Transition Final

Advanced Directives

A document made by a competent individual to establish desired health care for the future or to give someone else the right to make health care decisions if the individual becomes incompetent; examples include living wills and medical powers of attorney.

Durable Power of Attorney

A document that allows a person to name someone else to make medical decisions for him or her if he or she is unable to do so. This spokesperson's authority begins only when the patient is incompetent to make those decisions.

Living Will

A document that allows a person to state in advance that life-sustaining treatment is not to be administered if the person later is terminally ill and incompetent.

COLLABORATION (Win-Win)

**The Problem Solver** - Assertive and cooperative - Evaluates different views - Has creative and new ideas to solve problems - COLLABORATES to find a solution to benefit all

COMPROMISE (No lose- No Win)

**The Trader** - Middle of the road position - Give and take by BOTH parties

A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess?

Expert

The best ways to avoid malpractice suits

Maintaining knowledge, skills and practice standards

Which of the following actions by the nurse manager would indicate an autocratic management style?

Makes most of the decisions without input from the staff members

The health care team responsible for deciding whether to move a critically ill patient out of the ICU so that a new patient may be admitted to the unit is faced with what principle of an ethical dilemma?

Justice

Types of Leadership: Transformational Leadership

Leaders and followers WORK TOGETHER in a way that changes or transforms the organization, employees, and leaders

Types of Leadership: Contingency leadership

Leadership is FLEXIBLE enough to address varying situations

Levels of Disaster

Level I : local community can provide support Level II : Regional Response Necessary Level II : Federal need d/t exhaustion of local and regional resources (Usually a natural disaster except a local flood or tornado)

What is a correct statement regarding a nurse who acts beyond the scope of practice?

May be disciplined by the board of nursing

The nurse is reviewing categories for improving client safety. Which categories should the nurse review? Select all that apply: Medication management Surgery on wrong body part Prevention of hospital-related infections Tubing misconnections Facilitating information transfer and clear communication

Medication management Prevention of hospital-related infections Facilitating information transfer and clear communication

What can be delegated to an LPN

Monitoring findings (as input to the RN's ongoing assessment), reinforcing client teaching from standard care plan, preform trach care, check NG tube patency, administering enteral feedings, insert urinary catheter

Which Cultures Believe that Mental Health Should Not Be Addressed?

Muslim and Japanese

The soon to graduate nurse would like information about what to expect on the NCLEX-RN exam and how to apply to take the exam. Where would the student find information?

NCSBN website

What is the best legal safeguard for a nurse?

Competent practice

Scope of practice infractions are governed by

the State Board of Nursing

What is the legal source of rules of conduct for nurses?

Nurse Practice Acts

What would be the most effective way for a nurse to validate "informed consent?"

Ask the patient what he understands regarding the procedure.

The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership?

"Requires more time and effort to make decisions and accomplish goals"

Competent

**2-3 years of nursing experience** - Conscientious, deliberate planning - Begins to see nursing actions in light of patients' long term plans - Demonstrates ability to cope with and manage different and unexpected situations that occur

The Joint Commission (TJC) Role

**Addresses patient safety issues** - Accredits health care organizations that must meet certain quality standards to pass inspection - Publishes Sentinel Evert Alerts monthly - Mandates continuous quality improvement

Expert

**Advanced practice nurse clinicians and faculty** - Demonstrates an understanding of the situation and focus on the specific area of the problem - In depth understanding sees the whole situation - Highly skilled analytical ability in problem solving; performs masterful

Management Style: Democratic

**Advantages** -People oriented -Emphasis on effective group functioning -Open communication that flows both ways **The manager is a group member who organizes and keeps the group moving in the right direction**

Management Style: Autocratic

**Advantages** -Uses an authoritarian approach to direct activities of others -Emphasis is on the task **Disadvantages** - Makes decisions without input from others - Will have a difficult time motivating staff **Best for a crisis situation**

Assessing Spiritual Needs and Beliefs

**Consider the 6 spiritual dimensions:** 1. Spirit enhancing practices or rituals 2. Experience of God or transcendence 3. Sense of meaning 4. Giving and receiving love, or connectedness to self and others 5. Sources of hope and strength 6. Linkage between spirituality and health **(Read pg. 498-499)**

Management Style: Laissez-fiare

**Disadvantages** - Maintains a permissive climate with little direction or control - Allows staff members to make and implement decisions and relinquishes most of their power and responsibility **Good in highly motivated groups**

Advanced Beginner

**LAST SEMESTER nursing student and GRADUATE NURSE** - Delivers marginally acceptable care - Requires previous experience in an actual situation to recognize it - Begins to understand principles leading to interventions

Novice Stage

**NURSING STUDENT OR an EXPERIENCED NURSE in a new setting** - Needs rules and guidelines - Has difficulty applying theoretical concepts to patient care

Chemical Agents

**Nerve agents are the most severe and incapacitating** - Will be liquid at room temp but in vapor form nerve agents will penetrate the cornea, dermis, and resp tract

