NURS 142 Midterm
Tenets Characteristic of Nursing Practice
1) Caring and health are central to the practice of the registered nurse 2) Nursing practice is individualized 3) Registered nurses use the nursing process to plan and provide individualized care for healthcare consumers 4) Nurses coordinate care by establishing partnerships 5) A strong link exists between the professional work environment and the registered nurse's ability to provide quality health care and achieve optimal outcomes
American Nurses Credentialing Center developed the Pathway to Excellence Program:
1) Nurses control the practice of nursing 2) The work environment is safe and healthy 3) Systems are in place to address patient care and practice concerns 4) Orientation prepares nurses for the work environment 5) The CNO is qualified and participates in all levels of organization 6) Professional development is provided and used 7) Equitable compensation is provided 8) Nurses are recognized for achievements 9) A balanced lifestyle is encouraged 10) Collaborative relationships are valued and supported 11) Nurse managers are competent and accountable 12) A quality program and evidence-based practice is used
Provision 4 (4.4) Assignment and delegation of nursing activities or tasks
A registered nurse can direct another individual to do something that that person would not normally be allowed to do. Both papers stressed that the nurse retains accountability for the delegation. Nurses may not delegate responsibilities such as assessment and evaluation. They may delegate selected interventions according to state nurse practice acts.
What Is Ethics?
A specialized area of philosophy dating back to ancient Greece and earlier. A systematic study of what is right and good measured against principles, virtues and core values of a profession.
Provision 1 (1.5) Relationships with Colleagues and Others Interdisciplinary:
All colleagues, including unlicensed personnel
Provision 1 (1.5) Relationships with Colleagues and Others Inter-professional:
All licensed colleagues (medicine, pharmacy, social workers, dieticians, PT, OT, RT, etc.)
Provision 3 (3.2) Protection of human participants in research
All participants have a right to accept or refuse participation, to be given all the information a person would need to make a decision regarding participation, to withdraw from a study without being subject to reprisal or untoward consequences, and to be protected from risk of harm Voluntary participation of participants (No coercion, deceit) Informed consent documented and the right to withdraw at any point with no untoward consequences
What are the standards of practice?
Assessment Diagnosis Outcomes identification Planning Implementation Evaluation
Provision Three (3.4) Professional responsibility in promoting a culture of safety
Avoid or reduce errors, do not conceal errors, correct or treat errors, use chain of authority when reporting a problem, provide timely responsive communication, document
ASKED
Awareness Skill Knowledge Encounters Desire
The Five Healthy Nurse constructs
Calling for care Priority to self-care Opportunity to role model Responsibility to educate Authority to advocate
Elements of Informed consent
Capacity to decide, Pertinent, understandable information, Voluntary decision, Assent if a minor
Provision 1 (1.3) Nature of Health
Care shaped by patient preferences, needs, values, choices Evidence provides the science of options; patient particulars help choose the options Civic engagement refers to taking the values and ideals of nursing into political life
Provision 2 (2.3) Collaboration
Collaboration with others, including the patient to meet patient needs. The focus is on the nurse's commitment to the patient and therefore to collaboration that best serves to meets the care needs of the patient.
Legacy of the Code
Commitment to service is the most precious ideal of the nursing profession. The Code supports ideals of nursing's service. The Code guides all nurses in living out the values and ideals of the profession. The Code is a living, ongoing legacy of core values from Florence Nightingale in 1850 to 2015 and beyond.
What informs today's ethics?
Concepts of Hippocrates
Provision 3 (3.1) Protection of the rights of privacy and confidentiality
Confidentiality and privacy are the top of the list of the patient rights that nurses must protect The nurse, as well as the physician, has a clear obligation to keep secret any information relating to a patient illness which she obtains during the performance of her professional duties unless the patient authorizes her to disclose this information or a competent core ordeals her to reveal it. This obligation is based first, on the ethics of her profession and 2nd, on the law.
