Growth & development theories/Accountability & Liability & ETHICS

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1

The nurse is assigned to care for James Thomas, 54 a -year-old contractor who is recovering at home from a fall that caused a fractured femur and fractures in both arms. His wife Julie has taken a family leave of absence from work to take care of her husband. They have 4 children who are 25, 17, 12, & 5 years of age. The 5-year-old son is at home during the nurse’s visit.

The nurse is developing a care plan for James. She wants to make sure that she includes not only physical needs but also psychological. She refers to Erikson’s stages of development to help her in planning care. The nurse identifies that James is in which stage of development?

Generativity versus self-absorption

P & P 9th p. 133-134

2

James tells the nurse that his 5-year-old son has been acting up since he came home from the hospital. The nurse tells James that his son is in the initiative versus guilt stage of development. What are some signs that he is progressing appropriately through this stage? He:

plays quietly instead of jumping on his father’s bed, as his mother requested.

P & P 9th p. 134

3

Later in the week the nurse meets Jennifer, James’ pregnant 25 year old daughter. Jennifer asks the nurse about how she can keep her unborn baby healthy. The nurse starts the teaching by including the three risk factors that have been cited as posing possible impacts to prenatal development. These can be explained by the nurse as:

nutrition, stress and mother's age.

P & P p.142

4

James shares with the nurse that his father who is 85 years old has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He recently moved into a new apartment and his dog died 2 months ago. He is alert, but becomes easily distracted during conversations. James also notes that it is unusual for his father to not change his clothes daily, as well as James notes his father to have a foul odor. The nurse identifies which of these impairments is the most likely cause of his behavior?

Depression

P & P 9th p. 180-181

5

A year later, the nurse is working in a pediatrician’s office and encounters Jennifer. Jennifer brought in her 6-month-old infant for a well-child check. As the nurse interviews Jennifer, which of her statements indicates to the nurse that there is a need for further teaching?

"I've started giving her fruit juice to increase her vitamin intake."

6

Mary Gardner is a 58-year-old patient who is divorced with four grown children. Mrs. Gardner has amyotrophic lateral sclerosis (ALS), a serious neurologic disease that causes muscle weakness, disability, and eventually death. She has become debilitated and is not able to communicate to any needs and often does not respond. She is in the hospital for a urinary tract infection. Her primary care physician (PCP) is out of town, and a hospitalist is seeing her while her PCP is gone.

Mary’s son tells the nurse that his mother had indicated earlier in her illness that she did not want to be resuscitated. Although this is the case, he is unsure if this is still Mary’s wish & unsure if that is the best choice now. The nurse asks the son if Mary has an advanced directive. The son asks the nurse what that is.

Which of the following descriptions should be the basis for nurse to formulate a response?

It documents the wishes of a person in the event that he or she is incapacitated or appoints someone to make those decisions on his or her behalf.

P & P 9th p. 305 Advanced directives include living wills, healthcare proxies, & power of attorney, and DNR

7

Mary’s oldest daughter arrives and provides the document that indicates that she is the durable power of attorney for healthcare (DPAHC). The children decide that they want everything done for Mary. The nurse tells the hospitalist about this conversation. The hospitalist writes a DNR order and tells the nurse not to tell the family. The nurse decides that this is an ethical & legal dilemma because the patient has a DPAHC.

The nurse refers to the Code of Ethics for Nursing to reflect on this scenario. Which of the following statements are true about the American Nurses Association (ANA) Code of Ethics? (Select all that apply.)

  • The ANA Code of Ethics promotes principles of responsibility, accountability, and advocacy.
  • It is a guide for carrying out nursing responsibilities and obligations that provide quality nursing care.
8

The nurse notifies the nurse manager about this issue. The nurse manager advises that the ethics committee would be a good place to share this issue. What is the purpose of the ethics committee within a health care organization? (Select all that apply)

  • Ethical case consultation
  • Recommendation of policies and procedures related to ethics
  • Provision of multidisciplinary input
  • Facilitation of education about topical issues in clinical ethics
  • P & P 9th p. 297
9

This ethical/legal scenario inspired the nurse to review key terms. Arrange the descriptions to match the terms.

1) Consent

2)False Imprisonment

3)Negligence

4) Malpractice

5)Slander

6)Assault

7)Invasion of Privacy

8)Informed Consent

9)Battery

1)A signed form giving permission to deliver health care, treatment, invasive procedure, surgery, admission to the hospital, or enrollment in a research study.

2)Any time that a patient is aware that he/she is being confined or restrained without a legal reason.

3)Conduct that falls below the generally accepted standard of care of a reasonably prudent person, can result in disciplinary action or even a lawsuit.

4)A very serious type of negligence in which the professional failed to perform a duty owed to a patient or failed to meet the appropriate skilled standard of care expected for that duty, and there was harm to the patient, even though it may have been unintentional.

5)A type of defamation of character when one person speaks falsely about about another

6)An intentional threat (does not require actual contact) toward others that places the person in reasonable fear of harmful imminent, or unwelcome contact. The victim could be the patient or the nurse.

7)The release patient's medical information to an unauthorized person, or a violation of HIPPA.

8)A patient’s agreement to have a procedure after being told the all risks and benefits along with the consequences of refusing the procedure.

9)Any intentional offensive touching (or threat to the person's dignity) without consent or lawful justification. This could include the performance of a procedure that is beyond the scope of the patient's signed consent.

10

The nurse is caring for a 21-year old college student who was brought into the emergency room by a friend. The student was found lying on a side walk near a fraternity house and has a high blood alcohol level. The patient is unconscious and needs a sterile procedure for an intravenous central line insertion. The healthcare provider instructs the nurse to have a consent form signed for this special procedure. The nurse recognizes that which of the following is true regarding the informed consent? (Select all that Apply)

  • It is the healthcare provider responsibility to obtain the informed consent.
  • The patient's DPAHC can sign the consent form.
  • The procedure may be performed without consent.
11

The student's parents call and ask about the student's condition. Which of the following should be the nurse's action?

Have the parent speak directly to the college student.

P & P 9th pg. 306 & 310 Health Insurance Portability and Accountability Act (HIPAA) protects private health information

12

The nurse walks into a patient's room and finds the patient on the floor. The patient's granddaughter tells the nurse that she had just left the room for a minute, and the patient must have fallen while she was gone. What record will the nurse need to fill out about what happened?

Occurrence Report

13

The registered nurse is not just performing a set of tasks. The nurse is a professional who is expected to deliver patient-centered care in a safe, prudent, and knowledgeable manner. In addition to him/herself, the nurse is responsible and accountable to all other members of the healthcare team. With experience, the nurse has more flexibility and independence. Which term notes this increased independence?

Autonomy

P & P 282

14

The nurse recognizes that a child who blames an illness as punishment for misbehaving is in which stage of moral development according to Kohlberg’s Theory of Moral Development?

Level I: Preconventional Reasoning

P & P 9th pg. 137

15

The nurse is assessing a 12 hour old newborn infant. Which assessment finding will prompt the nurse to take action immediately?

A lack of reflexes

P & P 9th pg. 143