NSG 300: TOPIC 12

Restraints can be used...

(1) only to ensure the physical safety of the patient or other patients (2) when less restrictive interventions are not successful (3) only on the written order of a health care provider. The regulations also describe documentation of restraint use and follow-up assessments.

restorative and continuing care: family

-Maintain patients' functional abilities within the context of the family. -Make sure home environment will accommodate a patient's strengths and limitations. -Show how to perform aspects of physical care.

Attachment Theory

-Numbing: protects the person from the full impact of the loss -Yearning and searching emotional outbursts of tearful sobbing and acute distress -Disorganization and despair" endless examination of how and why the loss occurred or expressions of anger at anyone who seems responsible for loss -Reorganization: Accepts the change, assumes unfamiliar riles, acquires new skills, builds new relationships, and begins the separate himself or herself from the lost relationship without feeling that he or she is lessening its importance

what is the defintion of a family?

-The family can be defined biologically, legally, or as a social network with personally constructed ties and ideologies. -No two families are alike; each has its own strengths, weaknesses, resources, and challenges.

what are factiors that influence family forms

-family caregivers -poverty -homelesness -domestic violence

Ethics committees

-present in majority of hospitals and home health agencies usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation.

social networking and nursing

-risk to patient privacy is great

what are things a nurse should implement in end of life care

-therapeutic ocmmunication -manage symptons -promote dignity and self-esteem -maintain a comfortable ans peaceful enviroment -promote spiritual comfort and hope -protect against abandonment and isolation -support the grieving family

Patients may remain on their parent's health insurance until they are

26 years old

tort

A civil wrong made against a person or property.

Malpractice Insurance

A contract between the nurse and the insurance company Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance Nurses covered by institution's insurance while working

A health care proxy or durable power of attorney for health care (DPAHC)

A legal document that designates a person or people of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf

anticipatory grief

A person experiences this grief before the actual loss or death occurs, especially in situations of prolonged or predicted loss like caring for patients diagnosed with dementia or ALS.

exaggerated grief

A person with an this grief response often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these individuals.

chronic grief

A person with this grief experiences a normal grief response except it extends for a longer period of time.

delayed grief

A person's grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss.

risk management and quality assurance

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs

Informed consent

Agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal

Uniform Anatomical Gift Act

An individual who is at least 18 years of age has the right to make an organ donation. Donors need to make the gift in writing with their signature. In many states, adults sign the back of their driver's license, indicating consent to organ donation.

fidelity

As a nurse, you keep promises by following through on your actions and interventions. -also refers to the unwillingness to abandon patientsregardless of the circumstances, even when personal beliefs differ

Necessary losses

As people age, they learn that change always involves a necessary loss. They learn to expect that most necessary losses are eventually replaced by something different or better.

nonmalefiecence

Avoidance of harm or hurt. -(not only the will to do good, but an equal commitment to do no harm)

Civil law

Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur.

nuclear family

Consists of husband and wife (and perhaps one or more children). living as one unit

Criminal law (felonies or misdemeanors)

Criminal laws are meant to prevent harm to society and to provide punishment for crimes.

Deontology

Defines actions as right or wrong based on their "right-making characteristics," such as fidelity to promises, truthfulness, and justice.

ethics of care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives

health care reform

Facilitated access to care for millions of uninsured Americans

Health promotion

Focus on coping and optimizing health

Calgary Family Assessment Model

Focuses on interactions among the individuals in the family -famuly assessment questions include: family structure, developmental assessment, and family functioning

Standards are set by The Joint Commission and the ANA

Health care facilities have compliance officers who are responsible for making sure that the institution remains in compliance with standards and regulations.

Health Information Technology Act (HITECH)

In conjunction with HIPPA and in response to new technology and social media.

what is essential to provide individualized patient/family-centered care?

Incorporating the patient's and family's cultural beliefs, values, and communication patterns

blended family

Is formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation. -consists of a biological parent, a stepparent, and the children of one or both parents

standards of care

Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care

Disenfranchised grief

People experience this grief when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance.

autonomy

Refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and PROTECTING A PATIENTS INDEPENCENCE. Involving patients in decisions about their care is now standard practice.

alternative family

Relationships include multi-adult households, "skip-generation" families (grandparents caring for grandchildren), communal groups with children, "nonfamilies" (adults living alone), and cohabitating partners.

family as system

Remember that looking at the family as a system requires that you look at the family as context and as patient. These two perspectives are not mutually exclusive. You may use them simultaneously. -Both family members and family unit

Living wills

Represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition.

