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Tradition models of nursing care delivery methods:
• Team nursing and primary nursing
Team nursing is provided by a group of people led by an RN. The often includes other RNs, practical nurses, and assistive personnel (APs).
Primary nursing one RN assumes the responsibility for a caseload of patients from admission to discharge.
Total patient care is similar to primary nursing. In this model an RN is responsible for all aspects of care for one or more patients during a shift of care, working directly with patients, families, and health team members.
Is the study of what is right and wrong in our conduct.
Ethics
Law: Right afforded to every citizen is the right to refuse treatment.
Constitutional law
What act... Requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate to advance directive.
Patient Self-Determination Act
What department?
Identifying possible risks, analyzes risks, acting to reduce risk, and evaluating the steps to reduce risks.
Risk management.
Today's model for nursing care delivery method
Patient-and-family-centered care
•Patient and family-centered care promotes mutual partnerships among the patient, family, and health care team to plan, implement, and evaluate nursing and health. The patient are family member as the source of control and full partner in providing care.
•Dignity and respect, ensuring that the care provided is given on the basis of a patient’s and family’s knowledge, values, beliefs, and cultural backgrounds.
•Information sharing, meaning that health care providers communicate and share information so that patients and families receive timely, complete, and accurate information to effectively participate in care and decision making.
•Participation, whereby patients and families are encouraged and supported in participating in care and decision making.
•Collaboration, demonstrated by the health care leaders collaborating with patients and families in policy and program development, implementation, and evaluation and patients who are fully engaged in their health care.
•Case management coordinates and links health care services across all levels of care for patients and their families while streamlining costs and maintaining quality. Case managers work with patients to identify issues and overcome barriers to help patients become healthier. Oversee the management of patients with complex nursing and medical problems (e.g., patients with diabetes or traumatic brain injury) across all levels of care.
•Case managers are often advanced practice nurses who, through specific interventions, help to improve patient outcomes, optimize patient safety by facilitating care transitions, decrease length of stay, and lower health care costs. They are accountable for cost management and quality. Case managers help patients identify health needs, determine the services and resources that are available, and make cost-efficient choices.
Usually refer to judgement about behavior, based on specific beliefs.
Morals
Two types of statutory law:
Civil laws and Criminal laws
What is the Uniform Anatomical Gift Act?
An individual who is at least 18 years of age can make an organ donation. Donors make the gift in writing. Organ donation.
What department?
Patient safety and improved care are the goals.
Quality improvement
What type of management allows for decision making to occur at the level of the staff. Shared governance.
Decentralized management. This structure creates an environment in which managers and staff become more actively involved in making decisions to shape the identity and determine the success of a health care organization.
Is a deeply held personal belief about the worth a person holds for an idea, a custom, or an object. The values that a person holds reflect cultural and social influences.
Value
Protect the right of individuals and provide for fair and equitable treatment when civil wrongs or violation occur.
Ex. Nurses Practice Acts are civil laws that define nursing and standards you must meet within individual states.
Civil laws
What is the Omnibus Budget Reconciliation Act (1987)?
• Altered the way in which health care is provided to older adults. One change focused on the use of restraints intended to change older adult behavior. It addressed the use of both physical and chemical restraint use. Application of a physical restraint or chemical restraint must be the intervention of last resort and not the first intervention of choice when a patient is nonadherent, aggressive, or combative.
•Restraints can be used (1) only to ensure the physical safety of the patient or other patients, (2) when less restrictive interventions are unsuccessful, and (3) only on the written order of a health care provider.
Define: Responsibility, autonomy, authority, accountable in decision making
ØResponsibility: duties and activities an individual is employed to perform
ØAutonomy: independent decisions about patient care
ØAuthority: legitimate power to give commands and make final decisions specific to a given position
ØAccountability: answerable for actions
Represents a branch of ethics within the field of health care.
Bioethics
Protect society and provide punishment for crimes. Violations are defined as either misdemeanors or felonies.
Criminal laws
Enhanced nurse licensure compact (eNLC)= COMPACT STATES
The process of assigning part of your responsibility to another qualified person in a specific situation
Delegation
Effective delegation results in the achievement of quality, safe patient care; improved efficiency; increased productivity; empowered staff; and skill development
What ethical term is that patient is control over their healthcare.
