Intro to nursing quiz #2

Describe the components of a model nursing practice act  

• to ensure order, protect individual person, resolve disputes, and promote general welfare

• Nurse practice act defines the scope of practice, determines educational requirements of licensure 

• Important to professional nurses  

• ANA and NCSBN have developed and suggested language for the content of state NPA  

• Defines the standards and scope of professional nursing  

• Describes the authority, power, and composition of the board of nursing 

• Defined educational program standards  

• Sets the minimum educational qualifications and other requirements for licensure  

• Determines and protects the legal titles and abbreviations nurses may use  

• Provides for disciplinary action of licenses for certain causes  

Discuss the authority of state boards of nursing  

• It can adopt rules that clarify general provisions if the nursing practice act, but it does not have the authority to enlarge the law.

• The state boards of nursing have the authority to set and enforce minimum criteria for nursing education criteria  

• An applicant for licensure must graduate from a state approved nursing education program  

• The state boards of nursing have the power to sanction a nurse for performing professional functions that are dangerous to the patient or general public 

• Probation  

• Suspension  

• Revocation  

• Most common reasons: practicing while under the influence of alcohol or drugs 

Explain the conditions that must be present for malpractice  

• Comission: doing something that should have not been done

• omission: failing to do things that should have been done.

• Failure to follow standards of care  

• Failure to use equipment in a responsible manner  

• Failure to communicate  

• Failure to document  

• Failure to assess and monitor  

• Failure to act as a patient advocate  

• Professional nurses may delegate independent nursing activities (as well as medical functions that have been delegated to them) to other nursing personnel  

• State nurse practice acts do not give LPNs or LVNs the authority to delegate  

• Professional RNs retain accountability for acts delegated to another person  

• RN is responsible for determining that the delegated person is competent to perform the delegated act  

• The delegate is responsible for carrying out the delegated act safely  

• The professional nurse remains legally liable  

• Malpractice occurs when a professional, nurse, pr physician fails to act as a reasonably prudent professional would have acted under the same circumstances.  

Explain the legal responsibilities of nurses to enforce professional boundaries, including the use of social media  

• Confidentiality, HIPAA, and social media  

• NCSBN 2011: a nurses guide to the use of social media  

• Confidentiality and HIPAA regulations place significant limitations on the content of nurses social media activities and comments 

• the nurse has a duty to maintain confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues including social media and other means of communication.

• Nurses are responsible for providing accurate, relevant data to members of the health care team and others who have a need to know.  

Describe the strategies nurses can use to protect their patients, thereby protecting themselves from legal action  

• Practice in: practice in safe settings, qualities of safe agencies, risk management, the joint communication and  

• Communication: communicate with other health care professionals, patients, and families including accurate documentations. Preventing legal problems is keeping good records.  

• Meet: meet the standard of care. Be technically competent, keeping up to date with healthcare innovations, being aware of peer expectations, and participating as an equal on the healthcare team.  

• Carry and understand: carry and understanding professional liability insurance  

• Promote: promote positive interpersonal relationships  

safest situations is one in which the agency does the following

1. employs an appropriate number personnel with a vairety of skills to care adequetly for the number of agency patients at all levels of acuity

2. has policies, procedures, and personnel practices promoting quality and safety

3. keeps equipment in good working order

4. provides comprehensive orientation to new employees, supervises all levels of employes, and provides opportutnites for employees to learn new procedures consistent with the level of health care services provided by the agency.

informed consent

• Three major conditions of informed consent 

1. Consent must be given voluntarily  

2. Consent must be given by an individual with the capacity and competence to understand  

3. The patient must be given enough information  

 

Delegation

giving someone authority to act for another – is an issues that carries great legal and safety implications in nursing practice.  

• the ability to delegate has generally been reserved for professionals because they hold licenses that sanction the entire scope of practice for a particular profession.

