JURISPRUDENCE EXAM

WHICH ETHICAL VALUE? facilitating the client's health and welfare, and preventing or removing harm.

CLIENT WELL-BEING

DEFINITION In this approach, a client is viewed as a whole person.

CLIENT-CENTRED CARE

When assisting clients in making choices and articulating their wishes about end-of-life care, nurses are guided by two core themes:

COMMUNICATION IMPLEMENTATION

DEFINITION The ability of a nurse to integrate the professional attributes required to perform in a given role, situation or practice setting. Professional attributes include, but are not limited to, knowledge, skill, judgment, values and beliefs.

COMPETENCE

Decisions about the utilization of an RN and an RPN are influenced by these three factors:

1. Complexity 2. Predictability 3. Risk of negative outcomes

DEFINITION The obligation to answer for the professional, ethical and legal responsibilities of one's activities and duties.

ACCOUNTABILITY

TRUE OR FALSE? PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care.

TRUE

If a person is incapable, and there is no other substitute decision- maker, who is the substitute decision-maker of last resort.

the PGT

DEFINITION viruses found in blood which produce infection, such as hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV).

BLOOD-BORNE PATHOGENS

____________ restraints control a client's mobility. Examples include a secure unit or garden, seclusion or a time-out room.

Environmental

___________ is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem

Respect

WHAT IS "The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function."

SCOPE OF PRACTICE STATEMENT

DEFINITION Anything done for a therapeutic, cosmetic or other health-related purpose.

TREATMENT

Nurses implement a client's treatment and end-of- life care wishes by: the knowledge, skill and judgment to determine that ___________ has occurred;

death

In the event of an _____________ situation, the nurse working as a UCP will immediately function at the RN, NP or RPN level.

emergency

The spread of infection requires an _____________ ____________

infectious agent

CNO MISSION

regulating nursing in the public interest

DEFINITION the misuse of the power imbalance intrinsic in the nurse-client relationship. It can also mean the nurse betraying the client's trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the client

ABUSE

DEFINITION The means used to document and communicate to a substitute decision-maker a client's preferences regarding treatment in the event that the client becomes incapable of expressing those wishes.

ADVANCED DIRECTIVE

DEFINITION Undesirable physical reactions to health products, including drugs, medical devices and natural health products.

ADVERSE REACTION

DEFINITION Actively supporting a right and good cause; supporting others for speaking for themselves or speaking on behalf of those who cannot speak for themselves.

ADVOCATE

WHICH MODE OF TRANSMISSION? Small particle residue (five microns or smaller) of evaporated droplets may remain suspended in the _________ for long periods of time, or dust particles may contain an infectious agent.

AIR

DEFINITION a waterless antiseptic designed for application to the hands to reduce the number of viable micro-organisms. In Canada, such preparations usually contain 70 percent ethyl alcohol.

ALCOHOL-BASED HAND RINSE

MEDICATION TERMS The administration of an allergen by oral, inhaled or other route in which a positive test is a significant allergic response (for example, anaphylactic shock).

Allergy challenge testing

Who Should Be Involved in Developing a Directive?

Although it is by definition a medical document, the collaborative involvement of health care professionals affected directly or indirectly by the directive is strongly encouraged.

DEFINITION the nurse-client relationship is the point at which the relationship changes from professional and therapeutic to unprofessional and personal. Crossing a _____________ means that the care provider is misusing the power in the relationship to meet her/his personal needs, rather than the needs of the client, or behaving in an unprofessional manner with the client.

BOUNDARY

DEFINITION To work together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her or his scope of practice.

COLLABORATE

DEFINITION An organized group of people bound together by ties of social, ethnic, cultural or occupational origin; or by geographic location.

COMMUNITY

DEFINITION Descriptions of the expected performance behaviour that reflects the professional attributes required in a given nursing role, situation or practice setting.

COMPETENCY STATEMENTS

DEFINITION They include a wide range of treatment modalities, such as herbal therapies and manual healing, such as reflexology and acupuncture. The therapies are not discipline-specific, and the knowledge required to provide them is not specific to nursing.

COMPLEMENTARY THERAPIES

DEFINITION Activities that are considered potentially harmful if performed by unqualified people.

CONTROLLED ACTS

MEDICATION TERMS Any type of drug that the federal government has categorized as having a higher-than-average potential for abuse or addiction. Such drugs are divided into categories based on their potential for abuse or addiction.

CONTROLLED SUBSTANCE

DEFINITION A series or sequence of similar treatments administered to a person over a period of time for a particular health problem.

COURSE OF TREATMENT

DEFINITION Any sudden unexpected event that has an emotional impact that can overwhelm the usually effective coping skills of an individual or a group

CRITICAL INCIDENT

DEFINITION Reasoning in which one analyzes the use of language, formulates problems, clarifies and explains assumptions, weighs evidences, evaluate conclusions, discriminates between pros and cons, and seeks to justify those facts and values that result in credible beliefs and actions.

CRITICAL THINKING

DEFINITION Includes, but is not restricted to age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief and disability.

CULTURE

DEFINITION learned values, beliefs, norms and way of life that influence an individual's thinking, decisions and actions in certain ways.

CULTURE

_____________ restraints are any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behaviour or movement.

Chemical

DEFINITION A client-specific order can be an order for a procedure, treatment, drug or intervention for an individual client

DIRECT CLIENT ORDER

DEFINITION an order for a procedure, treatment, drug or intervention that may be implemented for a number of clients when specific conditions are met and specific circumstances exist

DIRECTIVE

DEFINITION a chemical agent with a drug identification number (DIN) used on inanimate (non-living) objects to kill micro-organisms.

DISINFECTANT

DEFINITION a process that destroys or kills some, but not all, disease-producing micro-organisms on an object or surface.

DISINFECTION

WHICH MODE OF TRANSMISSION? involves contact of the conjunctivae or mucous membranes of the nose or mouth of a susceptible host with large particle droplets (larger than five microns) that contain an infectious agent

DROPLET TRANSMISSION

WHICH COMPETENCY STATEMENT? Demonstrates competence in professional judgments and practice decisions by applying principles implied in the ethical framework, and by using knowledge from many sources. Engages in critical thinking to inform clinical decision- making, which includes both systematic and analytical processes, along with reflective and critical processes. Establishes therapeutic caring and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect

Ethical Practice

TRUE OR FALSE. A nurse's age, gender, past experiences, strengths and weaknesses have no impact client interactions.

FALSE. All the attributes of the nurse, including age, gender, past experiences, strengths and weaknesses, have an impact on the interaction with the client. Through reflection, learning and support, nurses will be better able to strengthen the quality of care they provide to the diverse communities they serve.

TRUE OR FALSE. An RPN hired to be a PSW is only accountable for working within the PSW scope of practice.

FALSE. An RPN working in a UCP role is still accountable as an RPN

TRUE OR FALSE? Clients have to be named for information to be considered personal health information.

FALSE. Information is "identifying" if a person can be recognized, or when it can be combined with other information to identify a person. Personal health information can also be found in a "mixed record," which includes personal information other than that noted above.

TRUE OR FALSE. Rules of confidentiality do not apply to interpreters.

FALSE. Interpreters need to recognize that, by virtue of their role, they are gaining access to personal health information that must be protected. To help the client feel comfortable with the interpreter, the nurse should inform the client that confidential information is shared only within the health care team. The interpreter must not disclose client information to anyone. Family members and friends, in particular, need to realize that the role they play as interpreter needs to be separated from their personal role.

TRUE OR FALSE? All nurses must respond to situations in the same way.

FALSE. Not all nurses experience the same situation in the same way, and a situation that causes conflict, uncertainty or distress for some nurses may be straightforward for others.

TRUE OR FALSE. CNO requires that all registered members receive annual influenza vaccination.

FALSE. Some employers may require that nurses be vaccinated each year during flu season. The College does not establish the requirements for immunization of health care workers. These requirements are established by individual workplaces and by legislation.

TRUE OR FALSE? It is important to maintain eye contact with the interpreter at all times so that valuable information is not missed.

FALSE. Talk to the client, not to the interpreter. Maintain eye contact as appropriate. Looking at the client directly reinforces that the communication is between the provider and the client, assisted by the interpreter. This also allows the provider to assess the non-verbal reactions and responses.

TRUE OR FALSE. If a nurse does not have time to complete an act ordered to her, it is acceptable for her to delegate it to a PSW.

FALSE. They cannot delegate an act that has been delegated to them - sub-delegation

TRUE OR FALSE. All nurses do not have the authority to certify death in any situation.

FALSE. While RNs and RPNs do not have the authority to certify death in any situation, Nurse Practitioners do have the authority to certify an expected death, except in specific circumstances;

TRUE OR FALSE? All conflict is negative.

FALSE. The experience of dealing with conflict can lead to positive outcomes for nurses, their colleagues and clients.

TRUE OR FALSE. Knowledge of different cultures is critical to client care because a person's culture dictates the nursing approach required.

FALSE. There is no single right approach to all cultures or all individuals with a similar cultural background. The focus of care is always the client's needs. Each client and each situation is unique and requires individual assessment and planning.

TRUE OR FALSE? When a nurse learns information that, if not revealed, could result in harm to the client or others, she/he must keep this information confidential within the therapeutic relationship.

FALSE. He/she must consult with the health care team and, if appropriate, report the information to the person or group affected.

TRUE OR FALSE. UNDER NO CIRCUMSTANCES SHOULD A NURSE PROVIDE CARE FOR A SEXUAL PARTNER.

FALSE. If a nurse's sexual partner is admitted to an agency where the nurse is providing care or services, the nurse must make every effort to ensure that alternative care arrangements are made. Until alternative arrangements are made, however, the nurse may provide care.

TRUE OR FALSE? It is always possible to find a conflict resolution that meets everyone's satisfaction.

FALSE. It is not always possible to find a resolution to a conflict that satisfies everyone. At these times, the best possible outcome is identified in consultation with the client, and the health care team works to achieve that outcome. Nurses may still not be individually satisfied with the resolution; in this case, they need to examine why they're unsatisfied, and consider the possibility of taking follow-up action.

