NSG 1600 FINAL Flashcards

Question

what are the 4 levels of health care in Canada?

Answer 1

Level l: Health Promotion Level 2: Disease & Injury prevention Level 3: Diagnosis and Treatment Level 4: Rehabilitation Level 5: Supportive Care

Answer 2

Examples: - Enabling people to increase control over or improve their health - Promotion of self-esteem in children and adolescents - Wellness services - Breakfast programs - Anti-smoking education - Anti-bullying campaign - Heart healthy menu options

Answer 3

From the Ottawa Charter for Health Promotion (1986) 1. Building Healthy Public Policy 2. Creating Supportive Environments 3. Strengthening Community Action 4. Developing Personal Skills 5. Reorienting Health Care Services

Answer 4

Prevention services/strategies Reduce risk factors for illness and injury Examples: - Cervical Cancer Screening - Immunizations - Support groups - Environmental Action

Answer 5

Primary Prevention: Prevent disease or injury before it occurs (e.g. use of seatbelts and bike helmets) Secondary Prevention: Promote early detection of disease once pathogenesis has occurred or halt/slow the progress of injury (e.g. mammograms to detect breast cancer) Tertiary Prevention: Directed toward minimizing disability from disease or injury and helping people to live with limitations (e.g. cardiac or stroke rehabilitation programs)

Answer 6

Recognizing and managing existing symptoms: Three sub-levels - Primary care: First contact with health care system such as family physician or NP - Secondary care: Provision of specialized medical services in hospital or home settings. Often referred to specialized practitioner for further diagnosis/care - Tertiary care: Specialized and highly technical care usually provided in hospitals with advanced care equipment/practitioners

Answer 7

Promote independence and self-care Improve health and quality Of life for those facing life-altering conditions Required after physical/mental illness, injury, or addiction Services include: - Physiotherapy - Occupational and speech therapy - Social services

Answer 8

Clients with chronic illness, progressive illness, or disability Long-term care and assisted-living facilities, adult day care centers, home care Also includes respite care and palliative

Answer 9

Cost Accelerators * Technologies * Demographics * Consumer involvement Equality (Equity) and Quality - Income Status - Cultural Competence, Safety, and Humility - Evidence-Informed Practice - Quality and Client Safety - Quality Workplaces - Privatization of Services - Health Care Human Resource

Answer 10

Types Of Nurses * Licensed Practical Nurses * Registered Nurses * Registered Psychiatric Nurses * Nurse Practitioners Licensing Scopes Of Practice Staff Mix * Unlicensed Health Care Providers and Delegation/Supervision

Answer 11

refers to discussions about, changes to, and creation of health policy that affects health care delivery on-going issues to address: - lack on continuity among providers and institutions - health system access problems - lack of care in rural and remote areas of Canada - quality of work life for health care providers Romanow Report (2001) - 47 recommendations - tasked with evaluating health care system to see if it is sustainable.

Answer 12

Values = our conception of what is good and most desirable Dictate what we consider "right" and "wrong" Instilled in us as we grow Often subconscious Reflected in the decisions we make, the actions we take, the opinions we express

Answer 13

Ethics = the critical, structured examination of how we should behave in various situations * Involves reflecting on and understanding norms, values, and beliefs Morality = beliefs and traditions about how should conduct ourselves toward others * Usually more action-oriented Moral Autonomy: we feel responsibility and ownership for our chosen values and belief

Answer 14

Situations in which the clear course of action may not be obvious or there is disagreement There may be strong ethical reasons to support multiple courses of action Or all alternatives have some kind of downside

Answer 15

Several Models available to nurses to follow Won't point to a specific answer or solution Instead, serve as a framework to guide discussion and analysis or ethical problems Commonly involves many stakeholders with their own values, perspectives, goals, and interests

Answer 16

- Recognize the moral dimension * Decide who the relevant parties are and determine their relationship - Figure out what values are involved * Weigh the benefits and burdens * Look for analogous cases * Discuss with relevant others * Determine if proposed decision is in agreement with legal/organizational rules * Reflect on own level of comfort with the decision * Gather background information * Identify whether the problem is an ethical one * Identify key stakeholders * Identify possible courses of action * Reconcile the facts of the case with relevant principles * Resolution

Answer 17

Moral Integrity = sense of consistency between our convictions and our actions Moral Distress = results when values are pushed to a limit by being consistently disrespected, trivialized, ignored, or compromised * Find ourselves in situations where, for some reason, it is difficult or impossible to stay true to our convictions * Can be the result of moral dilemmas that are not acknowledged or ignored and not resolved * Can lead to feelings of anger, resentment, despair, or powerlessness as well as anxiety, frustration, dissatisfaction or guilt

Answer 18

The examination of the norms, values, and principles in nursing practice Separate from bioethics as nursing has a unique focus on relationships * Nursing practice consistently exists within a relational context

Answer 19

Client Autonomy Informed Consent Trust Fidelity (Truth-Telling, Deception, and Withholding Information) Beneficence Non-maleficence Justice

Answer 20

Contains standards and expectations of ethical practice for professionals Founded on ethical theories, concepts, and principles (values) May also contain tools for ethical decision making Professional groups (like nurses) accept the duty serve the public interest and the common good Defines acceptable and unacceptable behaviors, rules of conduct, and professional values and responsibilities Clarifies principles that guide decisions and actions

Answer 21

Four fundamental responsibilities for nurses: * To promote health * To prevent illness * To restore health * To alleviate suffering Four elements: * Nurses and People— includes informed consent, confiden tiality, advocacy, social justice, and integrity * Nurses and Practice— incl udes competent practice, clinical judgment, personal health (fitness to practice), safety, and dignity * Nurses and the Profession— includes self-regulation, clinical practice standards, management, research, education, EIP, positive practice environments, and equitable working conditions * Nurses and Co-Workers — incl udes multidisciplinary relationships, collaboration, and reporting

Answer 22

First published in 1980 Several updates — most recent in 2017 Consists of 2 parts: * Part I— Nursing Values and Ethical Responsibilities * Outlines 7 primary values to guide practice * Part 2— Ethical Endeavors * Outlines approaches nurses can take to address social inequalities

Answer 23

Value A: Providing Safe, Compassionate, Competent, and Ethical Care Value B: Promoting Health and Well-Being Value C: Promoting and Respecting Informed Decision Making Value D: Preserving Dignity Value E: Maintaining Privacy and Confidentiality Value F: Promoting Justice Value G: Being Accountable

Answer 24

Nurses are being required to assume positions of leadership and management in health care delivery much earlier in their careers today. It is important to understand leadership and management roles early in your educational program and the relevant competencies required of entry-level nurses. You will need to "lead where you land"

Answer 25

Leadership = refers to a shared vision, values, organizational strategy, and relationships Management = refers to the competencies required to ensure day-to-day delivery of nursing care according to available resources and standards of professional practice Nursing leadership is needed at every level

Answer 26

Advocacy Conflict resolution Collaborative practice Patient centeredness Delegation Evidence-informed decision making

Answer 27

Bring nurses together for common goals or purposes * Political action * Advocacy * Professional development Also, to provide support, motivation, and socialization Promote leadership development

Answer 28

Nursing leaders do more than delegate, dictate, and direct others in clinical settings. Leadership involves helping others to reach for their highest potential. Nursing Organizations can: - Address complex problems, issues, or concepts - Capture the attention of the public - Cast nurses as credible advocates and leaders

Answer 29

Benefits: provide structure and forums for professional development, publication of research, lead national discussion on issues of importance to nurses, and networking opportunities Drawbacks: existence of so many organizations may blur the message of individual group or confuse who speaks for nurses

Answer 30

Regional or Provincial * College of Registered Nurses of Alberta (CRNA) * Alberta Association of Nurses (AAN) * United Nurses of Alberta (UNA) * Western and Northwestern Region of Canadian Association of Schools of Nursing (WNRCASN) National * Canadian Nurses Association (CNA) * Canadian Nursing Students Association (CNSA) * Canadian Federation of Nurses Unions (CFNU) * Canadian Association of Schools of Nursing (CASN) * Specialty Practice Groups (Ex: Canadian Council of Cardiovascular Nurses — CCCN) International * International Council of Nurses (ICN) * Specialized Focus Groups (Ex: International Family Nursing Association — IFNA)

Answer 31

administration regulation clinical practice education policy research protection

Answer 32

ICN (International Council of Nurses) CNA (Canadian Nurses Association): CASN (CanadianAssociation of Schools of Nursing) CNSA (Canadian Nursing Students' Association) CNPS (Canadian Nurses Protective Society) CFNU (Canadian Federation of Nurses Unions): CANA(College of Registered Nurses of Alberta) UNA (United Nurses of Alberta) AAN (Alberta Association of Nurses)

Answer 33

* CNA members are automatically members * Federation of national nurses' associations representing nurses worldwide * Ensures quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce * Advances nursing, nurses and health through its policies, partnerships, advocacy, leadership development, networks, congresses, and special projects * Works with agencies within the World Health Organization

Answer 34

Vision: * Registered nurses: Leaders and partners working to advance nursing and health. Mission: * CNA is the national professional voice of registered nurses, advancing the practice of nursing and the profession to improve health outcomes in a publicly funded, not-for-profit health system by: * unifying the voices of registered nurses; * strengthening nursing leadership; * promoting nursing excellence and a vibrant profession; * advocating for healthy public policy and a quality health system; and * serving the public interest

Answer 35

to advance nursing excellence and positive health outcomes in the public interest to promote profession-led regulation in the public interest to act in the public interest for Canadian nursing and nurses, providing national and international leadership in nursing and health to advocate in the public interest for a publicly funded, not-for-profit health system.

Answer 36

In pursuit of the vision and mission, CNA has established the following goals: * To promote and enhance the role of registered nurses to strengthen nursing and the Canadian health system. * To shape and advocate for healthy public policy provincially/territorially, nationally and internationally. * To advance nursing leadership for nursing and for health. * To broadly engage nurses in advancing nursing and health

Answer 37

Not-for-profit society that offers legal advice and support, risk-management services, legal assistance and professional liability protection related to nursing practice in Canada. Legal representation, whether it is in the context of a civil proceeding, a criminal prosecution, or other forms of legal proceedings. Provides a wide range of group workshops, webinars and online resources designed to reduce risk in your practice and help prevent patient harm. CRNA members are beneficiaries for its legal assistance if you are the subject of an investigation due to a complaint filed against you with the College (or the provincial or territorial association that regulates nursing practice.)

Answer 38

Advocates for nurses, nursing profession, and Canada's health care system Negotiates collective agreements (contract between employer and employees) that regulate salaries, benefits, scheduling rules, overtime pay, sick leave, job security, and working conditions Administers agreements to resolve disputes, improve working conditions and protect nurses' workplace rights Represents members before Labour Relations Board hearings, professional bodies' disciplinary meetings Affiliated with Canadian labour movement through membership in the CFNU If you work at a unionized worksite, you pay dues and may become a member

Answer 39

Represents nurses from provincial unions (UNA in Alberta) and student members of the CNSA Nurse's unions conduct negotiations, job actions, resolution of grievances related to their members while also considering impact on public Addresses labor relations and working conditions Advocates for safe client care, public healthcare system, social justice

Answer 40

Serve to protect the public by regulating the profession The CRNA is our regulatory body - their authority is dictated by the Health Professions Act (HPA). Establish and apply standards of practice Once a nurse is registered, they are also members of CNA and ICN

Answer 41

An association dedicated to advancing nurses and the nursing profession by augmenting the strengths of Alberta nurses. AAN is not a union Works collaboratively with regulatory bodies (i.e., CRNA) and unions to support and advance all Alberta nurses and nursing professionals Participation is voluntary

Answer 42

Courage and passion to address goals related to quality health care Energy, knowledge, and skills to continue on the path despite challenges and adversity Play a role in shaping the future of nursing education Contribute to your professional growth Network with other emerging health leaders Education beyond the classroom, negation training, leadership skills, travel Use your voice to turn your ideas into action Recognize that organizations have shaped your education experiences (curriculum, practicum, testing, etc.)

Answer 43

This legislation requires (and gives authority) to health professional colleges to follow rules for investigating complaints, setting educational standards, ensuring ethical practice, and setting practice standards for registered members. In Alberta, CRNA is responsible for establishing and enforcing safe, ethical, professional practice as set by HPA. Under the HPA, there is a common framework across all health professions for: - registration - continuing competence - restricted activities - professional conduct - regulation, bylaws, code of ethics and standards of practice - protected titles

Answer 44

Govern and regulate the practice of their members in manner to protect and serve public interest Protects public from incompetent and unethical practice

Answer 45

govern members in a manner to protect the public interest regulate the practice of the profession including the setting of qualifications for entering the profession establish, maintain, and enforce standards for registration and standards of practice establish, maintain, and enforce code of ethics approve programs of study and other courses for the purposes of registration requirements develop and enforce continuing competence program to ensure practicing registrants are maintaining competency in their practice address complaints

Answer 46

The Alberta Association of Graduate Nurses was formed in 1916 and incorporated that same year under Alberta laws. * Registered Nurses Act: By petition to the Alberta Legislature in 1920, the Act was amendedto Alberta Association of Registered Nurses. The regulation of registered nurses came under the Health Professions Act (1999) bringing the largest group of health-care professionals in the province under the Act and changing the name Of the regulatory body for registered nurses to the College and Association of Registered Nurses of Alberta (CARNA). In 2021, changed name to College of Registered Nurses of Alberta (CRNA) and took on a single regulatory mandate. Association activities passed on to newly created Alberta Association of Nurses (AAN)

Answer 47

CRNA endeavors to ensure that all Alberta RNs and NPs provide safe, competent and ethical nursing care by: 1. setting the qualifications for entering the profession 2. approving nursing education programs in the province that prepare individuals to enter the profession 3. issuing practice permits only to those who meet the legislated and regulatory requirements 4. developing and enforcing professional and ethical standards for the desired and achievable level of performance against which nursing practice can be measured 5. developing and enforcing a continuing competence program to ensure that practicing members are maintaining competence in their practice 6. taking action when a member of the public, an employer or a CARNA member submits a complaint about the practice of a regulated member 7. advocating for a high quality, cost-efficient health-care system that makes the best use Of the knowledge and skills Of RNS 8. providing progressive, innovative leadership that encourages excellence and influences health policy

Answer 48

Registration = the individual is a member of the provincial or territorial nursing college Licensing = Once registered, and having also demonstrated that they meet all provincial or territorial requirements for RN practice, a license is issued * This means they are authorized to practice in that particular province or territory

Answer 49

Practice standards: * are established by all nursing regulatory bodies across Canada * reflect the philosophy of nursing practice and codes of ethics * are relevant to malpractice and negligence issues provide directly relevant evidence of the standard of care - provide criteria by which a nurse's conduct will be judged in legal or disciplinary proceedings

Answer 50

provide a guide for safe practice describe nurses' responsibilities and accountabilities provide performance criteria and ensure continuing competence interpret scope of practice provide direction for nursing education and research-based practice facilitate peer review and quality improvement CRNA Practice Standards

Answer 51

Set by Provincial Regulatory Body Fairly consistent across the country Form part of the requirement for initial licensure often used to guide the development of nursing education programs

Answer 52

after initial licensure, must demonstrate a commitment to continued competency * Requires nurses to continually integrate and apply new nursing knowledge into their practice in order to remain current and safe Links to Code of Ethics, Standards of Practice, and lifelong learning * Reflect on own practice * Develop learning plan for coming year * Report on leaming plan — start cycle over

Answer 53

The procedures are generally as follows: * complaint in writing investigation * interim investigation * disciplinary committee hearing - penalties - Appeals CRNA Complaints

Answer 54

This privilege (nota right) is granted through legislation Allows a profession to govern its own members Comes with responsibility to protect public interest/trust When nursing care is seemed unsafe, incompetent, or unethical, the regulatory body intervenes and places the interest of the public ahead of the interests of the offending nurse

Answer 55

Describes the activities/interventionsthata professional is authorized to perform (educated on and competent). Other factors to consider: - Client need * Practice environment - Policies/standards of employer - Nurse's knowledge/competence/experience

Answer 56

Licensed Practical Nurses (called Registered Practical Nurses in ON) * 2-year Diploma Registered Nurses 4-year Baccalaureate * Same core knowledge for LPN and RN * Clinical Nurse Specialists (for example: Wound Care Nurse) Nurse Practitioner * Advanced nursing role with expanded scope * Requires additional training and education, as well as extensive clinical experience Registered Psychiatric Nurses * Focus on providing care to clients with complex psychosocial and mental health needs

Answer 57

RNs * Have a lengthier and more in-depth education, usually at the university level * Stronger focus on critical thinking, critical analysis, evaluation * Care for more complex and unpredictable client populations * Have more Opportunities to specialize * Leadership in practice, education, administration, research, policy development with opportunities for advanced practice roles RPNs/LPNs * Have a shorter and more basic education, usually at a community college * Care for less complex clients and predictable client populations * Have fewer opportunities to specialize

Answer 58

What Is Nursing? * There are numerous definitions of nursing; however, each province/territory will set out a broad definition of nursing in legislation. When Can You Call Yourselfa Nurse? * Only those who meet criteria defined in legislation can use the title Calling yourself a "Student Nurse" is a privilege that also comes with responsibilities

Answer 59

RN Practice In their practice, registered nurses do One or more of the following (based On an ethic of caring and the goals and circumstances of those receiving nursing services): apply nursing knowledge, skill and judgment to assist individuals, families, groups and communities to achieve their optimal physical, emotional, mental and spiritual health and well-being, assess, diagnose and provide treatment and interventions make referrals, prevent or treat injury and illness, teach, counsel and advocate to enhance health and well-being, co-ordinate, supervise, monitor and evaluate the provision of health services, teach nursing theory and practice, manage, administer and allocate resources related to health services engage in research related to health and the practice of nursing provide restricted activities authorized by the regulations.

