Nursing Ethics and Legal Responsibilities
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Questions and Answers

What is the purpose of the Health Practitioners Competence Assurance Act?

To protect the health and safety of members of the public by ensuring that health practitioners are competent and fit to practice their professions.

Which of the following are classified as Class A drugs under the Misuse of Drugs Act 1975? (Select all that apply)

  • Cocaine (correct)
  • Methamphetamine (correct)
  • Morphine
  • Heroin (correct)

    • Under the Mental Health Act 1992, a person can be considered mentally disordered based on their political beliefs.

    False

    The Code of Health and Disability Consumers Rights establishes _____ rights for consumers.

    <p>10</p> Signup and view all the answers

    What does the ABCDE tool stand for in nursing?

    <p>Airway, Breathing, Circulation, Disability, Exposure</p> Signup and view all the answers

    According to Erik Erikson's psychosocial development stages, what is the outcome of the stage 'Industry vs Inferiority'?

    <p>Competency</p> Signup and view all the answers

    Albert Bandura's Social Cognitive Theory emphasizes the role of observational learning.

    <p>True</p> Signup and view all the answers

    ______ reinforcement is when an individual is more likely to exhibit a behavior after seeing someone else rewarded for that behavior.

    <p>Vicarious</p> Signup and view all the answers

    What is the role of NCNZ in New Zealand?

    <p>To set standards for nursing and regulate the registration of nurses to protect the public.</p> Signup and view all the answers

    Nurses have a responsibility as Crown agents to protect the health and safety of the public.

    <p>True</p> Signup and view all the answers

    Which of the following are considered part of cultural safety in nursing?

    <p>All of the above</p> Signup and view all the answers

    Article Two of Te Tiriti O Waitangi guaranteed chiefs 'te tino rangatiratanga' which means chieftainship over their lands, villages, and treasured things, giving the Crown a right to deal with Māori in buying _____

    <p>land</p> Signup and view all the answers

    Match the following terms from Te Tiriti O Waitangi with their meanings:

    <p>Tino rangatiratanga = Self-determination, independence Equity = Achieving equitable health outcomes Kawanatanga = Governance Wairuatanga = Right to maintain spiritual practices</p> Signup and view all the answers

    What are the four dimensions of Māori well-being in Te Whare Tapa Wha?

    <p>Taha tinana, Taha wairua, Taha whānau, Taha hinengaro</p> Signup and view all the answers

    Which action area is NOT part of the Ottawa Charter for Health Promotion?

    <p>Advancing personal skills</p> Signup and view all the answers

    Transtheoretical Model consists of seven stages.

    <p>False</p> Signup and view all the answers

    Primary Health Care focuses on early diagnosis, effective treatment, and disease management, as well as actions that protect the environment, prevent illness and injury, and promote health and wellbeing of ______.

    <p>communities</p> Signup and view all the answers

    What is the viral disease that has been eradicated worldwide by vaccination in 1980?

    <p>Smallpox</p> Signup and view all the answers

    Match the Te Pae Mahutonga elements with their meanings:

    <p>Mana ora = Self-reliance Waiora = Healthy environments Toiora = Healthy individuals Te oranga = Healthy families Nga Manukura = Leadership Te Mana whakahaere = Autonomy</p> Signup and view all the answers

    What causes Staphylococcal scalded-skin syndrome?

    <p>Exfoliative toxin</p> Signup and view all the answers

    Smallpox can be cured with treatment.

    <p>False</p> Signup and view all the answers

    Scabies is caused by the __________ mite.

    <p>itch</p> Signup and view all the answers

    Match the following discomforts of pregnancy with their causes:

    <p>Bleeding Gums = Elevated progesterone levels Urinary Frequency = Increased levels of progesterone, HCG, and pressure from the uterus Heartburn = Increased progesterone causing sphincter relaxation Constipation = Increase in progesterone causing GI motility decrease</p> Signup and view all the answers

    What is the primary importance of immunisations?

    <p>Preventing infection</p> Signup and view all the answers

    Which part of the body is considered an IM administration site?

    <p>Deltoid</p> Signup and view all the answers

    Breastfed babies receive long-lasting immunity from their mothers.

    <p>False</p> Signup and view all the answers

    Whooping Cough is also known as ________.

    <p>pertussis</p> Signup and view all the answers

    Match the following diseases with their symptoms:

    <p>Measles = Rash, fever, possible permanent damage Mumps = Swollen salivary glands, headache, fatigue Rubella = Fever, sore throat, generalized rash</p> Signup and view all the answers

    Match the following disease manifestations with the corresponding diseases:

    <p>Urethritis, cervicitis, salpingitis = Gonorrhoea Ulcerative lesions with systemic involvement = Syphilis Ulcerative lesions only = Chancroid Non ulcerative lesions = Molluscum contagiosum Vulvovaginitis = Trichomoniasis</p> Signup and view all the answers

    What are the methods through which HIV is spread?

