Podcast
Questions and Answers
In the context of healthcare ethics, which principle emphasizes taking positive actions to help others?
In the context of healthcare ethics, which principle emphasizes taking positive actions to help others?
- Nonmaleficence
- Autonomy
- Beneficence (correct)
- Justice
A patient refuses a blood transfusion despite the medical team's recommendation. Which ethical principle is primarily involved in respecting the patient's decision?
A patient refuses a blood transfusion despite the medical team's recommendation. Which ethical principle is primarily involved in respecting the patient's decision?
- Beneficence
- Justice
- Fidelity
- Autonomy (correct)
A nurse discovers that they made a medication error but no one observed it. Aligned with the ANA Code of Ethics, what action should the nurse prioritize?
A nurse discovers that they made a medication error but no one observed it. Aligned with the ANA Code of Ethics, what action should the nurse prioritize?
- Discussing the error with colleagues without reporting it
- Reporting the error to ensure patient safety and prevent future incidents (correct)
- Omitting the error to protect their professional reputation
- Documenting the error in the patient’s chart
Which ethical principle could be most challenged in an emergency situation involving a mass casualty event where resources are limited?
Which ethical principle could be most challenged in an emergency situation involving a mass casualty event where resources are limited?
What is the primary purpose of values clarification in nursing practice?
What is the primary purpose of values clarification in nursing practice?
Which action violates patient confidentiality and professional boundaries in the context of social networking?
Which action violates patient confidentiality and professional boundaries in the context of social networking?
Which of the following resources typically provides guidance on complex ethical issues within a healthcare organization?
Which of the following resources typically provides guidance on complex ethical issues within a healthcare organization?
A nurse is unsure about the right course of action in an ethical dilemma. What should the nurse do first?
A nurse is unsure about the right course of action in an ethical dilemma. What should the nurse do first?
What does the ethical principle of fidelity primarily emphasize in the nurse-patient relationship?
What does the ethical principle of fidelity primarily emphasize in the nurse-patient relationship?
Which is an example of a situation where a nurse might face a dilemma related to accountability?
Which is an example of a situation where a nurse might face a dilemma related to accountability?
What is the primary focus of standards of care in nursing practice?
What is the primary focus of standards of care in nursing practice?
Which organization plays a key role in ensuring uniformity in nursing licensure across different states?
Which organization plays a key role in ensuring uniformity in nursing licensure across different states?
A registered nurse (RN) delegates a task to a licensed vocational nurse (LVN). According to delegation principles, who retains the accountability for the overall outcome?
A registered nurse (RN) delegates a task to a licensed vocational nurse (LVN). According to delegation principles, who retains the accountability for the overall outcome?
Which task is within the scope of practice of an RN but typically outside the scope of practice for a UAP?
Which task is within the scope of practice of an RN but typically outside the scope of practice for a UAP?
In the context of nursing, what does 'scope of practice' primarily define?
In the context of nursing, what does 'scope of practice' primarily define?
Which type of law deals with the rights and duties of private individuals or organizations?
Which type of law deals with the rights and duties of private individuals or organizations?
A nurse is charged with negligence for failing to monitor a patient adequately, leading to patient harm. Under which type of law would this case most likely be tried?
A nurse is charged with negligence for failing to monitor a patient adequately, leading to patient harm. Under which type of law would this case most likely be tried?
Which of the following is a key criterion that must be met to prove malpractice against a nurse?
Which of the following is a key criterion that must be met to prove malpractice against a nurse?
A nurse fails to follow the seven rights of medication administration, resulting in a patient receiving the wrong dose of medication. This scenario is an example of:
A nurse fails to follow the seven rights of medication administration, resulting in a patient receiving the wrong dose of medication. This scenario is an example of:
Which law ensures patient privacy and the confidentiality of health information?
Which law ensures patient privacy and the confidentiality of health information?
What is the primary purpose of Good Samaritan laws?
What is the primary purpose of Good Samaritan laws?
A nurse witnesses a colleague diverting narcotics for personal use but does not report it. Which legal and ethical concept is the nurse violating?
A nurse witnesses a colleague diverting narcotics for personal use but does not report it. Which legal and ethical concept is the nurse violating?
What is the primary purpose of an incident report?
What is the primary purpose of an incident report?
What is the Safe Harbor Peer Review?
What is the Safe Harbor Peer Review?
Which of the following is the best description of a living will?
Which of the following is the best description of a living will?
What should the nurse recognize in a patient with an advanced directive?
What should the nurse recognize in a patient with an advanced directive?
A competent, adult patient with a terminal illness decides to discontinue treatment. The healthcare team disagrees with this decision, believing that continuing treatment is in the patient's best interest. What is the ethically appropriate course of action?
A competent, adult patient with a terminal illness decides to discontinue treatment. The healthcare team disagrees with this decision, believing that continuing treatment is in the patient's best interest. What is the ethically appropriate course of action?
A nurse is caring for a patient who is scheduled for surgery. Which action demonstrates the nurse's role in ensuring informed consent?
A nurse is caring for a patient who is scheduled for surgery. Which action demonstrates the nurse's role in ensuring informed consent?
A nurse suspects that a colleague is impaired while on duty. What is the most appropriate initial action for the nurse to take?
A nurse suspects that a colleague is impaired while on duty. What is the most appropriate initial action for the nurse to take?
Which of the following situations represents a potential conflict between patient autonomy and beneficence?
Which of the following situations represents a potential conflict between patient autonomy and beneficence?
In which scenario would the Emergency Medical Treatment and Active Labor Act (EMTALA) be most relevant?
In which scenario would the Emergency Medical Treatment and Active Labor Act (EMTALA) be most relevant?
A patient reports that a nurse shared confidential medical information with an unauthorized person. Which legal tort has the nurse committed?
A patient reports that a nurse shared confidential medical information with an unauthorized person. Which legal tort has the nurse committed?
A patient who is competent refuses to take a medication. The nurse threatens to restrain the patient and administer the medication against their will. Which tort is the nurse committing?
A patient who is competent refuses to take a medication. The nurse threatens to restrain the patient and administer the medication against their will. Which tort is the nurse committing?
Following a total hip arthroplasty, a nurse fails to provide adequate education to the patient about rehabilitation exercises. As a result, the patient experiences complications and prolonged recovery. Which element would be needed to prove malpractice?
Following a total hip arthroplasty, a nurse fails to provide adequate education to the patient about rehabilitation exercises. As a result, the patient experiences complications and prolonged recovery. Which element would be needed to prove malpractice?
The nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA). Without permission, the nurse tells the patient's roommate the diagnosis. Which tort has the nurse committed?
The nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA). Without permission, the nurse tells the patient's roommate the diagnosis. Which tort has the nurse committed?
A nurse is served with a subpoena to testify in a legal case involving a former patient. What is the nurse's legal obligation?
A nurse is served with a subpoena to testify in a legal case involving a former patient. What is the nurse's legal obligation?
What is the primary goal of risk management programs in healthcare facilities?
What is the primary goal of risk management programs in healthcare facilities?
A nurse is asked to float to a critical care unit, but they have never oriented to that area and do not feel competent to care for the patients. Which of the following actions is most appropriate?
A nurse is asked to float to a critical care unit, but they have never oriented to that area and do not feel competent to care for the patients. Which of the following actions is most appropriate?
When can a nurse refuse an assignment?
When can a nurse refuse an assignment?
A nurse discovers that a colleague is stealing narcotics. Aside from reporting to a supervisor, what else should the nurse recognize?
A nurse discovers that a colleague is stealing narcotics. Aside from reporting to a supervisor, what else should the nurse recognize?
The nurse delegates a task to the nursing assistant but finds out the task was improperly performed. What is something to remember?
The nurse delegates a task to the nursing assistant but finds out the task was improperly performed. What is something to remember?
The nurse suspects the health care provider of being under the influence and potentially harming patients on the floor. Who else should the nurse notify besides their immediate supervisor?
The nurse suspects the health care provider of being under the influence and potentially harming patients on the floor. Who else should the nurse notify besides their immediate supervisor?
What is autonomy?
What is autonomy?
Flashcards
Autonomy
Autonomy
Freedom from external control or influence, respects patient's rights.
Beneficence
Beneficence
Taking positive actions to help others; doing good for patients.
Nonmaleficence
Nonmaleficence
The avoidance of harm or hurt; striving to do no harm to patients.
Justice
Justice
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Fidelity
Fidelity
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Advocacy
Advocacy
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Accountability
Accountability
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Responsibility
Responsibility
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Confidentiality
Confidentiality
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Value
Value
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Values clarification
Values clarification
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Standards of Care
Standards of Care
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Delegation
Delegation
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Civil Law
Civil Law
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Criminal Law
Criminal Law
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Duty (Malpractice)
Duty (Malpractice)
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Breach (Malpractice)
Breach (Malpractice)
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Causation (Malpractice)
Causation (Malpractice)
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Damages (Malpractice)
Damages (Malpractice)
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Incident Based
Incident Based
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Safe harbor
Safe harbor
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Study Notes
Ethical Considerations
- Terminology relating to ethics
- Nursing code of ethics
- Values that pertain to ethical decisions
- Ethical dilemmas that may challenge the nurse
Basic Terms In Health Ethics
- Autonomy is freedom from external control
- Beneficence means taking positive actions to help others
- Nonmaleficence is the avoidance of harm or hurt
- Justice is fairness
- Fidelity is an agreement to keep promises
Potential Ethical Dilemmas
- Autonomy dilemmas include no informed consent or infringing on right to refuse treatment
- Beneficence ethical dilemmas are utilitarianism in emergent situations and weighing pain management versus addiction risk
- Nonmaleficence ethical dilemmas are unintended harm of therapy, like chemotherapy or CPR
- Justice dilemmas could involve resource allocation or treatment for the uninsured
- Fidelity ethical dilemmas are confidentiality vs. safety and broken promises
ANA Code of Ethics
- Provides a framework for ethical practice in nursing
- The initial code was developed in the 1950s and it gets ongoing revisions
- The most recent revision was in 2015
ANA Code of Ethics - Tenets
- Advocacy is the support of a particular cause
Potential dilemmas are:
- Patient autonomy versus family wishes
- Informed consent
- Responsibility is respect for professional obligations and follow through
Potential dilemmas are:
- Competency and safety
- Personal values versus professional obligations
- Accountability is the ability to answer for own actions and are explainable
Potential dilemmas are:
- Mistakes and reporting
- Professional behavior
- Confidentiality is respect for patient privacy
Potential dilemmas are:
- Disclosure to family
- Shared workspace
Social Networking
- Social networking may assist in professional development, networking, support/education;
- Social networking presents risks to privacy, confidentiality, and professional boundaries
Values and Clarification
- Values are personal beliefs about the worth of a given idea, attitude, custom or object that sets standards and influences behavior
- Values clarification is the process of identifying and understanding personal values and how they influence nursing decision making
Processing an Ethical Dilemma
- Identify the dilemma
- Gather relevant information
- Clarify values
- Verbalize the problem objectively
- Identify possible courses of action
- Develop a plan
- Evaluate plan over time
Institutional Resources
- Family Conference facilitates effective and direct communication between healthcare providers, patients, and families.
- Staff Meeting provides a forum for discussing issues and seeking input from colleagues.
- Ethics Committee is a multidisciplinary group that provides guidance on complex ethical issues.
Emerging Hot Topics
- A.I. & Machine learning technologies are seeing increased use in healthcare practices.
- This raises ethical considerations regarding bias and fairness as well as privacy and security
- Telemedicine is a viable option for delivering patient care, but presents challenges related to access, equity, and quality of care.
- Genetics is a hot topic because genetic testing and personalized medicine bring up issues of genetic privacy and genetic discrimination.
- Inequities that impact access and outcomes among demographic groups bring up questions of equity in access and resource allocation
- Reproductive issues that include contraception, abortion, fertility, & gender transitions must address autonomy, choice, access & restrictions
- End of life care and decision making must address respecting wishes and family conflict when deciding about advance directives & DNR
Legal Considerations
- Standards of Care
- Delegation
- Laws
- Negligence & Malpractice
- Incident Reports & Peer Review
Standards of Care
- Refer to the guidelines and expectations for nursing practice that ensure safe, effective, and ethical care delivery.
Governing Bodies
- ANA (American Nurses Association) provides a framework for professional conduct.
- State Boards regulate licensure requirements for nurses
- Accrediting Organizations establish quality and safety benchmarks for healthcare institutions
- CMS enforces and regulates quality and safety standards
- NCSBN (National Council of State Boards of Nursing) oversees NCLEX exams and promotes uniformity in nursing licensure across states
- Professional Associations provide professional guidelines and support for nurses
Delegation
- It is the transfer of responsibility for the performance of an activity or task, while retaining accountability for the outcome.
- Delegation benefits include: achievement of quality, improved efficiency, increased productivity, empowered staff, trust among co-workers, facilitating skill development of others
- Delegated tasks must adhere to:
- Refer to your state Nurse Practice Act
- Institutional policy and procedure
- Effective delegation requires constant communication
- Right Task
- Right Circumstance
- Right Person
- Right Direction/Communication
- Right Supervision/Evaluation
Delegation and Scope of Practice
- UAP (Unlicensed Assistive Personnel) can perform:
- vital signs, glucose/finger sticks, ambulation, stool/urine specimen collection, client transport, ROM exercises, assistance with ADLs.
- LVN (Licensed Vocational Nurse) and LPNs (Licensed Practical Nurse) can perform all duties of the UAP and:
- medication administration, dressing changes, ongoing assessments
- LVNs cannot to perform initial assessments or triage.
- RNs can perform activities related to the nursing process, development of care plans, patient education, initial assessment, and triage, in addition to duties of a UAP and LPN / LVN
- SNs (Student Nurses) are allowed to perform nursing tasks as part of academic program
- If employed by a facility, must practice under skill level as UAP
Laws Impacting Nursing Practice
- Civil and Common Law Issues
- Torts
- Federal and State Laws
Civil Law vs. Criminal Law
- Civil Law protects the rights of individuals and provides for fair and equitable treatment when civil wrongs or violations occur
- Criminal Law protects society as a whole and provide punishment for crimes, which are defined by municipal, state, or federal legislation
Criteria for Malpractice Suits
- Duty: There must be a legal duty of care owed by the nurse to the patient.
- Breach: The nurse's conduct must violate their responsibility to the patient, falling below the standards of care.
- Causation: Nurse’s action or inaction causes the injury? Was the patient's injury foreseeable?
- Damages: The patient must suffer some type of harm or injury as a result of the misconduct.
Common Sources of Negligence and Malpractice
- Failure to assess and/or monitor
- Failure to notify health care provider of significant change in patient status
- Failure to respond to or correctly implement new/existing orders
- Failure to follow 7 rights of medication administration
- Failure to convey discharge instructions to patient and/or family
- Failure to ensure patient safety
- Failure to follow policies & procedures
- Failure to properly delegate and supervise
Federal & State Laws
- ACA (Affordable Care Act)
- ADA (Americans with Disabilities Act)
- UAGA (Uniform Anatomical Gift Act)
- HIPAA (Health Insurance Portability and Accountability Act)
- EMTALA (Emergency Medical Treatment and Labor Act)
- PSDA (Patient Self-Determination Act)
- Good Samaritan Laws
- Public Health Laws
- Determination of Death Laws
- Autopsy regulations
- Death with Dignity Laws
- Termination of Pregnancy Laws
Risk Management
- An incident report provides a database for further investigation to determine deviations from standards of care and to identify corrective measures needed to prevent reoccurrence
Peer Review
- Incident Based Peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses
- Safe Harbor Peer review can be initiated by a LVN, RN or APRN prior to accepting an assignment that they believe would place patients at risk of harm
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