Ethical Healthcare: Genetics Final
The Life Cycle Completed Updates
9th stage of development Addressed other issues related to old-old people Written by Joan Erikson
Willem Einthoven
A Dutch physician, discovered the existence of electrical properties of the heart with his intervention of the first EKG in 1903
New
A _______ prevention program should be initiated or an existing one improved based on the assumptions that arise from the assessment data
Organizational Ethics
A broad concept that includes not only culture but also the processes, outcomes, and character and denotes "a way of acting, not a code of principles...(that) at the heart, pumping blood perfuses the entire organization with a common sense of purpose and a shared set of values"
Just Generosity
A conception of justice highlighting human connections and not separateness
Rational Suicide
A type of voluntary, active euthanasia in which a person takes his or her own life after careful consideration and for reasons that would seem understandable to outside parties
Leader Succession Planning
A way for leaders to allow and enable other leaders to surface within an organization so that successors have an opportunity to develop and use their leadership skills Must mentor without fear of territorial loss
Indirect Service Learning
A whole community or the environment is the focus of these interventions
Do Not Resuscitate (DNR) Order
A written order kept in a patient's medical record to indicate that healthcare personnel are not to perform cardiopulmonary resuscitation (CPR) or other resuscitative measures on a patient
Conflicts of Commitment
AKA conflicts of interest Involves loyalties, concerns, and emotions in relationships that collide with the organizational and public interests
Compliance Program
AKA risk-management program Designed to prevent unlawful conduct and to promote conformity with externally imposed regulations and promote a second component of background for organizational ethics Became popular in 1980s - medicare and medicaid - expanded in 1991 when US Department of Justice created US Sentencing Guidelines to make consistent the sentencing process in federal courts
Service Learning
Academic experiences in which students engage both in social action and in reflection on their experiences in performing that action Ideally suited to support the moral development of public health nursing students A means for students and teachers to work with community leaders and agencies in collaboratively identifying and working toward a common good Service is usually focused on direct or indirect services, advocacy, or research
No (Impartial stance toward the persons who experience the effects of their morally related actions)
Accordian to Kantian ethics, is it natural for humans to favor people with whom they live and have frequent interactions?
Yes
According to Communitarian ethics, is it possible for humans to expand the scope of their empathy and compassion to unknown others?
Unconditional Positive Regard
According to Rogers, an attitude of total acceptance toward another person
Central Goal
According to Rogers, the development of person is the ____________________ of any person-centered relationship
Yes
According to communitarian ethics, is it natural for humans to favor people with whom they live and have frequent interactions?
Second Goal of Healthy People 2020
Achieve health equity, eliminate disparities, and improve the health of all groups
HIPAA
Acronym that stands for the Health Insurance Portability and Accountability Act A US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers.
Leadership Challenge for Public Health Nurses
Act as a resource, consultant, facilitator, educator, advocate, and role model
Deontology
Acting in accordance with one's duty
Communitarian Ethics
Acting to facilitate the common good for communities
Balanced
Actions to achieve the common good and good outcomes for the whole community must be ___________________ with actions directed at caring for the needs of individuals
Dr. Jack Kevorkian
Activist and physician who assisted in over 130 suicides. - did only in states without physician assisted suicide laws - what sent him to jail = active euthanasia of Thomas Youk on national tv Argued strongly for euthanasia when patients were in terminal state of dying
Daft's Types of Organizational Cultures
Adaptability Culture Mission Culture Clan Culture Bureaucratic Culture
US Sentencing Guidelines
Administer oversight of the organization Delegation of substantial discretionary authority Effective communication to all people at levels of the organization Reasonable steps to accomplish compliance for monitoring, auditing, and reporting suspicious wrongdoing without fear of retaliation Consistent attention to compliance standards, which includes disciplinary criteria Reasonable steps to respond to and prevent offenses and violations
Alasdair MacIntyre
After Virtue Popularized idea that communitarian ethics is based on the model of friendship and relationships.
Court Appointed Guardian or Legal Counsel and Undergoes Psych Testing
After person undergoes presumption of competency, he or she is given...?
Kantian Ethics (Deontology)
All rational persons are autonomous, ends in themselves, and worthy of dignity and respect Highly valued in Western medicine because of the focus on individual rights and informed consent. In public health, practitioners must balance the rights of individuals with the rights of members of populations and communities. - can be controversial and cause dilemmas - need to balance respecting the autonomy and protecting the confidentiality of one person while trying to protect the safety and rights of other persons
Surrogate Decision Maker
Also known as a proxy; an individual who is chosen to act on behalf of a patient who is incapable of making decisions. Either the patient, patient-surrogate relationship status, or the courts dictate this privilege
Pseudotransformational Leaders
Although effective, their primary aim and goals are to seek personal power and wealth or cause harm to others
Flourish
Although personal moral goals are significant, the importance of forming strong communities and identifying the moral goals of communities must bot be neglected if both individuals and communities are to be free to _______________
Humanistic Approach
An approach that puts the patient's humanity and well-being at the center of care is needed rather than unquestioned allegiance to rule-oriented behavior
Voluntary Euthanasia
An autonomous patient makes the decision to end his or her life
Meliorism
An ethic of action oriented at the relief, not the acceptance, of pain and suffering - causes healthcare workers to work curing disease and relieving suffering at all costs
Utilitarianism (Consequentialism)
An ethical approach based on maximizing the good, happiness, or moral consequences of one's decisions and actions Variations in ______________________ theories. When used in healthcare, the goal or intended consequence generally is to produce the greatest good for the greatest number of people - emphasis on population-centered care - also point in ANA Public Health Nursing: Scope and Standards of Practice
Trust
Confidentiality is one of the most important ethical precepts in psychiatric/mental health nursing because the therapeutic nurse-patient relationship is grounded in _______
External Community
Conflicts of interest can occur when the individual or organization or between the internal organization and the...?
Utilitarianism
Considering the actions that produce the greatest good for the greatest number of people
Servant Leader
Consistently makes decisions to further the good of the group of followers over any decisions that satisfy self-interests
Relational or Associational Privacy
Context of family and intimate relationships in which people collaborate to make decisions
Frankl's Approach to Aging
Continuing to choose to find meaning in all circumstances people encounter as their life stories are created and unfold that will eventually form the fabric of a meaningful life when people are old
Karen Ann Quinlan Legacy
Contributing to the definition of the term "persistent vegetative state" Setting precedence for parents (or legal guardians) to have a right to choose The formation of ethics committees in most healthcare settings The creation and implementation of the advance directive
Virtues May Proposed for Elders to Enhance Quality of Moral Lives
Courage Humility Patience SImplicity Benignity Integrity Wisdom Detachment and Nonchalance Courtesy Hilarity
Five Dimensions of Organizational Life
Cultural Interpersonal Organizational Social Natural Where most major relationships transpire
New Outcasts of Society
Culture has determined people with dementia to be ...?
WHO's Stop TB Program
DOTS remains central focus, evidence has shown it to be successful
Cause of Death from Terminal Sedation
Dehydration, starvation, or some other intervening complication, as all other life-sustaining interventions are withheld
Moral Authority
Described in terms of conscience. Four dimensions: 1. Sacrifice is the heart of moral authority or conscience. Sacrifice involves an elevated recognition of one's small, peaceful inner voice while subduing the selfish voice of one's ego 2. Being inspired to become involved with a cause that is worth one's commitment to it. A worthy cause inspires people to change their question from asking what is it to what is it being asked of us? One's conscience is expanded and becomes a factor of great influence in one's life 3. The inseparable of any ends and means. Moral leaders do not use unethical means to reach ends; as the philosopher Kant advocated for moral behavior, servant leaders must treat others as ends in themselves, never as a means to the end 4. The importance of relationships is enlivened through the development of conscience. Conscience transforms passion into compassion. Living according to one's conscience emphasizes the reality of the interdependence of people and relationships.
Capacity
Determined by healthcare professionals
Competency
Determined by legal team
Community Research
Develop and conduct surveys, gather, analyze, and report data issues regarding public health concern
Ageism
Discrimination against or negative perceptions of older persons based strictly on age
Tuberculosis
Disease caused by presence of Mycobacterium tuberculosis, most commonly affecting the lungs One of top 10 causes of death worldwide Highest in lower and middle income countries - indicates that is a disease of poverty Airborne Treatment = multiple drugs for extended period of time. Nonadherence is common - noncompliance is usually related to same social and psych factors that lead to infection in the first place
Outcomes of Involuntary Hospitalization Hearing
Dismissal of petition Appointment of limited guardianship Appointment of complete guardianship
Environmental Justice
Distributing environmental benefits and burdens in an equitable manner
No
Do many people complete an advanced directive?
Yes
Does each state have different laws regarding involuntary hospitalization?
No
Does involuntary hospitalization for psych permit medical treatment?
Yes
Does mental health stigmatization exist among healthcare professionals?
2 Obligations of Mercy Killing
Duty not to cause further pain and suffering Duty to act to end existing pain or suffering
Role Modeling
Education of communities often occurs through..?
Death and Dying, Quality of Life, and Mental/Functional Capacity
Elderly ethical dilemmas
Own
Elderly person's _______ feelings about the significance and meaning of their lives = important in moral world of elders
High (ageism and appearance)
Elders are at ________ risk for having their autonomy violated by healthcare professionals
Rapport
End goal of all nursing endeavors
The Life Cycle Completed
Erik Erikson's book (1982) Emphasized that all 8 stages of the Eriksonian life cycle cannot be distinctly separated but rather are interrelated Updated by his wife after his death
Transcendance
Erikson activated the word "transcendence" into...?
