Transition to the Registered Nurse Role

Comstock Act of 1873 :

Black Death:

Dark Ages of Nursing:

Bolton Act:

Ebers papyrus:

geroncomion:

Geneva Convention Treaty:

Health Amendments Act:

Gulf War syndrome:

Hammurabi’s Code:

Frontier Nursing Service:

Henry Street Settlement:

iatria:

International Red Cross :

Kaiserswerth Deaconess Institute:

Mosaic Law:

hôtels-dieu:

Hippocratic oath:

monasticism:

nosocomium:

National Organization of Public Health Nursing

National Association of Colored Graduate Nurses (NACGN):

Nurse Training Act of 1964:

New England Hospital for Women and Children:

Nightingale Training School for Nurses:

Planned Parenthood Federation:

unification model:

Parish nurse movement :

U.S. Cadet Nurse Corps:

Catherine of Siena:

Dorothea Lynde Dix:

Annie W. Goodrich:

Elizabeth Seton:

Catherine McAuley:

Clara Barton:

Frances Payne Bolton:

Fabiola:

Granger Westberg:

Friederike Fliedner:

Galen:

Florence Nightingale:

Hippocrates:

Helena:

Harriet Tubman:

Hildegarde of Bingen:

Isabel Hampton Robb:

Jean Henri Dunant:

Lina L. Rogers:

Knights Hospitallers of St. John

Luther Christman:

Lillian D. Wald:

Knights of St. Lazarus:

Lavinia Dock:

Margaret Sanger:

Mary Breckinridge:

Mary Brewster:

Martin Luther:

Phoebe:

Melinda Ann (Linda) Richards:

Mary Eliza Mahoney:

Theodor Fliedner:

Sojourner Truth:

St. Vincent de Paul:

Sisters of Charity:

Sisters of Mercy:

Knights Hospitallers of St. John of Jerusalem

Fabiola

Hildegarde of Bingen

Catherine of Siena

Helena

Knights of St. Lazarus

Late Middle Ages

Early Middle Ages

Early Middle Ages

Early Middle Ages

Late Middle Ages

World War II

World War I

World War I

Persian Gulf War

World War II

Korean War

Civil War

Vietnam War

Korean War

World War II

World War II

nursing informatics:

technical functions:

health maintenance:

Health Plan Employer Data and Information Set (HEDIS):

Needlestick Safety and Prevention Act:

health education:

hospice care:

secondary care:

tertiary care:

primary care:

chain of command:

authority:

centralized:

accountability:

decentralized:

culture care:

borrowed theories:

health promotion model:

developmental needs theory:

interpersonal theory:

adaptive response:

Lysaught report:

theory:

science of unitary human beings:

thermodynamics:

worldview:

theory of uncertainty:

systems theory:

mid-range theory:

Arlene B. Miller:

Betty Neuman:

Dorothea Orem:

Florence Nightingale:

Hildegard Peplau:

Imogene King:

Judith Allen Shelly:

Jean Watson:

Merle Mishel:

Katherine Kolcaba:

Martha Rogers:

Madeline Leininger:

Sister Callista Roy:

Nola Pender:

Myra E. Levine:

Virginia Henderson:

active euthanasia:

assisted suicide:

altruism:

American Nurses Association Code of Ethics for Nurses with Interpretive Statements:

autonomy:

critical social theory:

categorical imperatives:

beneficence:

caring ethics:

confidentiality:

informed consent:

in vitro fertilization (IVF):

ICN Code of Ethics for Nurses:

Karen Ann Quinlan case:

institutional review boards (IRBs):

International Society of Nurses in Genetics (ISONG):

moral philosophy:

Reconciliation Act (OBRA) of 1987:

nonmaleficence:

nursing process:

Nursing Home Reform Act:

obligations:

Nancy Cruzan case:

Nursing’s Social Policy Statement:

Roe v. Wade:

Patient Self-Determination Act:

standard of best interest:

residents' bill of rights:

passive euthanasia:

self-determining:

stem cell research:

A Patient's Bill of Rights:

veracity

utilitarianism:

teleological theory:

values clarification:

Tuskegee experiment:

therapeutic cloning:

Arlene B. Miller:

Auguste Comte:

Anne Boykin:

Jean Watson:

Ethics is the study of standards of conduct and moral judgment; it is considered to be a branch of moral philosophy. Philosophy can be defined as principles underlying conduct, thought, and knowledge.

