Fund 50 week 2

Question 1

A theory is composed of a (your theory of concepts is impressive)

Answer 1

group of concepts that describe a pattern of reality.

Question 2

Concepts, like ideas, are (the concept is abstract)

Answer 2

are abstract impressions organized into symbols of reality

Question 3

deductive reasoning

Answer 3

one examines a general idea and then considers specific actions or ideas

Question 4

inductive reasoning

Answer 4

one builds from specific ideas or actions to conclusions about general ideas

Question 5

patient - meaning of the word…

Answer 5

suffer

Question 6

Maslow ranked human needs to include (PSAEA) (e - lacking in…)

Answer 6

physiologic needs, safety and security, sense of belonging and affection, esteem and self-respect, and self-actualization.

Question 7

• Nurse Practice Acts legally define and regulate the scope of nursing practice and protect the public. They vary from state to state and from country to country.

Answer 7

they are there to protect the consumer, not the nurse.

Question 8

C A L I F O R N I A N U R S I N G
P R A C T I C E A C T ,
P A S S E D I N 1 9 7 5 (practice the scope of practice)

Answer 8

• Outlines our scope of practice as RNs; even delineates under what conditions nursing services may be rendered by a student (i.e. must be enrolled in a board approved prelicensure program, or school or nursing).

Question 9

practice act 1975 (can you practice science accurately?)

Answer 9

“A Registered Nurse shall be considered to be
competent when he/she consistently
demonstrates the ability to transfer scientific
knowledge from social, biological and physical sciences
in applying the nursing process.”
• Outlines grounds for discipline i.e. gross negligence,
incompetence…
BRN have disciplinary hearings and they want students to go. They want you to see what can happen.

Question 10

We are licensed by the

Answer 10

Board of Registered Nursing under the Dept. of Consumer Affairs, which exists to protect the client, not the nurse. For support and advocacy of nurses there are many professional organizations.
• BRN administers standardized tests (NCLEX) and
regulates (minimum standards). You need clinical judgement for the NCLEX - like the case study on bp.

Question 11

entry levels into practice

Answer 11

• ADN
• Diploma (no diploma programs here)
• Baccalaureate
• Masters
• Doctoral
• New Nursing Pathways:
1. Doctor of Nursing Practice (strong clinical component or teaching)
2. AB 1295 requires the Chancellor of the California State (regulation that we must have articulation agreement with Cal system, ie - sf state)
University to implement articulated nursing degree
transfer
pathways between the California Community Colleges
and
CSU prior to the commencement of the 2012–13
academic
year.

Question 12

C E R T I F I C A T I O N

Answer 12

• May choose to work toward certification in a specific area of
nursing beyond licensure to validate specialty knowledge and
demonstrate profciency
Examples:
• RN-BC - Medical-Surgical Nursing
• RN-BC - Gerontologic Nursing
• COCN - Certified Ostomy Care Nurse
• CPN - Certified Pediatric Nurse
• CNE - Certified Nurse Educator
• RNC-OB - Inpatient Obstetric Nursing

Question 13

characteristics of a professional (a prof is special in theory - w/ autonomy and ethics)

Answer 13

Special knowledge and education

Theoretical body of knowledge

Provides a special service

Autonomy: sets own standards

A code of ethics
you need to prioritize your patients above yourself

Question 14

Code of Ethics (the code is the framework)

Answer 14

Code of Ethics – A written list of professional values and standards of conduct which provide a framework for decision making.

Question 15

There are several codes of ethics that…(think AMA, but…)

Answer 15

may be adopted, but the in the U.S., the ANA (American Nurses Association) Code of Ethics are
generally accepted (last revised 2015).

Question 16

C L I N I C A L
R O T A T I O N

Answer 16

Duties of nursing instructors
• Make appropriate assignments (during your first week, walk into patient’s room, communicate, complete 5 minute clinical assessment tool (outlined in chasing zero) vital signs, stethascope on patient chest, maybe skin and lung assessment, adl, change linens. Then chart review)
• Give reasonable guidance and supervision
• Make sure students are prepared and competent
Duties of nursing students
• Responsible for own actions (ignorance is not an excuse)
• Prepare and carry out necessary care for clients
• Ask for help when unsure! Be assertive
• Comply with hospital and school policies
• Work within job description (like you cannot insert a catheter)
• Never carry out procedure unless determined to be competent to carry out specific skill by nursing instructor
must ALWAYS have supervisor with you when you give meds! You can hand nurse packages during wound change, but not change the dressing. Not delegated to staff nurse.