US Sentencing Guidelines
Established in 1991 by US Department of Justice Allowed for reduction in penalties if a corporation had previously implemented the seven standards of compliance before the organization incurred a federal violation and suggested ethical practices
Components of Prevention Programs
Ethics educational program for all employees Code of ethical conduct Hotline program Ongoing monitoring and training
Equaminity
Evenness of temperament GOOD VIRTUE FOR NURSES TO HAVE DURING A DISASTER
Lillian Wald
Excellent role model for members of communities because of her efforts to improve social justice through her work at the Henry Street Settlement
Nontherapeutic Gifts
Expensive gifts Patient is seeking approval by giving the gift Gift is given early in the relationship, may set stage for lax boundaries Nurse does not feel comfortable accepting the gift but does so because of not wanting to hurt the patient's feelings Nurse is having difficulty setting boundaries Nurses should NEVER accept money as tips or gifts
9th Stage
Extension of 8th stage of life cycle Time when elders develop to some degree either despair and disgust or integrity 8th or 9th decade of life
Three Important Aspects of Emotional Work
Face own grief and loss Find ways to deal with feelings before talking about them Mannerisms towards patients and feeling good about interactions with patients
Social Justice
Fair distribution of resources
HGP Ethical, Legal, and Social Issues
Fair use of information obtained from genetic testing Maintenance of information privacy and confidentiality Stigmatization due to genetic differences among people A number of reproductive issues, such as impact of genetic information on reproductive decision making and reproductive rights Clinical issues, such as education and implementation of quality standards Uncertainty in regard to gene testing when multiple genes or gene-environment interactions are involved Considerations of whether behaviors occur according to free will or are determined according to genetic makeup The safe use of genetically modified foods and microbes How property rights should be handled in regard to the commercialization of products
Surrogates
Family members serving as proxies
Experience of Gerotranscendent Individuals
Feeling a cosmic union with the universal spirit Perceiving time as being limited to nor or maybe only next week; otherwise, the future is misty Feeling that the dimensions of space have been decreased to the perimeter of what the person's physical capabilities allow Feeling that death is a sustaining presence for the person and viewing death as being "the way of all living things" Having an expanded sense of self that includes "a wider range of interrelated others"
Karen Ann Quinlan
First "right to die" case - 1975 The 21-year-old girl who went out for her friend's birthday, after a combination of Valium, alcohol, and dieting, she slipped into what had recently been labeled "persistent vegetative state" the courts decided that "the proposed removal from the respiratory machine was acceptable" (225). Religious Beliefs supported this case - lived for 10 years after vents unplugged - died from pneumonia brought publication to the living will and subsequently prompted legalization of the document
What is Nursing Ethics About?
First and foremost about relationships, alleviating patients' suffering, and facilitating patients' wellbeing - in relation to elders, nursing ethics is focused on helping elderly persons find and keep their voice or means of expressing their values and feelings
ACA
First major attempt to decrease health disparities since initiation of the Medicare and Medicaid programs in the Social Security Amendments of 1965
Compliance Programs
Focus on obedience to legal and required details of performance and have enforcement capability
Ethics Programs
Focus on the values of an organization, pursuing virtue, and delivering ethical patient care
Emergency Room Triage
Focused on prioritizing patients who are the sickest or most gravely injured, even those whose lives may not be salvageable
Complex Adaptive System
Focuses on external relationships, which places organization within a larger context or environment - healthcare organization
Blue Mountain Group
Followup to Wingspread conference Community of philosophers, scientists, and environmentalists Discussed the ethics that underlie the precautionary principle. Consensus = particular values form the basis of our survival Traditional science tries to separate evidence from values. Precautionary principle supports the integration of the two. Contended that humans are permeable with their environment and become the relationships they share Values affirmed by the group: gratitude, empathy, sympathy, compassion, and humility As members of the earth, we should practice respect, restraint, simplicity, and humor
Being a Good Citizen
For an organization to be characterized as ___________________________________, it must anticipate ethical issues or conflicts in external relationships and then engage in dialogue and activities to manage those concerns
Moral Community
Formed by community members who care about collectively alleviating the suffering and facilitating the well-being of other members of the community and may take action in doing so Individuals within a community may be active or inactive members of a moral community
Inner Tension
Frankl proposed that _______________________ may result from search for meaning, and it is a prerequisiste for mental lhealth
Primary
Frankl suggested that meaning is the ______________ motivation in the lives of humans
Transitoriness
Frankl's belief that the fleeting nature of life must not be denied by persons who are interested in putting the search for meaning at the center of their lives Suffering and dying can be actualizing experiences
Privacy
Freedom from intrusion (including keeping information inaccessible)
Organizational Integrity
Generally means that good and right behavior in relationships is found across the whole system
Military
Generally, in terrorism and natural disasters, _______________ triage is used rather than traditional medical
Three Conditions Necessary for Growth Promoting Environment
Genuineness or realness Acceptance, caring, or prizing Empathetic understanding
Nietzsche
German philosopher, proposed that everyone needs a philosophy of life in relation to death
Vorsorgeprinzip
German word for the principle of forecaring - forecaring = more than being cautious, using foresight and preparation, and is aligned with the principle of nonmaleficence and adage better safe than sorry this word is what the precautionary principle is based on
My Life is My Message
Ghandi quote about aging
Violations of Nurse-Patient Boundaries
Gifts Intimacy Inappropriate limits Neglect Abuse Restraints
Common Moral Career
Goffman (1963) People with a particular stigma, such as mental illness, have common experiences in terms of how they learn to view their stigma and their very conception of self
Identity
Goffsman (1963) Proposed that when people with a stigma meet other people with same stigma, ___________ develops
Trajectory
Good death indicates that people focus on the illness _________________________ and the best palliative care they can receive
Hilarity
Great merriment; extreme amusement Not taking oneself too seriously
October 5th, 2009
H1N1 vaccine was first distributed
April 15, 2009
H1N1 virus first identified in the US - 10 year old patient was tested in California as part of a clinical study
General HIV Testing Guidelines
HIV screening is recommended for patients in all healthcare settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening) Persons at high risk for HIV infection should be screened for HIV at least annually Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings
Benefience, Nonmaleficence, and Justice
Hurting or injuring someone because of illegal or unethical schemes violates the principles of...?
Aristotle
Idea that communitarian ethics is based on the model of friendship and relationships dates back to ancient Greece as noted by...?
Healthy People 2020
Nation's public health agenda First goal:help the US population "attain high-quality, longer lives free of preventable disease, disability, injury, and premature death" Public health nurses share this goal and other agenda goals, with the common hope to "achieve health equity, eliminate disparities, and improve the health of all groups and create social and physical environments that promote good health for all"
Self-Neglect
Involves behaviors committed by the older adult that endanger his or health, safety, and overall well-being Form of elder abuse
Brain Death
Irreversible cessation of all functions of the entire brain, including cessation of all functions of the brain stem
Yes
Is accepting gifts from pharmaceutical companies in exchange for prescribing their meds fraud?
Yes
Is it considered a conflict of interest when one's personal behavior conflicts with the organization's ethics?
No
Is relief of suffering and curing disease always possible?
Yes
Is there a potential for every organizational structure or be successful?
Essential
It is __________________ that executives disclose all significant facts and arrangements of any proposed transaction to the board or another executive of higher authority
RN Role in Informed Consent
It is neither ethical nor legal for a nurse to be responsible for obtaining informed consent for procedures performed by a physician - can help identify patient/proxy - witnesses signature by patient - should ensure that the patient understands
Gerotranscendence
Joan Erikson believed that if people in their 80s and 90s had developed hope and trust in earlier life stages, they would be able to move further down the path to...?
Perceived
Just generosity calls for not giving merely in proportion to what an individual receiver or community is _____________________ as being due, but instead they give to persons or communities based on the receivers' or communities' need
Justice vs Generosity
Justice = giving others what they are due Generosity = giving to people from a source that is somehow personal
Incites Us to Take Anticipatory Action in the Absence of Scientific Certainty
Key element of precautionary principle
Need to Produce a Vaccine After Appearance
Key problem expected during the 2009 H1N1 pandemic and remains serious problem with other potential influenza pandemics
Advocacy
Key role in public health nursing, when combined with service learning involves creating and supporting change in communities to benefit people in the community
When Terminal Sedation is Used
Last stages of life, when meds and nutrition, and hydration do not prolong life - DOES NOT SHORTEN LIFE
Affordable Care Act
Law passed in 2010 to expand access to insurance, address cost reduction and affordability, improve the quality of healthcare, and introduce the Patient's Bill of Rights
State
Laws vary _____________ by state regarding duty to warn known sexual partners about possible risk of exposure from individuals with HIV
Quality
Leaders use power to strive for excellence in delivery of care
Transactional Leaders
Leaders who set clear, short-term goals and reward people who meet them - EVALUATE MORALITY BASED ON OUTCOMES Focus on the management processes and controls facilitated by the values of responsibility, fairness, and honesty, but they persuade their followers to conform by exercising their power Transformational leaders embody some of these qualities
Develop Public Policies to Address the Underlying Causes of TB and Patient Nonadherence
Least problematic way to address the global burden of TB
5 Bases of Power
Legitimate power - from job title or credentials Referent power - leader has admirable qualities Expert power - followers believe leader has expertise Reward power - leader offers reward Coercive power - leader has ability to discipline
Breach of Trust to the Public
Main ethical issue involved with conflicts of interest
Clear
Maintaining a ________ focus on behaviors within and outside the organization helps to bring impending conflicts of interest to the forefront
Soft (Weak) Paternalism
Making decisions regarding what is best for a person when the person's ability to be autonomous (self-directing) is compromised in some way (when a person is unable to make rational decisions)
RTS,S
Malaria vaccine, being phased into use in parts of Africa Shown to provide partial immunity in children against the deadliest malaria parasite, Plasmodium falciparum
Ethics as Praxis
Means a leader clarifies, reflects on, and makes sense of, practices and embodies a leadership theory
Behaviors of Those Being Served
Measurement to the extent of which servant leaders are successful
EEG
Measures electrical activity in the brain
Young Adults and Financially Affluent Middle-Aged Population
Media's target audience
Military Triage
Medical need is considered, but decisions are balanced with consideration of the principle of social utility Battlefield = priority given to those who can return and continue to fight OVERALL = GREATEST GOOD FOR GREATEST NUMBER OF PEOPLE
Interactions
Members of communities learn about what is and is not accepted as moral through personal and group __________________________ and dialogue within their communities
