Crazy Lady Final

Explore communication strategies for effective professional and interprofessional teams.

Interprofessional: - TeamSTEPPS (Team Strategies and Tools and to Enhance Performance and Patient Safety) - SBAR (Situation, Background, Assessment, and Recommendation) -Cross-monitoring•CUS (Concerned, Uncomfortable, Safety) - Call out - Check back - Two-challenge rule

National Council of State Boards of Nursing (NCSBN)

Is an independent, not-for-profit organization through which boards of nursing act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of initial nursing licensure examinations. •(NCSBN) developed the Nurse Licensure Compact - statutory agreement between and among states to permit nurses who are residents of one state to have the privilege of practicing in another state without acquiring a license in a second state - subject to the provisions and laws of the other state •NCSBN generates the initial licensure exam

Level of evidence

Level I: Systematic reviews Level II: RCT Level III: Controlled trial without randomization Level IV: Non-experimental, Cohort and Case-control Level V: Systemic reviews of quantitative and descriptive studies Level VI: Single descriptive or qualitative study Level VII: Opinion of authorities, Clinical guidelines, and expert panel

ANA Scope and Standards of Practice (ANA, 2015)

Publication presents the: - framework and context of nursing practice; and - standards of professional nursing practice and their associate competencies that identify the evidence of the standard of care. Scope and standards describe a competent level of nursing practice and professional performance common to all RNs

Describe the process of QA and the link to patient safety.

Quality Assurance seeks to ensure that current quality exists. -Systems, processes, satisfaction, and cost outcomes. -Continuous process of improvement. -Pt identification, barcode, PPE, Five rights for medication, all provide QA.

Case Law

•Both civil and criminal •Established from court decisions - which can explain or interpret other laws •Defines legal rights and obligations •Example: nurse's obligation to practice as a reasonably prudent nurse is a legal obligation stemming from actual court decisions

Characteristics of a Profession

•Characteristics have been examined and amplified over the last century (Flexner (1915), Bixler & Bixler (1959), and Joel (2003)) •Criteria• Relevance to social values and needs •Lengthy and required education •Code of professional ethics •A mechanism for self-regulation •Research-based theoretical frameworks for practice •Common identity and a unique sub-culture •Members are motivated by altruism and commitment to the profession

Statutory Law

•Consist of the ever changing rules and regulations created by the US Congress, state legislators, local government, and constitutional law. •The statutes are the rights, privileges, or immunities secured & protected for each citizen by the U.S. Constitution •Created by the U.S. Congress, state legislators, local governments, & constitutional law •The process for creating legislation in complex. •Professional Organizations/Lobbyists •ANA has focused on advocating for legislation focused on patient safety. •Specialty professional organizations •Generally no action is taken on an a bill introduced to a legislative body unless there is a confluence of problems, solutions, and political circumstances to create a climate for passing legislation (Longest, 2002)

Criminal Law

•Criminal acts are classified as felonies & misdemeanors •Society is the plaintiff •A nurse selling or stealing drugs results in a criminal case •Criminal cases have a higher standard of evidence •Burden of proof is on the plaintiff

Boards of Nursing

•Discipline of Nurses In legal terms, licensure is a privilege not a right •BONs have moved to bar from initial licensure persons who have been involved in potential or actual physical harm felonies •Individuals with a history of drug-related & psychiatric health problems seeking initial licensure in any state may be allowed to practice but are required to enter into an agreement •Endorsement requires verification that the nurse's license has not been disciplined in another state

Interprofessional Collaborative Practice Domains (IPEC, 2011)

•Domains and general competencies address •Values and Ethics - maintaining a climate of mutual respect and shared values •Roles and responsibilities - communicating one's professional roles/responsibilities, knowing one's limits in relation to skills, knowledge and abilities •Interprofessional communication - includes appropriate use of discipline specific terminology and respectful language •Relationship building values and principles- promote effective, safe, quality teams delivering patient-centered care

Access to health care and healthcare professionals-Factors to Consider

•Economic barriers •Affordable Care Act •Poverty, Unemployment, and Access to Care •Geographic barriers •Rural residents lack of access to PCPs •Urban "provider deserts" in structurally disadvantaged neighborhoods •Sociocultural barriers •Cultural diversity of population growing + lack of diversity of providers, •importance of cultural humility: awareness of own biases/prejudices, recognition of power differential between provider and client, developing community partnerships to reduce health disparities •Continuity of Care •Routine Provider of Care •More likely to get preventive services •Better health outcomes •Reduced Health Disparities

Describe nursing as a profession.

"The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities, and populations."

Patient Self Determination Act (PSDA)

- Enacted 1991 -Designed to facilitate the knowledge and use of advanced directives - HC providers must ask patients if they have advanced directives and provide patients with AD information according to the patient's wishes - Provides nurses with a good opportunity to take an active role in facilitating the moral rights of patient in terms of end-of-life decision making - In addition to responding to direct questions - nurses should "listen" for the subtle cues that patients give related to their anxieties, fears

How does FCC differ from PCC?

- FCC is an extension of PCC - "Widening of the circle" to include persons who are important in patient's life (Henneman & Cardin, 2002) - Does not negate the patient's right to privacy and control - Important to view this philosophy within the context of care - not just a few politics.

Identify strategies for implementing evidence-based care.

-Specific identification of the facilitators and barriers to EBP -Education and training to improve knowledge and strengthen beliefs related to the benefits of EBP -Creation of an environment that encourages an inquisitive approach to patient care

Discuss the history of contemporary issues in nursing and its impact on current nursing practice.

