Leadership CMS Study Guide Part 3: Professional Responsibilities
confidentiality
the duty of the nurse to protect a client's private information. can be breached by inappropriate use of social media. depending on the circumstances, consequences, can include termination of employment, discipline by the board of nursing, charges of defamation or invasion of privacy, and even federal charges for violating HIPAA
witness
the nurse's role in the informed consent process is to ________ the client's signature on the form and to ensure that informed consent has been appropriately obtained
professional responsibilities
the obligations that nurses have to their clients. requires that nurses be knowledgeable in client rights, advocacy, informed consent, advance directives, confidentiality and information security, information technology, legal practice, disruptive behavior, and ethical practices
ethics committee
group of people with an institution that handles unusual or complex ethical issues
invasion of privacy, defamation, slander
nurses who disclose client info to an unauthorized person an be held liable for what?
caring, autonomy, respect, empowerment
what values are essential components of advocacy?
24 hours
within what time frame must the provider sign a verbal or telephone prescription after giving it?
the Joint Commission
accrediting body that helps develop and implement standards for nursing practice
quasi-intentional torts
acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character
state nurse practice acts
acts that govern nursing practice and help establish and enforce legal guidelines for nursing practice through a state board of nursing or other government agency. vary from state to state, so the nurse must be informed about their state's legal parameters of practice
sentinel event reporting
an unexpected occurrence involving death or serious or psychological injury, or the risk thereof; helps establish standards for nursing practice
ethical theory
analyzes varying philosophies, systems, ideas, and principles used to make judgments about what is right and wrong and good and bad
National Patient Safety Goals
augments core measures and promotes client safety through client identification, effective staff communication, safe medication use, infection prevention, safety risk identification, and preventing wrong-site surgery
DNR or AND (allow natural death) orders
written prescriptions by the healthcare provider that must be placed in the client's medical record in order to be honored. prior to administering these prescriptions, the provider consults the client and family.
competent adult
a person who can sign informed consent forms; a person who is capable of understanding the information provided by the healthcare professional who will be providing the service. must be able to fully communicate in return with the health care professional. includes emancipated minors.
unintentional torts
accidents or mistakes that are not planned or intended that result in harm to another. example: negligence, malpractice
circulatory, respiratory, brain stem
according to the Uniform Determination of Death Act, death is determined by one of two criteria. 1. irreversible cessation of _______ and _______ functions 2. irreversible cessation of all functions of the entire brain, including the ________.
privacy, confidentiality
clients have the right to _____ and _____ in relation to their health care info and medical recommendations
refusal of treatment
competent adults have this right, including a right to leave the healthcare facility without a prescription for discharge from the provider. if this occurs, client is asked to sign a document indicating that they understand the risk involved. if patient leaves the facility without a prescription for discharge, nurse must notify the HCP and discuss with the client the potential risks associated with leaving, including possible complications that could occur without treatment, possibility of permanent physical or mental impairment/disability, and possibility of other complications that could lead to death. nurse should then carefully document everything, and have the patient sign an AMA form
malpractice
failure of a person with professional training to act in a reasonable and prudent manner, which means actions that a person who has the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. issues that prompt these lawsuits can include failure to follow either professional or facility established standards of care, failure to use equipment in a responsible and knowledgeable manner, failure to communicate effectively and thoroughly with the client, and failure to document care that was provided
slander
defamation with the spoken word. example: a nurse tells a coworker that she believes a client has been unfaithful to the spouse
libel
defamation with the written word or photographs. example: nurse documents in a client's health record that a provider is incompetent
intentional torts
deliberate acts intended to cause harm. includes assault, battery, and false imprisonment
duty to provide care as defined by a standard
element necessary to prove negligence. care that should be given or what a reasonably prudent nurse would do
breach of duty (failure to meet standard)
element necessary to prove negligence; failure to give the standard of care that should have been given
breach of duty has potential to cause harm
element necessary to prove negligence; failure to meet the standard had potential to cause harm. the relationship must be provable
foreseeability of harm
element necessary to prove negligence; knowledge that failing to give the proper standard of care can cause harm to the client
harm occurs
element necessary to prove negligence; occurrence of actual harm to the client
healthcare facility policies and procedures
establish the standard of practice for employees of an institution and can be founded in a facility manual that provides detailed information about how the nurse should respond to or provide care in specific situations and while performing client care procedures. nurses who practice according to these guidelines are legally protected if that standard of care still results in an injury
standards of care (practice)
established or legal guidelines for care that nurses base their practice on, which can be found in the nurse practice act of each state, in published standards of nursing practice by professional organizations like the ANA and specialty organizations like the American Association of Critical Care Nurses, accrediting bodies like the Joint Commission, originally mandated quality assurance programs, sentinel event reporting, Failure Mode and Effects Analysis, National Patient Safety Goals, and health care facility policies and procedures. guide, define, and direct the level of care that should be given by practicing nurses and are also used in malpractice lawsuits to determine if that level was maintained.
