Intro to Clinical Text 2: Chapters 6, 7, 13, 15, 16

Value

A belief about what is important, meaningful, or worthwhile.

Value System

A hierarchy of values that guides a person's behavior and decisions.

Common Modes of Value Transmission

Modeling, Moralizing, Laissez-faire, Rewarding and punishing, Responsible choice.

Essential Professional Nursing Values

Altruism, Autonomy, Human dignity, Integrity, Social justice.

Value Clarification

A process of examining personal values and understanding how they influence actions.

Three Steps in the Valuing Process

Choosing, Prizing, Acting.

Ethics

Study of right and wrong conduct.

Morals

Personal beliefs about right and wrong.

Types of Ethics

Bioethics, Clinical ethics, Nursing ethics.

Two Theories of Ethics

Utilitarian, Deontologic.

Principle-Based Approach

Uses ethical principles to guide decision-making.

Four Principles of Bioethics

Autonomy, Nonmaleficence, Beneficence, Justice.

Ethical Dilemmas

Two or more moral principles apply but support inconsistent actions.

Care-Based Approach

Focuses on caring relationships, dignity, respect, and responsiveness.

Feminist Ethics

Emphasizes relationships, power dynamics, and social justice.

Ethical Agency

Ability to act ethically and uphold moral responsibilities.

Essential Elements of Ethical Agency

Ethical sensibility, Ethical responsiveness, Ethical reasoning, Ethical accountability, Ethical character, Ethical valuing, Transformative ethical leadership.

Virtues of Nurses

Compassion, trustworthiness, integrity, humility, courage.

Patient's Bill of Rights

Protects patient autonomy, dignity, and rights.

Bill of Rights for Nurses

Defines ethical obligations and duties of nurses.

Ethical Distress

Knowing the right action but being unable to perform it.

Models of Healthcare Decision-Making

Paternalistic, Shared decision-making, Consumer model.

Advocacy

Representing patients, promoting self-determination, and being politically active.

Law

Standard or rule enforced by government.

Types of Law

Public law, Private law, Criminal law.

Four Sources of Law

Constitutions, Statutes, Administrative law, Common law.

Litigation

Process of bringing and trying a lawsuit.

Plaintiff

Person bringing the suit.

Defendant

Person accused.

Voluntary Standards

Professional guidelines not legally required.

Legal Standards

Established by law.

Credentialing

Ensures competence.

Accreditation

Educational program meets standards.

Licensure

Legal permit to practice.

Certification

Recognition of advanced competence.

Crime

Wrong against person/property/public.

Misdemeanor

Punishable by fines or less than 1 year jail.

Tort

Wrong against a person/property.

Assault & Battery

Threat + physical contact.

Defamation

Damaging someone's reputation.

Invasion of Privacy

Violating confidentiality.

False Imprisonment

Unjustified restraint.

Fraud

Misrepresentation.

Negligence & Malpractice

Failure to act safely; professional negligence.

Liability Elements

Duty, breach, causation, damages.

Fact vs Expert Witness

Fact: Observes. Expert: Interprets.

Collective Bargaining

Negotiation for working conditions.

Competent Practice

Following policies, staying current.

Patient Education

Legal responsibility to teach.

Executing Orders

Follow physician orders safely.

Documentation & Staffing

Accurate charting; adequate staffing.

Liability Insurance & Risk Management

Protects nurses; prevents harm.

Incident Report

Documentation of unusual events.

Sentinel Event

Unexpected event causing death/serious harm.

Good Samaritan Laws

Protect providers giving emergency care.

Student Liability

Students held to same standards.

Laws Affecting Nursing Practice

OSHA, reporting obligations, controlled substances, impaired nurses, discrimination, disability laws, wills.

Historic Evolution of Nursing Process

1955 term introduced →1960s steps →1967 first book →1973 ANA standards →1982 boards adopt.

Five Steps of Nursing Process

Assess, Diagnose, Plan, Implement, Evaluate.

Characteristics of Nursing Process

Systematic, dynamic, interpersonal, outcome-oriented, universally applicable.

Benefits of Nursing Process

Patient: Holistic care, continuity, cost-effective. Nurse: Collaboration, satisfaction, professional growth.

Four Blended Skills

Cognitive, technical, interpersonal, ethical/legal.

Critical Thinking Model

Purpose, adequacy of knowledge, curiosity, discipline, creativity, confidence.

Habits for Technical Skills

Practice, seek help, familiarize equipment, stay current.

Interpersonal Skills

Promote dignity, caring relationships, mutual respect.

Accountability & Well-being

Nurse accountability ensures safe, effective care.

Reporting Issues

Report incompetent, unethical, illegal practices.

Whistle-Blowing

Reporting unsafe or unethical organizational practices.

Critical Thinking Indicators

Behaviors showing critical thinking.

Concept Map & Steps

Skeleton →categorize →analyze relationships →goals/interventions →evaluate.

Critical Pathway

Standardized plan for predictable clinical course.

Assessing

Systematic, continuous data collection.

Database

All patient information collected.

Types of Assessments

Comprehensive, focused, emergency, time-lapsed.

Nursing vs Medical Assessment

Nursing = responses; medical = pathology.

Objective vs Subjective Data

Objective = measurable; subjective = patient-reported.

Assessment Priorities

Health orientation, developmental stage, need for nursing, practical considerations.

Characteristics of Data

Complete, factual, accurate, relevant.

Sources of Data

Patient, family, record, professionals, literature.

Purpose of Observation, Interview, Physical Exam

Assess responses, abilities, environment.

Nursing History Components

Biographical, reason for care, health history, lifestyle.

Interview Phases

Preparatory, introduction, working, termination.

Physical Assessment Methods

Inspection, palpation, percussion, auscultation.

Problems in Data Collection

Omission, irrelevant data, misinterpretation.

When to Validate Data

When inconsistent or lacking objectivity.

Reporting & Documentation

Report significant changes; document timely.

Obtain & Document Data

Accurate, factual, relevant.

Diagnosing

Identify patient responses to health problems.

Health Problem

Condition requiring intervention.

Nursing Diagnosis

Problem nurses treat independently.

Medical Diagnosis

Disease identified by provider.

Collaborative Problem

Physician + nursing interventions.

Distinguishing Diagnoses

Nursing = response; medical = disease; collaborative = complications.

Four Steps of Data Interpretation

Recognize significant data →patterns →strengths/problems →conclusions.

Guidelines for Writing Diagnoses

Problem + etiology + defining characteristics.

Types of Nursing Diagnoses

Actual, risk, possible, wellness, syndrome.

Parts of Diagnosis

Label, definition, characteristics, related factors.

Validate Diagnoses

Check data accuracy, consult resources.

Benefits & Limitations

Benefits: individualized care, clarity. Limitations: misuse may misdiagnose.