Gastroenterology Nursing Process

Question 1

How has nursing evolved in medicine throughout time?

Answer 1

1. The concept of nursing has been around since the beginning of time and has transformed throughout history into what it is today
2. In the 3rd century BC, Greek physician Hippocrates referred to caregivers as assistants to the physician
3. In the 4th century, nursing was first differentiated from medicine by Hindu physician B.C. Charaka, who referred to the “aggregate of four” composed of the physician, the drug, the nurse and the patient
4. There are accounts from the pre-Christian era of nurses involved in caring for the sick
5. Archaeological discoveries describe early nursing procedures such as dressing wounds and feeding patients
6. The Egyptians had a highly developed medical community, wherein the members of the medical profession were organized do they could protect the secrets of their practice. The Egyptians were as progressive as today’s physicians in that specialists dedicated to one disease, such as treatment of the eyes, head, or stomach.
7. Accounts of the Egyptians, Greeks, and Romans all refer to the existence of midwives, whose art was the care of child-bearing women. When their civilizations declined, medical care of women deteriorated and was not brought back to its former stage of development until the 17th century
8. During the Middle Ages, nursing was done primarily by women and was the function of many religious orders. Between 500 and 1300 AD, nursing care consisted of only the most menial tasks, such as bathing, feeding and bed-making. The nuns, who were chiefly responsible for this care, were assisted by women who were being punished for thievery or prostitution,
9. It wasn’t until the 19th century that education and dignity were brought to the nursing profession. Florence Nightingale emancipated upper-class women from idleness and encouraged then to serve humanity. As women became educated, the care of the sick began to improve.
10. Throughout the 19th century, prominent women became involved in promoting the cause of nursing. School nursing, industrial nursing, and other nursing specializations began to emerge. As technology increased and physicians needed more time to learn and implement new techniques and practices, the responsibilities of nurses also increased
11. In the late 19th and early 20th centuries, nurses worked to address the health care needs of men, women, and children by delivering direct care, promoting health, and preventing disease in remote and isolated areas
12. The need for nurses increased during the world wars, with nurses being required to provide care without adequate training
13. During the 1940’s, Frances Reiter first described the nurse with advanced education and clinical competence as a “nurse clinician”. This was the precursor of nursing specialties with further education in certain fields that we recognize today

Question 2

How was the field of gastroenterology developed

Answer 2

1. As early as the time of Hippocrates, specific mention was made of the gastrointestinal tract in medicine.
2. Hippocrates recorded use of a candle to inspect the rectum
3. In the 18th century, Bozzini documented the use of a rigid sigmoidoscope
4. Almost 100 years later, Kussmaul made the first attempt to visualize the stomach with a rigid tube.
5. Rigid esophagoscopy developed slowly over the next 50 years, with progress being dependent primarily on the quality of the light source. The rigid instrument was able to survey only a small portion of the stomach, and it carried a significant hazard because of the possibility of perforation
6. In 1932, a semi flexible instrument was designed by Rudolph Schindler. The Schindler gastroscope remained the model for development of gastroscopes for the next 30 years. The semi-flexible gastroscope was based on the principle that a series of convex lenses could transmit light undistorted through a flexible tube if the distal tube was not bent beyond a certain angle. Risk of perforation was reduced by the placement of a rubber obturator at the tip
7. In 1958, Hirschowitz, Curtiss, Peters’s and Pollard published their report of a new gastroscope, which revolutionized gastroenterology. The development of fiberoptic scopes was made possible by the earlier work of Professor Harold Hopkins of University of Reading in the United Kingdom. Hopkins worked in parallel with John Logie Baird, the inventor of the television, to design fiberoptic bundles that would transmit the image. The optical principles are dependent on the total internal reflection of light in each fiber.
8. The fiber bundles are of two types: noncoherent bundles that conduct light but not images and coherent bundles that produce high-quality images
9. Modern flexible fiberoptic instruments have the same basic features as those developed in the early 1950s. The simplicity, ease of use, and safety compared to earlier instruments caused the rapid adoption of this new technology. As new technology continues to evolve, conceptual, diagnostic, and therapeutic advances in gastroenterology have rapidly advanced

Question 3

A clinical research study done at the end of the last century describes the ten most significant advances in gastroenterology during the 20th century

Answer 3

1. Helicobacter pylori identification and treatment
2. Use of fiberoptic endoscopy
3. Gastrointestinal imaging by radiograph and computed tomographic scan
4. Australia antigen, including vaccines for hepatitis A and B
5. The molecular basis of colon cancer
6. Liver transplantation
7. Laparoscopic-assisted surgery
8. Therapy for peptic ulcer disease, including H2-receptor antagonists and proton pump inhibitors
9. The discovery of gastrointestinal hormones, beginning with secretin
10. The discovery of the role for gluten in celiac disease

Question 4

How was the role of the gastroenterology nurse developed

Answer 4

1. Gastroenterology nursing was first recognized as an area of specialization in 1941, when a group of physicians called the American Gastroscopic Club met at Dr. Rudolph Schindler’s home in Chicago. This group, later named the Gastroscopic Society, was the forerunner of the American Society for Gastrointestinal Endoscopy.
2. At that time, Dr. Schindler was the recognized master gastroscopist, and hist wife Gabriele, was the first gastroenterology assistant, Gabriele Schindler was always at her husbands side, soothing the patient, helping with positioning and assisting during the procedure
3. The memory of Gabriele personifies the spirit of professionalism and caring that has become the mark of excellence for today’s gastroenterology nurses and associates. Since 1985, SGNA has annually presented the Gabriele Schindler award to one of its members in recognition of high standards and outstanding achievement in gastroenterology nursing.
4. The next several decades brought about many changes in gastroenterology nursing practice and education. Fiberoptic instrumentation developed rapidly, as did the demand for skilled personnel to operate this instrumentation, resulting in the need for dedicated professionals to work with patients who were under endoscopic procedures.
5. As the complexity of procedures increased, government and regulatory agencies added another aspect to the knowledge based required. The CDC and other organizations put forth guidelines that required gastroenterology personnel to be informed of these new regulations and guidelines and to integrate them into practice settings.

Question 5

What background should individuals in gastroenterology nursing possess

Answer 5

1. Solid education and training in the biological sciences
2. Pertinent experiences in the health care field
3. Familiarity with hospital and other practice settings, specific content areas that might be incorporated into a specialty training program including the following:
   - Anatomy and physiology of the GI tract and relationships to pathophysiology
   - Relevant diagnostic and therapeutic procedures as they relate to routine and emergent GI situations
   - Techniques of management of a gastroenterology unit
   - Skills in patient care, teaching, and staff development
   - Care and maintenance of clinical instrumentation
   - Pharmacology and intravenous (IV) therapy
   - Moderate sedation
   - Emergency management
   - Adult and/or pediatric advanced life support
   - Research methods and application of peer-reviewed, evidence-based published research to the practice setting
   - Ethical, professional, and legal standards inherent in professional conduct
   - Cultural diversity
   - Quality initiatives
   - Patient and family-centered care

Question 6

What are examples of duties and responsibilities for the nurse manager of the gastroenterology department

Answer 6

Planning and Organization
1. Plan, coordinate, and direct the flow of patients through the gastroenterology department
2. Allocate space and physical resources according to patient and physician need
3. Develop and review department performance improvement standards
4. Develop and update clinical competencies
5. Evaluate performance of staff as well as mentor and support staff to practice to their highest level of education

Management
1. Conduct performance reviews for assigned staff
2. Monitor clinical performance for compliance with established standards and policies

Staff allocation
1. Adjust staffing to meet workload volume

Fiscal responsibilities
1. Formulate and implement annual budget

Education and orientation
1. Support staff orientation and cross-training through education, case selection, assignment of preceptors, and ongoing evaluation
2. Assist staff in ongoing education process

Professional commitment
1. Actively participate in meetings or committees as assigned
2. Actively pursue certification in the specialty

Developing healthy working relationships, building teams, enhancing communication, and practicing delegation are other areas that can be included in a managers position description

Question 7

What are examples of some of the duties and responsibilities that may be assigned to an RN staff nurse

Answer 7

Nursing Process
1. Provide assessment
- Make initial observations of the patient on arrival at the gastroenterology unit
- Formulate nursing diagnosis based on data collected
- Communicate any significant patient assessment findings with the care team
- Provide assessment documentation that reflects the full range of patient needs, including physical, psychosocial, spiritual and safety
- Continue assessment of the patient throughout entire stay in the gastroenterology unit
2. Determine nursing diagnosis
3. Identify outcomes
4. Create plan
- Implement the plan of care
- Individualize the plan of care based on patient assessment
- Prepare rooms, equipment, and supplies to accommodate the patient load
5. Implement plan
- Implement the plan of care
- Administer medications and assist the physician with the procedure
- Monitor the patient before during, and after the procedure
- Provide patient education

Patient teaching
1. Assess the patient’’s needs to include family or significant other when appropriate
2. Provide the patient with relevant information regarding diagnosis, medications, diet, and other therapy

Question 8

What are examples of duties for the unlicensed assistive personnel

Answer 8

1. Assist the physician and/or RN with procedures
2. Implement the plan of care under direction of an RN
3. Receive and decontaminate instruments, equipment, and reusable supplies
4. Perform sterilization and reprocessing
   - prepare items to be sterilized and maintain sterility through proper handling
   - operate equipment used for cleaning and disinfecting endoscopic equipment
5. Receive and place supplies in assigned storage area

Question 9

Who was the first nurse leader and manager

Answer 9

Florence Nightingale

Question 10

What qualities or leader attributes upon which the leader must possess the ability to self-reflect

Answer 10

1. Awareness —the leader’s inner capacity to honestly assess him or herself and objectively evaluate the group members’ abilities, maturity, endurance, and commitment to both organizational and departmental goals. In addition, a leader has an obligation to set limits and delegate responsibility in order to maximize the group’s time and efficiency. Effective communication skills are essential for nurse leaders, as is an understanding of the use of power. Power may either be imposed on the group or shared with the group. An example of shared power is participative management
2. Assertiveness—is the expression of feelings, needs, ideas, and rights in a professional manner
3. Accountability—is defined as an obligation or willingness to accept responsibility for one’s actions. Leaders are accountable to themselves, the group, the profession, and their superiors
4. Advocacy—is a leader’s ability to support and defend the group