TRUE OR FALSE? A person has to be 18 years of age before they can give an informed consent.

FALSE. There is no minimum age for giving consent. Health care practitioners and evaluators should use professional judgment, taking into account the circumstances and the client's condition, to determine whether the young client has the capacity to understand and appreciate the information relevant to making the decision.

WHAT KIND OF ABUSIVE BEHAVIOUR? ■ borrowing money or property from a client; ■ soliciting gifts from a client; ■ withholding finances through trickery or theft; ■ using influence, pressure or coercion to obtain the client's money or property; ■ having financial trusteeship, power of attorney or guardianship; ■ abusing a client's bank accounts and credit cards; and ■ assisting with the financial affairs of a client without the health care team's knowledge.

FINANCIAL

DEFINITION Care that aims to relieve client suffering and improve the quality of living and dying. It strives to help clients and families address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears.

PALLIATIVE CARE

DEFINITION Two persons who have lived together for at least one year and have a close personal relationship that is of primary importance in both persons' lives.

PARTNERS

DEFINITION Assistance with, or supervision of, hygiene, washing, dressing, grooming, eating, drinking, elimination, ambulating, positioning or any other routine activity of living. It may also include a group or plan of personal assistance services.

PERSONAL ASSISTIVE DEVICE

DEFINITION specialized clothing or equipment (for example, gloves, masks, protective eyewear, gowns) worn by an employee for protection against an infectious hazard.

PERSONAL PROTECTIVE EQUIPMENT

WHAT KIND OF ABUSIVE BEHAVIOUR? ■ hitting; ■ pushing; ■ slapping; ■ shaking; ■ using force; and ■ handling a client in a rough manner.

PHYSICAL

DEFINITION A plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a person has and is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person's health condition.

PLAN OF TREATMENT

DEFINITION All people sharing a common health issue, problem or characteristic. These people may or may not come together as a group.

POPULATIONS

DEFINITION interventions implemented to reduce the risk of transmitting micro-organisms from client to client, client to health care worker, and health care worker to client.

PRECAUTIONS

WHICH ETHICAL VALUE? limited access to a person, the person's body, conversations, bodily functions or objects immediately associated with the person

PRIVACY AND CONFIDENTIALITY

DEFINITION Medications that are prescribed and administered as needed.

PRN MEDICATION

DEFINITION A clinical practice guideline, decision guide, algorithm or standardized interview tool.

PROTOCOL

DEFINITION relationship involves planned and structured psychological, psychosocial and/or interpersonal interventions aimed at influencing a behaviour, mood and/or the emotional reactions to different stimuli

PSYCHOTHERAPEUTIC RELATIONSHIP

WHICH COMPETENCY STATEMENT? Demonstrates professional conduct; practises in accordance with legislation and the standards as determined by the regulatory body and the practice setting; and demonstrates that the primary duty is to the client to ensure consistently safe, competent and ethical care

Professional Responsibility and Accountability

________ ____________ is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that create closeness.

Professional intimacy

What is the simplest and most important practice a nurse can do to reduce contamination and spread of infection?

Proper hand hygiene is the single most- important infection prevention and control practice.

DEFINITION The PGT is the substitute decision-maker of last resort for a mentally incapable person. The court will not appoint the PGT as guardian of property or guardian of the person unless there is no other suitable person available and willing to be appointed.

Public Guardian and Trustee (PGT)

Which legislation provides a broad protection to quality of care information produced by a health care facility or a health care entity, or for a governing or regulatory body.

Quality of Care Information Protection Act (QOCIPA)

DEFINITION Dosages, frequencies or routes that are prescribed in ranges (for example, Gravol 50-100 mg for nausea).

RANGE DOSES Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give nurses the flexibility to administer the dose that best suits the assessment of the client.

DEFINITION Two persons related by blood, marriage or adoption.

RELATIVES

WHICH ETHICAL VALUE? means that human life is precious and needs to be respected, protected and treated with consideration

RESPECT FOR LIFE

DEFINITION physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body.

RESTRAINT

DEFINITION An invasive and immediate life- saving treatment that is administered to a client who has a sudden unexpected cardiac or respiratory arrest. It may include basic cardiac life support involving the application of artificial ventilation (such as mouth-to-mouth resuscitation and bagging) and chest compression. It may also include advanced cardiac life support, such as intubation and the application of a defibrillator.

RESUSCITATION

RN OR RPN? - coping mechanisms and supports unknown, not functioning or not in place - requires close, frequent monitoring and reassessment

RN

RN OR RPN? - unpredictable, systemic or wide- ranging responses - signs and symptoms subtle and difficult to detect

RN

The more complex the care requirements, the greater the need for consultation and/or the need for an _______ to provide the full spectrum of care.

RN

The more complex the client situation and the more dynamic the environment, the greater the need for the ___________ to provide the full range of care, assess changes, reestablish priorities and determine the need for additional resources.

RN

RN OR RPN? recognizes changes, probes further and manages or consults appropriately with other health care team member

RPN

RN OR RPN? - predictable changes in health condition - predictable outcomes

RPN/RN

DEFINITION Referring to the extension of communication over a distance, this term covers all forms of distance and/or conversion of the original communications, including radio, telegraphy, television, telephony, data communication and computer networking

TELECOMMUNICATION

DEFINITION An order communicated via telephone by an authorizer who is not physically present to write the order.

TELEPHONE ORDER

DEFINITION The delivery, management and coordination of care and services provided via telecommunication technology

TELEPRACTICE

DEFINITION A relationship that is professional and ensures the client's needs are first and foremost. The relationship is based on trust, respect and intimacy and requires the appropriate use of the power inherent in the health care provider's role. The professional relationship between RPNs and their clients is based on a recognition that clients (or their alternative decision-makers) are in the best position to make decisions about their lives when they are active and informed participants in the decision-making process.

THERAPEUTIC RELATIONSHIP

DEFINITION An interactive process of transferring client-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity of care and the safety of the client

TRANSFER OF ACCOUNTABILITY

TRUE OR FALSE. Keeping secrets with the client and apart from the health care team (for example, not documenting relevant discussions with the client in the health record) is an example of crossing an ethical boundary.

TRUE

TRUE OR FALSE. Nurses must report suspected child abuse.

TRUE Child and Family Services Act, 1990 requires all health care professionals to report suspected child abuse to the Children's Aid Society; the Health Protection and Promotion Act permits reporting of certain conditions to the Medical Officer of Health.

TRUE OR FALSE. A nurse must obtain consent before using an interpreter in the presence of a language barrier between he/she and the client.

TRUE When using interpreters to communicate with clients, nurses need to obtain client consent, be sensitive to the issues surrounding interpretation and ascertain that the interpreter is appropriate for the particular client situation.

TRUE OR FALSE. It is acceptable for a nurse to delegate a patient's standard dose insulin injection to a family member.

TRUE The RHPA includes an exception allowing UCPs to perform some controlled acts as long as they are considered to be routine activities of living. Procedures are considered to be routine activities of living when the need for, response to, and outcome of the procedure have been established over time and are predictable. For instance, administering the same dosage of insulin to a person with well-controlled diabetes over an extended period of time is a routine activity of living. It is not a routine activity if the dosage or type of insulin requires frequent adjustment.

TRUE OR FALSE. Everyone has a culture.

TRUE.

TRUE OR FALSE. Omissions are as untruthful as false information.

TRUE.

TRUE OR FALSE. The most recent wishes a client expresses while he or she is capable prevail over any earlier wishes the client may have given.

TRUE.

TRUE OR FALSE? Consent from the client is required regardless if the therapy is requested by the client or proposed by a health practitioner

TRUE.

TRUE OR FALSE? Nurses must explain to clients that information will be shared with the health care team and identify the general composition of the health care team.

TRUE.

TRUE OR FALSE? Ethical disagreements between nurses are acceptable.

TRUE. There is room for disagreement among nurses on how they weigh the different ethical values. But above all, nurses need to choose ethical interventions that meet the needs of clients.

TRUE OR FALSE. Clients are always the best people to make decisions about their own health.

TRUE. If a client is competent, then they are the best person to make choices about their health, but... if a client is deemed incompetent, they a nurse must consult a substitute decision-maker

TRUE OR FALSE. In regards to ethical concerns, sometimes the best possible outcome may be the one that is least bad.

TRUE. Sometimes a completely good outcome is impossible

WHICH ETHICAL VALUE? speaking or acting without intending to deceive.

TRUTHFULLNESS

The Health Care Consent Act (HCCA) Health care practitioners have no ___________________ to make treatment decisions on behalf of clients, except in an ________________ when no authorized person is available to make the decisions. Similarly, they have no __________________ to make a decision to consent to the admission of a client to a care facility, except in a ________________.

authority emergency authority crisis

Nurses implement a client's treatment and end-of- life care wishes by: recognizing that all nurses have the _________________ to pronounce death when clients are _______________ to die and their plan of treatment does not include resuscitation.

authority expected

The Health Care Consent Act (HCCA) The goals of the HCCA include promoting individual authority and ______________, facilitating __________________ between health care practitioners and their clients, and ensuring a significant ___________ for family members when the client is _______________ of ________________.

autonomy communication role incapable of consenting

Treatment in an emergency can be provided immediately if incapable with respect to a treatment, a substitute decision-maker is not readily ___________, it is not ___________ ____________ to obtain a consent or refusal from the substitute, and a __________ will put the person at risk of sustaining serious bodily harm.

available reasonably possible delay

To manage conflict, a nurse can: __________ arguing, criticizing, defending or judging;

avoid

Nurses communicate the goals of care and treatment by: _________________ with other health care team members as required, to identify and resolve treatment and/or end-of-life care _________________. (For example, a nurse could present a client situation during a team meeting or rounds or include an ethicist on the care team, if it is appropriate);

consulting issues

If consent to admission to a care facility is required by law, then consent is needed in all cases except in a _____________ _____________.

crisis situation

To manage conflict, a nurse can: implement a ____________ ______________ management plan;

critical incident

COMPETENCY ASSUMPTIONS Entry-level RPNs use ____________ _______________ skills to support clinical decision-making and reflect upon practice experiences.

critical thinking

Nurses should not provide a treatment if there is any ______________ about whether the client understands and is capable of consenting. This applies whether or not there is an _____________, or even if the client has already consented. It does not ________________ if a substitute decision-maker has consented.

doubt order apply

If a person is incapable, the consent (or refusal to give consent) is to be obtained from who?

highest- ranked available substitute decision-maker from the HCCA hierarchy who is willing to make the decision.

