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Leadership ATI GO FREAKING LEVEL 3!!!!!!!!!!!!!!

Terms in this set (238)

management
this is the process of planning, organizing, directing, and coordinating the work within an organization
leadership
this is the ability to inspire others to achieve a desired outcome.
effective managers
these usually possess good leadership skills; however, they are not always in a management position.
authoritative
this type of leadership style makes decision for the group, motivates by coercion, communication occurs down the chain of comman, work output by staff is usually high, good for crisis situations and bureaucratic settings, effective for employees with little or no formal education.
democratic
this type of leadership style includes the group when decisions are made, motivates by supporting staff achievements, communication occurs up and down the chain of command, work output by staff is usually of good quality- good when cooperation and collaboration are necessary
laissez faire
this type of leadership style makes very few decisions, and does little planning, motivation is largely the responsibility of individual staff members, communication occurs up and down the chain of command and between group members, work output is low unless an informal leader evolves from the group, effective with professional employees.
contemporary leadership
this theory supports the belief that leaders can develop the necessary skills.
transformational leaders
these leaders empower followers to assume responsibility for a communal vision, and personal development is a secondary outcome.
transactional leaders
these leaders focus on immediate problems, maintaining the status quo and using rewards to motivate followers.
emotional intelligence
this is the ability of an individual to perceive and manage the emotions of self and others. The nurse must be able to perceive and understand his own emotions and the emotions of the client and family in order to provide client centered care.
emotionally intelligent leader
this leader has insight into the emotions of members of the team. Understands the perspective of others, encourages constructive criticism and is open to new ideas. Is able to maintain focus while multitasking. Is committed to the delivery of high quality client care.
emotional intelligence
this is developed through understanding the concept and applying it to practice in everyday situations.
planning, organizing, staffing, directing, controlling
the five major functions of management are
planning
the decisions regarding what needs to be done, how it will be done, and who is going to do it.
organizing
the organizational structure that determines the lines of authority, channels of communication, and where decisions are made.
Staffing
the acquisition and management of adequate staff and staffing mix
directing
the leadership role assumed by a manager that influences and motivates staff to perform assigned roles.
controlling
the evaluation of staff performance and evaluation of unit goals to unsure identified outcomes are being met.
critical thinking
this is used when analyzing client issues and problems. Thinking skills include interpretation, analysis, evaluation, inference and explanation. These skills assist the nurse to determine the most appropriate action to take.
critical thinking
this reflects upon the meaning of statments, examines available data, and uses reason to make informed decisions. This is necessary to reflect and evaluate from a broader scope of view.
clinical reasoning
this is the mental process used when analyzing the elements of a clinical situation and using analysis to make a decision.
clinical reasoning
this supports the clinical decision making process by guiding the nurse through the process of assessing and compiling data. Selecting and discarding data based on relevance. Using nursing knowledge to make decisions about client care. Problem solving is a part of decision making.
clinical judgement
this is the decision made regarding a course of action based on a critical analysis of data when using knowledge is applied to a clinical situation.
clinical judgment
the nurse uses this to analyze data and related evidence. Ascertain the meaning of the data and evidence. Determine client outcomes desired and or achieved as indicated by evidence based practices.
assigning
this is the process of transferring the authority, accountability, and responsibility of client care to another member of the health care team.
delegating
this is the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability
supervising
this is the process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team.
RNs
these are responsible for the supervision of client care tasks delegated to assistive personnal and licensed practical nurse.
ANA code of standards
nurses must follow the ________in delegating and assigning tasks.
abandonment
If there is an inappropriate assignment, the nurse should take the assignment to the attention to the charge, and negotiate a new assignment, then up to chain of command, if resolution is not made, a staffing complaint to Assignment Despite Objection (ADO) or Document of Practice Situatin (DOPS) should be filed with the appropriate administrator, failure to accept the assignment without following the proper channels may be considered ______________
state nurse practice act
RNs may delegate to other RNs LPNs and AP. RNs must be knowledgeable about the applicaple __________and regulations regarding the use of LPNs and AP.
higher level tasks
RNs must delegate tasks so that they can complete ___________that only RNs can perform
LPNs
RNs can delegate Monitoring client findings, reinforcement of client teaching from a standard care plan, tracheostomy care, suctioning, checking nagogastric tube patency, administration of enteral feedings, insertion of a urinary catheter, medication administration (excluding intravenous medications in several states) to _______________
UAP
RNs can delegate ADLs bathing, grooming, dressing, toileting, ambulating, feeding (without swallowing precautions), positioning, bed making, specimen collection, intake and output (I&O) vital signs (on stable clients) to __________
task circumstance, person, direction, supervision
what are the five rights of delegation.
right task
this is repetitive, requires little supervision, and is relatively noninvasive for the client.
right circumstance
assess the health status and complexity of care required by the client. Match the complexity of care demands to the skill level of the health care team member. Consider the workload of the team member. EX. Delegate AP to assist in obtaining vital signs from a stable postoperative client.
