regarding their rights to make informed decisions about their care, including the right to create an advance directive.
Key Points Chapter 23
It is important to know your Nurse Practice Act, to implement and follow agency policies and procedures, to delegate care appropri- ately, and to follow staffing and delegation guidelines to reduce your legal risk when practicing nursing.
Key Points Chapter 23
Risk-management, performance improvement (PI), and quality improvement (QI) activities enhance patient safety and reduce a nurse's legal risk by identifying potential safety issues, implement- ing actions to prevent patient harm, and evaluating the effects of these actions on patient outcomes.
Key Points Chapter 23
State health care acts outline which individuals may provide informed consent for a patient to have invasive procedures or to participate in a research study.
Key Points Chapter 23
The scope and standards of nursing practice, created by various professional organizations and health care agencies, define nursing and reflect the responsibilities, knowledge, and skills ordinarily expected from nurses.
Key Points Chapter 23
When a nurse's performance is questioned, the standard of proof in nursing is typically what a reasonably prudent nurse would do under similar circumstances in the geographical area in which the alleged breach occurred.
Key Points Chapter 23
Worsening pressure injuries, failure to contact the health care provider as conditions change, and medication errors often trigger complaints of negligence or malpractice against nurses.
Key Points Chapter 23
Adapting your communication approach with older adults, such as encouraging them to share life stories and reminisce about the past, can enhance your assessment and promote an effective nurse- patient relationship.
Key Points Chapter 24
Being aware of and analyzing the outcomes of your conversations with patients and the health care team and adapting your commu- nication approach as needed helps ensure that patients meet their outcomes effectively.
Key Points Chapter 24
Effective health care team communication using an approach modeled by the acronym SACCIA—Sufficiency, Accuracy, Clarity, Contextualization, and Interpersonal Adaptation—promotes working relationships that promote safe and effective care.
Key Points Chapter 24
Non therapeutic communication techniques damage professional and caring relationships; therefore pay attention to your own communication to remove these blocking techniques from your responses.
Key Points Chapter 24
Nonverbal communication, which occurs through the five senses and includes everything except the written or spoken word, is un- consciously motivated and more accurately indicates a person's intended meaning than spoken words,
Key Points Chapter 24
Nurses use critical thinking in communication by considering past experiences and knowledge and by interpreting messages received from others to obtain new information, correct misinformation, and make clinical judgments for patient-centered care.
Key Points Chapter 24
Nurses use the five levels of communication in their interactions: intrapersonal, interpersonal, small group, public, and electronic.
Key Points Chapter 24
Nursing actions that reflect caring in communication include being present and encouraging the expression of positive and negative feelings, instilling faith and hope, and promoting patient advocacy.
Key Points Chapter 24
Patients with special communication needs require you to use specific techniques to facilitate mutual understanding, such as lis- tening intently without interruption and ensuring patients use special devices to hear and see messages clearly.
Key Points Chapter 24
Taking a patient-centered approach by seeking a patient's viewpoints and being aware of your own personal biases will help you assess and identify your patients' communication needs.
Key Points Chapter 24
The circular transactional model of communication demonstrates the ever-changing nature of communication, and includes the refer- ent, sender and receiver, message, channels, feedback, interpersonal variables, and environment.
Key Points Chapter 24
There is a natural progression of four goal-directed phases—pre interaction, orientation, working, and termination—that characterize the nurse-patient relationship, even during a brief interaction.
Key Points Chapter 24
Use of both professional and therapeutic communication techniques contributes to achievement of patient outcomes. Practicing these techniques is essential in your development as a nurse.
Key Points Chapter 24
Verbal communication involves spoken or written words, and the vocabulary, meaning, pacing, tone, clarity, brevity, timing, and relevance of a message.
Key Points Chapter 24
Although ethical issues often change with changes in technology and society, common ethical issues surrounding nursing practice include the use of social media as a nursing professional, determining the burdens and benefits of treatment on a patient's quality of life, providing care at the end of life, and challenges regarding patients' access to health care.
Key points Chapter 22
Approaches to ethics include deontology, utilitarianism, and a relationship-based perspective.
Key points Chapter 22
In an ethical dilemma, a nurse faces two equally justifiable courses of action, whereas in moral distress the nurse feels unable to take the action that is correct.
Key points Chapter 22
Learning and applying the language of ethics is an essential element of nursing practice.
Key points Chapter 22
Understanding our own values and encouraging patients, families, and colleagues to clarify their values promote productive discussion of ethical problems.
Key points Chapter 22
defamation of character
Wrongfully hurting a person's good reputation. The law imposes a general duty on all persons to refrain from making false, defamatory statements about others.
Justice
Respecting the rights of others and giving them what is rightfully theirs
administrative law
The body of law created by administrative agencies (in the form of rules, regulations, orders, and decisions) in order to carry out their duties and responsibilities.
Statutory Law
The body of law enacted by legislative bodies (as opposed to constitutional law, administrative law, or case law).
Feedback
The receiver's response to a message
Bioethics
The study of ethics related to issues that arise in health care.
Complentary
Two angles whose sum is 90 degrees
Therapeutic communication
Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.
symmetrical
Well proportioned; balanced; the same on both sides
Accountability
Willingness to take credit and blame for actions.
Quasi-intentional torts
acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character
enviroment
all of the surrounding things, conditions, and influences affecting the growth or development of living things.
Nurse Delegation
an RN educates, observes, and verifies that a non-nurse can do a specific task that is usually completed by a nurse
Informed consent
an ethical principle that research participants be told enough to enable them to choose whether they wish to participate
Assertiveness
behavior intended to express dominance or confidence
Negligence
careless neglect, often resulting in injury
Occurrence report
confidential document that describes any patient accident while the person is on the premises of a health care agency
Deontology
defines actions as right or wrong
Scope of Nursing Practice
defines nursing and reflects the values of the nursing profession
Nurse practice acts
describe and define the legal boundaries of nursing practice within each state
nonmaleficence
do no harm
professional licensure defense
expensive when nurses do not have insurance that covers the costs of keeping their licenses to practice nursing
interpersonal variables
factors within both the sender and receiver that influence communication
neglect
fail to care for properly
fiedelity
faithfulness
Perceptual biases are:
human tendencies that interfere with accurately perceiving and interpreting messages from others
closed-ended questions
questions a person must answer by choosing from a limited, predetermined set of responses
open-ended questions
questions that allow respondents to answer however they want
Advocacy
taking action to influence others to address a health-related concern or to support a health-related belief
empathy
the ability to understand and share the feelings of another
Confidentiality
the act of holding information in confidence, not to be released to unauthorized individuals
Slander
the action or crime of making a false spoken statement damaging to a person's reputation.
Casuistry
the determination of right and wrong in questions of conduct or conscience by the application of general ethical principles; specious argument
Standard of proof
the level of certainty and the degree of evidence necessary to establish proof in a criminal or civil proceeding
channel
the means by which a message is communicated
Reciever
the person who decodes a message
Ethics
the principles of right and wrong that guide an individual in making decisions
Case Law
the rules of law announced in court decisions
Morals
the rules people develop as a result of cultural values and norms
Feminist Ethics
type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor
battery
unlawful touching of another person without consent
lateral violence
verbal, emotional, or physically abusive behavior of a registered nurse toward another staff member
message
whatever a speaker communicates to someone else
Libel
written defamation
Torts
wrongful acts for which an injured party has the right to sue
