Nursing Theories and Informed Consent

Legal Principles in Nursing

• Laws prescribe how people should act in society.
• Health care workers can face civil or criminal liability depending on the specific circumstances.
• Standards of care are the legal requirements for nursing practice; they describe the minimum acceptable nursing care.
• Standards reflect the knowledge and skill that nurses typically possess and use in practice.
• The Turkish Nurses Association (TNA) develops standards for nursing practice, policy statements, and resolutions.

Civil and Common Law Issues in Nursing Practice

• A tort is a civil wrong against a person or property.
• Torts can be intentional, quasi-intentional, or unintentional.

Intentional Torts

• Intentional torts involve actions like hitting someone (battery) or damaging their reputation (defamation).

Quasi-intentional Torts

• Quasi-intentional torts involve actions where the harm wasn't intended, but still caused an error, like accidentally violating someone's privacy.

Unintentional Torts

• Unintentional torts usually involve mistakes or accidents, like giving the wrong medication (negligence).

Assault and Battery

• Assault: Threatening physical harm to a patient. No actual contact needed.
• Battery: Intentional physical contact without consent. This includes a potentially harmful injection given or a procedure beyond the patient's consent, like performing a tonsillectomy after appendectomy consent. Consent plays a critical role.

Invasion of Privacy

• Release of a patient's medical information to unauthorized people (e.g., press, employer, family) is a privacy violation.
• Patient's medical records are confidential; sharing is limited to only those related to medical treatment.

Negligence and Malpractice

• Negligence occurs when a person's conduct falls below a standard of care (e.g., a driver failing to stop at a stop sign is negligent).
• Malpractice is a form of professional negligence, and specific criteria must be met for it to be established in a nursing context:
  • The nurse had a duty to the patient.
  • The nurse did not uphold that duty.
  • The patient was harmed.
  • The nurse's actions caused the patient's harm.
• A pie chart on page 12 shows the breakdown of medical malpractice claims between 2017-2021.

Consent

• Signed consent forms are needed for routine treatment, hazardous procedures (e.g., surgery), some treatment programs (e.g., chemotherapy), and research involving patients.
• Patients sign general consent forms when admitted to a hospital or healthcare facility.
• Separate special consent forms are required for specific procedures.
• Nurses need to understand laws regarding consent in their states and their employer's policies.
• Informed consent is a patient's agreement to treatment; it's not valid if only in an emergency.

Nursing Students

• Nursing students are liable if their actions cause harm to patients.
• The university or educational institution shares liability for harm caused by the student if it is a direct result of a student's action, or lack of action.
• Students are expected to perform as professional nurses would, providing safe patient care.
• Students should not perform tasks without direct supervision by a staff nurse or instructor.

Health Care Providers' Orders

• Health care providers (doctors, nurses) are responsible for directing medical treatment.
• Nurses should follow health care providers' orders unless they believe the orders are wrong or harmful.
• Nurses need to assess orders for potential mistakes or harm; if necessary, further clarification from the health care provider is needed.

Theoretical Foundations of Nursing

• Theory-based nursing practice is essential for designing and implementing interventions.

Nursing Theories

• Nursing theories classify nursing as unique from other disciplines, providing a framework for practice.

History of Nursing Theories

• Florence Nightingale's theory emphasized the environment's role in recovery, including cleanliness.
• Hildegard Peplau's theory focused on interpersonal relationships.
• Virginia Henderson emphasized patient independence in meeting basic needs.

Classification of Nursing Theories

• Grand theories are broad in scope.
• Middle-range theories address specific phenomena.
• Practice-level theories provide very specific, daily nursing actions.

The Nursing Metaparadigm

• The metaparadigm defines the main parts of nursing, including boundaries.

Think About...

• The unifying thread among diverse nursing roles is their shared theoretical foundations and the need to meet patient needs in different settings.

The Domain of Nursing

• Nursing is the diagnosis and treatment of human responses to actual or potential health problems.

Grand Theories

• Grand theory includes theories that are broad in scope and conceptual, which include Florence Nightingale's Environmental Theory and Dorothea Orem's Self-Care Deficit Theory.

Middle-Range Nursing Theories

• Middle-range nursing theories are more focused and specific, addressing specific phenomena; the theories include Patricia Benner's Novice to Expert Theory and Pender's Health Promotion Model.

Practice-Level Nursing Theories

• Practice-level nursing theories are very specific to daily nursing actions, like the Theory of Wound Healing and Postpartum Depression Theory.

Nursing Theorists

• Florence Nightingale: Environment, cleanliness, fresh air, and light
• Hildegarde Peplau: Interpersonal relationships, therapeutic interventions
• Virginia Henderson: Patient independence and basic needs
• Faye Abdellah: 21 nursing problems, patient-centered care
• Ida Orlando: Nursing process, validation of inferences; allows for adaptable plans
• Myra Estrin Levine: Conservation Model.
• Joyce Travelbee: Human-to-human relationships.
• Betty Neuman: Stress and variables affecting response.
• Sister Callista Roy: Adapting to changes, and promotion of health.
• Dorothea Orem: Self-care theory.

Nursing Models

• Maternal Role Attainment: Developmental and interactional process with mother and baby.
• Self-Efficacy: Personal factors, motivation, and feelings concerning health
• Life Perspective Rhythm: Develops nursing process towards health and growth.
• Health Promotion: Increasing patient's well-being.

Gordon's 11 Functional Health Patterns

• This model collects patient data based on health patterns, useful in nursing education settings.

Continued Evolution of Nursing Theory

• Nursing practice relies on both legal and theoretical foundations. Key theorists have influenced modern practice and continue to impact education and research.
• Deep understanding of concepts enhances professionalism.
• Continuing study is crucial to advance the profession.