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Terms in this set (88)
What does "abandonment of a patient" mean?
occurs when a nurse has accepted an assignment and then discontinues care without the client requesting the discontinuation or when replacement has not yet been provided.
How can nurses avoid "abandoning" patients due to personal value conflicts?
nurses need to aware and conscious of their own personal values and beliefs so that they can refuse an assignment instead of taking on the care of a patient and then abandoning them
Does CNO get involved with refusal of assignments and discontinuing of nursing services?
yes. the college is required to investigate all formal complaints including refusal of assignments and discontinuing of nursing services.
what are the exceptions that make it okay to discontinue nursing services? (3)
1. the client requests the discontinuation
2. alternative or replacement services are
3. the client is given reasonable opportunity
to arrange alternative or replacement services
Is refusing to work an extra shift or overtime considered abandonment or professional misconduct?
no, it is not considered abandonment but depending on the context and facts of a particular situation, nurses can be found guilty of professional misconduct under one of the other clauses.
can you refuse a patient assignment?
yes, if that patient assignment requires extra speciality training that you do not have or if you do not feel competent enough to provide proper care.
why is dealing properly with conflict a good thing?
it can lead to personal and organizational growth. learn from the conflict and make it better
what are 3 types of conflict that can happen with nurses?
1. nurse-patient conflict
2. nurse-colleague conflict
3. nurse-workplace conflict
what is the role of a nurse in formal leadership positions when it comes to dealing with conflict?
it is their responsibility to prevent conflict from occurring and promoting good conflict management if it does
what is important to do after a conflict is dealt with?
debrief the situation. reflect on and learn from the conflict
what is culture?
the values, beliefs and way of life that influences one's thinking, decisions and actions.
does everyone have a culture?
should nurses have knowledge of and understand all cultures?
no, it is impossible for nurses to acquire knowledge on every single culture, because culture is so diverse that it could be different for every person. instead, nurses must recognize that behaviours and responses that are viewed one way in one cultural context may be viewed in another way in another cultural context. nurses should be open and have a positive interest in learning about each patient's individual cultural needs.
what is Culture care preservation?
making efforts to integrate the client's preferences into the plan of care when these preferences are important to the client's physical, emotional or spiritual health.
What is culture care accommodation?
the nurse explores ways to honour client choice
by minimizing risks or finding ways to overcome barriers. Often this involves accommodating the key elements of the request, while negotiating with the client to undertake the actions or interventions that the nurse thinks are necessary for a positive health outcome.
what is culture care re-patterning?
the nurse works with clients to develop new patterns that extend beyond the client's usual way of doing things, while respecting traditional values and beliefs. Clients and care providers are encouraged to determine how a situation could be handled differently to optimize outcomes for the client, without violating beliefs or standards of practice.
is this situation an example of culture care preservation, accommodation, or re-patterning?
the client believes a picture of st. francis will help heal her wound, so she keeps it between pieces of gauze on her wound. the nurse recognizes, decides it does not pose a serious health risk and sterilizes the picture to keep it within the gauze safely.
culture care preservation.
is this situation an example of culture care preservation, accommodation, or re-patterning?
the client believes that the cause of her angina is the evil eye. she has a homemade remedy that she believes will get rid of the curse. The nurse acknowledges this belief, ensures that the remedy does not have risky ingredients (such as high sodium content), and then tries to get the client to also use the nitroglycerine in addition to the home remedy.
culture care accommodation
is this situation an example of culture care preservation, accommodation, or re-patterning?
A client is diagnosed with kidney failure and starts dialysis which requires high intake of protein. the client is hindu and although used to eat chicken and eggs, has since become a vegetarian because he believes the kidney failure was God's way of punishing him for not being true to the Hindu religion and not eat meat. The nurse understands what the client is saying and tries to introduce community and other sources to ensure the client is getting adequate protein intake. The nurse involves a dietitian to educate the client on vegetarian sources of protein, and involves a priest to address his spiritual needs.
culture care re-patterning
is client consent required for the use of an interpreter?
what happens if cultural sensitivity is not followed?
the therapeutic nurse-client relationship may. be negatively affected.
when did the MAID law come into effect? (year/month)
what are the 2 types of MAID?
1. clinician-assisted MAID
2. client self-administered MAID
what is clinician-assisted MAID?
clinician provides assistance by administering a medication to a client, at their request, that causes their death.
what is client self-administered MAID?
clinician prescribes or provides a medication to a client, at their request, so that they may self-administer the medication, and in doing so, cause their own death.
What health care professionals can administer or provide the medication for MAID to happen?