    <p>Unprotected sex and contact with infected blood</p> Signup and view all the answers

    What is the causative organism of syphilis?

    <p>Treponema pallidum</p> Signup and view all the answers

    Chlamydia can cause infertility if left untreated.

    <p>True</p> Signup and view all the answers

    ____ is an antiviral drug commonly used for the treatment of herpes.

    <p>Acyclovir</p> Signup and view all the answers

    How can Human Papillomavirus (HPV) be transmitted?

    <p>Vaginal and anal sex</p> Signup and view all the answers

    What is a common symptom of active labor?

    <p>Back pain</p> Signup and view all the answers

    The second stage of labor begins when the cervix is fully dilated.

    <p>True</p> Signup and view all the answers

    What may be required in case a woman needs assistance with their birth?

    <p>Forceps or ventouse (vacuum extraction)</p> Signup and view all the answers

    PPH occurs in approximately 1 in __ pregnancies.

    <p>500</p> Signup and view all the answers

    Match the following symptoms with their indication for postpartum hemorrhage:

    <p>Heavy bleeding from the vagina = Symptom of PPH Drop in blood pressure or signs of shock = Symptom of PPH Fussiness and irritability = Not a symptom of PPH Swelling and pain around the vagina or perineum = Symptom of PPH</p> Signup and view all the answers

    What is the function of amniotic fluid during pregnancy?

    <p>Shields the foetus against pressure, protects against temperature changes, allows movement for muscular development</p> Signup and view all the answers

    Why is smoking discouraged during pregnancy?

    <p>Increases the risk of preterm birth and low birth weight</p> Signup and view all the answers

    Folic acid helps prevent birth defects, particularly spina bifida.

    <p>True</p> Signup and view all the answers

    What does ______ syndrome stand for? Haemolysis, Elevated Liver enzymes, Low Platelet count.

    <p>HELLP</p> Signup and view all the answers

    Match the term with its description:

    <p>Ballottement = Sharp upward pushing against uterine wall with a finger for diagnosing pregnancy Linea nigra = Vertical brown line along the abdomen due to hormonal changes Melasma / chloasma = Brown patches on the face due to hormonal changes</p> Signup and view all the answers

    When does the posterior fontanelle usually close in an infant's life?

    <p>first several months</p> Signup and view all the answers

    Which reflex makes the infant extend the arm and leg on the side where the head is turned?

    <p>Tonic neck reflex</p> Signup and view all the answers

    The sucking reflex is voluntary from birth.

    <p>False</p> Signup and view all the answers

    The Babinski reflex disappears around ____ months of age.

    <p>12</p> Signup and view all the answers

    Match the reflex with its description:

    <p>Grasp reflex = Hand closes around a finger or stroking the palm Moro reflex = Arms thrown out with palms up in response to sudden noise Rooting reflex = Head turns towards cheek or mouth and mouth opens to suck Sucking reflex = Automatic sucking when the roof of the mouth is touched</p> Signup and view all the answers

    What risk factors are associated with cleft lip/palate birth defects?

    <p>medications, diabetes, obesity, family history</p> Signup and view all the answers

    What are the signs and symptoms of Coarctation of the Aorta?

    <p>nose bleeds, headaches, stroke, strong pulses in upper body, absent pulses in lower extremities, notching of ribs</p> Signup and view all the answers

    Coarctation of the Aorta occurs before the left subclavian artery.

    <p>False</p> Signup and view all the answers

    Study Notes

    Ethics and Morality

    • Ethics: customs and habits
    • Morality: customs and habits
    • Values: freely chosen, enduring beliefs and attitudes

    Relevant Legislations

    NZNO Guideline - Code of Ethics

    • Guides nurses' practice and communicates the nursing profession's ethical values
    • Nationwide use of the Code signals to other health professionals, managers, and the public that nurses are aware of their moral responsibilities
    • For nurses to explore ethical beliefs and guide individual situations in nursing practice

    Māori Values

    • Rangatiratanga: self-determination
    • Manaakitanga: hospitality, kindness, respect
    • Tika: truth, justice, rights
    • Whanaungatanga: relationships
    • Wairuatanga: spirituality
    • Kotahitanga: unity
    • Kaitiakitanga: guardianship

