TEST 1 - UNIT A - CH 3 - PROFESSIONAL RESPONSBILITIES (Leadership Book) Flashcards
Professional responsibilities
are the obligations
that nurses have to their clients.
To meet their
professional responsibilities, nurses must be
knowledgeable in the following areas:
AACC DEIIIL
advance directives,
advocacy
client rights,
confidentiality
disruptive behavior
ethical practice.
information security,
information technology,
informed consent,
legal practice,
Client rights are
the legal guarantees that clients have
with regard to their health care.
◯ Clients using the services of a health care institution
retain
◯ Residents in nursing facilities that participate
in Medicare programs
-their rights as individuals and citizens of the
United States.
-similarly retain resident
rights under statutes that govern the operation of
these facilities.
The American Hospital Association
(AHA) identifies client rights in health care settings
in
the Patient Care Partnership (www.aha.org).
Nurses are accountable for
Situations that require particular attention
include
protecting the rights of
clients.
informed consent, refusal of treatment, advance
directives, confidentiality, and information security.
Nurses must ensure that clients
Nurses also must
-understand their rights.
-protect clients’ rights during
nursing care.
● Regardless of the client’s age, nursing needs, or the
setting in which care is provided, the basic tenants are
the same. Each client has the right to the following.
◯ Be informed about all aspects of care and take an
active role in the decision‑making process.
◯ Accept, refuse, or request modification to the
plan of care.
◯ Receive care that is delivered by competent
individuals who treat the client with respect.
The Patient Self‑Determination Act (PSDA) stipulates that
-Competent
adults have the right to
on admission to a health care facility, all clients must be
informed of their right to accept or refuse care.
refuse treatment, including the
right to leave a health care facility without a prescription
for discharge from the provider.
If the client refuses a treatment or procedure, the
client is asked to
The client should be informed of the following.
sign a document (AMA Against Medical Advice form) indicating that they understand the risk involved with refusing the treatment or procedure, and that they have chosen to refuse it.
Possible complications that could occur without treatment
◯ Possibility of permanent physical or mental impairment or disability
◯ Possibility of other complications that could lead to death
● When a client decides to leave the facility without
a prescription for discharge, the nurse does what:
-notifies the provider and discusses with the client the potential
risks associated with leaving the facility prior to discharge.
-carefully documents the information that was provided to the client and that notification of the provider occurred.
If the client refuses to sign the form, this is
also
documented by the nurse.
Advocacy refers to
nurses’ role in supporting clients by
ensuring that they are properly informed,
that their rights are respected,
and that they are receiving the proper level of care.
Advocacy is one of the most important roles of the
_______, especially when clients are unable to speak or act
for themselves.
● As an advocate, the nurse ensures that the client has_______
● Nurses must act as advocates even when ________
● The complex health care system puts clients in a
_______
Nurse
-the information they need to make decisions about
health care.
-they disagree with clients’ decisions.
-vulnerable position.
Nurses are clients’ voice when the
system is
-not acting in their best interest.
● The nursing profession also has a responsibility to
support and advocate for
legislation that promotes
public policies that protect clients as consumers and
create a safe environment for their care.
As advocates, nurses must ensure that clients are
● Nurses must be careful to assist clients with making
health care decisions and not
-informed of their rights and have adequate information
on which to base health care decisions.
-direct or control their decisions.
Nurses mediate on the client’s behalf when the actions
of others are
not in the client’s best interest or changes
need to be made in the plan of care.
Situations in which nurses might need to advocate for
clients or assist them to advocate for themselves include
the following.
◯ End‑of‑life decisions
◯ Access to health care
◯ Protection of client privacy
◯ Informed consent
◯ Substandard practice
Nurses are accountable for their actions even if they are
carrying out a provider’s prescription.
It is the nurse’s responsibility to question a prescription if it could harm a client (incorrect medication dosage, potential adverse
interaction with another prescribed medication,
contraindication due to an allergy or medical history).
