Unit 2 (Beneficence and Caring)
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the part of philosophy which deals with systematic approaches to questions of morality and provides us with a framework to use in order to make decisions:
to take action or perform an act that will be beneficial:
to take no action because harm could result:
An act or action should be performed only if the intention is to
bring about the good effect and only if the bad effect is unintended or an indirect consequence:
principle of double effect
refresh: who is credited with the utilitarian theory and what is it?
- john stuart mill
- the theory which states that the ideal is to do the most good for the most people
list the four conditions of the double effect:
- The action must be good or morally indifferent in itself.
- The agent must intend only the good effect and not the evil effect.
- The evil effect cannot be a means to the good effect.
- Proportionality must exist between good and evil effects.
refresh: the seven biomedical principles are:
- role fidelity
1. goal of nonmaleficence vs. goal of beneficence:
2. how nonmaleficence is achieved vs. how beneficence is achieved:
3. importance of nonmaleficence vs. importance of beneficence:
- 1. to do no harm vs. to do good
- 2. achieved through passive omission vs. achieved through active process
- 3. primary responsibility of the health care provider vs. secondary in importance to nonmaleficence
most decisions concerning medical indications involving beneficence and maleficence fall into whose hands?
the principle of fairness:
the state of independent self-government:
in this principle of granted informed consent, the physician should do what is medically indicated such that, from a medical point of view, more good than evil will result:
the medical indication principle
commands that the surrogate choose what the patient would have chosen when competent and after having considered all available relevant information and the interests of the relevant others:
rational choice principle
what principle is followed for a mentally competent patient and what principle is followed for a mentally incompetent patient?
- competent: medical indication principle
- incompetent: rational choice principle/ best interest of the patient
Verbal and written agreements that help provide for patient autonomy:
what is the imaging professional's role as compared to the patient's role?
- To be aware of the obligations to do good and avoid harm.
- Participate in protecting their own good and avoiding their own harm by gathering information about the imaging procedure they will be undergoing.
The degree of skill or care practiced by a reasonable professional practicing in the same field:
Standard of Care
In our profession, what is our most basic legal parameter?
- the Standard of Care
- (authoratative basis of a profession)
list the three parts of the Standard of Care:
- Practice standards
- Education requirements
- Curriculum development
Where is the Scope of Practice for a technologist to be found?
in the Practice Standards, published by the ASRT
Provides standards for accreditation for educational programs in radiologic sciences:
Joint Review Committee on Education in Radiologic Technology (JRC-ERT)
When, where, and by whom was the CARE bill first introduced?
Give the original name of the CARE bill, when it changed to its current name, and the full current name:
- Consumer Assurance of Radiologic Excellence Act
- Consistancy, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Bill
What regulates the field of Mammography, when was it established, and who accredits Mammography programs?
- Mammography Quality Standards Act (MQSA)
- the American College of Radiology (ACR)
an unintentional tort resulting from actions not intended to do harm:
The degree of care a reasonable person, in a similar situation would use; determined by the applicable standard of care, by statute, or by previous judicial decisions called precedents:
A breach of the health care provider’s duty to follow the applicable standard of care that results in harm to the patient:
medical negligence/medical malpractice
How is the Standard of Care usually established in court?
through the testimony of a medical expert practicing in the same field as the defendant
a legal doctrine that states that an employer will be held accountable for an employee's negligent act:
- Respondeat Superior
- "let the master answer"
- a.k.a. vicarious liability, "captain of the ship"
the destruction or tampering with a legal document, such as medical records:
A legal concept invoked in situations in which a particular injury could not have occurred in the absence of negligence:
- Res Ipsa Loquitur
- "the thing speaks for itself"
- example: surgical sponges left in patient after surgery
A legal concept in which a thing or matter is settled by justice:
A legal concept in which a matter settles by a precedent:
the most important element in preventing and minimizing adverse consequences and/or malpractice suits:
the medical record (documentation)
Name an item that does NOT go into the medical record:
an incident report, which goes to risk management
What three things mandate the requirements of the technologist to obtain pertinent information/ patient history to aid in the diagnosis and treatment of the patient?
- the Code of Ethics
- the Joint Commission
- Departmental Policies
be familiar with ten documentation basics:
- Never alter or falsify a record
- If you make an error, draw a line through it and write “error”
- Know and adhere to your department’s policies and guidelines.
- Document clearly and in chronological order.
- Do not document irrelevant details
- Provide objective, factual information.
- Document all instances of patient noncompliance or refusal of recommended treatment.
- Sign your legal name and title and always make your documentation legible.
- Keep records in a safe place and respect confidentiality.
- Use incident reports to report unusual circumstances
who should be involved in creating a Patient Data Sheet or computerized form?
- department administrator
- risk manager
- legal council
be familiar with eight items to be included on a Patient Data Sheet:
- Basic patient identification information
- Pertinent patient history
- Answers to questions regarding pregnancy and last menstrual period
- Signature line
- Time of patient arrival and departure
- Name of technologist performing examination
- Comment section
- This form should be part of the patients' permanent record.
