Concepts Exam III

The Code of Ethics for Nurses (ANA, 2015a)

guides that advocacy includes supporting nurses who return to practice after receiving the appropriate assistance and treatment for substance abuse

reports made to prevent an incident from occurring again but not for discipline

incident report

What does downcast eyes usually indicate?

sadness, poor self-esteem, desire to avoid the conversation, respect, powerlessness, or submissive behavior.

What development variations need to be considered when communicating with an older adult?

sensory alterations, such as hearing loss or vision changes, or any of a variety of healthcare problems that affect cognition, and expression, such as dementia.

As a student, you may feel uncomfortable talking to Mr. Barker about his recent diagnosis. You may be tempted to say, "Maybe the test results are wrong," or "I think you can beat this." This is false reassurance and false hope. What could you say instead?

"You must have many questions. I will explain as much as I can, and we can ask your nurse to talk to you too, if you like." or "You have good reason to worry. It might help you to talk to someone about your concerns. Would you like for me to arrange for a more experienced counselor or hospital chaplain to come visit you when you're ready?"

What do Advanced Directives include and do?

(e.g., living will, durable power of attorney for healthcare) allow adults while they are competent to make decisions about their healthcare that will guide their care when they are no longer able to do so on their own.

Rigor morits

(the stiffening of the body after death) is caused by contraction of the muscles from a lack of adenosine triphosphate (ATP).

What should you chart?

- All interactions with clients, as well as the refusal of or noncompliance with treatment. - Telephone conversations with primary care providers, including time, content of the conversation and the action you took. - The facts; do not editorialize (e.g., do not write, "I could not check on the patient as often as prescribed because we were understaffed").

Intentional torts mostly encountered in nursing are:

- Assault - Battery - False imprisonment - Invasion of privacy.

What are some examples of violating right to privacy (invasion of privacy)?

- Discussing patients in public places (e.g., elevators, cafeterias) - Photographing patients without their permission - Providing information to news media without consent, - Searching a patient's personal belongings without permission - Releasing medical information without the patient's consent.

to win/recover damages in malpractice (cause injury or death) lawsuit for non-intentional torts, plaintiff (patient) must have these four areas:

- Duty - Breach of duty - Causation - Damages

List the five qualities that characterize communication in the therapeutic relationship.

- Empathy - Respect - Genuineness - Concreteness - Confrontation

characteristics of values include

- Formed throughout one's life - Are impacted by external influences - Can be highly individual - Vary from person to person - Can change over time - Are affected by new experiences

Through the Compact law, in most states, the applicant for licensure must:

- Graduate from an approved or accredited nursing program - Meet the established character criteria - Undergo a criminal background check and fingerprinting - Pass the NCLEX-RN or -PN exam - Pay an application fee - Meet additional state requirements

Methods of committing fraud include:

- Making false statements - Falsifying documentation - Concealing information that should have been disclosed

MORAL Model

- Massage the dilemma - Outline the options. - Resolve the dilemma. - Act by applying the chosen option. - Look back and evaluate.

Kübler-Ross Psychological stages of dying states that dying people:

- May not go through every stage - May not go through stages in a linear fashion but rather in a random order - Do necessarily complete one stage and move on to next - May experience two or three stages simultaneously

Safe and competent assessment and diagnosis practices require the nurse to:

- Perform an admission assessment. This duty cannot be delegated to a nursing assistant. - Analyze the assessment data to clearly identify problems. - Apply theoretical knowledge to ensure a correct diagnosis. The presenting signs and symptoms should be consistent with the disease process or medical problem. Remember that the nursing diagnosis consists of Patient Response r/t Etiology. - Report the symptoms to the appropriate provider and carry out the standard nursing care and prescribed interventions. - Conduct frequent focused assessments until the end of your shift or until the problem is resolved.

What do we listen for in tone of voice, or intonation?

- Pitch - Cadence - Volume

Purposes of HIPPA

- Protect health insurance benefits for workers who lose or change their jobs - Protect coverage to persons with preexisting medical conditions - Establish standards to protect the privacy of personal health information

Purpose of nurse practice acts

- Regulate nursing practice to protect the health, safety, and welfare of the general public. - Define the scope of nursing practice. - Approve programs providing prelicensure nursing education to students.

What techniques can be used to help identify client concerns and focus communication?

- Restating - Clarifying - Validating

What should you do if the family wishes to be alone with the body?

- Straighten the bedcovers - Remove all tubes - Make the patient look as natural as possible - Give them whatever time they need before preparing the body

PSDA requires all healthcare providers must:

- educate staff and patients - provide patients with information on their rights to accept or refuse treatment - provide an opportunity for all patients to complete an advance directive

When do nurses use interpersonal communication?

- go gather information during assessment - teach about health issues - explain care - provide comfort and care

What are some exclusions or items not covered by the insurance policy?

