Ch. 8 Professional Accountability/Ethics

SOAP

(Subjective data, Objective data, assessment, plan of action) This problem-oriented form of charting includes establishing goals, expected outcomes, and needs and then form a charting includes establishing goals, expected outcomes, and needs and then compiling a numbered list of problems. This is made for each seperate problem.

List of Joint Commission Core Measures

-Acute Myocardial Infarction (AMI) -Children's Asthma Care -Emergency Department -Hospital Outpatient Department -Hospital-Based Inpatient Psychiatric Services -Immunization -Perinatal Care -Stroke -Substance Abuse -Tobacco Treatment -Venous thromboembolism

Resuscitation Effort

-Advantage: Allow family to deny death is imminent. -Disadvantage: Cause unnecessary suffering and prolong dying process

IV Fluids for hydration

-Advantage: Relieve family's anxiety that the patient is thirsty. Keep mouth moist -Disadvantage: May result in congestive heart failure and pulmonary edema with increased dyspnea. Increase urinary output and incontinence may cause skin breakdown. Prolong dying process.

Ethical Issues related to treatment of terminally Ill patients

-Analgesia Advantage -Active treatments Advantage -Supplemental nutrition advantage -IV fluids for hydration -Resuscitation efforts

CNS Scope of Practice

-Assessing includes history, physical evaluation, screening tests, identifying risks, and ordering routine laboratory/ radio graphic tests. - Diagnosing includes integrating information from assessment with specific laboratory tests to arrive at a clinical diagnosis -Managing includes establishing a plan of care, providing interventions and education, referring to other healthcare providers or agencies, and reassessing the care plan based on outcomes/

Delegation

-Assessing the skills and availability of the team members, determining if a task is suitable for an individuals -Assigning tasks with a time line -Ensuring that the tasks are completed properly and on time by monitoring progress but not micromanaging - Reviewing the final results and recording outcomes.

Core Practice Standards of Nursing

-Assessment -Diagnosis -Outcomes Identification -Planning -Implementation -Evaluation

Scope and Standards of Advance Practice

-Care Process -Establishing Priorities -Collaboration -Documentation -Patient Advocacy -Continuous Quality Improvement -Research and Education -Prescriptions -Diagnostics Tests -Consultation -Referral -Coordination

Peer Review Ranking System

-Care is based on standards and is typical of that provided by like practitioners. -Variance may occur in care, but outcomes are satisfactory -Care is not consistent with the provided by like practitioners -Variance resulted in negative outcomes.

Outcomes in the Patient/Client Sphere

-Care is provided for specific populations -Areas requiring nursing intervention are identified -Nursing care targets specific causes of health disorders -Goals related to health promotion and prevention are met. -Nursing care plan meets the needs of patients. -Adverse events are prevented -Nursing outcomes are clarified. -Effective interventions are included in evidence-based guidelines -Ineffective interventions are eliminated -Collaboration with the patient/family, physician, and other staff is utilized as appropriate. -Educational programs are presented and evaluated -Smooth transitions occur -Results are published shared.

Purposes of Documentation

-Carrying out professional responsibility -Establishing accountability -Communicating among health professional -Educating staff -Providing information for research -Satisfying legal and practice standards -Ensuring reimbursement

Outcomes in the Organization/System Sphere

-Continuous improvements in care benefit the organization/system. -Evidence-based policies and care improve nurse/team practice -Innovations occur throughout the continuum of care -Innovative care provides cost-effective positive outcomes for patients -A common vision is shared by health professionals and management. -Factors contributing to problems, costs, and outcomes are clear to those who make decisions -Nursing care programs reflect the strategic plan, mission, and vision of the organization/system.

Problem Solving

-Define the Issue: Talk with the patient or family and staff to determine if the problem related to a failure of communication or other issues, such as culture or religion. -Collect Data: This may mean interviewing additional staff or reviewing documentation, gaining a variety of perspectives. -Identify important concepts: Determine if there are issues related to values or beliefs -Consider reason for actions: Distinguish between motivation and intention on the part of all parties to determine the reason for the problem. -Make a decision: A decision on how to prevent a recurrence of a problem should be based on advocacy and moral agency, reaching the best solution possible for the patient and family.

