Chapter 3: issues in nursing practice Flashcards
factors influencing heath care change
- changing characteristics of US population
- increasing population
- increasing number of older adults
- increasing cultural diversity
- evidence based practice
- multidrug resistant infectious organisms
- emerging viruses
- human trafficking awareness campaign
- technology: EHR, mobile health (tablets, smartphones, telehealth, apps, etc), remote pt monitoring, robotics
- nursing informatics
safe practice: medication errors
- increase w/ distractions
- interventions
- no interruption zones marked w/ bright colored tape
- wearing bright colored vests/sashes
- not interrupting others
- avoiding own interruptions
sentinel events
- fatal or serious injury or death that could have been prevented
a medication is specifically made for only ______type of admin route
ONE;
can ask hcp for alternate route such as someone who cannot take pills or is NPO, but cannot put IV medication in water and have them drink it
economic issues
medicare and diagnosis related groups
medicaid
hospital acquired conditions and present on admission reporting
managed health care
14 hospital acquired conditions
- foreign object retained after surgery
- air embolism
- blood incompatibility
- stage 3 and 4 pressure ulcers
- falls and trauma injuries
- manifestations of poor glycemic control
- catheter associated UTI
- vascular catheter associated infection
- surgical site infection following coronary artery bypass graft (mediastinitis)
- surgical site infection following bariatric surgery for obesity
- surgical site infection following certain orthopedic procedures
- surgical site infection following cardiac implantable electronic device
- DVT/PE w/ knee/hip replacement
- Iatrogenic pneumothorax w/ venous catheterization
the delegation process
- can delegate down, not up, make sure the UAP is within scope of practice, understands what you are asking, you have to follow up to see if it was done and what the results were
- know state nurse practice act
- identify skills of delegate
- use five rights of delegation
ethics
study of traditions, values, and beliefs, related to people/relationships
bioethics
ethical principles and values applied to human life
ethical questions
what should/ought we do?
morals
personal values
standards set by one’s conscience
personal choices of good and bad, right and wrong
values
- standards/ideals/concepts giving meaning to individual’s life
- derived from societal norms, religion, and family traditions
- guide decisions and actions
ethical principles
autonomy
beneficence
nonmaleficence
fidelity
veracity
justice
utilitarianism
outcomes most important elements for making decisions
deontology
actions/attitudes based on duty
theological perspectives
religious traditions
source of values and morals
ethical decision making steps
- identify ethical dilemma
- identify stakeholders and their values
- gathe and verify information
- examine possible actins and consequences
- determine ethical foundation for actions
- determine best action w/ strongest ethical support
- implement action
- evaluate outcome
regulation of nursing practice
- licensed health care profession
- goal: to protect the public
- regulated by state boards of nursing
- nurse practice acts: laws define scope of practice, vary by state
- license sanctioned for violations
violations
- unprofessional conduct
- incompetence
- conviction of a crime
- misuse of controlled substances
license sanctions
suspend
revoke
prescription medication
current prescription for current condition required
prescribed controlled substances
cannot work under the influence when substance affects your ability to work safely to protect your pts
prior misdemeanor or felony convictions
- may have a harder time getting a job or no able, or not able to do pt care
- when applying for state licensure: explain how you complied w/ court’s orders, tell why it will never happen again
- after licensure, report within 30 days of: address change, any conviction occurring anywhere, if in doubt report to avoid nonreporting sanction
mandatory reporting
vulnerable populations: children , older adults, disabled, mentally impaired
- known or suspected abuse
- inform appropriate state agency
examples of abuse
physical
sexual
verbal
emotional
financial/economic
neglect
human trafficking awareness
- victims utilize health systems to access tx for medical needs
- indicators to look for: pt has no identification, someone answering for pt, someone making decisions for pt, someone never leaving pt alone
physical and psychological indicators of human trafficking
chronic physical issues: headaches, back pain, stomach or abdominal pain
mental health issues and human trafficking
memory loss, depression, and anxiety
signs and symptoms of abuse and neglect and human trafficking
bruising, malnutrition, submissive behavior
if human trafficking suspected
- do NOT alert victim or confront trafficker
- confirm suspicions w/ healthcare team
- report to local law enforcement
health insurance portability and accountability act of 1996
- civil/criminal liability for healthcare workers who wrongfully disclose pt’s health information
- violation penalties include: disciplinary action by employer, fines, sentenced up to 10 years in prison, sued by pts
social media and hipaa
- always protect pt health info from unathorized disclosure
- keep professional and personal life separate
- employrs review social media sites
- examples: unauthorized access to medical records, taking unathorized photos of pts on personal electronic devices (pediatric pts require parental consent), posting pt info to social media such as lab studies, photos, x rays
nursing liability and the law
liability established by law for wrongful actions
- criminal law: regulates behaviors for citizens among society, imprisonment/fines
- civil law: basis for malpractice and common negligence, monetary recovery for injuries
torts
lawsuits for personal injury
civil liability suit
complaint
summons: must be answered by employer or nurse
malpractice
- the breach of a professional duty
- applies to nurses perforing nursing duties on the job
negligence
liability arising from an injury that results from a person’s failure to exercise due care
limiting liability
- ensuring patient rights
- following institutional policies
- practicing by current nursing standards
- documenting procedures appropriately
- pursuing continuing education
