MS3 Exam 1: Non-medical, nursing legalities stuff

Stack 1 of 2. Includes: 1-Becoming a professional nurse. 2-Nursing informatics. 3-Nursing Judgement and Flourishing

KBN

• creates/enforces regulations

• is under the Kentucky General Assembly

• defines nursing practice and professional conduct

• clarifies legal requirements

• approves nursing programs

• monitors CE requirement for licensure

Nursing License requirements

• graduate KBN approved program

• pass NCLEX-RN

• pass application fees

• fingerprint-based background check

• issue Nurse Licensure Compact (to practice multi-state in approved states)

• 1-time Domestic Violence CE

• 1-time HIV/AIDS CE

• Renew annually in OCTOBER

  • will need 14 contact hrs of CE

Nursing Scope of practice:

• Assess

• Create Plan of Care

• Admin meds

• Delegate tasks

Disciplinary Action

• Complaints can come from:

  • Employer

  • patient

  • colleague

  • public

• What can they complain about:

  • substance abuse

  • patient neglect

  • falsification of records

  • unprofessional conduct

• How can they punish you:

  • public reprimand

  • remedial education

  • probation

  • suspension

  • revoke/take away RN license permanently

  • Legal prosecution

Nurses are obligated to report:

• Colleague impairment from drugs, alcohol, or mental impairment

• Disclose your own criminal convictions/disciplinary actions

• Suspected child and elder abuse

• Patient communicable disease

  • ***** on Communicable Disease flashcard

• Employers must report

  • An employees terminations/resignations r/t misconduct

Communicable diseases (Off the hyperlink in powerpoint)

• Anthrax

• Arboviral diseases (disease spread by mosquitos, sandfies, ticks, etc.)

• Baesiosis

• Botulism

• Brucellosis

• Campylobacteriosis

• Cancer

• Candida Auris

• Carbapenemase-producing organisms

• Carbon Monoxide poisoning

• Chancroid

• Chickenpox/Varicella

• Chlamydia

• Cholera

• Coccidioidomycosis

• Covid 19

• Cryptosporidiosis

• Cyclosporiasis

• Dengue Virus infections

• Diphtheria

• Ehrlichiosis/Anaplasmosis

• Foodborne Disease outbreak

• Giardiasis

• Gonorrhea

• Haemophilus influenza

• Hansen disease

• Hantavirus infection or pulmonary syndrome

• Hepatitis A, B, C

• HIV/AIDS

• Influenza-related infant deaths

• Invasive pneumococcal disease

• Lead (elevated blood levels)

• Legionnaire diease

• Leoptospirosis

• Listeriosis

• Lyme Disease

• Malaria

• Measles

• Melioidosis

• Meningitis

• Mpox

• Mumps

• Novel influenza A

• Pertussis

• Pesticide-related illness/injury

• Plague

• Poliovirus infection

• Psittacosis

• Q-fever

• Rabies

• Rubella

• Salmonella

• Salmonellosis

• SARS Cov-2

• Shiga-Ecoli

• Shigellosis

• Smallpox

• Spotted fever Rickettsiosis

• Streptococcal toxic shock syndrome

• Syphilis

• Tetanus

• Toxic Shock Syndrome

• Trichinellosis

• Tuberculosis

• Tularemia

• Vancomycin resistant or intermediate Staphylococcus aureus

• Vibriosis

• Viral hemorrhagic fever (ebola, Lassa, etc)

• Waterborne disease outbreak

• Yellow Fever

• Zika virus

Law r/t Nursing Practice

• U.S Constitution:

  • 3 branches

  • checks/balances

• Statutory Law:

  • Legislative branch→ create federal laws

  • State legislative body → create state laws

  • Judicial branch → determine violation consequences

  • Nurse Practice Act is a statutory law

• Administrative Law:

  • Oversee administrative agencies (ex KBN)

  • KBN ensures compliance of Nurse Practice Act

• Common/Judicial Law (aka Case Law):

  • Judge makes decision that can be used to determine suture situations

• Health Insurance Portability and Accountability Act (HIPAA) protects:

  • personal health info

  • coverage for pre-existing conditions

  • health insurance benefits

• Emergency Medical Treatment and Active Labor Act (EMTALA):

  • Cannot deny care d/t inability to pay, legal action, or citizenship status

  • must provide medical screening exam to all patients in emergency department

  • Must stabilize/treat all emergent patients or laboring patients before discharge/transfer

