Professional Responsibilities

Question 1

State Nurse Practice Act

Legal Aspects of Care

Professional Responsibilities

Answer 1

This act defines the scope of nursing practice within each state.
1. It serves as the primary guide for what you can and cannot do as a nurse in a given state.

Question 2

Health Insurance Portability and Accountability Act (HIPAA)

Legal Aspects of Care

Professional Responsibilities

Answer 2

was developed to protect insurance coverage for workers when they lose or change jobs (portability) and stipulates regulations to preserve confidentiality, integrity, and availablility of information to protect an individual’s rights to privacy.
1. HIPAA protects the privacy of patients’ medical records and other identifiable health information.
a. Patients can obtain copies of their medical records and request changes if they identify errors.
2. HIPAA prevents denial of health insurance for pre-existing conditions, but does not regulate or mandate health insurance.
3. HIPAA sets standards for electronic transmission of certain protected health information.
4. Assure confidentiality when communicating health-related information about a patient; a healthcare provider is permitted to disclose protected health information about an individual to a healthcare provider for that provider’s treatment of the individual.
a. Personal health information generally may not be used for purposes not related to health care.
5. Information for all other reasons is considered confidential and is only on a “need to know” rather than a “nice to know” basis.
6. Exceptions to privacy rule:
a. If the patient is a danger to themselves or to others, or is being abused
b. Public health, legal and judicial mandates (e.g., reportable diseases, child abuse, threat to public safety)
7. Extreme care should be taken to avoid inadvertently sharing protected patient information in public settings (e.g., elevators) and to family and other interested parties.

Question 3

Family Educational Rights and Privacy Act (FERPA)

Legal Aspects of Care

Professional Responsibilities

Answer 3

1. FERPA is a unique and separate law from HIPAA governing health records specific to educational settings. Pediatric nurses must understand that health records in the school setting are governed by this separate law.
2. FERPA is a federal law that governs access to educational information and records by public entities, such as potential employers, publicly funded educaitonal institutions, and foreign governments.
3. Applies to public and private schools and state or local education agencies that receive federal education funds.
4. FERPA governs confidentiality and access to all educaiton records, including student health records.
5. When students reach the age of 18, or when they become students at postsecondary education institutions, rights under FERPA transfer from the parent to the student.

Question 4

21st Century Cures Act

Legal Aspects of Care

Professional Responsibilities

Answer 4

1. The Cures Act is a federal law that requires healthcare providers to offer patients (and proxy) immediate, secure, and free access to their complete medical record. This information includes laboratory reports, imaging, diagnoses and problem lists, as well as notes.
2. The goal is to promote transparency and enhance health equity. Patient portals and mobile health apps are two examples of technology access for patients.
3. The Cures Act reinforces the need for pediatric nurses to ensure health literacy of patients and families through advocacy and education.

Question 5

Consent and Assent in Research and Treatment

Legal Aspects of Care

Professional Responsibilities

Answer 5

1. Consent is an informed decision by a potential research subject to participate in research or accept treatment.
2. Assent is an active affirmation of desire to participate in Research or have treatment by a child who is at least 7 years of age.
   a. Not appropriate for children younger than 7 years or with limited cognitive ability.
   b. Assent is an adjunct to consent, NOT a replacement for consent.

Question 6

Negligence

Legal Aspects of Care

Professional Responsibilities

Answer 6

Conduct that falls below the behavior that is expected of a reasonably prudent person under similar circumstances (i.e., nurse fails to put crib side rails up).

Question 7

Malpractice

Legal Aspects of Care

Professional Responsibilities

Answer 7

Involves patient injury or harm as a result of negligence

Question 8

Coordination and Delegation of Care

Legal Aspects of Care

Professional Responsibilities

Answer 8

1. Delegated task must be allowed by the nurse practice act in the state
   a. Assessments may never be delegated (e.g., assessment of IV site, systems assessment).
2. Delegation involves the transfer of responsibility for the task/skill without transfer of accountability for the ultimate outcome.
3. Delegatee is defined as nursing assistive personnel (NAP)/unlicensed assistive personnel (UAP), including nursing students and nursing assistants or aides.
   a. Delegatee requirements:
   (1) Must be competent in the assigned task (e.g., capable, trained)
   (2) May not delegate a delegated task to another NAP/UAP
   (3) Delegatee may refuse a delegated task if delegatee is not competent/trained to perform the task

