Theory EXAM #2

African Americans are ____ times more likely to die from heart disease compared with whites.

3

As a nurse you _________ for the health, safety, and rights of patients, including their right to privacy. Your special relationship with patients provides you with knowledge that is specific to your role as a registered nurse and as such provides you the opportunity to make a unique contribution to understanding a patient's point of view.

Advocacy

Have a limited number of providers who agree to accept standard payment amounts for services. May use either prospective or retrospective payment. Cannot go outside of provider panel for services.

Health maintenance organizations (HMOs)

Who pays for the services of healthcare providers?

Healthcare Insurers Government Programs Private payers

The nurse is assisting the patient with complaints of new onset chest pain. This is which priority of a nursing need for this patient?

High priority

Remain at bedside to place drop of holy water from the River Ganges on the patients lips immediately after death to help his/her soul to the next life

Hindu

No meat, Cremation, Reincarnation

Hinduism

Breast and cervical cancer mortality rates are higher in _________ and ________ American women than in other American women.

Hispanic and African

Traditional fee-for-service plan. Payment is computed after patient receives services on basis of number of services used.

Private Insurance

When can a minor consent?

Legally emancipated Lawfully married or a parent (automatic emancipation) Pregnancy (excluding abortions-need either parent or court order) Abortion (in Nevada & California, but not all) Venereal disease Drug or substance abuse

___________ ____ ______ are the legal requirements for nursing practice that describe minimum acceptable nursing care.

Standards of care

Identifies equally with two or more cultures

Multiculturalism

Buried within 24 hours. *A dead man is washed by a male relative or an Imam. *A dead woman is washed by a female relative or a midwife. Do not offer a clergy - they make their own peace with Allah. Instead, offer a Quran Believe that "good souls" are awakened ~ therefore do not support cremation. Refuse autopsy or organ donation, fear of desecrating the dead and one has to be whole in front of creator Family members need to stay with body until it is removed from the hospital

Muslim

Prohibit presence of males in delivery room

Muslims, Hindus, Orthodox Jews

o Cultural practices vary greatly between tribes o Tend to take time to carefully consider and think before speaking o Family members show support with silence o Is rude to speak loudly or make direct eye contact o Use Healers, Medicine Man, Sweat Lodges, herbal medicine, prayers, dance o Tend not to seek Western medicine

Native American Communities

Dismemberment and mutilation outside the natural deterioration of the body is taboo (i.e. organ donation).

Native Americans

Attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Examples: Herbs, chemicals, heat, cold, massage, surgery

Naturalistic

Attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Examples: Herbs, chemicals, heat, cold, massage, surgery, bad winds

Naturalistic

Omission of an act that a reasonable and prudent nurse would perform in a similar situation

Negligence

Resolving an ethical dilemma is similar to the nursing process in its methodical approach to a clinical issue. But it differs from the nursing process in that it requires ________ ___ ___________ ___ __________.

Negotiation of differences of opinion.

What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

T = Time

MUST ask all patients over age 18 whether they wish to be an organ/tissue donor. National Organ Transplant Act prohibits the purchase or sale of organs

Uniform Anatomical Gift Act

In ____________ the person incorporates the loss into life; develops the capacity to have a breadth of emotions, even positive ones; and finds ways to move forward.

acceptance

Discharge planning begins the moment a patient is _________ to a health care facility.

admitted

Lack of __________ ________ and failure to provide _________ __________ care can greatly increase the stresses experienced by critically ill patients and can result in inadequate care

cultural awareness culturally competent

A way to identify new knowledge, improve professional education and practice, and use resources effectively

Collecting data through nursing research.

Describes a variety of health, personal, and social services provided over a prolonged period. These services are for people who are disabled, who were never functionally independent, or who suffer a terminal disease

Continuing care

_________ ________ is the process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care.

Cultural Competence

Relationship to deceased is not sanctioned (death of ex. Spouse, etc.)

Disenfranchised Grief

If unwanted consequence (i.e. hastening death) occurs as a result of an action taken to achieve a moral good (i.e. pain relief), the action is justified if the nurse's intent is to relieve pain and not to hasten death.

Double effect rule

Designates a person to make health care decisions when one can not make them any longer

Durable power of attorney

Outsider perspective

Etic Worldview Most research is Etic

What is covered under Medicaid?

Family planning services Nurse midwife services Rural health clinics FNP, PNP services FQHC services Home Health ESPDT (early periodic screening, diagnosis, and treatment) Hospital Care Prenatal Care Dx services SNF if over age 21

______ ______ have higher rates of human immunodeficiency virus and hepatitis infections than other groups.

Gay men

What are the Steps of Evidence-Based Practice?

1 Ask a clinical question. 2 Collect the most relevant and best evidence. 3 Critically appraise the evidence you gather. 4 Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. 5 Evaluate the practice decision or change. 6 Share the outcomes of EBP changes with others.

US ranked _____ by the World Health Organization (WHO) for Health Care System Performance

37

What are the different types of Medicare plans?

A,B,C,D

A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.) A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." C. "I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing." D. "Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses."

A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." Rationale Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees at all levels of their career, not just when they have experience. Nurses have a powerful voice in the legislature.

o amulets for protection against evil eye o Expect medication as soon as possible o Stop taking Rx when feel better, won't return for follow-up - education is important o Nurses are helpers, not professionals (especially women) o Male Doctors o Do not tell bad news to patient o Females avoid eye contact with males o Only same-sex touch for health care o Decisions made by males

Arab Community

A person experiences _________________ grief, the unconscious process of disengaging or "letting go" before the actual loss or death occurs, especially in situations of prolonged or predicted loss. When grief extends over a long period of time, people absorb loss gradually and begin to prepare for its inevitability. They experience intense responses to grief (e.g., shock, denial, and tearfulness) before the actual death occurs and often feel relief when it finally happens.

Anticipatory

Before loss happens

Anticipatory Grief

In rural __________ the rates of lung, colon, cervical, and rectal cancer are higher than the national average.

Appalachia

A client is taught the clinical manifestations of inflammation to allow early detection of a complication of a surgical wound. The client states, "I will look at the wound 4 times a day and tell my surgeon if it looks red or swollen." Her statement is an example of:

Application

_______ _________ may occur before imminent death or at the time of death

Bowel movement

Cerebral cortex stops functioning or is irreversibly destroyed.

Brain Death

No alcohol or illicit drugs

Buddhism

Lenten fasting from meat products Baptism, Sacrament of the Sick, Holy Communion, Rosary

Catholicism

Lenten fasting from meat products Baptism, Sacrament of the Sick, Holy Communion, Rosary

Catholicism

Alternating periods of apnea and then deep rapid breathing

Cheyne-Stokes respiration

Postpartum ________ like soups, rice, &, eggs _______ avoid beans, eggs, milk ________ ________ & ________ abdominal binder prevents air from entering uterus _______ ______ ________ bleeding = pollution. Ritual bath after bleeding stops before resuming relations with husband

Chinese Guatemalan Filipino, Mexican, Pacific Islanders (F,M,-PI) Filipino, Mexican, Pacific Islanders

Protect rights of the individual by encouraging what should be fair and right. *Looks for damages, fines or a statement that something is unfair

Civil law

Federal legislation known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates the protection of patients' personal health information.

Confidentiality

HIPPA Protects privacy without diminishing access to quality care. You may NOT share any health care information without the clients consent unless medically necessary to provide care.

Confidentiality

A utilitarian system of ethics proposes that the value of something is determined by its usefulness. This philosophy is also known as _______________ because its main emphasis is on the outcome or consequence of action.

Consequentialism

Higher prices result from rising costs within the health care business. As wages rise, cost rises. Malpractice.

Cost Push Theory

Crimes that have created harm for society and there are punishments. 2 Types Felony : more serious crime with jail time of > 1 year Misdemeanor: fine and/or jail time of less than 1 year

Criminal law

Writers with a ________ perspective tend to concentrate more on practical solutions than on theory.

Feminist

The term _________ refers to something that is hopeless or serves no useful purpose. In health care discussions the term refers to interventions unlikely to produce benefit for a patient. The concept is slippery when applied to clinical situations.

Futile

• Focus on physical and psychosocial needs of the patient and the patient's family • Provide comfort and supportive care during the dying process • Improve the quality of the remaining life • Help ensure a dignified death - find out what that means to the client

Goals of End of Life Care (EOL)

What are the types of third party payment?

