midterm short answer

consider why most children enjoy ice cream

• sweetness is naturally rewarding

• creamy textures are soothing

• cold temperatures feel novel

• positive associations

• choice in flavors and toppings

• colorful and playful

• shared experiences

• seasonal traditions

define endorsement

• another process by which a license may be awarded based on individual credentials judged to meet licensing requirements in the new state of residence.

  • a method of obtaining a professional license in a new state by having the state licensing board review and accept an individual’s existing credentials, education, and experience. Endorsement allows a practitioner to be licensed without repeating the entire application or examination process, providing they meet the new state’s requirements

define registration

similar to certification, individuals must meet certain educational requirements, as well as possibly successfully completing a national exam

• a process in which individuals are listed on an official registry after meeting specific educational or training requirements. Some professionals also require passing a national exam. Registration demonstrates that a practitioner has met minimum competency standards but is generally less rigorous than licensure

Discuss Act-Utilitarianism

In act-utilitarianism, a person makes values decisions based on the results that will produce the greatest balance of good over evil, everyone considered

• an ethical theory in which each action is evaluated based on the amount of good or harm it produces. A person chooses the action that results in the greatest balance of good over evil for everyone affected. The focus is on the consequences of the specific act, not on rules or general principles.

Discuss behavior associated with compassion/empathy

the identification with and understanding of another’s feelings and motives. Temporarily putting oneself if another’s shoes. Attempting to know how the patient feels

• putting oneself in the patient’s position

• listening attentively

• acknowledging emotions without judgment

• demonstrating concern through tone, body language, and supportive communication. Empathy helps build trust and strengthens the therapeutic relationship

Discuss deontological theory or duty-oriented theory

focuses on the essential rightness or wrongness of an act, not the consequences of the act. The golden rule is often cited in support of duty-oriented theory

• duty-oriented theory provides a foundation for rules of morality and for the idea of individual rights

Discuss Kant

Immanuel Kant is considered the founder of duty-oriented theory.

• Defined the categorical imperative

• Kant argued that people may never be used as a means to an end.

• Kant argued that it is not permissible to lie or break a promise in an effort to save a third party from harm

• Kant argued that moral actions are determined by duty, not consequences.

Categorical imperative

a rule that is considered a universal law binding on everyone and requiring action — as the guiding principle for all decision making. This principle means that there are no exceptions (categorical) from the rule (imperative). The right action is based on a determined principle, regardless of outcome

Discuss Kohlberg

• modified and expanded Piaget’s work, laying the foundation for modern studies on moral development.

• Consistent with Piaget, he proposed that children form ways of thinking through their experiences that include understandings of moral concepts such as justice, rights, equality, and human welfare.

  • Kohlberg differed from Piaget in that he followed the development of moral judgment beyond the ages studied by Piaget, and he determined that the process of attaining moral maturity took longer and was more gradual than Piaget had proposed.

Kohlberg suggested that moral reasoning can be understood as sequenced in six stages grouped into three major levels, which are:

1. Preconventional morality (ages 2-7)

2. Conventional morality (ages 7-12)

3. Postconventional morality (ages 12+)

Preconventional morality (ages 2-7)

• Stage 1: egocentric thinking - children obey authority figure without question

• Stage 2: begin to understand multiple perspectives - decisions are based on self-interest and reciprocal favors

Conventional morality (ages 7-12)

• Stage 3: desire to be seen as “good” - behavior aligns with social expectations and approval

• Stage 4: emphasis on duty, law, and respect for authority - rules are followed to maintain social order

Pre-conventional morality

• Stage 5: focus on social contracts and individual rights - strive for fairness and societal well-being

• Stage 6: guided by universal ethical principles like justice and human dignity - may challenge unjust laws

Discuss Maslow

• Wrote Motivation and Personality 1954, which identified a hierarchy of needs that motivates our actions.

• 5 stages of need that influence our behavior. We must satisfy each need in order, and the resulting progression is called a hierarchy of needs.