- intentional torts (e.g., sexual abuse of a patient, assault and battery) - Injury caused while the nurse is under the influence of drugs or alcohol - Criminal activity - Behaviors/actions that can lead to an award of punitive damages (damages awarded to punish the defendant for egregious acts or omissions)

What are some examples of external constraints that prevent nurses from implementing their ethical decisions?

- providers - laws or lawsuits - nursing administration - other nurses - clients and families

What are some signs of days to hours before death?

- shallow, rapid, irregular breathing; 10 to 30 seconds of apnea - congestion causes "death rattle" - Cheyne Stokes respirations - Peripheral circulation decreases (may feel "clammy); reduced kidney function - May retain feces; urine output decreases and more concentrated and foul smelling - muscles relax causing face to "droop" - vision blurs - restless and agitated; near death some may become coherent and energized for a time, others communicate less, quiet, withdrawn - Fatigue is common

What are some examples of internal constraints that prevent nurses from implementing their ethical decisions?

- socialized to follow orders - believing that taking a stand would make no difference - doubting your knowledge or motivation "What if I'm wrong?" - lack of courage, concern for reputation, hope for a miracle

The nurse is talking with family members of a client who has been diagnosed with terminal cancer. Which physiological changes should the nurse tell the family to expect in the client 1 to 2 weeks prior to death? Select all that apply. 1. yellowish skin color 2. increased perspiration 3. nonproductive cough 4. elevated BP 5. anorexia and ketosis

1, 2, 3

Which are examples of beliefs? Select all that apply. Elderly people cannot provide a good medical history. 1. A family should be told if a medical error occurs. 2. A nurse should not be allowed to work while impaired. 3. A person should not accept blood or blood products from another person. 4. Arriving 15 minutes before shift will give the appearance of dedication.

1, 3, 4

What is the mission of the Patient Care Partnership? 1. It encourages health-care providers to be more aware of the need to treat clients in an ethical manner and to protect their rights. 2. A client's values, preferences, need for information, and other factors that promote autonomy must be considered in the plan of care. 3. It states that ethical behavior in care, treatment, services, and business practices should be maintained at all times. 4. It addresses the nurse's responsibilities to clients and directs nurses to contribute to the establishment and maintenance of an ethical environment.

1.

active dying occurs over a period of?

10 to 14 days

When does Rigor mortis set in?

2 to 4 hours after death

According to the Uniform Determination of Death Act of 1981, which factors must be present to declare an individual dead? Select all that apply. 1. No response to painful stimuli 2. Irreversible cessation of cardiac functions 3. Permanent ending of respiratory functions 4. Permanent cessation of all brain functions

2, 3, 4

What circumstances of loss may result in prolonged or dysfunctional grief? Select all that apply. 1. Natural death 2. Homicide 3. Suicide 4. Accident

2, 3, 4

Which communication element is being used by the nurse when he or she informs the charge nurse of an inability to handle a new admission? 1. Channel 2. Message 3. Encoding 4. Feedback

2.

Which describes an ethical dilemma? 1. A client refuses treatment for cancer, stating that his or her religious beliefs forbid it. 2. A pregnant woman may miscarry if she takes a strong chemotherapy agent, but if she doesn't, her cancer will progress quickly. 3. A nurse catches a coworker diverting drugs, and the coworker asks him or her not to tell anyone. 4. A charge nurse asks a staff nurse to stay and work late, but the nurse has plans that evening.

2.

Which term describes the period of time after a spouse dies when a person adjusts to the change in his or her life? 1. Loss 2. Grief 3. Mourning 4. Bereavement

4.

How can a nurse recognize a client is struggling with an ethical issue? A. The client experiences conflict in some form. B. There is incongruent behavior between the client and the family. C. Vitals signs are abnormal and the client appears to be in distress. D. The physician and the client do not agree on the method of treatment.

A

Someone who was present when the incident occurred, whereas the defendant will testify about the care provided and the actions taken.

A fact witness

A physician delegated to an LPN the task of administering a polio booster to a 2-year-old boy. The nurse put the boy over her knee and proceeded to give the injection. The boy moved, and the needle broke off in his buttocks, where it remained for 9 months despite attempts to surgically remove it. Since the Washington State Nurse Practice Act at that time did not allow LPNs to give injections, the nurse was in violation of the Nurse Practice Act by performing a task that was outside of her legal limits (Barber v. Reinking, 1966). What backs up this case?

A nurse who practices outside the scope of practice can be charged with violation of the nurse practice act.

Nurses' Bill of Rights

A policy statement adopted by the ANA to identify the seven conditions that nurses should expect from their workplace that are necessary for sound professional practice. It provides a framework for employers to understand what nurses need for a safe work environment and to support nurses as they address such issues as unsafe staffing, workplace violence, and mandatory overtime (ANA, n.d.).

Passive euthanasia

A result of a lack of action (e.g., withholding medications or food necessary to sustain life).

Ethical dilemma

A situation in which a choice must be made between two equally undesirable actions. There is no clearly right or wrong option. Conflicting principles can produce an ethical dilemma

This is not a law (or legally binding) but it describes the standards of professional responsibility for nurses and provides insight into ethical and acceptable behavior. It describes nurses' obligations for safe, compassionate, nondiscriminatory, and quality care while defining commitments to self, the patient, the employer, and the profession.