The goal of end-of-life care is to _______________ the quality of living and dying, and ________________ unnecessary suffering.

improve minimize

The Health Care Consent Act (HCCA) When a health care practitioner finds a client is _________________ of making a treatment decision, the legislation requires the practitioner to provide the client with ___________________ about the consequences of the finding. This provision of information must be performed in accordance with __________________ established by the practitioner's governing body.

incapable information guidelines

If the nurse proposing a treatment or evaluating capacity to make an admission or personal assistance service decision determines the client is __________________ of making the decision, then the nurse _______________ the client that a substitute decision-maker will be asked to make the final decision. This is __________________ in a way that takes into account the particular circumstances of the client's condition and the nurse-client relationship.

incapable informs communicated

An individual's culture is ________________ by many factors, such as race, gender, religion, ethnicity, socio-economic status, sexual orientation and life experience. The extent to which particular factors influence a person will ______________.

influenced vary

A substitute decision-maker has the right to access the same ___________________ that a capable client would be able to access.

information

Clients have a legal and ethical right to ________________ about their care and treatment, and a right to _____________ that treatment.

information refuse

Nurses implement a client's treatment and end-of- life care wishes by: ensuring that the creation of the plan of treatment has involved both the ________________ _______ and the _________, and that the client has given informed consent for the plan of treatment before implementation;

interprofessional team and the client

When an unregulated care provider abuses a client, the nurse must ______________ to protect the client and notify the employer.

intervene

To manage conflict, a nurse can: ____________ the client, the client's family and the health care team members in assisting with the behaviour and developing ______________ to prevent or manage it;

involve solutions

Nurses communicate the goals of care and treatment by: using professional ________________ to determine how the interprofessional team needs to be involved in discussions about the client's end-of-life care wishes;

judgment

COMPETENCY ASSUMPTIONS Entry-level RPNs possess the ________________ required to demonstrate the wide range of competencies in this document.

knowledge

COMPETENCY ASSUMPTIONS Entry-level RPNs have a _______________ ___________ in nursing, health and social sciences, ethics, leadership and research.

knowledge base

Treatment in an emergency can be provided immediately if communication can't take place because of a ____________ ____________ or _____________, and reasonable efforts to overcome these have been made, but a ___________ will prolong the suffering the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm, and there is no reason to believe the person does _______ ___________ the treatment.

language barrier or disability delay not want

Many facilities in Ontario use a __________ ____________ philosophy that the quality of life for each client, with the preservation of dignity, is the value guiding the practice of health care practitioners, including nurses. CNO supports this in all settings where nurses practise.

least restraint

STANDARD STATEMENTS Prior to performing procedures, nurses ensure that they are able to identify the potential outcomes of procedures, have the authority and competence to ____________ the ________________ , or have the resources available to manage those outcomes.

manage the outcomes

How the infectious agent is transmitted from the reservoir to the susceptible host is called the ___________ of ___________________

mode of transmission

The Outreach Program provides ways for nurses to engage in _____________ ___________ by offering consultation and resources to help members practise according to the practice standards.

nursing regulation

According to College of Nurses of Ontario (CNO) standards, nurses are accountable for __________ ______________ whether the intervention or service relates to a treatment (as defined in the HCCA or as required in common law), admission to a facility, or the provision of a personal assistance service.

obtaining consent

Nurses can prevent the escalation of conflict by: ask __________-_____________ questions to establish the underlying meaning of the client's behaviour;

open-ended

A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 1 The nurse has the knowledge, skill and judgment to _______________ the procedure __________________.

perform competently

The Substitute Decisions Act (SDA) The Office of the PGT is the government department that deals with ____________ ____________ and _________________ _____________.

personal care property matters

To manage conflict, a nurse can: leave the situation to develop a ________ ___ ________ with the assistance of a colleague if the client intends to harm the nurse

plan of care

The nurse-client relationship is one of unequal ___________. Although the nurse may not immediately perceive it, the nurse has more _____________ than the client.

power power

The Substitute Decisions Act (SDA) A ____________ _____ _______________ for personal care comes into _______________ when the person who granted it becomes mentally incapable, unless it states otherwise.

power of attorney effect

In the event that symptoms present that are beyond the expectations of a UCP role, a nurse working as a UCP is accountable for:

practising as an RN or RPN until a member practising at the RN or RPN level is available

COMPETENCY ASSUMPTIONS Entry-level RPNs are _____________ to practise safely, competently and ethically in situations of health and illness with individuals across the lifespan.

prepared

Nurses can employ client-centred care strategies to _______________ behaviours that contribute to the escalation of conflict.

prevent

The nurse uses _______________ ______________ and _______________ __________ to determine whether the client is able to ________________ the information. For example, a young child or a client suffering advanced dementia is not likely to understand the information. It would not be reasonable in these circumstances for the nurse to inform the client that a substitute decision-maker will be asked to make a decision on his/her behalf.

professional judgment common sense understand

Nurses ______________ the client from harm by ensuring that abuse is prevented, or stopped and reported.

protect

The entry-level RPN is accountable for: Actively identifying and asking ________________ of self, colleagues (including members of the Interprofessional health care team) and clients.

questions

The health care practitioner who proposes the treatment is responsible for taking ______________ __________ to ensure that treatment is not administered without ______________.

reasonable steps consent

Because allergy testing and desensitizing injections carry a risk of adverse reactions, nurses must be able to do what?

recognize side effects, intervene in the event of complications (for example, difficulty breathing, rash or anaphylactic shock) and manage outcomes.

Nurses communicate the goals of care and treatment by: maintaining ______________ of client and interprofessional team communications about treatment and end-of-life care decisions according to organizational policies and procedures as well as the College's Documentation practice document;

records

Nurses can prevent the escalation of conflict by: _____________ to understand how her/his behaviour and values may negatively affect the client.

reflect

The consent must: ◗ __________ to the treatment being proposed; ◗ be ____________; ◗ be ____________; and ◗ not have been ______________ through misrepresentation or fraud.

relate informed voluntary obtained

Explain to the interpreter the importance of ______________ everything that the client and the health care provider say, without omissions, summary or judgments.

repeating

The HCCA does not specify that consent to a personal assistance service is ________________.

required

The infectious agent needs a ______________ where it can live, grow and reproduce

reservoir

Transfer requires a route for the infectious agent to exit the _____________ (a portal of exit), a mode of travel to the ________________ _______ (a mode of transmission) and a ___________ to enter the susceptible host (a portal of entry)

reservoir susceptible host route

Nurses can prevent the escalation of conflict by: _____________ and address the client's wishes, concerns, values, priorities and point of view;

respect

Reasons for using _____________ include protecting clients from injury, maintaining treatment and controlling disruptive behaviour.

restraints

The Health Care Consent Act (HCCA) The client has the ______________ to ask the Consent and Capacity Board (CCB) to review the finding of _________________.

right incapacity

A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 3 The nurse accepts ____________ ________________ for the decision to teach the procedure after considering: ■ the known __________ and _____________ to the client of performing the procedure ■ the ________________ of the outcomes of performing the procedure

sole accountability risks and benefits predictability

To manage conflict, a nurse can: _________ ___________ from the client, if necessary (for example, to regain composure or to set personal space boundaries);

step away

If a health practitioner or evaluator finds that a person is incapable of making a decision about a treatment or admission to a care facility, consent must be obtained from a _________________________

substitute decision-maker

Treatment in an emergency can be provided immediately if incapable with respect to the treatment decision but a __________________________ is available to give consent.

substitute decision-maker

Factors that influence a person's ________________ include age; general physical, mental and emotional health; the amount and duration of exposure to the agent; and the immune status and inherent susceptibility of the individual.

susceptibility

The transmission of infection also requires a _______________ _________

susceptible host

Conflict-management strategies should be individually ______________ to each client situation. Nurses need to use their _________________ ____________ to determine which strategy is most appropriate for each client.

tailored professional judgment

The entry-level RPN is accountable for: The application of _____________ to ______________ via the use of critical thinking and problem-solving skills consistent with the RPN's educational preparation.

theory to practice

COMPETENCY ASSUMPTIONS Entry-level RPNs enter into practice with competencies that are _______________ across diverse practice settings.

transferable

To manage conflict, a nurse can: state that abusive language and behaviours are ______________, if the nurse believes this will not ______________ the client's behaviour;

unacceptable escalate

Nurses can prevent the escalation of conflict by: continually seek to ________________ the client's health care needs and perspectives;

understand

A nurse who teaches, assigns duties to or supervises UCPs must ensure that the UCP: ◗ ________________ the extent of her or his responsibilities in performing the procedure(s) ◗ knows when and who to ask for _______________, ◗ knows when, how and to whom to ___________ the outcome of the procedure.

understands assistance report

Culture is _______________. It changes and evolves over time as individuals change over time.

dynamic

WHAT ARE THE EXCEPTIONS to the Need for Authorization UNDER WHICH AN RPN CAN PERFORM OTHER CONTROLLED ACTS?

1. EMERGENCY 2. STUDENT PRACTICING UNDER AN AUTHORIZE PERSON 3. when treating a member of a person's household and the procedure is within the second or third controlled act authorized to nursing; 4. when assisting a person with his/her routine activities of living and the procedure is within the second or third controlled act authorized to nursing; or 5. when treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment.