It is also important for a nurse leader to communicate a clear understanding of the organization and unit expectations. The nurse leader must be consistent in addressing critical issues such as availability, accountability and conflict among the staff members in order to maintain credibility as the leader of the group

Question 11

What are early leadership theories

Answer 11

1. Great Man Theory
2. Trait Theory
3. Contingency and Situational Theories
4. Empowerment Theory

Question 12

What is the Great Man Theory of leadership

Answer 12

1. Great Man Theory of Aristotle is one of the earliest leadership theories and is based upon the idea that leaders are born and not made.
2. European monarchs are examples of this theory, which suggests that leadership ability is inherited rather than learned

Question 13

What is Trait Theory of leadership

Answer 13

Trait theory was developed through a retrospective review of individuals though to be “great men” and included an examination of their traits and characteristics

Question 14

What are the Contingency and Situational Theories of leadership

Answer 14

1. Conditional and Situational theories contend that work environments influence outcomes as much as a leader’s style.
2. This theory suggests that varying mixtures of leadership styles are more effective than a sing;e style, and that the leadership model should be based upon the maturity levels inherent within the group dynamic

Question 15

What is the empowerment theory of leadership

Answer 15

Empowerment theory contends that formal and informal organizational structures influence a leader’s empowerment

Question 16

What are some contemporary leadership theories that became popular in the 1970s

Answer 16

1. Hierarchy-of-Needs Theory
2. Motivation-Hygiene Theory

Question 17

What is the Hierarchy-of-Needs theory of leadership

Answer 17

1. Maslow was one of the first to initiate the human behavior school with his theory
2. He classified human needs into five categories
   - Physiological
   - Safety
   - Love
   - Esteem
   - Self-actualization

Question 18

What is the Motivation-Hygiene Theory of leadership

Answer 18

1. Herzberg’s theory supports that job factors are classified as either:
   - satisfies or dissatisfies
   - satisfies or motivators
   - include:
   
   • achievement
   • recognition
   • work
   • responsibility
   • advancement
   • growth
2. For example, as an employee receives positive feedback, his or her level of performance improves
3. The job dissatisfiers, or hygiene factors include:
   
   • supervision
   • company policy
   • working conditions
   • interpersonal relations
   • job security
   • salary
4. These are not considered to be motivators because, for the most part, they do improve performance

Question 19

What are Interactive theories of leadership that became popular in the late 1970s and early 1980s

Answer 19

1. Theory X
2. Theory Y
3. Theory Z
4. The Transformational Leadership theory

Question 20

What is the Theory X of leadership

Answer 20

Theory X assumes that most people prefer to be directed, are not interested in assuming responsibility, and have to be constantly supervised

Question 21

What is the Theory Y of leadership

Answer 21

1. Theory Y assumes that the employee is mature, independent, and self motivated
2. Managers who believe that people are inherently lazy tend to use fear and threats to motivate personnel, delegate little responsibility, and don not include personnel in planning
3. Managers who philosophically believe that people are self-motivated and enjoy work use praise, offer recognition, and provide opportunities or growth

Question 22

What is Theory Z of leadership

Answer 22

Theory Z, also known as the Japanese or Participative style of management, focuses on increasing employee loyalty to the company by providing a job for life with a strong focus on the well-being of the employee, both on and off the job

Question 23

What is the Transformational Leadership Theory

Answer 23

1. The Transformational Leadership theory emphasizes collective purpose and mutual growth
2. It is a “style of leadership in which the leader identifies the needed change and executes the change with the commitment of other
3. Transformational leadership style occurs when the leader inspires the team to succeed through empowerment

Question 24

What are different leadership styles

Answer 24

1. Autocratic style
2. Democratic leadership style
3. Laissez-faire style

Question 25

What is autocratic leadership style

Answer 25

1. Autocratic leadership style demonstrates a behavior of control
2. The autocrat determines all the policies for the group, makes all the decisions, and details the implementation of goals
3. An example of this style is the military

Question 26

What is Democratic leadership style

Answer 26

Democratic leadership style involves individuals and groups in the decision-making process, and is particularly effective when cooperation and coordination among the group members is encouraged

Question 27

What is Laissez-faire style of leadership

Answer 27

1. Laissez-faire style empowers employees to do as they please
2. There are no policies and procedures in place, and no formal leadership structure

Question 28

What are different types of formal organizational structures

Answer 28

1. Line authority
2. Functional organization
3. Staff authority structure
4. Matrix organization
5. Project organization

Question 29

What is line authority in relation to different types of organizational structures

Answer 29

1. Line authority is the most traditional organizational structure, in which each position has authority over a lower one in the organization
2. This structure is better known as the chain of command or hierarchical structure

Question 30

What is functional organization in relation to different types of formal organizational structures

Answer 30

1. Functional organization authorizes a specialist from a given area to enforce recommendations within a clearly defined area
2. In an all-RN staff, one RN would act as the specialist or spokesperson for communication to the institutions administration

Question 31

What is staff authority structure is relation to different types of formal organizational structures

Answer 31

Staff authority structure assigns the staff the primary responsibility of assisting personnel who are in a line authority or direct chain of command

Question 32

What is matrix organization in relation to different types of formal organizational structures

Answer 32

1. Matrix organization looks at individual subsystems within a complex structure
2. Depending on the complex structure, these subsystems can be totally dependent or totally autonomous.
3. This is demonstrated in many decentralized systems in which subsystems are given the authority to work independently of other groups, toward a common goal

Question 33

What is project organization in relation to different types of formal organizational structures

Answer 33

1. Project organization is designed to accomplish a specific task.
2. When the task is completed, the group is disbanded

Question 34

What are organizational principles that outline the efficiency of the organizational structure and help the manager and employee function more effectively within that structure.

Answer 34

1. Unity of Command
2. Requisite Authority
3. Continuing Responsibility

Question 35

What is the organizational principle Unity of Command

Answer 35

1. Unity of command implies clear lines of authority
2. The employee knows to whom they report and who has the final authority

Question 36

What is the organizational principle of Requisite Authority

Answer 36

Requisite authority implies that when a subordinate has been delegated a task, he or she is given the final authority to accomplish the task

Question 37

What is the organizational principle of Continuing Responsibility

Answer 37

Continuing Responsibility implies that a manager who delegates responsibility for a function to a subordinate is still responsible for that function

Question 38

What is organizational cultures

Answer 38

1. Organizational cultures encompass how the organization thinks and behaves
2. Though not written, the cultures of an organization includes values, beliefs, traditions, diversity, language and customs and is unique to every organization
3. Positive cultures focus on encouraging employees to proactively collaborate and interact in an effort to achieve common goals
4. Negative cultures are more reactive and confrontational in their approach to goals and act as a mechanism to protect individuals’ status and security within the organization.
5. Leaders must understand the culture of their organizations to implement effective strategies to bring about change

Question 39

What are organizational tools

Answer 39

1. Organizational tools that are helpful to the gastroenterology manager include organizational charts and job descriptions
2. The organizational chart is a graphic representation of how the unit is organized
3. It depicts formal organizational relationships, areas of responsibility, and channels of communication
4. It is used for planning, administrative control, and policy making

Question 40

What are job descriptions

Answer 40

1. Job descriptions are important because they assist the manager with organizing the administration of the various job duties.
2. Descriptions specify the title of the position, the qualifications necessary to complete the duties listed, and the person to whom the employee is responsible

Question 41

What is span of control

Answer 41

1. Span of control or span management, is used to identify the scope of management responsibility
2. Although the manager remains the final authority, he or she delegates authority to subordinates who, in turn, supervise a group of employees
3. Factors that influence the manager’s capability to supervise include:
   - the amount of experience and management training a manager has acquired
   - the amount and nature of the work a manager is required to perform
   - the willingness to accept responsibility
   - the characteristics of employees themselves
   - the ability to design and define the complexity of procedures and activities that take place in the unit

Question 42

What are the different management theories involved in leadership

Answer 42

1. Scientific management theory
2. Human relations theory
3. Managerial grid
4. Contingency model of leadership

Question 43

What is scientific management theory

Answer 43

Scientific management theory focuses on the organization rather than the needs of people within the organization

Question 44

What is Human relations theory

Answer 44

1. Human relations theory stresses a concern for the needs of the people versus the task.
2. The human relations theory is based on the idea that the real power of the organization is the set of interpersonal relationships that develops within the working unit

Question 45

What is managerial grid

Answer 45

1. Managerial grid includes both take and relationship concepts
2. This tends to be an attitudinal model because it measures the values and feelings of the manager
3. This theory is based on the manager’s concern for tasks versus people within the organization

Question 46

What is the contingency model of leadership

Answer 46

1. The contingency model of leadership suggests that leadership style can be effective or ineffective, depending on the situation
2. This model defines three aspects of a situation that structure the leader’s role:
   
   • leader-employee relations
   • task structure
   • position power

Question 47

What are the five functions of management

Answer 47

1. Planning
2. Organizing
3. Staffing
4. Directing
5. Controlling

Question 48

What is the operating budget

Answer 48

1. The operating budget consists of consumable items and resources used to provide patient care
2. Operating expenses vary depending on the volume of patients and the procedures performed in the gastroenterology unit
3. Whatever budgetary goals are in place, the manager administering the budget should have a part in preparing it and be responsible for monitoring throughout the fiscal year

Question 49

How is an operating budget divided

Answer 49

1. Direct expenses—includes items such as staffing salaries, medical and surgical supplies, repairs and charges from other departments
2. Indirect expenses—include overhead cost including facility fees which contribute to the cost of running a business

Question 50

What are examples of direct expenses in an operating budget

Answer 50

1. Salaries and wages
2. Per diem staff
3. Overtime
4. On-call personnel
5. Disposable items
6. Instruments
7. Medical and surgical supplies
8. Repairs (endoscopes, electro surgical unit (ESU))
9. Pharmacy

