Proctor Study Guide:
Chapter 2 Legal and Ethical Issues:
1. Beneficence: duty to promote good
Ex: spending extra time to help an anxious client
2. Autonomy: respecting the rights of others
Ex: acknowledge the clients right to refuse meds
3. Justice: equal care
Ex: ICU nurse provided equal care to patient who has attempted suicide as to someone who
suffered a brain aneurysm
4. Fidelity: maintaining loyalty and commitment
Ex: client asks nurse to be present when talking to their guardian and the nurse remains with the
client during the interaction
5. Veracity: duty to always communicate truthfully
Ex: describing he adverse of effects of the meds in a truthful and non-misleading way
Types of admissions
Voluntary admission: client or client’s guardian chooses admission, has the right to refuse meds and
treatment, before release needs to be evaluated if not it becomes involuntary admission
Involuntary admission: enter facility against will. Criteria: clear risk of client’s danger and others, inability
to meet own basic needs, presence of mental illness and requires treatment but unable to seek it
voluntary. Limited to 60 days. Still have the right to refuse meds and treatment unless a judge has
declared them incompetent and assign a guardian.
Patient rights:
1. Right to humane treatment and care
2. Right to vote
3. Rights to granting, forfeiture or denial of driver’s license
4. Right to process of law Ex: press charges
5. Informed consent and right to refuse meds
6. Confidentiality
7. Written plan of care/treatment
8. Communication with people of the facility such as friends and family
9. Care provided with respect, dignity, and no discrimination
10. Freedom from harm from restraints, seclusion etc
Intentional Tort- willful or intentional acts that violate another person’s right
1. False Imprisonment: confining for convenience
2. Assault: making a threat to client, verbal
Ex: Saying you will never get out of here
3. Battery: touch the client in harmful or offensive
Ex: Shoving a patient from behind to hurry them up.
Unintentional Tort:
, • Negligence: failure to provide care in a personal or professional situation
Ex: Failure to question MD order, failure to protect patient from self-harm, failure to provide
patient teaching
• Malpractice: type of professional negligence (nurse claims that nurse did something that caused
an injury to a patient)
11.
Chapter 3 Effective Communication:
dont ask irrelevant personal questions
don’t ask why questions
giving approval or disapproval
offering advice or personal opinions
Chapter 4 Defense/Stress Mechanisms:
Anxiety mild: allows the client to perceive reality in sharp focus, and the actual problem solving becomes
more effective. Ex: finger or foot tapping, fidgeting, lip chewing
Moderate anxiety: perceptual field narrows, but the client is able to cope with some assistance.
Examples: concentration difficulty, tiredness, pacing, change in voice, headache, back pain, increase HR
and RR.
Nursing Interventions from Mild-Moderate Anxiety:
Encourage client to express their feelings, develop trust and identify sources of anxiety
Provide calm presence and recognize the client’s distress
Evaluate past coping mechanisms
Explore alternatives to problem mechanisms
, Encourage participation in the activities such as exercise
Severe anxiety: perceptual field is scattered, and the client is not able to focus on anything expect
relieving the anxiety. Examples: confusion, feelings of doom, hyperventilation, withdraw, tachycardia,
rapid speech.
Panic level: not able to process what is occurring and can lose touch with reality. Extreme fright and
horror. Examples: dysfunction in speech, dilated pupils, severe shakiness, severe withdraw, delusions and
hallucinations.
Nursing Interventions from Severe-Panic anxiety:
Provide environments that comfortable and meets physical and safety of the client
Needs to in a quiet environment
Use medications and restraints if needed
Encourage gross motor activities such as walking
It must be very frightening….
Defense mechanism:
Denial –Not reality
Projection –Your own feeling/thoughts into someone who does
Regression – Childlike behavior
Sublimation – Substituting anger
Splitting – Negative/Positive
Rationalization – Because, creating a reasonable explanation
Altruism –help others
Undoing - Make up for prior behavior
Reaction formation- client exhibits a behavior or emotion that is opposite of what they feel.
Displacement- redirection of thoughts, feelings, and impulses
Repression- avoiding all unpleasant experiences. emotions and ideas
Suppression is the only defense mechanism done voluntarily
Don’t get confused with projection and displacement. Displacement is feelings going to a 3 rd
party and after an event.
A good example of Undoing is the boyfriend giving flower to girlfriend when they do something
wrong. Trying to be undo the wrong
Chapter 5 Creating and maintaining therapeutic safe environment
Chapter 2 Legal and Ethical Issues:
1. Beneficence: duty to promote good
Ex: spending extra time to help an anxious client
2. Autonomy: respecting the rights of others
Ex: acknowledge the clients right to refuse meds
3. Justice: equal care
Ex: ICU nurse provided equal care to patient who has attempted suicide as to someone who
suffered a brain aneurysm
4. Fidelity: maintaining loyalty and commitment
Ex: client asks nurse to be present when talking to their guardian and the nurse remains with the
client during the interaction
5. Veracity: duty to always communicate truthfully
Ex: describing he adverse of effects of the meds in a truthful and non-misleading way
Types of admissions
Voluntary admission: client or client’s guardian chooses admission, has the right to refuse meds and
treatment, before release needs to be evaluated if not it becomes involuntary admission
Involuntary admission: enter facility against will. Criteria: clear risk of client’s danger and others, inability
to meet own basic needs, presence of mental illness and requires treatment but unable to seek it
voluntary. Limited to 60 days. Still have the right to refuse meds and treatment unless a judge has
declared them incompetent and assign a guardian.
Patient rights:
1. Right to humane treatment and care
2. Right to vote
3. Rights to granting, forfeiture or denial of driver’s license
4. Right to process of law Ex: press charges
5. Informed consent and right to refuse meds
6. Confidentiality
7. Written plan of care/treatment
8. Communication with people of the facility such as friends and family
9. Care provided with respect, dignity, and no discrimination
10. Freedom from harm from restraints, seclusion etc
Intentional Tort- willful or intentional acts that violate another person’s right
1. False Imprisonment: confining for convenience
2. Assault: making a threat to client, verbal
Ex: Saying you will never get out of here
3. Battery: touch the client in harmful or offensive
Ex: Shoving a patient from behind to hurry them up.
Unintentional Tort:
, • Negligence: failure to provide care in a personal or professional situation
Ex: Failure to question MD order, failure to protect patient from self-harm, failure to provide
patient teaching
• Malpractice: type of professional negligence (nurse claims that nurse did something that caused
an injury to a patient)
11.
Chapter 3 Effective Communication:
dont ask irrelevant personal questions
don’t ask why questions
giving approval or disapproval
offering advice or personal opinions
Chapter 4 Defense/Stress Mechanisms:
Anxiety mild: allows the client to perceive reality in sharp focus, and the actual problem solving becomes
more effective. Ex: finger or foot tapping, fidgeting, lip chewing
Moderate anxiety: perceptual field narrows, but the client is able to cope with some assistance.
Examples: concentration difficulty, tiredness, pacing, change in voice, headache, back pain, increase HR
and RR.
Nursing Interventions from Mild-Moderate Anxiety:
Encourage client to express their feelings, develop trust and identify sources of anxiety
Provide calm presence and recognize the client’s distress
Evaluate past coping mechanisms
Explore alternatives to problem mechanisms
, Encourage participation in the activities such as exercise
Severe anxiety: perceptual field is scattered, and the client is not able to focus on anything expect
relieving the anxiety. Examples: confusion, feelings of doom, hyperventilation, withdraw, tachycardia,
rapid speech.
Panic level: not able to process what is occurring and can lose touch with reality. Extreme fright and
horror. Examples: dysfunction in speech, dilated pupils, severe shakiness, severe withdraw, delusions and
hallucinations.
Nursing Interventions from Severe-Panic anxiety:
Provide environments that comfortable and meets physical and safety of the client
Needs to in a quiet environment
Use medications and restraints if needed
Encourage gross motor activities such as walking
It must be very frightening….
Defense mechanism:
Denial –Not reality
Projection –Your own feeling/thoughts into someone who does
Regression – Childlike behavior
Sublimation – Substituting anger
Splitting – Negative/Positive
Rationalization – Because, creating a reasonable explanation
Altruism –help others
Undoing - Make up for prior behavior
Reaction formation- client exhibits a behavior or emotion that is opposite of what they feel.
Displacement- redirection of thoughts, feelings, and impulses
Repression- avoiding all unpleasant experiences. emotions and ideas
Suppression is the only defense mechanism done voluntarily
Don’t get confused with projection and displacement. Displacement is feelings going to a 3 rd
party and after an event.
A good example of Undoing is the boyfriend giving flower to girlfriend when they do something
wrong. Trying to be undo the wrong
Chapter 5 Creating and maintaining therapeutic safe environment
