PHIL 235 - Exam #2

What are the signs of burnout?

- Feelings of helplessness and hopelessness - Negative attitude, self-concept - Physical, emotional exhaustion

How to prevent burnout?

-Recognize stress, how you respond to it -Identify situations that produce stress -Take steps to reduce the stress

What are the different types of commitment?

1. Affective Commitment 2. Continuance Commitment 3. Normative Commitment

What the four principles of Ethics for Nurses?

1. Autonomy. 2. Beneficence. 3. Justice. 4. Nonmaleficence

What is autonomy?

1. Deals with PATIENT; self determination. 2. Patient have the right to informed consent and full disclosure of treatment so they can make informed choices about their care. 3. Right to privacy; freedom of choice. Autonomy means that each patient's right to self-determination and making decisions is respected.

What are the stages of commitment development?

1. Exploratory. 2. Testing. 3. Passionate. 4. Quiet and bored. 5. Integrated.

What are the five stages of progression (Benner)

1. Novice. 2. Advanced beginner. 3. Competent. 4, Proficient. 5. Expert.

What are the four factors of professional commitment?

1. strong belief in and acceptance of professions code, role, goals, values, morales. 2. Willingness to exert considerable personal effort on behalf of the profession. 3. Strong desire to maintain membership in the profession. 4. Pattern of behaviors congruent with the nurses' professional code of ethics

Continually gaining knowledge....

is central to providing high-quality care, maintaining patient safety

What is the ANA Code of Ethics?

A guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.

Burnout may cause...

A nurse to abandon the profession

What is burnout?

A psychophysiological response due to frequent but generally ineffective efforts to meet excessive demands, involving a psychological, emotional, and sometimes physical withdrawal from an activity in response to excessive stress or dissatisfaction

What is beneficence?

Acting for the good and welfare of others and including such attributes as kindness and charity.

Abuses of power includes...

Attempt to use one's position or authority to shame, control, demean, humiliate, or denigrate another person to gain emotional, psychological, or physical advantage

What are some types of caring interventions?

Attitude and compassion

What is continuance commitment?

Awareness of costs associated with leaving profession. Develops when negative consequences with leaving are reasons for remaining. Individual DOES NOT manifest same ties as those motivated by affective or normative commitment, NOT inclined to promote profession. In the field of nursing for money, job security.

What is compassion?

Awareness of, concern about other individuals' suffering. Recognize patient's need, respond appropriately. Treat patient as unique, special individual and NOT as number or diagnosis. Advocate in at the organizational, local, state, and national level to develop laws and policies to protect and promote health and wellness of individuals, families and communities

Collaboration...

Being skilled in working as a team member

What are some examples of unprofessional behaviors?

Belitting someone's opinions or using patronizing language. Negative or disparaging nonverbal messages. Constant criticism. Elitism about experience, education, or practice area. undermining activities or causing unnecessary disruptions. Emotional outbursts. Pitting staff members against one another and propagating rumors.

What are some types of abuses of power...

Bullying. Sexual harassment. Improper use of authority. Intimidation.

Institute of Medicine (IOM)...

Calls for nurses to lead transformation of healthcare, protect a caring model within business model of healthcare

What are the key to a nursing professionalism

Caring interventions of attitude and compassion

What are the concepts related to professional behaviors?

Caring interventions. Clinical decision making. Healthcare systems. Communication. Culture and diversity. Safety.

What are some examples of collaboration?

Contributes to others' opinions of nurse as professional. Improves quality of care delivered to patient. Collaborates with others within nursing and the interdisciplinary team to meet patient's needs and improve outcomes

Nurse acts as patients advocate by...

Conveying patient's wishes to members of healthcare team. Communicating with patient's family. Encouraging patient to express his/her wishes

How is integrity demonstrated?

Engaging is consistency ethical behavior. Accepting feedback as a tool for improving delivery of patient care. Maintaining accountability for actions. Freely admitting mistakes. Following state's nurse practice act. Never working outside scope of practice.

