Professional Accountability Flashcards
1
Q
Professional accountability requires what?
A
requires perioperative registered nurses to be responsible for their specific behaviors
2
Q
What are the behaviors that should that nurses are responsible for?
A
- working within the perioperative scope of nursing practice
- adhering to regulatory standards and guidelines
- maintaining personal and professional growth
- participating in interprofessional collaboration
- participating in quality improvement practices
- encouraging and supporting a culture of safety
3
Q
What 2 things provide guidance for implementing nursing care?
A
professional standards and a legal framework
4
Q
the perioperative scope of practice is framed by what?
A
a combination of laws, standards, and guidelines established by authoritative regulatory and professional organizations
5
Q
Professional standards delineate activities related to?
A
performance, performance improvement, continuing education, ethical behavior, responsibility, and accountability
6
Q
Standards are developed by both what?
A
regulatory agencies and professional organizations
7
Q
How do regulatory agency standards vary from professional organization standards?
A
regulatory agency standards are legally binding vs. professional organization standards are voluntary
8
Q
Regulatory guidelines define what?
A
the boundaries of perioperative nursing practice
9
Q
What are the 3 primary agencies that influence nursing practice?
A
- the CDC
- the Centers for Medicare and Medicaid Services (CMS)
- the Occupational Safety and Health Administration (OSHA)
10
Q
What has the CDC created?
A
a list of recommendations for infection prevention related to HAIs. starting with Standard precautions
11
Q
HAIs have been associated with as little as what?
A
to contact between the patient’s skin and the contaminated hands of personnel and/or other patients or contaminated surfaces in the environment
12
Q
What did the CDC publish to minimizie risk for HAIs?
A
practice guidelines called standard precautions
13
Q
What are the CDC recommendations for prevention infections?
A
- hand hygiene practices
- environmental cleaning and disinfection practices
- use of PPE
- reprocessing standards
- respiratory hygiene practices
14
Q
Health care facilities depend on what for financial reimbursement?
A
depend on good patient outcomes
15
Q
The CMS has oversight for what?
A
for enforcing conditions for participation that determine reimbursement fees and fee-for-service regulations
16
Q
the most notable aspect of the CMS fee-for-service and reimbursement regulations is related to what?
A
related to patients who have hospital-acquired conditions (HAC)
17
Q
An HAC is an adverse event that is deemed preventable if…
A
current evidence-based practice guidelines were followed
18
Q
CMS lists how many categories of HACs that negatively affect reimbursement
A
14
19
Q
2 of the most pertinent categories of never events for the perioperative speciality include what?
A
retained foreign objects and surgical site infections
20
Q
the perioperative nurse plays an important role in helping to prevent hospital-acuqired conditions how?
A
by implementing evidence-based practice guidelines
21
Q
What is OSHA’s mission?
A
to ensure safe working conditions.
22
Q
OSHA regulations that are pertinent to the perioperative setting include what?
A
managing infectious diseases, establishing a culture of safety, addressing workplace violence, performing safe patient handling, and managing biological and chemical exposure risk
23
Q
What is the purpose of the CDC?
A
protects Americans from health, safety, and security threats
24
Q
What are the 2 key elements of the CDC?
A
- Sets guidelines for the prevention of health care-associated infections (i.e. standard precautions, airborne precautions)
- provides infection prevention guidelines
25
What is the purpose of the CMS?
improves patient outcomes
26
What are the 5 key elements of the CMS?
1. was previously called the health care financing adminstration (HCFA)
2. Focuses on decreasing fraud and abuse
3. Establishes value-based incentive reimbursement
4. Ties reimbursement to improve patient outcomes
5. Enforces compliance with the Health insurance Portability and Accountability Act (HIPPA)
27
What is the purpose of OSHA?
Ensures a safe and healthy work environment for both workers and paitents
28
What are the 3 key elements of OSHA?
1. provides a list of patient and employer rights
2. Publishes compliance standards
3. Requires employers to comply with standards
29
Is accreditation voluntary?
yes, denotes a commitment of excellence
30
In order to be eligible for reimbursement from CMS a facility must be what?
must be accredited
31
What is the focus of accrediting organizations?
patient safety and quality care
32
What are the 2 accrediting organizations that affect perioperative practice?
1. the Joint Commission
2. the DNV GL (Det Norske Veritas (Norway) and Germanischer Lloyd (Germany))
33
TJC does what?
accredits health care organizations that maintain performance standards by identifying and implementing the best practices
34
TJC publishes what?
both the National Patient Safety Goals (NPSGs) and the Surgical Care Improvement Project (SCIP) for improving patient safety and quality
35
NPSGs address what?
speciifc patient safety concerns and patient safety risk areas with EBP strategies
36
What is an example of an NPSG?
patient identification is a potential risk for patient safety
37
the NPSG requires what in regards to patient identification?
using a minimum of 2 specific patient identifiers to prevent patient identification errors
38
When were the first set of NPSGs published? How often are they updated?
