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Leadership > Lecture Exam 2 > Flashcards

Lecture Exam 2 Flashcards

1
Q

why do hospitals support professional certification?

A
  • to recruit and retain qualified nurses
  • knowledge that nurses have met rigorous national requirements and are role models of professional accountability
  • growing evidence links certified nursing practice and positive outcomes
  • certification is among key excellence indicators for programs such as Magnet Recognition and AACN Beacon Award
  • most hospitals offer certification financial incentive to improve salary and professional advancement opportunities
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2
Q

expressed consent

A
  • verbal or written consent by patient or appropriate surrogate to udnergo specific procedure or treatment
  • for invasive procedures or those with significant risk
  • documented on a consent form
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3
Q

what supports autonomous practice?

A
  • nurse-driven protocols and order sets
    • nurse-driven removal protocol
  • resecheduling meds in SCM to adjust per patient preferences
  • independently escalating education/services patients needs
  • nurses’ ability to adjust staffing and scheduling
  • nurses’ communication with and activation of team members
  • nurses’ participation in product trials to select products
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4
Q

care delivery system

A
  • system to deliver care that delineates nurses’ authority and accountability for decision-making
  • promotes continuous, consistent, efficient and accountable care
  • adapted to organization
  • examples:
    • team based
    • primary nursing
    • functional nursing
    • unit location-based or PODs
    • population-based nursing
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5
Q

National Practitioner databank

A
  • whenever a payment is made on behalf of a practitioner, it is reported to this databank
    • MDs, NPs, CNM
    • just that you were sued, just the payment
  • not open to public - push to make it public
  • also push to make payments on behalf of nurses put in this databank
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6
Q

filters of scope of practice

A
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7
Q

emancipated minors

A
  • emancipated in court
  • graduated high school at any age
  • married at any age
  • pregnant at any age
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8
Q

origin of Magnet

A
  • conceived from ideas of USA national nurse leaders
    • including Margaret Sovie CNO of HUP 1988-1996
  • first hospital to be designated Magnet in 1994
    • U Washington Medical Center in Seattle
  • connection with SON
    • Linda Aiken
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9
Q

Magnet Model

A

based on forces of magnetism

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10
Q

multiple disciplinarity

A
  • multidisciplinary: groups of people with different backgrounds, philosophical orientations that work together - but can still pick out individual roles and contributions
  • interdisciplinary - can pick out individual contributions but not so easily
  • transdisciplinary - totally blended together (not quite here yet)
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11
Q

discharge AMA

A
  • assess decision-making capacity
  • describe risks, alternatives to leaving
  • describe risks and benefits of ocntinued treatment
  • arrange appropriate discharge follow-up and perform discharge teaching
  • sign AMA form
  • thorough documentation
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12
Q

what do BON do?

A
  • oversee and ensure safe practice of nursing
    • outline standards for safe nursing care
    • issue licenses to practice nursing
  • continues oversight
    • monitoring licensees’ compliance to state laws
    • taking action against licenses of nurses who exhibit unsafe nursing practice
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13
Q

what are Boards of Nursing?

A
  • state governmental agencies responsible for regulation of nursing practice
  • established 100 years ago to protect public’s health and welfare
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14
Q

background knowledge for delegation

A
  • healthcare context that brings about need for delegation
  • organization
  • practice (state regulations)
  • yourself (emotional intelligence)
  • delegates
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15
Q

special situations in delegation

A
  • managing a friend
  • managing older/more experienced employees
  • subordinats won’t do what you ask
  • you don’t know answer to question
  • compared to previous manager
  • jealousy
  • resentment
  • competition
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16
Q

demonstrating empirical outcome (Magnet)