What is normative commitment?

Feeling of obligation to continue in profession. Develops as a result of having received benefits, positive experiences through engagement in the profession .

Patient advocacy is essential...

For patients in vulnerable populations

Scenario: Samantha is a 28-year-old college student who is eighteen weeks pregnant. She has a history of cardiac disease that has worsened because of the pregnancy. Samantha's doctor is concerned that continuing the pregnancy can cause her heart condition to worsen and could result in a life-threatening emergency. He has recommended termination of the pregnancy within the next two weeks. Samantha is reluctant, stating that, although she does not currently go to church, she was raised to believe abortion is wrong and believes God will heal her. She wants to know what the nurse would do in her position. Nurse Jennifer does not believe in abortion under any circumstance. Ethical Dilemma: Patients often look to nurses for advice about their health, wellness, and decisions regarding care. In some cases, such as the scenario presented here, the medical necessity for treatment or intervention contradicts a patient's personal morals and/or religious beliefs. It is not uncommon for patients to want someone to tell them which decision is best. An ethical dilemma in nursing can occur in situations like this, especially if the nurse has opinions that differ from the patient or doctor.

How to Deal with this Ethical Dilemma: According to the American Nurses Association Position Statement on Reproductive Health, "healthcare clients have the right to privacy and the right to make decisions about personal health care based on full information and without coercion. Also, nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client's life is in jeopardy, nurses are obligated to provide for the client's safety and to avoid abandonment." Although Nurse Jennifer does not believe in abortion, she should not express her personal beliefs or opinions to the patient. Instead, the nurse should encourage the patient to talk with her significant other (if appropriate), family, spiritual advisor, or others she feels she can confide in and seek advice. The nurse should schedule a follow-up visit with the physician to discuss options and decisions before the two-week deadline by which the doctor wants to perform the procedure.

Scenario: Mr. Simms was diagnosed with lung cancer three years ago. After chemotherapy, he experienced a brief remission but recently learned the cancer has recurred. Mr. Simms's doctor advised him and his family that treatment will likely be unsuccessful and, although it may offer a few more months of life, Mr. Simms's quality of life will rapidly deteriorate. The doctor recommends hospice at home with comfort measures only, including oxygen and opioid pain relievers. Despite symptoms of pain, such as grimacing and crying, Mr. Simms refuses pain medication, stating he does not want to experience the effects of feeling sleepy and missing precious time with his family. His wife is distraught and asks the nurse if there is a way to administer pain medication without her husband knowing. Ethical Dilemma: Beneficence describes the obligation of nurses to act for the benefit of patients, supporting moral values to protect patient rights, prevent harm, and remove conditions that could cause harm. Autonomy, on the other hand, is an act that is governed or allowed by the patient without interference or persuasion from medical or nursing personnel. Nurses who practice beneficence without respect for the patient's autonomy may end up performing acts that do not benefit the patient.

How to Deal with this Ethical Dilemma: Although the nurse may have good intentions, the patient's right to autonomy must be weighed against what the nurse feels is appropriate. If Mr. Simms can make independent decisions with a clear understanding of their consequences, the nurse must honor his wishes. The nurse should explain to Mrs. Simms that she understands her concern and desire for her husband to be pain-free, but also explain that the nurse is obligated by law and the nurse's Code of Ethics to allow Mr. Simms to make decisions for himself. If Mr. Simms does not have an Advance Directive, it is also appropriate for the nurse to recommend establishing one while he can still do so.

Scenario: Nurse Jordan worked in a busy COVID-19 unit where she cared for Mr. Miller. Nurse Jordan promised Mr. Miller and his family, who were not allowed to visit, that she would not let him die alone. The hospital adopted guidelines to protect nurses and other staff from extended exposure to COVID. After having been at Mr. Miller's bedside for a prolonged length of time, Nurse Jordan's supervisor instructed her to leave the room. Ethical Dilemma: Because of their role as patient advocates and bedside caregivers, nurses often face ethical dilemmas, especially about being present for pivotal moments in a patient's life. In this scenario, Nurse Jordan faced an ethical dilemma because her sense of duty and compassion for her patient did not align with the safety protocols the hospital had in place to protect nurses.