ANA Code of Ethics for Nurses

Freely and openly advocate for themselves and their patients, without fear of retribution is an example of a right a nurse has under what policy?

ANA Nurses' Bill of Rights

A patient is experiencing hair loss during chemotherapy. What type of loss is this?

Actual

Loss of Significant Relationships

Actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation.

External loss

Actual losses of objects that are important to the person because of their cost or sentimental value. These losses can be brought about by theft, destruction, or disasters such as floods and fire.

The nurse is concerned for the welfare of patients (advocacy), other nurses, and other providers. This demonstrates what behavior?

Altruism

The board of nursing enforces the NPA. Delegation and supervision is an example of what law?

Administrative law

Which developmental stage faces psychological, physiological, social, academic pressures, may lack emotional maturity, and have uncertainty in their identity and role?

Adolescence

Which developmental stage is cognitively able to understand the nature of death and have usually experienced other types of loss; over time, they perceive loss as a normal part of living?

Adulthood

Susan, RN, was employed by Landold Nursing Service and assigned to Alvalup Hospital from June 1, 2018, to May 30, 2019. Susan carried her own professional liability claims-made policy during this time. She decided to attend real estate school and not renew her policy. On August 10, 2019, a medical malpractice claim was filed against Susan. What kind of policy should she have obtained to have coverage for the claim made against her?

An occurrence policy or tail insurance

Experienced before a loss occurs. A wife caring for her husband through a long illness may grieve as she sees the vibrant man she once knew change before her eyes as she anticipates his death.

Anticipatory grief

The nurse enters the room of a client who is unresponsive. Which intervention best helps the nurse establish communication during the orientation phase?

Ask family members how the client would prefer to be addressed.

A nurse says to a patient "I will slap you" and raises her hand as if to slap the patient. What has she committed?

Assault

Occurs when there is the intent to cause a person fear combined with an offensive or harmful contact.

Assault and Battery

The right to self determination ---- to choose and act on that choice. Every competent person has the right to decide his own course of action.

Autonomy

Medical examination of the body to determine the cause of death. Also provides relevant data about disease processes and causes. Requires signed permission from the next of kin except in cases required by law.

Autopsy

If the client asks, "What should I do?" How should you respond?

Avoid statements such as, "If I were you ..." or, "You should ..." Help clarify the options and provide her with information about the choices.

A nurse who violates a provision of the Code of Ethics may have to: A. Appear in court on a criminal offense charge B. Defend her action to the state board of nursing. C. Resign from their job.

B

After removal of a prostate gland, a man may feel A. Psychological loss B. Both the physical and psychological loss of sexuality. C. Actual loss D. Physical

B.

How is causation usually established?

Based on testimony of experts

A client admitted for an elective surgical procedure complained that the automatic blood pressure cuff was causing her extreme pain and demanded it be removed. The nurse did not immediately remove the cuff as requested by the client. What is the nurse guilty of?

Battery but not assault, because there was no evidence that the nurse intended to create or cause fear or pain

A nurse needs to perform an invasive procedure on a patient. The nurse explained the procedure but never obtained the patient's consent. The patient experienced pain and uncomfort. What has been committed and why?

Battery; (1) an offensive or harmful physical contact is made to the client without his consent or (2) there is unauthorized touching of a person's body by another person.

The period of mourning and adjustment after a loss.

Bereavement

An example of what federal law is stated as protecting patients' privacy rights is a fundamental role of the professional nurse that is derived from the Fourth Amendment to the U.S. Constitution.

Bill of Rights

This doctrine relieves the primary employer of liability; the borrower becomes liable for the actions of the employee. This would apply, for example, to agency nurses. What type of liability is this?

Borrowed Servant Doctrine

The nurse is caring for a 7-year-old client admitted for pneumonia. Which action made by the nurse would facilitate communication with the child? A. Offering a favorite toy for the child to cuddle B. Soothing talk and gentle touch C. Using words and phrases the child understands D. Explaining the disease processes and treatments provided.

C

A 55-year-old client is upset and discussing recent losses with the nurse. Which type of losses is this client most likely experiencing based on his or her age? Select all that apply. A. Changes in relationships B. Loss and death of friends C. Children leaving the home D. Stress and job-related issues E. New-onset medical problems

C, D, E

A physician (surgeon) is held liable for the negligence of a nurse. The nurse is still help liable for her own actions. What type of liability is this?

Captain of the ship

Psychological loss

Challenges our belief system; Also known as perceived losses, they are commonly seen in the areas of sexuality, control, fairness, meaning, and trust.

Face to face communication, touch, written pamphlets, audiovisual aids, recordings, telephone and text messages, and the internet are all apart of what communication process?

Channel

Begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life.

Chronic grief

This policy covers only those claims in which the negligent action or omission occurred and the claim was filed or reported during the policy period.