Every page of a patient’s record should be clearly labeled with (2):
- the patient's name
- medical record number
A valuable risk management tool that is required on occurrences that have resulted or may result in hospital liability or patient dissatisfaction:
give examples of when to fill out an incident report (7):
- sudden deaths
- drug, contrast, and radiopharmaceutical errors and reactions
- injuries caused by faulty equipment
- injuries to employees or visitors
- threats of legal action
- Unexplained requests from attorneys for medical records
Be familiar with 14 items that should always be included on a Contrast Material and Radiopharmaceutical Data Sheet:
- documentation of the obtaining of informed consent
- the materials used
- the amount used (volume and radioactivity)
- time of administration
- path of administration
- injection sites
- name of person administering material
- time of reaction
- symptoms of reaction
- treatment of reaction
- physician treating
- time and condition upon leaving department
where should reactions to contrast material be documented?
- contrast data sheet
- incident report
- patient's medical chart
if hand delivering a document (especially to ER, intensive care, or OR), what should you make a record of (4)?
- the report delivered
- to whom
- time and date
- get an initial
Establishes policies and procedures regarding radiation exposure based on the ALARA principle:
- National Council on Radiation Protection and Measurements
- ALARA: as low as reasonably achievable
List six Quality Control and Assurance programs that help prevent patients from receiving unnecessary radiation:
- Repeat exam analysis with results tracked and corrections made on noticed problems
- Proper function of processing equipment
- Follow policies and procedures for shielding and collimation.
- Informed consent should be signed when patient is pregnant!
- Preventive maintenance and calibration should be performed routinely
- Equipment inspection is performed periodically by state and federal agencies
What is the greatest risk in radiation protection?
- use additional shielding and increase kVp to above 90
list eight comprehensive safety programs:
- Written policies and procedures regarding handling of hazardous materials
- Fire and electricity safety
- Emergency codes
- Back safety
- Patient transport and lifting techniques
- Infection control
- Occurrence reporting
- Loss prevention
A function of the whole person in which concern for the growth and well-being of another is expressed in an integrated application of the mind, body, and spirit that seeks to maximize positive outcomes:
Name seven expressions of caring:
- feelings of compassion and concern
- a philosophy of commitment
- an ethical approach to problems
- altruistic acts
- nurturing of growth
Compassion arising from an awareness of common bonds of humanity and common expression, fates, and feelings:
existential care (more abstract form of care)
The ability to recognize and to some extent share the emotions and state of mind of another and to understand the meaning and significance of that person’s behavior:
- (not the same as pity/sympathy/feeling sorry for)
A symbolic interaction: when one person says something to another and that person responds:
list five elements of communication in imaging:
- speaker or sender
- language spoken or body language
list obstacles to caring (7):
- scarcity of time
- technical priorities
- impact of personal life
- lack of training in caring for criticially ill/terminal patients
- lack of communication
- societal pressures
- lack of faith in self
list obstacles to communication:
- (from sender or receiver)
- thinking of other things
- temperature or other things
- distance and inability to see or hear
The application of the knowledge of a discipline, including its science, theory, practice, and art:
professional care (complementary to human caring)
The interaction of compassion, knowledge, and the experiences and emotions of the whole person gives rise to:
human and professional caring
_________________ is the basic element and has to be practiced before professional care can be obtained.
Professional expertise unaccompanied by ______________ is not enough to serve all the needs of the patient.
A __________________________ is produced if the emphasis is on skill at the expense of caring and empathy.
patient care gap
name some universal feelings we discussed:
is an important key to improving communication between the imaging professional and the patient:
Clear _________________ is a key element in the prevention of patient dissatisfaction and malpractice claims.
the ability to read, understand, and act on health care information to make effective health care decisions and follow instructions for treatment:
list factors affecting health literacy:
- general literacy (most common)
- a person's experience with health
- complexity of the information being presented
- cultural factors that affect decision-making
- the way the material is communicated
one out of five American adults reads at this level:
at or below the fith-grade reading level
the average American reads at this level:
at the 8th or 9th grade level
health care materials are written at this level:
above the 10th grade level
__________________ measures English literacy of American adults.
National Assessment of Adult Literacy (NAAL)
list the four levels that individuals are scored on by the NAAL:
- below basic (16% of population)
- basic (28% of population)
- intermediate (sufficient to function)
- proficient levels (sufficient to function)
Identified health literacy and self-management as a priority area for national action in transforming health care:
- Institute of Medicine
- “Priority Areas for National Action: Transforming Health care Quality”
list the six steps to improve interpersonal communication with patients:
- slow down
- use non-medical language
- show or draw pictures
- limit the amount of information provided and repeat it
- use the teach back or show me technique
- create a shame-free environment
give examples of Clinician-Patient Communication Problems Involved in Malpractice Lawsuits:
- Explanation of diagnosis is inadequate.
- Explanation of treatment is inadequate.
- patient feels ignored.
- Clinician fails to understand perspective of patient or relatives.
- Clinician discounts or devalues views of patients or relatives.
- Patient feels rushed.
Studies published in the Journal of the American Medical Association indicate that it is not necessarily the medical error itself that causes patients and families to sue, but:
the response to it
_________ states have passed legislation givingva physician the right to provide a _________________________ to patients at the time of an adverse outcome without threat of ______________.
- compassionate statement/"I'm sorry"
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