Provision 2 (2.4) Professional Boundaries
Dating and sexually intimate relationships with patients are always prohibited. •Intensely personal work with vulnerable patients may generate emotional attachments •Gifts generally not appropriate •Withdraw from problematic boundary situations with colleagues
Provision 3 (3.3) Performance standards and review mechanisms
Demonstrate ongoing knowledge, skills, dispositions and integrity for competence in practice•Assume accountability for current, quality nursing practice according to national, state, and institutional standards
How many standards of professional performance are there?
Eleven
An ethical code is an identifying feature of a profession to
Facilitate professional self-regulation and accountability Describe obligations of client-professional and colleague-to-colleague relationships Serve as a guide for analysis, decision and action
Special considerations for vulnerable people
Fetuses and human embryos, Pregnant women, children and minors, cognitively impaired persons, prisoners, traumatized and comatose patients, terminally ill patients, elderly/aged persons, economically or educationally disadvantaged persons, underserved populations
Caring is
Grounded in ethics, beginning with respect for the autonomy of the care recipient Grounded, as a science, in nursing, but is not limited to nursing An attribute that may be taught, modeled, learned, and mastered Capable of being measured and analyzed scientifically The subject of study within caring science institutes/academics worldwide Central to relationships that lead to effective healing, cure, and/or actualization of human potential.
Policies and practices in an age of technology
HIPAA: Adhere to federal and state regulations and confidentiality Facebook: Completely off limits for patient photos or identifying information Caring Bridge: Patients decide, nurses should not engage Electronic Health Records: Only shared with those directly involved in care
Provision 1 (1.1) Respect for Human Dignity
Human dignity is inherent, intrinsic, and inviolable Dignity is inherent not earned A patient never loses dignity A nurse must approach every patient with respect for dignity, regardless of personal attributes, health state, or any other situational or patient variable.
Nursing Social Policy Statement
Humans manifest an essential unity of mind, body, and spirit Human experience is contextually and culturally defined Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness. The relationship between the nurse and patient occurs within context of the values and beliefs of the patient and nurse Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing Individual responsibility and interprofessional involvement are essential
Institutional Review Board (IRB) approval of relevant research proposal
If the IRB determines that a research protocol is designed for conditions or for a subject population for which parental or guardian permission is not a reasonable requirement to protect their rights it may waive the consent requirements
Provision 3 (3.6) Patient Protection an impaired practice
Impaired practice may arise from illness, exhaustion, grief, burnout, or any number of cases including those of substance abuse or drug or alcohol intoxication. When impaired practice is suspected, patient safety may be jeopardized: Identify colleagues whose practice may be impaired or who are placing patients at risk Follow chain of authority with compassion and caring so remediation and recovery may follow Access employee assistance program for help
Who is the patient?
Individual Resident in LTC Consumer in mental health Client Recipient of care Family Group Community Population
The Code of Ethics for Nurses
It is foundational to nursing theory, practice, and praxis in its expression of the values, virtues, and obligations that shape, guide, and inform nursing as a profession. It establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making.
Provision 1 (1.5) Relationships with Colleagues and Others Trans-professional
Licensed colleagues working together on a team across fields of expertise
Jonsen's Four Boxes
Medical indications (principles of nonmaleficence and beneficence) Patient preferences (principle of respect for autonomy) Quality of life (principles of nonmaleficence, beneficence, and respect for autonomy) Contextual features (principles of justice and fairness)
What are synonyms for RN?
Nurse and professional nurse
Doctrine of Double Effect
Nurse may administer medications with the intent of reducing symptoms of dying, even though the secondary impact may decrease respirations and perhaps hasten death The nurse's actions do not cause the death, the terminal illness causes the death
Provision 4 (4.1) authority, accountability, and responsibility
Nurses are always accountable for their own actions, maintaining their competence to ensure safe practice. Technological advancements require ongoing learning. Evidence-informed practice mandates continuous learning. Shifting patterns of health care delivery demand orientation to changing lines of authority, communication channels and multisystem policies. APRNs adhere to scope of practice, as state nurse practice acts vary and reform roles periodically.