Question 51

What are examples of indirect expenses in an operating budget

Answer 51

1. Equipment depreciation
2. Building depreciation
3. Employee health benefits
4. Accounting
5. Purchasing
6. Utilities
7. Housekeeping
8. Clerical supplies

Question 52

How is nursing informatics used in nursing practice

Answer 52

1. Work lists for nursing interventions
2. Computer-generated client documentation
3. Data sheets/flow sheets to document vital signs and other measurements
4. Computer-generated nursing care plans and pathways
5. Automated billing for supplies and documentation
6. Reminders and prompts during documentation and charting
7. Accessibility to computer-archived patient data

Question 53

How is nursing informatics used in nursing administration

Answer 53

1. Automated staffing and scheduling
2. Email
3. Online variance reports
4. Quality assurance and outcome analysis
5. Online performance appraisals
6. Remote access to work computers
7. Presentation software slides and handouts

Question 54

How is nursing informatics used in nursing education

Answer 54

1. Computerized record-keeping
2. Computer assisted instruction
3. Distance learning
4. Internet’s resources and web-based education
5. Presentation software

Question 55

How is nursing informatics used in nursing research

Answer 55

1. Computerized literature searching
2. Adoption of standardized language related to nursing terms
3. Explore trends in combined and aggregate data
4. Internet-based research and data collection tools

Question 56

What are endogenous infections

Answer 56

1. Endogenous infections occur when micro flora colonizing the mucosal surfaces of the gastrointestinal or respiratory tract gain access to the bloodstream or normally sterile body sites as a consequence of a procedure
2. Examples of endogenous infections include cholangitis, following the manipulation of an obstructed biliary duct or endocarditis in patients with mitral valve regurgitation who have sustained transient bacteremia during esophageal dilation
3. The highest rates of bacteremia reported have been associated with esophageal dilation, variceal sclerotherapym and instrumentation of obstructed bile ducts
4. The microbes most frequently isolated have been E.coli, Klebsiella species (spp.), Enterobacter spp. and enterococci

Question 57

What are exogenous infections

Answer 57

1. Exogenous infections are the result of microorganisms introduced from a source outside the body
2. The most frequently isolated organisms have be Pseudomonas aeruginosa, salmonella spp., and mycobacteria
3. Bacteria less frequently isolated include H.pylori, Klebsiella, enterobacter spp. and serratia spp., as well as hepatitis C virus, and hepatitis B virus

Question 58

What are risk factors to developing infections

Answer 58

1. Age, both the very young and the elderly
2. Immune status and underlying disease (HIV, transplant patients, and patients receiving immunotherapy)
3. Endovascular surface integrity
4. Indwelling foreign material (prosthetic heart valves, joint replacements )
5. The presence of intrinsic infective foci

Question 59

What are the groups that items are sorted in to to determine the degree of risk for infection

Answer 59

Developed by Earl H. Spaulding

1. Critical items
2. Semi-critical items
3. Non critical items

Question 60

What are examples of critical items when referring to the degree of risk for infection

Answer 60

1. Critical items that present a high risk of infection if they are contaminated with any micro organism.
2. These are objects or instruments that break the mucosal barrier and enter sterile tissue or the vascular system
3. Examples of critical items in the gastroenterology unit are sclerotherapy or injection needles, biopsy forceps, metal clips, and intravenous catchers
4. Sterilization is recommended for reprocessing critical items

Question 61

What are examples of semi-critical items when talking about the degree of risk for infection

Answer 61

1. Semi-critical items are those that come in contact with non-intact skin or mucous membranes.
2. Endoscopes are considered semi-critical items
3. At a minimum, semi-critical items require high level disinfection using chemical disinfectants such as Glutaraldehyde, hydrogen peroxide, peracetic acid with hydrogen peroxide or orthophthalaldehyde (OPA)

Question 62

What are examples of non critical items based on the degree of risk for infection

Answer 62

1. Non critical items are those items that come in contact with intact skin, but not mucous membranes
2. There is relatively little risk of transmitting infection with these items. Some examples of non-critical items are stethoscopes, blood pressure cuffs, cardiac leads, and pulse oximetry, as well as bedside tables, bed rails, linens, patient furniture , and floors
3. These items require disinfection with a hospital-grade intermediate-level or low-level germicide

Question 63

What are different types of sterilizations

Answer 63

1. Steam
2. Ethylene oxide
3. Hydrogen peroxide gas plasma
4. Ozone
5. Vaporized hydrogen peroxide
6. Liquid chemical sterilants

Question 64

What is sterilization

Answer 64

Sterilization refers to a validated process resulting in the complete elimination or destruction of all forms of microbial life

Question 65

What is high-level disinfection

Answer 65

1. High-level disinfection is a process that removes or kills organisms likely to cause disease.
2. High-level disinfection destroys all mycobacteria, all viruses, all fungi, and all vegetative bacteria but not necessarily all bacterial spores.
3. The FDA clears products with a high-level disinfectant claim to kill 100 percent of the test organism mycobacterium tuberculosis
4. High-level disinfectants may be referred to as disinfectants or sterilants because some are capable of sterilization with extended soak times

Question 66

What is intermediate-level disinfection

Answer 66

Intermediate-level disinfection is a process that destroys M. Tuberculosis, vegetative bacteria, most viruses and most fungi. It does not kill bacterial spores

Question 67

What is low-level disinfection

Answer 67

Low-level disinfection is a process that destroys vegetative bacteria, some viruses, and fungi but is not effective against M. Tuberculosis or bacterial spores

Question 68

What are some concepts in infection prevention education

Answer 68

1. Standard precautions (hand-washing and personal protective equipment) -PPE
2. Bloodborne pathogens (HBV, HCV, and HIV)
3. Low-level disinfection of communication devices used in the GI setting such as phones and computers
4. Staff attire
5. Environmental conditions that support gastroenterology practice within gastroenterology, as well as infection prevention
6. Special considerations guidance in the handling of patients with C.Diff, M.tuberculosis that causes TB, VRE, CRE, or various parasite or vermin infestations such as lice and scabies
7. Reprocessing room requirements
8. Quality assurance measures
9. Identification of infection prevention champions
10. Response to failure in infection prevention
11. Supporting a culture of safety

Question 69

What information needs to be provided and recorded in a log for the reprocessing of a scope

Answer 69

1. Patient name
2. Medical record number
3. Date and time of the procedure
4. Procedure(s) performed
5. Clinician who performed the procedure
6. Serial number (or other identifier) and model of endoscope
7. Automated endoscope reprocessor (AER) model and serial number or other identifier (if applicable)
8. Minimum effective concentration (MEC) test results of high level disinfectant
9. Name of scope reprocessing staff member

Question 70

In order for manual cleaning of the scope to be effective, it must be

Answer 70

1. Performed by a person familiar with the structure and the particular characteristics of each model of endoscope to be reprocessed and trained in the proper cleaning procedure
2. Undertaken immediately after the endoscope is used so that secretions and debris do not dry and harden
3. Done in accordance with a protocol, which, using appropriate detergents and cleaning equipment, allows all surfaces of the endoscope —internal and external—to be cleaned
4. Followed by thorough rinsing to ensure that all debris and detergents are removed prior to disinfection

Question 71

What are the steps to reprocessing a scope

Answer 71

1. Pre-cleaning
2. Leak testing
3. Manual cleaning
4. Rinsing after manual cleaning
5. Visual inspection
6. High-level disinfection
7. Rinsing after high-level disinfection
8. Drying
9. Storage

Question 72

What 6 things does a device manufacturer need to comply with according to the FDA

Answer 72

1. Labeling should reflect the intended use of the device
2. Reprocessing instructions for reusable devices should advise users to thoroughly clean the device
3. Reprocessing instructions should indicate the appropriate microbial process for the device
4. Reprocessing instructions should be technically feasible and include only devices and accessories that are legally marketed
5. Reprocessing instructions should be comprehensive
6. Reprocessing instructions should be understandable

Question 73

What are advantages of using Glutaraldehyde as a disinfectant

Answer 73

1. Proven effectiveness against microorganisms
2. Relatively inexpensive against microorganisms
3. Excellent material compatibility
4. Not reported to cause adverse reproductive health effects or increased incidence

Question 74

What are disadvantages to using Glutaraldehyde as a disinfectant

Answer 74

1. Recent evidence of resistance by some microorganisms to the anti microbial effects of Glutaraldehyde, such as with strains of nontuberculosis mycobacteria and pseudomonas, as well as with some cyst and vegetative forms of Protozoa
2. Coagulates blood and fixes tissue to surfaces
3. Irritant to skin, eyes and respiratory system. Although symptoms are generally temporary, subsiding when leaving the exposure area, there is evidence that skin and respiratory irritant effects are exacerbated on repeated exposure to Glutaraldehyde
   - SKIN - skin contact irritation symptoms depend on contact time and can range from minor itching and slight local redness to moderate local redness and swelling
   - EYES - Glutaraldehyde in a concentration of greater than 0.1% is considered to be irritating to the eyes and may result in moderate to severe pain, excessive blinking, and tear production. Contact with solutions containing concentrations of 2% or greater cause severe eye irritation and corneal damage that could result in permanent vision impairment
   -Respiratory system - inhalation of Glutaraldehyde vapors may result in asthma-like symptoms, nose and throat irritation, and chest tightness. Additionally, there may be aggravation of pre-existing asthma and inflammatory or fibrotic pulmonary disease

Question 75

What are advantages to using hydrogen peroxide as a disinfectant

Answer 75

1. No activation is required
2. May enhance removal of organic matter and organisms. While it does not coagulate blood or fix tissue to surfaces, published studies indicate that it inactivates cryptosporidium
3. No disposal, odor or irritation issues

