professional caring & ethics - critical care nursing · pdf fileprofessional caring &...
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![Page 1: Professional Caring & Ethics - Critical care nursing · PDF fileProfessional Caring & Ethics Beth Torres, PhD, RN, ... basic values, rights, ... PowerPoint Presentation Author:](https://reader031.vdocument.in/reader031/viewer/2022022005/5abaabb57f8b9a321b8bf30b/html5/thumbnails/1.jpg)
Professional
Caring & Ethics
Beth Torres, PhD, RN, CCRN
CJW Medical Center
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Professional Caring &
Ethical Practice (20% = 30 questions)
• Advocacy / Moral Agency 3% (4 questions)
• Caring Practices 4% (6 questions)
• Collaboration 4% (6 questions)
• Systems Thinking 2% (3 questions)
– New PCCN: Informatics
• Response to Diversity 2% (3 questions)
• Clinical Inquiry 2% (3 questions)
• Facilitation of Learning 3% (4 questions)
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The Synergy Model
• The core concept for the model of certified practice is the AACN Synergy Model for patient Care.
• The needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses.
• Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse’s competencies
• Test questions cover application of the Synergy model, not its terminology
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Assumptions of the
Synergy Model
• Patients are biological, psychological, social, and spiritual entities who present at a particular developmental stage. The whole patient (body, mind, and spirit) must be considered.
• The patient, family, and community all contribute to providing a context for the nurse-patient relationship.
• Patients can be described by a number of characteristics. All characteristics and connected and contribute to each other. Characteristics cannot be looked at in isolation.
• Similarly, nurses can be described on a number of dimensions. The interrelated dimensions paint a profile of the nurse.
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Goal of Nursing in
Synergy Model • A goal of nursing is to restore a patient
to an optimal level of wellness as defined by the patient.
– Death can be an acceptable outcome, in which the goal of nursing care is to move the patient toward a peaceful death.
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Patient Characteristics
• Each patient and family is unique, with a varying
capacity for health and vulnerability to illness.
• These characteristics span the health-illness
continuum.
• Patients / families bring a set of unique
characteristics to the care situation. They are:
Resource Availability ▪ Resiliency
Participation in Care ▪ Complexity
Participation in Decision Making ▪ Vulnerability
Predictability ▪ Stability
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Nursing Characteristics
• Nursing care reflects on integration of knowledge, skills, experience, and attitudes needed to meet the needs of patients and families
• There are levels of expertise ranging from competent (1) to expert (5)
• Nurse characteristics are derived from patient needs. They include:
• Clinical Judgment
• Advocacy and Moral Agency
• Caring Practices
• Collaboration
• Systems Thinking
• Response to Diversity
• Facilitation of Learning
• Clinical Inquiry (Innovator / Evaluator)
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Clinical Judgment
• Clinical reasoning which includes clinical decision making, critical thinking, and a global grasp of the situation, coupled with the skills required.
• Decision making: Information is assimilated, integrated, weighed and valued to arrive at the selection of a course of action from several alternatives.
• Critical thinking: Controlled purposeful, goal- directed reasoning, thinking based on evidence rather than conjecture.
Nursing
Process!
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Moral Agency /Advocacy
• Working on another’s behalf and representing the concerns of the patient, family and community.
• Serving as a moral agent in identifying and helping to resolve ethical and clinical concerns.
• Advocacy: Respecting and supporting the basic values, rights, and beliefs of the critically ill patient
Source: AACN position statement
Role of the critical care nurse as patient advocate.
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Caring Practices
• Nursing activities responsive to the uniqueness of the patient and the family
• Create a compassionate and therapeutic environment
• Goal of comfort and prevention of suffering
• Basic needs may be the same but the manner in which they are fulfilled depends on personal abilities, environment, and life experience.
Maslow’s
Hierarchy!
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Recognizing that
Patients and Families
Come to Us in Crisis
• Crisis: An acute state of stress in which the person feels overwhelmed by stressors.
• Strategies: o Listen to the patient’s perception of the situation
o Encourage the patient to express feelings about the situation
o Help the patient to gain an understanding of the situation by discussing losses and positive outcomes
o Assist the patient in developing a viable solution
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Recognizing that
Patients and Families
Have Fear/ Anxiety
• Anxiety: An acute state of stress in which the person feels overwhelmed by stressors.
• Strategies: o Listen to the patient’s perception of the situation
o Encourage the patient to express feelings about the situation
o Help the patient to gain an understanding of the situation by discussing losses and positive outcomes
o Assist the patient in developing a viable solution
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Recognizing the Effect of
Powerlessness
• Perceived lack of control
• The patient’s perception that any action they take will not affect outcomes.
• Interventions: – Support the patient’s sense of control where
possible: time of bath, visitors, lights, etc.