beneficence
ethical principle; care that is in the best interest of the client
justice
ethical principle; fair treatment in matters related to physical and psychological care and use of resources
fidelity
ethical principle; keeping one's promise to the client about care that was offered
autonomy
ethical principle; the ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest
veracity
ethical principle; the nurse's duty to tell the truth
nonmaleficence
ethical principle; the nurse's obligation to avoid causing harm to the client
deontological theory
ethical theory. decision-making based on obligations, duty, and what one considers to be right or wrong.
utilitarianism (teleological theory)
ethical theory. decision-making based on what provides the greatest good for the greatest number of individuals
Failure Mode and Effects Analysis
examines all potential failures in a design, including event sequencing risks, vulnerabilities, and improvement areas. helps establish standards for nursing practice
ethics
expected behavior of a certain group in relation to what is considered right and wrong
Nurse Licensure Compact (NLC, mutual recognition model of nurse licensure)
has been adopted by many states to address issues related to the increase in the electronic practice of nursing. allows nurses who reside in a designated state to practice in another designated state. nurses must practice in accordance with the statutes and rules of the state in which the care is provided. state boards can prohibit a nurse form practicing under this if the license of the nurse has been restricted by a board of nursing.
state boards of nursing
have the authority to adopt rules and regulations that further regulate nursing practice. laws and rules governing nursing practice can be accessed at their website. have the authority to both issue and revoke a nursing license. can revoke or suspend a nurse's license for a number of offense including practicing without a valid license, substance use disorders, conviction of a felony, professional negligence, and providing care beyond the scope of practice. also set standards for nursing programs and further delineate the scope of practice for registered nurses, license practical nurses, and advanced practice nurses
controlled substances
health care providers who are found guilty of misappropriation of __________________ also can be charged with a criminal offense consistent with the infraction
American Hospital Association (AHA)
identifies client rights in health care settings in the Patient Care Partnership
state-based practice model
if a nurse doesn't reside in a nurse licensure compact state, they have to practice under this model. they must maintain a current license in every state in which they practice.
mandatory reporting
in certain situations, health care providers have a legal obligation to report their findings in accordance with state law. includes suspected abuse of children and vulnerable persons, and certain communicable diseases
disruptive behavior
includes incivility, lateral violence, and bullying. the perpetrator can be a provider or a nursing colleague. consequences include poor communication, which can negatively affect client safety and productivity, resulting in absenteeism, decreased job satisfaction, and staff turnover. if allowed to continue, while likely escalate and may come to be viewed as acceptable in the unit/department's culture
false imprisonment
intentional tort. a competent person not at risk for injury to self or others is confined or restrained against their will. example: using restraints on a competent client to prevent their leaving the health care facility
battery
intentional tort. intentional and wrongful physical contact with a person that involves an injury or offensive contact. example: restraining a client and administering an injection against their wishes
assault
intentional tort. the conduct of one person makes another person fearful and apprehensive. example: threatening to place an NG tube in a client who is refusing to eat
durable power of attorney for health care (health care proxy)
legal document that designates a health care surrogate, who is an individual authorized to make health care decisions for a client who is unable. the person should be very familiar with the client's wishes. adjunct to the living will. can be a more effective way of ensuring the client's decisions about health care are honored
living will
legal document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. often addresses types of treatments that have the capacity to prolong life such as CPR, mechanical ventilation, and artificial feeding. legal in all states, but state statutes and individual health care facility policies can vary. most state laws include provisions that health care providers who follow the health care directive in this document are protected from liability
client rights
legal guarantees that clients have with regard to their health care. clients retain their rights as individuals and citizens of the US. residents in nursing facilities that participate in Medicare programs also retain resident rights under statutes that govern the operation of these facilities. regardless of the client's age, nursing needs, or healthcare setting, each client has the right to be informed about all aspects of care and take an active role in the decision-making process, accept, refuse, or request modification to the plan of care, and receive care that is delivered by competent individuals who treat the client with respect.
