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234 Terms
1
autonomy
initiation of independent nursing interventions without a provider order
\-doing your job without being asked
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2
code of ethics
statement of philosophical ideals of right and wrong that define how to care for patients
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standards of nursing practice
\-assessment: collects data and information relative to healthcare or situation
\-diagnosis: RN analyzes the assessment data to determine the actual or potential diagnosis, problem, issue
\-outcome identification: RN identifies expected outcomes for a plan individualized to the patient
\-planning: the registered nurse develops a plan encompassing strategies to achieve expected outcomes
\-implementation: acting out the plan
\-evaluation: evaluates the progress toward goal and outcomes
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standards of professional performance
\-ethics
\-advocacy
\-respectful and equitable practice
\-communication
\-collaboration
\-leadership
\-education
\-scholarly inquiry
\-quality of practice
\-professional practice evaluation
\-resource stewardship
\-environmental health
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provider of care
care giver
\-help patient maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process
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advocate
\-protect patients legal and human rights
\-fight for your patient and what is right for them
\-even if it steps on toes
\-do what is right for your patient!
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educator
\-90% of nursing
\-identify patients willingness and ABILITY to learn, explain concepts about their health, describe the reason for care activities, reinforce behaviors, and evaluate their progress
\-teach families and other support people about the patient and their needs
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communicator
\-nurses talk to patients, families, peers, other professionals, resource people, the community
\-know your patients strengths, weaknesses, preferences, and needs
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manager
\-coordinate activities of members of a healthcare team
\-nurses establish an environment for collaborative patient centered care and safe evidence based care
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career development
\-health care is always changing and expanding
\-the nursing career path is limitless
\-take advantage of different clinical practices
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11
Clara Barton
founded the American Red Cross
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Mary Mahoney
1st professionally trained African American nurse
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13
Florence Nightingale
\-lady with the lamp
\-opened the first school of nursing
\-improved sanitation and quality of facilities, bringing mortality rates in Turkey from 42.7% to 2.2%
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Lillian Ward and Mary Brewster
opened the Henry Street Settlement which focused on the health needs of poor people who lived in tenements in NYC
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Mary Adelaide Nutting
first professor of nursing at Columbia University
\-brought nursing into universities
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16
Magnet Recognition Program
designates organizations world wide in which nursing leaders successfully align their strategic goals to improve the organizations patients outcomes
\-provides a roadmap to nursing excellence
\-American Nurses Credentialing Center (ANCC)
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Center for Ethics and Human rights
\-provides a forum to address the complex ethical and human rights issues confronting nurses
\-designs activities and programs to increase ethical competence in nurses
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other organizations formed in the 1920s
\-American Association of Critical Care Nurses
\-Association of peri Operating Room Nurses (AORN)
\-Infusion Nurses Society (INS)
\-Emergency Nurses Association (ENA)
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End of Life Nursing Education Consortium (ELNEC)
\-national and international education initiative to improve palliative centered care offered by the AACN and the City of Hope Medical Center
\-educational programs focus on end of life care
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Heath Care Reform
\-effects how health care is paid for and how it is delivered
\-greater emphasis on health promotion, disease prevention, and illness management
\-more services will be community based
\-nursing needs to respond by assessing resources, improving staffing and management models, changing nursing education, and helping patients adapt to new delivery methods
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evidence based practice
\-integrates findings into practice
\-current and future practice is based on evidence
\-always search for the best scientific research to apply to your patients problems
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Quality and Safety Education for Nurses (QSEN)
\-their project is to meet the challenge of preparing future nurses and advanced practice nurses to have knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care system
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electronic health record (EHR)
efficient method for documenting and managing patient health care information
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computerized physician/provider order entry (CPOE)
\-allows health care providers to directly enter medical orders
\-critical to patient safety especially medication ordering
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genomics
the study of all the genes in a person and interactions of these genes with one another and with that persons environment
\-genomics combined with health care technology can improve health outcomes, quality and safety, and reduce health care costs
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Hospital Compare
website that allows people to select multiple hospitals and compare performance measure information
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Hospital Consumer Assessment of Healthcare Providers and systems (HCAHPS)
website contains information about patients perspectives on hospital care
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RN education level
\-2 year associates degree
\-4 years bachelors degree
\-pass the NCLEX
\-can go back for masters and doctorate
\-many certifications available
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National Student Nurses Association (NSNA) or Canadian Student Nurses Association (CSNA)
\-consider issues of importance to nursing students such as career development and preparation for licensing
\-NSNA often cooperates in activities and programs with the professional organizations
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professional organizations
\-national league for nursing (NLN)
\-American nurses association (ANA)
\-international council of nursing (ICN)
\-many organizations for specific areas
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beneficence
\-actively promoting good
\-fundamental to the practice of nursing and medicine
\-implies that the best interest of the patient is most important
\-implies that nurses primarily work to service others
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nonmaleficence
\-do no harm
\-health care professionals try to balance the risks and benefits of care while striving to do as least harm as possible