• Patient Self-Determination Act:

  • Patient makes informed decisions about their health

• Good Samaritan Law:

  • Liability protection in emergent situation (ex. CPR, J-Thrust)

  • not applicable if not done in good faith, makes it worse, or shows negligence

  • best practice→ call 911

Torts

• Quasi-Intentional Torts:

  • Defamation of character

  • Slander (oral)

  • Libel (written)

• Intentional Torts:

  • Assault (verbal words of threat/harm)

  • Battery (physical actions of threat/harm)

  • False imprisonment (restraint w/o authorization -even physical or chemical)

  • Invasion of privacy (confidentiality breach)

  • Fraud (false charting)

Negligence vs. Malpractice

• Negligence→ failure to perform as a reasonable/prudent person would do

• Malpractice→ professional negligence (can be a professional individual or organization)

  • For patient to win case/be awarded damages (all 4 must be be true):

    • Existence of duty → they are your responsibility

    • Breach of duty→ failed to do your responsibility

    • Causation→ failure of duty caused the issue

    • Damages→ permanent damage/harm caused to patient

Organ Donation

• Network for Hope (former KODA and LifeCenter)

• Legally binding after registration

• Families can make next of kin decisions if pt not registered

• Uniform Anatomical Gift Act (UAGA)→ protects decision/wish to donate organs/tissues

• Hospitals are required to facilitate organ/tissue donation

Americans w/ Disabilities Act

• Can’t discriminate disabled patients regarding:

  • Employment→ must accommodate if you can still do your job

  • Public accommodations→ ramps, handicap access bathrooms, etc.

  • Government services→ have to prevent discrimination

  • Telecommunications→ r/t hearing and speech accommodations

Joint Commission

• Manage accreditation for Healthcare organizations

• create National Patient Safety Goals

Equal Employment Opportunity

• Prevents job discrimination

Nurses as Leaders: Classic Leadership Theories

• Autoritative/Autocratic:

  • Makes decisions for the group

  • Yields high productivity but offers low autonomy and creativity to staff

  • Works well in emergent situations when urgent decisions are needed

• Democratic:

  • Encourage group discussion/decision

  • Yields lower efficiency, but offers high satisfaction for staff

  • requires cooperation and coordination (teamwork)

• Laissez-faire:

  • Hands-off approach

  • Offers high autonomy, but can yield lower productivity/efficiency (depending on staff involved)

  • Works well if team members have the ability to work w/o oversight

• Situational:

  • Adapt amongst the different modes dependent on situation

Nurses as Leaders: Contemporary Leadership Theories

• Charismatic

  • Form emotional relations w/ team members

  • staff will feel inspired

• Transactional:

  • Use exchange of resources to motivate team members(quid pro quo)

  • “I’ll do ___ if you do ____”

  • Focused on task completion

• Transformational:

  • Fosters creativity and risk-taking

  • Inspirational

  • Similar to servant leadership (includes trust and collaboration)

• Shared Leadership

  • Co-leadership

  • Can be in cases where there is no leader, and instead the team works together.

5 Stages of Nursing Ability

• Novice

  • Task-oriented focus

  • Rule-based practice

• Advanced Beginner

  • Pattern recognition begins

  • Limited experience

• Competent Nurse

  • Organized approach

  • Deliberate planning

• Proficient Nurse

  • Intuition development

  • Holistic perception

• Expert Nurse

  • Intuitive grasp

  • Fluid performance

  • Deep understanding

Graduate Nurses (Novices)

• Anticipatory socialization

  • want to fit in

  • adopt norms and values of our desire groups (good thing if modeled after a good nurse)

  • eases transition to new role

  • internships/externships help ease into role

• Role stress and role overload

  • Discrepancy between your perception, expectations, and work demands

  • imposter syndrome

• New nurse Orientation

  • Varies in duration/expectation based on facility

  • speak up if you’re not ready to be on your own after orientation

• Role models and mentors

  • find the marigolds, avoid the walnuts (cling to those that help you thrive, not those that poison you)

• Professional Portfolio preparations

  • need resume

  • professional development (how to move up in education and work)

  • evidence of competencies and awards

  • have personal reflection thru your experience

Nursing Research

• A systematic, objective process of analyzing phenomena of importance of nursing.

  • this means→ we look at phenomenons and practices that impact nursing

• Encompasses all clinical practice arenas, nursing education, and nursing administration.

