Studied by 40 people
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
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Flashcard (65)