Fundamentals of nursing - Exam 2

Beneficence

Beneficence: taking positive actions to help others, "doing good" It required best interests of clients are more important that own self interest E.g.: giving a patient liquid medicine that he requested it when you know the patient difficult of swelling. It also causes risk of doing harm. E.g.: advising a patient about exercise to their health, but they are not doing so because the patient has respiratory disease.

Identify common forms of nursing malpractice.

Common forms of Nursing Malpractice - failure to note a change in patient condition - misuse of medical device - failure to get informed patient consent - documentation error - failure to promptly carry out doctor's order - failure to assess and document patient's condition or complaint - failure to notify doctor of a patient's condition - failure to evaluate and respond to a patient's needs - Medication error

***Justice

being fair, fair distribution of resource in health care. e.g.: transplant organ has to wait in order.

Identify characteristics of autonomy

***Autonomy: The right to make one's own decisions The nurses respect patient's rights to make decision, even when the choices seem to not met their status. It is treating others consideration, and it is not treating people as impersonal sources of knowledge or training. E.g.: Informed consent to people before test procedures Individual has the rights to make their own decisions, but as nurses, we may need to reframe interfering somebody' choice. Informed consent exercises the right of a person's autonomy

***Describe the Americans with Disabilities Act.

***Americans with Disabilities Act - It protects people have physical illness and mental disability, they prohibit discrimination, and give their opportunities to those disabled people have. ***ADA 1990, 2008 • Protects the rights of disabled people • "disabled person" - physical or mental impairment that substantially limits one or more major life activities • ***Several recent laws have further defined "disability" - HIV positive individuals • Privacy - right to determine disclosure of their disability • Protects disabled workers in employment and protects disabled patients from discrimination歧视

Identify communication techniques used with different age groups

***Communication: Children Ages 1-6 • Develop a rapport with parent & child • Initially focus on parent, get rapport with the parents, gives child a chance to "check out the nurse" • GOOD COMMUNICATION WITH PARENT = GOOD COMMUNICATION WITH CHILD • ***Consider child's level of language development • Be alert to parent/child interactions, because that can tell you a lot, do not assume relationships • Refer to child & parent(s) by name • Avoid being judgmental • Do not assume that partner with spouse is child's biological parent • Do not ignore the child, ask about their toys • Keep movements slow & deliberate - children are easily frightened Communication: Preschoolers Vocabulary - 2 years - ego-centric. Everything in their world comes from their point of view; they can combine with couple words, e.g.: all gone - 3 years - can use complex sentences, sometimes 3-4 words - 5-6 years- longer sentences with 6-8 words, well developed grammar Animistic精灵论的 thinking- inanimate objects are alive. E.g.: preschooler think stethoscope is a snake and it is going to bite them. - Communication: School Age Child (7-12 yrs) Able to tolerate & see other's viewpoints More objective, realistic Want to know how things work & why things are done Thinking is more logical but not yet abstract Interview child & parent together - Communication: Adolescent Adolescence begins with puberty Crave acceptance want everyone likes them Important to be respectful & honest - will pick up on dishonesty very quickly Avoid nonprofessional language - YOU ARE NOT THERE TO BE THEIR FRIEND Explain what you are doing Praise positive behaviors, address risky behaviors Be nonjudgmental - Communication: Older Adults will be longer interview Recognize hearing deficits Ask them "can you hear me? Do I need to talk louder?" Minimize distractions (turn television down) & face the patient when speaking (make sure they're listening when you're speaking) Allow time for responses "Do you want me to repeat that question? Do I need to give you a little more time?" Watch for impaired communication Ask their family members, "what is the best way that I can talk to their grandmother". Use last names when you speak to somebody older, never call them "sweet, honey", and you always ask them what they want to be called Avoid using "we", e.g.: it's time for our bath today. Expect longer interview with older person because they have a lot of stories.

Define cultural competence and the relationship with patient-centered care.

***Cultural Competence: process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent适合的 care (Campina-Bacote, 2002) treat every person as individual

Identify the relationship between culture and health.

