Fundamentals of Nursing Human Health and Function

ethics

used in healthcare and other professions at the social, community, and individual level to determine what “ought” to be.

International Council of Nurses (ICN)

the _________ makes periodic reviews and places changes in the Code of Ethics to reflect contemporary concerns

dilemmas

1. situations about how health is viewed and valued, how healthcare is organized, and how patients are treated

2. sometimes, there is no single answer that will equally satisfy everyone, yet the dilemma will need to be addressed 

3. new nurses especially will encounter dilemmas that will challenge their personal views of what is right and wrong when providing professional ethical and legal care 

family 

always incorporate ______ if possible, when dealing with a dilemma in healthcare 

values

1. standards for decision making that endure for a significant time in one’s life

2. ideas used to determine what is right and wrong

3. In nurse-patient relationships, values include health, dignity, respect, compassion, equity, and inclusivity

4. these are learned

value conflicts

1. family conflicts

2. healthcare conflicts

ex. one partner in a relationship does not want a health check-up

healthcare conflicts 

1. knowledge differences

2. developmental differences

3. cultural value system differences

ex. view of death

value indicators

1. attitudes— mindset

2. beliefs—- ideas accepted as true (the pt beliefs are regarded true)

3. behaviors—- actions

attitude

one’s disposition toward an object or a situation

beliefs 

• ideas that one accepts as true

• they may be expressed by such things as decisions, opinions, and creeds

ex. information for death of the pt can be determined by the family

behaviors 

1. actions that can be perceived or noticed 

2. nurse behaviors demonstrate the values that hold priority

ex. show that you care and are invested, behaviors are always being watched 

professional values

are values articulated through professional guidelines and codes (nursing student handbook)

laws

are rules or standards of human conduct established by legislative bodies and interpreted by courts to protect the rights of citizens

institutional policies

are guidelines developed by organizations or agencies to direct professional practice; they often reflect local, state, and federal laws and regulations (Lippincott Procedures for DeSales, LVHN)

socializing influences

1. family interactions- first teachers

2. school interactions- peers, supervisory adults, procedures

3. religious interactions- communities of belonging

4. workplace and service interactions- meeting expectations; guiding principles (change w/ age)

Ethics

branch of philosophy dealing with standards of conduct and moral judgement, guides clinical decision making 

ANA Code of Ethics Provision 1

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

ANA Code of Ethics Provision 2

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

ANA Code of Ethics Provision 3

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

ANA Code of Ethics Provision 4

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

ANA Code of Ethics Provision 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

ANA Code of Ethics Provision 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 conductive to safe, quality health care

ANA Code of Ethics Provision 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

ANA Code of Ethics Provision 8

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

ANA Code of Ethics Provision 9

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

principles of healthcare ethics

1. autonomy

2. nonmaleficence

3. autonomy

4. justice

autonomy

the principle for respect for ______ means that individuals have the right to make informed decisions about their own healthcare. Healthcare professionals must respect patients’ self-determinations and permissions, even if they disagree with them

nonmaleficence

means to “do no harm.” This principle asserts that healthcare providers have a duty to avoid causing harm to patients. In situations where harm cannot be entirely avoided, such as surgery, the potential benefits should significantly outweigh the risks 

beneficence

“Do good” The principle of _________ compels healthcare providers to act in the best interest of the patients.

ex. providing treatment to improve health and alleviate suffering, promoting actions to patients in preventive healthcare, like healthy lifestyle habits

justice 

Involves fairness and equality in medical care, it implies that all individuals should have equal access to healthcare resources and receive equal treatment regardless of factors like race, gender, socioeconomic status, or health condition

6 Basic Rights

1. High-quality hospital care

2. A clean and safe environment

3. Involvement in your own care

4. Protection of your privacy

5. Preparing you and your family for when you leave the hospital

6. Help with your bill and filing insurance claims

For patients and their families

Professional Patient Relationships

• veracity

• fidelity

• privacy

• confidentiality

veracity

principle of telling the truth, essential to the integrity of the patient-provider relationship

ex. nurses prefer to make decisions directly with patients, when possible, important to understand when cultural

fidelity

being faithful to one’s commitments and promises

• nurses’ commitments to patients include providing safe care and maintaining competence in nursing practice, what does the patient have a right to expect from any nurse regardless of biographic

Privacy

Patient confidentiality

• a loss of this occurs if others inappropriately use their access to a person

• Nurse must protect patient privacy and not go beyond required knowledge for patient care