Answer 60

Legislation specifically defines which activities can be performed by which professional groups High-risk activities performed as part of providing a health service that require specific competencies and skills to be performed safely Authorization under professional regulatory college and the employer Knowledge and competency of health care professional Client needs (assessment and critical thinking) Acuity/stability/complexity of the client

Answer 61

access the knowledge and skills of the delegate match tasks to the delegate's skills communicate clearly - give unambiguous directions listen attentively provide feedback

Answer 62

Right task * Appropriate to delegate for that patient Right circumstances * Good decision making needed to determine what to delegate and where Right person * Right nurse delegates to right staff member for the right patient Right direction/communication Right supervision

Answer 63

How does this differ from a vocation? A trade? What makes nursing a profession? What are some other professions? How is nursing similarto other professions? How is it different?

Answer 64

thorough academic preparation intensive clinical training unique body of expertise autonomous practice strong ethical guidelines sense of altruism

Answer 65

Society gives us elevated status as professionals and expects us to meet specific needs Have a duty to meet the needs determined by society Take that duty seriously (Historically, took oaths or pledges) Have an obligation to serve the public interest and common good (motivated by altruism) Focus not only on the individuals they serve but on society as a whole Placed in positions of respect and are given the power to engage in important decisions that influence and shape public policy, law, and societal norms

Answer 66

Refers to how a profession enacts its obligations to ensure the welfare of society In nursing, this means the provision of safe, competent, and ethical patient care Means we place the interests of the public above the interests of the profession or of individual nurses

Answer 67

expertise autonomy accountability autority unity

Answer 68

Specialized Knowledge * Bachelor degree prepared * Licensing exams * Continuing education * Specialty Certifications * Advanced degrees Technical Skills - Intensive Clinical practice preparation - On-going Certification Body of Knowledge - Evidence-based Practice - Reflective Practice * Scholarship and Research

Answer 69

Nursing is a self-regulated profession * Governed by regulatory bodies — CARNA * Have to meet specific criteria to obtain a license and practice as a member of the profession * Title of "nurse" is protected Individual Practitioners also have autonomy * Means we are free to make decisions and act based on our knowledge base — requires competency and accountability * Must remain within our scope of practice

Answer 70

"Nurses are accountable for their actions and answerable for their practice." - CNA Code of Ethics (2017) We must remain responsible and accountable - To CNA code of Ethics - To Nursing Practice Standards (CARNA, etc.) - Other documents from Regulatory bodies and Government - Scope of practice Statutes - Other literature/evidence/scholarship Doing so has made us the most trusted profession

Answer 71

Health Professions Act — Grants CARNA authority to regulate nursing in Alberta CARNA — Grants individuals authority to practice as Registered Nurses in Alberta Individual RNs — held accountable by society and CARNA to practice according to standards Can be disciplined by CARNA for malpractice or misconduct

Answer 72

As a group, have shared values and goals Come together with a shared voice Can act as powerful advocate or activist on many levels Work together to meet the healthcare needs of society Professional Associations and Unions

Answer 73

standardize services provided by its members perform political, advisory, and policy functions assist with educational needs of members provide a professional hub for its members

Answer 74

Being Accountable * Taking responsibility for and answering for the professional, ethical, and legal duties of one's own actions Public Trust - This is a privilege. Held to a higher standard - Ensure privacy and confidentiality - Accountable for all actions - Act in interest of public good at all times Professional Boundaries - Maintain appropriate boundaries within nurse- patient relationship - Onus is on the nurse - Must remain therapeutic boundaries - Includes steps of establishing, maintaining, and terminating the relationship Therapeutic Relationship * Introduce self using name and designation * Obtain consent for all actions * Keep all patient information private and confidential * Proper use of social media Professional Presence - Act with confidence, integrity, passion, optimism, and empathy in accordance with practice standards, codes of ethics, and other guidelines - Remain non-judgmental and objective Leadership - Not limited to high-level or formal roles - Includes taking initiative, advocacy, questioning appropriately, and peer support

Answer 75

an idea that we conceive to represent objects and experiences in the world around us. A concept can be about concrete things that we experience through our senses, such as pain, hunger, or shortness of breath. Concepts can also be about things that are abstract or not experienced through our senses, such as spirit, love, or grief. A concept is communicated using words to describe the concrete or abstract notion.

Answer 76

theories offering a general orientation of philosophical stance about nursing.

Answer 77

theories that are informed by practice or research and offer general direction about particular areas of nursing practice.

Answer 78

the set of core concepts that define the discipline of nursing. Includes the concepts of: person, health, nursing, environment.

Answer 79

theories offer direction for specific situations and focused nursing interventions.

Answer 80

theories focusing on nursing and the care of people, families, and communities. Typically, they address concepts in the nursing metaparadigm.

Answer 81

sets of concepts used to describe, explain, or predict the physical and social world. Theory suggests relationships within, between, or among concepts. In nursing, theory informs practice, and at the same time, practice informs, challenges, or confirms theory.

Answer 82

○ Person: receives care from the nurse ○ Health: beyond being well, one's ability to use all human powers ○ Environment: external (e.g., fresh air) and internal (e.g., intake) factors - Nursing: modifying and/or managing the environmental factors to implement laws of health The Concept of Person Nurses interact with persons for the intentions of providing holistic nursing care. The Concept of Health Includes the physical, psychosocial, relational, and spiritual aspects of an individual, family, or community. The Concept on Environment The totality of all the things that affect a person and includes both the external and internal contexts. The Concept of Nursing Provide safe, compassionate, competent, and ethical care Promote health and well-being Promote and respect informed decision-making Preserve dignity Maintain privacy and confidentiality Promote justice Be accountable

Answer 83

Grand nursing theories Midrange or middle-range theories Nursing practice theories

Answer 84

a systematic and ongoing process of gathering, organizing, validating, and documenting data related to the client's health status through inquiry, collaboration, and using various resources.

Answer 85

seeking additional information to confirm understanding.

Answer 86

the process nurses use to critically evaluate and interpret client data and then make informed decisions about their client's care.

Answer 87

involves analyzing data, identifying health problems and risks, as well as strengths, and formulating diagnostic statements

Answer 88

a pictorial depiction of how a person values his or her attachments to people or activities.

Answer 89

to review and measure whether the care goals were met, to identify if there were any unintended outcomes, and to determine if any changes to the plan are required to accomplish any unmet goals.

Answer 90

a pictorial representation of the client's family and health patterns.

Answer 91

an intentional effort to achieve the client's health-related goals.

Answer 92

understanding the clinical significance of how data fit together to inform clinical decisions regarding client care.

Answer 93

planned nursing actions taken to address client or family needs, working toward previously established collaborative goals for client or family outcomes.

Answer 94

a clinical judgement that identifies the client, family, group, or community's response to actual and potential health conditions/life processes.

Answer 95

a systematic and rational method for planning and providing client care organized around a series of phases that facilitates holistic and client-centered nursing practice.

Answer 96

a measurable response (such as an attitude, acquired skill, behaviour, or state) to nursing care provided to clients, families, or communities.

Answer 97

the steps taken by the nurse, interprofessional team, client, and family to develop goals, identify desired health outcomes, formulate care plans, prioritize nursing interventions, and coordinate necessary resources.

Answer 98

process of combining assessment data, nursing knowledge, and clinical experience to determine the provision of care.

Answer 99

a codified way of categorizing and classifying information.

Answer 100

Assessment Collect data Organize data Validate data Document data Purpose: establishing a database of information about the client's response to health concerns or illness and his or her ability to manage his or her health care needs. Diagnosis Analyze data Identify health problems, risks, and strengths Formulate diagnostic statements Purpose: identifying client strengths and any health problems that could be prevented or resolved by collaborative care and by independent nursing interventions. Outcomes/Planning Prioritize problems and diagnoses Formulate goals and define desired health outcomes Select nursing interventions Write nursing care plan Purpose: develop an individualized nursing care plan that specifies client goals and the desired health outcomes, along with related nursing interventions. Implementation Reassess client Determine resources requirements Implement nursing interventions Supervise delegated care Document nursing activities Purpose: assist the client in meeting the desired goals and health outcomes. Promote wellness. Prevent illness and disease. Restore health. Facilitate coping with altered function. Evaluation Collect data related to outcomes Relate nursing actions to client goals, outcomes Draw conclusions about problem status Continue, modify, or terminate the client's care plan Purpose: determining whether to continue, modify, or terminate the plan of care.

Answer 101

Initial assessment Meeting for the first time. Nurse explores presenting problems, contributing factors, and may also conduct a physical assessment. Focused assessment Specific details about the presenting concern. Ongoing assessment Re-evaluate client status. Will help determine if condition has improved, worsened, or stayed the same. Emergency assessment Trauma or emergency situation ABC - airway, breathing, circulation

Answer 102

Initial planning Usually part of the admission assessment and identifies what actions are required to move forward in providing client care. Ongoing planning Continuous and involves adapting client care in response to new information obtained through assessment and evaluation. Discharge planning Anticipates and plans for the client's needs as he or she transitions between health services as well as independent living.

Answer 103

specific measurable attainable/achievable relevant/realistic time-limited

Answer 104

the environment, situation, or occasion that affects a related thought or topic.

Answer 105

can be used interchangeably with critical thinking in some circumstances, depending on the definition of critical thinking. Infers an expanded type of thinking used to reflect on evidence for judgement.

Answer 106

a combination of skills and dispositions to maximize one's ability to purposely reflect, think deeply, and act purposely.

Answer 107

using generalizations to create specific conclusions.

Answer 108

personal traits, attributes, or qualities.

Answer 109

the use of various types of knowledge to guide one's practice in the clinical setting toward the goal of quality client care outcomes.

Answer 110

when specific events, or findings from those events, are used to form broader generalizations.

Answer 111

originally coined by Paul (1990), these are traits or goals that describe clear, concise, exemplary thinking.

Answer 112

positive, respectful examination, analysis, and questioning of a specific topic or issue.

Answer 113

a consecutive, successive thought process, prompted by uncertainty or perplexity, where consequence and grounds for the belief are thoroughly examined.

Answer 114

thinking that is considered unconventional or against commonly engrained traditions. Thinking outside the box is often used synonymously with creative thinking or creating a new perspective, in contrast to "thinking inside of the box," which is thinking that follows traditional pathways or perspectives. Thinking inside the box is often representative of the "status quo" or usual ways of thinking about things.

Answer 115

Refers to interpersonal communication skills, as well as the means of building and sustaining health promoting relationships with clients, families, colleagues, and others. (CLPNA) One of the NESA Cornerstones of Nursing Curriculum/Praxis: * Engaging students in partnering with people in their care, and other members of the inter-professional team, to build on strengths and create conditions that support health, healing, and wholeness. Nursing occurs within the context of a relationship. It is a "relational" practice.

Answer 116

Relational nursing practice is an understanding of patients' health care needs within complicated contexts, in which patients experience health care and nurses deliver nursing care.

Answer 117

true to yourself, actively present and genuine in how you communicate and interact with patients.

Answer 118

being present both physically and emotionally - actively listening and empowering the patient's own voice, involves creating a safe space for the client and being with the client. listen to what is said, AND what is not said.

Answer 119

meeting the needs of the client rather than your own needs. self-awareness developed through self-reflection.

Answer 120

the ability to emotionally and cognitively understand and communicate the experience and feelings from another's point of view - a critical ability for nurses to have.

Answer 121

development of trust and understanding within the nurse-client relationship

Answer 122

evolutionary process and an attitude in which an individual relies with confidence on another.

Answer 123

disclosure for the purpose of enhancing the therapeutic outcome for the client; safeguarding information and not sharing without consent.

Answer 124

finding common ground, a shared sense of understanding; actively choosing to care, ideally motivated by intrinsic desire to improve client's experience and outcomes.

Answer 125

continually assess, adapt, and revise understanding of the client's lived experience.

Answer 126

process of mentally reviewing, analyzing, and comprehending events, situations, or actions and their meaning.

Answer 127

1. Why is it important for me to actively listen to the client? 2. How am I demonstrating that I actively listen? 3. What strategies can I use to facilitate active listening? 4. What prevents me from actively listening? 5. What are the consequences to the nurse-client relationship if I fail to actively listen?

