Professional Nursing Exam 3

List: Steps of ISBARR

Introduction, Situation, Background, Assessment, Recommendation, Read-back.

List: CUS Model for Patient Safety

I am Concerned, I am Uncomfortable, This is a Safety issue.

List: Four Domains of Interprofessional Collaboration (IPC)

Values/Ethics, Roles and Responsibilities, Interprofessional Communication, Teams and Teamwork.

List: Five Rights of Delegation

Right Task, Right Circumstance, Right Person, Right Communication, and Right Supervision/Evaluation.

List: Conflict Resolution Steps

1. Identify the problem, 2. Reach agreement, 3. Clarify problem/outcomes, 4. Implement/Measure outcomes.

List: Five Components of Magnet Model

Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge/Innovation, and Empirical Outcomes.

List: Four Domains of Professional Identity

Knowledge, Leadership, Values & Ethics, Professional Comportment.

List: Socialization Types

Formal, Informal, Professional.

List: Causes of Nursing Shortage

Aging workforce (retirements), High burnout/stress, and Faculty shortages in nursing schools.

List: Four Elements of Negligence

Duty, Breach of Duty, Injury, and Causation.

List: Four Theories of Ethics

Utilitarianism, Deontology, Virtue Ethics, and Principalism.

List: Six Ethical Principles

Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, and Veracity.

List: Types of Ethical Dilemmas

Institutional/social issues, Immigration/migration, Professional behavior, Institutional constraints, Social media.

List: Types of Professional Organizations

Broad-purpose (e.g., ANA), Specialty practice (e.g., ER or ICU), and Special interest (e.g., nurse advocacy).

List: Stress Continuum Colors

Green (Ready), Yellow (Reacting), Orange (Injured), Red (Ill).

List: Orange Stress Causes

Life threat, Loss, Inner Conflict, Wear and Tear.

List: Essential Stress First Aid Skills

Recognize, Act, Know.

List: 7 C's of Stress First Aid

Check, Coordinate, Cover, Calm, Connect, Competence, Confidence.

List: State Board of Nursing Functions

Provides licenses, manages NCLEX, handles disciplinary actions.

Collaboration: ISBARR Use Case

Used for structured communication during patient handoffs or when calling a provider with a concern to ensure all critical information is shared.

Collaboration: CUS Model Use Case

Used as a safety 'stop' button when a nurse needs to escalate a concern about a dangerous situation immediately.

Collaboration: ISBARR Read-back Importance

The critical last step where the nurse repeats orders back to the provider to prevent medication or treatment errors.

Collaboration: Interprofessional Collaboration (IPC) Goal

To improve patient outcomes by coordinating care among different healthcare disciplines (e.g., nursing, PT, pharmacy).

Collaboration: Communication Barriers

Hierarchy (feeling unable to speak up), lack of structure (no ISBARR), time pressure, and incivility.

Collaboration: IPC Domains Purpose

To provide a framework for effective teamwork among different healthcare professionals to improve patient safety and care quality.

Collaboration: Professional Organization Purpose

'Strength in numbers' to advocate for the nursing profession and patient care.

Identity: Magnet Designation Definition

A prestigious award given by the ANCC to hospitals that provide exceptional nursing care and a supportive professional environment.

Identity: Magnet Designation - Nursing Impact

Increases nurse autonomy, improves job satisfaction, and promotes a culture of shared decision-making.

Identity: Magnet Designation - Patient Impact

Linked to better patient outcomes, lower mortality rates, higher patient satisfaction, and improved safety.

Identity: Magnet Characteristics

High level of nursing excellence, supportive management, opportunities for professional growth, and data-driven improvements.

Identity: Patient Autonomy vs. Nurse Autonomy

Patient autonomy is the patient's right to make their own choices; Nurse autonomy is the nurse's ability to make independent professional decisions within their scope of practice.

Identity: Specialty Nursing Certification

Validation of a nurse's advanced knowledge and skills in a specific clinical area (e.g., CCRN for ICU); requires clinical experience and passing an exam.

