NR226- Funds: Patient Care- Week 2: Managing Patient Care

When admitting a client to an acute care facility (hospital), the nurse addresses safe keeping of the client's belongings. Place the actions in the order in which the nurse completes them, starting with the first.​ List the belongings in the electronic health record (EHR), with as much detail as possible for accuracy.​ Ask the client what belongings they brought with them.​ ​Note the disposition of items on the inventory within the EHR.​ Advise the client that all items of value should be sent home for safe keeping. Document that the client was informed of the valuables policy and elected to dispose of items as noted on the valuables inventory.​

- Ask the client what belongings they brought with them. - List the belongings in the electronic health record (EHR), with as much detail as possible for accuracy. - Advise the client that all items of value should be sent home for safe keeping. - Note the disposition of items on the inventory within the EHR - Document that the client was informed of the valuables policy and elected to dispose of items as noted on the valuables inventory. Most acute care facilities recommend clients to leave all valuables at home. At the time of admission, the nurse should ask about any valuables they have with them, note them in the EHR, review the facility policy, and encourage the individual to send items of great value home with a loved one. For each valuable, note if the item remains in the client's possession or is given to another person for safe keeping. In the narrative admission note, document that the valuables policy was reviewed with the client.​

Which factors increase the quality of clinical decisions made by the nurse? Select all that apply.​ Ability of the nurse to organize data Nurse's ability to quickly complete the admission assessment Client's ability to clearly communicate their needs Nurse's understanding of client's current situation Client's desire to keep health history private Nurse following up on cues within the assessment data Nurse's use of open-ended questions Nurse's knowledge of health and illness

- Nurse's understanding of client's current situation - Ability of the nurse to organize data - Nurse following up on cues within the assessment data - Client's ability to clearly communicate their needs - Nurse's knowledge of health and illness - Nurse's use of open-ended questions Factors that increase the quality of clinical decisions can be found in both the client and the nurse. It is important that the nurse understands health, wellness, and illness; gets to know their client's current health and life situations; uses open-ended questions and encourages the client to share their needs and hopes; recognizes cues, cue clusters, and follow up as needed; and is able to organize their thoughts and actions during and after completing the initial assessment.​ The client contributes to clinical decision-making by providing information relevant to their current state of health and their current challenges or needs related to health maintenance and improvement. Some aspects of the client's health may be difficult for them to share​, but it is essential for the nurse to know as much of the information as possible, in order to make good clinical decisions. Admission assessment should be completed thoroughly, as rushing through it may result in missing critical information that may impede proper clinical decision-making.

Match its corresponding principle of building an effective healthcare team.​ Responsibility Autonomy Authority Accountability The ownership of the act​ The power to act​ The choice to act​ The obligation to act​

-Accountability: The ownership of the act​ -Authority: The power to act​ -Autonomy: The choice to act​ -Responsibility: The obligation to act​ An important aspect of being a member of the healthcare team involves responsibility, autonomy, authority, and accountability, or RAAA for short. It is a balanced application of these four principles that builds the foundation for safe and effective healthcare. These same principles apply to personal and therapeutic relationships, as well.​ Responsibility is the obligation to act​. Autonomy is the choice to act​. Authority is the power to act​. Accountability is the ownership of the act.

Bill (pronouns: he/him/his), a college graduate in his mid-twenties, was brought to the emergency department (ED) by friends after experiencing chest pain that radiated to his neck and left arm. After initial assessment and testing that determined the pain was angina, rather than a myocardial infarction (MI), admission to the hospital for observation and further testing was recommended. Since he has no medical insurance, Bill refused to be admitted and promised to follow up at a nearby clinic for care. After reviewing the scenario above, place the nurse's responsibilities involved with Bill's refusal to provide care in order, starting with the first and ending with the last.​

-Maintain therapeutic communication.​ -Verify that the client is competent to make this decision.​ -Ask the client to share his understanding of the treatment plan recommended, other options presented, and the consequences of leaving without care.​ -Respect the client's final decision.​ -Obtain the client's signature on the proper form.​ -Remind the client that he can return for treatment if needed.​ -Assure the client has safe transport home.​ -Provide the client's clothing, help him dress if needed, and allow him to leave.​ After providing care to Bill, the nurse will have determined his capacity to make decisions regarding his care, and the nurse must provide the care that is required to discharge him with the information and resources he needs, maintaining a therapeutic relationship during the process. The nurse reviews the criteria prior to validating that he is aware of the recommended treatment, alternative options, and potential consequences of leaving care. The nurse respects his right to self-determination and obtains his signature validating his desire to refuse care. Discharge instructions should include when and where to seek care should his symptoms recur. Finally, verify that Bill has safe transport, provide his clothing and any belongings he brought with him, and escort him from the facility.​

Which aspects of nursing care should never be delegated to an unlicensed assistive personnel (UAP)?​ Select all that apply. Evaluation of client outcomes​ Transporting a client to a test​ Delivering flowers to a client​ Client assessment​ Nursing diagnosis Bathing a client on total bedrest​

-Nursing diagnosis -Client assessment​ -Evaluation of client outcomes​ Aside from implementation of select care activities, the nurse should not delegate the nursing process to the UAP. This includes assessing the client, selecting the nursing diagnosis, and evaluating the client's response to care. The nurse may consider the input of other colleagues when planning care and include interventions that are implemented by other members of the healthcare team.​ Bathing a client, transporting a client, and delivering flowers to a client are activities that can be delegated to the UAP based on their job description, knowledge, and experience. ​

A client who does not want to have their life prolonged by artificial means, including CPR, shares with the nurse that they are concerned their family will not accept their wishes. How does the nurse act as an advocate for this client? Select all that apply.​ Offers to arrange a conversation with the family and healthcare provider to discuss the plan of care.​ Assesses the client's belief, values, and desires for care.​ Documents conversation in the electronic health record (EHR).​ Provides the client with information about an advance directive.​ Asks client for a copy of their advance directive.​ Asks the nursing supervisor to talk with the client.​ Clarifies the laws concerning the client's right to refuse care.​

-Offers to arrange a conversation with the family and healthcare provider to discuss the plan of care.​ -Documents conversation in the electronic health record (EHR).​ -Assesses the client's belief, values, and desires for care.​ -Provides the client with information about an advance directive.​ -Asks client for a copy of their advance directive.​ Nurses strengthen their ability to advocate for a client when they are able to accurately identify the values of the client and articulate the client's point of view. That is taking a step further by offering to arrange a care planning conference involving family and the healthcare provider and documenting the conversation in the EHR. Although the presence of an advance directive should have been completed at the time of admission, asking the client if they have one and offering information if they do not is another way for the nurse to advocate while promoting autonomy.​ The nurse has established a therapeutic relationship with the client that the supervisor has not and is, therefore, the best person to have this discussion with the client. Finally, reviewing the law provides knowledge for the nurse, but does not advocate for the client.​

Which are the five rights of delegation? Select all that apply.​​ Right Documentation​ Right Direction/Communication​ Right Task​ Right Person​ Right Supervision/Evaluation​ Right Time​ Right Circumstances​

-Right Direction/Communication​ -Right Person​ -Right Circumstances​ -Right Supervision/Evaluation​ -Right Task​ The five rights of delegation include the task, circumstances, person, direction/communication, and supervision/evaluation. ​ The decision to delegate appropriately does not require specific documentation. The needs of the client are considered as part of the circumstances when the nurse makes the decision to delegate a task, as is the location where the delegated task will be completed and the time frame in which it should be done, if any. ​

For each situation, if the nurse's responsibility, autonomy, authority, and accountability are out of balance, indicate which factor(s) of RAAA may cause the unbalance. Note: More than one factor may be affected in a situation. If the nurse's RAAA is balanced, place a check in the "Balanced RAAA" column. 1. A nurse who works on a medical unit is assigned to work on a mental health unit.​ 2. A nurse who administered the wrong medication to a client fails to document or report the error.​ 3. The nurse asks an unlicensed assistive personnel (UAP) to ambulate a client.​ 4. A nurse accesses a neighbor's electronic health record (EHR) for someone who is not a caregiver but wants to find out what is wrong with the neighbor.​

1. ACCOUNTABILITY: A nurse who works on a medical unit is assigned to work on a mental health unit.​ 2. RESPONSIBILITY, ACCOUNTABILITY: A nurse who administered the wrong medication to a client fails to document or report the error.​ 3. BALANCED RAAA: The nurse asks an unlicensed assistive personnel (UAP) to ambulate a client.​ 4. AUTHORITY, ACCOUNTABILITY: A nurse accesses a neighbor's electronic health record (EHR) for someone who is not a caregiver but wants to find out what is wrong with the neighbor.​

It is 23:30 and the oncoming nurse is determining the priority order in which to see their clients. Place these clients in the order in which the nurse should see them, with first on top and last on the bottom. ​ Felipe, a 79-year-old man with mild shortness of breath and chronic emphysema whose O2 sat is 88% on 2L Anika, a 45-year-old woman admitted with angina during the evening who is now having back and shoulder pain ​Rich, a 58-year-old man who needs reinforcement of teaching for a cardiac catheterization scheduled in the morning and is unable to sleep Vida, a 75-year-old woman who had a left-hemisphere stroke 4 days ago and is sleeping

1. Anika 2. Felipe 3. Vida 4. Rich Knowing that the client may experience the pain of myocardial ischemia in their back, the nurse will see Anika first as she may be experiencing a first-level priority physical need. Next to be seen will be Felipe, who is stable now, but that could change due to his chronic condition. After seeing Felipe, the nurse will look in on Vida to make sure she is sleeping safely and appears in no distress. Finally, the nurse can take a few minutes with Rich to discuss his upcoming cardiac catheterization, answer any questions he may have, perform an assessment, and see if he would like something to help him sleep.​

While assessing a newborn client discharged from the neonatal intensive care unit the previous day, a home-health nurse notices significant bruising on the 2-year-old sibling's head, arms, abdomen, and legs who is wearing only a diaper and playing with age-inappropriate toys. The parent of both children describes the toddler as "quite clumsy" and "always running into things" before handing the newborn to the nurse. ​ Place the actions the nurse will take in the order in which they should be completed, starting with the first.​ Assess the parent's knowledge of caring for the newborn.​ Assess the newborn.​ Establish nursing diagnosis and outcomes of care for the newborn.​ Provide teaching as needed.​ Document visit.​ End the visit.​ Contact the nursing supervisor to report the suspected abuse of the 2-year-old.​

1. Assess the newborn.​ 2. Establish nursing diagnosis and outcomes of care for the newborn.​ 3. Assess the parent's knowledge of caring for the newborn.​ 4. Provide teaching as needed.​ 5. Document visit.​ 6. End the visit.​ 7. Contact the nursing supervisor to report the suspected abuse of the 2-year-old.​ Although the nurse is in the home to care for the newborn, it is reasonable for them to make observations about others living in the same home. Since the appearance of the 2-year-old and the statements by the parent may indicate abuse, the nurse is obligated to report the incident as outlined by their employer. At this time, the toddler does not appear to be in immediate danger, so the nurse will contact the supervisor after caring for the newborn. To continue the visit, the nurse will focus on the client by applying the nursing process and clinical judgment.​

Successful patient-centered care delivery requires knowledge, skills, and attitudes. Review each statement below and identify it as a knowledge, a skill, or an attitude. 1. Value seeing healthcare situations "through patients' eyes." 2. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. 3.Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care.