Answer 128

Behavior - TR: Regulated (Code Of Ethics: Professional Standards) - PR: Guided by personal values and beliefs Remuneration - TR: Nurse paid to provide care - PR: No payment Length - TR: Only as long as needed for care - PR: As long as desired Location - TR: Defined: Where nursing care is provided - PR: Undefined; unlimited Purpose - TR: Goal-directed to provide needed care - PR: Pleasure; interest-directed Structure - TR: Nurse provides care to client - PR: Spontaneous: unstructured Balance of Power - TR: Unequal: Nurse in position of power - PR: Relatively equal Responsibility for relationship - TR: Nurse responsible - PR: Equal responsibility Preparation for relationship - TR: Nurse requires trashing/preparation - PR: No formal training or preparation Time spent in relationship - TR: Contract outlines hours Of work/care - PR: Personal choice

Answer 129

Pre-Orientation (or Pre-Interaction) phase * prior to meeting cient: May receive shift report, review client chart or other documents Orientation (or Interaction) Phase * Self-Awareness. Fist Impression. guiding Trust, Consent. Expectations Working Phase * Collaboration with client toward established goals Termination Phase

Answer 130

Open ended questions Clarification Probing Paraphrasing Sharing observations Silence Summarizing

Answer 131

Giving Advice Closed-Ended Questions * Leading Questions Changing the Subject Automatic Responses - False Reassurance Cliché - Sympathy Expressing Approval or Disapproval Belittling Feelings Defensive Responses

Answer 132

an objective measure

Answer 133

a person's subjective experience of being healthy

Answer 134

the physiological deviation from normal - considered objective and measurable

Answer 135

a person's subjective experience of living with disease

Answer 136

Health is "...a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (WHO, 1948) Health as a status vs. Health as a resource Well-being is "the presence of the highest possible quality of life in its full breadth of expression, focused on but not necessarily exclusive to: good living standards, robust health, a sustainable environment, vital communities, an educated populace, balanced time use, high levels of civic participation, and access to and participation in dynamic arts, culture, and recreation." (Canadian Index of Wellbeing, 2016)

Answer 137

emotional wellness intellectual wellness occupational wellness physical wellness sexual wellness spiritual wellness environmental wellness social wellness

Answer 138

Understanding feelings Managing and/or controlling those feelings Appropriately expressing feelings

Answer 139

Attainment of knowledge Realization of creative potential Seek stimulating activities to ensure growth of self

Answer 140

Also called vocational domain How much value placed on work? Paid vs. Volunteer Satisfaction through providing service to others

Answer 141

Efforts at sustaining states of health Lifestyle choices Diet/ exercise Self-care Developmental stages

Answer 142

Sexuality and sexual function Intimacy and respectful relationships Safety Cultural context

Answer 143

Holistic view of the individual — mind, body, and spirit Sense of meaning for life Relationships with self, others, nature, or a higher being

Answer 144

Use of and need for natural resources Clean air, water, land Food security Population, urbanization, industrialization Impacts of climate change

Answer 145

Relationships with others Friends and Family Roles, boundaries, identity Respect, cooperation, support, and communication Communities, civic relationships, economic relationships

Answer 146

May experience wellness changes in many domains Learn to care for others, but also need to care for themselves School is stressful, as is relocating and loss of social supports You are also forming a new identity and changing existing relationships and expectations Need to learn and maintain positive self-care habits

Answer 147

Process of enabling people to increase control over and to improve their health Can be focused on various levels: * Individual * Family * Groups/ Community * Population/ Society/ Nation - Global Is a process that is relational — depends on relationship between HCP(s) and target individual(s) or group(s)

Answer 148

Some focused more at the individual, family, or small group level * Pender's Health Promotion Model * Transtheoretical Model Some focused more at population, nation, global level * Population Health Promotion Model

Answer 149

Come from the Ottawa Charter for Health Promotion (WHO, 1986) 1. Strengthen Community Action 2. Build Healthy Public Policy 3. Create Supportive Environments 4. Develop Personal Skills 5. Reorient Health Services

Answer 150

All the qualities and capabilities of an individual relevant to his or her capability to practice as a nurse, including freedom from any cognitive, physical, psychological, or emotional condition or a dependence on alcohol or drugs, that impair his or her ability to practice nursing. (Gregory text, p. 77; CNA Code of Ethics)

Answer 151

Responsibility is on the nurse to determine their fitness to practice - Designated in Code of Ethics (Value G; Statement 5) and by Regulatory Body (CRNA Practice Standards for Registrants; Standard 1.13) Nursing Students vs. Employment - Regulations/Policies - Accommodations

Answer 152

Short-term - Acute illness - Injury - Accident - Sleep deprivation - Medication side effects Long-term - Chronic illness - Cognitive condition or impairment - Severe emotional stress - Problematic substance use

Answer 153

an individual who holds an attraction for more than one gender on an emotional, physical, and/or sexual level; sometimes, one gender is preferred over others.

Answer 154

an individual with a gender identity that aligns to one's assigned sex.

Answer 155

factors that affect health, such as income and social status, social support networks, education, working conditions, social environments, physical environments, personal health practices and coping skills, biology, gender, and culture.

Answer 156

the physiological deviation from "normal," that is, therefore, objective or measurable.

Answer 157

using the knowledge of ecosystems to advocate for sustainable communities.

Answer 158

in the context of individuals, this term refers to males who express and attraction to the same gender (male); the attraction is felt on a romantic, emotional, erotic, and sexual level. Men who participate in same-sex relationships may not self-identify as gay.

Answer 159

a positive concept, beyond physical capabilities, that emphasizes social and personal resources. Holistic understanding of health is central to the definition of health promotion. The Ottawa Charter emphasizes certain prerequisites for health, which include peace, adequate economic resources, food and shelter, and astable ecosystem and sustainable resource use. These prerequisites highlight the inextricable links between social and economic conditions, the physical environment, individual lifestyles, and health. Although health is a positive, it is not the point to living; health is a resource for living well.

Answer 160

the promotion of healthy ideas and concepts to motivate individuals to adopt healthy behaviours. Health promotion is also the provision of information and/or education to families and communities encouraging family unity, community commitment, and spirituality, all of which can make positive contributions to health.

Answer 161

the subjective experience of living with a disease or condition and its accompanying symptoms.

Answer 162

a woman who expresses an attraction to individuals of the same sex/gender; this attraction is felt on an emotional, physical, and/or sexual level.

Answer 163

a multistep framework used to create a plan of care, including assessment, nursing diagnosis, planning, interventions, and evaluation.

Answer 164

concrete, measurable knowledge; often easily defined as the "opposite of subjective".

Answer 165

an individual has a sexual attraction to a number of gender identities.

Answer 166

improving the determinants of health from the perspective of a nation.

Answer 167

all-encompassing term of diverse sexual orientations and gender identities; the term is inclusive of lesbian, gay, transgender, and other categories.

Answer 168

an action the client is willing to employ to meet health outcomes.

Answer 169

the judgement a person makes of his or her personal ability to organize and carry out a particular course of action.

Answer 170

knowledge informed by perception, personal views, experience, or background.

Answer 171

an individual who expresses himself or herself outwardly as a gender that is not based on anatomical sex.

Answer 172

an individual who self-identifies with a sex not assigned at birth. Transsexual persons may undergo hormonal and/or surgical transitioning to the sex they identify with most, i.e., female-to-male and male-to-female. Trans men and women can take social, legal, and medical, and/or surgical steps to find comfort in their own body.

Answer 173

from the Mi'kmaw Etuaptmumk, a way of viewing health that is both indigenous and western.

Answer 174

some indigenous peoples identify with both the feminine and masculine spirit. The term reflects distinct and diverse gender variances and expressions.

Answer 175

the presence of the highest possible quality of life, including aspects such as good living standards and education; robust health; a sustainable environment; vital communities with high levels of civic participation; and access to and participation in arts, culture, and recreation.

Answer 176

there is no universally accepted definition of wellness. Wellness is an evolving process of becoming aware of and making choices toward a fulfilling sense of individual life accomplishments. Dimensions of wellness includes both physical and mental components. Wellness describes a multidimensional state of being involving the existence of positive health, exemplified by the individual's experience of life quality and his or her sense of well-being.

Answer 177

The domains are interrelated Wellness seems to ebb and flow within and among domains The client is responsible for making choices toward reaching higher levels of wellness; the nurse cannot make choices for the client

Answer 178

Avoidable, unjust, and unfair systemic differences in health status within the population. Socially produced and modifiable.

Answer 179

Identified differences in health status of individuals, groups, or populations. These differences are based on measurable data, such as biological, socioeconomic factors (e.g., employment, income, education, social supports), individual behaviours, physical and environmental (i.e., geography), early childhood development, and health care access.

Answer 180

Measured outcomes caused by health inequities closely linked to determinants of health, and affecting diverse groups who have been discriminated against or excluded. The ability to track patterns enables assessment of health of populations to examine improvements over time, with a central aim to achieve health equity.

Answer 181

To adopt better governance and development. Goal: experiences in applying health impact assessment. Work across sectors to reduce poverty, improve social protection, advance key determinants, such as housing. To promote participation in policy-making and implementation. Goal: reforming government processes to increase openness of data, transparency and participation, and engaging citizens. Providing approaches to engage and empower indigenous peoples for self-governance. To further reorient the health sector toward reducing health inequities. Integrate equity, including gender-related considerations, into the design and delivery of programs and services. Provide capacity and tools to advance health equity. To strengthen global governance and collaboration. Provide financial contribution to countries and international organizations. Foster North-South support in information sharing and technical expertise. To monitor progress and increase accountability. Strengthen monitoring systems and methods to report on health inequalities. Share evidence to inform policy and action.

Answer 182

Preorientation phase Shift report. Employ critical communication and thinking skills when reviewing client data, recognizing that client conditions and behaviours change throughout the course of the client's stay or treatment. Orientation phase Self-knowledge on the part of the nurse is one of the greatest influences when communicating within the orientation phase. Working phase Nurse acknowledges that collaboration is the key to client success. Nurse uses effective communication such as silence, touch, open-ended questions, paraphrasing, shared observation, self-disclosure, and listening. Termination May occur at the end of each shift, upon client transfer to another unit or facility, upon discharge, or upon death.

Answer 183

Perception checking

Answer 184

Focusing; used to encourage a client to expand on or further explore their thoughts, ideas, and feelings; guides direction of conversation

Answer 185

Ability to repeat in your own words the essential thoughts, ideas, and feelings a client is trying to portray

Answer 186

Nurse verbally communicates observations regarding how a client looks, behaves, or sounds

Answer 187

Listening and non-verbally indicating interest

Answer 188

Intrapersonal communication (self-talk/internal thoughts) Thoughts, feelings, perceptions, values, beliefs, and attitudes toward another person, situation, or task. Often used during critical thinking about a client’s conditions and when initiating and working through the nursing process. Transpersonal communication Spirituality or spiritual inquiry Interpersonal communication (between 2 people) Mutually influence one another with the goal of creating shared meaning and understanding that is necessary when initiating or maintaining relationships. Small group communication (2-15 people) Public communication

Answer 189

Reduced ability to understand what others are saying, to express oneself, or to be understood. Strokes are a major cause.

Answer 190

Interferes with normal control of the speech mechanism. Speech may be slurred or otherwise difficult to understand due to lack of ability to produce speech sounds correctly, maintain good breath control, and coordinate the movement of the lips, tongue, palate, and larynx.

Answer 191

Hearing loss as observed as part of the ageing process is call “presbycusis”.

Answer 192

Laryngectomy, the surgical removal of the larynx (voice box) due to cancer. Other forms of disease may result in complete or partial loss of the voice.

Answer 193

Brain diseases that result in progressive loss of mental faculties may affect memory, orientation to time, place and people, and organization of thought processes, all of which may result in reduced ability to communicate.

Answer 194

idea that practice influences theory while at the same time theory influences practice. the integrated "whole" of reflective, relational, professional nursing practice that simultaneously apprehends the uniqueness of each situation, and a critical awareness of relevant theories and patterns. praxis unfolds in complex socio-cultural contexts that require nurses to integrate ways of knowing and sources of knowledge in relationships that support health, healing and wholeness, and address barriers and inequalities to achieving health experienced by those receiving nursing care. - health: health is a state of perceived wholeness and harmony in body, mind and spirit that is lived and defined by persons and is reflected in cultures, communities and populations. registered nurses strive to understand health as lived by engaging with people to understand how perceived wholeness is influenced by biology, history, identity, relationships, life course, culture and experiences, and within complex socio-cultural, historical, environmental and political contexts. - healing: an ongoing process of movement towards wholeness as defined and lived by each person or community. - wholeness: the inter-connectedness of all dimensions of life.

Answer 195

an idea that represents some aspect of our experiences and our world. - such as pain, hunger, shortness of breath, love, grief, etc. nurses use concepts to understand and/or describe situations and circumstances. - difficulty: not universally understood in the same way; influenced by context.

Answer 196

consists of several concepts used to describe, explain, or predict a particular phenomenon. - weaves together a variety of concepts in a unique way to describe their relationships. - helps organize knowledge, make sense of ideas, and promote new discoveries. can be tested. new research helps refine theory. a model is a visual representation of a theory.

Answer 197

represent the body of knowledge used to describe or explain various concepts found in nursing practice. different kinds of theories: - Grand Nursing Theory: highly abstract; frame disciplinary knowledge in ways that are not specific to one particular practice area. - Midrange/Middle-range Theory: narrower in scope; serve as a bridge between grand theories and practice theories; emerge at the intersection of research and practice. - Nursing Practice Theory: used for particular nursing care situation; provide a framework for nursing interventions and activities.

Answer 198

metaparadigm = a global framework or way that a professional discipline views the world. nursing metaparadigm describes key concepts central to the discipline of nursing. - developed officially in the 1970s. many theories/theorists before and since have organized their theories around the metaparadigm concepts.

Answer 199

nursing health environment person

Answer 200

any recipient of care (sick or well) client (can be an individual, family, community, or population) nurses interact with persons during nursing care persons are considered holistically distinct physical, psychological, social, spiritual, cultural, and developmental characteristics. perceptions, values, beliefs, preferences live within the context of systems (family, friends, social systems)

Answer 201

the intended outcome of nursing care determined by person or community physical, psychological, relational, and spiritual aspects (among others) determinants of health across the lifespan, an individual's expectations and definition of health changes goal: maximize one's potential not merely the absence of disease

Answer 202

the care provided to individuals/"clients" of all types and in all settings the practice of a nurse in Canada is guided, in part, by the CNA's Code of Ethics is profoundly relational in nature, so includes the characteristics and actions of the nurse in relationship with the patient and the care provided. seeks to understand and meet client's goals

Answer 203

anywhere nursing is carried out anything that affects a person and includes both the external and internal contexts. - disease, cultural, developmental, psychological, poverty, education, religion, climate, space, pollution, food choices, etc. health care system strength/challenges and social justice each person is part of an interacts with the environment

Answer 204

nursing theorists base their conceptual frameworks on various ways of thinking about human behaviour and experience. - some framed their ideas within theories of human behaviour, such as needs, interaction, or systems. - others drew their primary inspiration from what they observed in excellent nursing practice. all have the same goal: excellent decision making in nursing practice

Answer 205

Hildegard Peplau - Theory of Interpersonal Relations Virginia Henderson - Needs Theory Sister Callista Roy - Adaptation Model of Nursing Jean Watson - Theory of Human Caring Margaret Campbell - UBC Model of Nursing Dr. Laurie Gottlieb - Strengths-Based Nursing Care Katherine Kolcaba - Comfort Theory

Answer 206

differ form one another based on how the relationships between the metaparadigm concepts are contextualized or theory level (grand, mid-range, or practice)

Answer 207

theories provide direction to nursing research and nursing practice. nursing their and nursing research build nursing's unique knowledge base.

Answer 208

stimulates thinking and research creates a broad understanding of the science and practice of the nursing discipline. provides a rationale for nursing actions and decisions

Answer 209

a process that assists nurses to provide quality care by applying a systemic process that fosters critical thinking and optimizes client care outcomes. helps organize and prioritize nursing care allows nurse to provide multiple aspects of care simultaneously it is a tool to guide the nurse's thinking on a daily basis.

Answer 210

Assessment - Collect data - Organize data - Validate data - Document data Nursing diagnosis - Analyze data - Identify health problems, risks, and strengths - Formulate diagnostic statements Planning - Prioritize problems and diagnoses - Formulate goals and designed health outcomes - Identify nursing interventions Implementation - Reassess the patient - Determine the nurse's need for assistance - Implement nursing interventions - Supervise delegated care - Document nursing activities Evaluation - Collect data related to outcomes - Complete data with outcomes - Relate nursing actions to patient goals/outcomes - Draw conclusions about problem status - Continue, modify, or end the patient's care plan

Answer 211

collected data are like the piece of a puzzle fit together - when one piece or component is missing, the data are incomplete that could negatively impact the client's care data can be obtained from multiple sources: - the patient (and others) - physical examination and interview - diagnostics - other health care professionals - current medical records and past medical records - etc.