Community
Mental health patients were assured they would receive adequate treatment for their mental illnesses in the __________________________, but society and the medical community did not keep their promises
Decisional Capacity Vulnerable Populations
Mentally disabled persons Cognitively impaired elderly persons Children
Heart Stopped Beating and Breathing Stopped
Mid 19th - 20th century definition of death
Feminist
Minkler and Pies (2002) adapted a _____________ approach to the social change as an agenda for trying to eliminate health disparities in the equitable distribution of community resources
Healing
Moving toward a wholeness that goes beyond a single being - consistent with a belief in interconnection between all beings and the universe
Trust
Multifaceted virtue that serves as an umbrella over the key values in an organization
Risks of HIV Testing
Negative: none Positive: high risk psychologically for anxiety, depression, suicide, stigmatization, discrimination, and breaches of confidentiality
Benefits of HIV Testing
Negative: psychological well-being and opportunity to prevent future infection Positive: closer medical follow up, earlier use of antiretroviral agents, prophylaxis or other treatment of associated diseases, protection of loved ones, and a clearer sense of the future
Elder-Focused Ethics
Negotiation and a foundation in the virtues
Guidelines for Clinical Diagnosis of Persistent Vegetative State
No awareness of self or environment and an inability to interact with others No sustained, reproducible, or voluntary responses to visual, auditory, tactile, or noxious stimuli No language comprehension or expression Intermittent wakefulness exhibited by the presence of sleep-wake cycles Preserved autonomic functions to permit survival with medical and nursing care Incontinence - bladder and bowel Variable degrees of spinal reflexes and cranial-nerve reflexes, such as pupillary, oculocephalic, corneal, vestibulo-ocular, and gag
Promoted
No matter which culture is ________________________ by the organization's leaders, the culture needs to fit with its strategy and environment
Three Reasons for DNR Order
No medical benefit from CPR Person has poor quality of life before CPR Person's quality of life after CPR is poor
Boundary Violation
Nurse or patient exceeds the therapeutic limits of the nurse-patient relationship
Must
Nurses ________ try to bring to the forefront the idea that there need not be a sharp distinction between physical or biomedical health promotion and prevention and mental health promotion and prevention
Three Precepts in Controlling Pain
Nurses and physicians need to follow WHO's pain ladder protocol for palliative pain management Nurses and physicians need to treat pain early because, when pain is out of control, it is more difficult to treat Nurses and physicians need to explain to terminally ill patients that addiction should not be feared and that dying patients rarely develop an addiction to properly administered pain medications
Advocacy
Nurses championing the needs and well-being of individualized patients, families, groups, communities, or populations
Moral Nursing Care
Nurses must have moral values to deliver care Truthful to own values = truthful in patient actions
Value History
Nurses should conduct a ______________ with elderly patients when they enter a new healthcare system to ensure the ethical treatment of elders
Bias
Nurses should watch family members for ________________ when assessing situations that affect determinations of elders' decisional capacity
High Impact Prevention of HIV
Prioritizing the most cost effective strategies to reduce overall HIV infections Prioritizing practical large-scale strategies that can be accomplished with a reasonable cost Selecting "interventions based in part on how many people can be reached once the intervention is fully implemented" Combining interventions to target the most affected populations Prioritization based on potential impact on HIV infections
Underlying
Rogers believed there is an _________________ movement toward inherent possibilities that all humans exhibit
Rambam's Ladder
Salamon (2003 Adapted the Jewish physician and philosopher Maimonides' ladder of charity for contemporary use Provides a mediation on generosity and underscores that an awareness of the need for giving has become more important than ever in a post-9/11 world
Why Public Health is Important
Saves money, improves the quality of our lives, helps children thrive, and reduces human suffering
Terminal Sedation
Sedating a patient into unconsciousness and then withholding life-sustaining measures until the patient dies
Other Features of Transformational Leadership
Seeing big picture Role modeling Networking Flexibility
We Dont Ask Questions
Sentiment where Bigger-Than-Life CEO is an issue
Moral Sensitivity, Altruism, Caring, Empathy, and Ongoing Development
Servant leaders exemplify the values of ...?
Servants
Servant leaders see themselves first as ________________, and at some later point, they make the choice to lead while serving
Servant-First Leader vs Servant-Second Leader
Servant-first leader makes sure that other people's highest priority needs are being served Test: do the served become better people while being served?
Truth
Servant-leaders and servant-followers are both followers because they are following the ____________
Florence Nightingale
She made efforts to improve social justice and health protection through environmental measures and to elevate the characters of nurses. Exhibited moral concern for her local society, the nursing profession, and people remove from local associations, such as Crimean War soldiers
Exemptions to Voluntary Consent for HIV Testing
Situations in which there has been significant occupational exposure and when the person whose HIV status is in question refuses testing Prior to organ transplant donation Coroner needs to determine cause of death Testing is needed in emergency diagnostic purposes when person is unable to consent and surrogate is not available
Must
Persons who are the receivers of soft paternalistic actions _______ have some form of compromised ability for this form of weak paternalism to be justified
4
Physician assisted suicide is legal in how many states?
Oregon, Montana, Washington, and Vermont
Physician assisted suicide is legal in which states?
Futile
Pointless or meaningless events or objects
Justice
Practicing the virtue of ____________ promotes fair distribution of resources among individuals within the organizations and in the external community
Pandemic Goal
Preserving the functioning of society
Jenning's 7 Signs of Organizational Ethical Collapse
Pressure to maintain numbers Fear and silence "Young'uns and a bigger-than-life-CEO" Weak board Conflicts Innovation like no other Goodness in some area atones for evil in others
Main Goals of Palliative Care
Prevent and relieve suffering Allow for the best care possible for patients and families
Salvageability/Unsalvageability Principle
Principle of justice based on how unsalvageable the providers of care believe a permanently unconscious person to be
Collaboration
Principled leaders use their power to make __________________________ decisions for the best possible patient and organizational outcomes Must listen to new perspectives on what could be done to ensure best practices and confront difficulties within organization
Autonomy and Beneficence
Principles nurses need to uphold when caring for a patient who is contemplating rational suicide
Autonomy, Beneficence, Nonmaleficence, Justice
Principles that may be violated in relation to patients, healthcare professionals, and the general public during noncompliance
US Government Accountability Office Key Issues in Response to H1N1 Pandemic
Prior planing and funding to prepare for a potential H5N1 avian influenza threat was beneficial during the H1N1 pandemic The number of available vaccine doses did not meet expectations set by the government, and as a result the government's credibility was hurt A mandate for a 100-dose minimum vaccine order was problematic The CDC generally rated well in terms of communication with the public, but communication fell short with non-English-speaking people Medicines and supplies from the Strategic National Stockpile were sufficient to meet goals, but disparities were identified between the materials ordered and materials received, and problems were identified with long-term storage of materials
Why Eliminating Health Disparities is a Moral Issue for Public Health Nurses
Social justice and communitarian ethics are based on building flourishing communities that support the common good for all community members
1850s
Society began believing death should be avoided
Weakness
Some people link servant leadership to...?
Omnipotence
Some say rational suicide is unethical because it leads people to a false sense of...?
Leader
Someone who influences a group or organization by engaging in relationships to further the shared goals of the other leaders and followers
What to Include in Advanced Directives
Specific treatments to be refused or administered Time the directive needs to take effect Specific hospitals and physicians to be used Which lawyer, if any, should be consulted Other consultations
1981 Definition of Death
Specified that one of two criteria, or both, must be met for a physician to pronounce a person dead, either whole-brain death or cessation of circulatory and respiratory functions
WHO's Pain Ladder
Step 1: nonopioids and adjuvants Step 2: Mild opioids (eg., codeine) Step 3: Strong opioids (eg., morphine)
5 Attributes of Servant Leaders
Stewardship: acting on behalf of others and being an agent of the followers Obligation: taking seriously the responsibilities to the followers and the organization Partnership: viewing followers as partners, not subordinates Emotional healing: being empathetic and an active listener and instilling a sense of wholeness Elevating purpose: striving for high moral purpose and understanding the roles of followers and oneself as a leader
US Surgeon General on Stigma
Stigma tragically deprives people of their dignity and interferes with their full participation in society
Reflections
Students' ____________ on service learning experiences are an integral and defining part of service learning - moral imaginations and development of intelligent habits are cultivated
Kindness and Respect
Studies have shown that most families approve of spirituality in nursing at end-of-life care as long as it involves _______________________________
Three Types of Surrogate Decision-Making Standards
Substituted judgment standard Pure autonomy standard Best interest standard
Patient Targeted Googling
Survey that found that most psychiatrist googled their patients
1981 Definition of Death
Sustained one of the following: - irreversible cessation of circulatory and respiratory functions - irreversible cessation of all functions of the entire brain, including the brain stem
Compassion
Sympathy for another's suffering; pity
Passive Euthanasia
Taking a life by the purposeful withdrawal of withholding of treatments or procedures used to prolong or sustain life
Physician Assisted Suicide
Taking one's own life via self-administration of physician-ordered drugs
Active Euthanasia
Taking purposeful steps to end a life, such as the administration of certain drugs. One reason for inducing death in this manner might be terminal illness
24-54
Target audience for TV ads
Important Advocacy Role of Public Health Nurses
Teaching people in the community about how to begin grassroots political efforts to obtain needed resources
Three Major Themes of Maeve's Study
Tempering involvement (conflict about becoming involved) Doing the right thing/good thing Cleaning up (end of involvement with patient)
Population
Term used to describe the recipients of the health promotion and disease and disability prevention care that is the primary focus of public health nursing
DSM IV
The 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; the most widely accepted Seen as "too powerful for its own good" - diagnosis inflation
Assessment Phase Prevention Strategies
The CEO or board should consider hiring an external consultant to conduct assessment The current fraud risks should be assessed Interviews with stakeholders should be held, which usually reveal the organization's risks for fraud An independent agent should perform an internal audit Benchmarks should be set for measuring best practices to prevent fraud
Interrelated
The Eriksons believed that individuals and society are __________________ and people are constantly involved with the give and take of a dynamic community
Enlightenment
The _________________ period fostered beliefs that the human body is like a machine
Moral Agency
The ability to make decisions that can affect the well-being of oneself or others; taking responsibility for one's own thoughts, beliefs, or actions
Autonomy
The ability to make independent decisions for oneself and to have those decisions respected by others
Decisional Capacity
The ability to make what is generally considered to be reasonable choices
Competence Criteria