informed consent
legal process by which a client has given written permission for a procedure or treatment to be performed. considered when the client has been provided with and understands the reason the treatment/procedure is needed, how the treatment/procedure benefits them, risks involved with the treatment/procedure, other options to treat the problem (including doing nothing), and risk involved if no treatment is chosen
torts
legal wrongs committed against a person. type of civil law that relates to the provision of nursing care. can be classified as unintentional, quasi-intentional, or intentional
Enhanced Nurse Licensure Compact (eNLC)
licensure model that was revised in 2017. aligned licensing standards (criminal history background checks) in an effort to bring more states into the compact. nurses have one multi-state license with the ability to practice in person or via tele-health in both their home state and other designated states
written consent
must be provided by the client for an invasive procedure or surgery
interpreter
needed when the person giving informed consent is unable to communicate due to a language barrier or hearing impairment
communicable diseases
nurses are mandated to report these to the proper agency (local/state health department) when a client is diagnosed according to the CDC. each state mandates which ones must be reported in that state. there are more than 60 that must be reported to public health departments to allow officials to ensure appropriate medical treatment of diseases, monitor for common-source outbreaks, plan and evaluate control and prevention plans, identify outbreaks and epidemics, determine public health priorities based on standards, and educate the community on prevention and treatment
privacy rule
part of HIPAA that requires that nurses protect all written and verbal communication about clients. only health care team members directly responsible for the client's care are allowed access to the client's records. nurses can't share info with other clients or staff not involved in the client's care. clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client request so read or have a copy of the record. no part of the client record can be copied except for authorized exchange of documents between health care institutions, such as during transfer from a hospital to an extended care facility or in the exchange of documents between a general practitioner and a specialist during a consult. client medical records must be kept in a secure area to prevent inappropriate access to information. using public display boards to list client names/diagnoses is not allowed. electronic records should be password-protected, and nurses must take care to prevent public viewing of the info. health care workers should only use their own passwords to access info. client info can't be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone. many hospitals use a code system in which information is only disclosed to individuals who can provide the code. communication about a client should only take place in a private setting where it can't be overheard by unauthorized people. walking rounds and taped rounds are discouraged
security and privacy rules
part of HIPAA that were enacted to protect the confidentiality of health care info and to give the client the right to control the release of information. provides specific rights such as the right to obtain a copy of your medical record and to submit requests to amend erroneous or incomplete info, the rights of clients to privacy and confidentiality, and includes a requirement for health care and insurance providers to provide written info about how medical information is used and how it is shared with other entities (permission must be obtained before information is shared)
e-health
part of informatics. clients can access their electronic health record. enables the client to make appointments online, review lab results, refill electronic prescriptions, and review billing info. goal of this is improved health outcomes due to 24 hour access by the client and provider to the client's health care info
ethical dilemmas
problems for which more than one choice can be made, and the choice is influenced by the values and beliefs of the decision-makers. common in health care and require application of ethical theory and decision-making. cannot be solved solely by a review of scientific data, involves conflict between two moral imperatives, and the answer will have a profound effect on the situation/client
information security
protecting an organization's information and information systems from unauthorized access, use, disclosure, disruption, modification, or destruction. protocols for nurses include logging off from the computer before leaving the workstation, never sharing a user ID or password with anyone, never leaving a client's chart or other printed/written protected health info where others can access it, and shredding any printed or written client info used for reporting or client care after it is no longer needed
peer assitance programs
provided by many health care facilities to help facilitate entry of employees with substance use disorders into a treatment program
social media
provides a mechanism for nurses to access current info about health care, enhances communication among nurses, colleagues, and clients and families, and provides an opportunity for nurses to express concerns and seek support from others. nurses must be cautious about the risk of intentional or inadvertent breaches of confidentiality
advance directives
purpose is to communicate a client's wishes regarding end-of-life care should the client become unable to do so. required by the Patient Self-Determination Act that all clients admitted to a health care facility be asked if they have them. if they don't, must be given written info that outlines their rights related to healthcare decisions and how to formulate these documents
defamation