Right person
Assess and verify the competency of the health care team member. The task must be within the team members scope of practice, the team member must have the necessary competence training. Continually review the performance of the team member and determine care competency. Assess team member performance based on standards and, when necessary, take steps to remediate a failure to meet standards. EX. Delegate LPN to administer enteral feedings to a client who has a head injury.
Right direction communication
communicate either in writing or orally, data that need to be collected, method and time line for reporting, including when to report concerns, assessment findings, specific tasks to be performed; client specific instructions, expected results, time lines, and expectations for follow up communication. EX Delegate AP the task of assisting the client in room 312 with a shower, to be completed by 0900.
right supervision evaluation
the delegating nurse must provide supervision either directly or indirectly (assigning supervision to another licensed nurse), provide clear directions and understandable expectations of the tasks to be performed (time frames, what to report), monitor performance, provide feedback, intervene if necessary (unsafe clinical practice), evaluate the client and determine if client outcomes were met. Evaluate client care tasks and identify needs for quality improvement activities and or additional resources. EX. After completing the admission assessment, an RN delegates to an AP the task of ambulating a client.
staff education
this refers to the nurses involvement in the orientation, socialization, education, and training of fellow health care workers to ensure the competence of all staff and to help them meet standards set forth by the facility and accrediting bodies. The process of staff education may also be referred to as staff development.
orientation
this helps newly licensed nurses translate the knowledge, skills, and attitudes learned in nursing school into practice.
preceptors
these assist in orienting newly licensed nurses to a unit and supervising their performance and acquisition of skills. They are usually assigned to newly licensed nurses for a limited amount of time.
mentors
these may also serve as a newly licensed nurses preceptor, but their relationship usually lasts longer and focuses more on assumption of the professional role and relationships, as well as socialization to practice.
coaches
these establish a collaborative relationship to help a nurse establsih individual goals. The relationship is typically time limited.
socialization
this is the process by which a person learns a new role and the values and culture of the group within which that role will be implemented. if this is successful, it helps new staff members fit in with already established staff on a client care unit.
competence
this is the ability of an employee to meet the requirements of a particular role at an established level of performance. Nurses will usually progress through several stages of proficiency as they gain experience in a particular area.
patricia benner
this person identified five stages of nursing ability, which are based on level of competence. Level of competence related to length of time in practice and exposure to clinical situations. When nurses move to a new clinical setting that requires acquisition of new skills and knowledge, their level of competence will return to a lower stage.
educational programs
these should be included for ___________1. identify, 2 analyze 3research 4 plan 5 implement 6 evaluate
novice nurse
these may be students or newly licensed nurses with minimal clinical experience. Approach situations from theoretical perspective relying on context free facts and established guidelines. Rules govern practice.
advanced beginner
most new nurses function at the level of this, practice independently in the performance of many tasks and can make some clinical judgments. Begin to rely on prior experience to make practice decisions.
competent nurse
these are usually nurses who have been in practice for 2 to 3 years. Demonstrate increasing levels of skill and proficiency and clinical judgment. Exhibit the ability to organize and plan care using abstract and analytical thinking. Can anticipate the long term outcomes of personal actions.
proficient nurse
these are nurses who have a significant amount of experience upon which to base their pracitce. Enhanced observational abilities allow nurses to be able to conceptualize situations more holistically. Well developed critical thinking and decision making skills allow nurses to recognize and respond to unexpected changes.
expert nurse
expert nurses have garnered a wealth of experience so they can view situations holistically and process information efficiently. Make decisions using an advanced level of intuition and analytical ability. Do not need to rely on rules to comprehend a situation and take action
quality improvement
this is the process used to identify and resolve performance deficiencies. This includes measuring performance against a set of predetermined standards. In health care these standards may be set by the specific facility and take into consideration accrediting and professional standards.
joint commissions accreditation standards
these require institutions to show evidence of quality improvement in order to attain accreditation status.
quality improvement process
this will include outcome, or clinical, indicators for the desired outcomes, structure indicators, process indicators, and benchmarks.
structure indicators
these reflect the setting in which care is being provided and the available human and material resources.
process indicators
these reflect how client care is provided and are established by policies and procedures (clinical practice guidelines).
benchmarks
these are goals that are set to determine at what level the outcome indicators should be met.