Proficient

**Nurse clinicians and nursing faculty** - Demonstrates ability to recognize and understand the situation as a whole - Demonstrates the ability to anticipate events - Holistic understanding

Characteristics of a Mentor

**Partnership between 2 people Serve a role models, counselors, and guides to promote you in your career** - Trusted advisor - Teacher - Guide - Not in a position of authority over the mentee **Partners who encourage open discussion of strengths, weaknesses, professional development, and concerns**

AVOIDANCE (Lose-Lose)

**The Escapist** - Unassertive and uncooperative - Tries to remain neutral - Delays responding to conflict

ACCOMMODATION (Lose-Win)

**The Peacemaker** - Suppresses and smoothes over differences - Dreads conflict - Maintains harmony by ACCOMMODATING others despite their own wants

COMPETITION (Win- Lose)

**The Player** - Based on power and force - Aggressive and uncooperative - Appropriate for short term needs

Sexual Harassment in the Workplace

- 70% iof females reported sexual harassment by male patients AND coworkers - With the increased number of men entering the nursing profession, there is a potential for men to experience sexual harassment by women in the workplace

Anthrax

- A durable spore that lives in the soil **Transmitted via:** 1. Inhalation of the spore 2. Contact with the spore 3. Ingestion of contaminated food **Isolation Precaution:** - Use standard isolation precautions while pt is sick **Treatment:** - ABX (cipro)

Complementary Alternative Modalities (CAM)

- A group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine **EXAMPLE:** Aroma therapy, Chiropractic care, massage, biofeedback, acupuncture

Root Cause Analysis

- A process to assess, analyze and mitigates risk - Can be performed for simple or complex errors - Identifies all factors leading to the error

Religion

- A set of institutionalized beliefs & rituals

What can be delegated to an AP

- ADL's: dressing, toileting, bathing, feeding without swallow precautions, grooming and ambulatin - Other Tasks: positioning, routine tasks, bed making, specimen collection, I and O, Vital signs

Change process: Unfreezing Phase

- All factors that may cause resistance to change are considered - Will need to determine whether the environment of the organization is receptive to change

Interstate Compact License

- Allows nurses to work in different states - The nurse holds one license issued in the state of residence but is also responsible for the laws of the state in which she travels - The nurse must comply with the Nurse Practice Act in which they practice

What is the NCLEX?

- An exam to evaluate understanding of standards for safe practice of nursing **- Exam is based on an analysis conducted by the NCSBN**

Epidemic

- An outbreak of disease that attacks many people at about the same time and may spread through one or several communities

What can't we delegate?

- Any part of ADPIE, teaching, counseling, or referrals. - You should always consider the risk and benefits to the client

Interview Skills and Strategies

- Arrive early - Make a good first impression - Smile at everyone you meet - Shake hands firmly - Good body language - Maintain eye contact - Don't ask about salary until the end - Bring a list of questions

Nerve Agents: Treatment

- Atropine

Level I Examples

- Auto accidents - House fires

Cultural Competence

- Awareness of your own existence, sensations, thoughts, and environment - Having no undue influence on others - Understanding others cultures by accepting and respecting cultural differences **When planning healthcare, consider lifestyles, values, and religious beliefs**

Provider Barrier

- Barriers that a nurse may have - Lack of information about a cultures customs regarding healthcare **How to overcome barrier:** Learn about different cultures and be cultural competent Example: lack of kosher foods on menus

Western Medicine

- Based on scientific traditions - Focuses on the treatment of medical conditions with medications - Care managed by nurses, doctors, and conventional healthcare providers

Types of Power: Expert Power

- Based on specialized knowledge, skills, or abilities that are recognize and respected by others **Example:** Clinical nurse leader

What Can You Do About Sexual Harassment?

- Be direct and tell them to STOP - Put your statement in writting and keep a copy for yourself - Tell other people (family, friends, physician, minister) about what is happening and how you are dealing with it - File a formal grievance that requires a filing of written complaint with an official group such as a hearing procedure

Reality Shock: Recovery Phase (Table 1-1)

- Beginning to have a sense of humor - Decrease in tension - Ability to be objective

Following Up Communication: Telephone Follow Up

- Call to follow up if you have not heard back by the specified date - Always appear nice and professional over the phone. Recruiters and receptionists are more likely to pass along info where you were impolite

Acute Radiation Syndrome

- Caused by dirty bombs - Illness caused by irradiation of the entire body by a high dose of penetrating radiation in a very short time (minutes) **S/S:** - Loss of appetite, - fatigue - fever - N/V/D - Possibly seizures and coma - Drop in ALL blood counts **This seriously ill stage may last from a few hours up to several months** **Onset occurs 5-6 hrs after exposure. Death occurs within 3 days of exposure**

Chemical Agents: Types

- Chlorine gas - Phosgene gas - Nerve agents

Types of Power: Reward Power

- Comes about because the individual has the power to provide or withhold rewards **Example:** supervisors

Mentees Role (Table 3-1)

- Communicate clearly - Welcome input and accept constructive feedback - Practice openness and sincerity - Take initiative to maintain relationship - Share results with the mentor - Listen to the mentors whole message and feelings - Be alert of mentors nonverbal communication **Set goals associated with the relationship as well as professional & personal development**

Do's of Dressing for an Interview

- Conservative and professional outfit - Cover body art and remove visible piercings - Conservative with perfume, makeup, hairstyle, and jewelry - Wear panty hose - Look yourself over in the mirror before you leave

Hispanic Beliefs

- Consult with OLDER FAMILY - usually men - Illness is GODS WILL - Treat with HOME REMEDIES, HOT and COLD THERAPY

What is the Nurse Managers Main Role?

