4 Leadership and Management Ch. 4

delegate (pp 62)

Nurses are ethically and legally accountable for their own actions and for the actions of those to whom they ___ care.

leaders and managers

Nurse ___ are responsible and accountable for ensuring that staff members maintain competence, provide safe and ethical care, and practice within legal and regulatory boundaries.

patient-centered care
teamwork and collaboration
quality improvement
informatics
safety (pp 62)

Knowledge, skills, and attitudes related to ethical and legal aspects:

Ethical

___ nursing practice necessitates applying moral beliefs and making logical, consistent decisions.

Ethics

___ in nursing requires "the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice, which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, enviro

morals (pp 63)

The terms morals and ethics are often, incorrectly, used interchangeably. ____ are defined as "conduct, character, and motives involved in moral acts and include the notion of approval or disapproval of a given conduct, character, or motive that we descri

morals and ethics

Both morals and ethics are influenced by peronal life experiences and value systems.

Moral integrity (pp 63)

___ refers to quality of character and involves acting consistently with personal and professional values.
Honest and trustworthy, consistently do the right thing, and stand up for what is right despite the consequences. Nurses with moral integrity have a

moral obligation (pp 63)

A __ or duty to provide care in a nondiscriminatory manner. Although nurses have a moral obligation to care for patients at all times, situations may arise in which nurses could face potential personal harm.
NA asserts that nurses are morally obligated to

Values (pp 64)

___ are personal beliefs that influence behavior and give meaning and direction to life. Values evolve over time and reflect ethnic background, family life, cultural beliefs, environment, and societal norms.

values clarification

The process one goes through to understand personal values is called ___.

Values clarification

__ is the process of reflecting on and analyzing values to better understand what is important. A readiness and willingness to take an honest look at personal behaviors, words, actions, motivations, and any congruencies or incongruencies among them.

self-awareness

Values clarification leads to ___.

Professionalism (pp 64)

____ in nursing is defined as "the consistent demonstration of core values evidenced by nurses working with other professionals to achieve optimal health and wellness outcomes in patients, families, and communities by wisely applying principles of altruis

professional

Being a ___ nurse involves accountability for oneself and one's nursing practice and a duty to provide safe and quality care.

1. Altruism: A concern for the welfare and well-being of others. In professional practice, altruism is reflected by a nurse's concern and advocacy for the welfare of patients, other nurses, and other health-care providers.
2. Autonomy: The right to self-d

There are five core professional values nurses
must follow:

Ethical principles (pp 65)

___ are basic moral truths that guide a person's actions. Valuing human dignity, respecting individuals, and believing in an individual's right to be self- governing are the foundation of ethical principles.
The principles:
autonomy
beneficence
nonmalefic

autonomy

respecting a persons right to self-determination

beneficence

adhering to the duty to do good

nonmaleficence

adhering to the duty to do no harm

justice

treating others with fairness

fidelity

keeping promises

veracity

telling the truth

privacy

respecting a persons right to keep information about himself or herself from being disclosed to others

confidentiality

preventing disclosure of a persons private information

autonomy (pp 65)

The principle of autonomy refers to self-governance, in that an individual is free to make choices about what can be done to his or her body.
An individual makes autonomous decisions based on his or her own values, adequate and appropriate information, an

beneficence (pp 66)

___ a core principle of patient advocacy and refers to any action intended to benefit another�in other words, one's actions should always promote good.
Example:
encouraging a patient to undergo painful treatment if it will increase quality and quantity of

nonmaleficence (pp 66)

___ refers to the moral obligation to do no harm or injury to another person.
To avoid imposing risks of harm to another and includes moral rules such as the following:
1. Do not kill.
2. Do not cause pain or suffering.
3. Do not incapacitate.
4. Do not c

Nonmaleficence vs beneficence

Nonmaleficence differs from beneficence in that nonmaleficence morally prohibits people from causing harm to anyone; beneficence is failing to help or benefit another, but it is not always considered immoral.
A common example is the administration of chem