A
  • must be written in this format:
    • background/problem
    • goal statement
    • description of intervention
    • participants (names, crednetials, titles, dept)
    • outcomes (in graph)
      • at least 1 baseline data point
      • intervention time point
      • 3 post-intervention data points
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17
Q

malpractice in Philadelphia

A
  • Phila court system pushing towards fast track (2-3 year resolution)
  • more malpractice money in Phila county than in entire state of Cali
    • no caps in Phila (yes in Cali)
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18
Q

benefits of professional certification

A
  • higher wages
  • more productive/highly trained workforce
  • prestige and competitive advantage for individual
  • enhanced employment opportunities
  • assist employers in making informed hiring decisions
  • assist consumers in making informed provider decisions
  • protect general public from incompetent and unfit practitioners
  • establish professional standard for individuals in particular field
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19
Q

implied consent

A
  • inferred from circumstances
  • relied upon for care or treatment which is routine and does not involve significant risk
  • rarely documented
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20
Q

barriers to delegation

A
  • I can do better/faster myself
  • loss of control
  • lack of confidence in others
  • lack of ability to direct others
  • aversion for taking risks
  • fear of criticism
  • person to whome you wish to delegate tasks already overworked
  • lack of self-confidence
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21
Q

multidisciplinary research considerations

A
  • MDR is new standard
  • requires greater coordination
  • can strengthen research rigor and reach
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22
Q

Magnet projects

A
  • get presented at local, regional and national conferences
  • projects get published
  • projects change practice
  • projects evaluate practice
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23
Q

types of mixed methods

A
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24
Q

what people must be in place to apply for Magnet?

A
  • Magnet Program Director (MPD)
    • Masters degree
    • oversees and leads all Magnet work with nurse leaders, point person for Magnet Program Office communication
    • communicates with Magnet Program Office (Analyst)
    • informs organization of changes to Magnet application
    • works with nurses to design acceptable Magnet projects
    • coordinates work for written Magnet application
    • responsible for Magnet application
    • Magnet Webinars
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25
Q

why does magnet matter?

A
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26
Q

structures needed to apply for Magnet designation

A
  • shared governance model
  • professional practice model
  • care delivery system
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27
Q

levels of clinical experience

A
  • novice and advanced beginner: use protocols for delegation
  • competent: focus on patient outcomes and how assistive personnel can help
  • proficient and expert: guide others to use assistive personnel and refine/articular decisions about using personnel in various situations
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28
Q

competency vs decision-making capacity

A
  • competency is a legal thing
    • must be declared incompetent in court
  • patients can be lacking decision-making capacity
    • temporarily or not
    • need consent from next of kin or surrogate
  • emergency situations do not require designated decision-maker
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29
Q

what are CNA/NAP/UAP/PCT

A
  • certified nursing assistant
  • nursing assistive personnel
  • unlicensed assistive personnel
  • patient care technician
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30
Q

guidelines for effective communication

A
  • introduce self, ID badge
  • inform patient of role in caring for him/her
  • address patient by name
  • listen to patient, maintain eye contact
  • explain in lay person’s terms
  • answer patient’s questions and ask if they have additional questions
  • compassion and courtesy
  • behaviors leaving unfavorable impressions: rudeness, aloofness, acting superior, impatience, ignoring presence
31
Q

good practice r/t personal risk management

A
  • scope of practice - boundaries of practice determined at state level by NPA
    • institutional policies restrict further
    • malpractice insurance covers WITHIN scope of practice
  • standard of care - from professional standards, government agencies, literature, hospital polciies, manufacturer guidelines, precedent court decisions
32
Q

displaying credentials

A
  • preferred order
    • highest earned degree
    • licensure
    • state designations/requirements
    • national certification
    • awards/honors
    • other
  • why?
    • education first since its permanent
    • licensure and state required for practice
    • followed by voluntary credentials
33
Q

components of nurse practice acts

A
  • statements re: health & safety of population
  • define professional nursing
  • define advanced practice nursing
  • licensure requirements
  • requirements/procedures for practice
  • requirements for licensure renewal
  • designation of regulatory board
  • guidelines for delegation of nursing care
  • define scope of practice
34
Q

nursing certification

A
  • formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes
  • after meeting defined eligibility criteria, certification candidate achieves nationally recognized credential through successful completion of rigorous examination
35
Q

what is health services research?