Autonomy
What law is considered regulatory law, more clearly defines expectation of civil and criminal laws.
Administrative law (states the duty of the nurse)
Who investigates, suspends, and/or revokes a license if a nurse's conduct violates the Nurse Practice Act.
The State Board of Nursing
Know what can be delegated to APs and LPNs
•APs attend to basic patient needs (e.g., hygiene, meal assistance, ambulation)
• LPNs can provide basic direct nursing care (e.g., observe and report clinical changes, perform wound care, and ADLs).
Doing good. Implies that the best interests of the patient remain more important than self-interest.
Beneficence
Originates from decision that were made in the absence of law.
Ex. the right to privacy is implied to the US Constitution. It prevents nurses and health care providers from sharing patient information with others who are not caring for the patient.
Common law
What is under the informed consent and health care acts?
-An explanation of the procedure or treatment
-The names and qualifications of people performing and assisting in the procedure
-A description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort.
-Knows that he or she has the right to refuse the procedure/treatment
-Knows that he or she may refuse the procedure/treatment
What are the five rights of delegation?
ØRight task, right circumstance, right person, right directions or communication and right supervision or evaluation
Refers to the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good but the equal commitment to do no harm.
Nonmaleficence
Describes decisions made in legal cases that were resolved in courts. After a case is presented to a judge or jury, there is a report of the issue, facts, findings, and subsequent decision that was made to resolve the issue. Ex. Estate of Turner v. M. Medical Center.
Case Law
Informed Consent for adults and minors (also special considerations use a professional interpreter instead of a family member).
•Adults
•A. Any competent individual 18 years of age or older for himself or herself
•B. Any parent for his or her unemancipated minor
•C. Any guardian for his or her ward
•D. Any adult for the treatment of his or her minor brother or sister (if an emergency and parents are not present)
•E. Any grandparent for a minor grandchild (in an emergency and if parents are not present).
•Minors
•A. Ordinarily minors may not consent to medical treatment without a parent. However, emancipated minors may consent to medical treatment without a parent.
•
•Emancipated minors include:
•1. Minors who are designated emancipated by a court order
•2. Minors who are married, divorced, or widowed
•3. Minors who are in active military service
•B. Unemancipated minors may consent to medical treatment if they have specific medical conditions
•1. Pregnancy and pregnancy-related conditions (Various states differ in characterizing a pregnant minor as either emancipated or unemancipated. Know your state rules in this matter.)
•2. A minor parent for his or her custodial child
•3. Sexually transmitted infection (STI) information and treatment
•4. Substance abuse treatment
•5. Outpatient and/or temporary sheltered mental health treatment
• C. The issue of emancipated or unemancipated minors does not relieve the health care provider’s duty to attempt to obtain meaningful informed consent
Refers to fairness and the distribution of resources
Justice
-Defines nursing and reflects the values of the nursing profession
-Reflect the knowledge and skill ordinarily possessed and used by nurses
-American Nurses Association (ANA)
The scope and standards of nursing
If informed consent is not given, the healthcare provider is at risk for?
What is the nurse's role in informed consent.
Battery
To witness only.
The nurses witness consent; they do not obtain consent for procedures performed by others. The nurse’s signature as a witness to the consent means that the patient appeared to voluntarily give consent, he or she appeared capable to give consent, and that the patient signed the consent in the nurse’s presence. If you suspect that the patient does not understand or did not voluntarily and/or knowingly give consent, notify the health care provider and nursing supervisor. If a patient refuses the treatment, ensure that documentation of the rejection is written, signed, and witnessed.
Refers to faithfulness or the agreement to keep promises
Fidelity
Definition: What a reasonably prudent nurse would do under similar circumstances in the geographic are in which the alleged breach occurred. What is malpractice?
Standard of proof. Malpractice is the result of nursing care falling below a standard of care. It is when the nurse had a duty of care (ex. Nurse Practice Act), that the duty was breached (ex. nursing regulations), that physical harm occurred (ex. testimony and records), an that in that state damages or monetary compensation are allowed.
Limit liability and offer immunity if a nurse helps at the scene of an accident.
Good Samaritan laws, if you perform within your scope of practice and have training. Once you start treatment you can't leave patient until transfer of care, if not this would be abandonment.
