Nursing 350: Prof Role 2 Exam 1- Code of Ethics, Legal COncepts, Nurse Practice Act Lecutre 2

ethical dilemma

A problem where more than one choice can be made, and the choice is influenced by the values and beliefs of the decision-makers.

In health care.

Where are ethical dilemmas commonly encountered?

Ethical theory and decision-making.

What must nurses be prepared to apply when facing ethical dilemmas?

When it cannot be solved by looking at scientific data, involves conflict between two moral values, and usually requires a decision with a profound effect on the situation or patient.

When does a problem become an ethical dilemma?

- Scientific data is insufficient to solve it

- Conflict between two moral values

- Decision with a profound effect

What elements are typically involved in an ethical dilemma?

Nurses must identify ethical situations and report them.

What is the nurse's role regarding ethical situations?

To support patients' rights, ensure their voices are heard, and guide decisions in their best interests.

What is the nurse's role as an advocate in ethical dilemmas?

Advocacy

Protecting patient rights

Ensuring informed consent

Maintaining confidentiality

Practicing legally and ethically

Using information technology and security properly

Addressing disruptive behavior

What are some professional responsibilities of nurses in ethical practice?

that clients have rights regarding their health care and retain these rights when using the services of a health care institution.

What do client rights guarantee?

Nurses

Who is accountable for protecting client rights?

Ensure clients understand their rights

Protect clients' rights during nursing care

What must nurses do to uphold client rights?

Yes, basic rights are the same regardless of age, nursing needs, or care setting.

Are client rights the same for all patients?

Situations involving confidentiality, information security, and maintaining the patient's rights while receiving health care.

What situations require specific interventions to protect client rights?

Patients should be informed of all aspects of their care, take an active role in decision-making, and include family as appropriate.

How should patients participate in their care?

Clients can ask for a different plan of care, accept it, or deny it.

What choices can clients make about their care?

Clients have the right to receive care from competent providers.

What is expected regarding the competency of care providers?

Evidence-Based Practice (EBP)

A framework used by nurses and other healthcare professionals to guide clinical decision-making using the best available evidence.

Supports problem solving

Improves patient care and outcomes

Encourages innovation in practice

Ensures nursing practice is current and relevant

Reduces variations in care

Meets standards of accrediting agencies

Promotes high-quality patient care

How is EBP relevant in nursing?

Cultivate a spirit of inquiry and a culture of EBP among nurses and within the organization.

What is the first step in the EBP process?

Ask a clinical question.

What comes after identifying an issue in EBP?

Search for and collect the most relevant and best evidence to answer the clinical question (e.g., procedure, model).

How do nurses find evidence for EBP?

Critically appraise and synthesize the evidence.

What is done after collecting evidence in EBP?

Integrate evidence with clinical expertise and patient preferences to make the best clinical decision.

How is evidence applied in EBP?

Evaluate the outcome of any EBP change and disseminate the results.

How are EBP outcomes evaluated?

Lack of value for research in practice

Difficulty changing practice

Lack of administrative support

Lack of knowledgeable mentors

Insufficient time

Lack of education about the research process

Lack of knowledge about EBP

Lack of knowledge on how to critique articles

Feeling overwhelmed by the process

Lack of sense of control over practice

Lack of confidence to implement change

Lack of leadership, motivation, vision, strategy, or direction among managers

What are common barriers to implementing EBP?

By learning about Evidence-Based Practice and staying current with research.

How can nurses educate themselves to support EBP?

Conduct face-to-face or online journal clubs.

What is one way to conduct EBP discussions among nurses?

Share new research reports and guidelines, and provide support to other nurses.

How can nurses share research findings with peers?

Share results through posters, newsletters, unit meetings, or published articles.

How can nurses disseminate the results of EBP changes?

Adopt a reflective and inquiring approach to practice.

What mindset should nurses adopt to support EBP?

By learning about Evidence-Based Practice and staying current with research.

How can nurses educate themselves to support EBP?

Conduct face-to-face or online journal clubs.

What is one way to conduct EBP discussions among nurses?

Share new research reports and guidelines, provide support to other nurses, and disseminate results through posters, newsletters, unit meetings, or published articles.

How can nurses share research findings with peers?

Adopt a reflective and inquiring approach to practice.

What mindset should nurses adopt to support EBP?

it reduces liability and helps protect patients.

How does following EBP reduce risk for nurses?

Care must be within the nurse's scope of practice.

What is important for providing care within professional standards?

Obtaining informed consent if it is not part of the nurse's authorized duties.

