Bedside Management and Professional Boundaries Flashcards
Management tips
get report, start by reading history/physical, check recent labs, look at meds, perform head to toe, make schedule/set goals, chart as you go (in the room)
Start by reading history and physical
what brought them in, meds, what have they been doing?
Check recent labs
especially for trends, prioritization (ex: high wbcs, still high but lower = don’t freak out)
Look at meds
schedule out - before meals, with meals
Perform head to toe or focused assessment
usually second round, baseline for how doing today
Making the most of your time
start planning meds when receive report (no multitasking), sinking ship, delegate, documentation, receiving report
Sinking ship
be aware of who can help you, help others
Delegate
find out who’s good at doing what
Receiving report
active listening, don’t ask questions till the end
Documentation
as early as possible, take notes throughout day
What is something to be aware of with boundaries when caring for people you know?
could be overinvolved
It is the __________ responsibility to maintain therapeutic relationship
nurse’s
Professional boundaries
nurses are trusted, abstain from attaining personal gain at pt expense. maintain therapeutic relationship - not under or over involvement, careful w/ social media, sexual misconduct
Red flags for boundary crossings
flirting, sharing personal info, keeping secrets, you’re the only one who can help, more time, pt asking about you
Boundaries
space between nurse’s power/pt vulnerability
Boundary crossings
for therapeutic purpose
Boundary violations
for nurse’s need
Nurse’s responsibility to maintain therapeutic relationship
no secrets, super nurse, role reversal, double blind, professional privilege
Super nurse
I’m the only one who can take care of the pt
role reversal
nurse using pt for satisfaction/gratification, pt taking care of nurse
double blind
pt wants to terminate relationship but needs help from nurse so can’t
professional privilege
nurse uses info learned for personal benefit
bedside reporting
report at the bedside, pt feels part of the report, new nurse builds rapport with the family,
Maintaining professional boundaries
clearly share role/limits, aware of vulnerable pts, keep personal/professional separate, touch appropriately, don’t overshare about personal life, be aware of your emotional response to pt, don’t friend on social media
Nurses _________ buy/sell from a patient/family or be the power of attorney on their will
can’t
What are some ways to determine who gets what patients?
proximity, acuity, staff mix
Patient safety (bedside reporting)
lay eyes on pt, decreased potential for near miss, they hear what’s been said
Top three reasons for bedside reporting
patient safety, patient satisfaction, benefits nursing staff, teamwork, ownership, accountability
Patient satisfaction (bedside reporting)
they see nurses working together, feel more empowered/involved, become additional resource, pt want you at the bedside
Benefits nursing staff (bedside reporting)
can prioritize care based on seeing, accountability between shifts
Organizing information
ex: trifold, notes on what to tell next nurse. find one that works for you
Hourly rounding
if you check on pts every hour they won’t use the call bell
What are the four Ps?
potty, pain, position, possession
Hourly rounding helps prevent ____________
sentinel events
Most sentinel events are from
lack of communication, insufficient pt education
Tips to increase time at the bedside
document at bedside, plan ahead/have supplies with you
Warning signs for boundary problems
excessive self disclosure, secretive behavior, special treatment, flirtation, overprotective behavior
Document Head to Toe in pt’s room
True
professionalism
change from pt focus to nurse focus
maintaining therapeutic relationship
be clear on role and care limits,
cognitive impairment
history of physical or verbal abuse,