Question 76

What are disadvantages of using hydrogen peroxide as a disinfectant

Answer 76

1. Material compatibility concerns exist in the form of cosmetic (discoloration) and functional changes to brass, zinc, copper, nickel, and silver plating
2. Mild eye and skin irritation may result at the 2% concentration, while severe and corrosive irritation with irreversible eye tissue damage and blindness may result at 7.5% concentration
3. Vapors inhaled can be severely irritating to the nose, throat and lungs
4. The OSHA permissible exposure limit for hydrogen peroxide vapor is 1ppm as an 8-hour total weight average
5. Must be used in well-ventilated areas. Users should wear eye protection such as safety glasses, goggles, or face shields, and skin protection such as rubber, neoprene, vinyl or nitrile gloves. Rinsing per manufacturer instructions should be followed to ensure that residual hydrogen peroxide is removed to protect the patient from mucous membrane irritation
6. Solutions must be diluted with a large volume of water, allowing the chemical to decompose prior to disposal into a suitable treatment system in accordance with federal, state, and local regulations

Question 77

What are advantages of using peracetic acid as a disinfectant

Answer 77

1. Rapid sterilization cycle time in a fully automated format, using low-temperature liquid emersion
2. Production of environmentally friendly by-product (acetic acid, oxygen, water)
3. Enhanced removal of organic material land endotoxins
4. Fewer adverse health effects to operators as compared to aldehydes
5. No coagulation of blood or fixing of tissue to surfaces
6. Rapidly sporicidal
7. Compatibility with many materials and instruments
8. Provision of procedure standardization (constant dilution, perfusion of channel, temperatures, and exposure)

Question 78

What are disadvantages of using peracetic acid

Answer 78

1. Potential material incompatibility, such as dulling of aluminum anodized coating
2. Allowing only one scope per cycle
3. More expensive (endoscope repairs, operating costs, purchase costs) as compared to aldehydes
4. Serious eye and skin damage with concentrated solution contact
5. Is a point of use system with no sterile storage

Question 79

What are advantages of using ortho-phthaladehyde (OPA) 0.55% as a disinfectant

Answer 79

1. Reusable product with a maximum reuse life of 14 days as validated by testing to ensure that the solution remains at or above its MEC of 0.3%
2. Barely perceptible odor
3. Does not require exposure monitoring
4. No required mixing or activation
5. Stable at a wider pH range of 3 to 9
6. Lasting longer before reaching its MEC limit (about 82 cycles) compared with Glutaraldehyde (after 40 cycles) in an automated reprocessor
7. Excellent material compatibility claims
8. Fast-acting high-level disinfectant
9. Does not coagulate blood or fix tissues to surfaces
10. No reported reproductive or mutagenic effects in humans

Question 80

What are disadvantages of using ortho-phthaladehyde

Answer 80

1. Residues remaining on inadequately rinsed devices can result in staining of skin, mucous membranes, clothing, and environmental surfaces. Care should be taken to ensure that the recommended number of fresh-water rinses are performed as per the manufacture IFUs
2. More expensive than Glutaraldehyde
3. Slow sporicidal activity. Some studies indicate that some strains of mycobacteria, as well as some cyst and vegetative forms of Protozoa, show resistance to OPA
4. Can cause redness and irritation with eye contact. PPE should be worn to prevent contact with OPA solutions, including glove, long sleeves, and splash proof mono goggles
5. Can cause irritation with inhalation that could result in discharge, coughing, wheezing, tightness of chest and throat, difficulty breathing, stinging in the nose/throat/mouth, lip-tingling, headache, loss of smell and dry mouth. These symptoms are temporary and reversible. Pre-existing asthma may be aggravated by exposure. Solutions should be used in a well ventilated area

Question 81

What are advantages of using peracetic acid-hydrogen peroxide solutions in disinfectants

Answer 81

1. No activation required
2. Odor or irritation is not significant

Question 82

What are disadvantages of using peracetic acid-hydrogen peroxide solutions

Answer 82

1. Material compatibility concerns with lead, brass, copper and zinc, both cosmetic and functional
2. Limited clinical experience with its use
3. Potential for eye and skin damage with exposure
4. Not compatible with some endoscopes

Question 83

What features should the automated endoscopic reprocessor (AERs) have

Answer 83

1. The machine should provide circulation of fluids through all channels at equal pressure without trapping air. Channel flow sensors provide an added measure of compliance
2. The detergent and disinfectant cycles should be followed by thorough rinse cycles and forced air pressure to remove all used solution
3. The disinfectant should not be diluted with any fluids other than what is supplied through the AER
4. The machine should be self-disinfecting
5. No residual water should remain in hoses and reservoirs at completion of the cycle
6. Cycles for alcohol flushing and forced air drying are desirable
7. The machine should feature a self-contained or external water filtration system
8. A method automatically store or print data verification of cycle completion is desirable

Question 84

What are the different disinfection measures that should be taken

Answer 84

1. Hands should be washed before and after each patient interaction, regardless of whether or not gloves are worn
2. An Environmental Protection Agency (EPA)-registered hospital-grade disinfectant should be used for general wipe-down of non-critical items, such as procedure carts, bedside and over-bed tables, and stretchers. Label instructions, including contact time, should be referenced for proper use
3. Environmental surfaces such as walls and floors should also be wiped down on a routine basis. Facility policies and procedures must be developed and adhered to for routine housekeeping
4. Visible spills of blood or other potentially infectious materials should be cleaned using products such as 10% bleach solution for blood, urine, or feces. Institution protocol should be followed
5. Isolation precautions for patients with potential infections should be maintained when patients are transported to the endoscopy department for procedures
6. Specific methods to prevent infection transmission for patients with such infections as C.Diff, TB, VRE, and CRE should be followed. Examples include hand hygiene with soap and water for C.Diff, use of an EPA-registered hospital disinfectant with label claims to kill specific organisms, room incubation post exposure of patients with airborne transmitted illnesses such as TB, and enhanced environmental surface cleaning to eliminate such pathogens as CRE and VRE. Staff must give attention to the discovery, containment, and handling of patients with parasitic or vermin infections such as head lice, scabies or bed bugs
7. Endoscopy schedules should be planned so there is sufficient time for adequate processing of instruments and for cleaning/setting up the unit for the next patient

Question 85

What are unresolved issues relating to gastrointestinal endoscopy that require further study to develop guidelines include

Answer 85

1. Replacement of water bottles and tubing. The optimal frequency for replacing clean water bottles, tubing for insufflation of air, lens wash water, waste vacuum canisters, and suction tubing has not yet been determined. Concerns involve the potential for backflow from a soiled endoscope against the direction of forced fluid and air passage into the clean air or water source and from a contaminated tubing and collection chamber against a vacuum into clean instruments used on subsequent patients
2. Surveillance and indicators. The use of surveillance culturing of endoscopes, as well as alternative indicators of adequate reprocessing (rapid indicators), are ongoing topics of investigation. At present, facilities are not specifically required to conduct these tests
3. Duodenoscope reprocessing. The optimal methods for cleaning and disinfection or sterilization of Duodenoscope remain incompletely defined
4. Endoscope cabinet features. Endoscope cabinet features that are optimal for preventing contamination have not yet been determined. This includes cabinet ventilation parameters and the capacity to store accessories
5. Replacement of endoscopes. While endoscopes should be serviced no less frequently than indicated in the FDA-cleared manufacturer IFUs, the optimal time interval for replacing the endoscope and its accessories has not yet been determined

Question 86

All electrical equipment should be inspected prior to each use. Inspection should include but not be limited to, the following activities

Answer 86

1. Check outlets and switch plates for damage
2. Check power cords and plugs for fraying or other damage
3. Check that all new equipment has been inspected by a biomedical technician or electrical safety officer before it is introduced into the practice setting and at established intervals for preventative maintenance

Question 87

What is the voltage of wiring that has the potential for electrocution with direct contact and what are complications

Answer 87

110 or 220 volt

And if the voltage is high enough it can damage the brain, impair respiration and cause cardiac dysrhythmia (ventricular fibrillation0, resulting in cardiopulmonary arrest

Complications may include vascular injury, tissue destruction from the inside out, loss of consciousness, damage to the respiratory center, infection, or eye damage

Question 88

To prevent fires and reduce the risks of burns and electrocution associated with electrically powered equipment, gastroenterology personnel can take the following measures

Answer 88

1. Use appropriate precautions when using flammable gases or liquids
2. Before use, check the integrity of all electrical equipment, including cords, switches, plugs, and wall receptacles. When possible, use an emergency power outlet
3. Ensure that all electrical equipment is properly grounded
4. Do not use multiple-outlet adapters or two-wire extension cords, and do not remove ground pins from three-pin plugs
5. Avoid routing power cords through heavy traffic areas, and avoid rolling equipment over electrical cords. Store cords loosely coiled, without kinks
6. Follow manufacturers’ recommendations and standards for all electrical equipment. Attach user manuals to equipment. When that is not possible, keep information within easy reach of staff in an area close to where the equipment is used
7. Follow institutional policies and procedures regarding testing electrical equipment. Never use an electrical device that does not have appropriate documentation of preventative maintenance inspections from the biomedical department (this may include a biomedical label with date inspected)
8. Remove any electrical equipment for which physicians or staff members have noted possible operational problems. Do not use if damaged or in need of repair. Report the item as defective, and tag it with the facility-approved process for repair
9. Never place containers of liquid on or near electrical equipment
10. Keep smaller electrical equipment secured on carts that do not tip easily

Question 89

What does RACE acronym stand for

Answer 89

1. R—rescue patients and staff from the immediate danger zone, if feasible
2. A—sound the alarm and proceed according to institutional fire policy. In the procedure area, the alarm is to call out there is a fire. The procedure team response includes recognition and acceptance of the event in order to react. If the fire is not immediately put out, the fire alarm is pulled to notify the team in the general area of the need for help
3. C—close all doors to contain smoke and flames
4. E—smother or extinguish flames, if possible, using a Halon (ABC) extinguisher for an electrical fire. A Halon extinguisher contains a liquified, compressed gas that stops the spread of fire by chemically disrupting combustion, leaving no residue behind. Halon is rated for class A, B, and C. It is safe fore human exposure. If unable to extinguish, evacuation will be necessary. This should be done swiftly with good communication. Evacuation is done horizontally first, then vertically

