NR222 Nursing Process and Ethical Principles Study Guide

ANA Code of Ethics

• Guides nursing practice through professional values.
• Serves as a decision-making tool for ethical dilemmas.
• Nine provisions:
  • 1-3: Direct client care.
  • 4-6: Ethical workplace environment.
  • 7-9: Nursing's role in healthcare advancement.

Ethical Principles in Nursing

• Autonomy: Respecting clients' decisions.
• Beneficence: Promoting good for the patient.
• Nonmaleficence: Avoiding harm.
• Justice: Ensuring fair treatment for all patients.
• Fidelity: Keeping promises made to patients.
• Veracity: Being truthful in interactions with patients.

Common Ethical Issues

• Ethical dilemmas necessitating a resolution.
• Moral distress experienced by nurses in ethical situations.
• Strategies to resolve dilemmas using professional core values and the chain of command.

ANA Scope and Standards of Practice

• Defines expectations for all Registered Nurses (RNs).
• Comprised of 18 Standards of Practice:
  • 6 Standards: Nursing Process (ADOPIE):
  • Assessment: Collecting subjective and objective data.
  • Diagnosis: Identifying patient issues (e.g., "Impaired Gas Exchange").
  • Outcome Identification: Setting patient goals.
  • Planning: Prioritizing care interventions.
  • Implementation: Executing the care plan.
  • Evaluation: Assessing the effectiveness of interventions.
  • 12 Standards: Professional performance expectations.

Nurse Practice Act

• State law regulating nursing care.
• Overseen by State Boards of Nursing (BONs).

Responsibilities of BON

• Define nursing scope of practice.
• Issue and renew nursing licenses.
• Oversee nursing education programs and establish curriculum standards.
• Enforce nursing regulations and discipline violations.

The Nursing Process (ADPIE)

• Framework for Critical Thinking in Patient Care:
  1. Assessment: Collect both subjective (patient-reported) and objective (measurable) data.
  2. Diagnosis: Identify patient problems (e.g., label as "Impaired Gas Exchange").
  3. Planning: Set goals and prioritize interventions based on assessment data.
  4. Implementation: Carry out the care plan through direct or indirect care.
  5. Evaluation: Check the effectiveness of the interventions.
• Recognized in nursing exams and the NCLEX-RN through Clinical Judgment Measurement Model (CJMM).

Clinical Judgment & CJMM

• A framework for real-time decision-making to ensure safe patient care.
• CJMM aligns with ADPIE:
  1. Recognize Cues: Identify relevant patient data.
  2. Analyze Cues: Interpret these findings effectively.
  3. Prioritize Hypotheses: Determine urgent issues.
  4. Generate Solutions: Decide on interventions needed.
  5. Take Action: Implement and carry out the necessary care.
  6. Evaluate Outcomes: Assess the intervention effectiveness.

Example Scenario & Matching Ethical Principles

• Fidelity: Upholding commitments (e.g., promise to return with medications).
• Veracity: Obligation to be truthful (e.g., withholding info at family request).
• Autonomy: Client choice regarding treatment (e.g., refusing medications).
• Advocacy: Supporting patient safety (e.g., reporting impaired nurse).
• Beneficence: Ensuring comfort (e.g., creating a healing environment).
• Justice: Equitable treatment across all patients.

Assessment & Implementation

• Subjective vs. Objective Data:
  • Subjective Data: Patient-reported information. (e.g., pain, emotions)
  • Objective Data: Observable and measurable signs. (e.g., vital signs)

Types of Care in Implementation

• Direct Care: Involves hands-on patient interactions (e.g., medication delivery).
• Indirect Care: Actions taken on behalf of the patient (e.g., charting).
• ADLs vs. IADLs:
  • ADLs: Basic self-care tasks (e.g., eating).
  • IADLs: More complex tasks (e.g., managing household tasks).

Sample Practice Questions

1. A nurse educates a client about medications, but the client refuses a specific drug.
   • Answer: Autonomy.
2. Which statement is correct regarding the Nurse Practice Act?
   • Answer: It consists of state-specific laws regulated by the Board of Nursing.
3. A nurse assesses pain medication effectiveness. Which nursing process step does this reflect?
   • Answer: Evaluation.
4. In client history collection, which CJMM step is being carried out?
   • Answer: Recognize Cues.
5. Which statements about ANA Scope and Standards of Practice are appropriate?
   • Answer: Six standards relate to nursing processes; twelve relate to professional performance.

Cultural Competence and Attributes

• Cultural Competence: Ability to deliver care that respects cultural diversity.
• Cultural Competence vs. Cultural Humility:
  • Competence: Skills and knowledge about cultures.
  • Humility: Continuous self-evaluation and addressing power dynamics.
• Developing Cultural Competence:
  • Seek knowledge about diverse cultures.
  • Address personal biases.
  • Engage face-to-face with diverse groups.

Performing a Cultural Assessment

• Ask about:
  • Health beliefs and practices.
  • Family support structures.
  • Dietary preferences.

Culturally Competent Care

• Culturally Congruent Care: Align with personal beliefs and practices.
• Key Aspects: Sensitivity, appropriateness, and competence.

Family Influences on Health

• Types of Families:
  • Nuclear: Traditional two-parent structure.
  • Blended: Includes step-family structures.
  • Extended: Includes broader kinship ties.
  • Alternative: Non-traditional family forms.

Family Characteristics

• Durability: Long-lasting family structure.
• Resiliency: Adaptation capacity.
• Diversity: Variability in family backgrounds.
• Dynamics: Relationship influences on health.

Factors Affecting Families

• Social, economic, and environmental conditions.
• Family impact on health: behaviors, access to care, and social support.

Social Determinants of Health (SDOH)

• Definition: Elements influencing health outcomes.
• Categories:
  • Upstream: Societal factors (policies, income).
  • Midstream: Community and employment conditions.
  • Downstream: Individual health behaviors.

HP 2030 Goals

• Focus on reducing health disparities and promoting equity.

Using an Interpreter in Healthcare

• Guidelines:
  • Use trained interpreters, not relatives.
  • Speak to the patient directly.
  • Keep language simple and assess understanding.

Patient Education

• Role of the Nurse: Facilitate and empower learning.
• Teaching vs. Learning: Teaching imparts, learning encompasses understanding.
• Factors Affecting Learning:
  • Readiness, cognitive ability, emotional state, and literacy.
• Evaluation of Learning: Use teach-back method to confirm understanding.

Domains of Learning

• Cognitive: Knowledge understanding.
• Affective: Emotional aspects.
• Psychomotor: Skill performance.
• Multiple Domains: Involvement maximizes learning success.