ESSENTIAL COMPONENTS OF ADVOCACY
skills
values
skills -
● Risk‑taking
● Vision
● Self‑confidence
● Articulate communication
● Assertiveness
values-Caring
● Autonomy
● Respect
● Empowerment
Informed consent is a legal process by which
a client
has given written permission for a procedure or
treatment to be performed.
Consent is considered to be
informed when the client has been provided with and
understands the following.
◯ Reason the treatment or procedure is needed
◯ How the treatment or procedure will benefit the client
◯ Risks involved if the client chooses to receive the
treatment or procedure
◯ Other options to treat the problem, including the
option of not treating the problem
◯ Risk involved if the client chooses no treatment
The nurse’s role in the informed consent process is to
witness the client’s signature on the informed consent
form and to ensure that informed consent has been
appropriately obtained.
Consent is required for
For most aspects of nursing care,
-all care given in a health care
facility.
-implied consent
is adequate.
The client provides implied consent when
they comply with the instructions provided by the nurse.
For example, the nurse is preparing to administer a TB
skin test, and the client holds out their arm for the nurse.
For an invasive procedure or surgery, the client is
required to provide
● __________ regulate who is able to give informed consent.
Laws vary regarding age limitations and emergencies.
Nurses are responsible for knowing the laws in the state
of practice.
● The nurse must verify that ________
-written consent.
-state laws
-consent is informed and
witness the client sign the consent form.
The form for informed consent must be signed by a
WHAT ABOUT EMANCIPATED MINORS?
-competent adult.
◯ Emancipated minors (minors who are independent
from their parents [a married minor]) can provide
informed consent for themselves.
The person who signs the form must be capable of
The person must be able to
-understanding the information provided by the health
care professional who will be providing the service.
-fully communicate in return
with the health care professional.
When the person giving the informed consent is
unable to communicate due to a language barrier or
hearing impairment,
a trained medical interpreter
must be provided. Many health care agencies
contract with professional interpreters who have
additional skills in medical terminology to assist with
providing information.
Individuals authorized to grant
consent for another person
Parent of a minor
● Legal guardian
● Court‑specified representative
● Client’s health care surrogate (individual who has the
client’s durable power of attorney for health care/health
care proxy)
● Spouse or closest available relative (state laws vary)
INFORMED CONSENT RESPONSIBILITIES
PROVIDER
NURSE
CLIENT
ROVIDER - Obtains informed consent
NURSE - Witnesses informed consent
CLIENT - Gives informed consent
PROVIDER: Obtains informed consent. To do so, the
provider must give the client the following.
Complete description of the treatment/procedure
● Description of the professionals who will be performing
and participating in the treatment
● Description of the potential harm, pain, and/or
discomfort that might occur
● Options for other treatments and the possible
consequences of taking other actions
● The right to refuse treatment
● Risk involved if the client chooses no treatment
CLIENT: Gives informed consent. To give informed consent,
the client must do the following.
Give it voluntarily (no coercion involved).
● Be competent and of legal age, or be an emancipated
minor. (If the client is unable to provide consent, an
authorized person must give consent.)
● Receive sufficient information to make a decision based
on an informed understanding of what is expected.
NURSE
● Witnesses informed consent. The nurse is responsible
for the following.
Ensuring that the provider gave the client the
necessary information
◯ Ensuring that the client understood the information
and is competent to give informed consent
◯ Having the client sign the informed
consent document
◯ Notifying the provider if the client has more questions
or does not understand any of the information
provided (The provider is then responsible for
giving clarification.)
WITH REGARD TO INFORMED CONSENT, THE NURSE DOCUMENTS THE FOLLOWING:
Reinforcement of information originally given by
the provider
◯ That questions the client had were forwarded to
the provider
◯ Use of an interpreter
The purpose of advance directives is to
communicate
a client’s wishes regarding end‑of‑life care should the
client become unable to do so.
The PSDA (PATIENT SELF DETERMINATINO ACT) requires that all clients admitted to a health
care facility be asked if
◯ A client who does not have advance directives must be
given __
◯ A health care representative should be
- they have advance directives.
