Online Nursing Classes
Cultural Diversity and Ethical, Legal Issues
We will now begin the first day of our program.
Our Topic for today is about Cultural Diversity.
We will try to master this topic today.
How can we do that?
By doing the following method:
1. From 8:00 Am to 12:00 PM – you must read the topic repeatedly until such time that you had memorized the important “nursing keywords” necessary to pass the exam.
2. Follow the procedures in reading: From 8:00 AM – 10:00 AM
- First reading: read the topic “cultural diversity”
- Second reading: read the topic and look for “words that are in bold, they are the keywords that you must memorize”
- read again the whole topic and “Memorize the keywords”
3. From 10:00 AM to 10:30 AM – take a break
4. From 10:30 AM to 12:00 PM
- Third reading: read again the whole topic then “close your eyes” when pronouncing the keywords loudly. This will make you assess if you really memorized the “nursing keywords” that are necessary to pass the exam.
Four (4) hours is long enough to be familiar with cultural diversity and memorize the important keywords.
What is the benefit in reading the concept again and again?
According to Og Mandino, a very well known author of different bestseller books wit the topic about “How to Make Man Great” in whatever field he chooses.
“Reading information again and again will make it reside to your subconscious and can be retrieved easily when needed”.
Now, Do you need this concept to reside in your subconscious?
Yes! You need it very badly!
You need it to become “NCLEX-RN!”
If you do. Follow the guideline; it will make you “Master the Fundamentals of Nursing”
4. From 12;00 PM to 1:00 PM - take a break and eat your lunch
5. From 1:00 PM to 3:00 PM - answer 100 questions from Saunders Practice Test about Fundamental Skills. (I will give it to you for free!!!, it contains more than 2,000 questions with rationale). It will surely help a lot with your review proper.
Upon receiving the copy of the Saunders Practice Test, Follow the sequence to go to Fundamentals Practice Test.
- In step 1 - click the “study mode”
- In step 2 – click the “content area”
- Then scroll down and click for the “fundamental skills”
- answer 100 items
7. From 3:00 PM to 3:30 PM – take a break
8. From 3:30 PM onward – read and analyze the rationale. It will give additional information about the topic. Do not forget to read the “STRATEGY” after reading the rationale. It will teach you how to “attack the question properly” that will lead you to pick the correct answers.
You can now proceed with your review proper,
I. CULTURAL DIVERSITY
- Direct eye contact with authority is viewed as rude; but it is an important part of communication among family members/significant others.
- Personal questions are considered intrusive during initial contact; e.g. relationships, divorce, conflicts.
- Touching another’s hair is offensive.- Illness is believed to be caused by demons/spirit
- Folk healer/herbalist may be consulted before seeking medical treatments
Native Americans/American Indians
- silence indicate respect for the speaker
- eye contact as a sign of disrespect
- They value the practice of massage to promote bonding between mother and newborn. Rooming-in is preferred for the mother and the newborn
- integration of religion and healing practices is observed
- Illness is caused by supernatural forces and disequilibrium between person and environment.
- Direct eye contact with authority is viewed as rude
- head nodding does not necessarily mean agreement
- saying “NO” is considered as disrespect for others
- do not touch member of the opposite sex
- illness is believed to be an imbalance between positive (+) and negative (-) energy forces
- Promotion of healing by Yin and Yang principle
- Cold foods (Yin)
- Hot foods (Yang)
- Cold foods are given for hot illness
- Hot foods are given for cold illness
- do not admire a child. They believe that you may afflict the child with “evil eye,” it will cause an illness to the child
- they avoid eye contact with authority to show respect
- they use embraces/handshakes; they are very tactile
- they believe that health results from balance between “hot/cold”, “wet/dry” forces
- illness is a result of God’s punishment
- communicate with male head of the family especially for major decisions, like signing consent for procedures because they have patriarchal society
- the most valued members of the family is the children
- religious practices are related to treatment of illness
European (White)-Origin Americans
- eye contact indicates trustworthiness
- they primarily depend on modern western health care services
Autopsy is prohibited among:
- Eastern Orthodox
- Jehovah’s Witness (NO BLOOD TRANSFUSION)
- Orthodox Jews
- Jehovah’s Witness (prohibited)
- Muslims (prohibited)
- Buddhists (act of mercy)
- Hindus (cast ashes in Holy River, they believe that they can join the Creator faster this way)
- Mormons (prohibit cremation)
- Eastern Orthodox (prohibit cremation)
- Islam/Muslims (prohibit cremation)
- Jews (prohibit cremation)
Religion and Dietary Practices
- prohibits alcohol; discourages tea and coffee
- prohibits alcohol and drug use
- most of them are vegetarians
- considered the cow as sacred animal that is why they prohibit eating of beef and veal
- most of them are vegetarians
- prohibits pork, alcohol and drugs
- daytime fasting is practiced during the time of Ramadan
- prohibits food to which blood has been added
- allow animal flesh that has been drained from blood
- KOSHER DIET: prohibits meat and milk combination
- Prohibits pork and scavenger fish (shrimps, squids, crabs, fishes with no scales)
- Meat is allowed if from animals that are vegetable-eaters, cloven-hoofed, and ritually slaughtered
- prohibits alcohol, tea and coffee
- practice of fasting every first Sunday of the month
- encourages limited consumption of meat
- No meat on ash Wednesday and Good Friday (abstinence)
- Optional fasting during lent season
Seventh day Adventist
- prohibits alcohol, tea and coffee, meat, and scavenger fish
- No surgeries or any procedures during Saturdays (Sabbath Day – sundown Friday to sundown Saturday).