- Coordination and representation

Color System: Black

- Deceased - Injured persons who are beyond the scope of medical assistance

Color System: Yellow

- Delayed - Injured persons who are medically stable but require medical assistance

Accountability

- Delegation is a transfer of responsibility NOT accountability - Everyone is responsible for actions including the one who delegated the task

Don'ts of Dressing for an Interview

- Don't wear casual clothes - Poor hygiene and grooming - Do not chew gum - Wear uncomfortable shoes - Bring children with you - Wear wrinkled or revealing clothing

Level III Examples

- Earthquake - Tsunami - Hurricane

African American Beliefs

- Extensive FAMILY BONDS - OLDER MALES of the family are honored - Avoidance of conflict - Respect authority

Pacific Islander Beliefs

- FAMILY and CHURCH oriented - Extensive family bonds - Key family member is consulted for health related decisions - ILLNESS is a PUNISHMENT from God for WRONG DOING, VOODOO, SPIRITS, or DEMONS - Illness is PREVENTED through good diets, herbs, rest, cleanliness, and laxatives to clean the system - Wear copper and silver bracelets to prevent illness

Plague S/S

- Fever, cough, chest pain - Bloody sputum - Sputum can be thick and very purulent or watery with gram-negative rods - Bronchopneumonia

Anthrax S/S

- Flu-like s/s - Respiratory failure - Hemodynamic collapse - Localized itching followed by a papular lesion that turns vesicular and develops a black eschar in 2-6 days - Responds well to antibiotics - Abdominal pain, nausea, vomiting, fever - Bloody diarrhea, emesis - Usually fatal if untreated

Supervising and Evaluating Others (pg. 253)

- Give directions with clear expectations of how a task is to be performed - Assure that the task is being performed according to standards of practice - Monitor tasks being performed and intervene if necessary - Evaluate the status of the patient - Evaluate the performance of the task - Provide feedback as necessary - Reassess the plan of care and modify as needed

Characteristics of a Preceptor

- Has set time limit - Termination date - Assigned - Formalized orientation - Assists in fine tuning skills - Offers suggestions - Work related focus **Assigned to assist with orientation and skill development over short periods of time**

Types of Power: Leadership Power

- Having the ability to create stability and calmness out of the chaos created by conflict, problems, and disorder - Used to empower nurses and provide them with a greater power in the profession and decision making opportunities in the roles

Color System: Red

- Immediate - Injured persons who must be assisted by advanced medical care immediately or within the next hour

Plague

- Infectious bacterial disease **Transmission:** 1. Most likely to be aerosolized in a bioterrorism attack 2. Spread person to person **Isolation Precaution:** - Droplet **Treatment:** - Supportive therapy - Strong ABX (streptomycin, gent, doxy, or cipro)

Nerve Agents: S/S

- Inhibit atropine - Paralysis - Convulsions and seizures

Management

- Is a problem oriented process with similarities to the nursing process (ADPIE) - A manager is assigned or appointed to a position

Personal Barrier

- Judgement of a culture **How to Overcome Barrier:** Nurses need to assess/determine their strengths & weaknesses

Types of Power: Information Power

- Knowledge a person possesses that is needed by others to function effectively **Example:** Nurse educators

Color System: Green

- Minor - Injured persons who do not need medical care for at least several hours - Persons can usually walk with or without assistance - Mainly consists of bandages and acute first aide

Small Pox

- Natural occurring virus that's been eradicated **Transmission:** - Person-to-person via droplet **Isolation Precaution:** - Droplet precautions - especially if POCKS develop inside the mouth **Treatment:** - No treatment - VACCINE ONLY

Botulism

- Neurotoxin **Transmission:** 1. Ingestion of toxin-contaminated food 2. Aerosolized and inhaled **Treatment:** Supportive care only **Isolation Precautions:** No isolation precautions implemented

Spirituality

- No clear definition - An individualized journey - Characterized by experiential descriptors such as meaning, purpose, transcendence, connectedness, and energy

Stressors Related to Role Transition for New Graduates

- Not feeling confident and competent - Making mistakes because of increases workload responsibilities - Encountering new situations, surroundings, and procedures - Inconsistent preceptors - Getting to know the staff - Encounters with unhappy nurses and other personnel - Short staffing - Staff nurses who were unwilling to help