    Western Values

    • Autonomy: self-determination
    • Beneficence: doing good
    • Non-maleficence: doing no harm
    • Justice: fairness
    • Confidentiality: privacy
    • Veracity: honesty
    • Fidelity: faithfulness
    • Guardianship of the environment and its resources: protecting the environment/resources
    • Being professional: being accountable for own nursing practice

    Code of Health and Disability Consumers' Rights

    • Establishes the rights of consumers and the obligations and duties of providers to comply with the Code
    • 10 rights, including:
      • Right to be treated with respect
      • Right to freedom from discrimination, coercion, harassment, and exploitation
      • Right to dignity and independence
      • Right to services of an appropriate standard
      • Right to effective communication
      • Right to be fully informed
      • Right to make an informed choice and give informed consent
      • Right to support
      • Right to complain

    Health Practitioners Competence Assurance Act

    • Protects the health and safety of members of the public by providing mechanisms to ensure that health practitioners are competent and fit to practise their professions

    Mental Health Act (Compulsory Assessment and Treatment Act) 1992

    • Provides a legal framework for those who require compulsory psychiatric assessment and treatment
    • Redefines the circumstances and conditions under which persons may be subject to compulsory psychiatric assessment and treatment
    • Refines the rights of such individuals and provides better protection for those rights

    Other Acts and Plans

    Misuse of Drugs Act 1975

    • Classifies drugs into three classes based on risk of harm
    • Provides for the prohibition and regulation of drugs

    Intellectual Disability Act (Compulsory Care and Rehabilitation) 2003

    • Establishes a scheme that authorises the provision of compulsory care and rehabilitation to individuals with an intellectual disability who have been charged with a prisonable offence

    Whaio Te Ao Marama / Māori Disability Action Plan 2012

    • Establishes priority areas of action to enable disabled Māori to achieve their aspirations and reduce barriers that may impede them from gaining better outcomes

    Faivo Ora / National Pacific Disability Plan 2014

    • Enables disabled Pacific people to live in their homes and participate in the community

    NZ Disability Strategy

    • Focuses on education, employment, and economic security, health and wellbeing, rights protection and justice, accessibility, attitudes, and choice and control

    Vulnerable Children's Act 2014

    • Ensures that children's agencies work together to improve the wellbeing of vulnerable children

    Oranga Tamariki (Children, Young People, and Families Act) 1998

    • Looks after young children involved in child and family abuse

    Privacy Act 2020

    • Makes it an offence to fail to inform the Privacy Commissioner of a notifiable privacy breach

    Crimes Act

    • Makes it an offence to fail to protect a child or vulnerable adult

    Suppression of Tohunga Act 1908

    • Outlawed traditional Māori health practices

    Nursing Leadership and Management

    Process of Influencing

    • Influencing the behaviour of others to achieve goals in a given situation

    Management Skills

    • Developing peer relationships
    • Negotiating
    • Motivating
    • Conflict resolution
    • Networking
    • Dissemination of information
    • Ability to make decisions in conditions of extreme ambiguity
    • Allocation of resources

    Leadership Implications

    • Good time management reduces stress
    • Identifying stress within staff
    • Making organisational changes to reduce staff
    • Role modelling positive behaviour
    • Inspiring hope and vision
    • Knowledge of support systems

    Concepts

    • Manaakitanga: leading with a moral purpose
    • Pono: having self-belief, self-esteem, and self-care
    • Ako: being a learner
    • Awhinatanga: guiding and supporting

    5 Rights of Delegation

    • Right activity
    • Right circumstance
    • Right person
    • Right communication
    • Right direction

    Professional Practice

    Staff Development

    • Professional development
    • Education and training

    Patient Safety

    • Ensure patient safety on discharge
    • Consider patient's rights and dignity

    Cultural Safety

    • Extends beyond ethnic groups to include age, gender, sexual orientation, occupation, and socioeconomic status, ethnic origin, and disability
    • Respect for patients' beliefs and values

    Tikanga Māori

    • Respect for Māori cultural practices and values
    • Negotiating with family and whānau

    Te Tiriti O Waitangi

    • Partnership between Māori and the Crown
    • Tino rangatiratanga: self-determination
    • Equity: achieving equitable health outcomes for Māori
    • Active protection: achieving equitable health outcomes for Māori
    • Options: health and disability services provided in a culturally appropriate way

    Power Imbalance

    • When health professionals dominate decision-making or assert power in a way that disadvantages patients or is not in their best interest

    Responsibility of Nurses

    • Protecting the health and safety of members of the public### Māori Cultural Concepts
    • Whakapono: faith, trust, honesty, integrity, trustworthy, truthful, ethical leadership, seeking guidance and support when needed
    • Tumanakotanga: aspirations of self and others, motivated, sense of mission, visionary, proactive, strategic
    • Mohiotanga: expanding knowledge, utilisation of evidence-based research, contributing to knowledge of others
    • Manaakitanga: hospitality, leading with moral purpose, learning health and social outcomes, team outcomes
    • Pono: reality and truth, having self-belief, self-esteem, self-care, emphasising resilience and wellbeing
    • Ako: to learn and teach, being a learner, keeping up to date, own and others' professional development
    • Awhinatanga: guiding and supporting, empathy for individuals and groups and views of others
    • Wairuatanga: spirituality
    • Hinengaro: the mind
    • Taha tinana: physical wellbeing
    • Whanaungatanga: extended family
    • Mauri: life force in people and objects
    • Mana ake: unique identity of individuals and family
    • Hā a koro ma, a kui ma: breath of life from forbearers
    • Whatumanawa: open and healthy expression of emotion

    Nursing Tools

    • ABCDE: Airway, Breathing, Circulation, Disability, Exposure
    • SAMPLE: Signs and symptoms, Allergies, Medication, Past medical history, Last meal, Events leading to current illness
    • ISBARR: Identification, Situation, Background, Action, Response/rationale

    Motivational Interviewing

    • Having courageous conversations to enable behaviour change and client-centred improved health outcomes
    • Increases desire for change, strengthens motivation to change, whānau-centred, brief intervention (1-4 sessions)

    The 4 Processes

    • Engaging
    • Focusing
    • Evoking
    • Planning

    3 Harms

    • Privacy and confidentiality must never be broken unless:
      • They are harming themselves
      • They are harming others
      • Someone is harming them

    The Gillick Competency

    • Used to decide whether a child under 16 is mature enough to make decisions
    • Balances the need to listen to their wishes with the responsibility to keep them safe

    Fraser Guidelines

    • Apply specifically to contraceptive advice and sexual health
    • Proceed with giving contraceptive advice and treatment to a girl under 16 provided:
      • She will understand advice
      • She cannot persuade her to inform her parents or allow them to inform her parents she is seeking contraceptive advice
      • She will continue having sexual intercourse with or without contraceptive treatment
      • Unless she receives contraceptive advice or treatment, her physical and mental health will suffer
      • Her best interests require contraceptive advice, and or treatment without parental consent

    Standard Precautions

    • Hand hygiene
    • PPE use
    • Safe sharps disposal
    • Aseptic non-touch technique
    • Reprocessing of reusable medical equipment and instruments
    • Resp.hygiene
    • Routine environmental cleaning
    • Waste management
    • Appropriate linen handling

    Falls Risk Prevention

    • Belongings within reach
    • Bell within reach
    • Breaks on
    • Bed low
    • Bed rails

    Documentation

    • PIE: Problem, Implementation, Evaluation
    • SOAPIE: Subjective data, Objective data, Assessment, Planning, Implementation, Evaluation

    Nursing Theories

    • Erik Erikson's Psychosocial Development Theory
      • A person's personality is developed over 8 stages
      • Each stage has a crisis and its outcome has a positive or negative impact on personality development
    • Abraham Maslow's Hierarchy of Needs
      • People are motivated to fulfill basic needs before moving on to other, more advanced needs
      • People have an inborn desire to reach the top of the hierarchy
    • Sigmund Freud's Psychosexual Development Theory
      • Personality is developed through a series of childhood stages in which pleasure-seeking energies become focused on certain erogenous areas
      • A person's libido determines their behavior, if their issues are not resolved at the appropriate stage, fixations can develop and they can become stuck at that stage
    • B.F. Skinner's Operant Conditioning Theory
      • An individual makes an association between a particular behavior and consequence, thus believing behavior comes from rewards and punishments
    • Jean Piaget's Cognitive Development Theory
      • Suggests children move through 4 stages of mental development
      • Focuses on understanding how children acquire knowledge and the nature of intelligence
    • Ivan Pavlov's Classical Conditioning Theory
      • Learning to associate an unconditioned stimulus that already brings about a particular response with a new (conditioned) stimulus, so that the new stimulus brings about the same response
    • John Watson's Behaviourism Theory
      • The idea that behavior can be controlled and predicted
      • Based on the idea that behavior is affected by the environment
    • Albert Bandura's Social Cognitive Theory
      • Based on behavior and consequences
      • Agrees with classical conditioning, but adds mediating processes occur between stimuli and responses

    Models of Care

    • Te Wheke / The Octopus: The dimensions are interwoven, representing the close relationship of the tentacles
    • Te Whare Tapa Wha: Strong foundations and four equal sides, symbolizing the four dimensions of Māori well-being
    • Ottawa Charter: Framework for constructing health promotion programs that address the determinants of health
    • Te Pae Mahutonga (Southern Cross Star Constellation): Brings together elements of modern health promotion as they apply to Māori health

    Primary Health Care

    • Focuses on early diagnosis, effective treatment, disease management
    • Actions that protect the environment, prevent illness and injury, and promote health and wellbeing of communities
    • Empower populations to live healthy lives

    Quality Improvement

    • 6 dimensions:
      • Safety
      • Effectiveness
      • Equity
      • Efficiency
      • Timeliness
      • Patient-centeredness
    • These dimensions rest on foundations of partnership, participation, protection principles of Tiriti o Waitangi

    Cervical Screening

    • Purpose:
      • Looks for abnormal changes in cells on the surface of the cervix
      • Some cells with abnormal changes can develop into cancer if they are not treated
      • Treatment of abnormal cells is very effective at preventing cancer as it allows for early detection, follow-up testing, and treatment### Immunisation
    • Provides one of the most cost-effective means of preventing infection in infants
    • Not only protects those receiving vaccinations from developing serious diseases but also helps protect entire communities by preventing and reducing the spread of infectious agents
    • Offers the only means of control as antibiotics cannot destroy viruses

    IM Administration Sites

    • Deltoid
    • Ventrogluteal
    • Dorsogluteal
    • Vastus lateralis
    • Rectus femoris

    First Assessment

    • Assess if the child is well today
    • Assess the need for the vaccine
    • Check for any previous history of reactions (anaphylaxis)

    Breastfeeding and Vaccinations

    • Breastfed babies receive additional antibodies from their mothers' milk, but this immunity does not last long
    • Babies need immunisations to provide ongoing protection

    MMR Vaccine

    • Given at 12 months and 15 months

    Settling a Child after Vaccination

    • Provide lots of cuddles, fluids, and breastfeeding
    • Reduce temperature by undressing them to a single layer
    • Administer medications for temperature and pain
    • Apply an ice pack wrapped in a dry cloth to the injection site
    • Use distraction to divert their attention

    Passive and Active Immunity

    • Passive Immunity: involves the transfer of active humoral immunity (synthesised B cells) of ready-made antibodies
      • Can occur naturally through breastfeeding
    • Active Immunity: happens when the immune system is triggered to produce antibodies to fight a disease
      • Occurs through natural infection or vaccination

    Whooping Cough (Pertussis)

    • A bacterial infection that can lead to pneumonia
    • Characterised by a whooping sounding cough, spread by droplets
    • Infants under 12 months are at the highest risk of pertussis
    • A notifiable disease

    Immunisation Schedule

    • 6 weeks, 3 months, 5 months, 4 years, 11 years, 45 years
    • Also given to pregnant women during the third trimester as it is effective in passing high levels of antibody protection to newborns

    Other Diseases

    • Diphtheria: a bacterial infection that affects the nerves, causing heart damage
    • Measles: a highly contagious virus that causes rash, fever, and possibly permanent damage
    • Mumps: a virus that affects the body (parotid) glands around the neck and face, can cause meningitis
    • Rubella: a rash caused by the rubella virus, can cause congenital rubella syndrome

    Hepatitis

    • Hep A: spreads through the faecal-oral route, symptomatic after 2 weeks, vaccine available
    • Hep B: spreads through blood or bodily fluids, contagious and life-threatening, vaccine available
    • Hep C: spreads through blood, co-infection with HIV, requires lifestyle changes
    • Hep D: spreads through blood, requires Hep B
    • Hep E: spreads through the oral-faecal route, poor sanitation, requires Hep C

    Other Important Information

    • Shock: may result from trauma, heatstroke, blood loss, allergic reaction, severe infection, poisoning, severe burns, etc.
    • Dehydration: first signs include low BP, feeling thirsty, dry mouth, and peeing little
    • Healthy Lifestyle: importance of a balanced diet, regular exercise, and maintaining a healthy weight
    • Genetic Disorders: overview of Fragile X Syndrome, Prader-Willi Syndrome, Angelman Syndrome, Velocardio-facial Syndrome, Rett Syndrome, ASD, and Foetal Alcohol Syndrome
    • Cushing's Syndrome: a set of symptoms resulting from exposure to high levels of cortisol
    • STI/STD: overview of Gonorrhoea, Syphilis, Herpes, HPV, and AIDS

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    This quiz covers the ethical and legal responsibilities of nurses, including customs, habits, and values, as well as relevant legislations such as the NZNO Guideline - Code of Ethics.

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