Week 3 study guide.docx

STUDY GUIDE FOR WEEK 3 Introduction to the American Nurses Association Code of Ethics ============================================================== A professional code of ethics is the trademark of a profession and is a statement of goals, values, and obligations held by the members of the group...

STUDY GUIDE FOR WEEK 3 Introduction to the American Nurses Association Code of Ethics ============================================================== A professional code of ethics is the trademark of a profession and is a statement of goals, values, and obligations held by the members of the group that defines the nature of professional relationships (LeDuc & Kotzer, 2009). The American Nurses Association's (ANA) Code of Ethics for Nurses guides practice through a set of professional values expected from every member of the profession, including future nurses. The code is formally revised every 10 years, with the last revision in 2015. Miller et al. (1991) described the ANA Code of Ethics as a contract between nurses and society, and that contract is relevant in any situation. The code is non-negotiable in any setting (Fowler, 2015). As you have already learned, several key principles for nursing include advocacy, responsibility, accountability, and confidentiality. **Advocacy** "The act or process of supporting a cause or proposal. Nurses instinctively advocate for their patients, in their workplaces, and in their communities" (AACN, 2021, p. 55). **Responsibility** "An obligation to perform required professional activities at a level commensurate with one's education and in compliance with applicable laws and standards; the opportunity or ability to act independently and make decisions without authorizations; refers to the blameworthiness or praiseworthiness that one bears for one's conduct or the performance of duties. It is often expressed as liability for one's actions and may be apportioned in degree based on circumstances" (Fowler, 2015, p. 59). **Accountability** "To be answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard such as that established by the Code of Ethics for Nurses With Interpretative Statements" (Fowler, 2015, p. 59) **Confidentiality** The nondisclosure of patient secrets or information without patient authorization" - **Provision 1** - The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. - **Provision 2** - The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. - **Provision 3** - The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. - **Provision 4** - The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care. - **Provision 5** - The nurse owes the same duties to self as to others, including the responsibility\ to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. - **Provision 6** - The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conductive to safe, quality healthcare. - **Provision 7** - The nurse in all roles and settings advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. - **Provision 8** - The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. - **Provision 9** - The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. - Introduction to Ethical Principles in Nursing ============================================= Ethics is the study of right and wrong behavior. Actions that are ethical reflect a commitment to doing what is right. However, ethics may not be this straightforward in healthcare. When medical decisions must be made, disagreement may occur among professionals, families, and clients. The right thing to do may be hard to determine, particularly when values and beliefs differ. It is also important to understand that ethical issues differ from legal issues. Legal issues reference laws that are typically concrete. Ethics is broader than the law and refers to behavior and character. #### **Autonomy** Autonomy refers to freedom from external control. In healthcare, this means that we respect the client's decisions. It also means that healthcare institutions respect the autonomy of healthcare professionals. In client care, respecting autonomy means that the client is informed of all the risks and benefits of each aspect of care. Then, together with the client, the healthcare team devises a plan that matches the client's goals and values. In many cases (e.g., surgery and other invasive procedures), the client's consent is documented with their signature. Another way that nurses show respect for client autonomy is by thoroughly explaining all procedures, clarifying questions, and ensuring informed consent is obtained. In the professional workplace, respect for autonomy occurs when a nurse is reassigned duties when an assignment conflicts with personal values or beliefs. Another example is when nurses report unsafe working conditions and are protected from retaliation. #### **Beneficence** Beneficence refers to taking positive actions to help others. This concept is fundamental to nursing practice and means that nurses act with the best interests of the client in mind at all times. Nurses practice primarily in service to others. EX: Nurse taking time to provide reassurance\ to a client before a surgical procedure. Maleficence refers to harm; therefore, nonmaleficence means to avoid harm. This means that nurses strive to do good for clients but also to do no harm to clients. Sometimes these concepts are in conflict and the positive benefits must outweigh any negative consequences. For example, a bone marrow transplant involves client pain and suffering. However, it may be the best possible chance at a cure for certain conditions. A nurse starting an IV knows that the procedure\ is painful but understands the medication\ may be necessary