Give an example of care that might fall outside the nurse's scope of practice.

HIPAA

he Health Insurance Portability and Accountability Act; protects patient health information and privacy.

Prohibits discrimination against individuals with disabilities and ensures equal access to services and employment.

What does the Americans with Disabilities Act (ADA) do?

Requires insurance coverage for mental health conditions to be comparable to coverage for physical health conditions.

What is the Mental Health Parity Act (MHPA)?

Ensures patients are informed of their rights to make decisions about their health care, including advance directives.

What is the Patient Self-Determination Act (PSDA)?

Regulates organ donation and transplantation, including prohibiting the sale of organs.

What is the National Organ Transplant Act (NOTA)?

Requires hospitals to provide emergency medical treatment to all patients regardless of ability to pay.

What is the Emergency Medical Treatment and Active Labor Act (EMTALA)?

A subsection of public law that deals with crimes, including violations such as falsification of records.

What is criminal law in the context of nursing?

Falsification of a patient record.

Give an example of a criminal law violation for nurses.

malpractice

Failure to follow professional or facility standards of care, resulting in harm to a patient.

- Use equipment responsibly and knowledgeably

- Communicate effectively and thoroughly with clients

- Document care provided accurately

How can nurses follow the standards of care to avoid malpractice?

- Follow standards of care and provide competent care

- Communicate with other health team members

- Develop a caring rapport with clients

- Fully document assessments, interventions, and evaluations

How can nurses avoid liability for negligence?

Nursing practice is regulated primarily by state law through boards of nursing.

How is nursing practice regulated?

Boards can issue, suspend, or revoke a nursing license.

What authority do boards of nursing have?

It defines their scope of practice and the legal standards they must follow.

What is important for nurses to know about their practice act?

Nurse Licensure Compact (NLC)

Allows nurses in NLC states to practice in other NLC states without obtaining additional licenses.

Yes, but they must follow the state-based practice model and the laws of the state where care is provided.

Can nurses practice in a state outside the NLC if their license is from a non-NLC state?

Pass a licensure examination

Maintain a valid license (illegal to practice with an expired license)

Background checks with license renewal in some states

What are legal requirements for licensure?

To protect patients and ensure safe, competent care.

Why is licensure required in nursing?

Standards of Care in Nursing

Legal guidelines or established standards for providing safe, competent care.

- ANA (American Nurses Association)

- WHO (World Health Organization)

- The Joint Commission and other accrediting bodies

What organizations develop standards of nursing practice?

They direct the level of care that should be given by licensed nurses and serve as legal and professional guidelines.

Why are standards of care important?

To guide, define, and direct the level of care that should be given by a practicing nurse.

What is the purpose of standards of care?

They are used in malpractice lawsuits to determine if the nurse met professional obligations.

How are standards of care used in legal situations?

In policy and procedure manuals within healthcare institutions.

Where are standards of care maintained?

The nurse is usually legally protected and not charged with misconduct.

What happens if a nurse follows institutional policy but injury still occurs?

The nurse may be liable for failing to apply the established standards of care.

What is the risk if a nurse fails to implement a protocol?

Through positive professional actions, including:

Thorough, easy-to-understand communication with patients

Well-written documentation and nurse's notes

How can nurses avoid lawsuits?

Failure to follow standards of care

Failure to communicate

Failure to document

Failure to assess and monitor patients

What are common reasons nurses face lawsuits?

It provides legal protection by clearly showing that standards of care, monitoring, and communication were followed.

Why is detailed documentation important in avoiding lawsuits?

B. An ethical dilemmaRationale: Ethical dilemmas occur when there are conflicting moral values, requiring the nurse to make a decision that profoundly affects the patient.

A nurse is faced with a situation where a patient's family insists on aggressive treatment, but the patient has an advance directive refusing it. This is an example of:

A. A legal issue

B. An ethical dilemma

C. A conflict of interest

D. Standard practice

B. Explaining the patient's rights and allowing the patient to participate in care decisions

Rationale: Nurses must ensure clients understand their rights and take an active role in decision-making.

Which action by the nurse demonstrates respect for client rights?

A. Making all decisions for the patient without discussion

B. Explaining the patient's rights and allowing the patient to participate in care decisions

C. Requiring the patient to follow the physician's plan without question

D. Only involving family in care decisions

C. Cultivate a spirit of inquiry

Rationale: The first step is fostering a culture of inquiry and openness to EBP among nurses and the organization.