• RNs only have the legal authority to delegate tasks to: LPN’s/ LVNSs & UAPs

• right task

• right circumstances

• right person

• right direction/communication

• right supervision/ evalution

confidentially

• both a legal and an ethical concern in nursing practices. It is the protection of private information gathered about a patient during the provision of healthcare services. 

• Confidentiality: HIPAA; social media standards  

Assault & battery towards patient

Assault is threatening with treatments. Battery doing the procedure against the individuals wishes 

Prescriptive authority:

only for providers (NP, MD, PA) 

Define licensure according to the national council of state boards of nursing  

• Mandatory law: requires any person

who practices the occupation or

profession to be licensed.

• Permissive law: protects and limits the

use of the title granted in the law but does

not prohibit persons from practicing the

occupation/profession if they do not use

the title.

• it ensures public safety by assessing basic and continuing competence

• all 50 states now have mandatory licensure law

• must graduate from a state approved nursing education program as a prerequisite to being admitted to the licensure examination.

• Licensed: LPN, RN, APN, PA, physicians

• The licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process 

• Computerized adaptive testing: minimum 85, maximum 135, Duration: 5 hours 

Differentiate between negligence and malpractice  

• Negligence: failure to act as a reasonably prudent person would have acted in the same circumstances  

• Malpractice: is negligence applied to the acts of a professional (RN)

Discuss the benefits of using electronic medical records  

• Benefits:  

• Generate reminders  

• Pull information  

• Populate notes  

• Generate reports  

• Information available, easy to find and aggregated: increase in the spread at which care can. Be delivered  

• Cataloged and grouped: easier to find information. More efficient access to information  

• Patient tracking  

• Standardization of care  

Ethical Principles

• autonomy

• beneficence

• nonmaleficence

• justice

• fidelity (confidentitality)

• veracity

challenges of using electronic medical records 

• Privacy and security  

• limited patient - clinician interaction

• documentation accuracy

• note bloat

• technology failure

Describe the role of nursing and healthcare informatics

• ANA: nursing information “is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice” 

• AMIA: “the science and practice that integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide.” 

• Nurses deal with the management and communication of information and knowledge.

Describe the benefits of challenges of use of social media in health care  

• you must not post or otherwise transmit digitally any thing about your patients that may violate their rights to privacy and confidentiality

• never post images of patients

• online contact with patients blurs professional and personal boundaries

• you are ethically obligated to report any breach in confidentiality or privacy that you encounter online

• remember that posting anything leaves a permenant digital footprint.

two disticnt problems with the use of social media in health care

1. the transmission of potientally idenfitifable patient information

2. the blurring of professional and personal boundaires

Explain the legal responsibilities of nurses to enforce professional boundaries, including the use of social media  

• engage the assistance of a nurse manager or supervisor before confronting your colleague if you suspect they are impaired

• or if your colleague has obtained information about someone from the hopsital electronic health records and posted them on a website

Review all APA quizzes

Autonomy 

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

• Moral basis: respect for individuals  

• Overemphasis/ downside: lack of caring, not interefering with decision making  

• Challenging's in health care: some patients defer autonomy to their providers  

Beneficence (patient advocacy)

• Moral basis: do good,  

• Overemphasis: paternalism – inflicting own values 

• Challenged: context of patients life and situation must be considered. Beneficence may conflict with informed refusal  

Nonmaleficence: 

• Moral basis: do no harm 

• Overemphasis: lack of action, questionable treatments not offered 

• Challenges: therapeutic interventions may cause harm  

Justice : 

• Moral basis: be fair; provide care appropriate to needs 

• Overemphasis: with lack of resources impossible to be fair or individualize 

• Challenges: is health care a right or privalege? Shoulkd nonadherent patients continue to receive health care resources? Health disparities highlight the lack of health care justice  

Fidelity  (confidentiality and synergistic with veracity )

• Moral basis: loyality and truthfulness 

• Overemphasis: confidentiality may impede efficiency and quality of care  

• Challenges: no absolute duty to keep promises: in each situation, the harmful consequence of the promised action must be weighted against the benefits of promise keeping  

