Exam 3 - Fundamentals - Concepts of Culture, Ethics, Health Care Law, Patient Education, Informatics, and Documentation

The nurse is learning about ethics in nursing practice. Which actions should the nurse perform to meet the American Nurses Association (ANA) code of ethics? Select all that apply. 1Consider the patient as the primary commitment. 2Strive to protect the health and rights of the patient. 3Consider personal and professional growth a priority. 4Contribute to nursing practice and knowledge development. 5Ignore other healthcare professionals and perform one's own duties.

1,2,4 The nurse's primary commitment is to the patient, whether that is an individual, family, group, or community. As per the American Nurses Association (ANA) code of ethics, the nurse should promote, advocate for, and strive to protect the health, safety, and rights of the patient. The nurse should contribute to nursing practice and knowledge development and thus participate in the advancement of the profession. The professional growth of the nurse should continue alongside patient care, but it is not an ethical responsibility. Nurses should collaborate with other healthcare professionals, not just perform their own duties.

Culturally Sensitive

- cognitive: aware - affective: sympathetic - psychomotor: developing skills

Culturally Competent

- cognitive: knowledgeable - affective: committed to change/learning - psychomotor: highly skilled

Understand the American Nurses Association (ANA) Code of Ethics

-9 Code of Ethics to follow 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems - EVERY patient is a "VIP" 2. The nurse's primary commitment is to the patients, whether an individual, family, group or community. -You care for everyone! Regardless of family being 1 or 20 people. 3. The nurse promotes, advocates for, and strives to protect the health, the safety and the rights of the patient -Safety is number 1 4. The nurse is responsible an accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. -Need to delegate some work to the CNAs (especially primary care) 5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal professional growth. -Learn to make time for yourself, and to also continue education 6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. -You have to be a special person to be a nurse, who has a specific set of characteristics and valuesNO BATTLE AX 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge developments --Your education is your responsibility 8. The nurse collaborates with other health professionals and the public promoting community, national and international efforts to meet health needs -You need to give back to the community and promote the nursing piece 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. -You are now on the nursing stage, be a role model, and embody the profession

Informed consent:

-A person has the right to decide what will be done to his or her body and who can touch his or her body -Informed consent is given by a responsible party - a wife, husband, parent, daughter, son, guardian, or legal representative -Consent is needed when the person enters the agency -You are never responsibility for obtaining written consent

Professional Nursing Code of Ethics

-A set of guiding principles that all members of a profession accept -Helps professional groups settle questions about practice or behavior -expectations and standards of behavior. The American Nurses Association (ANA) established its first Code of Ethics for Nursing in 1950, and the organization has continued to review and revise it periodically. The provisions of the Code of Ethics describe the nurse's obligation to the patient, the role of the nurse as a member of the health care team, and the duties of the nurse to the profession and to society. A few of the key principles in the code include advocacy, responsibility, accountability, and confidentiality.

When caring for a patient, the nurse is distressed over an ethical dilemma and attempts to resolve it. Arrange in order the steps involved in the resolution of an ethical dilemma. 1.Evaluate the action plan. 2.Gather information about the case. 3.Identify the course of action and draw a plan. 4.Clearly verbalize the ethical problem. 5.Distinguish among facts, values, and opinion.

2, 5, 4, 3, 1 The first step in resolving an ethical dilemma is to gather information relevant to the case from the perspective of the patient, family, institution, and society. Next, the nurse should distinguish among facts, values, and opinion. Verbalizing the problem helps; although it may not be easy, creating a clear statement of the dilemma helps to facilitate discussion and ensure that the final plan is effective. Next, a course of action should be identified and a plan discussed. The implemented plan should be evaluated over time.

CulturalHumility /Competence

A core competency for all registered nurses Requires lifelong learning Acquired through three stages: • Culturally incompetent • Culturally sensitive • Culturally competent Each stage has three dimensions: • Cognitive (thinking) • Affective (feeling) • Psychomotor (doing)

Health care information system (HIS)

A health care information system (HIS) consists of "computer hardware and software dedicated to the collection, storage, processing, retrieval, and communication of patient care information in a healthcare agency" (Hebda et al., 2019). An HIS consists of two major types of information systems: a clinical information system and an administrative information system. Together the two systems operate to make the entry and communication of data and information more efficient. Individual health care agencies sometimes use one or several clinical information systems and administrative information systems. Administrative information systems include databases such as payroll, financial, and QI systems Application of computer and information science in all basic and applied biomedical sciences to facilitate the acquisition, processing, interpretation, optimal use, and communication of health-related data.