What is the first step a nurse should take when implementing EBP?

A. Critically appraise evidence

B. Ask a clinical question

C. Cultivate a spirit of inquiry

D. Disseminate results

B. Feeling overwhelmed by the process

Rationale: Feeling overwhelmed is a common personal barrier that prevents nurses from implementing EBP.

A nurse feels overwhelmed and unsure how to apply research findings to practice. Which barrier to EBP is this?

A. Lack of administrative support

B. Feeling overwhelmed by the process

C. Lack of leadership vision

D. Insufficient time

B. EMTALA

Rationale: The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates emergency care for all patients, regardless of ability to pay.

Which federal regulation requires hospitals to provide emergency treatment regardless of a patient's ability to pay?A. HIPAA

B. EMTALA

C. PSDA

D. ADA

Answer: C. Thoroughly documenting care, interventions, and assessmentsRationale: Proper documentation shows adherence to standards of care and provides legal protection.

Which of the following actions can help a nurse avoid malpractice claims?

A. Delegating all tasks to unlicensed personnel

B. Using equipment improperly

C. Thoroughly documenting care, interventions, and assessments

D. Ignoring patient complaints

Answer: B. The nurse may be protected legally if facility standards were followedRationale: Following established policies and procedures usually protects nurses legally even if an injury occurs.

A patient develops a pressure ulcer despite the nurse following all institutional policies. Which statement is correct?

A. The nurse will be charged with misconduct

B. The nurse may be protected legally if facility standards were followed

C. The nurse should be suspended

D. The nurse is automatically liable

Answer: B. Explaining the plan in understandable terms and answering questionsRationale: Advocacy includes ensuring the patient understands care options and actively participates in decision-making.

A patient asks the nurse to explain a treatment plan. Which action demonstrates advocacy?

A. Providing a brief summary and leaving the room

B. Explaining the plan in understandable terms and answering questions

C. Referring the patient to another nurse without explanation

D. Telling the patient to trust the physician's decisions

Answer: B. The nurse can practice under the NLC without a new licenseRationale: NLC allows nurses to practice in other compact states without obtaining a new license.

A nurse with a license in a Nurse Licensure Compact (NLC) state moves temporarily to another NLC state. Which statement is correct?

A. The nurse must obtain a new license in the new state

B. The nurse can practice under the NLC without a new license

C. The nurse can only observe, not provide care

D. The nurse cannot practice at all

Answer: B. Malpractice due to failure to documentRationale: Failure to document is a common reason for lawsuits and may constitute negligence.

A nurse fails to document a patient's vital signs after surgery, and the patient develops complications. What legal principle may apply?

A. Advocacy

B. Malpractice due to failure to document

C. Ethical dilemma

D. Standard practice

Answer: B. Continuously monitoring the patient's condition, including exact required assessments, even when not presentRationale: Proper monitoring includes clear instructions and ongoing oversight to prevent harm.

Which statement demonstrates proper monitoring to avoid liability?

A. "I'll check the patient when I return; it's not urgent."

B. Continuously monitoring the patient's condition, including exact required assessments, even when not present

C. Relying on unlicensed staff without clear instructions

D. Documenting only abnormal findings

Answer: B. Sharing patient health information on social mediaRationale: HIPAA protects patient privacy; sharing identifiable information publicly is a violation.

Which action violates HIPAA regulations?

A. Discussing patient care with the healthcare team in a private room

B. Sharing patient health information on social media

C. Documenting care in the patient's medical recordD. Storing records securely

Answer: A. Preserving wholeness of characterRationale: Nurses owe duties to themselves and patients, including maintaining integrity and ethical practice.

Which professional obligation is essential for nurses in ethical practice?

A. Preserving wholeness of character

B. Ignoring patient preferences

C. Delegating all decisions to physicians

D. Avoiding professional reflection

B. PSDARationale: The Patient Self-Determination Act guarantees patients' rights to make healthcare decisions and complete advance directives.

A patient wishes to complete an advance directive. Which federal law ensures the nurse informs the patient of this right?

A. ADA

B. PSDA

C. MHPA

D. NOTA

Answer: B. Thorough, easy-to-understand communication and detailed documentationRationale: Clear communication and accurate documentation reduce risk of misunderstandings, negligence claims, and lawsuits

Which action most effectively prevents legal issues related to patient care?

A. Minimal documentation, only when required

B. Thorough, easy-to-understand communication and detailed documentation

C. Assuming the patient understands instructions without clarification

D. Delegating all patient teaching to unlicensed staff