to restore health. #### **[Justice]** #### Justice refers to fairness and the equitable distribution of resources. In healthcare, justice often refers to access to care. This often involves discussions about health insurance, hospital locations and services, and organ transplants. Another important term to learn is "just culture," which refers to the opportunity for open discussion without fear of retaliation whenever mistakes are made. Institutions that practice just culture withhold blame for mistakes so that system issues can be identified for their contribution to an error. For example, a nurse may give the wrong medication to a client, but perhaps the wrong medication was loaded into the dispensing cabinet drawer. Certainly, the nurse should have performed medication checks to catch the error but a systems error was involved as well. #### **Fidelity** Fidelity refers to faithfulness or the agreement to keep promises. As nurses, we have a duty to the clients we care for, the institutions we work for, and ourselves. In client care, we keep promises to clients. For example, if a client is in pain, nurses work to provide management interventions as quickly as possible. When we strive to provide excellent client care, fidelity is honored. In the workplace, we have a duty to be faithful to our employer. This means that nurses follow policies and procedures and show up for work on time when scheduled. We honor fidelity to ourselves when we provide for physical and emotional self-care. This includes maintaining competence and improving our skills. #### **Veracity** Veracity refers to telling the truth. For example, when conducting a research study, participants in the study must be fully informed of what will happen to them as study participants. If information is withheld, this is a violation of veracity. Steps to Resolving an Ethical Dilemma ===================================== Consider this seven-step process when attempting to resolve an ethical dilemma. - **Step 1** : Is this an ethical dilemma? - Ask yourself this question. - **Step 2** : Gather relevant information. - Sources of information may include the client, family, institutional policies, and leadership. - **Step 3** : Identify the ethical elements in the situation. - Clarify values and recognize the ethical principles involved. - **Step 4** : Name the problem. - A clear, simple statement helps to clarify the plan and facilitate discussion. - **Step 5** : Identify possible courses of action. - Seek others\' input and be creative in identifying options. - **Step 6 :** Create and implement an action plan. - Identify an alternate action if the chosen one does not Ethical Dilemma --------------- When two opposing but justifiable options are presented, often using the nursing process will identify more options for the nurse. Nurses also use the code of ethics to guide their professional moral compass. In Steven's situation, spending time with the client to understand their feelings and cultural needs may aid Steven's decision making. Talking with the family to express concerns while listening to their feelings may help as well. Moral Distress -------------- With moral distress, often the environment contributes to the problem. Discussing the situation with another person may be helpful. Working together with a supervisor or manager may best address the factors contributing to moral distress. Nurses also use the code of ethics to resolve ethical issues. In Katie's situation, there may not be time to involve others in a lengthy discussion. However, reminding the healthcare provider about the client's wishes may prompt a different outcome. After the situation, Katie should speak with a nursing supervisor to discuss this issue and how best to handle similar problems in the future. Chain of Command ================ A chain of command, also called a line of communication, is the line of authority and responsibility used to resolve administrative, clinical, or client safety issues in healthcare organizations. When a nurse is presented with a concerning issue, the proper line of authority must be followed with all communication. For example, a staff nurse usually speaks first with the charge nurse then escalates concerns to a nursing manager or supervisor. The staff nurse does not go directly to the chief nursing officer, bypassing all others in the chain of command. Code of Ethics Provision 3 ========================== Provision 3 of the American Nurses Association Code of Ethics includes protecting client information, whistleblowing, attributes for professional practice, a culture of safety, and processes to address questionable practice (Fowler, 2015). *"The nurse promotes, advocates for, and protects the rights, health, and safety of the patient" (Fowler, 2015, p. 41).* #### **Protection of the Rights of Privacy and Confidentiality** #### **Protection of Human Participants in Research** #### **Performance Standards and Review Mechanisms** #### **Professional Responsibility in Promoting a Culture of Safety** #### **Protection of Patient Health and Safety by Acting on Questionable Practice** #### **Patient Protection and Impaired Practice** Code of Ethics Provision 4 ========================== Provision 4 of the American Nurses Association Code of Ethics includes nursing authority, accountability, and responsibility, as well as delegation of nursing activities or tasks (Fowler, 2015). Select each tab below to learn more about Provision 4 of the ANA Code of Ethics. *"The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care" (Fowler, 2015, p. 59).