Hierarchy of substitute decision-makers

1. Guardian of the person — appointed by the court. 2. Someone who has been named as an attorney for personal care. 3. Someone appointed as a representative by the CCB. 4. Spouse, partner or relative in the following order: a. spouse or partner, b. child if 16 or older; custodial parent (who can be younger than 16 years old if the decision is being made for the substitute's child); or Children's Aid Society; c. parent who has only a right of access; d. brother or sister; e. other relative. 5. PGT is the substitute decision-maker of last resort in the absence of any more highly ranked substitute, or in the event two more equally ranked substitutes cannot agree.

3 questions a nurse must ask herself when providing complementary therapy:

1. Is it appropriate to provide the complementary therapy? 2. Do I have the required knowledge, skill and judgment to provide this therapy safely and effectively? 3. Do I understand, and can I deal with, the possible outcomes of this therapy?

WHAT ARE THE 3 CONTROLLED ACTS THAT NURSES CAN PERFORM?

1. Performing a prescribed procedure below the dermis or a mucous membrane. 2. Administering a substance by injection or inhalation. 3. Putting an instrument, hand or finger beyond the external ear canal, the point in the nasal passages where they normally narrow, the larynx, the opening of the urethra, the labia majora, the anal verge, or into an artificial opening into the body.

2 documents that provide the legislative framework for regulating nursing in Ontario:

1. Regulated Health Professions Act, 1991 2. Nursing Act, 1991

CNO'S 7 ETHICAL VALUES

1. client well-being; 2. client choice; 3. privacy and confidentiality; 4. respect for life; 5. maintaining commitments; 6. truthfulness; 7. fairness.

3 requirements of nursing documentation

1. documentation presents an accurate, clear and comprehensive picture of the client's needs, the nurse's interventions and the client's outcomes. 2. documentation of client care is accurate, timely and complete. 3. safeguard client health information by maintaining confidentiality and acting in accordance with information retention and destruction policies and procedures that are consistent with the standard(s) and legislation.

WHAT ARE THE TWO CONDITIONS BY WHICH AN RPN CAN PERFORM A CONTROLLED ACT?

1. if initiated (see Appendix D) in accordance with conditions identified in the regulation; 2. if the procedure is ordered by a physician, dentist, chiropodist, midwife or NP.

Your client with an acquired brain injury has been stabilized and is being transferred to another hospital for continuing care. The client is unconscious. Her husband is aware of the transfer, but does not know it is happening today. You tried to reach him by telephone, without success. Before the client is transferred, you want to share information about the care she received and the current plan of care with the nurse who will receive her. The client's cost for this transfer is being covered by private insurance, so you also need to share personal health information with the insurance company. How much information can you share, and with whom, under these circumstances?

1. the receiving hospital nursing staff. These nurses are members of the health care team; therefore, there is implied consent for the sharing of information with them to provide health care. You can, therefore, share her personal health information. 2. the insurance company. Express consent is required because this disclosure is not to a custodian and is not required to treat the client. Because the client is incapable of providing this consent, her husband (the substitute decision- maker) must provide express consent either in writing or verbally, before you share information. Since you cannot reach him, you may arrange her transfer. Once you obtain express consent from the husband, you may provide the information to an insurance company staff member.

The Regulated Health Professions Act, 1991 identifies a number of exceptions that allow individuals who are not members of a regulated health profession to perform some controlled act procedures. These exceptions include:

1. treating a member of her/his household, and the procedure falls within the second or third controlled acts authorized to nursing, 2. assisting a person with routine activities of living, and the procedure falls within the second or third controlled acts authorized to nursing (see the table below).

A person is capable of giving consent to a treatment, admission to a care facility and personal assistance services if he/she:

1. understands the information that is relevant to making a decision concerning the treatment, admission or personal assistance service; and 2. appreciates the reasonably possible consequences of a decision or lack of a decision.

How many requirements must be met before a nurse can delegate to an UCP.

10

HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991?

13

TRUE OR FALSE. Consent for flu shot must be given in writing.

FALSE. Consent can be written or oral. Nurses should document that consent was obtained, either by using a consent form or by recording it in the health record.

HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM?

3

TRUE OR FALSE. Feeling other members of the team do not understand a specific client as well as you do is a warning sign that a nurse should be mindful of

TRUE

TRUE OR FALSE. Finding yourself frequently thinking about a client when away from work is a sign of being overly attached to a client.

TRUE

WHICH MODE OF TRANSMISSION? Food, water or medication contaminated with an infectious agent can act as a ________________ for transmission when consumed

VEHICLE

DEFINITION What a capable person expresses about treatment, admission to a care facility or a personal assistance service.

WISHES

How many requirements must be met before a nurse can accept delegation?

7

WHICH ETHICAL VALUE? self-determination and includes the right to the information necessary to make choices and to consent to or refuse care

CLIENT CHOICE

MEDICATION TERMS a prick/puncture procedure to determine allergies, if any.

ALLERGY TESTING

DEFINITION Involving the client in making decisions based on the client's values, beliefs and wishes.

ANTICIPATORY PLANNING

DEFINITION a substance that destroys or stops the growth of micro-organisms on living tissue (for example, skin).

ANTISEPTIC

_________________ is demonstrated through one's decision-making processes, competency and integrity. It is reflected in accurate documentation and in the nurse's actions.

Accountability

DEFINITION defining lines that separate the therapeutic behaviour of an RPN from any behaviour that, well-intentioned or not, could reduce the benefit of nursing care to clients, families or communities.

BOUNDARY

DEFINITION Any act or verbal comment that could isolate or have negative psychological effects on a person. Bullying usually involves repeated incidents or a pattern of behaviour that is intended to intimidate, offend, degrade or humiliate a particular person or group of people.

BULLYING

WHICH MODE OF TRANSMISSION? Direct contact transmission involves contact between the infectious agent and the susceptible host.

CONTACT TRANSMISSION

DEFINITION The same as the power of attorney for personal care, except relating to decisions about property.

Continuing power of attorney for property

DEFINITION The formal process that transfers authority to perform a controlled act.

DELEGATE

DEFINITION formal process that transfers the authority to perform a controlled act

DELEGATION

DEFINITION the transfer of authority to perform a controlled act procedure from a person who is authorized to perform the procedure to a person who is not otherwise authorized to perform the procedure.

DELEGATION

MEDICATION TERMS an intracutaneous injection to desensitize to an allergen

DESENSITIZING INJECTION

DEFINITION At every stage of life, health is determined by complex interactions among social and economic factors, the physical environment and individual behaviour. They do not exist in isolation from each other. These determinants, in combination, influence health status.

DETERMINANTS OF HEALTH

DEFINITION if the person is experiencing severe suffering or is at risk of sustaining serious bodily harm if the treatment is not administered promptly.

EMERGENCY

DEFINITION an agent that destroys micro-organisms, especially pathogenic organisms. A product with the suffix "-cide" indicates that it is an agent that destroys the micro-organism identified by the prefix (for example, virucide, fungicide, bactericide).

GERMICIDE

DEFINITION A process that ensures that a second practitioner conducts a verification, either in the presence or absence of the first practitioner.

Independent double-check.

DEFINITION any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer.

MEDICATION ERROR

error does not reach the client, but had it, the client could have been harmed

NEAR MISS

DEFINITIONS A pharmacologically inert substance that has no physiological effect.

PLACEBO

What legislation governs health care information privacy in Ontario?

Personal Health Information Protection Act, 2004 (PHIPA)

What is personal health information?

Personal health information is any identifying information about clients that is in verbal, written or electronic form.

RN OR RPN? high risk of negative outcomes

RN

COMPETENCY ASSUMPTIONS Entry-level RPNs are committed to engaging in quality assurance practices, including ____________ _____________.

Reflective Practice

DEFINITION Administrating one's own medication.

SELF-ADMINISTRATION

DEFINITION The use of communications and information technology to deliver health care services and information over large and small distances

TELEHEALTH

WHAT IS AN INTERPRETER'S ROLE?

The interpreter's role is to be the voice of the client.

What is the purpose of the Quality of Care Information Protection Act (QOCIPA)?

To promote open discussion of adverse events, peer review activities and quality of care information, while protecting this information from being used in litigation or accessed by clients.

Nurses work with the client to ensure that all professional behaviours and actions meet the _______________ needs of the client.

therapeutic

To give informed consent, the client must be provided with the information necessary to make a decision to consent to or refuse the vaccine. This information must include the following:

■ the nature of the treatment; ■ expected benefits of the treatment; ■ material risks and adverse effects of the treatment; ■ alternative courses of action; and ■ likely consequences of not having the treatment.

DEFINITION thin sheets of tissue that line various openings of the body, such as the mouth, nose, eyes and genitals.

MUCUS MEMBRANES

____________ is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client.

Empathy

Consent is informed if, before giving it:

1. the person received the information about the treatment that a reasonable person in the same circumstances would require to make a decision; and 2. the person received responses to his/her requests for additional information about the treatment.

There are four standards, each with accompanying indicators, that describe a nurse's accountabilities when performing any procedure, whether or not it requires delegation, what are they?

1. Appropriate health care provider 2. Authority 3. Competence 4. Managing Outcomes

5 statutory committeess

1. Discipline 2. Fitness to Practice 3. Inquiries, Complaints, and Reports 4. Quality Assurance 5. Registration

Admission to a care facility without consent may be authorized if:

1. the person who has been deemed incapable requires immediate admission as a result of a crisis; and 2. it is not reasonably possible to obtain immediate consent or refusal on the incapable person's behalf.

The four major elements to preventive practice are:

1. HANDWASHING 2. PROTECTIVE BARRIERS 3. CARE OF EQUIPMENT 4. HEALTH PRACTICES OF THE NURSE

4 regulatory functions:

1. practice standards. 2. entry to practice. 3. quality Assurance Program. 4. enforcing standards

A client asks a nurse to perform an act that has an unknown risk, what two things should the nurse do?

