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CEN > Professional Issues > Flashcards

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.

1
Q

4 ethical principles

A

autonomy
beneficence
nonmaleficence
justice

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2
Q

cultural considerations

A 
cultural assessment
cultural competence
communication
family presence
grief and loss
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3
Q

define evidence-based practice

A

conscious, explicit, and judicious use of current best evidence in making decisions about care of patients

based on clinical experience and research

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4
Q

validity

A

degree to which an instrument measures what it is intended to measure

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5
Q

reliability

A

degree to which an assessment tool or measurement produces consistent results

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6
Q

quantitative study

A

deductive process that uses numeric findings for quantification

examines relationships between variables and determines cause and effect

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7
Q

randomized controlled trial

A

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

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8
Q

systematic review and meta-analysis

A

review of multiple studies on a particular topic that identifies and critically analyzes the best research and makes practice recommendations based on that analysis

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9
Q

cohort study

A

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

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10
Q

qualitative study

A

an inductive process involving interviews where words, not numbers, are used to give meaning to data.

involves interaction between researcher and subject

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11
Q

case study

A

study that generally highlights an unusual or interesting case a practitioner has encountered

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12
Q

define critical incident stress

A

can produce reactions that may interfere with or overwhelm a person’s ability to function or cope either at the scene or later

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13
Q

behavioral reaction to abnormal event

A

restlessness
irritability, moodiness
antisocial behavior
increased alcohol

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14
Q

cognitive reaction to abnormal event

A

poor concentration
confusion or uncertainty
nightmares

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15
Q

physical reaction to abnormal event

A 
vomiting, chills
HA
disrupted sleep
muscle tremors
chest pain
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16
Q

emotional reaction to abnormal event

A

depression and anxiety
intense anger
grief
guilt

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17
Q

critical incident stress management

A

multicomponent crisis intervention program

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18
Q

steps of debriefing in critical incident stress management

A 
introduction
details of event
emotional responses
personal reactions/actions
symptoms
instruction phase
resumption of duty
followup
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19
Q

defusing in critical incident stress management

A

20-45 min conducted w/in 12 hours of event

small number of people

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20
Q

debriefing in critical incident stress management

A

7-step process

1-3 days after event

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21
Q

benefits of lifelong learning

A 
promotes competence
enhances working knowledge
advances skills
improves pt healthcare
personal/professional development
career goals
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22
Q

define triage

A

to sort - the process of determining and prioritizing patients’ treatments based on severity of their conditions

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23
Q

two-tiered triage

A

initial ID of pts where delaying tx would be unsafe

those not needing immediate intervention are forwarded to an assessment nurse

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24
Q

triage bypass or direct bedding

A

when there are open beds, pt taken directly to room and initial assessment initiated

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25
Q

team triage

A

nurse/provider
licensed independent provider exam
orders

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26
Q

five-level triage

A

recommended
ESI
-severity
-resource consumption

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27
Q

Canadian Triage and Acuity Scale

A

CTAS

based on arrival time to time seen by RN or provider

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28
Q

four-level triage

A

life threatening
emergent
urgent
nonurgent

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29
Q

three-level triage

A

emergent
urgent
nonurgent

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30
Q

goal to triage

A

w/in 5 min of arrival

2-5 min process

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31
Q

triage process

A 
across-the-room assessment
subjective data/interview
VS
objetive data
severity rating
safety, security
documentation
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32
Q

define patient safety

A

avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from processes of healthcare

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33
Q

define error

A

failure of planned action to be completed as intended

of commission, omission, or execution

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34
Q

leadership report in culture of safety

A 
error-reporting systems
root cause analyses
culture surveys
audits
surveillance
just culture
safety rounds
near misses
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35
Q

technology in culture of safety

A 
EMRs
electronic reporting systems
computerized order entry
smart pumps
barcodes
standardized order sets
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36
Q

teamwork and communication in culture of safety

A

interdisciplinary training

standard methods of pt handoff

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37
Q

pediatric considerations in culture of safety

A

inadequate training
weight-based dosing
medicine dilution
communication

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38
Q

medication recommendations in culture of safety

A

limit number of concentrations, dose strengths

standard instructions

oral syringes vs IV syringes

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39
Q

forensic evidence collection

A

nursing science and legal procedure involving victims and perpetrators of abuse, violence, and trauma

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40
Q

examples of forensic cases

A 
bioterrorism
disasters
MVCs
missile injuries
burns
workplace violence
elder and child maltreatment
sexual assault
intimate partner violence
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41
Q

steps in evidence collection

A

assessment
evidence collection
documentation

42
Q

general principles of evidence collection

A

gloves
avoid damaging evidence
evidence in paper bags or cardboard boxes
secure evidence for law enforcement

43
Q

if pt is DOA and not resuscitated

A 
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
44
Q

define palliative care

A

comprehensive approach to a life-threatening or terminal condition

45
Q

goals of palliative care

A

alleviate physical, psychological, emotional, and spiritual suffering and promote quality of life

46
Q

advanced directive

A

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

47
Q

living will

A

declaration of wishes regarding what treatment individual does and does not want applied

48
Q

durable power of attorney for healthcare

A

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

49
Q

durable power of attorney for finance

A

identifies a person to manage financial matters including health insurance and medical bills

