M1 Clinical Judgement/Communication Flashcards
Tort
intentional or unintentional act of wrong doing
depending on severity, can be held in both a civil and criminal trial
Intentional tort examples
Assault
Defamation
Invasion of privacy
False imprisonment (putting up all the safety bars)
Fraud
Unintentional tort examples
Negligence
Malpractice
Negligence
Omission or commission of actions that a reasonably prudent person would or would not do
Malpractice
Negligence by professional personnel
4 elements of liability
Duty
Breach of duty
Causation
Damage
Components of informed consent
Disclosure
Comprehension
Competence
Voluntariness
Who obtains informed consent
what are we responsible for
Dr.
Dr. Pt. and witness signature. (witness preferably not you the nurse)
Before giving med verify
Name
Date of birth
If pt has med questions
resolve issues before giving
dosage
side effect
reaction
questions can be addressed via
drug reference hand book
What to do if wrong med is given
Immediately stop med
Assess pt
Notify provider
Document
Never event
an event for which there already are safety checks
Sentinel event
death
permanent injury
long lasting/severe injury
Critical pathway
a relatively standardized prediction of a patients prognosis
5 rights of delegation
Right task
Right circumstance
Right person
Right direction/communication`
Right level of supervision
Improper delegating involves
wrong time
wrong person
wrong reason
Are RNs liable for work they delegate to NAPs
Nursing assistive personnel
YES
Can NAPs do invasive sterile treatment
NO
only noninvasive and nonsterlie
What reports can NAPs collect and document
Vitals
Height
Weight
Intake/Output
Capillary blood
Urine test
What movement tasks can NAPs assist with
Ambulation
Positioning
Turning
Can NAPs help transport clients within facility
YES
What hygiene can NAPs assist with
Personal hygiene
Bed washes
Elimination
Vaginal irrigation
Cleansing enemas
Can NAPs assist with eating
what if pt has breathing or swallowing problems
YES
feeding
cutting food
placing meal tray
then NO
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
I
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
NO
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