The Uniform Determination of Death Act

States that health care providers can use the cardiopulmonary definition or the whole brain definition to determine death.

what are teh 7 steps that will guide you thorugh an ethical dilemma

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action.

Situational losses

Sudden, unpredictable external events

Family durability

System of support and structure within a family that extends beyond the walls of the household

Bargaining

The person cushions and postpones awareness of the loss by trying to prevent it from happening

Anger

The person expresses resistance or intense anger at God, other people, or the situation

Acceptance

The person incorporates the loss onto life

Depression

The person realizes the full impact of the loss

extremely flexible family structures

There is sometimes an absence of stability that would otherwise lead to automatic action during a crisis or rapid change.

Casuistry, or case-based reasoning

Turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an "intimate understanding of particular situations." This approach to ethical discourse depends on finding consensus more than an appeal to philosophical principle.

family diversity

Uniqueness of each family unit

The Oregon Death With Dignity Act

Was the first statute that permitted physician-assisted suicide

the nurse as an educator

Your focus as an educator may be on the family caregiver, to prepare that person to manage the skills and processes needed to manage the patient's needs within the home.

Nursing negligence or malpractice is an example of...

a civil law violation.

misdemeanor

a crime that, although injurious, does not inflict serious harm. -o usually has a penalty of a monetary fine, forfeiture, or brief imprisonment.

single-parent family

a family in which only one parent is present to care for the children -Is formed when one parent leaves the nuclear family because of death, divorce, or desertion, or when a single person decides to have or adopt a child.

Maturational losses

a form of necessary loss and includes all normally expected life changes across the life span. Maturational losses associated with normal life transitions help people develop coping skills to use when they experience unplanned, unwanted, or unexpected loss.

family heath system (FHS)

a holistic model that guides the assessment and care for families. It includes five realms/processes of family life: interactive, developmental, coping, integrity, and health.

complicated grief

a person has a prolonged or significantly difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future.

value

a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior.

felony

a serious offense that results in significant harm to another person or society in general. -carry penalties of monetary restitution, imprisonment for greater than 1 year, or death.

Ambiguous loss

a type of disenfranchised grief, occurs when the lost person is physically present but is not psychologically available, as in cases of severe dementia or severe brain injury.

family resiliency

ability to cope with expected and unexpected stressors

Grief Tasks Model

accepts the reality of the loss, experience the pain of grief, adjusts to a world in which the decrease is missing, emotionally relocated the deceased and moves on with life

The Joint Commission (TJC) requires

accredited hospitals to have written nursing policies and procedures. -These internal standards of care are specific to the agency and need to be accessible on all nursing units.

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 providers, families, and patients turn to palliative care measures as a more constructive approach to the situation.

Assault

an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.

battery

any intentional offensive touching without consent or lawful justification.

Nurses who float must inform the supervisor of

any lack of experience in caring for the type of patients on the nursing unit. They should request and receive an orientation to the unit.

Never events

are preventable errors, which may include falls, urinary tract infections from improper use of catheters, and pressure ulcers.

Intentional torts

are willful/deliberate acts that violate another's rights. These include assault, battery, and false imprisonment.

A nurse can view the family in three ways: as _____, as _____, or as ______.

as context, as the patient, or as a system

Disabilities Act

bans discrimination against people with physical, mental, or emotional challenges

results if the health care provider performs a procedure that goes beyond the scope of the patient's consent, what is this considered

battery

For living wills or durable powers of attorney for health care to be enforced, the patient must

be declared legally incompetent or lack the capacity to make decisions regarding his or her own health care treatment.

Boards of Nursing

can help address questions about scope of practice and competency

what are the types od complicated grief

chronic, exaggerated, delayed, masked

Any health care professional who does not report suspected child abuse or neglect may be liable for

civil or criminal legal action.

Normal (uncomplicated) grief

common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death.

Ethical dilemmas almost always occur in the presence of...

conflicting values

Patient Protection and Affordable Care Act (PPACA)

created a new Patient's Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick.

The consequences of civil law violations are...

damages in the form of fines or specific performance of good works such as public service.

