Chapter Two Flashcards
Purpose of Nursing
To provide care and education to the acutely ill, patient’s, family, and the community about medical conditions, and to provide advice and emotional support to patients and their families.
Participating in health and wellness activities.
Delegation
Advanced practice nurses are prepared to diagnose, advanced assessments, and have prescriptive authority.
Standards of Nursing Practice
Reflect the values and priorities of the Nursing Profession
Provide direction for professional nursing practice
Provide a framework for the evaluation of nursing practice
Define the profession’s accountability to the public and the client outcomes for which nurses are responsible.
The American Nurses Association (ANA) sets standards for Professional Nursing Practice in the US.
Ethics American Nurses Association ANA
Ethics are fundamental to the integrity of the nursing profession. Every day, nurses support each other to fulfill their ethical obligations to the patient’s and to the public (ANA, 2017).
Ethics and Values
Professional practices which guide the provisions of care within state and national mandate
State Nurse Practice Act
American Nurse Association (ANA)
Standards of Professional Nursing Practice
State Nurse Practice Act
Each state has their own nursing act, regulating a nurse’s scope of practice in which he/she are licensed to work
These laws protect patients from harm
Protects the public by legally defining and describing the scope of nursing practice
Controls nursing practice through licensing requirements and education
Nurses shall adhere to their state Nurse Practice Act
Mandatory reporting of unsafe practice and/or unprofessional conduct
ANA Standards of Professional Nursing practice
American Nursing Association Standards of Professional Practice
The scope of practice describes:
Competent to perform within the terms of their license
Describes the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice
American Nursing Association Standards of Professional Practice
The “who” indicates the individual that has met the educational and licensing requirements needed to maintain active licensure to practice.
The “what” represents the protection, promotion, and optimization of health and abilities to prevent illness and injury, facilitate healing and avoid suffering, advocacy in the care of individuals, families, groups, communities, and populations.
The “where” represents the area the patient is in need of care
The “when” represents whenever the need for nursing knowledge, compassion and expertise is needed
The ”why” is knowing that the profession exists to achieve positive outcomes
Criminal Law Violations
Patient abuse Physical Psychological Verbal Sexual Euthanasia Substance Abuse Practicing without a License Assisted Suicide Defined as Assault and battery or Attempt Murder in most states Only legal in Oregon, Montana, Vermont, and Washington
Assisted Suicide / Euthanasia
The ANA recognizes that nurses play a role in end-of-life care.
Nurses manage the bio-psychosocial and spiritual needs of patients and families both independently and in collaboration with other members of the inter-professional healthcare team
The American Nurse Association, ANA, prohibits nurses’ participation in assisted suicide / euthanasia as this is a violation of the Code of Ethics.
Negligence
Negligence (malpractice) is “the failure to use ordinary care” through either an act or omission.
Negligence occurs when all four of the following elements are present:
Duty: failure to provide care and/or protect patients/clients against reasonable risks
Breach of Duty: failure to perform according to the established standard of conduct in providing nursing care
Injury/damages: failure to meet standards of care therefore causing an actual injury or damage to the patient/client. May be mental or physical
Causation: a connection between conduct and the resulting injury. Expert testimony is necessary to establish this element
Malpractice
Negligence that result in malpractice: Failure to follow: Standards of Care To use equipment in a responsible way To communicate To document To assess and monitor, ie: following institutional protocols To act as a patient advocate
Defamation
Defamation of character includes both libel and slander.
Libel: This is the written word
Slander: This is the spoken work
The Scope of Nursing Practice
Nursing Scope of Practice, depicts the duties and responsibilities that a nurse is deemed competent and qualified to perform in keeping within the terms of their professional licensure.
The Nursing Scope and Standards of Practicedescribe the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice.
5 steps in Delegation
1 Task 2 Delegated 3 Clear communication 4 Reaching a mutual agreement 5 Evaluation
What is the definition of evidence based practice?
Conscientious use of current best evidence in making decisions about patient care
What is evidence based practice?