2003; updated annually
39
Each year, what does TJC decide?
Whether to keep an established goal or retire the goal based on data collected from the previous year
40
NPSGs are specific to what?
health care facility type
41
Both hospital and ambulatory NPSGs contain what?
guidelines specific to the surgical specialty
42
How are SCIP designed?
specifically designed to improve surgical care by reducing surgical complications
43
TJC and CMS collaborate to develop what?
specific SCIP measures
44
How often are the SCIP measures updated?
updated annually
45
SCIP measures are specifically focused on what?
on the surgical specialty and should be understood by all staff
46
the core measures of the SCIP related to what?
infection prevention, beta blocker therapy, and venous thromoembolism prophylaxis
47
When was the DNV GL formed?
2013
48
What was the DNV GL formed to be?
formed as an international certification body and classification society
49
How are the DNV GL and TJC similar?
they make surgery visits
50
The DNV GL focuses on what?
quality management projects that support consistent work processes
51
What are the defining organizations that help guide perioperative practice?
1. the state boards of nursing
2. American Nurses Association
3. the Association of perioperative registered nurses
52
The National Council of State Boards of Nursing (NCSBN) was established to what?
to protect the public by helping ensure that nurses practice in a safe, competent way
53
What is the NCSBN?
an independent, not-for-profit organization through which state BONs act and counsel together on matters of common interest and concern affecting public health, safety, and welfare, including the development of nursing licensure examinations
54
A provision of the NPA in each state is what?
the establishment of a board of nursing responsible for creating rules, regulations, and standards that define nursing practice in that state
55
the NPA gives what?
authority to regulate the practice of nursing and the enforcement of law to an administrative agency or BON that is charged with maintaining the balance between the rights of the nurse to practice nursing and the responsibility to protect the public health, safety, and welfare of its citizens
56
It is the nurses' responsibility to read and understand what in their state of licensure to ensure compliance with the laws regulating professional nursing practice
NPA
57
the ANA is a membership organization responsible for what?
for creating and promoting nursing standards of care
58
the ANA publishes what?
the Code of Ethics for Nurses with Interpretive Statements
59
What does the Code of Ethics for Nurses with Interpretive Statements address?
addresses the role of the nurse in relation to patient, self, society, and the profession
60
The Code of ethics guides nurses how?
guides nurses in providing patient care and in making patient care decisions
61
All RNs are held to what regardless of what?
the same code of ethics
62
What is AORN?
a membership organization that supports the perioperative nursing specialty by providing continuing education, standards of practice, and reosurces for practice such as the Guidelines for Perioperative Practice
63
the AORN guidelines present practice recommendations based on what?
the latest research and EBP standards
64
AORN guidelines provide standards for what?
standards for perioperative nursing practice that promote patient safety and positive outcomes
65
AORN developed the perioperative explications based on what?
the ANA code of ethics for nurses with interpretive statements
66
What did AORN develop standards of perioperative nursing based on?
ANA code of Ethics
67
Based on ANA code of ethics, AORN developed standards of perioperative nursing to do what?
to outline the responsibility of RNs in providing ethical care that reflects the Code of Ethics for the nursing profession
68
AORN is involved with both state and federal governments to what?
pursue legislation related to perioperative nursing
69
What is professionalism?
the behavior and conduct that represent a commitment to and a belief in the profession of nursing
70
What is accountability?
the willingess of a nurse to accept full responsibility for his or her professional practice
71
What is one key aspect of professional nursing practice?
the ability to make independent decisions based on scientific knowledge
72
How can nurses promote independent decisions and AUTONOMY?
by projecting confidence while working within their identified scope of practice
73
What is the hallmark definition of nursing behavior?
concern for the welfare of others
74
what does nursing emody?
true altruism since 1990-an exception to nursing's place as the most trusted profession was in 2001, with firemen earned this distinction with the WORLD TRADE CENTER ATTACKS
75
Fidelity refers to what?
to a nurse's loyalty and faithfulness related to accountability and commitment to the profession
76
The perioperative nurse has a belief system based on what?
personal and professional values that are exhibited in nursing practice
77
Nursing excellence is operationalized in nursing practices when the actions of nurses do what 4 things?
