N110 Quiz #3 Flashcards
What is interprofessional and interdisciplinary health care?
- Enhances patient, family and community-centered goals and values.
- Optimizes staff participation in clinical decision-making
- Fosters respect for the contributions of all HCP’s
What does evidence demonstrate that interprofessional collaborative patient-centered practice can positively impact?
-Wait times, healthy workplaces, health human resource planning, patient safety, rural and remote accessibility, primary health care, chronic disease management, population health and wellness
What is interprofessional education (IPE)?
- Exposing students to IPE can contribute to effective interdisciplinary collaboration
- Establishes competency in communicating between professions and improves teamwork by clarifying the roles and responsibilities of each profession.
What are the different purposes of the BCCNP, NNPBC , and the BCNU?
BCCNP- college: protects public by ensuring safe care through regulation of nurses
NNPBC- association: works in the interest of nurses to advance the profession and influence policy.
BCNU- union: acts in the interest of the workers with a focus on salary, benefits, and working conditions.
Which has a responsibility to set standards for practice for nurses in order to protect the public?
BCCNP
The BCCNP requires that Nurses participate annually in quality assurance activities, this includes?
- meeting minimum practice hours
- self assessment of practice
- seek out feedback from peers
- develop a learning plan
- evaluate your learning and how it has impacted your practice
What are the Professional Standards?
- Overall framework with 4 standards
- Set minimum levels of performance
- Outline professional responsibility
- Practice standard are expectations related to specific areas of practice
What are the 1-4 Controls on Practice?
1- Regulation/legislation
2-BCCNP standards, limits and conditions
3- Employer policies
4- Individual Nurse competence
What are the indicators to the Standards of practice?
-Criteria that is specific to four different areas of practice
What are the four different areas of practice?
-Clinical, Education, Administration, Research
What is the First Standard; Professional Responsibility and Accountability
“Maintains standards of nursing practice and professional conduct determined by BCCNP”
- fitness to practice
- understands role of regulatory body
- creates a learning plan
What is the Second Standard; Knowledge Based Practice
“Consistently applies knowledge, skills and judgement in nursing practice.”
-includes practice based on current evidence, knowledge of how to access information to support care, implements, evaluates and revises plan of care for patient as necessary
What is Standard Three; Client-Focused Provision of Service
“Providing nursing services and works with others to promote health care services in the best interest of clients”
-includes coordinates care to promote continuity in client care, communicates and collaborates with others, reports incompetent care
What is Standard Four; Ethical Practice?
“Understands, upholds and promotes the ethical standards of the nursing profession”
-Preserve and protect client dignity, demonstrates honesty and integrity, promotes informed decision making”
What is the CRAAP test?
Currency, Relevance, Authority, Accuracy, Purpose
What do nurses teach?
- persons across the lifespan, diversity in culture, ability/disability, gender identity and sexual orientation
- individuals, dyads, families, groups
- other HCP’s
- people in a wide variety of settings
What are the goals of teaching? (3)
- Maintaining and promoting health/preventing illness
- Restoring health
- Optimizing quality of life for those with impaired function
What are the 5 steps of the teaching process?
- Collect data, assess learning strengths/needs
- Make educational diagnosis
- Make a teaching plan
- Implement the teaching plan
- Evaluate client based on the learning outcomes created
What are the 3 domains of learning?
- Cognitive- thinking and intellectual behaviours
- Affective- expression of feelings, acceptance of attitudes, opinions, values
- Psychomotor- Acquiring skills, requires coordination of mental and muscular activity
What are the 4 learning styles?
Visual, Auditory, Read/Write, Kinetic
What is the teachable moment?
If a person is not ready or does not want to learn, learning is unlikely to occur.
What is the transtheoretical Model of Change
Precontemplation: unaware of need for change
Contemplation: aware of need for change
Preparation: Altering behaviour in minor ways
Action: modifies behaviour for sustainable change
Maintenance: focuses on solidifying new behaviour
What is the social learning theory?
People are more likely to perform consistently when they believe they can (Self-efficacy)
-Nurses interventions can enhance perceived self-efficacy and learning success
What are the four sources for Self-Efficacy in the Social Learning theory?
- verbal persuasion
- vicarious experiences
- enactive mastery
- physiological and affective states
What is the patient-centered approach RNAO L.E.A.R.N.S model?
-interactive, holistic, and social process that guides HCPS:
support clients to become active, responsible partners in their health care
identify previous knowledge/understanding and link to new learning
plan intentional learning sessions
assess and document client learning
What is the L.E.A.R.N.S. model include?
L- listen to client needs
E- establish therapeutic partnership relationships
A- adopt intentional approach to every learning encounter
R- reinforce health literacy
N- name new knowledge via teach-back
S- strengthen self- management via links to community resources
What should be in a teaching assessment?
-Use open-ended questions to find out: learning needs or knowledge deficits motivation and abilities teaching environment health beliefs, cultural factors, learning style resources or support system
Patient learning outcomes..?
Specify the knowledge or skills the client requires using SMART format
How can a nurse best assess a client’s style of learning?
Ask the client how he or she learns best.
What are the 5 basic functions of law?
- maintain order
- provide solutions to resolve conflicts
- bring about social change
- outline civil rights of individuals and protect those rights
- reflect social norms and expectations
what is a fiduciary relationship?
one in which a professional provides services that cause the recipient to trust in the specialized knowledge and integrity of the profession.
Federal vs. Provincial laws?
federal: unemployment insurance, postal service, criminal law.
provincial: management of hospitals, solemnization of marriage, civil rights (property)
Every province except ___ has common law?
Quebec- applies civil law
What is statute law?
