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
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
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
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
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
6
Q
filters of scope of practice
A
7
Q
emancipated minors
A
- emancipated in court
- graduated high school at any age
- married at any age
- pregnant at any age
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
9
Q
Magnet Model
A
based on forces of magnetism
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)
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
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
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
14
Q
background knowledge for delegation
A
- healthcare context that brings about need for delegation
- organization
- practice (state regulations)
- yourself (emotional intelligence)
- delegates
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
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
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)
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
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
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
21
Q
multidisciplinary research considerations
A
- MDR is new standard
- requires greater coordination
- can strengthen research rigor and reach
22
Q
Magnet projects
A
- get presented at local, regional and national conferences
- projects get published
- projects change practice
- projects evaluate practice
23
Q
types of mixed methods
A
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
25
Q
why does magnet matter?
A
26
Q
structures needed to apply for Magnet designation
A
- shared governance model
- professional practice model
- care delivery system
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
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
29
Q
what are CNA/NAP/UAP/PCT
A
- certified nursing assistant
- nursing assistive personnel
- unlicensed assistive personnel
- patient care technician
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
