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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:
ethics
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to take action or perform an act that will be beneficial:
beneficence
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to take no action because harm could result:
nonmaleficence
-
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:
- autonomy
- beneficence
- confidentiality
- justice
- non-malificence
- role fidelity
- veracity
-
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 doctor
-
the principle of fairness:
justice
-
the state of independent self-government:
autonomy
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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:
contractual agreements
-
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
- 2006
- 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)
- 1992
- the American College of Radiology (ACR)
-
an unintentional tort resulting from actions not intended to do harm:
negligence
-
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:
reasonable care
-
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:
spoliation
-
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:
Res Judicata
-
A legal concept in which a matter settles by a precedent:
Stare Decisis
-
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
- physicians
- 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:
incident reporting
-
give examples of when to fill out an incident report (7):
- falls
- 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
- allergies
- the materials used
- the amount used (volume and radioactivity)
- time of administration
- path of administration
- injection sites
- name of person administering material
- reaction
- 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?
- pregnancy
- 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:
caring
-
Name seven expressions of caring:
- feelings of compassion and concern
- a philosophy of commitment
- an ethical approach to problems
- altruistic acts
- nurturing of growth
- empathy
- advocacy
-
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:
- empathy
- (not the same as pity/sympathy/feeling sorry for)
-
A symbolic interaction: when one person says something to another and that person responds:
communication
-
list five elements of communication in imaging:
- speaker or sender
- language spoken or body language
- environment
- listening
- feedback
-
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
- noise
- 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.
human caring
-
Professional expertise unaccompanied by ______________ is not enough to serve all the needs of the patient.
human compassion
-
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:
- pain
- lonliness
- suffering
- fear
- death
-
is an important key to improving communication between the imaging professional and the patient:
active listening
-
Clear _________________ is a key element in the prevention of patient dissatisfaction and malpractice claims.
two-way conversation
-
the ability to read, understand, and act on health care information to make effective health care decisions and follow instructions for treatment:
health literacy
-
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 ______________.
- sixteen
- compassionate statement/"I'm sorry"
- litigation
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