Notes Finals

8/13/2019 Notes Finals

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CONTRACT

Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to

render some service

A promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy (Breach)

KINDS OF CONTRACT

Formal- refers to an agreement between parties and is required to be in writing.

E.g. marriage contract ..

Informal-one in which the law does not require the same to be in writing.Express- the conditions and terms of contract are given orally or in writing by the parties concerned.

E.g. PDN under the doctrine of "facio ut des" means I do that you may give.

Implied- one that is concluded as a result of acts of conduct of the parties into a contract.

Void- one that is inexistent from the very beginning and therefore may not be enforced.

Illegal- one that is expressly prohibited by law

Those that are made In protection of the law

Consent obtained by fraud; duress; undue influence and material misrepresentation

CONSENT

a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is

legally capable to give consentInformed Consent-a written consent should be signed to show that the procedure is the one consented to and that the

person understands the nature of the procedure

Nurses responsibility regarding informed consent

(1) witness the exchange between the client and the physician

(2) witnessing the client affix his signature

(3) establishing that the client really understood.

Characteristics of a Valid Consent

Voluntariness; free from coercion

Opportunities to ask questions expalined

Treatment explainedUnderstood by the patient

Maturity of parties (physically and mentally)

CRITERIA OF GOOD CONSENT

Eighteen years old and above

Mentally capacitated

Proxy consent-


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*The chart is owned by the hospital

DOS & DONTS IN CHARTING

DOS

Full, factual and objectively accurate

Legible

Immediate

Personal

DONTSLanguage or unacceptable words

Improper corrections

Spaces & skips

Abbreviation, not standard

Dont tamper the medical record by:

Adding

Rewriting

Destroying original record Observe agencys standards on documentation

Complete & Concise

Specific & Standard abbreviationsWriting an Incident Report:

A tool used as a means of identifying and improving client care. They are usually made immediately after its occurrence

and validated immediately by co-workers.

Purpose: to provide accurate documentation of occurrences affecting the client as to have basis for its intervention.

The following are common situations that require an incident report:

MOST OF THEM ARE NEGLIGENT ACTS Falls , burns & medication error Break in the aseptic technique Incorrect sponge count during surgery Failure to report the clients condition

Rules in Incident Report

Dont use the word error or include lawful judgment or inflammatory words

NURSES AND WILLS, GIFTS, ADVANCE DIRECTIVES

WILLS- legal declaration of a persons intentions upon death.

Called a testamentary document because it takes effect after the death of its maker

An act whereby a person is permitted with the formalities prescribed by law, to control a certain degree the deposition

of his estate, to take effect after death.

Decedenta person whose property is transmitted through succession whether or not he left a will

Testatora person who left a will.

Testatrixa woman who is making a will

Heira person called to succession either by the provision of a will or by operation of law

Testatea person who dies leaving a will

Intestatea person who died without leaving a will

Probatevalidation of a will in court

Administratorone who administers the provision of the will

Estatethe interest a person has in lands or in any other subject to property

Attestation Clause- means the clause wherein the witness certifies that the instrument has been executed before them,

and the manner of the same.

TYPES OF WILLS

Holographic willa will is written, dated and signed by the testator

Nuncupative will or Nuncupation- an oral will

WHO CAN MAKE A WILL?

Sound mind

Eighteen years old & above

Not prohibited by law


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WHO CAN WITNESS?

Sound mind

Eighteen years old & above

Able to read and write

Not blind, deaf or dumb

The Nurses obligation in the Execution of a will

Note the soundness of the pts mind

Ensure there was freedom from fraud or under influenceThe pt should be above 18 years of age

Note the will was signed by the testator and that the witnesses signed the will in the presence of the testator

For protection, the nurse must make a notation on the pts chart

Gifts:Another way of disposing property

Four legal requirements for a gift:

gift must consist of personal property Intention to make the gift Indication of transfer of control over such property acceptance by the recipient

Gifts Causa Mortis or Donation Causa MortisGifts made by a person because of anticipation of death or beliefs in

approaching death.

ADVANCE CARE DIRECTIVE: a document written or completed by the client and used by a facility or hospital to provide

care at a time when client cannot make his own decision

SUBJ ECTS:

1. Show risk for early dementia

2. Show risk for stroke

3. Activities- severe head injuries

4. Severe and recurring psychiatric illness

5. Terminally ill

Characteristics of Advance Directives

a. Allows clients to participate in choosing health care providersb. Allows also in choosing the type of medical treatment the client desires.

c. Allows clients to consent or refuse treatments

TYPES:

1. INSTRUCTIVE DIRECTIVE-specifies life- sustaining treatment to be withheld or withdrawn.

LIVING WILL-legal document stating person does not wish to have extra-ordinary life saving measures when not

able to make decisions about his own care.

-applicable for life saving treatment only.

Example: DNR

2.PROXY OR DURABLE POWER OF ATTORNEY: legal document giving designated person authority to make health care

decisions on the clients behalf when the client is unable to do so.