1. refuse to follow the client's wishes if she/he believes it may cause harm. 2. share her/his reasons for this decision with the client.

CNO'S 8 RIGHTS

1. right client, 2. right medication 3. right reason, 4. right dose, 5. right frequency, 6. right route, 7. right site, 8. right time;

One of Joanne's clients in the psychiatric unit, John, confides to her that he is fascinated by young children, boys and girls. He tells Joanne he is afraid that he will hurt a child some day. Joanne brings that information to the team. A short time later, John is discharged. Some weeks following his discharge, Joanne notices that John is the ice-cream vendor in her neighbourhood. She is concerned for the children in the neighbourhood, her own as well as the others, and wonders what she should do.

A. ASSESS There is no absolute duty to respect confidentiality. Confidential information can be disclosed when a person(s) is at serious risk. However, it is preferable if the client discloses the information. Joanne decides that she needs to know more about John's clinical situation and sees John's psychiatrist the next time she is working. The psychiatrist shares Joanne's concerns. With the information she has, Joanne thinks the dilemma is whether she should break client confidentiality to protect children from the threat of serious harm. Joanne is also concerned about John's well-being, now that he is living in the community and has found employment. As well, by disclosing confidential information, she will not have maintained a commitment to a client. Try to meet both her obligation to protect the public and to protect her client's confidentiality and well-being. Working with the mental health care team, Joanne would arrange for John to be assessed by the team to determine whether he poses a danger to children at this time. If the team determines that John poses a serious danger to children, it must then decide how to respond to this situation. John could be an involuntary client unless he agreed to be admitted to a psychiatric facility. If it were found that John does not pose a danger, then there is no justification to disclose confidential information. With this option, Joanne can begin to meet her obligations to the client and to the public.

DEFINITION the act of determining or allocating responsibility for particular aspects of care to another individual. This includes procedures that may or may not be a controlled act. Ideally, a range of care needs, rather than specific procedures.

ASSIGNING

DEFINITION means by which the authority to perform a procedure is obtained or the decision is made to perform a procedure

AUTHORIZING MECHANISM

_____________ can take many forms, including verbal and emotional, physical, neglect, sexual and financial.

Abuse

Who must determine capacity in the case of admission to a care facility or provision of personal assistance services?

An evaluator. The evaluator may be the person proposing the admission or services, or the evaluator may be identified by facility or agency policies. Nurses and some other health care professionals may be evaluators.

The Health Care Consent Act (HCCA) _________________ the client's capacity to make a treatment decision is the responsibility of the health care practitioner proposing the treatment.

Assessing

DEFINITION Individuals, families, groups or entire communities across the lifespan who require nursing expertise.

CLIENT

A _______________ ______________ conducts assessments of capacity on persons who need decisions made on their behalf on a continuing basis.

CAPACITY ASSESSOR NPs, RNs and RPNs are eligible to become capacity assessors. Designation will require the successful completion of a capacity assessor education or training course approved or required by the attorney general.

DEFINITION an individual who is found to be colonized (culture-positive) for a particular organism, at one or more body sites, but has no signs or symptoms of infection.

CARRIER

DEFINITION A board established by and accountable to the government. Its members are appointed by the government. The Board considers applications for review of findings of incapacity, applications relating to the appointment of a representative, and applications for direction regarding the best interests and wishes of an incapable person.

Consent and Capacity Board (CCB)

DEFINITION the conversion of data into a form called cipher text that cannot be easily understood by unauthorized people.

ENCRYPTION

DEFINITION giving the wrong medication

ERROR OF COMMISSION

DEFINITION not administering an ordered medication

ERROR OF OMISSION

DEFINITION Practice that is based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence, including client perspective, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data.

EVIDENCE-INFORMED PRACTICE

DEFINITION when, in the opinion of the health care team, the client is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health or the client refuses the treatment that is available.

EXPECTED DEATH

DEFINITION a circumstance of being in contact with an infected person or item in a manner that may allow for the transfer of micro-organisms, either directly or indirectly, to another person.

EXPOSED

WHICH ETHICAL VALUE? allocating health care resources on the basis of objective health-related factors

FAIRNESS

TRUE OR FALSE. It is acceptable to spend time outside of work hours with a client.

FALSE

TRUE OR FALSE? A nurse cannot teach a PSW how to administer medication.

FALSE Nurses may teach UCPs medication administration, including the process of administration and documentation, as required.

TRUE OR FALSE? If a nurse delegates medication administration to a PSW, they assume all the responsibilities related to med admin.

FALSE The nurse remains responsible for the: - ongoing assessment of the client's needs; - plan of care in conjunction with the health care team; - evaluation of the client's health status; and - effectiveness of the medication(s).

TRUE OR FALSE. Disclosing personal information to a specific client is a good way of getting a patient to open up to you.

FALSE.

TRUE OR FALSE. It is acceptable for a nurse to spend extra time with one client beyond his/ her therapeutic needs.

FALSE.

TRUE OR FALSE. Your client never has any visitors and discloses extreme loneliness, giving them your phone number so that they can call you when they're feeling down is a good way to boost their spirits.

FALSE.

WHICH ETHICAL VALUE? keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings.

MAINTAINING COMMITMENTS

DEFINITION Drugs that bear a heightened risk of causing significant client harm when they are used in error.

HIGH ALERT MEDICATIONS

DEFINITION Interpersonal conflict among colleagues that includes antagonistic behaviour such as gossiping, criticism, innuendo, scapegoating, undermining, intimidation, passive aggression, withholding information, insubordination, bullying, and verbal and physical aggression.

HORIZONTAL VIOLENCE

MEDICATION TERMS A vaccine.

IMMUNIZING AGENT

DEFINITION the physical separation of infected individuals from uninfected individuals for the period of communicability of a particular disease.

ISOLATION

A home care client has lost sensation and mobility in her legs. On a home visit to provide wound care for a severe burn on the sole of her left foot, the nurse discovers a picture of St. Francis of Assisi covered in plastic and carefully placed between the layers of bandage around the foot. The client describes the picture as a relic that can prevent or positively influence life's problems, and that St. Francis is known for healing animals and people. She believes that placing the picture in the dressings will help the wound to heal.

In considering the client's preference, the nurse considers the risk of harm. In this instance, the request may be unusual, but does not pose a threat to the client if the relic is cleansed appropriately and wrapped in gauze. The spiritual benefits of the relic to the client should be recognized.

TRUE OR FALSE. Culture is individual.

Individual assessments are necessary to identify relevant cultural factors within the context of each situation for each client.

________________ can be essential in situations in which a language barrier exists between the nurse and the client

Interpreters

Nurses may administer the flu vaccine to their colleagues if the employer approves this practice and provides the necessary supports to meet the standards of practice. What should they remember when doing so?

It is important to recognize that by administering the vaccine, the nurse is establishing a nurse-client relationship with the colleague and must keep any information obtained in the course of providing the treatment confidential.

___________ _____________ means all possible alternative interventions are exhausted before deciding to use a restraint.

Least restraint

DEFINITION microscopic organisms such as bacteria, virus or fungus, commonly known as germs, that can cause an infection in humans.

MICRO-ORGANISM

The Health Care Consent Act (HCCA) ______________ adjustments to a treatment plan for an incapable client can be made without having to seek repeated consent from a substitute decision- maker.

Minor

WHAT KIND OF ABUSIVE BEHAVIOUR? ■ non-therapeutic confining or isolation; ■ denying care; ■ non-therapeutic denying of privileges; ■ ignoring; ■ withholding clothing, food, fluid, needed aids or equipment, medication, and/or communication.

NEGLECT

DEFINITION infection acquired in a health care setting.

NOSOCOMIAL INFECTION

DEFINITION therapeutic relationship that enables the client to attain, maintain or regain optimal function by promoting the client's health through assessing, providing care for and treating the client's health conditions.

NURSING

Which legislation contains a scope of practice statement that describes in a general way what the profession does and the methods that it uses?

NURSING ACT

DEFINITION Expectations that contribute to public protection that inform nurses of their accountabilities and the public of what to expect of nurses. These apply to all nurses regardless of their role, job description or area of practice.

NURSING STANDARDS

A man who received severe facial injuries in a motor vehicle crash arrives in your emergency room (ER). He is unable to communicate. No next of kin has come with him. A woman calls in distress and asks if her husband is a patient in your ER. She provides you with details that match the information on the man's identification. You believe she is the wife of the man with the facial injuries. Can you tell this woman that he is in the ER?

Normally, a client would have an opportunity to request that the hospital not disclose that he is a client in the facility or his location within the facility. This information may be given out in this case, however, because it is reasonably necessary to provide care. Because the law permits disclosure that a person is a client in a facility, and his/her location and general health status, you may provide this information to the woman. PHIPA allows you to contact a friend or relative of an injured client for consent. You may provide more information if the woman indicates she is the person who can act as a substitute decision-maker for consent to treatment.

DEFINITION a prescription for a procedure, treatment, drug or intervention

ORDER

MEDICATION TERMS Medications and preparations that do not require a prescription; for example, herbal therapies and acetaminophen.

OVER THE COUNTER (OTC)

___________ restraints limit a client's movement. These restraints include a table fixed to a chair or a bed rail that cannot be opened by the client.

Physical

DEFINITION A legal document in which a capable person gives someone else the authority to make decisions about his/her personal care in the event that he/she becomes incapable. The document could also contain specific instructions about particular treatment decisions.

Power of attorney for personal care

A 35-year-old client is diagnosed with chronic renal failure and has started peritoneal dialysis. Maintaining adequate protein intake is an essential part of the client's ongoing treatment, and animal protein is the recommended source. The client is a Hindu by religion and has been eating eggs, chicken and goat all his life. However, since the commencement of dialysis, he has stopped eating these foods and has become a vegetarian. He tells the health care team that he wants to become a good Hindu so that God will help him with his ordeal. He says that even though many Hindus eat meat, not eating meat is a more devout way of life and one he wishes to follow.