Government funded. Medicare (A,B,C,D) Medicaid

_____________ is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Validates effectiveness of nursing interventions.

Nursing research

What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, patient perception)?

O = Outcome

Nodding and smiling, regardless of comprehension General inhibition in asking questions Passive about their care and treatment plans

Observed traits and behaviors of LEP patients/families

*More frequent use of ER *Longer hospital stays, more return visits. *Increased costs due to more tests. *Delayed diagnoses *Misunderstanding of care plan *Lack of follow-through by patient *Medication errors *Lower Patient-Satisfaction scores

Obstacles of Language Barriers

___________ programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care by physicians and health care organizations. These programs are quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements.

Pay for performance

A panel of experts who are familiar with the topic have reviewed the article.

Peer-Reviewed Articles

Believe external agent, human or nonhuman causes health and illness. Examples: living and deceased deities, Voodoo, sorcerer, ghosts, Shaman, massage, aromatherapy, herbs

Personalistic

What are the steps in the research process?

Phase 1: Conceive the Study Phase 2: Design the Study Phase 3: Conduct the Study Phase 4: Analyze the Study Phase 5: Use the Study CDCAU

The most cost effective health care service is

Primary Care

Mr. Schumer is a 72 year old male who is on your orthopedic unit after having his second knee replacement. He also has type 2 diabetes mellitus, hypertension, and is still recovering from a colostomy for extensive colon cancer 6 months earlier. He lives alone in a two story home with the bedrooms on the upper floor. His provider has suggested that he goes to an extended care facility so that he can have help with his ADLs and meds until he regains his strength and is able to move around enough to care for himself independently. The type of care the provider recommended is most likely:

Restorative Care Mr. Schumer will be going to restorative care (often known as rehabilitation) so that he can regain his strength and flexibility enough to move independently though his home. Some assistance is provided with ADLs and meds, but the focus is on regaining his prior level of function after becoming deconditioned after an injury/illness.

Mr. Schumer is a 72 year old male who is on your orthopedic unit after having his second knee replacement. He also has type 2 diabetes mellitus, hypertension, and is still recovering from a colostomy for extensive colon cancer 6 months earlier. He lives alone in a two story home with the bedrooms on the upper floor. His provider has suggested that he goes to an extended care facility so that he can have help with his ADLs and meds until he regains his strength and is able to move around enough to care for himself independently. The type of care the provider recommended is most likely:

Restorative care

Patients recovering from an acute or chronic illness or disability often require additional services to return to their previous level of function or reach a new level of function limited by their illness or disability. The goals are to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care.

Restorative care

Some patients require ongoing wound care and activity and exercise management until they have recovered enough following surgery to independently resume normal activities of daily living.

Restorative care

No alcohol, most are vegetarian, practice fasting

SDA

________ is a critical part of quality health care. The National Quality Forum (NQF) identified 34 health care practices, organized in seven functional areas that improve patient _________ by decreasing the occurrence of adverse events. Examples of NQF practices include hand hygiene, teamwork, training, influenza prevention, catheter-associated urinary tract infection prevention, fall prevention, and medication reconciliation

Safety safety

Who is liable? Mr. Fagin was admitted for treatment of a fractured tibia. After a fiberglass cast was applied, Mr. Fagin was sent to the orthopedic unit. The night nurse notes that his foot was cold to touch, looked purple, and was swollen. The nurse documents these findings and reports them to the day nurse. The day nurse immediately relays these findings to the MD who said not to bother him again unless there was an emergency. The day nurse then called the ER MD to check on the patient. The ER MD removed the cast and found that the client's leg was necrotic. The leg was amputated three days later.

The night nurse should have called the MD. Because she didn't act on it and call the MD ASAP she did not initiate that communication.

As with deontology, ____________ relies on the application of a certain principle, (i.e., measures of "good" and "greatest").

Utilitarianism

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

Value

To resolve ethical dilemmas one needs to distinguish among _______, ________, and _______.

Value, fact, and opinion.

Ideals that give meaning to an individual's life. We develop them in childhood and they ten to change with life experiences and situations.Derived most commonly from societal norms, cultural, religious beliefs, and family orientation. (Individual rather than universal)

Values

The duty to tell the truth, unless telling the truth causes more harm than good. Can only tell pt what is in the scope of your practice.

Veracity

The stages of dying are not _________. Patients will move back and forth through the stages.

linear

In 2006 the National Quality Forum defined a list of 28 ________ that are devastating and preventable. Examples of ____________ include patient death or serious injury related to a medication error or the administration of incompatible blood products. In 2007 Medicare ruled it would no longer pay for medical costs associated with these errors.

"Never Events" Never Events

How much do we spend (USA) on healthcare?

$2.5 trillion ~ $8,047 per person in 2010 Expected to rise 6.7% annually between 2007 - 2017

What are nursing examples of Beneficence?

*A nurse provides certain care to a dying patient, though some interventions may cause pain. *Turning pt's q 2 h to prevent pressure ulcers. *We turn pt's more towards end of life because it speeds up the dying process.

Jose is a 32 year-old patient with advanced AIDS who has decided to forego further treatment. During a clinic visit, Jose is diagnosed with active respiratory tuberculosis. Jose wishes to decline TB treatment. What issues exist? Can Jose be forced to receive treatment? Can he be isolated to protect the public?

*He "may" be contagious *He can infect other people *Jose can decline treatment but there can be a legal hold. *Infection of TB does not typically result in disease. *HIV weakens the immune system thereby increasing the likelihood of TB. *If a pt refuses treatment public health laws and authorities may place him in isolation until there is no threat to the public. The hospital is backed up by the laws TB pt's may not be forced to undergo treatment but have to be isolated What do you do if this person comes into the hospital? Isolate and ethics committees

Types of Payment

*Self Pay *Third Party Payment *Government Funded Medicare Medicaid *Insurance Traditional Indemnity PPO HMO

Who Pronounces Death - and when?

- Physician pronounces - 2 RN Pronounces

What are the Key Steps in the Resolution of an Ethical Dilemma?

1. Ask the question, "Is this an ethical dilemma?" Perplexing, profound relevance for human concern. 2. Gather information 3. Examine and determine own values 4. Verbalize problem 5. Consider courses of action 6. Negotiate outcome at bedside or conference room. 7. Evaluate the plan over time. A-GE-VINE Who can help you? Ethics committee

What are the 4 types of Intentional torts?

1. Assault 2. Battery 3. False imprisonment 4. Intentional infliction of emotional distress

Cultural competence is the process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care. This process has five interlocking components:

1. Awareness 2. Knowledge 3. Skills 4. Encounters 5. Desires ASKED

Quality Standards Subcommittee of the American Academy of Neurology diagnostic criteria to diagnose brain death.

1. Coma or unresponsiveness 2. Absence of brainstem reflexes 3. Apnea 4. Specific assessments by a physician

What are the 2 types of Quasi-Intentional torts?

1. Invasion of privacy/ Breach of confidentiality 2. Defamation of Character

2 types of Unintentional Torts

1. Negligence 2. Malpractice

Admission for Hospice has two criteria

1. Patient must desire the services 2. Physician must certify that the patient has 6 months or less to live

When does the Coroner get involved - and what is the role of the nurse?

1. Pt expires within 24 hours of hospital admission. 2. All deaths in which the attending physician has not been in attendance of the decedent within 30 days prior to the death. 3. All deaths resulting from accident, suicide, homicides or undetermined cause and manner. For example, falls, poisoning, industrial accidents, automobile accidents, automobile-pedestrian accidents, battered children, etc., should be reported. 4. Deaths that occur in the emergency room, operating room, and during or shortly following a medical procedure. 5. Deaths resulting from therapeutic procedures, or deaths possibly related to the procedure 6. deaths due to unexplained causes or under suspicious circumstances. 7. Deaths resulting from a disease which may be hazardous, contagious, or which may constitute a threat to the health of the public (Infectious Disease Cases). 8. Sudden deaths of persons appearing to be in good health. 9. All cases in which trauma is, or may be associated with the death. Cases where the patient entered the medical facility due to trauma. Cases should be promptly reported even though death may be attributed only indirectly to the trauma. 10. All deaths while in custody of law enforcement officials or while incarcerated in a public institution.

Key Steps in the Resolution of an Ethical Dilemma Step 1: Ask the __________, is this an ________ ________? If a review of scientific data does not resolve the question, if the question is perplexing, and if the answer will have relevance for areas of human concern, an ethical dilemma probably exists. Step 2: Gather ____________ relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information. Step 3: __________ values. Distinguish among fact, opinion, and values. Step 4: __________ the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: _________ possible courses of action. Step 6: _________ a plan. This requires a confidence in one's own point of view and a deep respect for the opinions of others. Step 7: _________ the plan over time.

