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45 Cards in this Set
- Front
- Back
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Discuss advocacy. What is the nurse's role? |
- Advocacy refers to the 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 nurse, especially when the clients are unable to speak or act for themselves - Nurses must act as advocates even when they disagree with the client's decision
* As advocates, nurses must ensure that clients are informed of their rights, and have adequate information on which to base health care decisions * |
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What is the NURSES' role in client rights? |
- Client rights are the LEGAL GUARANTEES that clients have in regard to their health care - Nurses are ACCOUNTABLE for PROTECTING the rights of the client's
- Situations that require particular attention include: * Informed consent * Advance directives * Refusal of treatment * Confidentiality & information security
* Nurses must ensure that clients understand their rights, and nurses must also PROTECT client rights during nursing care * |
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Discuss informed consent. |
- Informed consent is the LEGAL PROCESS by which a client has given WRITTEN PERMISSION for a procedure of treatment to be performed
- Consent is considered to be informed when the client has been provided with and understands the following: * The reason the treatment or procedure is needed * How the treatment or procedure will benefit the client * The 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
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What is the nurses' role in the informed consent process? |
- The nurses' 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 |
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Discuss advance directives. |
- The purpose of advance directives is to COMMUNICATE a CLIENT'S WISHES regarding end-of-life care, should the client be UNABLE to do so - The Patient Self Determination Act (PSDA) requires that ALL clients admitted to a health care facility be asked if they have ADVANCE DIRECTIVES
- 2 components of an advanced directives are: 1. Living will 2. Durable power of attorney |
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What is the nurses' role in patient confidentiality? |
- Client's 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 - Nurses NEED TO BE AWARE of the rights of the client's in regard to PRIVACY and CONFIDENTIALITY - Nurses must ADHERE to the policies and procedures regarding patient confidentiality |
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Compare and contrast the 3 types of managers: 1. Authoritative 2. Democratic 3. Laissez Faire |
- AUTHORITATIVE: * Makes decisions for the group * Motivates by COERCION (motivates someone using threats) * Communication occurs down the chain of command * Work output by staff is usually HIGH - good for crisis situations and bureaucratic settings
- DEMOCRATIC: * INCLUDES the GROUP when decisions are made * Motivates by SUPPORTING staff achievements * Communication occurs up and down the chain of command * Work output by staff is usually of GOOD QUALITY - good when COOPERATION and COLLABORATION is necessary
- LAISSEZ FAIRE: * Makes VERY FEW DECISIONS and does LITTLE PLANNING * Motivation is largely the responsibility of individual staff members * Communication occurs up and down the chain of command and between group members * Work output is LOW unless an INFORMAL leader evolves from the group |
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Define critical thinking and decision making. |
- CRITICAL THINKING: * The mental process of analyzing or evaluating information
- DECISION MAKING: * The process by a course of action is determined * The course of action may be in response to a problem or an issue |
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Give an example of each of the prioritization principles: 1. System before local 2. Acute before chronic 3. Actual before potential 4. Trends vs. transient findings 5. Signs of medical emergencies/complications vs. "expected findings" |
- SYSTEM BEFORE LOCAL: * "LIFE BEFORE LIMB" * Prioritizing interventions for a client in shock OVER interventions for a client with a localized limb injury
- ACUTE BEFORE CHRONIC: * Prioritizing the care of a client with a new injury/illness (mental confusion, chest pain), OR an acute exacerbation of a previous illness over the care of a client with a long-term chronic illness
- ACTUAL BEFORE POTENTIAL: * Prioritize actual problems before potential future problems * Prioritizing administration of medication to a client experiencing acute pain OVER ambulation of a client at risk for thrombophlebitis
- TRENDS VS. TRANSIENT FINDINGS: * Recognize a gradual deterioration in a client's level of consciousness and/or Glasgow Coma Scale
- SIGNS OF MEDICAL EMERGENCIES/COMPLICATIONS VS. "EXPECTED CLIENT FINDINGS": * Recognizing signs of increasing intracranial pressure in a client newly diagnosed with a stroke vs. the clinical findings expected following a stroke |
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Discuss priority-setting frameworks, give example of the following: 1. Maslow's Hierarchy 2. Airway, Breathing, Circulation (ABC framework) 3. Safety/Risk Reduction 4. Assessment First 5. Survival Potential 6. Least Restrictive |