quantitative methods
these are primarily used int he data collection process, although client interview is also an option.
structure audits
these evaluate the influence of elements that exist separate from or outside of the client staff interaction.
process audits
these review how care was provided and assume a relationship exists between nurses and the quality of care provided.
outcome audits
these determine what results, if any, occurred as a result of the nursing care provided.
nursing sensitive outcomes
these are outcomes that are directly affected by the quality of nursing care. Examples include client fall rates and the incidence of nosocomial infections.
retrospective
these audits occur after the client receive care
concurrent
these audits occur while the client is receiving care.
propective
these audits predict how future client care will be affected by current level of services.
root cause analyses
these focus on variables that suround the consequence of an action or occurrence. These are commonly done for sentinel events (client death, client care resulting in serious physical injury) but may be done as part of the quality improvement process.
root cause analysis
this investigates the consequence and possible causes, analyzes the possible causes and relationships that may exist. Determines additional influences at each level of relationship. Determines the root cause or causes.
quality improvemen
nurses role in this is to serve as unit representative on comittees developing policies and procedures. Enhance knowledge of policies and procedures, provide care by policies, make judgments about performance in regards to findings, assist with provision of education or training necessary to improve staff performance, act as a role model, assist with reevaluation of staff performance by collecting information.
performance appraisal
this is the process by which a supervisor evaluates an employees performance in relation to the job description for that employees position as well as other expectations the facility may have. these are done at regular intervals and may be more frequent for new employees
performance expectations
these should be based on the standards set forth in a job description and written in objective terms. Acutal observed behavior should be documented and used as evidence of satisfactory or unsatisfactory performance.
performance appraisals
these allow nurses the opportunity to discuss personal goals with the unit manager as well as to receive feedback regarding level of performance. These can also be used as a motivational tool.
deficiences
these are identified during a performance appraisal or reported by coworkers may need to be addressed in a disciplinary manner.
perfromance appraisals
a formal system for conducting these should be in place and used consistently. These tools should reflect the staff member's job description and may be based on various types of scales or surveys. Various sources of data should be collected to ensure an unbiased and thorough evaluation of an employees performance.
anecdotal notes
during a performance appraisal, actual observed behavior should be documented/ and used as evidence of satisfactory or unsatisfactory performance. These may be called _____________and are kept in the unit manager or equivalent positions files.
peer review
this is the evaluation of a colleagues practice by another peer. These should begin with an orientation of staff to the peer review process, their professional responsibility in regard to promoting growth of colleagues, and the disposition of data collected.
performance appraisal
this should be hosted by the unit manager in a private setting and held at a time conducive to the staff member's attendance. The unit manager should review the data with the staff member and provide the opportunity for feedback. Personal goals of the staff member should be discussed and documented, and avenues for attainment discussed. Staff members who do not agree with the unit managers evaluation of their performance should have the opportunity to make written comments on the evaluation from and appeal the rating.
first
this step in the progressive discipline includes informal reprimand, manager and employee meet, discuss the issue, suggestions for improvement and correction.
second
this step in the progressive discipline includes written warning, manager meets with employee to distribute written warning, review of specific rules and policy violations, discussion of potential consequences if infractions continue.
third
this step in the progressive discipline includes employee placed on suspension with or without pay. Time away from work gives the employee opportunity to examine the issues, consider alternatives.
Fourth
this step in the progressive discipline includes employee termination, follows after multiple warnings have been given and employee continues to violate rules and policies.
chain of command
staff members who witness an inappropriate action by a coworker should report the infraction up the
conflict
this is the result of opposing thoughts ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals. This is an invevitable part of professional, social, and personal life and can have constructive or destructive results. Nurses must understand conflict and how to manage it.
conflict
lack of ________can create organizational stasis, while too much can be demoralizing, and produce anxiety, and contribute to burnout.
interpersonal conflict
this in the health care setting involves disagreement among nurses, clients, family members, and within a health care team. This is a significant issue in nursing, especially in relation to new nurses, who bring new personalities and perspectives to various health care settings. This contributes to burnout and work related stress.
