CEPN - FINAL Exam Review

Social Media use

healthcare settings now generally have policies in place to govern the use of social media from workplace settings, as do many non-health-related employers

HIPAA guidelines on social media

have placed regulations on significant limitations on the content of nurses’ social media activities and comments

• violating these regulations means that the nurse has broken federal law and may have also broken state laws in the process

Hospice care

for people who no longer want treatment or whose illness has stopped responding to treatment

• for people who will not pursue aggressive measures to preserve and prolong their life

Palliative care

to provide support and mitigate the consequences of the disease/disorder

• GOAL: to reduce suffering while being treated

• an individual cannot be certified to receive hospice care while receiving palliative care

Differences between Hospice and Palliative Care

• Hospice care is for individuals with a shorter life expectancy

• Palliative care is an added specialty type of care that is “added” to regular healthcare

• Hospice “takes over” care—individual no longer sees his/her “regular” health care team

Similarities

• both focus on symptom management

• have a team approach to care (whole person care)

• require referrals from primary health care providers (physicians)

• both support family members

• most insurance companies pay for hospice and palliative care

Medical aid in dying

nurses should provide interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life

Levels of U.S. healthcare system

primary care, secondary care, and tertiary care

Primary care

major point of health promotion and illness prevention

Secondary care

management of a chronic illness by a specialist and taking care of people who have complex illnesses

Tertiary care

hospitals, long-term care facilities, rehabilitation centers, hospice centers

Therapeutic communication

technique in which the nurse seeks to understand a patient’s message more clearly

Therapeutic communication methods

• actively listening

• open-ended questions

• empathetic responses

• giving information (remember the “teach-back” method)

• reflection

• therapeutic silence

Interprofessional practice

working together with other professionals to improve a patient’s health status or to solve an organizational problem

Key components of interprofessional practice

• respect for other collaborators

• confidence in own knowledge

• willingness to learn

• cooperative spirit

• excellent communication skills

• self-awareness

SBAR

• situation, background, assessment, recommendations

• a structured way of relaying critical information in spoken form

• information is clear, complete, concise, and structured, therefore, more efficient and accurate

Holistic care

caring for the whole person, providing your physical, mental, spiritual, and social needs

Spirituality

a belief in a higher power, interconnectedness among living beings, and an awareness of life’s purpose and meaning

• is more personal

• may or may not be meaningful for people as they maintain health or cope with illness

Spirituality care

important for nurses to assess and meet patients’ and families’ spiritual needs

• strategies: remember spirituality is one part of the human dimension; assess for spiritual distress, and spiritual perspectives and practices are different from person to person

Obstacles to providing spiritual care

• discomfort or feelings of inadequacy

• lack of comfort and knowledge to provide spiritual care

• lack of time

Cultural competence

nurses’ development of knowledge, skills, and desire to provide culturally congruent care

• it’s about the journey NOT the destination (it’s never ending, its ongoing)

Culturally congruent care

safe, satisfying, beneficial, and meaningful to people of similar or diverse cultures for their health, wellbeing, and healing, and to help people face disabilities and death

• actual care that you provide that the patient asks/seeks

Licensure

• need to have to work as a nurse

Negligence

the failure to act as a reasonably prudent person

6 Major Categories of Negligence resulting in lawsuits against nurses

1. Failure to follow standards of care

2. Failure to use equipment responsibly

3. Failure to communicate

4. Failure to document

5. Failure to assess and monitor

6. Failure to act as a patient advocate

Malpractice

negligence applied to the act of a professional

• suits are usually civil (not criminal)

• can result from acts of commission and omission

4 elements that must be proved to malpractice suit against a nurse

1. the nurse assumed the duty and responsibility of care

2. the nurse failed to meet the standard of care

3. the failure to meet the standard of care was the proximate (preceding) cause of the injury

4. injury is proven

Commission

did it, but shouldn’t have

Omission

didn’t do it, but should have

Delegation

giving someone authority to act in one’s place

• RNs cannot delegate the nursing process itself

• carries great legal and safety implications in nursing practice

• RNs may delegate, LPN/LVNs can not

• RNs are responsible for determining that the delegated person is competent to safely perform the task

Informed consent

all patients or their guardians must be given an opportunity to grant informed consent before treatment unless there is a life-threatening emergency

3 Major Conditions of Informed Consent

1. Voluntary

2. “of sound mind”

3. Given enough information

Confidentiality

the protection of private information gathered during healthcare services

• both a legal and ethical concern in nursing practice

Exceptions to the obligations of confidentiality include

1. Discussion with others who are involved in direct patient care

2. Quality assurance initiatives (according to institutional policy)

3. Legally mandated disclosure (e.g. reporting suspected child abuse)

4. Disclose if concerned about possible harm to innocent parties

HIPPA

• health insurance portability and accountability act

• enacted to promote privacy and confidentiality of all patients

The 6 Ethical Principles

autonomy, beneficence, nonmaleficence, justice, fidelity, veracity

Autonomy

individuals have the right to determine their own actions and the freedom to make their own decisions

• autonomous decisions are based on individuals’ values, adequate information, freedom from coercion

Beneficence

“the doing of good” while respecting their autonomy and avoiding harm

Nonmaleficence

the duty to do no harm

Justice

equals should be treated the same and unequals should be treated differently

Fidelity

faithfulness or honoring one’s commitments or promises

Veracity

telling the truth

Double effect

concept that justifies risking harm

Patient Self-Determination Act

each person has legal and moral rights to informed consent about medical treatments and the person’s right to choose (autonomy)

• nurses assist patients and families as they discuss end-of-life care decisions

Advanced directives

written instructions (recognized by state laws) for an individual’s preferences about medical intervention if the individual is incapacitated

The 6 QSEN

patient-center care, quality improvement, teamwork and collaboration, evidence-based practice, safety, informatics

Patient-center care

recognize the patient (or family) as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs

Quality improvement

use data to monitor the outcomes of care processes and use strategies to continuously improve the quality and safety of health care systems

Teamwork and collaboration

function effectively within nursing and interprofessional teams, fostering open communications, mutual respect, and shared decision-making to achieve quality patient care

Evidence-based practice (QSEN)

integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health

Safety

minimize risk of harm to patients and providers through evaluation

Informatics

use information and technology to communicate, manage knowledge, mitigate error, and support decision making

• clinical informatics: clinical care, health system, information technology

Evidence-based practice

providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs

3 Key Components of EBP

best scientific evidence, clinical experience (expertise), and patient values

Nursing research

a systematic inquiry aimed at developing trustworthy evidence to address various health issues in nursing

Steps of the Research Process

1. identification of a researchable problem

2. review of literature

3. formulation of the research question or hypothesis

4. design of the study

5. implementation of the study

6. drawing conclusions based on findings

7. discussion and/or clinical implications

8. dissemination of findings

Community Nursing

voluntary rebid process of educational programs by a professional organization known as accrediting agency

• adheres to standards to promote the quality of education, safest, and profession

Public health nursing

broader concept, population-based health concerns