Foundations of Nursing Practice Study Guide for Exam 3

What are the advantages to joining a professional nursing organization?

Allows you to network with others in similar specialties.

Access to professional literatures, newsletters, mentors, correspondence, and support for transitioning into practice.

Allows nurses to be actively involved in their specialties.

Define accountability.

A legal and moral commitment to do the right thing, every time, and in every situation. The nurse takes ownership of their decisions, actions, and is answerable for their actions and their consequences.

Describe transactional leadership.

Establishes standards and obligations.

Uses rewards and punishments.

Valuable in crisis situations and short-term goals.

Do not encourage creativity.

Describe transformational leadership.

Establishes a common vision and mission.

Provides meaning for and challenges employees.

Stimulates others by asking "why" or "how".

Passionate leaders who inspires others.

Describe Laissez-Faire leadership.

Hands-off leaders but provides the necessary resources.

Oversees team and provides little direct control.

Leaders have confidence in the skills of others.

Leaders are open for consultation.

Define bureaucratic leadership.

Leaders abide by specific policy, procedures, or rules.

Relies on consistency and adherence to the rules.

Leader pays great attention to detail for control/clarity.

Ensures that employees know roles/responsibilities.

Describe situational leadership.

Transitions from one style to another as needed.

Assesses situation and decides which strategy is best.

Based on task, nature of the group, or requirements of the organization.

What are the pros of transactional leadership?

Encourages by motivating people to follow the rules.

Provides a clear structure that requires repetition of tasks.

Makes short-term goals achievable.

Rewards and punishments are defined.

What are the cons of transactional leadership?

Motivation level is only as effective as the reward is enticing.

Creativity is limited because the leader sets the goals.

Person is only motivated to do well to keep getting rewards and avoid punishments.

What are the pros of transformational leadership?

Sells the vision for improvement and growth.

Promotes enthusiasm through self-motivation.

Focuses on doing the right thing in the right way.

Creates a sense of community in the workplace.

What are the cons of transformational leadership?

Too much passion can overlook logic, truth, and reality.

Requires continued communication and openness with the team.

Requires followers to agree with the goal.

Can lead to employee burnout.

What are the pros of Laissez-Faire leadership?

Works well for highly educated personnel.

Encourages independent thinking and action.

Leader is available for consultation.

What are the cons of Laissez-Faire leadership?

Does not work for those who lack knowledge or skills.

Can result in poor performance and outcomes.

Leader may be viewed as absent.

What are the pros of bureaucratic leadership?

Clear structure of who oversees whom.

Increased safety when working with dangerous or delicate equipment.

Improved quality when checklists are followed correctly.

What are the cons of bureaucratic leadership?

Lacks creativity.

Can result in a negative work environment.

Promotes poor communication.

What are the pros of situational leadership?

Assesses the willingness or motivation level of the follower.

Strategy or approach is handled differently based on the situation.

Focuses on problem solving.

What are the cons of situational leadership?

Difficult to apply to everyone.

Can exclude some followers.

Ignores differences.

Focuses on short-term goals.

What is the chain of command?

Organizational hierarchy identifying the lines of authority within an organization and is used to notify and involve superiors, beginning with those closest to the level of the event.

What is shared governance and its importance?

The process that guides decisions towards accountability and ownership of clinical outcomes. By being a contributing partner in the decisions of nursing practice, nurses will have access to resources, information, data, and growth opportunities.

What are the 3 principles of shared governance?

1. It is grounded in accountability.

2. The processes for organizational work and decision making are designed around accountability.

3. Its structure demonstrates shared decision-making.

What are the core four interlocking principles of the shared governance model?

Caring, navigating, knowing, and leading

What is the 2nd level of the shared governance model?

Various councils for professional practice, quality and safety, infection prevention, staffing, leadership, research and EBP, recruitment and retention, informatics and technology, and education and staff development.

What is the outer circle of the shared governance model?

