Professional Issues Flashcards
1. Explain concepts related to professional issues in emergency nursing. 2. List professional issues in emergency nursing practice. 3. Describe various professional issues in emergency nursing.
4 ethical principles
autonomy
beneficence
nonmaleficence
justice
cultural considerations
cultural assessment cultural competence communication family presence grief and loss
define evidence-based practice
conscious, explicit, and judicious use of current best evidence in making decisions about care of patients
based on clinical experience and research
validity
degree to which an instrument measures what it is intended to measure
reliability
degree to which an assessment tool or measurement produces consistent results
quantitative study
deductive process that uses numeric findings for quantification
examines relationships between variables and determines cause and effect
randomized controlled trial
large experimental research study designed to randomly assign patients to experimental and nonexperimental groups, comparing the results from one form of treatment against a control group that receives the standard of care.
gold standard of research
systematic review and meta-analysis
review of multiple studies on a particular topic that identifies and critically analyzes the best research and makes practice recommendations based on that analysis
cohort study
subjects who have a certain condition or receive a particular treatment are followed over time and compared with another group not affected by that condition
qualitative study
an inductive process involving interviews where words, not numbers, are used to give meaning to data.
involves interaction between researcher and subject
case study
study that generally highlights an unusual or interesting case a practitioner has encountered
define critical incident stress
can produce reactions that may interfere with or overwhelm a person’s ability to function or cope either at the scene or later
behavioral reaction to abnormal event
restlessness
irritability, moodiness
antisocial behavior
increased alcohol
cognitive reaction to abnormal event
poor concentration
confusion or uncertainty
nightmares
physical reaction to abnormal event
vomiting, chills HA disrupted sleep muscle tremors chest pain
emotional reaction to abnormal event
depression and anxiety
intense anger
grief
guilt
critical incident stress management
multicomponent crisis intervention program
steps of debriefing in critical incident stress management
introduction details of event emotional responses personal reactions/actions symptoms instruction phase resumption of duty followup
defusing in critical incident stress management
20-45 min conducted w/in 12 hours of event
small number of people
debriefing in critical incident stress management
7-step process
1-3 days after event
benefits of lifelong learning
promotes competence enhances working knowledge advances skills improves pt healthcare personal/professional development career goals
define triage
to sort - the process of determining and prioritizing patients’ treatments based on severity of their conditions
two-tiered triage
initial ID of pts where delaying tx would be unsafe
those not needing immediate intervention are forwarded to an assessment nurse
triage bypass or direct bedding
when there are open beds, pt taken directly to room and initial assessment initiated
team triage
nurse/provider
licensed independent provider exam
orders
five-level triage
recommended
ESI
-severity
-resource consumption
Canadian Triage and Acuity Scale
CTAS
based on arrival time to time seen by RN or provider
four-level triage
life threatening
emergent
urgent
nonurgent
three-level triage
emergent
urgent
nonurgent
goal to triage
w/in 5 min of arrival
2-5 min process
triage process
across-the-room assessment subjective data/interview VS objetive data severity rating safety, security documentation
define patient safety
avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from processes of healthcare
define error
failure of planned action to be completed as intended
of commission, omission, or execution
leadership report in culture of safety
error-reporting systems root cause analyses culture surveys audits surveillance just culture safety rounds near misses
technology in culture of safety
EMRs electronic reporting systems computerized order entry smart pumps barcodes standardized order sets
teamwork and communication in culture of safety
interdisciplinary training
standard methods of pt handoff
pediatric considerations in culture of safety
inadequate training
weight-based dosing
medicine dilution
communication
medication recommendations in culture of safety
limit number of concentrations, dose strengths
standard instructions
oral syringes vs IV syringes
forensic evidence collection
nursing science and legal procedure involving victims and perpetrators of abuse, violence, and trauma
examples of forensic cases
bioterrorism disasters MVCs missile injuries burns workplace violence elder and child maltreatment sexual assault intimate partner violence
steps in evidence collection
assessment
evidence collection
documentation
general principles of evidence collection
gloves
avoid damaging evidence
evidence in paper bags or cardboard boxes
secure evidence for law enforcement
if pt is DOA and not resuscitated
do not remove clothing wrap pt in white sheet do not give belongings to family notify law enforcement paper bags over hands wrap bullets in gauze
define palliative care
comprehensive approach to a life-threatening or terminal condition
goals of palliative care
alleviate physical, psychological, emotional, and spiritual suffering and promote quality of life
advanced directive
guide to patient wishes with end-of-life care, written when pt is competent and becomes effective when pt loses decision-making capacity
state-by-state differences
flexible, can be changed/revoked
living will
declaration of wishes regarding what treatment individual does and does not want applied
durable power of attorney for healthcare
designates a surrogate decision maker when an individual is unable to make own decisions.