Answer 212

signs - objective assessments; what the nurse can see, feel, smell, hear symptoms - subjective sensations; reports from clients - e.g., my heart is racing objective data - what you (nurse) observe: skin colour, temperature, pressure sore subjective data - what the client states: "my leg hurts", "I can't breath"

Answer 213

cluster different pieces of information to create a holistic "picture" of the situation. physiology anatomy critical thinking pathology psychology problem-solving research and evidenced informed practice the nurse's experience diagnostic tests creativity laboratory tests pharmacology

Answer 214

MEDICAL DIAGNOSIS relates primarily to the disease process, pathology, and/or condition has implications for medical treatments tends to remain static during episode of illness ex. COVID pneumonia NURSING DIAGNOSIS relates to the "client's" response to or experience of actual or potential health conditions and/or life processes - can relate to health problems, health risks, or health promotion is a clinical judgement made by the nurse can change throughout the illness or disease experience ex. difficulty breathing; inadequate gas exchange; pain; sleep disturbance

Answer 215

involve client prioritize based on urgency of care. - "CURE" approach priorities change as the client's condition changes - what can be realistically done first, and what can wait? three types of planning: - initial planning (at admission) - on-going planning - discharge planning

Answer 216

once priorities are determined, goals are established to help the client move toward wellness the client, nurse, physician, and other team members may collaboratively participate in goal setting Use SMART goal approach: - S = Specific - M = Measurable - A = Attainable/Achievable - R = Relevant/Realistic - T = Time-related

Answer 217

nurse carries out and documents the interventions needed to achieve the client's health-related goals the interventions must match the goal actions can include providing care, client education, preventative measures, and health promotion activities nurses may delegate certain actions to others this is a living, evolving plan

Answer 218

evaluation is the final step int he nursing process and involves: collect data related to outcomes and document relate nursing actions to client goals/outcomes draw conclusions about problem status continue. modify, or end the client's care plan. - have the goals been met?

Answer 219

a purposeful process that is reflective, consecutive, and intentional a mode of thinking about any subject, content, context, or issue in which the thinker endeavours to improve the quality of his or her thinking by applying intellectual standards to the thinking process.

Answer 220

systemic inquisitive judicious truth-seeking confident in reasoning open-minded analytical

Answer 221

a skill acquired through learning and experience supported by reflective thinking. - reflection is the heart of developing critical thinking; nurses reflect on personal values, assumptions, experiences, and the thinking process itself. CRNA identifies critical thinking as an important practice standard and expects it to be demonstrated by its members it is foundational to the nursing process.

Answer 222

understanding and applying knowledge in the nursing role critical thinking coming to "know" and the attainment of knowledge

Answer 223

ability to ask questions being well informed being honest in facing personal biases being willing to reconsider and think differently about issues

Answer 224

self-aware analytical and insightful open and fair-minded genuine/authentic logical and intuitive sensitive to diversity patient and persistent effective communicator confident and resilient creative flexible curious and inquisitive honest and upright realistic and practical health-oriented alert to context autonomous/responsible proactive improvement-oriented reflective and self-corrective careful and prudent courageous

Answer 225

INTERNAL PROCESSES reflecting on values reflecting on assumptions reflecting on thinking EXTERNAL PROCESSES engage in critical questioning writing to develop and communicate thought evaluate/utilize research and evidence reading critically

Answer 226

Common legal proceedings Quality documentation Electronic temptations Patient safety Dispute resolution

Answer 227

Sources of law: Act of Parliament, Act of Legislature, regulations, courts decisions, administrative tribunal decisions. Canada is a bijuridical country: Quebec has retained the Napoleonic Civil Code as its provincial law. The rest of the country adheres to the common law system, which applies statutes and judicial precedence: like cases are to be decided in a like manner. Hierarchy of laws: constitutional law, federal statute & regulations, provincial statute & regulations, common law.

Answer 228

The manner of your communications is as important as your content A failure of professionalism engenders two types of risk: Care of your patient Risk of legal sanction against you

Answer 229

Professional discipline e.g., under the Regulated Health Profession Act, 1991, S.O. 1991, c. 18 Professional negligence lawsuit Criminal offences Human rights violations Privacy law Labour and employment

Answer 230

An authoritative statement from the nursing regulatory body that describes the mandatory minimum expectation of every nurse Has its basis in the legislation governing nursing practice Used to evaluate individual performance

Answer 231

In the law of negligence, the degree of care which a reasonably prudent person should exercise in the same or similar circumstances to avoid foreseeable harm. A legal determination made by the Court.

Answer 232

Legislation and regulation Legal precedent Standards of professional practice Clinical guidelines e.g., SOGC, Fetal Health Surveillance: Antepartum Consensus Guideline (2018) Institutional policies Expert opinions

Answer 233

Identify that which is within your control and act accordingly Evidence of your reasonable actions will assist you if you ever have to account for your practice in a legal proceeding In brief, the law expects a registered health professional to: adhere to the standards of the profession; to practice ethically; and act reasonably and carefully in the circumstances, which includes exercising forethought for the benefit of your patient.

Answer 234

Plaintiffs have to prove: ○ Duty of care owed by defendants ○ Standard of car that should have been given ○ Breach in the standard of care ○ Foreseeable harm caused by the breach Defence: reasonable in the circumstances Consequences: ○ Claims dismissed ○ Claims settled ○ Damages award ($); in some provinces, e.g., Ontario, Alberta, self-report a Court finding of negligence/malpractice to nursing regulator.

Answer 235

Nursing knowledge and skills are accompanied by competencies such as effective professional presence, critical thinking, triage, and advocacy. Health institutions are obligated to take reasonable care in hiring personnel, to have safe systems for patients in place (which includes a variety of things such as having appropriate supplies, etc.), and also have specific duties as employers e.g., occupational health and safety.

Answer 236

The commonality in various types of legal proceedings: information can be admitted as evidence when relevant to a material issue in the case. Common types of evidence are: ○ Verbal testimony (of a party or witness) ○ Documents ○ Expert witnesses

Answer 237

The purpose of documentation is to record relevant patient information so the patient is cared for properly. Documents admissible in court are those which were created contemporaneously by the person with knowledge of events who has a duty to record events. The chart is used to refresh memory and provide an accurate chronology. Expert witnesses use its contents as a basis for their opinions.

Answer 238

Become familiar with the statutory law in your province or territory regarding privacy of personal health information [phi] Subjects they typically address: ○ Definitions e.g., custodian, trustee, agent ○ Collection of phi ○ Permitted uses and disclosure of phi ○ Process for patient to correct content ○ Penalties for breach of privacy ○ Dispute resolution

Answer 239

Provinces have enacted a number of statutes relating to patient safety: ○ Reporting within the organization ○ Investigation by Quality Committees ○ Apology to the patient ○ (Report to government de-identified data) Patient may choose to sue, complain to licensing body

Answer 240

Frame your requests for assistance from nursing colleagues in terms of patient care. Who will be your mentor? Millennials, Gen X, Boomers ○ Respect their experiences ○ See things from their perspective ○ Do you stereotype your elders? ○ What do you bring to the table?

Answer 241

Communication ○ Know what you want to say ○ Convey your goal to the person ○ Say it to the person who needs to hear it ○ Know what you are going to do if you don’t get the response you need. Bear in mind the purpose of documentation - it is not a separate, optimal task but an integral part of nursing care ○ Practice standards ○ Policies ○ Critical incident reports Working with others e.g., PCW, novice nurses ○ Know your employer's job descriptions and policies ○ Develop (nursing) care plans ○ Be specific about reportable parameters ○ Indicate prioritize Intervene if necessary

Answer 242

a legal system used in Quebec that is based on a code that contains a comprehensive set of rules that are followed by judges in deciding court cases.

Answer 243

a legal system used across Canada, with the exception of Quebec, based on judge-made law where cases are decided following precedents

Answer 244

a client must give consent before any medical intervention takes place. Consent must be voluntary, given by a client with capacity, refer to the intervention, and informed. Consent may be either express or implied by the circumstances.

Answer 245

an error or mistake may not be negligent if the health professional has acted with reasonable care, exercising the skills of a normal, prudent professional.

Answer 246

a client must be given the necessary information to give an informed consent to a medical intervention. A client must be informed of the material risks that a reasonable person in the position of the client would want to know.

Answer 247

a negligence claim has 4 elements: the defendant health professional owes the plaintiff a duty of care, the defendant breached the standard of care, the plaintiff suffered an injury or loss, and the defendant's conduct was the actual and legal cause of the plaintiff's injury or loss.

Answer 248

a principle or rule established by a prior court decision with similar facts that are used by judges to make decisions in subsequent cases.

Answer 249

the law requires a medical practitioner to exercise the care and skill that could reasonably be expected of a normal, prudent practitioner of the same experience and standing.

Answer 250

the employer is liable for the negligent acts of an employee and will be responsible for paying any damages awarded to the injured client.

Answer 251

Private law: focuses on the relationships between individuals. 2 different legal traditions: common law and civil law Public law: refers to the relationships between government and its citizens.

Answer 252

There are 4 elements that a plaintiff must prove before a negligence lawsuit against a nurse or other health professional will be successful: The defendant must owe the plaintiff a duty of care. The defendant must breach the standard of care established by law. The plaintiff must suffer an injury or loss. The defendant's conduct must cause the plaintiff's injury.

Answer 253

Informed consent: individuals need information to be able to make a decision and to make the right choice for themselves. ○ Person must be capable of making the decision. ○ The information required to make the decision must be shared. - The person must be assured that the choice it totally voluntary.

Answer 254

The principle of autonomy is based on respect for the person's individual liberty and the right to self-determination, all grounded in ethical theory.

Answer 255

○ Confirm that the person is capable of giving consent. ○ Ensure, when possible, that the environment is suitable to the discussion and enhances the nature of the conversation. ○ Some people may need more time than others to consider the information they have received and to reflect on their choices. ○ Ensure the person understands the information and options presented. ○ The person may have had many experiences with health care, or this may be their first. ○ Supplement verbal information with verbal material, web-based education, videos, pictures, etc. ○ Give person the choice to have family member or friend present for moral support. ○ Be sensitive to cultural and language issues. ○ Be an active listener and be aware of pt's emotional and physiological responses. ○ Build a relationship of trust. - Ensure that the person understands that although this is a shared process, the decision is ultimately his or hers and that he or she can change their mind at any time.

Answer 256

Expressed consent: clear statement of consent from the patient. Implied consent: inferred from a patient's conduct. Consent must: ○ Be voluntary and genuine ○ Be given with the knowledge that agreeing to treatment is not consent ○ Be specific ○ Specify the person providing treatment ○ Be obtained by the person providing the treatment ○ Be given by a capable client - Be given by a mentally competent client

Answer 257

Maintenance of professional competence Legal liability to compensate others injured by their conduct Criminal liability for conduct that violates the provisions of the Criminal Code

Answer 258

Duty of care owed to the plaintiff (e.g., a patient or client). Breach of duty of care by the defendant (e.g., a nurse or physician) by failure to administer treatment or provide health care in accordance with a particular standard of care. Patient suffers damage as a direct result of the breach of the duty of care.

Answer 259

Record contemporaneously Record only your own actions Record in chronological order Record clearly and concisely Make regular entries Record corrections clearly Record accurately Record legibly

Answer 260

A rights is a claim or privilege to which one is justly entitled, either legally or morally. Legal rights make explicit an individual's claim to such entitlement. Rights come with responsibilities

Answer 261

the Canadian Patient Safety Institute (CPSI) describes an adverse event as an unexpected and undesired effect during the process of providing care.

Answer 262

the CPSI defines contributing factors as the reason(s), situational factor(s), or latent conditions that caused an adverse event.

Answer 263

a serious incident (undesired outcomes) resulting in loss of life or loss of body parts.

Answer 264

a caregiver's well-defined communication process (disclosed by a caregiver) to inform the patient and their families of a safety issue.

Answer 265

an event process, process, practice, or outcome that creates a risk for patients.

Answer 266

a set of practices designed to promote positive patient outcomes by reducing and intercepting harmful acts.

Answer 267

a systematic process of investigating a critical incident to determine the multiple, underlying, and casual factors

Answer 268

the CPSI describes risk as the probability of danger, loss, or life-threatening injury within health care.

Answer 269

an organizational strategy designed to reduce and prevent adverse events or moderate the actual financial losses following an undesired outcome.

Answer 270

describes the entirety of a health process, operation, or structure that caused the patients and/or health care workers injury or undesired outcomes.

Answer 271

(1) harmful incident: a patient safety incident that resulted in harm to the patient (replaces "preventable adverse event"). (2) near miss: a patient safety incident that did not reach the patient and therefore no harm resulted. (3) no-harm incident: a patient safety incident that reached the patient but no discernable harm resulted.

Answer 272

Gather information Initial understanding Additional information Literature review Time line and final understanding Determine contributing factors and root causes Formulate casual statements Develop actions

Answer 273

Conflict with a nurse's personal values that he or she finds objectionable on moral or religious grounds.

Answer 274

Ensure appropriate staffing is in place Reward effort and achievement Strengthen organizational structures Support nursing leadership and professional development Promote workplace health and safety Ensure a learning environment Promote effective recruitment and retention

Answer 275

Developing and sustaining nursing leadership Intra-professional collaborative practice among nurses Embracing cultural diversity in health care: developing cultural competence Professionalism in nursing Developing and sustaining safe, effective staffing and workload practices Workplace health, and safety and well-being of the nurse guideline Preventing and managing violence in the workplace Managing and mitigating conflict in health-care teams Practice education in nursing Developing and sustaining interprofessional health care: optimizing patients/clients, organizational and system outcomes Adopting eHealthy solutions: implementation strategies Preventing and mitigating nurse fatigue in health care

Answer 276

The emotional and psychological pain that occurs when "one knows the right things to do, but institutional constraints make it nearly impossible to pursue the right course of action." Often arises in situations in which nurses are faced with moral uncertainties or dilemmas, and power imbalances exist within the team in making the difficult ethical decisions.

Answer 277

Right to privacy Freedom of expression Right to respect Freedom from discrimination, harassment (sexual or otherwise), physical abuse Right to work in an environment with minimized risks of harm Although professional rules and regulations and ethical responsibilities may limit individual rights, nurses are entitled to: - respect from colleagues and patients - freedom from discrimination, harassment, and physical or sexual abuse - function in a work environment where risk of harm is minimized

Answer 278

Right to Conscientious Objection: decline to participate in certain actions on moral or religious grounds Duty to provide care - Is it an emergency? If so, nurses are required to help the client until alternative care is available. A nurse's own values - Anticipate conflict with your conscience

Answer 279

Prohibits discrimination on the basis of race, sexual & gender orientation, religion, age, physical or mental disability, nationality, or ethnic origin Corresponding obligation: employers are required to structure work conditions to cause the least possible interference with gender, religious views, etc.