Council of chief nursing officers

Define a Zero-Tolerance Policy.

Recommended integrated approach by the TJC that describes an absolute no tolerance for incivility, bullying, harassment, or other acts of intimidation or violence in the workplace.

What is autonomy in healthcare?

The nurse's obligation to respect the client's right to make their own decisions regarding their healthcare (unless it is harmful to others), including the right to refuse care.

What is the ethical principle of beneficience?

The nurse's obligation to minimize harm and practice in a way that benefits the client and going above what is required.

What is the ethical principle of non-maleficence?

The nurse's obligation to do no harm, or the least amount of harm to the client, while trying to achieve the best possible outcome.

Why is the ethical principle of veracity important?

The nurse is obligated to provide truthful and accurate information to the client which strengthens the nurse-client relationship by building trust.

Why is the ethical principle of fidelity important?

The nurse's obligation to demonstrate loyalty, to keep promises, and to uphold commitments. Following through with agreements or promises made to clients is critical to build and strengthen the nurse-client relationship and improve patient-centered care.

What is the ethical principle of justice?

The nurse's obligation to provide treatment, care, and resource allocation that is impartial, fair, and equitable to all clients regardless of age, sex, race, or economic status.

What are the steps in the Ethical Decision-Making Model?

1. Is there an ethical dilemma?

2. Clearly identify the ethical dilemma.

3. Identify possible solutions.

4. Apply ethical principles to the solutions.

5. Include all relevant individuals and factors.

6. Decide on a solution.

7. Review the decision.

8. Put the decision into action.

What are examples of ethical issues that arise in the practice of nursing?

Stem cell research, late termination of pregnancy, medically assisted death, refusal or termination of care/treatment, care of clients who have a substance use disorder, clients who have experienced abuse, care of clients in legal custody, the allocation of scarce resources, etc.

What is EMTALA?

Emergency Medical Treatment and Active Labor Act

An ED cannot turn away clients for reasons such as being under- or uninsured, or their inability to pay for care. All clients must have a medical screen evaluation (MSE), the hospital must stabilize clients experiencing emergencies or transfer a stabilized client to a facility that can provide further treatment/management, and the physician must verify and sign off transfer (benefits > risks) if the client cannot be stabilized in the ED.

Define confidentiality.

Not disclosing personal information without the person's permission.

How is privacy different than confidentiality?

Privacy is physical seclusion, protection of personal information and identity, and the ability to make autonomous decisions.

What should nurses remember to follow when using social media?

1. Do not transmit or post ANY IDENTIFIABLE client information.

2. Maintain professional BOUNDARIES if communicating with client through social media.

3. Expect posted information to be POTENTIALLY VIEWED by clients, peers, and supervisors.

4. Use PRIVACY SETTINGS provided by social media platforms and attempt to keep personal vs. professional information separate.

5. Advocate for client rights and REPORT any incidences of client information or communication on social media that is in violation of ethical and legal standards.

6. WORK WITH THEIR EMPLOYER to develop effective policies and procedures to ensure professional communication with clients and to SAFEGUARD client information on social media.

Define genetic testing.

Examining a client's DNA to reveal the individual genetic markings that make the client unique. Clients are often searching for answers and concerned about hereditary diseases and this can be done prenatally to detect disorders such as Down syndrome.

What are the legal issues associated with genetic testing?

Concerns that the client could face possible discrimination such as increased health insurance premiums if found to be at an increased risk for genetic disorders.

What act provides protection from discrimination based on genetic testing results?

Genetic Information and Nondiscrimination Act of 2008

What are the ethical issues associated with genetic testing?

The need to respect the client's confidentiality and autonomy.

Define tort.

An act or omission that causes legally cognizable harm to persons or property.

Define negligience.

When the nurse is found to have breached their duty of care, and places the client at risk for harm which may result in client injury or suffering. Examples include medication errors, documentation omissions, client falls, failure to identify clients' allergies, failure to maintain medical equipment, or inadequate client teaching.