  • Maslow defined 1-3 as deficiency, or D needs

  • 4 and 5 are growth needs, also known as being, or B needs

Maslow’s Hierarchy of Needs

1. The need for basic life - food and shelter

2. The need for a safe and secure environment

3. The need to belong and be loved

4. The need for esteem, where status, responsibility, and recognition are important

5. The need for self-actualization, for personal growth and fulfillment

Originally, Maslow believed that the needs followed a strict order, but in his later years, he allowed for the possibility that some people may not require meeting all the D needs before moving onto the B needs.

Discuss Piaget

Defined four levels of moral development by observing children at play:

1. Sensorimotor: birth-2

2. Preoperational: 2-7

3. Concrete operational: 7-12

4. Formal operational:

Sensorimotor (birth-2)

the child is totally self-centered. Child explores the world with their 5 senses, and cannot yet see another’s POV

Preoperational (2-7)

As infants grow, they develop an awareness of things and people even if not in their direct sight, leading to this stage, also known as the egocentric stage.

i.e. when playing a game, the child is not concerned with the rules of play, rather than their own fun

Concrete operational (7-12)

children tend to see things as either right or wrong, and to see adults as powerful and controlling

Formal operational

children develop abstract thought and begin to understand that there may be different degrees of wrongdoing. During this stage and adulthood, intentions, such as lying and stealing are central to decisions made.

i.e. children in earlier stages will say a lie is wrong because it is bad, whereas children in the formal operational stage will say it’s because a lie isn’t true

What are the 3 C’s

most vital to the professional success of healthcare practitioners:

• courtesy

• compassion

• common sense

List the crimes that could revoke a license

• Crimes involving fraud or deception

• Crimes involving violence or harm

• Crimes involving controlled substances

• Crimes involving moral turpitude

• Sexual crimes

• Crimes directly related to professional practice

crimes involving fraud or deception

undermine trust and integrity

• insurance fraud

• falsifying medical records

• prescription fraud

• billing fraud

crimes involving violence or harm

suggesting danger to patients or coworkers

• assault

• DV

• homicide or attempted homicide

Crimes involving controlled substances

raise concerns about impairment, diversion, and patient safety

• illegal drug use

• drug possession

• diversion of controlled substances

• practicing while impaired

crimes involving moral turpitude

acts considered contrary to honesty, justice, or good morals

• theft

• embezzlement

• perjury

sexual crimes

taken very seriously due to patient vulnerability

• sexual assault

• sexual misconduct with a patient

• child exploitation offenses

crimes directly related to professional practice

show incompetence or reckless disregard for patient safety

• gross negligence

• criminal negligence

• practicing without a license

• violating state practice acts

discuss the medical practice act and its roles

established by statute to govern the practice of health care practitioners

1. define what is meant by the practice of the individual profession in each state

2. explain requirements and methods for licensure

3. provide for the establishment of licensing boards

4. establish grounds for suspension or revocation of license

5. give conditions for license removal

Patients have the right to

• receive considerate and respectful care

• receive complete current information concerning their diagnosis, treatment, and prognosis

• receive information necessary to give informed consent prior to the start of any procedure and/or treatment

• refuse treatment to the extent permitted by law

• receive every consideration of their privacy

• be assured of confidentiality

• obtain reasonable responses to requests for services

• obtain information about their healthcare

• know whether treatment is experimental, and be free to refuse to participate in research projects

• expect reasonable continuity of care

• examine their bill and have it explained

• know which hospital rules and regulations apply to patient conduct

• terminate the physician-patient contract, which includes leaving a hospital or refusing the treatment against medical advice

patients are obligated to

• follow any instructions given by the physician and cooperate as much as possible

• give all relevant information to the physician to reach a correct diagnosis. If an incorrect diagnosis is made because the patient fails to give the physician the proper information, the physician is not liable

• follow the physician’s orders for treatment, provided the treatment is similar to that administered by the members of the system to school of medicine to which the physician belongs. If a patient willfully or negligently fails to follow the physician’s instructions, that patient has little legal recourse.