Recognizing that, at times of crisis, clients may revert to more traditional beliefs, the team needs to work with this client to determine the reason for his change in dietary practices. The goal is not to change his beliefs, but to increase the client's choices about how to achieve adequate protein intake. The team could involve a dietitian to teach ways to increase protein intake from vegetarian sources, such as cheese, lentils, nuts, beans and tofu. They also want to help the client explore his perceptions of what caused his illness and the role religion plays in his care. Involving a Hindu priest may be an effective way of addressing spiritual needs, and the priest may, in fact, be able to assist the client in resuming some intake of animal protein, if he chooses to do so. Regardless of approach, the ultimate decisions about diet remain with the client.

The client is a woman who has developed a very good relationship with the nurse in the community health clinic. On a visit, she asks the nurse how to arrange for the excision of female genitalia for a member of her community.

Regardless of her personal feelings about female genital excision, the nurse needs to understand the meaning of this custom for the client, which is linked to values about family purity and family honour. The nurse, however, also knows that the practice is illegal in Canada. The nurse needs to inform the client, in a nonjudgmental manner, of the potential risks and harm associated with the practice and of the legal implications. By exploring the custom and providing education and support to the woman, the nurse has a better chance of preventing a practice that carries considerable risk of harm.

WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sexually demeaning, seductive, suggestive, exploitative, derogatory or humiliating behaviour, comments or language toward a client; ■ touching of a sexual nature or touching that may be perceived by the client or others to be sexual; College of Nurses of Ontario Practice Standard: Therapeutic Nurse-Client Relationship, Revised 2006 ■ sexual intercourse or other forms of sexual contact with a client; ■ sexual relationships with a client's significant other; and ■ non-physical sexual activity such as viewing pornographic websites with a client.

SEXUAL

DEFINITION may include, but is not limited to, the person who a client identifies as the most important in his/her life.

SIGNIFICANT OTHER

DEFINITION Two persons who are married to each other, or who are living in a conjugal relationship and have cohabited for at least a year, or who are the parents of a child or who have a cohabitation agreement under the Family Law Act.

SPOUSE

DEFINITION A person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision. Usually a spouse, partner or relative.

SUBSTITUTE DECISION-MAKER

WHICH COMPETENCY STATEMENT? Demonstrates an understanding of professional self-regulation by developing and enhancing one's competence, ensuring consistently safe practice, and ensuring and maintaining one's fitness to practise.

Self-Regulation

WHICH COMPETENCY STATEMENT? Demonstrates an understanding of the concept of public protection and the duty to practise nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public.

Service to the Public

5 Steps to obtaining consent

Step 1 Assess capacity. Step 2 Provide emergency treatment or crisis admission. Step 3 Inform the client that a substitute decision-maker will make decision. Step 4 Identify a substitute decision-maker. Step 5 Obtain consent from the substitute decision-maker.

________________ involves the monitoring and directing of specific activities of UCPs. It does not include ongoing managerial responsibilities. Often, the person who assigns a task also _______________ the performance of that task. This can be direct or indirect, depending on the circumstances. For direct, the supervisor is physically present during the provision of care. For indirect, the supervisor is not physically present but monitors activities by having the UCP report regularly to the supervisor, or by periodically observing the UCP's activities.

Supervising supervises

A nurse is asked to teach a 60-year-old woman of Chinese descent how to perform self-continuous ambulatory peritoneal dialysis. The woman has no family, speaks only Mandarin and lives in a Chinese housing environment. The visiting nurse identifies the language barrier and creates a care plan with the goal of promoting communication. The client identifies her next-door neighbour as an interpreter she would be comfortable with. The nurse asks the neighbour if she is willing to help in this role. The neighbour agrees, and the nurse reviews with the neighbour the need to maintain client confidentiality. A written list of visit dates and times is given to the neighbour, who agrees to be available for scheduled nursing visits. The care plan indicates that the nurse will knock at the neighbour's door at the start of each visit, the neighbour will accompany the nurse to the client's apartment, and the nurse will use the interpreter to promote communication throughout the visit.

The care planning demonstrates a thoughtful process, responsive to the client's needs. There is evidence of the nurse consulting with the client and supporting the client's choice of an interpreter. The nurse stresses confidentiality and respects the neighbour's schedule by providing a list of planned visits.

You are a visiting nurse providing palliative care. Your client has been told by the health care team that there are no more "curative" treatment options available to him, and the plan of treatment is to provide comfort and support. The client is having great difficulty accepting this. He has heard about an unconventional treatment involving IV infusion of ozone and is asking you to provide this treatment. What should you do?

The client is asking you to participate in an unconventional treatment. You have an obligation to explore with the client his understanding of the treatment and his reason for choosing it. It is important to seek guidance from your agency and colleagues, and as much information about the treatment as possible. If you are unable to obtain adequate information about this treatment to assess the risk and recognize that there may be a significant risk, you would determine that it is not appropriate to get involved in this treatment. You would then explain your decision to the client.

Your client has reviewed his health record. You answered his questions to ensure he understood the record, but he wants corrections made to a consulting physician's note. What do you do?

The issue is correcting a health record made by another health care professional. If the client requested a correction to your note, and you agreed with the correction the client requested, you could have the client write a correction and include it with the record or make the changes yourself. If you did not agree with the correction the client requested, then you can have the client make a note and append it to the record. You can then make a separate note regarding the client's request in the health record. A client does not have the right to correct an opinion or professional judgment by a health care professional. Because this is a note by another health care professional (the consulting physician), you cannot be certain about the accuracy of the information that the client wants corrected. You have two options in this case: you can either contact the health care professional who wrote the note and have this physician speak with the client about the corrections; or you can speak with the person responsible for ensuring compliance with PHIPA in your practice setting.

A nurse is providing direct care to an elderly woman newly diagnosed with angina. She has been prescribed nitroglycerine to manage her angina attacks. The client reveals to the nurse her firm belief that her illness is caused by the "evil eye," a glance cast upon her by another to cause this condition. She shows the nurse her own remedy, which she claims will lift the curse of the evil eye and cure her.

The nurse assesses the client's remedy for possible health risks, such as a high sodium content. As well, the nurse negotiates with the client to take the nitroglycerine. In doing so, the nurse will need to be vigilant to potential objections the client may have to taking the medication. The goal is to have a plan of care that includes the remedy for the evil eye, but also includes the appropriate use of the nitroglycerine. The nurse and the client may not fully understand each other's preferences, but are willing to accommodate both interventions.

A nurse, working as a community case manager, visited the home of a toddler with severe physical and developmental delays. She explained to the parents that with their consent she would refer the child to a physiotherapy and occupational therapy program that would help the child be more independent. The parents refused, saying that it was their duty to care for their child because the child's condition is punishment for having conceived before they were married. They were not supportive of a program to increase independence. The nurse was upset and felt the parents were not acting in the child's best interests.

The nurse did not understand the family's initial refusal of treatment. After reflection and discussion with colleagues, she realized that her personal and professional values of independence were causing her to feel upset with the parents' refusal. She decided to explore with the family their goals for their child. In doing this, she learned that the parents wanted their child to become stronger and have fewer infections. When the same therapies were described as a means of meeting these goals, the parents were quite willing to participate. The program was developed to meet the goals that the family identified as important.

A woman, 35, is admitted to the general medical unit. While in the hospital, she expresses concern about her partner's ability to care for her children. She also appears worried about how she will manage at home after she is discharged. The nurse suggests that perhaps a family meeting is necessary and offers to contact her husband. The nurse further suggests that maybe the client's mother, who has called often to inquire about her daughter, should be involved in the meeting.

The nurse has made an assumption that the client's partner is male and that the relationship with the mother is one that will be supportive to the entire family. For many couples in a homosexual relationship, the issue of family can be sensitive. For some people, "family" is often their chosen family as opposed to kin. By using the word "partner," and asking the client who would be appropriate for a family meeting, the nurse shows openness and a nonjudgmental attitude.

WHICH MODE OF TRANSMISSION? insects may harbour an infectious agent and transfer it to humans through bites (for example, West Nile virus).

VECTORBORNE

WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sarcasm; ■ retaliation or revenge; ■ intimidation, including threatening gestures/ actions; ■ teasing or taunting; ■ insensitivity to the client's preferences; ■ swearing; ■ cultural/racial slurs; and ■ an inappropriate tone of voice, such as one expressing impatience.

VERBAL AND EMOTIONAL

DEFINITION An order that is communicated by an authorizer who is present in the practice environment but is unable to document the order.

VERBAL ORDER

A client from a First Nations community requests that a sweetgrass ceremony be performed in the hospital as part of the treatment. The ceremony involves chanting and burning some substances, which will result in small amounts of smoke (similar to that of burning an incense stick). The nurse's initial reaction is that something like this has never been done, and that it is against hospital policy. However, she also understands the significance of this ritual for the client. The nurse raises the issue with the unit administration and, with the support of colleagues, explores the potential impact on other clients. The nurse also reviews relevant fire policies and consults with appropriate staff in other departments. It is determined that any risk to other clients can be removed by transferring the client to a private room. This is done, and the ceremony is performed.

The nurse's commitment to client-centred care prompts her to explore ways of meeting the client's needs within the limits of the hospital setting. Lack of experience and fear are two of the most common barriers to providing culturally sensitive care. Through collaboration with other colleagues, the nurse is able to address the assumption that it cannot be done and to determine ways of meeting client needs without exposing other clients to discomfort or risk. The nurse succeeds in meeting the needs of her client, not only because of her creativity, but because she takes responsibility for influencing policies and procedures in the practice setting.

WHAT MUST A NURSE POSSESS BEFORE ACCEPTING A TELEPHONE ORDER

The person accepting the order must have knowledge of the client, including his or her health history and treatment plan.

You are an OHN. The manager of an employee who is your client has asked questions about the client's health condition. The manager has also asked if the client has medical notes to substantiate absences on particular dates. Can you provide this information to the manager?