Created by federal and provincial elective legislative bodies (Health Professions Act in BC)
Whose responsibility is the Canadian Health Care system?
- Shared responsibility of federal and provincial governments (set out in constitution act of 1867)
- Health care delivery largely within authority of provinces and territories (most often delegated to professional organizations)
What is a tort?
Civil wrong committed against a person or property- intentional or unintentional
Required elements of negligence are?
Duty- owed patient a duty of care
Breach- standard of care not enacted/ did not carry out duty
Harm-client sustained injury
Causation- harm direct result of nurse failing to meet standard of care
What is consent required for?
all routine treatment and all hazardous procedures
What is the PSLS Patient Safety Learning System?
analyzes process issues and system failures
avoids blame and promotes a culture of safety and continuous improvement
What did the BC PSLS stats show
falls were most reported
medication/iv fluid errors were second
behaviour third
What is QSEN (Quality and Safety Education for Nurses)?
-prepares future nurses with knowledge, skills and attitudes necessary to continuously improve the quality and safety of health care systems
What are the competency involved in QSEN?
patient-centered care teamwork and collaboration evidence-based practice quality improvement safety informatics
What are safeguards?
Clinical health systems like electronic records or medication administration ‘apps’ require a warning sign or alert for prescribed dosages that are higher than the recommended dose
Ethics are?
Study of philosophical ideals of right and wrong behaviour baed on what one thinks one ought to do
What is the CNA code of ethics?
outlines nurses professional values and commitments to patients, communities
-can be used as a tool to guide nurses through ethical challanges
What are the 10 top ethical challenges in health care facing the Canadian public
- pt/family disagreements about treatment
- waiting lists
- access to health care resources
- shortage of physicians
- medical errors
- when to withdraw treatment
- achieving informed consent
- research participation
- substitute decision making
- ethics of surgical innovation
What are the seven values of the CNA code of ethics?
- providing safe, compassionate, competent, and ethical care
- promoting health and well-being
- promoting and respecting informed decision-making
- preserving dignity
- maintaining privacy and confidentiality
- promoting justice
- being accountable
what is the code of ethics and responsibility?
characteristics of reliability and dependability
- know right from wrong
- perform actions adequately and thoughtfully
- nurse uphold responsibilities related to all values in code of ethics
code of ethics and accountability?
- accepts responsibility for ones own actions.
- grounded in principles of fidelity and respect for dignity, worth and self-determination of patients
Nurses and ethics-advocacy?
- “acting on behalf of another person, speaking for persons who cannot speak for themselves”
- work to eliminate social inequities
- protecting patients right to choice
What is the difference between Deontology and Utilitarianism?
The focus on consequences or outcomes.
- Deontology= concerns the presence of principles regardless of outcome
- Utilitarianism=concerns effect the act will have, greatest good for greatest number of people
What are bioethics?
Bioethical theory is obligation based, outcome-oriented, and based on reason
Moral decision making should be based on what 4 principles?
- autonomy
- beneficence
- non-maleficence
- justice
Bioethics in concern with autonomy?
People are free to make their own choices when capable, nurses may assess pt capacity and help to facilitate decision making
Bioethics and beneficence?
- doing or promoting good for others
- best interest of patient more important than self-interest
bioethics and nonmaleficence?
- avoidance of harm or hurt
- balance risk and benefit, strive for least amount of harm to individual
What is justice?
fairness.
mandates that decisions be fair and hopefully unbiased
social justice- equitable distribution of benefits and burdens of society
feminist ethics?
- focusing on inequalities between people
- hold belief that society is patriarchal
What are relational ethics?
ethical understanding emerge from and are formed based on a persons relationship with others.
Four themes in relational ethics?
- Environment (characteristics of health care system)
- Embodiment (recognition that science and compassion are equal)
- Mutuality (relationship benefits patient and nurse, harms neither.
- Engagement (connecting with one another in open, trusting, manner)
What is an ethical dilemma?
- conflict between 2 sets of human values that are believed to be good
- can cause distress and confusion
What is advanced care planning?
Patient, family and caregivers often involved in process
patient can also identify surrogate decision makers
-potential to improve patient/family wants/experiences for end of life care
-nurse can be in role of advocate and educator for patient
What is MAID?
Medical assistance in Dying
- 2016 permitted physician assisted death
- nurses are often the first care givers to receive the request
- CNA’s document National nurisng framework on medical assistance in Dying in Canada
Moral distress?
Occurs when nurses cannot act according to their moral judgement
Moral integrity?
Nurses may lose this when they are committed to certain values and beliefs that are not upheld because of situational constraints
Moral residue?
Long standing feelings of guilt, remorse, or inadequacy an individual experiences because of unresolved ethical conflicts or moral distress
What is values clarification?
- Clarifying values helps you to recognize what matters most to you
- Important to recognize what values guide you
- It is the process of exploring your personal values, involves personal reflection, greater self-awareness
What is the framework for Ethical Decision Making by Oberle and Bouchal (2009)?
- structure of related concepts to give direction to practice
- way to select the “right” course of action
What is the first step?
Assessing the ethics of the situation, relationships, goals, beliefs, values.
Asks: what is happening here?
Step 2?
Reflecting on and reviewing potential actions
Asks: what could i do? what impact will each action have? who will be impacted?
Step three?
Selecting an ethical action; maximizing good
Asks: What should I do?
Step four?
Engaging in ethical action
Asks: What will I do? Am I acting with accordance to the CNA code of ethics?
Step five?
Reflecting on and reviewing the ethical action.
Asks: Was the situation handled as best it could be? was harm minimized and good maximized? what could be done differently?