Question 90

Besides RACE what other information should be remembered in case of a fire

Answer 90

1. Know different types of fire extinguishers classified according to source of fire. These include A,B,C, or multipurpose fire extinguisher, B-C or A-B-C. Additionally D is for metals and K is for oils/fats
   - A=common combustibles like paper
   - B=flammable liquids
   - C=electrical
2. Never use water to extinguish an electrical fire
3. Activate circuit breakers and close gas supply valves as directed by institutional policy
4. Treat materials that are melting, dripping, or smoking as if they are actually burning to eliminate the possibility of their igniting or reigniting
5. Direct firefighters to the location of the fire

Question 91

What are the steps of checking the endoscopic imaging system before procedure

Answer 91

1. Check the integrity of all electrical cables before use. Frayed, cracked, or kinked cables are damaged. Do not use them
2. Do not handle equipments when hands, feet, body or floor is wet
3. Never use the light source as a supply table
4. Ensure that all components of the imaging system are correctly connected
5. Check the video image on the monitor(s) for clarity, and ensure additional equipment (e.g., image manager, printer, slide maker, computer) set-up is correct before use
6. Turn on all system components and suction to make sure they are functioning properly
7. Turn the light source or processor off when not in use. If doing hourly scheduled procedures, do not turn light source or processor off between each case

Question 92

When using an electro surgical unit where can burns result from

Answer 92

A. Poorly applied patient dispersive electrodes (grounding pads)
B. Electrical current seeking an alternate pathway out of the body, such as through ECG electrodes or metal objects like IV poles and x-ray tables

Question 93

If a patient has a pacemaker or ICD what precautions need to be taken before the use of the electro surgical unit

Answer 93

1. Know the manufacturer of the device (e.g., make a copy of patient’s wallet device ID card)
2. Validate battery life for the ICD/pacemaker with the patient’s identified device clinic/practitioner. Battery life and device checks are scheduled every 3-6 months after implantation
3. Coordinate ICD therapy suspension with a magnet or by a device representative before using any electrical energy tools that may cause interference. Provide continuous cardiac monitoring and position the defibrillator/resuscitation equipment for emergency care
4. Ensure that the distance between the active and dispersive electrodes is as short as possible
5. Place both electrodes as far from the pacemaker site as possible. Follow the manufacturer’s instructions for use for dispersive electrode placement
6. Keep all ESU cords and cables away from the pacemaker/ICD and its leads
7. Use the lowest possible power setting on the ESU

Question 94

When using Argon enhanced coagulation (AEC) aka argon plasma coagulation (APC) what precautions need to be taken

Answer 94

1. Observing all safety measures used for the ESU according to IFU
2. Avoiding placing the electrode in direct contact with tissue. This can cause gas embolism to occur
3. Activating the argon gas flow and the ESU simultaneously
4. Limiting the argon gas flow to the lowest level possible
5. Purging the argon gas line of air before each procedure and flushing air out of the argon gas line by pushing the “purge” button twice, allowing gas to travel through the line between each purge
6. Activating the system after moderate delays between uses
7. Testing the system to assure it is working properly before handing the physician the probe

Question 95

The most dangerous aspects of laser use are misdirection, scattering of the laser beam, smoke inhalation and fire hazards. Whenever lasers are in use, there is a potential for fire, damage to the skin or eyes, and respiratory tract irritation of patients and personnel. To prevent such injuries, personnel should follow these guidelines

Answer 95

1. Place a warning sign on the door leading into the room where the laser is in use. The sign should include “LASER IN USE” in bold letters, the specific laser type, the international laser symbol, wavelength, and maximum voltage
2. Provide protective eyewear for all patients and personnel. Extra eyewear should be left hanging on the procedure room door so additional or unexpected personnel may put them on before entering the room. The optimal density of the eyewear should be equivalent to the wavelength of the laser used
3. Use instruments that are anodized or covered with non-reflective coating to prevent inadvertent beam reflection
4. Place the laser in the standby mode when it is not in use, and provide the physician access to only one foot pedal when in use
5. Be knowledgeable about the laser key control, how it functions, and the emergency stop or “shut-down” button
6. Use lasers with a tamper proof audio tone that sounds when the beam is being activated
7. Use smoke evaluators and high-filtration masks to minimize the inhalation of the smoke produced in laser procedures
8. Do not use flammable or combustible materials near the laser beam. Follow all guidelines for electrical safety
9. Complete a laser safety “check-list” for each case so quality safety measures can be tracked

Question 96

Any level of ionizing radiation is potentially harmful. Unnecessary exposure can be minimized by:

Answer 96

1. Decreasing the time of exposure
2. Increasing the distance from the source
3. Placing a shield between the radiation source and the body
4. Questioning all female patients of childbearing age about the possibility of pregnancy before Radiographic procedures (maternity leaded aprons can provide double thickness in the area where protection is needed most)

Question 97

What are the protective guidelines may help minimize the exposure of gastroenterology patients and personnel to ionizing radiation

Answer 97

1. Wear lead-lined, flexible wraparound aprons and gloves, at a minimum, in accordance with institutional guidelines. Consider thyroid collars and protective eyewear (leaded, with side shields)
2. Use patient gonadal shielding as appropriate. Aprons should fully cover the breast area for females, and aprons must be long enough to cover long bones of the operators body
3. Wear film badges during procedures in which radiation exposure is encountered. These badges should be worn in the same place each time. A monitor at the neckline measures the amount of exposure to the head, neck and lens of the eye. Endoscopists who perform biliary procedures should wear a finger monitor in the same location for each procedure
4. Analyze exposure levels monthly. Film badges should be stored at the hospital and not worn or taken away from the workplace, as they may collect ionizing radiation from unrelated sources like the sun, soil, or airport scanners
5. Alternate personnel for procedures that require radiation, and limit exposure time for personnel holding patients and/or films
6. Ensure personnel do not turn their unshielded backs to the Radiographic equipment and maintain as great a distance from the x-ray beam as possible when the fluoroscope is in use
7. Allow only trained personnel to operate and maintain all Radiographic equipment
8. Be certain that the contrast medium selected is effective the the type of study being done
9. Make sure the patient is properly prepared and positioned. Expose only the targeted area of study to the film or fluoroscopy to help reduce unnecessary repeat procedures
10. Consult with a radiation safety office regarding equipment inspection, analysis of radiation exposure badges, and educational in-services
11. Check newly purchased leaded protective devices for cracks or holes that may compromise their integrity to protect personnel. The leaded devices should also be checked at least annually, and according to facility protocol, to determine the need for replacement. Follow the institutional policies, and participate in yearly in-service
12. Inspections are documented and will be available for regulatory agency reviews
13. Store leaded aprons flat or hung vertically. Do not fold leaded aprons
14. Clean leaded protective devices with an EPA-registered hospital disinfectant after every use

Question 98

What individuals are at a higher risk for developing a latex allergy

Answer 98

1. Workers with ongoing exposure, such as health care personnel who frequently change latex gloves
2. Individuals with a tendency toward multiple allergic conditions
3. Persons with allergies to certain foods, especially avocados, potatoes, bananas, tomatoes, chestnuts, kiwi fruits, and papaya
4. Persons with spina bifida, asthma, or a history of multiple surgical procedures

Question 99

What precautions should be taken for those with latex allergies

Answer 99

1. Notify the endoscopy unit as soon as the known or suspected latex allergy is discovered. Place a “latex alert” on the schedule for that patient
2. Schedule the procedure as the first case of the day, if possible
3. Remove all latex items from the patient care area, including the procedure room, admission, and post-procedure recovery area
   - remove all known latex supplies and equipment
   - check blood pressure cuffs for latex
   - check supplies and tubing, ampules, etc. Remove the rubber stoppers before withdrawing the medications instead of withdrawing medication with a needle through the rubber stopper
4. Remove boxes of latex gloves from all areas and replace them with latex-free gloves, both sterile and non sterile
5. Educate the patient, family, or significant other(s) regarding the latex-safe plan
6. Document the “LATEX ALLERGY” in the electronic medical record and place an allergy band on the patient
7. Monitor for severe allergic response.
8. Discuss treatment options available during the Time Out to IV fluids, emergency drugs (i.e. antihistamine, oral steroid tablets, and epinephrine), and resuscitation equipment

Question 100

What are the common-sense rules for handling chemicals

Answer 100

1. Always read and follow label directions
2. Ensure that all care providers have easy access to and an understanding of the information provided on the safety data sheet (SDS) that accompanies all hazardous chemicals
3. Familiarize all employees with a spill-containment plan specific for the liquid chemical germicide used. The information from the specific SDS should be incorporated into the plan
4. Mix chemicals only in accordance with directions
5. Follow the rules of standard precautions as if the chemicals were body fluids. If it will come in contact with hands, wear gloves. If it might splash, wear a face shield and protective clothing. Always wash hands after exposure to any chemical
6. Follow institutional policies and procedures for chemical spills, which may include but are not limited to the following:
   - Drip or splash—wipe up with gauze and dispose in biohazard bag
   - Larger than a drip or a splash—use appropriate spill kit. Dispose in spill kit disposal bag after material solidifies. Use spill kit brush and pan. Call environmental services personnel to cleanse floor and transport segregated spill kit bag to chemical disposal room
   - larger than the available spill kits—if fumes are overbearing, evacuate. Call protective services to secure area. Call facilities engineering to evaluate airflow, and make changes to prevent fumes from entering patient care areas. Call professional disposal team to clean up spilled chemical with special equipment
7. After the chemical is removed, rinse instruments and surfaces thoroughly to remove any harmful residue

Question 101

What steps should be taken to avoid accidental falls in the endoscopy unit

Answer 101

1. Hallways and doorways should be free of equipment, supplies (with special attention to incoming supplies delivered by non-department personnel) and carts
2. Rooms should be kept neat and orderly
3. Electrical cords, cables, and accessories should be placed so that personnel do not trip or fall
4. Beds should be locked using floor brakes, and side rails should be up when stepping away from a patient’s bedside
5. Post-sedation patients should be assisted in dressing and going to the restroom