The ability to receive information from surroundings The capacity to remember information received The ability to make a decision and give a reason for it The ability to use relevant information in making the decision The ability to appropriately assess the relevant information Ability to engage in mutual questioning and answering
Therapeutic Use of Self
The ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention - characterizes nurse-patient relationship in psychiatry
Guidelines for Rule of Double Effect
The act, considered independently of its evil effect, is not in itself wrong The agent intends the good and does not intend the evil either as an end or as a means The agent has proportionately grave reasons for acting, addressing his relevant obligations, comparing the consequences, and, considering the necessity of the evil, exercising due care to eliminate or mitigate it
Organizational Trust
The belief that another individual, group, or organization is competent, open and honest, concerned about employees, reliable, and identifies with common goals, norms, and values The essential ingredient that facilitates everyday business transaction
Justified Paternalism
The belief that beneficence overrules the need to respect autonomy in cases where a patient's judgement is compromised and the planned interventions would be deemed acceptable by general consensus
Paternalism
The belief that the requirement to act beneficently outweighs the need to respect a person's autonomy; the idea that people in positions of authority know what's best and it is acceptable for said authority figures to make decisions on behalf of others
Expands
The combination of the virtue of justice with the virtue of generosity _____________ the scope of justice
Social Justice
The fair distribution of benefits and burdens among members of a society
Pressure to Maintain Numbers
The first and earliest sign that an organization is in trouble
Clan Culture
The focus is on employee needs and the strategies employees can engage with for high performance Key values in this culture consist of leaders taking care of their employees and making sure they have appropriate avenues to satisfaction and productivity Responsibility and ownership are the other key values in this type of culture Rapid change occurs in this environment because of changing expectations form the external environment One example is the MTW Cooperation, which sells web-based software and provides consultation to state governments and the insurance industry
Adaptability Culture
The focus is on the external environment where innovation, creativity, risk taking, flexibility, and change are the likely elements for success This type of organization creates change in a proactive way in an effort to anticipate responses and problems Examples: e-commerce companies such as Amazon.com and Buy.com, which are required to change quickly in anticipation of customers' needs
True
True or false: some ethicists believe that excessive paternalistic behavior exhibited by healthcare workers in the past has caused a backlash, currently resulting in an elevated and imbalanced interest in respecting patients' autonomy
True
True or false: some people may look past old age and see death - which reminds them of their own imminent death and thus contributes to ageism
True
True or false: studies have shown that physicians frequently rate the quality of a patient's life lower than the patient rates it
True
True or false: the life cycle cannot be appropriately understood if it is not viewed within a social context or in terms of the community in which it is actually lived
True
True or false: the roles of clinical care and triage should be separated
True
True or false: there is no one set of published criteria to be used in all assessments of delusional capacity and competence
True
True or false: there is no right way to help someone die because death is individual experiences
True
True or false: there is often fragmentation in mental health care when patient treatment is based on the medical model
True
True or false: today, ageism may be more focused on elderly persons who are disabled
True
True or false: trust increases strategic alliances, teamwork, and productivity
True
True or false: trust promotes economic value within organizations
True
True or false: values and goals may be different among people of different age groups
True
True or false:passive euthanasia has become widely accepted today and active has not
Fairness
Trust flourishes in organizations only when there is evidence of...?
Public Health Ethical Failures
Tuskegee syphilis research (40 years under US Public Health Service) Failure of US government to address HIV outbreak when first identified UN's laxness in screening peacekeepers sent to Haiti caused introduction of cholera after Haitian earthquake
Immortality Projects and Dependence on Rescuer
Two defenses against morality of death, according to Yalom (1980)
Living Will and Durable Power of Attorney
Two types of advanced directives
Active and Passive
Two types of euthanasia
Nociceptive and Neuropathic
Two types of pain
Service Learning and Servant Leadership
Two ways to ground nursing practice in principles of public health nursing
Somatic (Musculoskeletal) and Visceral (Organ)
Types of nociceptive pain
Market Justice
US dominant model of healthcare
Servant Leadership
Ultimate level of ethicality
Historical Ways of Determining Death
Unconscious Palpate pulse Listen for breath sounds with ears Look for condensation on an object when held close to nose Fixed and dilated pupils
Young Adults
Undeserved population for health insurance benefits
Substituted Judgment Standard
Used to guide medical decisions for formerly competent patients who no longer have any decision-making capacity and based on the assumption that incompetent patients have the identical rights as competent patients to make judgments about their healthcare
Pure Autonomy Standard
Using a previously autonomous (but now incapacitated) patient's own decisions and wishes to direct care
Public Health Controversial Achievements
Vaccinations to prevent diseases: false accusations of being dangerous and linked to autism Prevention and control of infectious diseases: arguments against using tax dollars to control HIV and other infectious diseases. Some people think those with HIV deserve it Tobacco control: some are angry about limiting autonomy to protect greater good by enacting nonsmoking laws and regulations Maternal and infant health: support for safe abortions, which are legal under federal law, is challenged. Nutritional and financial support for children in poor families is challenged Motor vehicle safety: mandatory seat belt laws limit autonomy Public health preparedness response: in crisis, who will decide how rationing occurs?
Problems with Living Wills
Vague language May contain only instructions for unwanted treatments Lack of description of legal penalties for those people who choose to ignore the directive of living wills Legally questionable as to authenticity
Dangerous Misconception
Valuing the need to strive toward equilibrium and homeostasis is a ______________________ according to Frankl - especially true when interacting with elders, whose whole state of being does not generally remain in state of equilibrium
Viktor Frankl
Viennese neurologist and psychiatrist who wrote Man's Search for Meaning in 1959
Sharing Patient Information
Violation of intimacy by nurse
7 Pro Physician Assisted Suicide
Washington Oregon California Colorado Montana Vermont Hawaii Washington DC
Finding Meaning and Significance
What alleviates suffering and promotes well-being for many elderly persons?
Whole Brain Death or Cessation of Circulatory and Respiratory Functions
What criteria must be met for definition of death?
Ethic of Organization
What defines the organization's mission and values?
Silence (when a reasonable person would normally offer another sign of agreement)
What does not convey consent?
Advancements in Technology
What enabled physicians to pronounce death with a stand alone criterion of whole brain death?
Autonomy
What ethical principle surrounds a patient's right to die?
Homeless or Jailed
What happened to many patients when they were released from mental asylums in the 1960s and 1970s?
Values
What heavily influences mental health care?
Side Effects
What is a major con of psychotropic drugs?
Communication
What is an important skill for nurses to have during HIV testing?
Deontology
What is at the center of transformational leadership
Relationships with Patients
What is at the heart of nursing?
Nature of Professional-Patient Relationships
What is more in important in psychiatry than other specialties?
Utilitarianism (Emphasis on population-centered care)
What is the most widely used ethical approaches in public health?
Comfort
What is the nurse's aim to provide for patients?
Barbiturates or Benzos
What meds are used in terminal sedation?
Stigma and Decreased Ability to Exercise Judgement
What predisposes psychiatric patients to exploitation?
Nurses
What profession is the most active in meeting palliative care needs?
Ethics Process
What serves as a mechanism for organizations to address ethical issues regarding financial, business, and management decisions
Dignity
What should surrogate take into account when making decisions based on best interest standard?
Death
What signifies the end of a living person's embodiment?
Organizational Citizenship
What society and communities expect from open systems Expectations are part of establishing and maintaining those external relationship, including suppliers, regulatory bodies, customers, allies, competitors, communities, and society as a whole
1950s-1970s
When did it become apparent that the definition of death needed to include brain death as well
1950s and 1960s
When did life support technology come to be?
1970s
When did medical futility become more talked about?
Ancient Greece
When did medical futility first come to be?
1960s and 1970s
When did organ transplants come to be?
1920s
When did patient privacy begin receiving attention?
1950s and 1960s
When did psychotropic drugs come out and transform mental health care?
Conflicts of Interest
When one's self interests or potential personal gain is incompatible with that person's professional obligations, positions, or roles Legal term
Animal Nature
When realizing that human nature is also _________________________, vulnerability and dependence are accepted as natural human conditions
Partnerships
When the practice of just generosity is consistent with the top step of Maimonides's ladder, public health nurses must enter into community ______________________ and to each other people to be responsible for helping themselves and their communities so that community members, and ultimately the whole community, becomes self-reliant whenever possible
1981
When was the legal definition of death established?
1819
When was the stethoscope invented?
1960s and 1970s
When were many patients released from asylums due to new psychotropic drugs?
Durable Power of Attorney
Which advanced directive has the most strength for facilitating healthcare decisions?
Netherlands
Which country has loose euthanization policies?
Instrumental
Which ethical climate manifests from self-interest gains and profits within organizations and poses more serious ethical problems than any of the other ethical climates?
Autonomy
Which principle corresponds to informed consent?
Qui Tam Lawsuits
Whistle blowers Filed by private citizens who sue on behalf of the federal government by alleging fraud against those organizations that received government funding Case is successful - private citizen receives portion of money - government receives major portion of recovered funds
Nurses
Who has the responsibility to bridge the gap between therapists and physicians in treating mental health disorders?
FBI
Who investigates all healthcare fraud for federal, state, and local levels of government and for private insurance and other programs?
US Department of Health and Human Services and Department of Justice Health Care Fraud and Abuse Control Program
Who investigates healthcare fraud?
FBI
Who investigates occupational fraud and abuse?
St. Thomas Aquinas
Who is the rule of double effect attributed to (he wrote about self defense in a homicide) ?
Public Health Nurses
Who would be at the epicenter of the healthcare system in the event of a highly contagious epidemic?
Self Written or Prepared by Someone Else
Who writes advanced directives?
Wisdom and Integrity Difficulties for Elderly
Wisdom requires the senses of sight and hearing to see, hear, and remember - Integrity is compared with tact, which is related to touch - In their 90s, elderly persons often lose or have impaired senses Late 80s or 90s, despair may occur because people realize life is too short to make up for lost opportunities Despair may occur as elderly try to get through day with physical limitations and added burden of regrets about earlier life - when persons believe their lives are not what they wished them to be, despair deepens In 80s and 90s, people are likely to experienced losses of relationships to a greater degree than any other age. Suffer these losses and realize death is not so far away
Terri Schiavo
Woman who had been in a vegetative state for 15 years, supreme court ruled that her husband could remove the feeding tube, she died 15 days later.
Man's Search for Meaning
Written by Frankl Rated as one of the 10 most influential books in a survey conducted by the Library of Congress About how Frankl found meaning in his experiences in Auschwitz and other concentration camps during WWII - last of human freedoms was to choose his attitudes toward suffering
Advance Directive
Written instructions for use in taking medical decisions if a patient is rendered incompetent or is otherwise unable to express consent
Psychiatric Advance Directive (PAD)
Written instructions regarding a person's wishes pertaining to his or her psychiatric treatment should the patient lose the ability to consent to treatment
Criteria for Physician Assisted Suicide
You (the nurse) must know the person intents to end his or her life You (the nurse) must make the means to commit suicide available to the person The person must then end his or her own life
All
_____ people are subject to vulnerabilities and dependence
20
_____% of the US population is taking a psychotropic drug, 7% are addicted
Poverty
_________________ and the placement of people within the margins of society are key factors in the determination of public health
People
__________________ who work in the organizations are the ones who behave ethically or unethically and therefore shape the ambiance and character of the organization
Populations
___________________ in general and moral communities in particular are the starting points for public health nursing practice
Privileged Communication
_______________________ more legal nature
Confidentiality
_______________________ pertains more to ethics
Facilitative Relationships
____________________________ are often key to therapeutic effectiveness with psychiatric patients
Norms of Ethical Behavior
How people ought to act
Authenticity Can Be Overstated and Indistinguishable
Risks of authentic leadership
Salamon's Ladder
1. Reluctance: To give begrudgingly (same as Mam's) 2. Proportion: To give less to the poor than is proper, but to do so cheerfully 3. Solicitation: to hand money to the poor after being asked 4. Shame: to hand money to the poor before being asked, but risk making the recipient feel shame 5. Boundaries: to give to someone you don't know, but allow your name to be known 6. Corruption: to give to someone you know, but doesn't know who from he is receiving help 7. Anonymity: to give to someone you don't know, and to do so anonymously 8. Responsibility: at the top of the ladder is a gift of self-reliance. To hand someone a gift or a loan or to enter into a partnership with him or to find work for him so that he will never have to beg again
Phases of Human-to-Human Relationships
1. The phase of original encounter: first impressions of both the patient and nurse are perceived. The nurse must be aware of value judgements and feelings 2. The phase of emerging identities: a bond is established between the nurse and patient. There is again an emphasis on awareness by the nurse of how the patient is being perceived. Nurses must develop an awareness and a valuing of the uniqueness of others 3. The phase of empathy: this is a conscious process of sharing another person's experiences 4. The phase of sympathy: in this phase, the nurse progresses further than empathy and wants to alleviate a patient's distress 5. The phase of rapport: Rapport is the end goal of all nursing endeavors, it a process, an experience, or a happening; it is the human-to-human relationship
Two Ways of Analyzing Ethical Nature of Leadership
1. To analyze the ethical perspectives of process and performance - is the leadership being done in a way that is ethical at the moment? - examine the degree and nature of the influence relationship between the leaders and followers - ethical = people in leader-follower relationship should be using a variety of nonforced measures to influence people and develop a collaborative agreement that reflects shared purposes 2. Determine whether the shared and intended change in the community or organization is ethical - scrutinize what is being proposed - goals must be genuinely communal and shared by everyone in the community as a whole
Buried Alive
18th and 19th century Europe, there was widespread fear of...?
Carl Rogers
1902-1987 Field: humanistic Contributions: founded person-centered therapy, theory that emphasizes the unique quality of humans especially their freedom and potential for personal growth, unconditional positive regard, fully functioning person
Harvard Medical School
1968, an ad hoc committee at ____________________ to redefine death not only in terms of heart-lung cessation, added reliable brain death criteria for ventilator-dependent patients with no brain function
Humanistic Nursing Practice Theory
1976 - women's movement in US Authentic dialogue with patients, students, and other healthcare professionals Emphasizes art and science of nursing Nursing = two way interactions that receive meaning from and are grounded in the nurse and patient's existential experiences
In the Matter of Baby K
1991 - baby born with anencephaly - physicians didnt want to keep her on a vent due to futility - mother believed all life is precious - found monetary support to pay and baby lived 2 years in a nursing home on a vent
Gilgunn v. Massachusetts General Hospital
1995 - 71 year old comatose patient, family wanted treated but physician refused, wanted to stop medical futility
Wingspread Conference
1998, sponsored by SEHN Met to discuss using the precautionary principle as the basis of international agreements, especially related to environment and health Developed statement: "when an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically"
Robert Greenleaf
2002 One of business people who developed and articulated the concept of servant leadership in management - developed idea after reading The Journey to the East
Memoria, Docilitus, Solertia
3 parts of prudence (wisdom)
Best Interest Standard
A decision-making criterion used for patients who have never been competent and able to express their own autonomous wishes for health care (such as a child or adult mentally disabled since childhood). A surrogate's assessment of what would provide the most benefits and fewest burdens to the patient
Empathetic Understanding
A deep sensitivity to the patient's feelings, both on level of awareness and below
Malaria
A disease caused by mosquitoes implanting parasites in the blood Word means "bad air" Malaria death toll remained unchanged over a year, 2016 = return to 2012 levels of cases, unlikely to meet goal of 40% reduction by 2020
Medicare
A federal program of health insurance for persons 65 years of age and older
Living Will
A formal legal document that outlines a person's desired medical care to be provided in specific circumstances; a type of advanced directive
Euthanasia
A good or painless death; the act of intentionally ending a life- often, though not always - with the goal of limiting or relieving pain and suffering
Community
A group of people who have a shared interest in a common good, and members of the group have the potential to share in a collective dialogue about their common good
Population (According to Book)
A group of people who share at least one common descriptive characteristic, but do not necessarily have a collective commitment to a common good
Organization
A group of two or more people with an intentional focus with on accomplishing a shared set of goals that are consistent with the ________________________'s purpose and conduct
Precautionary Principle
A guiding principle that action should be taken to prevent a future harm even if there is no conclusive scientific evidence that future harm is inevitable ANA 2013 - good guide to use in supporting social justice and populations' rights
Benignity
A kind of purified benevolence
Relationships
A large portion of elder-focused ethics is based on _________________________ elders have with other people in society
Death with Dignity Act
A law in Oregon that allows for the practice of physician-assisted suicide seeing that very specific circumstances are met RNs maintain support. comfort, confidentiality, discussing end-of-life options, be present for administration of meds and death RNs may not: inject medications themselves, breach confidentiality, subject others to any type of judgmental comments, or refuse to provide care for the patient
Authentic Leader
A leader who finds true identity in the self by retrieving and developing the soul - inspire and encourage well-being and thriving DEEPLY ANCHORED IN RELATIONAL TRANSPARENCY (HONESTY AND OPENNESS) IN THEIR SENSE OF SELF AND RIGHT AND WRONG
Transformational Leader
A leader who focuses on raising the moral benchmark on human behaviors of both leaders and followers, internalizing a sense of commitment, facilitating the higher-order needs and creativity of followers, placing importance on relationships and shared goals, and striving for follower empowerment to promote transformation - ethical obligations, relationships, and deontology are at the center
Privilege
A legal status that protects certain individuals (such as medical professions) from having to disclose information in court proceedings; privilege is not guaranteed, and there are limits to the types of information that can be kept confidential
Durable Power of Attorney
A legal written directive in which a designated person can make either general or specific healthcare and medical decisions for a patient
Communitarian Ethics
A moral responsibility to promote community, mutuality, and persons-in-relation who live simultaneously for others and for themselves Opposition to rights theories that promote liberal individualism Communal values, the common good, social goals, traditional practices, and cooperative virtues Relevant to moral relationships in any community Focus on populations and community instead of individuals
Suffering
A perceived undesirable inner experience that could threaten the whole existence of being, yet is a necessary element of life, as are joy and happiness. The feeling experienced when a person is unable to achieve personal fulfillment; a negative experience that permeates the entire being
Perspective
A person first has to put death in perspective to understand any portion of life
Spirituality
A sense of unification of self with the world, with or without belief in a higher power; a highly personal and important part of a person's being
Rule of Double Effect
A set of criteria used to determine the ethics of a decision that involves weighing the benefit of an action (the intended, expected, positive outcome) with its possible negative but foreseeable consequences of the effects. The action is considered ethical if the action in and of itself is moral, the actor intends only the positive outcome, or the good outcome greatly outweighs the possible negatives
Hippocratic Oath
A set of promises about patient care that new doctors make when they start practicing medicine Origins of confidentiality
Persistent Vegetative State
A state in which a person with severe brain damage has enough automatic function to survive with constant medical intervention (eg., can breathe without a ventilator) but does not exhibit any awareness or higher-brain function
Marginalized Population
A subgroup of the population that tends to be hidden, overlooked, or on the outer edge
Directly Observed Therapy (DOT)
A system of providing medications for clients with tuberculosis infection in which the client is monitored to maximize adherence to the medication regimen and treatment
Suffering Person
A tormented being whose pain can be apparent to others
Successful Leader
An ethical leader who attempts to align the values of the enterprise with those of the individuals who form it, striving to facilitate a sense of deep meaning and commitment in their work A precondition is a heightened degree of sensitivity on the part of the leader to the values of society, the enterprise, and the individuals who constitute it
Callahan's Definition of Meaning
An inner feeling supported by "some specifiable traditions, beliefs, concepts or ideas, that one's life" has purpose and is well structured in "relating the inner self and the outer world" - and even in the face of aging and death, it is a life which makes sense to oneself; that is, one can give a plausible, relatively satisfying account
Healthcare Fraud
An intentional deception or misrepresentation that an individual makes, knowing it to be false and that it could result in some unauthorized benefit to self or others
Human Genome Project
An international collaborative effort to map and sequence the DNA of the entire human genome. Spanned 13 years, completed in 2003 Collab beween US Department of Energy and NIH
Cole's Definition of Meaning
An intuitive expression of one's overall appraisal of living. Existentially, meaning refers to lived perceptions of coherence, sense, or significance, in experiences
Person
An organization is sometimes compared to a ________________ because it functions as a moral agent that is held accountable for its actions
Two
An organization must practice and sustain ____ principles so the community it serves can have a sense of fairness - without 2, trust and justice will be questioned
Ethic of an Organization
An organization's attempt to define its mission and values, recognize values that could cause tension and seek the best solutions to resolve these tensions, and manage the operations to maintain quality and the organization's values
Organizational Culture
An organization's past and current shared assumptions, experiences, and philosophy, much like a tribe with its own language, stories, beliefs, assumptions, ceremonies, and power structures
Trust
Another important element in ethics and public health care during disaster situations
Ethical Principlism
Applying rule-based principles
YES
Are compliance programs mandatory?
No
Are slow codes legal or ethical?
No
Are there definite criteria for higher-brain death?
Integrity
As a whole is equated with the following: - keeping consistency between what an organization does and what it says - maintaining mindfulness of relationships with others - listening and including all voices, whether disagreeable or agreeable, in everyday business practices - having a collective, worthwhile purpose
RN Role in Psychiatric Stigma
Assess safety factors and the therapeutic value of relationships among psychiatric patients Sensitivity to stigma and how stigma affects patients' perceptions of other people who have lived through similar experiences
Three Types of Occupational Fraud and Abuse
Asset misappropriations: stealing and misusing an organization's resources Corruption: Employee's use of their influences in a manner that violates the duty owed to the employer for personal gain, such as bribery, extortion, or conflict of interest Financial fraud statement: a deliberate misstatement or omission of material information in an organization's financial report, such as documenting factitious revenues, concealing expenditures and obligations, or reporting inflated assets
Incompetent Patients Have Same Exact Rights as Competent
Assumption for substituted judgment standard
Know Signs and Report
At a minimum, what should nurses know in terms of elder abuse?
Market Justice
Based on the principle that the benefits & burdens of a society should be distributed among its members according to the members' individual efforts & abilities to pay for services
Why Early Identification of HIV Infections will Lead to Better Health Outcomes
Basic screening for treatable conditions is common public health secondary prevention tool
Vulnerability
Because of ____________________, moral agency is a key consideration in relationships with elders
Current and Future
Because the best interest standard is patient centered, the surrogate must make decisions on ____________________________________ interests
Unite Followers
Benefit of authentic leadership
Perceived Burden
Concern of patients that may influence right to die decisions - physical, emotional, spiritual, financial, religious, etc
Types of Healthcare Fraud
Billing for services not rendered Upcoding of services - higher code = more pay Upcoding of items Duplicate claims Unbundling - eg., ordered one panel, but charged as separate ones Excessive services Medically unnecessary services Kickbacks - giving people gifts for referring services that are paid for by medicare or medicaid
HealthSouth Corporation
Birmingham, Alabama Largest provider of integrated healthcare services in the US, numerous locations Three healthcare fraud schemes - false claims for outpatient PT services that were in not plan of care, administered by licensed PTs, or 1-on-one therapy as indicated by bill - accounting fraud that resulted in over billing Medicare on hospital cost reports and homoe office cost statement - billing medicare for a range of unallowable costs Qui tam lawsuits
Protocol if Executive's Transactions are not Disclosed
Board confronts person and allow for an explanation through deliberation If unsatisfactory, take disciplinary action If a board member is the one who breached trust, exclude them from meetings and deliberations until a time comes for confrontation If money or luxury gifts are a source of breached trust, the state of affairs then becomes complicated - tends to be gray area of ethical wrongdoing If board members cannot find solid evidence of breach on their own, they must determine if legal fees and time are worth the effort of a trial
The Journey to the East
Book about a servant named Leo who is on a journey to the East with a group of men, members of a mysterious league, who are on a mission to find spiritual renewal. Leo brings the group together as a community with his spirit and songs. When Leo decides to leave the group, the small community becomes dysfunctional and disbands. Later, one of the journeymen discovers that Leo was really the head of the league that sponsored their original journey Leo was a noble leader who had chosen the role of the servant but whose leadership was of the utmost importance to the journeying group's sense of community
The Least Worst Death
Book by Battin (1993) Argued that euthanasia is morally right and a humane act on the grounds of mercy, autonomy, and justice
Indicators of Elder abuse
Bruises, pressure marks, broken bones, abrasions, and burns may indicate physical abuse, neglect, or mistreatment Bruises to the breasts or genital area can occur from sexual abuse Sudden changes in alertness and unusual depression may be indicators of emotional abuse Sudden changes in financial situations may be the result of exploitation Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect Behavior such as belittling, threats, and other uses of power and control by spouses or those who should be in position of trust are indicators of verbal or emotional abuse Strained or tense relationships and frequent arguments between the caregiver and elderly person
July 1st, 2011
CDC document released about how to distribute vents during pandemic Shift from individual to community SHOULD BE GIVEN TO WHOEVER IS MOST LIKELY TO RECOVER AFTER RECEIVING THEM
Treatments Often Considered Futile
CPR Meds Vent Artificial feeding and fluids Hemodialysis Chemo
Yes
Can an elderly person disoriented to time and names and roles of persons retain the capacity to make reasonable decisions regarding life and treatment?
Yes
Can involuntary hospitalization hearing outcomes be appealed?
Involuntary Hospitalization
Can only happen after less restrictive options have failed or carefully been determined to not be a viable option
Three Standards for Death
Cardiopulmonary death: A person is dead by cardiopulmonary criteria when the cessation of breathing and heartbeat is irreversible Whole-brain death or permanent brain failure: death is regarded as irreversible cessation of all brain functions, with no electrical activity in the brain, including the brain stem Higher-brain death: human death is considered the irreversible cessation of the capacity for consciousness, which implies that the person is dead even though the continual function of the brain stem regulates breathing and heartbeat (such as in a persistent vegetative state)
Palliative Care
Care that focuses on maintaining quality of life and relieving pain and suffering instead of effecting a cure
Five Dimensions of Ethical Climates
Caring: Interested in team values and goals, well-being of others, and friendships Law and code: guided by professional codes of conduct Rules: strict adherence to policies and procedures Instrumental: focused on self-interest and company profits - manifests from self-interest gains and profits within organizations and poses more serious ethical problems than any of the other ethical climates Independence: Focused on personal moral beliefs and decision making
Three Areas Distinguishing Psychiatry from other Medical Specialties
Characteristics of the therapeutic relationship Characteristics of the psychiatric patients Therapeutic project
Cerebrovascular or Alzheimer's Diseases
Chronic conditions, such as ________________________________, cause elders to lose their most crucial link with others: their voice within society
8 Characteristics of Authentic Presence
Clarity Courage Integrity Service Trust Humility Compassion Vulnerability
Reasons for Stress in Healthcare Environment
Clash in values among people involved in decision making Toxic or destructive leader displaying unethical behaviors
Friendships and Relationships
Communitarian ethics is based on the model of...?
Four Phases of Addressing Public Health Disparities
Community participation Community mobilization Commitment to social justice Leadership challenge
Cognitive Impairment
Competence is founded in ...?
Dame Cicely Saunders
Concept of modern hospice movement started in 1967 in London AKA Florence Nightingale of the hospice movement
Autonomy, Vulnerability, and Dependence
Concepts integrally related to moral agency
Pregnant Women HIV Screening Guidelines
HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women HIV screening is recommended after the patient is notified that testing will be performed unless the pregnant declines (opt-out screening) Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women
Slow Codes
Half-hearted effort at resuscitation is made to a patient whose condition has been deemed futile
Indebtedness
Hallmark of just generosity
Eudaimonia
Happiness or flourishing Product of authentic leadership
Virtue Ethics
Having good character and being concerned about the common good
Characteristic
Health disparities occur because of some _______________________ of the persons or population affected
Not
Health does ______ always mean absence of disease
Asian
Healthcare professionals and patients from some cultures, especially ________ cultures, may be reluctant to give or accept a psychiatric diagnosis
Traditional Approach to Community Address of Health Disparities
Healthcare professionals must appeal to the self interest of the community and its members - argument: emphasizes individualism and separateness - does not support interest in common good
African American Men Who Have Sex With Men
Highest risk of contracting HIV in US
System
Highly integrated parts or groups to accomplish shared goals - organizations are one
Governmental or Nonprofit Agencies (People who think negatively about the government may think negatively about public health)
Historically, what has public health been associated with?
Signs of Self-Neglect
Hoarding of objects/animals to the extent that the safety of the individual (and/or other household or community members) is threatened or compromised Failure to provide adequate food and nutrition for oneself Failure to take essential meds or refusal to seek medical treatment for an illness Leaving a burning stove unattended Poor hygiene Not wearing suitable clothing for the weather Confusion Inability to attend to housekeeping Dehydration
1
How many EEGs are sufficient to pronounce someone as dead?
3 (1918, 1957, and 1968)
How many influenza pandemics occurred in the 20th century?
4
How many phases of stigma are there?
4 Components of Transformational Leadership
Idealized influence: A solid ground of high morality exists with ideals of trust and authenticity Inspirational motivation: The personality traits and charisma of the transformational leaders inspire followers to commit to and search for meaning in their work toward achieving shared values and goals Intellectual stimulation: Transformational leaders encourage followers to think freely and be creative with the ways to connect to the leader and achieve shared goals Individual consideration: Individuals are boosted by the transformational leader's focus on each person as an individual who has a need for self-actualization, growth, and opportunities. The leader's mentoring and teaching enhance the continued growth and success of followers
HGP Goals
Identify all of the approximately 20,000-25,000 genes in human DNA Determine the sequences of the 3 billion chemical base pairs that make up human DNA Store this information in databases Improve tools for data analysis Transfer related technologies to private sector Address the ethical, legal, and social issues that may arise from the project
Needs
If a person is on life sustaining treatment, an EEG _________ to be ordered to determine brain death
Critiques of Precautionary Principle
If science has not provided certain evidence that a particular activity or substance is harmful, the activity or substance is assumed to be safe until shown otherwise - defense: by time evidence is available, harm will already be done
Imaginative Dramatic Rehearsal
Imagining an ideal scenario (such as an ideal death) to take meaning from the experience and shape how the scenario plays out in real life
Therapeutic Project
Important part of ethics and mental health Major undertaking that involves reforming the patient's whole self or character, when these terms are understood in holistic terms as the set of a person's long-term dispositions, capabilities, and social relational attributes
1968
In ____________, two kinds of death for humans: heart-lung and brain
Technology and Curing Diseases
In a market justice system, money for health care tends to be invested in _______________________________ rather than health promotion and disease prevention
Personal Evaluation
In quality-of-life judgements, a person's rating of the value of his or her own life
Beneficence or Nonmaleficence
In soft paternalism, an agent intervenes in the life of another person on grounds of _________________________________________ with the goal of preventing substantially nonvoluntary conduct
Physician Assisted Suicide
In the US, euthanization is legal if limited to ...?