Claims-made insurance

"Doing your own thing." Exploring different sets of values on your own with little guidance or discipline

Laissez-faire

Affirmative duty - the duty that nurses will exercise independent judgment to prevent harm to patients is an example of what law?

Common law

The rightness or wrongness of an action depends on the consequences of the action

Consequentialist

Freedom of speech is an example of what law?

Constitutional law

What is the natural response to a loss of a person or object?

Uncomplicated Grief (Normal/Functional grief)

When speaking to your patient who is sitting or lying in bed, what could you do to form a genuine connection?

Crouch or kneel down to be at eye level, rather than speaking from an elevated, standing position.

Written by a provider and means do not resuscitate the patient (or DNAR—do not attempt resuscitation) in the event of cardiac or respiratory failure.

DNR prescription

A dying patient has a surge of energy that brings mental clarity and a desire to eat and talk with family members. However, patient becomes dehydrated and have difficulty swallowing resulting in decreased blood volume; tissues of tag sag, gag reflex declines so secretions accumulate. Mucous membranes become dry and lips become cracked. Dehydration stimulates endorphin release.

Days to Hours before death

"I'll think about it later; right now, I'm busy trying to keep a roof over our heads and care for my children" What type of grief is this person experiencing?

Delayed grief

Considers the action as right or wrong independent of its consequences. It is based on rules, principle, and standards to determine what is right or wrong.

Deontology

Experienced in connection with a loss that is not socially supported or acknowledged by the usual rites or ceremonies. Some examples include the unplanned termination of a child's foster placement or a mistress whose lover dies. The bereaved person lacks the familial or communal support that is helpful in grieving. The relationship is "secret."

Disenfranchised grief

Also known as prolonged acute grief, is characterized by intensity of emotion and length of time. The person's responses are maladaptive, dysfunctional, unusually prolonged, or overwhelming

Dysfunctional (Complicated Grief)

A 27-year-old patient died from septic shock and peritonitis after being treated and discharged from the ED. The deceased, who had a gastric bypass 15 months earlier, went to the ED with complaints of abdominal pain. Language barriers interfered with her ability to communicate a full medical and surgical history. She was given an opioid analgesic, which decreased her pain to 0 on a 10 scale (0/10) and discharged home with a laxative. Later on the same day, she returned the ED with a 10/10 pain level. The physician provided treatment and discharged her home with an 8/10 pain level. What act was violated?

EMTALA

As a beginning nursing student, you might feel anxious about caring for Mr. Barker. It makes me nervous to be assigned to him." Or you might avoid eye contact and tell your instructor, "I'm going to need some help today." This is an example of what communication process?

Encoding

Bioethics

Encompasses a number of fields of "life sciences"; application of ethical principles to every aspect of healthcare.

Going to college would be an example of what type of loss?

Environmental

A nurse taking care of a client who has been involved in a motor vehicle accident while intoxicated is an example of which principle?

Ethics

A patient came to the Ed with 3rd degree burns after a fire started in her home. Unfortunately, the fire department wasn't able to put the fire out time and her home burned down. What type of loss might this patient be experiencing?

External

Documenting client care, it should be:

F - factual A - accurate C - complete T - timely U - usual occurrences A - assessment data L - legal document

Nursing ethics

Formal study of ethical issues that arise in the practice of nursing and analysis used by nurses to make ethical judgements.

A nurse, whose license had been revoked, was arrested and charged for trying to obtain a new nursing license with fraudulent documents. What would her charge be?

Fraud

principle of utility

Greatest good (positive benefit) for the greatest number of people

Physical, psychological, and spiritual responses to a loss.

Grief

A pediatric nurse was fired for posting a series of comments about a hospitalized child with a rare case of measles that could have been prevented with vaccination. The information could have potentially identified the patient. This is a violation of what federal law?

HIPPA

A certified nursing assistant (CNA) was charged with voyeurism after posting on her Facebook page a picture of a patient's buttocks after he had had a bowel movement. As required by this act, her coworkers reported the breach after seeing it on social media. The CNA was terminated and lost her license. What act was violated?

HITECH

Under the ___________ Act data breach notification provision, healthcare agencies are required to notify clients of breaches without unreasonable delay and in no more than 60 days. Posting client info online can trigger a violation of this law.

HITECH

For nursing interventions that you perform (e.g. urinary catheterization), you must:

Have the patient's informal, verbal consent. Contact the primary care provider if patient refuses or objects.

Defines death as the irreversible cessation of all "higher" brain functions (e.g., cognitive functioning, consciousness, memory, reasoning); functioning brainstem could maintain both respiratory and cardiac activity but no responses to external stimuli

Higher-brain Death

Holistic care of patients who are dying and not expected to improve. A provider must certify that the patient is likely to die within 6 months. An interprofessional team plans holistic care with the patient and family.

Hospice care

Algor mortis

When the blood stops circulating. The body temperature drops about 1.88°F (1°C) per hour until it reaches room temperature.