Question 102

What should the endoscopy unit be stocked with to prepare for a patient emergency

Answer 102

1. Oxygen, via different methods of delivery (non rebreather mask, face mask, nasal cannula)
2. Crash cart with appropriate equipment and medications
3. Immediate availability of personnel trained in cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS). All endoscopy staff should be proficient in CPRm with annual validations
4. Immediate availability of personnel knowledgeable in the use of medications, recognizing side effects, and understanding peak effect and reversal medication
5. Immediate availability of personnel trained in pediatric advanced life support (PALS) and neonatal advanced life support (NALS), if applicable. The pediatric crash cart should be stocked with size appropriate equipment for the age groups receiving care in the facility. All medical facilities involved in the care of children must be prepared for the possibility of a life-threatening emergency

Question 103

What are the OSHA recommendations for abatement of workplace violence

Answer 103

1. Develop a crisis management plan
2. Require mandatory training for all workers in prevention techniques, restraint and seclusion procedures, and multicultural diversity techniques
3. Increase staff-to patient rations, when applicable
4. Identify patient with increased potential for violence

Question 104

What are standards

Answer 104

1. Standards are an acknowledged measure of comparison for quantitative or qualitative value, such as a model, criterion, or rule of professional behavior
2. They can be used as guidelines either in the workplace or in legal and ethical arenas.
3. Standards are indicators of competent practice
4. They can be revised to reflect changing practice requirements and needs based on scientific and technological advances

Question 105

What are standards of practice

Answer 105

1. Standards of practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently.
2. They describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process.
3. They are not intended to specify how an outcome is to be achieved, but rather what is to be achieved.
4. Standards of care can be defined as measurable statements that demonstrate the means by which practice outcomes are accomplished
5. They define criteria against which the nurse’s level of performance can be measured.
6. Standards of practice should be continually updated and validated in the practice setting.

Question 106

What are standards of Professional Nursing Practice

Answer 106

Standards of professional nursing practice consist of standards of practice and standards of professional performance

Question 107

What are Standards of Professional Performance

Answer 107

1. Standards of professional performance describe a competent level of behavior in the professional role
2. They include activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resource utilization, and environmental health
3. All registered nurses are expected to engage in professional role activities, including leadership appropriate to their education and position.
4. Nurses are accountable for their professional actions to themselves, their health care consumers, their peers, and ultimately to society at large
5. The profession of nursing is both a science and an art, requiring both judgement and skill

Question 108

What are the Standards of Practice for the Registered Nurse in the Gastroenterology Setting

Answer 108

1. Assessment
2. Diagnosis
3. Outcomes Identification
4. Planning
5. Implementation
6. Evaluation
7. Ethics
8. Culturally Congruent Practice
9. Communication
10. Collaboration
11. Leadership
12. Education
13. Evidence-Based Practice and Research
14. Quality of Practice
15. Professional Practice Evaluation
16. Resource Utilization
17. Environmental Health

Question 109

What are the competencies to the assessment standards of practice

Answer 109

1. Prioritizes data collection based on the patient’s immediate condition or anticipated needs and the relationship to the proposed intervention
2. Collects comprehensive, pertinent data using appropriate evidence-based assessment techniques, instruments, and tools
   A. Obtains data by interview, examination, observation, and review of health records
   B. Obtains data related to age-appropriate assessment and culturally sensitive needs
   Data includes:
   1). Preferences, values, expressed needs, and knowledge of the health care situation.
   2). Function and significance to the gastroenterology/endoscopy patient, such as: airway patency, body image/need for privacy, current level of comfort or pain, physical limitations, communication barriers, elimination patterns, nutrition and hydration status, safety measures, self-care deficits, skin integrity/color/turgor, venous access, and the ability to swallow
   3). Knowledge of health maintenance and practice of health promotion and disease prevention activities
   4). Educational needs/developmental level
   5). Previous access to and utilization of the health care system
   6). Current diagnosis(es), medication(s), and treatment(s)
   7). Environmental, occupational, recreational, psychological, cultural, and spiritual information
   8). Pat medical history
   9). Review of body systems
3. Synthesizes available data, information, and knowledge relevant to the situation to identify patterns and variations
4. Assess the impact of family dynamics on the patient’s health and wellness
5. Considers the interaction between the patient, family, and healthcare providers, as well as the environment, for holistic data collection
6. Documents relevant data accurately and in a manner accessible to the inter professional team
7. Applies ethical, legal and privacy guidelines and policies to the collection, maintenance, use, and dissemination of data and information

Question 110

What are the competencies of the diagnosis standard of practice

Answer 110

1. Develops the nursing diagnosis from the assessment data. Examples may include:
   A. Potential risk for bleeding related to alterations in blood clotting mechanism
   B. Knowledge deficit related to newly diagnosed gastrointestinal disorder (e.g., Crohn’s disease, cancerous polyps)
2. Validates nursing diagnoses and identifies actual or potential risks with the patient, family, and health care providers, when possible and appropriate
3. Prioritizes diagnoses, problems, and issues based on mutually established goals to meet the needs of the patient across the health continuum
4. Documents diagnoses, problems, and issues in a manner that facilitates the determination of the expected outcomes and plan

Question 111

What are the competencies of the outcome identification standard of practice

Answer 111

1. Engages the patient, family, and inter professional team in formulating expected outcomes
2. Formulates culturally sensitive expected outcomes through collaboration with the patient by integrating his or her culture, values, and ethical considerations with assessment findings and nursing diagnoses
3. Applies clinical expertise and current evidence-based practice to identify health risks that can impact expected outcomes
4. Documents expected outcomes as measurable goals with a time frame for attainment. Examples may include:
   A. The patient will meet discharge criteria within a specified time frame
   B. The patient will identify the name, dose, and frequency, purpose, and potential side-effects of the medications prescribed
5. Develops and modifies expected outcomes according to the status of the patient and evaluation of the situation for the actual outcomes that will facilitate the continuity of care

Question 112

What are the competencies of the planning standard of practice

Answer 112

1. Develops an individualized, evidence-based plan of care by partnering with the patient and inter professional team by considering examples, such as:
   A. The ability of the patient to tolerate preparation for diagnostic or therapeutic interventions
   B. The patient’s/family’s readiness to learn
2. Establishes the plan priorities with the patient, family, and inter professional team
3. Ensures that the plan reflects current evidence-based nursing strategies to address identified diagnoses, problems, and expected outcomes. Examples may include, but are not limited to, the following:
   A. Consideration of the patient’s rights and expectations
   B. Priorities for nursing actions and interventions
4. Modifies the plan according to the ongoing assessment of the patient’s response and other outcome indicators
5. Documents the plan using standardized language or recognized terminology

Question 113

What are the competencies of the implementation standard of practice

Answer 113

1. Partners with the patient to implement the plan in a safe, effective, efficient, timely, patient-centered, and equitable manner
2. Demonstrates and employs carding behaviors to foster therapeutic relationships among the patient and interprofessional team.
3. Utilizes evidence-based interventions and strategies to achieve the mutually identified goals and outcomes specific to the needs of the patient and the diagnosis or problem. Examples may include:
   A. Ensuring patient safety
   B. Acting as a patient advocate
   C. Ensuring the patient’s privacy and confidentiality are maintained at all times
   D. Providing dignified, culturally sensitive care that focuses on the patient
4. Implements interventions that comply with existing professional practice standards, regulatory agencies, accrediting bodies; and organizational policies and procedures. Examples may include:
   A. Infection prevention measures
   B. Sedation and analgesia safety
   C. Radiation safety
   D. Handling of hazardous materials
   E. Health promotion, teaching, and safety
5. Implements the plan in a timely manner in accordance with the patient’s safety goals
6. Documents implementation and any modifications, including changes or omissions, of the identified plan
7. Collaborates with a diverse, interprofessional team to implement a coordinated plan focused on the mutually identified expected outcomes

Question 114

What are the competencies of the evaluation standard of practice

Answer 114

1. Conducts a systemic, ongoing, criterion-based evaluation of the outcomes, including elements such as:
   A. Response to diagnostic or therapeutic interventions
   B. Level of understanding of health promotion and maintenance
2. Collaborates with the patient and others involved in the care or situation in the evaluation process
3. Uses ongoing assessment data to revise diagnoses, outcomes, plan, and implementation strategies as new needs are identified for the patient.
4. Shares evaluation data and conclusions with the patient/significant others and interprofessional team
5. Documents the results of the evaluation

Question 115

What are the competencies of the ethics standards of practice

Answer 115

1. Utilize the Guide to the code of ethics for nurses with interpretive statements: Development, interpretation and application (2nd ed.) to guide practice
2. Maintain patient confidentiality
3. Serves as a patient advocate by assisting the patient with self-advocacy skills and informed decision-making
4. Delivers care in a matter that preserves and protects patient autonomy, dignity, rights, values and beliefs
5. Takes appropriate action in instances of unethical or inappropriate behavior
6. Advocates for equitable patient care
7. Maintains responsibility for nursing practice through continued professional development
8. Contributes to the advancement of gastroenterology nursing though scholarly inquiry, professional standards development, generation of policy, and collaboration with other healthcare professionals

Question 116

What are the competencies of the culturally congruent practice standard of practice

Answer 116

1. Demonstrate respect, equity, and empathy in actions and interactions with all patients
2. Participates in lifelong learning to understand cultural preferences, worldview, choices, and decision-making processes of diverse patient populations
3. Applies knowledge of variations in health beliefs, practices, and communication patterns in all nursing practice activities
4. Uses the skills and tools that are appropriately vetted for the culture, literacy, and language of the population served
5. Communicates with appropriate language and behaviors, including the use of medical interpreters and translators, in accordance with patient preferences
6. Respects the patient’s decisions based on age, traditions, beliefs, family influence, and stage of acculturation

Question 117

What are the competencies of the communication standard of practice

Answer 117

1. Assess own communication skills and effectiveness
2. Seeks continuous improvement of communication
3. Assesses the patient’s communication ability, health literacy, resources, and preferences
4. Conveys accurate information
5. Contributes the nursing perspective in discussions with the interprofessional team
6. Maintains communication with the interprofessional team to minimize risks associated with transitions in care delivery
7. Incorporates appropriate alternative strategies to communicate effectively with patients who have visual, speech, language, or communication challenges