There are two issues here. The first is what is included in the definition of personal health information; the second is if a manager has access to personal health information. Medical notes to substantiate the employee's absences may be held in an employee's health file. If the medical note does not contain other personal health information (e.g., symptoms, treatment, diagnosis), then this information can be provided to the manager. Information concerning accommodation for the employee's needs may be given so the employer can make provisions to meet these needs. Accommodation information does not include the nature of the illness or the diagnosis. If there is personal health information included in the note, then the OHN can only provide the information that there were notes to substantiate the absences on the applicable dates. The manager is not entitled to any personal health information. This includes information about the nature of the illness, the diagnosis, the plan of treatment or any care provided; therefore, you cannot respond to any questions about the nature of the illness(es) or health condition(s). In this example, the nurse is the custodian and is responsible for maintaining the confidentiality of the client's personal health information. Providing information to the employer without the client's express consent is a breach of PHIPA. However, if a client would like personal health information to be given to the employer, then the client must give express consent to the nurse. In obtaining express consent, the nurse needs to clarify exactly which information the client is requesting be disclosed, and obtain written express consent that includes the employee's specific request.

TRUE OR FALSE. Reactions to cultural differences require a lot of thought and reflection.

They are automatic, and often subconscious and influence the dynamics of the nurse-client relationship.

A couple comes to a walk-in clinic with a young child who is crying and tugging at his ears. The couple has recently come to Canada, but understands English well enough that the nurse feels language is not an issue. An assessment reveals that the child has an infection in both ears, and the couple is given a prescription for an antibiotic and Tylenol drops for fever and pain. The situation is fairly routine, and an interpreter is not considered necessary. The parents are informed about the diagnosis and treatment, and they nod in understanding. The next day the couple returns with the child whose condition seems to have worsened. There is now pink discharge from both ears, and the entire family is in distress. An interpreter is called to assist. Through the interpreter, the nurse learns that the parents had the prescription filled promptly, and they understood the child was to be given the medicine every four hours. They had been administering the antibiotic orally, but since they had treated previous ear infections with ear drops, they had administered the Tylenol drops in the child's ears.

This example illustrates the importance of confirming that accurate communication has been achieved. To reduce the chance of confusion, the nurse could have demonstrated how to measure, and then administer, both medications. Culturally appropriate client education materials would also have been helpful.

Jody, a three-year-old, is intubated post-operatively on a ventilator following brain surgery. To prevent her from pulling out the endotracheal tube, her hands are restrained with mittens. Prior to the surgery, the need to use the mittens was explained to her parents and consent was obtained.

This is an appropriate use of restraints that will be discontinued as soon as possible. To avoid frightening the child, the nurse arranged for the family to reassure Jody during the post-operative period. As well, using language Jody could understand, the nurse explained to her why she had to wear mittens. There are circumstances in which a nurse may need to restrain clients when they are not capable of understanding the necessity for the intervention. The nurse needs to consider these situations carefully and use the least restraint possible.

___________ is critical in the nurse-client relationship because the client is in a vulnerable position.

Trust

WHAT SHOULD A NURSE DO IF THEY DISCOVER THAT A CLIENT'S WISHES CONFLICT WITH THEIR OWN PERSONAL VALUES?

When a client's wish conflicts with a nurse's personal values, and the nurse believes that she/he cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation. If no other caregiver can be arranged, the nurse must provide the immediate care required. If no other solution can be found, the nurse may have to leave a particular place of employment to adhere to her/his personal values.

Who is responsible for ensuring client safety when learners participate in providing client care?

a nurse supporting the learner is responsible for ensuring client safety while facilitating a positive learning experience.

A woman arrives at a walk-in clinic with her nine- year-old son. She does not speak English, but the child is available to interpret for his mother. The client is clutching her abdomen and showing what appears to be visible signs of pain. The child says he is very worried about his mother.

While it is often convenient to rely on children to interpret for their parents, it is important for the nurse to be sensitive to the needs of the parent and the child. If no other interpreter is readily available, the nurse will have to work with the child to do the initial assessment and determine the severity of the situation. The woman and the son may feel uncomfortable talking about health issues such as vaginal discharge, menstruation and pregnancy, thus compromising the accuracy of the health history. An adult, preferably female, interpreter should be sought with urgency to ensure a thorough and comprehensive history. The nurse also needs to address the child's concerns and fears appropriately, as well as the stress associated with having to interpret for his mother. When using family members as interpreters, the nurse must carefully evaluate each situation on an ongoing basis.

You have completed Levels 1 and 2 of a therapeutic touch program. In the acute care setting where you work, you have identified some clients you think could really benefit from this intervention. Is it acceptable for you to suggest it to them?

You may propose to a client the use of therapeutic touch if you have the knowledge to believe that the treatment would benefit the client, and therapeutic touch has been recognized by the acute care agency as an appropriate intervention. If the agency has not determined the appropriateness of this intervention, then you may advocate to have it recognized.

In the long-term care setting where you work, some of the residents are prescribed herbal remedies by a physician who practises Chinese medicine. What are you accountable for in administering these substances?

You must balance client choice with professional responsibility. At a minimum, you would need information about the purpose, action and anticipated effects of the substance to fulfil your professional responsibility to assess the risks and benefits of providing this treatment in relation to the health status of the client. You would also be responsible for evaluating the effects of the treatment. If you had access to sufficient information to meet this expectation, then you may agree to provide this treatment. One way to achieve this would be to arrange for a team conference with the physician to develop a plan of care related to the administration of the prescribed herbal substances.

Conflict between a nurse and a client can escalate if a client has:

a) a history of aggressive or violent behaviour, or is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance); b) a medical or psychiatric condition that causes impaired judgment or an altered cognitive status; c) an active drug or alcohol dependency or addiction; d) difficulty communicating (for example, has aphasia or a language barrier exists); and/or e) ineffective coping skills or an inadequate support network.

Conflict between a nurse and a client can escalate if a client is:

a) intoxicated or withdrawing from a substance- induced state; b) being constrained (for example, not being permitted to smoke) or restrained (for example, with a physical or chemical restraint); c) fatigued or overstimulated; and/or d) tense, anxious, worried, confused, disoriented or afraid.

Conflict between a nurse and a client can escalate if a nurse:

a) judges, labels or misunderstands a client; b) uses a threatening tone of voice or body language (for example, speaks loudly or stands too close); c) has expectations based on incorrect perceptions of cultural or other differences; d) does not listen to, understand or respect a client's values, opinions, needs and ethnocultural beliefs;12 e) does not listen to the concerns of the family and significant others, and/or act on those concerns when it is appropriate and consistent with the client's wishes; f) does not provide sufficient health information to satisfy the client or the client's family; and/or g) does not reflect on the impact of her/his behaviour and values on the client.

Nurses who obtain consent have a professional ___________________ to be satisfied that the client is capable of giving consent

accountability

Nurses can prevent the escalation of conflict by: __________________ the feelings behind the client's behaviour;

acknowledge

Nurses can prevent the escalation of conflict by: engage in ____________ _____________ (for example, use verbal and nonverbal cues to acknowledge what is being said);

active listening

A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 2 The nurse has the _________________ knowledge, skill and judgment to teach the procedure.

additional

The nurse uses professional judgment to determine the scope of ______________ ______________ to assist the client in exercising his/her options. The nurse documents her/his actions according to CNO's Documentation, Revised 2008 practice standard and agency policy.

advocacy services

Nurses need to __________________ for clients' access to information about care and treatment if it is not ___________________ from other care providers.

advocate forthcoming

Nurses communicate the goals of care and treatment by: _______________ for the creation or modification of practice-setting policies and procedures to support client choices during treatment and end- of-life care, based on College documents.

advocating

Nurses implement a client's treatment and end-of- life care wishes by: ___________________ for the creation or modification of practice-setting policies and procedures on the implementation of clients' treatment and end-of- life care wishes that are consistent with College documents.

advocating

STANDARD STATEMENTS Nurses must consider each situation to determine if the performance of the procedure promotes safe client care, and if it is ______________ for a nurse to perform the procedure.

appropriate

Nurses communicate the goals of care and treatment by: _________________ whether the client has sufficient and relevant information to make an ________________ decision about treatment and end-of-life care, including ____________________;

assessing informed resuscitation

The nurse is responsible for ________________ and _______________ appropriately to the client's cultural expectations and needs.

assessing responding

The entry-level RPN is accountable for: All decisions about _____________ _________ to other care providers

assigning care

STANDARD STATEMENTS Nurses ensure that they have the appropriate _______________ before performing procedures.

authority

The Health Care Consent Act (HCCA) One health care practitioner can propose a plan of treatment and obtain consent to the plan on _____________ of all the health care practitioners involved in the plan.

behalf

To manage conflict, a nurse can: focus on the client's _________________ rather than the client personally;

behaviour

A nurse's culture is influenced by personal ______________ as well as by nursing's professional ______________. The _____________ of the nursing profession are upheld by all nurses.

beliefs values values

Nurses can prevent the escalation of conflict by: use open ___________ ______________ to display a calm, respectful and attentive attitude;

body language

Nurses are responsible for effectively establishing and maintaining the limits or ______________ in the therapeutic nurse-client relationship.

boundaries

The Health Care Consent Act (HCCA) The HCCA deals separately with consent to treatment, consent to a care facility and consent to a personal assistance service. In all cases, consent must be given by a _______________ person

capable

Treatment in an emergency can be provided immediately if the person is _____________ of giving consent and provides the consent.

capable

The Health Care Consent Act (HCCA) Consent to treatment, and assessing the capacity to consent to treatment, must relate to a specific treatment or plan of treatment. A person could be _____________ of giving consent to one treatment, but ________________ with respect to another.

capable incapable

The Substitute Decisions Act (SDA) Only trained _____________ _______________ may determine capacity for the purpose of the SDA (i.e., the capacity to make decisions on an ongoing basis). The HCCA requires assessment of capacity to make decisions about a specific treatment.