Professional Practice Standards of Nursing

-Ethics -Education -Evidence-based practice and research -Quality of practice -Communication -Leadership -Collaboration -Professional practice evaluation -Resource Utilization -Environmental Health

Active Treatment Advantage

-Examples: Antibiotics or Chemotherapy -Advantages: Prolong life. Relieve Symptoms. Reassure Families -Disadvantages: Prolong the dying process. -Side Effects: may be serve (such as with chemotherapy)

American Medical Association guidelines for informed consent

-Explanation of diagnosis -Nature and reason for treatment or procedure -Risks and benefits or proposed treatment or procedure -Alternative options (regardless of cost or insurance coverage) -Risks and benefits of alternative options -Risks and benefits of not having a treatment of procedure.

Parts of an Ethical Framework for Complex Healthcare Situations

-Identify Issues: Objectively describe the ethical issue, acknowledging emotional biases -Clarify values: Determine if decision-making is affected by person values or the values of others, and whether there is conflict in these values -Identify influences and barriers: Consider medical condition, risk factors, socioeconomic status, religion, support systems, and barriers, such as conflicts, differing professional assessments, regulations, and control issues -Apply principles: Use and apply ethical principles: autonomy, beneficence, nonmaleficence, justice, privacy, confidentiality, veracity, and fidelity -Find alternative solutions: Explore alternate solutions, considering pros and cons, ethical issues, and outcomes -Resolve conflicts: Use collaboration, compromise and/or accommodation, rather than coercion or avoidance, to reach a solution -Implement Solution: Select and carry out a solution that you can defend as an ethical decision -Assess process and outcomes: Assess the process of reaching an ethical solution and the outcomes.

Methods of Docummentation

-Narrative -SOAP -Subjective -Objective -Assessment -Plan

Outcomes in the Nurse/Nurse Practice Sphere

-Needs for staff training and development are outlined -Practice reflects current best practices -Changes in practice result from accessible research -Nurses identify contributions specific to nurses and expected outcomes. -Care providers develop solutions to patient problems. -Collaborative efforts achieve target patient outcomes. -Nurses have educational programs that are readily available to enhance their careers. -Nursing staff gains confidence in providing patient care. -Job satisfaction increases -Staff retention improves -Staff is engaged in the learning process -Programs developed for nursing education are implemented and evaluated for effectiveness -Case is cost-effective through the efficient use of resources

Ways to resolve Ethical and Clinical Conflicts

-Open communication is critical to solving these. Asking what steps could be taken to resolve the this or how it could be handled differently often leads to compromise because it allows for exchange of ideas and validates legitimate concerns. Sharing cultural perspectives can lead to better understanding. -Advocacy for the patients/families must remain at the center of conflict resolution.

CNS Spheres of Influence

-Patient/client sphere -Nurse/nursing practice sphere - Organization/system sphere

Analgesia Advantage

-Provide Comfort. East the dying process. -Disadvantage: Increase sedation and decrease cognition and interaction with family. - Side Effects: May hasten death.

Supplemental Nutrition Advantage

-Relieve family's anxiety that child is hungry. Prolong life -Disadvantage: May cause nausea, vomiting. May increase tumor growth with cancer. May increase discomfort.