1. Question; ethical dilemma 2. Information 3. Clarify 4. Verbalize 5. Identify 6. Negotiate 7. Evaluate

What are the Five Rights of Delegation?

1. Right Task 2. Right Circumstances 3. Right Person 4. Right Direction/Communication 5. Right Supervision/Evaluation P. 280/281 P&P

Give 2 examples of autonomy

1. When a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient's autonomy. 2. The consent that patients read and sign before surgery documents this respect for autonomy.

To distinguish an ethical problem from other kinds of problems, Curtin (2004) proposes that, if the issue is an ethical one, it entails at least one of the following: 1. ______________ 2. ______________ 3. ______________

1. You are unable to resolve it solely through a review of scientific data. 2. It is perplexing. You cannot easily think logically or make a decision about the problem. 3. The answer to the problem will have a profound relevance for areas of human concern.

Support of a cause.Nurse ____________ for health, safety, and rights of a client! Report what might affect client health or safety.

Advocacy advocate

__________ women will only allow women to examine them

Afghan

Which of the following activities performed by the nurse is/are focused on the patient-centered care principle of physical comfort? (Select all that apply.) A. Asking the patient what a tolerable level of pain is for him or her following surgery B. Providing a back rub at bedtime C. Offering the patient a warm washcloth for his or her hands before eating D. Teaching the patient about the new antihypertensive medication ordered E. Scheduling the patient's follow-up appointments on discharge F. Changing the bed linens for a patient who is experiencing diaphoresis

A. Asking the patient what a tolerable level of pain is for him or her following surgery B. Providing a back rub at bedtime C. Offering the patient a warm washcloth for his or her hands before eating F. Changing the bed linens for a patient who is experiencing diaphoresis Rationale Interventions for the patient-centered care principle of physical comfort are focused on care that increases the comfort of the patient. Responding to patients' need for pain medications and using nursing interventions that increase comfort are important. Teaching is focused on the principle of continuity and transition; scheduling appointments is an intervention for access to care.

When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy

A. Fidelity Rationale Requiring a return to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity.

o Always address as "Mr." "Mrs." or "Miss" unless permission is given. o Prefer being called African American for race o Religion: 'Laying on of Hands', Prayer, Dance o Illnesses may be associated with nature (cold, rain, heat, demons/evil spirits)

African Community

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? A. Patient safety B. Evidence-based practice C. Patient satisfaction D. Maintenance of competency

A. Patient safety Rationale Near-miss events are events that could have caused a problem with patient safety had they not been stopped before patient harm occurred. Nurses who investigate ways to prevent near-miss events work on issues surrounding patient safety.

The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care? A. Patient will be able to walk 200 feet without shortness of breath B. Wound will heal without signs of infection C. Patient will express concerns related to return to home D. Patient will identify strategies to improve sleep habits

A. Patient will be able to walk 200 feet without shortness of breath Rationale Restorative interventions focus on returning a patient to his or her previous level of function or a new level of function limited by his or her illness or disability. The goal of restorative care is to help individuals regain maximal functional status and enhance quality of life by promoting independence.

Which of the following is/are characteristics of managed care systems? (Select all that apply.) A. Provider receives a predetermined payment for each patient in the program. B. Payment is based on a set fee for each service provided. C. System includes a voluntary prescription drug program for an additional cost. D. System tries to reduce costs while keeping patients healthy. E. Focus of care is on prevention and early intervention.

A. Provider receives a predetermined payment for each patient in the program. D. System tries to reduce costs while keeping patients healthy. E. Focus of care is on prevention and early intervention. Rationale Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people stay healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual. BackSettingsContinue

Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that: A. Specially educated personnel make requests. B. Requests are usually made by the nurse caring for the patient at the time of death. C. Only patients who have given prior instruction regarding donation become donors. D. Professionals need to be very selective in whom they ask for organ and tissue donation.

A. Specially educated personnel make requests. Rationale Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process.

Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following? A. The value of something is determined by its usefulness to society. B. People's values are determined by religious leaders. C. The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. D. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider.

A. The value of something is determined by its usefulness to society. Rationale Utilitarianism specifically refers to the greatest good for the greatest number of people, whereas goodness is determined primarily by usefulness. The concept is easier to apply in a community where shared values allow for agreement about a definition of usefulness.

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations B. To await new clinical orders from the physician C. To limit discussions about ethical principals D. To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Rationale Nursing plays a unique and critical role in the resolution of difficult ethical situations. The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the health care team.

Where can evidence come from? EBP

Agency policy and procedures, quality improvement data, existing clinical practice guidelines, or computerized bibliographical databases, The Cochrane Database of Systematic Reviews

Answer for one's own actions. *Accidently gave meds to wrong pt.

Accountability

While administering medications, the nurse realized that he has given the wrong medication to a patient. HE acts by completing an occurance report and notifying the Physician. The nurse is demonstrating:

Accountability

___________ refers to the ability to answer for one's actions. You learn to ensure that your professional actions are explainable to your patients and your employer. Health care institutions also exercise ___________ by monitoring individual and institutional compliance with national standards established by agencies such as The Joint Commission (TJC) and the ANA.

Accountability

Adopting a second culture which replaces the primary culture

Acculturation

Sometimes people experience losses that are marked by uncertainty. ___________ loss, a type of disenfranchised grief, occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury. Other times the person is gone (e.g., after a kidnapping or as a prisoner of war); but the grieving person maintains an ongoing, intense psychological attachment, never sure of the reality of the situation. ____________ losses are particularly difficult to process because of the lack of finality and unknown outcomes.

Ambiguous Ambiguous

Occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury. Other times the person is gone (e.g., after a kidnapping or as a prisoner of war); but the grieving person maintains an ongoing, intense psychological attachment, never sure of the reality of the situation. Type of disenfranchised grief

Ambiguous Loss

Protects rights of handicapped individuals in workplace, educational settings and society. HIV patients too. Ramps, language (hearing and vision impaired)

Americans with Disabilities Act (ADA)

o Health is a state of spiritual and physical harmony in nature o Yin (cold) or Yang (hot) o Not vocal about problems, quiet sufferers o Avoid direct eye contact o Males make the decisions o Family helps with all care including personal o Feet are dirty (should be touched last during assessment)

Asian Community

__________ & _________ view as a hot state and drink cold beverages (milk)

Asian and Hispanics

A culture is absorbed into a different community, loss of language, customs, ethnicity (spontaneous or forced)

Assimilation

Self-determination Right to make health care decisions for oneself, even if the health care provider does not agree with the decisions made or the reasoning behind them Example: A client has had the procedure behind a colonoscopy provided to him by the health care team. He verbalizes understanding of the procedure and signs the consent giving permission to have the test done before proceeding with the colonoscopy.

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

Am I ___________ of my personal biases and prejudices towards cultural groups different than mine?

Aware Awareness

The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow? A. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. C. The patient cannot make changes in the advance directive once admitted to the hospital. D. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state Rationale A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.

46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: A. Chose to be bicultural. B. Adapted to and adopted the American culture. C. Had an extremely negative experience with the American culture. D. Gave up part of her ethnic identity in favor of the American culture.

B. Adapted to and adopted the American culture. Rationale Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture.

The nurses on the unit developed a system for self-scheduling of work shifts. This is an example of: A. Responsibility. B. Autonomy. C. Accountability. D. Authority.

B. Autonomy. Rationale Autonomy is freedom of choice and responsibility for the choices. One type of autonomy for nurses is work autonomy. In work autonomy the nurse makes independent decisions about the work of the unit such as scheduling or unit governance.

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy

B. Beneficence Rationale The immunization is a clear effort to provide benefit. Beneficence refers to "doing good." Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding health care plans.

A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.) A. Quality of life is measured by potential income, and average income varies in different regions of the country. B. Community values are subject to change, and communities influence definitions of "quality." C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

B. Community values are subject to change, and communities influence definitions of "quality." C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging. Rationale Definitions of quality depend on individual experience and value integrated into community standards, but value refers to elements beyond monetary value.