Stages of grief

denial anger bargaining depression acceptance

beneficence

doing good, Implies that the best interests of the patient remain more important than self-interest, taking positive actions to help others

how can acute/chronic illness influence a family?

economically, emotionally, socially, and functionally and affects the family's decision making and coping resources.

Utilitarianism

ethics proposes that the value of something is determined by its usefulness. The greatest good for the greatest number of people is the guiding principle for determining right action in this system. -because its main emphasis is on the outcome or consequence of an action

feminist ethics

focuses on the inequality between people

what is the best way for nurses to avoid malpractice

follow standards of care, give competent health care, and communicate with other health care providers.

Genetic factors reflect a family's...

heredity or genetic susceptibility to diseases that may or may not result in actual development of a disease.

Family caregiving activities include...

include finding resources, providing personal care, monitoring for complications or side effects, providing instrumental activities of daily living and ongoing emotional support and decision making

Statutory laws (Nurse Practice Act)

include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state.

Members of the interprofessional team

includes physicians, social workers, therapists pharmacists, and chaplains. All may be interacting with the patient or aware of the situation that you are facing. Hearing their perspectives can help you to identify the problem and consider solutions.

extended family

includes relatives (aunts, uncles, grandparents, and cousins), in addition to the nuclear family.

PPACA was developed to

increase access to health care.

The five areas of family life to include in an assessment are...

interactive, developmental, coping, integrity, and health processes of the family

Quasi-intentional torts

invasion of privacy defamation of character

Clarifying values

is an important and effective part of ethical discourse. In the process of values clarification, you learn to tolerate differences in a way that often (although not always) becomes the key to the resolution of ethical dilemmas

Negligence

is conduct that falls below the generally accepted standard of care of a reasonably prudent person.

Malpractice

is one type of negligence and often referred to as professional negligence.

Defamation of character

is the publication of false statements that result in damage to a person's reputation.

libel

is the written defamation of character

Perceived losses

is uniquely defined by the person experiencing the loss and is less obvious to other people.

Advance directives

legal documents that allow people to choose what medical care they wish to have if they are unable to make those decisions themselves

Nursing colleagues

listen to the problem, offer alternative actions, and help you articulate the issue. Giving and receiving support from other nurses promotes a positive work environment

Dual Process Model

loss oriented and restoration oriented

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

mandates protection of the patient's personal health information.

Nurse leaders

may include a preceptor, charge nurse, manager, educator or advanced practice RN. They may have faces and manages similar situations and so have guidance to offer, They can also access other resources withing the hospital.

Consultation services

may include ethics committees and palliative care specialists

unintentional tort

negligence and malpractice

If patients deny understanding of a procedure or you suspect that they do not understand what should the nurse do

notify the health care provider or nursing supervisor

In a malpractice lawsuit, a nurse's actual conduct is compared to...

nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.

what are 5 trends that are threats/concerns for families

o (1) changing economic status o (2) homelessness o (3) domestic violence o (4) the presence of acute or chronic illnesses or trauma o (5) end-of-life care.

A nurse may refuse an assignment when...

o (1) the nurse lacks the knowledge or skill to provide competent care; o (2) care exceeding the Nurse Practice Act is expected; o (3) health of the nurse or her unborn child is directly threatened by the type of assignment; o (4) orientation to the unit has not been completed and safety is at risk; o (5) the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds; or o (6) the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient.

Hospice care

o A philosophy and model for the care of terminally ill patients and their families at the end of life. It gives priority to managing a patient's pain and other symptoms; comfort; quality of life; and attention to physical, psychological, social, and spiritual needs and resources. o Manage pain, provide comfort, ensure quality of life o Adheres to patient wishes

Code of nursing ethics

o A set of guiding principles that all members of a profession accept o Helps professional groups settle questions about practice or behavior o Includes advocacy, responsibility, accountability, and confidentiality

what are the steps involved in risk management and quality assurance

o Identify possible risks o Analyze risks o Act to reduce risks o Evaluate steps taken

Certain criteria are necessary to establish nursing malpractice:

o The nurse (defendant) owed a duty of care to the patient (plaintiff). o The nurse did not carry out or breached that duty. o The patient was injured and the nurse's failure to carry out the duty caused the injury.

