Exit HESI Practice - Professional Standards

JusticeThe equitable distribution of potential benefits and tasks determining the order in which clients should be cared forVeracityobligation to tell the truthFidelityThe duty to do what one has promisedEthical dilemmaOccurs when one or more ethical principles are in conflictEthical Reasoningis the process of thinking through what one should do in an orderly and systematic manner to provide justification for actions based on principlesAdvocateA person who speaks up for or acts on behalf of the client, protects the client's right to make his or her own decisions and upholds the principle of fidelityNurse Practice actA series of statutes that have been enacted by each state legislature to regular the practice of nursing in that stateStandards of CareAre guidelines that identify what the client can expect to receive in terms of nursing careRespondeat SuperiorThe employer is held liable for any negligent acts of an employee if the alleged negligent act occurred during the employment relationship and was within the scope of the employee's responsibilitiesT/F: Charges of abandonment may be made against nurses who "walk out" when staffing is inadequateTrueT/F: Nurses in short staffing situations are NOT obligated to report it to the nursing administrationFalseFloatingIs an acceptable practice used by healthcare facilities to alleviate understaffing and overstaffingT/F: Legally the nurse cannot refuse to float unless a union contract guarantees that a nurse can work in a specified area or nurse can prove lack of knowledge for the performance of assigned tasksTrueT/F: Nurses in floating situation CAN assume responsibility beyond their level of expertise and qualificationFalseCauses of disciplinary action In nursing- Unprofessional conduct - Breach of client confidentiality - Failure to use knowledge, skills or nursing judgement - Physically or verbally abusing the patient - Knowingly delegating to UCP nursing care that places patient at risk for injury - Failure to maintain accurate record for each patientNegligenceis conduct that halls below the standards of care. Can include acts of omission and comissionMalpracticeIs negligence on the part of the nurseHow is Malpractice determined?Owed duty to client that was not carried out and the client was injured because of failure to perform duryContract LawLaw concerned with the enforcement of agreements among private individualsCivil Lawlaw concerned with private wrongs against individualsCriminal Lawlaw concerned with public wrongs against societyTort LawIs a civil wrong, other than a breach of contract, in which the law allows an injured person to seek damages from a person who caused the injuryT/F: Nurses need their own liability insurance for protection against malpractice lawsuitsTrueExamples of Negligent Acts in Nursing- Medication Errors - IV Administration errors - Falls that occur due to failure to provide safety - Failure to report changes in client's condition - Failure to use aseptic technique when indicatedGood Samaritan LawLaws that encourage healthcare professionals to assist in emergency situations and limit liability and offer legal immunity for persons helping in an emergency provided they give reasonable careCollective BargainingIs a formalized decision-making process between representatives of management and representatives of labor to negotiate wages and conditions of employmentT/F: Strikes do not represent a moral dilemma for nursesFalseAssaultOccurs when a person puts another person in fear of harmful or offensive contactBatteryIntentional touching of another's body without the other's consentInvasion of PrivacyViolating confidentiality and intruding on a client's private matters, or sharing client information with unauthorized personsConfidentialitythe act of holding information in confidence, not to be released to unauthorized individualsFalse ImprisonmentOccurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the clientT/F: False imprisonment can occur when restraints are used without proper clinical needTrueDefamationIs a false communication that causes damage to someone's reputationT/F: There may be exceptions to certain legal risk areas when caring for a client with a mental health disorderTruePatient's Bill of RightsAcknowledges the patient's right to participate in their own healthcare with an emphasis on patient autonomyWho issued the Patient's Bill of Rights?American Hospital AssociationWho developed the "Right's for Mentally Ill People"?Mental Health Systems ActWho developed the "Code of Ethics for Nurses?"American Nurse's AssociationAmericans with Disabilities Act (ADA)Prohibits discrimination against people with disabilities in all areas of public lifeT/F: Psychiatric facilities are required to display the Right's for the Mentally Ill in a visible areaTrueAdvanced Directivea legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health careUniform Anitomical gift actProvides list of individuals who can provide informed consent for the donation of a deceased individual's organsUnited Network of Organ Sharing (UNOS)Sets the criteria for organ donationT/F: An organ donor does not need to be free of infections disease or cancerFalseWhich organs have to be obtained from someone who is on mechanical ventilation?Heart, Lungs, and LiverT/F: Organ donations delay funeral arrangementsFalseWho request organ donation from the deceased family?The Primary Care provider or a nurse specially trained to make such requestsT/F: A patient can withdraw consent at any timeTrueWhich exceptions is parental consent not needed to provide healthcare services to a minor?