nursing fundamentals exam 2

safety

• identify safety considerations for adults of all ages

• describe industry standard and regulations regarding microbiological, physical and environmental safety

• differentiate safety considerations among diverse clients

• apply decision making related to measures to minimize use of restraints

factors affecting safety

• age and development

• lifestyle

• mobility and health status

• altered sensory perception

• knowledge/cognitive awareness

• ability to communicate

• psychosocial state/ emotional status

safety issues

• poisoning

• carbon monoxide

• suffocation

• choking

• noise

• electrical hazards

• firearms

• falls

• seizures

environmental factors

• home smoke alarms, CO detectors, keep well maintained, adequate lighting

• workplace-occupational hazards, noise, pollution, toxins, and infectious agents

• community-safe water, sanitary food

• health care setting-clients are at risk: medication errors, falls, burns, pressure ulcers

• what factors increase the risk of human error

nursing role in the threats of bioterrorism

• bioterrorism- the deliberate spread of pathogenic organisms into a community to cause widespread illness, fear, and panic (CDC)

• biologic agents of concern

• weapons of mas destruction (chemicals, nuclear terrorism, cyber terror)

• mass trauma-bombs, explosive

• nurses/health care workers: emergency preparedness

implementation

• adolescents

• young adults (college age 19-22)

• adults

• older adults: decreased vision, reflexes slower, bones brittle, confusion, memory issues, elder abuse, depression, suicide

nursing intervention for safety

• restraints-protective devices used to limit the patients freedom and movement

  • chemical: medications

  • physical: side rails, wrist, ankle, and waist restraints

  • currents standard of care in LTC: provide safe care without the use of physical or chemical restraints

• the purpose of restraints is to help prevent the patients from being harmed

• must have a doctors order

• no PRN orders for restraints

• monitor hourly or per facillity policy

• re-evaluate the need for restraints constantly

• discontinue at the earliest possible time

• alternatives to restraints

module 4: differentitate scopes of practice within the nursing profession

• distinguish among the different levels of nursing education

• specify the ethical and legal boundaries of the student nurse as presented in the code of ethics and the nurse practice act

• detail responsibilty for maintaining client confidentiality

• describe the contribution of all members of the health care team

• identify the role of evidence-based practice in nursing

• identify the concept of quality in client care

nursing aims and competencies

nursing practice identified in the definition of nursing

• promote health

• prevent illness

• restore health

• faciliate coping with disability or death

roles and functions of the nurse

• caregiver

• communicator

• teacher/educator

• counselor

• change agent

• leader

• patient advocate

• manager

• case manger

• research consumer

nursing professions

• hospitals

  • med/surg

  • icu

  • ob

  • er

  • or/crnas

• long term care

• home health care

• private duty

• hospice

• outpatient

• case mangement

• community or public health nurse

• marketing (health products)

• school nursing

• mangement

• administration

• nurse educators

• research

• independant practitioners

• insurance companies

• nursing informatics

delegation

5 rights of delegation

• right person

• right task

• right circumstance

• right directions and communication

• right supervision and evaluation

never delegate

• teaching

• assessments

• planning

• evaluating

healthcare educational programs

• UAP (CNAs)

• LPN

• ADN

• Diploma

• BSN

• CNS

• MSN

• PhD/DNP

values and bioethics

• professional values

• principles of bioethics: four common ethical principles

• beneficence (do good)

• non-maleficence (do no harm)

• autonomy (control by the individual)

• justice (fairness)

• fidelity (keep promises)