Provision 4 (4.3) Responsibility for nursing judgments, decisions and actions
Nurses are responsible for their judgments, decisions, and actions. Responsibility, however, may be shared. Responsibility apportions praise worthiness or blameworthiness (liability) Adhere to Nursing: Scope and Standards of Practice, including APRN scope and standards Maintain standards of practice Participate in peer review, credentialing Engage in committees and other mechanisms to make sound decisions about quality and safety of care Refuse assignments beyond competence Seek consultation when in doubt
The what of nursing?
Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations
The Where of Nursing Practice
Nursing occurs in any environment where there is a healthcare consumer In need of care, information, or advocacy. Nursing has been transforming to virtual due to the number of technological advances we have come to
Provision 2 (2.2) Conflict of Interest for Nurses
Often care-givers will find that their needs to care for themselves come in conflict with the care that they must give to others. Nurses care for patients and need not agree with or support the value structure of the patient, but work for the patient's health, healing, and well-being, nonetheless. Professional integrity may be damaged if a nurse does not withdraw from a conflict of interest.
The ANA (American Nurse Association) defines a healthy nurse as
One who actively focuses on creating and maintaining a balance and synergy of physical, emotional, social, spiritual, personal, and professional well-being.
When nursing is practiced, it is holistic and the nurse:
Partners with the individual/family/group/community/population Considers norms and values, health and illness perspectives and practices, customs, behaviors, and beliefs of the healthcare consumer Arrives at healthcare decisions that are contextualized by how the individual/family/ community/ population perceives health, the nature of the body, and its relationship to mind, emotion, energy, spirit, or environment.
Provision 1 (1.4) The Right to Self-Determinism
Patient's right to self-determination as a participant in research
Standard 2 of Practice Diagnosis:
RN analyzes assessment data to determine actual problem
Standard 10 of Professional Performance Collaboration:
RN collaborates with healthcare consumer
Standard 1 of Practice Assessment:
RN collects pertinent data/information relative to healthcare consumers health/situation
Standard 9 of Professional Performance Communication:
RN communicates effectively
Standard 14 of Professional Performance Quality of Practice:
RN contributes to quality nursing practice
Standard 5A Practice Coordination of Care:
RN coordinates care delivery
Standard 4 Practice Planning:
RN develops a plan that prescribes strategies to attain expected, measurable outcomes
Standard 5B Practice Health Teaching and Health Promotion:
RN employs strategies to promote health/safe environment.
Standard 15 of Professional Performance Professional Practice Evaluation:
RN evaluates one's own and other's nursing practice
Standard 6 Practice Evaluation:
RN evaluates progress toward attainment of goals
Standard 3 Practice Outcomes Identification:
RN identifies expected outcomes for a plan individualized to the healthcare consumer
Standard 5 Practice implementation:
RN implements the identified plan
Standard 13 of Professional Performance Evidence-based practice and research:
RN integrates evidence and research findings
Standard 11 of Professional Performance Leadership:
RN leads within professional practice setting
Manner
RN practices according to the Code of Ethics for Nurses with Interpretive Statements, standards for professional nursing practice, institutional review boards protocols, and directives of other governing and regulatory bodies that guide the conduct of professional nursing practice.
Standard 7 of Professional Performance Ethics:
RN practices ethically
Standard 8 of Professional Performance Culturally Congruent Practice:
RN practices in a manner that is congruent with cultural diversity and inclusion principles
Standard 17 of Professional Performance Environmental Health:
RN practices in an environmentally safe/healthy manner
Standard 12 of Professional Performance Education:
RN seeks knowledge/competence reflects current nursing practice and promotes futuristic thinking
Standard 16 of Professional Performance Resource Utlization:
RN utlizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe and effective
The who of nursing?