1. Present positive requirements for action
2. Do not need to be followed impartially
3. Generally do not provide reasons for legal
punishment when rules are not followed
1. Present negative requirements for action
2. Must be followed impartially
3. Provi

Major rules of beneficence:
Major rules of nonmaleficence:

paternalism (pp 67)

___, which is "the intentional overriding of one person's preferences or actions by another person" or, in the health-care world, con- trolling a patient's choices.
Many times a nurse, because of his or her knowledge, education, and experience, may believ

justice (pp 67)

Refers to the obligation of nurses to provide fair, equitable, and appropriate treatment to all patients based on their needs and without prejudice.
Treating everyone equally and fairly and giving people what they deserve.

fidelity (pp 68)

___ refers to being faithful or loyal by keeping promises to others.
Loyal, truthful, fair, and advocates for patients.
Nurse leaders and managers apply fidelity professionally when they keep promises to staff by maintaining a culture of safety and a heal

veracity (pp 68)

___, which is connected to autonomy and fidelity, is the notion that patients have a right to truthful information.
Nurse leaders and managers apply the principle of veracity professionally when they are truthful with employees and avoid intentionally dec

privacy (pp 68)

__ refers to a person's right to have control over access to his or her personal information. Protected by the Health Insurance Portability and Accountability Act (HIPAA).
Nurse leaders and managers promote patient privacy when they create an environment

confidentiality (pp 68)

___ means preventing disclosure of private information shared between a patient and the health-care team.
Nurse leaders and managers provide employees confidentiality by securing their personal information such as Social Security numbers and medical infor

privacy vs confidentiality (pp 69)

An infringement of a person's right to confidentiality occurs only if the person (or institution) to whom the information was disclosed in confidence fails to protect the information or deliberately discloses it to someone without first-party consent.
By

Ethical theories

__ do not offer solutions to ethical problems; rather, they provide a guide for nurses at all levels to clarify their personal values and beliefs;
utilitarianism, deontology, and principlism

Utilitarianism (pp 69)

____ is a form of teleological theory, from the Greek word telos meaning "the end." The basic premise of utilitarianism is the notion that acting morally should increase human happiness and make the world a better place- which assumes it is possible to ba

Deontology (pp 70)

_____ comes from the Greek word deon, meaning "that which is obligatory." The basic premise of deontology is that the rightness or wrongness of an action often depends on the nature of the act rather than the consequences of the act.
A person is moral whe

principle-based approach

___ uses rule-based criteria for conduct that stem from the identification of obligations and duties. Principles are sets of rules, ideals, standards, and values characteristic of a group.

Principlism (pp 70)

_____ is a theory in which one or more ethical principles are used to address an ethical issue or dilemma.

code of ethics (pp 70)

An essential requirement for any profession. Values and beliefs shared by members, informs the public of the standards of ethical conduct for the profession, and provides rules and principles for self-regulation.
International Council of Nurses ICN Code o

code of ethics

Respect for patients and their dignity and right to autonomy. Focus on nursing's obligation to uphold professional standards, maintain competence, promote patient safety, participate in ongoing lifelong learning, and collaborate with health-care team memb

ICN Code of Ethics for Nurses (pp 71)

Purpose: "a guide for action based on social values and needs. . . . The Code must be understood, internalised, and used by nurses in all aspects of their work".
Recognizes that the need for nursing is universal and delineates four fundamental responsibil

CNA Code of Ethics for Registered Nurses (pp 72)

Divided into two sections.
Part one addresses the core responsibilities central to ethical nursing practice, including providing safe, compassionate, competent, and ethical care; promoting health and well-being; promoting and respecting informed decision

American Nurses Association Code of Ethics for Nurses With Interpretive Statements (pp 72)

Nightingale Pledge, drafted in 1893 and modeled after the Hippocratic Oath, was the first code of ethics for nurses.
"Tentative code" and published in the American Journal of Nursing in 1940 but was never formally adopted until 1950 as the Code for Profes

ANA code of ethics (pp 73)

Provisions one through three address the fundamental values and commitments of the nurse, including dignity and respect for patients; patients such as self-determination, safety, privacy, and confidentiality; and acting on questionable practice.
Provision

ethical dilemma (pp 73)

___ occurs when obligations, principles, rights, values, and beliefs are in conflict.
There is not a clear-cut right or wrong solution.

