Test 1 - Unit A - Chapter 3 - Nursing Leadership and Management Flashcards
Professional responsibilities
obligations
that nurses have to their clients
To meet their professional responsibilities, nurses must be knowledgeable in
client rights,
advocacy,
informed consent,
advance directives,
confidentiality and information
security, information technology,
legal practice,
disruptive behavior,
ethical practice
Client rights
-legal guarantees clients have
with regard to their health care
-Clients using services of health care institution retain rights as individuals and citizens United States.
-American Hospital Association (AHA) identifies client rights in health care settings in the Patient Care Partnership
-Nurses - accountable for protecting the rights of clients
-regardless of age, nursing needs, or care setting
Residents in nursing facilities -participate
in Medicare programs
similarly retain resident
rights under statutes that govern the operation of these facilities
protecting clients rights situations that require particular attention include
informed consent,
refusal of treatment,
advance directives,
confidentiality,
information security.
Nurses must ensure that clients understand
Nurses also must protect
their rights.
clients’ rights during nursing care.
QSEN - Holistic
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
on admission to a health care facility, all clients must be informed of their right to accept or refuse care
Competent adults have the right to
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
-sign a document indicating that they understand risk involved refusing treatment or procedure,
-and that they have chosen to refuse it.
When a client decides to leave the facility without a prescription for discharge, the nurse does what
-notifies provider
-discusses with client potential risks - leaving facility prior to discharge.
-documents the information provided to client and that provider notification
-When a client decides to leave the facility without a prescription for discharge,
-The client should be informed of the following.
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
-The client is asked to sign an Against Medical Advice form.
● If the client refuses to sign the form, it is documented by the nurse.
Advocacy refers to nurses’ role in supporting clients by
ensuring they are properly informed,
their rights are respected,
receiving the proper level of care.
Advocacy is one of the most important roles of the nurse, 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
-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 the clients best interest.
● The nursing profession also has a responsibility to
-support and advocate for legislation that promotes public policies - protect clients as consumers
-create a safe environment for their care.
As advocates, nurses must ensure that
-clients informed of rights/have adequate information to base health care decisions.
● Nurses must be careful to assist clients with making health care decisions and not
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 nurses might need to advocate for clients or assist them to advocate for themselves include
◯ 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 nurse’s responsibility question a prescription if it could harm client
ie. (incorrect medication dosage,
otential adverse interaction with another prescribed medication,
contraindication due to an allergy or medical history).
ESSENTIAL COMPONENTS OF ADVOCACY
skills
● Risk‑taking
● Vision
● Self‑confidence
● Articulate communication
● Assertiveness
ESSENTIAL COMPONENTS OF ADVOCACY
values
● Caring
● Autonomy
● Respect
● Empowerment
Informed consent
-legal process - client has given written permission for procedure/treatment to be performed.
-Consent is considered informed when 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
-nurse’s role in informed consent process
-witness client’s signature on informed consent form and ensure that informed consent has been appropriately obtained.
The nurse should seek the assistance of an ____________ if the client does not speak and understand the language used by the provider.
interpreter
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
● State laws regulate who is able to _____ and vary regarding age limitations and emergencies.
Nurses are responsible for knowing
-written consent.
-give informed consent.
-the laws in the state of practice.
● Nurse responsibitlity with regard to informed consent
The nurse must verify that consent is informed and witness the client sign the consent form.
The form for informed consent must be signed by a
-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 consent form must be capable of
-understanding the information provided by the health care professional who will be providing the service.
-person must be able to fully communicate in return with the health care professional.
When 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:
CLIENT
NURSE
- Obtains informed consent
- Gives informed consent
- Witnesses informed consent
To obtain informed consent, the provider must give the client the following.
Complete description of treatment/ procedure
● Description of professionals performing /participating in treatment
● Description of potential harm, pain, and/or discomfort that might occur
● Options for other treatments and 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 provider gave client necessary information
◯ Ensuring client understood information
/ competent to give informed consent
◯ Having client sign informed
consent document
◯ Notifying provider if client has more questions/does not understand any information provided (The provider is responsible for clarification.)