1. Attitudes 2. Knowledge 3. Skills

The nurse is caring for an elderly client who is cooperative and pleasant. About 2 hours into the shift, the client says, "You are so pretty and could be beautiful if you did not have acne." The nurse thanks them for the compliment, finishes administering medications, ensures the client has what they need, and leaves the room. Over the next several hours, the client continues to comment on the nurse's acne, despite the nurse's request not to. When the nurse realizes their emotions may interfere with their care of the client, they speak with their nurse manager, and the client is assigned to another nurse for the remainder of the shift.​ In the table below, place a check to indicate which factor of RAAA (responsibility, autonomy, authority, and accountability) is imbalanced in this communication. If all factors are balanced, place a check in Balanced RAAA.​ 1. Nurse 2. Client 3. Manager

1. Balanced 2. Responsibility, Autonomy 3. Balanced The client feels the responsibility to address the nurse's acne, and uses their autonomy to do so. Unfortunately, they continue to press their concerns despite the nurse's request to stop. The nurse and their manager acted appropriately, so their RAAA is balanced. During interactions with others, the ability of all individuals to keep their RAAA balanced can be an ongoing battle. While the client may have felt comfortable discussing the nurse's appearance, felt responsible to speak up, and exercised their right to start the conversation, they did not consider if the therapeutic relationship was the appropriate place for that conversation to take place. The nurse attempted to set professional boundaries by asking the client to end the discussion, yet the client persisted. Realizing their desire to avoid the client and conversation could impact safe care, the nurse took responsibility for consulting with the unit manager, who felt a responsibility to change the assignments for the remainder of the shift.​ The client felt hurt that the nurse did not want to care for them. The nurse felt hurt that the client did not listen to them, inadequate that they could not put the feelings aside to provide care, and ashamed that their adult acne had become a topic of gossip for the unit. Finally, the manager was discouraged that a colleague was being disrespected.​ In reality, the client was acting from a place of care. Whether related to their age, cultural background, family dynamics, or personal experience, the client felt that the nurse needed encouragement that the acne would not last forever and reinforcement that they are still attractive.

For each aspect of the "Right Supervision/Evaluation" step of delegation, indicate if it is the nurse and/or unlicensed assistive personnel (UAP) that is responsible for that action. Each aspect may apply to one or both colleagues.​ 1. Following up with colleague ​ 2. Evaluating client outcomes ​ 3. Completing documentation ​ 4. Verifying if documentation was completed ​ 5. Retains overall accountability for the client ​

1. Both 2. Nurse 3. Both 4. Nurse 5. Nurse When delegating, the nurse is responsible for monitoring the delegated task, following up with the delegatee, and evaluating the client outcomes. The nurse should also be available to assist as needed with documentation and verify that documentation of the task is completed. The nurse who delegated retains overall responsibility and accountability for the client.

The nurse has completed passing medications to a stable client on airborne precautions and is preparing to provide education on new medications. A rapid response team (RRT) is paged to the room of another one of the nurse's clients. Before leaving the client's (who is stable) room, list the steps the nurse will take in the correct order, starting with the first.​ Remove mask​ Remove goggles or face shield, if using​ Wash hands​ Ensure current client is safe and comfortable​ Remove gloves​ Close door ​ Remove gown​

1. Ensure current client is safe and comfortable 2. Remove gloves 3. Remove goggles or face shield, if using 4. Remove gown 5. Remove mask 6. Wash hands 7. Close door In all instances, the nurse is responsible for the safety of the client with whom they are working first. To do this, they must ensure the client is safe and comfortable, remove their PPE in the correct order (gloves, goggles/face shield, gown, mask), perform hand hygiene, and then close the door when leaving the room. ​In this case, that client is stable. Based on the compared needs of the two clients, level-three for the current client and level-one for the other, the nurse decides to leave the current client. Had the nurse not been in an isolation room, the steps would change to ensuring the safety and comfort of the current client, responding immediately, and performing hand hygiene as they walk to the emergency. Since the nurse is caring for both clients, it is not appropriate for them to stay with a stable client during an emergency.​ This question is an example of the complexity of clinical decision-making in healthcare. As you continue to increase your knowledge and gain clinical experience, you will encounter similar situations. When possible, debrief with the nurse involved to discuss their decision-making process and how they cope with the interruption to their planned schedule so you can be better prepared for future decision making.​

Sort the interventions based on the level of priority: time-dependent, client needs, or client preference. ​ 1. Time-Dependent Priorities 2. Client Need Priorities 3. Client Preference Priorities

1. Medication peak and trough measurement, Intake and output totals. 2. Low blood pressure, cardiac arrest 3. Softer pillow, change of clothing Time-dependent priorities​: medication peak and trough measurement​ intake and output totals​ Client needs priorities​: low blood pressure​ cardiac arrest​ Client preference priorities​: change of clothing​ softer pillow​ ​If you are unsure of which priority is highest, ask yourself "Will someone be harmed if I do A before B?" Here are examples from the list you just sorted.​ Will someone be harmed if I get this client a pencil before I start CPR on that client? Yes, the person needing CPR will be harmed.​ Will someone be harmed if I total the I&O for this client before I give that client their medication? Probably not, unless the timing of the medication is critical, and there is not enough information to answer that clearly. It is probably safe to add the numbers first, especially if you are already in that person's room.​ Will this client be harmed if I find them a softer pillow before I report their very low serum potassium to their healthcare provider? In all cases, a very low serum potassium should be reported immediately because of the risk it poses to the client's overall health, even if they are stable now. If you see an unlicensed assistive personnel (UAP) as you head to the phone, delegate the pillow hunt to them so the client's request is met sooner.​

After caring for a client on the first day of a 2-day clinical, the student nurse was confident that the schedule for the second day would be the same as the first day's. For each event in the table, indicate if it has become a higher priority, a lower priority, or there is no change in priority. 1) 14:45—Arrive and be ready at 15:00​ 2) 15:00—Pre-conference​ 3) 16:00—Report from nurse; take vital signs and blood sugar​ 4) 17:00—Medications; administer insulin when the meal tray arrives​; then eat my own dinner 5) 18:00—Physical assessment​ 6) 19:00—Change intravenous fluid bag 7) 20:00—Medications, dietary, and discharge teaching​ 8) 21:00—Evening care​ 9) 22:00—Report to nurse 10) 22:30—Leave for post-conference

1. No Change 2. No Change 3. Higher Priority 4. No Change 5. Higher Priority 6. Higher Priority 7. Lower Priority 8. Lower Priority 9. No Change 10. No Change

The nurse and their family are at the lake with friends. During lunch, the nurse's partner says, "Look to the left, about 50 feet out. I think someone is drowning!" Considering the scenario, place the following nursing actions in order of priority. Find a boat, raft, or some type of flotation device.​ Direct someone to locate a phone and call 911. ​ Observe the individual and the surroundings.​ Determine who is the strongest swimmer in the group.​

1. Observe the individual and the surroundings.​ 2. Direct someone to locate a phone and call 911. ​ 3. Determine who is the strongest swimmer in the group.​ 4. Find a boat, raft, or some type of flotation device.​ Using the nursing process, the nurse will start by assessing the situation for data that provides cues to what is happening. As the nurse collects and prioritizes data, another member of the group should call 911 and relay the nurse's assessment to emergency responders so they are better prepared to help the victim. The nurse's knowledge of the nursing process and skill along with clinical decision-making is often seen by others as a reason to rely on their leadership in emergency situations.​ If conditions in the water are safe for bystanders to attempt a rescue, the group should determine who has the swimming skills to reach the victim and raise their head above water while other members of the group search for a boat or flotation device to use to bring the victim to shore.​ Tip: When answering this type of prioritization question, focus less on the situation (particularly if you know nothing about boating) and more on the safety of the individual who needs help. ​

The nurse is caring for a client admitted with a gunshot wound to the left thorax that resulted in fractured ribs and a hemopneumothorax. The client has requested that their name not to be listed on the list of individuals currently in the hospital as they believe they are in danger, though they do not know who shot them. A woman who identified as the client's daughter is calling for an update on the client. In what order will the nurse complete these actions? Place actions in order, from first to last.​ Locate the unique identifier to verify the caller. Review the client's record for individuals identified to receive health information. Provide an update on the client's status. Place the caller on hold. Ask the caller for the unique identifier.

1. Place the caller on hold 2. Review the client's record for individuals identified to receive health information. 3. Locate the unique identifier to verify the caller 4. Ask the caller for the unique identifier 5. Provide an update on the client's status Many interactions on a nurse's day present ethical dilemmas. In this situation, it is the responsibility of the healthcare facility and the nurse to provide privacy to the client by keeping health information private. Names are usually available to colleagues to help visitors locate an individual to send a card or visit. It is normal to withhold the names of public figures and individuals who have experienced abuse or violence, and best when only one or two other people know the client is at the facility.​ When clients are admitted to healthcare facilities, they are asked to identify family and friends to whom their information can be released. In this case, the nurse must ensure that the person calling is on the list. In addition to the release of information, a unique identifier is created and given to the family and friends identified in the release of information, which will be used to release information. Once the nurse verifies the release of information and the unique identifier, they may provide the update requested.

The nurse uses clinical decision making to keep ___(1)___ focused on ___(2)___ .

1. the healthcare team 2. actions that move the client toward health Accurate clinical decision making keeps the entire healthcare team (not nursing colleagues or the client) focused on actions that move the client toward health (not the client or delivering safe and effective care to all). If the nursing plan of care is based on inaccurate data and poor clinical decisions about a client, undesirable outcomes are more likely to occur. This results in the client's level of health being less than its full potential. For this reason, it is critical that the nurse develops an organized approach to applying the nursing process. As you learn, take the time to attend and listen to the client, look for the cues (obvious or subtle) that point to a pattern of findings, and direct the assessment to explore that pattern further. ​

The nurse receives a change-of-shift report for the clients below. Which client should be assessed first? ​ A 28-year-old client with a fracture who reports chest pain and shortness of breath A 56-year-old client with a left leg amputation who reports phantom pain A 42-year-old client with carpal tunnel syndrome who reports pain A 64-year-old client with osteoporosis awaiting discharge

A 28-year-old client with a fracture who reports chest pain and shortness of breath The client reporting chest pain and shortness of breath is at risk for pulmonary embolism due to the fracture and should be assessed immediately. As a general rule, airway and breathing are high priorities. Although all of the other clients' concerns are important and the nurse will want to see them as soon as possible, none of their complaints are urgent.​

Consent for Healthcare Can Be Provided By...

Adults -Any competent individual 18 years of age or older for themselves. -Any parent for their unemancipated minor. -Any guardian for their ward. -Any adult for the treatment of their minor sibling (in an emergency if parents are not present). -Any grandparent for a minor grandchild (in an emergency if parents are not present). Minors -Minors ordinarily cannot consent to medical treatment without a parent's consent, except for emancipated minors. --Emancipated minors include: ---Minors designated emancipated by a court order. ---Minors who are married, divorced, or widowed. ---Minors in active military service. Unemancipated minors may consent to medical treatment for specific conditions: -Pregnancy and pregnancy-related conditions (varies by state). -A minor parent for their custodial child. -Sexually transmitted infections (STI) information and treatment. -Substance abuse treatment. -Outpatient or temporary mental health treatment or shelter.