Question 17

S T A N D A R D S O F C A R E F O R
P R A C T I C E I N N U R S I N G (standards different for every institution, but must follow federal guidelines)

Answer 17

• The Nurse Practice Act, professional nursing organizations and The Joint Commission define legal guidelines for practice in nursing.
• Written policies and procedures of institutions detail how nurses are to perform specific duties and tasks (e.g., dressing changes). These are available on the intranet for the institution, or on all units. These must conform to state and federal
laws and cannot conflict with legal guidelines that define acceptable care.

Question 18

Informed consent – responsibility of person performing procedure

Answer 18

RN can witness actual discussion and consent or signature only (just evaluating that they understand, just a witness)

Question 19

good samaritan act (informed consent)

Answer 19

• Designed to protect health practitioners against malpractice claims for care provided in emergency situations
• Nurse required to perform in a reasonable and prudent manner
• If informed consent cannot be obtained and immediate treatment is required to save “life or limb” emergency laws can be applied.

Question 20

torts

Answer 20

A wrongful act or an infringement of a right leading to CIVIL legal liability

Question 21

Intentional Torts: (intentional torte is BAID)

Answer 21

• Assault – any intentional threat to bring about harmful or offensive contact
• Battery – any intentional touching without consent
• Defamation of Character (slander or libel)
• Invasion of Privacy – all information about patients is considered private or confidential (HIPAA).

Question 22

T O R T S - steps for protection (She SSED, protect the tort)

Answer 22

Don’t ask questions about patients in cafeteria, ANYWHERE in public.

• Follow standards of care
• Careful documentation
• Follow code of ethics
• Know scope of practice

Question 23

A R E A S O F P O T E N T I A L L I A B I L I T Y

Answer 23

• Invasion of privacy
• Unprofessional conduct
• Scope of practice
• Job abandonment - can’t leave job if there is no one to replace you.
• Refusal to “float” (don’t carry out care that you aren’t deemed competent in during floating)
• Notifying provider (know the chain of command, and how long is safe - give provider X number of minutes to respond, and if not, go up chain of command)
• Confidentiality
• Documentation

Question 24

C O N F I D E N T I A L I T Y

Answer 24

• Confidentiality – information will never be made public or available to others.
• HIPAA standards (the Health Insurance and Portability and Accountability Act, 1996).
Establishes national privacy standards for all individuals and institutions.
• Social Networks

Question 25

confidentiality - Reporting duties by healthcare providers: Responsibilities outlined in California Nurse Practice Act

(types of abuse)

Answer 25

• Child abuse
• Domestic abuse
• Elder abuse
• Sexual assault

Question 26

D E L E G A T I O N

Answer 26

(you aren’t delegating the patient, but the task. The assessment of lung sounds - if it’s abnormal, you need to follow up with that)

Review Taylor, Ch. 7 Appendix A “Guidelines for Delegation Decision Making”
• Transferring the responsibility for the performance of an activity or task
while retaining accountability for the outcome
• Nurse Practice Acts define the scope of an RN’s practice and defines those activities which only an RN can perform (e.g., assessment & planning of care)
• Do not delegate care: Tasks are delegated, not clients
• Assistive personnel are not assigned sole responsibility for care of clients
• Determine that work is consistent with staff member’s job description,
level of competency and normal duties
• Complex tasks requiring specialized knowledge should not be delegated

Question 27

Communication - difference between…

Answer 27

therapeutic and professional communication

Question 28

M E T H O D S O F R E C O R D I N G

Answer 28

Paper Record (probably won’t be doing paper recording)
• Episode oriented
• Key information may be lost from one episode of care to the
next
Electronic Health Record (EHR)
• A digital version of a patient’s medical record
• Integrates all of a patient’s information in one record
• Improves continuity of care

Question 29

D O C U M E N T A T I O N is (2 things - clearly measure the documentation)

Answer 29

clear and measurable terms

Question 30

Remember: Not documented, not done.