• pay the fees charged for services rendered

Discuss the role of constitutional law

provides the ultimate legal foundation that protects patient rights, limits government power, and ensures that all healthcare laws and practices operate within the boundaries of the US constitution

• protects individual rights

• defines government powers in public health

• establishes framework for healthcare legislation

• guides court decisions in medical-legal conflicts

• protects vulnerable populations

List the seven universal principles of health care ethics

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

• Confidentiality

• Role-fidelity

• Veracity

Autonomy or self determination

the capacity to be one’s own person and make one’s own decisions without being manipulated by external forces

autonomous decisions are characterized by

• competency: a person must be competent to make decisions

• the ability to act on the decision

• respect for the autonomy of others

beneficence

acts performed by a healthcare practitioner to help people stay healthy or recover from illness

• healthcare practitioners’ first duty is to promote health for the patient above all other considerations

nonmaleficence

the duty to do no harm

• the benefit to the patient must always outweigh the harm

justice

providing what is due an individual

• for justice to exist, no one should be denied the possibility to be healthy for belonging to a group that has historically been economically/socially disadvantaged

confidentiality

the act of holding information in confidence, not to be released to unauthorized individuals

• healthcare practitioners who take care to maintain confidentiality at all times are equally as effective as laws

• healthcare practitioners mindful of protecting privacy and confidentiality do not conduct conversations about patients in the hospital hallway, in the medical office breakroom, or with an acquaintance. They also take care to protect computerized medical information, and when patients ask that information be kept from concerned relatives, such requests are honored.

• Healthcare practitioners are most likely to violate confidentiality rules

role fidelity

being faithful to the scope of practice of your profession

• all healthcare practitioners have a specific scope of practice for which they are licensed, certified, or registered and from which the law says they may not deviate

veracity

truth telling

• Because health care practitioners want to do what is best for the patient, they may not always tell the whole truth

  • i.e. placebos: many studies have shown that if patients believe they are taking a drug that will help them, even if they are taking a placebo, their conditions may improve;

  • i.e. paternalistic view about truth-telling, in which the practitioner determines that what the patient doesn’t know won’t hurt them

Discuss the standard of care

the level of performance expected of a healthcare practitioner in carrying out professional duties

• physicians have a duty of care to patients with whom they have established a physician-patient relationship, but they may also be held to a duty of care toward people who are not patients, and office personnel.

• Generally, if actions or omissions within the scope of a health care practitioner’s job could cause harm to someone, that person is owed a duty of care

Discuss unethical and unlawful acts

• An illegal act by a healthcare practitioner is always unethical, but an unethical act is not necessarily illegal

• Ethics are concerned with standards of behavior and the concept of right and wrong, over and above that which is legal in a given situation

Discuss what happens in an ethical dilemma

when a person must choose between two or more morally acceptable options, or between two undesirable alternatives, and no choice is clearly right. Each option involves a conflict of values, duties, or principles. In healthcare, ethical dilemmas often arise when

• patient autonomy conflicts with beneficence

• confidentiality conflicts with duty to warn

• institutional policies conflict with personal judgment

Downfalls of value ethics decision making

• lack of clear guidance

• subjectivity

• difficult to apply in emergency situations

• hard to evaluate legally

• potential for bias

Downfalls of value ethics decision making: lack of clear guidance

value ethics does not always provide rules for complex situations, leaving too much to personal interpretation

Downfalls of value ethics decision making: subjectivity

values differ between individuals, cultures, institutions, making decisions inconsistent

Downfalls of value ethics decision making: difficult to apply in emergency situations

healthcare often requires quick, decisive action; value-based decisions reasoning can be too abstract or slow

Downfalls of value ethics decision making: hard to evaluate legally

courts rely on objective standards, not personal virtues, so value-based decisions may not hold up in legal settings

Downfalls of value ethics decision making: potential for bias

a provider’s personal values may unintentionally override patient autonomy or cultural differences

establishment of ethical standards

ethical standards are created to guide professional behavior, protect patients, and ensure consistent, safe, and fair practice. They are established through:

• professional organizations

• laws and regulations

• institutional policies

• ethical theories and principles

• court decisions

establishment of ethical standards: professional organizations

groups such as the AMA, ANA, AAPA, and others create code of ethics that outline expected conduct

establishment of ethical standards: laws and regulations

federal and state laws (HIPAA, EMTALA, licensing acts) set minimum ethical and legal reuirements

establishment of ethical standards: institutional policies

hospitals and clinics develop policies to ensure compliance with laws and professional guidelines

establishment of ethical standards: ethical theories and principles

foundational principles: autonomy, beneficence, nonmaleficence, justice — shape ethical expectations

establishment of ethical standards: court decisions

• legal cases help define what is considered acceptable or negligent behavior

  • ethical standards ensure accountability, protect patient rights, and promote trust in the healthcare system

Explain and discuss ways of risk management

• Risk management involves identifying problem practices or behaviors and then eliminating or controlling them. Risk management activities that may help avoid litigation include providing written job descriptions for health care practice employees and prividing office procedures manuals and employee handbooks that can help avoid misunderstandings and mistakes that lead to liability risks.

• Other activities include medical record charting, patient scheduling, writing prescriptions, and communicating with patients.

• Methods used to manage risk are part of quality improvement or quality assurance

Quality improvement/quality assurance

a program of practices performed by health care providers and practitioners to uphold the quality of patient care and to reduce liability risk

Autonomous decisions are characterized by

• competency: a person must be competent to make a decision

• the ability to act on the decision

• respect for the autonomy of others

Explain civil law

• law that involves wrongful acts against persons

  • involves crimes against the state

• Under civil law, a person can sue another person, a business, or the government

• civil disputes often arise over issues of contract violation, slander, libel, trespassing, product liability, or automobile accidents

• many civil suits involve family matters such as divorce, child support, and child custody

• court judgments in civil casses often require the payment of a sum of money to the injured party

Explain confidentiality

• the act of holding information in confidence, not to be released to unauthorized individuals

• it is the ethical and legal duty of health care professionals to maintain confidentiality

the following suggestions for maintaining confidentiality of patient health care records can serve as a guide for all health care practitioners who may be asked to provide or release patient information:

• no disclosure without consent: never share patient information—including confirming if someone is a patient—without signed consent. This applies to insurance companies, lawyers, and even curious acquaintances

• Stay neutral about your patient morals: confidentiality must be upheld regardless of your personal views about the patient’s belief or behaviors

• protect financial information: treat financial details (like bank account balance) as confidential. Avoid discussing them where others may overhear

• Be careful on the phone: don’t say a patient’s name if others are nearby. Keep phone conversations discreet.

• Secure physical records: never leave patient documents visible to others. Confidentiality procedures must be part of staff training and facility policies.

• Respect patient refusals: if a patient won’t release information, don’t share it—unless legally required (i.e. subpoena, public health laws, or safety concerns

Explain critical thinking skills

as a healthcare practitioner, you will be expected to approach a problem at work in a manner that lets you act as ethically, legally, and helpfully as possible. Sometimes, solutions to problems must also be found as quickly as possible, but solutions to problems must always be within the scope of your training, licensure, and capabilities.

5 step process for approaching a problem using critical thinking

1. identify and clarify the problem

2. gather information

3. evaluate the evidence

4. consider alternatives and implications

5. choose and implement the best alternative

Explain decision-making skills

• ethical decision making requires you to tap into your values, morals, and sense of fair play, so that you can be comfortable with the decisions you implement and so that your decisions do not harm others

• Effective decision-making skills involve the ability to evaluate information, consider alternatives, and choose actions that are responsible, ethical, and aligned with professional standards. In healthcare, decision making requires balancing clinical facts with personal values, legal obligations, and the potential impact on clients.

Ethical decision making specifically requires you to draw on your values, morals, and sense of fairness so that the choices you make:

• are consistent

• do not cause harm

• respect patient rights and dignity

• can be justified and defended

• allow you to feel confident and comfortable with the outcome

explain duty of care

the obligation of health care workers to patients and, in some cases, nonpatients. Physicians have a duty of care to patients with whom they have established a physician-patient relationship, but they may also be held to a duty of care toward people who are not patients, such as the patient’s family members, former patients, and office personnel. Generally, if actions or omissions within the scope of a health care practitioner’s job could cause harm to someone, that person is owed a duty of care.