- Emergencies - Substance abuse treatment - Treatment and testing of STIs - Birth control and pregnancy services - Psychiatric services - Emancipated minor or legal court order is obtainedWho is considered an Emancipated minor?Established independence from parents through marriage, pregnancy, service to the armed services or via court orderT/F: An emancipated minor is legally capable of signing an informed consentTrueHealth Insurance Portability and Accountability Act (HIPAA)Describes how personal health information may be used and how the client can obtain access to the informationWhat is considered "Private Health Information" PHI?Identifiable information the relates the client's past, present and future health as the payment made for healthcare services.T/F: Exposure of confidential information exposes the nurse to liability for invasion of the client's privacyTrueRisk ManagementPlanned method to identify, analyze, and evaluate risks, followed by a plan for reducing the frequency of accidents and injuriesOccurence Reportconfidential document that describes any patient accident while the person is on the premises of a health care agencyT/F: An occurrence report is a substitute for a complete entry of the incident in the client's recordsFalseT/F: The nurse if obligated to carry out a PCP's prescription except when the nurse believes that prescription to be inappropriate or inaccurateTruePatient Self-Determination ActA law that requires patients be provided with information about their right to have written directions about the care that they wish to receive in the event that they become incapacitated and are unable to make healthcare decisionsT/F: An advance directive does not have to be included in the patient's recordsFalseInstructional DirectivesLists the medical treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill.durable power of attorney for health careappoints an agent the person trusts to make decisions in the event of subsequent incapacityDo Not Resuscitate (DNR)The patient does not want to undergo cardiopulmonary resuscitation if neededT/F: If a patient does not have an DNR order, HCPs need to make every effort to revive the patientTrueInstances when nurses are required to report:- Child or elder abuse - Dog bite or another animal bite - gunshot and stab wounds - Assaults and homicides - Suicide - Certain communicable infectious diseasesT/F: If a co-worker is impaired or under the influence of a substance, the nurse is not required to report to charge nurse or nursing adminsitrationFalseOccupational Safety and Health Administration (OSHA)Requires that employer provides a safe workplace for employees according to regulationsManaged CareA health care system whose goals are to provide cost effective quality care.Case managementoptimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide servicesCase managera professional nurse who assumes responsibility for coordinating the client's care at admission and after dischargeAffordable Care Act (ACA)Federal legislation with provisions designed to increase access to healthcare, improve the quality of healthcare, and explore new models of delivering and paying for healthcare.HMO's (Health Maintenance Org)a network of providers for which costs are covered inside but not outside the networkPPO's (Preferred Provider Org)a network of providers that contract to provide health services to a group of peopleEPOs (exclusive provider organizations)Plans generally limit coverage to care from providers (doctors, specialists, or hospitals) in the plan's networkPoint-of-Service PlansA plan whereby patients with HMO membership may receive care at non-HMO providers in exchange for a referral and paying a higher deductible.High Deductible Plansplan with monthly premiums that are usually lower, but individual ends up pay more health care costs before insurance company starts to pay its shareHealth Savings Account (HSA)Tax-sheltered savings account similar to an IRA but created primarily to pay for medical expenses.MedicareA federal program of health insurance for persons 65 years of age and older, certain people with disabilities, and people with ESRDMedicare Part ACovers hospital stays, skilled nursing facilities, hospice care, and some home health careMedicare Part BPays for services not covered by part A. Usually 80% of approved services.Medicare Part CHealth plan offered by a private insurance agency that contract with Medicare to supplement coverageMedicate Part DCovers prescription medications needsMedicaidjoint federal-state medical insurance program for low-income adults, children, pregnant women, elderly people, and people with disabilities.Critical Pathwayis a clinical management care plan for providing client-centered care and for planning and monitoring the client's progress within an established tmie frameVariation AnalysisA continuous process that the case manager and other caregivers conduct by comparing the specific client outcomes with the expected outcomes described on the critical pathwayNursing Care Plana written guide about the person's nursing careFunctional NursingA nursing care pattern focusing on tasks and jobs; each nursing team member has certain tasks and jobs to doDrawbacks for Functional Nursing ApproachFocus is on delegated task and not patient; results in fragmented care and lack of accountability by team membersTeam Nursinga nursing care pattern; a team of nursing staff is led by an RN who decides the amount and kind of care each person needsModular NursingModification of team and primary nursing Similar to team nursing but uses a smaller team. Takes into account structure of the unitRelationship-based Practice (Primary Nursing)Concerned with keeping the nurse at the bedside, actively involved in client care, while planning goal-directed, individualized careClient-focused careThe nurse assumes