Answer 280

Health care environments pose multiple risks to employees, such as: - exposure to harmful agents and infectious diseases - increased stress - disrespectful and non-supportive coworkers - risk of physical harm from patients

Answer 281

Chemicals Physical hazards Violence Stress "During a natural or human-made disaster, including a communicable disease outbreak, nurses have a duty to provide care using appropriate safety precautions" (CNA, 2017, p. 9) Corresponding obligation: responsibility of healthcare organization to ensure strategies are in place to prevent harm to caregivers (personal protective equipment: PPE; training, legislation, prevent/respond to violence)

Answer 282

Nurses have an ethical and legal obligation to provide care to all assigned patients. Employers have an obligation to provide their employees with necessary safety precautions. Nurses must balance the rights of protecting themselves with protecting the patient' s rights. Duty to provide care unless unreasonable burden

Answer 283

Healthy Work Environment= "a practice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance and societal outcomes" In order to ensure a healthy environment, leaders should: - Ensure the resources and structures are available to support nursing care. These include: - appropriate staffing ratios - optimizing full time positions, while offering flexible opportunities for nurses at various stages of their career

Answer 284

Workers have the right to refuse to work in unsafe circumstances, unless: - risk is inherent in the work - refusal would endanger the life, health, or safety of others Employers have a legal responsibility to minimize risks nurses have a duty to provide care using appropriate safety precautions" (CNA, 2017, P. 9)

Answer 285

Ensure appropriate staffing ratios Promote effective recruitment and retention Reward effort and achievement Support leadership and professional development Promote workplace health and safety lntra/interprofessional collaborative practice Embracing cultural diversity Minimizin moral distress

Answer 286

Can come from many sources - patients - Family members - Other staff and healthcare team members Often goes unrecognized or unacknowledged Major contributor to moral distress for nurses in the workplace

Answer 287

A union is: - a provincially certified group of employees with a common employer or industry - a bargaining agent for its members Certification is a process that must be completed before the union can represent its members Decertification occurs when a union is dissolved or loses the right to negotiate on behalf of its members The majority of nurses in Canada are members of unions United Nurses of Alberta - the union for more than 25,000 Registered Nurses, Registered Psychiatric Nurses and allied workers in Alberta - advocate for nurses, the nursing profession and Canada's fair and efficient public health care system

Answer 288

Collective bargaining (mediator) - employers - unions - collective agreement (improve working conditions and protect nurses' workplace rights) why unite? power and leverage (numbers)

Answer 289

Union for RNs, RPNs and allied workers in AB Represents nurses in bargaining, in their profession, and in disputes with employers and licensing bodies Professional Responsibility Committees (joint employer and union): gives nurses the opportunity raise concerns about safe staffing levels (PRC forms) Occupational Health and Safety Committees: ensure employers provide safe working environments

Answer 290

Is the contract that emerges from the collective bargaining process Must be in writing and effective for at least one year If it expires before a new one takes place, the terms of the old one apply for a certain period of time (cooling-off period) No job action (strike or lockout) can occur when a collective agreement is in place

Answer 291

Agreements contain a mechanism for resolving disputes between management and labour The usual three-step process involves * a written submission * a meeting with the grievance committee * binding arbitration

Answer 292

A grievance is a violation of one or more provisions in the CA. When a formal grievance is filed, the employer has a obligation to meet with the Employee/union to discuss a possible solution. If you think you may be disciplined, you have the right to have union representation. The union will be on your side and at your side for all disciplinary action and the member has the right to have union representation. UNA represents all its members through CRNA investigations and discipline. UNA will provide members legal council if required and no additional cost.

Answer 293

The manager has the right to direct work. - lf you feel the expectations are inappropriate, then try to have a respectful conversation about your objections. If a compromise cannot be found, you must obey. Afterwards make detailed notes and contact your union rep as soon as possible. Exceptions —the work is illegal, outside of your scope of professional practice, the work will endanger yourself or others, or there would be no adequate redress through the grievance procedure.

Answer 294

Conscientious Objection —the nurse should communicate refusal in advance so alternate arrangements can be made. You have the responsibility not to abandon your patient and are legally bound to continue treating until you can have your patient reassigned. Refusing Work—the nurse can only refuse work when it is physically unsafe and there is impending and/or immediate danger.

Answer 295

Every Local has an Executive that is there to represent you and answer any questions you may have regarding your rights under the Collective Agreement UNA has 2 full-time offices with staff including the Executive Officers, Accounting, computer services and Labor Relations staff. Locals work collaboratively with LRO's (Labor Relations Advisors) to interpret and uphold the collective agreement, attend disciplinary/grievance meetings and manage multiple other functions required to run the Local.

Answer 296

Nurses are accountable to their profession, regulatory body, patients, and employers Union membership can conflict with these accountabilities Ethical and professional responsibilities must remain paramount

Answer 297

Short staffing - Written report (PRC forms) Physician orders - Nurses follow orders unless they believe an order is in error, violates agency policy, or is harmful to patients.

Answer 298

Do we have this right? Governments have tried to pass legislation to prevent this * So far, unsuccessful Declare nurses as "essential workers" * Limits rights to strike Strikes can be legal or illegal

Answer 299

You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. You are expected to perform as a professional when rendering care. You must separate your student nurse role from your work as an unregulated care provider.

Answer 300

Nurses have the right to - be treated with respect - practise in an environment that is safe, and free from harm and abuse. As nurses have obligations to patients, employers have obligations to protect the rights of nurses. Nurses must be aware of their rights and acquire the knowledge to address challenges in the work environment.

Answer 301

What is it? * The reduction and mitigation of unsafe acts within the health care system, as well as through the use of best practices shown to lead to optimal patient outcomes. Unsafe events happen everyday in health care - What are the challenges and road blocks to safe practice? - How do we overcome or eliminate them? Some can be controlled by the nurse Others require a systems approach - Endeavour to create a system that eliminates risks or threats to safety

Answer 302

Incident = events, processes, practices, or outcomes that are noteworthy by virtue of the hazards they create or the harms they cause to patients - The Canadian Patient Safety Institute (CPS) states that "a patient safety incident is an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient" (CPSI, 2016, p. I l).

Answer 303

Harm = a product of unsafe acts or safety events. * Occurs as a result of a health care interaction, whether or not it is related to the reason the person entered the health care system. * Can occur to the patient, members,or staff members. * Can impact any dimension of health — physical, emotional, social, and/or spiritual.

Answer 304

harmful incident near miss no-harm incident critical incident

Answer 305

Rely on 3 interdependent components: * Measurement * System tools and change strategies * Culture Conceptual Models * Focus on the system, not the individual

Answer 306

Swiss Cheese Model * Event passes through several layers to reach the patient * Have to find the holes in each layer it passed through, and find ways to prevent them * Prevention at even one layer would stop the event Domino Model * Event passes through multiple layers (dominos), but as it passes through, it creates more momentum (more falling dominos) * Have to find ways to stop the momentum * Only have to stop the domino at one layer from falling to stop the event Iceberg Model * The incident is only the tip of the iceberg that we can see * Have to look at all the submerged (invisible) aspects that led to the event * Correction/prevention often occurs at the invisible level

Answer 307

Help identify contributing factors - Contributing factors = the reasons, situations, factors, or latent conditions that played a role in the genesis of an adverse event Leads to identification of the root causes (usually a system failure) - System failure = faulty organizational process, operation, or structure that places the patient and/or HCP in danger of harm

Answer 308

Organizational Culture is shaped by two forces: - The organizational framework - The behaviours demonstrated by the employees of the organization Both must commit to patient safety in order for a culture of safety to exist

Answer 309

Organizational Framework * Funding for safety mechanisms (equipment, processes) * Organizational leaders must make safety a priority * Empower staff to engage in safety projects Behavior of Employees * Everyone MUST be on board * Think safety at all times * Follow policy and procedure * Avoid shortcuts

Answer 310

Reporting Culture — reporting is the norm. Must trust that reporting will not result in punishment. Informed Culture — gains knowledge from analyzing adverse event reports. Is the outcome Of a reporting culture. Flexible Culture — open to changing processes based on new knowledge gained. Requires teamwork and shared accountability, shared power, and open communication. Learning Culture — learns from experience, makes necessary adjustments to the system. Requires the culture to be informed and flexible.

Answer 311

risk management quality improvement reporting disclosure inter-professional communication investigation of events human factors engineering staffing

Answer 312

Minimize the occurrence of untoward events by planning for their occurrence and placing safeguards to offset the danger Often takes the form of policies, procedures, and processes.

Answer 313

Includes activities to enhance the patient's (and/or staffs) experience, outcomes, and safety

Answer 314

Imperative to report all real, and potential, safety events. Should be reported as soon after the event as possible. Adverse events — results in harm to the patient Critical incident — results in significant impairment or loss of life Good catch/Near miss — an event caught right before it reached the patient

Answer 315

Process of communicating and adverse event to the patient Who should communicate? What should they communicate?

Answer 316

Requires efforts from whole health care team. Need to work collaboratively and use a shared voice to identify safety issues and solutions. Challenge: Power/Authority gradients within health-care can serve as barriers to effective communication * (Ex: staff nurse ignores student nurse concerns about the patient) Respect for each person's contribution to the health care team will improve the culture of safety

Answer 317

Most institutions use a root-cause analysis (RCA) approach to investigating events Identifies the underlying factors and/or system failures involved in the event, determines risk reduction strategies, and develops a plan of action in response to the event. Focus is on the system, not individuals Lessons learned are then disseminated to the employees of the organization This communication contributes to quality improvement

Answer 318

A scientific discipline that focuses on designing systems that meet the needs of a specific user population

Answer 319

Understaffing results in overworked, stressed, fatigued nurses— increases risk for errors and adverse events Multi-tasking, caring for multiple patients, taking shortcuts, and lack of organization can also lead to safety events

Answer 320

your abilities will continue to grow: - thorough assessments - appropriate nursing priorities/diagnoses - adherence to professional standards - competency-based practice - clinical thinking and clinical judgement - safety precautions; work together to reduce risk - prioritize safety; protect self and others - communicate effectively suggestions: - be prepared, be knowledgeable, and ask for clarification - maintain competency - organize yourself before performing skills - extra attention to medications (number 1 student incident) - speak up; ask questions when unsure - mentorship - accountability for your actions - report adverse events and near misses - communicate potential safety concerns

Answer 321

National * CNA: Code of Ethics * CASN Framework and Competencies Provincial * Health Professions Act * CRNA Practice Standards Other * OH&S legislation * Institutional Policies

Answer 322

a claim or privilege to which one is justly entitled, either legally or morally. in health care, made explicit through - standards in Canada health act or other legislation - professional code of ethics. - policies and practice documents legal rights vs. moral rights

Answer 323

a corresponding duty which is carried by another. anything a person must do, re refrain from doing, to permit full exercise of the rights of another. with corresponding obligations, rights become meaningless

Answer 324

rights are not absolute - they are agreed upon they come with corresponding responsibilities upon the person exercising the right if the person violates their responsibilities, may render their right void or obsolete medical institutions often have lists of patient rights and responsibilities

Answer 325

treat others with respect respect the needs of other persons disclose: - information important to ensure their safety care - concerns when they disagree with a plan of care

Answer 326

treat others as persons worthy of respect address persons by their preferred name or title introduce yourself by name focus in their perceptions and their needs talk to the client, even when the are not conscious there is more to the client than their diagnosis - they have a history, a story, family, friends, etc.

Answer 327

based on principle of autonomy come with obligation on HCP to provide all necessary information treatment without consent can have legal/criminal indications more details in informed consent presentation

Answer 328

nurses have obligation to provide patients with knowledge and skills to care for themselves after discharge - or friends, family, caregivers if patient cannot provide self-care clients should be aware of how to access further information help as needed medical diagnosis should be communicated by those whose scope it is to make the diagnosis.

Answer 329

nurses have obligation to maintain confidentiality includes verbal, written, electronic, and all other forms of information all provinces and territories have enacted legislation which protects personal health information by: - establishing rules for the collection, use, and disclosure of health records - providing individuals with a right of access - providing for independent review of complaints

Answer 330

be very conscious of where your re discussing patient information be very conscious of what you are discussing be very conscious of with whom you are discussing be aware of what is visible and accessible in your environment (charts, computers, screens, etc).

Answer 331

an older expression that includes the individuals and activities related to the care and treatment of a patient. - covers the health care providers who deliver care and services for the primary therapeutic benefit of the patient - covers related activities such as lab work and professional or case consultation with other health care providers. only share required info with those who need it who are within the circle fo care. only access info about patients/clients to whom you are assigned to provide care disclosure of personal health info without consent can lead to: - civil liability - professional discipline - employment issues

Answer 332

unauthorized access and data sharing do not share your password log off when leaving the computer

Answer 333

increased risks of unintentional breaches - content of posts - pictures - discussing "work" responsibility as a "representative" of nursing and the nursing profession - real or assumed

Answer 334

right to confidentiality may conflict with the obligation to provide care and prevent harm. - the privacy officer or manager has authority to disclose info (not the RN directly). health care providers have a duty to disclose knowledge of: - certain communicable or sexually transmitted diseases - suspected child abuse/elder abuse - gunshot wounds intent to harm or kill another person

Answer 335

health care providers may be required to disclose info in disciplinary hearings or legal cases however, legally there is no obligation for HCP to aid police in investigations also, confession of prior illegal activity may not necessarily need to be disclosed (ex., drug use).

Answer 336

provincial nursing statutes permit disclosure in the case of legal proceedings such as: - medical malpractice actions - coroner's inquests - criminal or civil cases the nurse must answer any and all questions put to them the nurse should, however, only disclose details relevant to the issues and only what is asked for.

Answer 337

the right to privacy goes hand in hand with the right to confidentiality, one cannot have one without the other nurses obligated to ensure: - patient privacy during bathing, examinations, or procedures - that pictures are not taken without permission, even if done for educational purposes. - that privacy is respected with regards to consults with religious leaders, counsellors, or social workers.