* Scope and Standards: Standard 7 =============================== In addition to the Code of Ethics, nurses must abide by the American Nurses Association's Scope and Standards of Practice. As we review Standard 7, we learn that the registered nurse integrates ethics into all aspects of practice (ANA, 2021). The competencies expected of the nurse are: - Use the Code of Ethics for Nurses as a moral foundation to guide nursing practice and decision making. - Demonstrate that every person is worthy of nursing care through the provision of respectful, person-centered, compassionate care, regardless of personal history of characteristics (beneficence). - Advocate for client perspectives, preferences, and rights to informed decision making and self-determination (autonomy). - Demonstrate a primary commitment to the recipients of nursing and healthcare services in all settings and situations (fidelity). - Maintain therapeutic relationships and professional boundaries. - Act to prevent breaches of privacy and confidentiality. - Safeguard sensitive information within ethical, legal, and regulatory parameters (nonmaleficence). - Identify ethics resources within the practice setting to assist and collaborate in addressing ethical issues. - Integrate principles of social justice in all aspects of nursing (justice). - Refine ethical competences through continued professional education and personal self-development. - Depict one's professional nursing identity though demonstrated values and ethics, knowledge, leadership, and professional behavior. - Engage in self-care and self-reflection to support personal health and well-being. - Contribute to the establishment and maintenance of an ethical environment to support safe, quality care. - Collaborate with other healthcare professionals and the public to protect human rights, promote health diplomacy, enhance cultural sensitivity, and reduce health disparities. - Represent the nursing perspective in all ethical discussions. Scope and Standards: Standards 15, 16, and 17 ============================================= If we continue to review the American Nurses Association's Scope and Standards of Practice, Standards 15, 16, and 17, we learn more about quality of practice, professional practice evaluation, and resource stewardship (ANA, 2021). Select the tabs below for details. American Nurses Association Scope and Standards of Practice =========================================================== Nurses provide services based on specific standards of practice and a code of ethics. You have already been introduced to the code of ethics. In this lesson, you will learn more about the scope and standards for nursing. "The Scope of Nursing Practice describes the who, what, where, when, why, and how associated with nursing practice and roles" (ANA, 2021, p. 3). Since 1960, the American Nurses Association has defined the scope of nursing and developed standards for professional practice. This publication guides nurses to make significant contributions that improve the health and well-being of clients, communities, and populations. As a future nurse, it is important that you understand nursing's professional expectations. In this lesson, you will explore the American Nurses Association Scope and Standards of Practice. **Standard 1. Assessment** The registered nurse collects pertinent data and information relative to the healthcare consumer's health or the situation. **Standard 2. Diagnosis** The registered nurse analyzes assessment data to determine actual or potential diagnoses, problems, or issues. **Standard 3. Outcomes Identification** The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. **Standard 4. Planning** The registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes. **Standard 5. Implementation** The registered nurse implements the identified plan. **Standard 5A. Coordination of care** The registered nurse coordinates care delivery. **Standard 5B. Health Teaching and Health Promotion** The registered nurse employs strategies to teach and promote health and wellness. **Standard 6. Evaluation** The registered nurse evaluates progress toward attainment of goals and outcomes. **Standard 7. Ethics** The registered nurse integrates ethics in all aspects of practice. **Standard 8. Advocacy** The registered nurse demonstrates advocacy in all roles and settings. **Standard 9. Respectful and Equitable Practice** The registered nurse practices with cultural humility and inclusiveness. **Standard 10. Communication** The registered nurse communicates effectively in all areas of professional practice. **Standard 11. Collaboration** The registered nurse collaborates with the healthcare consumer and other key stakeholders. **Standard 12. Leadership** The registered nurse leads within the profession and practice setting. **Standard 13. Education** The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking. **Standard 14. Scholarly Inquiry** The registered nurse integrates scholarship, evidence, and research findings into practice. **Standard 15. Quality of Practice** The registered nurse contributes to quality nursing practice. **Standard 16. Professional Practice Evaluation** The registered nurse evaluates one's own and others' nursing practice. **Standard 17. Resource Stewardship** The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously. **Standard 18. Environmental Health** The registered nurse practices in a manner that advances environmental safety and health. Standards 8 and 12-14 ===================== Throughout this course, you will explore all 18 scope and standards. Here we will discuss standards 8, 12, 13, and 14 (ANA, 2021). Each standard has a general statement and numerous action statements, which explain how the nurse demonstrates the standard. Select each item to learn more about these specific