Nursing Practice: Clinical Judgment, Reflection, and Consent

What is the Clinical Judgment Model (CJM)?

A framework that guides nurses in making sound judgments to ensure safety, advocacy, ethical practice, and competency.

What is reflective practice in nursing?

A continuous process of self-assessment and learning that enhances professional competence and improves patient care.

Why is self-reflection important in nursing?

It supports safe practice, ethical decisions, and professional growth by allowing nurses to understand their personal values and biases.

What are the four phases of noticing in Tanner's Clinical Judgment Model?

Interpreting, Responding, Reflecting, and Noticing.

What are the benefits of reflective practice?

Enhanced learning, increased self-awareness, improved decision-making, greater patient-centered care, and professional development.

What skills are required for effective reflective practice?

Self-awareness, description, critical analysis, synthesis, and evaluation.

What is Gibbs' Reflective Cycle used for?

To examine experiences that went well or didn't go well, enhancing leadership skills and decision-making.

What characterizes superficial reflection?

Basic descriptive reflection that lacks depth and does not critically analyze experiences.

What is medium reflection?

A dialogic reflection where the individual explores thoughts, feelings, and assumptions to understand experiences better.

What defines deep reflection?

Critical reflection that leads to significant changes in a person's views and understanding of self and practice.

What are personal values in nursing?

Core beliefs that guide behavior, such as compassion, respect for dignity, integrity, and accountability.

How can assumptions and biases affect nursing practice?

They can influence decisions, impact patient trust, and affect safety and outcomes.

What is self-awareness in nursing?

The ability to understand one's strengths, weaknesses, and influence on others, leading to better decision-making and relationships.

When should a nurse seek assistance?

When situations are beyond their scope, knowledge gaps exist, emotional triggers occur, or complex ethical situations arise.

What should a nurse consider when caring for a patient from an unfamiliar cultural background?

How personal values influence responses and the potential biases that may exist.

What is the importance of therapeutic relationships in nursing?

They are built on authenticity, patience, neutrality, and understanding, essential for effective patient care.

What is the role of continuous improvement in nursing?

It involves learning from experiences and identifying barriers to enhance patient care and professional development.

What does the term 'countertransference' refer to in nursing?

The emotional reactions a nurse may have towards a patient based on personal experiences and feelings.

What is the purpose of the individual reflection prompt in class?

To encourage students to think about discomfort in interactions and learn from those experiences.

What is the significance of knowing when to seek help in nursing?

It ensures that nurses provide safe and effective care while recognizing their limitations.

What are some ethical considerations in nursing practice?

Ensuring patient safety, advocating for patient needs, and maintaining professional integrity.

What is the relationship between self-awareness and communication in nursing?

Self-awareness enhances communication by allowing nurses to understand their impact on others and improve interactions.

What is the goal of reflective practice?

To transform nursing practice through continuous self-reflection and learning from experiences.

What are the course learning outcomes for Module 1?

Apply self-reflection to nursing practice, demonstrate critical self-awareness, and identify situations requiring support.

What is the role of values in patient-centered care?

Values guide nurses in providing compassionate and respectful care tailored to individual patient needs.

What is the purpose of the CNO Code of Conduct?

To outline professional accountabilities and expectations for nurses, protecting the public and promoting safe, equitable, and culturally inclusive care.

What is the role of nurses in supporting informed decision-making?

Nurses ensure clients understand the nature of treatment, risks, alternatives, and potential consequences before consenting.

What is the Substitute Decision Maker (SDM) hierarchy in Ontario?

1. Guardian of the person, 2. Attorney for personal care, 3. Person appointed by the Consent and Capacity Board, 4. Spouse, partner, or relative, 5. Public Guardian and Trustee.

What does the Health Care Consent Act (HCCA) promote?

It promotes informed decision-making and patient autonomy regarding treatment, care facility admission, and personal assistance.

What is the difference between Power of Attorney (POA) and Substitute Decision Maker (SDM)?

POA is a legal document appointing someone to make decisions on behalf of another, while SDM is appointed when there is no POA.

What is the nurse's accountability in the consent process?

Nurses are responsible for obtaining informed consent and verifying that clients understand the information provided.

What are the types of consent recognized by the CNO?

1. Implied consent (based on actions), 2. Explicit consent (verbal agreement), 3. Written consent (required for surgeries or procedures with serious risks).

What are the legal requirements for consent in Ontario?

Consent must be informed, voluntary, and ongoing, adhering to the Health Care Consent Act and Substitute Decisions Act.

What should a nurse do if a patient withdraws consent?

The nurse must stop the procedure immediately and respect the patient's decision.

What is the role of the nurse in obtaining informed consent?

Nurses must ensure clear communication, verify understanding, and provide information about treatment options and risks.

What constitutes a breach of confidentiality in nursing?

Unauthorized disclosure of personal health information (PHI) that violates trust and legal requirements.

What are the consequences of a privacy breach in nursing?

Consequences can include fines, public reprimands, suspension, and potential legal action.

What is the Personal Health Information Protection Act (PHIPA)?

A law that governs the collection, use, and disclosure of personal health information in Ontario.

What is the significance of the CNO Practice Guideline on Consent?

It outlines the ethical and professional responsibilities of nurses in obtaining and managing consent.

What must a nurse consider when a patient is unable to give consent?

The nurse must identify the appropriate SDM to make decisions on behalf of the patient.

What is implied consent?

Consent inferred from a patient's actions, such as lifting an arm for a blood pressure check.

What is explicit consent?

Verbal agreement from a patient indicating their acceptance of a treatment or procedure.

What is written consent necessary for?

For procedures with serious complications or side effects, such as surgeries or blood transfusions.

What should be documented when consent is obtained?