- MASLOW'S HIERARCHY: * The nurse should consider this hierarchy of human needs when prioritizing interventions * Example: the nurse should prioritize a client's need for airway, oxygenation (or breathing), circulation, and potential for disability over need for shelter * Need for safe and secure environment over a need for family support
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AIRWAY, BREATHING, CIRCULATION (ABC framework) |
- AIRWAY, BREATHING, CIRCULATION: * The ABC framework identifies in order, the 3 basic needs for SUSTAINING LIFE * An OPEN AIRWAY is necessary for breathing, so it is the HIGHEST PRIORITY * BREATHING is necessary for oxygenation of the blood to occur * CIRCULATION is necessary for oxygenated blood to reach the body's tissues |
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SAFETY/RISK REDUCTION |
- SAFETY/RISK REDUCTION: * Look 1st for SAFETY RISK! * For example: is there a finding that suggests a RISK for AIRWAY OBSTRUCTION, HYPOXIA, BLEEDING, INFECTION, or INJURY? * Next ask, "What's the RISK to the client?" and "How significant is the risk compared to posed risks?" * Give PRIORITY to responding to whatever finding poses the GREATEST (or most imminent) RISK to the client's physical well-being |
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ASSESSMENT FIRST |
- ASSESSMENT FIRST!: * Use the nursing process to gather pertinent information PRIOR to making a decision regarding a plan of action * For example: determine if ADDITIONAL assessment information is needed PRIOR to calling the PCP to ask for pain medication for a client |
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SURVIVAL POTENTIAL |
- SURVIVAL POTENTIAL: * Use this framework for situations in which health care resources are EXTREMELY limited (mass casualty, disaster triage) * Give PRIORITY to clients who have a REASONABLE chance of SURVIVAL with PROMPT INTERVENTION - clients who have a LIMITED LIKELIHOOD of survival even with intense intervention are assigned the LOWEST PRIORITY |
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LEAST RESTRICTIVE |
- LEAST RESTRICTIVE: * Select interventions that MAINTAIN CLIENT SAFETY while posing the LEAST AMOUNT of restriction to the client * For example: if a client with a HIGH FALL RISK index is getting out of bed without assistance, move the CLIENT CLOSER to the nurses' work station area RATHER than choosing to apply restraints * LEAST INVASIVE 1st! |
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List 5 time savers. |
1. Documenting nursing interventions AS SOON AS POSSIBLE after completion to facilitate accurate and thorough documentation 2. GROUPING ACTIVITIES that are to be performed ON THE SAME CLIENT or are in CLOSE PHYSICAL PROXIMITY to PREVENT unnecessary walking 3. Estimating HOW LONG each activity will take and planing accordingly 4. MENTALLY ENVISIONING the procedure to be performed and ensuring that ALL equipment has been gathered PRIOR to entering the client's room 5. Taking time to plan care and taking priorities into consideration |
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List 5 time wasters. |
1. Documenting at the END of shift ALL client care provided and assessments done 2. Making repeated trips to the supply room for equipment 3. Providing care as opportunity arises regardless of other responsibilities 4. Missing equipment when preparing to perform a procedure 5. Failing to plan or managing by crisis |
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Compare and contrast: 1. Assigning 2. Delegating 3. Supervising |
- ASSIGNING: * Assigning is the process of TRANSFERRING AUTHORITY, accountability, and responsibility of client care to ANOTHER member of the health care team
- DELEGATING: * Delegating is the process of transferring authority and responsibility to ANOTHER TEAM MEMBER to COMPLETE A TASK, while RETAINING ACCOUNTABILITY
- SUPERVISING: * Supervising is the process of directing, monitoring, and evaluating the performance of tasks by ANOTHER member of the health care team * RN's are responsible for the supervision of client care tasks delegated to assistive personnel (AP) and LPN's |
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Explain the rights of delegation. |
- Nurses can only delegate tasks APPROPRIATE for the skill and education level of the health care provider who is receiving the assignment - RN's CANNOT delegate the nursing process, client education, or tasks that require nursing judgment to LPN's or AP's |
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What are the 5 rights of delegation? |
1. RIGHT TASK: delegate AP to assist a client who has pneumonia to use a bedpan 2. RIGHT CIRCUMSTANCE: delegate AP to assist in obtaining vital signs from a STABLE postoperative client 3. RIGHT PERSON: delegate LPN to administer enteral feedings to a client who has a head injury 4. RIGHT DIRECTION/COMMUNICATION: delegate AP the task of assisting a client in room 312 with a shower, to be completed by 0900 5. RIGHT SUPERVISION: after completing admission assessment, an RN delegates to an AP the task of ambulating the client |
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Give an example of wrong supervision. |
- PRIOR to performing an admission assessment, an RN delegates to an AP the task of ambulating the client |
