Legal and Ethics

What is a false communication or careless disregard for the true that causes damage to someone's reputation?

Defamation is a false communication or careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander).

What is the nurses ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making?

Ethical Agency

What is a belief you have about the worth of something that serves as a principle or a standard that influences decision making?

-Values

A patient askes the nurse to tell her the medical true about the outcomes of her terminal illness, the nurse responded with the truth, this is an example of what moral principle?

-Veracity -the nurse must not withhold the whole true from clients even when it may lead to patient distress

What is altruism?

-being concerned about well being of others, such as Pts, nurses, HCPs

What moral principle is the duty to do or promote good called?

-beneficence

What moral principle is this example? A nurse lifting side rails on a patients hospital bed to prevent falls?

-beneficence

What moral principle is this example? A resuscitating a drowning victim

-beneficence

What are some professional examples of human dignity?

-complete and culturally sensitive care -protect privacy and confidentiality -design care with sensitivity to individual patient needs

What moral principle is the obligation to keep promises?

-fidelity

What occurs when someone is unable to carry out his or her moral decision?

-moral distress

What is moral distress?

-occurs when someone is unable to carry out his or her moral decision -situations prevent nurse from doing what she know s to be right

What is beneficence?

-one of the moral principles of nursing -to do good -the duty to do or promote good

What is human dignity?

-respect for the worth and dignity of person -respect for patient and colleagues -respect for cultures

What are some professional examples of altruism?

-understanding different cultures and beliefs -advocating for patients, especially the vulnerable -taking risks on behalf of pt and colleagues -mentoring other professionals

What is social justice?

-upholding moral and legal tenets -giving equal treatment under the law

What is the moral principle veracity?

-Telling the truth --the nurse must not withhold the whole true from clients even when it may lead to patient distress

Forms the basis of behavior?

-Values

Give direction to life is an example of what?

-Values

What influence decisions and actions, including ethical decisions?

-Values

What is moral outrage?

- perceive others as behaving immorally, may lead to Whistleblowing

Ethics & Laws: Law

-Rules of expected conduct -Established by humans over time -Concerned with fairness & justice -Enforceable by judicia/legall system -Documented and defined -Clear definition of wrong (illegal) actions and consequences

What is nursing ethics?

-Subset of bioethics -Deciding nature & extent of own involvement -Support of patients -Situations that have to do with nurse's actions/decisions

Lying is bad is an example of what?

-A belief

What are values?

-A belief you have about the worth of something that serves as a principle or a standard that influences decision making -Lasting beliefs or attitudes about the inherent worth of a person, object, idea, or action -they influence decisions and actions, including ethical decisions -also influences behavior and character. -people have many different beliefs and attitudes, but only a small # of values -Ex) Equality, fairness, courage, compassion -not all values are ethical -gives direction to life

What is a behavior that benefits another individual at a cost of oneself (ex. Giving your lunch away to someone who is hungry, but at a cost of being hungry yourself)?

-Altruism

A way of responding to a situation or things?

-Attitude

What are mental dispositions or feeling towards a person, object, or idea?

-Attitude

What is a person that is self-controlling and not governed by outside forces. Ex the government that can run itself w/o aid from an outside country?

Autonomy

Performing a procedure w/o consent is an example of what?

Battery

Refers to the application of ethics to healthcare?

Bioethics

The application of ethical principles to every aspect of healthcare?

Biotethics

What is Medical Futility?

A judgement that further medical treatment of a patient would have no useful result

The nurse arrives at work and is told to report (float) to the ICU for the day because the ICU is understaffed and needs additional nurses to care for the clients. THe nurse has never worked in the ICU. THe nurse should take which best action? 1. Refuse to float to the ICU based on lack of unit orientation 2. Clarify the ICU client assignment with the team leader to ensure that it is a safe assignment 3. Ask the nursing supervisor to review the hospital policy on floating. 4. Submit a written protest to nursing administration, and then call the hospital lawyer.

Answer 2 Floating is an acceptable practice used by hospitals to solve understaffing problems legally the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. THe nurse should set priorities and ID potentially areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform.

The nurse calls the PCP regarding a new medication prescription, because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PCP and the medication is due to be administered. Which action should the nurse take? 1. contact the nursing supervisor 2. Administer the dose prescribed 3. Hold the medication until the PCP can be contacted 4. Administer the recommended dose until the PCP can be located

Answer: 1 It is the RNs responsibility to contact the PCP. If there is no resolution regarding the prescription, the RN should contact the nurse manager or supervisor for further clarification as to what the next step should be

Which identifies accurate nrusing documentation notations. Select all that apply 1. the client slept through the night 2. Abdominal wound dressing is dry and intact w/o drainage 3. the client seemed angry when awakened for vital sign measurement 4. the client appears to become anxious when it is time for respiratory treatments 5. The clients left lower medial leg wound is 3 cm in length w/o redness, drainage, or edema

Answer: 1, 2, 5 avoid appears and seemed, this suggests nurses opinion rather than fact factual documentation contains descriptive objective info about what the nurses sees, hears, feels or smells. Using inferences w/o factual data is not acceptable because it can be misunderstood.