A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? a. Lecture b. Role play c. Demonstration d. Question and answer sessions

ANS: B Affective learning deals with expression of feelings and acceptance of attitudes, beliefs, or values. Role play and discussion (one-on-one and group) are effective teaching methods for the affective domain. Lecture and question and answer sessions are effective teaching methods for the cognitive domain. Demonstration is an effective teaching method for the psychomotor domain.

A patient learns that a normal adult heartbeat is 60 to 100 beats/min after a teaching session with a nurse. In which domain did learning take place? a. Kinesthetic b. Cognitive c. Affective d. Psychomotor

ANS: B The patient acquired knowledge, which is cognitive. Cognitive learning includes all intellectual skills and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. Kinesthetic is a type of learner who learns best with a hands-on approach. Affective learning deals with expression of feelings and development of attitudes, beliefs, or values. Psychomotor learning involves acquiring skills that require integration of mental and physical activities, such as the ability to walk or use an eating utensil.

A nurse is teaching a patient about healthy eating habits. Which learning objective/outcome for the affective domain will the nurse add to the teaching plan? a. The patient will state three facts about healthy eating. b. The patient will identify two foods for a healthy snack. c. The patient will verbalize the value of eating healthy. d. The patient will cook a meal with low-fat oil.

ANS: C Affective learning deals with expression of feelings and acceptance of attitudes, beliefs, or values. Having the patient value healthy eating habits falls within the affective domain. Stating three facts or identifying two foods for a healthy snack falls within the cognitive domain. Cooking falls within the psychomotor domain.

Concepts Related to Ethics

Advocacy -Ensure patients receive sufficient information on which to base their consent for care and treatment; allow patients to make their own decisions Cognition and Development -Duty to advocate for these individuals; ensure they do not become victims of abuse Comfort -Determine acceptable outcomes for patients with chronic pain; discuss realistic expectations; seek assistance; discuss abuse of narcotic Communication -Ensure confidentiality of all patient information Legal Issues -HIPAA; advance directives, confidentiality Teaching and Learning -Ethical duty to ensure the patient understands the teaching and can carry out any self-care tasks

Core Values for the profession of nursing

Altruism Concern for the welfare and well-being ofothers Autonomy Right to self-determination Human Dignity Worth and uniqueness of individuals and populations Integrity Acting within accordance to the code of ethics and accepted standards of practice; honesty Social Justice Treating all patients equally without regard to economic status, ethnicity, age, gender, religion, citizenship, disability, or sexual orientation

Principles and Practices of Ethical Decision Making in Nursing

Autonomy Patients have the right todetermine their own plan ofcare; respect the patient'swishes even when you do notagree with them. Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Autonomy means freedom from external control. Beneficence Have compassion, take positive actions to help others follow through on the desire to do good; basic obligation to assist others. Beneficence refers to taking positive actions to help others. Nonmaleficence - Do NoHarm • Remain competent in the field; report suspected abuse Nonmaleficence refers to the avoidance of harming or hurting others. Justice Treating all patients fairly and equally; consider the entire person when deciding therapies, medications, or procedures. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Veracity Truthfulness; providing complete information; timely and accurate documentation Fidelity refers to the agreement to keep promises. The nurse assesses the patient's needs and performs interventions to fulfill them. If the interventions are not found to be effective, the nurse still follows through on the actions and modifies the care plan to reduce the pain.

Culture

Culture refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions. Learned behavior of a society or a group.The ensemble of stories we tell ourselves about ourselves.

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by A. Bias. B. Stereotyping. C. Prejudice. D. All of the above.

D

What are Ethics?

Defined as a system of moral principles or standards of governing behaviors and relationships that are based on professional nursing beliefs and values Standards of right and wrong that influence human behavior Rights, obligations, benefits to society, fairness Advocate a person who expresses and defends the cause of another person

Caring for immigrant patient and their risk

For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources, and transportation. Immigrant populations face multiple diverse health issues that cities, counties, and states need to address. These health care needs pose significant legal and policy issues. For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources, and transportation.

Methods of documentation

Flow Sheets: series of rows and columns organized by body system (vital signs, I&O). Documents on which frequent observations or specific measurements are recorded. Progress Notes: health team members monitor and record the progress made in resolving the patient's problem Charting by Exception: -Documentation of deviations.-Use of a shorthand method.-Documentation of significant findings. -Charting methodology in which data are entered only when there is an exception from that which is normal or expected -Documentation of patient concerns. -Inclusion of subjective assessment findings.