explain general compensatory

• type of damage-monetary compensation to plaintiff based on the extent of injuries, loss of income, damage to reputation, or other harm that can be proven when a defendant is found guilty of tort (such as negligence, breach of contract, libel, or slander)

purpose of general compensatory

to compensate for injuries or losses due to violation of patient’s rights

general compensatory — considered by court:

• physical disability

• loss of earnings

• mental anguish

• loss of service of spouse or child

• losses to date

• future losses

general compensatory— award

specified by the court. dollar value need not be proved; loss must be proved

explain moral values

• moral values are beliefs formed through the influence of family, culture, and society

• the main purpose is to serve as a guide for personal ethical conduct

• in terms of standards, it serves as a basis for forming a personal code of ethics

• penalties of violating moral values includes difficulty in getting along with others

• moral values are beliefs about right or wrong shaped by family, culture, and society. They guide personal ethical conduct and help form an individual’s personal code of ethics. Strong moral values skills involve involve recognizing these beliefs and applying them consistently in daily behavior. Violating moral values can lead to difficulty getting along with others and loss of trust.

People skills include such attributes as the following:

• a relaxed attitude when meeting new people

• an understanding of and empathy for others

• good communication skills, including writing, speaking, and listening

• patience in dealing with others and the ability to work as a member of a healthcare team

• tact, or sensitivity when dealing with others or with difficult issues

• the ability to impart information clearly and accurately

• the ability to leave private concerns at home

• trustworthiness and a sense of responsibility

Explain technical skills

technical skills include those abilities you have acquired in your course of study, including but not limited to the following:

• computer literacy

• proficiency in English, science, and mathematics

• a willingness to learn new skills and techniques

• an aptitude for working with the hands

• ability to document well

• ability to think critically

What are the 4 C’s of medical malpractice prevention?

• Caring

• Communication

• Competence

• Charting

Caring (medical malpractice prevention)

• show genuine concern and sincerity toward patients

• caring improves patient outcomes and reduces complaints or lawsuits

• avoid criticizing other healthcare providers

• listen to patient concerns and relay issues appropriately to the treating provider

communication (medmal prevention)

• communicate clearly and confirm understanding with patients and colleagues

• accurately relay information, including phone messages

• stay within your legal scope of practice

• report adverse events properly and never ignore patient involvement

competence

• know your professional role, limits, and standards of care

• maintain and update skills and knowledge continuously

• consult other healthcare professionals when needed

• follow safe medication practices (triple check medications)

• stay informed through continuing education and professional resources

charting (medmal prevention)

• accurate, complete documentation is essential—if it’s not written, it didn’t happen

• include all relevant records (tests, progress notes treatments)

• chart objectively and professionally, assuming the patient may read the record

explain veracity

• ambiguous in healthcare world because when providers want to what is best for the patient, they may not always tell the whole truth

  • placebos

  • paternalistic view

Federal rules that govern drugs and medical devices

• drugs and medical devices are regulated under separate federal laws, both enforced by the FDA

• An important issue in deciding drug injury cases is whether or not the drug manufactureer made false or misleading statements to win FDA approval

• Drugs are regulated under the Federal Food, Drug, and Cosmetic Act (FD&C Act)

• Medical devices are regulated under the Medical Device Amendments of 1976

List the physician’s responsibilities to their patient

• use due care, skill, judgment, and diligence in treating patients, which other physicians of the same practice usually exercised in similar locations and under similar circumstances

• stay informed about the best methods of diagnosis and treatment

• perform to the best of one’s ability, whether or not a fee is received

• exercise one’s best professional judgment in all cases, particularly those in which considerable doubt is involved

• consider the established, customary treatment administered by members of the medical profession in similar cases

• abstain from performing experiments on a patient without first securing the patient’s complete understanding and approval

• provide proper instructions for a patient’s care to the person responsible for such care, so that proper treatment will be administered to the patient in the doctor’s absence

• furnish complete information and instructions to the patient about diagnosis, options and methods of treatment, and fees for services