standards. #### **Standard 8. Advocacy** #### **Standard 12. Leadership** #### **Standard 13. Education** #### **Standard 14. Scholarly Inquiry** Standard 12 Leadership ====================== Let's further explore Standard 12 -- Leadership. Nurses are responsible for leading decision-making groups and promoting effective relationships to achieve quality outcomes and a culture of safety. Additionally, nurses are to implement evidence-based practices and mentor colleagues to enhance knowledge. Finally, nurses must advocate for all aspects of human and environmental health in practice and policy (ANA, 2021). Code of Ethics Provision 7 ========================== Though different documents, the ANA "Scope and Standards of Practice" and the "Code of Ethics" are closely related. Since we just discussed the standards of education and scholarly inquiry, let's review Provision 7 of the code of ethics. Provision 7 requires that nurses study research and use scholarly inquiry to advance the profession (Fowler, 2015). *"The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy" (Fowler, 2015, p. 113).* #### **Contributions through Research and Scholarly Inquiry** #### **Contributions through Developing, Maintaining, and Implementing Professional Practice Standards** #### **Contributions through Nursing and Health Policy Development** Introduction to the Nursing Process =================================== The nursing process is a critical thinking five-step process that professional nurses use to apply the best available evidence to deliver nursing care. It is a systematic, rational method of organizing and providing client care. The nursing process involves five cyclical and dynamic steps, which are all interrelated. The steps in the nursing process are: 1. assessment 2. diagnosis or analysis 3. planning and outcome identification 4. implementation 5. evaluation These are the core essential standards of nursing practice as developed by the American Nurses Association. All registered nurses must be able to competently perform each step. Critical Thinking ================= Critical thinking is the ability to think in a systematic and logical manner with openness to questions and reflection on the reasoning process. It is an essential process for safe, efficient, and skillful nursing intervention. Critical thinkers do not passively accept information from others or view information hastily. Critical thinkers question, seek, and look for answers and the deep meaning in information. In fact, you think critically every day! Let's review an example of critical thinking. -- -- Critical Thinking for Nurses ============================ **Clinical Judgment** A conclusion about a client's needs or health problems and the decision to take or avoid action **Diagnostic Reasoning** Analytical process for determining a client's health problems **Clinical Inference** Process of drawing conclusions from related pieces of evidence and previous experience **Clinical Decision Making** Choosing the best option for the best client outcomes based on the client's condition and problems **Concept Map** Visual representation of a client's problems and interventions that shows their relationship to one another **Deductive Reasoning** Moves from reviewing general knowledge to the specific pieces of evidence **Inductive Reasoning** Moves from reviewing specific data elements to making a conclusion about the related pieces of evidence **Reflection** A part of the critical thinking process that involves purposefully reviewing a situation to discover its meaning **Components of Critical Thinking** 1\. **Knowledge Base**\ Prepares you to anticipate and identify client problems.\ 2. **Experience**\ Clinical learning experiences are necessary to acquire clinical decision-making skills.\ 3. **Competence**\ You must know how to use the nursing process and perform nursing skills competently.\ 4. **Attitude**\ There are 11 attitudes that define a critical thinker's approach to problem solving: confidence, independent thinking, fairness, responsibility and authority, risk taking, discipline, perseverance, creativity, curiosity, integrity, and humility.\ 5. **Standards**\ Professional standards guide nursing practice. Standards come from nurse practice acts, institutional practice guidelines, and professional organizations. **Thinking About Actions (reflect)** - Did you achieve the goals of the plan? - Could anything have been done differently? - Did you work well with the team? - Did you communicate well? - What should you do in a similar situation in the future? **Thinking Ahead Actions (anticipate)** - Nurses anticipate equipment and supplies needed, how long an activity will take, and how the client will respond. **Thinking in Action (act)** - Nurses evaluate client response to interventions and act accordingly. We reprioritize and adjust the plan of care throughout the day based on client needs. We troubleshoot problems as they arise. **Scientific Method Compared to the Nursing Process** Scientific Method - State an observed problem - Form an hypothesis about the problem - Develop a method to test the hypothesis - Perform the experiment - Draw conclusions Nursing Process - Assessment - Diagnosis/Analysis - Planning - Implementation - Evaluate **Objective Data** Objective data is information collected using our five senses. Can we hear it, touch it, smell it, see it, or taste it? Of course, we do not taste our clients! But we do use our senses to collect objective assessment data. This information is either a measurement or an observation. Examples: vital signs, wound appearance, client gait, and laboratory values Documentation example: The client presents to the clinic for a physical