Integration of best current evidence, clinical expertise, and patient values to deliver quality health care, and nursing actions that meet this competency, such as:
- following policies and procedures
- Keeping up with current literature in your area of expertise
- Know clinical practice guidelines
SBAR
Situation-Background-Assessment-Recommendation
Effective communication
Provides a framework for communication between health care professionals about a patient’s condition
S = Situation(a concise statement of the problem)
B = Background(pertinent and brief information related to the situation)
A = Assessment(analysis and considerations of options — what you found/think)
R = Recommendation(action requested/recommended — what you want)
Major cause of medical malpractice litigation
ineffective communication, poor documentation, and short cuts that are unsafe short cuts.
Professional negligence = Malpractice
The National Council of State Boards of Nursing (NCSBN)
Mission:
Provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.
Nurse Practice Act
Unique to each State;
Education and specific scope of practice vary from state to state.
A duty to protect those who receive nursing care. Safe, competent nursing practice is grounded in the Nurse Practice Act.
The standards and scope of nursing practice are aligned with the nursing process.
A comprehensive nursing assessment based on biologic, psychological, and social aspects of the patient’s condition
Collaboration colleagues
Patient-centered health care
Standards of Practice for Nursing
ANA Standards of Practice: Assessment Diagnosis Outcomes Identification Planning Implementation Coordination of Care Health Teaching and Health Promotion 6 Evaluation Standards of Professional Performance Ethics Culturally Congruent Practice Communication Collaboration Leadership Education Evidence-based Practice and Research Quality of Practice Professional Practice Evaluation Resource Utilization Environmental Health
National League for Nursing (NLN)
“Dedicated to nursing excellence, it is the premier organization for nurse faculty and leaders in nursing education. The NLN offers professional development, networking opportunities, testing services, nursing research grants, and public policy initiatives to all their members” (NLN, 2019).
Recommendations & Reforms
Affordable Care Act (ACA): Access to care Funding Allocating Resources Aging population Healthy People 2020 Institute of Medicine Future of Nursing Pay for performance
Healthy People 2020
Healthy People 2020- a science-based, 10-year national objectives for improving the health of all Americans.
Encourage collaborations across communities and sectors.
Empower individuals toward making informed health decisions.
Measure the impact of prevention activities.
Healthy People 2020 Goals
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Institute of Medicine (IOM)
The Institute of Medicine, (IOM) recommends that all health professionals should be educated to deliver patient-centered care asmembers of an interdisciplinary team, emphasizing evidence-based practice, qualityimprovement approaches, and informatics
Pay for Performance (P4P)
Value-based payment
Financial incentives/disincentives to provider performance
P4P is part of the overall national strategy to transition healthcare to value-based medicine.
It ties reimbursement to metric-driven outcomes, proven best practices, and patient satisfaction, thus aligning payment with value and quality.
CMS has developed 3 programs that impact hospital reimbursement through Medicare:
The Hospital Value-Based Purchasing Program (VBP)
The Hospital Readmission Reduction Program (HRRP)
The Hospital-Acquired Condition (HAC) Reduction Program.
A primary care provider’s orders indicate that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement best illustrates the nurse fulfilling the client advocate role?
A. “The doctor has asked that you sign this consent form.”
B. “Do you have any questions about the procedure?”
C. “What were you told about the procedure you are going to have?”
D. “Remember that you can change your mind and cancel the procedure.”
A nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. The most appropriate initial action by the nurse is which of the following?
A. Call the nursing supervisor
B. Call the police
C. Call security
D. Lock the co-worker in the medication room until help is obtained
The nurse’s partner/spouse undergoes exploratory surgery at the hospital where the nurse is employed. Which of the following practices is most appropriate?
A. Because the nurse is an employee, access to the chart is allowed.
B. The relationship with the client provides the nurse special access to the chart.
C. Access to the chart requires a signed release form.
D. The nurse can ask the surgeon to discuss the outcome of the surgery.
An 87 year-old female is brought to the emergency room for treatment of a fractured arm. On physical assessment, a nurse notes old and new ecchymotic areas on the client’s chest and legs. The nurse asks the client how the bruises were sustained. The client although reluctant, tells the nurse in confidence that her son frequently hit her if supper is not ready on time when he arrives home from work. Which of the following is the most appropriate nursing response?
