NURS 3342
CH 4,6, 38-39
1
Chapter 4
Cultural/ legal/ ethical considerations
WHY we do what we do how we do it!
2
Student Centered
objectives
Know why we do what we do so you can feel smug and
secure!
E
...
NURS 3342
CH 4,6, 38-39
1
Chapter 4
Cultural/ legal/ ethical considerations
WHY we do what we do how we do it!
2
Student Centered
objectives
Know why we do what we do so you can feel smug and
secure!
Explain to the patient what you know will help them so they
will take it to heart and THANK you!
Recall the 2 MAGIC WORDS for pt compliance and the ONE
to be avoided!
Read lab reports and be the first to catch when an antibiotic
needs to be changed, thus preventing needless suffering
and death!
3
Culture
Includes ethnicity PLUS group socialization
CP 450 system affected by ethnicity as well
as aging
Culture affects diet, healthcare practices and
all aspects of pts lifestyle, “who they are”
Q1 How can a patient’s ethnicity change their use
of and response to medication?
4
Q2. How do we find out a patient’s “hidden”
(unspoken) cultural beliefs? Why is that
important?
Q3. How do we handle a patient’s cultural
beliefs that are harmless and would not
interfere with medication therapy? What if
they ARE potentially harmful or might
interfere with the needed therapy?
5
Landmark Drug Legislation 6
1906- free of adulterants list addictive substances
1938- regulation of SAFETY
1962- proof of EFFECTIVENESS required
1970- Controlled substances act
1992- “Fast track” (expedited) added (Why?) AIDS
1997- broad overhaul
2002-2003- Pedi research added
1997- Women added-sometimes (Left out?) women were
childbearing
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Controlled drugs 7
Schedule C-I- high abuse, no common medical use (Ex?) heroine
C-II- high abuse, severe dependence risk (Ex- Cocaine,
methadone- what medical uses?) coming off of heroine
C-III- less abuse and moderate dependence risk
(Tylenol #3- contains codeine)
C-IV- less abuse and limited dependence (Benzos)
C-V- limited abuse potential (cough syrup and Antidiarrheals with
narcotics)
Determined by FDA, enforced by DEA
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New Drug Development 8
U.S. FDA drug approval process
Preclinical testing- no patients
Clinical studies
Investigational drug studies
Expedited drug approval
NUSRES ARE PATIENT ADVOCATES
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Stages of New Drug
Development
Preclinical testing- “investigational”- lab, animals
(Investigational new drug (IND) application)
Informed consent
Clinical testing
Phase I- healthy volunteers
Phase II and III- may be double-blind/ placebo controlled
***FDA Approval****
Phase IV: Post marketing surveillance
This is the only time placebos are used
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Q4. How does the FDA (supposedly) protect
us from drugs that are unsafe, impure or
otherwise dangerous? How do nurses help in
this effort?
Q 5. What do the following terms mean:
orphan drug, controlled substances,
expedited approval, double-blind study, black
box warning, placebo, controlled study?
10
Exercising Discretion 11
Regarding Change:
“Be neither the first to adopt the new nor the
last to abandon the old.”
New drugs are not always better!
(But ALWAYS more EXPENSIVE!)
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12 Limitations of the Testing
Procedure
Limited information for
Women
Children
Obesity
Elderly
Failure to detect all adverse effects
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Ethical Nursing Practice 13
American Nurses Association (ANA) Code of Ethics for
Nurses
International Council of Nurses (ICN) Code of Ethics for
Nurses
How are ethical principles manifest in patient care,
medication use, drug research?
Be patient advocate. Let them know they are in a controlled
study. Educate them on how exactly to use their medication.
Ethical principles
Autonomy- people are in charge of their own
selves
Beneficence- do good
Nonmalficence- do no harm
Justice- be fair
Veracity- don’t lie
14
The patient really needs some experimental
chemo treatment or her likelihood of death is
95% in the next 6 months. She is 60 years old
and is very afraid of the chemo due to a close
friend’s prior experiences. With treatment her
chance of 5 year survival is 90%. There is a
50% risk of serious complications with the
chemo. The nurse is there helping the patient
understand what the physician has told her so
she can decide about the chemo. The
patient’s adult daughter wants the nurse to
“soft peddle” the risks of chemo “to avoid
scaring her any worse”. Pt wants to know and
decide for herself.
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Q5.
How is autonomy illustrated?
Beneficence?
Confidentiality?
Nonmaleficence?
Veracity?
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Chapter7
Patient education
and drug therapy
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The Domains of Learning 18
Affective domain
Cognitive domain
Psychomotor domain
Summary- What you need to be (or feel), know and be
able to do
Q6. A patient is newly diagnosed with a sexually
transmitted infection and needs to take
antibiotics, along with her partner. What needs
might the patient have in the following area:
Affective?
Cognitive?
Psychomotor? (prevention)
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Q7. Give two questions the nurse might ask to
assess the patient’s teaching needs before she
plans the needed patient education?
How should the nurse use body language,
space, touch, eye contact, empathy and a nonjudgmental attitude in teaching this patient?
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Patient Education: 21
Assessment
Psychosocial- Who is this?
Cognitive/ Developmental status
Emotional status it affects their ability to learn and
remember what you say to them
Environment: home and work
Financial status
Cultural- Race and/or ethnicity, Religious beliefs, Family
relationships understand that different cultures have
different ways
Patient Education: 22
Assessment (cont’d)
Medical- what do they have to learn (unlearn)?
Past and present health behaviors, Coping mechanisms
Level of knowledge/ Misinformation about current
medications
Current medications, including over-the-counter and
herbal medications
Past experience with drug regimens and other therapies
Patient Education: 23
Assessment (cont’d)
How/ when will they (?) best learn this?
Limitations (physical, psychological, cognitive, motor,
Sensory impairment)
Language(s) spoken, Level of education/literacy level
Motivation, Self-care ability
Social support/ helpers
Readiness to learn
DO NOT USE FAMILY MEMBERS AS TRANSLATORS
Patient Education: 24
Nursing Diagnoses
Communicate with staff- basis for planning
Deficient knowledge
Ineffective health maintenance
Ineffective therapeutic regimen management
Risk for injury (self) (Ex- sedatives, narcotics)
Impaired memory
Noncompliance (Ex- Rx $$$$$)
Patient Education: 25
Planning
Goals and Outcome Criteria- SMART goals!
Specific
Measurable
Actions
Realistic
Time frame
Patient Education: 26
Implementation
Teaching-learning sessions
Consideration of age-related changes
Consideration of language barriers
Safe administration of medications at home
Return demonstration with equipment
For adults, it is recommended that materials be written at
an 8th grade level
Patient Education: 27
Teaching-Learning Sessions
Individualize the teaching session
Use positive rewards or reinforcement for accurate
return demonstration of procedures or technique
(Example?)
Patient Education: 28
Teaching-Learning Sessions
(cont’d)
Use audiovisual aids when appropriate
Involve family members or significant others (Why?
How?)
They may be able to understand. They also may not be the
one giving the medication
Keep teaching on a level that is meaningful to the
patient
Therefore, know THEIR goals
Patient Education: 29
Teaching-Learning Sessions
(cont’d)
Consider resources when the patient does not speak
English
If possible, communicate with the patient in the patient’s
native language, esp greetings
Use a translator if necessary
Provide publications in the patient’s native language
Phone translation services (AT &T)
Q8. How do we decide when/ how to use direct 1:1
discussion, pamphlets and written materials,
internet resources, DVDs, demonstration/
return demonstration or other teaching
methods?
Pointers for effective/ appropriate use of a
translator?
30
Patient Education: 31
Evaluation
Validate whether learning has occurred
Ask direct questions!
Have the patient provide a return demonstration
Behavior, such as adhering to schedules
Avoidance of noncompliant behaviors
Patient Education: 32
Evaluation (cont’d)
Document for team follow up
Develop and implement new plan of teaching as needed
for:
Noncompliance
Inadequate levels of learning
Sample education planSAFE Meds
Skills
Action
Facts (patho about disease)
Environment, emotional aspects
MEDS- pt education pointers about SE, AE,
danger sx, administration, diet/ drug IA,
expected benefits and timeline
Time may be needed before
the medication will work
33
Q9. How can you correct a patient’s
misinformation without “putting her down”?
When/ how should the family be included in
patient education?
The 2 “magic words” and NEVER word
PLEASE AND THANK YOU!!
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Dad’s philosophy
Life is not meant to be a journey to the grave, with
the intention of arriving safely in an attractive
and well-preserved body. But rather to slide in
sideways, cigar in one hand, favorite drink in
the other, body thoroughly used up, totally
worn out and screaming- WOO
HOO!
What a RIDE!
Anti-infective
Medications
ADAPTED FROM: NANCY F. ROGERS
PHD, RN, FNP-CS
ASSOCIATE PROFESSOR
CH 38- 39
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Part I: Terminology
Infectious diseases- Variety of illnesses caused by
pathogenic (disease-causing) microorganisms
Antimicrobial- Agent or activity that destroys or prevents
development of microorganisms [bacterial, fungal, antiviral,
ant parasitic, antiprotozoal, antimycobacterial (TB)]
FACT: one sixth of the TEN MILLION deaths in WWI were from
infection! By WWII, antibiotics had decreased this rate
tremendously.
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• Antibiotics (destructive to life/bios)- Natural or synthetic
substances produced from various microorganisms that destroy
other microorganisms or inhibit growth; used for
antimicrobial/anti-infective action to treat infectious diseases
• Antibacterial- Agent or activity that interferes with growth &
reproduction of bacteria.
*Now antibacterials most commonly described as agents used to
disinfect surfaces and eliminate potentially harmful bacteria.
Unlike antibiotics, they aren’t used as medicines, but are found in
cleansers.
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