Details of the consent process, including the information provided and the patient's understanding.

What are the ethical responsibilities of nurses regarding patient consent?

To ensure that consent is informed, voluntary, and that patients understand their right to refuse treatment.

What is the role of the nurse in emergency situations regarding consent?

In emergencies, consent may be implied, but efforts should be made to contact the SDM as soon as possible.

What is the importance of clear communication in the consent process?

It ensures that patients fully understand the procedures, risks, and their rights, fostering trust and compliance.

What happens if a patient refuses treatment after initially consenting?

The nurse must respect the patient's decision and discontinue the treatment immediately.

What are the principles of the CNO Code of Conduct?

1. Respect clients' dignity, 2. Provide culturally safe care, 3. Ensure safe and competent care, 4. Work respectfully with the healthcare team, 5. Act with integrity, 6. Maintain public confidence.

What is the role of the nurse in advocating for patients during the consent process?

Nurses must ensure that patients' rights are respected and that they receive all necessary information to make informed decisions.

What should a nurse do if a patient cannot understand the information provided for consent?

The nurse should assess the patient's capacity and involve an appropriate SDM if necessary.

What does the nursing scope of practice encompass?

Responsibilities related to patient care, health promotion, disease prevention, and rehabilitation.

What are the components of the nursing scope of practice?

Legal authority, legal framework, and relevant legislation such as the Nursing Act and Regulated Health Professions Act.

What factors influence whether a nurse can perform a procedure?

Legislation, employer and practice setting, and individual competence.

What must a nurse confirm before performing an intervention?

Their legal authority as defined by legislation.

What are controlled acts in nursing?

Procedures restricted to authorized professionals, such as administering injections or treating with psychotherapy techniques.

What are the two ways RPNs and RNs obtain authority to perform controlled acts?

Through orders and delegation.

What is a direct order in nursing?

A prescription for a specific procedure, treatment, drug, or activity for an individual client.

What is a directive in nursing?

A written order from a physician or NP that applies to a group of clients under specific criteria.

What is the role of a delegator in nursing delegation?

To temporarily grant their authority to perform a controlled act to another individual.

What responsibilities does a nurse have when receiving delegation?

To ensure they are competent to complete the task and can explain the procedure confidently.

What is initiation in the context of nursing practice?

When RNs/RPNs are permitted to independently assess and perform specific controlled acts without an order.

What types of wound care can RPNs/RNs initiate?

Cleansing, soaking, irrigating, probing, packing, and dressing wounds below the dermis or mucous membrane.

What factors must nurses consider when determining competence?

Knowledge, skill, judgment, and the overall condition and needs of the client.

What does context refer to in nursing practice?

The practice setting and broader environment, including available resources and employer policies.

How can employer policies affect nursing practice?

They can limit the scope of practice but cannot grant additional practices.

What are the key accountabilities of nurses in relation to authority?

Legislation, orders/delegation, documenting, and obtaining informed consent.

What is the significance of assessing environmental risks in nursing?

To ensure safe practices and avoid unsafe or inappropriate activities.

What skills are included in the concept of competence for nurses?

Knowledge, skill, judgment, leadership, decision-making, and critical thinking skills.

What is the importance of advocating for necessary resources in nursing?

To support safe and effective nursing activities and ensure adequate care for clients.

What does the term 'accountability' mean in nursing?

Accepting responsibility for one's actions and ensuring safe and ethical practice.

What is the role of critical thinking in nursing practice?

To evaluate situations and make informed decisions regarding patient care.

What should nurses do if an order does not make sense?

Question the order to ensure clarity and appropriateness.

What is the purpose of intervention in nursing?

To assess indications and contraindications, and evaluate risks and benefits.

What does RHPA allow regarding controlled acts?

It allows controlled acts to be performed without prior authorization.

What are the components of professional accountability in nursing?

Responsibility for competent, safe care, adherence to CNO standards, and ongoing education.

What must nurses assess regarding their education?

Nurses need to assess their current education and competence in relation to their scope of practice.

What is a reflection point for nurses regarding their scope of practice?

Just because a task is within the nursing scope does not mean an individual nurse can perform it.

What questions should a nurse ask before performing a controlled act?

Do I have the authority, context, and competence to perform this act?

What authority is required to administer insulin?

A direct order is needed to administer insulin as it is outside the normal scope of practice.

What is required to perform suctioning on a tracheostomy?

A direct order is needed, and the nurse must have the correct supplies and access to emergency resources.

Can a nurse order blood work?

Yes, a nurse can order blood work, but does not need authority to carry it out.

What is the authority required for initiating oxygen therapy?

A nurse can perform it in emergencies without an order, but needs an order for non-emergency situations.

What is the duty to report in nursing?

It is an ethical and legal obligation to report certain situations to the CNO and employer.

What situations require mandatory reporting by nurses?

Situations like sexual abuse, inappropriate touching, or conversations unrelated to care.

What is self-reporting for nurses?

Reporting about oneself when charged, found guilty, or under investigation for professional misconduct.

What constitutes professional misconduct in nursing?

Violations of CNO's Code of Conduct and standards of practice.

What is the process for reporting misconduct to the CNO?

Complaints must be in writing, signed, and submitted to the CNO for investigation.

What are the safeguards for whistleblower protection?

Occupational Health and Safety Act (OHSA), Public Servants Disclosure Protection Act (PSDPA), and institutional policies.

What is included in the reporting guide for nurses?

What to report, inclusions in the report, professional accountability in reporting, and next steps after a report is received.

What are the consequences of failing to report misconduct?

Consequences may include disciplinary actions and legal repercussions.

What is the importance of understanding professional misconduct for nursing students?

It is crucial for ensuring safe practice and maintaining professional standards in their future careers.