How to Deal with this Ethical Dilemma: Following protocols can feel difficult, especially in situations when you feel your patient needs you at their bedside. While the nurse understandably wanted to comfort the patient and his family by promising he would not be left alone, it would have been best to not make a promise she did not know she could keep. If a situation occurs where compassion and duty do not align with a facility protocol, the nurse should immediately talk to the charge nurse and explain the situation and ask for advice or intervention. In this scenario, the charge nurse may not have allowed Nurse Jordan to remain in the room, but she could have sent another nurse.

Scenario: Mr. Elliott is a fifty-eight-year-old male who came to the emergency department following a motor vehicle accident. He has several injuries, and it has been determined he is experiencing internal bleeding. The emergency doctor has requested a surgery consult. Although Mr. Elliott consents to surgery, if needed. However, he declines consenting to a blood transfusion even if his life depends upon one. His reason for refusing a blood transfusion is Mr. Elliott is a Jehovah's Witness and receiving a blood transfusion goes against his religious beliefs. Ethical Dilemma: It can be difficult to remain objective with patients, especially in life-threatening situations. An ethical dilemma in nursing can occur when a patient's wishes contradict what may be medically necessary to promote health or sustain life.

How to Deal with this Ethical Dilemma: If a patient is alert, oriented, and understands the consequences of accepting or rejecting medical care or treatment, he may refuse that care. Although it is normal to want to promote any life-saving measures, nurses must learn to draw a line between providing accurate information and pushing their own opinions or beliefs. The nurse should document any education provided and the patient's response, including his reason for declining treatment. Proper documentation will protect the nurse and healthcare facility from legal ramifications if the client or his family later feels treatment should have been provided.

Scenario: Michael is a sixteen-year-old who was diagnosed with a sexually transmitted infection (STI). Although the doctor examined Michael and told him about his diagnosis privately, Michael's mother is in the waiting room and wants to know what the doctor said. Michael told the doctor and nurse that he does not want anyone to know about the STI, including his mother. Ethical Dilemma: Perhaps one of the most common examples of ethical dilemmas in nursing occurs when nurses must determine if it is appropriate to discuss a patient's medical information with a parent or guardian. For years, parents and guardians were allowed access to medical records for any patient under the age of eighteen. Today, every state has some laws allowing minors to consent to care under certain conditions without parental knowledge, consent, or access to their medical records.

How to Deal with this Ethical Dilemma: In most states, when an adolescent is old enough to give consent for healthcare, information pertaining to that care is typically considered confidential. Violating a patient's confidentiality can result in serious repercussions, including loss of job or licensure. Therefore, it is necessary for nurses to be aware of their state laws and to work closely within those laws and with supervisors to adhere to their organization's guidelines. It is always appropriate to defer to your facility's policies or to ask for a supervisor's intervention or guidance if you are unsure.

Scenario: Mr. Jones is a 34-year-old brought to the emergency department following a motor vehicle accident. He is well-known to the ER staff, having been admitted for drug abuse complications on more than one occasion previously. While waiting for x-rays of his left leg which appears broken, Mr. Jones complains of "extreme pain" and asks for pain-relieving medication. The emergency physician will not write an order for pain medication stating Mr. Jones is an "addict with a preference for pain medications." Ethical Dilemma: Nurses are often faced with the dilemma of whether they should follow a physician's order without question or if they should seek intervention from supervisors or administrators. Going up the chain of command could put the nurse at risk for professional retribution and accusations of insubordination. Conversely, inaction on the nurse's part means the patient's complaints of pain would be ignored because he is an addict.

How to Deal with this Ethical Dilemma: It is always appropriate to advocate for a patient's needs. If the physician refuses to provide pain management options, despite the patient's request and the nurse's assessment of pain, the nurse should present to a supervisor.