Answer 338

governs the collection, use and disclosure of health info by custodians only collected for an authorized purpose and limited to the amount required for that purpose custodian must safeguard your information to protect privacy and confidentiality custodians make effort to ensure your info is complete before using it

Answer 339

patients cannot be held - some special circumstances related to particular mental health challenges have right to leave, even if against medical advice (AMA)

Answer 340

vulnerable to disrespectful behaviour (even unintentional) those with cognitive impairments are especially vulnerable because they cannot advocate for themselves dignity enhances sense of self and well-being - take time to listen to their story treat with respect deserve to maintain independence as much and as long as possible permitted to participate in care permitted to make their own decisions - how to live, where they die

Answer 341

ask them how they wish to be addressed instead of endearing terms use available aids to promote communication introduce yourselves remember, they are not children take measures to prevent incontinence attention to appearance promote sleep based on need, rather than staff schedules elders experiencing abuse may be reluctant to disclose due to sense of family loyalty establish trust and encourage dialogue

Answer 342

as per Canadian human rights act, gender identity or sexual orientation is not used for discrimination every individual is to be considered equal still risk of harassment and discrimination

Answer 343

in positions of vulnerability and misunderstanding. nurses must: - recognize their unique need related to privacy, access to washroom facilities, room assignment, etc. - refrain from making assumption about their needs, and listen to them - ask about their preferred names or pronouns and mirror their language when referring to themselves, their partners and their bodies - treatments are often not covered through Medicare - take time to learn from them - be person-centered

Answer 344

choice respected traditional healing vs. western medicine right to maintain their health practices non-indigenous clients also have the right to choose holistic medicine instead of western approaches

Answer 345

stigmatization and risk for misunderstanding greater risk for drug dependency risk for homelessness mental health act - involuntary admission - if a person's state of mental health poses a risk to self or others, they can be committed to a mental health facility for treatment - can be detained in the facility if they remain a risk to self or others - this does not mean that they have forfeited their other rights capacity, ability to understanding what form or consent is being requested and the ability to appreciate the consequences of withholding or giving consent

Answer 346

create a culture of safety obligations - disclosure of errors (patient right to know) - reporting of incidents/errors

Answer 347

right to honesty right to seek maid

Answer 348

not directly connected to the patient/nurse relationship, or the health care system however, we must ensure all rights in the Charter are also observed and not violated

Answer 349

consent = person gives permission to a HCP to follow through on a proposed plan of care informed consent = individuals need all the information necessary to make a decision about their care - protects patient autonomy - patient given opportunity to choose their own course of action regarding their plans for health care - seen as a patient right - refuse right to interventions or recommendations

Answer 350

Information: - requires disclosure and understanding of info - include enough detail to fully understanding health condition, options/alternatives, risks, benefits, and consequences voluntary: - have the freedom to voluntarily accept or reject - must be free of coercion, force, manipulation, or influence - includes HCPs and family

Answer 351

incorrect or incomplete info deprives patients of their right to informed consent provision of treatment without informed consent can lead to liability for negligence or battery

Answer 352

paternalism (historical) - traditionally, the HCP (doctor) made the decision - seen as the expert with the knowledge to make the decision - expected to make decisions in patient's best interests (beneficence) - large potential for abuse of power (even when motivated by beneficence) autonomy (current) - believe individual has right to make own choices - based on principles of respect, dignity, and freedom - may not be as prominent in non-western cultures - threatened by prevailing paternalism, value conflicts, assumptions, and cultural misunderstanding/misinformation

Answer 353

patient's have the right to make the choice, we have corresponding obligations. advocate for the patient, especially those: - who are not full informed - who require more time to reflect on alternative - when their wishes have not been respected ensure all the info necessary to make the choice has be provided. - must act if becomes apparent the patient is not appropriately informed can witness signature on consent forms honor patient choices

Answer 354

when the plan involves low risk and high certainty of success (ex. consent for BP assessment) more thorough explanation is required when the level of risk increases (ex. catheter insertion) discussions AND decisions are documented in the client's records higher risk and invasive procedures require more comprehensive consent process and TIME for the client to consider options

Answer 355

explanation of the procedure names/qualifications of those performing/assisting the procedure benefits/risks alternatives (and their benefits/risks) risk of doing nothing provision are made for deaf, or foreign language patients. use a professional interpreter a patient has the right to revoke or withdraw their consent at any time (even if treatment has begun). rejection should also be written, signed, and witnessed.

Answer 356

person must be legally capable of making the decision person must demonstrate that this information is understood person must be assured that the decision is totally voluntary process must be free of deceit and coercion consent may be withdrawn at any time person has the right to refuse consent, even if the proposed intervention is in their best interests.

Answer 357

confirming that the person has legal and mental capacity of giving consent. ensuring the right amount of time is given to the conversation demonstrating compassion and concern for the person's well-being being sensitive to cultural and language issues autonomous consent

Answer 358

client is not capable of making decisions there is evidence of causing harms to oneself and/or others unreasonable, futile, or illegal request. incompetent adults, dementia, children, emergency treatment, proxy consent

Answer 359

consent is voluntary signature is authentic patient appears competent to provide consent the nurse's signature does not mean that the nurse will be performing the procedure or that the nurse described the risks/alternatives

Answer 360

written consent, not usually obtained however, clients still have right to refuse always gain permission prior to touching a client fully explain all invasive procedures legal responsibility to ensure clients give consent based on their full understanding about what is happening.

Answer 361

action, inferred form the patient's conduct (e.g., holding out arm for injection. filling a new prescription) a clear statement of assent (e.g., agreeing to a urinary catheterization) formally in writing types of consent: expressed, implied

Answer 362

medications pain controlling nature of health care environment (power and intimidation) impaired emotional state (high emotional charge) social support (or lack of support) culture previous experience (including emotional trauma) fear, anxiety

Answer 363

the ability to understand information provided, retain the information and weigh options presented. if they are not capable, consider advance directive, next of kin, substitute decision maker, or court appointed guardian. if none, is there time to pursue guardianship? clients who lack capacity to consent for themselves should be encouraged to participate in decision-making as they are able. they retain the right to be involved in their care.

Answer 364

the patient must: - have the ability to understand all information - have the ability to communicate understanding and choices - have personal values and goals that guide the decision - have the ability to reason and deliberate can also be applied to the SDM.

Answer 365

power of attorney for personal care (written document) substitute decision maker spouse or partner child or parent (or children's aid society) sibling another relative (next of kin)

Answer 366

advance directives: - enabling a mentally competent person to plan for a time when they may lack the mental capacity to make treatment decisions power of attorney: - person appointed to make decisions limited by the authority contained in the document proxy: - person appointed as health care agent to make treatment decisions living will: - detailed instructions that the client has made; take effect when the client is no longer capable to make decisions for themselves

Answer 367

related to informed consent - essentially it is consent or refusal in advance two main elements to most: proxy directive and instruction directive - proxy directive: designate someone to make decisions on you behalf when yo no longer have the capacity to do so = Substitute Decision Maker (SDM) - instruction directive - instructions that declare what kinds of treatment you do or do not want; provide direction to the SDM. good advance directive also state your values and goals - used to ensure all decisions are in alignment with your wishes

Answer 368

ensure patients have opportunity to complete ensure appropriate time given to adequately deliberate and decide ensure complies with legal, policy, and institutional procedure complete our own (self-awareness of own values/goals) raise public awareness r/t advance directives

Answer 369

if an individual is incapable of giving consent, most provinces have laws addressing substitute decision-makers and advance directives must generally follow the wishes expressed by the client while he or she was capable and, if no such wishes are applicable, act in the best interest of the client. legislation across Canada outlines the hierarchy of substitute decision-makers: - proxy identified by the persons in advance, through an advance directive, power of attorney for personal care - next of kin - legally appointed decision-maker - court appointed guardian

Answer 370

at least 16 years of age capable of making decisions with respect to the treatment not prohibited by court order available, and willing to assume the responsibility of giving or refusing consent

Answer 371

no specific minimum age for consent instead, do they have capacity to understand the nature of the treatment, benefits, risks, side effects, alternatives and consequences of not having the treatment?

Answer 372

in some provinces, a child mature enough to understand the nature and risks inherent in a procedure is given the right to consent. the capacity of the child will depend on each child's age, intelligence, maturity, experience, and other such factors. the information that the child must understand in giving or refusing consent will be provided by the health care practitioner.

Answer 373

Mental Health Acts across the country govern approaches to consent to treatment in circumstances where the person is deemed incapable If the patients are deemed capable; they can make their own decisions Attending physician decides if the patient is capable or not?

Answer 374

common law allows health care providers to administrate treatment during an emergency even if a client's consent cannot be obtained

Answer 375

Health practitioners should document the process and the decision that was made Often captured on specified “consent” forms If not, written note should be included Need to know what procedures require a written consent, and which ones do not

Answer 376

Non-Compliant Should we even use this term? What is really happening here? CAM (complimentary and alternative medicine) Questions re: scientifically unproven and what risks involved? How can we best support? Controversy What to do when patients make controversial choices for themselves or others?

Answer 377

all nurses have a fiduciary relationship with those in their care - fiduciary = the recipient of the care has to trust in the professional's competency and integrity, because of the nature of the services provided. this means the onus is on the nurse to ensure they practice safety and competency - if harm is caused the nurse will be held accountable. this also means that the nurse is responsible to know the legal limits that direct their practice.

Answer 378

To ensure safe and competent practice, the profession of nursing is regulated by professional regulatory body (CRNA), under the statutes of provincial legislation (HPA). Regulatory bodies are responsible for: - Ensuring safe, competent, and ethical nursing care (through standards of practice) - Granting registration and licensing - Ensuring continuing competency - Investigating complaints against members conduct - Disciplining members when necessary - Approving nursing education programs

Answer 379

Duty of Care owed to those who retain our services or are placed under our care Expected to act in a competent and diligent manner to ensure care meets reasonable standards and expectations Competence refers to professional knowledge, attitude, and skills that the nurse must have to work in the profession. Usually codified in Standards of Practice and Scope of Practice type documents

Answer 380

professional misconduct professional malpractice

Answer 381

Professional Misconduct Behavior that fails to meet the ethical and legal rules and standards of the profession Acts (or omissions) that breach or abuse the nurse-client relationship Professional Malpractice Nursing acts that are performed in a sub-standard or careless manner that does not conform to the generally recognized practice standard Does not necessarily involve misconduct

Answer 382

Failure to maintain nursing practice standards (provincial) Failure to uphold the code of ethics Abusing a person verbally, physically, emotionally, or sexually Misappropriating personal property, medications, or other property belonging to the client or employer Wrongfully discontinuing services for, or abandoning, a client Neglecting to provide care to a client Failure to maintain privacy or confidentiality Falsifying records or failing to keep appropriate records. Inappropriately using professional status for personal gain Inappropriately or unlawfully delegating a controlled action

Answer 383

Doing or Saying nothing when action is required (failure to take appropriate action) Injuring a patient with equipment (IV, catheter, lift, etc.) Improper administration of medication (route, drug, patient, time, etc) Acts of negligence (however, negligence is a legal term) Inappropriate or inadequate documentation

Answer 384

Nursing practice is also regulated by Canadian law Nurses must understand the law to protect themselves from liability, and to protect their patient’s rights - Some laws differ from province to province, so need to be familiar with the laws of the province or territory where you work Knowing the law can also help nurses to be better patient advocates

Answer 385

law: system of binding rules of action or conduct. public law: concerned with relations between an individual and the state/government (or society). is the same across the country. - taxes - constitution - human rights - criminal codes private law: concerned with relations between individuals. Quebec uses "civil law". rest of Canada uses "common law". - wills - contracts - marriage and family - civil wrongs (law suits)

Answer 386

Statute law - Created by elected legislative bodies (Parliament, provincial/territorial legislatures) - Federal statutes apply throughout the country - Provincial/territorial statutes apply only in the province/territory of creation Case law - Built on the precedent of decisions set by other similar cases

Answer 387

intentional torts (assault, battery, invasion of privacy, false imprisonment) unintentional torts (negligence)

Answer 388

A civil wrong committed by one person against another causing injury or damage, either to person or property Classified as intentional or unintentional Enables the victim to get compensation from the culpable (guilty) person(s)

Answer 389

assault - conduct that creates the apprehension or fear of imminent harmful or offensive contact - no actual contact is required to be charged with assault battery - the intentional physical contact with a person, without person's consent - can be harmful and bring about injury, or simply offensive to the patient's personal dignity invasion of privacy - protects patient from unwanted intrusion into the personal affairs - includes nurse's duty to keep all information confidential (including electronically) false imprisonment - protects the patient's liberty and basic rights - examples: restraints, discharge

Answer 390

Generally, if the aggrieved person has consented to the conduct being visited upon him or her, the perpetrator may escape liability for such conduct in some cases. No medical treatment may be administered without the patient’s consent, unless the situation is life-threatening and the patient is unconscious or mentally incompetent Can be implicit or explicit

Answer 391

Must be obtained before all treatments (low risk to high risk), procedures (including surgery), some treatment programs (like chemotherapy), and for research involving patients To be valid: - Patient must have legal and mental capacity to consent - Consent must be voluntary without coercion - Consent must be informed (patient understands all options, risks, and benefits)

Answer 392

unintentional tort Negligence May be liable for a tort, even though no harm or injury was intended Consists of nursing actions (or omissions) that do not meet the standard of care established by law May involve inadvertent, thoughtless, or inattentive action violating patient rights; or carelessness

Answer 393

To be liable for negligence, three elements must be present: - Duty of care owed to the patient/client - Breach of that duty of care by healthcare provider - Patient suffered damage as a direct result of the breach of the duty of care

Answer 394

Preventing Negligence: - Follow the standards of care - Give competent health care - Insist on proper orientation, continuing education, and adequate staffing - Communicate with other HCPs - Develop a rapport of caring with the patient - Document all assessments, interventions, and evaluations fully

Answer 395

duty of care: - to be liable, must owe a duty of care personally, as a member of a class of persons (ex. Nurses). - if no duty of care is owed, defendant is not liable to the plaintiff, even if actions/inaction directly caused harm - duties may be outlined in statutes (law, legislation, policy), or common law standard of care: - nurse are held to a high standard - the public has high expectations of our care - standards are outlined by regulatory bodies, and other documents - nursing practice acts - provincial/territorial laws regulating health care agencies - professional and specialty nursing organizations - written polices and procedures - must act as any other "reasonable and prudent nurses" would in the same situation - prudent practice proximate cause - defendant is liable for any harm caused by their negligence - challenge is to prove what harm was or was not caused by the act of negligence - damage must be something that could reasonably be foreseen as resulting from the negligent conduct contributory negligence: - even if the plaintiff is partly to blame at fault for the harm suffered, they can still receive damages for the remaining portion - essentially, damages are reduced by the percentage to which the plaintiff is to blame

Answer 396

Nursing students are responsible to know their own capabilities and competencies and must not perform nursing actions unless competent to do so If a nursing student performs a nursing action, they will be held to the same standard of care as that of an RN You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university If you are employed as an unlicensed HCP, you must know your scope in that role and not exceed it (even if trained).

Answer 397

gross negligence - conduct that drastically departs from the standard of a reasonably competent nurse criminal negligence - by definition, must result in death or serious bodily harm - constitutes a criminal offence that may be punishable by law - includes actions (or lack of action) that "shows wanton or reckless disregard for the lives or safety of other persons" - example: practicing while impaired may be grounds for criminal negligence

Answer 398

Every one who undertakes to administer surgical or medical treatment to another person or to do any other lawful act that may endanger the life of another person is, except in cases of necessity, under a legal duty to have and to use reasonable knowledge, skill and care in so doing. Goes back to our fiduciary responsibility, as well as our standards of care

Answer 399

Used to protect HCPs against the potential costs of litigation Most nurses are employed by publicly funded health facilities, which carry malpractice insurance. - Health care facilities, as employers, are vicariously liable for the negligent acts of their employees. A nurse who performs acts outside the normal scope of nursing would be fully liable for his or her own negligence. Nurses who are self-employed need to consider independent insurance coverage.

Answer 400

Canadian nursing profession's legal support system A not-for-profit society created and operated by nurses for nurses Specifically tailored to meet the professional liability needs of registered nurses in all nursing roles Occurrence-based: registered nurses can seek assistance from the CNPS in respect of any incident arising from nursing practice that occurred while they were members of a CNPS member organization, irrespective of when a claim arising from this incident is made or a civil action is commenced.

Answer 401

Employers have a common law duty to take active steps to ensure that nurses falling short of a standard receive the appropriate improvement plan. The employer may be held liable otherwise. These steps may include counseling, education, and disciplinary measures.