After the 0700 shift report the registered nurse (RN) delegates three tasks to the nursing assistant. At 1300 the RN tells the nursing assistant that he would like to talk to her about the first task that was delegated, which was walking the patient, Mrs. Taylor, earlier that morning. The RN says, "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes. Please walk Mrs. Taylor again by 1500." Which characteristics of good feedback did the RN use when talking to the nursing assistant? (Select all that apply.) A. Feedback is given immediately. B. Feedback focuses on one issue. C. Feedback offers concrete details. D. Feedback identifies ways to improve. E. Feedback focuses on changeable things. F. Feedback is specific about what is done incorrectly only.

B. Feedback focuses on one issue. C. Feedback offers concrete details. D. Feedback identifies ways to improve. E. Feedback focuses on changeable things. Rationale These are characteristics of good feedback. Immediate feedback is not appropriate because the RN did not provide feedback immediately. The nursing assistant performed the task in the morning, but the feedback was not given until the afternoon. Giving feedback about only incorrectly done tasks is not correct because you give both positive and negative feedback (to improve the incorrectly done tasks).

Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? A. Consult a professional ethicist to ensure that the steps of the process occur in full. B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. C. Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. D. List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.

B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. Rationale Before proceeding with discussion about any difficult situation, just as in the nursing process, participants take time to gather all relevant information as insurance for reliability and validity during the discussion.

The nurse is explaining the case management model to a group of nursing students. Which characteristics best describe the model? (Select all that apply.) A. Case managers provide all patient care. B. Multidisciplinary care plans are used. C. Case managers coordinate discharge planning. D. Staffing is expensive and may not decrease care costs. E. Communication with health care team members is important. F. Model helps to improve patient safety and quality.

B. Multidisciplinary care plans are used. C. Case managers coordinate discharge planning. E. Communication with health care team members is important. F. Model helps to improve patient safety and quality. Rationale Case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Activities listed in answers 2, 3, 5, and 6 are characteristics of the case management model or responsibilities of the case manager. Answers 1 and 4 are not characteristics of the case management model. They are typically seen with the primary care model.

11. When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? A. Yes because ethics is essentially a democratic process, with all participants sharing an equal voice B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do C. Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care D. No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department

B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do Rationale Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion.

Which of the following strategies focus on improving nurse-physician collaborative practice? (Select all that apply.) A. Inviting the physician to attend the practice council meeting B. Participating in physician morning rounds C. Placing physician photos and names in unit newsletter D. Contacting physician promptly to discuss patient problems E. Providing a list of physician contact numbers to all staff nurses

B. Participating in physician morning rounds D. Contacting physician promptly to discuss patient problems E. Providing a list of physician contact numbers to all staff nurses Rationale Inviting the physician to attend the practice council meeting, participating in physician morning rounds, and contacting the physician promptly to discuss patient problems improve nurse-physician collaboration by focusing on strategies that are related to professional practice. Collaboration is a process whereby different perspectives are synthesized to better understand complex problems and an outcome that is a shared solution that could not have been accomplished by a single person or organization. Placing physician photos and names in a newsletter and providing physician contact numbers to all staff nurses provide information to the nursing staff and help them identify and contact providers but are not focused specifically on nurses working with physicians to provide patient care.

A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) A. Information provided by the head nurse B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission's manual E. The American Nurses Association standards of nursing practice

B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission's manual E. The American Nurses Association standards of nursing practice Rationale Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.

Which of the following are examples of the principle of patient-centered care that is focused on respect, values, preferences, and expressed needs? (Select all that apply.) A. Administer antihypertensive medications to patient daily B. Pulling the curtain around the patient bed before changing the wound dressing on the patient's leg C. Allowing the patient to ask questions and express his or her concern about surgery D. Explaining a colonoscopy procedure to the patient E. Working with the family to bring in ethnic foods that the patient prefers

B. Pulling the curtain around the patient bed before changing the wound dressing on the patient's leg C. Allowing the patient to ask questions and express his or her concern about surgery E. Working with the family to bring in ethnic foods that the patient prefers Rationale Patient-centered care that is focused on respect, values, preferences, and expressed needs focuses on treating the patient with dignity and respect. A component is to keep the patient informed and involved in decision making. Consider patient preferences and perspectives when planning care. An environment where the patient is respected focuses on quality of life.

A group of staff educators are reading a research study together at a journal club meeting. While reviewing the study, one of the nurses states that it evaluates if newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse's statement? A. Introduction B. Purpose statement C. Methods D. Results

B. Purpose statement Rationale The purpose statement includes research questions or hypotheses—predictions made about the relationship or difference between study variables (concepts, characteristics, or traits that vary within or among subjects).

A nurse researcher interviews parents of children who have diabetes and asks them to describe how they deal with their child's illness. The analysis of the interviews yields common themes and stories describing the parents' coping strategies. This is an example of which type of study? A. Historical B. Qualitative C. Correlational D. Experimental

B. Qualitative Rationale The data in this study were collected during interviews; information from the interviews was used to describe common themes and experiences of the parents. These are characteristics of qualitative research.

Which of the following explain how health care reform is an ethical issue? (Select all that apply.) A. Access to care is an issue of beneficence, a fundamental principal in health care ethics. B. Reforms promote the principle of beneficence, a hallmark of health care ethics. C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

B. Reforms promote the principle of beneficence, a hallmark of health care ethics. C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics. Rationale Since health care reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Access to care is an issue of justice.

The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? A. Patients B. Relationships C. Ethical principles D. Code of ethics for nurses

B. Relationships Rationale The foundation of the ethics of care is its attention to relationships, as distinguished from other more principal based philosophies.

A group of nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. Their next step is to: A. Conduct a literature review. B. Share the findings with others. C. Conduct a statistical analysis. D. Create a well-defined PICOT question.

B. Share the findings with others Rationale After completing an EBP project and evaluating its effectiveness, it is important to communicate the results with others.

Which of the following is an example of the principle of patient-centered care focused on continuity and transition? A. The nurse asks the patient who in the family should have access to patient information B. The nurse is teaching the patient how to change the wound dressing at home C. The nurse responds promptly to the patient's request for pain medication D. The nurse schedules the patient's diagnostic scan following the physical therapy session

B. The nurse is teaching the patient how to change the wound dressing at home Nursing interventions focused on transition and continuity provide patients with information about medications to take, dietary or treatment plans to follow, and danger signals for which to look after hospitalization or treatment. These interventions also provide patients and families with health care resources after discharge.

11. The nursing staff is developing a quality program for the floor. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.) A. Number of medication errors committed by registered nurses (RNs) B. Turnover rate of nurses on the unit C. Incidence of patient falls D. Number of certified RNs E. Number of emergency department admissions per year

B. Turnover rate of nurses on the unit C. Incidence of patient falls D. Number of certified RNs Rationale Nursing-sensitive outcomes are patient outcomes that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, and costs. They are also related to the environment in which nurses practice, which impact patient outcomes. For example, the nursing staff that implements strategies to decrease turnover on the nursing unit impacts overall hospital turnover rates. Nurses assume accountability and responsibility for the consequences of these outcomes.

_____________ stage cushions and postpones awareness of the loss by trying to prevent it from happening. Grieving or dying people make promises to self, God, or loved ones that they will live or believe differently if they can be spared death.

Bargaining

If the health care provider performs a procedure that goes beyond the scope of the patient's consent. For example, if the patient gives consent for an appendectomy and the surgeon performs a tonsillectomy.

Battery

The obligation to provide benefits and to balance benefits against risks. Requires positive steps to help others, "do good"

Beneficence

________ refers to taking positive actions to help others. It implies that the best interests of the patient remain more important than self-interest. This means that nurses practice primarily as a service to others, even in the details of daily work.

Beneficence

_________ is an individual's response to the loss of a significant person. May begin before death occurs.

Bereavement

__________ is an individual's response to the loss of a significant person. May begin before death occurs

Bereavement

Cerebral cortex stops functioning or is irreversibly destroyed

Brain death This is the criteria for "legal death"

No dogmatic rules for what kind of care the body of the dead person should be given, aside that the process should be handled in a worthy and respectful way.

Buddhism

Miss O'Malley has is being treated in the intensive care unit after a traumatic brain injury and is nonresponsive and mechanically ventilated. The nurse recognizes that this patient is close to death and plans a care conference with the family. When explaining the patient's status to the family, the nurse recognizing that death has occurred in this patient when A. the cerebral cortex function ceases. B. respirations cease and the heart stops beating. C. absence of brainstem reflexes, nonreactive EEG, and apnea occurs. D. cardiopulmonary resuscitative efforts are not effective.