• Enhances quality of patient care

• Expectation of:

  • American Nurses Association (ANA) standards

  • Quality and Safety Education for Nurses (QSEN)

  • Institute of Medicine (IOM)

Ways to Gain Nursing Knowledge

• Trial and error plus common sense

  • Try what makes sense

  • If it doesn’t work, try something else.

• Authority and tradition

  • Do it “how it has always been done”

  • Do what those with more experience tell you

• Intuition and inspiration

  • Do what “feels” right

  • Go with your gut

• Logical reasoning

  • Use your knowledge and the available facts to form conclusions

Research Utilization

• The reason for conducting research is to establish evidence-based practice

• Must apply evidence to nursing care practices.

• Nurses have a responsibility to provide care based on the best available evidence, even if it contradicts with:

  • What they have been taught.

  • What other nurses do

  • What facility policies say (using the proper channels to help change policy)
    
    

Barriers to Using Research

• Lack of knowledge of nursing research

• Negative attitudes toward research

• Inadequate forums for disseminating research

• Lack of support from the employing institution

• Study findings that are not ready for the clinical environment.

Informatics and Nursing Practice

• What is informatics?

  • Managing and processing information necessary to make decisions.

• What is nursing informatics?

  • Managing and processing information applying to nursing practice, education, and research.

• It facilitates evidence-based practice

  • New model of decision making

    • Base plans of action and care on “best evidence” instead of “how it has always been done”

  • Affords rapid access to most current health information

    • Latest data can be accessed and used in decision making and care planning.

Electronic Communication (uses and benefits)

• Internet in Healthcare

  • Scheduling

  • Patient flow

  • Policies and procedures

  • Staff education

  • Internal sources of EBP

• Electronic mail, distribution lists, text messaging, communication apps.

  • Allow large-scale communication

  • Security/encryption is a high priority!

• Social Networking

  • Connect with others

  • Important in hiring/job search

• Web conferencing

  • Allows teams to interface from distant locations

  • Important tool in collaborations

• Telehealth

  • Removes physical barriers to accessing providers

  • Requires internet access, security, and know-how

Electronic Health Records

• Improves efficiency, productivity, and continuity of care

  • Standardized care plans

  • Standardized codes make billing simpler

• Reduce redundancy

  • Access to previous diagnostic information prevents unnecessary tests and procedures

• Improves accessibility

  • Computers at nurse’s stations, ipads, and the ability to access information from multiple locations.

• Serves as a clinical support tool

  • Most EHRs contain resources to help with clinical decision-making and patient care

• Reduces physician order entry errors

  • Eliminates the need to decipher handwriting

  • Often contains prompts for missing/inconsistent information

• Privacy

  • Access can be limited to those with legitimate need

• Public Health Benefits

  • Collected data and information can be used for research and quality improvement planning

The Role of AI in Nursing Informatics

• Benefits and Uses of AI

  • Simplifies charting process

  • Predictive analytics for anticipating adverse events

  • Real-time monitoring and alert systems

  • Improves diagnostic accuracy

  • Optimizes care plans

  • Streamlines and improves resource allocation

• Potential Harms of AI

  • Loss of the “Human Touch” and use of intuition

  • Data security issues

  • Disparities in availability

  • Biases within AI algorithms

• Best Practices

  • Trainings on effective, responsible use

  • Limit to areas where most appropriate

What is Clinical Judgement?

• Clinical judgement is→ Utilizing the processes that promote safe client care

  • As nurses we:

    • Recognize and interpret client problems

    • Prioritize a response

    • Take action

    • Evaluate outcomes

    • Modify actions as needed

What is Clinical Reasoning?

• Clinical reasoning is the process of synthesizing knowledge and information from numerous sources and incorporating experience to develop a plan of care for a particular client or case scenario

  • A.k.a…..Doing the nursing process

  • It requires reliance on your knowledge and experience to form a conceptual image of a client’s problem and its effective management.

  • Basically its taking all the information you have access to (patients history, providers notes, current data, labs, vital signs) and combining that provided info into your plan of care

What are Critical-Thinking Skills?

• Gathering information on a problem or issue

  • Subjective data

    • Data that comes from what someone feels or thinks on an issue (What patient or family member reports)

      • Ex. nausea, pain, itching, impending doom, etc.

  • Objective data

    • Data that we can quantify/validate/see

      • Ex. VS, physical assessment, labs, diagnostics

• Recognizing the need for more information

  • Further probing of patient report

    • If patient reports pain → what else do we want to know?