Question 9

Emancipated minor

Legal Aspects of Care

Professional Responsibilities

Answer 9

1. The granting of basic adult rights; definition varies among states and not all states recognize emancipated minor status
2. Generally includes the following:
   a. Under age 18 and usually older than age 14
   b. Legally married
   c. On active military duty
3. Minors who can demonstrate maturity and financial independence; may have to make a legal informed declaration
4. Parents no longer required to pay financial support
5. Assume responsibility for their own medical coverage
6. Give consent for all medical care, without parentla consent, knowledge, or liability
7. Can enter into a binding contract; can consent to participate in research

Question 10

Individuals with Disabilities Education Improvement Act (IDEA)

Laws for Children with Chronic Conditions

Professional Responsibilities

Answer 10

1. Guarantees that children with disabilities will receive a “free and appropriate public education in the least restrictive environment”
   a. For example, child with Down syndrome should be educated primarily in a regular classroom of same age healthy peers
2. Gurarantees that children thought to have disabilities will be evaluated free of charge.
3. Guarantees that an Individualized Education Program (IEP) be developed by a team of specialists and include the parents. This will identify the special education and related services that will be provided for the child.
4. Requires that a transition plan be developed by age 16 to assist the student to plan for transition to vocational training, postsecondary educaiton, or assisted living/complete care facilities.
   a. Nurses should be assisting patients to begin planning to make the transition from pediatric care to adult care.
5. Requires early intervention identificaiton of infants and toddlers with disabilities and intitation of measures that will assist the child to enter the school in a state of rediness.
   a. Requires the development of an Individualized Family Service Plan to identify the needed services and to coordinate the plan of care.

Question 11

Section 504 of the Rehabilitation Act of 1973

Laws for Children with Chronic Conditions

Professional Responsibilities

Answer 11

1. Civil rights law that prohibits discrimination on the basis of disability in programs that receive federal financial assistance.
2. States that no qualified individual with a disability shall be excluded from, denied the benefits of, or subjected to discriminaiton under any program that receives financial assistance.
3. Requires that reasonable accommodations be made to assist the individual in being successful. This may require wider doors for wheelchairs; ramps/curb cuts/elevators for those in wheelchairs; special desks and chairs; computers, telecommunication devices, or special devices for communication; performing tube feedings or percussion and postural drainage within the school setting so that the child can attend school.
4. The development of a 504 plan details the accommodations needed by the individual.

Question 12

Refusal of Care

Legal Aspects of Care

Professional Responsibilities

Answer 12

1. May be due to religious or cultural beliefs, misinformation, fears or terminal illness
   a. Nurse’s role is to provide information and support evidence-based practice
2. Assess for rationale and provide appropriate education
3. Be advocate for child’s wishes
4. In severe cases, the legal system may become involved

Question 13

Custody

Legal Aspects of Care

Professional Responsibilities

Answer 13

Consents can only be obtained from custodial parent or legal guardian

Question 14

Autonomy

Ethics

Professional Responsibilities

Answer 14

Personal freedom and self-determinatino; the right to choose

Question 15

Beneficence

Ethics

Professional Responsibilities

Answer 15

Actions taken should promoate good

Question 16

Nonmaleficence

Ethics

Professional Responsibilities

Answer 16

Do no harm

Question 17

Veracity

Ethics

Professional Responsibilities

Answer 17

Truth telling

Question 18

Fidelity

Ethics

Professional Responsibilities

Answer 18

Keeping one’s promises/commitments

Question 19

Justice

Ethics

Professional Responsibilities

Answer 19

Treating all fairly and equally

Question 20

Respect Others

Ethics

Professional Responsibilities

Answer 20

Avoiding coercion/undue influence

Question 21

Research

Research/Evidence-Based Practice

Professional Responsibilities

Answer 21

Research is the generation of new knowledge through scientific inquiry.
1. One of nursing’s roles is to identify clinical questions and collect data

Question 22

Evidence-based practice

Research/Evidence-Based Practice

Professional Responsibilities

Answer 22

a. Nurses engaged in evidence-based practice are “consumers” of research knowledge.
b. Nursing’s role is to apply research to practice via creation of policies, development of clinical pathways, etc.

Question 23

Quality Improvement

Research/Evidence-Based Practice

Professional Responsibilities

Answer 23

a. The purpose is to improve patient care processes.
b. Nursing’s role is to participate in data collection and to change nursing interventions or processes based on findings.