Marginalized groups disparities

Gay, lesbian, bisexual, or transgender; people of color; people whoare physically and/or mentally challenged; and people who are notcollege educated

A nurse is teaching a patient who has low health literacy about chronic obstructive pulmonary disease (COPD) while giving COPD medications. Which technique is most appropriate for the nurse to use?

Include the most important information at the beginning of the session for patients with literacy or learning disabilities. Also, use visual cues and simple, not complex, analogies when appropriate. Another technique is to frequently ask patients for feedback to determine whether they comprehend the information. Additionally, provide teaching materials that reflect the reading level of the patient, with attention given to short words and sentences, large type, and simple format (generally, information written on a fifth grade reading level is recommended for adult learners).

informed consent

Informed ConsentPatient's legal and ethical rights to be informed of, and give or refuse permission for any healthcare procedure or treatment. Guidelines: The diagnosis or condition that requires treatment purpose of the treatment that the patient can expect to feel or experience The intended benefits of the treatment Possible risks or negative outcomes of the treatment Advantages and disadvantages of possible alternatives to treatment (including no treatment) Must be voluntary; the patient should not be coerced or pressured in any manner Patient must understand Use layman's terms; not medical jargon Be mindful of language barriers and low literacy levels Cultural and spiritual preferences Person who is performing the procedure is responsible for obtaining consent

Mandatory Reporting

Legal requirement to report an act, event, or situation that is designated by state oflocal law as a reportable event. Nurses are required to report abuse or suspected abuse, certain types of illnesses and injuries, and crimes involving minors. Good faith immunity protects healthcare workers from civil or criminal liabilities when they report suspected abuse in good faith Nurses are mandatory reporters

Nursing documentation; what goes in the chart, language used and if things are documented incorrectly (what should you do

More advanced systems incorporate standardized nursing languages such as the International Classification for Nursing Practice (ICNP), the North American Nursing Diagnosis Association International (NANDA-I) nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) into the software Use clear, concise descriptions in patient's own language. Draw single line through error, write word "error" above it, and sign your name or initials and date it. Then record note correctly.

Provision

NURSE HAS POWER TO TAKE ACTION AND PROMOTE HEALTH.

How to implement nursing care while incorporating cultural belief and practices

Negotiate a treatment plan, considering that it is beneficial to incorporate selected aspects of the patient's culture into the plan.

National Council of State Boards of Nursing(NCSBN)

PROVIDES LEADERSHIP TOADVANCE REGULATORYEXCELLENCE FOR PUBLICPROTECTION MEMBERSHIPS INCLUDES BON FROM ALL 50 STATES, THE DISTRICT OF COLUMBIA, AND FOUR U.S. TERRITORIES(GUAM, VIRGIN ISLANDS, AMERICAN SAMOA, &NORTHERN MARIANA ISLANDS) RESPONSIBLE FOR DEVELOPING LICENSURE AND ASSESSMENT EXAMS OFFERS CONTINUING EDUCATION IMPORTANT SOURCE OF DATA AND RESEARCH ABOUT NURSING PRACTICE

Advanced Directives: Role of the Nurse

Patient has the option to change their advance directive decision at any time Patient and family needs to have an accurate understanding of life-sustaining measures. It is important to let the family know that for example, pt is a vegetable on the ventilator. Assist patients to provide a copy of their AD to their next of kin, primary healthcare providers, and any healthcare facility they are admitted to: ER, REHAB FACILITIES AND SENIOR LIVING CENTERS

Health insurance portability and accountability Act(HIPAA)

Privacy Rule protects all individually identifiable health information held or transmitted in any form or medium -electronic, paper, or oral Privacy includes the rights of individuals to keep their personal information form being disclosed. The individual decides when, where, and with whom to share his or her health information Confidentiality refers to the assurance the patient has that private information will not be disclosed without his or her consent Disclosure of patient information is a breach of confidentiality that may subject a nurse to legal action

SBAR

S: Situation B: Background A: Assessment R: Recommendation he SBAR or ISBAR format is a commonly used framework for a narrative note when exceptions occur. Both are also popular formats for verbal reporting (see Chapter 24). When changes in a patient's condition develop, you must include a narrative progress note that provides a thorough and precise description of the effects of the changes on the patient and the actions taken to address those changes.