Nurse practitioners and physicians.
what is a nurses role in MAID? (4)
1. educate clients
2. inserting an IV line
3. providing emotional support to client and family
4. assist self-administration by apply force to a syringe, but both the decisioned action of taking the medication must be the client's own.
as a nurse, can you refuse a patient assignment involving MAID?
yes. if your personal values/beliefs conflict with MAID, you can request to not be put on a MAID assignment or refuse the assignment. however, the nurse cannot communicate this objection to the client and the nurse must transfer the patient care to a nurse who is okay with MAID. until the transfer of care is made, the nurse must perform all other patient care not related to MAID.
which 5 criteria determine if a client is eligible for receiving MAID?
1. that the request for MAID is voluntary with no external pressure
2. that the client has been given extensive education on options for relief of suffering
3. that the client has a irremediable medical condition
4. that the client is at least 18 years old and is competent/capable of making their own health-related decisions.
5. that the client is eligible to receive Canadian healthcare.
what happens if a NP or physician denies the client MAID because they believe the client does not meet the right criteria?
the client can go to another NP or physician and request again.
after eligibility is confirmed, what 5 safeguards must be met before MAID is carried through?
1. written formal request
2. independent witnesses
3. second opinion
4. communication with pharmacist
5. waiting period
what is the written formal request safeguard for MAID?
after being informed by NP or physician that they have an irremediable condition, the client must write a formal request (signed/dated) for MAID. if client is unable to do so, someone who is at least 18, understands MAID and gains no benefit from the client's death may write the request in the client's presence and expressed direction.
what is the independent witnesses safeguard for MAID?
NP or physician must be satisfied that two independent witnesses (who are at least 18, understand MAID, gain no benefit from the client's death, are not part of client's care in any way) must sign and date the written request AFTER the client made, signed and dated the letter.
what is the second opinion safeguard for MAID?
Another NP or physician must confirm that the client meets all of the eligibility criteria. the NP or physician giving the second opinion must NOT be connected in anyway to the NP granting the request.
what is the communication with a pharmacist safeguard for MAID?
communication must be initiated early in the process to ensure the pharmacist knows the prescription request is for someone requesting MAID.
what is the waiting period safeguard for MAID?
there must be a 10 day waiting period between when the client signs the request and when the MAID is provided. if the NP or physician believes the death or loss of capacity to consent is imminent (and this is confirmed by a second opinion), the 10 days can be shortened.
what must happen after MAID occurs?
the death must be reported to a coroner, who decides if he will issue a medical certificate of death after an investigation into the MAID death, or if the NP can complete the medical certificate of death themselves.
when was the professional health information act passed? (year)
can a patient's health information be shared between health care members?
yes. only if they are part of the patient's health care treatment team and this information must be shared securely.
What does the Professional health information act state?
The client has the right to control their own health information including how the information is collected, used, and disclosed. This act permits the use of the health information to be shared among those involved in the care of the patient but must remain secure and confidential (unless the client otherwise refuses this consent).
hat does the Quality of Care information protection act state?
promotes discussion of events, peer reviewed activities, and quality of the health information
Can the Personal health information act be used in legal proceedings?
Can the quality of care information protection act be used in legal proceedings?
Can the quality of care information protection act be accessed by clients?
What classified information as personal health information?
Any information that can identify the client, even without being named
How is it that medical notes don't breach the confidentiality?
Employers can request medical notes in which the physician can sign and send, but these notes cannot include any symptoms the patient had, diagnosis, or any treatment they received.
As a health care provider, what 3 things must be ensured when collecting health information?
1. Information is only being used for its purpose
2. only the information that is needed is gathered, and nothing more.
3. Information is complete, accurate and up to date.
If a patient is unable to communicate their health information, can this pertinent information be gathered by other sources? If yes, what are those sources?
yes. Substitute decision makers,
Is consent written or verbal?
Consent can be both written or verbal, but written consent helps avoid discrepancy.
A custodian can use health care information without the consent of the client to manage risks, to support quality to care providers, to allocate resources, to obtain payment, to do research??
when can practitioners disclose information?
to provide care and consent cannot be given quick enough, to contact a relative/friend of an injured/ill patient for consent, to reduce a significant risk of harm to the patient.
when can personal health information be disclosed to someone else who is not the client?
Who must be notified if confidentiality is breached?
Privacy commissioner and CNO must be notified, and both will conduct an investigation.
hat are the consequences of breaching confidentiality?
up to 6 months prosecution, up to $100, 000 fine, loss of employment, revocation of license, and the victim can sue privately.
If a nurse disagrees with plan of care or intervention, what should be done before informing the responsible health care provider?
The nurse should assess the situation, consult the client (if appropriate), consult nursing colleagues and other experts, and refer to relevant reference material so that their concern is supported.