- written information that outlines their rights
related to health care decisions and how to formulate
advance directives.
-available to
help with this process.
Two components of an advance directive are
the living
will and the durable power of attorney for health care.
living will is a legal document that
Types of treatments that are
often addressed in a living will are those that have
the capacity to ___
Examples of treatments
that are addressed are
-expresses the client’s wishes regarding medical treatment in the
event the client becomes incapacitated and is facing
end‑of‑life issues.
-prolong life.
-cardiopulmonary resuscitation,
mechanical ventilation, and feeding by artificial means.
Living wills are
However, state
statutes and individual health care facility policies can
Most state laws include provisions that
legal in all states.
vary. Nurses need to be familiar with their state statute
and facility policies.
health care providers who follow the health care directive in a living
will are protected from liability.
A durable power of attorney for health care/health care
proxy is a l
egal document that designates a health care
surrogate, who is an individual authorized to make health
care decisions for a client who is unable.
A durable power of attorney for health care/health care
proxy is a
Legal document that designates a health care
surrogate, who is an individual authorized to make health
care decisions for a client who is unable.
The person who serves in the role of health care
surrogate to make decisions for the client should be
●
-very
familiar with the client’s wishes.
Living wills can be difficult to interpret, especially in
the face of unexpected circumstances. A durable power
of attorney for health care, as an adjunct to a living will,
can be
a more effective way of ensuring that the client’s
decisions about health care are honored.
● Unless a do not resuscitate (DNR) or allow natural death
(AND) prescription is written, the nurse should
● Additional prescriptions by the provider are based on the
client’s individual needs and decisions and provide for
initiate CPR when a client has no pulse or respirations.
comfort measures. The client’s decision is respected in
regard to the use of antibiotics, initiation of diagnostic
tests, and provision of nutrition by artificial means.
The
written prescription for a DNR or AND must be placed
in the client’s medical record. The provider consults
the client and the family prior to administering a
DNR or AND.
NURSING ROLE IN ADVANCE DIRECTIVES
Providing written information regarding advance
directives
● Documenting the client’s advance directives status
● Ensuring that advance directives are current and
reflective of the client’s current decisions
● Recognizing that the client’s choice takes priority when
there is a conflict between the client and family, or
between the client and the provider
● Informing all members of the health care team of the
client’s advance directives
Clients have the right to
privacy and confidentiality in
relation to their health care information and medical
recommendations
Nurses who disclose client information to an
unauthorized person can be
liable for invasion of
privacy, defamation, or slander.
The security and privacy rules of the Health Insurance
Portability and Accountability Act (HIPAA) were enacted
to
protect the confidentiality of health care information
and to give the client the right to control the release of
information.
Specific rights provided by HIPAA the legislation
include the following
The rights of clients to obtain a copy of their medical
record and to submit requests to amend erroneous or
incomplete information
◯ A requirement for health care and insurance providers
to provide written information about how medical
information is used and how it is shared with
other entities (permission must be obtained before
information is shared)
◯ The rights of clients to privacy and confidentiality
NURSING ROLE IN CONFIDENTIALITY
It is essential for nurses to be aware of the rights of
clients in regard to privacy and confidentiality.
Facility
policies and procedures are established in order to ensure
compliance with HIPAA regulations.
It is essential that
nurses know and adhere to the policies and procedures.
HIPAA regulations also provide for penalties in the event
of noncompliance with the regulations.
The Privacy Rule of HIPAA requires that nurses
protect all
written and verbal communication about clients.
COMPONENTS OF THE PRIVACY RULE
Only team members directly responsible
for client’s care - access to the client’s
records.
Nurses cannot share information with other
clients or staff not involved in the care of the client.
● Clients have a right to read and obtain a copy of their
medical record, - agency policy should be followed
when client requests read/copy of
the record.
