CHAPTER 4 Cultural_ Legal_ and Ethical Considerations

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CHAPTER 4 Cultural_ Legal_ and Ethical Considerations Powered By Docstoc
					   1. Discuss the various cultural, genetic, and racial or ethnic
    factors that may influence an individual’s response to
   2. Identify various cultural phenomena affecting health care
    and use of medications.
   3. List the various drugs more commonly affected by
    cultural, racial, and ethnic factors.
    4. Develop a nursing care plan that addresses the cultural
    care of patients in drug therapy and the nursing process.
   5. Briefly discuss the important components of drug
    legislation at the state and federal levels.
   6. Identify the impact of drug legislation on drug therapy
    and the nursing process.
   7. Discuss the various categories of controlled substances
    and provide specific drug examples.
   8. Identify the process involved in the development of new
    drugs, including the investigational new drug application,
    phases of investigational drug studies, and process for
    informed consent.
   9. Discuss the nurse's role in the development of new and
    investigational drugs and the informed consent process.
   10. Discuss the ethical aspects of drug administration as they
    relate to drug therapy and the nursing process.
   11. Identify the ethical principles involved in making an
    ethical decision.
   12. Develop a nursing care plan that addresses the legal and
    ethical care of patients, drug therapy, and the nursing
   1906: Federal Food and Drug Act
   1912: Sherley Amendment (to the Federal Food
    and Drug Act of 1906)
   1914: Harrison Narcotic Act
   1938: Federal Food, Drug, and Cosmetic Act
    (revision of 1906 act)
   1951: Durham-Humphrey Amendment (to the
    1938 act)
   1962: Kefauver-Harris Amendment (to the 1938
   1970: Controlled Substance Act
   Orphan Drug Act (1983)
   Investigational new drug (IND) application
       Informed consent
   U.S. FDA Drug Approval Process
     Preclinical testing
     New drug application
     Investigational drug studies
     Expedited drug approval
   Preclinical investigational drug studies
   Clinical phases of investigational drug studies
       Phase I
       Phase II
       Phase III
       Phase IV
   Autonomy
   Beneficence
   Confidentiality
   Justice
   Nonmaleficence
   Veracity
   American Nurses Association (ANA) Code of
    Ethics for Nurses
   ICN Code of Ethics for Nurses
   Assess the influence of a patient’s cultural
    beliefs, values, and customs
   Drug polymorphism
   Compliance level with therapy
   Environmental considerations
   Genetic factors
   Varying responses to specific drugs
   Changing national demographics
   Influence of ethnicity and genetics
   Rapid and slow acetylators
   Examples of various ethnic groups found in the U.S.
       Asian
       African American
       Hispanic
       Native American
   Health beliefs and practices
   Past uses of medicine
   Folk remedies
   Home remedies
   Use of OTC drugs and treatment
   Use of herbal remedies
   Usual response to illness
   Responsiveness to medical treatment
   Religious practices and beliefs
   Dietary habits
   1. Compare the following terms related to drug
    therapy in the context of professional nursing
    practice: adverse drug event, adverse drug reaction,
    medication error, and the new term medication
   2. Discuss the importance of the 100,000 Lives
    Campaign as related to drug therapy.
   3. Describe the medication errors that are most
    common among professional nurses and other
    health care professionals.
   4. Develop a framework for professional nursing
    practice that includes specific measures to prevent
    medication errors in patients of all ages.
   5. Identify the possible consequences of a medication
    error on a patient's physiologic and psychologic well-
   6. Discuss the impact of medication errors in patients of
    different ages and cultural backgrounds.
    7. Analyze the various ethical dilemmas associated
    with medication errors as related to the nursing
   8. Distinguish the various needs of patients in different
    age groups for political action related to drug therapy
    and the prevention of medication errors.