A

multidisciplinary field of scientific investigation that studies how

  • social factors
  • financing systems
  • organizational structures and processes
  • health technologies
  • personal behaviors

affect acces to health care, quality and cost, and ultimately our health and well-being

36
Q

history of nursing certification

A
  • Margretta “Gretta” Styles
    • leader in field of nursing certification
    • conducted 1st comprehensive study on nurse credentialing in 1970s
  • ANA offered certification in 1974
    • pediatric NP, gerontology, psych-mental health
  • certified nurses day is celebrated on March 19 in honor of Styles’ birthday
  • Mean Maganet Organization Certification Benchmark
    • direct care RNs certified by nationally recognized certifying organization = 33.77%
  • 345 National Nursing Certifiations recognized by ANCC Magnet Recognition Program
37
Q

clinical research

A
  • applied - answer specific question
  • uses people
  • approaches:
    • cohort studies
    • observational vs interventional, randomized vs not
  • sample topics:
    • drug efficacy
    • clinical procedure efficacy
38
Q

basic research

A
  • pure - knowledge for knowledge’s sake
  • animal models
  • wet lab
  • sample topics:
    • mechanisms of anesthesia
    • mapping out neural circuits
39
Q

4 C’s of communication

A
  • clear
  • concise
  • correct
  • complete
40
Q

certificate of merit

A
  • when a plaintiff submits a law
  • have to sign a document that they had their case reviwed by a “qualified” individual who is of merit to the case
    • ex: podiatrist not qualified
41
Q

good communicaton r/t personal risk management

A
  • biggest problem is the illusion it has been achieved
  • clear communication is proven deterrent to injury, dissatisfaction, litigation
  • patient more likely to sue if perceive health care professional did not care about him/her during treatment than if professional had good rapport
42
Q

HATRICC

A
  • handoffs and transitions in critical care
  • OR to ICU handoffs
43
Q

examples of sources of evidence from Magnet hospitals

A
  • narrative statements
    • what content?
  • 5 pieces of evidence or documents to support story (exhibits)
44
Q

informed consent

A
  • given by patient based on knowledge of nature of procedure/treatment to be performed
    • risks, benefits, alternatives
  • process, not just a form
45
Q

organizational accountability for delegation

A

relates to providing sufficient resources, including:

  • sufficient staffing w/ appropriate mix
  • documenting competencies for all staff providing direct patient care
  • ensuring RN has access to competence information for staff they are delegating to
  • organizational policies on delegation developed with active RN participation
  • policies acknowledge delegation is professional right and responsibility
46
Q

criteria defining professional specialty certification

A
  • certification developed to reflect a professional body of knowledge and skills, which typically have been defined in scope and standards of practice
  • development of certification relies on:
    • national role delineation study or logical job analysis that is revised q7 years to reflect current knowledge and skills required of profession
    • generally accepted test development and psychometric principles
    • time-limited recert interval is defined
    • certification is national in scope
47
Q

when is consent needed?

A

absent an emergency:

  • surgery, including anesthesia
  • radiation or chemo
  • blood transfusion
  • surgical device or appliance
  • experimental med, device, or approved med/device in experimental manner
48
Q

shortcomings related to knowing your delegates

A
  • lack of understanding of expectations
  • lack of insight into parameters of acceptable performance
  • unmet educational needs
    • knowledge and attitudinal issues
  • needs for supervision and guidance
  • failure to address motivations
    • self-fulfillment, self-esteem, belonging, safety/security
49
Q

statue of limitations on medical malpractice suits

A
  • 2 years
  • discovery rule - when pt “discovers” they were injured
50
Q

communication process of delegation

A
  • p;ositive attitude
  • clarify who coordinates UAP
  • be careful of tone and way of presenting requests
  • use plain language
  • define what needs to be done, how, when
    • for complex tasks: reportable tasks and rationale
  • clearly indicate priorities
  • verify comprehension
  • give and receive feedback (also about patient responses)
51
Q

management considerations re: delegation

A
  • provide adequate staffing and othe resources for safe and effective patient care
  • follow up on every report of concern for safe staffing or safe practice
    • correct situations that prevent safe/effective care
  • provide education/orientation to all employees, including training in delegation
52
Q

components of informed consent AND refusal

A
  • description of procedures, facts, benefits, risks, alternatives
  • risks need to include most serious and most frequent
  • added risks based on hx or medical problems
  • good faith effort by provider to fill in appropriate risks relvant to procedure and patient
53
Q

skills in delegation: need-to-knows

A
  • what needs to be done
  • how to prioritize
  • how to match job to delegate
  • how to communicate
  • how to resolve conflict
  • evaluating and problem-solving
54
Q