Identity: Advanced Practice Nurse (APN)

Nurses with a Master's or Doctoral degree prepared for specialized roles like NP, CRNA, or CNS; practice authority is granted by the Board of Nursing (BON).

Identity: Civility

Professional, respectful, and polite behavior that fosters a healthy work environment, supports effective communication, and promotes patient safety.

Identity: Incivility

Rude, disrespectful, or aggressive behavior (e.g., gossiping, bullying, 'eating the young') that leads to nurse burnout, high turnover, and threatens patient safety by breaking down communication.

Identity: Civility vs. Incivility Importance

Essential because respectful communication is required for safe patient care; incivility creates a toxic environment where errors are more likely to occur.

Identity: Professional Comportment

A nurse's professional behavior, speech, and appearance; how they carry themselves and communicate their professional role to others.

Identity: Formal Socialization

Planned educational experiences (e.g., lectures, nursing school, clinical assignments).

Identity: Informal Socialization

Lessons learned incidentally while observing other nurses (e.g., hearing nurses talk in the lounge or watching a preceptor's routine).

Identity: Reality Shock

The stress and frustration when a new nurse moves from the 'ideal' school environment to the 'real world' of practice.

Ethics: Moral Distress Example

A nurse knows a patient needs more pain meds, but the hospital policy prevents them from giving more.

Ethics: Moral Courage Example

A nurse reports an impaired colleague to protect patient safety, even if it risks their friendship.

Ethics: Ethical Dilemma Example

A patient refuses a life-saving blood transfusion due to religious beliefs (Autonomy vs. Beneficence).

Ethics: Moral Reflection Example

After a difficult shift, a nurse thinks about how their personal values influenced their care decisions.

Ethics: Moral Distress

Knowing the right thing to do but being unable to do it because of institutional constraints.

Ethics: Moral Courage

Taking action for what is right despite personal or professional risk or fear.

Ethics: Ethical Dilemma

A conflict between two or more ethical principles (e.g., Autonomy vs. Beneficence) where there is no clear single right answer.

Ethics: Moral Reflection

Thinking about one's own values and the ethical aspects of a situation to guide future action.

Ethics: Autonomy

Respecting the patient's right to self-determine their care and make their own decisions (e.g., informed consent or refusing treatment).

Ethics: Beneficence

The duty to 'do good' and act in the best interest of the patient.

Ethics: Nonmaleficence

The duty to 'do no harm'; balancing the risks and benefits of care (e.g., a painful but necessary procedure).

Ethics: Justice

Fairness and equality in the distribution of resources and treatment of all patients.

Ethics: Fidelity

Faithfulness and loyalty; keeping promises made to the patient.

Ethics: Veracity

The obligation to tell the truth and be honest with the patient.

Ethics: Utilitarianism

Theory focused on the greatest good for the greatest number of people; common in triage or mass casualty events.

Ethics: Deontology

Theory focused on duty and following rules; 'Do the right thing because it is the right thing to do' regardless of the outcome.

Ethics: Virtue Ethics

Theory focused on the character of the individual; emphasizes being a good person with natural tendencies toward right action.

Ethics: Principalism

Theory where decisions are made based on a set of core ethical principles and acting from good character.

Legal: Protection from Legal Action

Accurate, timely, and thorough documentation is the nurse's best defense in a legal case.

Legal: Confidentiality and Social Media

Identifying a patient or a specific situation on social media is a HIPAA violation, even if no name is used.

Legal: HIPAA (Confidentiality)

Federal law protecting patient health information; electronic documentation must be encrypted.

Legal: Informed Consent - Provider Role

Responsible for explaining the procedure, risks, benefits, and alternatives in understandable language.

Legal: Informed Consent - Nurse Role

Witness the patient's signature; confirm the patient is competent and the signature is authentic.