may include limits or parameters for what types of medical treatment must be followed by surrogate
durable power of attorney for finance
identifies a person to manage financial matters including health insurance and medical bills
POLST
order that addresses what lifesaving measures should NOT be initiated
may limit CPR/intubation but does not withhold/limit comfort measures
types of pain
somatic
visceral
neuropathic
areas of somatic pain
skin, subQ, bone, muscle, blood vessels, connective tissue
characteristics of somatic pain
localized
constant
achy
areas of visceral pain
organs
linings of body cavities
characteristics of visceral pain
poorly localized
diffuse
cramping
areas of neuropathic pain
central and peripheral nervous systems
characteristics of neuropathic pain
poorly localized
shooting, burning
sharp
numbness, tingling
N-PASS
neonatal pain, agitation and sedation scale
FLACC
for children’s pain
Face Legs Activity Cry Consolability
numeric pain rating scale
some peds, adults
picture pain scale
for multiple age groups
PAINAD
pain assessment in advanced dementia
organ procurement for death/imminent death in hospital
only organ procurement staff may approach family
Uniform Anatomical Gift Act
regulatory framework for the donation or organs, tissues, and other human body parts in the US
follows state law
Uniform Determination of Death Act
irreversible cessation of:
- circulatory/resp fxns
- all fxns of entire brain
reasons to notify medical examiner
homicide, suicide unintentional injury/death death w/in 24 hours of admission admitted in comatose state death of minor
once a patient is declared dead…
care not directed by EM provider
orders are written by Organ Procurement Officer (OPO) are valid and should be followed
how long after asystole can procurement occur?
up to 10 hours
procedure for preserving body if donating organs
keep body refrigerated
if donating eyes:
- elevate HOB 20 degrees
- tape eyelids with paper tape
postmortem care
in ME cases, leave tubes cover large wounds w/ gauze clean sheets, gown sensitive to family proper ID before releasing body
define EMTALA
law written to protect patients who are transferred to assure their appropriate stabilization, care, and placement
transport considerations
prevent aspiration with NG
vascular access
blood products
Foley?
considerations during air transport
air expands with altitude
consider gas-filled organs
consider air-filled equipment
maybe chest tubes even for small pneumothorax
define delegation
transfer of responsibility for performance of a task from one individual to another while retaining accountability for outcome
define handoff
transition of care between equals or to higher level of care
what to communicate in handoff
CC or diagnosis
test results
care provided and response
care to be completed
how to safely and effectively handoff
standardized tools
include pt and family
education and training
types of handoff
internal/shift report
admission
boarding
transport
four factors of malpractice
duty
breach of duty
proximate cause
injury
express consent
general consent given by patient, legal guardian, or family member for genera/low-risk care and procedures
implied consent
pts with life-threatening conditions who cannot give consent because of condition are implied to be giving consent
involuntary consent
to provide treatment to patients who are deemed not competent
informed consent
for high-risk/invasive procedures that requires certain disclosures
disclosures in informed consent
procedure description
alternatives
risks
benefits
can nurses witness informed consent?
yes, if they witness the entire consent process
consent with minors
parents give consent
if refusing life-saving tx, consider legal counsel for court order
consent with nonparticipating hospitals
if gatekeeper refuses tx due to insurance
refusal of tx remains the responsibility of the patient
AMA
ensure competency
explain risks of leaving
sign release
consent when in custody of law enforcement
consent with individual
pt under arrest can refuse care
some laws can override
reasons for mandatory reporting
crimes suicides suspected maltreatment some communicable diseases deaths special circumstances
symptom surveillance
communicable disease outbreaks plan to identify, contain recognize clusters of sx isolation reporting
purpose of documentation
communication among healthcare professionals and record of patient progress
documentation requirements
minimum requirement varies by institution
J.Co has standards
trauma centers have requirements
state laws
define quality improvement
formal approach to analysis of performance and systematic efforts to improve it
PDSA
RCA
HIPAA
protected health information may be used by the medical provider only for treatment, payment, and healthcare operation activities
communication with pt or authorized rep
release to law enforcement in specific circumstances
four steps of disaster preparedness
mitigation
preparedness
response
recovery
mitigation in disaster preparedness
before and after emergency
determine risk
mitigate/lessen impact
HVA
preparedness in disaster preparedness
before an emergency mutual aid agreements 96 hours of self-sustainment incident command plan alternatives
response in disaster preparedness
during emergency
warning of impending disaster
hospital may be isolated until help arrives
recovery in disaster preparedness
after emergency
return to normal operation
hours, days, weeks, months
disaster triage
START, jumpSTART
limited resources
maximize care
most good for most people