The nurse documents the following. with regard to informed consent
◯ Reinforcement of information originally given by the provider
◯ That questions the client had were forwarded to the provider
◯ Use of an interpreter
COMPONENTS OF ADVANCE DIRECTIVES Two components
-living will
-durable power of attorney for health care.
living will is a legal document that expresses
the client’s wishes regarding medical treatment in event client becomes incapacitated and facing
end‑of‑life issues.
Types of treatments often addressed are those that have
Examples of treatments addressed are
–capacity to prolong life.
-cardiopulmonary resuscitation,
-mechanical ventilation, and
-feeding by artificial means.
Living wills are legal in _____ However, state statutes and individual health care facility policies can ___.
Nurses need to be familiar with their state statute and facility policies.
-all states.
-vary
● Most state laws include provisions that
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 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 ____
-A durable power of attorney for health care, as an
-unexpected circumstances.
-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
initiate CPR when a client has no pulse or respirations.
The written prescription for a DNR or AND must be placed where
in the client’s medical record. The provider consults the client and the family prior to administering a DNR or AND.
DNR
AND
-DO NOT RESUSCITATE
-ALLOW NATURAL DEATH
Additional prescriptions by the provider are based on
client’s individual needs and decisions and provide for 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.
NURSING ROLE IN ADVANCE DIRECTIVES
Providing written information regarding advance directives
● Documenting client’s advance directives status
● Ensuring advance directives are current and reflective of client’s current decisions
● Recognizing client’s choice takes priority when 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
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 in a conflict between the client /family, or between client / provider
● Informing all members of the health care team of the client’s advance directives
there is a conflict between the client and family, or between the client /provider
● Informing all members of the health care team of client’s advance directives
Confidentiality and
information security
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 ______________were enacted
to protect the
Health Insurance Portability and Accountability Act (HIPAA)
confidentiality of health care information
and to give the client the right to control the release of information.
Specific rights provided by HIPAA legislation include the following:
rights of clients to obtain 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
Facility policies and procedures are established in order to ensure
compliance with ___________.
It is essential that nurses know and adhere to to the ______________
-rights of clients in regard to privacy and confidentiality.
HIPAA regulations
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
First two
Only care team members directly responsible - client’s care - allowed access - client’s records. Nurses cannot share information w/other clients/staff not involved in care client.
● Clients - right to read/obtain copy of medical record, - agency policy should be followed when client requests to read/copy the record.
COMPONENTS OF THE PRIVACY RULE
Next three
-No part client record can be copied except for authorized exchange between health care institutions.
EX: Transfer - hospital to extended care facility
Exchange between a general
practitioner and specialist during a consult
- Client records - kept in secure area -
prevent inappropriate access to the information.
-Using public display boards to list client names and diagnoses is restricted.
COMPONENTS OF THE PRIVACY RULE
-Electronic records password‑protected, –care taken to prevent public viewing of
information.
-Health care workers-only their
own passwords to access information.
-Client information cannot be disclosed to unauthorized -individuals, including family members 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.
COMPONENTS OF THE PRIVACY RULE
Last one
-Communication about a client - take place in a private setting where cannot be overheard by unauthorized individuals. —–practice of “walking rounds,” (other clients/visitors can hear) no longer sanctioned.
-Taped rounds also discouraged - nurses should not receive information about clients 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.
HIPAA
COMPONENTS OF THE PRIVACY RULE
Short n Sweet
-only those in direct care of client
-client can read/copy medical record
- no part of client record can be copied except between institutions providing care
-records kept in secure area
-electronic records password protected
-client info not disclosed to unauthorized persons
-comms about client only in private
Items found on Advance Directive Form
- choice to either prolong or not prolong life
- choices regarding organ donation
-gives agent authority to make health care decisions if client is unable
Health information systems (HIS) are used to manage
The clinical portion of the system is often referred to as the _______.
The CIS can be used to coordinate______________
-administrative functions and clinical functions.
clinical information systems (CIS)
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 computer before leaving the workstation -ensure others cannot view protected health information (PHI)
● Never share user ID or password with anyone.
● Never leave client’s chart/ printed / written PHI where others can access it.
● Shred written/printed client information used for reporting after no longer needed.
social media by members of the nursing
profession is __________.
The benefits using social media -
-common practice
-provides a mechanism fornurses to access current information about health care
-enhances communication among nurses, colleagues,/clients/families.
-opportunity for nurses to express concerns and seek support from others.