Nursing is governed by professional nursing principles and moral norms and also has written standards of conduct generally assumed to be based on universal ethical principles that should govern the actions of all nurses. Nurses are frequently faced with the need to apply these norms and principles and make moral and ethical decisions involving professional responsibility and patient care in both research and practice situations.

professional standards of conduct and care and also by the beliefs and values associated with personally held worldviews. Beliefs and values are shaped by one’s cultural and family background, one’s religious or philosophical persuasion, and the beliefs and values of the peer groups that one identifies with.

Ethical or moral dilemmas arise when one’s personal or professional beliefs and value system are challenged in some way by a situation that requires the person to adopt different beliefs and values or to act in a way that would be inconsistent with his or her generally accepted worldview.

Codes make explicit the primary goals, values, and obligations of the nursing profession. Codes of ethics are considered part of the regulatory criteria for professional nursing. Two ethical codes are the American Nurses Association Code of Ethics for Nurses with Interpretive Statements (2001) and the ICN Code of Ethics for Nurses (2005).

residents’ bill of rights

Nursing’s Social Policy Statement

ICN Code of Ethics for Nurses

ANA Code of Ethics for Nurses with Interpretive Statements

A Patient’s Bill of Rights

ICN Code of Ethics for Nurses

A Patient's Bill of Rights

ICN Code of Ethics for Nurses

ANA Code of Ethics for Nurses with Interpretive Statements

Accepting an assignment that a nurse does not feel personally or professionally equipped to handle could be considered an ethical violation and could also result in legal action if harm comes to a patient. Nurses have a responsibility to identify and know their own personal and practice limitations.

The nursing process is an ongoing and systematic cycle of sequential steps including assessment, analysis (diagnosis), planning, implementation (interventions or strategies), and evaluation; all of these involve the nurse in critical thinking skills designed to attain expected outcomes and to meet patient-centered goals for health restoration, health maintenance, and health promotion (Carpenito 1993).

The steps of the nursing process applied to ethical decision making are as follows:


Identification of the problem or the ethical dilemma


Problem clarification


Options identification


Planning and decision making


Intervention, or implementation and taking action


Outcome evaluation

also called utilitarianism or consequentialism, The end of an action, therefore, justifies the means

Utilitarianism has been criticized on three primary grounds:

(1) the difficulty in applying it and judging the amount of happiness or usefulness achieved,

(2) its unfairness to people who might not benefit or might reap negative consequences from someone else’s happiness,

(3) its failure to take motives or intentions into consideration when making ethical decisions (Flew 1984).

Deontological ethics is based on the writings of the German philosopher Immanuel Kant. Kant’s theory has also been described as an example of duty-based, or principle-based, ethics. The morality or rightness of any decision is judged by an examination of the nature of the action and the will of the agents rather than on the goals or outcomes of that action. The basis for moral action, according to Kant, is duty. The focus on the action itself, rather than on the consequence of the action, is based on Kant’s belief that it is impossible to accurately predict or control the outcome of an action. In this system of ethics, there is respect for people, who are believed to have intrinsic worth. The end can never justify the means if the means might violate the basic principle of respect for the person.

The primary criticism of deontological ethics is that neither good nor bad consequences factor into the decision-making process; pain or negative consequences may result from a choice or decision that is believed to be morally right in and of itself.

According to Madeline Leininger, care is “the essence of nursing and the central dominant and unifying focus of nursing.” Leininger is also an anthropologist and has written extensively on caring across cultures and the different ways that caring is expressed and interpreted. In this system of ethics, culture is the primary consideration when making ethical decisions. Caring behaviors identified by Leininger include empathy, enabling, health maintenance acts, presence, protective behaviors, restorative behaviors, stress alleviation, and touching.

One criticism of caring ethics is the diversity of viewpoints and disagreement among nurse theorists and practitioners about the meaning of caring. Carson has also noted that in much of the caring literature, the focus on “being with” appears to exclude or carry more significance than “doing for” or “doing with.”