    • If family member states “this isn’t how he usually is” → how can we obtain additional information?

  • Additional VS or Assessment data

    • Lung sounds

    • BP on both arms

    • Focused Neurological exam

    • Finger-stick blood glucose

  • Diagnostic tests/images (x-rays, lab values, etc)

• Evaluating the information you have gathered (put pieces together)

  • Are any values outside the normal range form this patient?

  • Are there any changes that indicate a trend in the patient’s condition?

  • Does any of the data seem suspect?

    • Does the data need to be collected again to be sure?

    • Would alternative collection strategies alter the data?

• Recognizing gaps in one’s own knowledge

  • Are there diagnostic tests unfamiliar to you?

  • Are there abnormal lab values that you don’t know the causes for?

  • Are there medications or medical conditions you need to know more about in order to provide care?

  • Always try to know what you don’t know?

• Separating relevant from irrelevant data

  • This comes with time and experience

  • Abnormal findings that are trending “down” (in a negative direction) are more significant than those that are trending “up” (in a positive direction).

  • Some abnormal findings are more concerning than others depending on patient condition.

    • Elevated K in a patient with CKD vs in a patient with a severe respiratory infection.

    • Low O2 in a patient with COPD vs in a patient with a spinal cord injury.

• Organizing data

  • Put data together (in your head) that goes together

    • Data related to your diagnosis, s/s, etc.

  • Prioritize findings

    • Which data are more concerning right now?

    • Which data is expected?

• Making inferences:

  • Observation→ uses senses → ex. patient’s O2 sat is low

    • Here is what i see in my patient

  • Inference→ based on critical thinking and incorporation of other data →ex. Patients O2 sat is low because…..sensor is detached, or there is an airway obstructions, or…. etc.

    • Here is why i think it is happening.

  • Observation + knowledge help generate inferences.

  • Inferences guide interventions.

  • Use your understanding of pathophysiology and disease processes.

  • Put clues together

  • You won’t always be right.

• Generating potential solutions

  • Least invasive to most invasive

  • With experience and intuition, you get better at this

  • Follow facility policies

  • Get an order! Unless your facility has standing orders or order sets, then in that case know your standing orders.

Culturally Appropriate Care

• Cultural beliefs provide identity and a sense of belonging.

• Culture consists of common beliefs and practices

• Cultural assumptions can be unconscious

• Understanding how our own culture impacts how we interact with our patients is essential to quality care.

Concepts Related to Culture

• Ethnicity

  • A group of members that share a common social and cultural heritage (and frequently a common biological heritage.

    • Can impact what diseases are common in that particular group, how medications work, what care they think is appropriate, how they interact with provider, etc.

• Race

  • Is based on physical similarities and culture. (biological trend)

  • Its a social construct with no basis in science

  • From a scientific perspective, there is no such thing as race.

• Religion

  • Ordered system of beliefs

  • Can have a significant impact on care.

    • Ask your patient about their beliefs and practices that can impact their care.

Cultural Specifics that Affect Health

• Communication

  • Language→ address patient in a language they fluently speak

  • Nonverbal communication

  • Rules/norms on who may speak

• Space

  • Can be a perceived violation that leads to anxiety and fear

• Social organization

  • Family unit vs community

• Environmental control

  • Health beliefs and practices

  • Beliefs about illness

• Religion and philosophy

  • Willingness to seek care

  • Allowed vs forbidden forms of care

  • Beliefs about dying and death

• Education

  • Understanding of condition and care

  • Expectations for care

• Technology

  • patient’s level of comfort with technology

• Politics and Economy

  • Can determine who can access care

  • Publicly funded programs

Healthcare Variations

• Provide care within the patient’s boundaries.

• It is not up to you to decide what is and is not appropriate care

  • Your job is present to the patient he best alternative, and let them decide what route they want to do.

• Allopathy/conventional medicine

  • Focus is on treating the disease symptoms

• Complementary medicine

  • Rigorously tested therapies (chiropractic care, biofeedback, supplements, etc.)

• Alternative medicine

  • Not studied or fully understood (aromatherapy, magnets, crystals, etc.)

• Ayurveda

  • Harmony with nature (medicine, massage, herbs, visualization, etc.)

• Traditional Chinese medicine

  • Balance energies (herbs, acupuncture, massage, hot/cold therapy, etc.)