C

What is the usual standard of care or current intervention used now in practice?

C = Comparison of interest

Which of the following nursing activities is found in a tertiary health care environment? A. Administering influenza immunizations at the senior independent living facility B. Providing well-baby care in the clinic run by the local community health department C. Admitting a patient following open heart surgery to the cardiovascular intensive care unit D. Working the triage desk in the emergency department

C. Admitting a patient following open heart surgery to the cardiovascular intensive care unit Rationale Tertiary health care is focused on treatment of disease and illness. Tertiary health care takes place in intensive care and subacute care units. Emergency departments are part of secondary acute care. Preventive and health-promotion activities are part of primary care.

You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take? A. Give the family the record B. Give the patient the record C. Discuss the issues that concern the family with them D. Call the nursing supervisor

C. Discuss the issues that concern the family with them Rationale Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how to best address their concerns.

Which is the best method of negotiating or processing difficult ethical situations? A. Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. B. Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. D. Medical experts are best able to resolve conflicts about outcome predictions.

C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. Rationale Ethics is ultimately an activity of community, resolved successfully through institutional ethics committees and not easily resolved by deference to a single expert or leader.

The nurse is assisting the patient with coughing and deep-breathing exercises following abdominal surgery. This is which priority nursing need for this patient? A. Low priority B. High priority C. Intermediate priority D. Nonemergency priority

C. Intermediate priority Rationale Assisting the patient with cough and deep breathing is an intermediate priority. Intermediate priorities are nonemergency, nonlife-threatening actual or potential needs that the patient and family members are experiencing. Anticipating teaching needs of patients related to a new drug or taking measures to decrease postoperative complications are examples of intermediate priorities.

The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? A. Yes because patient privacy would not be violated as long as the patient identifiers were removed B. Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work D. No because the principal of justice requires you to allocate resources fairly

C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work Rationale Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information.

The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy

C. Nonmaleficence Rationale Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care.

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? A. Nurses understand the principle of autonomy to guide respect for patient's self-worth. B. Nurses have a scope of practice that encourages their presence during ethical discussions. C. Nurses develop a relationship to the patient that is unique among all professional health care providers. D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

C. Nurses develop a relationship to the patient that is unique among all professional health care providers. Rationale None of these options is wrong, but the point of the question is to build confidence and even pride in the value of the special body of knowledge that a nurse acquires about patients, the result of a unique relationship with them.

When a nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, the nurse is working in which area? A. Integrated delivery system B. Health care patient system C. Nursing informatics D. Computerized nursing network

C. Nursing informatics Rationale Nursing informatics is the use of information, data, and technology to communicate, manage knowledge, mitigate errors, and support decision making. It requires knowledge, skills, and attitudes from the nurse to be able to effectively use information and technology. Nursing informatics is focused on the organization, analysis, and dissemination of information.

A nurse who works in a newborn nursery asks, "I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding." In this example of a PICOT question, the I is: A. Breastfeeding moms. B. Infants. C. Peaceful music. D. The nursery.

C. Peaceful music. Rationale The Intervention in this PICOT question is playing peaceful music.

A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) A. The nurse represents the plaintiff. B. The defendant must prove injury, damage, or loss. C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. Rationale The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.

The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? A. This health plan is for people who cannot afford their own health insurance B. This health plan is operated by the government to provide health care to older adults C. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose D. This is a fee-for-service plan in which you can choose any physician or hospital

C. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose Rationale Preferred provider organization (PPO) plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance.

_________means that the providers receive a fixed amount per patient or enrollee of a health care plan. ________ aims to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost.

Capitation Capitation

Organized system for delivering health care to an individual patient or group of patients across an episode of illness and/or a continuum of care; includes assessment and development of a plan of care, coordination of all services, referral, and follow-up; usually assigned to one professional.

Case Management

A _________ _______ ________ is a set of guiding principles that all members of a profession accept. It is a collective statement about the group's expectations and standards of behavior. Codes serve as guidelines to assist professional groups when questions arise about correct practice or behavior.

Code of Ethics

Judge makes a decision in court

Common law

Medication errors IV therapy errors Burns to clients Patient falls Failure to use asepsis Failure to adequately monitor Failure to notify of significant change

Common negligent acts that result in lawsuits

Who can consent?

Competent adult > 18 yrs Parent of unemancipated minor Legal guardian Adult sibling for the treatment of minor brother or sister (if an emergency and parents are not present) Grandparent for a minor child (if an emergency and parents not present)

Some people do not experience a normal grief process. In _____________ 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. _____________ grief occurs more often when a person had a conflicted relationship with the deceased, prior or multiple losses or stressors, mental health issues, or lack of social support. Loss associated with homicide, suicide, sudden accidents, or the death of a child has the potential to become complicated. Specific types of __________ grief include exaggerated, delayed, and masked grief.

Complicated Complicated Complicated

Prolonged, difficulty moving on, homicide, sudden accident, suicide

Complicated Grief

_________ is a way of life for a group of people. It includes the behaviors, beliefs, values, traditions, and symbols that the group accepts, generally without thinking about them. This way of life is passed along by communication and imitation from one generation to the next. You can also think of _________ as cultivated behavior that is acquired through social learning. It is the totality of a person's learned, accumulated experience that is socially transmitted.

Culture culture

What is the best example of the nurse practicing patient advocacy? A. Seek out the nursing supervisor in conflicting procedural situations B. Document all clinical changes in the medical record in a timely manner C. Work to understand the law as it applies to an error in following standards of care D. Assess the patient's point of view and prepare to articulate it

D. Assess the patient's point of view and prepare to articulate it Rationale Seeking out the nursing supervisor, documenting clinical change in the medical record in a timely manner and working to understand the law as it applies to an error in following standards of care are not wrong; but advocacy generally refers to the nurse's ability to help speak for the patient.

Which activity performed by the nurse is related to maintaining competency in nursing practice? A. Asking another nurse about how to change the settings on a medication pump B. Regularly attending unit staff meetings C. Participating as a member of the professional nursing council D. Attending a review course in preparation for the certification examination

D. Attending a review course in preparation for the certification examination Rationale Maintaining ongoing competency is a nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.

The type of care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality is: A. Primary nursing. B. Total patient care. C. Functional nursing. D. Case management.

D. Case management. Rationale Case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Case management is defined as "a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."

A nurse is presenting information to a management class of nursing students on the topic of groups of inpatient hospital services that have a fixed reimbursement amount, with adjustments made on the basis of case severity and regional costs. The nurse is presenting information to the class on which topic? A. Utilization review committee B. Resource utilization group C. Capitation payment system D. Diagnosis-related groups

D. Diagnosis-related groups Rationale Diagnosis-related groups (DRGs) are grouped inpatient hospital services for Medicare patients. Each group has a fixed reimbursement amount, with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set amount for each patient based on the assigned DRG, regardless of patient's length of stay or use of services. DRGs are part of the prospective payment system.

A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as: A. Assimilation. B. Acculturation. C. Biculturalism. D. Enculturation.

D. Enculturation. Rationale Socialization into one's primary culture as a child is known as enculturation

The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. What principles would be a priority in a discussion about ethics? A. Accountability because you as the nurse are accountable for the well-being of this patient B. Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant C. Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources

D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources. Rationale Accountability, respect or autonomy and ethics of care are not necessarily wrong, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.

Nurses on a pediatric nursing unit are discussing ways to improve patient care. One nurse asks a colleague, "I wonder how best to measure pain in a child who has sickle cell disease?" This question is an example of a/an: A. Hypothesis. B. PICOT question. C. Problem-focused trigger. D. Knowledge-focused trigger.

D. Knowledge-focused trigger. Rationale Knowledge-focused triggers are questions about information available on a specific topic.

Which of the following statements is true regarding Magnet status recognition for a hospital? A. Nursing is run by a Magnet manager who makes decisions for the nursing units B. Nurses in Magnet hospitals make all of the decisions on the clinical units C. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need D. Magnet is a special designation for hospitals that achieve excellence in nursing practice

D. Magnet is a special designation for hospitals that achieve excellence in nursing practice. Rationale Magnet status is a process and review in which hospitals participate that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.

False statements that result in damage to a person's reputation. Malice: Person publishing the information knows it is false and publishes it anyway. Slander: One verbalizes the false statement Libel: Written defamation of character. Charting false entries

Defamation of Character.

A person's grief response is unusually _________ or postponed, often because the loss is so overwhelming that the person must avoid the full realization of the loss. A __________ grief response is frequently triggered by a second loss, sometimes seemingly not as significant as the first loss.