Question 118

What are the competencies of the collaboration standard of practice

Answer 118

1. Identifies the areas of expertise and contributions of other professionals to optimize the attainment of desired outcomes
2. Communicates and coordinates with the patient, family, and interprofessional team regarding patient care and the nurse’s role in the provision of care
3. Participates in building consensus or resolving conflicts in the context of patient care
4. Adheres to the standards and applicable codes of conduct to create a work environment that promotes cooperation, respect, and trust
5. Partners with the patient, family, and others in creating a comprehensive plan of care

Question 119

What are the competencies for the leadership standard of practice

Answer 119

1. Contributes to the establishment of an environment that supports and maintains respect, trust and dignity
2. Manages change and addresses conflict
3. Mentors others for the advancement of gastroenterology nursing practice and profession
4. Promotes the advancement of the profession and gastroenterology nursing practice through participation within SGNA and certification through the American Board of Certification for Gastroenterology Nurses (ABCGN)
5. Seeks ways to advance gastroenterology nursing autonomy and accountability
6. Demonstrates a commitment to continuous, lifelong learning for self and others

Question 120

What are the competencies for the education standard of practice

Answer 120

1. Acquires knowledge and skills relative to gastroenterology nursing
2. Demonstrates a commitment to lifelong learning through self-reflection and inquiry
3. Demonstrates accountability for maintaining competency and participates in educational activity relevant to professional issues and changing needs in gastroenterology nursing practice
4. Shares educational findings, experiences, and ideas with peers
5. Facilitates as work environment of role-modeling, encouraging, and mentoring

Question 121

What are the competencies of the evidence-based practice and research standards of practice

Answer 121

1. Utilizes current evidence-based nursing knowledge, including valid research findings, to guide practice and coordination of patient care
2. Incorporates evidence when initiating changes in nursing practice
3. Promotes ethical principles of research in practice and the healthcare setting
4. Participates in the formulation of evidence-based practice through research by:
   A. Identifying clinical problems suitable for nursing research
   B. Participating in data collection
   C. Participating in a unit, organization, or community research committee or program
   D. Sharing research activities with peers and colleagues
   E. Conducting research
   F. Reading and critiquing research for application to practice
   G. Using knowledge gained from research findings in the development and revision of policies and procedures

Question 122

What are the competencies of the quality of practice standards of practice

Answer 122

1. Participate in quality improvement initiatives, which may include:
   A. Identifying barriers and opportunities to improve health care safety, effectiveness, efficiency, equitability, timeliness, and patient-centeredness
   B. Identifying indicators used to monitor quality, safety, and effectiveness of nursing care (e.g., use of reversal agents, return to baseline status).
   C. Collecting data to monitor quality and effectiveness of nursing practice
   D. Analyzing quality data to identify opportunities to improve nursing practice
   E. Formulating recommendations to improve nursing practice
   F. Implementing activities to enhance the quality of nursing practice
   G. Collaborating with interprofessional teams to implement quality improvement plans and interventions
   H. Developing, implementing, and evaluating policies and procedures to improve quality of practice
2. Utilizes the results of quality improvement initiatives to change nursing practice
3. Achieves professional certification

Question 123

What are the competencies of the professional practice evaluation standards of practice

Answer 123

1. Engages in self-evaluation of practice on a regular basis, identifying strengths and areas for professional growth
2. Accepts feedback regarding own practice
3. Takes action to achieve goals identified during the evaluation process
4. Participates in peer review
5. Provides the evidence for practice decisions and actions as part of the evaluation process
6. Collaborates with peers and colleagues to enhance own professional nursing practice

Question 124

What are the competencies of the resource utilization standards of practice

Answer 124

1. Identifies patient care needs, potential for harm, complexity of the tasks and desired outcome when considering resource allocation
2. Delegates elements of care to appropriate team members in accordance with any applicable legal or policy parameters or principles
3. Advocates for resources, including technology that enhance nursing practice
4. Assists the patient and family in identifying and securing appropriate services to address needs across the health care continuum

Question 125

What are the competencies for the environmental health standards of practice

Answer 125

1. Promotes a safe and healthy workplace and professional practice environment
2. Attains knowledge of environmental health concepts
3. Assesses the environment to identify risk factors
4. Maintains a practice environment that reduces environmental health risks
5. Communicates environmental health risks and exposure reduction strategies to patients, families, colleagues, and communities
6. Participates in developing strategies to promote healthy communities and practice environments

Question 126

What are the SGNA’s specific standards of practice

Answer 126

1. “Standards of Clinical Nursing Practice and Role Delineations in the Gastroenterology Setting”
2. “Statement on the Use of Sedation and Analgesia in the Gastrointestinal Endoscopy Setting”
3. “Standards of Infection Prevention in Reprocessing of Flexible Gastrointestinal Endoscopes”
4. “Standards of Infection Prevention in the Gastroenterology Setting”
5. “Guidelines for Use of High-Level Disinfectants & Sterilants in the Gastroenterology Setting”

Question 127

What are the different Accrediting organizations

Answer 127

1. The Joint Commission
2. DNV GL Healthcare
3. Center for Improvement in Healthcare Quality (CIHQ)
4. Accreditation Association for Hospitals/Health Systems, Inc (AAHHS)
5. Accreditation Association for Ambulatory Health Care, Inc (AAAHC)

Question 128

What federal organizations develops the regulations and guidelines

Answer 128

1. Centers for Disease Control and Prevention (CDC)
2. US Environmental Protection Agency (EPA)
3. US Food and Drug Administration (FDA)
4. Occupational Safety and Health Administration (OSHA)
5. Health Insurance Portability and Accountability Act (HIPAA)

Question 129

What are the basic principles of process improvement utilized in healthcare organizations

Answer 129

1. Most problems are process issues rather than people issues
2. The people closes to the process are the experts who have interest in improving the process
3. Decisions should be made based on measurable data
4. Changes should be evaluated for effectiveness

Question 130

What are some examples of process improvement models

Answer 130

1. Plan-Do-Study-Act (PDSA)
2. Six Sigma
3. DMAIC
4. Lean Management
5. Positive Deviance
6. Standards for Quality Improvement Reporting Excellence (SQUIRE)
7. Chronic Care Model (CCM)

Question 131

What is the process improvement model Plan-Do-Study-Act (PDSA)

Answer 131

1. Plan-Do-Study-Act (PDSA) is a best-practice model of continuous improvement that focuses on promoting learning from experiences through repetitive and systematic reflection
2. The model’s various steps including forming a team; setting aims; establishing measures; and selecting, testing on a small scale, implementing, and spreading changes

Question 132

What is the process improvement model Six Sigma

Answer 132

1. Six Sigma is a quality improvement method that uses a defined series of steps to improve quality by identifying and eliminating errors, while minimizing variability for complex problems within large organizations

Question 133

What is the process improvement model DMAIC

Answer 133

1. DMAIC is an acronym for define, measure, analyze, improve, and control
2. Specially, the model uses these steps to define the problem, measure baseline performance, analyze root causes of clinical dilemma, improve by implementing change, and control and ensure that gains from change are sustained
3. It is a prescribed improvement process for Six Sigma methodology that focuses on learning more about the root causes of a problem through structured analysis and prudent use of data, without prematurely applying solutions to the complex problem

Question 134

What is the process improvement model lean management

Answer 134

1. Lean management is a continuous process improvement model focused on eliminating and reducing waste with the goal of transforming organizational behaviors and culture through incremental changes and, as a result, improving efficiency and quality
2. It’s key principles are to identify value, map the value stream, create flow, establish pull, and seek perfection

Question 135

What is the process improvement model positive deviance

Answer 135

1. Positive deviance is a tool for improving processes based on the premise that individuals involved in the process are able to find the best solution

Question 136

What is the process improvement model Standards for Quality Improvement Reporting Excellence (SQUIRE)

Answer 136

1. Standards for Quality Improvement Reporting Excellence (SQUIRE) is a model that follows the principle that improvement is an applied science rather than an academic discipline
2. It’s immediate purpose is to change human performance rather than generate new knowledge
3. It is driven mostly by experiential learning

Question 137

What is the process improvement model Chronic Care Model (CCM)

Answer 137

1. Chronic Care Model (CCM) is a process that synthesizes evidence-based system changes that are known to improve outcomes with an emphasis on six areas: organization of healthcare, community linkages, self-management support, delivery system design, decision support and information systems

Question 138

What do indicators make it possible to do

Answer 138

1. Document the quality of care
2. Make comparisons through benchmarking
3. Make decisions based on data
4. Set priorities
5. Support accountability, regulation, and accreditation
6. Support quality improvement

Question 139

Providing a solid foundation for a comprehensive process improvement plan requires a working knowledge of the process and the tools necessary to achieve the goal. These include:

Answer 139

1. Flowcharting the process through process mapping or value stream mapping
2. Establishing work teams with defined roles
3. Collecting and interpreting data

Question 140

What is the criteria for developing effective quality indicators

Answer 140

1. Objectivity
2. Specificity
3. Measurability
4. Comprehensiveness
5. Validity
6. Reliability
7. Relevancy
8. Efficiency

Question 141

What are the three types of indicator standards

Answer 141

1. Structure indicators
2. Process indicators
3. Outcome indicators

Question 142

What is a structure indicator

Answer 142

1. Structure indicators denote the characteristics of the health care setting where patient care occurs and describe the health care systems ability to meet the health needs of its patients.
2. Material, human, and financial resources, as well as organizational structure, are examples of structure indicators

Question 143

What is a process indicator

Answer 143

1. Process indicators assess what the provider did for the patient and how well it was done
2. They denote what transpired in the process of giving and receiving care
3. In other words, process indicators measure the activities and tasks in episodes of care