Intergroup conflict
this occurs between two or more groups of individuals, departments, or organizations and may be caused by a new policy or procedure, a change in leadership, or a change in organizational structure.
organizational conflict
this can disrupt working relationships and create a stressful atmosphere. This can include ineffective communication unclear expectations of team members in their various roles, poorly defined or actualized organizational structure, conflicts of interest and variance in standards, incompatibility of individuals, management or staffing changes, diversity related to age, gender, race, or ethnicity.
conflict resolution
open communication among staff and between staff and clients can help defray the need for
open communication
when potential sources of conflict exist, the use of_________________and problem solving strategies can be effective tools to de esculate the situations.
personal differences
to resolve conflict, use "I" statements, and remember to focus on the problem, not on
perspective
to resolve conflict, listen carefully to what the other people are saying, and try to understand their
emotions
to resolve conflict, move a conflict that is escalatingto a private location or postpone the discussion until a later time to give everyone a chance to regain control of their emotions.
chance to speak
to resolve conflict, share ground rules with participants, for example, everyone is to be treated with respect, only one person can speak at a time, and everyone should have a chance to speak.
solving process
these are steps of the ____________Identify the problem, discuss possible solutions, analyze identified solutions, select a solution, evaluate the solutions ability to resolve the original problem.
negotiation
the is the process by which interested parties resolve ongoing conflicts, agree on steps to take, bargain to protect individual or collective interests, and pursue outcomes that benefit mutual interests. Most nurses use this on a daily basis.
avoiding withdrawing
with this strategy, both parties know there is a conflict, but they refuse to face it or work toward a resolution, may be appropriate for minor conflicts or when one party holds more power than the other party or if the issue may work itself out over time. Because the conflict remains, it may surface again at a later date and escalate over time. This is usually a lose lose solution.
smoothing
with this strategy, one party attempts to "smooth" another party by trying to satisfy the other party. Often used to preserve or maintain a peaceful work environment. The focus may be on what is agreed upon, leaving conflict largely unresolved. This is usually a lose lose solution
competing coercing
one party pursues a desired solution at the expense of others. Managers may use this when a quick or unpopular decision must be made. The party who loses something may experience anger, aggravation, and a desire for retribution. This is usually a win lose solution
cooperating accomodating
one party sacrifices something, allowing the other party to get what it wants. This is the opposite of competing. The original problem may not actually be resolved. The solution may contribute to future conflict. This is a lose win solution.
compromising negotiating
each party gives up something, to consider this a win/lose-win/lose solution, both parties must give up something equally important. If one party gives up more than the other, it can become a win lose solution.
avoiding withdrawing
with this, the nurse basically cannot use these strategies due to the immediacy of the situation. The assignment cannot be simply avoided or smoothed over; it must be accepted or rejected.
competing coercing
with this, if the nurse truly feels unqualified to work on a specific unit when asked to float there, then this approach may be appropriate, the nurse must win and the manager must lose. Although risking termination by refusing the assignment, the nurse should take an assertive approach and inform the manager that children would be placed at risk.
cooperating accommodating
with this, if the nurse decides to accomodate to the managers request of floating to another unit that the nurse says she can't work on, then the patients on that unit may be at risk for incompetent care. Practice liability is another issue for consideration.
Compromising negotiating
with this approach, it generally minimizzed the losses for all involved while making certain each party gains something. Although each party is giving up something the manager gives in to a different solution and the nurse still has to work on another unit, this sort of compromise can result in a win win resolution.
assertive communication
this allows expression in direct, honest, and nonthreatening ways that do not infringe upon the rights of others. It is a communication style that acknowledges and deals with conflict, recognizes others as equals, and provides a direct statement of feelings.
assertive communication
elements of this include, selection of an appropriate location for the verbal exchange, maintenance of eye contact, establishing trust, being sensitive to cultural needs, speaking usin "I" statements and including affective elements of the situation, avoiding using "you" statments that can indicate blame. Stating concerns using open, honest, and direct statements, conveying empathy, focusing on the behavior or issue of conflict and avoiding personal attacks, concluding with a statement that describes a fair solution
grievance
this is a wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint. If this cannot be satisfactorily resolved between the parties involved may need to be managed by a third party.
grievance process
steps of a____________include, formal presentation of the complaint, using the proper chain of command. Formal hearing if the issue is not resolved at a lower level. Professional mediation if a solution is not reached during a formal hearing.
resource management
this includes budgeting and resource allocation. Human, financial, and material resources must be considered.
budgeting
this is usually the responsibility of the unit manager, but staff nurses may be asked to provide input.
resource allocation
this is a responsibility of the unit manager as well as every practicing nurse.
inspect patient for injuries
an older adult client who is on fall precautions is found lying on the floor of his hospital room. Which of the following actions is most appropriate for the nurse to take first?
mentally envision the procedure when collecting supplies
a nurse is preparing to iniate IV therapy for a client who has a prescription for morphine 10mg IV bolus. Using time management principles, what should the nurse do first.
avoidance
a nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nures notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. What conflict resolution strategy is the unit manager demonstrating.
collaboration
this involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems. The specialized knowledge and skills of each discipline are used in the development of an interprofessional plan of care that addresses multiple problems.