– Assist them where they can perform activities independently
– Keep patient informed about plan of treatment
– Encourage involvement in decision making
– Increase control as condition improves
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Assisting Patients &
Families at End of Life • Most Americans fear the process of dying more than death itself.
– Most would prefer to die at home
– A large percentage die in the hospital setting
• Many terminally ill patients report moderate to severe pain and discomfort during the last hours, often related to treatments / therapies such as:
– Wound care
– Suctioning
– Turning /positioning
• Patient’s desires regarding end of life care are often not known by the attending physician.
– Having an advance directive does not change the plan of care.
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Assisting Patients &
Families at End of Life
• Encourage sharing concerns and fears
• Do not give false hope. Provide realistic projections by asking: – “Would I be surprised if this patient does not survive this ICU
stay?”
• As add more therapies, re-clarify patient and family wishes.
• Provide presence and compassion
• Encourage family presence
• Assure comfort measures and analgesia
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Assisting Patients &
Families at End of Life What Do They Want?
• Frequent information about the patient ‘s condition
– Set up guidelines so that a family spokesperson can call for information
• Assurance
– To feel as if staff care about their loved one
– To know if they will be called if something happens
– To know they will get the best care
• Support
– To feel there is hope -- Even hope of a peaceful death
– Hope that the patient will be fully cared for
• Proximity
– To be able to see them frequently
– To be close by in a waiting room
• Comfort
– Families rank their need for comfort last
– Phones, refreshments, comfortable seating areas
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Collaboration
• Working together in a way that promotes and
encourages each person’s contributions.
• Collaborative practice:
– Sharing in planning, decision-making, problem-
solving, goal- setting, and responsibility
– Coordinating
– Cooperating
– Communicating openly and respectfully
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True Collaboration
• All team members master skilled communication
• Each team member embraces true collaboration as an ongoing process and invests in its development
– Team members know how unwillingness to collaborate will be addressed.
• Each team member acts with a high level of personal integrity
• Each team member demonstrates competence appropriate to his or her role and responsibilities
• Decision making authority of nurses is acknowledged and incorporated as the norm.
• Every team member contributes by giving power and respect to each person’s voice, integrating individual differences, resolving competing interests, and safeguarding the contribution of all team members .
AACN Standards for Establishing and Sustaining Healthy Work Environments
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Systems Thinking
• Knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient / family.
• Helps patient / family navigate through the system.
• Anticipates their needs: • Includes care delivery models
• Outcome management
• Quality improvement
• Conflict resolution
• Managing change
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Response to Diversity
• The sensitivity to recognize, appreciate and incorporate
differences into the provision of care.
• Culture: The learned, shared and transmitted values, beliefs,
and practices of a particular group that guide thinking,
actions, behaviors, interactions with others, emotional
reactions to daily living and one’s world view. – Culturally congruent care: Use of nursing interventions that
incorporate an individual’s cultural values, beliefs, and lifeways.
– Culturally inappropriate care and inattention to cultural differences may negatively affect health outcomes
– Individuals from different cultures and illegal immigrants often delay seeking medical attention because of language, cost, and cultural barriers.
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Facilitation of Learning
• The ability to facilitate learning for patients/ families, nursing staff, other members of the healthcare team, and community.
• Adult learning principles: – Goal directed, less flexible
– Longer time to learn tasks
– Impatient in the pursuit of objectives
– Finds little use for isolated facts
– Strives for recognition and success
– Has multiple responsibilities, all of which compete for their time.
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Adult Learners
• Experienced in the “school of life”
• Requires a more constant and ideal learning environment
• Usually comes to the learning situation on a voluntary basis
• Wishes to be involved in mutual planning of learning experiences
• Expects a climate of mutual respect, trust, and collaboration that supports learning
• Likes to participate in diagnosing needs for learning, formulating objectives, and evaluating learning.
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Learning Issues for
Patients
• Physiologic instability
• Psychological factors (anxiety, pain, etc)
• Poor language or reading skills
• Sensory deficits (vision, hearing)
• Poor manual dexterity for psychomotor skills
• Attitudes and beliefs that conflict with teaching.
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Clinical Inquiry
• The ongoing process of questioning and evaluating practice and providing informed practice.
• Creating practice changes through research utilization and experiential learning
• Primary goal of nursing research is to develop a specialized, scientifically based body of nursing knowledge to facilitate improvement in patient care
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Research Ethics
• Protect the rights of research subjects
• Ensure the potential benefits of the study outweigh any potential risk to the subject
• Obtain informed consent from the subject
• Assure IRB review of the research
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Nursing Responsibilities
in Research
• Identify problem areas and research questions for
investigation
• Assist in data collection
• Read and interpret research findings
• Assess the quality of the research and its applicability
to practice
• Apply research findings to change clinical practice
• Share research findings with peers
• Design and conduct research
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During the Exam
• Read each question carefully
• Formulate your answer first
• Narrow down choices
• Spend about 1 minute per question
• Bookmark
• Trust your first instincts!