***Culture and Health • Culture defines when a person is healthy and when they require intervention. Influences what people think is cause of disease. • Culture influences what people believe to be the cause of disease- hence what the intervention should be • Culture is one of the most influential factors in a person's health

List cultural conflicts that could affect patient care.

***Ethnocentrism: a tendency to hold one's own way of life as superior to others. Your culture, values and viewpoints are the only truth. Other people's views don't matter. Giver other groups negative characteristics.

***Discuss the role of Standards of Care

***Standards of Care: are the minimum requirements for providing safe nursing care. • Legal guidelines for nursing practice • Provide minimal acceptable nursing care • Set by: each state in its Nurse Practice Act, federal and state laws, by professional nursing organizations, health care facilities and accrediting bodies • Must know your state's standards of care and any restrictions • IGNORANCE OF THE LAW IS NO DEFENSE AGAINST MALPRACTICE What if... • If a nursing negligence law suit is filed, the jury will use that standards of care to determine if the nurse acted appropriately • Will be held to the same standard as other nurse in your setting (ICU, OR, specialty) • Specialized nurses will be compared to other specialized nurses

Accountability

- Accountability is the willingness to accept responsibility for one's action. - Accountability is required to provide safe patient care and address potential problems. - An important aspect of accountability is tested when a nurse inadvertently makes a mistake. - A nurse who is being accountable reports the error and take responsibility to ensure patient safety, regardless of the personal consequences.

***Define the role of an interpreter.

- Do not ask a family member to be the interpreter - Be aware of gender and age differences - Address questions to the client, not the interpreter - Ask the interpreter to interpret as closely as possible the words used by the nurse - Speak slowly and distinctly, avoid metaphors - Observe facial expressions and body language that the client assumes when listening and talking to the interpreter - Federal mandates require accommodation for language differences - Use hospital provided interpreters when possible

Discuss the role of ethics in professional nursing

- Ethics: the study of conduct and character. Concerned with determining what is good or valuable for individuals and society at large. Ethics helps people to understand human behavior. It expected standard of moral behavior of particular group, and describe that groups, their professional code of ethics. Nursing ethics is ethical issues that occur in nursing practice. ANA Scope and Standards of Practice holds nurses accountable for their ethical conduct. Values: personal beliefs about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. In nursing, you agree to provide your clients based on their needs of service. Many of these people have different values. It is very important to clarify your own values that you can respect somebody else. Values influence decisions and your actions. Value system is an organization of values. It is a basic way of life, and it is basic of your behavior. A belief is an opinion, an interpretation, or a conclusion that someone has made or accepted as true; it based more on faith than on fact. A belief is not necessary involve the value. E.g.: if I study really hard, I will get a good grade. -belief. Good grades are really important to me. I am studying hard to get the good grade. - value. Attitudes are mental position or feelings toward somebody else, an object, or an idea. E.g.: compassion, empathy Personal values vs. professional values Personal values are those we derive from society from subgroups or families that used to help feel excepted Professional values are acquired by nurses/faculty during socialization process.

Verbal Responses to Improve Communication

- Facilitation助长- wanting person to continue talking- nodding, mmm go on- maintain eye contact - ***Silence-time to think- you can observe a pt. - Reflection-teaching a pt. words- repeating - Empathy- recognizing someone's feeling and putting it into words - Clarification- Using ambiguous words choice- "explain this to me"

Define health disparities and challenges with health care.

- Healthy People 2020 defines health disparities不一致 as: "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage." - ***Health Disparities: differences in care experienced by one population compared with another population. It can be a culture, and can be ethnic group Asian adults 65 or older 50% non-like immunization

Describe the basic elements of the communication process

Communication Elements - Courtesy: Knock on doors before coming in; say hello/bye; - Use of names: always introduce yourself and your title. - Trustworthiness: help other people without hesitating; be open with people - Autonomy & responsibility: - Assertiveness魄力，自信: Assertiveness is the ability to express ideas and concerns clearly while respecting the thoughts of others. - Sending (sender is the person who delivered/encode the message by translating their thought and feelings into communication with a receiver; message contains verbal and nonverbal; nonverbal is more important) - Receiving (receiver is the person who receive and decode解码 that message) - Comprehension of the message (it takes two people to understand the same message differently, message including spoken, written, and nonverbal modalities形式.) - Feedback (also very important; the message indicates whether somebody has received the same message that you think they have.)