Answer 402

Short staffing: - Legal problems occur if there is an inadequate number of nurses to provide care - Should not walk out – may be charged with abandonment Floating: - Based on census load and patient acuities - Can only practice within your level of competence Physician’s orders: - Nurses follow orders unless they believe an order is in error, violates agency policy, or is harmful to patients - Nurses also have a duty to make sure the physician is properly informed Dispensing advice over the phone - High-risk activity and legally accountable Contracts and employment agreements - Nurse expected to perform competently, adhering to policies and procedures of agency

Answer 403

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Steps involved: - Identify possible risks - Analyze risks - Act to reduce risks - Evaluate steps taken Incident report (adverse occurrence report) - Requires sufficient documentation

Answer 404

Unexplained or unexpected death must be investigated to determine the cause of death If there is any evidence of negligence, the coroner may order an inquest - Becomes a court case (but not a criminal trial) - Primarily fact-finding and investigatory endeavor Some provinces (Alberta) moving to a Medical Examiner system - Basically the same If you think it may become a coroner’s case, DO NOT TOUCH the body in any way, in order to preserve evidence

Answer 405

Documentation is your best defense Documentation is one of the most important skills to learn, and often one of the most difficult to do well. Documentation: - includes anything written or produced electronically that describes the status of the patient or the care/service provided The nurse’s assessment and progress notes monitor the course of treatment and the effect of interventions on a continuing basis As much as 35% of nurses’ time is spent on documentation

Answer 406

facilitate communication between health care professionals planning a course of treatment record of the care the patient has received legal use as part of audits, disciplinary proceedings, civil or criminal proceedings, or coroner's inquests education of health care providers research

Answer 407

Anything written or electronically generated that describes the status of a client or the care given to that client Chronological record of nurse’s assessment , decisions, interventions, and client outcome Prompt and effective documentation can positively affect the quality of life and health outcomes for clients and minimize the risk of errors. documentation is a written form of communication. we know what happens with miscommunication. failure to document or failure to review client information can negatively influence quality of care

Answer 408

factual - contains descriptive, objective information - avoid subjective info or opinion accurate - truthful and exact - concise and clear - easy to understand (includes abbreviations, acronyms, symbols, etc.) - only use approved abbreviations - correct spelling and grammar (errors can make meaning unclear) organized - follow a logical order/pattern - example: head to toe timely - should occur as soon as possible after the assessment, incident, or intervention - describe events chronologically - flow sheets may also be used - different expectations on frequency complete - include all appropriate and essential info - chart only your actions and observations - signed (shows your accountability to what has been charted) - not charted = not done compliant with standards - CRNA documentation standards 2022 - agency/employer standards - ex. inclusion vs. exclusion correcting errors phone/verbal orders charting by inclusion vs. exclusion

Answer 409

Discharge status: Alive but without permission. The patient has no previous history of suicides. She has no rigors or shaking chills, but her husband states she was very hot in bed last night. Patient has chest pain if she lies on her left side for over a year. On the second day, the knee was better, and on the third day it disappeared. The patient has been depressed since she began seeing me in 1993. The patient expired on the floor uneventfully. She slipped on the ice and apparently her legs went in separate directions in early December. By the time he was admitted, his rapid heart had stopped and he was feeling much better. The patient is a 79-year-old widow who no longer lives with her husband. Reason for leaving AMA – “pt. wants to live” MD @ bedside, attempted to urinate.

Answer 410

Initial and ongoing assessments - eg: pain, wounds, compromised skin integrity, conversations had with clients/family Current signs/symptoms Interventions (What did you DO?) - eg: non-scheduled medications administered (prn), health teachings Patient response. (What happened?) What did you do to ensure safety? (callbell within reach, siderails up) Attempts to contact another health care provider (physician) How is the person's ability to manage needs after discharge?

Answer 411

falsifying records / documenting ahead of time failing to record client changes failing to document notification of primary provider incomplete documentation failing to follow polices documenting the observations and/or the work of others

Answer 412

Erase, apply correction fluid, or scratch out errors Write critical comments about client or care by other health care professional Rush to complete charting Speculate or guess Leave blank spaces in nurse’s notes Use felt tip pens or erasable ink Chart for someone else Use generalized empty statements such as “status unchanged” or “had a good day” “Pre-chart” or wait until the end of shift to record important changes

Answer 413

Be considerate: offer the chart to another healthcare provider, when requested Communicate: where are you taking the chart? (in the event that it has to be located quickly) Replenish forms Keep the charts intact: never remove individual papers from the record. It becomes too risky to lose a part of the document gather thoughts and a draft on a separate sheet of paper. this enables you to receive feedback/editing assistance

Answer 414

The courts look to the patient’s chart for a chronological record of all aspects of the patient’s care from the time of admission until discharge Courts use nursing documentation at trial to reconstruct events, establish times and dates, refresh the memories of witnesses, and to resolve conflicts in testimony What will the courts look at? - Nursing Notes - Checklists - Flow Charts (ex. Vitals, Ins and Outs) - Hospital policies - Etc. The patient’s chart may also be entered as evidence at a trial to support your defence. - Your lawyer will rely heavily on your charting to establish that your nursing actions were “reasonable and prudent” in the circumstances, and to show that you did not cause the patient’s injuries. - Conversely, the patient’s lawyer will use the patient’s chart to try to show that you failed to meet the standard of care of a reasonable prudent nurse.

Answer 415

In order for notes to be used as evidence, the court must be satisfied that - the notes were made by the person testifying - it was part of that nurse’s duty to make notes - the notes were made contemporaneously with the event (or reasonably so) - there have been no alterations, additions, or deletions to the notes Trials can occur years after the event, making it impossible to rely on memory Meticulous, clear, and well-organized records help the court determine how events took place (sequence and circumstances) - Timely records will carry more weight. Delays raise questions about accuracy. Inadequate or missing documentation can have serious consequences - Vague or incomplete documentation undermines the testimony. Testimony can be strengthened or weakened by records

Answer 416

electric charting - Benefits: greater legibility, reduced errors, decreased time spent documenting, mobility, improved communication, greater opportunities for monitoring and improving care, difficult to tamper with documents or timelines - Challenges: security vs. access, confidentiality, legality of electronic signature expert witness - Can interpret the health care record and assist the court in reconstructing events - Can be used by the plaintiff or the defence - Are permitted to express an opinion and describe an appropriate standard of care and documentation telephone advice (and other media) - a nurse must exercise caution when giving advice over the phone (or via other media) - document: the patient's name and contact information; the symptoms reported; the advice or referrals given (and time frame for follow-up); the data and time of the call. - if in doubt, do not give advice. arrange to meet instead. - advise the caller to go to the nearest emergency department without delay if his or her problem seems serious (and document same)

Answer 417

Health Link Alberta provides health advice and information through a toll-free phone number to all Albertans. Access is 24 hour, 7 day a week and support is provided by experienced registered nurses and other health-care professionals. To help meet the needs of Alberta’s diverse populations, Health Link Alberta provides access to translators in up to 120 languages. These translators quickly (within two minutes) become a part of a three-way conversation including the caller and Health Link Alberta staff. The goal of Health Link Alberta is to support Albertans in managing their own health. The result is a more knowledgeable public, fewer hospital visits and healthier communities. By having a single, coordinated service across the province, Alberta Health Services is able to provide consistent information to the public.

Answer 418

May be in paper format or digital Do not form part of the health record Used for investigative and quality improvement purposes May be used to provide staff education and address system issues

Answer 419

Nurses should know the legal boundaries affecting their practice : - To protect themselves from liability - To protect client’s rights Courts will prove / disprove that nurses provided a reasonable standard of care.

Answer 420

Many of our most challenging legal and ethical issues in health care are associated with the end of life. Dying has become more complex. We now have the technology to preserve life, even long after a person's ability to interact with the world has gone.

Answer 421

HUGE Advancements in past 100 years * Medications * Surgical techniques * Machines/equipment * Diagnostics * Specialized Treatments * Increased Knowledge Benefits: Saved lives, Improved Quality of Life, Prevented disease, Alleviated suffering Challenges: Ensuring death remains dignified

Answer 422

Minimize suffering Compassionate care Respect for different perspectives about death and dying Dignity Presence during time of death Comfort to the client and family: share information, permit questioning, clarifying, listening Facilitate traditional practices, respecting cultural diversity (by asking)

Answer 423

Quality Of Life - Living constitutes MORE than just physical existence - Quality — what makes life worth living - Subiective and individualized Quantity of Life - Sanctity of Life - All life must be preserved - All life must be valued Nurse's Role at End-of-Life: - Clarify the patient's (and family's) values regarding quality of life - Explain treatment options and their potential impact on preservation of life AND quality Of life

Answer 424

Life-sustaining treatment is withdrawn Previously labelled as "passive euthanasia" Difficulty arises when patient or family views contrast with that of the health care team Courts have generally upheld the process when continuation prolongs suffering

Answer 425

Justifies the provision of appropriate pain relief, even if it may hasten death, because: - a subsequent effect of that good intention may or may not hasten death - the good intention is to eliminate pain There is legal and ethical support for such actions

Answer 426

Who gets to declare death? When is someone "truly dead"? With technological advances, new criteria were needed - Harvard Medical School criteria: * Brain death is cessation of all brain function (both cerebral and brain stem) * Must be irreversible - This is the criteria used in most Canadian provinces and territories

Answer 427

Some have suggested the definition include cortical death, which would include: * anencephalic neonates * patients in a persistent vegetative state Procedural and ethical questions would include: * At what point would the declaration of death occur? * Would it apply universally? * Can death be redefined because it is suitable?

Answer 428

Communication and facilitating communication is crucial, especially when there is disagreement

Answer 429

Enhancing quality of life Dignity with dying (dying peacefully) GoaIs of palliation: 1 )Prolonging life 2)Promoting a quality dying process and a dignified death 3)Controlling pain 4)Hastening the end of life

Answer 430

Definitions: * Burkhardt et al.: situations in which interventions are judged to have no medical benefit or in which the chance for success is low * CNA (2001 a medical treatment that is seen to be non-beneficial because it is believed to offer no reasonable hope of recovery or improvement of the patient's condition Who gets to decide? * Historically, was up to the physician * Now, involve family, nurses, other team members Nurses often play key role in identifying futile care, but also providing it * Can lead to moral distress, compassion fatigue, and even traumatic stress

Answer 431

DNR vs. "No CPR" New: Goals of Care * Far more distinctions * It is better to focus the discussion on allowing for a natural death * Decisions must be made in context, and nurses play a vital role Who decides? * Historically made by physicians * New move toward patient/family making the decision * Decision making can place a significant burden on the patient/ family to either "do nothing" or "play God"

Answer 432

Come into effect should a person become incompetent or incapacitated. They provide: * instructions regarding decisions about care * a substitute decision maker Since it is difficult to envision all possible scenarios, a recent trend is towards life-values advance directives, which... * can outline values in advance * are not yet legal in all provinces

Answer 433

Used to be called "euthanasia" or "physician-assisted suicide" and was considered illegal An act that brings about the immediate death of a terminally ill patient A means to end suffering and allow death with dignity * Seen as an act Of compassion by those who support it Legal in the Netherlands since 2002 (one of the first), with due process *the illness must be terminal, with no hope for recovery *the request must be voluntary and well considered *the patient must be suffering unbearable pain - a second physician must be consulted New Guidelines and Process in Canada o CRNA Medical Assistance in Dying Standards of Practice for Nurse Practitioners (2016) Revisions/Updates being debated currently Worries of a "slippery slope"

Answer 434

recall: conscientious objection 10 day waiting period Age: 18 or Older Serious, incurable disease or disability Irreversible decline in capability Physical or psychological suffering is intolerable and cannot be relieved under conditions the client considers are acceptable Natural death is reasonably foreseeable Client must be capable of making their own decisions Demonstrate voluntary request for MAID (no coercion) Provide informed consent (information provided about methods for relieving suffering) 2 clinicians (independently) assess criteria 10 day waiting period

Answer 435

care for and comfort the patient and family alleviate fear of the unknown *Ensure they are not alone preserve the patient's dignity and support the family respect the role of culture, spirituality, and religion

Answer 436

Family and Friends Present Space to Be Alone vs. Don't Leave Alone Listen — Need to Talk Alleviate Fears (Nighttime) Physical Touch Provide Comfort Maintain Dignity Promote Independence Respect Decisions

Answer 437

Explain what they are seeing and what to expect Teach them how to participate in care Give options Provide respite Give time to be with loved one

Answer 438

Very stressful time Patient and/or Family expected to make complex and emotionally laden decisions Nurses need to ensure effective and respectful communication, answer all questions, and listen

Answer 439

Number of donors has not kept up with need for organs Due to several issues: - Lack Of declared donors - Technology advances prolong life of potential donors - Timeline for harvesting/transporting organs - Obtaining consent If organ donation is suitable, the family is should be approached for consent - Health care providers should NOT assume that the family would decline; they have the right to make their own decision

Answer 440

Recorded consideration * staff must document and request of all suitable patients Required request * approach all patients on admission Presumed consent * patients must opt out if they do not wish to donate Market strategies * Offer lump-sum payment or funeral expenses Public Education

Answer 441

Inter vivo gifts of tissue can be made * if the donor is living; *consent must be written and signed; and *if the donor is over 18 years of age (with exceptions) * generally, minors or the mentally incompetent can donate under special circumstances For post-mortem gifts of tissue *the laws are more permissive due to great need *consent may be written or oral (in the presence of witnesses) *there is a hierarchy of persons who may give consent if the deceased expressed no wishes - no person may act on a consent if a person with the same or closer relationship to the donor objects

Answer 442

Determination of death Donor management (keep organs viable) Family Recipient responses Can lead to moral distress for staff if the transition from trying to save a life to managing that patient's organs to benefit others is not properly handled

Answer 443

Patient Considerations * In light of the expansion of technology, nurses have responsibility to maintain the human focus of nursing care Nurse Considerations * Nurses also need to recognize their own needs for debriefing and self-care when dealing with death

Answer 444

The spirit gives life to, or animates, a person. It is the essence of the individual being. Described as the center of all aspects of a person's life, whatever gives that person ultimate meaning. Spirituality remains a highly subjective, complex, and ineffable concept. Separate from religion (though often connected for the individual) * Religion is "an organized system of beliefs regarding the cause, purpose, and nature of the universe that is shared by a group of people, and the practices, behaviors, worship, and ritual associated with that system."