Moral uncertainty (pp 73)

___ results when a nurse senses there is a moral problem but he or she is not sure of the morally correct action or what moral principles apply. He or she is uncomfortable about the situation but cannot explain why.

Moral distress (pp 74)

___ results when a nurse knows the right action to take to solve a moral problem but cannot follow his or her moral beliefs because of organizational constraints.
Threat to one's moral integrity. Stems from a nurse's personal traits and experiences, the w

Moral courage (pp 74)

_____ requires a steadfast commitment to fundamental moral principles despite potential risks. Nurse is pre- pared to confront unethical situations despite the negative consequences, such as emotional anxiety, shame, threats to reputation, horizontal viol

holistic (pp 76)

Regardless of the framework or model, ethical decision making should be ___ and begin with gathering all the facts.

ethical decision making (pp 76)

There are four key aspects of ethical decision making (Cooper, 2012, p. 608):
1. Identifying an ethical problem and gathering relevant facts
2. Considering all involved in terms of impact, views, and opinions
3. Identifying possible options, and choosing

ethics committee (pp 76)

Health-care organizations seeking accreditation or maintaining accreditation must address ethical issues through an ethics consultation service. Typically, interprofessional committees or teams provide ethics consultation services when ethical dilemmas ar

ANA position statements related to ethics and human rights (pp 76)

? Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks
? Cultural Diversity in Nursing Practice
? Constituent/State Nurses Associations (C/SNAs) as
Ethics Resources, Educators, an

1) institutional policy review and development
2) ethics education
3) case consultation
(pp 77)

Ethics committees in organizations have three interrelated functions:
Responsible for developing and review- ing policies and procedures, such as those relating to informed consent, advance directives, and withholding or withdrawing life support measures.

interprofessional

The nature of ethics committees is ___; nurse leaders and managers frequently participate on ethics committees.

ethics committee review (pp 77)

A common service provided by an ethics committee is consultation to address ethical issues related to current clinical situations.
The goals of consultation include intervening to protect patient rights, making recommendations to resolve ethical conflicts

Accountability

___ is "to be answerable to oneself and others for one's own choices, decisions and actions as measured against a standard"
Nurses at all levels must embrace an approach to nursing practice that includes application of ethical principles; respect for the

Nurse managers (pp 77-78)

____ must have a complete understanding of the mini- mum standards of clinical practice, the requirements of licensure, regulations that impact nursing, federal and/or state legislation in place to protect both health-care workers and their patients, clas

1) nurse practice act of the state in which a nurse practices, discussed in greater detail in the next section, "Licensure and Regulation of Nursing Practice."
2) the ANA Code of Ethics for Nurses With Interpretive Statement (2015a), details the ethical s

There are four foundational resources that provide registered nurses in the United States with the critical knowledge needed to inform clinical decision making and guide professional nursing practice:
standards for clinical practice

The Essence of the Profession

___ defines nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, familie

1. Organization, delivery, and financing of quality health care
2. Provision for the public's health
3. Expansion of nursing and health-care knowledge and appropriate application
of technology
4. Expansion of health-care resources and health policy
5. Def

The profession of nursing has a contract with society that grants the profession authority and reflects nursing's core values:

Nursing's Social Policy Statement
(pp 78)

___ as a foundational resource to reinforce with nursing staff on a regular basis the concepts of autonomy and competence, the scope and standards of nursing practice, and the nursing process.
Can provide a basis for developing a unit vision, mission, and

Nursing: Scope and Standards of Practice (pp 79)