1. demonstrate consistent practice based on scientific knowledge and theory
2. challenge mediocrity
3. integrate patient perspectives
4. align with continuous efforts to develop new knowledge
78
the American Nurses Credentialing Center promotes what?
promotes nursing excellence through the credentialing process
79
the ANCC created the Magnet Recognition program to promote the achievement of 3 primary goals:
1. promoting quality in a facility that supports professional practice
2. identifying excellence in nursing care for patients, and
3. disseminating best nursing practices
80
Facilities that achieve magnet status are recognized nationally as demonstating what?
best practices related to patient safety and satisfaction, a collaborative culture, and a primary focus on advancing nursing standards
81
What is an important part of achieving magnet status?
certification
82
Credentialing for the perioperative nursing community is completed through?
CCI
83
CCI offers what?
1. CNOR credential for perioperative nurses
2. CNAMB credential for ambulatory surgery
3. CSSM credential for surgical services managers
4. CNS-CP credential for the clinical nurse specialist specific to the perioperative speciality
84
the certified nursing professional is required to demonstrate what?
professional growth through lifelong learning that demonstrates continuing competence
85
What allows perioperative nurses to enjoy both personal and professional growth?
continuous professional development
86
What are 6 traits of nursing professionalism?
1. fidelity
2. values
3. excellence
4. altruism
5. autonomy
6. accountability
87
A professional development plan may include what 5 things?
1. participating in educational activities
2. maintaing competency
3. achieving specialty certification
4. seeking advanced degree credentials, and
5. participating actively in professional organizations
88
the 2010 Institute of Medicine (IOM) report The Future of Nursing: Leading Change and Advancing Health includes 4 key messages:
1. Nurses should practice to the full extent of their education and training
2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
3. Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States
4. Effective workforce planning and policymaking require better data collection and an improved information infrastructure
89
the 2010 Institute of Medicine (IOM) report The Future of Nursing: Leading Change and Advancing Health serves as what 2 things?
is both a blueprint for individual nurses to advance their personal professional development and a larger plan for improving patient care
90
What are educational activities that are important for nursing professional growth?
seeking continuing education, participating in facility-based training for equipment and technology, seeking advanced degrees, and committing to remain current with EBP guidelines
91
the 2010 Institute of Medicine (IOM) report The Future of Nursing: Leading Change and Advancing Health discusses the importance of what?
the importance of lifelong learning as a commitment to improving patient outcomes
92
Individual professional accountability includes what?
participating in educational activities to maintain competency
93
Maintaining clinical competency is a what?
a TJC standard
94
Perioperative managers and educators should put what in place to verify that personnel have the necessary skills, attitude, and knowledge to provide safe patient care?
competency assessment strategies
95
Managers and educators should implement assessment strategies that do what?
that evaluate the need for knowledge and skill acquisition pertinent to new hires, core job functions, newly implemented policies, changes in practice, and practices that demonstrate a high patient safety risk or are determined to be problematic
96
Education related to compency standards is directly realted to what?
specialty certification
97
Specialty certification is one way perioperative nurses can do what?
work to the full extent of their education and training as outlined in the IOM report
98
What does the ANA state certification does?
certification validates an individual's knowledge and skills in a defined role and clinical area of practice, based on predetermined standards
99
Increasing knowledge and experience is required to achieve and maintain what?
specialty certification
100
Nurses who seek specialty certification demonstrate what?
a commitment to lifelong learning
101
How is perioperative certification requirements moving toward a more rigorous process of competency verfication?
it includes professional practice activities to demonstrate implementation of current evidence based standards of practice
102
Participation in lifelong learning validates that the perioperative nurse is committed to what?
to improving patient outcomes
103
One study showed that certified perioperative nurses do what 4 things?
1. identify specialty certification as a personal accomplishment
2. have an increased level of personal satisfaction
3. identify certification as an indicator of professional growth
4. demonstrate a commitment to the nursing profession
104
Nurses are expected to provide care with what 4 things?
1. a high level of critical thinking skills
2. collaborate across the health care continuum
3. use advanced technological tools
4. use high-level information management systems
105
What is the purpose of a professional development plan?
to outline the steps required to meet a personal and professional goal of a lifelong learning to promote positive patient outcomes
106
What are 2 examples of interdisciplinary teamwork?
1. participation in shared governance
2. education
107
What is a difference between multidisciplinary and interdisciplinary collaboration?
interdisciplinary collaboration involves professionals who are grounded in their own separate disciplines and specialties coming together to work on a project that represents a "coordinated and coherent whole"
108
Shared governance enlists what 3 key principles?