Scenario: Mr. Thomas is a 68-year-old male with a history of diabetes and peripheral hypertension. Because of vascular changes and uncontrolled blood sugar, Mr. Thomas developed ulcerations on his right heel. Treatment of the wounds has been unsuccessful, and Mr. Thomas' physician suggests the next step is amputation. Mr. Thomas agrees with the doctor, but his wife does not. Mrs. Thomas voices concern to the nurse that her husband is being tricked into having his foot amputated because the doctor is tired of treating the wounds. Ethical Dilemma: The concept of informed consent is a common ethical dilemma in nursing. Informed consent to treatment is the process whereby a patient or their designated representative grants healthcare providers permission to administer treatments or perform procedures. Informed consent requires healthcare providers to advise patients of potential risks and benefits of suggested treatments and inform them of any alternative treatment options.

How to Deal with this Ethical Dilemma: It is common for patients or their loved ones to confide concerns or ask questions of nurses before talking to doctors, especially when they are worried or stressed. In this scenario, Mrs. Thomas seems to feel more comfortable talking with the nurse. It is crucial that the nurse try to understand Mrs. Thomas' concerns and offer her comfort. Additionally, it is essential for the nurse to notify the charge nurse and the physician regarding Mrs. Thomas' statements and concerns. While the decision for treatment is up to Mr. Thomas, concerns from his spouse should not be ignored.

Scenario: Nurse Micah works with Nurse Saundra caring for patients on the cardiac unit. Today, one of Nurse Micah's patients experienced a spike in blood pressure above the safe protocol ranges. Because he was busy caring for another patient, Nurse Micah forgot to report the change in blood pressure to the physician. Since the patient's blood pressure returned to a normal level, he did not document the incident. He confided in Nurse Saundra about the patient's blood pressure and that he did not document the change or report it to the physician. Ethical Dilemma: While no nurse wants to believe a fellow nurse is not competent to provide care, issues of incompetence are real and can create situations of an ethical dilemma in nursing. Nurses often develop close relationships with their peers, which makes deciding to report errors or omissions difficult. However, the primary responsibility of all nurses is to provide safe, competent nursing care to all patients.

How to Deal with this Ethical Dilemma: It is never appropriate to shirk responsibilities, including documenting changes in patient statuses or reporting to physicians when needed. The first response for Nurse Saundra should be to encourage Nurse Micah to document the patient's change in vital signs and report the spike and return to normal to the physician. If she is unsure whether Nurse Micah documented and reported the patient's change or feels uncomfortable with the situation, Nurse Saundra should report the information to her charge nurse. As always, the safety and well-being of patients should be of utmost importance to all nurses.

Scenario: Charge Nurse Hale assigned Nurse Mary to work on the post-partum floor due to a shortage of nursing staff there. One of the patients has requested assistance with breastfeeding stating her baby is not latching on. Nurse Mary has been a nurse for one year but has never worked with post-partum patients. She has voiced concern that she has no experience working with newborns or post-partum mothers. Ethical Dilemma: It is not uncommon for nurses to float from one department to another during their shifts and throughout the course of their careers. While there is nothing wrong with assigning nurses to different departments, as needed, an ethical dilemma in nursing can occur if the nurse finds herself asked to provide care she has never performed.

How to Deal with this Ethical Dilemma: It is vital for nurses to understand that clinical experiences in nursing school are broad and may not offer in-depth training in specific areas. This scenario is one example of a nurse graduating nursing school and becoming licensed but not having experience in an area (post-partum care). The appropriate nursing response is for Nurse Mary to tell Charge Nurse Hale she has not had the opportunity to learn first-hand about teaching breastfeeding techniques and ask for guidance. In an ideal situation, the charge nurse should accompany Nurse Mary to the patient's room and offer instruction to both Nurse Mary and the patient. If the charge nurse refuses to assist Nurse Mary or to assign an experienced nurse to help, it may be appropriate for Nurse Mary to report to the next person in the chain of command.

Scenario: Mr. Wesley has been diagnosed with intestinal amebiasis, for which the doctor has prescribed Tinidazole 2 grams once daily for five days. Nurse Lin notes Mr. Wesley's chart says he is allergic to Flagyl and knows Tinidazole is contraindicated in patients with a Flagyl allergy. Ethical Dilemma: Some of the most common examples of ethical dilemmas in nursing occur because of inappropriate or questionable medication orders. As nursing students begin to learn about medication and administration of drug therapy, they must learn the "Five Rights of Medication Use" which are the right patient, right drug, right time, right dose, and right route. While nurses should not randomly choose which physician's orders to follow and which to disregard, it is the nurse's responsibility to provide safe patient care, which includes verifying questionable orders.

How to Deal with this Ethical Dilemma: Nurse Lin should immediately verify with Mr. Wesley what medication allergies he has and ask what his reaction to that medication is. Once the Flagyl allergy is confirmed, Nurse Lin should notify the doctor and ask for an alternative option for the patient. In most cases, physicians will change the order when a medication is contraindicated. However, if the physician refuses to change the order, the nurse should notify the nursing supervisor immediately. Nurse Lin should also advise Mr. Wesley that she is verifying the physician's order because of his drug allergy and ask him to wait until the order is confirmed or changed before filling the medication and taking it.

Scenario: Mrs. Douglas has metastatic lung cancer. Her physician has advised about treatment options that may prolong her life by six months to a year. However, to the dismay of her family, Mrs. Douglas has chosen comfort measures only. Mrs. Douglas has prepared an Advanced Directive, including signing a DNR (Do Not Resuscitate). Ethical Dilemma: Decisions about end-of-life care is one of many examples of ethical dilemmas in nursing. Nurses can easily become overwhelmed when trying to comfort loved ones while honoring patient wishes.

How to Deal with this Ethical Dilemma: Nurses are invaluable resources of help for patients and their loved ones during end-of-life transitions. If Mrs. Douglas is of sound mind and clearly understands her prognosis with and without treatment, she has the right to decide what treatment she does or does not want. Although the situation may be difficult, the nurse's primary responsibility is to her patient. Nurses must advocate for the autonomy and rights of patients. Because the patient in this scenario prepared an Advance Directive, the responsibility of following her wishes may be easier.

Scenario: Wesley is a patient at the local outpatient clinic where Nurse Sabrina works. After almost a year of him being a patient at the clinic, Wesley told Sabrina he thinks she is very pretty and asked to take her to dinner. Ethical Dilemma: Patients trust nurses with some of their most sensitive information. While this trust is good and puts nurses in unique positions to help patients, an ethical dilemma in nursing can occur if the nurse does not keep relationships professional.

How to Deal with this Ethical Dilemma: Professional boundaries safeguard nurses and patients. It is essential that nurses recognize warning signs that could lead to crossing those boundaries before things get out of hand. Nurses should avoid after-hour phone calls to and from the patient of a personal nature, giving and receiving gifts, flirting, keeping secrets, or becoming overly involved in a patient's business or personal affairs.

Scenario: Nurse Madison works on a busy pediatric ward and loves her job. Recently, the mother of one of her patients sent her a friend request on social media and posted a comment on Nurse Madison's public wall asking about a patient who was in the room next to her son's. The post said, "Hey Maddie! How is Gavin? We haven't seen him since Austin was discharged." Ethical Dilemma: Our world is filled with technology at our fingertips. When used correctly, there is nothing wrong with using technology such as social media platforms. For nurses, it is essential to understand where the line between personal and professional relationships or acquaintances lies and to be careful not to blur or cross those lines.

How to Deal with this Ethical Dilemma: Protecting patient privacy and confidentiality is the responsibility of all nurses. That responsibility does not end when a patient is discharged from care. In this case, the best thing for Nurse Madison to do is NOT accept the friend request from her former patient's mother. If Nurse Madison and the mother develop a friendship that extends outside of her son's care and a social media connection is made, Nurse Madison must be responsible for the things posted on her public wall or shared with anyone. She must also be proactive by removing any communication in public view and expressing to her friend that she must always maintain patient confidentiality.

Scenario: Mr. Jenkins has been in the intensive care unit for ten days. He was initially admitted through the emergency room for an elevated temperature of unknown origin and suspected sepsis. After diagnostic testing, it was determined Mr. Jenkins had a perforated bowel that resulted in full-body sepsis. In the past twelve hours, he has experienced two strokes, become unresponsive, and has no Advance Directive. Mr. Jenkins' children state they are "holding on to faith that God is going to bring him through." Despite efforts from the doctor to explain the gravity of the situation and attempts to prepare the children for the worst, they insist that all possible life-saving measures be used. Ethical Dilemma: Health and nursing care are results-driven and based on science. The science behind patient care may contradict personal or religious beliefs. Nurses may feel frustrated because the science they know is not enough to save their patients. When families find it difficult to accept a poor prognosis for their loved one and cling to religious beliefs instead, nurses may feel helpless.

How to Deal with this Ethical Dilemma: The American Nurses Association Code of Ethics states nurses should acknowledge and respect the "unique differences of patients, including lifestyle, value system, and religious beliefs." However, the Code also states respect for the patient's belief "does not imply that the nurse condones those beliefs or practices on a personal level." Many patients experience reduced stress when they rely on their faith during times of medical challenges. Nurses should be mindful of a patient's spiritual and religious needs. In this scenario, although the nurse accepts the science behind the patient's diagnosis and expected outcome, her job is to honor the family's decisions and be supportive of them.

Scenario: Mr. Morris is in end-stage renal failure. Despite efforts to help manage the disease, including dialysis three times weekly, his condition has worsened. Mr. Morris's physician has noted the decline in his status and has informed the family that Mr. Morris may have only a few weeks to live. Mrs. Morris and their children are skeptical about telling Mr. Morris how bad his condition is, and the physician has made no effort to talk to the patient about it. After his family left the hospital for the evening, Mr. Morris called for the nurse and asked her to tell him what the doctor said, stating he felt like he was not getting the whole story. Ethical Dilemma: The decision to disclose the seriousness of a patient's condition is not a new ethical dilemma in nursing. For years, physicians were recognized as the decision-makers for patients and determined whether to withhold information based on whether they thought the information would cause undue stress or more harm than good. In more recent years, the idea that patients are entitled to know the truth about their diagnosis and prognosis has become the norm. Unfortunately, nurses often find themselves caught somewhere between telling the patient news that could cause greater distress or using blanket answers to help decrease anxiety.

How to Deal with this Ethical Dilemma: The bottom line and most important thing for nurses to remember is patients have a right to know about their own diagnosis and potential outcome of treatment or lack thereof. The physician is initially responsible for notifying the patient of his diagnosis. However, nurses typically have more face-to-face encounters with patients and are often the ones the patients look to for clarification. It is best to answer questions as carefully and thoroughly as possible. If you are unsure of the appropriate answer, defer the question to your supervisor or the patient's physician.

Scenario: Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she notices he seems confused and is unsure where or how to sign the paperwork. Ethical Dilemma: It is common for nurses to be the ones to get signatures on consent forms, especially for procedures like the one described in this scenario. When faced with a situation like the one here when the nurse is not sure that the patient understands what he is being told or if he can read, the decision of whether to delay a busy schedule to have the doctor come back and talk to the patient or explain to the best of her knowledge and get the patient's signature may seem difficult to make.

How to Deal with this Ethical Dilemma: The language used in healthcare and on healthcare documents is complicated to most patients. It can be even more challenging for patients with poor literacy levels. Nevertheless, all patients have the right to be fully informed about and understand treatment options and procedures before they are provided. It is ALWAYS right to err on the side of a patient's vulnerability. The nurse should provide information in a way the patient understands, allowing him to ask questions and have the option to allow or refuse treatment. If the patient does not fully understand what the nurse is saying, the nurse should notify the doctor and ask him to explain the procedure, including anticipated outcomes and risks again.

Scenario: Nurse Cathy is working the evening shift on the Medical-Surgical ward. The hospital has established protocols that include nurse-patient ratios should not exceed more than six patients per nurse. There are twenty-three patients on the Med-Surg floor. One nurse called in, leaving three nurses to provide patient care. Ethical Dilemma: Nurses have an obligation to promote patient safety. An ethical dilemma in nursing occurs when nurses find themselves with more patients than they can safely provide care to, putting patients and staff at risk.

How to Deal with this Ethical Dilemma: There are times when staff shortages are unexpected or unavoidable. It is the responsibility of the charge nurse or director of nursing to implement efforts to keep the ratio of nurses to patients within facility guidelines. However, nurses should never abandon their posts because of disproportionate nurse-patient numbers. When nurses are faced with inadequate staffing issues, it is necessary to immediately direct concerns to the supervising nurse. The nurse should then prioritize care based on patient needs or status.

Scenario: Nurse Judy is the wound care nurse for a home health agency. She stopped by the office to pick up additional wound care supplies for her weekend visits. However, the charge nurse told her the wound care supplies delivery did not arrive. As a result, there are not enough supplies on hand for the visits Nurse Judy has scheduled. Ethical Dilemma: Nurses may face situations that require them to determine which patient needs supplies or treatment more than another. While this is not an ideal situation, it happens more often than most people care to admit.

How to Deal with this Ethical Dilemma: This situation requires the nurse to use her triage skills and determine which patients if any, could safely have orders changed or amended. The nurse should review nurses' notes and get a report from the last person who saw the clients for whom she is scheduled to give weekend care. If any patient has a wound that is resolved or improving, she should report these changes to the nurse supervisor, primary care provider, or physician on call to determine if orders can be changed. By doing this, the nurse may now have enough supplies to care for the patients who require wound care services until supplies are delivered.

Scenario: Mr. Black is the father and sole-guardian of five-year-old twins who are preparing to start Kindergarten. Mr. Black never had his children vaccinated and states forcing him to have his children vaccinated is a violation of his and his children's rights. Ethical Dilemma: In the interest of protecting the health of populations and communities, the healthcare industry advocates for vaccination against preventable diseases. Nurses may feel caught between being proactive about vaccines and the patient's or guardian's right to choose which treatment to accept.

How to Deal with this Ethical Dilemma: Vaccination laws are generally based on recommendations from the CDC. Each state requires an up-to-date immunization record for children entering elementary, secondary, or post-secondary schools and daycares. While some states allow vaccine exemptions under certain circumstances, it is not the nurse's job to enforce administering or withholding a vaccine. Instead, the nurse's job is to provide enough education for the parent to make an informed decision about the safety of the vaccine and any potential risks. If a parent refuses to vaccinate their child, the nurse should have the parent sign a declination form and document any education provided to the parent.

Scenario: Mrs. Wilhite is a 74-year-old woman with a diagnosis of Stage IV breast cancer with metastasis to the lungs. Although Mrs. Wilhite spoke with the nurse and conveyed her wishes for no life-saving measures, she does not have an Advanced Directive in place. Mrs. Wilhite has experienced a significant decline in cognitive function and is presently unable to make decisions for her care. Her children cannot agree on what treatment or life-saving measures are appropriate. Ethical Dilemma: Unfortunately, this is a common ethical dilemma in nursing. When patients do not have an advanced directive, nurses may feel stuck between listening to well-meaning loved ones and doing what the patient asks. The family may want staff to exhaust efforts to save their family member, although the patient expressed a desire to withhold treatments or life-saving efforts.

