M1 Clinical Judgement/Communication Flashcards by Josh Kotov

Tort

intentional or unintentional act of wrong doing

depending on severity, can be held in both a civil and criminal trial

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Intentional tort examples

Assault
Defamation
Invasion of privacy
False imprisonment (putting up all the safety bars)
Fraud

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Unintentional tort examples

Negligence
Malpractice

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Negligence

Omission or commission of actions that a reasonably prudent person would or would not do

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Malpractice

Negligence by professional personnel

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4 elements of liability

Duty
Breach of duty
Causation
Damage

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Components of informed consent

Disclosure
Comprehension
Competence
Voluntariness

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Who obtains informed consent

what are we responsible for

Dr.

Dr. Pt. and witness signature. (witness preferably not you the nurse)

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Before giving med verify

Name
Date of birth

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If pt has med questions

resolve issues before giving

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dosage
side effect
reaction

questions can be addressed via

drug reference hand book

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What to do if wrong med is given

Immediately stop med
Assess pt
Notify provider
Document

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Never event

an event for which there already are safety checks

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Sentinel event

death
permanent injury
long lasting/severe injury

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Critical pathway

a relatively standardized prediction of a patients prognosis

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5 rights of delegation

Right task
Right circumstance
Right person
Right direction/communication`
Right level of supervision

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Improper delegating involves

wrong time
wrong person
wrong reason

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Are RNs liable for work they delegate to NAPs
Nursing assistive personnel

YES

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Can NAPs do invasive sterile treatment

NO
only noninvasive and nonsterlie

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What reports can NAPs collect and document

Vitals
Height
Weight
Intake/Output
Capillary blood
Urine test

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What movement tasks can NAPs assist with

Ambulation
Positioning
Turning

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Can NAPs help transport clients within facility

YES

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What hygiene can NAPs assist with

Personal hygiene
Bed washes
Elimination
Vaginal irrigation
Cleansing enemas

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Can NAPs assist with eating

what if pt has breathing or swallowing problems

YES
feeding
cutting food
placing meal tray

then NO

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Can NAPs assist with ADLs

YES

7 criteria for a task to be deligated

Task is frequent There are steps Little modification from 1 client to the next Predictable outcome NO assessment interpretation or decision making Does not endanger client Task is allowed by policy

If a task involves _ , _ , or _ you CAN NOT delegate it

Assessment Interpretation Decision-making

Cultural phenomena to consider when delegating

Communication Space Social organization Time Environmental control Biological variations

Communication aspects to consider

Touch Volume Eye contact

Time aspects to consider

is culture past present or future oriented

Environmental control

Internal or external locus

Communication can be

Written Nonverbal Verbal

Sender and receiver of message are both influenced by their own

Internal climate External climate

Internal climate

Values Feelings Temperament Stress level

External climate

Weather Temperature Timing Status Power Authority Organizational climate

Communication must be

clear simple precise

after sending a message, the sender should seek

feedback

Upward communication

from subordinate to superior

Downward communication

superior to subordinate

Horizontal communication

peer to peer

Diagonal communication

Between individuals at different hierarchys

Grapevine communication

informal random chatter

To be more clear and firm in verbal communication use _ statements

How to respond to aggressive communiation

Repeat the message back in your own words Ask inquisitive questions

ISBAR

I am _ Situation Background Assessment Recommendation

IPASS

Illness severity Patient summary Action list Situational awareness and contingency planning Synthesis (read back)

GRRRR listening

Greeting Respectful listening Review Recommend or request more info Reward

Is the EHR specific to one facility

Stage of a group process

Forming Storming Norming Performing

Group process forming

Testing of boundaries

Group process storming

resistance to influence polarization into subgroups

Group process norming

Consensus evolves as group cohesion develops Conflict is overcome

Group process performing

Structure focuses on task completion

Triage categories

Emergent Urgent Non -emergent Expecting

Sepsis red flags to watch for sepsis is about TIME

Temperature - high or low Infection - s/s Mental decline - confusion, difficult to arouse Extremely ill - pain, discomfort, SOB

Medication reconciliation

Develop list of current meds Develop list of meds prescribed Compare Make clinical decision on comparison Communicate list to care giver

Med management complications

Med interactions Overdose Appropriateness of treatment Side effect Patient teaching

Maslow's hierarchy

5 self actualization 4 esteem 3 love/belonging 2 safety 1 physiological

Different ways to prioritize care

Actual vs potential Acute vs chronic Least invasive first

5 rights of delegation CPSTD

Circumstance Person Supervision Task Direction

Delegation errors

Under delegation Over delegation Improper delegation - 5 rights

what can APs do

vitals height weight i&o, specimen collection food (without swallowing precaution) ADL positioning transport

When to contact physician use

When there is a noticeable change in pt status SBAR

What to do before call Assess Review Focus Report

Assess pt Review record - report allergies, meds, IV fluids, lab and test results Focus on problem - report the issue, not the whole patient outline Report

4 modes of communication

Written - sbar, notes, emails Face to face - discussion, bedside, meetings Telephone - telemedicine Nonverbal - gestures, body language

Written communication issue

OPEN TO INTERPRETATION

Face to face comms issue

limited time

Nonverbal communication is more _ than verbal

Communicative speaks volumes