Nursing staff members are sitting in the lounge taking their morning breaks. An assistive personnel (AP) tells the group that she thinks that the unti secretary has acquired AIDs and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. The RN should inform the AP that making this accusation has violated which legal tort? 1. Libel 2. Slander 3. Assult 4. Negligence

Answer: 2 Defamation is a false communication or careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). Assault occurs when a person puts another person in fear of a harmful or offensive contact Negligence involves the actions of professionals that fall below the standard of care for a specific professional group

The nurse had a documentation error regarding the dose administratio of an opiod medication. The nurse administered 1 mg from the vital but documented they administered 1 mg. The nurse should take which action(s) to correct the error in the MAR. Select all that apply 1. complete and file an occurence report 2. Right click on entry and modify it to reflect the correct info 3. Document the correct info and end with the RNs sign and title 4. Obtain a cosignature from the RN who witnessed the waste of remaining 1 mg 5. Document in a nurse's note in the client's record detailing the corrected ino

Answer: 2, 3, 4, 5 EMR will hate date stamps that indicates an amendment the nurse should follow agency P&P to correct the error The MAR can be modified to reflect correct into since it is an opioid med, the nurse should obtain a cosignature from RN who witnessed the wasting and validate that 1 mg was given not 2 a nurses note should detail the even and the corrections made an occurrence report is not necessary

The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid into the antecubital area. Which is the most appropriate action by the nurse? 1. call security 2. call the police 3. call the nursing supervisor 4. Lock the coworker in the medication room until help is obtained

Answer: 3 The nurse practice acts require reporting impaired nurses the board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to e reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required.

An older woman is brought to the ER for treatment of a fx arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the RN in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which is the most appropriate nursing response? 1. Oh really. I will discuss this situation with your son 2. Lets talk about ways you can manage your time to prevent this from happening 3. Do you have any friends who can help you out until you resolve these important issues with your son? 4. As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay.

Answer: 4 The nurse must report situations related to child or elder abuse, gunshot wounds, and other criminal acts, and certain infectious disease. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends w/o the clients permission. The client should be assured the info is confidential, unless it places the nurse under legal obligation.

A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? 1. I will sign as a witness to your signature 2. You will need to find a witness on your own 3. Whoever is available at the time will sign as a witness for you 4. I will call the nursing supervisor to seek assistance regarding your request

Answer: 4 The clients signature must be witnessed by specified individuals or notarized. Vary from state to state, nurse needs t oknow the laws. Many states prohibit any employee to serve as a witness Option 2 is not therapeutic

Threatening to give a client a medication constitutes as what?

Assult

Refers to a person's right to choose and his ability to act on that choice?

Autonomy

Telling the client that they cannot leave the hospital constitutes as what?

False imprisonment

What is integrity?

Honest with strong moral principles

What moral principle is treating all fairly?

Justice

The nurse is treating a sex convict the same way as she is treating someone's grandma, this is an example of what type of moral principle?

Justice -nursing care must be fairly, justly, and equitably distributed among a group of patients

Situations that prevent the nurse from doing what she knows to be right is known as what?

Moral distress

Nursing ethics versus bioethics?

Subset of bioethics, Nursing ethics refers to ethical questions that arise out of nursing practice. Bioethics is a broader field that refers to the application of ethics to healthcare

What is moral or ethical agency?

ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making.

Occurs when a person puts another person in fear of a harmful or offensive contact is what?

assault

What is libel and slander?

lies to intentionally damage a person's reputation; libel is written, slander is spoken

He five values of the American Association of Colleges of Nursing

-Altruism- a behavior that benefits another individual at a cost of oneself (ex. Giving your lunch away to someone who is hungry, but at a cost of being hungry yourself) -Autonomy: a person that is self-controlling and not governed by outside forces. Ex the government that can run itself w/o aid from an outside country -Human Dignity -Integrity: the quality of being honest and having strong moral principles -Social Justice

What is based on personal ideas rather than facts?

-Belief

The nurse employed in a hospital is waiting to receive a report from the lab via fax machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate initial nursing action? 1. Call the police 2. Cut up photograph and throw it away 3. Call the nursing supervisor and report the occurenece 4. Call the lab and ask for the name of the individual who sent the photograph

Answer 3 Sexual harassment is prohibited by state and federal laws

A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of "invasion of client privacy." Which situation, if identified by the student, indicates an understanding of a violatio of this client right? 1. Performing a procedure without consent 2. Threatening to give a client a medication 3. Telling the client that her or she cannot leave the hospital 4. Observing care provided to the client without the client's permission.