___ answers each of these questions and "describes a competent level of nursing practice and professional performance common to all registered nurses".
Serves as a basis for the following (ANA, 2015b, pp. 49-50):
? Quality improvement systems
? Health-car

Licensure (pp 79)

__ is the process by which boards of nursing grant permission to an individual to engage in nursing practice after determining that the applicant has the necessary competencies.
Basic requirements for a nursing license are graduating from an approved nurs

professional regulation
self-regulation
legal regulation
(pp 80)

The nursing profession ensures that members act in the public's best interest when providing nursing care through :

Professional regulation (pp 80)

___ consists of the oversight, monitor- ing, and controlling of members based on principles, guidelines, and rules deemed standard in the profession.

Self-regulation (pp 80)

___ is personal accountability for one's professional nursing practice based on those same principles, guidelines, and rules; nurses regulate their own practice by maintaining current knowledge, skills, and attitudes through academic and continuing educat

Legal regulation (pp 80)

___ consists of oversight and monitoring based on applicable statutes and regulations such as licensure, nurse practice acts, civil law, and criminal law. Federal and state regulations are overseen by administrative agencies; two of the most important are

nurse practice acts (pp 80)

All ____ include the following (NCSBN, 2014b, para. 5):
? Authority, power, and composite of a state board of nursing
? Education program standards
? Requirements for licensure
? Types of titles and licenses
? Scope and standards of nursing practice
? Gro

developing the NCLEX-RN
promoting uniformity of nursing regulation
maintains a national database on disciplinary action
(pp 80)

NCSBN is responsible for:

NCSBN (pp 80-81)

The ___ is a not-for-profit organization whose membership consists of a board of nursing members from the United States, the District of Columbia, and the U.S. territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Isla

? Enforcing the state's NPA and nurse licensure
? Accrediting or approving nursing education programs
? Developing practice standards, policies, and administrative rules and regulations
? Addressing violations of the NPA
(pp 81)

The role of the state board of nursing varies by state but typically includes the following (NCSBN, 2011a):

state board of nursing (pp 81)

Unsafe or incompetent nursing practice should be reported to the __.

? Being impaired by drugs or alcohol while working
? Stealing from a patient
? Practicing out of the scope of practice, such as providing treatment that should be provided only by a physician or advanced practice registered nurse
? Falsifying records
? Ph

Examples of serious reportable behaviors that violate the NPA include the following :

Health Insurance Portability and Accountability Act (pp 81)

Enacted in 1996 to improve portability and continuity of health insurance coverage; combat waste, fraud, and abuse in health insurance and health-care delivery; promote the use of medical savings accounts; improve access to long-term care coverage and ser

privacy rule (pp 82)

The ___ protects all identifiable health information or protected health information (PHI).

personal health information (PHI)
(pp 82)

PHI includes information that relates to an individual's past, present, or future physical or mental health or condition; the provision of health care to the individual; or the past, present, or future payment for the provision of health care to the indiv

HIPAA violation
(pp 82)

A __ occurs when PHI is inappro- priately used or is disclosed to a person not involved in the patient's care, to a person who does not require the information to provide care, or in a situation in which disclosure is not in the patient's best interest.

Patient Self-Determination Act (PSDA)
(pp 82)

__ in 1990 to ensure that health-care organizations inform patients about their rights and institutional policies to accept or refuse treatment and to prepare advance directives.
To promote patients as active participants in health-care decisions, thus in

? The individual's right under the law to make decisions about medical care, including the right to accept or refuse medical and surgical treatment
?The individual's right under state law to dictate advance directives such as living wills or durable power

PSDA
Medicare and Medicaid patients to develop and maintain written policies and procedures and to provide written information to adults receiving health care.
Including the following:

Safe Medical Devices Act (SMDA)
(pp 83)

The ___ was enacted in 1990 to require health-care agencies to report to the Food and Drug Administration (FDA) serious injuries, illness, or death resulting from the use of a medical device.
Requires health-care agencies to report to the FDA within 10 da

medical device
(pp 83)

A __ is any medical product that is not absorbed in the body.