Delayed

Being so overwhelmed that you can't process what has happened right then. Could be days, weeks, months later.

Delayed Grief

Process of assigning another member of the health care team to be responsible for aspects of patient care (e.g., assigning nurse assistants to bathe a patient). It results in achievement of quality patient care, improved efficiency, increased productivity, empowered staff, and development of others.

Delegation

The quantity of health care consumers are willing to purchase at a variety of prices. Quantity increases as price decreases and increases as income increases

Demand

Increases in health care cost occur from excess demand and spending on health care when insufficient supply exists • Larger elderly population with increased health needs • Increased use of insurance (3rd party payment) protects consumer (1st payer) from actual cost

Demand - Pull Theory

All persons are worthy of respect and should be treated the same. If an act is just, respects autonomy, and is good, then it will be right, and ethical. Duty based. Right or wrong are determined on the basis of one's duty or obligation to act, not on the consequences of action. Examples: 1. Abortion and euthanasia would be considered never acceptable b/c it violates duty to respect life (no value to who it affects). 2. Lying would never be acceptable b/c it violates the duty to tell the truth according to ____________ Theory Its foundations come from the work of an eighteenth-century philosopher, Immanuel Kant.

Deontological Theory of ethics

_______ defines actions as right or wrong based on their "right-making characteristics" such as fidelity to promises, truthfulness, and justice. It specifically does not look to consequences of actions to determine right or wrong. Instead it examines a situation for the existence of essential right or wrong.

Deontology

What is my genuine _________ to "want to be" culturally competent?

Desire

Racial/ethnic minorities have higher rates of obesity and chronic illness, including:

Diabetes Hypertension COPD Cancer Stroke Others

Goals of Transcultural Nursing 1. Discovery of culturally relevant facts that can guide the nurse in providing culturally congruent care 2. Provide nursing care which respects and integrates cultural values and beliefs of the client, family, and/or community Who created this?

Dr. Madeleine Leininger

A duty was owed to the client Was there a professional relationship? The nurse violated the duty and failed to conform to the standard of care Was there a breach of duty? The nurse's action or failure to act was the proximate cause of the injury Causality? Actual injury resulted from the breach of duty Was the client damaged?

Elements of malpractice (Think of this as the "DUTIES" of the nurse were not met!)

Must evaluate and stabilize before transfer. No patient "dumping." Must stabilize and make sure they show improvement before transfer.

Emergency Medical Treatment and Active Labor Act (EMTALA

Insider or native perspective

Emic Worldview

How many face-to-face _____________ have I had with patients from diverse cultural backgrounds?

Encounters

Socialization into one's primary culture as a child

Enculturation

_________ _________ occur in when values conflict (with someone else)

Ethical dilemmas

Requires an individual to make a choice between two equally unfavorable alternatives. No simple, correct solution and the final decision will almost certainly be against the wishes of at least one party.

Ethics

______ is the study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large.

Ethics

Holds one's own way of life as superior to others

Ethnocentrism

What should you look for when critiquing the evidence you have gathered?

Evaluate scientific merit Evaluate clinical applicability Look for strong basis for use in practice Does the articles offer evidence to explain my PICOT question? Is the evidence true and reliable? Can I use the evidence in practice? Look at Abstract, Introduction and Lit Review first

A problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise and patient preferences and values in making decisions about patient care

Evidence-based practice (EBP)

Self destructive behaviors, behavioral - suicide potential

Exaggerated Grief

Who can you ask? EBP

Faculty, APN's, staff educators, risk managers, infection control RN's, medical librarian.

Use of threats or medications that interfere with a clients ability to leave a facility. If client alert, oriented, and not a danger to self or others. Unjustified restraint of a person without legal warrant. This occurs when nurses restrain a patient in a confined area to keep the person from freedom.

False imprisonment

As a nurse you keep promises by following through on your actions and interventions. If you assess a patient for pain and offer a plan to manage the pain, the standard of _________ encourages you to monitor the patient's response to the plan. Professional behavior includes revision of the plan as necessary to try to keep the promise to reduce pain. __________ also refers to the unwillingness to abandon patients even when care becomes controversial or complex.

Fidelity

Obligation to be loyal to commitments made to oneself and also to others. In nursing, this includes the nurse's faithfulness to responsibilities accepted as a member of the profession. Main basis for the concept of accountability in nursing. Keep your promises. If you have a plan stick to it or modify it but still reach the goal you had set out to reach.

Fidelity

_________ _________ can alert a patient to a condition that may not yet be evident but that is certain to develop in the future.

Genetic testing

How can you integrate evidence to practice?

Get coworkers involved to integrate the evidence into every day practice Is the staff supportive? Does the change fit within the scope of practice? Pilot Study

Nurses who provide care in an emergency situation are immune from lawsuit if: *Acting according to established guidelines. *Actions were within the scope of education and training. ****Must stay with pt until help arrives.

Good Samaritan Act

Is the emotional response to a loss, manifested in ways unique to an individual and based on personal experiences, cultural expectations, and spiritual beliefs.

Grief

Differences in measures of health status among different groups of people living in a community. Occur when one group of people has a higher incidence or mortality rate than another, or when survival rates are less for one group than another.

Health Disparities

Refers to a range of skills needed to prevent disease and promote health, including the abilities to *Read, comprehend, analyze information *Understand instructions *Weigh risks and benefits *Make decisions and take action

Health Literacy

o Most are Catholic o Strong family support systems o Mental health/retardation are shamed, hidden o Women prefer their Mothers to be at births o Large family presence o Family makes decisions

Hispanic Community

The provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation.

Home care

A widely used standardized satisfaction survey which is administered after a patient is discharged from a hospital is referred to as:

Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS)

What questions should be asked to evaluate the decision or change?

How well did the change work? What can we keep in practice and what do we need to change?

PICOT Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)?

I = Intervention of interest

_________ _________ means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity.

Informed consent

Rx coverage (2006)- has huge ($2300) gap in coverage for medication costs >$2800 per year.

Part D

__________ is based on the principle that a large group of people pay a premium into a pool knowing that a small group of those people will need funds for health care. The insured person pays in to protect themselves in case they are one of the smaller group

Insurance

A willful act that violates another person's rights or property.

Intentional torts

Interventions that promote cultural sensitivity?

Interpreters

When forming your question for EBP, what type of questions should you ask?

Is there current evidence out there? What doesn't make sense? What needs to be clarified? Is there a problem or something that interest you? Time consuming? Costly? Not Logical? *Use the PICOT when forming/stating your question!

Daytime fasting during Ramadan, No pork, alcohol. Cleaning hands with water before prayer 5 times/day to Mecca (East)

Islam

Daytime fasting during Ramadan. No pork, alcohol. Cleaning hands with water before prayer 5 -> face east towards Mecca

Islam

No blood transfusions or transplants

Jehovah's Witness

Will turn head eastward or to the right side. *Quick burial within 24 hours *Against cremation, organ donation and chemical preservation of the body. Viewing the corpse is also viewed as disrespectful.

Jewish

Kosher meals, no pork or shellfish, no mixing meat/milk, Circumcision on the 8th day by Rabii

Judaism

________ refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. By fostering open discussion about errors, members of the health care team become informed participants, able to design new systems that prevent harm.

Just Culture

The obligation to be fair to all people. As a healthcare provider our goal is to be fair to all.

Justice

The term is most often used in discussions about access to health care resources, including the just distribution of resources. Discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of __________.

Justice

Basing her research on interviews with dying people, _____________ describes five stages of dying in her classic behavioral theory: denial, anger, bargaining, depression, and acceptance.

Kübler-Ross

No alcohol, caffeine, tobacco, illicit drugs, fasting one Sunday per month, Elders anoint and pray

LDS

No alcohol, caffeine, tobacco, illicit drugs, fasting one Sunday per month, Elders anoint and pray

Latter Day Saints

_________ are more likely to be obese when compared with their heterosexual counterparts. _______and ________ ________ have increased risk factors for cardiovascular disease.

Lesbian women Lesbian and bisexual women

Individual unable to speak, read, write or understand English at a level that allows him/her to interact effectively with health and social-service agencies and providers

Limited English Proficient (LEP) -Ask what language client prefers to receive language in.

Directs treatment according to client wishes in the event of illness.

Living will

Where are the best places to search for EBP?