Patient's Rights

-Respect for patient, including personal dignity and psychosocial, spiritual, and cultural considerations. -Response to needs related to access and pain control -Ability to make decisions about care, including informed consent, advance directives, and end of life care -Procedures for registering complaints or grievances -Protection of confidentiality and privacy -Freedom from abuse or neglect -Protection during research and information related to ethical issues of research -Appraisal of outcomes, including unexpected outcomes -Information about organization, services, and practitioners -Appeal procedures for decisions regarding benefits and quality of care -Organizational code of ethical behavior - Procedures for donating and procuring organs/tissues

Joint Commission Focus for Peer Review

-The design should include definitions of peer, methods in which peer review panels are selected, triggering events, and time frames. It should also outline the participation of the person being reviewed. -The function must be consistently applied to all individuals, balanced and fair, adherent to timelines, ongoing, and valuable to the organization. Decisions should be based on solid reason and literature review and must be defensible

4 steps to Addressing Moral Distress

1) Asking: personal questioning to gain awareness of moral issues 2) Affirming: Recognizing the reality of issue and determining to address the issue. 3) Assessing: Determining the source and severity of moral distress and evaluating the pros and cons of action. 4) Acting: Making the decision to act and taking steps to resolve moral issues while anticipating and dealing with obstacles

Nursing Code of Ethics

1) The nurse treats all patients with respect and consideration, regardless of social circumstances or health condition. 2) The nurse's primary commitment is to the patient, regardless of conflicts that may arise. 3) The nurse promotes and advocates for the patient's health, safety, and rights, maintaining privacy and confidentiality and protecting the patient from questionable practice or care. 4) The nurse is responsible for his/her own care practices and determines appropriate delegation of care. 5) The nurse must retain respect for self and his/her own integrity and competence. 6) The nurse participates in ensuring that the healthcare environment is conductive to providing good health care and consistent with professional and ethical values. 7) The nurse participates in education and knowledge development to advance the profession. 8) The nurse collaborates with others to promote efforts to meet health needs. 9) the nursing profession articulates values and promotes and maintains the integrity of the profession.

Clarity in Documentation

A standardized vocabulary should be used for documenting, including lists of approved abbreviations and symbols. Abbreviations and symbols, especially, can pose serious problems in interpretation, so they should be sparingly.

Utilitarianism Theory

Act, Rule: This theory is based on the concept that consequences are predictable. In Act this, ethical decisions are those that benefit the most people, regardless of person feelings or laws. In Rule This, ethical decisions must take laws and fairness into consideration.

Computerized Charting

All record keeping is done electronically, usually at point of care. Computer terminals must be placed where others cannot read notes being written, and access must be placed where others cannot read notes being written, and access must be password protected. These systems may include clinical decision support system (CDSS), which provide diagnosis and treatment options based on symptoms. Computerized charting has some advantages: It is legible and tamper-proof and tends to reduce errors as many systems signal if a treatment is missed or the wrong treatment is given.

Subjective Notes

Client's statement of problem

Health Insurance Portability and Accountability Act (HIPAA)

Congress passed this in 1996. This includes a number of provisions that aim to improve the portability of health information records. The Department of Health and Human Services was charged with establishing national healthcare standards for storage and transfer of electronic health care information to improve the exchange of information from one insurance company/physician to another.

Standards of Care

Core Practice Standards are required for the nurse to achieve a competent level of patient care, while professional practice standards related to professional behavior. The CNS is responsible for competency in both areas of practice, should be actively involved in activities related to professional standards, such as evidence-based practice and research, and should serve as a resource person for other staff members, helping them to achieve adequate standards of care.

Assessment

Determination of possible causes

Nurse Practice Act

Each state has its own this, which is administrated by the state of Board of Nursing. This outlines requirements for licensure and certification and delineates the scope of practice of nurses, including duties and delegation. Typically, licensure is granted to those who complete an accredited LVN/LPN or RN program and pass the nursing exam or receive endorsement because of licensure in another state. This also provides the requirements for advanced practice certification and the professional designation. Additionally, this acts outline the requirements for re-licensing or re-certification, often including the need for continuing education. This also includes provisions for disciplinary action.

Privacy

HIPPA addresses the rights of the individual related to privacy of health information. The nurse must not release any information or documentation about a patient's condition or treatment without consent as the individual has the right to determine who has access to to personal information.