? Discontinue the use of the device immediately.
? Follow your agency's policies related to equipment use.
? Document the incident accurately in the medical record, on an incident report, and on any agency-specific forms.
? Record the identification numbe

A nurse's responsibility related to an incident involving a medical device covered under the SMDA includes the following:

Good Samaritan laws
(pp 83)

Encourage health-care professionals to render care in emergencies.
Protect anyone who renders care during an emergency or disaster or at the scene of an accident as long as care is provided at the scene of the emergency, care is not grossly negligent, app

child neglect (pp 83)

Nurses as well as other health-care professionals must report suspected __ and suspected child abuse to the state-designated officials.
Health-care providers are protected from lia- bility if they report suspected child abuse or neglect in good faith but

Age Discrimination in Employment Act (ADEA)
(pp 84)

Prohibits discrimination against a person 40 years or older when forming an employment relationship or promotion.

Americans With Disabilities Act (ADA)
(pp 84)

Prohibits discrimination against a person with mental or physical impairment in the workplace and requires the employer to make reasonable accommodations to allow employees to perform essential job functions

Civil Rights Act of 1964, 1991
(pp 84)

Prohibits discrimination on the basis of race, national origin, or lineage when forming an employment relationship; amended in 1991 to define sexual harassment and the employer's re- sponsibility related to it

Consolidated Omnibus Budget Reconciliation Act (COBRA)
(pp 84)

Ensures employees and their families have health-care coverage for a specified time after employment is terminated, hours are reduced, or an employee becomes eligible for Medicare

Emergency Medical Treatment and Labor Act (EMTALA)
(pp 84)

Establishes a right of access to emergency medical care regard- less of a person's citizenship, age, or ability to pay; amended
in 2003 to expand the definition of an emergency patient to include persons a reasonably prudent person would believe had an em

Family and Medical Leave Act (FMLA)
(pp 84)

Maintains job protection for an individual for up to 12 weeks of unpaid leave per year for an employee to care for an ill family member, after adoption, or for his or her own health

False Claims Amendments Act of 1986,
(pp 84)

Also called the "Whistleblower Law," protects employees from retaliation and threats against discharge when the employee, in good faith, reports a violation of federal or state laws or rules

Occupational Safety and Health Act of 1970
(pp 84)

Ensures safe and healthy work conditions for employees and protects employees from workplace hazards such as blood and body fluid exposure, hazardous materials, and fires

Criminal law
(pp 85)

___ relates to conduct that is harmful to society as a whole as well as to an individual victim. Crimes are classified as either a misdemeanor, which is punishable by fines or imprisonment for less than 1 year, or a felony, a more serious offense pun- ish

Civil law
(pp 85)

__ pertains to the rights and duties of private citizens and is enforced through the courts as damages or monetary compensation. Tort law is the foun- dation of civil law and is the most common type of law that affects health-care professionals.

tort
(pp 85)

A __ is a civil wrong committed against another person or a person's property and includes personal injury inflicted on another through actions of commission or omission.

Intentional torts
(pp 85)

__: Willful acts that are intentional and cause injury. An intentional tort is a direct violation of a person's legal rights and includes assault, battery, false imprisonment, and fraud.

Quasi-intentional torts
(pp 85)

___: Willful acts that cause injury but are unintentional torts. A quasi-intentional tort typically involves communication issues that result in defamation of character, violation of personal privacy, or breach of confidential- ity (Aiken, 2004).