How to Deal with this Ethical Dilemma: Whenever possible, nurses should encourage every patient to prepare an Advanced Directive. When patients have an Advanced Directive, healthcare providers know what the patient's wishes are if they become unresponsive and need interventions to sustain life. It also helps take the weight of difficult decisions from family members, which is important as loved ones may be influenced by emotions. In cases where there is no Advanced Directive in place, state laws have provisions that allow for authority to be given to parents, guardians, a spouse, or another person. Hospitals also have ethics committees who step in when the patient has no Advanced Directive or family member to whom authority may be delineated.

Part of commitment to a profession is learning...

How to manage stress associated with it

What is affective commitment?

Identification with and involvement in profession. Develops when involvement in profession produces a satisfying experience

What is the testing stage?

Individual discovers NEGATIVE elements, starts to assess willingness and ability to deal with them. Some DO NOT get beyond this stage but drop out

What is the exploratory stage?

Individual explores positive aspects of the profession

What is the integrated stage?

Individual has integrated positive, negatives into flexible, complex, enduring commitment

What is the quiet and bored stage?

Individual settles into humdrum routines.

What is the passionate stage?

Individual synthesizes positive, negative elements

Unprofessional behaviors can...

Interfere with provision of high-quality patient care

Nurse's commitments to behaving professionally include...

Looking and acting like a professional AKA bias. Acting autonomously AKA Think on your own, critical thinking. Demonstrating commitment to nursing

What are the types of unprofessional behaviors?

Many forms, ALL involving making members of healthcare team and patients feel uncomfortable, hurt, intimidated, threatened, or targeted

What is an example of a patient in a vulnerable population?

Patients with disabilities or mental health diagnoses. NOTE: Ricky's law

Advocacy...

Practice of expressing, defending patients' needs ANA emphasizes patient advocacy as key concern

How to reduce stress?

Quiet activities that are personally meaningful for daily relaxation. Regular exercise program to direct energy outward. Learn assertiveness techniques, ability to say NO. Accept errors and failures as learning experiences. Accept what cannot be changed. Get involved in creating positive change in organizational policies, procedures. Develop collegial support groups. Participate in professional organizations. Counseling to help clarify problems, reactions to them.

What is competent in Benner's stages of progression?

Someone who has 2-3 years of experience in the field. Think: Smitty (From The Rookie)

What is proficient in Benner's stages of progression?

Someone who has 3-5 years of experience in the field. Think: Tim (From The Rookie)

What is an advanced beginner in Benner's stages of progression?

Someone who is emerging in the field. Think: Aaron or Lucy (From The Rookie)

What is an expert in Benner's stages of progression?

Someone who's performance is fluid and is highly proficient. Highly skilled, intuitive, and analytical abilities and practice. Think: Grey (From The Rookie)

What is a novice in Benner's stages of progression?

Someone with no experience. Think: Rookie Feds

What is justice?

The idea that all medical and nursing decisions and care should be fair in some way

What is attitude?

The mental state involving values, beliefs, feelings, mood. Affects the individual and others nearby. Professional behavior includes maintaining positive attitude

What is critical thinking?

The objective analysis and evaluation of an issue in order to form a judgment.

Accountability

The process in which the nurse has an obligation or duty to act and is answerable for his/her choices, decisions, and actions. Involves assuming only the responsibilities within one's scope of practice. Involves admitting mistakes rather than blaming others. Includes a responsibility to the client to provide competent nursing care and adhere to the professional code of ethics. Expectation of competence begins at enrollment, continues through practice

What is organizational commitment?

The relative strength of individual's relationship to, sense of belonging to an organization

What is commitment?

The state of being obligated or emotionally impelled.

Each nurse must pinpoint areas of strength, weakness

Then seek opportunities to gain competence in areas of incompetence. Self-examination necessary to be truly professional nurse

Inappropriate communication includes...

Withholding information to colleagues. Disrespectful to coworkers or patients/families

What is integrity?

adherence to moral and ethical principles; soundness of moral character; honesty

what is nonmaleficence?

duty to do no harm

Licensed nurses expected to maintain....

update knowledge bases through career