Veracity 

• Moral basis: truth telling or not lying 

• Overemphasis: truth may cause harm  

• Challenges: cultural variances existing regarding truth telling with healthcare information. Sometimes a desire to justify why deceit is best in situations occurs

Social media practices and principles (benefit of social media)

• maintain seperate personal and professional platforms

• never disclose patient information or patient indetifiers

• social media can enhance or hurt the image of the career of nursing

• nursing students should never post photos of their clinical experiences

Benefit

• dissemination of research information and best practice as well as educating public in health promotion

HIPAA

• Patients are able to see and obtain copies of their medical records, generally within 30 days of their request, and to request corrections if they detect errors.

• Providers must give patients written notice describing the provider's information practices and explaining patients' rights.

• Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared.

four elements of a cause of action for negligance

1. The professional (nurse) has assumed the duty of care (responsibility for the patient's care).

2. . The professional (nurse) breached the duty of care by failing to meet the standard of care.

3. The failure of the professional (nurse) to meet the standard of care was the proximate cause of the injury.

4. The injury is proved.

role of nurse of informed consent

• Unless primary provider, nurses collaborate with the primary provider  

• A nurse may witness a patients signing but is not responsible for explaining the proposed treatment  

• The nurse is not responsible for evaluating whether the physician has truly explained the significant risks, benefits, and alternative treatments  

• The nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to withdraw consent or grant consent previously with held and communicating the patients needs for further information to the primary provider.  

• Ensure the patient is competent: is this a child? Is child's caregiver competent? 

ANA principals of social networking

1. Be aware of your audience

2. Maintain your professionalism

3. Know your social media policy.

4. Secure your social media profiles.

5. Share credible information only.

6. Engage with respectful content.

two requirements of malpractice action

1. the defendant (nurse) has specialized knowledge and skills

2. through the practice of that specialized knowledge the defendant causes the patients injury

exceptions to the obligation of confidentiality

• discussing the care of patients with others involved in their direct care

• quality assurance activities,

• legally mandated disclosure to public health authorities

• information required by third party payers

Book formatting

Author. (Date). Title (italicized, sentence cased). Publisher Name. URL  

Journal formatting

Periodical title, volume #, issue #, pages or article #, DOI if available. No italic, sentence case

website formatting

Author. (full date). Title of article (italicized, sentenced cased). Site Name (title case). Retrieved. URL

narrative vs paraethnical

n: authors name is incorporated into the sentence only (date) 

p: (authors last name, date).

componenets of an APA paper

• title page: title case, bold, centered, 3 - 4 lines below top of page, one double space blank line after title 

• page number: flush right, every page 

• Margins should be 1inch on all sides  

• Times new roman, 12 point  

• Double spacing  

• running head: 50 characters or less, on every page, all capital letters, flush left 

• college / department, University / Institution 

• Title, abstract (if required), text, references, footnotes, tables, figures, appendices 

Level headings

• 1: centered, bold, title case 

• 2: flush left, bold, title case  

• 3: flush left, bold, italic, title case  

• 4: indented, bold, title case, ending with a period  

• 5: indented, bold, italic, title case, ending with a period

Delegation by RNs

• Professional nurses may delegate independent nursing activities (as well as medical functions that have been delegated to them) to other nursing personnel  

• State nurse practice acts do not give LPNs or LVNs the authority to delegate  

• Professional RNs retain accountability for acts delegated to another person  

• RN is responsible for determining that the delegated person is competent to perform the delegated act  

• The delegate is responsible for carrying out the delegated act safely  

• The professional nurse remains legally liable  

• Malpractice occurs when a professional, nurse, pr physician fails to act as a reasonably prudent professional would have acted under the same circumstances.  

Electronical medical records vs Electronical Health records

EMR: limited to a single practice

EHR: share information across providers