Critical social theory focuses on ethical issues of social equity and justice. It had its beginning in the 1920s in Germany and was influenced by the writings of Karl Marx, who, along with a number of other philosophers, believed that social phenomena need to be examined within a historical context. Jürgen Habermas revised critical social theory in the 1970s. This theory has been used in nursing and other research as a foundation for several (primarily qualitative) research methods in an effort to better understand how people communicate and develop meanings in a society. This type of study is particularly useful in the study of vulnerable populations and the study of issues related to powerlessness, exploitation, and repression.

Autonomy means independence or self-law. Based on the principle of autonomy, patients should always be cared for with the understanding that they are people of value and worth who generally have a desire to be both autonomous and self-determining (i.e., able to make their own decisions about what is best for themselves). Autonomy is an important principle in research studies and is often called the right to self-determination.

Based on the ethical principal of autonomy, patients should be able to make their own decisions. However, situations often arise in which a patient’s right to make autonomous, self-determining decisions may, in fact, not be in his or her best interests or in the best interests of others. For example, a stroke can affect one’s decision-making capability.

Beneficence is the quality of kindness and the obligation to do good and no harm to others. Related to beneficence is the concept of altruism. Altruism is an unselfish concern for the welfare of others. In ethical theory, altruism is not the means but the end of any moral action, implying that people have both the right and the responsibility to do good for others and to seek to alleviate situations that cause pain and distress. These principles are key ethical values for nursing practice and nursing research.

When something is confidential, it is private information entrusted to another person with the understanding that the information will not be shared with anyone else. The principle of confidentiality is an important part of all nursing codes as well as patient codes and bills of rights. Anonymity is related to confidentiality. When specifically associated with research, anonymity means that the identities of individuals (who are usually called research subjects) will not be made public, nor will they be associated in any way with data or information gathered by the researcher.

Fidelity means being faithful to one’s vows or obligations. In health care, it is often associated with being faithful to the principles of various codes of ethics. It can also mean faithfulness in relation to one’s employer and the employment responsibilities agreed to when hired or faithfulness to the various principles described in the codes of ethics for nurses.

In order for patients to be responsibly involved in decision making, they must be fully informed of all aspects of their conditions, prognoses, and treatment options as well as the anticipated results of treatments and any possible side effects. This process results in informed consent and should be followed by all health care workers involved in treating patients. Informed consent is also a principle used in research; before patients sign a consent form agreeing to be part of a research study, they should be fully informed about all aspects of the study, including their right to refuse to be study subjects or to withdraw from the study at a later date if they so desire.

Nonmaleficence is related to the principle of beneficence. Nonmaleficence means the prohibition from intentionally harming others. One of the most famous examples of a violation of this principle was connected with a research study now commonly known as the Tuskegee experiment. The study’s investigators claimed that the study was for the greater good of science, yet in the process, much harm was deliberately done to study participants.

The standard of best interest is an ethical principle that governs decisions made for others. It means that all decisions should be made in the best interest of the person. Sometimes the person who can no longer make autonomous decisions has made his or her wishes known beforehand in a living will or some other type of advance directive. When this is not the case, the people making the decisions for the patient should act in faith that they are doing what the patient would do if he or she was mentally able or cognitively intact.

Veracity is truthfulness or honesty. The principle of veracity in nursing can be applied in many situations, especially when dealing with decisions that involve patients’ right to know the truth about their diagnoses

Obligations are moral or ethical responsibilities or duties that often exist in the form of legal contracts or agreements. The nurse’s primary obligation is to the patient. Nurses also have obligations to their employers based on the terms of employment that they agreed to when hired and to coworkers in nursing and in other disciplines. Finally, nurses have an obligation to themselves to be true to what they believe and value and to honestly engage in values clarification when ethical dilemmas arise.

The principle of justice in general refers to the rights of others, especially vulnerable patients who must always be treated justly or fairly. In health care situations, a more specific type of justice is called distributive justice; this term relates to the distribution of services and goods, such as organs for transplantation. Decisions related to justice are often based on factors such as age, general health, and the potential for life.

What two foundational concepts are related to bioethical issues in nursing? Why? What are five specific ethical issues in health care related to these concepts?

