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Ch 3 Critical Thinking, Ethical Decision Making, and the Nursing Process

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assessment
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the systematic collection of data to determine the patient’s health status and any actual or potential health problems
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collaborative problems
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specific pathophysiologic manifestations that nurses monitor to detect onset or changes in status
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critical thinking
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a process of insightful thinking that utilizes multiple dimensions of one’s cognition to develop conclusions, solutions, and alternatives that are appropriate for the given situation
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deontologic or formalist theory
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an ethical theory maintaing that ethical standards or principles exist independently of the ends or consequences
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ethics
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the formal, systematic study of moral beliefs
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evaluation
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determination of the patient’s responses to the nursing interventions and the extent to which the outcomes have been achieved
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implementation
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actualization or carrying out of the plan of care through nursing interventions
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moral dilemma
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situation in which a clear conflict exists between two or more moral principles or competing moral claims
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moral distress
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conflict that arises within oneself when a person is aware of the correct course of action but instituitional constraints stand in the way of pursuing the correct action
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moral problem
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competing moral claim or principle; one claim or principle is clearly dominant
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moral uncertainty
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conflict that arises within a person when he or she cannot accurately define what the moral situation is or what moral principles apply but has a strong feeling that something is not right
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morality
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the adherence to informal personal values
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nursing diagnoses
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actual or potential health problems that can be managed by independent nursing interventions
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nursing process
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a deliberate problem-solving approach for meeting people’s health care and nursing needs; common components are assessment, diagnosis, planning, implementation, and evaluation
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planning
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development of goals and outcomes, as well as a plan of care designed to assist the patient in resolving the diagnosed problems and achieving the identified goals and desired outcomes
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teleologic theory or consequentialism
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the theoretical basis of ethics, which focuses on the ends or consequences of actions, such as utilitarianism
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utilitarianism
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a teleologic theory of ethics based on the concept of “the greatest good for the greatest number”
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What’s required in order to do critical thinking?
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Reasoning, purposeful, systematic, and outcome directed thinking based on a body of knowledge, examination, and analysis of available information.
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Give examples of the components of cognitive and mental activities involved in critical thinking.
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*Asking questions to reach understanding. *Gathering and validating relevant data. *Analyzing data to determine its meaning. *Considers problem solving options then formulates independent decisions. *Draw on past clinical experience and knowledge to explain what is happening and to determine what might happen next. *Maintaining a flexible attitude that takes all possibilities into account. *Looks at advantages and disadvantages to each option. *Formulates decisions using creativity.
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Give examples of the benefits of using critical thinking in nursing.
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*It leads to clinical expertise. *It includes patient/nurse interactions and being more open-minded. *It’s the foundation for decision making. *It takes time and practice to become a critical thinker. *It helps the patient to receive quality care which is the ultimate goal.
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Give examples of ethical dilemmas in the health care field that are the result of increased and advanced technology.
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*Life sustaining machines *Harvesting, freezing, and the use embryos *Stem cell research
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Give examples of situations that can cause ethical dilemmas for nurses.
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Confidentiality: verbal discussions, access to computer records, HIPAA violations can result in loss of jobs or criminal charges Restraints: Limits patient’s autonomy, risk of harm vs. protection from self, strict policies on using restraints Trust: When and how to communicate info to the patient & family Refusal of Care: When patients are behaving in certain ways or having procedures you don’t agree with End of Life: Accepting patients choices in their treatment, Advanced directives (living wills), power of attorney, patient rights
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What is the definition of “ethics”?
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the formal, systematic study of moral beliefs.
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When faced with ethical issues, what source should nurses rely on for guidance?
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Use the nursing process for guidance with ethical issues. The Nursing Process is a deliberate problem solving approach/steps to meeting patient needs.
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What tool or method does the nurse use to communicate that the nursing process is being used?
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The Nursing Process is communicated and placed in the Nursing Care Plan.
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Identify the official steps of the Nursing Process & what’s involved in each one.
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Assessment-collection of data/information. Ex. Health history, physical assessment, family history, data records Nursing Diagnosis-stating what the problem is. NANDA (North American Nursing Diagnosis Association) published list of acceptable and approved problem statements. Represents actual/potential health problems and not medical diagnoses. Problem statement includes what the problem is and what it is related to. Outcome Identification-desired solution or goal. Goal statement will be patient focused/centered and include who, what, when, where, how the patient will respond to interventions. Goals can be immediate to long term. Establish a basis for evaluating the planned nursing interventions. Planning-how to resolve the problem and reach the desired outcome. Identify nursing interventions and educational needs that are evidence based nursing practices and don’t require physicians orders. Should be sensitive to patient’s healthcare needs. Plan will be communicated to all team members. Implementation-carrying out the proposed plan of nursing care for the patient. Nurses are responsible for implementation and coordination of plan. Assessment is continued. Interventions involve assistance, promotion, support, facilitation, management, provisions. Outcome-desired. Evaluation-deciding if the problem was resolved. If not what to do next? Collect more data, reassess problem statement, redefine outcome, adjust plans.
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Collaborative problems:
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specific pathophysiologic manifestations that nurses monitor to detect onset of complications or changes in status.
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Deontologic or formalist theory:
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an ethical theory maintaining that ethical standards or principles exist independently of the ends or consequences.
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Utilitarianism:
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a telelogic theory of ethics based on the concept of “the greatest good for the greatest number”.
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Moral Dilemma:
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situation in which a clear conflict exists between two or more moral principles or competing moral claims.
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Moral Distress:
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conflict that arises within oneself when a person is aware of the correct course of action but institutional constraints stand in the way of doing the correct action.
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Moral Problem:
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competing moral claim or principle; one claim or principle is clearly dominant.
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Moral Uncertainty:
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conflict that arises within a person when he or she cannot accurately define what the moral situation is or what moral principles apply but has a strong feeling that something is not right.
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Morality:
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the adherence to informal personal values.
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Autonomy:
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right of patients to receive accurate information so they can make decisions on their own free from constraints.
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Beneficence and Nonmaleficence:
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Beneficence-duty to do good. Nonmaleficence-do no harm.
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Double Effect:
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a principle that may morally justify some actions that produce both good and evil effects. All four of following must be fulfilled to meet this criteria. 1) The action itself is good or morally neutral 2) The agent sincerely intends the good and not the evil effect 3) The good effect is not achieved by means of the evil effect 4) There is proportionate or favorable balance of good and evil
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Distributive Justice:
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Like cases should be treated alike without discrimination.
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Therapeutic Communication Techniques
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Listening-active process of receiving information and examining one’s reactions to the messages received. Silence-periods of no verbal communication among participants for therapeutic reasons. Gives patient time to think and gain insights, slows pace of interaction, encourages patient to start up conversation with nurse, understanding, acceptance. Restating-validates that the nurse is listening and calls attention to important things. Reflection-directing back to the patient his or her feelings, ideas, questions, or content. Validates that the nurse understands what the patient is saying. Clarification-asking the patient to verbalize what he or she means to enhance nurse’s understanding. Focusing-questions or statements to help the patient develop or expand an idea or feeling. Broad openings-encouraging patient to select topic of discussion. Humor-discharge of energy through the comic enjoyment of the imperfect. Informing-giving information. Teaching. Sharing perceptions-asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling. Theme identification-underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship. Helps nurse understand important problems. Suggesting-presentation of alternative ideas for the patient’s consideration.