Answer 4 Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure with out consent is an example of battery. Threatening to give a client a medication constitutes as assault Telling the client that they cannot leave the hospital constitutes as false imprisonment

The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the primary healthcare provider, and completes an occurrence report. Which statement should the nurse document on the occurrence report? 1. The client fell out of bed 2. The client climbed over the side rails 3. The client was found laying on the floor 4. The client became restless and tried to get out of bed

Answer: 3 The occurrence report should contain a factual description of the occurrence, any injuries experienced by those involved, and the outcome of the situation.

A client is brought to the ER department by an emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which si the BEST action? 1. Obtain a court order for the surgical procedure 2. Ask the EMS team to sign the informed consent 3. Transport the victim to the operating room for surgery 4. Call the police to ID the clien and locate the family

Answer: 3 there are 2 situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment fo the purpose of obtaining informed consent would result in injury or death to client 2nd: when the client waives the right to give informed consent.

involves the actions of professionals that fall below the standard of care for a specific professional group

Negligence

Ethical questions that arise out of nursing practice (subset of bioethics)?

Nursing ethics

What normal principle does this example demonstrate? After the ventilator is discontinued from a client with a terminal illness, the nurse stays with the client to provide support.

-Autonomy -the nurse respects the patient's right to choose to die

Moral Principles in Nursing

-Autonomy- client centered decision making -Beneficence- to do good -Justice- treating all fairly -Fidelity- fulfilling promises -Veracity- truth telling -Non-maleficence- "do no harm", must determine if degree of risk outweighs potential benefit

What is something that one accepts as true?

-Belief

What is judged by others as correct or incorrect?

-Beliefs

An example when a moral action can also be unethical?

-Ex a lawyers who tells the court that his client is guilty may be acting out of a moral desire to see justice done, but this is deeply unethical because it violates the attorney-client privilege.

An example of when something ethical isn't always moral?

-Ex the code of silence developed among members of the mafia, used to protect criminals from the police. This follows rules of ethically correct behavior for THAT organization, but it can also be viewed a wrong from a moral standpoint.

A patient requests that a nurse not reveal his terminal diagnosis to his family is an example of what moral principle?

-Fidelity -the nurse is keeping a promise

What is the moral principle of fidelity?

-Fulfilling promises

Ethics & Law: Ethics

-Govern conduct and protect individual rights -Violations are not enforceable by legal avenues -Not always clear what is "right and wrong"- determined by the circumstances and parties involved

What are Beliefs?

-Is something that one accepts as true -Opinions -based on personal ideas rather than facts -judged by others as correct or incorrect -Ex) Spiritual, moral, social, intellectual, economic, political -ex) God is all knowing and creator of heaven on earth, lying is bad.

What are attitudes?

-Mental dispositions or feelings toward a person, object or idea (acceptance, compassion, openness) -Our way of responding to situations or things -Judged as bad or good, positive or negative. Vary among individuals

When you perceive others as behaving immorally, may lead to whistleblowing is known as what?

-Moral outrage

What is the moral principle autonomy?

-One of the moral principles of nursing - patient self-determination are up when the nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values, and beliefs. -Nurses encourage patients to make their own decisions w/o any judgments or coercion from the nurse -the patient has the right to reject or accept all treatments -refers to a person's right to choose and his ability to act on that choice - a person that is self-controlling and not governed by outside forces. Ex the government that can run itself w/o aid from an outside country -client centered decision making

What are morals?

-Private, personal, or group standards or right and wrong -Individuals own principles, good and bad. -often based on religious or societal beliefs -developed in childhood -morals are not always ethical

What are ethics?

-Refers to rules provided by an external source, specific rules and actions or behaviors, not black and white -The practice or beliefs or system of morals of a certain group -Ethics aren't always moral or visa versa -ex) government, ANA

What are some professional examples of social justice?

-access to healthcare, not denying care -fairness, and non-discrimination -universal access to healthcare -encourage laws and policies consistent with advancement of nursing and healthcare

What is the moral principle justice?

-one of the moral principles of nursing -treating all fairly -nurses making impartial medical decisions regardless or ethnicity, sexual orientation etc. -nursing care must be fairly, justly, and equitably distributed among a group of patients

What are some examples of integrity?

-provides care based on ethical framework from professional organization -honest information to patients and public -document care accurately and honestly -try to remedy other you or others made

What are some professional examples of autonomy?

-respecting Pt's right to make decisions about healthcare -plan care in partnership -provide info so patients can make informed choices

What is the moral principle of non-maleficence?

-two fold principle of doing no harm and preventing harm -"do no harm" -harm can be intentional or unintentional

The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider have assessed the client and have determined that the client is not injured. After completing the occurance report, the nurse should implement which action next? 1. reassess the client 2. Conduct a staff meeting to describe the fall 3. Contact the nursing supervisor to update information regarding the fall 4. Document in the nurse's notes that an occurrence report was completed

Answer: 1 After a client fall, the nurse must frequently reassess the client d/t potential complications do not always appear immediately after the fall. An occurence report is a problem solving document, however its completion is not documented in the nurses notes