The primary principle underlying the Roe v. Wade decision, which legalized abortion, is the principle of autonomy (i.e., a woman has the right to control her own body and the products of her body; this includes the right to choose whether or not to have an abortion). The nature and essence of what it means to be human is the primary concern raised by opponents of the Roe v. Wade decision, who view abortion as a violation of the right to life and the sanctity of life.

One argument consistent with deontological and Judeo-Christian caring ethics is that human embryonic stem cell research necessitates the destruction of human embryos and is therefore unethical, regardless of its proposed benefits. Teleological or utilitarian arguments and humanistic caring arguments generally favor embryonic stem cell research based on the understanding that the excess embryos would eventually be destroyed anyway or the fetuses would still be aborted, so they should be used to improve the health of others.

Therapeutic cloning involves creating an embryonic clone or a genetic copy of a person; the embryo is destroyed after its stem cells are harvested. These stem cells then might be used to treat diseases. Proponents of therapeutic cloning argue that cloning lessens the risk of stem cell rejection from immunologically incompatible cells and that benefits to patients suffering from as yet incurable and debilitating diseases far outweigh concerns about destroying embryos. Those arguing against cloning believe that taking human life at any stage, even the embryonic, cannot be justified under any circumstances, even for health-related gains. The former argument is an example of utilitarian ethics, and the latter is an example of deontological ethics.

The Patient Self-Determination Act stipulated that any facility receiving federal Medicare reimbursement must inform patients about their right to refuse treatment. Facilities are also required to ask patients if they want to prepare an advance directive like a living will or a durable power of attorney for health care and to specifically indicate in writing their wishes concerning such things as resuscitative efforts and the institution and withdrawal of supportive and life-sustaining therapies like artificial nutrition and hydration. Physicians are also required to include specific DNR (do not resuscitate) orders in charts if patients choose that option. This act was prompted by the Cruzan case, where the court ruled in favor of Cruzan’s parents to remove their daughter’s feeding tube based on the standard of best interest

Passive euthanasia occurs when the normal dying process is not interfered with. For example, when an elderly nursing home resident refuses to eat or drink and also refuses to be fed by artificial means like a feeding tube, he or she is engaging in voluntary and passive euthanasia (though some would argue that this could be considered active if not eating or drinking is an intentional act). Active euthanasia requires that either the patient or someone else take active steps to end that patient’s life. An example is taking or giving a drug overdose that results in cessation of respiration.

Assisted suicide occurs when one person takes the initiative to deliberately end another person’s life by providing the means by which to do so. Competing ethical principles include the issues of autonomy and the right to die versus nonmaleficence; the latter is related to a belief in the sanctity of life and that one should do no harm to another person or to oneself.

Equity means fairness or impartiality, especially in reference to the issue of access to care. Distribution of health care resources and health care access are often determined by the ability to pay. People often choose to forego medical treatment because of lack of income. The underinsured and those without health care insurance or the support of government programs, including the homeless, the self-employed, and people working for companies that do not provide health insurance for employees, are especially vulnerable.

assure the public, especially patients and their families, that the nursing care they receive is competent and that there are evaluation criteria for nursing activities.

Accreditation standards for health care facilities are quality control mechanisms used to assess, implement, and evaluate standards of care and nursing practice. Governmental agencies like state health departments and voluntary health care regulatory agencies like JCAHO and CHAP can accredit various health care facilities.

A benchmark is a standard or a point of reference used to measure or judge quality or value. In nursing, a benchmark involves comparing one’s own specific nursing practice against a best-practice standard. Best-practice standards should be congruent with the latest research. Nursing practice standards are considered benchmarks. Benchmarks might also be well-established nursing practices in one hospital or nursing home that other hospitals or nursing homes would like to implement in their own facilities.

The goal of health outcomes management is to improve the effectiveness, value, and cost of treatment services across the entire system of care in a facility like a hospital or a nursing home. If a problem or need is identified from measurements of patient outcomes, then specific goals, objectives, and standards should be set in order to improve the situation.