Question 144

What is an outcome indicator

Answer 144

1. Outcome indicators describe the effects of care on the health status of the patient(s) or patient populations.
2. Outcome measures sometimes need to be risk-adjusted for factors operating outside the health system in order for fair comparisons to be made
3. Examples of factors included in risk adjustments are patient demographic variables, psychosocial characteristics, severity of illness, health status,and comorbid conditions

Question 145

What are some examples of indicators that may be appropriate for the gastroenterology unit

Answer 145

1. Proper cleaning and disinfection of equipment (structure)
2. Emergency equipment available and functional for all procedures (structure)
3. Qualifications of gastroenterology nurses in the procedure suites (structure)
4. Number of incomplete procedures because of poor bowel prep (process)
5. Number of patients who do not have necessary lab work pre-procedure (process)
6. Patient or family who rate satisfaction with nursing care as 80 percent or above (outcome)
7. Patients having sclerotherapy who have blood pressure and pulse within the range of plus or minus 5 percent of their baseline value, if available, before discharge (outcome)

Question 146

Indicators must be stated in a concise manner and be easy to locate to facilitate the data collection. Indicators ideally should be:

Answer 146

1. Based on agreed upon definition
2. Specific and sensitive (i.e. detects few false positives or false negatives)
3. Valid and reliable
4. Able to permit useful comparisons
5. Supported by evidence-based literature

Question 147

What are the joint commission requirements for performance improvement

Answer 147

1. Set priorities for data collection
2. Identify the frequency for data collection
3. Collect data on performance improvement priorities identified by leaders (e.g., adverse events related to using moderate sedation; significant medication errors; patient perception of safety; and quality of care, treatment, or services)

Question 148

Regarding the compilation and analysis of data, organizational leaders must

Answer 148

1. Use statistical tools and techniques
2. Compare internal data over time to identify levels of performance, trends, and variations
3. Use results of data analysis to identify improvement opportunities

Question 149

Regarding improving performance within the organization, organizational leaders must

Answer 149

1. Take action on improvement priorities
2. Take action when planned improvements are not achieved or sustained

Question 150

To measure the quality of care provided, it is necessary to establish the following components

Answer 150

1. Written indicators and thresholds
2. Tools for data collection and tabulation
3. Predetermined acceptable levels of variance for evaluating each indicator
4. A means for reporting the findings

Question 151

What are strategies for implementing change and improvement

Answer 151

1. Education and training
2. Team approach
3. Easily attainable

Question 152

In relation to strategies for implementing change and improvement what is education and training

Answer 152

1. Education is essential when implementing change
2. Staff cannot be expected to understand the need for change, or the effect of a change on their role, without adequate knowledge
3. Training in process improvement should be incorporated into job orientation and also be a part of the annual review process

Question 153

In the relation to strategies for implementing change and improvement what is team approach

Answer 153

1. The entire unit needs to be involved.
2. A basic tenet of process improvement is that those people closest to the issue are the ones who understand it best and must be involved in the development of the solution
3. The Joint Commission advises that, when a process involves more than one department, the group improving the process must reflect that cross-departmental activity

Question 154

In relation to strategies for implementing change and improvement what is easily attainable

Answer 154

Start with an easily attainable, timely process improvement

Question 155

With continuous process improvement, there is always room for improvement; current measures should be under constant review so that poorly performing measures can be adapted or eliminated and replaced with better quality measures. What is the criteria to use for this effort

Answer 155

1. Employing measures that are based on a strong foundation of research and show the process addressed by the measure
2. Capturing accurately whether the evidence-based care has been delivered (e.g., the measurement strategy is not a check mark in a box on a form)
3. Addressing a process that is as close to the desired outcome as possible with very few intervening processes
4. Having minimal or no unintended adverse consequences for the measure

Question 156

All research, whether quantitative or qualitative in design, follows what specific steps

Answer 156

1. Identify the problem
   A. State the problem
   B. State the research question or hypothesis
2. The literature review: Find relevant evidence
   A. Determine what is currently known about the topic
   B. Find the relevant literature and identifying the sources of evidence
   C. Appraise the evidence: What to look for in research reports
3. Identify the implications for nursing and nursing practice
   A. The importance for the nursing profession, clinical decision-making, and nursing practice
4. Determine the methodology: How the study will be executed
   A. Define the basic research terminology
   B. Describe a theoretical framework
   C. Determine the study design for either qualitative or quantitative research
   D. Identify the sample or population and study setting
   E. Determine the number of participants needed for the sample
   F. Identify ethical considerations: Protection of Human Subjects and Institutional Review Board
5. Data collection plan: Implement the study and collect the data
   A. Plan the method of implementing the study
   B. Plan how to protect the data
6. Analyze the data and interpret the findings
   A. Plan how data will be analyzed
   B. Cover the basic statistical terminology
7. Report the findings in the study
   A. Illustrate how the statistical findings relate to the research questions
   B. Incorporate basic statistics when reporting study findings
   C. Describe the conclusions found in the study
   D. Explain any limitations found in the study
   E. Discuss the findings, and include finding or implications that the findings could have for nursing and/or nursing practice
8. Disseminate the results
   A. Present as a poster presentation
   B. Present as a podium presentation
   C. Submit a written manuscript

Question 157

What is important to consider during the first step of the research process

Answer 157

1. Interest level—is there interest among the professional community in the findings to come out of the proposed research
2. Motivation—is the researcher sufficiently interested in the topic to sustain motivation to study the problem until the work is completed
3. Time—is the scope of the problem such that it can be studied with substantial outcome data within the time allotted for the study
4. Availability of subjects—can the researcher obtain a sufficient number of subjects to investigate the problem
5. Cooperation of others—researchers rarely conduct investigations independently. Are the necessary resources available to enable the research to complete the project. Will it be a problem to get the necessary permissions required from subjects, guardians, institutional administrators and so on
6. Facilities and equipment—what facilities and what equipment will be needed, and will they be available to complete the study
7. Money—will funding be necessary? if so, how much, does the anticipated cost outweigh the value of the expected findings
8. Experience of the researcher—is the problem form a field in which the researcher has some experience? If not, is there another more experienced investigator with the substantive knowledge of existing concepts, findings, and theories who can guide the researcher in developing methods of study and help avoid research problems that would require sophisticated measuring instruments and/or complex statistical analyses

Question 158

What are the objectives when conducting a literature review

Answer 158

1. Identify whether the proposed problem has already been solved
2. Determine whether the problem has been studied, but not sufficiently to rule out further investigation. This is termed a “research gap” in the literature. In this case, it may be feasible to replicate the study according to methods outlined in the literature
3. Determine whether certain research designs are appropriate for the proposed topic. There are many resources to use when designing a study. Some may not be appropriate. Other researchers have made mistakes that must be avoided
4. Identify the sources of the evidence and critically appraise the strength of the evidence

Question 159

What tools may be useful in retrieving pertinent literature on the topic of interest

Answer 159

1. Abstracts—contain summaries of journal articles
2. Indexes—printed indexes, such as index medicus can unlock vast stores of literature on every subject imaginable
3. Computer databases—databases are associated with specific types of literature and are really accessible, usually for free in large medical institutions
4. References—references provide compilations of books, periodicals and reports on topics. References can also identify other investigators with experience in the area of interest
5. Personal contacts—contacting other investigators can help clarify information they published and help the researcher refine his or her own purpose and methods

Question 160

What is important to look for in research reports

Answer 160

1. Facts, statistics and findings
2. Theory or interpretation
3. Methods and procedures
4. Opinions speculation, anecdotes, clinical impressions, or narrations of incidents and situations
5. Negative findings

Question 161

What are experimental studies and what are their importance

Answer 161

1. The researcher is interested in the relationship between the independent variable and dependent variable
2. The classic design is a randomized control trial
3. The importance
   A. Ensuring the creation of a control and comparison group
   B. Random assignment for control and intervention groups
   C. Strict control of how the intervention is provided to the intervention group

Question 162

What is a non-experimental study

Answer 162

1. Examples include descriptive or observational studies
2. The researcher observes the same population in the natural setting and does not attempt to manipulate the variable in the study
3. The variables in descriptive study can be characteristics such a as blood pressure, age, gender, and weight

Question 163

What is a correlation study

Answer 163

Correlation studies employ research design that describes a relationship or connection between variables in terms of direction that is either positive or negative, and strength that is strong, moderate, or weak.

These relationships are determined using statistical testing

Question 164

What is a quasi-experimental study

Answer 164

1. Quasi-experimental studies are similar in design to experimental studies, but when the researcher cannot control any once of the components of experimental design, the lack of control could potentially include uncontrolled, or extraneous, variables
2. A quasi-experimental research design is used to identify the impact of treatment or preventative measures on disease
3. This research design establishes a casual connection between the intervention and the outcome
4. Also, in quasi-experimental research design, the intervention group receives the experimental treatment, and the comparison group does not receive the experimental intervention
5. This type of research is also referred to as an interventional study

Question 165

What are examples of vulnerable participants in an experiment

Answer 165

1. Children
2. Subjects who are emotionally, mentally or physically disabled
3. Institutionalized individuals
4. Incarcerated individuals
5. Pregnant women

Question 166

What are some rights that participants in research have

Answer 166

1. Privacy—participants have the right to ask how and with whom their personal and health information will be shared
2. Confidentiality—data collected is only shared with others identified in the consent signed by the participant
3. Anonymity—data collected should not identify the participants or be linked to the participants’ identify
4. Justice—participants must be treated fairly and without bias
5. Beneficence—participants are protected from harm, pain, or discomfort. The phrase “harm and discomfort” is not limited to physical injury and should also address emotional concerns. The risk, benefits, and alternatives must also be disclosed

Question 167

What information needs to be provided to gain approval from the organizations Internal Review Board

Answer 167

1. A plan for how the data will be collected must be clearly stated, and time frames for completion of the study should be identified. Because this phase of research is labor-intensive, resources needed to execute the study should also be included in the planning
2. The research must include careful observation and ongoing assessment during the data collection process to ensure that the data is collected and documented as planned. In addition the collected data needs to be protected. Preparation should include a secure location for data storage. Locked cabinets may be used but should be limited. Data is best stored in a password-protected and secure databases specifically for this purpose