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ch 3 professional responsibilities

Terms in this set (51)

● Only health care team members directly responsible for the client's care are allowed access to the client's records. Nurses may not share information with other clients or staff not involved in the care of the client.
● Clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client requests to read or have a copy of the record.
● No part of the client record can be copied except for authorized exchange of documents between health care institutions. For example:
◯ Transfer from a hospital to an extended care facility
◯ Exchange of documents between a general practitioner and a specialist during a consult

● Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client names and diagnoses is restricted.
● Electronic records should be password-protected, and care must be taken to prevent public viewing of the information. Health care workers should use only their own passwords to access information.
● Client information may not be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone.
◯ Many hospitals use a code system in which information is only disclosed to individuals who can provide the code.
◯ Nurses should ask any individual inquiring about a client's status for the code and disclose information only when an individual can give the code. ● Communication about a client should only take place in a private setting where it cannot be overheard by unauthorized individuals. The practice of "walking rounds," where other clients and visitors can hear what is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not responsible. Change-of-shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present
● Informatics is the use of computers to systematically resolve issues in nursing. The use of technology in healthcare is increasing and most forms of communication are in electronic format.
● Examples of how a nurse can use the electronic format while providing client care include laptops for documentation and the use an of automated medication dispensing system to dispense medications.
● Databases on diseases and medications are available for the nurse to review. These databases can also be used as a teaching tool when nurses are educating clients.
● The nurse can review medications, diseases, procedures, and treatments using an electronic format.
● Computers can be beneficial for use with clients who have visual impairments.
● The Internet is a valuable tool for clients to review current medications and or health questions. This is especially true for clients who have chronic illnesses.
● Nurses should instruct clients to only review valid and credible websites by verifying the author, institution, credentials, and how current the article is. A disclaimer will be presented if information is not medical advice.
● Clients can access their electronic health record (EHR) which is part of e-health. E-health enables the client to make appointments online, review laboratory results, refill an electronic prescription, and review billing information. The goal of e-health is improved health care outcomes due to 24 hr access by the client and provider to the client's health care information.
● Nurses base practice on established standards of care or legal guidelines for care. These standards of care can be found in the following.
◯ The nurse practice act of each state
■ These acts govern nursing practice, and legal guidelines for practice are established and enforced through a state board of nursing or other government agency.
■ Nurse practice acts vary from state to state, making it obligatory for the nurse to be informed about her state's nurse practice act as it defines the legal parameters of practice.
◯ Published standards of nursing practice: These are developed by professional organizations such as the American Nurses Association, National Association of Practical Nurse Education and Services, Inc., and specialty organizations such as the American Association of Critical Care Nurses, Wound, Ostomy and Continence Nurses Society; and Oncology Nurses Society.
◯ Accrediting bodies (e.g., The Joint Commission)
◯ Originally mandated quality assurance programs, which have evolved into quality improvement ◯ Sentinel event reporting: "An unexpected occurrence involving death or serious or psychological injury, or the risk thereof"
◯ Failure Mode and Effects Analysis: Examines all potential failures in a design, including event sequencing risks, vulnerabilities, and improvement areas
◯ National Patient Safety Goals: Augments core measures and promotes patient safety through patient identification, effective staff communication, safe medication use, infection prevention, safety risk identification, and preventing wrong-site surgery
◯ Health care facility policies and procedures
■ Policies and procedures, maintained in the facility's policy and procedure manual, establish the standard of practice for employees of that institution.
■ These manuals provide detailed information about how the nurse should respond to or provide care in specific situations and while performing client care procedures.
■ Nurses who practice according to institutional policy are legally protected if that standard of care still results in an injury. For example, if a client files a complaint with the board of nursing or seeks legal counsel, the nurse who has followed the facility's policies will not usually be charged with misconduct.
■ It is very important that nurses are familiar with their institution's policies and procedures and provide client care in accordance with these policies.

For example: ☐ Assess and document findings postoperatively according to institutional policy.
☐ Change IV tubing and flush saline locks according to institutional policy.

● Standards of care guide, define, and direct the level of care that should be given by practicing nurses. They also are used in malpractice lawsuits to determine if that level was maintained.
● Nurses should refuse to practice beyond the legal scope of practice and/or outside of their areas of competence regardless of reason (staffing shortage, lack of appropriate personnel).
● Nurses should use the formal chain of command to verbalize concerns related to assignment in light of current legal scope of practice, job description, and area of competence.
In certain situations, health care providers have a legal obligation to report their findings in accordance with state law.

● All 51 jurisdictions (50 states and the District of Colombia) have statutes requiring report of suspicion of child abuse. The statutes set out which occupations are mandatory reporters. In many states, nurses are mandatory reporters.
● A number of states also mandate that health care providers, including nurses, report suspected abuse of vulnerable persons, such as older or dependent adults.
● Nurses are mandated to report any suspicion of abuse following facility policy.

CoMMUniCable Diseases
● Nurses are also mandated to report to the proper agency (local health department, state health department) when a client is diagnosed with a communicable disease.
● A complete list of reportable diseases and a description of the reporting system are available through the Centers for Disease Control and Prevention Web site, Each state mandates which diseases must be reported in that state. There are more than 60 communicable diseases that must be reported to public health departments to allow officials to do the following.
◯ Ensure appropriate medical treatment of diseases (tuberculosis).
◯ Monitor for common-source outbreaks (foodborne: hepatitis A).
◯ Plan and evaluate control and prevention plans (immunizations for preventable diseases).
◯ Identify outbreaks and epidemics.
◯ Determine public health priorities based on trends.
◯ Educate the community on prevention and treatment of these diseases.
Ethical dilemmas 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.
● A problem is an ethical dilemma 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.
● Nurses have a responsibility to be advocates, and to identify and report ethical situations.
◯ Doing so through the chain of command offers some protection against retribution.
◯ Some state nurse associations offer protection for nurses who report substandard or unethical practice.
● Ethical decision-making is the process by which a decision is made about an ethical issue. Frequently, this requires a balance between science and morality. There are several steps in ethical decision-making:
◯ 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 for resolving the dilemma, and review implications of each option.
◯ Select the option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care. Justify why that one option was selected.
◯ Apply this decision to the dilemma and evaluate the outcomes.
● The American Nurses Association Code of Ethics for Nurses (2001) and the International Council of Nurses' Code of Ethics for Nurses (2006) are commonly used by professional nurses. The Code of Ethics for Licensed Practical/Vocational Nurses issued by the National Association for Practical Nurse Education and Services also serves as a set of standards for Nursing Practice. Codes of ethics are available at the organizations' websites.
● The Uniform Determination of Death Act (UDDA) can be used to assist with end-of-life and organ donor issues.
◯ The UDDA 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.
■ 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.