Describe effective communication techniques for those with impaired communication

Communication: Patients with Special Needs Cannot Speak Clearly (Aphasia, ***Dysarthria: can offer patient paper & pen, Mute) • Listen carefully, do not interrupt • Yes/no question • Allow time for response • Use visual cues (words, pictures, papers to write response) when possession • Communication aids Communication: Patients with Special Needs Hearing Impaired • Check for hearing aids • Reduce environmental/ background noises • Get patient's attention before speaking • Face the patient • Speak at normal volume unless patient asks you to speak louder • Rephrase if misunderstood Communication: Patients with Special Needs • Visually Impaired • Check for use of glasses • Identify your self when you enter a room • Speak in normal tone of voice • Do not rely on gestures or nonverbal communication • Use indirect lighting, avoiding glare • Use at least a 14 font print Communication: Cognitively Impaired • Simple language • Ask only one question at a time • Allow time for response • Attentive listening • Include family and significant other • Pictures on gestures may be uses Communication: Chemically Impaired • Many poly-drug abusers name of the drug, the quantity of the drug • May be agitated, bizarre or paranoid behavior • Sometimes will be violent • Decreased sensitivity to pain • Use simple, non-threatening questions • Priority is to find out what specific drugs, names, and quantity the patient has ingested • Be aware of security in place- do not put yourself in a bad situation Communication: Sexually Aggressive • Flirtatious comments, seductive innuendos, sexual advances • May cause feelings of embarrassment, anger Communication: Threat of Violence • Red flag behaviors- fist clenching, pacing, vacant stare confusion • Watch for statements that indicate out of touch with reality • 1st PRIOPITY is SAFETY - diffuse situation, call security • TRUST YOUR INSTINCTS leave the door open, and place yourself between the patient and door • Remain calm, do not raise your voice of threaten the patient • If you are uncomfortable Communication: Emotional Patients • Crying • May enhance communication, may make patient feel better • Offer tissues, allow them time, acknowledge their feelings Anger Do not blame yourself Deal with your own feelings before you speak Consider the circumstances and why the patient is angry Nonverbal behaviors that may indicate tension and anger include: Frowning, Stiff posture, Squinting, clinched teeth, Staring, Crossed arms, Disgusted affect Possible causes of patient nonverbal indications of tension and anger include: Pain, Frustration over cancer diagnosis, Fear of dying, Anger over being sick and unable to provide for his family, Concern about who will take care of his wife and children if he dies, Frustration with feelings of fatigue, Lack of information regarding experimental treatment options, Indecision about what treatment to pursue Anxiety Normal in the health care environment People may become more aggressive when ill or may be unusually dependent Communication: Patients with Special Needs Does not Speak English • Speak in normal tone of voice • Provide an interpreter • Avoid using family member, esp. children, as interpreter • Use communication board or pictures • Translate a few basic needs word Communication: Patients with Special Needs Unresponsive Patient • Call patient by name when interacting • Communicate verbally and by touch • Speak to patient as though they can hear you • Explain all procedures • Orient patient to person, place and time • Avoid talking to others about the patient in their presence

***Identify features of therapeutic and nontherapeutic communication - know definitions as well as being able to identify a technique used in a situation