decisive
in this decision making process, the team uses a minimum amount of data and generates one option.
flexible
in this decision making process, the team uses a limited amount of data and generates several options.
hierarchical
in this decision making process, the team uses a large amount of data and generates one option.
integrative
in this decision making process, the team uses a large amount of data and generates several options.
centralized hierarchy
with decision making, nurses in a __________at the top of the organizational chart make most of the decisions.
decentralized hierarchy
with decision making ,staff nurses who provide direct client care are included in the decision making process. Large organizations benefit from the use of this because managers at the top of the hierarchy do not have firsthand knowledge of unit level challenges or problems. This promotes job satisfaction among staff nurses.
rational empirical
with this, the manager provides factual information to support the change. Used when resistance to change is minimal.
Normative reeducative
with this, the manager focuses on interpersonal relationhships to promote change.
power coercive
with this, the manager uses rewards to promote change. Used when individuals are highly resistant to change.
forming
in this stage of team formation, members of the team get to know each other. The leader defines tasks for the team and offers direction.
storming
in this stage of team formation, conflict arises, and team members begin to express polarized views. The team establishes rules, and members begin to take on various roles.
norming
in this stage of team formation, the team establishes rules. Members show respect for one another and begin to accomplish some of the tasks.
performing
in this stage of team formation, the team focuses on accomplishment of tasks.
generational differences
this can influence the value system of the members of an interprofessional team and can affect how members function within the team. This can be challenging for members of a team, but working with individuals from different generations also can bring strength to the team.
veteran
characteristics of this generation include supports the status quo, accepts authority, appreciates hierarchy, loyal to employer, born from 1925 to 1942
baby boomer
characteristics of this generation include accepts authority, workaholics, some struggle with new technology, loyal to employer, born 1943 to 1960
generation x
characteristics of this generation include adapts easily to change. Personal life and family are important. Proficient with technology, makes frequent job changes, born 1961 to 1980
generation y
characteristics of this generation include optimistic and self confident. Values achievement, technology is a way life. at ease with cultural diversity, born from 1981 to 2000
magnet recognition
the american nurses credentialing center awards this to health care facilities that provide high quality client care and attract and retain well qualified nurses. The term is used to recognize the facilitys power to draw nurses to the facility and to retain them. Fourteen forces of this provide the framework for the review process. First step is self appraisal based on established standards. The award lasts four years. To maintain stauts, the facility must maintain the established standards and submit an annual report.
case management
this is the coordination of care provided by an interprofessional team from the time a client starts receiving care until he or she is no longer receiving services. This focuses on managed care of the client through collaboration of the health care team in both inpaient and postacute settings for insured individuals. The goal is to avoid fragmentation of care and control cost.
case manager
this person collaborates with the interprofessional health care team during the assessment of a client's needs and subsequent care planning, and follows up by monitoring the achievement of desired client outcomes within established time parameters.
case manager
this person may be a nurse, social worker, or other designated health care professional. Their role and knowledge expectations are extensive; therfore, case managers are required to have advanced practice degrees or advanced training in this area. They do not usually provide direct client care, they usully oversee a caseload of clients with similar disorders or treatment regimens in a residential setting.
critical or clinical pathway or care map
these may be used to support the implementation of clinical guidelines and protocols these tools are usually based on cost and length of stay parameters mandated by prospective payment systems such as medicare and insurance companies.
case management
the nurses role in this is to coordinat care, particularly for clients who have complex health care needs, facilitating continuity of care, improving efficiency of care and utilization of resources, enhancing quality of care provided, limiting unnecessary costs and lengthy stays, advocating for the client and family.
continuity of care
this refers to the consistency of care provided as clients move through the health care system. It enhances the quality of client care and facilitates the achievement of positive client outcomes.
continuity of care
this is desired as clients move from one level of care to another, such as from the ICU to a medical unit, or facility to another, such as from an acute care facility to a skilled facility, or unit/department to another, such as from the PACU to the postsurgical unit.
continuity of care
nurses are responsible for facilitating continuity of care and coordinating care through documentation, reporting, and collaboration, a formal, written plan of care enhances coordination of care between nurses, interprofessional team members, and primary care providers.
coordinator of care
the nurses role of ________includes facilitating the continuity of care provided by members of the health care team, acting as a representative of the client and as a liaison when collaborating with the provider and other members of the health care team. When acting as a liaison, the nurse serves the role of client advocate by protecting the rights of clients and ensuring that client needs are met.
standardized nursing care plans
these provide a starting point for the nurse responsible for care plan development. They must be individualized to each client. All documentation should reflect the plan of care.
poor communication
this can lead to adverse outcomes, including sentinal events such as unexpected death or serious injury of a client.