D. Most early nursing functions were passed down through generations as traditions

B. Monasticism

C. American Association of Nurse-Midwives

A. Federal funding for nursing education went directly to nursing schools.

A. Assisting, technical, and professional functions

B. The closure of some nursing schools and the development of interdisciplinary education

B. The role of the nurse as patient advocate

D. regulatory issues involving licensing and practice.

B. reforming nursing education and improving educational standards.

D. An increased interest by the American public in alternative spiritualities

D. Treatment of STIs and substance abuse

A. The Centers for Medicare and Medicaid Services (CMS)

D. Health maintenance and disease management

B. The Needlestick Safety and Prevention Act

C. philosophy

B. hospital emergency room.

D. the Partnership for Human Research Protection (PHRP).

C. The consumer health movement prompted the passage of a bill of rights for patients.

B. issues related to fraud.

B. An HMO

C. a nursing home with dedicated respite beds.

B. direct patient care.

A. developmental needs.

B. goal attainment for a patient to be able to walk following a stroke.

A. Watson’s theory of transpersonal caring

B. observations of patient care given by employees.

D. the steps in the nursing process.

B. ethics.

C. The code stresses respect for human dignity and the uniqueness of all persons.

B. Deontological ethics

D. Veracity

D. Striking a combative patient

A. Patients can obtain a list of organizations that have access to their medical records.

B. Spiraling costs and the need for more preventive service

B. American Nurses Association

A. were based on the apprenticeship model of training

B. They are considered the most common type of basic registered nursing education in the United States.

C. an articulation program.

A. continuity of care.

B. High costs of health care and the need for cost containment at all levels

C. the type of education, the clinical experience, and the competencies of the nurse.

D. Interventions for illness treatment and prevention and health promotion

Babylonian

B. Many hospitals were city run, and nursing care was often given by women with little training or education

ethical issues and birth control information.

C. The Nurse Training Act of 1943 (the Bolton Act)

D. The Study of Credentialing in Nursing: A New Approach

D. The provision of culturally sensitive care

A. Access to health care for all people

A. National League for Nursing. (Correct)

A. Community-acquired infections

D. Stoicism

B. Medicaid

B. disease management.

C. can make cash payments to the client for food each month

A. provide financial assistance to ease the nurse shortage.

A. particular nursing theories.

A. accountability.

C. Teach an elderly man in an assisted living center how to care for a permanent colostomy to prevent skin breakdown

D. provide voluntary accreditation for hospitals, nursing homes, and community agencies.

D. The practice of nursing in multiple states and liability issues related to licensure

B. extensive training in technical skills.

A. a baccalaureate degree in nursing.

C. Martha Rogers

D. Shalom

D. Values clarification

D. the need to respect spiritual beliefs and cultural customs

A. standard of best interest.

D. The raise of the sole physician or nurse practitioner in private practice

C. Mildred Montag.

C. An associate nurse

D. A teenager who is newly diagnosed with type I diabetes

D. the Pew Health Professions Commission.

A. The level of skill and competency of the LPN/LVN

C. Pain related to a fractured hip

C. health teaching and case management.

Basing theory based practice allows a specialized knowledge base, which is a characteristic of a profession

To develop a standard language for nursing treatments to be used in practice education and research.

in fucntional nursing the nusre is assigned a care task based on thier ability and scope of practice.

Florence Nightengale

Lillian Wald

Jean Watson

Virginia Henderson

Dorthea Orem

Martha Rogers

visiting homebound sick

Ada M. Stewart

Dautghters of Charity

Florence Nightengale

Lavinia Dock

Clara Burton

to analyze the changin needs of the nursing profession

it hold the emnployer responsible for the actions of the employee

ADA (Americans with Disability Act)

The Omnibus Budget Reconciliation Act is a law passed in 1987 that is being implemented in regards to a checklist for nursing home care facilities

utilitarianism

to provide clients with necassary cost effective care

The nurse will cary out a specific duty or function for a large number of patients

Pts outcomes and indicators of the patients condition

Civil War

Mary Mahoney

Cadet Nurse Corps

influincing reform in nursing education

begining the Army School of Nursing

Establishging nursing as a technical profession

decreasing number of health care professionals including nurses

to establish excellence in the program

continuing education

enviroment and sanitation

Adaption

Open Systems

Self-care

a college or university education for nurses

promote health and quality of health by supporting both nursing education and practice

nursing assistants in nursing homes

Statutory law

to protect the patient

ANA (American Nurses Association)

New Jersey

contain health care cost