Key Steps in the Resolution of an Ethical Dilemma

Step 1: Ask: Is this an ethical problem? Step 2: Gather information relevant to the case. Patient, family, health care agency, and social perspectives are important sources of relevant information. Step 3: Identify the ethical elements in the situation by clarifying values and recognizing the principals involved. Distinguish among fact, opinion, and values. Step 4: Name the problem. A clear, simple statement of the problem is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: Identify possible courses of action. Access others for their input and be creative in identifying different options. Step 6: Create and implement an action plan. Gather support from others and identify an alternative action if the chosen one does not achieve resolution. Step 7: Evaluate the action plan to determine whether further action is needed or if lessons learned in this experience can be applied forward.

social determinants of health disparities

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

teach back method

The nurse provides teaching on a particular topic, then asks the patient to describe the main points from that teaching using his or her own words

Nurse Practice Acts

The practice of nursing is regulated at the state level through a nurse practice act (NPA). Each state's NPA is enforced and administered by a state board of nursing (BON). ◦ Definition of nursing ◦ Requirements for licensure ◦ Penalty for practicing without a license ◦ Exemptions from licensure ◦ Licensure across jurisdictions

The purpose of hand-off/shift change reporting

The real-time process of passing patient-specific information from one caregiver to another or among interdisciplinary team members to ensure continuity of care and patient safety is often called a handoff. Oral, face-to-face, telephone, written, recorded Between providers, between shifts At unit transfer or discharge referral Provide accurate and timelyinformation about Care Treatment Services rendered Address Current condition Anticipated changes

advanced directive (living will)

a document developed by the patient that instructs others to do tasks before, during, and after his or her death a statement of the patient's wishes if a respiratory or cardiac arrest occurs and a copy of the patient's durable power of attorney for health care (DPAHC) a living will is invoked only when the patient is in a persistent vegetative state

durable power of attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient An advance directive is a document developed by patients that instructs others to do tasks before, during, and after their death. At a minimum, an advance directive includes a statement of a patient's wishes if a respiratory or cardiac arrest occurs and a copy of the patient's durable power of attorney for health care (DPAHC). Instructions regarding care before or during cardiac or respiratory arrest should be signed by either a physician or a nurse practitioner. Unless otherwise specified by state law, the document should be treated as an order; it may direct whether to provide lifesaving measures such as cardiopulmonary resuscitation (CPR) or to provide comfort care only.

Health disparities

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage -differences among populations in the availability, accessibility, and quality of health care services.-differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases, and related complications.- differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications.

Advanced Directives

a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. A healthcare advance directive is a legal document executed by an individual that expresses that individual's desires regarding medical treatment that maybe used if and when the individual is no longer able to communicate their preferences directly. Patient Self-Determination Act Living Will - provides specific instructions about what medical treatment the patient chooses to omit or refuse A durable power of attorney for healthcare - patient may designate another individual as healthcare surrogate or healthcare proxy

Domains of learning

a) Cognitive - obtaining new information, being able to apply the information, and able to evaluate the information. b) Affective - involves feelings, beliefs and ideals. c) Psychomotor - learning how to complete a physical activity or motor skill

Nurse practice acts

are civil state laws that define nursing and the standards nurses must meet within individual states. Your state's nurse practice act defines a nurse's scope of practice, the educational requirements you must have to be a nurse, and how to obtain licensure as a nurse in your state (Oyeleye, 2019; Pozgar, 2020). Nurse practice acts also distinguish nursing from other health professions (e.g., medicine, therapists, and alternative medicine providers).

Intentional torts

are deliberate acts against a person or property that may result in both civil and criminal actions. Assault is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact (Furrow et al., 2018). No actual contact is required for an assault to occur. For example, if a nurse threatens to give a patient an injection or to restrain a patient while having an x-ray taken when the patient has refused consent, the nurse's action is considered an assault. Likewise, assault occurs when a patient threatens a nurse. Battery is any intentional offensive touching without consent or lawful justification (Furrow et al., 2018). The contact can be harmful to the patient and cause an injury, or it merely can be offensive to the patient's personal dignity. In the example of a nurse threatening to give a patient an injection without the patient's consent, if the nurse gives the injection, it is battery. Battery also results if a health care provider performs a procedure that goes beyond the scope of a patient's consent. For example, if a patient gives consent for an appendectomy and the surgeon performs a tonsillectomy, battery has occurred. The key component is the patient's consent