Advance Directives for Healthcare

Advance Directives for Healthcare -Key Legal Cases: The U.S. Supreme Court rulings in the cases of Nancy Cruzan and Terri Schaivo affirmed that individuals' healthcare wishes should be respected after they lose the capacity to make their wishes known. -Patient-Self Determination Act (1990):Requires healthcare providers (hospitals, skilled nursing facilities, home health agencies, hospice programs, and HMOs) to: ---Inform clients of their rights to make healthcare decisions. ---Inquire and document if the client has executed an advance directive. ---Not discriminate against persons with advance directives. ---Implement advance directives according to state law. ---Provide educational programs on self-determination and advance directives. Living Wills (Advance Directives) -Purpose: Legal documents allowing individuals to communicate their healthcare wishes for when they are unable to do so themselves.

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. This is an example of ___________which is an ______________.

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. This is an example of BATTERY which is an INTENTIONAL TORT. The nurse committed battery, the willful touching of a person without permission. This would be an intentional tort because the nurse performed the procedure on purpose (also called malpractice).

Which actions taken by the nurse could result in both criminal and civil law sanctions? Select all that apply.​ Completing an occurrence report on the unit Applying physical restraints without a written prescription from the healthcare provider Taking controlled substances that are diverted from clients for whom they were prescribed Reporting suspected abuse and neglect of children Delegating assessment of a postoperative client to an unlicensed assistive personnel (UAP) Refusing to provide healthcare information to a client's child

Applying physical restraints without a written prescription from the healthcare provider Taking controlled substances that are diverted from clients for whom they were prescribed A crime is an act, or failure to take action, that breaks a criminal law. Taking or selling controlled substances that are diverted from clients for whom they were prescribed and physically restraining a client without a prescription are violations of both civil and criminal law. ​ Refusing to provide healthcare information to a client's child, reporting suspected abuse, and completing employer-required documentation are not acts that violate a law. Nor do they violate the civil law that governs the interactions between two parties that results in harm to one of the parties.​ Inappropriate delegation violates civil, but not criminal, law.​

For each statement, specify whether it is appropriate or inappropriate based on the five rights of delegation. Appropriate Delegation Inappropriate Delegation Asking the unlicensed assistive personnel (UAP) to give a client their morning medications. An experienced nurse asks a new nurse to ambulate a client so they can speak with a healthcare provider. Asking another registered nurse on the floor to watch a patient while you are at lunch. Assigning a licensed vocational nurse (LVN) to care for the same clients as the day before.

Appropriate Delegation An experienced nurse asks a new nurse to ambulate a client so they can speak with a healthcare provider. Asking another registered nurse on the floor to watch a patient while you are at lunch. Assigning a licensed vocational nurse (LVN) to care for the same clients as the day before. Inappropriate Delegation Asking the unlicensed assistive personnel (UAP) to give a client their morning medications.

A nurse, whose grandfather recently passed away, is returning to work after bereavement leave. During reporting, the nurse learns that one of their assigned clients is at the end of their life. The nurse believes they will be unable to provide care for this client and family due to the nurse's recent loss. What is the best action for the nurse to take?​ Request to go home.​ Ask that another nurse trade a client with them.​ Accept the assignment.​ Report her colleagues for inappropriate assignments.

Ask that another nurse trade a client with them.​ It is vital that the nurse delivers client-centered care that focuses on the values and beliefs of the client. Although setting aside personal values can be challenging, it is the nurse's responsibility to provide supportive care to others in all situations. If a situation arises in which the nurse feels unable to resolve a conflict of values or ethics, the nurse should request another assignment and seek support to explore the ethical dilemma in which they find themselves.​ Requesting to go home is not the best action if the nurse is simply concerned with caring for an individual approaching the end of their life. Accepting an assignment that creates strong emotions for the nurse increases the risk to the nurse and their entire assignment. Reporting the colleague who created the assignments is not appropriate, particularly if they were unaware of the nurse's recent loss.​​

What steps can the nurse take to ensure a new client understands their rights and responsibilities related to receiving healthcare? Select all that apply. Require the client to acknowledge receipt of the Patient's Bill of Rights in writing.​ Include the Patient's Bill of Rights with all admission paperwork.​ Secure the Patient's Bill of Rights on the wall next to the bed.​ Ask the client if they have questions about their healthcare-related rights.​ Provide a copy of the Patient's Bill of Rights written in the client's primary language.​

Ask the client if they have questions about their healthcare-related rights.​ Provide a copy of the Patient's Bill of Rights written in the client's primary language.​ Providing a printed copy in a person's preferred language increases the likelihood that comprehension and understanding will occur. Following up to answer questions or clarify details is another tactic that can increase understanding. ​ While providing a standard copy of the Patient's Bill of Rights is a good first step, securing a copy to the wall, ensuring a copy is available in the admission paperwork folder, and asking an individual to sign a statement that a copy of their rights has been received do not help the nurse confirm the individual understands their rights as a client.​​

The nurse is supervising a practical nurse (PN) who says, "I gave the client with myasthenia gravis 90 mg of neostigmine instead of the ordered 45 mg!" In which order should the nurse perform the following actions?​ Notify the healthcare provider of the incorrect medication dose ​ Ask the PN to explain how the error occurred Assess the client's heart rate Complete a medication error report

Assess the client's heart rate Notify the healthcare provider of the incorrect medication dose ​ Ask the PN to explain how the error occurred Complete a medication error report The first action after any medication error is to assess the client for adverse outcomes. The nurse should evaluate this client for symptoms such as bradycardia and excessive salivation, which indicate cholinergic crisis, a possible effect of excessive doses of anticholinesterase medications such as neostigmine. The healthcare provider should be rapidly notified so that treatment with atropine can be ordered to counteract the effects of the neostigmine, if necessary. Determining the circumstances that led to the error will help decrease the risk for future errors and will be needed to complete the medication error report. ​

The nurse is caring for a client with osteoporosis who is at increased risk for falls. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)?​ Monitoring gait, balance, and fatigue level with ambulation Assisting the client with ambulation to the bathroom and in the halls Collaborating with the physical therapist to provide the client with a walker Identifying environmental factors that increase risk for falls

Assisting the client with ambulation to the bathroom and in the halls Assisting with activities of daily living, including assisting with ambulation to the bathroom, is within the scope of the UAP's practice. The other three interventions require additional educational preparation and are within the scope of practice of licensed nurses, but not for the UAP's. ​

For each situation, select the ethical principle that is involved using the drop down menu.​ Parents refusing to have a child vaccinated Contacting a healthcare provider to report that a client does not fully understand a course of treatment and will not sign the informed consent document without further information Advocating for a client in pain whose healthcare provider has not prescribed sufficient pain medications Concern that a client is concealing information that may impact their health Rubbing a child's back while they fall asleep Encouraging a client with dementia to select which clothes to wear Bringing a client's preferred beverage when administering medications

Autonomy—Parents refusing to have a child vaccinated Justice—Contacting a healthcare provider to report that a client does not fully understand a course of treatment and will not sign the informed consent document without further information Justice—Advocating for a client in pain whose healthcare provider has not prescribed sufficient pain medications​ Nonmaleficence—Concern that a client is concealing information that may impact their health​ Beneficence—Rubbing a child's back while they fall asleep​ Autonomy—Encouraging a client with dementia to select which clothes to wear Beneficence—Bringing a client's preferred beverage when administering medications

The nurse whose work focuses on lowering the cost of care without compromising quality is working in which role?​ Home care ​ Community health ​ Case manager Rehabilitation nurse​

Case manager Focused on lowering costs without compromising quality, the case management approach to care is designed to coordinate all healthcare services for clients and their families. As a collaborative process involving all disciplines caring for the client, the case manager plans, facilitates, and advocates to secure the services needed to meet the needs of the client. Effective communication and knowledge of resources are key to successful case management of clients with complex nursing and medical problems. Rehabilitation nurses focus on the physical and psychosocial needs of the client. Home care nurses focus on the care of the client in their own home setting. Community health nurses provide care in locations outside of the typical hospital setting. These may include outpatient clinics and schools. ​

A nurse arrives at work and is told to report to the intensive care unit (ICU) for the day due to short staffing. The nurse has never worked in the ICU. Which is the most appropriate action by the nurse? ​ Collaborate with ICU staff to identify tasks that can be safely performed.​ Call the hospital legal department for advice and submit a report to the ethics line.​ Refuse to work in the ICU and file a complaint.​ Contact the hospital's nursing supervisor and ICU manager.​

Collaborate with ICU staff to identify tasks that can be safely performed.​ When a nurse is assigned to a specialty with which they are unfamiliar, the nurse's first action is to identify tasks that can safely be performed. If there are additional questions or concerns, it's a good idea to speak with the charge nurse or the manager on that unit about the knowledge and skill gap the nurse feels may put the clients at risk. It is likely that ICU nurses have worked with non-ICU nurses in the past, and they can work with the nurse to assign a stable client or a series of tasks that support the ICU nurses in providing care. It is acceptable practice to reassign nursing staff to areas of a facility that need assistance. In most facilities, colleagues rotate reassignment to ensure equity is maintained, so refusing to go is not an option. While the nursing supervisor may offer encouragement, they will most likely enforce the facility reassignment policy, as will the legal department.

Organ and Tissue Donation

Complexity: Life support systems can affect organ donation opportunities. Education: Health professionals must educate clients about using life support temporarily to support organ donation. Legal Framework: Governed by the Uniform Anatomical Gift Act (UAGA), which allows temporary use of life support systems to maximize organ procurement.

The nurse assessing a client's foot wound is unsure if the underlying cause is related to arterial or venous insufficiency. Realizing that the plan of care will differ based on the underlying pathology, what is the best action for the nurse to take?​ Delegate the plan of care to the next shift.​ Ask the client about the wound.​ Select an alternate nursing diagnosis.​ Consult with a more experienced nurse.​

Consult with a more experienced nurse.​ When faced with evidence of a knowledge deficit, the nurse uses the opportunity to increase their knowledge base. In the case of this assessment, consulting a more experienced team member is the best option of those provided. The colleague could be from the same unit, a wound care nurse, or the healthcare provider, if available. Although asking the client for information about the wound provides more data, it is best for the nurse to seek input from another health professional when using information to plan care.​ Selecting an alternate nursing diagnosis is not appropriate unless it is a higher priority need for the client. Even then, care of the wound should be incorporated into the client's overall care and needs to be addressed.​ Delegating the plan of care to the next shift is not in the client's best interest. It also does not show care for colleagues. The nurse is responsible for completing aspects of care as assigned to them.​

Patient Centered Care

Definition -Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care, based on respect for the patient's preferences, values, and needs. Knowledge -Integrate understanding of multiple dimensions of patient-centered care: ---Patient/family/community preferences, values ---Coordination and integration of care ---Information, communication, and education ---Physical comfort and emotional support ---Involvement of family and friends ---Transition and continuity -Describe how diverse cultural, ethnic, and social backgrounds influence patient, family, and community values. Skills -Elicit patient values, preferences, and expressed needs during clinical interviews, care planning, and evaluation. -Communicate patient values and needs to other members of the healthcare team. -Provide patient-centered care with sensitivity and respect for human diversity. Attitudes -Value seeing healthcare situations "through patients' eyes." -Respect and encourage individual expression of values and preferences. -Value the patient's expertise in their own care, recognizing human diversity. -Acknowledge personal attitudes about working with patients from different ethnic, cultural, and social backgrounds. -Support patient-centered care for those whose values differ from your own.