What are examples of intentional torts?

Invasion of privacy, defamation, assault, and battery

What is informed consent?

A legal and ethical obligation to get formal permission granted to a provider to provide care by the client or legal representative with the knowledge of the possible consequences (risks + benefits) and alternatives without coercion.

What is the nurse's role regarding informed consent?

Verify and witness that the client or legal representative signs the consent form in their presence.

Verify that the client has adequate knowledge to make the treatment decision referred to in the consent process.

Notify the provider if the client has more questions or does not understand because it is the provider's responsibility to explain and clarify.

Accurately document including the client's questions and if the provider was notified.

What are advance directives?

Legal documents in which a client's decisions related to healthcare are documented. Includes a living will (which life-sustaining treatments if incapacitated) and the durable power of attorney for health care.

What is the nurse's role regarding advance directives?

Ensure healthcare team's compliance with client's wishes.

Supporting client's choices through planning process.

Determine client's literacy level.

Identify any need for assistance in obtaining or completing the form.

Provide information about what an AD is and why it is important.

What would be included in an AD?

Living will, durable power of attorney for health care, organ donation form, DNI order

What are Good Samitaran Laws?

Protects nurses from claims of negligence if they provide reasonable care during emergencies to protect an injured person's life and save them from further harm until emergency personnel arrive, without expectation of payment.

In order for Good Samitaran Laws to apply to a nurse, what are the requirements?

1. No protection if care is rendered without due care or with a disregard for the safety of the individual ("grossly negligent care").

2. The nurse cannot know any medical condition or other condition of client they are providing care to.

3. The nurse receives no compensation for the care provided.

Define whistleblowing.

A nurse formally reporting on illegal acts, wrongdoings, or unethical practice within an organization to the national and/or state agency that is responsible for regulation of the organization.

How are whistleblowers protected?

Federal and state-level safeguards

What should the nurse do if they are "whistleblowing"?

Make sure they have all necessary documentation and data report and keep copies of the documentation.

Prior to reporting, seek out the expertise of their board of nursing and perhaps even legal counsel.

Define mandatory reporting.

Legislation mandating that certain officials have a legal duty to report information that can prevent maltreatment and provide safety to another individual(s).

Are nurses mandatory reporters?

Yes, they should be familiar with their state regulations and facility's specific reporting procedures.

What is an example of mandatory reporting?

There are several specific diseases and illnesses that must be reported because they pose a threat to the general public according to the CDC. Examples include anthrax, botulism, chlamydia, foodborne disease outbreak, Hepatitis A-C, HIV, influenza, measles, rubeola, tuberculosis, and the Zika virus.

Define a near miss incident.

An incident or potential error that was caught or avoided, thus, no harm or injury occurred. Ex. A nurse discovers an expired medication loaded into the delivery system prior to administration.

What is a sentinel (never) event?

A critical and unexpected adverse event that resulted in the permanent disability, dismemberment, temporary severe injury, or the death of a client.

Why is the reporting of incidents important?

1. Protects the client from further harm.

2. Provides information surrounding the event that can result in improved processes in the future and is designed to be nonpunitive in nature.

3. Can be used as a tool to grow and improve as a nurse.

What are some examples of sentinel events?

Anesthesia-related event (anesthesia medication error), care management event (falls, PIs), criminal event (assault), environmental event (fires), product or device event (failure of IV device), protection event (elopement, abduction), suicide (while recieving care or 72 hours after), surgical or invasive procedure events (wrong procedure/site)

When should incidence or event reporting occur?

Any event that is outside of client care, such as a medication error or missed provider prescription.

Incidents involving workplace violence.

Any near-miss events.

Any adverse events that occurs to a client, staff member, or visitor such as a fall.

Any sentinel event.

What are the general rules for the documentation of reporting?

