Deck 2 Module 49 Flashcards
During a clinical rotation, the nursing instructor evaluates that a student is adhering to clinical performance guidelines. Which actions did the instructor observe the student performing in order to come to this conclusion?
Select all that apply.
A) Changing an intravenous access device site for the first time without supervision
B) Raising the side rails on the client’s bed after completing morning care
C) Reviewing the hospital’s procedure for a treatment before performing it
D) Researching the client’s prescribed medications before administering them
E) Observing the staff nurse irrigate a nasogastric tube because the instructor was not available to assist with placement
B) Raising the side rails on the client’s bed after completing morning care
C) Reviewing the hospital’s procedure for a treatment before performing it
D) Researching the client’s prescribed medications before administering them
E) Observing the staff nurse irrigate a nasogastric tube because the instructor was not available to assist with placement
Rationale:
The nursing student is held accountable to the same standard of care as the licensed nurse. Clinical performance guidelines for nursing students include: making client safety the first priority, knowing the facility’s policies and procedures for care, ensuring knowledge about clients’ prescribed medications, never performing care for which the student is unprepared, and allowing staff to perform actions if the instructor is not available.
A home healthcare case manager often receives documents that pertain to the care of clients on a shared fax machine. The case manager is aware of how important it is to protect each client’s health information. Which action by the nurse ensures that the Health Insurance Portability and Accountability Act (HIPAA) requirements are met in this situation?
A) Have sending agencies call ahead before any information is sent.
B) Take relevant information over the phone.
C) Have the client sign a consent form for information to be released.
D) Do not utilize the fax machine; depend on the mail system.
A) Have sending agencies call ahead before any information is sent.
Rationale:
Case manager nurses need to maintain vigilance to protect the privacy of client healthcare information when sending and receiving messages. In this case, having the sending agency call prior to faxing information would alert the nurse to collect the information from the fax machine at the time it is received, securing that information so others would not have access to it. Signing a consent form for information to be released is necessary to share information, but this would ensure only the disclosure aspect of HIPAA–not the privacy aspect. Sending information through the mail takes time and does not ensure the privacy of the information. Taking information over the phone must be done in a way that is protected and secured in order to ensure that HIPAA privacy aspects have not been breached.
While preparing a pain medication for a client, the nurse notes that there is a discrepancy with the last removal and reports the incident. Which is an expected consequence of the nurse’s action?
A) Being sued by the nurse who made the error
B) Being ostracized by the staff
C) Being protected by the law
D) Being summoned to testify
C) Being protected by the law
Rationale:
The nurse will be protected by a law known as the whistleblower act because misuse of narcotics is against the law. The staff should not know that the incident was reported. The nurse will probably not have to testify because the management team will gather the evidence. The nurse will not be sued because the nurse reports the incident but does not necessarily identify the individual responsible for it.
The staff development trainer is preparing a seminar to review the concepts of a just culture, which is being implemented in the organization. Which elements are integral when training on this content?
Select all that apply.
A) Managers providing feedback to staff regarding actions
B) Proactive environment that supports employee involvement in decision making
C) Supports learning
D) Examines system failures when an adverse event occurs
E) Nurse accountability for actions
B) Proactive environment that supports employee involvement in decision making
C) Supports learning
E) Nurse accountability for actions
Rationale:
Just culture is a proactive environment that supports employee involvement in decision making, supports learning, and examines what systems failed when an error or adverse event occurs. Nurses remain accountable for their own actions and are expected to provide constructive feedback to their peers. The nurse manager is not expected to provide feedback to staff regarding actions that may have led to an adverse event.
The nurse manager is evaluating the success of staff training on just culture. Which observations indicate that training has been successful?
Select all that apply.
A) Staff members are reporting safety errors.
B) Staff members are taking responsibility for actions.
C) Staff members are naming others responsible for errors.
D) Staff members are neglecting client safety initiatives.
E) Staff members are reporting unsafe staffing conditions to the media.
A) Staff members are reporting safety errors.
B) Staff members are taking responsibility for actions.
E) Staff members are reporting unsafe staffing conditions to the media.
Rationale:
Just culture is based on the understanding that errors are often the result of system failures rather than human failures. It recognizes that an atmosphere of punishment impedes error prevention by promoting intimidation and secrecy rather than shared accountability. Just culture focuses on the system rather than the individual while still maintaining an environment of individual accountability for both front-line staff and leaders and managers. Successfully establishing an environment of just culture requires that leadership encourage proactive system management as well as individual accountability. Just culture does not accept or tolerate conscious disregard of client and staff safety. Each member has the responsibility to take action to prevent errors and also to respond to errors, recognizing that errors are more often the result of system failures than individual error, and that when individual error does occur, it is more likely to be accidental than willful or neglectful. As more organizations begin to embrace just culture, front-line staff is likely to feel more support from management in critical areas, including staffing. However, nurses and other front-line staff may find themselves in situation where management is unresponsive to suggestions for improvement or reporting of critical shortages or potential for errors related to client safety. In these cases, staff may find themselves in the awkward position of needing to report these problems outside the agency.