The experienced nurse is precepting a nurse during their orientation to the facility. The orienting nurse has reviewed the policy and procedure manual for key nursing care activities and is preparing to bathe a client with an indwelling urinary catheter. Before entering the client's room, the experienced nurse hands the orienting nurse packets of povidone-iodine (Betadine) swabs to cleanse the urinary catheter and perineum. The orienting nurse inquires if the client has a condition that requires cleansing with something stronger than soap and water, which is what the facility policy and procedure manual recommends.​ Both nurses reviewed the client's electronic health record (EHR) and current procedure for catheter care to verify the correct type of catheter care was provided for this patient.​ What type of learning occurred in this situation?​ Formal​ Internet-based​ Experience​ Employer-sponsored ​

Experience In this situation, each nurse had the opportunity to learn. The orienting nurse could have learned that the client to be bathed had been prescribed povidone-iodine for catheter care based on their physiological needs. On-the-job learning, such as described here, is a type of learning by experience.​ Who do you think was correct, the experienced nurse or the orienting nurse? As it turns out, the orienting nurse was correct that soap and water should be used. However, the orienting nurse had not reviewed the client's EHR to verify that no special care or products were needed during the bath, so it was a good learning experience for both nurses.​

A client has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The client experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the client's toes have become pale and cold, but forgets to document this because another client experienced cardiac arrest at the same time. Two days later, the client in skeletal traction has an elevated temperature, and is prepared for surgery to amputate the leg below the knee. Which statements regarding a breach of duty apply to this situation? Select all that apply.​ Failure to use proper medical equipment ordered for client monitoring.​ Failure to document a significant change in assessment data.​ Failure to follow the six rights of medication administration.​ Failure to notify a healthcare provider about a change in the client's condition.​ Failure to provide discharge instructions.​

Failure to document a significant change in assessment data.​ Failure to notify a healthcare provider about a change in the client's condition. In this situation, the nurse failed to document or report a significant change in the client's condition. Individuals who are placed in a plaster cast immediately after the injury occurs are at risk for compartment syndrome, a condition caused by swelling around the injury. With the presence of the cast, the swelling results in high pressure in the leg that interferes with nerve conduction (decreased sensation) and circulation (cold toes). ​ This client was not being discharged and did not require discharge instructions. This situation did not involve medication administration. This situation did not require the use of medical equipment to monitor the client.​

Types of Consent

General Consent -Purpose: Consent to be assessed and treated for routine care such as basic tests, blood work, X-rays, medications, and physical therapy. -Required for: General admission and non-invasive procedures. -Example: Signing upon admission to the hospital to allow care and basic treatments. Informed Consent -Purpose: Consent for invasive procedures like surgery, which carry more significant risks. -Elements of Informed Consent: ---Diagnosis (if known). ---Purpose of the proposed action. ---Risks and benefits of the action. ---Alternatives, regardless of cost or insurance. ---Risks and benefits of alternatives. ---Risks and benefits of no action. -Requirement: The client must understand the options and have the capacity to consent. Insurance Authorization -Purpose: Allows the hospital to share medical records with the insurance company for reimbursement. -Includes: Client accepting responsibility for their portion of healthcare costs. Patient's Bill of Rights -Purpose: Ensures the client knows their rights as a patient. -Required Action: Client acknowledges receipt by signing a form.

Entry-Level Knowledge, Skills, and Abilities

Goal -Newly licensed nurses aim to deliver safe care that improves lives. -Nursing education ensures that nurses meet the minimum necessary competencies for the profession. Entry-Level Nursing Competencies -​Possess a systems focus to see the big picture.​ -Understand the environment of care.​ -Manage the care of patients.​ -Prioritize basic patient care needs.​ -Be able to critically think as demonstrated by assessment of problem, identification of solution, implementation of solution, evaluation of care, and follow-up of care.​ -Communicate effectively with healthcare providers and healthcare team members.​ -Nursing knowledge and display confidence in knowledge base.​ -As a team member, collaborating with healthcare team members.​ -Have a patient orientation and focus with actions focused on patient and patient needs.​ -Respect the rights, beliefs, wishes, and values of patients.​ -Be a patient advocate.​ -Recognize own limitations and see support of validation of decisions as needed.​ -Demonstrate knowledge of roles, responsibilities, and functions of a nurse. (Potter et al., 2023, p. 303) Entering the Clinical Setting -Starting your clinical as a student nurse takes courage, even if you've worked in healthcare. -Stay focused on learning, use the nursing process as your guide, and rely on your instructor as you grow into your professional role.

Many of the skills that have supported your success as a student are transferable to your role as a nurse. In the table below, match the items in the "Student," "Linking Phrase," and "Nurse" columns.

In Student Column: Family, work, and school; multiple deadlines in a session In Linking Phrase Column: Prioritize; Evaluation In Nurse Column: Clinical decisions; Colleagues, medical supplies

In its simplest form, a moral describes the __________________ an individual or group attaches to right and wrong. It is these values, or morals, that ____________________ not only their own behavior, but how they interpret the behavior of others. Ethics is the study of right and wrong applied to questions of correct behavior. Behavior is interpreted as _______________ or ________________when judged against agreed upon aspects of universal fairness. In theory, ethical principles apply to all ___________________ equally.

In its simplest form, a moral describes the value (not perspective or definition) an individual or group attaches to right and wrong. It is these values, or morals, that influence (not explain or reflect) not only their own behavior, but how they interpret the behavior of others. Influenced by a variety of factors including family, culture, religion, and education, morals have an element of subjectivity and preference.​ Ethics is the study of right and wrong applied to questions of correct behavior. Behavior is interpreted as responsible (not just or proper) or irresponsible (not unjust or improper) when judged against agreed upon aspects of universal fairness. In theory, ethical principles apply to all actions (not individuals or situations) equally. ​

The nurse asks an unlicensed assistive personnel (UAP) to total the shift intake and output for a group of clients to which the UAP is not assigned. After clarifying the nurse's expectations related to time of completion and reporting back, the UAP enters the room of a client with IV fluids infusing. The "Intake and Output Record" does not include an intake amount for IV fluids, though. What should the UAP do?​

Inform the nurse that the IV fluid total is missing.​ As the delegatee, the UAP has the responsibility to let the nurse know when something unexpected occurs during the completion of a task. In this case, the UAP is unable to total the client's input due to missing information. For this reason, the best action is for the UAP to inform the nurse that the IV total is missing. Because the UAP is not responsible for administering the IV fluids, it is not appropriate for the UAP to record the value for the nurse.​ The other options do not provide the best care for the client, support the healthcare team with accurate client data on which to make decisions, or adhere to the five rights of delegation.​

Informed consent is an agreement from the ________to have a medical procedure and requires full disclosure of the __________and benefits of ___________, alternative care options, and the consequences of taking no action from the healthcare provider. The information provided to obtain consent must be done using terms that the client understands. ​Elements of informed consent: diagnosis and _________of proposed action; risks and benefits of action; alternatives; risks and benefits of alternatives; and risks and benefits of no action. It also requires that the client has the ______________to understand their options for care.​

Informed consent is an agreement from the CLIENT to have a medical procedure and requires full disclosure of the RISKS and benefits of TREATMENT, alternative care options, and the consequences of taking no action from the healthcare provider. The information provided to obtain consent must be done using terms that the client understands. ​Elements of informed consent: diagnosis and PURPOSE of proposed action; risks and benefits of action; alternatives; risks and benefits of alternatives; and risks and benefits of no action. It also requires that the client has the CAPACITY to understand their options for care.​

Delegation of Care

Know your employer's policies and procedures related to clinical practices and delegation. Unfamiliarity with established policies and protocols is not a defense, especially if a clinician has acknowledged receiving education on such policies and protocols. ​ Evaluate the unlicensed assistive personnel skills and performance of tasks and provide feedback for improvement if needed.​ While collaborating with others on implementing a plan of care is appropriate for all healthcare professionals, collaborating on development of a plan of care is strictly within the registered nurse's scope. Any healthcare professional who suspects abuse should report it as directed by their facility's policies, local requirements, and state laws. Prior to delegating tasks, be aware of the knowledge and skills, training, diversity awareness, and experience of the individual to whom you are delegating elements of care. Use good clinical judgment, which includes the complexity of the client and the availability and competence of the unlicensed assistive personnel, prior to delegating client care. ​Monitor implementation of the delegated task, as appropriate, to the overall client plan of care. ​Evaluate the overall condition of the healthcare consumer and the consumer's response to the delegated task.​

Categorize these nursing actions based on whether or not each action could result in the nurse being found liable for malpractice. Drag each option to the corresponding drop-zone.​ Malpractice Not Malpractice​ Documents care that was not provided.​ Does not complete the client assessment.​ Increases frequency of assessment for an unstable client.​ Instructs the unlicensed assistive personnel to administer medications.​ Notifies the healthcare provider of critical lab values in a timely manner.​ Earns certification on new piece of equipment.​ Does not allow an unsteady client to ambulate without assistance.​ Does not follow up on the client's complaints.​ Leaves work without providing the hand-off report.​ Documents the client's drug allergies.​

MALPRACTICE: -Does not complete the client assessment.​ -Leaves work without providing hand-off report.​ -Does not follow up on client's complaints.​ -Instructs the unlicensed assistive personnel to administer medications.​ -Documents care that was not provided.​ NOT MALPRACTICE: -Notifies healthcare provider of critical lab values in a timely manner.​ -Increases frequency of assessment for an unstable client.​ -Earns certification on new piece of equipment.​ -Does not allow an unsteady client to ambulate without assistance.​ -Documents client's drug allergies.​

A healthcare provider prescribes one tablet of a medication, but the nurse accidentally administers two. The nurse monitors the client for untoward effects of which there are none, then notifies the healthcare provider. Is the client likely to be successful in suing the nurse for malpractice?​ Yes, because the nurse should have foreseen the outcome of their actions. Yes, because the nurse's action was a breach of duty.​ No, because the client was not harmed.​ No, because the nurse notified the healthcare provider.​

No, because the client was not harmed.​ To meet the requirements of medical negligence, the injured party must be able to prove that the health professional had a duty to provide care and that the duty was breached or broken. Because an injury may result from various causes, the injured party must also prove that the breach of duty caused the injury. Damages are assigned after the first three elements have been met (Ronquillo et al., 2020).​ To prevent malpractice, the nurse should follow the standards of care, establish a therapeutic relationship with those in their care, and work cooperatively with the healthcare team. The provision of competent care requires the nurse to be knowledgeable of their employer's policies and procedures as well as remain current on advances within their area of practice. ​

Indicate which leadership characteristics are required of the nurse leader and which are required by the staff nurse by placing a check in the appropriate column. Note that some characteristics may apply to both.​ 1. Is an effective communicator 2. Is consistent in managing conflict 3. Is a role model for colleagues 4. Motivates and empowers others

Nurse Leader: Select all Staff Nurse: Select all The staff nurse, as the leader of the nursing care team, requires the same leadership skills and characteristics as the nurse leader managing the entire unit. The nuances and depth of skill required differ, as does the experience that most nursing leaders bring with them to their role and their team.​

Reflecting on Time Spent

Overview -After each clinical, take time to review your schedule and assess how your day went. -File your schedule with your clinical paperwork and take some time for yourself. Preparing for Next Clinical Experience -Review old time planners for opportunities to be more efficient and effective with your time. Key Areas to Reflect On -Review Paperwork ---Check for any private health information (PHI) that may have been removed from the clinical site. ---Avoid taking PHI out of the clinical area to comply with HIPAA laws. -Increase Assessment Efficiency ---Compare how much time you're spending on assessments with your classmates. ---Aim to reduce assessment time to improve efficiency during early clinicals. -Ask the Instructor ---If you find yourself with extra time, reach out to your clinical instructor for additional tasks. -Make a List ---Avoid multiple trips for supplies by bringing the right materials at once. ---Use scrap paper to make a list if needed. -Have Goals ---Set specific goals for time spent with your nurse mentor (e.g., watching an assessment or listening to discharge teaching).