Physical loss

Includes (1) injuries (e.g., when a limb is amputated), (2) removal of an organ (e.g., hysterectomy), and (3) loss of function

Actual loss

Includes the death of a loved one (or relationship), theft, deterioration, destruction, and natural disaster. The loss can be identified by others, not just by the person experiencing it

Briefly describe the nurse's role as a client advocate.

Inform, Support, Communicate

What should nurses be familiar with regarding care that is reasonable, appropriate, and expected in the context of that facility and can be used as evidence of a violation of a standard of care if you failed to follow them?

Institutional Policies and procedures

Action taken by one person with the intent to harm another person

Intentional tort

The distance that body contact occurs. As a nurse, you invade a client's space to perform assessments and procedures, or even while using touch to offer support. This may make some clients uncomfortable. What distance is this?

Intimate

Area immediately surrounding people that they define as their private space; Western cultures, this distance is typically within 18 inches of the other person.

Intimate distance

"This will work! I can do it" This constructive affirmation (positive) is an example of what communication

Intrapersonal communication

Whose research led him to conclude that children go through a sequence of moral reasoning ability, proceeding through several stages?

Kohlberg's

Vicarious Liability

Legal doctrine under which a party can be held liable for the wrongful actions of another party.

The formal process wherein the legal issues, rights, and duties between the parties are heard and decided (adjudicated).

Litigation

Alex is being deployed tomorrow. What type of loss might his wife experience?

Loss of significant relationships

Several staff members at a mental health facility were charged with the criminal offenses of vulnerable adult abuse and assault and battery. The provider and nurse were charged with failure to report the abuse of vulnerable adults. What law was violated?

Mandatory Reporting law

A man whose wife has died may begin drinking heavily, or a couple who lost a child start to argue more intensely with each other. These are examples of?

Masked grief

A patient suffering a stroke with paralysis has lost his mobility, independence, and familiar surroundings when moved to a skilled care facility. How might this patient grieve?

May experience dysfunctional (or complicated) grief because they have sustained several losses in a short period of time.

A dying patient does not respond to touch or sound and cannot be awakened. There is a short series of long-spaced breaths before breathing ceases entirely and the heart stops beating.

Moments before death

"This way is the only way." -> makes it difficult to make independent choices

Moralizing

Consists of actions associated with grief (e.g., wailing, wearing black clothing).

Mourning

To be licensed by endorsement, you do not have to retake the NCLEX examination, but what must a nurse do in order to practice in that state?

Must apply to the new state and fulfill any of that state's application requirements

Under the _______________, certain states, through a multistate agreement, allow nurses whose primary state of residency is in a compact state to practice in other compact states without obtaining a new license.

Mutual Recognition Model (MRM)/Nurse Licensure Compact

A physician informed a patient who was a 45 year old mother that she would need surgery but the patient refused. The patient's son states, "Mom, if you don't let them do this, I'm never coming back to see you." Because of this, the patient signs. Is this consent valid?

No

Death is not seen as a natural part of life, but rather as something to avoid at all costs in what culture?

North American

Jane is a clinical nurse in the U.S. Air Force Reserve. She is licensed in the state of Texas, but is assigned to a military hospital in Nevada for her 2-week annual military tour. Jane will not need to obtain a license in the state of Nevada to practice at the military hospital. Why is this allowed?

Nurses employed by the military may practice without obtaining new licensure as long as they practice in their scope of their employment.

The phase begins when you meet the client and introduce yourself and your role in the relationship. The goal of this phase is to establish rapport and trust through the use of verbal and nonverbal communication. Ends when the relationship has been defined.

Orientation phase

This policy covers malpractice claims for any injury or damage that occurred during the time the policy was in force, regardless of when the claim was reported and the lawsuit occurred.

Occurrence-type insurance

Masked grief

Occurs when the person is grieving but expressing the grief through other types of behavior.

Which developmental stage is likely to lose friends and siblings in rapid succession and may begin the process of preparatory grief?

Older Adulthood

Duty to the patient begins?

Once you accept the assignment. You are legally responsible for the assignment that you accept. If your assignment becomes overwhelming and unmanageable, immediately contact the charge nurse or nursing supervisor for assistance.

A dying patient withdraws, their sleep increases, have difficulty digesting food, appetite and food intake decreases, and liquids are preferred. What physiological stage of dying might this patient be in?

One to Three months before death

A dying patient's body begins to lose its ability to maintain itself. There's a reduction in BP, change in pulse and skin color (yellowish pallor), and extreme pallor of extremities. Temperature fluctuates and perspirations increases. Respiratory rate may increase or decrease; periods of apnea during sleep; rattling sound/nonproductive cough.

One to Two weeks before death

Mr. Green was in a coma as a result of head trauma experienced in a motor vehicle accident. In his DPOA, he had designated his brother, Joey, as his surrogate. Although Mr. Green is married with two adult children, Joey is the person legally recognized to make decisions regarding Mr. Green's healthcare. Two weeks later, Mr. Green came out of the coma and regained the ability to make decisions. At that point, Mr. Green no longer required Joey as a surrogate. This is a case example of what act?