Pilgrimage
In the late 1700s and early 1800s, old people were encouraged to view their lives as a ___________________________ and to prepare for death while still participating in service to family and community
Beauchamp and Childress Standards for Decisional Capacity
Inability to express or communicate a preference or choice Inability to understand one's situation and its consequences Inability to understand relevant information Inability to give a reason Inability to give a rational reason (although some supporting reasons may be given) Inability to give risk- or benefit-related reasons (although some rational supporting reasons may be given) Inability to reach a reasonable decision (as judged, or example, by a reasonable person's standard)
Restraint Guidelines
Individuals have the right to be treated with respect and dignity in a safe, humane, culturally sensitive, and developmentally appropriate manner that respects individual choice and maximizes self-determination Seclusion or restraint must never be used for staff convenience or to punish or coerce individuals Seclusion or restraint must be used for the minimal amount of time necessary and only to ensure the physical safety of the individual, other patients or staff members, and when less restrictive measures have proven ineffective Individuals who are restrained mechanically must be afforded maximum freedom of movement while assuring the physical safety of the individual and others. The least number of restraint points must be utilized and the individual must be continuously observed
Stigma
Individuals' personal characteristics (such as mental illness) that are associated with being dishonorable or shameful
Health Disparities
Inequalities or differences in healthcare access and treatment that result in poor health outcomes for persons or populations
Power
Influence that leaders have over their followers to achieve common goals
4 Types of Privacy
Informational privacy: communication of information Physical privacy: with regard to personal spaces Decisional privacy: with regard to personal choices Proprietary privacy: property of interests, including interests with regard to bodily tissues, one's name, and so forth
Vulnerability and Dependence
Inherent human conditions as people move from childhood to adulthood - progress to capable and independent - as age, start to head abck
Death Anxiety
Innate fear of death, or nonbeing
Other Ways to Reduce Malaria Incidence
Insecticide-treated bed nets Indoor spraying with insecticides Preventative treatment among infants and pregnant women Appropriate and timely diagnosis and treatment with effective medications
Trust
Integrity and __________ must go hand in hand
Factors to Consider When Accepting Gifts from Patients
Intent Value Nature Timing Cultural norms
Unethical or Illegal Behaviors in Organizations
Occupational fraud and abuse Conflicts of interest Greediness Covert operations Misleading services Cheating on negotiated terms Fuzzy policies Disloyalty Poor quality and services Humiliating strategies Bigotry, racism, sexism, and favoritism Suppressing freedom of speech and choice Mindlessly and routinely obeying authority Price fixing Not speaking up when ethically obliged to do so Hurting others while climbing the ladder Using or blaming others to get the job done Exaggerating advantages of a plan just to gather support Uncooperative with others Lying for the sake of the business Not taking responsibility for injurious practices Abusing organizational perks Corrupting the public process through legal means Obstructing, stalling, dithering, and inefficiency
Pregnancy (Patients with HIV may have concommitant infections such as CMV)
One commonly accepted justification for nurse to refuse to treat HIV positive patient
Self-Neglect
One of most frequent concerns reported to adult protective services
Spirituality
One of most important aspects of end-of-life care
Loss of Voice
One of most profound causes of isolation for elders
1918 Influenza Pandemic
One of the deadliest disease events that ever occurred with 40-50 million people dying worldwide
Compliance Officer
One of the most sought-after roles in a healthcare organization Oversees and monitors regulatory requirements and internal policies because organizations are at risk of being found guilty of criminal conduct, such as felonies or misdemeanors
Ethical Leader
One who is both a moral person and a moral manager influencing others to behave ethically
Danger to Self or Others
Only time patient's right to refuse treatment can be overridden
Organization's Image
Organizational ethics is concerned with...?
High
Organizations heading toward ethical collapse often have extremely _________ levels of innovation and achievement
Never
Organizations with innovation and extreme success are not always on the verge of ethical collapse, collapse is linked to organizations' _________ forming or practicing standards of ethical excellence that make up a healthy ethical climate
Why Public Health is Controversial
Outcomes of public health are not directly recognizable People who pay the greatest economic cost for public health may not be the biggest recipients of the benefits Public health activities, regulations, and interventions sometimes interfere with the financial bottom line of some organizations "People often are unwilling to pay short-term costs in order to obtain a benefit in the long term" Sexual and reproductive health and safety efforts through public health interventions sometimes raise religious and moral opposition
Compassion and Healing
Paired needs of elders
Ways Public Health Nurses Can Minimize Risk of HIV
Participation in counseling, community education, or social and political activism
Nancy Cruzan: Withdrawing Treatment Guidelines
Patient has a right to refuse medical treatment Artificial feeding constitutes medical treatment When the patient is mentally incompetent, each state must document clear and convincing evidence that the patient's desires for discontinuance of medical treatment
Helga Wanglie Case
Patient was permanently unconscious, no advance directive except "life is precious", medical staff wanted to remove care but family did not, patient died before courts could rule.
Limits to Confidentiality
Patients are a threat to themselves or to identifiable others Statutes require the disclosure of certain happenings, such as abuse, rap, incest, or other crimes The patient consents to the release of information A court mandates the release The information is needed for other caregivers to provide care to the patient, that is, when certain people have a need to know the information
Environmental Racism
Patterns of development that expose poor people, especially minorities, to environmental hazards
2005
Peak of AIDS related deaths
Good Death
People do not allow medical care and treatment to control all their thoughts about their death; rather, they focus on the illness trajectory and the best palliative care they can receive
Meaningful Involvement
People have an opportunity to participate in decisions about activities that may affect their environment and/or health The public's contribution can influence the regulatory agency's decision Community concerns will be considered in the decision making process Decision makers will seek out and facilitate the involvement of those potentially affected
Compliance Officers
People in charge of overseeing ethical and legal issues within an organization Need to develop clear policies regarding conflicts of interest and conduct formal reviews of actions
Fiduciary Relationships
People place trust in others to carry out activities related to their position with morally good judgement These relationships represent a formal duty to another of others, imposed by loyalty, commitment, and organizational structure
Turning Point
People who are stigmatized often have ___________________________ in their lives - may or may not be noticed
Authentic Presence
People-focused leaders who are true to themselves and deeply aware of who they are an dhow others perceive them - true to self translates to being powerful
Involuntary Hospitalization Criteria
Person is a danger to themself A danger to others Gravely disabled - some states
Direct Service Learning
Person-to-person interactions occur between students and recipients of students' work - may be aimed at developing a broader awareness of the needs and issues of various cultures, populations, or age groups while providing a needed service to a population
RN Role in Psychiatric Nursing
Provide data and descriptions of observations to enable a diagnosis Integrate the nomenclature of diagnosis into the language of mental health nursing practice Administer medications that have been determined by psychiatric diagnosis Engage in service user and family education based on psychiatric diagnosis and treatment
Antipsychiatry
Providers focus more on the beliefs and values of their patients and include the spiritual, political, and socio-cultural dimensions of experience in their practice. This approach indicates that the concept of illness is far too restrictive to assist us in understanding insanity and reminds us that in order to understand mental illness some deconstruction of what constitutes mental illness is necessary
Society
Psychiatric diagnoses often represent the boundaries of what is characterized as normal vs abnormal in _________________________ - can perpetuate oppressive power relationships
Involuntary Hospitalization Process
Psychiatrist determines person to be incompetent = temporary commitment Court proceedings initiated to extend the involuntary treatment or commitment - expedited when person is held against will
Presumption of Competency
Psychiatrist determines that someone exhibits a lack of decision-making capacity, petition is filed with the court to determine competency Beginning of involuntary hospitalization process
Public Trust
Public health agencies cannot function without _______________________
Everyday
Public health nurses need to expand scope of concern to consistently include people affected by healthcare disparities, diseases, epidemics, and ethic violence and wars all over the world ________________, not only when highlighted by the media
Basic Dignity and Personal Dignity
Pullman (1998) divided dignity into these two categories
Ethic of Dignity
Pullman (1998) proposed that this be used as opposed to an ethic of autonomy in long term care
Paternalistic Interventions
Pullman (1998) suggested that long term care often requires __________________________ from the beginning of patient-provider relationships
Value Judgements
Quality of life determinations are _____________________, according to Jonsen, Siegler, and Winslade
Observer Evaluation
Quality-of-life judgements made by someone other than the person whose life is under consideration
Immortality Project
Raising children or throwing self in work One of defenses against death
Eisenhower Medical Center
Rancho Mirage, CA Overbilling of federal health insurance programs Former employee filed qui tam lawsuit - alleged healthcare financial advisors helped the hospital seek reimbursement for unallowable costs and specifically, that the advisors prepared two cost reports - an inflated one submitted to medicare and one designed for internal use that accurately reflected the amount of reimbursement that the hospital should have received
5 Rs Approach
Reading Reflecting Recognizing Resolving Responding Guide for nurses to prepare to act ethically under any sudden and stressful situation
3 Basic Elements of Informed Consent
Receipt of information Consent for treatment must be voluntary Person must be competent
RN Role in Palliative Care
Recognize patients' symptoms, take measures within scope of practice to administer meds, provide other measures for symptom alleviation, collaborate with other professionals to optimize patients' comfort and families' understanding and adaptation
Two Unethical Components of Rational Suicide
Requires autonomy - if person doesn't have autonomy, life is not worth living Self-destruction
PSDA of 1990
Requires that healthcare facilities offer patients advanced directives and that employees receive training about advanced directives.