capacity assessors

The entry-level RPN is accountable for: All client __________ she or he provides.

care

Nurses implement a client's treatment and end-of- life care wishes by: deciding, if necessary, the ________________ of health care provider that will pronounce the death;

category

The Health Care Consent Act (HCCA) Consent to treatment involves an ongoing process that can ________________ at any time.

change

Also, nurses are professionally accountable for acting as _____________ ______________ and for helping clients __________________ the information relevant to making decisions to the extent permitted by the client's capacity.

client advocates understand

COMPETENCY ASSUMPTIONS Entry-level RPNs' practice decisions are _________-___________ and must take into account the environment, the client's circumstances and whether the client's needs can be met by the entry-level RPN.

client-specific

COMPETENCY ASSUMPTIONS Entry-level RPNs are beginning practitioners whose level of autonomy and proficiency will grow through ______________ and ______________ from the interprofessional health care team.

collaboration support

Nurses use a wide range of effective _____________ _____________ and _____________ __________ to appropriately establish, maintain, re-establish and terminate the nurse-client relationship.

communication strategies interpersonal skills

Nurses communicate the goals of care and treatment by: identifying and using appropriate _______________ ______________ when discussing treatment and end-of-life issues with the client;

communication techniques

The entry-level RPN is accountable for: Knowing and recognizing her or his _______________ __________ (knowledge, skill and judgment) when making decisions and providing care to clients.

competence level

A nurse cannot assume that a UCP is _________________ to perform any procedure, regardless of how straightforward the procedure appears.

competent

STANDARD STATEMENTS Nurses ensure that they are ________________ in both the cognitive and technical aspects of a procedure prior to performing it.

competent

A nurse who teaches, assigns duties to or supervises UCPs must: know the UCP is _______________ to perform the particular procedure or activity safely for the client in the given circumstances. When ________________ a UCP, a nurse is expected to have first-hand knowledge of the UCP's competence. A nurse who assigns or supervises is expected to ___________ that the UCP's competence has been determined.

competent teaching verify

Nurses can prevent the escalation of conflict by: acknowledge the client's _______________ about the health care system and his/her experiences as a client;

concerns

Nurses can prevent the escalation of conflict by: anticipate _______________ in situations in which it has previously existed and create a plan of care to prevent its escalation

conflict

An examination or diagnostic procedure that is a treatment may be conducted without ____________ if it is reasonably necessary to determine if there is an emergency.

consent

Clients differ in their ___________________ of health, well-being and quality of life, as well as their ______________ for treatment and who they consider appropriate providers of care.

definitions goals

A UCP only has the authority to perform a controlled act through an exception or when an individual who has the authority to order or perform the act ________________ this authority to the UCP.

delegates

Poor relationships among members of the health care team negatively affect the ___________ ____ ___________.

delivery of care

The Substitute Decisions Act (SDA) An individual may _______________ a specific person to make decisions about his/her personal care or treatment in the event that he/she becomes _______________. The person may also express his/her wishes about the kinds of decisions to be made or factors to ______________ decisions.

designate incapable guide

A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 4 The nurse has _______________ that the UCP has acquired, through teaching and supervision of practice, the knowledge, skill and judgment to perform the procedure.

determined

Nurses communicate the goals of care and treatment by: helping and being involved in client and family _________________ about treatment and/or end-of-life care;

discussions

Nurses implement a client's treatment and end-of- life care wishes by: __________________ in a written plan of treatment all information that is relevant to the implementation of the client's wishes for treatment at end of life;

documenting

Nurses communicate the goals of care and treatment by: identifying the client's wishes about preferred treatment and/or end-of-life care as ___________ as ________________, while considering the client's condition and the degree to which the therapeutic nurse-client relationship has been established;

early as possible

RN OR RPN? - care needs well defined and established - health condition well controlled - ittle fluctuation in health condition over time

either RN/RPN

Consent is required for any treatment except treatment provided in certain ______________ _____________.

emergency situations

To manage conflict, a nurse can: remain calm and ______________ the client to express his/her concerns;

encourage

A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 6 Considering the factors in Requirements 3 and 4, the nurse ________________ the continuing competence of the UCP to perform the procedure or reasonably believes that a mechanism is in place to determine the UCP's continuing competence.

evaluates

The Health Care Consent Act (HCCA) An ___________________ determines client capacity to make a decision about admission to a care facility or a personal assistance service. Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) may be _________________.

evaluator evaluators

Regardless of whether consent has been obtained by the nurse, nurses should always _____________ to the client the treatment or procedure they are performing.

explain

Nurses communicate the goals of care and treatment by: ________________ the client's wishes to all members of the interprofessional care team;

explaining

If there is an indication that the client is uncomfortable with the finding of incapacity when the finding was made by another health care practitioner, then the nurse _______________ and ________________ the nature of the client's discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the health care practitioner who made the _________________ of incapacity and discusses appropriate _____________-_____.

explores clarifies finding follow-up

If there is an indication that the client is uncomfortable with this information, then the nurse ________________ and _________________ the nature of the client's discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the client of his/her _______________ to apply to the CCB for a review of the finding of incapacity, and/ or for the ________________ of a representative of the client's choice.

explores clarifies options appointment

The Health Care Consent Act (HCCA) A _______________ ________________ acting as a substitute decision- maker is not required to make a formal statement verifying his/her status. The legislation does contain a __________________ of substitute decision-makers.

family member hierarchy

Nurses implement a client's treatment and end-of- life care wishes by: __________________ the client's wish for no resuscitation even in the absence of a physician's written do-not-resuscitate (DNR) order;

following

Nurses communicate the goals of care and treatment by: providing an opportunity to discuss, identify and review the client's end-of-life care ________________;

wishes

The Health Care Consent Act (HCCA) A person's ________________ about treatment, admissions or personal assistance services may be expressed _____________, in ______________, in any other form, or they may be _______________.

wishes orally writing implied

To manage conflict, a nurse can: protect themselves and other clients in abusive situations by ______________ services, if necessary

withdrawing

Consent can be __________________ at any time.

withdrawn

Informed consent does not always need to be ______________, but can be oral or implied.

written

Steps a nurse should take if they are concerned with the plan of care.

■ assess the situation, consult with the client (as appropriate), nursing colleagues and other experts (for example, other health care professionals) and refer to relevant reference material; ■ inform the responsible health care provider of the concern and support the concern; ■ discuss the concern with the immediate manager (if the concern remains unresolved); ■ contact the responsible health care provider for further discussion (if the immediate nursing manager shares the concern); ■ refer to agency policy to identify how to bring the concern to the attention of a higher medical or other authority in the facility (if the health care provider doesn't consider alternatives to the original treatment plan); ■ decide whether to report the concern to a higher management authority (if the immediate manager does not share the concern and cannot provide information that will eliminate the concern); ■ continue to report to higher authorities in the facility until convinced of the appropriateness of the treatment or until the treatment is changed; ■ inform the health care provider of the decision and the action taken to date (if the decision is to refuse to implement the treatment plan); and ■ document in the client's record the concern and the steps taken that directly relate to client care. If necessary, refer to agency policy for the appropriate format to document information not directly related to client care.

Nurses implement a client's treatment and end-of- life care wishes by: engaging in the following when a client's death is expected or unexpected:

■ identifying whom to notify when the client dies; ■ identifying the most appropriate category of health care provider to notify the family; ■ identifying the client's and family's cultural and religious beliefs and values about death, and management of the body after death;24 ■ identifying whether the family wants to see the body after death; and ■ documenting according to policies and procedures;

Before administering a vaccination to a client, colleague or family member, a nurse must consider four issues:

■ if informed consent has been obtained; ■ if a prescription/medical directive is in place; ■ if she or he is competent to deliver and manage the vaccine; and ■ how the administration will be documented.

Nurses communicate the goals of care and treatment by: contributing to ongoing communication about end-of-life care wishes and implementing the client's wishes by:

■ reviewing the client's plan of treatment including resuscitation wishes as needed or when required by organizational policy. (For example, in long-term care settings, the review could be part of the regular client health review); ■ documenting the relevant information; and ■ communicating any changes in client's wishes to the interprofessional team and ensuring the wishes are included in the plan of treatment;

Nurses implement a client's treatment and end-of- life care wishes by: not initiating treatment that is not in the plan of treatment, except in emergency situations, when:

■ the client has not given informed consent, and/or the plan of treatment does not address receiving the treatment; ■ the incapable client's wish is not known, and the substitute decision-maker has indicated that he or she does not want the client to receive the treatment; ■ the attending physician has informed the client that the treatment will be of no benefit and is not part of the plan of treatment that the client has agreed to. In this situation, the nurse is not expected to perform life-sustaining treatment (for example, resuscitation), even if the client or substitute decision-maker requests it; or ■ the client exhibits obvious signs of death, such as the absence of vital signs plus rigor mortis and tissue decay;

Nurses implement a client's treatment and end-of- life care wishes by: acting on behalf of the client to help clarify the plans for treatment when:

■ the client's condition has changed and it may be necessary to modify a previous decision; ■ the nurse is concerned the client may not have been informed of all elements in the plan of treatment, including the provision or withholding of treatment;21 ■ the nurse disagrees with the physician's plan of treatment;22 and ■ the client's family disagrees with the client's expressed treatment wishes;23

Nurses communicate the goals of care and treatment by: knowing the end-of-life care wishes of the client or obtaining that knowledge from:

■ the client's direct instructions (which include non-verbal means); ■ the client's advance directive (such as a living will or power of attorney for personal care); ■ the substitute decision-maker's instructions, if the client is incapable; or ■ documented instructions from another member of the health care team;

Nurses implement a client's treatment and end-of- life care wishes by: initiating treatment when:

■ the client's wish for treatment is known through a plan of treatment and informed consent; ■ the client's wish is not known, but a substitute decision-maker has provided informed consent for treatment; or ■ it is an emergency situation, there is no information about the client's wish, and a substitute decision-maker is not immediately available;