Collaborative practice exam 1.

A guide that provides principles of right and wrong to provide care to patients, what is this guide?

code of ethics

Historical nursing figure volunteered during the Crimean war also known as the "lady with the lamp"

Florence Nightingale

Moral distress

occurs when one knows the ethically correct action to take but feels powerless to take that action.

The primary cause of ethical dilemmas is what?

Presence of conflicting values.

Criterion must be successfully completed to enter the nursing profession in the United States.

Licensure examination

Utilitarianism

System of ethics focuses that focus on the greatest good for the greater number of people.

Novice nurse

The *novice nurse* has no experience with specific patient populations and uses rules to guide performance.

First step of the nursing process:

assessment

Ethical principle directs us to act in ways that avoid harm

Nonmaleficence

If you find one of your patients lying on the floor of the bathroom floor, what should you do FIRST?

Assess the patient for injuries FIRST

second step of nursing process

diagnosis (nursing diagnosis NOT a medical diagnosis)

Third Step of the Nursing Process

Outcome Identification

Fourth step of the nursing process

planning

Fifth step of nursing process

implementation (carry out plan)

Sixth Step of Nursing Process

evaluation (did the patient reach their goal?)

1st step of the clinical judgement process is to

recognize cues (what matters the most?)

2nd step of the clinical judgement process is to

analyze cues (what does it mean?)

3rd step of the clinical judgement process is to

prioritize hypotheses (where do I start?)

4th step in clinical judgement process is to

generate solutions (what can I do?)

5th step of the clinical judgement process is to

take action (what WILL I do?)

6th step of the clinical judgement model is to

Evaluate outcomes (did it help?)

Evidence based practice:

clinicians are expected to use BEST EVIDENCE to inform practice.

Critical judgement is...

Critical thinking in action

Critical thinking

Thinking in a systematic and logical manner, openness to reflect on reasoning process.

Attributes of clinical judgement:

-Involves a holistic view of the

patient situation.

-Has a process orientation (a

circular process).

-Requires reasoning and the

interpretation of data.

Tanner Clinical Judgement Model in order

1. Noticing 2. interpreting

3. responding 4. reflecting

Narrative reasoning

looks at pt's view of what is happening and their meaning of the illness or situation

Intuitive Reasoning

take into account knowledge of this specific patient as well as previous experiences

Analytical

Relies mainly on theoretical knowledge (novice nurses)

what type of nurse draws from a variety of reasoning patterns

expert nurses

Quality and safety education for nurses (QSEN)

a national framework launched in 2005 to prepare future nurses with the KNOWLEDGE, SKILLS, AND ATTITUDES (KSAs) needed to continuously improve the quality and safety of healthcare systems

safety

Minimizing risk of harm to patients and providers through both system effectiveness and individual performance.

adverse event

Unintended harm by an act of commission or omission rather than as a result of disease process

A patient falls out of bed because side rails were not up. What type of event is this?

Adverse event

Near miss

Error of commission or omission that could have harmed a patient, but harm did not occur as a result of chance

A med error that caused so harm to the patient is an example of what type of event?

Near miss

sentinel event

an unexpected occurrence involving death or serious injury

Nursing staff accidentally gave the same medication twice, as a result the patient overdoses. What type of event is this?

Sentinel event

categories of errors:

Diagnostic

Treatment

Communication

Just Culture

culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action

Quality and safety are:

the main focus for healthcare delivery systems

perceptions of safety

what does it mean to be safe?

alternatives must be tried before________________________ a patient

restraining

physical restraint

any method, device, material, or equipment that restricts a person's freedom of movement.

chemical restraint

Medications used to manage a patient's behavior and are not a standard treatment or dosage for the patient's condition.

restraint alternatives:

trained sitters, diversional activities, verbal interventions, etc......

How often should you monitor a violent pt that is restrained?

every 15 minutes

How often should you monitor a non-violent patient that is restrained?

every two hours

How long does an order to restrain a pt last?

an order to keep a pt restrained only last 24hrs and must be renewed if need be.

what should be monitored when checking on a restrained pt.

vital signs, skin integrity under the restraints, hydration, range of motion, elimination needs, circulation, and the need for said restraint.

Code of nursing ethics

-A set of guiding principles that all members of a profession accept

-Helps professional groups settle questions about practice or behavior

-Includes advocacy, responsibility, accountability, and confidentiality

Nonmaleficence

do no harm

Autonomy

independence to make decisions, includes informed consent

veracity

truthfulness, honesty

fidelity

Follow through, keep promises

Beneficence

in the best interest of the patient; not self

Moral distress

occurs when you know the ethically correct action to take but feels powerless to take action.

When do ethical dilemmas almost always occur?

In the Presence of conflicting values (TEST QUESTION)

Ethics of care

care-based ethics focuses on understanding relationships, especially as they are revealed in personal narratives.

Deontology

Approach to ethics that judges the action based on the action's adherence to rules. Described as duty or obligation, because rules 'binds you to your duty' (either right or wrong)

Who/what holds the legal authority for nursing practice and regulates nursing practice?

State board of nursing

Who is responsible for obtaining informed consent?

The provider performing the procedure

Assult

the conduct of one person makes another person fearful and apprehensive

Battery

intentional and wrongful physical contact with a person that involves an injury.

False Imprisonment

restraining an individual or restricting an individual's freedom (against their will)

Malpractice (professional negligence)

example: a nurse administers a large dose of medication due to a calculation error; the client has a cardiac arrest and dies

Unintentional Torts

negligence and malpractice

Negligence

failure to take proper care in doing something

Nurse practice acts

describes and define the legal boundaries of nursing practice within each STATE (varies state to state)

Intentional Torts

assault, battery, false imprisonment

living will

a document in which a person states his or her wishes about life support and other treatments

Durable power of attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient

Americans with Disabilities Act (ADA)

Protects rights of people with physical or mental disabilities

Health Insurance Portability and Accountability Act (HIPAA)

Provides confidentially of a pt's medical information

How often MUST restraints be released?

every 2 hours

What can you do to help reduce your legal risk in healthcare?

DOCUMENT, DOCUMENT, DOCUMENT!!!!

Human Flourishing

-Encouraging patients in their difficult times

-Seeking additional resources for patients with limited discharge planning issues

-Create a positive, encouraging environment for patients and families

"ADOPIE" stands for:

assessment, diagnosis, outcome identification, planning, implementation, evaluation

coordination of care

The registered nurse coordinates care delivery.

Professional practice evaluation

The registered nurse evaluates one's own and others' nursing practice.

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

Mary Mahoney

First professionally trained African American nurse

Continuing Education:

involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. (Often required)

In-service education:

programs are instruction or training provided by a health care agency or institution designed to increase skills and competencies in healthcare professionals.