examination. The nurse auscultates lung sounds as clear bilaterally. The heart rate is regular and 68 beats per minute. The respiratory rate is 18 per minute and oxygen saturation is 99%. **Subjective Data** Subjective data is information that the client tells the nurse. It is often found in quotation marks in the medical record. We cannot verify the information using our five senses to observe or measure the data. **Nursing Versus Medical Diagnoses** A medical diagnosis is the identification of a disease condition based on specific evaluation of signs and symptoms, the client's medical history, and the results of diagnostic testing or procedures. A medical diagnosis is what the client has, not necessarily what the client needs. Nurses cannot treat medical diagnoses. A nursing diagnosis is a clinical judgment made by a nurse to describe a client's response to a health condition that a nurse is licensed and competent to treat. A nursing diagnosis is what you are going to do about the medical diagnosis. Nurses can treat a client's response to a health condition. For example: **Medical Diagnosis** **Nursing Diagnosis** ----------------------- --------------------------------------------------- Heart Failure Decreased cardiac output Diabetes Mellitus Imbalanced nutrition: less than body requirements Dysphasia Impaired verbal communication **Prioritizing Nursing Diagnoses** Often, clients have more than one problem that needs to be addressed. Therefore, our nursing diagnoses must be prioritized. To do this, the nurse determines what the immediate client need is, what can wait to be addressed, and what can be deferred. By prioritizing client problems, we can properly order nursing care interventions. Now, prioritizing does not mean that one problem must be completely resolved before we begin working on another problem, but the immediate need will take precedence over other client problems. Sometimes decreasing the severity or resolving one problem helps to eliminate another. You will learn more about how to prioritize client problems in future courses. Planning: What is Your Plan to Address the Problem? =================================================== After identifying nursing diagnoses, the nurse begins the planning step of the nursing process. Planning is a deliberative, systematic phase of the nursing process that involves decision making and problem solving. The goal is to develop an individualized plan of care that specifies client goals and desired outcomes and to choose related nursing interventions. Goals and desired outcomes describe what the nurse hopes to achieve by implementing the plan of care. These can be short term or long term. Let's learn more about the goals and outcomes during the planning process. Outcomes must be SMART: - **S**pecific: Outcomes should be specific and narrow for more effective planning. Example: "The client" - **M**easurable: Define what evidence will prove the client is making progress with the outcome. Example: "will drink" - **A**ttainable or Achievable: Make sure the client can reasonably accomplish the outcome within the specified timeframe. Example: "100 mL of water every hour" - **R**elevant: Outcomes should align with the client\'s goals. Example: "without vomiting" - **T**ime-based: Outcomes should be realistic with a set end date/time. Example: "by 15:00." All together: The client will drink 100 mL of water every hour without vomiting by 15:00. Implementation: What Are You Doing to Address the Problem? ========================================================== Implementation is the fourth step in the nursing process and begins after the plan of care is developed. It involves the performance of nursing actions or interventions needed to achieve the goals and desired outcomes to support client health. A nursing action or intervention is any treatment based on clinical judgment and knowledge that a nurse performs to achieve client outcomes. They should be evidence-based approaches and are either indirect or direct care measures. Explore the difference between direct and indirect care measures. Implementation: What Are You Doing to Address the Problem? ========================================================== Implementation is the fourth step in the nursing process and begins after the plan of care is developed. It involves the performance of nursing actions or interventions needed to achieve the goals and desired outcomes to support client health. A nursing action or intervention is any treatment based on clinical judgment and knowledge that a nurse performs to achieve client outcomes. They should be evidence-based approaches and are either indirect or direct care measures. Explore the difference between direct and indirect care measures. measures. Evaluation: How is the Plan Working? ==================================== Evaluation is the fifth step in the nursing process that determines whether a client's condition is improving after nursing interventions are delivered. In this step, the nurse measures the degree to which the goals and desired outcomes have been met. The end goal is to decide if the plan of care should continue, be modified, or terminated. **Promoting Wellness** Knowledge - Underlying disease processes - Normal growth and development - Normal physiology and psychology - Normal assessment findings - Health promotion - Assessment skills - Communication skills Standards - ANA Scope and Standards of Nursing - Specialty standards of practice - Intellectual standards of measurement Attitudes - Perseverance - Fairness - Integrity - Confidence - Creativity Experience - Previous patient care experience - Validation of assessment findings - Observations of assessment techniques