Answer 445

creativity passion purpose forgiveness trust hope peace interconnection meaning

Answer 446

Defined as "a connectedness with self, others and the sacred that transcends and empowers the self" Spirituality has the power to mobilize personal capacities, illness-coping strategies, and positive health behaviours Seen as an integral component of holistic health and health promotion Studies have shown positive effects of spirituality on mental health, pain management, the healing process, and other aspects of health Prayer, meditation, contemplation, sacraments, rituals, and other practices that support spiritual and religious expression may reduce stress and support health and healing

Answer 447

HISTORICALLY, NURSING ORIGINATED FROM RELIGIOUS ORDERS * THERE IS A LONG HISTORY OF SPIRITUALITY ASA PART OF NURSING CARE * NURSES ORIGINALLY SAW THEIR "CALLING" AS ONE FROM GOD. MANY EARLY NURSES WERE MEMBERS OF RELIGIOUS ORDERS * NURSES THEMSELVES WERE EXPECTED TO BE PURE AND VIRTUOUS (RELIGIOUS CONCEPTS) RELIGIOUS AND SPIRITUAL CONCEPTS WERE PART OF MANY NURSING THEORIES, EVEN TO THE PRESENT TIME * SPIRITUAL HEALTH IS STILL CONSIDERED AN ASPECT OF HOLISM/HOLISTIC CARE MANY RELIGIOUS ASPECTS HAVE DIMINISHED WITH THE FLOURISHING OF AND RELIANCE ON MEDICAL SCIENCE * INTERESTINGLY, MEDICAL SCIENCE IS NOW TRYING TO EXPLAIN AND EXPLORE THE CONNECTIONS BETWEEN SPIRITUALITY AND HEALTH

Answer 448

PATIENT'S SPIRITUALITY HAS WELL DOCUMENTED IMPACT ON: * PATIENT SUFFERING * PATIENT COPING * PROMOTING HEALING IF DON'T ADDRESS SPIRITUAL NEEDS: * RISK GREATER SUFFERING * COMPROMISED ABILITY TO NAVIGATE HEALTH CHALLENGES individual balance, boundaries, harmony - spiritual dimension (intuition, wisdom, experience) - physical dimension (respect, kindness, vision) - emotional dimension (honesty, relationships, time) - mental dimension (reality, responsibility, nurturing)

Answer 449

Illness/lniury * Can cause suffering and loss * For some, leads to questions about spirituality/religion * Can feel abandoned by God * Can lead to anger * For others, increases their spiritual and religious practices * Prayer, services, rituals Terminal illness/End-of-Life * Question meaning of life and what comes after * Spirituality and religion can provide answers/meaning * Improved ability to cope * Provide source of comfort and strength * Alleviates fear

Answer 450

Healthcare culture, focused on science and technology, often discourages interaction with patients on the spiritual level Nurses received mixed messages in workplace and education about the importance and relevance of spiritual nursing care Nurses feel uncomfortable addressing spirituality - See it as intrusive, irrelevant, beyond their expertise

Answer 451

Name and explore their fears and concerns Find supportive mentors who model holistic practice Deepen their spiritual awareness and growth Gain awareness about various spiritual beliefs and practices

Answer 452

Before I can provide spiritual care, I must reflect on my own spirituality to begin understanding what this means, for me. Spiritual beliefs are diverse and have individual influences Spiritual Assessment - Meaning and purpose - Inner strengths - Interconnectedness This includes cultural beliefs

Answer 453

NEED TO UNDERSTAND THE PATIENT'S SPIRITUALITY AND SPIRITUAL NEEDS * ASK: REQUIRES GOOD COMMUNICATION * SEEK TO UNDERSTAND THE VALUES, BELIEFS, AND PRACTICES THAT ARE IMPORTANT TO CONSIDER AND INFORM CARE * FIND OUT WHAT THE PATIENT EXPECTS FROM YOU (LISTEN, SUPPORT SPIRITUAL PRACTICES, MAKE REFERRALS, ETC.) WANT TO AVOID HARMING THE PATIENT BY "BREAKING" THEIR RELIGIOUS/SPIRITUAL CONSIDERATIONS CAUTION WITH "ASSESSING" OR "TREATING" SPIRITUALITY

Answer 454

Invite patients to share their spiritual beliefs and values Learn about those beliefs and values Open an opportunity for compassionate care Empower patients to draw on their resources for healing and acceptance Identify practices and beliefs that are important for the plan of care Identify those patients who would benefit from a referral to a spiritual care provider

Answer 455

IDENTIFY POINTS OF COMMONALITY ACROSS DIVERSITY * MANY NURSES FOCUS ON MAKING A HUMAN CONNECTION THAT TRANSCENDS DIFFERENT BELIEF SYSTEMS * CAN INVOLVE ACTIVE LISTENING, ACKNOWLEDGING BELIEFS AND "CUES", CONTACT/TOUCH, TONE AND NON-VERBAL, AND EMPATHY UNDERSTAND AND RESPECT APPROPRIATE NURSE-PATIENT BOUNDARIES ENSURE YOU ARE COMPETENT TO ENGAGE IN SPIRITUAL CARE; SEEK/REFER TO OTHERS IF YOU FEEL THAT YOU ARE NOT HOWEVER, DON'T OVERLOOK SPIRITUAL CARE OR AVOID PROVIDING IT BE FULLY PRESENT: SLOW DOWN, TAKE TIME THERAPEUTIC USE OF "SELF" BE SILENT; DON'T HAVE-TO-HAVE ANSWERS OFFER PRAYER RECOGNIZE AND SUPPORT MOMENTS OF CONNECTION MOBILIZE RESOURCES WISHES AND DREAMS FINDING MEANING OR MEANING MAKING

Answer 456

faith and belief importance community address in care

Answer 457

DEFlNlTlON 0F SPlRlTUAllTY: "WHATEVER OR WHOEVER GlVES UΙΤΙΜΑΤΕ MEANlNG AND PURPOSE ΙΝ ONE'S LlFE, ΤΗΑΤ lNVlTES PARTlClULAR WAYS OF BElNG ΙΝ ΤΗΕ WORLD ΙΝ RELATlON ΤΟ OTHERS, ONESELF ΑΝD ΤΗΕ UNlVERSE“ SPIRITUALITY IS ΑΝ INTEGRAL DlMENSlON OF ΑΝ lNDlVlDUAL'S HEALTH SPlRlTUAL BELIEFS ARE DIVERSE: R/T lNDlVlDUAL AND CULTURAL INFLUENCES BElNG ATTENTlVE ΤΟ ΑΝ lNDlVlDUAL'S SPIRITUALITY IS A COMPONENT OF A HOLlSTlC NURSlNG ASSESSMENT ΑΝD NURSlNG PRACTlCE CNA SUPPORTS ΤΗΕ DEVELOPMENT, TEACHlNG ΑΝΟ PRACTlCE OF COMMUNlCATlON STRATEGlES ΤΗΑΤ CREATE OPENNESS AND SKILL ΙΝ DlSCUSSlONS WlTH lNDlVlDUALS ΑΒΟUT THElR SPlRlTlUAL BELIEFS GROWING INTEREST IN THE SPIRITUAL ASPECTS OF HOLISTIC CARE SPIRITUAL CARE PRACTICES MAY EASE SUFFERING SPIRITUALITY HAS A WIDE AND DIVERSE SET OF ORIENTATIONS AND INTERPRETATIONS NURSES NOT REQUIRED TO BE KNOWLEDGEABLE IN PARTICULAR SPIRITUAL TRADITIONS, BUT THEY ARE REQUIRED TO BE OPEN TO INVITING OR ALLOWING REFLECTION BY THE INDIVIDUAL ON THE SPIRITUAL DIMENSION OF HIS OR HER EXPERIENCE OF ILLNESS AND SUFFERING SELF-REFLECTION ON PERSONAL SPIRITUAL BELIEFS MAY BE BENEFICIAL PRACTICE THERAPEUTIC COMMUNICATION THAT CAN CREATE AN OPENING FOR DISCUSSIONS WITH INDIVIDUALS ABOUT THEIR SPIRITUAL BELIEFS AND VALUES TAKE INTO ACCOUNT THE UNIQUE SPIRITUAL BELIEFS AND VALUES OF INDIVIDUALS, FAMILIES AND COMMUNITIES DURING DECISION-MAKING, TREATMENT AND CARE, INCLUDING THE TERMINOLOGY USED TO DESCRIBE SUCH BELIEFS DEMONSTRATE SENSITIVITY TO AND RESPECT FOR DIVERSITY IN SPIRITUAL BELIEFS, SUPPORT OF SPIRITUAL PREFERENCES AND ATTENTION TO SPIRITUAL NEEDS AS NURSING COMPETENCIES WORK COLLABORATIVELY WITH OTHER CARE PROVIDERS TO BE ATTENTIVE TO THE SPIRITUAL BELIEFS AND VALUES AND THE PHYSICAL AND PSYCHOSOCIAL NEEDS OF INDIVIDUALS AND FAMILIES AT ALL STAGES OF LIFE

Answer 458

the process of moving toward wholeness in all dimensions of health, encompassing the mental, emotional, physical, relational, cultural, and spiritual; as such, it may or may not be associated with curing disease or disorder.

Answer 459

relevant, nonintrusive care that tends to the spiritual dimension of health by addressing universal spiritual needs, honoring unique spiritual worldviews, and helping individuals to explore and mobilize factors that can help them gain/regain a sense of trust in order to promote optimum healing.

Answer 460

an organized way of expressing and nurturing spirituality through affiliations, rites, and rituals based on creeds, codes of conduct, and communal practices.

Answer 461

a spiritually healing environment in which individuals are supported and nurtured, in which they feel spiritually calm, where they are connected to elements of nature, and in which health and well-being are promoted.

Answer 462

the essence of the individual being, expressed, and experienced through multifaceted connections with oneself, others, the environment, and with a universal life force as it is understood by the individual.

Answer 463

the dimension of health associated with "matters of the spirit," as ultimately defined by each individual.

Answer 464

a highly subjective and ineffable concept that defies standard definition and encompasses the individual's beliefs; expressions of these beliefs; perceptions of the meaning of life and death; and how the person relates to self, others, the world, and the possibility of greater power.

Answer 465

processes of inner quieting to help attain a state of calm centeredness and receptive awareness, which nurtures the spirit and deepens insight, attention, and compassion for oneself and others.

Answer 466

distress, pain, and anguish, whether physical, mental, emotional, and/or spiritual, which can challenge the very trust we have in life.

Answer 467

an experience of moving to higher levels of self-awareness, consciousness, and spiritual well-being that offers individuals new possibilities and choices in their lives and in their relationships.

Answer 468

a way of being with patients that involves a deeply authentic connectedness and produces an unconditional acceptance of each patient's essence or spirit, regardless of feelings, behaviours, challenges, or any part of their lived experience.

Answer 469

a mental map containing a set of core beliefs and meanings that we use to explain the world around us and guide our way of being in the world.

Answer 470

Traditions Spiritual and/or religious practices, individually or in community, current and past (as relevant to care/healing). Reconciliations Unresolved issues and exploration of how/if these might be reconciled. Understandings Personal beliefs and how they influence well-being positively and/or negatively (i.e., sustaining, distressing?) Searching Existential and/or faith questions prompted by current challenges. Teachers Spiritual/religious mentors and internal/external resources the individual trusts to help sort through relevant issues.

Answer 471

The practical expression of presence, guidance, and interventions, interventions, individual or communal, to support, nurture, or encourage an individual's or group's ability to achieve wholeness; health; personal, spiritual, and social well-being; integration of body, mind, and spirit and a sense of connection to self, others, and a higher power.

Answer 472

It is a broader concept than religion. It involves a personal quest for meaning and purpose in life. It relates to the inner essence of a person. It is a sense of harmonious interconnectedness with self, others, nature, and an ultimate other. It is the integrating factor of the human person.

Answer 473

Paying attention to a particular way: on purpose, in the present moment, and nonjudgmentally.

Answer 474

Our attitude toward the situation What we see, hear, and attend to How we interpret what we take in What we think the outcome will be How we act (including what we feel, say, and do) How we appraise the consequences of our actions

Answer 475

Personal Time and Interests Need for Socializing (but with some boundaries) Maintaining Sleep Schedules Healthy Diet Mental Health Get Involved – Make Connections

Answer 476

PLAN Make a plan, be prepared. Don’t get overwhelmed by leaving everything till the last minute. ANTICIPATE Use strategies to help you manage demands on your time. School, work, family, and social time.. ALL are important. DELEGATE Responsibility to protect your own health as well as the health of others.

Answer 477

includes research, theory development, reflection IN and ON practice Related fields: biomedical sciences- A&P, pharmacology, social sciences- psychology, sociology, anthropology, humanities- art, music, story

Answer 478

Nursing knowledge: Developed through formal and informal processes - Nursing school vs. practice experience - Research vs. reflection We draw on practice knowledge from related fields Nursing knowledge is dynamic & evolving Nursing theory: provides structure for our thinking Nursing Practice: learning in practice setting

Answer 479

Conscious activity looking back on practice to see if you can improve it Reflecting after something has happened Reconsider the situation Think about what needs to change in/for the future Thinking on your feet, and responding Reflecting as something is happening Deciding how to act Thinking ahead Analyzing Experiencing Critically responding

Answer 480

“The process in which individuals take on the responsibility for their own learning process by diagnosing their personal learning needs, setting goals, identifying resources, implementing strategies, and evaluating the outcomes”

Answer 481

Identify Knowledge and/or Practice Gaps Make Goals Develop a Learning Plan/Contract Consider your unique learning styles/strengths

Answer 482

Designed to describe RN practice at the point of entry into the profession and/or initial registration and licensure Expected to be learned in the context of nursing education program Entry-level RN is a beginner – “unrealistic to expect an entry-level RN to function at the level of practice of an experienced RN.” (p. 4) 101 competencies grouped around 9 roles: - Clinician, Professional, Communicator, Collaborator, Coordinator, Leader, Advocate, Educator, and Scholar

Answer 483

Maintaining Competence - Stay current: What you learned in Nursing School will not serve you throughout your entire career - Continuous Improvement - Document your Growth Formal Learning - in-services - conferences - workshops - courses/certificates - advanced education Informal Learning - Reflection in/on Action - Collaboration with Others - Experience - Asking Questions - Learning from Clients

Answer 484

A survival mechanism - “Fight, Flight, or Freeze” A physiological response - Causes changes in the body - Can be short-term or long-term depending on the type of stress Long-term, or chronic, stress is usually the main cause of stress-related health problems

Answer 485

ACTH stimulates release of Cortisol from Adrenal Cortex. ACTH also stimulates release of epinephrine and norepinephrine from Adrenal Medulla.

Answer 486

ACUTE STRESS - the body prepares to defend itself - it takes about 90 minutes for the metabolism to return to normal when the response is over CHRONIC STRESS - stimulated by various factors in life: expenses, work, family, health, etc. - this is the stress we tend to ignore or push down. - left uncontrolled this stress affects your health - your body and your immune system EUSTRESS - stress in daily life that has positive connotations - examples: marriage, promotion, baby, winning, new friends, graduation, etc. DISTRESS - stress in daily life that has negative connotation - examples: divorce, punishment, conflict, injury, negative thoughts/feelings, financial problems, work difficulties

Answer 487

Occurs when a continuous state of acute stress responses keeps the body on constant alert Disrupts the normal fluctuations of cortisol levels in the body Consistent high levels of stress (and cortisol) contribute to several health issues.

Answer 488

Numerous studies have reported high levels of stress and mental health disruptions amongst nursing students High levels of stress and mental health disruptions are also seen in the nursing workforce The development of resilience is a necessary, but often overlooked component of nursing education High levels of stress in nursing students may affect academic performance and increase stress-related symptoms such as anxiety and illness HOWEVER: - Not all stress is harmful - Learning to utilize and implement effective coping techniques = opportunity to engage with stressors in a productive, healthy way

Answer 489

The American Psychological Association (2018) defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress” (para. 4) Resilience is the ability to recover quickly from difficulties or tough times Resilience is NOT a fixed attribute Research shows it is a dynamic process which can be taught, developed, and enhanced (Reyes, Andrusyszyn, Iwasiw, Forchuk, & Babenko-Mould, 2015) Building resilience helps us to combat the effects of stress by giving us the ability to adapt and ‘bounce back’ from adversity.

Answer 490

The Presence of Being Mindfulness is the psychological process of purposely bringing one's attention to experiences occurring in the present moment without judgment, which one develops through the practice of meditation and through other training (Kabat-Zinn, 1994)

Answer 491

An online program of practicing mindfulness - Links added to CANVAS course page Widely implemented as a technique to reduce the negative effects of chronic stress Frequent and regular practice has been shown to produce better results

Answer 492

A mind-body practice grounded in silence and stillness An experiential exercise that you can do by yourself and for yourself Includes a variety of practices to relax the body and still the mind Is psychologically and physically refreshing and energy restoring Studies have shown it relieves nervous system stress more efficiently than either dreaming or sleeping

Answer 493

Progressive Relaxation = a method of decreasing muscular tension to promote a relaxation response On-the-spot Relaxation = instant techniques that can be used in the face of sudden or unexpected stressful situations - Breathing techniques - Meditation - Prayer - Mental Imagery Stretching for Relaxation

Answer 494

Internal dialogue has been shown to have significant impacts on behavior and performance Goes on continually – need to be cognitively aware of it and learn to direct it Can be destructive or constructive

Answer 495

Starts with an assessment: - What am I telling myself? - What negative thoughts am I generating that are destructive to me? - What positive thoughts am I generating that are constructive to me? - Is my self-talk helping me? - How can I change my self-talk so that it is more positive?

Answer 496

Self-talk statements of what you want, written in the positive tense, as if they have already happened Can help you remain optimistic Language matters – reframe to more positive terms