Confidentiality

Practice of keeping patient information private

• what is documented in the patient’s record is accessible only to those providing care to the patient

resolving ethical dilemmas (strategies to resolve)

validate feelings (acknowledge, identify), conduct a case study, identify outcomes, identify short-and-long-term goals, clarify accountabilities, follow through on plan, resolve reactions (discuss- avoid repeating in future)

Ethics committees

important vehicles for working through ethical issues in practice, the ANA encourages the development of ethics committees as interdisciplinary vehicles for identifying and addressing ethical issues (help nurses navigate complex clinical situations)

Laws 

rules or standards of human conduct established by legislative bodies and interpreted by courts to protect the rights of citizens 

• nurses must be aware of the legal guidelines that govern their area of practice and recognize that myths abound 

constitutions

are the foundation of the system of justice. In the US, this is a supreme law that establishes the organization of the federal government and grants power

legislative statutes

are laws derived from a legislative body. Nurse practice acts and adult or child abuse laws are examples of ____________

commn law 

evolves from decisions of courts. These decisions are ones that cannot be supported by statutory or constitutional law alone

nursing licensure 

legal ability to practice, mandatory. each state has a nurse practice act

standards of care

the expected level of performance or practice as established by guidelines, authority, or custom

-ANA defines these on the national level

-Joint Commission accredits healthcare facilities and sets nursing standards for some aspects of care, such as documentation

crime

results in prison time, fine, or short jail sentence to punish offender

intentional torts 

includes assault, battery, defamation of character, slander, fraud, invasion of privacy, false imprisonment

unintentional torts

negligence, malpractice

legally sensitive areas of practice

1. controlled substances

2. death and dying

3. assisted suicide

4. terminal sedation

5. advanced directives

6. resuscitation (DNI, DNR)

7. good Samaritan laws

good Samaritan laws

involves the right of people/bystanders to help in an emergency situation without the worry of being sued

nursing negligence

when a nurse fails to use such care: as a reasonably prudent nurse would use in same or similar circumstances

nurses must

• be knowledgeable about legal issues in healthcare

• practice good nursing care

• know good defensive measures

• elements of negligence (duty, breach of duty, injury)

Do not do something you do not know how to do, get help!

breach of duty 

when the nurse fails to follow through with the duty owed to the patient

duty defined

nurse act, board regulations, health and safety laws, case laws, workplace policies/procedures, custom/standards of practice

statute of limitations

time in which suit can be brought

adults- two years

children- can bring suit on their own when reach adulthood

exceptions- discovery rule/fraudulent concealment

protecting yourself legally

1. professional practice

2. professional liability insurance

3. documentation

professional practice

practiced standards must be evidence-based and practicable with the resources available, new knowledge must be applied, policies, procedures, protocols must be followed

professional liability insurance

because a nurse may be sued for some act related to nursing but outside the scope of employment, professional insurance is important for nurses (hands-on patient care places the nurse at risk for liability

documentation 

this should be accurate, complete, and finished when care is given. Avoid precharting or documenting events before they occur. Make sure documentation guidelines are within the agency’s policy. Precise time and event in the records is important. 

should nurses carry professional liability?

1. nurses should be covered (personal and employer)

2. high-risk practice areas

3. homestead laws protect assets

4. areas of immunity from liability — government positions/Good Samaritan laws

good defense against lawsuit 

• good documentation

• protect yourself

• refresh your memory

• communicate nursing process

• benefit legal process

good defense

• good people skills

• provide best of care for everyone

• know your scope of practice and function accordingly

• stay within nurse’s act 

legal pitfalls in nursing

• take appropriate action

• assist when needed

• document all measures to protect

medication errors

• actions/side effects

• indications/contraindications

• look up if unfamiliar

know the safe dose for meds

improper use of equipment 

• must be in good condition

• if unfamiliar, seek help

• use approved supplies/equipment

failure to monitor adequately

assess patient appropriately, monitor as condition dictates, document all findings

failure to communicate

report changes in patient’s condition, listen to/assess all somatic complaints, keep physician informed, document all findings/interventions

accountability

actions, beneficence, nonmaleficence, negligence, veracity

acts of negligence

failure to respond, failure to use adequate precautions, inadequate or dated nursing knowledge, abandoning a patient, failure to teach a patient, failure to make sure that faulty equipment is removed