MEDLINE and CINAHL

The American Nurses Credentialing Center (ANCC) established the _________ Program to recognize health care organizations that achieve excellence in nursing practice.

Magnet Recognition

Administering a medication to a patient even though the medical record contains documentation that the patient has an allergy to that medication.

Malpractice

Failure to act in accordance with standard of care. Commission of something a reasonable person would not do in that situation. Nurses are held to a higher standard of conduct than the ordinary person.

Malpractice

Behave in a way that interferes with normal functioning but you are unaware of it.

Masked Grief

Sometimes 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.

Masked Grief

Federally funded, state-operated program that provides: (1) health insurance to low-income families; (2) health assistance to low-income people with long-term care (LTC) disabilities; and (3) supplemental coverage and LTC assistance to older adults and Medicare beneficiaries in nursing homes. Individual states determine eligibility and benefits.

Medicaid

1965—federal program to ensure adequate health care for elderly. 1972-added benefit for long-term disability (>2 years). Funded through combined mandatory employee and employer contributions Must have contributed to receive benefits. ESRD is the only disease entity covered.

Medicare

a funded national health insurance program in the United States for people 65 years and older. Part A provides basic protection for medical, surgical, and psychiatric care costs based on diagnosis-related groups (DRGs); also provides limited skilled nursing facility care, hospice, and home health care. Part B is a voluntary medical insurance; covers physician, certain other specified health professional services, and certain outpatient services. Part C is a managed care provision that provides a choice of three insurance plans. Part D is a voluntary Prescription Drug Improvement

Medicare

Differences in Medicare and Medicaid __________ provides services to elderly (over 65) and disabled __________ provides services based on poverty levels __________ is funded totally by federal government __________cost is shared between federal government and individual states Until Part D, __________ did not contribute to cost of prescribed drugs __________ covers prescribed drugs

Medicare Medicaid Medicare Medicaid Medicare Medicaid

Similarities between _________ & ___________: Both are federally supported programs enacted in 1965 to provide health care coverage to vulnerable populations Services provided under each program are mandated by the federal government, i.e. feds decide what gets covered under each program and state or local governments have no input.

Medicare and Medicaid

Insurers can decline to cover mental health BUT, if benefits are offered - cannot place limits that differ from those offered for other diagnoses

Mental Health Parity Act

Naming ceremony 8 days after birth with circumcision

Nigeria

A bone marrow transplant procedure may offer a chance at cure; but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and full of uncertainty, precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit. This is an example of

Nonmaleficence

The obligation of health care providers to "do no harm." *Hippocratic oath *Passive in that it requires merely the omission of activities that cause harm

Nonmaleficence

What are the different types of grief?

Normal Anticipatory Disenfranchised -Ambiguous loss Complicated -Exaggerated -Delayed -Masked

___________ grief is a common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death. Feelings of acceptance, disbelief, yearning, anger, and depression are displayed in normal bereavement grief.

Normal (uncomplicated)

Universal, disbelief, yearning, anger, depression, etc.

Normal Grief

Statutes enacted by the legislature of any of the states or the appropriate officers of the districts or possessions that describe and define the scope of nursing practice.

Nurse Practice Acts

Who has legal control over nursing practice?

Nurse practice act Individual State Boards Criminal courts Civil courts

Pray in groups at bedside. Bury body before sundown.

Orthodox Jews

The difference between utilitarianism and deontology is the focus on ___________. ____________ measures the effect that an act will have; ___________ looks to the presence of principle regardless of outcome.

Outcomes; Utilitarianism; Deontology

The aim is to ask a question that contains as many of the PICOT elements as possible. For example, here is a meaningful question that contains only a P and O: How do patients with cystic fibrosis (_) rate their quality of life (_)?

P O

Another example of a PICOT Question is: Is an adult patient's (_) blood pressure more accurate (_) when measuring with the patient's legs crossed (_) versus the patient's feet flat on the floor (_)?

P O I C

Example of a PICOT Question: Do patients who have had abdominal surgery (_) and who rock in a rocking chair (I) have a reduced incidence of postoperative ileus (_) during hospitalization (_) when compared with patients who receive standard nursing care following surgery (_)?

P O T C

PICOT Identify patients by age, gender, ethnicity, and disease or health problem.

P = Patient population of interest

________ care can include hospice care before or at the EOL

Palliative

Aimed to prevent and relieve suffering For all patients receiving curative or restorative healthcare

Palliative Care

Hospitalization, home health, hospice, SNF for 100 days immediately following in-pt hospitalization, most people don't have to pay.

Part A

Outpatient services (premium for 2012 costs patients $99.90 a month for coverage), some preventive services, (needed for ESRD)

Part B

Maganged Care Option

Part C

__________ can be a negative outcome of beneficence.This occurs when health care providers decide what is "best" for clients. Example: 14 yr old comes into ER looking for birth control. Physician looks at the benefits and the risks. We don't want any babies but patient is too young but will do it anyways to prevent pregnancy.

Paternalism

Intensity does not wane after first year

Pathologic grief

Intensity does not wane after first year.

Pathologic grief

________ ______-_____________ _______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. Under the act the patient's record needs to document whether or not the patient has signed an advance directive. For living wills or durable powers of attorney for health care to be enforceable, the patient must be legally incompetent or lack the capacity to make decisions regarding health care treatment.

Patient Self-Determination Act (PSDA) (1991)

Have certain contracted providers which agree to perform services for set amount (usually more than HMO but less that "usual and customary"). Can go outside of panel, but will have higher co-pay, deductibles, etc.

Preferred provider organizations (PPOs)

Method of nursing practice in which the patient's care is managed for the duration by one nurse who directs and coordinates other nurses and health care personnel. When on duty, the primary nurse cares for the patient directly.

Primary Nursing

__________focuses on improved health outcomes for an entire population. It includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of diseases. ____________ requires collaboration among health professionals, health care leaders, and community members.

Primary health care Primary health care

Adequate pain relief is an important outcome for all patients. In particular for patients who are terminally ill.

Principle of Beneficence

Preventing or reducing harm to patient. Providing adequate pain control to alleviate suffering in the terminally ill. Secondary effect of hastening death (euthanasia) is ethically justified.

Principle of Nonmaleficence

___________ nursing research is the study of phenomena that are difficult to quantify or categorize such as patients' perceptions of illness. This method describes information obtained in a nonnumerical form (e.g., data in the form of written transcripts from a series of interviews). ____________ research offers answers when trying to understand patients' experiences with health problems and the contexts in which the experiences occur. Patients have the opportunity to tell their stories and share their experiences in these studies. The findings are in depth because patients are usually very descriptive in what they choose to share. Examples of __________ studies include "patient's perceptions of nurses' caring in a palliative care unit," and "the perceptions of stress by family members of critically ill patients."

Qualitative Qualitative Qualitative

__________ health care is the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"

Quality

___________ nursing research is the study of nursing phenomena that offers precise measurement and quantification. For example, a study dealing with pain therapies _____________ measures pain severity. A study testing different forms of surgical dressings measures the extent of wound healing. ___________ research is the precise, systematic, objective examination of specific concepts. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings.

Quantitative Quantitatively Quantitative

___________ law, or administrative law, reflects decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations. An example of a __________ law is the requirement to report incompetent or unethical nursing conduct to the State Board of Nursing.

Regulatory regulatory

Carrying out duties associated with a particular role. *Maybe in the end that choice caused injury.

Responsibility

The word _____________ refers to a willingness to respect one's professional obligations and follow through on promises.

Responsibility

No alcohol, most are vegetarian, practice fasting

Seventh Day Adventist

Do I have the _________ to conduct a cultural assessment and perform a culturally-based physical assessment in a sensitive manner?

Skill

State legislature and congress *Election, listen to people, propose bills to become law

Statutory law

Working with a Qualified Medical Interpreter

Step 1: Have a pre-interview with the interpreter and tell them what you hope to accomplish with this communication. Step 2: Position the interpreter to the side and slightly behind the patient/parent --> to be able to connect w/pt Step 3: Make eye contact with the patient/parent and not at the interpreter. **Speak in short sentences to the patient/family ***Avoid jargon and phrases that may not translate well from English into another language, such as "the ball is your court." ****Can request a specific gender

"All are alike", does not take individual differences

Stereotyping

SSI

Supplemental Security Income

Quantity of a service producer is willing to sell at various prices. It increases as price increases.

Supply

Drives the U.S. health care system?