\-decisions about the best course of action can be difficult and uncertain to avoid harm
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justice
\-fairness and the distribution of resources
\-mostly used when discussing access to health care
\-controversialj
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just culture
\-promotion of open discussion without the fear of retaliation when errors occur
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fidelity
\-agreement to keep a promise
\-do not abandon a patient
\-nurses have a duty to be faithful to patients
ex: if patient is in pain your fidelity encourages you to initiate interventions quickly
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responsibility
\-willingness to respect ones professional obligations and to follow through
\-maintaining your competence to provide care and seeking guidance when you are uncertain of applying your skills and knowledge
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accountability
\-answering for your own actions
\-ensure that your professional actions are explainable to your patients and your employer
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The Joint Commission (TJC)
establishes national patient safety guidelines to ensure patient and workplace safety through consistent, effective nursing practices
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confidentiality
\-the health care teams obligation to respect and protect patients privacy
\-fundamental of trust relationship between nurse and patient
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Health Insurance Portability and Accountability Act (HIPPA)
\-mandates confidentiality and protection on patients personal health information
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veracity
\-confirmatory to facts
\-accuracy
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Patient Protection and Affordable Care Act
\-consumer rights and protections
\-affordable health care coverage
\-increased access to care
\-stronger Medicare to improve care for vulnerable populations
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Emergency Medical Treatment and Active Labor Act (EMTALA)
when a patient comes into the ED, an appropriate medical screening occurs if an emergency condition exists, staff must stabilize the patient prior to transfer
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Health Information Technology Act (HITECH)
ensures that private health information (PHI) is not inadvertently used on social media
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Americans with Disabilities Act (ADA)
prohibits discrimination and ensures equal opportunities in employment, state and local services, public accommodations, commercial facilities and transportation
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Mental Health Parity Act
requires insurance companies to provide same level of coverage for mental health and substance abuse care as they provide for medical and surgical care
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Patient Self Determination Act (PSDA)
\-enacted in 1991
\-requires facilities to provide written information regarding their right to make health care decisions
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advance directives
\-based on value of informed consent, patient autonomy, truth telling, and control over the dying process.
\-facilities are legally required to provide written information to patients concerning their legal rights to make decisions, including the right to refuse treatment and formulate advance directives
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living will
written documents that direct treatment in accordance with a patients wishes in the vent of a terminal disease or condition
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health care proxies and durable power of attorney
legal document that designates a person or people of the patients choosing to make health care decisions if the patient is no longer able to do so
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Uniform Anatomical Gift Act
Any adult (18 years and older) has the right for organ donation
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The Omnibus Budget Reconciliation Act
focuses on patient rights, quality of life, quality of care, and the physical environment
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deontology
defines actions as wrong or right based on their adherence to rules and principles such as fidelity to promises, truthfulness, and justice
\-looks at the act itself and judges its “rightness” by the rules or principles it upholds
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utilitarianism
\-the value of something is determined by its usefulness
\-consequentialism
\-emphasis is on the outcome or consequence of the action
\-”the greatest good for the greatest number of people”
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casuistry
\-case based reasoning
\-turns away from conventional ethics to decide the best actions and focuses instead on the details of a situation
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feminist ethics
focuses on one nature of relationships to guide making difficult decisions, especially relationships in which power is unequal or where the patient feels ignored or invisible
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ethics of care
delivery of health care based on ethical principles and standards of caree
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ethical dilemma
\-two opposing courses of action can both be justified by ethical principles
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moral distress
feeling the need to take a specific action while believing that action to be wrong
ex: pro life doctor doing an abortion
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processing an ethical dilemma
1\. is this an ethical dilemma?
2\. gather information relevant to case
3\. clarify values
4\. verbalize the problem
5\. identify possible courses of action (know all options) (use ethics committee)
6\. negotiate a plan
7\. evaluate the plan over time
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Ethical Committees
\-provide clinical ethics consultations
\-develop/revise policies pertaining to ethics (advance directives, withholding/ withdrawing life support, informed consent, organ transplant)
\-facilitate education about issues in clinical ethics
\-anyone involved in care can request a meeting (patients, physicians, families, nurses, etc)
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social media
\-supportive source of information about patient care or professional nursing activities and can provide you with emotional support
\-a source to support your patients, to connect with friends and loved ones
\-there is a risk of patient privacy
\-online friendship with a patient risks the clouding the professionalism in the relationship
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quality of life
\-deeply personal, use quality of life measures to define value and benefits of medical interventions
\-objective measures: patient age, ability to live independently, ability to contribute to society
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end of life care
\-can be difficult to convey to families
\-death and dying are deeply spiritual and cultural
\-conflicts can occur between health care members and families
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futile
\-hopeless or serves no useful purpose
\-interventions unlikely to produce benefit for a patient
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access to healthcare
\-is healthcare a right or privilege or both?