Do not Resuscitate (DNR)

Factors in giving order of resuscitation:

1. Clients will and advance directives

2. Disease prognosis such as cancer or HIV

3. Clients ability to cope

4. Whether CPR will be given or not

Reasons for refusing to perform resuscitation

Epidemic or widespread disease or debilitating condition & that CPR is not beneficial

CPR will aggravate or prolong the agony of the client against cultural & religious suffering

Advance directives & Will


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Organ Donation

REQUIREMENTS:

Any person 18 years of age or older may become an organ donor by written consent. Informed choice to donate an organ can take place with the use of a written document signed by the client prior

to death, a will, or a donor card or an advance directive.

In the absence of appropriate documentation, a family member or legal guardian may authorize donation on thedescendants organs.

In case of newborns, they must be full term already (more than 200 grams)TYPES:

1. Autotransplantation- donor and recipient are one and the same

Ex: skin and bones

2. Heterologous- donor and recipient are two different individuals.

a. animal to human

b. human to human

c. cadaver donor

d. living donor

Types of organs used :

1. Those that regenerate

- bone marrow, skin

2. Those that come in pair

- kidneys, eyes

Religions that have different views regarding organ donations Russian Orthodox: permits all donations EXCEPT THE HEART. Jehovahs Witness: DOES NOT ALLOW organ donation and all organ to be transplanted must be drained of blood

first.

Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.

NURSINGETHICS

ETHICS: Came from the Greek word ETHOS moral duty

Studies how people make judgment in regard to right or wrong

MORALITY

It is the right or wrong; good or evil; proper or improper, cruel or benevolent acts

Health Care ethics: Division of ethics that relates to human health

Bioethics: Focuses on moral issues in the field of health care

NURSING ETHICS: The examination of all ethical and bio-ethical issues from the prospective of nursing theory and

practice

PRINCIPLES IN BIOETHICS

BENEFICENCE: means to do only whats good

NON- MALEFICENCE: Principle of do no harm

AUTONOMY: the right to make ones own decision; self-determination

STEWARDSHIP: not harm our body because it is Gods not ours

JUSTICE: The right to be treated fairly, justly and equally

FIDELITY: refers to the obligation to be faithful to the agreements, commitments and responsibilities that one has made

to oneself and others

VERACITY: Truthfulness or honesty

RESPECT: treat all individuals as persons with rights with or without abnormality.

INVIOLABILITY/ SANCTITY OF LIFE: No one can violate or destroy life

SHARING OR ALLOCATION OF RESOURCES: applies when resources are scanty or very limited


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Standards of Care: Guidelines for determining whether nurses have performed duties in an appropriate manner &

guidelines in which the nurse should practice

PATIENTS BILL OFRIGHTS

1. Right to considerate and respectful care:nurse avoids discriminating acts that tends to bring the appearance of

favoritism; a tender loving care attitude

2. Right to information about diagnosis, treatment and prognosis

3. Right to informed consent: refers to the capacity of the patient to accept or refuse treatment options offered by the

health care provider.Elements:

Voluntariness Informed Competent parties Knowledgable info. provided Signed prior to pre-op meds

4. Right to an advance care directive

5. Right to Privacy

6. Right to confidentiality: all records and communications held in confidence

when to divulge information:

1. patient placed in serious danger

2. public welfare

3. legal proceeding

7. Right to go over records

8. Right to services and to transfer: Referral

9. Right to know relationship with other health care and educational institutions

10. Right not to be subjects of research or experimentation

11. Right to expect reasonable continuity of care:follow up consultations

12. Right to know what hospital rules and regulations apply to his conduct as a patient

MORAL PRINCIPLES

The golden rule: Do unto others what you would like others do unto you

The two fold effect:

May have bad and good effect Must be morally good Good effect must be willed and the bad effect merely allowed Good effect must not come from an evil action Good effect must be greater than the bad effect

The Principle of Totality: The whole is greater than any of its parts

Epikia: Exception to the general rule

One who acts through an agent is himself responsible

Ex. Nurse recommends patient to another clinic for abortion but does not want to perform

No one is obliged to betray himself/herself

No one can force any person to answer a question if such will incriminate him/her

The end does not justify the means

Giving sleeping tablets to someone who has chronic illness

Defects of nature may be corrected

Corrected by plastic surgery

If one is willing to cooperate in the act, no injustice is done to him/herWith patients consent

A little more or less does not change the substance of an act

Stealing

The greatest good for the greatest number

Have more good effects for more people than a smaller group


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REGISTERED NURSES AND THE PROFESSION

Ethical Principles:

1. Maintain loyalty

2. Compliance with by laws of accredited professional organizations

3. Commitment to continual learning

4. Contribute to the improvement of the socio-economic conditions and welfare of nurses

Guidelines to be observed:

a. Be a member of accredited prof organization (PNA)b. Strictly adhere to nursing standards

c. Strive to secure equitable working conditions through appropriate legislation and other means

d. Assert for the implementation of labor and work standards

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