quasi-intentional tort. false communication or communication with careless disregard for the truth with the intent to injure an individual's reputation. includes libel and slander
invasion of privacy
quasi-intentional tort. intrusion into a client's private affairs or a breach of confidentiality. example: the nurse releases the medical diagnosis of a family member to the press
advocacy
refers to nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. one of the most important roles of the nurse, especially when clients are unable to speak or act for themselves. nurses ensure that the client has the info needed to make decisions about health care. applies even when the nurse disagrees with the client's decisions. nurses also support and promote legislation that promotes public policies that protect clients as consumers and create a safe environment for their care. the nurse's role also includes mediating on the client's behalf when the actions of others are not in the client's best interest or changes need to be made in the plan of care
state laws
regulate the core of nursing practice. each one has statutes that define parameters of nursing practice and give the authority to regulate the practice of nursing to state boards of nursing
state laws
regulate who is able to give informed consent. vary regarding age limitations and emergencies
organ donation
regulated by federal and state laws. health care facilities have policies and procedures to guide health care workers involved with this process. can be stipulated in a will or designated on an official card. federal law requires health care facilities to provide access to trained specialists who make the request to client and/or family members and provide information regarding consent, what will be donated, and how burial/cremation will be affected. nurses are responsible for answering questions about the process and for providing emotional support to family members
consent
required for all care given in a health care facility
client
responsibilities regarding informed consent include giving informed consent. in order to do this, they must give it voluntarily without coercion, be competent and of legal age, or be an emancipated minor, and receive sufficient info to make a decision based on an informed understanding of what is expected
provider
responsibilities regarding informed consent include obtaining the informed consent by giving the client information about the procedure including: complete description of treatment/procedure, description of professionals who will be performing/participating in the treatment, description of potential harm, pain, and/or discomfort, options for other treatments and possible consequences of taking other actions, the right to refuse treatment, and the risk involved if the client chooses no treatment
nurse
responsibilities regarding informed consent include witnessing informed consent. they are responsible for ensuring the provider gave the patient the necessary info, ensuring the client understood the info and is competent, having the client sign the document, and notifying the provider if the client has more questions or does not understand any of the info provided. also responsible for documenting reinforcement of info originally given by the provider, questions the client had were forwarded to the provider, and the use of an interpreter
federal regulations
source of law that has a great impact on nursing practice. laws that affect nursing practice include HIPAA, the Americans with Disabilities Act, Mental Health Parity Act, Patient Self-Determination Act, Uniform Anatomical Gift Act, National Organ Transplant Act, and Emergency Medical Treatment and Active Labor Act
civil laws
source of law that protects the individual rights of people. includes tort law
criminal laws
source of law. subsection of public law that relates to the relationship of an individual with the government. violations can be categorized as either a felony (serious crime like homicide) or misdemeanor (less serious crime like petty theft). example: a nurse falsifies a record to cover up a serious mistake
ethical principles
standards of what is right or wrong with regard to important social values and norms
published standards of nursing practice
standards that are developed by professional and specialty organizations
Patient Self-Determination Act
stipulates that on admission to a health care facility, all clients must be informed of their right to accept or refuse care
ethical decision-making
the process by which a decision is made about an ethical issue. requires a balance between science and morality. steps: -identify whether the issue is an ethical dilemma -state the ethical dilemma, including all surrounding issues and individuals involved -list and analyze all possible options for resolving the dilemma, and review implications of each option -select the option that is in concern with the ethical principle applicable to this situation, the decision-maker's values and beliefs, and the profession's values set forth for client care. justify why that one option was selected -apply this decision to the dilemma and evaluate the outcomes
invasion of privacy
the release of client health information to others without the client's consent. one of the fundamental rights of client care. may result from the improper use of social media
informatics
the use of computers to systematically resolve issues in nursing. use of technology in health care is increasing (laptops for documentation, use of an automated medication dispensing system) and most forms of communication are in the electronic format. allows the nurse to access databases on diseases and medications and to use them as a teaching tool when educating clients. beneficial for clients with visual impairments. also allows nurses to review meds, diseases, procedures, and treatments using an electronic format
immediate supervisor (charge nurse)
to ensure client safety, at the time of the infraction in which a nurse suspects that a coworker is using alcohol or other substances while working, to whom should the nurse report the concern?