Cultural Beliefs and Practices on Death and Dying
- When a Chinese client dies, they cover him/her with mirror with white cloth
- A dying client must face East (Middle East) or West/Southwest (North America). The dead body will be washed by a family member of the same sex and then covered with white cloth
- The dead body is blessed by Spiritual Adviser
- Anointing of the sick is done by the priest, to a dying client
II. ETHICAL AND LEGAL ISSUES
• It is a written document that provides directions concerning the provision of care when a person is unable to make his/her own treatment choices.
Two types of advance directive:
a) Living Will – it is the expression of the person’s wishes regarding end-of-life care. It is prepared by a competent adult that provides direction regarding medical care in the event of the person’s incapacitation or otherwise becoming unable to make decisions personally.
b) Durable Power of Attorney – I is an authorization that enables any competent individual to name someone to exercise decision-making on his/her behalf under specific circumstances. Example, end-of-life situation.
Clarifying Unclear/Inappropriate Physician’s Order
• Clarify the order with the physician who gave the order
• Contact nurse manager/supervisor if no resolution occurs regarding the order in question
• It is acceptable and legal practice
• Nurse cannot refuse to float; but the nurse should not assume responsibility beyond level of experience or qualification
• The nurse should inform the supervisor of any lack of experience in caring for the type of clients on the new nursing units
• The nurse should be given an orientation to the new unit
• Floating nurse should be assigned with patients with stable conditions; or similar to his/her training or experience
• Floating nurse should not be assigned to patients who are for discharge and who require patient teaching
Good Samaritan Laws - These laws encourage health care professionals to assist in emergency situations without fear of being sued for the care provided
Informed Written Consent• Physician not the nurse, is the primary responsible to secure written consent
• Nurse may sign as a witness. It attests that the client signed the consent
Written consent is legal when:
• The person is in legal age (18 y/o and above)
• The consent is secured without force, duress, or coercion
• The person is not under the influence of drugs or alcohol
• The person is not mentally incapacitated
Parents or guardian can signed for minors/i> and persons who are physically or mentally incapacitated
• Minors who are married or emancipated from the parents and those seeking for treatment for STD’s can signed an informed consent
• Written consent can be waived in time of emergency to save the life of the person
• Validity of informed consent is 24 hours. If the procedure is postponed, secure another consent
• Secure consent for each procedure
• Age requirement is 18 y/o and above before signing a form for organ donation
• Informed choice to donate an organ may be through written document signed by the client prior to death, a will, a donor card, or an advance directive
• Family member or legal guardian may authorize organ donation if the client is dead
• Nurses is duty-bound to carry out a doctor’s order except when the nurse believes that the order is inappropriate
• Nurses who carry out inaccurate order is legally responsible for his/her action
• Date and time the entry
• Repeat (read back) the order to the physician and record the order
• Sign the order begin with the t.o., write the doctor’s name, and then sign the order; e.g. (t.o. Dr. Alec Tinio/ your signature RN
• It is necessary that the doctor countersign the order within the time frame based on the agency policy (usually 24 hours)
Use of Restraints
• Written consent is needed coming from relatives/significant others
• Secure consent for each episode of application of restraints
• PRN order: legally unacceptable
• Apply soft restraints
• Secure restraints at he bed frame, not on the side rails
• Check restraint application every 15-20 minutes
• Release restraints every 2 hours for 30 minutes
• Change restraints every 24 hours
For Narrative Documentation
- it should be accurate, complete, factual, and objective
- use a black pen
- document care, medications, treatments, and procedures as soon as possible, after completed
- document responses to interventions
- document consent for a refusal of treatments
- document calls made to other health care providers
- use appropriate abbreviations
- in case of error, draw one line through the error, initial and date
- never erase any entry, do not use correction fluid
- do not leave blank spaces on documentation forms. Avoid judgmental or opinionated statements, such as “uncooperative client.”
- Do not document for others or change documentation for other individuals
For Computerized Documentation
-use only the user identification (ID) code, name, or password
- maintain privacy and confidentiality of documented information printed from the computer
Principle of Confidentiality
- information about a client be kept private
- information in the client’s record is accessible only to those providing care to the client
- No one else is entitled to that information unless the client has signed a Consent for Release of Information that identifies with whom information may be shared and for what purpose.
- Discussing clients outside the clinical setting, telling friends, or family about clients or even discussing clients in the elevator with other workers violates client’s confidentiality.