A. “Oh really, I will discuss the situation with your son.“
B. “Do you have any friends who can help you out until you resolve these important issues with your son?“
C. “Lets talk about the ways you can manage your time to prevent this from happening.“
D. “This is a legal issue, and I need to let you know that I will need to report it.“
A client is brought to the emergency room by the EMS after being hit by a car. The name of the client is not known. The client has sustained severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. In regard to informed consent for the surgical procedures, which of the following is the best initial nursing action?
A. Call the police to identify the client and locate the family
B. Obtain court order for the surgical procedure
C. Ask the EMS team to sign the informed consent
D. Transport the victim to the OR surgery
Libel is defamation of character through spoken words.
True
False
You are responsible for eleven patients on the unit this evening, even though you are usually only assigned nine. In your rush to complete your care, you inadvertently leave the side rail down on a patient who is known to be at high risk for falls. If the patient is hurt, you would be most likely be charged with
A. Assault
B. Negligence
C. Malpractice
D. Defamation
As a nurse in the open-heart surgical unit, you come in contact with a number of individuals and their family members. Your husband, an insurance agent, begins telling you about a man for whom he is about to write a one million-million dollar life insurance policy. You know that this man’s father and all other male family members have died young as a result of cardiovascular disease. If you reveal this information to your husband, you might be committing which crime, if any?
A. Negligence
B. Defamation by slander
C. Defamation by libel
D. No crime would be committed, because the
information is factualWhich is not an element of the fraud?
A. The plaintiff was damaged as a result of the representation
B. The plaintiff did not know the representation was false
C. The plaintiff did not rely on the representation to be true
D. The speaker knew the representation was false
Healthy people 2020 provide emphasis on individual communities to strengthen their own capabilities.
True
False
An attempt or threat to touch another person unjustifiably
A. Abandonment
B. Fraud
C. Slander
D. Assault
A tool used to measure efficiency, satisfaction, and quality:
A. Critical Path
B. Continuous Quality Improvement
C. Outcomes Management
D. Certification
When discussing the cause of action on the theory of abandonment, what is not an element?
A. Damages
B. Existence of a nurse-patient relationship
C. Agreed severance of the relationship with reasonable notice and an adequate substitute provided
D. The necessity of continuing attention
Which is a “DO NOT” of documentation?
A. Sign every entry
B. Circle and sign every error
C. Use white out
D. Be specific
Torts (Corporate Negligence) is a legal wrong:
True
False
Criminal negligence is a commission or omission of an app that causes a serious long to another.
True
False
A nurse is thinking of her professional boundaries. What is an example of a subtle behavior that could be interpreted as crossing a professional boundary?
A. Sexual misconduct
B. Criminal behavior
C. Flirting
D. Neglect
Which is not an element of informed consent?
A. The patient must have capacity to sign the consent
B. The patient must be informed of the risks, benefits, and alternatives to the treatment or procedure
C. All of these
D. The patient must be provided with written information regarding the procedure or treatment
Control and minimize loss to protect assets through quality improvement.
A. Risk management
B. Utilization
C. Quality assurance
D. Peter review
The right to self-determination, freedom, and independence:
A. Veracity
B. Autonomy
C. Nonmaleficence
D. Ethics
Informed consent:
A. The patient must have the capacity to sign the consent
B. The patient must be informed regarding the treatment or procedure
C. The patient must be provided with an opportunity to review the consent and ask questions
D. All of the above
The obligation to do good and avoid harm:
A. Veracity
B. Beneficence
C. Nonmaleficence
D. Confidentiality
Which is true and reference to the ”Nursing for the Future” study?
A. Nursing education was founded to have slow progress
B. The study emphasized the necessity for formal examination for schools, public awareness of accredited schools, and public pressure to discontinue non-accredited schools
C. The study suggested that nursing education could be divided into professional and practical groups
D. All of the above
Person’s right to self-determination, freedom, and independence:
A. Fidelity
B. Beneficence
C. Confidentiality
D. Autonomy
Voluntary accreditation agency that reviews hospital records and meeting minutes.
A. HCFA
B. JCAHO
C. ANA
D. All of the above
The Good Samaritan laws protect nurses even if the nurse does not possess a degree of confidence in the area of assistant that needs to be rendered.
True
False