ethics

• what is ethics

• how does this encompass nursing

• theories of ethics

• principle based approach

• care- based approach

• ethical dilemmas

• ethical conduct

• nursing code of ethics

• nursing standards of practice

ANA code of ethics

• primary commitment to patient

• promote and advocate for health and safety

• accountable for nursing practice

• responsible for maintaining competency

• participation in advancement for profession

• collaboration

nursing process and ethical decisions

1. assess the situation = gather data

2. diagnose or identify the ethical problem

3. plan or identify and weigh alternatives

4. implement decision

5. evaluate decision

   1. what was learned from this process

   2. how can you improve in future decision making

examples of ethical problems

• paternalism

• deception

• privacy

• confidentiality

• allocation of scarce nursing resources

• valid consent or refusal

• conflicts concerning new technologies

• unprofessional, incompetent, unethical, or illegal physician practice

• unprofessional, incompetent, unethical, or illegal nursing practice

• short staffing or whistle-blowing

• end of life issues

legal issues related to end of life

• autopsy

• certificate of death

• DNR

• euthanasia

• organ donation

advance directives

• question all patients if they have an advance directive

  • living will

  • durable power of attorney or health care proxy

legal aspects of nursing

public law

• deals with relationships between individuals and government agencies

civil law

• relationships between individuals

state mechanisms to ensure public safety

laws are in place to protect patients

• good samaritan act

• regulation of practice: nurse practice act

• credentialing

  • accreditation

  • licensure

  • certification

torts

intentional

• assault

• battery

• defamation

• invasion of privacy

• false imprisonment

• fraud

unintentional

• negligence

• malpractice

negligence/malpractice

categories

• failure to follow standards of care

• failure to use equipment correctly

• failure to assess and monitor

• failure to communicate

• failure to document

• failure to act as a patient advocate

elements to prove

• duty

• breach of duty

• causation

• damages

HIPAA

health insurance portability and accountability act

• invasion of privacy

• confidentiality

nursing compliance with HIPAA

• patient names

• chart/ EHR

• access to information

• discussion of sensitive patient information

• student role

impaired nurse

what is an impaired nurse

• ability to perform job is hampered

• chemical dependency- drugs or alcohol

• mental illness

how would you reconginze an impaired nurse

what is your responsibility

legal dimensions

• reporting obligations

• discrimination and sexual harassment

• HIPAA

• restraints

• disabilities-americans with disabilites act (ADA)

• sentinel events

• never events - established 9/11

• patient rights

• good samaritan laws

• student liability

‘incident reporting

• use facts not opinions

• not part of the medical record

• do not record in the chart that incident reporting was completed

• should be used as a change process

  • clear and factual

  • follow chain of command

patient consent

informed consent

expressed consent

implied consent

informed consent for invasive procdues

requirments

• diagnosis

• purpose

• what to expect

• intended benefits

• possible risks

• advantages/disadvantages of alternatives

elements of informed consent

• voluntary

• ability to understand

• sufficient information

indiviuals who cant give informed consent

• minors

• unconscious or serious injured

• deemed incompetent

nurse’s role in informed consent

• witness

• assess whether the patient is competent and signs voluntary

• ensure the patient understands (have the patient describe)

executing physician orders

• who can write/take orders

• be familiar with agencies policy regarding physician orders

• physician orders can be via:

  • verbal

  • telephone

  • CPOE

• what steps should be taken to prevent errors

• when should we question an order

carrying out physician orders

categories of orders that nurses must question

• question any order that a patient questions

• question any order if the patients condition’s changed

• question and record verbal orders to avoid miscommunication

• question any order that is illegible, unclear or incomplete

legal responsibilities of students

• responsible for own actions

• liable for negligence

• college insurance

• instructor responsibility

evidence based practice (EBP)

• assess need for change

• find best practice

• analyze

• design plan

• integrate and maintain change in practice

documentation and communication

• use therapeutic communication techniques

• identify strategies to adapt communication to the client, audience and situation

• verify information sources are reliable and current

• use correct medical terminology and abbreviations

• describe ways to report client information

• describe legal and standard documentation guidelines

nursing documentation systems

• computerized documentation (EHR)

• source oriented: narrative charting

• problem-oriented: SOAP

• PIE

• focus

• charting by exception

documentation of nursing activities

• admission and nursing assessment

• nursing care plans

• progress notes

• flowsheets: graphic records, VS, I/O

• medication record (MAR)

• discharge and transfer summaries

general guidelines for charting

• medical record is a legal document

• include date/time, signature and title

• be accurate, logical and concise

• HIPAA

• military time

• use only approved abbreviations

charting errors

if using paper

• write legibly using ink

• one line through entry

• error or mistaken entry

• date/signature and title

other types of reporting

• change of shift report/handoff

• telephone reports

• telemedicine

• transfer/discharge

• I-SBAR-R

communication in nursing

types of communication

• verbal- spoken or written word

• nonverbal gestures, facial expressions or touch

factors which influence the communication process

• development

• sociocultural differences

• role and responsibilities

• personal space

• territoriality

• values and perceptions

• environment

therapeutic communication

• conversation skills: eye contact

• attentive/active listening

• silence

• touch

• humor

therapeutic communication techniques

• be respectful and assertive using open, honest, and direct communication

• avoid asking questions using the words why and how

• use open-ended questions

• validate feelings

• restating or paraphrasing

therapeutic communication techniques

• seeking clarification

• offering self

• acknowledging

• focusing

• reflecting

• summarizing

barriers to therapeutic communication

• stereotyping

• challenging

• probing

• testing and rejecting

barriers to therapeutic communication

• changing the subject

• unwarranted reassurance

• passing judgment

• giving advice

disruptive interpersonal behavior

• incivility-rude, intimidating and undesirable behavior directed at another person

• horizontal violence/bullying- anger and aggressive behavior between nurses

  • also referred to as lateral violence or professional incivility

  • psychological and social harassment