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Issues Finals Articles

Terms in this set (45)

IOM recommendations for Nursing
1) remove scope-of-practice barriers (practice to full extent of training and education)
2) expand opportunities for nurses to lead and diffuse collaborative improvement efforts
3) implement nurse residency programs
4) increase the proportion of nurses with a bachelor's degree to 80% by 2020
5) double the number of nurses with a doctorate by 2020
6) ensure that nurses engage in lifelong learning
7) prepare and enable nurses to lead change to advance health
8) build an infrastructure for the collection and analysis of interprofessional health care workforce data
responsibilities of the delegating nurse
-Review the patient assessment and plan the delegation
-Communicate with the assistive person, confirming
understanding of the task and verifying that the assistive person accepts the delegation
-Supervise the delegation by monitoring the performance of the task and assuring
compliance with standards of practice, policies, and procedures
-Evaluate the effectiveness of the delegation and provide feedback as indicated.
responsibilities of the assistive person in delegation
-Ask questions and seek further education or clarification of expectations, as needed
-Accept the delegation, if able to safely and competently perform the task
-Perform the task as directed by the nurse, seeking supervision as needed
-Document the care provided
responsibility of the organization/employer in delegation
-Provide policies and procedures to support the delegation process
-Assure adequate time for effective clinical training
-Maintain and assure access to documentation of assistive personnel competencies
-Provide resources needed to support safe delegation, including adequate staffing and appropriate skill mix
an LPN may perform what tasks related to IV therapy?
-set up equipment and infusions
-insert peripheral IV lines
-monitor and adjust flow rates
-administer intermittent or continuous meds and solutions
-monitor pt getting blood products
-hang a subsequent bag or the same solution
-monitor a PCA pump
-saline and heparin flushes
-d/c or remove IV lines
-change IV dressing
-draw blood from line
an LPN may not perform which actions related to IV therapy?
-insert or remove a central line
-administer the first dose of a med/solution
-administer chemo
-administer blood products
-initiate PCA pump
-administer IV fluid bolus for plasma volume expansion
-administer IV push meds
features of magnet hospitals that can be applied to pt safety
-shared vision
-authentic leadership
-commitment to life-long learning
-intentionality in daily practice
benefits of a good work environment
-increased RN job satisfaction and retention
-more experienced and skilled nursing workforce
-safer pt care
ways nursing units have improved their work environments
-ID areas in need of improvement
-make a concrete plan to target a specific issue
-staff must be invested and embedded in the process
-shared governance, unit-based councils, and change champions
-continuing professional development of RNs (education, etc.)
four factors involved in providing safe and effective care and reducing adverse events
-quality of the nursing work environment
-availability of unit-level data
-preventative capacity of evidence-based practice
-staff readiness for change
list the three domains of human factors engineering
-physical (workplace layout)
-cognitive
-organizational (communication and teamwork)
threats to safe nursing practice
-unfamiliarity with the task
-inadequate time
-poor communication
-underestimation of risk
-poorly designed workflow
factors that promote human error
lack of sleep
fatigue
illness
boredom
fear
stress
reliance on memory
interruptions and distractions
noise
inadequate lighting
sleep deprivation can cause the same level of impairment as a BAC level of...
0.05%
what is an important tool in preventing omissions
checklists
what are the three tiers of the intervention hierarchy to prevent errors
-stronger: eliminate the chance of an error, forcing functions (can't connect enteral tubing to IV tubing)
-intermediate: strategies that make it easier to do the right thing and to make errors visible (hand sanitizer outside pt rooms)
-weaker: mitigates error consequences by providing education and training (pt at high fall risk placed in a low bed to reduce injury from a fall)
in psychologically safe environments providers are more likely to...
feel safe about reporting mistakes or asking for help, education, or feedback
in environments that are not psychologically safe workers are more likely to...
keep their concerns to themselves
what are the four fears that promote silence?
fear of being perceived as ignorant, incompetent, negative, or disruptive
ways to transform power-based relationships
-have leaders directly accessible to the team
-access barriers need to be removed (need to go through residents, etc.)
-treat team members with respect to reinforce willingness to share information
-seek feedback from team members
-leaders must not tolerate inappropriate or disruptive behaviors
factors that can threaten team communication
gender, age, race, religion, culture, tenure, education, and cliques
what three questions need to be addressed when acting with moral courage?
1) what is the right thing to do
2) what do i need to handle my fear
3) what action do i need to do to maintain my integrity
prior to submitting an event report what actions should a nurse take?
-review the facility's event reporting policy
-verify presence of institutional/state retaliation policy
-written record of the incident and any encounters/discussions that occur as shes writing the report or after it is filed
what is a good faith claim?
a breach in the standard of care is reported and made without malice or consideration for personal gain
what is a whistle-blower?
people who expose negligence, abuse, or danger such as professional misconduct or incompetence
what are some instances requiring moral courage?
-conflicting loyalties
-highly charged conflict situations
-violation of pt rights
define moral courage
standing up for one's ethical beliefs when moral principles are threatened regardless of risks
define moral distress
when nurses feel powerless to act after witnessing improper behavior
define virtue
acting in accordance with one's moral and ethical principles
define virtue ethics
emphasizes the role of character rather than doing one's duty to bring about good consequences
-recognizes that more than moral wisdom is required to ensure a moral outcome
barriers to showing moral courage
-organizational culture
-lack of concern by colleagues
-groupthink (people collectively decide to look the other way)
-preference for redefining unethical actions as unacceptable
what does C.O.D.E. stand for? (moral courage aid)
C-courage
O-obligations to honor
D-danger management
E-expression (action through assertiveness and negotiation skills)
what is the negative assertion technique?
respond with the part of the statement you agree with then tell the part that you don't agree with
ways for nurses to advocate for health (involving policy)
-attend policy internships, fellowships, or workshops
-writing letters or making calls to public officials
-testify at public meetings
-work with the media to bring attention to issues
define expert power
possessing knowledge and skill that someone else needs
define legitimate power
power bestowed on an individual (by a facility, licensing board, etc.)
define referent power
power gained through admiration and respect
define reward power
ability to give people what they want and ask for things in exchange
define coercive power
ability to punish and is rooted in fear
what are the three phases of policy making?
1) formulation phase-imput of information/ideas
2) implementation phase-disseminating info about the policy and putting it into action
3) evaluation/modification phase-ammend/rewrite policy if needed
what is the function of a committee in policy?
conflicting points of view are discussed and legislation is "hammered out"
forward those worthy of floor debate and ignore the rest
what is the nurse in washington internship (NIWA)?
internship that teaches about ways to advocate for nursing issues
what does public policy include?
laws, regulations, programs, and practices of government
that meet social needs and problems and disburse public funds
a policy window appears when what three things exist?
-existence of a problem
-logical, feasible, and rational policy proposal
-shift in politics due to political turnover, changing public opinion, etc.
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