Answer 30

If you fail to document, and you are called to litigation. When care is not documented, it creates a legal inference that it was not done. Puts a nurse in a precarious position of having to prove that care was provided, even though it was not documented.

Question 31

Document all clinical…(observe and diagnose)

Answer 31

observations and critical diagnostics

Question 32

T E L E P H O N E O R V E R B A L O R D E R S

Answer 32

(usually only in emergent situations)
write order as you heard it, then read it back verbatim to provider. make sure they agree with what you wrote.
• Countersigned within 24 hours
• Limit to emergent need when there is no alternative
• Document order exactly as given
• Read back order after entered to provider for confirmation
• Follow policy guidelines
• Document the order with time, date and situation necessitating order
• Text message orders? providers have secure ipads.

Question 33

I N C I D E N T / V A R I A N C E
O R
O C C U R A N C E
R E P O R T I N G

Answer 33

just describe the facts - ie - walked into room and found patient lying on the ground.
Do not document that you completed this form in the chart. If you do, then you’re subject to litigation. This is a private communication between you and supervisors.
Means of identifying risks
• Make facts available to facility in case of litigation
• Computer based reporting forms
• Privileged communication between you and the
hospital lawyer or Quality Assurance Committee.
Chart the facts of the incident. Do Not chart or tell
non-nurses that you filled out the form

Question 34

R E C O M M E N D A T I O N S F O R
D E V E L O P I N G
P R O T E C T I V E S T R A T E G I E S T O
R E D U C E
L E G A L L I A B I L I T Y (remember time limits, give dr a limited amount of time to respond, then move up chain)

Answer 34

• Acquire knowledge of practice
• Maintain currency in practice
• Question uncertain orders or actions
• Initiate the chain of command when warranted
• Establish time limits for actions
• Document the Nursing Process
• Utilize critical thinking skills and exercise independent judgment.

Question 35

Informed consent is required before providing care, except

Answer 35

when an emergency exists

Question 36

informed consent must Must meet three requirements (CVU - think of dad)

Answer 36

1. Individual has capacity to consent
2. Voluntary
   
   3. The individual understands treatment and information presented Includes
      • What is being done
      • Why it is being done
      • Risks of procedure
      • Possible alternatives

Question 37

Communication Barriers to Informed Consent (and signed by…)

Answer 37

Verbal or Written Consent: When verbal consent, notation should be made:
Describes detail of how and why verbal consent was obtained. Place in record.
Witness and sign by two persons

Question 38

informed consent - right to refuse

Answer 38

Courts have upheld the right of competent clients to refuse treatment

Question 39

Unintentional Torts: 2 types

Answer 39

• Malpractice
• Negligence

Question 40

Must always communicate patient status accurately with (everyone)

Answer 40

staff, supervisors, management, healthcare providers (physicians, etc..), via telephone, personal contact, shift report, etc….

Question 41

• SBAR: Must develop skills to

Answer 41

clearly articulate positions and recommendations. Needs to be an increased emphasis on ensuring that correct message was heard.*

Question 42

• Handoff communication (just inform the doc of changes)

Answer 42

• Must inform physicians of changes in a patient’s condition and communicate information to other personnel.
• Must know chain of command at institution
• Must document communication in progress notes - can aslo document response of provider

Question 43

Documentation needs to follow whose standards? (document the joint)

Answer 43

Joint Commission Standards.

Question 44

The Joint Commission requires documentation within the context of the nursing process, including (remember to teach the patient)

Answer 44

documentation of teaching and discharge planning.

Question 45

Documentation must be (FACCO)

Answer 45

• Factual
• Accurate
• Complete
• Current
• Organized

Question 46

Document conversations with

Answer 46

other providers regarding patient issues

Question 47

• Document which specific health care provider

Answer 47

was notified of which specific concerns at what specific time.

Question 48

• Document that the chain of command has been

Answer 48

engaged when necessary

Question 49

Make sure that the medical record reflects (follow through)

Answer 49

that you pursued your concerns to resolution

Question 50

unintentional torts - malpractice (mal is not professional)

Answer 50

any professional misconduct or unreasonable lack of professional skill

Question 51

unintentional torts - • Negligence (a negligent person is not prudent, nor follows policy)

Answer 51

failure to do what a reasonable and prudent person would do (including failure to follow policy and procedures)