Change process: Moving Phase

- Occurs once a group of individuals has been recruited to take on responsibilities for implementing to change - The group then identifies strategies to implement change

Change process: Refreezing Phase

- Occurs when the plan is in place and everyone involved knows what is happening and what to expect - Need to publicize the ongoing assessment of pros and cons of the plan to change - Someone needs to be responsible for continuing to work on the plan

Native American Beliefs

- Oriented to present - Value FAMILY and SPIRITUAL belief - STRONG TIES TO FAMILY AND TRIBE - State of health with harmony - Believe in MEDICINE MAN and DISTRUST HEALTH CARE PROVIDERS

Communication Styles Agressive

- People put their own needs above others and shows no concern for others - Communicate in an angry, dominating way - Attempts to humiliate or put down others - Controls and manipulates others

Communication Styles: Passive/ Avoidant

- People with this behavior let others push them around - Do what they're told regardless of how they feel - Are not able to share their feelings - Won't ask for help - Have negative feelings towards others for taking advantage of them

Communication Styles: Assertive

- Person stands up for themselves but does not violate the basic rights of another - Is direct with communication - Doesn't allow others to take advantage of them - Shows respect - Can accept criticism and compliments **Best type of communication style**

Types of Power: Referent Power

- Power a person has because others closely identified with that person's personal characteristics -They are liked and admired by others **Example:** People who have an addictive personality

Types of Power: Legitimate Power

- Power connected to a position of authority **Example:** Charge nurse has legitimate power and authority as a result of the position held

Types of Power: Coercive Power

- Power derived from fear of consequence **Example:** parents and supervisors

Prioritization

- Prioritization is done continuously throughout the course of the nursing process - Decision management should be prioritized based on patient safety, acuity on condition and risk **Think:** What comes first? Who dies first? How fast will something go wrong?

Small Pox S/S:

- Prodrome of fever and myalgia - Vesicles on the distal limbs (hands,feet)

Botulism S/S

- Pt is usually responsive (just paralyzed) - No fever - Drooping eyelids, weakened jaw clench, difficulty swallowing or speaking - Blurred vision and double vision - Descending paralysis - Respiratory depression d/t muscle weakness

Computerized Adaptive Testing Method

- Questions are assembled interactively as the candidate progresses through the exam - Future questions based on the answers that were given previously

Reality Shock

- Reaction experienced when one moves into the work force - Movement from a comfortable and familiar environment into a new role in the workforce - 3 Phases

Reality Shock: Honeymoon Phase (Table 1-1)

- Sees the world of nursing looking quite rosy - Often fascinated with the thrill of "arriving" in the profession - Exciting phase

Sentinel Events According to TJC

- Serious medications errors - Significant drug reactions - Wrong surgical sites - Blood transfusion reactions - Infant abductions

Vietnamese Beliefs

- Slow to trust authority - PATRIARCHAL society - HOME REMEDIES are tried first then they will be compliant with Western Medicine

NCLEX Test

- The detailed test plan is published by NCSBN and lists a percentage of questions by content type -Tests on adults and geriatric clients with stable and unstable chronic conditions -Computer Adaptive Testing - Score can range from 75-265 questions

Systems Barriers

- Those that exist in an agency - Because of the agency's STRUCTURE and POLICIES are not designed to support cultural diversity **How to overcome barrier:** Provide support for different cultures - Example: strict visiting policies, let families practice end of life rituals

Resolving conflict should be...

- Thoughtful - Sensitive to time - Sensitive to emotions - In an appropriate location for a discussion

Level II Examples

- Train derailment - Building collapse - Tornado - Flood - Shooting or Bombing

TJC Patient Safety Goals

- Use 2 patient identifiers - Improve effectiveness of communication among caregivers - Improve safety of medications - Improve safety of infusion pumps - Reduce risk of healthcare associated infections - Accurately reconcile meds - Reduce risk of harm d/t pt falls - Encourage involvement of pt and pt families in their care - Prevent healthcare associated pressure ulcers - Identify safety risks to patient population - Improve recognition and response to changes in pt condition (Read pg 509)

Muslim Beliefs

- Use MODERN and TRADITIONAL practice **EMOTIONAL and MENTAL RETARDATION is not acknowledged**

Reality Shock: Shock and Rejection Phase (Table 1-1)

- When the bad days outnumber the good ones. - Has excessive mistrust - Experiences increased concern over minor pains and illness - Experience decrease in energy and excessive fatigue - Hypercritical attitude towards nursing profession - Feels moral outrage

Following Up Communication: Follow Up letter

- Write a note of thanks for the time and interest spent on your behalf - May include additional information - your continuing interest on the position, additional thanks, change in phone number, time when you can be reached - Use plain thank you cards - not frilly cute ones

Which incidences or occurrences must a nurse report to proper authorities? (pg. 471)

-A duty to report other health care professionals whose behaviors are unprofessional and/or could cause harm to the public. This includes drug and alcohol abuse. -A duty to report evidence of child or adult or elder abuse and neglect, including any acts of a sexual nature against vulnerable (i.e. anesthetized) patients -A duty to report certain communicable diseases -A duty to report certain deaths under suspicious circumstances, including deaths during surgery. -A duty to report certain types of injuries that are or could be caused by violence. -A duty to report evidence of Medicare fraud. -Emergency Medical Treatment and Active Labor ACT (EMTALA) violations.

Japanese Cultural Beliefs

-CONTACT with BLOOD and SKIN DISEASES cause illness - IMPROPER CARE of the body causes illness - Believe in HEALERS - The ENTIRE FAMILY makes DECISIONS - PAIN is NOT expresses **DISABILITY and MENTAL ILLNESS is shamed and taboo**

Types of Leadership: Interactional Leadership

-Development of TRUST in relationship -Uses democratic concepts and views tasks from others perspective

Leadership

-Is a way of behaving -it is the ability to cause others to respond, not because they have to, but because they want to - A leader selects and assumes a role

How to amend a wrong entry in a patient's chart

-make corrections appropriately and according to agency or hospital policies. Do not ever obliterate or destroy any information that is or has been in the chart. -chart "late entry" noting the time the charting actually occurred and the specific time the charting reflects. (pg 466)

Managers Must Have...

... Good communication and interpersonal skills

Aggressive behavior is used to...

... achieve the goals of the aggressor and not the team or others

Assertive behavior is....

... both accountable and direct

Smooth transitions into practice helps nurses by...

... forming healthy habits which allows patients to be provided with better care

Listening is...

... the most important aspect to good communication and is often the least focused on when emotions are high (Not listening to others when you're angry)

Successful transitions always involve...

.... self-assessment and seeking feedback

A nurse is preparing an in-service program about preventing medication errors when transcribing a prescription. The nurse is using a dosage example of two tenths of a milligram. Which of the following examples should the nurse use to show appropriate transcription of this dosage? 0.2 mg .2 mg 0.20 mg 2.0 mg

0.2 mg

4 Basic elements of malpractice:

1) You must have a duty. 2) You must have breached that duty 3) Your breach of duty must have been a foreseeable cause of the injury 4) Damages or injury must have occurred

3 classifications of euthanasia

1. Active 2. Passive 3. Voluntary

Management Style (3)

1. Autocratic manager 2. Democratic manager 3. Laissez- faire manager

Types of Conflict Resolution

1. COMPETITION 2. AVOIDANCE 3. ACCOMMODATION 4. COMPROMISE 5. COLLABORATION

Types of Leadership Styles (6)

1. Contingency leadership 2. Situational leadership 3. Interactional leadership 4. Transactional Leadership 5. Transformational Leadership 6. Complex Theory Leadership

Key Aspects to Include on a Resume (pg. 80-82)

1. Demographic date - name, address, phone number 2. What position you are applying for 3. Education 4. Professional experience 5. Licensure 6. Professional organizations 7. Honors and awards 8. References`

Communication Styles

1. Passive/ avoidant 2. Agressive 3. Assertive

Potential Barriers

1. Personal Barrier 2. Provider Barrier 3. System Barrier

Other Common Areas of Conflict Between Nurses and Patients/ Family

1. Quality of care **Most common** 2. Treatment decisions - usually between family and an OA 3. Family involvement - Who's involved with the patients plan of care 4. Quality of Parental Care - Nurses are unhappy with how parents are participating in the patients care 5. Staff Inconsistency - Staff is consistent in enforcing policies

Five Rights of Delegation

1. RIGHT TASK - Is the task in the delegatee's scope of practice? Tasks should be considered routine and low risk. 2. RIGHT CIRCUMSTANCE - Is the delegatee competent of task? 3. RIGHT PERSON - Is this the right staff member to delegate the task to? Is your client stable? 4. RIGHT DIRECTION - Were instructions clear, concise, correct, and complete? 5. RIGHT SUPERVISION - Ask for input, give credit, and follow up

Phases of the change process (3)

1. Unfreezing Phase 2. Moving Phase 3. Refreezing Phase

Types of power (6)

1. legitimate power 2. reward power 3. coercive power 4. expert power 5. referent power 6. leadership power

According to the Utah Nurse Practice Act Rule, how many hours must a licensed nurse practice without an additional requirement of contact hours to renew their license?

400

After a nursing student has graduated from their program, what is the timeframe the applicant has to take and pass the NCLEX-RN? (According to the Utah Nurse Practice Act Rule)

5 years

Defamation

A civil wrong in which an individual's reputation in the community, including the professional community, has been damaged.

Which of the following describes reward power used by the nurse manager? (Select all that apply.)

A nurse manager who uses fear of consequences to motivate staff A nurse manager who uses salary increases to motivate staff

Which of the following actions is consistent with a nurse leader?

A nurse who encourages staff to give excellent patient care

What is the Nurse Licensure Compact?

A nurse with a permanent residency in a Nurse Licensure Compact state has a multi-state nursing license and is eligible to work in other states that make up the "compact states."

Autonomy

A patient's right to Self-determination without outside control Example: Freedom to make choices and decisions about one's own care without interference, even if those decisions are not in agreement with those of the health care team.

What is the best definition of malpractice?

A professional act or failure to act that leads to injury of a patient

The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of the primary cause of untoward events in the hospital setting? A)"unclear, ineffective communication." B)"unclear chain of communication for reporting." C)"ineffective reporting of the untoward event." D) "lack of consistent supervision of nursing staff."

A)"unclear, ineffective communication."

What is the goal of the Patient Safety and Quality Improvement Act? A)to improve client safety by encouraging voluntary and confidential reporting B)to ensure nurses follow universal protocol C)to ensure physicians treat nurses with respect D)to punish nurses who make serious medication errors

A)to improve client safety by encouraging voluntary and confidential reporting

Areas outside of the nurse's scope of practice:

Actions outside of license allowed by the state the nurse is working in.

If the position paper from the ANA in 1965 had been adopted, which of the following would be true?

All RNs would have a BSN

A nurse tells a patient, "If you don't stop getting out of that chair, I'm going to put some restraints on you." What may this nurse be accused of?

Assault

What is the first step to understand or resolve a conflict?

Assess the situation or conflict

The nurse is reviewing I-SBAR-R with a coworker at the end of the shift. Which statement indicates that they are discussing the Situation component? A)The nurse states the patient's name using two identifiers. B)The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today. C)The oncoming nurse acknowledges the info that has been received. D)The nurse states an opinion on what is happening with the patient.

B)The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today.

Invasion of Privacy

Claims that involve gossip or talking about patients unnecessarily

The nurse manager needs to let a nurse know that he will be put on probation if he continues to be tardy to work. Which type of power is the nurse manager using?

Coercive power

What type of resolution is the BEST strategy to avoid or resolve conflicts?

Collaboration

The student nurse is reviewing sentinel events in healthcare. According to the Joint Commission which of the following is considered the main reason for Sentinel Events? Communication errors Ambiguity in responsibilities Conflict among staff Medication errors

Communication errors

How does legislation define a profession?

Completion of courses in specialized intellectual instruction.

Civil Actions

Concern private interests and rights between the individuals involved in the cases. Remedy is usually some type of compensation.

According to the American Hospital Association, what is a basic right of patients?

Considerate and respectful care from all care providers

George the construction worker tells the Ameritech students preparing for a quiz on ethics: "I find it easy to make the right decision. All life is sacred, and all decisions must be made with the intent to continue life." What do we call the framework from which George approaches ethical reasoning?

Deontological

How is assertive behavior described? Apologetic Coercive Direct Self-denying

Direct

What do you NOT do to prepare for NCLEX?

Do NOT cram - Instead the **top priority** is rest, relax, and eat a healthy diet

Beneficence

Duty to actively do good for patients Example: Deciding what nursing intervention should be provided for patients who are dying when some of those interventions may cause pain.

Nonmaleficence

Duty to prevent or avoid doing harm, whether intentional or unintentional Example: Floating to an unfamiliar area that requires the administration of unfamiliar medications

AHA "Patient Bill of Rights"

Ensures that patients are involved, informed, and treated with respect and confidentiality

What are ethical and unethical practices by nurses?

Ethical: Autonomy, Fidelity, Justice, Nonmaleficence, Beneficence, Veracity Unethical: Not doing the above

In a malpractice suit, how may a breach of duty be established?

Expert testimony

Negligence

Failure to act as an ordinary prudent person when such failure results in harm to another.

George was taken to the emergency room after falling off a crane in the Ameritech construction site. George's buddies came to the emergency room to visit. A doctor told George's buddies that George is HIV-positive. What ethical principle did the doctor violate?

Fidelity

Where does the definition of nursing "one that would put the client in the best condition for nature to act upon him" come from?

Florence Nightingale

What are actions allowed or disallowed under HIPPA laws

HIPPA: includes an elaborate system for ensuring privacy for individually identifiable health information. Information used to render treatment, payment, or health care operations does not require the patient's specific consent for its use. this includes processes such as quality assurance activities, legal activities, risk management, billing, and utilization review. Another aspect involves electronic information and the security measures necessary to ensure that protected patient info is not accessed by those without the right or need to know. Many states have physician-patient privilege laws that protect communications between caregivers and their patients.

A nurse manager needs to purchase new thermometers for the nursing unit. What technique would demonstrate a laissez-faire style of leadership?

Having the nurses on the day shift order any thermometer that they want

Types of Leadership: Transactional Leadership

Hold POWER AND CONTROL over followers by PROVIDING INCENTIVE when followers respond in a positive way Example: PUNISHMENT AND REWARD

The nurse is considering strategies to increase nurses' time at the bedside. Which strategies should be included? Select all that apply: Hourly rounding by staff members Supplies in s central location near the nurses station Effectiveness in medication administration Standardized documentation tools Bedside change of shift report

Hourly rounding by staff members Effectiveness in medication administration Standardized documentation tools Bedside change of shift report

What is the purpose of the Robert Wood Johnson Institute of Medicine report?

To make recommendations for the nursing profession to transform healthcare.

The nursing student is studying federal safety legislation. Which of the following is the main goal of the Patient Safety and Quality Improvement Act? Encourage healthcare providers to report errors with tiered retribution based on severity. Improve client safety by encouraging voluntary and confidential reporting of adverse events. Set up a plan of network safety databases to conduct research and development. Force communication about incidence that link workplace stress to healthcare errors.

Improve client safety by encouraging voluntary and confidential reporting of adverse events.

George the construction worker decided to leave the emergency room against medical advice. His nurse is an incredibly ethical AmeriTech graduate. What did the nurse do in this situation?

Informed George that he could return to the hospital if he changes his mind

In a legal suit, what element is necessary to prove a tort has been committed?

Injury

Which organization developed the most definitive statement on the competencies needed by the newly licensed RN?

National Council of State Boards of Nursing (NCSBN)

what is a continuing education unit (CEU)?

Non academic credit offerings

George the construction worker fell off a crane while working on the Ameritech roof. The students rushed to his aid, and decided not to move him in case he had sustained a neck injury. What ethical principle were the students following?

Non-maleficence

The nursing student is studying about root cause analysis (RCA) Which of the following is a critical element in error reporting? Communication is linked to increased errors. Non-punitive action when errors are reported. Errors are documented as person focused. Individuals are encouraged to report near misses.

Non-punitive action when errors are reported.

What aspects define nursing as a profession? select all that apply

Nurses have developed a Code of Ethics. Nurses serve the public. Nurse's possess a specialized body of knowledge.

What are the key messages that structure the discussion and recommendations presented in the Robert Wood Johnson Institute of Medicine Report? Select all that apply

Nurses should practice to the full extent of their education and training Effective workforce planning and policy making require better data collection and an improved information infrastructure Nurses should be full partners, with physicians and other health professionals, in redesigning health care i the U.S. Nurses should achieve higher levels of education and training through and improved education system that promotes seamless academic progression.

What distinguishes nursing from medicine?

Nurses use a holistic perspective of patient care.

What is the role of the NCSBN?

To outline the laws related to nursing practice.

Incident or occurrence report-when and how would it be completed or documented? (pg. 478-479)

Only the person directly involved should objectively document the facts. Conclusions, opinions, defensiveness, and judgment or blame of others have absolutely no place in this document or process. The document should never be used for punitive reasons.

George and his fellow construction workers were listening to the Trends class study for a quiz on ethics. What is NOT an ethical dilemma that the students are discussing?

Parking

What is the main source of conflict between nurses, patients, and patients family?

Quality care

The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider's order is received without error? Advise the health care provider that the order must be written on the chart within the next 24 hours. Ask the nurse in charge to come to the phone to take the order. Write the order without using any unclear or unapproved abbreviations. Repeat the order, write the order verbatim, and read it back to the provider.

Repeat the order, write the order verbatim, and read it back to the provider.

Responding to Interview Questions

Response to interview questions should be behavioral positive explanation of your experience related to the question

A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first? Review the events leading up to each medication administration error. Develop a quality improvement program for nurses involved in medication administration errors. Require staff nurses to demonstrate competency by passing a medication administration examination. Provide an inservice on medication administration to all the nurses.

Review the events leading up to each medication administration error.

Deontological

Rules represent beliefs about intrinsic good that are moral absolutes revealed by God. Example: euthanasia are never acceptable actions, because they violate the duty to respect the sanctity of all life.

Types of Leadership: Situational Leadership

SITUATION IS ANALYZED leadership style is selected that will best address an issue Example: Punishing children differently based on their personalities

Dr. Jones asks you to give a medication to one of his patients, and you know the patient is allergic to it. When you point this out, Dr. Jones says, "Give the medication or I'll report this to your supervisor." What is the best assertive response? Agree to give the medication and hope no one finds out. Say "I won't give the medication, and I don't care who you talk to about it." Walk away and ignore him. Say "Perhaps you and I could talk this over with my supervisor together."

Say "Perhaps you and I could talk this over with my supervisor together."

A charge nurse explains to a student: "I tend to act differently depending on which nurses are working that particular shift. Some nurses need more direction from me than others." What type of leadership style best describes this charge nurse's approach?

Situational

Voluntary euthanasia

Situations when the dying individual expresses his or her desires regarding the management and time of death to a sympathetic physician who then provides the means for the patient to obtain a lethal dose of medication

Nursing scope of practice:

Tasks or procedures that the nurse can perform within the state the nurse is working in.

What does the "scope of nursing practice" refer to?

The activities legally permissible for a nurse to perform in a particular state

Fidelity

The duty to be faithful to commitments Example: Keeping information confidential and maintaining privacy and trust (HIPPA)

Veracity

The duty to tell the truth Example: If a patient finds out that you have lied, will that patient have any reason to trust you again?