Names of individuals involved

Objective language

Any direct quotes

Report immediately

Follow all facility policies and procedures

Complete as soon as possible

Individual who discovers is the one to file.

Is the incident report apart of a client's medical record?

No, it is a tool for the risk management department. By documenting the assessments, interventions, and outcomes surrounding the event, the facility is NOT required to share it in a court of law if there is a lawsuit.

What is just culture?

An atmosphere of nurses maintaining accountability for themselves and each other within the profession, following the guidelines of the Code and ANA standards of practice. Doing what is right and fair but also recognizing the humanity of nurses and the potential for mistakes. Includes a zero-tolerance policy.

What are the five rights of delegation?

Right Task (Within one's scope or "job description")

Right Circumstance (Client should be stable)

Right Person (Has the knowledge and skills)

Right Directions and Communications (Specific and answer questions)

Right Supervision and Evaluation (Monitor, completed appropriately, evaluate, accurate documentation)

How can a nurse prevent breaches of confidentiality?

Do not discuss private information about a client in public areas.

Maintain privacy of personal computer passwords.

Log out of computers when not in use.

Ask for code words or phrases for the client before providing informatiob over phone or electronic communication.

Not using personal cell phones to take pictures of clients.

Avoid posting references to work or clients on social media.

Define nurse fatigue.

The physical and pyschological exhaustion that can cause a nurse to be unable to function safely and competently. Caused by long shifts, increased client load, and nursing shortages and results in negative effects on the client such as increased risk of medication errors. Often short-term that can be alleviated with proper self-care and rest.

Define professionalism.

Embodies the actions, behaviors, and attitudes of an individual that are reflective of the core values, ethical principles, and regulatory guidelines of the profession.

What are some examples of professionalism in nursing?

Accountability

Integrity

Compassion

Evidence-based Knowledge

Adherence to the code of conduct and ethics

Client-and family-centered care

Health advocacy

Recognize personal/professional boundaries

Self-care

Define advocacy and its importance.

The act of defending the interests, rights, and safety of those who cannot do it for themselves such as clients with behavioral health issues who are unable to make sound decisions, children, and those who are illiterate/uninformed/fearful/untrusting of medical professionals.

What are examples of accountability?

Using the 6 rights of medication administration, planning and intervening in a way that safeguards clients, preventing client harm, preventing medication errors, staying current on changes in nursing, commitment to lifelong learning

What are some examples of shared governance in nursing?

Hospital-Wide Nursing Councils, Unit-Based Councils, Administrative Councils, Themed Councils, Interdisciplinary Councils

Define Durable Power of Attorney.

A client can appoint an individual to make health care decisions on their behalf if they are unable to do so.

What are adverse events?

A situation or circumstance that caused unexpected harm to a client.

What are some common examples of adverse events?

Client falls, suicide, adverse drug events, HAIs, restraint-related injuries, etc.

Define CLABSI.

Central-line Associated Bloodstream Infection:

Occurs when pathogens enter the bloodstream via a central line, which accesses a large vein in the body and can remain in place for long periods of time.

Define CAUTI.

Catheter-associated Urinary Tract Infection:

Occurs when pathogens enter the urinary system via a catheter inserted through the urethra into the bladder.

Define VAP/VAE.

Ventilator-associated Pneumonia or Events:

Penumonia or other complications such as fluid overload that develops while a client is on a ventilator.

What is hourly rounding?

Every 1 hour, a member of the nursing staff checks on clients and proactively addresses their needs such as toileting, positioning, pain management, and safety checks of siderails/bed position/proximity of the call light to the client.

What is occurence or incidence reporting?

A tool used to report an adverse event, sentinel event, client safety event, or near miss.

How can one's body be exposed to chemicals?

Inhalation: Breathing in the fumes or air that has been contaminated by the chemical.

Skin or Eyes: Contact with skin or eyes

Ingestion: Direct (swallowing) or indirect (contamination of the hands which then touch food or liquid that is consumed)

Injection: Due to needlestick injury

What kind of harm can chemical exposure cause?