Knowledge Building

Overview -As a nursing student, you're constantly learning and applying knowledge, but nursing evidence grows rapidly. -Nurses must commit to life-long learning to maintain and improve their knowledge and skills. Personal Development -Professional development can take many forms, such as: ---Employer-sponsored training ---Formal education ---Internet-based courses ---Experience ---Reading professional journals Obtaining and Renewing Your Nursing License(s) -Each state board of nursing has requirements for both initial licensure and periodic license renewal. -Many states require continuing education units (CEUs) for license renewal. -Nurses are responsible for obtaining and tracking their own CEUs, and nationally-accredited CEUs are readily available.

Confidentiality in the Workplace

Overview -As you prepare for direct client care, develop habits to protect privacy and confidentiality. -Basic actions, like covering paperwork and speaking quietly, are essential, but other steps ensure confidentiality. Common Practices to Protect Client Information -Avoid Multiple Client Identifiers ---Use initials and date of birth instead of full names. ---Write the client's name on a separate slip of paper if needed, and shred it once memorized. -Shred Unused Confidential Documents ---Shred any documents containing client identifiers after use. ---Mark documents with "please shred if found" and your name to avoid confusion. -Verify Access to Unassigned Clients' Information ---Check with your clinical faculty before accessing any information for clients not assigned to you. ---Unauthorized access may violate HIPAA. -Secure Documents in Clinical ---Keep paperwork in a secure location to protect client privacy. ---Even with limited identifiers, the information could compromise privacy if seen by unauthorized personnel. -Implement Screen Privacy ---Be aware of who can see client information on your monitor. ---Log out or end your session each time you step away from the monitor.

Clinical Decisions

Overview -Clinical decisions are integrated into processes that ensure effective patient care. -The nurse gathers patient information and develops a plan of care based on assessment and clinical decision-making. Obtaining Patient Information -It requires more than just gathering formal assessment data. -Learn about the patient's typical patterns of responses, their current situation, and their individuality. -The initial contact with a patient is important for developing a caring relationship. -Encourage patients to share their health narrative with questions like: ---"Tell me about how you are dealing with..." ---"Can you share what has been your biggest challenge since becoming ill?" Developing a Plan of Care -After assessment, the nurse develops a care plan, implements interventions, and evaluates outcomes using critical thinking. -Accurate clinical decisions based on the nurse's knowledge of patient needs should lead to improved health. -However, not all patients respond to care in the same way, and some may not improve despite appropriate interventions. -A plan of care based on inaccurate data can lead to undesirable outcomes and limit the patient's potential health. ---Nurses must develop an organized approach to applying the nursing process. ---Listen to the patient and look for cues that may reveal a pattern. ---Direct assessments to explore those patterns further. -Accurate clinical decision-making keeps the healthcare team focused on the proper course of action to support the patient's optimal health.

Common Ethical Concerns in Healthcare

Overview -Despite changes over time, ethical and legal issues in healthcare consistently arise in several key areas, impacting both clients and health professionals. Quality of Life -Quality of life goes beyond physical health and includes self-actualization and personal development (Maslow's Hierarchy of Needs). -Nurses must respect and support the client's life choices, even if they find those choices difficult to accept. -Helping clients recognize that their desire to contribute meaningfully defines quality of life is important. Disability -Ethical considerations regarding care, treatment, and quality of life for clients living with disabilities require nurses to provide compassionate, respectful care that upholds the dignity of the individual. End-of-Life Care -End-of-life care can cause moral distress when aggressive treatments are futile. -Health professionals must confirm with the client whether to continue treatments or shift to palliative care and comfort measures. -A common understanding that aggressive treatment won't alter a terminal condition can allow for a more constructive approach to end-of-life care. Health Inequity -Access to healthcare varies due to factors such as race, ethnicity, socioeconomic status, age, gender, disability, sexual orientation, and geography. -The Affordable Care Act (ACA) aimed to improve access, but disparities persist, especially highlighted by the COVID-19 pandemic. -Nurses must provide client-centered care that focuses on the client's values, even if personal beliefs differ. -If the nurse feels unable to resolve a conflict of values, they should request another assignment and seek support.

Discharge Planning

Overview -Discharge planning starts when a patient is admitted to the hospital. -Nurses use critical thinking and holistic knowledge to anticipate and identify the patient's continuing needs. -It is a centralized, interdisciplinary process that ensures a plan for continuing care after leaving the healthcare agency. Effective Discharge Planning -Requires referrals to other healthcare disciplines, such as physical therapy. -Tips for successful referrals: ---Make the referral as soon as possible. ---Provide as much information about the patient to the referral service as possible. ---Involve the patient and family in the referral process. ---Explain the service, reason for the referral, and what to expect from the referral services. Patient Education -Education is often provided by health professionals (e.g., dieticians, physical therapists) during the hospital stay. -The discharging nurse should review the following at discharge: ---Medication administration ---Use of medical equipment ---Food-drug interactions and modified diets ---Rehabilitation techniques for independence ---Access to community resources ---When and how to obtain further treatment ---Skills and knowledge to meet healthcare needs ---When to notify the healthcare provider Documentation -The nurse should document discharge instructions, have the patient sign to indicate they received them, and provide the patient with a copy to take home.

Ethics in Nursing

Overview -Ethical practice is a foundation of nursing, beyond demonstrating medical competence. -Nurses adhere to moral principles and professional standards to provide high-quality, safe care. Key Ethical Principles in Nursing -Autonomy ---Clients have the right to self-determination and can decide what happens to them. ---Nurses must respect clients' wishes, even if they conflict with the nurse's own beliefs. ---Examples: Right to refuse care, informed consent, self-determination. -Beneficence ---Promoting or doing good for the patient. ---Nurses work to achieve optimal outcomes and act in the best interests of their clients. ---Examples: Administering vaccinations, resuscitating a patient, promoting quality of life. -Justice ---Treat all clients equally and fairly. ---Nurses must distribute time and resources fairly based on the needs of each individual. ---Examples: Protecting clients' rights, ensuring adequate staffing and supplies. -Nonmaleficence ---Avoiding harm to patients. ---Nurses must maintain competent practice to prevent injury or suffering. ---Examples: Attending staff education to maintain competence, reporting suspected abuse.

Ethical Dilemmas

Overview -Ethical principles can present challenges due to conflicts between them. -These principles may have equal moral weight, making them difficult to compare. -Autonomy may not transcend cultural barriers, differing between individual or group autonomy depending on the culture. Conflicts Between Principles -Example: A client with cancer refuses treatment. The nurse must balance respecting autonomy with the goal of ensuring the client receives life-saving care. -Conflicts like this are complex, and solutions are rarely clear-cut. -Most healthcare facilities have an ethics committee to help resolve ethical dilemmas, but nurses may need to seek immediate support from colleagues, nurse managers, or supervisors. Key Steps in Resolving an Ethical Dilemma -Ask the question: Is this an ethical dilemma? -Gather relevant information: Include perspectives from the client, family, institution, and society. -Clarify values: Separate facts, opinions, and values. -Verbalize the problem: A clear statement of the dilemma facilitates effective discussion. -Identify possible courses of action. -Negotiate a plan: Requires confidence in your viewpoint and respect for others' opinions. -Evaluate the plan over time.

Ethics and Healthcare

Overview -Ethics in healthcare supports clients, loved ones, and health professionals in reaching agreements on treatment goals and outcomes that respect client values. -Ethical discussions are flexible, filled with differences of opinion, and focused on understanding human interaction. Theoretical Ethics -Deontology: ---Focuses on right or wrong based on fidelity, truth, and justice. ---Health professionals must agree on what is just and the role of autonomy and goodness in care. ---Deontology can be influenced by cultural, familial, and personal values. -Utilitarianism: ---Aims for the best outcome for the greatest number of people. ---Like deontology, it can be influenced by cultural, familial, and personal values, leading to confusion. Practical Ethics -Closely Related to Feminist Ethics: ---Considers the nature of relationships to guide decisions, especially in unequal power dynamics. ---Without ethical principles, solutions may be based on subjective judgment. Ethics of Care -Focuses on relationships between care providers and those receiving care. -Incorporates feelings and the environment in decision-making. -Highlights the importance of incorporating ethics into healthcare.

Balance of Responsibility, Autonomy, Authority, and Accountability (RAAA)

Overview -For nurses to practice effectively, there must be a balance between responsibility, autonomy, authority, and accountability (RAAA). -An imbalance can cause the nurse to question, "Is this fair?" Responsibility vs. Autonomy -Example: Rayden is responsible for ensuring his siblings behave but is not allowed to discipline them when they fight. -Issue: He has the duty to act (responsibility) without the freedom to act (autonomy), which he feels is unfair. Autonomy vs. Authority -Example: Gloria and Charles share a car based on a set schedule. Gloria starts using the car outside her scheduled times, overstepping her authority. -Issue: Gloria overextends her authority, leading to a loss of her driving privileges. She feels this is unfair, while Charles uses proper authority to resolve the issue. Imbalance of RAAA During a Global Pandemic -Since late 2019, healthcare professionals have faced situations where their authority to act was challenged by a lack of supplies to meet the demands of providing safe care. -Issue: Professionals had to choose between fulfilling their responsibility to act or protecting their own personal autonomy in unsafe conditions, leading to an imbalance of RAAA that was not fair.

Common Sources of Negligence

Overview -Malpractice is a type of negligence where a health professional's failure to provide the expected level of care leads to injury. -Nurses can prevent negligence by following standards of care, fostering therapeutic relationships, and working with the healthcare team. Scope of Malpractice in Nursing -Malpractice includes failure to: ---Assess and monitor (including making a nursing diagnosis). ---Observe, assess, diagnose, or treat in a timely manner. ---Use, calibrate, or replace equipment necessary for safe care. ---Document care and evaluations in a timely manner. ---Notify the healthcare provider of significant changes in client status. ---Respond to or implement orders accurately. ---Follow the six rights of medication administration. ---Convey discharge instructions properly. ---Ensure client safety, especially for those at risk (e.g., fall risks, frail, confused). ---Follow policies and procedures. ---Delegate and supervise properly. Medical Negligence -Four elements of medical negligence: ---Duty of care: The professional had a responsibility to the client. ---Breach of duty: The duty was broken or unmet. ---Causation: The breach caused the injury. ---Damages: Compensation is assigned for the injury. Preventing Malpractice -Follow standards of care and employer's policies. -Stay current on advancements in your area of practice. -Build therapeutic relationships with clients to foster trust. -Provide timely and truthful explanations for errors and document events accurately.

Characteristics of an Effective Leader

Overview -Nurse leaders can be anyone from nurse managers to future nurses like yourself. -As a registered nurse, you will lead nursing colleagues in providing patient care. -Leadership skills grow with experience and education, just like the ability to coordinate nursing care. Key Leadership Characteristics -Effective communicator -Consistent in managing conflict -Knowledgeable and competent in all aspects of care delivery -Role model for staff -Uses a participatory approach in decision-making -Appreciates a job well done -Delegates work appropriately -Sets objectives and guides staff -Displays caring, understanding, and empathy for others -Motivates and empowers others -Proactive and flexible -Focuses on team development (Potter, 2023, p. 303)

Interprofessional Communication Skills

Overview -Nurses in the U.S. work with individuals from diverse backgrounds and specialties. -Nurses spend a significant amount of time providing direct care, giving them a unique opportunity to understand patients and serve as advocates for their needs and hopes to the healthcare team. Key Factors of Interprofessional Communication Skills -Value Team Input ---Document patient data accurately and in a timely manner. ---Focus on patient needs and outcomes during communication. ---Actively listen to and address concerns. ---Seek clarification if unsure about the treatment plan. -Exchange Relevant Information Within the Team ---Set expectations for what, where, and when to communicate. ----Repeat what you've heard to ensure understanding. ---Use the ISBAR format (Information, Situation, Background, Assessment, Request) for critical conversations. ---Focus on the patient and their care when conflict arises. -Coordinate Workload With Colleagues ---Assist with a colleague's assignment if one of their patients needs attention. ---Delegate care appropriately. ---Assess the capabilities of team members.

Resource Utilization

Overview -Nurses support the business of healthcare by carefully using physical resources to provide patient care. -Simple steps ensure that everyone has the right resources at the right time, promoting successful patient outcomes. Report Broken Equipment -Remove broken equipment from use immediately. -Tag or label the item with the date and a brief description of the damage. -Contact the appropriate colleagues to fix the issue. Take Only What You Need -Supplies should not be taken from one patient's room to another to prevent infection spread. -Bring only enough supplies into a room for the task at hand. Charge for Supplies Used -Document the use of supplies for reimbursement by using stickers or barcodes in the electronic health record (EHR). -Some items are included in daily charges, while others (medications, dressing supplies) are charged as used. -The colleague using the supplies is responsible for documenting their use. Use Time Wisely -Time management is crucial for caring for patients, colleagues, and yourself.

Nursing Care Delivery Models​

Overview -Nursing care is delivered by a team that includes RNs, LPNs/LVNs, and NAP/UAPs. -The RN leads the nursing team and collaborates with all members to ensure effective care. -Patient involvement and teamwork are central to all models. Total Patient Care -First used during Florence Nightingale's time. -The RN provides all aspects of care for the patient during their shift. -High degree of collaboration among healthcare team members. -Primarily used when RN availability is high or for patients needing continuous, knowledgeable care from a single provider. Patient-Centered Care (PCC) -Also referred to as Patient-Family-Centered Care (PFCC). -A multidisciplinary approach that focuses on the patient, not the organization. -Defined by the Institute of Medicine (2011) as care that is respectful of, and responsive to, individual patient preferences, needs, and values, ensuring that these values guide all clinical decisions. -Requires an organizational culture that prioritizes the patient, supported by senior leadership and championed by all colleagues. Case Management -Focuses on lowering costs without compromising care quality. -A collaborative process involving all healthcare disciplines. -The case manager coordinates care, plans, facilitates, and advocates for the patient, securing the necessary services. -Effective communication and knowledge of resources are essential, especially for patients with complex nursing and medical problems.

Working Smart and Caring, Together!

Overview -People are the most important resource in healthcare. -Patient care is smoother when team members work together and care for each other. Asking for Help as a Student -Asking for help may feel uncomfortable, but it's normal for novice nurses. -It's important to ask questions and seek a second opinion to ensure evidence-based care. -Even experienced health professionals reach out to peers for confirmation of assessment findings and discuss the best course of action. Caring as a Core of Nursing -"In professional nursing practice, a core of caring is necessary for it to become nurturing and to do what is best for the patient" (Karlsson & Pennbrant, 2020, p. 3). -Never hesitate to ask for or offer help that increases patient comfort and safety. Examples of Teamwork in Action -Repositioning patients every 2 hours with a colleague's help. -Walking with a wheelchair behind a patient being ambulated by a UAP in case the patient tires. -Assisting with a complex dressing change.

Setting Priorities

Overview -Prioritization is an essential skill for nurses. -When delivering care, priorities are based on factors like time of day, patient needs and status, and patient preferences. -Nurses use critical thinking and knowledge of their patients to set appropriate priorities. Time-Dependent Priorities -Some interventions (e.g., medication administration, vital signs) need to be completed at specific times. -Other tasks (e.g., bathing, dressing changes) can be done when convenient for the patient and nurse. -Start with timed activities, then add tasks that can be completed during the shift. Patient Need Priorities -At the start of the shift, the nurse's priority is to see the patients in their care. -Walking rounds allow the nurse to observe each patient's status and organize the day based on patient needs. Priority Levels -First-Level (High) Priority Problems ---Emergent and life-threatening issues, such as establishing an airway or supporting breathing. -Second-Level (Intermediate) Priority Problems ---Require prompt intervention to prevent further deterioration (e.g., mental status changes, acute pain, abnormal labs, risks of infection). -Third-Level (Low) Priority Problems ---Important to patient health but can be attended to after more urgent issues. ---These are long-term problems requiring collaboration between the patient and healthcare professionals. Patient Preference Priorities -If time and physical status allow, interventions based on patient choice should be completed when requested (e.g., shaving before family visits, bathing before bedtime to aid sleep). Flexibility and Resources -Priorities change as a patient's condition changes. -Nurses must be flexible, recognize changing needs, and make the best use of time and resources.

Organization

Overview -Safe and effective care requires organization. -Nurses must develop a plan alongside their knowledge, skills, and attitude to ensure effective patient care. -Establishing an organized system during clinical experience will provide a foundation for professional practice throughout a nursing career. Supporting Patient Care Through Organization -Use Interaction ---With each patient interaction, learn more about them as a person. ---Show interest in how their health impacts their life and any concerns they have about going home and self-care. -Cluster Nursing Interventions ---Group related nursing interventions to complete them together. ---Example: When administering medications, assess the patient's understanding of the drug and reinforce information as needed. -Gather Supplies ---Before entering the patient's room for a procedure, ensure all necessary supplies are gathered. -Safety and Accessibility ---Before leaving the patient's room, check that they are safe and comfortable, have essential items within reach, and that their environment is clean and uncluttered.

Social Media and the Nurse

Overview -Social media presents ethical challenges for nurses. While it can provide support, it also poses significant risks to client privacy and professionalism. Social Networks -Pros: Social networks can offer supportive information and emotional support regarding client care or work hardships. -Cons: Posting images or details about clients, even without identifiers, can lead to a breach of client privacy. Shared media can resurface in ways that make the client identifiable. Client Etiquette -Avoid becoming friends with clients on social media platforms like Facebook or online chat rooms. -Social media relationships can interfere with your ability to maintain an objective and therapeutic relationship. -Public online connections may risk other clients' trust in your impartiality and professionalism. Workplace Policies -Refer to workplace policies to understand when and where it is appropriate to engage in social media about workplace issues. -The American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) provide guidelines. ---"Effective nurse-patient relationships are built on trust. Patients need to feel confident that their personal information and dignity will be protected by the nurse" (NCSBN, 2018).

Good Samaritan Law

Overview -Statutory law is created by elected legislative bodies, such as state legislators and the U.S. Congress. -Examples include the Nurse Practice Act and Good Samaritan laws. -Good Samaritan laws offer legal protection to people who provide reasonable assistance to those believed to be injured, ill, or in danger. Nurse Practice Act -Defines the scope of nursing practice and establishes education and licensure requirements. -State boards of nursing enact rules and regulations defining nursing practice, such as IV therapy guidelines and the use of unlicensed assistive personnel (UAP). -All nurses are responsible for knowing their state's Nurse Practice Act and regulations. Good Samaritan Laws -Protect healthcare professionals who assist in emergencies outside their workplace. -Legal protection is provided if the care is within the provider's scope of practice and if they remain with the injured person until care is transferred to a qualified medical professional. -Leaving before transferring care can result in abandonment charges. Statutory Law -Divided into: ---Criminal law: Protects safety and punishes criminal actions. ---Civil law: Involves private rights and remedies. -A single action can violate both criminal and civil law.

Right to Refuse Care

Overview -The Patient's Bill of Rights ensures individuals have the right to make decisions about their plan of care, including the right to refuse care. -Healthcare professionals must respect the client's choice and continue providing care that aligns with their wishes. Treatment Consent and Refusal -For consent or refusal of treatment to be valid, the decision must be both voluntary and made after being adequately informed. ---Informed: Complete information about treatment, including benefits, risks, alternatives, and what happens if treatment is refused. ---Voluntary: The decision must be made without pressure from healthcare professionals, family, or friends. -Capacity: Adults are presumed to have the capacity to make medical decisions unless there is significant evidence to suggest otherwise. Inability to Decide -A person lacks capacity if their mind is impaired or disturbed, making them unable to make a decision at the time. -Examples: ---Mental health conditions (e.g., schizophrenia, bipolar disorder) ---Dementia ---Conditions causing confusion, drowsiness, or unconsciousness ---Intoxication from drug or alcohol misuse Leaving Against Medical Advice (AMA) -The healthcare provider must discuss treatment options, risks, benefits, and alternatives. -If a client refuses care, the nurse may need to obtain the client's signature on a refusal document (AMA). -The nurse must confirm that the client: ---Understands the risks and benefits of the recommended treatment, alternatives, and no treatment ---.Can make a voluntary and informed decision. -If the nurse determines the client is not properly informed or lacks capacity, they should notify the healthcare provider. -Refusal of care can create an ethical dilemma. The nurse can seek support from a manager or the facility's ethics committee.

Patient Belongings

Overview -The average hospital stay in the U.S. is 5.5 days. -Patients often have limited storage for personal belongings in hospital rooms. -Hospitals have policies to manage patient belongings and ensure their safety. Common Facility Policies -Facilities recommend patients do not bring valuables (e.g., cash, credit cards, wallets). -Necessary items like hearing aids, glasses, contacts, dentures, and cell phones are allowed. -Comfort items like slippers and robes are also permitted. -Electrical devices must be inspected for safety; defective devices are returned home. Nurses' Responsibility -During admission, a nursing colleague (RN, PN, or UAP) inventories the patient's personal property, recording it in the Nurses' Notes. -Upon discharge, the valuables inventory serves as a checklist to ensure all belongings are returned. -For valuables that cannot be sent home, nurses contact security to store them in a safe, providing the patient with a receipt. -The nurse must request the return of valuables before discharge. -For patients going to surgery, valuables may be taken by security if family members cannot hold them.