Unintentional torts
(pp 85)

___: Careless acts or accidents that cause injury. Negligence and malpractice are examples of unintentional torts.

torts
(pp 85)

__ are the most frequent causes of legal action taken against health-care professionals, and, of those, the unintentional torts of negligence and malpractice are the most common

Negligence
(pp 85)

__ is a deviation from the standard behavior or actions that an average, prudent person would use in a similar situation.

malpractice
(pp 85)

__ is a more specific term and addresses a professional standard of care. Malpractice, also known as professional negligence, is a deviation from the standard of care that a reasonably prudent health-care professional would use in a similar situation.
In

1. Duty owed the patient
2. Breach of the duty owed the patient
3. Foreseeability of harm
4. Causation
5. Injury or harm
(pp 86)

Five essential elements must be present for malpractice to be charged:
f one of these elements is missing, the malpractice claim will not be successful.

Assault
Battery
False imprisonment
Fraud
Defamation of character
Violation of privacy
Breach of confidentiality
Negligence
Malpractice (professional negligence)

pp 86

Duty Owed the Patient (pp 87)

Implies that the patient is dependent on the nurse for safe and quality nursing care.

standard of care

___ related to medication administration is to check the patient's medical record for allergies. When administering medications to patients, nurses have a duty to follow this standard and always check for allergies.

Breach of the Duty Owed the Patient
(pp 87)

Nurses must deliver care according to a standard of care that a reasonably prudent nurse under similar circumstances would use.
EX.
A patient is allergic to penicillin and a nurse did not check the patient's medical record for allergies before administeri

Foreseeability of Harm
(pp 87)

Certain actions can be expected to have specific consequences.
Ex.
All nurses know that neglecting to check the medical record for allergies before administering a medication could result in harm to a patient.

Causation
(pp 87)

Any injury that occurs is directly a result of the breach of duty owed to the patient.
EX.
If the patient in the scenario develops an allergic reaction after the nurse administers the penicillin, there is a cause-and-effect relationship between failure to

Injury or Harm
(pp 87)

Some type of physical injury must result from the breach of duty.

1. Failure to assess and monitor
2. Failure to follow standards of care
3. Failure to communicate
4. Failure to document
5. Failure to act as a patient advocate
6. Failure to use equipment in a responsible manner
(pp 88)

Six common categories of nursing practice have the potential for negligence and possible malpractice:
Failing to perform these actions can constitute negligence if the required elements are present.

ANA resource, Nursing: Scope and Standards of Practice
(pp 88)

Describes a competent level of nursing practice and professional performance common to all registered nurses in all settings regardless of role�in other words, the minimum requirement for acceptable nursing practice.

Failure to Assess and Monitor
(pp 88)

The registered nurse collects pertinent data and information relative to the health-care consumer's health or situation. Failure to complete a shift assessment, implement a plan of care, observe a patient's progress, or accurately interpret a patient's si

Failure to Follow Standards of Care
(pp 88)

authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform competently"
Nurses must be knowledgeable about their state's NPA and standards of care, hospital policies and procedu

Failure to Communicate
(pp 89)

The registered nurse communicates effectively in all areas of practice"
Failure to listen to a patient and act on his or her concerns or failure to ensure effective teaching of self-care or discharge instructions to a patient can be considered negligence

Failure to Document
(pp 90)

Failure to document pertinent assessment informa- tion or a patient's response to nursing interventions can be considered negligence.

Failure to Act as a Patient Advocate
(pp 90)

They must support and promote patient rights. Failure to act on incompetent practice, question illegible medical orders, or provide a safe environment for patients can be considered negligence.
Similarly, the nurse leaders and managers must support and pr

Failure to Use Equipment in a Responsible Manner
(pp 90)

Nurses must know how equipment functions, follow manufacturer's guidelines for operation, check the equipment for safety before use, and place equipment properly during treatment.

