Professionalism, Ethics, and Compliance

Charting

A form of communication and is a legal document.

Face the person

Maintain an open and engaged posture.

Have good eye contact

Show attentiveness without making the patient uncomfortable.

Lean toward the person

Demonstrate interest in what they are saying.

Respond to the person

Offer verbal affirmations or thoughtful nods.

Paraphrasing

Restate the person's message in your own words to confirm understanding.

Clarifying

Ask questions to ensure you fully understand the message.

Silence

Recognize that sometimes sayingnothing can provide comfort or encourage further sharing.

EHR

Electronic Health Record

Electronic Health Record

Legal documentation of patient care, making accuracy and thoroughness essential to ensure compliance, protect patient safety, and support medical and legal accountability.

Cultural competency

Involves understanding, respecting, and adapting to the cultural values and health beliefs of diverse patients.

Effective care

Care involves acknowledging that cultural backgrounds can influence health decisions, comfort levels during procedures, and perceptions of treatment outcomes.

Religious beliefs

Dietary restrictions, modesty preferences, and prayer needs.

Medical Interventions

Patient declines certain treatments

LEP

Limited English Proficiency

Informed Consent

Explaining the procedure in clear, simple terms,allowing the patient to ask questions, and confirming their voluntary agreement.

Implied Consent

When a patient is unable to provide explicit permission, but these instances require careful documentation.

PPE

Personal Protective Equipment

CDC

Centers for Disease Control and Prevention

EPA

Environmental Protection Agency

Contact precautions

Required to prevent an infection with an organism transmitted fecal- orally, such as Clostridium difficile, or a wound or skin infection, or an infection with multi-drug resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).

Bloodborne transmission

Pathogens is largely due to percutaneous injuries, which can be prevented by using certain techniques and safety devices.

Droplet precautions

Necessary when a patient infected with a pathogen such as influenza is within three to six feet of the patient. Infections are transmittable through air droplets by coughing, sneezing, talking, and close contact with an infected patient's breathing.

Airborne precautions

Required whenever entering the room or environment of a patient who has been diagnosed with or is being tested for with high suspicion of anthrax, tuberculosis, measles, chickenpox, or disseminated herpes zoster or other pathogens that can be transmitted through airflow, are five micrometers or smaller in size, and remain in the environment for long periods of time.

PHI

Protected Health Information

HIPPA

Health Insurance Portability and Accountability Act

HITECH

Health Information Technology for Economic and Clinical Health

OSHA

Occupational Safety and Health Administration

HCS

Hazard Communication Standard

SDS

Safety Data Sheets

Essential for Immediate Intervention

Recognizing lethal arrhythmias, such as ventricular fibrillation, ventricular tachycardia without a pulse, and asystole.

BLS

Basic Life Support

ACLS

Advanced Cardiovascular Life Support