Who Can Provide Consent for Medical Care?

Overview -The relationship between individuals seeking care and healthcare professionals is based on trust. -Consent is needed for care and involves informing individuals of risks, benefits, and alternative options for treatment. -State laws determine who can provide consent, and nurses must know the laws of their state and their employer's policies. Who Can Provide Consent? -Competent individuals over the age of 18. -Emancipated minors (minors who are legally granted adult status). ---The duty to obtain informed consent remains, even if the patient is an emancipated minor. Special Accommodations for Consent -For clients who are: ---Hearing impaired. ---Unable to read. ---Non-English speakers. The healthcare provider must: -Provide consent information in a manner the client understands. -Accommodations may include: ---Printed materials in the client's preferred language. ---Audio or visual aids. ---Certified medical interpreters (provided at no cost).

Clinical Care Coordination

Overview -The skills required by a nurse to coordinate and deliver patient care are similar to the skills used by a student nurse to balance learning and life. -These skills include decision-making, priority setting, organization, resource management, time management, and evaluation. Student and Nurse Priorities -Life decisions (Student) → Decide → Clinical decisions (Nurse) -Family, work, and school (Student) → Prioritize → Patient needs (Nurse) -Family, work, and school (Student) → Organize → Multiple priorities (Nurse) -Money, time, energy (Student) → Resources → Colleagues, medical supplies (Nurse) -Multiple deadlines in a session (Student) → Time → Multiple deadlines in a shift (Nurse) -What works and doesn't work (Student) → Evaluation → Patient outcomes (Nurse)

Tort Law

Overview -Tort law is part of civil law and involves disputes where compensation is awarded to a victim. -A tort is a civil wrong that causes harm to another person without a contract involved. -Three types of torts: Intentional, Quasi-intentional, and Unintentional. Intentional Torts -Assault: Threatening or attempting to harm someone (e.g., threatening to restrain a wandering patient). -Battery: Touching someone without consent (e.g., administering a vaccine against the parent's wishes). -False Imprisonment: Restraining someone's movement without cause (e.g., not allowing a patient to leave after refusing treatment). -Abuse: Causing harm through physical, verbal, or emotional means (e.g., neglect or abuse by caregivers). ---Cues of abuse: Unexplained injuries, poor hygiene, personality changes, or statements indicating abuse. Quasi-intentional Torts -Invasion of Privacy: Physical or informational violations (e.g., not covering a patient properly or sharing personal information without consent). -Defamation of Character: False statements damaging someone's reputation. ---Slander: Spoken form of defamation. ---Libel: Written form of defamation (e.g., falsely claiming a patient is seeking drugs). Unintentional Torts -Negligence: Failing to provide expected care, resulting in injury (e.g., a UAP leaving water on the floor, leading to a visitor's fall). -Malpractice: Professional failure to use expected skills, causing harm (e.g., not recognizing labored breathing leading to pulmonary arrest).

Time Management

Overview -Unexpected interruptions can happen, but nurses can plan beforehand to manage their shift effectively. -Creating a schedule helps you: ---Set goals for yourself and your patient. ---Determine priorities of care. ---Know when you can assist classmates. ---Remind yourself to take breaks, such as eating lunch. Updating Your Schedule -Update your schedule with any changes throughout the day for a "before and after" account of how your day went. -Over time, you can analyze your schedule to see how you are using your time, identify areas where you may be spending too much time, and track your growth in time management skills.

Patient-Centered Care, Total Patient Care, and Case Management

Patient-Centered Care -Focus: What is important to the individual. -Key Characteristics: ---Adapting care as the needs of an individual change. ---Ensuring the client understands new information about their health. ---Respecting the individual's health and lifestyle choices. Total Patient Care -Nurse Responsibility: ---RN is responsible for all care during their shift. -Key Characteristics: ---Often used for critically ill clients. ---Requires a high degree of interprofessional collaboration. ---Nurse benefits from being fully knowledgeable about the client's health history and care needs during that shift. Case Management -Primary Focus: Coordinating resources to improve care for clients with complex needs. -Key Characteristics: ---Linking health services across all levels of care. ---Clinicians focus on groups of patients with specific illnesses. ---Goal: Improving outcomes while reducing the overall cost of care.

Match their corresponding nursing care delivery system.​ Patient-Centered Care Total Patient Care​ Case Management Adapting care as the needs of an individual change and conveying respect for the individual's health and lifestyle choices​​ RN responsible for all care on a shift​ and requiring a high degree of interprofessional collaboration​ Clinicians focusing on groups of clients with specific illnesses with the goal of improving outcomes while reducing the overall cost of care

Patient-Centered Care: Adapting care as the needs of an individual change and conveying respect for the individual's health and lifestyle choices​​ Total Patient Care​: RN responsible for all care on a shift​ and requiring a high degree of interprofessional collaboration​ Case Management: Clinicians focusing on groups of clients with specific illnesses with the goal of improving outcomes while reducing the overall cost of care

A client with an expected outcome of "Able to bathe and brush teeth independently" is looking forward to discharge in the near future. The nurse observes the unlicensed assistive personnel (UAP) performing the following actions. For which action must the nurse intervene?​ Assisting the client to the bathroom and back to bed Performing a complete bath for the client Setting up a meal tray and encouraging the client to feed themselves Reminding the client not to look at their feet while walking

Performing a complete bath for the client All of these actions fall within the scope of practice for a UAP, and the UAP should help the client with morning care as needed; however, the goal is to keep this client as independent and mobile as possible, so the client should be encouraged to perform as much morning care as they can. Assisting the client in ambulating (for safety), reminding the client not to look at their feet (to prevent falls), and encouraging the client to feed themselves are all appropriate to the goal of maintaining independence. ​ It is the nurse's responsibility to supervise the UAP, providing guidance and education as needed. Communication should be respectful, focus on the actions that need to change, and be based on what is best for the client. Best practice is to ask the UAP to restate the expectation for care of this client to ensure both the nurse and UAP are in agreement on actions needed to help the client remain independent.​

Which actions are appropriate to assign to a practical nurse (PN) working under the supervision of a registered nurse (RN)? Select all that apply. ​ Performing a routine check of a client's visual acuity using the Snellen eye chart​ Administering ophthalmic drops to a child with conjunctivitis Reviewing the health history of a client to identify risk for ocular manifestations Assessing nutritional factors for a client with age-related macular degeneration Demonstrate the proper process used to gently cleanse eyelid margins Reinforcing hand-washing and hygiene practices with an older adult with an eye infection

Performing a routine check of a client's visual acuity using the Snellen eye chart​ Administering ophthalmic drops to a child with conjunctivitis Demonstrate the proper process used to gently cleanse eyelid margins Reinforcing hand-washing and hygiene practices with an older adult with an eye infection Administering medications (ophthalmic drops), reviewing and reinforcing health promotion skills (hand hygiene), demonstrating a standard procedure (cleansing eyelids), and performing standardized assessments with predictable outcomes (checking visual acuity) are within the PN scope of practice and can safely be assigned or delegated to them. ​ Assessing the client for risk factors related to an alteration in health, a vital step in the nursing process, is the responsibility of the RN. ​ It is the responsibility of both the RN and PN to be familiar with the Nurse Practice Act of the state in which they work to ensure that they are working within their defined scope of practice.​

Durable Power of Attorney for Healthcare (DPOA)

Purpose: Legal document designating a proxy to make healthcare decisions when an individual is unable to do so. Activation: Requires physician certification of the individual's inability to make decisions. Role of Proxy: Communicates with the healthcare team and makes decisions based on the client's wishes or in their best interest. Limitations: Proxy's authority ends if the client regains decision-making capacity. State Laws: Vary by state; nurses must be familiar with local regulations.

Living Wills

Purpose: Legal document for future healthcare decisions if an individual cannot make decisions themselves. Used when a person is terminally ill or permanently unconscious. Content: -Prolonging life (e.g., dialysis, tube feeding, life support)Do-Not-Resuscitate (DNR) orders -Comfort care or palliative care -Organ and tissue donation Conditions: Requires confirmation from two healthcare providers that the client cannot make decisions and is terminally ill or permanently unconscious. Flexibility: Clients can change or revoke their living will at any time.

Do-Not-Resuscitate (DNR) Orders

Purpose: Request to prevent life-prolonging treatments (e.g., CPR, intubation). Treatment Focus: -Palliative care measures continue to improve quality of life. -No treatments to cure or prolong life after the order is enacted. Applicability: Hospital DNR orders are typically facility-specific; POLST documents provide broader instructions for home settings.

The nurse is caring for a client experiencing extremely low blood pressure. The healthcare provider prescribes a vasoconstrictive medication with which the nurse is unfamiliar. When considering which action to take next, the nurse considers which aspects of RAAA? Select all that apply.​ Responsibility Autonomy Accountability Authority

Responsibility Autonomy Accountability The nurse knows that they are not familiar with the medication and realizes that they are likely to be unable to prepare and administer the medication safely. To do so would be accepting too much responsibility. Knowing that they have the autonomy to make a decision in the client's best interest, the nurse asks a more experienced colleague to prepare and begin the medication infusion. Finally, this nurse owned their lack of knowledge (accountability) by asking for help. This patient-focused application of responsibility, autonomy, and accountability led to a decision that made the client's safety everyone's priority. Once the client is stabilized, the nurse can use the authority to access information about the medication for future reference.

Responsibility, Autonomy, Authority, and Accountability (RAAA)

Responsibility — Duty to Act -Responsibility refers to the obligation to act. -Nurses are responsible for providing care as defined by their job description and delegation from the nursing manager. -Accepting responsibility means understanding and committing to meet expectations. Autonomy — Freedom to Act -Autonomy is the freedom to make choices within the nurse's scope of practice. -Nurses exercise autonomy in planning and providing care independently, but have less autonomy when following prescribed tasks from healthcare providers, such as administering medications. Authority — Power to Act -Authority is the power to act, derived from the nurse's education, licensure, state laws, and workplace policies. -Nurses are expected to practice within the authority of their role. Accountability — Owning the Act -Accountability is ownership of actions, regardless of the outcome. -Nurses must be accountable for following facility policies and must take ownership when they choose not to follow those policies.