PSDA

Which federal law requires healthcare agencies to provide clients with information about advance directives?

PSDA

Aggressively planned "Comfort care." The patient will receive treatment to minimize unpleasant symptoms, (e.g., nausea, pain); Does not have to be "actively dying." Provided over a long period of time for those who have slowly progressive diseases.

Palliative care

Replaced the American Hospital Association's Patient Bill of Rights and is not legally binding. The brochure is available in eight languages. It explains to patients that during hospitalization, they should expect: ■ High-quality care ■ A clean and safe environment ■ Involvement in care ■ Protection of privacy ■ Help when leaving the hospital ■ Help with billing claims

Patient Care Partnership (PCP)

This act consists of two types of legal written advance directives: living will and durable power of attorney for healthcare

Patient Self Determination Act

An example of collaborative communication in which the healthcare team gathers at the patient's bedside to discuss goals for care and/or changes in the plan of care and to respond to the questions of the patient, family, and healthcare staff.

Patient rounding

A woman diagnosed with a sexually transmitted infection perceives herself as having lost her purity. What type of loss is this?

Perceived

A nurse failed to perform neuro checks on a post-stroke patient who had an unwitnessed fall, as required by agency policy. The patient was later found dead in the lobby sitting in a chair. The fall resulted in blunt force head trauma and a subdural hematoma. The nurse was charged with involuntary manslaughter (Brown, 2018). This is a case of?

Practice Negligence

18 inches to 4 feet; common distance that clients and healthcare team members usually communicate; facilitates sharing of feelings or personal thought, caring or concern.

Personal distance

A patient loses his ability to move. What type of loss is this?

Physical

Loss of Aspects of self

Physical losses, body organs, limbs, body functions, body disfigurement, one's personality, developmental changes (aging process), loss of hopes and dreams, and loss of faith.

False imprisonment can involve the use of:

Physical restraints (e.g., vest or wrist restraints) or chemical restraints (e.g., sedatives or opioids). You may restrain patients who pose an immediate threat to themselves or others. However, you must immediately obtain the proper authorization to continue the restraint.

ANA standards specifically require nurses to formulate a _____________.

Plan of care; may be written or unwritten depending on state regulations. Many agencies require nurses to complete nursing care plans or patient care tools as a means of measuring patient outcomes and progress. The plan of care should be consistent with standards of treatments acceptable for the given diagnosis or problem.

Before meeting the client. You lay the groundwork for communication by gathering information about the client, but you do not have direct communication. As a student, you initiate this phase as you prepare for clinical days. The client also experiences this phase when she identifies the need for healthcare.

Pre-interaction phase

Whose responsibility is it to explain the treatments and options?

Provider

Beyond 12 feet; requires loud and clear enunciation and characterized by a lack of individuality; this distance, for example, would be used in a lecture to a large group or community.

Public distance

Actions that injure a person's reputation; defamation of character must be present.

Quasi-intentional torts

The hospital can be sued for a medication error made by a labor and delivery nurse working within the scope of her practice. What type of liability is this?

Respondeat Superior

Why is it important to close the eyes and mouth of the deceased and position the body within at least 2 to 4 hours after death?

Rigor mortis occurs about 2 to 4 hours after death. It does not disappear until about 96 hours after death. You would not be able to do these things after the body becomes rigid.

SBARQ stands for...

S - Situation B - Background A - Assessment R - Recommendation Q- Question

The nurse cannot find documentation in the patient's medical record for informed consent. Knowing her legal role in informed consent, she refuses to assist with treatment when a patient has not given informed consent. What law protects her from dismissal for denying the surgeon's request for her to obtain informed consent.

Safe Harbor Law

How can you make sure the conversation is clear and brief to hold the interest of all parties?

Select words that convey the intended meaning, make sure your spoken words and the nonverbal language send the same message, and use the fewest words possible.

Alcoholics Anonymous, Weight Watchers, Narcotics Anonymous, and Reach for Recovery are all examples of what group?

Self-Help Groups

What is an appropriate nursing intervention for moral distress?

Self-manage emotions; discuss moral distress with a mentor if you are having difficulty

Begins the conversation to deliver a message (content) to another person

Sender

The nursing supervisor calls you into a conference room and states, "I know that you have been stealing (diverting) narcotics from the unit and injecting yourself with it while at work. It shows, because your work is sloppy and you are falsifying your documentation. You are a poor excuse for a nurse." Before you can defend yourself, the supervisor turns and leaves. The statements are not true. Nurses in the conference room try to console you. The supervisor has committed?

Slander

4 to 12 feet; It is used in more formal interaction or when communicating with a group. At this distance, individuals are not within range to be physically touched. People share personal feelings and thoughts less often at this distance.

Social distance

The definition of nursing is an example of what law?

Statutory law

Fraud

The false representation of significant facts by words or by conduct. It is intentionally misleading or deceiving another person to act (or not act) for the personal gain of the one committing the fraud.