• take every precaution to prevent the spread of contagious disease

• advise patients against needless or unwise operations

reasons for doctors or nurses to lose their license

• sexual misconduct

• substance abuse

• professional discipline for criminal convictions or unprofessional conduct

• fraud and misrepresentation

• patient abuse

• medication violations

• unethical behavior

• poor documentation or record keeping

• unlicensed practice

reasons why we have moral standards

to guide behavior, promote fairness, and support healthy relationships in society. They help individuals distinguish right from wrong, encourage trust, and create expectations for responsible conduct. In healthcare, moral standards protect patients, support professional integrity, and ensure that decisions are made with compassion, respect, and honesty

responsibility of liability by healthcare workers

healthcare workers have a legal and ethical responsibility to provide care that meets the accepted standard or practice. Liability arises when a provider’s actions—or failure to act— cause harm to a patient. Responsibilities include

• using appropriate skills and knowledge

• following professional guidelines and institutional policies

• documenting accurately

• communicating clearly

• acting within one’s scope of practice

If a provider is negligent, carless, or violates professional standards, they may be held legally liable for resulting injuries

Role of American health care association

represents long-term care facilities; including nursing homes and assisted-living centers. Its role includes:

• advocating for high quality care for older adults and individuals with disabilities

• supporting federal and state policies that improve long-term care services

• providing education, resources, and best-practice guidelines for facilities

• Promoting safety, regulatory compliance, and ethical standards in long-term care

AHCA helps ensure that vulnerable populations receive safe, ethical, and consistent care across the long-term care system

Role of joint commission

• an independent, not-for-profit organization that accredits many types of health care organizations

• also publishes patient safety goals for hospitals, ambulatory care, behavioral care, home care, and critical access hospital care

  • their guidelines for patient safety are used as checklists before surgeries and other procedures

Role of the commission on accreditation of allied health education programs

• to earn and maintain TJC accreditation, an organization must undergo an on-site survey by a TJC survey team for at least 39 months. Laboratories must be surveyed every 2 years

• TJC also offers program certifications in specific health care areas for organizations within a TJC accredited organization

role of the ethics committee

a committee made up of individuals who are involved in a patient’s care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases.

role of the expert witness

testify to the standard of care regarding the matter in question. Expert witnesses may, and usually do, give their opinions on the facts

role of the National Committee for Quality Assurance

agency that provides accreditation and establishes standards for healthcare delivery for:

• health plan organizations (HMOs and PPOs)

• disease and case management plans

• Accountable care organizations (ACOs)

• patient-centered medical home organizations

• credential verification organizations

• HEDIS compliance audit certification

• a variety of other providers, practices, health plans and data information, and technical programs

Talk about what happens in a crisis situation

normal routines break down and quick, organized action is required. Emotions may run high, communication can become strained, and decisions must be made rapidly. Healthcare workers focus on:

• ensuring immediate safety

• stabilizing the patient or environment

• following emergency protocols

• communicating clearly with the team

• prioritizing tasks based on urgency

crisis situations demand calm judgment, teamwork, and adherence to established procedures to prevent harm and restore order

understand the scope of practice for various healthcare professions

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What does the government enact?

governments enact laws to keep society running smoothly and to control behavior that could threaten public safety

• these laws form the framework for licensing, patient rights, public health measures, and the regulation of drugs, devices, and healthcare facilities

What issues occur with modern medical technology

• privacy concerns (EHR, data breaches)

• high costs and unequal access

• complexity of informed consent for advanced procedures

• end-of-life dilemmas (life support machines, artificial nutrition)

• genetic testing and reproductive technology is misused or misunderstood

• dependence of technology potentially reducing hands-on skills

What must be included in a negligence case

• Duty

• Dereliction

• Damage

• Direct Cause

Duty (negligence case)

the person charged with a negligence owed a duty of care to the accuser

Dereliction (negligence case)

the health care provider breached the duty of care to the patient

Damage (negligence case)

the health care provider’s dereliction of duty caused injury to the patient (depending on the outcome of malpractice trials, monetary awards to plaintiffs may be court-ordered as compensation for proven injuries. These awards are referred to as damages).

Direct cause (negligence case)

the breach of the duty of care to the patient was a direct cause of the patient’s injurywh