Registered Nurse (RN) and Advanced Practice Registered Nurses
Foundation: Nursing's Professional Scope of Practice, Standards of Practice, Code of Ethics, and Speciality Certification
Scope of practice guides nursing practice in all roles and settings. Speciality certification provides additional verification and validation of competence for a focused body of knowledge and associated skill sets of practice.
Why Ethics in Nursing?
Serve vulnerable persons Promise to protect patients Impact patient well-being Depend on public trust Have a moral relationship with patients that gives rise to ethical obligations
How many standards are in the standards of practice?
Six
The American Association of Critical-Care Nurses has identified six standards for establishing and maintaining healthy work environments that remain unchanged today:
Skilled Communication True Collaboration Effective Decision-making Appropriate Staffing Meaningful recognition Authentic Leadership
The Code of Ethics for Nurses Provision Eight School of Public Health/IPE/relationships
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
1.5 Relationships with colleagues and others
The nurse creates an ethical environment, a culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect. Cultivate civility, collaboration, and collegiality to ensure: Safe, quality patient care and outcomes Compassionate, transparent, effective health services A hospitable work environment
The Code of Ethics for Nurses Provision Four Nurse Takes Initiative
The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
The Code of Ethics for Nurses Provision Seven President Amanda
The nurse in all roles and settings advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
The Code of Ethics for Nurses Provision Five Awareness/something I'm not
The nurse owes the same duties to self as others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
The Code of Ethics for Nurses Provision One Treat Others Equally
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
Provision 1 (1.2) Relationships and Patients
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Establishing relationships of trust and provide nursing services according to need, setting aside any bias or prejudice (harmful or damaging opinion of another person or a class that is rooted in bias, preference, preconception, antagonism, or unreasoned dislike). Prejudice and discrimination are not the same, prejudice is a form of unjust discrimination. Honoring patients' choices even when risky.
The Code of Ethics for Nurses Provision Three Patient Empowerment/Feminism
The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
The Code of Ethics for Nurses Provision Six Don't Kill the Patients
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conductive to safe, quality health care.
The Code of Ethics for Nurses Provision Two Grandma/Patient focus
The nurses' primary commitment is to the patient, whether an individual, family, group, community, or population.
The Code of Ethics for Nurses Provision Nine Gay Marriage/ Doon Doon Doon duroon (penguins)
The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
Ethical principalism
These principles are general guidelines for the formulation of more specific rules." These principles and their subsidiary rules give rise to specific points of analysis.
Provision 3 (3.5) Protecting patient health and safety by action on questionable practice
This interpretive statement deals with questionable practice, weather impaired, incompetent, illegal, or unethical. The professional organization has a responsibility to protect the practice of those nurses who choose to report their concerns through formal channels.
Provision 4 (4.2) Accountability for nursing judgments, decisions, and actions
To be accountable, nurses follow a code of ethical conduct that includes such moral principles as Fidelity(loyalty, including keeping promises, honoring agreements, performing competently, etc.), loyalty, veracity,(truth-telling; non-deception) beneficence(doing what benefits the patient), nonmaleficence (non-infliction of harm)and respect for the dignity, worth, and self-determination of patients, as well as adhering to the scope and standards of nursing practice.
The Expert Panel identified four interprofessional collaborative practice domains
Values/Ethics for Interprofessional Practice Interprofessional Teamwork and Team-based practice Interprofessional Communication Practice Roles Responsibilities for Collaborative Practice
values specific to nursing
Wisdom, compassion, honesty, patience, altruism, and courage
Transformational Leadership (MRP)
ability to articulate a strong vision that aligns strategic goas across the organization. Inspire their followers to succeed by empowering them to achieve professional goals and developing them professionally into leaders
Structural Empowerment (MRP)
achieved by developing structures and processes that support a decentralized environment, include a shared governance, and decision-making framework, support lifelong learning, professional development, certification and academic advancement, and promotes voice of nursing by ensuring that nurses are included in decision-making.