Supply and demand

That which causes a good outcome for the most people is a good action. Value is determined by its usefulness Utilitarian based. Right or wrong are based on the consequences of a given action - Ends justify the means Examples: 1. Abortion may be acceptable as it lessens the burden on society caused by unwanted babies. 2. Euthanasia may be acceptable because it decreases suffering and lessens $$ spent on futile care 3.Lying may be acceptable if it causes less harm than telling the truth

Teleological theory of ethics

TANF

Temporary Assistance for Needy Families

___________ is a standardized survey developed to measure patient perceptions of their hospital experience. _________ was developed by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality as a way for hospitals to collect and report data publicly for comparison purposes.

The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) HCAHPS

Accredits health care organizations across the continuum of care, including hospitals and ambulatory care, long-term care, home care, and behavioral health agencies.

The Joint Commission

Nursing delivery of care model originally developed during Florence Nightingale's time. In the model a registered nurse (RN) is responsible for all aspects of care for one or more patients. The RN works directly with the patient, family, physician or health care provider, and health care team members. The model typically has a shift-based focus.

Total pt care

Pays 80% of "usual and customary" charges after meeting deductible. Only a very few of these programs still exist.

Traditional Indemnity "80-20 Plans"

True or false: Gay men and lesbian women have higher smoking rates than heterosexuals.

True

True or false: You should use different combinations of key words to get the article you want or to narrow your search. EBP

True

True or false: Hearing is usually the last sense to disappear

True

During childbirth: ___________ stoic _________& ________vocalize pain ________ physically and verbally more expressive __________ fear of drug addiction, will not complain

Vietnamese Puerto Rican & Mexican Arab Filipino

Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an __________ __________.

ethics committee

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

exaggerated

When experiencing the ________ stage of adjustment to loss, a person expresses resistance and sometimes feels intense anger at God, other people, or the situation.

anger

Intentional threat. No actual contact is necessary. Did the client give consent? If they did, nurse is not responsible for ____________.

assault

It is an ________ for a nurse to threaten to give a patient an injection or to threaten to restrain a patient for an x-ray procedure when the patient has refused consent. Likewise, it is an ________ for a patient to threaten a nurse

assault assault

Chinese American-family will ______ patient after death

bathe

Intentional touching without consent. Usually includes assault component, hence "assault and __________." Consent is key.

battery

The term ___________ encompasses both grief and mourning and includes the emotional responses and outward behaviors of a person experiencing loss.

bereavement

An example of a __________ law violation for a nurse is negligence or malpractice.

civil

A group of people whose members share values and ways of thinking and acting that are different from those of people who are outside the group.

culture

Grunting, gurgling, or noisy congested breathing is called the ________ ________ - also due to mouth breathing

death rattle

A person in the __________ stage cannot accept the fact of the loss, which often provides psychological protection from a loss that the person cannot yet bear.

denial

Traditional theory of ethics that proposes to define actions as right or wrong based on the characteristics of fidelity to promises, truthfulness, and justice. The conventional use of ethical terms such as justice, autonomy, beneficence, and nonmaleficence constitutes the practice of _____________. You focus less on the consequences (ethically speaking). If an act is just, respects autonomy, and provides good, it will be right, and it will be ethical according to this philosophy. ___________ depends on a mutual understanding and acceptance of these principles.

deontology Deontology

When a person realizes the full impact of the loss, _____________ occurs. Some individuals feel overwhelmingly sad, hopeless, and lonely.

depression

The _____________ of health are factors that (1) influence the health of individuals and groups and (2) help explain why some people experience poorer health than other

determinants

People experience ________________ grief, also known as marginal or unsupported grief, when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance. The person's loss and grief do not meet the norms of grief acknowledged by his or her culture, cutting the grieving person off from social support and the sympathy given to persons with "legitimate" losses. The grieving person often wonders if he or she should call the experience a loss. Examples include the death an ex-spouse, a gay partner, or a pet or death from a stigmatized illness such as alcoholism or during the commission of a crime

disenfranchised

Health ___________ is achieved when every person has the opportunity to attain his or her health potential and no one is disadvantaged.

equity

Give an example of nonmaleficence in terms of nursing.

floating to an unfamiliar unit that requires administration of critical medications with which you are not familiar.

In relation to medical procedures, Obtaining __________ ___________is not the role of the nurse - ensuring it exists IS. Needs to include Complete explanation of procedure Names of those performing and assisting Potential outcomes (positive and negative) Alternative therapies, as well as the risk of doing nothing Right to refuse

informed consent

A ________-_______ trigger is a question regarding new information available on a topic. For example, "What is the current evidence to improve pain management in patients with migraine headaches?" Important sources of this type of information are standards and practice guidelines available from national agencies such as the Agency for Healthcare Research and Quality (AHRQ), the American Pain Society (APS), or the American Association of Critical Care Nurses (AACN). Other sources of _______-_______ triggers include recent research publications and nurse experts within an organization.

knowledge-focused knowledge-focused

Health care system in which there is administrative control over primary health care services. Redundant facilities and services are eliminated, and costs are reduced. Preventive care and health education are emphasized.

managed care

MD directs ________ treatment. Nurses must follow MD orders unless they believe the order to be in ________ or will cause _________. A nurse carrying out an _________ or _________order may be legally liable

medical error or will cause harm inaccurate or unsafe

African American ______ are less likely to be offered intervention procedures for cardiovascular disease and stroke.

men

Fundamental standards of right and wrong. Based on religious beliefs, societal norms, personal and family values. Difficulty arises when _______ values conflict Example: Animal rights activists believe killing animals for sport, fur, or food is morally objectionable. Most hunters don't think of killing animals as a _________ issue at all.

morals moral

It is __________ obligation to provide comfort and pain relief at the EOL.

nurses

In a lawsuit for malpractice or nursing negligence, a ____________ expert testifies to the jury about the standards of nursing care as applied to the facts of the case. A _______ may be requested to give evidence in a deposition; this appearance needs to be taken seriously. The jury uses the ___________ _____ _________ to determine whether the nurse acted appropriately. _________ experts base their opinions on existing standards of practice established by Nurse Practice Acts, professional organizations, institutional policies and procedures, federal and state hospital licensing laws, TJC standards, job descriptions, and current nursing research literature.

nursing nurse Standards of care Nurse

Quality Standards Subcommittee of the American Academy of Neurology diagnostic criteria for death.

o Coma or unresponsiveness o Absence of brainstem reflexes o Apnea o Specific assessments by a physician

What are the integumentary physical manifestations of impending death? ON EXAM

o Mottling (blotching) on hands, feet, arms, and legs o Cold, clammy skin o Cyanosis on nose, nail beds, knees - caps o Cold, clammy o "Waxlike" skin when very near death o Some edema

The difference between utilitarianism and deontology is the focus on __________. Utilitarianism measures the effect that an act will have; deontology looks to the presence of principle regardless of outcome.

outcomes

Disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs.

preventive care

Combination of primary and public health care that is accessible to individuals and families in a community and provided at an affordable cost.

primary health care

A ________-________ trigger is one you face while caring for a patient or a trend you see on a nursing unit. For example, while Rick is caring for patients following abdominal surgery, he wonders, "If we changed our patients' activity levels after surgery, would they experience fewer episodes of postoperative ileus?" Other examples of _________-_________ trends include the increasing number of patient falls or incidence of urinary tract infections on a nursing unit. Such trends lead you to ask, "How can I reduce falls on my unit?" or "What is the best way to prevent urinary tract infections in postoperative patients?"

problem-focused problem-focused

The question of ________ ____ ________ is central to discussions about futile care, cancer therapy, health care provider-assisted suicide, and DNR discussions.

quality of life

Rick considered whether to have the patients on his unit use a rocking chair following abdominal surgery, he needed to know if this had been tested on similar patients and the outcomes or results. This is an example of the _______ ______; a systematic, step-by-step process that provides support that the findings from a study are valid, reliable, and generalizable to subjects similar to those researched.

scientific method

The ________ ________ is the foundation of research and the most reliable and objective of all methods of gaining knowledge. This method is an advanced, objective means of acquiring and testing knowledge. Aspects of the method guide you in applying research evidence in practice and in conducting research.

scientific method

A _______ is a civil wrong made against a person or property. Torts are classified as intentional, quasi-intentional, or unintentional.

tort

The greatest good for the greatest number of people is the guiding principle for determining right action in this system. As with deontology, _____________ relies on the application of a certain principle, (i.e., measures of "good" and "greatest")

utilitarianism