Justice

The duty to treat all patients fairly, without regard to age, socioeconomic status, or other variables Example: Allocation of scarce and expensive health care resources

Where should a nurse go if they are facing a dilemma in patient care with no absolute right or wrong answer?

The hospital Ethics Committee

Why should nurses be concerned with the image of nursing?

The images can influence the attitudes of the public.

A nurse is being sued for battery. What does this mean?

The nurse, without consent, touched the patient in an offensive, insulting, or injurious way.

Slander

The oral or spoken form of defamation

The ethical principle of autonomy is not applicable in which patient situation?

The patient is unaware of who he is and where he is

A nurse who commits an infraction of the Nurse Practice Act may be subject to discipline by what group?

The state board of nursing

Libel

The transmission of defamation in written form

Criminal Actions

These occur when you have done something that is considered harmful to society as a whole. Example: State vs. Nurse

Alternative Therapies

Those that are used INSTEAD of mainstream therapies

Integrative Therapies

Those that have some scientific basis for use

What is the purpose of the nurse's Code of Ethics?

To guide the behavior of the professional nurse

A nurse is interested in moving into a management position. Which action would assist with accomplishing this?

Use of expert power

Complementary Therapies

Used in CONJUNCTION with mainstream treatments

The new graduate nurse is working to create culture of safety on the unit. What actions will exemplify a culture of safety? Select all that apply: Using the I-SBARR when collaborating with a provider. Using Universal Protocol 3 steps prior to surgery and procedures. Over riding the smart IV pump to save time. Adopt a work around when the system is not functioning to save time. Refusing to be interrupted during medication administration. look at systems and processes to identify areas that need to be changes

Using the I-SBARR when collaborating with a provider. Using Universal Protocol 3 steps prior to surgery and procedures. Refusing to be interrupted during medication administration. look at systems and processes to identify areas that need to be changes

Areas within the nurse's scope of practice:

Utah.gov (1) Each person licensed under this chapter is responsible for confining his practice as a nurse to those acts and practices permitted by law. (2) A person licensed under this act may not engage in any act or practice for which he is not competent.

Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.)

Value-driven visionaries Lifelong learners Courageous change agents

The new graduate nurse is explaining TeamSTEPPS to their preceptor. What would the new graduate describe as TeamSTEPPS? a positive environment which mutual support and clear communication is used the steps needed to gain promotions on the unit teams who identify the highest educated person as the leader the nurse manager identifies nurses on the unit who are stellar examples to be on the team

a positive environment which mutual support and clear communication is used

Active euthanasia

administration of a lethal drug or another measure to end life and alleviate suffering

Administrative law

administrative agencies that have been granted the authority to pass rules and regulations and render opinions, which usually explain in more detail the state statutes on a particular subject.

Which of the following is the most frequent reason for revocation or suspension of a nurse's license?

alcohol or drug abuse

Case law

composed of the decisions rendered in court cases by appeal courts.

How does the Utah Nurse Practice Act Rule define a Comprehensive nursing assessment?

conducting extensive initial and ongoing data collection

Common law

decisions made by judges in court cases or is established by rules of custom and tradition.

What is the primary role of The Joint Commission (TJC)? granting magnet status to excellent hospitals. lobbying Congress on behalf of Medicare/Medicaid patients. ensuring medical facilities meet patient safety guidelines. inspecting hospitals for compliance of infection control standards.

ensuring medical facilities meet patient safety guidelines.

Documentation of facts is

essential to legal responsibility

What are the factors that contribute to medication errors? Select all that apply: inadequate staffing high nurse-client ratios the use of Computerized Physician/ Provider Entry CPOE overly tired nurses computerized drug monitoring and electronic dispensing systems

inadequate staffing high nurse-client ratios overly tired nurses

ANA "Nurse's Code of Ethics"

is a guide to professional conduct and behavior in ethical situations.

Battery

legal term applied to nonconsensual actual touching

Assault

legal term applied to nonconsensual threat of touch

Failure to act

may be liable for negligence

Informed Consent

must be documented and signed by patient or a representative in the presence of a witness

Patient has the right to?

receive or refuse treatment

The nurse is describing the "failure to rescue" to a new graduate nurse. Which statement by the new graduate would indicate an understanding of the definition? the inability to prevent death after the development of a complication inadequate training and performance of CPR pointing out nurses who provide reckless care of clients preventing all falls of clients over 65 years old

the inability to prevent death after the development of a complication

The nurse is implementing fall prevention protocol. What would be included in the protocol? thorough and sound assessment of clients abilities and limitations assessment of medication side effects bed and chair alarms placing the client ben is a high position toileting every 2 hours and visual hourly checks

thorough and sound assessment of clients abilities and limitations assessment of medication side effects bed and chair alarms toileting every 2 hours and visual hourly checks

Passive euthanasia

withdrawal of extraordinary means of life support (ventilator, feeding tube)