NormativeEthics
addresses the questions of the ought, the four fundamental terms of which are right and wrong (human action), good and evil (human behavior)
Four moral elements
attentiveness, responsibility, competence, (patient)responsiveness.
Art of Nursing
based on caring and respect for human dignity. It embraces spirituality, healing, empathy, manual respect, and compassion.
Interprofessional collaboration
care coordination, requiring effective communication by all stakeholders.
Four phases of caring
caring about, taking care of, care giving, care receiving
What are the four APRN recognized roles?
certified registered nurse anesthetist, certified nurse midwife, clinical nurse specialist, or certified nurse practitioner
Use of methods
communicating predictably and comprehensively using approaches such as informatics, electronic health records, and established processes to prevent error. Methods can include situation, background, assessment, and recommendation
Ethical Virtues of All Health Professionals
compassion, discernment, trustworthiness, integrity, conscientiousness
Standards of Professional Performance
competent level of behavior in the professional role
Advanced Practice Registered Nurse (APRN)
completed an accelerated graduate-level education program preparing them for the 4 recognized APRN roles.
Aristotle held that there are five essential social virtues
courage, compassion, self-love, friendship, and forgiveness
Exemplary Professional Practice (MRP)
demonstrates what professional nursing practice can achieve with structures and processes that support professional roles of the nurse as consultant, teacher, and interprofessional team member.
Standards of Practice
describe a competent level of nursing care demonstrated by critical thinking model known as the nursing process, and nursing process is the foundation of clinical decision making and actions
Quality of life (principles of nonmaleficence, beneficence, and respect for autonomy)
describes features of the patient's life prior to and following treatment, insofar as these features are pertinent to medical decisions (patient prospects of returning to normal life, deficits that might be predicted, what the patient desires in terms of quality of life, whether quality of life can be improved, under what conditions should treatment be stopped)
What do provisions one through three address?
direct patient care and describe the most fundamental values and commitments of the nurse.
Metaethics
domain that studies the nature of ethics and moral reasoning. Is there always an element of self-interest in moral behavior? Why be good?
Peak: Self Determination
exercising judgments based on integration of content, decisions, and actions from the three lower tiers.
Healing
fostered by helping, listening, mentoring, coaching, teaching, exploring, being present, supporting, touching, intuition, service, cultural competence, tolerance, acceptance, nurturing, mutually caring, and conflict resolution.
Culturally congruent practice
he application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the healthcare consumer and other stakeholders.
The ways in which RN's practice reflects integration of the five core practice competencies of all healthcare professionals:
healthcare consumer-centered practice, evidence-based practice, interprofessional collaboration, use of informatics, and continuous quality improvement.
Contextual features (principles of justice and fairness)
identify the familial, social, institutional, financial, and legal settings within which the particular case takes place, insofar as they influence medical decisions (risks of professional or institutional conflicts of interest, vested interests, financial factors, institutional/social scarcity of resources, potential legal issues, public safety issues)
Evidence-based practice (means):
incorporate the best available evidence, healthcare consumer preferences, provider expertise, and contextual resources in which nursing is delivered.
What does Provision 4-6 focus on?
individual nurse's responsibility and accountability in nursing practice, as well as the promotion of safe, quality health care.
RNs
individuals who are educationally prepared and licensed by state common wealth, territory, government, or regulatory body to practice as a registered nurse.
Nurse Practice and Rules and Regulations
legislative and regulatory authorities govern through nurse practice acts, statue, code, and regulation administrated by state boards of nursing and exemplified by licensure status.
Ethics is divided into
metaethics, normative ethics, and applied ethics.
The study of ethics is often called
moral philosophy or moral theology
How many provisions are in the code of ethics for nursing
nine
Individual level of advocacy
nurse engages in informing healthcare consumers so they can consider actions, interventions, or choices in light of their own personal beliefs, attitudes, and knowledge to achieve the desired outcome.
Policy level of advocacy
nurse translates the consumer voice into policy and legislation that address such issues as control of healthcare access, regulation of health care, protection of the healthcare consumer, and environmental justice.
Institutional Policies and Procedures
occurs through the established policies, procedures, and governing statements that influence and direct nursing practice and its environment.
What do you need to become a APRN?
passed a national certification, advanced clinical knowledge (direct care of individuals), greater depth and breadth of knowledge then RN's prepared to assume responsibility for health promotion assessment, diagnosis, and management of patient problems obtained license
Healthcare consumers
patients, persons, clients, families, groups, communities or populations who are the focus of attention and to whom the RN is providing services
Graduate-level prepared RNs
prepared at the masters or doctoral education level
Empirical Outcomes (MRP)
recognizing that outcomes are essential to establishing and maintaining organizational excellence.
Medical indications (principles of nonmaleficence and beneficence)
refer to the diagnostic and therapeutic interventions that are being used to evaluate and treat the medical problem in the case (diagnosis, treatment, prognosis, acuity, chronicity, reversibility, terminality, goals of treatment, treatments that are not indicated, probability of success, benefit to the patient)
Morality
refer to what would be called personal values, character, or conduct of individuals or groups within communities and societies.
Whistle blowing
refers to the disclosure of wrongdoing. That wrongdoing may be observed in research, academic, institutional, clinical, or any other setting. Whistle blowing is also an exception when research results have been falsified or academic standards for honesty, particularly plagiarism or theft of the work of another, have been violated.
Ethics
refers to the formal study of that morality from a wide range of perspectives including semantic logical, analytic, epistemological, and normative.
The Code of Ethics for Nurses with Interpretive Statements
serves as the ethical framework in nursing regardless of practice setting or role and provides guidance for the future.
What does the standard of professional nursing practice consist of?
standards of practice and standards of professional performance
Patient preferences (principle of respect for autonomy)
state the express choices of the patient about their treatment, or the decisions of those who are authorized to speak for the patient when the patient is incapable of doing so. (patient informedness, comprehension, voluntariness, free consent, mental capacity, legal status, advance directive and or prior expressed preferences, surrogate, cooperation)
Healthcare consumer-centered approach (nursing process):
the RN collaborates with and treats all healthcare consumers with the utmost respect. Demonstrates culturally congruent practice, always advocating that healthcare consumers have sufficient information and questions answered.
Advocacy
the act or process of pleading for, supporting, recommending a cause or course of action. It occurs at the individual, interpersonal, organization and community, and policy levels.
Interpersonal level of advocacy
the nurse empowers healthcare consumers by providing emotional support, attainment of resources, and necessary help through interactions with families and significant others in their social support network.
Organization and community level of advocacy
the nurse support cultural transformation of organizations, communities, or populations when present.
What is nursing
the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations
The How of Nursing
the ways, means, methods, processes, and manner by which registered nurses' practice professionally.
New Knowledge, Innovation, and Improvements (MRP)
to evolve and innovate, organizations must proactively integrate research and best evidence into clinical and operational practice.
When Does Nursing Occurs
whenever there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education. The term whenever encompasses anytime, anywhere, with anyone.
The scope of nursing provides the
who, what, where, when, why, and how
Applied ethics
wrestles with questions or right, wrong, good, and evil in a specific realm of human action, such as nursing, business, or law.
ANA's Code of Ethics for Nurses with Interpretive Statements ("the Code")
•Conveys shared ethical values, obligations, duties and ideals of nurses individually and collectively •Provides an implied contract with the public •Informs society of the moral values and ideals by which it functions •Informs new professionals of the expected moral behaviors •Guides the profession in self-regulation •Provides a framework for ethical decision-making Is unapologetic, aspirational and nonnegotiable
Provision 2 (2.1) Primacy of the Patient's Interests
•Engagement, trust, intimacy, presence •Based on covenant relationship, existential encounter, response to vulnerability