If a nurse brings a concern to a physician about a plan of care of intervention, and the concern remains unresolved, what should the nurse do next?
bring the concern to the immediate manager. Continue bringing the concern to higher authorities until convinced that the decision is appropriate or until the decision is changed.
if the decision is to refuse to implement the plan of care, what must the nurse make sure to do?
document the concern and steps taken to alter the plan of care in the client's chart.
what could happen if the nurse fails to report a disagreement in plan of care?
the nurse could be held liable if they disagreed with a plan of care or intervention and did it anyway (if there is a negative outcome).
what should a nurse do if they disagree with an ordered medication?
the nurse should discuss their concern with the doctor. If the concern is still valid but the doctor is still standing by their order, report the concern to higher authority. DO NOT give the medication unless it has been proven to you that the order is appropriate.
what are the 3 factors in the three-factor framework?
the client, the nurse and the environment.
what are the 4 controlled acts that RNs can do?
1. performing a prescribed procedure below the dermis or mucous membrane
2. administering a substance by injection or inhalation
3. putting an instrument, hand or finger: etc.
4. dispensing a drug
What type of patients can RPNs care for? (compared to RNs)
stable patients or patients with expected outcomes.
What type of patients can RNs care for? (compared to RPNs)
unstable patient or patients with unexpected outcomes
What are the 3 types of authorizing mechanisms?
order, delegation, initiation
what is the name for a means through which nurses get authority to perform or make the decision to perform a procedure by providing nurses with the authority to implement treatment plans and protocols?
what is the name for a prescription for a procedure/treatment/drug/intervention?
what are the 2 types of orders?
1. direct order
what is the difference between a direct order and a directive?
A direct order is client specific and can be either written or verbal.
A directive may be implemented for a number of clients if specific conditions are met, and need to be written.
what is the authorizing mechanism of initiation?
RNs have the authority to initiate 4 of the controlled acts. They can decide that a procedure is required and initiated it without an order or delegation.
Is the authorizing mechanism of initiation the same everywhere?
no. The different acts that can be initiated by RNs without order or delegation may be limited or differ depending on legislation or practice-setting policies.
What is the name for the process through which somebody who has the authority to perform a procedure gives another individual (who otherwise does not have the authority) the authority to perform the procedure?
-what is the one (out of the 4) controlled acts that RNs cannot delegate?
dispensing a drug.
what is sub-delegation and why is it important?
sub-delegation is when an act that is delegated to someone is then delegated to someone else below that. This is not allowed. (ex. If a physician delegates an act to an RN, that RN cannot then delegate that act to someone else).
Who is responsible for the decision of delegating an act and ensuring the person taking on the delegation is competent and capable? (Ex. A physician delegates an act to an RN)
The person delegating the act (ex. the physician) would be responsible.
Who is responsible for the decision to carry out and perform a delegated act? (Ex. A physician delegates an act to an RN).
-The person accepting the delegation (ex. The RN) would be responsible
what must the documentation of delegation include? (4)
2. delegator's name
3. delegatee's name
4. conditions applicable to the delegation.
What are 4 examples of directives?
2. blood work or urine sample for certain conditions
3. sucrose for babies
4. Tylenol for certain conditions.
What is an unregulated care provider?
Someone who is not regulated under the Regulated Health Professional's act, but may provide health care or other care to clients.
What are 4 examples of unregulated health care providers?
2. Family Member
3. Physician's assistant
4. Health Care aid
When did the Regulated Health Professional's act come into effect? (year)
What are the 3 ways an unregulated care provider might perform a procedure/activity?
3. if the procedure/activity is NOT a controlled act
Which controlled act(s) might an unregulated care provider perform via exception? (if criteria are met)
Administering a substance by injection or inhalation
Putting an instrument, hand or finger into a body orifice or artificial opening in the body.
Which part of the "putting an instrument, hand or finger..." controlled act can unregulated care providers possibly do?
...into a body orifice or artificial opening in the body.
What type of situations/unregulated care providers permit exception?
a family member, or another unregulated care provider if the act/procedure is part of routine daily living.
What controlled act is the only act that requires delegation no matter who the unregulated care provider is, or what the situation is?
performing a procedure below the dermis or mucous membrane.
Is delegation required for family members as unregulated care providers?
only if the controlled act to be performed is a procedure below the dermis or mucous membrane.
What 6 requirements must an RN meet in order to teach a procedure to an unregulated care provider?
1. RN must have the knowledge, skill and competence to perform the procedure.
2. RN must have the additional competence to teach the procedure to someone else.
3. RN must accept sole accountability for teaching the unregulated care provider
4. RN must determine that the UCP has acquired the competence to perform the procedure.
5. RN may teach the UCP to perform the procedure for more than one client if the nurse has determined it is appropriate and the UCP is competent/capable.
6. RN must evaluate the continuing competence of the UCP.
hat is the major difference between delegating and assigning?
Delegating occurs when the act/procedure IS NOT within the UCP's scope of practice.
Assigning occurs when the act/procedure IS within the UCP's scope of practice.
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