Family caregiving

o The routine provision of services and personal care activities for a family member by spouses, siblings, friends, or parents

slander

occurs when one speaks falsely about another

false imprisonment

occurs with unjustified restraint of a person without a legal reason.

Professional organizations

often set standards for nursing practice and have web-based resources to help you develop knowledge and skills in ethical analysis

family forms

patterns of people considered by family members to be included in the family

Family as context

primary focus is on the health and development of an individual member existing within a specific environment -Although the focus is on the individual's health status, assess how much the family provides the individual's basic and psychological needs.

Americans with Disabilities Act (ADA)

prohibits discrimination and ensures equal opportunities for people with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation.

Public health laws

protect populations, advocate for the rights of people, regulate health care and health care financing, and ensure professional accountability for care provided.

Occurrence reporting

provides a database for further investigation in an attempt to determine deviations from standards of care and corrective measures needed to prevent recurrence, as well as to alert risk management of a potential claim situation

The Emergency Medical Treatment and Active Labor Act

provides that if an emergency condition exists, staff must evaluate the patient and may not discharge or transfer him or her until the patient's condition stabilizes.

Nurses act as Good Samaritans when

providing care at the scene of an accident. All states have Good Samaritan Acts.

justice

refers to fairness

futile

refers to something that is hopeless or serves no useful purpose.

Accountability

refers to the ability to answer for one's own actions.

just culture

refers to the promotion of open discussion without fear of recrimination whenever mistakes, especially those involving adverse events, occur or nearly occur.

Advocacy

refers to the support of a particular cause. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.

Responsibility

refers to willingness to respect obligations and to follow through on promises.

The Patient Self-Determination Act (PSDA)

requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.

Common law

results from judicial decisions concerning individual cases. -Most of these revolve around negligence and malpractice

what are providers legally obligated to inform patietns about?

risks and benefits of treatment plans and then to enste that they indtertans and agree with their plan

rigid family sturctures

specifically dictate who accomplishes different tasks and also limit the number of people outside the immediate family allowed to assume these tasks.

caregiver burden

stress responses experienced during prolonged periods of home care by family caregivers

trauma

sudden, unplanned, and sometimes life threatening event

The nurse's signature as a witness to the consent means...

that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent

Quality-of-life measures may take into account...

the age of a patient, the patient's ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality

A nurse's documentation is often...

the evidence of care received by a patient and establishes support that the nurse acted reasonably and safely.

family as patient

the family processes and relationships are the primary focuses of nursing care. -Focus your nursing assessment on family patterns rather than the characteristics of the individual members.

An autopsy or postmortem examination may be requested by

the patient or patient's family

the ethical doctrine of autonomy ensures

the patient the right to refuse medical treatment.

Denial

the person cannot accept the fact of the loss.

Palliative care focuses on

the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness.

invasion of privacy

the release of a patient's medical information to an unauthorized person such as a member of the press, the patient's employer, the patient's family, or online.

Nurse Practice Acts define

the scope of nursing practice, distinguishing between nursing and medical practice and establishing education and licensure requirements for nurses.

The American Nurses Association (ANA) outline...

the scope, function, and role of the nurse in practice.

end of life care

the support and care given during the time surrounding death

Cardiopulmonary resuscitation (CPR) is an emergency treatment provided without patient consent. Health care providers perform CPR on an appropriate patient unless

there is a DNR order in the patient's chart.

Nurses follow health care providers' orders unless...

they believe that the orders are in error, violate agency policy, or are harmful to the patient

what is the goal of family centered nursing

to address the comprehensive health care needs of the family as a unit; and to advocate, promote, support, and provide for the well-being and health of the patient and individual family members.

the primary gial of palliative care is...

to help patients and families achieve the best possible quality of life.

For older adults the aging process leads

to necessary and developmental losses

Young adults and grief

undergo many necessary developmental losses related to their evolving future.

School-age children and grief

understand the concepts of permanence and irreversibility but do not always understand the causes of a loss.

Masked grief

when a grieving person behaves in ways that interfere with normal functioning but is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution

If a patient has been hospitalized or is in a rehabilitation setting discharge planning begins...

with the initiation of care and includes the family

family nursing is based on the assumption that...

Þ all people, regardless of age, are members of some type of family.

the structure of a family is based on...

Þ the ongoing membership of the family and the pattern of relationships