Unintentional Torts (Negligence)

arise when a person is harmed and the person inflicting the harm knew, or should have known, that these actions were less than the accepted scope and standard of practice. Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person (Furrow et al., 2018). Anyone, including people not in the medical field, can be liable for negligence. Nurses are negligent when they had a duty of care that is breached and their patient is physically harmed. A reasonably prudent nurse under similar circumstances would have provided care differently. The law establishes the standard of care to protect others against an unreasonably great risk of harm (Furrow et al., 2018). Negligent acts, such as hanging the wrong intravenous solution for a patient or applying a warm compress that causes a burn, often result in disciplinary action by the State Board of Nursing and a lawsuit for negligence against the nurse and the employer

Know the meaning of assault, battery, abandonment, false imprisonment, invasion of privacy and malpractice

assault -intentionally attempting or threatening to touch a person's body without the person's consent battery -Battery is touching a person's body without his or her consentConsent may be verbal - "yes" or "okay." abandonment fidelity demands that we not abandon the patient but instead find an equally qualified professional to provide the care we are unable to provide. false imprisonment the unlawful restraint or restriction of a person's freedom of movement invasion of privacy violating a person's right not to have his or her name, photo, or private affairs exposed or made public without giving consent Negligence and malpractice: Malpractice is negligence by a professional person. Negligence is an unintentional wrong. The negligent person did not act in a reasonable and careful manner. As a result, a person or the person's property was harmed-Standard of care refers to the skills, care, and judgements required by a health team member under similar conditions-You are legally responsible (liable for your own actions)

Boards of Nursing

can help address questions about scope of practice and competency.

Factors that influence learning process

readiness, motivation to learn -reading and comprehension level -mobility Health beliefs and practices Changing a patient's health beliefsmay not be possible Cultural factors Affect patients' learning needsPatient may understand the healthcare information being taught but prefer to follow practices of patient's culture Economic factors Ability to obtain medication and supplies may affect learning Learning styles Nurse may not have time or skills to assess each learner's styleUse variety of teaching techniques to ensure highest rate of retention Support systems Helpful to determine extent to which others may enhance learning, offer support

Issues in Health Care Ethics

social media -On the other hand, the risk to patient privacy with social media is great (NCSBN, 2018). Posting information or pictures about patients, even without specific identifiers, is a violation of confidentiality. Interaction between health care professionals and patients on social media is also problematic. quality of life Health care researchers use quality-of-life measures to scientifically define the value and benefits of medical interventions., shots give pain but prevents infections. care at the end of life The term futile refers to something that is hopeless or serves no useful purpose. In health care discussions, the term futile refers to interventions unlikely to produce benefit for a patient (Fromme, 2020). For example, if a patient is dying of a condition with little or no hope of recovery, almost any intervention beyond symptom management and comfort measures is seen as futile. In this situation an agreement to label an intervention as futile can help the health care team members, families, and patients turn to palliative care measures as a more constructive approach to the situation (see Chapter 36). access to health care In some cases, health insurance is provided as a benefit of employment. Those who do not have employer-based health insurance may qualify for state-based Medicaid programs on the basis of need or for Medicare, a federal insurance program available to all individuals age 65 and older. Because of conflicting views about what is fair and because of its effect on everyone, access to health care is a controversial issue.

Torts:

wrongful acts for which an injured party has the right to sue. A tort is a wrong committed against a person or the person's property.

Culturally IncompetenT

• Cognitive: Oblivious • Affective: Apathetic • Psychomotor: Unskilled

Guidelines for Telephone and Verbal Orders

• Only authorized staff (who are identified in a written policy by each agency) receive and record telephone and verbal orders. • Clearly identify the patient's name, room number, and diagnoses. • Use clarification questions to avoid misunderstandings. Ask health care provider to repeat a word or phrase if needed. • Document "TO" (telephone order) or "VO" (verbal order), including date and time, name of patient, the complete order; the name and credentials of the health care provider giving the order(s); and your name and credentials as the nurse taking the order. • Read back all orders prescribed to the health care provider who gave them and document "TORB" (telephone order read back) when signing your name and credentials. • Follow agency policies; some agencies require TOs and VOs to be reviewed and signed by two nurses. • The health care provider cosigns each TO and VO within the time frame required by each agency (usually 24 hours).

SOAP notes

• S: Subjective—Patient states, "My leg is so swollen. I'm worried about this blood clot. Do you know how they are going to treat it?" • O: Objective—Patient asking question about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction. • A: Assessment—Patient lacks knowledge regarding anticoagulation therapy, seeking information about therapy. • P: Plan: Discussed importance of bed rest and the reason for treatment with heparin infusion. Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves.