quiz 2 NURS 100 (ch. 6, 8, 9, 15, 19, 13)

nursing research

systematic inquiry or study conducted to generate new knowledge or refine existing knowledge

what does nursing research provide

results provide foundation for practice decisions and behaviors; create strong scientific base for nursing; support for quality and cost-effectiveness of interventions

national institute of nursing research

promote research for critical health problems that confront the nation

foci of NINR

build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, enhance end-of-life and palliative care

potential funding areas

determining disease risk and treatment thru using genetic info, effective health promotion strategies, discovering approaches that encourage people to take responsibility for symptom management and health function, assist in identification and management of symptoms, improve clinical settings, improve quality of care in long-term care/home/community, understanding health predispositions, improve symptom management at end-of-life

agency for healthcare research and quality (AHRQ)

agency of US dept. of health and Han services that aims to improve the outcomes and quality of health care, reduce costs, address pt. safety and medical errors and broaden access to effective services

AHRQ goal

reducing hospital-acquired conditions; goal of the partnership for patients, AHRQ’s pt. safety research formed the foundation of methods/tools/resources used to reduce HACs

AHRQ results

>21% reduction since 2010, 3 mil. fewer adverse events, 125,000 lives saved

provate foundations

Robert wood johnson, W.K. Kellogg foundation, Helene fuld trust

nursing organizations that fund research

sigma theta tau international, oncology nurses society, American nurses foundation, American nurses association

components of the research process

formulate research question, define purpose of study, review related literature, formulate hypotheses and defining variables, selecting research design, select population/sample/setting, conducting pilot study, collecting data, analyzing data, communicate conclusions

PICOT format for clinical questions

p: population, I; interventions/interest areas, C: comparison interventions/group, O: outcome, T: time

study designs

plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific questions

quantitative designs

study of nursing phenomena that offers precise measurement and quantification, focuses on numerical data/statistical analysis and controls to eliminate bias in findings

qualitative designs

study of phenomena that are difficult to quantify or categorize, such as pt. perception of illness; nonnumerical, pts. have opportunity to tell their stories and share their experiences

research use

extensive concern that nurses have failed to realize the potential for using research findings as a basis for making decisions and developing interventions

locating published research

focus on usefulness of computerized databases like CINAHL and MEDLINE

clinical nurse specialist

MSN, assess agencies readiness for research utilization, work w/ staff to identify clinical problems, help staff find/implement/evaluate findings relative to current practice

clinical nurse researchers

doctorate, focuses on conduct/facilitation of research, work w/ staff to identify research questions, design studies, disseminates findings to staff/admin/legislators

institutional review

IRB or human subjects committee required by institutions receiving federal funding

historical examples of unethical research

Nazi experiments, Tuskegee syphillis study, jewish chronic disease hospital in NY

statutory law

laws written and enacted by legislative bodies, violations are criminal offenses and punishable (fines/imprisonment)

effect of federal statutes related to nursing care

big effect, mandate a minimum standard of care in settings that receive federal funds (medicare/medicaid)

federal false claims act

offense to submit a false claim payment of healthcare services

emergency medical treatment and active labor law (EMTALA)

prohibits refusal of care for indigent/uninsured seeking care in ED, prohibits transfer of unstable pts. between facilities, applicable to non emergent depts.

Americans with disabilities act (1990)

prohibits discrimination against people with disabilities by removing barriers

patient self-determination act of 1990

require federally funded hospitals to inform adult patients in writing about treatment choices and ask about living will/power of attorney

health insurance portability and accountability act of 1996

ensure confidentiality of medical records (HIPAA)

nurse practice act and board of nursing rules and regulations

define scope and limitations

common elements of nurse practice act and board of regulations

definition of term RN, descriptions of professional nursing functions, standards of competent performance, misconduct behaviors/prohibited practice, disciplinary actions, fines/penalties

violations of common elements of NPA and BON

licensing board has authorization to hear and decide cases, penalties include formal reprimand, probation period, levying fines, limiting/suspending/revoking license

nurse/pt. ratios and mandatory overtime statutes

CA first to have nurse/pt. ratios (2004) in acute care facilities (led to lower mortality and “failure to rescue” rates)

child abuse prevention and treatment act

report specific health problems and suspected abuse (children/elders/certain communicable diseases) or suffer fine/imprisonment, most statutes protect against lawsuit

institutional licensing laws

healthcare facilities must follow licensing laws (minimum standard of maintenance of building, basic operations, aspect for major departments, essential aspects of pt. rights/informed consent, can get laws from health dept. )

common law

created thru cases heard/decided in fed/state appellate courts, aka decisional judge-made law

nursing case law

written opinions on nursing practice, establishment of “affirmative duty”, nurses should review case law/journals, provides courts with guidelines for future cases

negligence

failure to act in a reasonable/prudent manner

malpractice

special type of negligence, failure of a professional

elements essential to prove negligence and malpractice

nurse owed patient a special duty of care, nurse preached duty, patient suffered harm/damaged, cause established between standard of care provided and patient injury

frequent allegations of nursing negligence

failure to ensure safety, improper treatment, failure to monitor and report findings, medical errors, failure to follow policy/procedure

doctrine of res ipsa loquitur

“the thing that speaks for itself”, expert nurse witness not needed

gross negligence

reckless acts, conscious disregard for pt. welfare, court may award punitive damages

who must supervise nursing students

faculty or licensed RN

criminal negligence

so reckless it results in serious injury/death; additional consequences could be loss of job, suspension/revocation of license, out of pocket fines (levied by nursing board), significant attorney fees, malpractice insurance may not cover costs

how many pts. die as a result of malpractice/negligence

about 98,000

how many deaths from hospital acquired infection

about 90,000

defense against negligence claims

(cannot use physicians orders) emergency situations, government immunity, Good Samaritan act, ANA code of ethics and AMA code of ethics

statutes of limitation in malpractice cases

time limits to initiate a lawsuit, varies depending on state laws and circumstances

what can lower ramifications for error

telling the pt. or family about the error

reasons for malpractice insurance

expanding functions of RNs, floating, increase in responsibility for supervising staff, failure of employers to defend nurses, work liability insurance coverage limits that are lower than judgment made in lawsuits

liability

every person is responsible for mistakes due to carelessness

personal liability

requires nurse to take responsibility for pt. harm/injury that is result of negligence, cannot be relieved by physician/nurse manager, damages can be levied against current assets/future earnings

personal liability with floating and cross-training

nurses should know statutes/law outside of usual practice area, cannot practice if their knowledge is lacking, legal duty to refuse specific tasks they can’t safely perform and negotiate with supervisor

personal liability for team leaders/managers

held to standard of care of a reasonably prudent supervisor; have been held negligent for triage of staff and equipment, supervision of subordinates, delegation of patient care tasks, reporting of team member performance deficits, supporting/invoking chain of command

nurse managers/admin held liable for

inadequate training, failure to periodically reevaluate staff competencies, failure to discipline or terminate unsafe workers, negligence in developing appropriate policies and procedures, failure to uphold institution licensing laws and state/federal statutes

corporate liability

healthcare corporations help to specific standards of care, have been found to corporately liable for failing to have adequate numbers of nursing staff, TJC developed standards related to orientation/training/education of agency staff (the joint commission accredits healthcare organizations and programs)

risk management systems

track incidents and accidents in facility, assist in development of policy/procedure to improve practice, provide knowledge about federal/state law, licensing law, healthcare case law

incident reports/unusual occurrence reports

legally bound to report critical incidents to manager, can lead to malpractice claim

incident report procedures

know procedures to write incident report, describe events objectively, never note IR in med. records, never photocopy IR, physicians order for IR should not be written in chart, report every unusual incident

intentional torts in nursing practice

direct violation of a person’s legal rights, plaintiff doesn’t have to prove the nurse was negligent or breached a special duty, consequences include fines/punitive damages but can become criminal

assault

causing a person to fear they’ll be touched without consent

battery

unauthorized touching and may rise to the level of a crime, nurse should ask pt. permission before starting a procedure and doctor permission granted

libel

defamation by written word

slander

defamation by spoken word

false imprisonment

unlawful restraint or detention against wishes, nurse has no authority to detain a pt. even under likelihood of harm/injury

invasion of privacy

pt. private affairs made public without consent

intentional infliction of emotional distress

behavior so outrageous it leads to pt. emotional shock

misdemeanor offenses

illegal practice of medicine, failing to report child abuse, falsification of medical records, assault/battery/physical abuse

felony offenses

drug trafficking, fraud in billing, theft, rape, murder

advanced directives

grant adults right to refuse treatment with no hope of recovery, pt. wishes via living will, medical and physician directives

DNR orders

from pt. by physician, nurses must respect

power of attorney

pt. names person who makes end of life decisions

informed consent

physician/nurse must disclose info so pt. can make intelligent decisions

what must be disclosed to a pt

nature of therapy/procedure, expected benefits/outcomes, potential risks, alternative therapies, risks of not having procedure

right to refuse treatment

pt of sound mind has right to refuse even when previously agreed to, nurses must notify provider, provider should educate pt

leaving AMA

nurse must promptly notify provider, must explain danger of leaving, nurses have been charged when they unlawfully detain pts.

use of physical restraints

chemical/physical restraint is imprisonment, use least restrictive deemed by government, can be charged with assault/battery, can be used in an emergency, MD orders required, careful documentation required

nursing ethics

system of principles that govern the actions of the nurse in relation to the patient, family, and other health care providers, policymakers, and society

code of ethics

implicit standards for the profession, ANA and ICN

bioethics

interdisciplinary field within healthcare that’s evolved with modern medicine to address questions that arise as science/tech produces new ways of knowing

dilemmas for healthcare professionals

life/death, quality v. quantity of life, right to decide, informed consent, alternative treatment issues, stem cell research, therapeutic/reproductive cloning, in vitro fertilization, surrogates, organ transplantation

dilemmas created by technology

fatal illnesses now chronic illnesses, consequences of prolonging life with tech, manipulation of DNA

values

personal belief about worth that act as a guide to behavior

value system

entire framework on which actions are based

values clarification

process where people attempt examine the values they hold and how those values function as part of a whole

moral development

forming a worldview and value system thru an evolving, continuous, dynamic process that moves along a continuum of development

infant learning right and wrong

no concept, if trust is met infants develop the foundation for secure moral thought

school age children learning right and wrong

good behavior is rewarded and bad behavior is punished, begin to make choices based on understanding of good/bad

adolescent learning right and wrong

question existing moral values and relevance to society, become more aware of contradictions and develop set of morals, begins to make choices based on internalized set of principles

kohlbergs theory

most widely accepted theory in understanding moral development, a cognitive develop that is sequential in nature, actions based on principles of justice and respect for the dignity of all human kind

essential nursing values and behaviors

altruism, autonomy, human dignity, integrity, social justice

utilitarianism

an action/practice is right if it leads to the greatest possible balance between good consequences and bad, fewest possible bad, strongest approach to bioethical decision making

deontology

humans are rational and act out of principles that are consistent/objective and compel them to do what is right, a decision is right only if it conforms to an overriding moral duty and wrong if it violates that moral duty

beneficence

to promote goodness, kindness, and charity; to abstain from injuring others and help others further their well being by removing harm; risks of harm must be weighed against benefits

nonmaleficence

implies a duty not to inflict harm, to abstain from injuring others, to help others further their well being by removing harm

veracity

principle of truth telling

bioethical issues

abortion, reproduction, quality of life and definition of death, euthanasia and assisted suicide, right to health care, allocation of scarce resources, challenge of paternalism, autonomy, accountability

influences on the adoption of the EHRS

fed. gov., health insurance plans

electronic health records

system that captures, processes, communicates, secures, and presents pt. data

EHR functionalities

health info, results management, computerized provider order entry with or without decision support, clinical decision support electronic communication and connectivity, pt. support for pt. education, home monitoring, administrative processes, reporting and population health management