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Give an example of a wrong task. |
- Delegate an AP to administer a nebulizer treatment to a client who has pneumonia |
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Give an example of wrong communication. |
- Delegate the AP the task of assisting a client in room 312 with morning hygiene |
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List 3 components of staff education. |
- ORIENTATION: * Orientation helps newly licensed nurses translate the knowledge, skills, and attitudes learned in nursing school into practice
- SOCIALIZATION: * Socialization is the process by which a person learns a new role and values and culture of the group within which that role will be implemented
- EDUCATION & TRAINING OF FELLOW HEALTH CARE WORKERS TO ENSURE COMPETENCE OF ALL STAFF: * Staff education or staff development, is the process by which a staff member gains knowledge and skills * The goal of staff education is to ensure that staff have have the most current knowledge and skills necessary to meet the needs of the clients |
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What is the focus of performance improvement? |
- Performance improvement (quality improvement, quality control), is the process used to identify and resolve performance deficiencies - Performance improvement process focuses on assessment of outcomes and determines ways to improve the delivery of quality of care - ALL LEVELS of employees are involved in the performance improvement process |
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Define performance appraisal. |
- Performance appraisal is the process by which a supervisor evaluates an employee's performance in relation to the job description for that employee's position as well as other expectations the facility may have - Performance appraisals are done at regular intervals and may be more frequent for new employees |
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List 5 conflict resolution strategies. |
1. AVOIDING/WITHDRAWING: * Both parties know there is a conflict, but they refuse to face it or work toward a resolution
2. SMOOTHING: * One party attempts to "smooth" another party by trying to satisfy another party * Often used to preserve or maintain a peaceful work environment
3. COMPETING/COERCING: * One party pursues a desired solution at the expense of others * Managers may use this when a quick unpopular decision must be made
4. COOPERATING/ACCOMMODATING: * One party sacrifices something, allowing the other party to get what it wants - the opposite of competing
5. COMPROMISING/NEGOTIATING: * Each party gives up something * Both parties must give up something equally important |
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Discuss the interdisciplinary team and collaboration. |
- INTERDISCIPLINARY TEAM: * An interdisciplinary team is a group of health care professionals from various disciplines
- COLLABORATION: * Collaboration involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems * The specialized knowledge and skills of each discipline are used in the development of an interdisciplinary plan of care that addresses multiple problems * Collaboration occurs among different levels of nurses and nurses with different areas of expertise |
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What is involved in continuity of care? |
- Continuity of care refers to the consistency of care provided as clients move through the health care system - It enhances the quality of client care and facilitates the achievement of positive client outcomes - Nurses are RESPONSIBLE for facilitating continuity of care and coordinating care through documentation, reporting and collaboration - The nurse should act as a REPRESENTATIVE of the client and as liaison when collaborating care with primary care provider and other members of the health care team |
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Define NEGLIGENCE. |
- NEGLIGENCE: * Failure to take PROPER CARE IN DOING SOMETHING
- EXAMPLE: * The nurse fails to implement safety measures for a client who has been identified as at risk for falls |
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Define MALPRACTICE (professional negligence). |
- MALPRACTICE: * Improper, illegal professional activity or treatment
- Example: * A nurse administers a large dose of medication due to a calculation error - the client is in cardiac arrest and dies |
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Define BREACH OF CONFIDENTIALITY. |
- BREACH OF CONFIDENTIALITY: * Occurs when data or information provided in confidence is disclosed to a 3rd party WITHOUT their consent
- EXAMPLE: * A nurse releases the medical diagnosis of a client to a member of the press |
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Define DEFAMATION OF CHARACTER: |
- DEFAMATION OF CHARACTER: * An INTENTIONAL false statement about someone
- EXAMPLE: * A nurse tells a coworker that she believes a client has been unfaithful to the spouse |
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Define ASSAULT. |
- ASSAULT: * The crime of TRYING or THREATENING to hurt someone physically * The conduct of one person makes another person fearful and apprehensive
- EXAMPLE: * Threatening to place an NG tube in a client who is refusing to eat |