total responsibility for planning and delivering care to a clientAccountabilityThe acceptance of responsibility for one's choices, decisions, and actions.LeadershipInterpersonal process that involves influencing others to achieve goalsManagementIs the accomplishment of tasks or goals by oneself or by directing othersAuthoritarian LeadershipThe leader or manager is focused and maintains strong control, makes decisions, and addresses all problems. Commands rather than seek suggestions or inputDemocratic Leadership (participative management)Focuses on the belief that every group members should have input into problem solving and development of goalsLaissez-faire Leadershipleader or manager assumes passive, nondirective, and inactive approaches and relinquishes part of all of the responsibilities of the group. Provides very little to no guidanceSituational Leadershipuses a combination of styles based on current circumstances or eventsBureaucratic LeadershipLeader or manager believes that individuals are motivated by external forces. They rely on organizational policies and procedures for decision makingTransformational LeadershipFocused on building relationships. Motivates team members through shared vision and mission. Encourages and praises staff members and inspires them to improve performance.Servant LeadershipInfluences and motivates others by building relationships and developing the skills of individual team membersFront-line managersFunctions in supervisory roles of those involved with the delivery of client care; Charge nurse, team leader, client care coordinatorMiddle ManagerResponsibilities may include supervising staff, preparing budgets, work schedules, writing and implementing policies; Unit manager and supervisorNurse ExecutiveA top-level nurse manager and may be the director of nursing services or the vice president for client care servicesPowerThe ability to influence others and control their actions to achieve desired resultsEmpowermentAn interpersonal process of enabling others to do for themselves; involves open communication, mutual goal setting, and shared decision makingT/F: Nurses can empower their patients through teaching and advocacyTruePoliciesGuidelines that define the organization's directives on courses of actionProcedureBased on policies and define methods of tasksProtocolsPrescribe a specific course of action for a specific type of client or problemCentralizationMaking of decisions by a few individuals at the top of the organizationDecentralizationThe distribution of power across all levels of the organizationEvidence-based practiceAn approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality careIndividualizationDetermining the client's personal, social, cultural and religious preferencesQuality ImprovementFocuses on the processes or systems that significantly contribute to client safety and effective client care outcomesRetrospective Audit"Looking back"; an evaluation method used to inspect the medical record after the client's discharge for documentation of compliance with the standardsConcurrent Audit"at the time"; An evaluation method used to inspect compliant of nurses with predetermined standards and criteria while the nurses are providing care duding the client's stayPeer ReviewProcess in which nurses evaluate the care delivered to the clientLewin's Change Model1. Unfreezing 2. Changing 3. RefreezingUnfreezingthe first step in Lewin's change model, in which individuals are encouraged to discard old behaviors by shaking up the equilibrium state that maintains the status quoChangingsecond stage in the process of changing an organization in which individuals adopt new values, beliefs, and attitudesReasons for Resisting Change- Conformity - Dissimilar beliefs and values - Habit - Secondary Gains - Threats to satisfying basic needs - Fearrefreezing stagechange agent integrates the change into the organizationSecondary GainsBenefits or payoff are present, so there is no incentive to changeModes of Conflict Resolution- Avoidance - Accomodation - Competition - CompromosePrimary Health Care Provider (PHCP)Specialist that diagnoses and treat diseasePhysicians Assistant (PA)Acts to a limited extent in the role of the physician during the physician's absenceNurse PracticionerAn advanced practice registered nurse (APRN) who is educated to diagnose and treat acute illness and chronic conditions health promotions and maintenance is a focusT/F: APRNS have independent practice authority in most statesTruePhysical Therapist (PT)provides treatment to prevent disability or restore function through the use of exercise, heat, massage, or other techniquesOccupational Therapist (OT)a therapist who helps residents to learn to compensate for their disabilities and assist them with activities of daily livingRespiratory Therapist (RT)individual who provides treatment and/or management of acute and chronic breathing disorders through the use of respirators or the administration of medication in aerosol formSpeech Therapist (ST)Works with people's speech production, vocal production, swallowing difficulties and language needs through speech therapyNutritionistAssists in the planning dietary measures to improve or maintain a client's nutritional statusContinuing Care NurseCoordinates discharge plans for the clientAssistive Personnelunlicensed nursing staff member who assists with basic patient care such as giving patient baths, checking vital signs, bed making, and positioning; nursing assistantsPharmacistspecialist in preparing and dispensing drugsSocial Workercounsels clients and their support persons regarding problems such as finances, marital difficulties and adoption of childrenChaplainProvides spiritual support and guidance to clients and families