Medical errors vs. Medication errors
   Medication errors (MEs)
   Adverse drug events (ADEs)
   Adverse drug reactions (ADRs)
   By definition, all ADRs are also ADEs
   But all ADEs are not ADRs
   Two types of ADRs
       Allergic reactions
       Idiosyncratic reactions
   Adverse effects
       Usually predictable
       Are ADEs but not thought of as ADRs
   Preventable
   Common cause of adverse health care
   Effects can range from no significant effect to
    directly causing disability or death
   Minimize verbal or telephone orders
       Repeat order to prescriber
       Spell drug name aloud
       Speak slowly and clearly
   List indication next to each order
   Avoid medical shorthand, including
    abbreviations and acronyms
   Never assume anything about items not
    specified in a drug order (i.e., route)
   Do not hesitate to question a medication
    order for any reason when in doubt
   Do not try to decipher illegibly written
    orders; contact prescriber for clarification
   NEVER use “trailing zeros” with medication
   Do not use 1.0 mg; use 1 mg
   1.0 mg could be misread as 10 mg, resulting in
    a tenfold dose increase
   ALWAYS use a “leading zero” for decimal
   Do not use .25 mg; use 0.25 mg
   .25 mg may be misread as 25 mg
   “.25” is sometimes called a “naked decimal”
   Check medication order and what is
    available while using the “Five Rights”
   Take time to learn special administration
    techniques of certain dosage forms
   Always listen to and honor any concerns
    expressed by patients regarding medications
   Check patient allergies and identification
   Possible consequences to nurses
   Reporting and responding to MEs
       ADE monitoring programs
       USPMERP (United States Pharmacopeia Medication Errors
        Reporting Program)
       MedWatch, sponsored by the FDA
       Institute for Safe Medication Practices (ISMP)
   Notification of patient regarding MEs
   1. Discuss the importance of patient education in the
    safe and efficient administration of drugs (e.g.,
    prescription drugs, over-the-counter drugs, herbal
    preparations, dietary supplements).
   2. Discuss some of the teaching and learning principles
    related to patient education and drug therapy across
    the life span that are applicable to any health care
    setting or to home care.
   3. Identify the impact of the various developmental
    phases (as described by Erikson) on patient education
    and drug therapy.
   4. Develop a complete patient teaching plan as part of a
    comprehensive nursing care plan for drug therapy.
   Adaptation to any illness
   Cognitive abilities
   Coping mechanisms
   Cultural background
   Developmental status (cognitive and mental
    processing abilities)
   Emotional status
   Environment: home and work
   Family relationships
   Financial status
   Psychosocial growth and development
   Health beliefs
   Information patient understands about past
    and present medical conditions, medical
    therapy, medications
   Language(s) spoken
   Level of education/literacy level
   Level of knowledge about current medications
   Limitations (physical, psychologic, cognitive, motor)
   Current medications, including OTC and herbals
   Mobility
   Motivation
   Nutritional status
   Past and present health behaviors
   Past and present experience with drug
    regimens and other therapies
   Race and/or ethnicity
   Readiness to learn
   Self-care ability
   Sensory status
   Social support
   Infant (birth to 1 year)
       Trust vs. mistrust
   Toddler (1 to 3 years)
       Autonomy vs. shame and doubt
   Preschooler (3 to 6 years)
       Initiative vs. guilt
   School-aged child (6 to 12 years)
       Industry vs. inferiority
   Adolescent (12 to 18 years)
       Identity vs. role confusion
   Young adult (18 to 45 years)
       Intimacy vs. isolation
   Middle-aged adult (45 to 65 years)
       Generativity vs. stagnation
   Older adult (older than 65 years)
       Integrity vs. despair
   Deficient knowledge
   Ineffective health maintenance
   Ineffective therapeutic regimen management
   Risk for injury (self)
   Impaired memory
   Noncompliance
   Goals and Outcome Criteria
     Measurable
     Realistic
     Based on patient needs
     Stated in patient terms
     Time frame
   Teaching-learning sessions
   Consideration of age-related changes
   Consideration of language barriers
   Safe administration of medications at home
   For adults, it is recommended that materials be
    written at an 8th-grade level
   Individualize the teaching session
   Use positive rewards or reinforcement for
    accurate return demonstration of procedures
    or technique
   Complete a medication calendar
   Use audiovisual aids
   Involve family members or significant others
   Keep teaching on a level that is meaningful to that
   Consider resources when the patient does not speak
   Validate whether learning has occurred
       Ask questions
       Have patient provide a return demonstration
       Behavior, such as compliance and adherence to a
       Occurrence of few or no complications
   Develop and implement new plan of
    teaching as needed for:
       Noncompliance
       Inadequate levels of learning

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