Key Ethical Principles and Nursing Practices

Scope of Practice

(2 step process) state legislature passes NPA to regulate nurse practice within a state, state legislature identifies a regulatory body, usually state Board of Nursing to enforce rules set by NPA.

State Board of Nursing

(BON) makes rules and regulations set by NPA.

PICOT

(Population, intervention, comparison, outcome, time) it is used to develop a specific and clear question.

Stage 3: Competent

2-3 years of experience, can prioritize tasks more quickly and accurately.

Patricia Benner's From Novice to Expert Theory

A framework describing the progression through various stages of nursing competence.

Patient-centered care

A nurse is providing care with the focus of care being on the client and their family.

Substance use disclosure

A nurse is required to disclose substance use within the past 5 years when completing the renewal application.

Evidence-Based Practice (EBP)

A problem-solving approach to client care that combines accurate scientific evidence with clinical expertise and client values.

Health Promotion

Actions taken by nurses/health care workers to empower clients to take control over their own health habits for a healthier life.

Advocator

Acts on behalf of patient to protect rights and ensure they receive proper care.

Dorothea Dix

Advocated for mental health awareness and indigenous rights.

Identify a Problem

Ask a question.

ADN

Associate degree in nursing: 2-3 years, focus on technical skills, quick entry to workforce.

BSN

Bachelor's degree in nursing: 4 years, leadership, research, public health, preferred for management roles or advanced study.

Stage 5: Expert

Can draw on extensive experience and knowledge and rely on intuition in complex situations.

Palliative Care

Care focus on relieving symptoms and improve quality of life for patients with serious illnesses, not necessarily at the end of life.

Implement Recommendations

Change interventions.

Emergency Medical Treatment and Active Labor Act (EMTALA)

Clients must receive a medical screening evaluation (MSE).

Case Manager

Conduit between clients and health care system, ensure clients receive care and safely navigate to healthcare system to achieve safe outcomes.

Review Their Effectiveness

Do the new interventions improve results?

Educator

Educate clients and increase their knowledge, improve their skills, decisions, and quality of life.

EMTALA

Emergency Medical Treatment and Active Labor Act- prevent 'patient dumping', so individuals who come to Emergency Department are required to check patients with medical screening examination and treatment till stable

Code of Ethics

Ethical values, obligations, and duties of every nurse; guide to make ethical decisions, ensure safety and well-being of patients.

Clara Barton

Founded the American Red Cross and formed nursing education.

HIPAA

Health Insurance Portability and Accountability Act - provides privacy and security protection for individuals' health information.

Diploma

Hospital based programs: less common, 2-3 years, strong clinical focus, less academic preparation.

EBP Steps

Identify problem, search credible sources, evaluate findings, implement recommendations, review effectiveness, share results.

I-SBAR

Introductions, Situation, Background, Assessment, Recommendation, Readback- is a standardized communication tool to establish uniform delivery of information from one provider to another during transfer of care

Multi-state license

It allows the nurse to practice in their primary state of residence and other compact states under one multi-state license.

Durable Power of Attorney

Legal document that designates someone to make healthcare decisions on behalf of a person if unable to do so themselves.

Stage 2: Advanced beginner

Little experience, need supervision still, can recognize patterns and recurrent situations.

Search Credible Sources of Evidence

Look for factual information.

Continuity of Care

Maintaining client safety as they transition from one provider to another or from one level of care to another.

Behavior Associated with EBP

Making reliable information on the change readily available for all staff to review.

Disease Prevention

Measures taken to limit exposure or effects of illness or disease.

Compassionate Care

care that is characterized by empathy and concern for the patient's well-being.

Secondary Prevention

consists of early screening to detect a disease process before it progresses to cause symptoms or complications in the client (screen test- blood pressure)

Informed Consent

demonstrates a skill that is outside the nurse's scope of practice.

Nursing Scope and Standards of Practice

document identifies what a nurse does, a nurse's responsibilities, when and where client care is to be performed and why and how client care is achieved.

Primary Prevention

focus on decreasing risk for development of medical conditions by changing behaviors or minimize exposures (vaccines, no drugs)

Tertiary Prevention

focuses on controlling the chronic effects of health issue that has already occurred and on restoring the individual to optimal functioning (self-care education- cancer, diabetes, arthritis)

Quaternary Prevention

focuses on protecting clients from excessive use of medical interventions that can cause more harm than good (medical tests, meds)

Autonomy

freedom or independence to make own decisions

Ethical Principles

guidelines that help nurses make decisions about patient care.