The code of nursing ethics has four principals: Advocacy, Responsibility, Accountability, and Confidentiality. Describe.
•Advocacy refers to the application of one’s skills and knowledge for the benefit of another person. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.
•Responsibility refers to a willingness to respect one’s professional obligations and to follow through. As a nurse you are responsible for your actions, the care you provide, and the tasks that you delegate to others.
•Accountability refers to answering for your own actions. You ensure that your professional actions are explainable to your patients and your employer.
•Confidentiality refers to the health care team’s obligation to respect patient privacy.
What is the Patient Protection and Affordable Care Act?
-Helped with consumer rights and protection
-Affordable health care coverage
-Increased access to care
-Quality of care that meets the needs of patient
Laws affect individuals, populations, and communities that are intended to improve the health of people
Public health laws
Value and value clarification
Value: A deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors.
Values clarification: Ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion.
What is the Emergency Medical Treatment and Active Labor Act?
When a patient presents to an emergency department, they must be treated.
Determines actual death
The Uniform Determination of Death Act
-Deontology
-Utiltarianism
-Casuistry
-Feminist ethics
-Ethics of care
Deontology defines actions as right or wrong based on their adherence to rules and principles such as fidelity to promises, truthfulness, and justice.
Utilitarianism: the value of something is determined by its usefulness. Is based on outcome or consequence of an action. The greatest good for the greatest number of people.
Casuistry: case-based reasoning. (Reviewing previous cases to make a decision).
Feminist ethics it looks at the nature of relationships to guide participants in making difficult decision, especially relationships in which power is unequal or in which a point of view has become ignored or invisible.
Ethics of care understanding relationship, emphasizing the role of the decision maker.
What is Health Insurance Portability Act (HIPPA)?
Establishes patient rights regarding privacy of their health care information and records.
Torts are civil wrongful acts or omission made against a person or property. Classified as intentional, quasi-intentional, or unintentional.
What are examples of intentional and describe.
•Intentional: Deliberate acts against a person or her property that may result in both civil and criminal action.
•Assault: an intentional threat toward another person that places the person in reasonable fear or harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur. For example, if a nurse threatens to give a patient an injection or to restrain a patient for an x-ray film procedure when the patient has refused consent.
•Battery is any intentional offensive touching without consent or lawful justification. In the example of a nurse threatening to give a patient an injection without the patient’s consent and gives the injection.
False imprisonment happens when nurses restrain a patient in a confined area, preventing the ability to move freely in a bed, chair, room, or other area in which the patient wishes to be
Ethical dilemma vs moral distress Review pg 299 for an example
Ethical dilemma: When two opposing courses of action can both be justified by ethical principles.
Moral distress: Instead of competing options for action, the nurse feels the need to take a specific action while believing that action to be wrong
What is the Health Information Technology Act?
Nurses must ensure PHI is protected
What is Quasi-intentional torts and describe them?
•Acts in which a person may not intend to cause harm to another but does. Typically, the person invades another’s privacy or in some way defames his or her character.
•Defamation of character is the publication of false statements that result in damage to a person’s reputation.
•Slander occurs when one speaks falsely about another. For example, if a nurse tells people erroneously that a patient has gonorrhea and the disclosure affects the patient’s business
Libel is the written defamation of character (e.g., charting false defamatory entries in a medical record)
What is the Americans with Disabilities Act (ADA)?
Protects rights of people with physical or mental disabilities.
What are unintentional torts and describe each?
•Unintentional torts arise when a person is harmed and the person inflicting the harm knew, or should have known, that his or her actions were less than the accepted scope and standard of practice.
•Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person. Negligent acts, such as hanging the wrong intravenous solution for a patient.
•Malpractice is a type of negligence. A person being held liable for malpractice must be a professional. Certain criteria are necessary to establish nursing malpractice: (1) the nurse (defendant) owed a duty of care to the patient (plaintiff), (2) the nurse did not carry out or breached that duty, (3) the patient was injured due to the breach in duty, and (4) damages or remedies are allowed under state law to “make the person whole” in the eyes of the court.
What is the Mental Health Parity and Addiction Equity Act?
Requires health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment.
What should a nurse do if they are floating to another unit and they are unfamiliar with a skill needed for a patient.
Speak to the unit supervisor.