• Folk medicine

  • Passed among cultural groups (healers, home remedies, etc.)

• Holistic healthcare

  • Maintain whole-body health (diet, exercise, rest, etc.)

Barriers to Culturally Competent Care

• Bias = lack of impartiality

  • Attributing a woman’s pain to emotional reaction

  • Assuming a patient from a low-income area does not understand their care

• Ethnocentrism = viewing other cultures as inferior

  • Viewing alternative diets or practices as “weird”

  • Joking about a patient’s preferences

• Prejudice = negative attitudes towards others based on stereotypes

  • Belief that homosexual patients are mentally ill or socially deviant

• Discrimination = behavioral manifestations of prejudice

  • Refusing to provide care based on gender identity, marital status, religion, etc.

Developing Strategies to provide culturally competent care

• Reflect and know yourself

  • recognize your own biases

• Keep learning

• Accommodate and negotiate

  • embrace helpful or neutral cultural practices

  • discourage harmful cultural practices

• Collaborate with providers of alternative care

• Respect the beliefs of others

• Don’t make assumptions

Vulnerable Populations as Subcultures

• People experiencing homelessness

• People experiencing economic instability

• People experiencing mental illness

• People with physical disabilities

• Young (children)

• Older adults

• Some ethnic and racial minority groups

• Gender identities

Neighborhood

• Housing is a basic need

  • unsafe or poor quality can affect health

  • lead, asbestos, etc.

• Access to healthcare services

  • people in rural settings have higher rates of obesity and chronic disease

  • urban centers may have high crime areas

• Physical activity and nutrition affected by neighborhood

  • air pollution

  • overcrowding contributes to disease spread

  • noise pollution

  • stress and cortisol levels

  • food deserts

Economics and Healthcare

• Socioeconomic status is the main non-medical factor affecting health

  • access to healthy foods and safe housing

  • exposure to toxins

  • safety concerns based on neighborhood

• Related to wealth, education, and occupation

  • affording medical care

  • understanding rights and resources

  • dangerous jobs/working conditions

Health Disparities and Health Equity

• Heath Equity

  • Not all our patients get the exact same care.

  • Patients get the care they need based on what is going on with them.

  • Not based on their ability to pay or understand what is going on

• Health Disparities

  • No having access to reputable healthcare for whatever reason.

  • Factors and conditions leading to health disparities

    • Gender

      • Women use healthcare services more

      • may not receive same quality of care as men

      • Worse when combined with racial and ethnic differences

    • Age

      • Older adults are at risk

        • # of diagnostic tests done

        • getting accommodations to/from hcp

        • restrictions to testing d/t age

        • aggressiveness of treatment used

      • Black and latino older adults

        • disproportionately affected by chronic illnesses, disabilities, depression, and substandard quality of life

    • Ethnicity

    • Socioeconomic status

    • Education

    • Location

    • Sexual Orientation/Gender Identity

      • Important to address what they identify as

      • Biological Sex

        • assigned at birth

        • determined by external/internal genitalia and chromosomes

      • Gender

        • social construct

      • Gender Identity

        • self-perceived gender

        • may be same or different as biological sex assigned at birth

          • Cisgender→ gender identity same as biological sex

          • Transgender→ gender identity different than biological sex

    • Disability status

LGBTQ+ Healthcare

• The Minority Stress Model

  • stigma and discrimination are often based on cultural, political, legal, and historic contexts

  • created a hostile culture

• Homosexuality was identified by the American Psychiatric Association as a mental illness in 1973

• Some religions do not acknowledge or accept same sex behaviors or feelings.

• Same sex marriage legalized by US Supreme court in 2015. It changed:

  • Who can make healthcare decisions

  • Legal visitation during hospitalization

  • Spousal health insurance coverage

• Pervasive discrimination by healthcare providers is felt by 56% of LGB persons and 70% of transgender-identifying persons

• LGBTQ+ care challenges and barriers

  • care considerations

  • effective communication

• Joint Commission accreditation standards now include:

  • non-discrimination visitation policies

  • available unisex or single stall bathrooms

  • intake forms that address sexual and gender identity

• Establish the patient’s preferred name, gender identity, and use of pronouns

  • using a patient’s chosen name is respectful

  • the legal name may be different and may be referred to as their “dead name”

  • verify EHR information is correct

    • ask patient their sex assigned at birth

    • request their current gender identity

  • clarify preferred gender specific pronouns

  • acknowledge and apologize for any identification errors you make