consultant
this is a professional who provides expert advice in a particular area. This person is requested to help determine what treatment and services the client requires.
consultant
this person will provide expertise for clients who require a specific type of knowledge or service such as a cardiologist for a client who had a myocardial infarction, a psychiatrist for a client whose risk for suicide must be assessed.
discharge planning
this is an interprofessional process that is started by the nurse at the time of the clients admission.
professional responsibilities
these are the obligations that nurses have to their clients. To meet these responsibilities, nurses must know client rights, advocacy, informed consent, advance directives, confidentiality and information security, legal practice, disruptive behavior, ethical practice.
client rights
these are the legal guarantess that clients have with regard to their health care.
patient self determination act
the ________stipulates that on admission to a health care facility, all clients must be informed of their right to accept or refuse care. Competent adults have the right to refuse treatment, including the right to leave a health care facility without a discharge order from the provider.
advocacy
this refers to nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care.
advocacy
this is one of the most important roles of the nurse, especially when clients are unable to speak or act for themselves. As this, the nurse ensures that the client has the information he needs to make decisions about health care. Nurses must be this even when they disagree with clients' decisions.
advocate
situations in which nurses may need to _____________for clients or assist them to advocate for themselves include end of life decisions, access to health care, protection of client privacy, informed consent, substandard practice
informed consent
this is a legal process by which a client has given written permission for a procedure or treatment to be performed. This is considered to be informed when the client has been provided with and understands the reason for treatment or procedure, how the treatment will benefit the client, risks involved.
consent
this is required for all care given in a health care facility. For most aspects of nursing care, implied consent is adequate.
Implied consent
the client provides_________when she complies with the instructions provided by the nurse. For example, the nurse is preparing to administer a TB skin test, and the client holds out her arm for the nurse.
written consent
for an invasive procedure or surgery, the client is required to provide ____________
consent
individuals authorized to grant _______for another person include parent of a minor, legal guardian, court specified representative, spouse or closest available individual who has durable power of attorney for health care
emancipated minor
minors who are independent from their parents, such as a married minor can provide consent for themselves.
provider
the_______obtains informed consent. And gives a complete description of the treatment/procedure, a description of the professionals who will be performing and participating in the treatment, a description of the potential harm, pain, and discomfort that might occur, options for other treatments, the right to refuse treatment, the risk involved if the client chooses no treatment
nurse
the ________witnesses informed consent, and is responsible for ensuring that the provider gave the client the necessary information. Ensures that the client understood the information and is competent to give informed consent, notifying the provider if the client has more questions or does not understand any of the information provided. Documentation, reinforcement of information originally given by the provider, that questions the client had were forwarded to the provider, use of an interpreter.
living will
this is a legal document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end of life issues. Types of treatments that are often addressed in a living will are those that have the capacity to prolong life. Examples of treatments that are addressed are cardiopulmonary resuscitation, mechanical ventilation, and feeding by artificial means.
living will
these are legan in all states. However, state statues and individual health care facility policies may vary. Nurses need to be familiar with their state statute and facility policies. Most state laws include provisions that health care providers who follow the health care directives in a _________are protected from liability
durable power of attorney
this is a legal document that designates a health care proxy, who is an individual authorized to make health care decisions for a client who is unable. The person who serves in the role of health care proxy to make decisions for the client should be very familiar with the client's wishes. Living wills may be difficult to interpret, especially in the face of unexpected circumstances.
durable power of attorney
this for health care, as an adjunct to a living will, may be a more effective way of ensuring that the client's decisions about health care are honored.
health information systems
these are used to manage administrative functions and clinical functions. The clinical portion of the system is often referred to as the clinical information systems CIS. The CIS may be used to coordinate essential aspects of client care.
criminal law
this is a subsection of public law and relates to the relationship of an individual with the government. Violations of this may be categorized as either a feloney or misdemeanor. A nurse who falsifies a record to cover up a serious mistake may be found guilty of breaking this
civil law
this will protect the individual rights of people. One type of this relates to the provision of nursing care is tort law. Torts may be classified as unintentional, quasi intentional, or intentional, negligence and malpractice (professional negligence) are unintentional torts.
negligence
this is an unintentional tort, ex. a nurse fails to implement safety measures for a client who has been identified as at risk for falls.
malpractice
this is an unintentional tort, ex. a nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies.
breach of confidentiality
this is a quasi intentional tort, ex. a nurse releases the medical diagnosis of a client to a member of the press.
defamation of character
this is a quasi intentional tort, ex. a nurse tells a coworker that she believes a client has been unfaithful to the spouse.