Communication: Therapeutic ***Active Listening - SOLER - Sit facing the person - Observe an open posture don't cross your arms and legs - Lean 倾向towards the person - Establish & maintain eye contact (establish and maintain intermittent间歇的 eye contact, not constant不变的) - Relax Communication: Therapeutic Sharing first technique • Observation- where you are going to address their nonverbal behavior; allows patient to validate a nurse perception; it provides an opening for patient to share a little bit more. E.g.: you look very tense today. • Empathy- is the ability to understand and accept another person's reality; reflects that you understand what they are feeling; feeling with people • Hope- communicate a sense of a possibility • Humor- provides encouragement; lighten up that heavy moment; if used properly they can focus on positive progress, and not change subjective communication. • Reflecting Feelings- focusing on the patients identifies feeling based on their verbal or nonverbal cues. Reflecting directs the focus of the conversation back to the client so that he can further explore his own feelings. Communication: Therapeutic Using Touch and Silence Touch - conveys empathy, provides emotional support, provides encouragement, gives somebody personal attain, helps relax someone. Silence - gives time to reflect; provides time for them to think about what they were saying, or you as a nurse to process what they were saying; can communicate concern when there is nothing adequate to say. Communication: Therapeutic Providing Information- you want to provide information is facts; you provide means to develop their trust, develop knowledge phase, so the patient can make decisions. - Clarifying - restating, reflecting, paraphrasing checking whether the understanding is accurate, relate to unclear message; helps to avoid misunderstanding, includes restating, reflecting, paraphrasing, and encourage somebody to describe the situation more fully to demonstrate they are listening. E.g.: a patient says to you, "I cannot sleep last night". The nurse can say you have trouble sleeping last night? Make sure what are hearing is they are saying. - Focusing- encouraging someone to share specific data, in order to completes an assessment; give you a better understanding of what they are saying; ask the patient to provide details, e.g.: "when did you start feeling short breath?" Communication: Therapeutic Paraphrasing or restating- encouraging your pt. to share more information, demonstrate you are listening. E.g.: P: "I couldn't sleep last night." N: "You had trouble sleeping last night?" ***Summarizing- reduces interact to 3-4 points, allows the patient to agree or add additional concerns - Self-Disclosure/Offering Self: demonstrate compassion and concern for the patient; establishes a caring relationship. Showing that you care, and you have to be careful about what say to the patient. E.g.: I will sit with you for a while. - Confrontation: helping a patient become more aware inconsistency. Uses when you establish trust. Communication: Therapeutic - ***Asking Relevant Questions - General leads- encourages someone to keep talking, demonstrates the nurse's interest in the patient's concerns. E.g.: and then? Go on. Tell me more. - Broad openings- clarify the patient to take the lead in a conversation and discourages small talk E.g.: What do you want to talk about today? - Exploring- examines ideas and experiences a little more fully. You don't want to probe if they are not willing to cooperate. - Encouraging comparisons- helps the patient to clarify something - Open-ended Questions Communication: Nontherapeutic • ***Asking personal questions-be careful when asking personal questions- must have a good relationship with person • Asking closed-end questions- "yes or no" question. Allows patient to refuse forms of care "Do you feel better today", "Can I give you your meds now?" • ***Giving personal opinion/advice- discouraging someone from finding an appropriate response-removes decision making authority from the person • Changing the subject- avoids exploration of the topic, demonstrates nurses discomfort with something Communication: Nontherapeutic • Automatic responses- discounts someone's belief/opinions, limits further on subject, might be perceived by someone who is judgmental. saying "I am giving you a bath because it's for you" • ***False reassurance- discounts the patient's feelings. Cuts off conversation about legitimate concerns of the patient. Demonstrates a need by the nurse to "fix" something that the patient just wants to discuss. E.g.: everything will be okay. • Minimizing feelings-the nurse is not able to understand or empathize with the patient saying the patient's feelings are not valid. Saying "you worry too much"- makes the person not feel good • Sympathy-saying "I'm so sorry you have cancer." Communication: Nontherapeutic • Asking "why" questions-implies criticism- can cause someone to become defensive- requires justification of actions. Focus on a problem rather than a solution, saying "Why did you do that?", "why are you feeling that way why do you smoke when you know it's unhealthy?" • Arguing- challenging someone else's views, denies their feeling is not real. • Defensive responses- on one here is trying to hurt you, you will not get any better anywhere else • Negative Nonverbal-bad body language-arms crossed, not making eye contact • Excessive self-disclosure- you are implying that your experiences are similar to your patients. Experiences telling them all about your breast cancer when your patient has newly diagnosed it • Being defensive- focusing away from the patient discounting their feelings and limiting

Differentiate between culture and ethnicity.