The Five Rights of Delegation

Right Task -Tasks should be delegated to colleagues whose job description includes the activity. -Tasks are often repetitive, non-invasive, and pose little risk to the patient. -The RN should not need to supervise the delegatee. ---Example: An LVN is responsible for passing medications, while a UAP is not. Therefore, the LVN is qualified to administer pain medication to a patient. Right Circumstances -The patient should be stable, and the task should not require the nurse's knowledge to ensure safety. -The resources needed to complete the task should be available. ---Example: A nurse delegates ambulating a stable patient to a UAP while they attend to another patient experiencing chest pain. Right Person -The nurse must ensure the delegatee has the experience and is comfortable with the task. ---Example: A NICU nurse, who has not inserted a urinary catheter in 20 years, declines the task and another nurse performs it instead. Right Direction/Communication -The nurse must communicate specific instructions and ensure the delegatee understands the task, including any data collection, reporting timeframes, and clarifications. -The delegatee must agree to the task and understand they cannot make decisions without consulting the nurse. ---Example: A UAP is instructed to take a patient's temperature at 12:30 and report the result within 5 minutes. Right Supervision/Evaluation -The nurse is responsible for monitoring the task, evaluating patient outcomes, and ensuring proper documentation. -The delegatee retains accountability for reporting patient outcomes. ---Example: After a patient is assisted to the restroom by an LVN, the nurse checks on the patient, verifies documentation, and the LVN reports how the patient tolerated the activity.

Match the definition below with the type of law it describes: Legislation passed by the U.S. Congress and the state legislatures is civil or criminal. Protects the rights of individuals by settling disputes between citizens. Defines nursing standards that must be met within individual states. Defines offenses and punishments for those who threaten, harm, or endanger society. Decisions are made based on previous court cases. Case law Civil law Criminal law Nurse Practice Acts Statutory law

STATUTORY LAW Legislation passed by US Congress and state legislatures that is civil or criminal. CIVIL LAW Protect the rights of individuals by settling disputes between citizens. NURSE PRACTICE ACT Define nursing standards that must be met within individual states. CRIMINAL LAW Defines offenses and punishments for those who threaten, harm, or endanger society. CASE LAW Decisions made based on previous court cases.

Resolving an Ethical Dilemma: Scarcity of Resources (example)

Scenario -A tornado disrupts power and phone services, causing damage and requiring clients to be transferred. -Colleagues are forced to choose between responsibilities to clients and their families, as communication with off-duty staff is not possible. Steps in Ethical Decision-Making -Ask the question: Is this an ethical dilemma? ---Yes, colleagues must decide between their responsibilities to clients and families. -Gather information: ---Damage is widespread, with power and phone outages. ---Limited emergency services can transport clients. ---Injured community members are overwhelming the emergency department. ---Space to care for clients is limited. -Clarify values: ---Facts: Storm impact increased care needs, limited support staff, no phone service. ---Opinions: People should care for loved ones first, even if leaving work. ---Values: Family first (autonomy), clients first (beneficence), justice, and nonmaleficence. -Verbalize the problem: ---What is the best course of action to ensure safe care for clients while awaiting transport? -Identify possible actions: ---Call in staff not at work. ---Discharge medically stable clients with a safe place to go. ---Contact neighboring communities for support. ---Prioritize client needs based on predefined criteria. -Negotiate a plan: ---Use the disaster preparedness plan for emergency situations. -Evaluate the plan over time: ---Debrief the event to analyze the plan's effectiveness and update it based on evidence.

Delegation

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A client who was admitted after a motor vehicle crash is scheduled for surgery later in the day. When completing a focused assessment, the nurse notices that the client is wearing a wedding band and has a mobile phone with a charging plug/cable. Their wallet, dentures, and a case for their contact lenses are sitting on the bedside table.​ Drag each of the client's possessions to the cell on the table that indicates whether the item should be sent home or placed in the drawer at the bedside.

Send home: Wallet and rings Drawer at bedside: Dentures, Phone w/ charging plug/cable; case for contact lenses.

Place the key steps for ethical dilemma resolution in the correct order, starting with the first step and ending with the last step.​ Gather information relevant to the case. ​ Verbalize the problem. ​ Identify possible courses of action.​ Ask the question: "Is this an ethical dilemma?" Clarify values. Distinguish among fact, opinion, and values.​ Evaluate the plan over time.​ Negotiate a plan. ​

Start by confirming the situation represents an ethical dilemma. Then gather relevant information. Clarify values, facts, and opinions. Verbalize the problem to provide focus for discussion. Identify potential interventions. Negotiate a plan that balances the values and opinions with the facts. Implement and evaluate the plan.

After the nurse has performed a skin assessment on a recently admitted 19-year-old client, which finding is the highest priority to report to the healthcare provider?​ Scattered brown macules on the face Tenting of the skin on the forearms Mole 2 mm in diameter on the chest Patches of vitiligo around both eyes

Tenting of the skin on the forearms Tenting of the skin on younger clients may indicate dehydration and the need for oral or intravenous fluid administration. The other data will be recorded but does not require any rapid interventions.

The nurse stops at the scene of a motor vehicle crash intending to assist individuals who were injured. The nurse understands their actions are supported by which principles? Select all that apply.​ The nurse is functioning within the guidelines of the Good Samaritan Law for the state in which they practice.​ If after assessing the situation, the nurse determines the care needed is outside their scope of practice, they can leave to obtain help.​ As long as the nurse provides care within their scope of practice, they cannot be held liable for a negative outcome.​ Compensation for assisting victims will be provided by the state, based on the nurse's current rate of pay.​ The victims have the right to refuse the nurse's offer of help.​

The nurse is functioning within the guidelines of the Good Samaritan Law for the state in which they practice.​ As long as the nurse provides care within their scope of practice, they cannot be held liable for a negative outcome.​ The victims have the right to refuse the nurse's offer of help.​ Good Samaritan Laws offer legal protection to people who voluntarily provide reasonable assistance to those injured individuals first enacted to protect healthcare professionals who assist in emergencies outside their place of employment.​ It is important for the nurse to understand the guidelines of the Good Samaritan law where they live, as the law varies by state. When acting as a Good Samaritan, the nurse must act within their scope of practice as defined by the State Nurse Practice Act, including not abandoning the injured party to get help. The injured person has the right to refuse assistance, even if the nurse feels it is not in their best interests, though the nurse should remain with the injured person until qualified medical professionals assume care to avoid abandonment charges and being held responsible for any harm that occurs after they leave the injured person. The Good Samaritan Law clearly states the nurse is acting voluntarily and should accept no compensation for the care provided.​

A middle-aged adult presents to the clinic for a follow-up after having been diagnosed with pulmonary hypertension. The client has a history of sarcoidosis. Their vital signs are within normal reference ranges. The client states that they wish to discuss options for care as their conditions worsen. Which provision of the Patient Self-Determination Act (PSDA) requires health professionals to participate in this discussion? ​ The need for a thorough psychiatric evaluation to determine the client's capacity to make decisions The requirement to have a primary care referral before establishing care with a specialist The requirement to inform clients of their health-related rights under state laws The mandate to offer healthcare despite the cost to the client

The requirement to inform clients of their health-related rights under state laws Patient Self-Determination Act (PSDA) mandates that hospitals, nursing facilities, hospices, home health, and HMOs perform a number of specific actions and ensure that certain other conditions are met in order to protect the client.​ As the first legislation of its kind, the PSDA creates a stance on advance directives and requires clients to be informed of their health-related rights under state laws.​ The PSDA also allows for decreased costs by giving an option to elect or decline critical care/ICU interventions in the face of death due to terminal illness or injury.​ The Patient Protection and Affordable Care Act functions to address the correction of the uninsured population within the United States. It is not tied to the PSDA.​​

A client who is critically ill will benefit most from being admitted to a nursing unit that utilizes which type of nursing care delivery system?​ Total patient care​ Holistic care Interdisciplinary care​ Patient-centered​ care

Total patient care​ Total patient care is provided by a single nurse, allowing that nurse to be knowledgeable about all aspects of their care and to serve as the point of contact for the healthcare team. It is used most often in intensive care units to deliver care to critically ill individuals.​ All clients should receive care that is patient-centered, holistic, and delivered by an interdisciplinary team of health professionals.​

Interprofessional Communication

Value team input​ -Document patient data accurately and in a timely manner​ -Focus on patient needs and outcomes during all communication​ -Actively listen to, and address, concerns ​ -Seek clarification when unclear of the treatment plan​ Exchange relevant information within the team​ -Set expectations for what, where, and when to communicate ​ -Repeat what you've heard so the person who shared information can confirm you understood​ -Use the I-SBAR (Information-Situation-Background-Assessment-Request) format for critical conversations ​ -Focus on the patient and their care when conflict arises​ Coordinate workload with colleagues​ -Care for a colleague's assignment if one of the patients needs their attention​ -Delegate care appropriately​ -Assess capabilities of individuals within the team​

The nurse caring for a friend who is ready to be discharged home after surgery takes a picture with the friend as she sits in the car and posts it on social media with the caption, "So proud of my BFF for being the best client ever! Love you!!!❤" For each ethical principle or professional standard (in the left column below), indicate if the nurse violated or not violated it.

Violated: Privacy, Confidentiality, Justice, Nonmaleficence, Fidelity Did not violate: Autonomy, Beneficence, Self-determination While it may seem natural to take and post a selfie with a friend, the nurse must keep in mind professional boundaries. By putting the image on social media, the nurse has put a client's PHI (image and hospital stay) in the public domain, breaking both privacy and confidentiality standards. Ethically, posting an image of a friend who is a client means that the nurse is not treating that client the same as others, which goes against the ethical principle of justice. The nurse-client relationship represents a professional promise by the nurse to do no harm (nonmaleficence) and follow facility guidelines for privacy and confidentiality (fidelity). The nurse violated both principles by posting the image on social media.​ The nurse did not violate autonomy (did not prevent the client from being independent), beneficence (did not impact the client's positive clinical outcome), and self-determination (did not prevent the client from controlling their own life).

Delegation and the Student Nurse

When Approached for a Task -As a student nurse, you may be asked to help with a task or offered the opportunity to perform a skill on a patient. -A good response is: "I would like to help. Can it wait until I get my clinical instructor?" -While searching for your instructor, consider the five rights of delegation. If the Task Meets the Five Rights of Delegation -If you're the right person and your instructor agrees, this is a great learning opportunity for your professional growth. -Before completing the task, review the five rights again, focusing on: ---What has been communicated to you. ---What you need to report back to the nurse. ---What you will do if something unexpected happens (though it probably won't!). -Though it may seem like a simple task (e.g., helping a patient to the bathroom), the thought processes you practice now will set the foundation for future critical thinking. If the Task Does Not Meet the Five Rights of Delegation -If the task does not meet the five rights, you may not be ready to assist. -Offer to do something else to give the nurse time to complete the task themselves—a gesture you'll appreciate when you become a nurse!

A woman calls the hospital asking for information on a client's condition. The woman claims to be the client's ex-wife and demands to speak with the healthcare provider about the current treatment plan. The nurse explains that they are unable to speak to her because her name is not included on a list of persons with whom the client's information can be shared. ​ Select the ethical principles and client's rights the nurse displayed during this conversation.​ Confidentiality ​ Beneficence ​ Autonomy ​ Fidelity ​ Veracity ​ Reasonable accommodations ​

fidelity, veracity, confidentiality The nurse is ensuring a client's right to confidentiality by acting ethically and following the facility policies regarding confidentiality (fidelity) and being honest with the caller (veracity). By not sharing the client's information with a caller who has not been approved to speak with caregivers, the nurse is protecting the client's confidentiality.​ Providing reasonable accommodations is a right that pertains to care delivery, not communication with family. Beneficence is an ethical principle that also concerns care delivery, more so than communication. ​Autonomy is the client's right to make decisions about their medical care without their healthcare provider trying to influence the decision.