- The clients has a right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law
Incident Reports/Variance Reports
- A tool used as a means of identifying and improving care.
- The reports should be complete, accurate, and factual.
- The reports should not include opinions or interpretations.
- The report form should not be copied or placed in the client‘s record.
- It is not a substitute for a complete entry in the client’s record regarding the incident.
- Nurses may administered controlled substances (narcotics, depressants, stimulants, and hallucinogens), only under the directions of a physicians or other authorized providers.
- Controlled substances must be kept securely locked, and only authorized personnel should have access to them.
Reporting Responsibilities. The following situations need to be reported to the Local Authority.
This is a LAW.
Failure to report any of these situations is a malpractice.
- communicable diseases
- Abuse: sexual, child, wife, husband, elderly abuse. (Whenever abuse is suspected, it should be reported to the local authority. It will be the court to prove or disprove abuse.)
- gunshot/ stab wounds
- vehicular accidents
Clients Advocacy - Involves concerns and actions on behalf of another person in order to bring about change.
3 Elements of Advocacy
1. Beneficence - means doing and promoting good.
e.g., administering pain medications.
Practicing asepsis to prevent infection.
Promoting safety of restless and confused clients.
Providing psychosocial support to an anxious client.
2. Nonmalefincence - means to avoid doing harm, to remove from harm, and to prevent harm.
e.g., protecting the client from a practitioner who practices drug abuse.
Reporting abuse prevent further victimization.
3. Autonomy – right to make one’s own decision
4. Fidelity – being faithful to agreement and promises
5. Veracity – telling the truth
6. Justice - fairness
Torts and Crimes - These are legal wrongs committed against a person or property.
Crime - Results in prison term or fine or short jail sentence to punish offender.
a. Felony - A crime of serious nature.
b. Misdemeanor - An offense punishable by imprisonment of les than one year or a fine less than 1,000 dollars. Does not amount to a felony.
c. Manslaughter - A second degree murder. It is unintentional killing.e.g., accidental administration of overdose narcotics that resulted to death of the clients.
Torts - Result in civil trial to assess compensation for plaintiff
1. Intentional Torts:
- Assault and Battery
a. Assault – is the threat of touching another person without his/her consent
b. Battery – is the actual carrying out of such a threat
- Defamation of Character - is a communication that is false or made with careless disregard for the truth, and results in injury to the reputation of the person
a. Libel – defamation by means of print, writing, or pictures
b. Slander - is defamation by spoken word, stating unprivileged or false words by which the reputation of the person is damaged
- Fraud - is the willful, purposeful misrepresentation of self or an act that may cause harm to a person or property
- Invasion of Privacy - is disclosure confidential information to an inappropriate third party (subjects the nurse to invasion of privacy even if the information is true).
- False Imprisonment – occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the client
- Negligence – mistake or failure to be prudent. An act of omission or commission
- Malpractice – is negligence in the practice of profession (e.g. error in sponge counts)
To prove malpractice, four elements are necessary
a. a duty of the nurse to the client
b. a breach of duty on the part of the nurse
c. an injury to the client
d. a causal relationship between the breach of duty and the client subsequent injury
Potential Malpractices Situations in Nursing
- medication error
- sponge count error
- burning a client
- client falls
- mistaken identity
- loss/damage of client’s property
- failure in reporting crimes, torts, and unsafe practice
“Only the Task not the Accountability may be Delegated to another”
Best Practice: Always ensure client safety
Death and Dying
- Right of Informed Refusal – a competent adult has the right to refuse treatment, even life-sustaining treatment
- Do Not Resuscitate (DNR) Order – a written order must be present and must be reviewed on a regular basis. The client or his/her legal representative must provide informed consent for the DNR status. Both DNR and cardiopulmonary resuscitation (CPR) must be clearly defined so that other treatments, not refused by the client will be continued.
Euthanasia – physician or nurse-caused death (active euthanasia), deliberately hastening a person’s death, is considered murder in all states and almost all other countriesPronouncement of Death
- in some States, the nurse may pronounce death at the bed side
- in most States, however, the physician has the legal responsibility of pronouncing the person dead. “To be safe in answering, always choose PHYSICIAN.”
Death Certificate – the physician is responsible for signing a death certificate
Care of the Body – the nurse is responsible for preparing the body for the morgue or mortuary. Consider the cultural practices and wishes of the family. Treat the body with dignity.
Rigor Mortis :
- stiffening of the body (occurs 2-4 hours)
- position the body, the dentures, close the mouth and eyes before RM set in
Algor Mortis – decrease in body temperature (1C/hr)
Livor Mortis – discoloration of the skin because of the RBC breakdown
- make the body appear natural and comfortable
- allow the family to view the patient’s body
- place the body in supine positions, the arms at the side and palms down
- place one pillow under the head and shoulder to prevent blood from discoloring the face
- place absorbent pads under the buttocks to take up any feces or urine
- apply identification tags, one on the ankle and one at the wrist
- wrap the body in shroud, place the third tag for identification