NUR 212 exam #5 advocacy, legal issues, ethics

Belief

Things you hold to be true

Value

Strong beliefs that direct what you do

Virtue

Character trait that makes you a good person

Morals

Refers to personal or communal standards of right wrong

Ethics

A systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing

Utilitarian

Right or wrong depending on the consequence of the action. Decisions are made with the goal of providing the greatest good for the greatest number of ppl

Deontologic

Rights, duty, intuitionist based, Right or wrong based on a rule, regardless of its concequence

Rights based

Individuals have basic inherent rights that should not be interpreted with during decision making

Duty based

Decisions are made bc one has a duty to do something or to refrain from doing something

Intuitionist

Issues are weighed on a case by case basis to determine relative goals, duties, and rights

Paternalism

One individual assumes the right to make decisions for another

justice

Give each their due; act fairly

Utility

The good of many outweighs the wants or needs of the individual

Fidelity

Keep promises

Ethical dilemma

They arise when attempted adherence to basic ethical principles result in two conflicting courses of action

Goals of patients bill of rights

To help patients feel more confident in the US health care system, to stress importance of a strong relationship between patients and their health care providers, and to emphasize the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health care providers

ACA

Was established to give a greater patient protections in dealing with insurance companies

ACA protections

Includes the elimination of annual and lifetime coverage limits, provides choice of physician, allows health insurance regardless of existing medical condition, allows kids to stay on parents insurance until 26, restricts health insurance companies from being able to take back coverage bc of honest mistakes on insurance applications

Whistleblowing

Occurs when nurses are frustrated with unsafe environments speak up. It’s a warning from a present or past member of an organization to the public concerning a serious wrongdoing or danger created or masked by the organization (some have been threatened with the loss of their jobs and licenses)

Internal whistleblowing

Occurs within an organization, reporting up the chain of command

External whistleblowing

Involves reporting outside the organization such as to the media or elected officials

Tort

Wrongful act that results in injury, loss, damage

Federal legislation covers

Medicare and Medicaid provisions related to reimbursement for nursing services

State legislation covers

Scope of practice for RNs, LPNs, advanced practice RNs, nursing educational requirements, composition and disciplinary authority of board of nursing

Board of nursing covers

Delegation, medication administration, unprofessional conduct, and licensing

Health care institution covers

Clinical procedures, such as wound dressing changes, policies specific to the institution, speciality, or practice setting, personnel and employment policies

Informed consent requirements

Disclosure: they have been informed of the procedure, risks, benefits, alternatives, no outcome is guaranteed, comprehension, competence, voluntariness: no coercive or manipulative influences

If consent is refused what should be documented?

The refusal to sign, The patient should be informed of the possible consequences of the refusal, they also have to sign a form indicating their refusal to consent and releasing the interdisciplinary team from responsibility for outcomes of this act (has to be witnessed)

Collective bargaining

A legal process in which representatives of organized employees negotiate with employers abt such matters as wages, hours, and conditions

Competent practice

• Developing and maintaining interpersonal communication skills

• Respecting legal boundaries of practice

• Knowing and following institutional procedures and policies

• "Owning" personal strengths and weaknesses; seeking means of growth, education, and supervised experience to ensure continued competence for new and evolving responsibilities

• Evaluating proposed assignments; refusing to accept responsibilities for which you are unprepared

• Keeping current in nursing knowledge and skills

• Respecting patient rights and developing rapport with patients

• Working within the facility to develop and support management policies

• Keeping careful documentation

5 rights of delegation

Right task, circumstance, person, directions & communication, supervision & evaluation

Genetic information nondiscrimination act (GINA)

Prevents genetic discrimination, introduced the idea that they increase premiums due to genetics/disabilities

Lobbying

Bringing arguments to government officials usually includes money

ANA code of ethics

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

2. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.

3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care

5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

6. The nurse through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Nurses bill of rights

Not legally binding

• Full authority for nurses to practice at the top of their license, credentials, and professional standards without barriers

• Continuous access to training, education, professional development, as well as pathways for nurses to be recognized as leaders and in roles to direct shared decision making

• Work and practice in environments that ensure respect, inclusion, diversity, and equity

• Just care setting

• Safe work environment (well being, support, resources to stay psychologically and physically whole)

• Freedom to advocate

• Competitive compensation

• Collective and individual right to negotiate terms, wages, and work conditions

Nonmaleficence

Doing no harm

Beneficence

Doing all good

Fidelity

Keeping promises

Veracity

Telling the truth

Moral outrage

Occurs when a person witnesses the immoral act of another but feels powerless to stop it

Moral distress

Occurs when you know the right thing to do, but either personal or institutional factors make it difficult to follow the correct course of action

Moral resilience

Is the developed capacity to respond well to morally distressing experiences and to emerge strong

Moral injury

Occurs when there has been a betrayal of what’s right by someone who holds legitimate authority or by oneself, in a high stakes situation

Conscientious objection

Is the refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurses personal and professional ethical beliefs and standards

Ethical framework

They guide individuals in solving ethical dilemmas

Moral decision making model

Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process.

Outline options: Identify alternatives and analyze the causes and consequences of each.

Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid.

Affirm position and act: Develop the implementation strategy.

Look back: Evaluate the decision making.

Steps of approaching an ethical dilemma

Define the problem, clarify facts and assumptions, compile a list of all options, evaluate options with interdisciplinary team input, and choose the most appropriate option and implement the plan

Employer liability insurance

Tailored to facility, “claims made”, limited to facility

Personal liability insurance

Your best interest at hand, follows you, protection outside of employment

Obligation to report

Child abuse, trafficking, elder abuse, syphillis, gonorrhea, chlamydia, chancroid, HIV, injuries resulting from criminal activity, healthcare associated infections, inappropriate nursing conduct

What to include in incident report

Names of those involved, date, time, place, objective info, equipment/resources used, key factors, physician assessment/intervention

What not to include in incident report

Subjective terminology, speculation, clinical observations, mentions of the incident report in the medical record