Question 24

Clinical Pathways and Care Bundles

Research/Evidence-Based Practice

Professional Responsibilities

Answer 24

Clinical Pathways are structured multi-disciplinary tools used to operationalize evidence-based health care recommendations into clinical processes of care
1. Provides the steps in the course of treatment/care for a specific population, such as bronchiolitis or asthma pathways.
2. Removes provider variability in treatment.
a. Care Bundles are a set of 3-5 evidence-informed practices performed collectively and reliably to improve the quality of care.
(1) Aims to prevent and manage specific health conditions, such as Central Line Bundle (to reduce Central Line Associated Blood Stream Infection [CLABSI])
b. Bundles are a hallmark of evidence-based practice and patient care excellence

Question 25

Evidence-based Tools

Research/Evidence-Based Practice

Professional Responsibilities

Answer 25

Measurement instruments that are both reliable and valid that provide for accurate measurement in clinical practice and promote evidence-based practice.
1. Examples include pain assessment tools [FACES/FLACC], skin pressure injury risk assessment tools [Braden QD], and fall risk assessment tools [General Risk Assessment for Pediatric Inaptient Falls [GRAF-PIF]).
2. Provides a consistent and evidence-based means of communication among healthcare providers.

Question 26

Conflict Resolution

Professional Communication Issues

Professional Responsibilities

Answer 26

1. Conflicts within the healthcare team should be resolved at the lowest level, starting 1:1 between the parties involved.
2. The principles involved are personal responsibility and interpersonal accountability.

Question 27

Customer Service

Professional Communication Issues

Professional Responsibilities

Answer 27

1. Majoryity of patient-family grievances are related to customer service issues.
2. Key individual factors include service attitude/mentality, active listening, body language, and problem-solving skills.
3. Key organizational factors include leadership excellence, people management, quality service, brand loyalty, and creativity/innovation.

Question 28

Shared Governance

Professional Communication Issues

Professional Responsibilities

Answer 28

1. An administrative model that provides an active role for all staff nurses in decision-making and policy formation.
2. Structures in shared-governance models include staff councils/committees for practice, management, education, etc.
   a. These may be unit-based and/or hospital-based; this is where unit and hospital issues are discussed and recommendations and decisions are made.

Question 29

The nurse is a patient and family advocate

Professional Communication Issues

Professional Responsibilities

Answer 29

1. The nurse must defend, speak for, protect, and safeguard the child and family to the interdisciplinary team.
   a. Advocate related to the rights of teh child and family, ethical and legal issues, and understanding and participating in the plan of care (autonomy)
   b. Empower families and patients to be their own advocate
2. Access resource and healthcare services to meet child and family needs.
3. Transition to adult care:
   a. Involve the multi-disciplinary team to coordinate transition needs; this includes nursing, medical, case management and family.
   b. For children with chronic conditions covered under IDEA, transition plans must be developed in the child’s school IEP by age 16 to plan transition to workplace, continuing educaiton and healthcare.
   c. Be aware of the multitude of complex issues in the transition, including emotional and access issues.

Question 30

Inter/Intra-professional Communication

Professional Communication Issues

Professional Responsibilities

Answer 30

1. Handoffs is the transfer of care responsibility from one provider to the other, such as sift report, unit to unit, or hospital to outside facility
   a. It is a national patient safety goal to prevent adverse clinical events
   b. Should be standardized and provide an opportunity for question/answer
2. SBAR Communication: Situation, Background, Assessment, and Recommendation
   a. A framework for communication among the healthcare team about a patient’s condition, particularly for critical patient issues
   b. Goal is to promote patient safety by making a streamlined approach

Question 31

The pediatric nurse collaborates with the child, family, and health care team in providing family centered care. This is an exaple of which of the following?

a. Standard of care
b. Standard of professional performance
c. Evidence-based practice
d. Atraumatic care

Answer 31

b

Collaboration is one of the standards of professional performance. Standards of care consist of the nursing process components and provide guidelines for a nurse.

Question 32

An essential role of the pediatric nurse is to function as an advocate. Which of the following is an accurate statement regarding advocacy?

a. In order to be an advocate for the hospitalized child, the nurse must be inolved in patient care.
b. The United Nations provides gudielines to assist the nurse in functioning as an advocate.
c. Advocacy is a model that is intended only for ethical issues.
d. Nursing is th emain department i a hospital that functions in advocacy.

Answer 32

b

The United Nations provides a declaration of child rights that helps to serve as a guideline for optimal care. Although bedside nurses function as advocates, nurses who are removed from the bedside are also in a role to function as a child and family advocate.

Question 33

Daniel, a pediatric nurse, is interested in becoming involved with disaster preparedness. Which of the following represents the correct sequence of the 4 phases of disaster preparedness?

a. Mitigation, preparedness, response, and recovery
b. Response, mitigaiton, preparedness, and recovery
c. Preparedness, mitigation, response, and recovery
d. Recovery, mitigation, preparedness, and response

Answer 33

a

Mitigation represents prevention of a disaster. Preparedness represents the way in which workers will respond and what resources will be used. Response represents the period immediately following the event. REcovery includes short- and long-term plans.