assault
this is an intentional tort, ex. the conduct of one person makes another person fearful and apprehensive (threatening to place a ng tube in a client who is refusing to eat)
battery
this is an intentional tort, intentional wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against his wishes)
false imprisonment
this is an intentional tort, a person is confined or restrained against his will (using restraints on a competent client to prevent his leaving the health care facility)
state law
the core of nursing practice is regulated by
good samaritan law
these may vary from state to state, they protect nurses who provide emergency assistance outside of the employment location. The nurse must provide a standard of care that is reasonable and prudent.
mutual recognition model
this is also known as the nurse licensure compact which has been adopted by many states. This model allows nurses who reside in a compact state to practice in another compact state. Nurses must practice in accordance with the statues and rules of the state in which the care is provided. State boards may prohibit a nurse from practicing under the compact if the license of the nurse has been restricted by a board of nursing.
state based practice model
nurses who do not reside in a compact state must practice under the __________In other words, if a nurse resides in a non compact state, the nurse must maintain a current license in every state in which she practices. Some states now require background checks with licensure renewal. It is illegal to practice nursing with an expired license.
published standards of nursing practice
these are developed by professional organizations such as the american nurses association the national association of practical nurse education and services, and speciality organizations such as the american association of critical care nurses the wound, ostomy and continence nurses society, and the oncology nurses society
negligence
these are the five elements necessary to prove ____1. Duty to provide care as defined by a standard 2. Breach of duty by failure to meet standared 3. Foressebaility of harm 4. Breach of duty has potential to cause harm (combines elembents 2 and 3. 5. Harm occurs.
incivility
this is defined as an action that is rude, intimidating, and insulting. It includes teasing, joking, dirty looks, and uninvited touching.
Lateral violence
this is also known as horizontal abuse or horizontal hostility. It occurs between individuals who are at the same level within the organization. ex. a more xperienced staff nurse may be abusive to a newly licensed nurse. Common behaviors include verbal abuse, anudermining activities, sabotage, gossip, withholding information, and ostracism.
bullying behavior
this is persistent and relentless and is aimed at an individual who has limited ability to defend himself or herself. This occurs when the perpetrator is at a higher level than the victim, for example, a nurse manager to a staff nurse. It is abuse of power that makes the recipient feel threatened, disgraced, and vulnerable. ex. a nurse manager may demonstrate favoritism for another nurse by making unfair assisnments or refusing a promotion.
morals
these are the values and beliefs held by a person that guide behavior and decision making.
ethical theory
this analyzes varying phiolosophies systems, ideas, and principles used to make judgments about what is right and wrong, good and bad. Two common types of ethical theory are utilitarian and deontology
ethical principles
these are standards of what is right and wrong with regard to important social values and norms.
Autonomy
the ability of the client to make personal decisions, even when those decisions may not be in the client's own best interest
beneficence
the care that is in the best interest of the client
fidelity
keeping one's promise to the client about care that was offered
justice
fair treatment in matters related to physcial and psychosocial care and use of resources
nonmaleficence
the nurse's obligation to avoid causing harm to the client
veracity
the nurse's duty to tell the truth.
ethical dilemmas
these are problems for which more than one choice can be made, and the choice is influenced by the values and beliefs of the decision makers. These are common in health care, and nurses must be prepared to apply ethical theory and decision making.
ethical delemma
a problem is an __________if it cannot be solved solely by a review of scientific data. It involves a conflict between two moral imperatives. The answer will have profound effect on the situation/client.
ethical decision making
this is the process by which a decision is made about an ethical issue. Frequently this requires a balance between science and morality. Steps of this will include identify whether the issue is an ethical dilemma. State the ethical dilemma, including all surrounding issues and individuals involved. List and analyze all possible options with the ethical principle applicable to this situation, the decision makers values and beliefs, and the professions values set forth for client care. Justify why that one option was selected, apply this decision to the dilemma and evaluate the outcomes.
uniform determination of death act
this can be used to assist with end of life and organ donor issues, this provides two formal definitions of death that were developed by the national conference of commissioners on uniform state laws. Death is determined by one of two criteria, an irreversible cessation of circulatory and respiratory functions, irreversible cessation of all functions of the entire brain, including the brain stem. A determination of death must be made in accordance with accepted medical standards.
quality and safety education for nurses
this faculty propose that nursing education focus not only on the knowledge needed to provide safe care but also on the skills and attitudes that accompany this competency.
safety
the minimization of risk factors that could caues injury or harm while promoting quality care and maintaining a secure enironment for clients self and others.