50
Q

POLST

A

order that addresses what lifesaving measures should NOT be initiated

may limit CPR/intubation but does not withhold/limit comfort measures

51
Q

types of pain

A

somatic
visceral
neuropathic

52
Q

areas of somatic pain

A

skin, subQ, bone, muscle, blood vessels, connective tissue

53
Q

characteristics of somatic pain

A

localized
constant
achy

54
Q

areas of visceral pain

A

organs

linings of body cavities

55
Q

characteristics of visceral pain

A

poorly localized
diffuse
cramping

56
Q

areas of neuropathic pain

A

central and peripheral nervous systems

57
Q

characteristics of neuropathic pain

A

poorly localized
shooting, burning
sharp
numbness, tingling

58
Q

N-PASS

A

neonatal pain, agitation and sedation scale

59
Q

FLACC

A

for children’s pain

Face
Legs
Activity
Cry
Consolability
60
Q

numeric pain rating scale

A

some peds, adults

61
Q

picture pain scale

A

for multiple age groups

62
Q

PAINAD

A

pain assessment in advanced dementia

63
Q

organ procurement for death/imminent death in hospital

A

only organ procurement staff may approach family

64
Q

Uniform Anatomical Gift Act

A

regulatory framework for the donation or organs, tissues, and other human body parts in the US

follows state law

65
Q

Uniform Determination of Death Act

A

irreversible cessation of:

  • circulatory/resp fxns
  • all fxns of entire brain
66
Q

reasons to notify medical examiner

A 
homicide, suicide
unintentional injury/death
death w/in 24 hours of admission
admitted in comatose state
death of minor
67
Q

once a patient is declared dead…

A

care not directed by EM provider

orders are written by Organ Procurement Officer (OPO) are valid and should be followed

68
Q

how long after asystole can procurement occur?

A

up to 10 hours

69
Q

procedure for preserving body if donating organs

A

keep body refrigerated

if donating eyes:

  • elevate HOB 20 degrees
  • tape eyelids with paper tape
70
Q

postmortem care

A 
in ME cases, leave tubes
cover large wounds w/ gauze
clean sheets, gown
sensitive to family
proper ID before releasing body
71
Q

define EMTALA

A

law written to protect patients who are transferred to assure their appropriate stabilization, care, and placement

72
Q

transport considerations

A

prevent aspiration with NG
vascular access
blood products
Foley?

73
Q

considerations during air transport

A

air expands with altitude
consider gas-filled organs
consider air-filled equipment
maybe chest tubes even for small pneumothorax

74
Q

define delegation

A

transfer of responsibility for performance of a task from one individual to another while retaining accountability for outcome

75
Q

define handoff

A

transition of care between equals or to higher level of care

76
Q

what to communicate in handoff

A

CC or diagnosis
test results
care provided and response
care to be completed

77
Q

how to safely and effectively handoff

A

standardized tools
include pt and family
education and training

78
Q

types of handoff

A

internal/shift report
admission
boarding
transport

79
Q

four factors of malpractice

A

duty
breach of duty
proximate cause
injury

80
Q

express consent

A

general consent given by patient, legal guardian, or family member for genera/low-risk care and procedures

81
Q

implied consent

A

pts with life-threatening conditions who cannot give consent because of condition are implied to be giving consent

82
Q

involuntary consent

A

to provide treatment to patients who are deemed not competent

83
Q

informed consent

A

for high-risk/invasive procedures that requires certain disclosures

84
Q

disclosures in informed consent

A

procedure description
alternatives
risks
benefits

85
Q

can nurses witness informed consent?

A

yes, if they witness the entire consent process

86
Q

consent with minors

A

parents give consent

if refusing life-saving tx, consider legal counsel for court order

87
Q

consent with nonparticipating hospitals

A

if gatekeeper refuses tx due to insurance

refusal of tx remains the responsibility of the patient

88
Q

AMA

A

ensure competency
explain risks of leaving
sign release

89
Q

consent when in custody of law enforcement

A

consent with individual
pt under arrest can refuse care
some laws can override

90
Q

reasons for mandatory reporting

A 
crimes
suicides
suspected maltreatment
some communicable diseases
deaths
special circumstances
91
Q

symptom surveillance

A 
communicable disease outbreaks
plan to identify, contain
recognize
clusters of sx
isolation
reporting
92
Q

purpose of documentation

A

communication among healthcare professionals and record of patient progress

93
Q

documentation requirements

A

minimum requirement varies by institution

J.Co has standards

trauma centers have requirements

state laws

94
Q

define quality improvement

A

formal approach to analysis of performance and systematic efforts to improve it

PDSA
RCA

95
Q

HIPAA

A

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

96
Q

four steps of disaster preparedness

A

mitigation
preparedness
response
recovery

97
Q

mitigation in disaster preparedness

A

before and after emergency
determine risk
mitigate/lessen impact
HVA

98
Q

preparedness in disaster preparedness

A 
before an emergency
mutual aid agreements
96 hours of self-sustainment
incident command
plan alternatives
99
Q

response in disaster preparedness

A

during emergency
warning of impending disaster
hospital may be isolated until help arrives

100
Q

recovery in disaster preparedness

A

after emergency
return to normal operation
hours, days, weeks, months

101
Q

disaster triage

A

START, jumpSTART
limited resources
maximize care
most good for most people

CEN (12 decks)

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