● No part of client record can be copied except for
authorized exchange of documents between health care
institutions. For example:
◯ Transfer from a hospital to an extended care facility
◯ Exchange of documents between a general
practitioner and a specialist during a consult
ADDITIONAL COMPONENTS OF THE PRIVACY RULE
Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client names and diagnoses is restricted.
● Electronic records should be password‑protected, and care must be taken to prevent public viewing of the information. Health care workers should use only their own passwords to access information.
MORE COMPONENTS OF THE PRIVACY RULE
Client information cannot be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone.
◯ Many hospitals use a code system in which information is only disclosed to individuals who can provide the code.
◯ Nurses should ask any individual inquiring about a client’s status for the code and disclose information only when an individual can give the code.
LAST COMPONENT OF PRIVACY RULE
Communication about a client should only take place in a private setting where it cannot be overheard by unauthorized individuals.
The practice of “walking rounds,” where other clients and visitors can hear what
is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not
responsible.
Change‑of‑shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present.
Health information systems (HIS) are used to
The clinical portion of the system is often referred to as the
The CIS can be used to
- manage
administrative functions and clinical functions.
-clinical information systems (CIS).
-coordinate essential aspects of client care.
● In order to comply with HIPAA regulations, each
health care facility has
specific policies and procedures
designed to monitor staff adherence, technical protocols,
computer privacy, and data safety.
INFORMATION SECURITY PROTOCOLS
● Log off from the computer before leaving the workstation to ensure that others cannot view protected health information (PHI) on the monitor.
● Never share a user ID or password with anyone.
● Never leave a client’s chart or other printed or written PHI where others can access it.
● Shred any printed or written client information used for reporting or client care after it is no longer needed.
The use of social media by members of the nursing
profession is common practice. The benefits to using
social media are numerous.
-It provides a mechanism for nurses to access current information about health care
-enhances communication among nurses, colleagues,
and clients and families.
-provides an opportunity for nurses to express concerns and seek support from others.
However, nurses must be cautious about the risk
of intentional or inadvertent breaches of confidentiality
via social media.
The right to privacy is a
Invasion of privacy as it relates to health care is the
Confidentiality is the duty of
-fundamental component of client care.
-Release of client health information to others
without the client’s consent.
-the nurse to protect a client’s private information.
The inappropriate use of social media can result
in a
Depending on
the circumstances, the consequences can include
breach of client confidentiality.
termination of employment by the employer,
discipline
by the board of nursing,
charges of defamation
or invasion of privacy,
federal charges for violation of HIPAA.
Protecting yourself and others WITH REGARD TO INVASION OF PRIVACY BY:
Become familiar with facility policies about the use of social media, and adhere to them.
● Avoid disclosing any client health information online. Be sure no one can overhear conversations about a client when speaking on the telephone.
● Do not take or share photos or videos of a client.
● Remember to maintain professional boundaries when interacting with clients online.
● Never post a belittling or offensive remark about a client, employer, or coworker.
● Report any violations of facility social media policies to the nurse manager.
Informatics is
The use of technology in health care is
- the use of computers to systematically
resolve issues in nursing.
-increasing and most forms of
communication are in electronic format.
Examples of how a nurse can use the electronic
format while providing client care include
● Databases on diseases and medications are available for
● The nurse can review medications, diseases, procedures,
and treatments using an
● Computers can be beneficial for use with clients who
have
-laptops for documentation and the use of an automated medication dispensing system to dispense medications.
-the nurse to review. These databases can also be used as
a teaching tool when nurses are educating clients.
-electronic format.
-visual impairments.
The Internet is a valuable tool for clients to review
● Nurses should instruct clients to only review
● Clients can access their electronic health record (EHR)
which is part of
current medications and health questions. This is
especially true for clients who have chronic illnesses.
-valid and credible websites by verifying the author, institution,
credentials, and how current the article is. A disclaimer
will be presented if information is not medical advice.
-e‑health.
E‑health enables the client to
The goal of e‑health is
make appointments online, review laboratory results,
refill an electronic prescription, and review billing
information.
improved health care outcomes due to 24 hr access by the client and provider to the client’s health care information.