patient centered care
this is the provision of caring and compassionate, culturally sensitive care that addresses client's physiological, psychological, sociological, spiritual, and cultural needs, preferences and values
evidence based practice
this is the use of current knowledge from research and other credible sources on which to base clinical judgment and client care.
informatics
this is the use of information technology as a communication and information gathering tool that supports clinical decision making and scientfically based nursing practice.
incident reports
these are records made of unexpected or unusual incidents that affected a client, employee, volunteer, or visitor in a health care facility. These circumstances include med errors, procedure/treatment errors, equipment related injuries/errors, needlestick injuries, client falls/injuries, visitor/volunteer injuries/ threat made to client or staff/ loss or property (dentures, jewelry, personal wheelchair).
mass casualty incident
this is a catastrophic event that overhwelms local resources, and multiple resources (federal and state) are necessary to handle the crisis.
emergency operating plan
every health care facility will have this, it is an essential component of the provision of training all personnel regarding components for emergencies and JCO implements two tests per year.
internal emergencies
these are events that occur within a facility and include loss of electric power or potable water and severe damage or casualties related to fire, severe weather (tornado, hurricane), an explosion, or a terrorist act. This rediness includes safety and hazardous materials protocols and infection control policies and practices.
external emergencies
these are events that affect a facility indirectly and include severe weather (tornado, hurricane), volcanic eruptions, earthquakes, pandemic flu, chemical plant explosions, industrial accidents, building collapses, major transportation accidents, and terrorist acts (including biological and chemical warfare). This readiness includes a plan for participation in community wide emergencies and disasters.
fire
code red
newborn abduction
code pink
chemical spill
code orange
mas casualty incident
code blue
tornado
code gray
emergent category class i
in a mass casualty, highest priority is given to clients who have life threatening injuries but also have a high possibility of survival once they are stabilized.
urgent category class ii
in a mass casualty, second highest priority is given to clients who have major injuries that are not yet life threatening and usually can wait 45 to 60 min for treatment
nonurgent category class iii
in a mass casualty, the next highest priority is given to clients who have minor injuries that are not life threatening and do not need immediate attention
expectant category class iv
in a mass casualty, the lowest priority is given to clients who are not expected to live and will be allowed to die naturally. Comfort measures may be provided, but restorative care will not.
inhalational anthrax
manifestations, sore throat, fever, cough, shortness of breath, muscle aches, severe dyspnea, meningitis, shock
inhalational anthrax
treatment for this will include, oral ciprofloxacin (cipro), IV ciprofloxacin, in addition to IV ciprofloxacin, one or two additional antibiotics such as vancomycin, penicillin
cutaneous anthrax
manifestations, this starts as a lesion that may be itchy, develops into a vesicular lesion that later becomes necrotic with the formation of black eschar, fever, chills,
cutaneous anthrax
treatment for this will include, oral ciprofloxacin, doxycycline.
botulism
manifestations of this include, difficulty swallowing, double vision, slurred speech, descending progressive weakness, nausea, vomiting, abdominal cramps, difficulty breathing
botulism
treatment for this will include, airway management, antitoxin, elimination of toxin.
ebola
manifestations of this will include sore throat, headache, high temperature, nausea, vomiting, diarrhea, internal and external bleeding, shock
ebola
treatment for this will include, no cure, supportive care, minimize invasive procedures, prevention; vaccine
plague
treatment for this will include, antibiotics must be given within 24 hr of first symptoms. Steptomycin, gentamicin, the tetracyclines, and chloramphenicol, are all effective against the pneumonic _________-
pneumonic plague
this infects the lungs. The first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock.
bubonic plague
this is swollen, tender lymph glands, fever, headache, chills and weakness.
Septicemic plague
this occurs when plague bacteria multiply in the bloo. Manifestations include fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs.
small pox
manifestations of this include high fever, fatigue, severe headache, rash, chills, vomiting, delirium
small pox
treatment for this will include, no cure, supportive care; prevent dehydration, provide skin care, medications for pain and fever, prevention vaccine
tularemia
manifestations of this include sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, progressive weakness, if airborne, life threatening pneumonia and systemic infection
tularemia
treatment for this will include, steptomycin IV or gentamicin IV or IM are the drugs of choice; in mass causality, use doxycycline or ciprofloxacin. Prevention; vaccine under review by the FDA.
white phosphorous
if a client comes in with a chemical burn, take off clothing and irrigate skin with water. If it is a dry chemical such as lye or ________ brush the agent off of the client's clothing and skin.
functional nursing model
nurses use the _______________of care when assigning specific tasks to staff. This approach places the focus on the task to be performed.
peer reviewed nursing journals
the nurse should collect data from ___________when contributing to the development of a new policy. This is the best source of information because it is current, accurate, and research based.
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