implementation: education

A
  • departmental meetings
  • educational conferences
  • emails
  • website
  • flyers
  • implementation support team
  • mandatory web training
55
Q

history of delegation

A
  • ANA and National Counce of SOB jointly wrote statements on delegation in 2005
    • essential nursing skill
    • developed to support practicing nurse in using delegation safetly and effectively
56
Q

role delineation studies re: professional certification

A
  • to develop certification core curriculum
    • what to study
  • assigns percetn to test blueprint for specific areas of practice
  • informs specialty of focus of practice
  • guides certification review courses
57
Q

types of nursing care related to patient outcomes (measured by CMS)

A
  • falls
  • falls with injury
  • hospital acquired pressure ulcers
  • unit acquired pressure ulcers
  • patients with physical restraints
58
Q

conclusions about multidisciplinary research

A
  • leverages strengths of different investigators, disciplines, approaches to research
  • teams should be defined by research question
59
Q

delegation: what’s in it for me?

A
  • gives sense of purpose for long and short term
  • enhances ability to motivate co-workers along track to achieve outcomes
  • clarifies patient/family expectations when outcomes are discussed and planned
  • promotoes job satisfaction and collaboration for whole team
60
Q

what are LPN/LVN

A
  • licensed practical nurse
  • licensed vocational nurse
61
Q

specific skills in multidisciplinary research

A
  • secondary data analysis
  • qualitative and mixed methods
  • pseudo-randomization
  • natural experiments
  • adaptive study designs
  • advocacy
62
Q

exhibits to demonstrate sources of evidence (Magnet)

A
  • signifies how or what is demonstrated
  • to support narrative
  • copies of actual completed documents
  • examples:
    • approved policies, procedures
    • meeting minutes/records of meetings
    • flyrs/agendas for programs
    • correspondence
    • screenshots of internet materials or resources
    • PP slides
    • rosters of attendance
    • newsletters or media publications
    • conference brochures
    • pt education brochures/teaching materials
63
Q

American Nurses Credentialing Center (ANCC) Magnet Recognition Program

A
  • ANCC Magnet-recognized organizations serve as the fount of knowledge and expertise for delivery of nursing care globally
  • organizations are groudned in core Magnet principles
  • 49 standards in 4 Magnet Model Components that define excellence for organization
  • 446 with Magnet Designation
64
Q

surveying

A
  • Press Ganey vs. HCAHPS
  • transition to electronic data collection
  • Likert scale and open ended questions
65
Q

exemplary professional practice (EP) in Magnet Model

A
  • true essence of Magnet organization stems from exemplary professional practice within nursing
    • comprehensive understanding role of nursing
    • application of that role with patients, families, communities and interdisciplinary team
    • application of new knowledge and evidence
  • goal is more than establishment of strong professional practice - what professional practice can achieve
  • Forces of Magnetism represented:
    • professional models of care; consultation and resources; autonomy; nurses as teachers; interdisciplinary relationships
66
Q

new knowledge, innovation & improvements (NK) in Magnet Model

A
  • Magnet organizations have ethical and professional responsibility to contribute to patient care, the org, and the profession in terms of new knowledge, innovations, and improvements
  • current systems and practices need to be redesigned and redefined
  • includes new models of care, application of existing evidence, new evidence, and visible contributions to science of nursing
67
Q

translational research spectrum

A
68
Q

good documentation r/t personal risk management

A
  • most important form of communication
  • primary communication medium
  • only mechanism to all providers
  • poor documentation: raises questions about facts and quality of care
    • if not documented, didn’t happen
  • other purposes:
    • compliance, reimbursement, legal document
69
Q

scope of practice - varies state to state

A
  • licensed or registered?
  • within scope?
  • outside scope?
  • typical roles, skills, tasks
  • who supervises and delegates them?
  • who do they supervise and delegate to?
70
Q

effectiveness-implementation trials

A
71
Q

kinds of collaborators needed for multidisciplinary research

A
72
Q

who can consetn

A
  • competent adults
  • emancipated minors
  • appropriate surrogates
73
Q

Magnet sources of evidence (SOE): must demonstrate

A

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