Autonomy (Informed Consent)
Respecting a person's autonomy to make personal choices based on the appropriate appraisal of information about the actual or potential circumstances of a situation
Signs of Abuse Occurring Within Healthcare Facility
Restraints: physician's orders for restraints (should be time-limited), the number of patients who are physically restrained, the type of restraints used, the correct application of restraints, and how often staff check restrained patients Signs of overmedication Signs of harassment, humiliation, or threats from staff or other patients Patients being uncomfortable around staff Signs of bruises or other injuries Evidence of patient neglect, such as patients left in urine or feces without cleaning
Bureaucratic Culture
The focus is primarily on the internal environment, where stability is a mainstay. Leaders develop and carry out scrupulous and detailed plans in a cautious and stable environment with slow-paced change. In this environment, personal engagement and involvement are not cultivated; instead, there is a high level of consistency, conformity, efficiency, and integration Because of the inflexibility of this culture, many organizations are forced to change in a different, more adaptable culture. Once successful organization with this type of culture is the Pacific Edge Software Company, run by husband-and-wife team, which thrives on order, discipline, and control
Withholding and Withdrawing Treatment
The forgoing of life-sustaining treatment that the patient does not desire because of either a perceived disproportionate burden on the patient or family members or other reasons
Norms of Ethical Behavior
The foundation of normative leadership
Purpose
The fundamental ____________________ of public health nursing is consistent with the overarching goals articulated by the US Department of Health and Human Services in Healthy People 2020
Greenleaf's Leader
The great leader is seen as a servant first, and that simple fact is the key to his (or her) greatness
Self-Actualizing Tendency
The human motive toward realizing our inner potential - life is active process - happens even when conditions are not favorable - psych patients are always striving to reach full potential, just might not be what mentally healthy people deem as acceptable
Rapport
The human-to-human relationship
Right to Die
The idea that an autonomous person has the prerogative to refuse life-saving or life-sustaining treatments
Nonvoluntary Euthanasia
The intentional taking of a patient's life when the patient is unable to consent to the procedure, for example, after authorization by a surrogate decision maker
Involuntary Euthanasia
The intentional taking of one's life when the person could consent but does not, for example, in cases of capital punishment
Higher-Brain Death
The irreversible loss of higher brain function; lower brain stem continues to provide respiration, blood pressure, and a heartbeat without the assistance of a respirator Person lives in a persistent vegetative state indefinitely but without mechanical ventilation
Ethic of Dignity
The moral character of caregivers is the focus rather than the autonomy of the recipients of care - can provide compassionate means of care when people are no longer able to exercise full autonomy
Prevention Strategies
The most effective and efficient ways to deter financial loss through fraud
Duty to Warn
The need to disclose confidential information in instances when a clearly indentifiable person is at risk of harm
Confidentiality
The nondisclosure of information; preventing access to information by unapproved parties
Increased
The number of older adults in America have increased/decreased in recent decades
Advocacy According to Gadow
The nurse as existential advocate does not merely help patients chose what they want - for example, the drug user who wants to be as "high" as possible while in the hospital. The existential advocate is there to help patients recognize and realize their best selves, given their situation
Ethical Climate
The organizational members' shared perceptions of their values related to how ethical decisions are made on the issues of power, trust, and human interactions - plays a large role in shaping the culture - formed by the way the organization responds to ethical issues and challenges
Elder Abuse
The physical, sexual, emotional, psychological abuse or neglect, abandonment, and financial or material exploitation of old people by someone with whom they share an intimate or caring relationship
Public Health Nursing
The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences Evidence based and focuses on promotion of the health of entire populations and prevention of disease, injury, and premature death
Three Components of Psychiatric Nursing
The psychotherapeutic nurse-patient relationship (words) Psychopharmacology (drugs) Milieu management (environment) ALL OF WHICH MUST BE SUPPORTED BY A SOUND UNDERSTANDING OF PSYCHOPATHOLOGY
Transformation
The rapid ________________ of healthcare organizations has been a contributing factor in the erosion of trust
Basic Dignity
The respect and equality due to all human beings
Children's Health Insurance Plan
The result of federally mandated legislature passed in 1997 to expand health insurance to the nation's uninsured children.
Callahan's Definition of Significance
The social attribution of value to old age, that it has a sturdy and cherished place in the structure of society and politics, and provides a coherence among the generations that is understood to be important if not indispensable
Wisdom
The strength or virtue some elders depend on to successfully navigate both the eighth and ninth stages of development
Take into Consideration Patient's Conception of Good and Bad
The surrogate acting in best interest standard should NOT _________________________________________________________ when making decisions on behalf of the patient
DSM III
The third edition of the Diagnostic and Statistical Manual for Mental Disorders, published in 1980. Introduced revolutionary changes in the diagnostic system, including explicit, etiologically neutral diagnostic criteria and a multiaxial system of diagnosis. FIRST IN A SERIES OF DSM MANUALS TO USE RESEARCH AS A BASIS FOR CATEGORIZING DIAGNOSES
Appropriate Science
The type of science needed to support the precautionary principle, distinguished from traditional science Based on the context of the problem at hand rather than requiring scientific pursuits to be forced into the preconceived idea of necessary rigor
Medical Futility
The unacceptably low chance of physicians achieving a therapeutic benefit for the patient
Occupational Fraud and Abuse
The use of one's occupation for personal enrichment through the deliberate misuse or misapplication of the employing organization's resources or assets
Personal Dignity
The value a community places on an individual and the individual's place in society
Discussing and Articulating
The value of ____________________________ an approach to communitarian ethics lies in the benefit that can be gained through illuminating and appreciating the relationships and interconnections among people that are often overlooked in everyday life
Mission Culture
The vision and goals are clearly focused on a high level of competiveness and profit-making strategies In this type of culture, executives and managers strongly communicate a strategic plan for the organization's employees and expect high productivity, performance, goals, and fringe benefits for goal attainment. Example is PepsiCo
Decrease
There has been a __________________ in HIV infections over the past three decades
Fragmentation
There is _____________________ between providers who treat psychiatric illnesses with therapy (eg., therapists or counselors) and biomedically (eg., physicians)
Labeling
There is controversy around _________________ people with psychiatric diagnoses, it may cause more harm
Diagnosis
There is controversy surrounding the ______________ of mental disorders
Paradigm
There was a ___________________ shift in diagnosing mental disorders between DSM IV and DSM 5
Autonomy and PDSA of 1990
Things violated when organizational schemes potentially harm patients without knowing
Moral Imagination
Thinking and acting in terms of the comprehensive virtue of just generosity requires the use of one's ________________________ to envision what could be
Frederic Chopin
This person's will stated that he be dissected before burial to prevent being buried alive
True
True or false: risk-based screening of HIV is becoming less effective now because of the mix of people becoming infected with HIV is changing to persons who are unaware of their high risk status: - racial and ethnic minorities - people younger than 20 - nonmetropolitan area dwellers - heterosexuals
Frankl's Belief
To live is to suffer, to survive is to find meaning in the suffering. If there is a purpose in life at all, there must be a purpose in suffering and dying
Transcendence
To rise or go beyond a limit, to exceed, to excel
Education
Transforming a community from an us-versus-them mentality to one that seeks a common good is possible through...?
Emergency Response
Triage expert should be identified - sensor status at institution - respected by staff and has relevant clinical experience and authority to carry out decisions At least 3 members assembled to help triage expert
True
True or false: Genomics is one of the 8 new domains of public health practice
True
True or false: Nursing ethics should not be compromised during a disaster
True
True or false: People must ask to be shown the data supporting the truth of statements that there are fewer resources for public health than there were when effective therapies were not available to treat many diseases
True
True or false: Well-being involves the relief of suffering through the acceptance of suffering
True
True or false: When any community members are suffering or in need, all people in the community are affected, even if it is in imperceptible ways
True
True or false: a moral community can be as large as the global community or as small as a community of senior nursing students at a university
True
True or false: a significant trend that has concerned the FBI is the willingness of medical professionals to commit schemes that risk patients' health and cause potential patient harm - attributed to technology/computers
True
True or false: a violation of trust in organizations is generally illegal and less forgivable than in a personal relationship where trust historically exists between two people
True
True or false: as a general rule, a person's HIV status is confidential information
True
True or false: as evidenced in many cooperate scandals, trust in organizations has been eroding for years, and now it is at an all-time low
True
True or false: as people age, they often become despondent about the losses they experience in regard to their appearance and physical abilities
True
True or false: compliance programs are not synchronous with ethics programs, yet organizations tend to use compliance programs as a way of addressing ethical issues
True
True or false: elders often feel dehumanized when interacting with healthcare professionals
True
True or false: every facility has different protocols as to how DNRs are written and carried out
True
True or false: it is yet to be determined whether the ACA will stand as a low and have a positive impact
True
True or false: membership in a community becomes part of a person's identity
True
True or false: most of the time there are no legal ramifications for the patient's right to die?
True
True or false: no one in the US or elsewhere should feel safe from mass casualties involving infectious diseases
True
True or false: often, a person's ethical obligations to fulfill job commitments can interfere with time available for family or others
True
True or false: often, the lives of elders are set aside from the lives of other adults in communities
True
True or false: once a person has met brain death UDDA criteria and pronounced dead, mechanical ventilation and medical treatment can be discontinued
True
True or false: organizations need to define their values operationally, and likewise, their ethical practices in writing and verbal communication
True
True or false: patients should not be denied care based only on their HIV-positive status
False
True or false: people can supply another person's life with meaning
True
True or false: people with dementia can be viewed as less than persons
True
True or false: psychiatric patients may be more vulnerable than other patients to exploitation, dependence, and inequality in relationships
True
True or false: public health does not always protect individuals
True
True or false: public health nurses usually do not directly give money or material resources to people
True
True or false: since the 1981 definition of death was adopted, criteria for brain death have been adopted by every state
Medical Hold
appeal of involuntary hospitalization hearing
DSM 5
the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders. BASED ON MEDICAL MODEL OF DIAGNOSING ILLNESS
DSM IV-TR
the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with an updated "text revision"; a widely used system for classifying psychological disorders.