Immediate such as exposure to chlorine gas or long-term such as exposure to asbestos.

How can nurses identify the risks of chemical exposure?

Using Safety Data Sheets (SDSs), which all manufacturers have to label their containers with. Specifies the appropriate steps to take to decrease exposure, the steps to take if exposure occurs, and methods to clean and dispose of a spilled chemical.

What are examples of PPE?

Gloves, gowns, masks, face shields, goggles, hair caps

What can increase or decrease the risk of radiation exposure?

Directly proprtional to the exposure time and the distance from the source.

What can exposure to high doses of radiation cause?

Cellular damage that can lead to cancer.

What is important to remember about radiation exposure?

The amount of radiation recieved from a CT scan is greater than that received from an X-ray.

Children are at a much higher risk due to the rapid rate at which their cells are dividing.

Procedure should be withheld if the client is pregnant unless it is a true emergency.

Signs must be posted to warn all who enter that area about its use or storage.

What are important reminders for nurses who work in radiology or those who accompany clients for monitoring during radiology studies?

1. Reduce time.

2. Increase distance.

3. Use shielding.

What are the 3 categories of radiation exposure?

Alpha = Least amount of risk which does NOT penetrate clothing and only travels a few cm. Minor health hazard.

Beta = Middle level of risk and travels a small distance. Needs specialized clothing and is a minimal health hazard.

Gamma = High risk health hazard which DOES penetrate through clothing and body tissue. Requires lead shielding.

What are some causes of radiation exposure besides imaging technology in the healthcare setting?

Bombs, war, nuclear radiation, contaminated water/food/soil, industrial accidents

What are initial signs of radiation contact?

Diarrhea, nausea, vomiting, burns, alopecia

What is the treatment for radiation exposure?

Wash the body with water (scrub skin, wash hair, liberal eye irrigation).

Remove and discard clothing.

Take vitals, physical/mental assessment, and basic health history.

First responders and healthcare professionals must wear PPE.

Potassium iodide may be used to prevent thyroid from absorbing radioactive material.

What is a home hazard assessment?

Providing clients with information neede dto ensure their home is free from safety hazards which will help decrease the risk of injury or death for every member of the family.

When are home hazard assessments used?

Clients who are at an increase risk for injury due to a fall, following a recent surgery, and with the development of a disabling condition such as dementia, etc.

Where can clients reduce home hazards in their homes?

Bathroom

Kitchen

Bedroom

General (All over)

What is the RACE acronym?

Fire Safety

RESCUE: Assist in removing clients, visitors, and employees who are in immediate danger.

ALARM: Activate the emergency fire alarm per facility protocol.

CONTAIN: Close all the doors and windows, which decreases the oxygen source.

EXTINGUISH: Attempt for small fires if the proper extinguisher is available. and it is safe to do so.

What is the PASS acronym for?

How to correctly use a fire extinguisher:

PULL: The pin out, which breaks the tamper-resistant seal.

AIM: At the base of the fire while pointing the nozzle, horn, or hose to the lowest point.

SQUEEZE: The handle to release the contents at the base of the fire.

SWEEP: Spray from side to side until extinguished. Repeat steps if it reignites. If it gets too large, evacuate.

What is a biological mass-casualty event?

When one or more people are exposed to a biological toxin. It may be caused by accidental exposure (touch) or terrorist-related (air) and results in exposure to diseases such as anthrax, smallpox, ebola, or COVID-19.

When can mass-casualty events be suspected?

When multiple patients present in the ED with the similar or same symptoms.

What are precautions for biological mass-casualty events?

1. All medical personnel need to wear the appropriate PPE.

2. Full PPE may include a Powered Air Purifying Respirator (PAPR) which filters any airborne biological agent.

3. The victim's clothing needs to be cut off and disposed of in 2 biohazard bags.

4. Victims should be placed in decomtamination rooms and showered.