The conclusion of the relationship marks the this phase, whether at the end of the nurse's shift or on the client's discharge from the unit, facility, or service. Reviewing and summarizing help to bring the relationship to a comfortable conclusion. If communication has been effective, this phase prepares the nurse and client for future interactions.

Termination phase

What act provides guidance on tissue, eye, and organ donation? It was amended to add language that would prevent others from overriding an individual's prior decision regarding organ donation.

The Uniform Anatomical Gift Act (UACA)

Denotation

The dictionary definition of a word

A registered nurse (RN) is leaving the hospital after working a 12-hour shift, when she witnesses a single-person motor vehicle accident. She calls 911, stops, and approaches the accident scene, where she smells gasoline. Fearing that the car will explode, she pulls the accident victim from the car, places him flat on the ground, and assesses his injuries. She puts pressure on his bleeding femoral artery and stays with him until the ambulance arrives. The victim has spinal cord injuries and sues the nurse for removing him from the car. Would the nurse be charged?

The nurse is protected from liability by the Good Samaritan law.

A 54-year-old uninsured and unemployed woman arrives at the ED of a small private hospital complaining of chest pain and nausea. The triage nurse calls the on-call provider, who instructs the nurse to send the patient to the county hospital several blocks away. The nurse assesses the patient and contacts her supervisor, who directs her to contact the medical chief of staff to inform him that the patient is in need of emergency treatment. Was the nurse's action appropriate or inappropriate?

The nurse's action was appropriate and complied with the requirements of the Emergency Medical Treatment and Labor Act (EMTALA). The patient was assessed and stabilized.You should not follow a provider's order that will result in harm to the patient.

What is and is not the nurse's role in informed consent?

The nurse's role is to verify that the patient understands and to obtain her signature but not to explain the procedure.

What development variations need to be considered when communicating with a toddler?

They may communicate nonverbally; Your response may combine verbal and nonverbal communication.

What is a potential negative outcome of anticipatory grief?

The survivor may detach from a dying person too early in the dying process, leaving him without emotional support, or it may prolong the grief of the survivor.

A nurse forgot to change the patient's dressing at the scheduled time, but changed it 3 hours later. The hospital policy reads that nurses must administer medications or perform prescribed treatments within 30 minutes before or 30 minutes after the scheduled time. The patient did not experience any harm or infection. In this case, would a malpractice action been rewarded?

There was an existence of a duty and a breach of duty, but the breach of duty did not cause any harm or injury to the patient, so no, the malpractice action would not have been rewarded.

Why is it important to position the body with a pillow under the head and shoulders soon after death?

To prevent discoloration from blood settling in these areas, which would be upsetting to the family.

Further clarified and expanded the definition to include the "irreversible cessation of circulation and respiratory functions"

Uniform Determination of Death Act

"Irreversible cessation of all functioning of the brain, including the brainstem"

Uniform Law Commission

If a victim has little potential for survival, he may receive comfort care, or his treatment may be postponed to allow the healthcare team to treat those victims with the greatest potential to survive (i.e., "benefit the greatest number").

Utilitarianism

The ethical theory stating that the value of a situation is determined by its usefulness

Utilitarianism

Livor mortis

When the dependent parts of the body appear bluish and mottled. Blood stops circulating and RBCs break down, releasing hemoglobin.

Where most therapeutic communication occurs; the active part of the relationship. During this phase, the nurse communicates caring, the patient expresses thoughts and feelings, mutual respect is maintained, and honest verbal and nonverbal expression occurs.

Working phase

Mejonus X Institute is advertising an associate degree nursing program that can be completed in 12 months at a cost of $45,000. You are interested in the program but are not sure whether it is legitimate. Where would you first go to to investigate the program?

Your initial investigation of the program should start with the state board of nursing, which approves nursing education programs. A list of approved nursing programs can usually be found on the state board of nursing Web site in many states.

Value

a belief about the worth of something; it serves as a principle or a standard that influences decision making.

Environmental loss

a change in the familiar, even if the change is perceived as positive.

active euthanasia

a result of a direct action (e.g., giving an overdose of medication). It can be voluntary (patient consents), involuntary (patient refuses), or nonvoluntary (patient is unable to consent, or someone else makes the decision and the patient is unaware of it).

Ethics

a systematic study of principles of right and wrong conduct, good and evil as they relate to conduct and human flourishing.