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Define BATTERY. |
- BATTERY: * Criminal offense involving unlawful PHYSICAL CONTACT * Intentional and wrongful physical contact with a person that involves an injury or offensive contact
- EXAMPLE: * Restraining a client and administering an injection against his wishes |
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Define FALSE IMPRISONMENT. |
- FALSE IMPRISONMENT: * A RESTRAINT of a person in a bounded area WITHOUT justification or consent * A person is CONFINED or RESTRAINED against his will
- EXAMPLE: * Using restraints on a competent client to prevent his leaving the health care facility |
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Define ETHICAL DILEMMA, and give an example. |
- Ethical dilemma: problems for which MORE THAN ONE CHOICE can be made and the choice is influenced by the value and beliefs of the decision makers
- Example: a problem CANNOT be solved solely by a review of scientific data, or the answer will have a profound effect on the situation/client |
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Discuss the use of safe equipment, and handling of infectious and hazardous materials. |
- Handling infectious and hazardous materials refers both to infection control procedures and to precautions for handling toxic, radioactive, or other hazardous materials - Infection control is EXTREMELY important to PREVENT cross contamination of communicable organisms and health care-associated teams |
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Discuss accident and injury prevention. |
- Preventing injury is a MAJOR NURSING RESPONSIBILITY - many factors affect a client's ability to protect himself, these factors include the client's: * Age (young and old are at greatest risk) * Mobility * Cognitive and sensory awareness * Emotional state * Lifestyle and safety awareness
- ALL health care workers must be aware of: * How to assess for and recognize clients at risk for safety issues * Procedural safety guidelines * Security plans * Protocols for responding to dangerous situations |
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Discuss home safety and ergonomic principles. |
- HOME SAFETY: * In addition to taking measures to prevent injury of clients in a health care setting, nurses play a pivotal role in promoting safety in the client's home and community * Nurses can often collaborate with the client, family, and members of interdisciplinary team (social workers, OT's) to promote client safety * Identify safety risks for different age groups (infants/toddlers ect.)
- ERGONOMIC PRINCIPLES: * Ergonomics are the factors or qualities in an objects design and/or use that contribute to comfort, safety, efficiency and ease of use * Implementing the use of proper body mechanics and correct body alignment * The risk of injury to the client and the nurse is reduced with the use of good body mechanics |
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Discuss the use of incident reports. |
- Incident reports are records made of UNEXPECTED or UNUSUAL INCIDENTS that affected a client, volunteer, or visitor in a health care facility - Incident reports may be referred to as "unusual occurrence reports"
- Incidents that REQUIRE reports include: * Medication errors * Procedure/treatment errors * Equipment related injuries/errors * Needlestick injuries * Client falls/injuries * Visitor/volunteer injuries * Threat to staff |
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Discuss DISASTER PLANNING, EMERGENCY RESPONSE, and SECURITY PLANS. |
- DISASTER PLANNING: * A disaster is a mass casualty or intra-facility event that overwhelms or interrupts, at least temporarily the normal flow of services in a hospital * Can include internal or external emergencies
- EMERGENCY RESPONSE: * Each health care institution must have emergency preparedness plan that has been developed by a planning committee * Triage principles may be used in a mass casualty event * During mass casualty events, casualties are separated to their potential for survival or treatment is allocated accordingly
- SECURITY PLANS: * ALL health care facilities should have security plans in place that include preventative, protective, and response measures designed for identifying security needs * Electronic security systems in high-risk areas (newborn/nursery to prevent abductions) |
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List tasks that can be delegated to the LVN: |
- Monitoring client findings (as input to the RN's ongoing assessment of the client) - Reinforcement of client teaching from a standard care plan - Tracheostomy care - Suctioning - Checking NG tube patency - Administration of enteral feedings - Insertion of a urinary catheter - Medication administration (excluding IV medications in several states) |
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List tasks that can be delegated to the CNA: |
- ADL's - Bathing - Grooming - Dressing - Toileting - Feeding WITHOUT swallowing precautions - Positioning - Bed making - Specimen collection - Vital signs on stable clients - Intake and output |
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List tasks that MUST be the responsibility of the RN: |
- Completing admission assessment - Administering medications through IV - Client teaching |