Right to care

If all patients deserve an equal right to care but resources are limited, then the task becomes one of determining ways to acquire more resources so all can be serves, but this not always possible. There is unequal geographic and economic distribution of resources.

Legibility in Documentation

If hand entries are used, then writing should be done with blue or black permanent ink pen, and writing should be neat and legible, in block printing if handwriting is illegible. Some facilities require blank ink only, so if unsure, should use blank ink. No pen or pencil that can be erased can be used to document in a patient's record because this could facilitate falsification of records. For the same reason, a line must be drawn through empty spaces in the documentation.

Quality of Life

If limited resources are allocated according to quality of life issues, someone has to decide what qualities take precedence, but this is little consensus in healthcare. Gender, race and ethnicity should not be factors, but it can be difficult to separate these from economic factors or social support issues.

Care Process

In assessing, diagnosing, developing, and implementing a plan of care, and evaluating the patient's response, the CNS must use the scientific method and national standards as the basis for care.

Ethical and Clinical Conflicts

Issues frequently related to medications and treatments, religion, concepts of truth telling, lack of respect of patient's autonomy, and limitations of manged care or incompetent care.

Confidentiality Agreement

Most organizations require personnel engaging in review of medical records or participating in improvement activities to sign this which outlines privacy issues and increase awareness of confidentiality concerns.

Timeliness in Documentation

Nurse should chart every 1-2 hours for routine care (bathing, walking), but medications and other interventions of changes in condition should be charted immediately. Failure to chart medications, especially prn medications, in a timely manner may result in the client receiving the medication twice. Additionally, if one nurse is caring for an umber of patients, if may be easy to forget to omit or confuse information. Nurses must never chart in advance because it is illegal and can lead to unforeseen errors. Guessing that a client will have no problems and care will be routine can result in having to make corrections. Nurses must chart the time of all interventions and notations. Time may be a critical element. Military time is used in many healthcare institution but if standard time is used, the nurse should always include "AM" or "PM" with time notriciation

Objectives Notes

Nurse's observation

Living Donor

Organs are donated by a living individual (one kidney, one lobe of liver, one lobe of lung, part of intestine, blood, stem cells)

Need to Know

Patients have a right to expect that they divulge personal information to a nurse that only those with a need to know (such as the physician and other nurses) will be provided this information. When nurse must document care, they must be sensitive to the information that they put into written record or report because many people have access to these records. If the information is health-related, then the nurse is obligated to record this and should tell the patient. These issues also relate to the patient's need to know about care and prognosis.

Organ Donation

People of any age can donate any of these: -Organs -Stem Cells -Blood/platelets -Tissue -Whole Body

Coercion

Power issues are inherent in matters associated with professional boundaries. Nurses can easily intimidate patients into having procedures or treatments they don't want. Regardless of age, patients have right to choose and the right to refuse treatment. Forcing the patient to do something against his/her will borders on abuse and can sometimes degenerate into actual abuse if physical force is involved.

5 Rights of Delegation

Prior to delegating tasks, the nurse should assess the needs of the patients and determine the task that needs to be completed and ensure that he/she can remain accountable and can supervise the task appropriately and evaluate effective completion. This includes: -Right task -Right circumstance -Right person -Right direction -Right supervision

Establishing priorities

Providing education and encouraging the patient/family to take an active role in self care is a primary concern. The CNS must ensure that the patient can make informed decisions. The CNS must assist the patient through all aspects of health care to ensure patient safety and optimal care.

Diagnostics

The CNS can order laboratory, EKG, and radio-graphic tests for routine screening and health assessment. The CNS can also diagnose based on assessment. There are limitations, depending upon the individual state nursing practice act.

Research and Education

The CNS initiates, participates in, and utilizes the results of research in clinical practice.

Accuracy in Documentation

Regardless of format, charting should always include any change in client's condition, treatments or other interventions, medications, client responses, and complaints of family or client. Nurses should avoid subjective descriptions (especially negative terms, which could be used to establish bias in court), such as tired, angry, confused, bored, rude, happy, and euphoric. Instead, more objective descriptions, such as "Yawning 2-3 times a minute" should be used. Clients can be quoted directly. If errors are made in charting, for example, charting another patient's information in the record, the error cannot be erased, white-out, or otherwise made illegible. The error must be indicated by drawing a line through the text and writing "Error"

Plan Notes

Short and long range goals and immediate plan of care

Gifts

Small tokens of appreciation that can be shared with other staff, such as a box of chocolates, are usually acceptable (depending on policy of institution), but almost any other gifts (jewelry, money, clothes) should be declined. Declining may relieve the patient of the feeling of obligation.

Donation after cardiac or brain death

Solid organs must be transplanted between 6-72 hours after removal although tissues can be frozen and banked.

Prescription

Terminology varies from state to state with CNS allowed to "furnish" or "prescribe" some types of medications. In some states they may do so independently; in others, they must be "supervised" by a physician under whose auspices they provide care to patients. The CNS should maintain a list of medications and consider cost-effectiveness when ordering medications.

Patient Advocacy

The CNS advocates for the individual patient in the process of care but also advocates for patients at the state and national level in order to facilitate patient access to care and improve the quality of care.

NACNS Statement of Practice

The CNS is 1 of 4 advanced practice nursing professionals recognized in the United States along with NP, Midwives, and CRNA. In 1998, the National Association of CNSs clarified the role of the CNS and identified 3 interrelated spheres of influence: Patient/client, nurse/nursing practice and organization/system.

Collaboration

The CNS is a member of the interdisciplinary health team and consults with others when appropriate and refers the patient to specialists as needed. When this is mandated by law, the CNS complies with all requirement.

Documentation

The CNS keeps accurate, legal, legible records and maintains patient confidentiality. The CNS ensures that the patient signs a release before providing medical records to other parties.

Organization/System Sphere

The CNS may be actively involved in administrative committees and may participate in planning for the organization.

Patient/Client Sphere

The CNS may provide assessment and direct care of the patient and family members related to a particular focus of health, such as diabetic care.

Continuous Quality Improvement

The CNS recognizes the need for constant learning and evaluation and reevaluation. It participates in quality review and continuing education while maintaining certification and utilizing clinical guidelines and standards of care.

Nurse/Nursing Practice Sphere

The CNS serve as a mentor, educator, or supervisor for other nursing staff. The goal of the CNS is to advance the practice of nursing.

Core Measures

The Joint Commission established these to determine if healthcare institutions are in compliance with current standards. This involve a series of questions that are answered either "yes" or "no" to indicate if an action was completed. The data is public and provides useful information about these particular standards, but does not necessarily reflect the overall quality of care. This alone are not adequate performance measures, but must be considered along with other indications.

Right Circumstance

The nurse has considered the setting, resources, time factors, safety factors, and all other relevant information to determine the appropriateness of delegation.

Right supervision

The nurse is able to supervise, intervene as needed, and evaluate performance of the task.

Right person

The nurse is in the right position to choose the right person (by virtue of education/skills) to perform a task for right patient.

Right direction

The nurse provides a clear description of the task, the purpose, any limits, and expected outcomes.

Right task

The nurse should determine an appropriate task to delegate for a specific patient.

Informed Consent

The patient or the patient's family must give this for all treatment the patient receives or for any study in which the patient participates. The physician must give a through explanation of all procedures and treatment and the associated risks. Patients and/or their families should be apprised of all options and be allowed input on the treatments administrated. Patients and/or their families should be made aware of all risks and any complications that might be lift threatening or increase morbidity.

Flow Sheet

These are often a part of other methods of charting and are used to save time. They may be used to indicate completion of exercises or treatments. They usually contain areas for graphing data and may have columns or rows with information requiring check-marks to indicate an action was done or observation made.

Critical Pathways

These are specific multi-disciplinary care plans that outline interventions and outcomes of disease, conditions, and procedures. Critical pathways are based on data and literature and best practices. The expected outcomes are delineated as well as the sequence of interventions and the timeline needed to achieve the outcomes. There are many different types of forms that appear similar to flow sheets but are more complex and require more documentation. Any variance from the pathway or expected outcomes must be documented. Critical pathways are increasingly used to comply with insurance limitations to ensure cost-effective timely treatment.

Conflict of Interest

These polices should be in place in each healthcare organization to ensure that those involves in review activities should be in place in each healthcare organization to ensure that those involved in review actives should not be primary care givers or have an economic or personal interest in care under review. In all cases, access to PHI should be limited to those who need the information to complete duties related to direct care of performance improvement review activities. `

Peer Support

Theses are becoming more common as the profession recognizes that the nurse must often cope with psychologically traumatic experiences as part of their profession as well as in their personal lives. These may comprise members from various levels of the organization, but when possible, the members should be chosen by staff rather than assigned.

Personal Information

This can is PHI and can be shared with spouse, legal guardians, those with durable power of attorney for the patient, and those involved in care of the patient (such as physicians) without a specific release, but the patient should always be consulted if this is to be discussed with others present to ensure there is no objection.

Narrative

This charting provides a chronological report of the patient's condition, treatment, and responses. It is an easy method of charting but may be disorganized and repetitive, and if different people are making notes, they may address different issues, making it difficult to get an overall picture of the patient's progress.

Protected Health Information

This consists of any identifying or person information about the patient (e.g. health history, conditions or treatments in any form) and any documentation (electronic, verbal, or written).

Charting by exception

This form of charting was developed in response to problem-oriented charting in an attempt to simplify charting. It includes extensive use of flow sheets and intermittent charting to document unexpected findings and interventions. However, because this focuses on interventions, those problems that require no particular intervention (such as increased discomfort after ambulating) may be overlooked, and charting may not be adequate for legal challenge because lack of charting may not be adequate for legal challenge because lack of charting may be constructed as lack of care of evaluation.

American Nurses Association's Scope and Standards of Gerontological Nursing Practice

This includes many skills, such as providing care, managing care, advocating for the patient, and researching ways to improve care. Education is an essential role of the this nurse. Duties outlined by this includes utilizing data, information, and knowledge to develop a patient care plan; assessing information for diagnosis; influencing health outcomes; planning care to provide appropriate treatment, implementing interventions and evaluating treatment progress; evaluating the quality of care; self-assessment of ability and performance in relation to professional standards; keeping up to date in the field; providing care in an ethical manner; working collaboratively with patients, family, caregivers, and interdisciplinary team members, utilizing research to provide evidence-based care; and providing and promoting safe and cost-effective care to all patient.

Referral Services

This includes referring patients to physicians, such as orthopedic specialists, and to organizations or agencies, such as drug rehabilitation programs.

Printed Newsletters

This involves costs that must be considered as part of operating expenses. These is also staff time involved in preparing the document as well as copyright considerations. Most government publications are copyright exempt and can be reproduced, but articles of interest from journals require permission to reproduce, which may be difficult to obtain for new materials. An alternative method is for someone to write a review of an article or articles, including summary of the main points. Use of pictures adds expense, especially if they are in color.

Electronic Newsletters

This involves staff time but are considerably less expensive. Additionally, links to online articles and color pictures can be easily inserted into the newsletter.

Bioethics

This is a branch of ethics that involves making sure that the medical treatment given is the most morally correct choice given the different options that might be available and the differences inherent in the varied levels of treatment.

Documentation

This is a form of communication that provides information about the healthcare patient and confirms that care was provided. Accurate, objective, and complete documentation of patient care is required by both accreditation and reimbursement agencies, including federal and state governments.

Competence

This is a legal definition that refers to the cognitive ability to make informed decisions or carry out activities.This is a property. People are assumed to be this and are able to comprehend information and understand consequences unless declared not this through a judicial process. People may be judged this because of psychiatric illness, mental disability, or dementia.

Capacity

This is a medical definition that refers to a the degree of capability a person has to make informed decisions, to comprehend information, and to understand consequences of accepting or refusing treatment. This is an ability, not a property. This may vary, depending on circumstances including whether the patient is ill or medicated, and may change over a period of time. This may be determined by physicians, but may require referral to the judicial system for a ruling of incompetence. This should be considered both when a patient accepts and refuses treatment.

Ombudsman

This is a person charged with advocating for the rights of the patient and for adequate patient care, and with assisting in resolving conflicts. This person may visit patients and work with staff to resolve moral distress and ethical conflicts. In many cases, this person is a trained volunteer and often serves geriatric or disabled patients and/or those in long-term care.

Benefience

This is an ethical principle that involves performing actions that are for the purpose of benefiting another person. In the are of a patient, any procedure or treatment should be done with the ultimate goal of benefiting the patient, and any actions that are not this should be reconsidered. As a patient's condition changes, procedures need to be continually reevaluated to determine if they are still of benefit.

Nonmalificence

This is an ethical principle that means healthcare workers should provide care in a manner that does not cause direct intentional harm of the patient: -The actual act must be good or morally neutral -The intent must be only for a good effect -A bad effect cannot serve as the means to get to a good effect -A good effect must have more benefit than a bed effect has harm.

Peer Review

This is an intensive process in which an individual practitioner is reviewed by like practitioners. It may be used for an individual practitioner and patient or a group of patients and often relates to data found as part of a root cause analysis, infection control, or other surveillance measures.

Nursing Informatics

This is basically the study of information and how it is managed. According to the ANA scope and standards, this is the integration of nursing, computer and information sciences in the management of data and information. Much of nursing time is involved in documenting data and managing information, so this person seeks methods to streamline and improve these processes. Credentialing is available in this.

Justice

This is the ethical principle that related to the distribution of limited resources of healthcare benefits to the members of society. These resources must be distributed fairly. These issues may arise if there is only one bed left and two sick children. This comes into play in deciding which child should stay and which should be transported or otherwise cared for. The decision should be made according to what is best or most just for the patients and not colored by personal bias.

Autonomy

This is the ethical principle that the individual has the right to to make decisions about his/her own care. In the case of children, the child cannot make this type of decisions, so the parents serve as the legal decision maker. The nurse must keep the parents filly informed so that they can exercise this in informed decision-making.

Confidentiality

This is the obligation that is present in a professional-patient relationship. Nurses are under an obligation to protect the information they posses concerning the patient and family. Care should be taken to safeguard that information and provide the privacy that the patient deserves. This is accomplished through the use of required passwords when family call for information about the patient and through the limitation of who is allowed to visit. There is a time when this can be broken to save the life of a patient, but those circumstances are rare.

Organizational Ethics

This is the value system at work within an organization. While almost all health organizations have a code of ethics, an ethical organization embodies that code within all process including: -Relationship with customers and the public, utilizing a code of right conduct -Recognition of the patient's/customer's right to quality care and respect for personal religious beliefs, culture, and psychosocial values -Openness is disclosure of information and accountability -Adherence to regulations and best practice -Recognition of the need to empower staff and patient/customers -Leadership without intimidation of fear tactics -Following standard open guidelines for organ donation and procurement and for research projects -Maintenance of a bioethics committee to provide guidance related to ethical issues in healthcare

Ethical Consult Team

This is usually composed of interdisciplinary team members who meet on request to to assist with solving ethical problems. The team members also often educate other staff members, patients, and community members about ethical issues and provide recommendations and advice.

Consultation services

This may include a variety of services, such as assessment of growth risk factors, providing interventions (e.g. diet and exercise programs), and educating patients/families.

Negligence

This may involve a number of failures, such as not referring a patient when needed, incorrect diagnosis, incorrect treatment, and not providing the patient/family with adequate or essential information.

Moral Distress

This occurs when a person acts in a manner inconsistent with personal and moral values or is aware an ethical action but unable to carry it out. Indications of this are: -Physical problems such as insomnia, weight changes, impaired cognition, GI disturbances, fatigue, and various physical ailments. -Emotional problems such as anger, grief, depression, outburst, confusion, and frustration -Behavioral problems such as substance abuse, gambling, inflexibility, aggression, depersonalization, and violations of boundaries. -Spiritual problems such as loss of faith or meaning in life, impaired relations with others

Chaplains

This person provides spiritual and emotional support to patients, family and healthcare providers. In some cases, such as Catholic hospitals, the chaplain is a priest, but other hospitals may have chaplains who are priest, rabbis, imams, or pastors.

Problem, Intervention, Evaluation (PIE)

This problem-oriented form of charting is similar to SOAP but is less complex. It combines use of flow sheets with progress notes and a list of problems. Each problem is numbered sequentially, and this is made for each problem at least one time daily (of during treatment, depending on frequency)

Rights Theory

This theory protects and supports the rights set by society, such as those permitted by tradition law. Individuals may also grant rights other others. However, this theory doesn't establish an ethical basis for establishing rights.

Virtue Theory

This theory purports that when one's ethical decisions are questionable, then the person's morals and motivation (virtues) should be taken into account; however, this theory doesn't recognize that morals can change.

Casuist Theory

This theory states one should compare a current ethical dilemma with similar ethical dilemmas to study outcomes and arrive at a compromise solution. In some cases, however, there may not be comparative dilemmas.

Deontology Theory

This theory states that when confronted with an ethical dilemma, people should adhere to obligations and duties. This provides consistency, but there is no clear method of establishing the basis for deciding on obligations and duties.

Focus/ data, action, response (DAR)

This type of focused charting includes documentation about health problems, changes in condition, and concerns or events, focusing on data about the injury/illness, the action taken by the nurse, and the response. The written format is usually a 3 columns (D-A-R) rather than traditional narrative linear form. This is used for each focus item.

Care Conference

This usually involves all team members charged with care of a patient and may be activated routinely on a regular basis, such as weekly, but may meet more frequently at the rest of a team member or when concerns regarding moral distress and ethical conflicts are voiced by the patient or family member. Whenever possible, the patient or family member should attend this. Conflicts often result from inadequate communication.

ANA Social Policy Statement

This was written in 1980, revised in 1995, and revised again in 2003. This provides a description and definition of nursing practice and outlines the knowledge based required for nursing and the requirements and scope of practice for advance practice nurses, such as the CNS. This is recognizes the social contract that exists between nursing and society and the responsibilities that the social contracts entails. This also describes the regulation of nursing, including self-regulation, professional, and legal, centering on the code of ethics, and meeting of certification requirements.

Coordination Services

This with the nurse maintaining contact and receiving reports from referrals in order to provide an integrated plan of care, serves as a valuable service to patients who often must deal with many different healthcare providers who have little or not contact with each other. This type of service can prevent unnecessary duplication of service but also ensure that findings are not overlooked.

Delegating Tasks to Unlicensed Assistive Personnel

To do this you must make sure, providing those personnel have adequate training and knowledge to carry out the tasks. This should be manage the workload and to provide adequate and safe care. The nurse who delegates remains accountable for patient outcomes and for supervision of the person to whom the task was delegated, so the nurse must consider the following: -Whether the knowledge, skills, and training of the unlicensed assistive personnel provides the ability to perform the delegated task. -Whether the patient's condition and needs have been properly evaluated and assessed -Whether the nurse is able to provide ongoing supervision

Whole Body Donation

Usually organs cannot be donated separately and the body is donated intact

Economic Considerations

With limited resources, care is often rationed according to those who have insurance or other economic means to pay for it. Medicaid and other programs to pay for care provide some balance, but these programs may not pay for expensive procedures that are available to those with more financial resources.