Culture - ***learned, shared knowledge of values, beliefs, & ways of life of a particular group, transmitted from one generation to another Ethnicity - an individual's identification with or membership with a group (could be racial, cultural) based on cultural similarities & differences

***Apply critical thinking to ethical dilemmas

Ethical Dilemmas: occur in the presence of conflicting values, clarifying your own values is an important part of your ethical clarification. E.g.: abortion, Resuscitated被复苏的, DNR (do not resuscitate) All hospitals have Ethics Committee includes ethical case consultation, recommendations of policies & procedures related to ethics, provision of multidisciplinary input. Ethics Committee is a group of people that helps to make decisions. They punish anybody. ***What is the purpose of the Ethical Committee? • ethical case consultation • recommendations of policies & procedures related to ethics • provision of multidisciplinary input. • Referencing care givers an ethical issue The Ethics Committee is an advisory committee that reviews and request ethical or moral questions that may come up during a patient stay. The committee members include doctors, nurses, social workers, attorneys, medical ethical professionals.

Define HIPPA

HIPPA was enacted in 1996 to protect the privacy of health care information. HIPPA contains four sets of standards each with rules that must be implemented by all health care facilities.

***Identify a nurse's communication approaches within the four phases of a helping relationship

Helping relationship - any interact you have with the patients - Preinteraction: Before you meet the patients, you need to learn about the patient, e.g.: review the data about that patient or health records, where are they from, their diagnosis, you might talk to others (nurses work with you) ask if anything you need to know. Before meeting the patient, you: • Review available data, including the medical and nursing histories • Talk to other caregivers who may have information about the patient • Anticipate health concerns or issues that may arise • Identify a location and setting that will foster comfortable, private interaction • Plan enough time for the initial interaction - Orientation (or introductory): interview, assessment, nursing diagnosis Where you meet the patient and get to know them some. Relationship is superficial. Expect them to test your competence. Important to look at nonverbal behavior Clarify roles. Let the person know what to expect Make comments (card and pictures) in room to try to get to know them better and learn about them. When you and the patient meet and get to know one another. you: • Set the tone for the relationship by adopting a warm, empathetic, caring manner • Recognize that the initial relationship may be superficial, uncertain, and tentative试验性 • Expect the patient to test your competence and commitment • Closely observe the patient and expect to be closely observed by the patient • Begin to make inferences and form judgments about patient messages and behavior • Assess the patient's health status • Prioritize patient problems and identify patient goals • Clarify the patient's and your roles • Form contracts with the patient to specify roles - ***Working: intervention, ***goals or outcome Work with the patient to try to solve problems and goals. You know the patient is a little bit better, and you work with them. You are going to provide the information (education); you help them set some goals, using therapeutic communication; you can use appropriate self-explosion, e.g.: there are some appropriate things you can share about yourself Working phase is where you use the therapeutic communication When you and the patient work together to solve problems and accomplish goals, you: • Encourage and help the patient to express feelings about his or her health • Encourage and help the patient with self-exploration • Provide information needed to understand and change behavior • ***Encourage and help the patient to set goals • Take actions to meet the goals set with the patient • Use therapeutic communication skills to facilitate successful interactions • Use appropriate self-disclosure and confrontation对抗 - Termination: - evaluation Ending the relationship. Remind your patient: "my shift ends at 3 o'clock, so I won't be here after 3pm. So I want evaluate what goals are, you did this this this." During the ending of the relationship, you: • Remind the patient that termination is near • Evaluate goal achievement with the patient • Reminisce about the relationship with the patient • Separate from the patient by relinquishing responsibility for his or her care • Achieve a smooth transition for the patient to other caregivers as needed

***Nonmaleficence

Nonmaleficence: avoidance of harm or hurt Harm: intentional harm is never acceptable. You can put somebody at risk for harm. e.g.: medications, chemotherapy. We know the harm can bring the benefit for the patient. Unintentional harm risk could not have been anticipated, such as in doing CPR, and brake the patient's rib.