Expert Witness
(pp 90)

is to help educate the jury regarding the nurse's actions in the particular case and the applicable standard of care-
Three factors are critical to selecting the best nurse expert witness: The nurse expert must have the necessary qualifications, must have

liability
(pp 90)

__ refers to the nurse's responsibility for a possible or actual loss, penalty, burden, or expense that the law requires the nurse to compensate the victim.
Personal liability defines a nurse's account- ability for professional actions to patients and fam

espondeat superior (pp 90)

let the master answer," holds employers accountable for the negligent actions of their employees, or vicarious liability.
Nurse leaders and managers can avoid issues of vicarious liability by ensuring that staff members are qualified and competent to per

Failure to orient, educate, and evaluate
Inappropriate assigning of staff and failure to supervise
Unsafe staffing
Negligent retention practices
Failure to warn
(pp 92)

Nurse leaders and managers can be considered negligent when they do not fulfill specific responsibilities such as the following;

challenges for nurse leaders:
(pp 92)

The challenges for nurse leaders and managers include determining and providing for educational needs, assessing competency, providing appropriate evaluations essential to enhance patient safety, and minimizing organizational liability.

Professional liability
(pp 93)

___ insurance protects nurses against lawsuits related to alleged errors that occur while delivering nursing care.
Professional liability insurance benefits include payment for the cost of legal advice and representation, payment for court costs, settleme

If a nurse is found liable and has his or her own insurance policy, the monetary award will be higher (neither judge nor jury can be informed about insurance coverage)
The patient will more likely bring a lawsuit if he or she knows that a nurse has insura

False arguments about liability insurance:
The bottom line is that having professional liability insurance will not protect a nurse from a lawsuit, but it will help the nurse with attorney fees, court costs, and the financial obligations if a nurse is fou

advanced directive (pp 94)

a document that provides information about a person's desires should he or she become unable to make health-care decisions- directive provides directions to family and health-care professionals by a person in advance of becoming ill and incapacitated.
Nur

? Initiating discussion with a patient about advance directives
? Providing a patient with written information about advance directives
? Communicating the presence of an advance directive to all members of the health-care team
? Ensuring that advance dir

nurse roles in advanced directives:

A living will
A do not resuscitate (DNR) order
A durable power of attorney for health care
(pp 94)

There are three types of advance directives:

living will (pp 94)

a legal document that details a person's wishes regarding health- care treatments and procedures in the event the person becomes incapacitated and is facing end of life.

DNR (pp 94)

indicates the life-sustaining measures that should be withheld in the event of impending death.

allow natural death (AND) (pp 94)

__ order is initiated, which means that only comfort measures will be provided

Durable Power of Attorney (pp 95)

Legal document that identifies a health-care surrogate. The surrogate is a person designated to make health-care decisions for another person, who is incapacitated.

HIPAA (pp 96)

The __, discussed earlier in this chapter, requires that nurses protect all verbal and written communication about patients, including medical records, electronic records, and verbal ex- change of patient information such as patient teaching and change-of

1. Nurses must not transmit or place online individu- ally identifiable patient information.
2. Nurses must observe ethically prescribed profes- sional patient-nurse boundaries.
3. Nurses should understand that patients, colleagues, institutions, and empl

ANA principles for social networking:

Informed consent
(pp 97)

__ represents the ethical principle of autonomy and reflects the patient's autonomous decision to accept or refuse health care. Also a legal process by which a patient or legal representative voluntarily gives permission for a treatment or procedure.
Ther

? Verifying that the health-care provider gave the patient the necessary information to make an "informed" consent
? Ensuring that the patient understands the information and procedure or treatment
? Validating that the patient is competent to give consen

A nurse's role in obtaining informed consent includes the following:

Disruptive behavior
(pp 97)

__ includes "overt actions such as verbal outbursts and physical threats, as well as passive activities as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities

Lateral violence (pp 97)

__ refers to acts that occur between nurses.

Incivility (pp 97)

___ consists of rude and discourteous actions and includes gossip- ing and spreading rumors.

Bullying (pp 97)

___ is described as unharmful actions intended to humiliate, offend, and cause distress. Negative acts perpetrated by one in a higher level of authority, a misuse of power

low staff morale; increased absenteeism; attrition; unman- aged anger leading to insomnia, hypertension, depression, and gastrointestinal dis- orders; and threatened patient care quality
(pp 98)

Lateral violence, incivility, and bullying effects on staff: