Clinical Sonography:What every student needs to know. Harry H. Holdorf

Principles of Bioethics

Many bioethics principles are self-evident.For example, the concept that a physician should not harm a patient, or should develop a care plan that provides the most benefit to the patient. If the patient has the mental capacity to do so, they must indicate a willingness to accept the proposed course.

Major Principles of Medial EthicsFour commonly accepted principles

of health care ethics include:

1. Respect for autonomy2. Non-maleficence3. Beneficence4. Justice

Respect for Autonomy

Respect for autonomy means that the patient has the capacity to act intentionally, with understanding and free will.

This principle is the basis of the INFORMED CONSENT.

In mak9ing voluntary, knowledgeable decisions, the patient is assumed to be of sound mind.

Non-Maleficence

The principle of non-maleficence requires that we avoid needless harm or injury to the patient, whether by action or inaction.

Imposing careless or unreasonable risk of harm on a person is negligence.

Beneficence

The actions of health care providers should benefit the patient.

This duty extends from individual patients to our entire community.

It includes improving the patient’s health, as well as preventing disease in the general population.

Justice

Justice in health care is usually defined as fairness.

Generally, people who are equals should qualify for equal treatment, regardless of age, gender, educational background, and other factors.

INFORMED CONSENT

Informed consent is the process by which patients are educated about the essentials of a medial procedure.

This process allows them to make an informed, educated, and voluntary decision about the health care they are to receive.

The most important goal of informed consent is for patients to have an opportunity to be a knowledgeable participant in their health care decisions.

Complete informed consent generally includes the following: The nature of the procedure Reasonable alternatives The risks, benefits, and uncertainties related

to each alternative Assessment of the patient’s understanding The patient’s acceptance

For a patient’s consent to be valid, the patient must be considered competent to make the decision and the consent must be voluntary.

Since the patient’s comprehension is equally as important as the information provided, the discussion should be in a layperson’s terms and the patient’s understanding should be assessed throughout the process.

When is it appropriate to question a patient’s ability to participate in decision making? If a patient is underage (typically

under 18), the patient’s guardian must provide consent.

If a patient is incapacitated or incapable of providing consent, the patient’s guardian or surrogate decision maker must provide consent.

If the patient does not speak English, the assistance of a translator may be necessary to obtain the patient’s consent.

It is preferable that the translator be hospital approved.

A bilingual family member or other person can communicate with the patient as long as the patient has signed a HIPAA-compliant release form to proactively authorize ongoing involvement of a family member.

However, only the patient can provide consent.

Revocation of Consent

A patient may withdraw previously granted consent at any time.

The sonographer must respect this decision and promptly bring the exam to a close.

This should be done without exposing the patient to any additional risks or threats to safety.

Patient-Sonographer Interaction What should the sonographer do

when first meeting a patient? Upon meeting a patient:

Treat the patient respectfully. Introduce yourself and describe the procedure and your role in performing it.

Identify the patient. If possible, use the patient’s wrist-band for identification. If there is no wrist-band, it is acceptable to include patients in their own identification. For example, ask the patient for a birth date or full name.

If a sedated patient arrives without a wrist-band, call the nurse.

The patient may be sent back to the floor and the study rescheduled when the patient has appropriate identification.

It is inappropriate for the sonographer to cancel the exam.

Ordering or canceling an examination is outside the sonographer’s scope of practice.

Patient Dignity Dignity is defined as the quality of being

worthy, honored, or esteemed. Every patient has a right to be treated in

a dignified manner, one that is respectful and ethical.

Dignity includes a patient’s perception of being in control and having self-worth.

Factors that make a patient vulnerable to a loss of dignity include advanced age, infirmity, and lack of privacy.

Sonographer-Work Environment Interaction No matter what we do, it is important

to be safe, comfortable, and free from work-related injuries.

Interpretation of the exam In order to produce a diagnostic examination, a

sonographer must be knowledgeable of abnormal and normal sonographic findings.

Sonographers must be aware of and follow departmental guidelines when providing their preliminary findings of the exam to a physician.

However, sonographers should refrain from providing a clinical interpretation or discussing the findings directly with the patient.

In fact, in some states, these acts may be considered the unauthorized practice of medicine.

Ergonomics

Ergonomics studies the interaction between the sonographer, patient, and equipment in order to optimize the well-being of sonographers in their professional environment.

Sonographers must be in good physical shape and have full use of their hands, wrists, and shoulders.

More than 3 out of 4 sonographers experience pain from work related musculoskeletal injury.

Nearly 20% of sonographers end their careers as a result of such injuries.

The Occupational Safety and Health Administration (OSHA) and Society of Diagnostic Medial Sonography (SDMS) have formed an alliance, with goals of reducing and preventing work related musculoskeletal disorders.

Causes of Injury

The causes of such injuries include repetitive motions, forceful or awkward movements, poor posture, improper positioning, strain, and pressure on joints for extended periods.

Ergonomic Devices

Adaptive ergonomic devices have been designed and created for the sonographer.

These devices include wrist support braces, adaptive support cushions, cable braces to keep the cable out of the sonographer’s way, ergonomic transducer design, chairs with adjustable armrests and footrests and bed designs with expandable adjustment options.

Most importantly, control panel and monitor articulation (swivel and extension) allow the sonographer to maintain the recommended wrist, eye, neck, and body positions.

Best Practices Best practices include:

Keeping your arm close to the body Staying close to the patient Positioning the system’s monitor directly in

front of you and at eye level Minimizing the extent of twisting or bending

over Using proper sitting positions Holding the probe using a whole hand grip,

PLAMER GRIP Keeping the wrist in a neutral position Using proper foot support

Laboratory Polices and Procedures Laboratory polices and procedures

must include standards for ergonomics and sonographer health.

Routine lab operation should include educational programs regarding best practices, proper use of equipment, and safety concerns.

Annual continuing medical education regarding ergonomics is essential.

Effective patient scheduling can also reduce workplace injuries.

Avoid scheduling the same type of exam consecutively to minimize strain and repetitive motion for extended periods.

Limit the number of studies each day and incorporate non-scanning activities between studies.

Standard Precautions

Standard precautions are a set of guidelines to minimize the exposure and risk of health care workers when in contact with a patient.

Standard precautions are based on the idea that all patients should be treated as potentially infectious.

Standard precautions are an extension and clarification of universal precautions.

Universal precautions were originally developed in the 1980s to minimize the risk of patients with HIV, and other Bloodborne pathogens.

All health care workers should routinely practice good hygiene habits, which include hand washing and the use of appropriate barrier precautions to prevent skin and mucous membrane exposure during contact with any patient’s blood or body fluids

This includes the use of appropriate personal protective equipment such as gloves, gowns, eye wear and face masks whenever exposure to a patient’s body fluid is anticipated.

Standard precautions apply over a very broad range: all body fluids, secretions, excretions, mucous membranes, airborne particles, and to non-intact skin.

Standard precautions also apply to any items soiled with these substances.