In order to be safe practitioners, nurses must understand
the
● Understanding the laws governing nursing practice
allows nurses to
● Nurses are accountable for practicing nursing in
accordance with
It is important that nurses know and comply with these laws.
legal aspects of the nursing profession.
-protect client rights and reduce the risk
of nursing liability.
-the various sources of law affecting
nursing practice.
By practicing nursing within the confines of the law, nurses are able to do the following.
◯ Provide safe, competent care
◯ Advocate for clients’ rights
◯ Provide care that is within the nurse’s scope of practice
◯ Discern the responsibilities of nursing in relation to the responsibilities of other members of the health care team
◯ Provide care that is consistent with established standards of care
◯ Shield oneself from liability
SOURCES OF LAW
Federal regulations
Some of the federal laws affecting nursing
practice include the following
HIPAA
● Americans with Disabilities Act (ADA)
● Mental Health Parity Act (MHPA)
● Patient Self‑Determination Act (PSDA)
● Uniform Anatomical Gift Act (UAGA)
● National Organ Transplant Act (NOTA)
● Emergency Medical Treatment and Active Labor
Act (EMTALA)
Criminal law is a subsection of public law and relates to
Violations of criminal law can be categorized as either
EX: A nurse who falsifies a record to cover up a serious mistake can be found guilty of
-the relationship of an individual with the government.
-a felony (a serious crime [homicide]) or
misdemeanor (a less serious crime [petty theft]).
-breaking a criminal law.
Civil laws protect the
-One type of civil law that relates to the provision of nursing
care is Torts can be classified as unintentional,
quasi‑intentional, or intentional.
-individual rights of people.
-tort law.
Torts can be classified as
unintentional,
quasi‑intentional, or intentional.
types of unintentional torts
Negligence:
● Malpractice:
Unintentional torts
● Negligence:
● Malpractice:
Practice or misconduct that does not meet
expected standards of care and places the client at risk
for injury (a nurse fails to implement safety measures
for a client who has been identified as at risk for falls).
Professional negligence (a nurse
administers a large dose of medication due to a
calculation error. The client has a cardiac arrest and dies).
types of quasi-intentional torts
Invasion of privacy: Intrusion into a client’s private
affairs or a breach of confidentiality (a nurse releases the
medical diagnosis of a client to a member of the press).
● Defamation: False communication or communication
with careless disregard for the truth with the intent to
injure an individual’s reputation.
◯ Libel: Defamation with the written word or
photographs (a nurse documents in a client’s health
record that a provider is incompetent).
◯ Slander: Defamation with the spoken word (a nurse
tells a coworker that she believes a client has been
unfaithful to the spouse).
Invasion of privacy:
Defamation:
Intrusion into a client’s private
affairs or a breach of confidentiality (a nurse releases the
medical diagnosis of a client to a member of the press).
False communication or communication with careless disregard for the truth with the intent to injure an individual’s reputation.
types of defamation
◯ Libel:
◯ Slander:
◯ Libel:
◯ Slander:
-Defamation with the written word or
photographs (a nurse documents in a client’s health
record that a provider is incompetent).
Defamation with the spoken word (a nurse
tells a coworker that she believes a client has been
unfaithful to the spouse).
types of intentional torts
Assault:
● Battery:
● False imprisonment
Assault:
● Battery:
● False imprisonment:
-The conduct of one person makes another
person fearful and apprehensive (threatening to place a
nasogastric tube in a client who is refusing to eat).
-Intentional and wrongful physical contact with
a person that involves an injury or offensive contact
(restraining a client and administering an injection
against their wishes).
-A competent person not at risk for
injury to self or others is confined or restrained against
their will (using restraints on a competent client to
prevent their leaving the health care facility).
The core of nursing practice is regulated by
state law.
● The nurse should seek the assistance of an interpreter if
-
the client does not speak and understand the language
used by the provider.