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Affordable Care Act (ACA)
\-2010
\-passed to create regulations that control costs and improve availability of insurance
\-offered changes in payment for services to reward practices that reduce harm and promote quality outcomes
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criminal laws
\-protect society and provide punishment for crimes which are defined by municipal, state, and federal legislation
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civil law
\-protect the rights of individuals and provide fair and equitable treatment when violations occur
\-penalty is fines or community service
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common law
\-originates from decisions that were made in the absence of law
\-ex: right to privacy was implied in the Constitution
\-patient confidentiality started as common law
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case law
\-decisions that were made in legal cases resolved in court
ex: Jefferson vs Mercy Hospital and Medical Center (2018) Ms. Turner alleged that her health care providers did not meet the standard of practice when caring for a tracheostomy and she died
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statutory law
\-derived by statues passed by legislatures
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nurse practice acts and licensure
\-civil state laws that describe the scope of nursing practice and sets educational requirements
\-protects citizens and makes nurses accountable for the care they give
\-state boards can suspend or revoke license if nurses conduct violates act
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good Samaritan law
\-limits liability and offers legal immunity if a nurse assists at the scene of an accident if nurse does what is reasonable to save a persons life within their expertise
\-once started the nurse must stay with the patient until able to hand off care
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public health laws
\-protect populations, advocate for rights, regulate healthcare, and provide health care financing, and ensure professional accountability for care provided
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Nurses are MANDATORY reporters of
suspected abuse or neglect
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Uniform Determination of Death Act
2 standards for determination of death
\-irreversible cessation of cardiac and respiratory function
\-irreversible cessation of all brain function, including brain stem, allows for the procurement of organs
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autopsy
happens when there are reasonable grounds to believe that the patient died as a result of
\-violence
\-homicide
\-suicide
\-accident
\-death in an unusual and suspicious way
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death with dignity or physician assisted suicide
\-a competent individual with a terminal illness makes a request for medication to end their life in a humane and dignified manner
\-if a nurse participates they will automatically lose their liscence
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nurse to patient ratio
\-adequate staffing is required to run a floor t ensure safety and satisfaction with care
\-ex: Spires v. Hospital Corporation of America (2006) poor patient care due to insufficient nursing staff resulted in the death of a patient
\-this case emphasized the seriousness of short staffing
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nursing assignments
\-sometimes nurses are asked to “float” to a different unit if that unit is understaffed
\-it is crucial to tell supervisor if you do not feel qualified to work in that unit
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patient abandonment
nurse refuses to provide care after having established a nurse patient relationship
\-BEFORE building the relationship a nurse can refuse to attend to that patient because
\-the nurse lacks skills and knowledge for that patient
\-care exceeds the nurses practice
\-health of the nurse or the nurses unborn child is threatened
\-orientation to that unit has not be performed
\-nurse documents objection based on ethical, moral, or religious ground
\-nurses clinical judgement is impaired due to fatigue
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nurse delegation
process of assigning part of the responsibility to another qualified person in a specific situation
\-RN educates, observes, verifies that a non registered nurse can do a specific task
\-RN retains responsibility to ensure patient safety
\-RN must periodically asses whether nurse delegation continues to be appropriate
\-deliberate acts against a person or property that may result in civil or criminal actions
\-ex: assault , battery, false imprisionment (restraint without reason)
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quasi-intentional torts
intent is lacking but violation action and causation occur
\-ex: invasion of privacy-protects patients rights to be free from unwanted intrusion into private files
\-defamation of character- slander (words) libel (written)
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unintentional torts
\-negligence- conduct that falls below the generally accepted standard of care of a reasonably prudent person
\-malpractice- professional negligence
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4 criteria that establish malpractice
\-duty of care
\-did not do duty
\-patient is injured/harmed
\-that harm is from your error
ex: did not check ID, gave them blood, they had a reaction
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standard of proof
what a reasonably prudent nurse would do under similar circumstances in the geographical area which the alleged breach occurred
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malpractice insurance
contract between an insurance company and a nurse or an employer
\-intended to cover costs incurred when a patient sues the employer and or the nurse
\-provides for a defense of the nurse and the employer in a lawsuit
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nurse experts
\-has education and experience related to the alleged complaint of the patient and accurately and concisely describes the pertinent scope and standards of practice
\-based their opinions on existing standards of practice established by nurse practice acts, federal and state licensing standards
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informed consent
\-patients agreement for a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal
\-must disclose in terms the patient can understand
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in informed consent the patient receives-
\-explanation of treatment/ procedure
\-names and qualifications of person performing and assisting
\-description of risks that may occur and inflict pain
\-explanation of alternatives and what would happen if they did nothing
\-knows they have the right to refusal without discontinuing other care
\-they can refuse even after care has begun
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occurrence report
provides database for further investigation in an attempt to determine deviations from standards of care, to identify corrective measures needed to prevent recurrence and alert risk management
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interprofessional theory
collaborative practice with an interprofessional framework embodies communication and decision making, which allows separate and sharked knowledge and skills diverse providers to synergistically influence care
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interprofessional
made up of various disciplines working collaboratively towards a common goal
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intra-professional
healthcare professionals with the same background collaborating to provide care
\-team of same profession
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interprofessional relationships
nurse, nurses aids, physicians, therapist, etc
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goals of interprofessional teams
\-improve patient outcomes
\-reduce medical errors
\-start treatment faster
\-reduce inefficiencies in health care
\-improve staff relationships and job satisfaction
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multidisciplinary
involve team members working independently to create plans specific to their discipline
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Flashcard (20)