1. principle 1 - accountability of the primary care nurse
2. principle 2 - foundation is built upon clinical decision making and overall professional accountability
3. principle 3 - must include distributive decision making
109
Shared governance represents a what?
a system where workers are responsible form management specified and direction functions and activities, and managers are accountable for the products of work
110
What does shared governance ultimately do
this distribution of authority and work is aligned in a way that advances efficiency and productivity
111
management is responsible for ensuring what?
that the staff are appropriately trained to provide safe care to all patients
112
Teamwork among staff is important why?
for ensuring each member has the knowledge and skills to function in his or her role
113
Interdisciplinary teams are essential to promote what?
teamwork and education among the perioperative staff
114
How can nurses demonstrate accountability?
for one's own education and support others
115
The ANA nursing scope and standards of practice states that the nurse is responsible for supporting what with preceptoring and mentoring?
is responsible for supporting acculturation of nurses new to their roles by role modeling, encouraging, and sharing pertinent info relative to optimal care delivery
116
The perioperative nurses' commitment to collaborative practice uses what?
uses the unique and complimentary abilities of all members of the team to optimize attainment of desired outcomes
117
Quality improvement helps what?
helps change practice based on the best evidence available
118
What helps to identify processes that do not meet the current standard of practice?
audits
119
What is the process of identifying and gathering evidence upon which practice should be based?
nursing research
120
How can perioperative nurses be assured that nursing practice is both current and contributes to improving patient outcomes?
through research utilization and implementation of EBP standards
121
How is an organization able to identify areas for improvement?
through quality improvement activities and nursing research
122
Sharing the results of activities and research is key to addressing what?
performance improvement to stakeholders
123
What is research utilization?
the application of information discovered in one or more research studies in one's own practice
124
What is commonly used to implement EBP changes that have been identified in an organization?
the Iowa Model of Evidence-Based Practice
125
What does the Iowa Model of Evidence-Based Practice involve?
involves collaboration through a team approach to develop, evaluate, and plan the necessary changes in practice
126
Changes in practice are based on what?
on an identified need followed by a literature search and research utilization
127
How is EBP different from research utilization?
it differs in that EBP is usually applied to a specific clinical probelm
128
When a clinical problem is identified, what does a nurse do?
seeks research information and decide how that information can be applied to solve the problem
129
Performance improvement depends on what?
the effective and timely communication of identified performance indicators that require improvement
130
the ANA created the National Database of Nursing Quality Indicators to do what?
collect and analyze data linked to nursing practice
131
Nursing-sensitive indicators reflect what 3 outcomes of nursing care?
structure, process, and patient outcomes
132
What encompasses structure of nursing care?
supply of nursing staff, skill level of staff, and education of staff
133
What encompasses process of nursing care?
assessment, intervention, and job satisfaction
134
What encompasses outcomes of nursing care?
patient oucomes that improve if there is greater quantity and quality of nursing care
135
nursing-specific indicators put the responsible on the nursing professional to become what?
involved in quality improvement activities
136
What is a just culture?
a culture in an environment that is free of retribution and that is built on trust, accountability, open and honest communication, integrity, and common goals
137
What does working in an environment that promotes a culture of safety and just culture?
contributes to better patient outcomes and satisfaction, lessens the risk of medical errors, and decreases attrition
138
Two behaviors that threaten patient and worker safety and undermine a culture of safety are what?
1. disruptive behaviors
2. impaired practice
139
In January 2009, TJC published a leadership standard that discussed what?
accountability for addressing behaviors that undermine a culture of safety
140
What are 3 key parts of the 2009 TJC leadership standard that address these behaviors that undermine a culture of safety?
1. implementing a zero-tolerancy policy for disruptive behaviors
2. educating all health care team members about the policy
3. holding all team members accountable for their behaviors
141
VitalSmarts study called Silence Kills report identifies 7 crucial concerns as prevalent in the workplace:
1. broken rules and shortcuts
2. mistakes
3. lack of support
4. incompetence
5. poor teamwork
6. disrespect
7. micromanagement
142
ANA and AORN support the belief that a nurse has an obligation to do what?
to speak up and address behaviors that are potentially harmful to patients
143
When speaking up and addressing disruptive behaviors, it is important to do what?
collect all the facts, assume good intentions, ensure a safe environment for the conversation, and state clear objective data
144
What should you do when hit with anger?
diffuse it
145
What is an important part of speaking up?
being supportive of peers and helping them to seek assistance
146
What is an important factor in maintaining safe patient care and outcomes?
appropriately managing impaired or incompetent practice
147
Reporting any practice that is unsafe begins with and is followed by?
begins with consulting supervisory personnel, following by approaching the individual in a clear and supportive manner and by helping the individual access appropriate resources
148
As the patient's adovcate, the nurse's primary responsibility is to what?
protect the patient from harm
149
In perioperative environment, remaining silent about behaviors that lend themselves to adverse outcomes can truly what?
kill
150
The RN nmust follow what when addressing an unsafe care provider?
the facility policy and any regulatory requirements