Legal: Informed Consent - Patient Confusion

If the patient doesn't understand the procedure, the nurse must call the provider back to explain it before the patient signs.

Legal: Act of Omission Example

A nurse forgets to give a scheduled dose of antibiotics to a patient.

Legal: Act of Commission Example

A nurse gives a medication to the wrong patient because they didn't check the ID band.

Legal: Negligence element - Duty

The nurse's legal responsibility to provide care for an assigned patient.

Legal: Negligence element - Breach of Duty

The nurse's failure to perform their duties according to the professional standard of care.

Legal: Negligence element - Injury

Actual harm (physical, emotional, etc.) experienced by the patient.

Legal: Negligence element - Causation

The link proving the nurse's breach of duty was the direct cause of the patient's injury.

Legal: Proving Negligence

To win a lawsuit, all four elements (Duty, Breach, Injury, Causation) must be proven; if one is missing (like injury), there is no case.

Legal: Negligence Definition

Failing to act as a reasonable person would in a similar situation, causing harm; anyone can be negligent.

Legal: Malpractice Definition

Professional negligence; specifically when a professional (like a nurse) fails to meet the standard of care.

Legal: Act of Omission

Failing to do something that should have been done, such as forgetting to give a medication.

Legal: Act of Commission

Doing something that should not have been done, such as giving the wrong medication to a patient.

Legal: Nurse Practice Act (NPA) Purpose

The state law that defines the scope of nursing practice and requirements for licensure.

Legal: State Board of Nursing (BON) Functions

Provides nursing licenses, administers the NCLEX, and handles disciplinary actions.

Legal: Nurse Licensure Compact (NLC)

An agreement allowing nurses to have one multistate license to practice in multiple participating states.

Stress Continuum Target Audience

Designed for nurses, healthcare providers, and high-stress teams to manage occupational stress.

Stress Continuum Focus

Occupational stress and the healthcare team's mental health; it is not for patient diagnosis.

Essential Stress Skills: Recognize

See symptoms of stress in yourself and others.

Essential Stress Skills: Act

Ask if someone is okay or say 'you seem tired'; reach out for help.

Essential Stress Skills: Know

Knowing and sharing resources available (EAP, counselors).

Stress Continuum Definition

A model used to identify a person's current stress level and response, ranging from optimal wellness to clinical illness.

Stress Continuum Purpose

To help individuals and teams recognize stress reactions early and determine the appropriate level of support or intervention needed.

Stress Continuum Green State

Ready—Optimal functioning, adaptive growth, wellness, calm, and motivated.

Stress Continuum Yellow State

Reacting—Mild/transient distress that always goes away; irritable, anxious, or loss of focus.

Stress Continuum Yellow Causes

Any stressor can cause a reaction.

Stress Continuum Yellow Timing

Transient; it always goes away.

Stress Continuum Orange State

Injured—More severe distress that 'leaves a scar'; panic, rage, or not feeling like normal self.

Stress Continuum Orange Causes

Life threat, loss, inner conflict, or wear and tear.

Stress Continuum Orange Wear and Tear

Persistent stress from heavy workloads or chronic pressure over time.

Stress Continuum Orange Timing

More severe or persistent distress; 'leaves a scar.'

Stress Continuum Red State

Ill—Clinical mental disorder; unhealed stress injury with persistent symptoms.

Stress Continuum Red Timing

Symptoms persist and worsen over time; social or occupational impairment.

Stress Continuum Red Clinical Need

Requires professional clinical help due to occupational or social impairment.

Stress Continuum Red Examples

PTSD, depression, anxiety, or substance abuse.

Stress: Acute Stress

A short-term, intense reaction to a specific event (like a lightning bolt) with a quick recovery.

Stress: Chronic Stress

Long-term, persistent stress (like a slow-burning fire) that leads to wear and tear and burnout over time.

Stress: Acute vs. Chronic Difference

Acute is transient and event-specific; Chronic is persistent and leads to the 'Orange' zone of the stress continuum.