implied consent
type of consent that is adequate for most aspects of nursing care. provided by the client when they comply with the instructions provided by the nurse. example: nurse is preparing to administer a TB skin test, and the client holds out their arm for the nurse
incivility
type of disruptive behavior that is defined as an action that is rude, intimidating, or insulting. includes teasing, joking, dirty looks, and uninvited touching
bullying
type of disruptive behavior that is persistent and relentless and is aimed at an individual who has limited ability to defend themselves. occurs when the perpetrator is at a higher level than the victim, such as a nurse manager to a staff nurse. abuse of power makes the recipient feel threatened, disgraced, and vulnerable. example: a nurse manager demonstrates favoritism for another nurse by making unfair assignments or refusing a promotion
lateral violence (horizontal abuse/hostility)
type of disruptive behavior that occurs between individuals who are at the same level within the organization. example: a more experienced staff nurse can be abusive to a newly licensed nurse. common behaviors include verbal abuse, undermining activities, sabotage, gossip, withholding information, and ostracism
cyberbullying
type of disruptive behavior using the Internet or other electronic means
negligence
unintentional tort. practice or misconduct that does not meet expected standards of care and places the client at risk for injury. example: nurse fails to implement safety measures for a client who has been identified as at risk for falls
malpractice
unintentional tort. professional negligence. example: a nurse administers a large dose of medication due to a calculation error, and the client has a cardiac arrest and dies
Uniform Determination of Death Act (UDDA)
used to assist with end-of-life and organ donor ethical issues. provides two formal definitions of death that were developed by the National Conference of Commissioners on Uniform State Laws. a determination of death must be made in accordance with accepted medical standards
health information systems
used to manage administrative functions and clinical functions. clinical portion of the system is often referred to as the clinical information system and can be used to coordinate essential aspects of client care. in order to comply with HIPAA regulations, each health care facility has specific policies and procedures designed to monitor staff adherence, technical protocols, computer privacy, and data safety
Internet
valuable tool for clients to review current medications and health questions, especially for clients who have chronic illnesses. nurses should instruct clients to only review valid and credible websites by verifying the author, institution, credentials, and how current the article is.
morals
values and beliefs held by a person that guide behavior and decision-making
Good Samaritan laws
vary from state to state. protect nurses who provide emergency assistance outside of the employment location, but the nurse must provide a standard of care that is reasonable and prudent.
parents of a minor, legal guardian, court-specified representative, client's health care surrogate (health care proxy/durable power of attorney for health care), spouse or closest available relative (state laws vary)
what are some examples of individuals who are authorized to grant consent for another person?
end-of-life decisions, access to health care, protection of privacy, informed consent, substandard practice
what are some situations that may require nurses to advocate for clients or help them in advocating for themselves?
date and time, dosage, frequency, route, signature of nurse and provider
what are the necessary elements of a prescription that must be included when transcribing a phone or verbal order?
federal regulations, criminal/civil laws, state laws, licensure
what are the sources of law that govern nursing practice and conduct?
living will, durable power of attorney for health care
what are the two components of an advance directive?
document it in the record
what should the nurse do if the client refuses to sign an AMA form but wants to leave AMA?
risk-taking, vision, self-confidence, articulate communication, assertiveness
what skills are essential components of advocacy?