A contract law, a type of civil law, involves:

a written or oral agreement between two parties in which one party accepts an offer made by the other party to perform (or not perform) certain acts in exchange for something of value

integrity

acting in accordance with an appropriate code of ethics and accepted standards of practice

Attorneys orally question parties to the lawsuit under oath, as though they were testifying in court

deposition

how can you avoid charges of battery?

always obtain informed consent before providing certain treatments

Internal loss

another term for perceived or psychological loss

"If you ring that call bell one more time, I will physically take it away from you." is an example of what?

assault

To avoid communication failures that can lead to unanticipated adverse events in patients, nurses must speak up when they have concerns and take the necessary steps to communicate ___________________ and collaboratively with the healthcare team

assertively

The ANA "prohibits nurses' participation in ___________ and euthanasia because these are in direct violation of Code of Ethics for Nurses With Interpretive Statements ..., the ethical traditions and goals of the profession, and its covenant with society"

assisted suicide

Promoting good: If the man has fallen in the river, jump in and try to save him, or toss him a lifeline and call 911 if you can't swim. You are honoring what principle?

beneficence

Which developmental stage thinks that death is temporary and reversible?

childhood

Intrapersonal communication

conscious internal dialogue, sometimes known as self-talk.

In Nurse P.'s case, the court orders the hospital to award the patient a large sum of money for pain, suffering, and the costs associated with additional hospitalization and treatment that were required as a result of the malpractice. This is an example of what?

damages

Fidelity

duty to keep promises

When a nurse asks, "What is the story of this person's life, what is going on right now in his life, and what does that have to do with the morality of the action I'm considering?" the nurse is using what philosophy?

ethics-of-care

true/false: nurses never have to consider their consequences; will always be able to decide only on basis of principles and rules.

false

What can help you communicate with individuals with impaired verbal communication?

gestures

Perceived loss

internal; identified only by the person experiencing it

Nurse P. fails to check the medication administration record before giving a prn drug. Another nurse had already given the pain medication an hour and a half earlier, while Nurse P. was at lunch. The 88-year-old patient is over sedated, falls while trying to get out of bed, and breaks her hip. This is an example of what?

malpractice

A lawsuit brought against a healthcare provider for damages (e.g., money) when there has been death of, injury to, or other loss to the person being treated.

medical malpractice

Attitudes

mental dispositions or feelings toward a person, object, or idea.

"Abortion is wrong. I do not support it." This would be an example of a person's?

morals

A felony is punishable by ______ than 1 year and a misdemeanor is _______ than 1 year.

more; less

"I can't do this, it is too difficult" is called

negative self talk

The nursing assistant prepares a basin of water for the patient to soak her feet. She does not test the temperature of the water and the patient suffers second-degree burns because the water is too hot. This is a common situation of?

negligence

When you are careful to prevent medication errors or use an ambulation belt for assisting patients to walk, you honor what principle?

nonmaleficence

Duty

nurse-patient relationship

basis for liability in nursing practice

nurses are legally responsible for their own actions and this responsibility cannot be delegated

malpractice

one source of legal liability. It means that a professional person has failed to act in a reasonable and prudent manner. If someone is harmed, the professional may be held liable.

Saying to a client, "Trust us; we know what is best for you to do in this situation," would represent what principle?

paternalism

Morals

personal or communal standards of right and wrong.

whistleblowing

reporting about the practices of others that are perceived as wrong, fraudulent, corrupt, illegal, or a detriment to the health, safety, and welfare of the clients they serve.

human dignity

respect for the inherent worth and uniqueness of individuals and populations

The nurse works to ensure equal treatment under the law and equal access to quality healthcare.

social justice

belief

something that one accepts as true but it may or may not be true and may or may not involve values.

Slander

spoken or verbal form of defamation of character

Moral reasoning is based on personal interest and avoiding punishment. The right actions avoid punishment.

stage I

Principles focus on pleasing others and following rules.

stage II

Moral principles are based on universal and impartial principles of justice; final level; occurs in adulthood. The right action is determined by conscience and abstract principles such as the Golden Rule.

stage III

Nurse practice acts is an example of what law?

statutory law

Ethical agency

the ability to behave in an ethical way; nurses have a choices and are responsible for their actions.

Connotation

the implied or emotional meaning of the word

When do patients need skilled care around the clock as body systems fail?

the last 4 to 48 hours of life

According to professional ethics, who is the nurse's first allegiance to?

the patient

true/false: The death of a child or a young person is almost universally more difficult to accept than the death of an older person. (Loss of potential)

true

true/false: The greater the attachment, the more difficult the grief will be.

true

true/false: mandatory laws and the Good Samaritan laws vary state to state.

true

A nurse who does not believe women should not have abortions still provides competent nursing care to a client who wants to terminate her pregnancy even though his personal values about abortion are different from the clients. This demonstrates what behavior?

value neutrality

Healthcare professionals may feel uncomfortable giving families "bad news." So instead of saying, "Your father has a fatal illness and is unlikely to live for more than a month," they may say, "Your father is very ill, but we will do everything we possibly can for him." This challenge is example of what prinicple?

veracity

Suppose someone makes a V with the second and third fingers of the hand. To some people, this is a peace sign. What could it also mean?

victory sign, number 2, or no meaning at all

Moral distress

when situational constraints prevent nurses from acting on their moral decisions

Libel

written or published form of defamation of character

A tort law, a type of civil law, involves:

wrongs done to one person by another person that do not involve contracts.

"Golden Rule," states...

you should treat others as you wish to be treated.