Fidelity

keeping promises or commitments

Accountability

legal obligation with moral and ethical commitment to do right thing every time and every situation

Veracity

telling the truth

Professional Judgment

the ability to make informed decisions based on knowledge and experience.

Advocacy

the act of protecting the client's rights of autonomy and self-determination, often serving as a voice for the client.

Professionalism

the competence or skill expected of a professional.

Quality of Care

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.

Nursing Ethics

the ethical obligations and duties of nurses.

Patient Safety

the prevention of errors and adverse effects to patients associated with health care.

Client Rights

the rights of clients to make decisions about their own care.

Nonmaleficence

to do no harm

Quantitative research

use numerical data to evaluate outcomes (numbers, counts, measures collected and analyzed using statistics)

Recommendation (I-SBAR)

what do you suggest to be done?

Assessment (I-SBAR)

what do you think the problem is?

Background (I-SBAR)

what is clinical background or context? (Diagnosis, meds, vitals)

Situation (I-SBAR)

what is happening right now?

Patient Advocacy

supporting and promoting the interests of patients.

Patient Self-Determination Act

Requires all health care organizations to inform clients of their right to make decisions regarding their care.

Evaluate the Findings

Review the information.

Disseminating the Results

Share the findings with others.

Qualitative nursing research

Studies phenomena that are difficult to quantify such as feelings or emotions

Level I Evidence

Systematic review.

EBP Implementation Example

The nurse is providing care that integrates best current practice based on literature review with clinical practice.

Nurse Practice Act

serve as current laws and regulations governing nursing practice in every state/territory of U.S.

Eddie Bernice Johnson

U.S. Congressional Representative who created opportunities for minorities.

Behavior Associated with EBP

Valuing evidence-based practice as critical to the development of staffing guidelines for the institution.

Justice

actions are fair and equitable

Beneficence

actions guided by compassion/kindness

Social Media Use

Positive and negative impacts with it and keep in mind confidentiality, professionalism, ethical boundaries.

Protected Health Information (PHI)

Refers to any information in a medical record that can be used to identify a patient and that was created, used, or disclosed during the course of care.

Violation of Confidentiality Example

Reporting client findings to a family member over the phone.

Stage 4: Proficient

More than 2-3 years of experience, understand the bigger picture and desired outcome of situations.

Florence Nightingale

Mother of nursing, pioneer in nursing education, recognized the correlation between infection and unclean conditions.

Healthy People 2030

National health promotion and disease prevention initiative developed every 10 years to improve the health of Americans, focusing on reducing preventable death and injury.

Stage 1: Novice

Nursing students with no previous experience.

Safety

One of the QSEN competencies aimed at minimizing risk and harm to patients.

Teamwork & Collaboration

One of the QSEN competencies emphasizing the importance of working together in healthcare.

Quality Improvement

One of the QSEN competencies focused on enhancing healthcare services.

Informatics

One of the QSEN competencies involving the use of data and information technology in nursing.

Evidence-Based Practice

One of the QSEN competencies that encourages the use of research and data in clinical decision-making.

Sentinel events

One that results in a client death or permanent or severe temporary harm.

Professional Boundaries

Patient-centered care, effective communication, ethical conduct, accountability, leadership.

Nursing Licensure Compact (NLC)

Permits nurses to practice in home states and other compact states under one multistate license.

QSEN Competencies

Project created in response to an identified need for improving quality and safety in nursing.

Confidentiality

Protect patients' private and personal information.

Caregiver

Provide knowledgeable, compassionate care to promote health and address illness.

Collaborator

Work with other healthcare professionals to provide the best care.

Living Will

Written statement outlining a person's wish regarding medical treatment if unable to communicate wishes in future cases.

Health Literacy

ability to process and comprehend basic health information that is necessary for the client to make appropriate health care decisions

Responsibility

obligation to perform work, duties or tasks using professional judgment- being reliable and dependable to commitment

Good Samaritan Law

protecting nurse as long as you maintain scope of practice from being held responsible for harm

NPA

provide general guidelines, but each state creates rules/regulations to further explain or make NPA more detailed.

Burnout

state of emotional, mental, and physical exhaustion by prolonged stress, often from long hours, emotional strain, high patient ratios, lack of support- fatigue, poor job performance

Legal Obligations

responsibilities that are enforced by law.

Qualitative research

seeks to increase understanding, describe, explore, or illuminate value-laden issues in health care