Identify nursing responsibilities related to the use of restraints

Restraints抑制- difficult area • Federal Nursing Home Reform Act (1987) - Gave residents the right to be free from unnecessary restraints • The Joint Commission (2011) and CMS (2007) set standards for reducing the use of restraints in health facilities • Must try less restrictive methods first, have written order (updated every 24 hours), order must be updated frequently • Order includes start and stop time • Nurses must to know assess the condition of the client frequently, skin, circulation, mental status, documentation is very important.

***Veracity

Veracity诚实: telling the truth Choice not very clear e.g.: should nurse tell truth when it is known to cause harm. Potassium in IV; it is better to tell the patient that is going to be painful, do not lie to reliance some of their anxiety.

***Fidelity

agreement to keep promises, includes obligation to follow though with care when it offered to clients. E.g.: if you offer a client of plan of care, then you are obligated to monitor that person with response.

***Autonomy

the right to make one's own decisions/determination

Levels/types of Communication

• ***Intrapersonal: self talk; internal discussion we are having. Meditation is a continuous thought process that centers on one idea with the goal of achieving inner peace and relaxation. Some people use meditation regularly as a means of self-encouragement and reassurance. • Interpersonal: communication that occurs between two or more people; it is most common type of communication in nursing. Effective interpersonal communication among health care professionals is essential to ensure patient safety. SBAR model: situation, background, assessment, and recommendation (p. 43) • Transpersonal: communication that dresses spiritual needs, such as prayer, meditation, guided reflection (e.g.: deep breathing before exam is transpersonal communication) • Small-group: in group of people; usually goal directly; need to understand group dynamics for small-group communication • Public: in large groups; education, teaching, e.g.: nursing instructor teach nursing student • Interprofessional: between professions. That is TEAMWORK.

***Define the factors that inhibit sensitivity to diversity.

• ***Stereotyping刻板印象 ALL members of a culture, ethnic group, or race, i.e.: all homeless people have mental illness • ***Prejudice偏见 preconceived notion or judgment. Not based on knowledge. Devalues a group due to assumed behaviors or attributes. Labeling a group. E.g.: Asians are better at math. • Racism assumptions held about racial groups. Physical and biological characteristic. One race is superior or inferior to another. E.g.: red heads have pale skin. • Discrimination policies or practices that harm groups and members, e.g.: harsher treatment of minorities by law enforcement. Segregation种族隔离 • Generalization statement. Broad application of an idea.

Discuss the role of values in the study of ethics

• Altruism- concern for welfare and well-being of others It reflects when you take care of people that you have concerns for them. • Autonomy- the right to make one's own decisions/determination • Human Dignity- the respect or the worth and uniqueness of individuals. It includes populations. It reflected when a nurse values and respects of the patients and colleagues. • Integrity-acting in accordance with appropriate code of ethics, accepting standards of practice. It reflects when the nurse honest. • Social Justice-acting in accordance of fair treatment regarding economic status, race, ethnicity, age, citizen ship, disability, and sexual orientation. It is acting important with fair treatment.

***Identify nursing student legal responsibilities.

• Can't witness any legal document • Can't administer blood • Can be held liable for their actions • ***can ambulate with patient • ***can demonstrate medicine to patient • If you work as a tech and have learned

Health Disparities ***Minority populations more likely to:

• Have poor health • Die at an earlier age because of genetic differences, health behavior- using herb treatment maybe harmful to the body, and socioeconomic factors • Have lower quality of preventive, primary and specialty care because they have a decrease access of care - poor access to health care, quality of care Disparities occurs in access to care, they occur in quality of care, preventive care, in health educations, also in available resources HP 2020's high priority goal is to eliminate disparities

Identify and differentiate various types of law -statuatory, Regulartory, and Common law.

• Statutory法定的 Law- enacted by levels of legislature is created by legislative bodies such as the U.S. Congress and state legislatures立法机关. Statutory laws are often referred to as statutes. State statutes should be consistent with all federal laws. Statutes governing health care, such as provisions for care of the uninsured and the actions that constitute child abuse, originally became law after they were introduced and passed as bills in a legislative body. Legislators introduce bills in Congress or state legislatures in response to the rapidly changing health care environment, nursing and medical research, and constituents' concerns. • Regulatory Law- administrative bodies set up in the state and federal government Outlines how the requirements of statutory law will be met. Nursing rules and regulations are categorized as regulatory law. • Common Law- judgment law, - nursing practice. E.g.: the law regarding form consent, a client refuse to medical treatment

***Differentiate between Civil and Common law including intentional and unintentional torts

• Torts侵权行为-civil wrong against a person, agency, or property. It is the opposite of criminal law. E.g.: I am suing the nursing home because they didn't take care of my mother appropriately. Torts are wrongs committed against another person that do not involve a contract. Torts against another person may cause injury, damage property, or infringe侵犯 on an individual's personal rights. Torts can be classified as intentional or unintentional. • Classification: • intentional 蓄意的- intentional torts are wrongs committed by individuals who deliberately seek to injure or hurt another person. • unintentional - unintentional torts are omissions or acts by individuals that cause unintended harm. The unintentional torts of negligence and malpractice are charged when individuals, health care providers, or institutions fail to act responsibly, causing injury to others. Intentional Torts • Assault- intentional threat to bring about harmful contact, actual contact not necessary Assault is a threat of bodily harm or violence caused by a demonstration of force by the perpetrator. A feeling of imminent harm or feeling of immediate danger must exist for assault to be claimed. Key issue - consent同意，赞成 • Battery- often come with assault. intentional touching without consent, contact can be harmful or merely offensive to personal dignity Actual physical harm caused to another person is battery. The threat to hurt someone is carried out. E.g.: performing a surgical procedure without informed consent is an example of battery. Inserting an intravenous catheter or urinary catheter against the will of a patient. Key issue - Consent • False Imprisonment监禁，关押 - unjustified restraint of a person against his wishes without a legal warrant. Actually force is not necessary to support the false imprisionment Unauthorized restraint or detention of a person is considered false imprisonment. E.g.: preventing patients from leaving a health care facility at their request. The patient is asked to sign a AMA (against medical advice) form if a patient chooses to leave a facility when physicians think the patient need to hospitalized. • Invasion of Privacy - when a person's private affairs is made public without consent; release of medical information to unauthorized person E.g.: Public disclosure of private information, use of a person's name or likeness without permission, intrusion into a person's place of solitude, and meddling into another's personal affairs. Accessing the medical record of a patient for whom a nurse does not have the responsibility of providing care. • Defamation诽谤 of Character- publication of false statements that result in damage to pt.'s reputation Occurs when a public statement is made that is false and injurious to another person. • Slander诽谤 - Oral defamation • Libel诽谤罪 - Written forms of defamation诽谤 of character are considered libel Unintentional Torts • Negligence 疏忽- failure to act in a reasonable and prudent谨慎的 manner Creating a risk of harm to others by failing to do something that a reasonable person would ordinarily do or doing something that a reasonable person would ordinarily not do constitutes negligence. E.g.: if water is spilled on a hospital corridor floor, a reasonable person would recognize it as a potential fall hazard, seek to alert others to it presence, and have it cleaned up as quickly as possible. • ***Malpractice 玩忽职守，治疗不当- professional negligence; the failure of a person with specialized education and training to act in a reasonable and prudent谨慎的 manner. Malpractice is negligence committed by a person functioning in a professional role. E.g.: engaging in sexual activity with a patient; calculating medication dosages inaccurately, resulting in a patent's drug over dose. To avoid a charge of malpractice, a nurse must provide care commensurate with care provided by other nurses with similar levels of education and experience.