- Greek Era- Hippocrates said illness natural not god-inflicted - Roman Era-Promoted evolution of nursing with portable war nursing units - Middle Ages-role of deaconesses emerged as caregivers in Christianity; Black death - The Renaissance- the revival of learning - The Reformation- religious changes during this period influenced nursing- the creation of public hospitals. - Dark Period of Nursing -1500-1860 loss of religious orders providing care led to nursing care being provided by the illiterate class - Industrial Revolution-Social, economic and industrial changes increased exposures to health hazards; social reform area and renewed energy on the religious communities caring for the sick.

Emphasis of the Code

- All nurses, all roles with various scopes of practice and settings - Relationship with other caregivers, including unlicensed personnel - Increasing diversity of patients and nurses - Wholeness of character: (Knowing the values of the nursing profession and ones own values and integrating these 2 systems) - Nursing as a lifetime endeavor; core values and dispositions pervading all aspects of life

Describe the responsibilities inherent in being a member of a profession.

- Autonomy and Accountability

Ethical Principlism

- Autonomy: one's ability to self rule; to make personal decisions independently - Beneficence: mercy, kindness and charity; taking actions that benefit others and facilitate well being - Nonmaleficence: do no harm; refraining from actions that might harm others - Justice: a principle; a virtue; foundation of duty-based ethical framework moral reasoning. Fair distribution of benefits and burdens

BSN Essentials (American Association of Colleges of Nursing, 2008)

- BSN Curriculums are guided by the BSN Essentials - AACN is our program's accrediting body

Describe organizational culture in relationship to patient care safety.

- Care based on continuous healing relationship - Care that is customized (patients needs and preferences) - Patient is the source of control - Knowledge is shared and info flows freely- pts. Have access to their medical information - Decision-making is evidence-based - Safety is a system property - Transparency is necessary for informed decision making - Patient needs are anticipated, rather than the system merely reacting - Waste of resources and patient time is continuously decreased - Cooperation among clinicians is a priority

Factors that Facilitate Professional Role Development and Lifelong Learning

- Career management - Mentoring - Engagement in your healthcare organization - Engagement in professional nursing organizations - Self-appraisal using your organization's guidelines, nursing professional documents and specialty-based professional nursing organizations - Taking care of self

Discuss the role of the nurse in quality improvement.

- Caregiver - Critical Thinker - Advocate - Change Agent - Teacher - Care Coordinator - Colleague

Appraised of Research using Critical Appraisal Skills Programme (CASP)

- Checklists provide tools to interpret research evidence - Checklists are specific to types of research - Checklists provide frameworks to determine the strength and reliability of research reports

Classification and Enforcement of the Law

- Civil law - Criminal law

Steps in the EBP Process

- Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization - Identify an issue and ask the question - Search for and collect the most relevant and best evidence to answer the clinical question - Critically appraise the evidence and synthesize the evidence - Integrate evidence with clinical expertise and patient preferences to make the best clinical decision - Evaluate the outcome of any EBP change - Disseminate the outcomes of the change

Define strategies for maintenance of healthy living; stress management in the work place.

- Eating a balanced diet with nutritious, balanced, regular meals ◦Appollonie's Campus Cupboards - Getting enough sleep: 7-9 hours, sleep hygiene ◦Lack of sleep affects memory, judgment and mood - Avoiding addictive substances -Exercising on a regular basis ◦PAG are 150 min of moderate activity per week (5 of 7 days); can do 15 min increments or ◦75 min of vigorous activity per week - Paying attention to mental and spiritual health - Being vigilant in coping with stress triggers at work and at home - Separate home from work

Promoting EBP: Individual Nurse

- Educate yourself about EBP - Conduct face-to-face or online journal clubs, share new research reports and guidelines with peers and provide support to other nurses - Share your results through posters, newsletters, unit meetings, or a published article - Adopt a reflective and inquiring approach to practice

Revision Considerations

- Not a lightning rod for controversial, divisive public debate - Not political - Timeless language, no buzzwords that outdate - Succinct, clear, and understandable to students and new nurses - Useful to all nurses in all roles and settings

Describe the role of nurses in delivering safe health care.

- Nurses in-executive positions and on the frontlines of care are instrumental in preventing harm to patients and improving patient outcomes. - Nurses are at the "sharp end of health care" having significant, direct contact with patients. - While delivery of healthcare is extremely complex and there are tremendous systems challenges, nurses often have been held accountable for harm to patients

QSEN COMPETENCIES

- PATIENT-CENTERED CARE - TEAMWORK AND COLLABORATION - QUALITY IMPROVEMENT - INFORMATICS - EVIDENCE-BASED PRACTICE - SAFETY

IOM COMPETENCIES (2003)

- PROVIDING PATIENT-CENTERED CARE - WORKING ON INTERDISCIPLINARY TEAMS - APPLYING QUALITY IMPROVEMENT - UTILIZING INFORMATICS

Define 4 concepts of the metaparadigm of nursing

- People The person receiving the nursing. - Environment The environment in which the person exists. - Health The health-illness continuum in which the person falls at the time of the nurse interaction. - Nursing The nursing actions.

Structure of the Code

- Preface - Introduction - Provisions 1-3 with Interpretive Statements: Nurses and Patients - Provisions 4-6 with Interpretive Statements: Boundaries of Duties and Loyalty - Provisions 7-9 with Interpretive Statements: Commitments Beyond Individual Patient Encounters - Afterword - Glossary - Time line: The Evolution of Nursing's Code of Ethics

BON Guiding Principles

- Protection of the public - Competence of all practitioners regulated by the board of nursing - Due process and ethical decision making - Shared accountability - Strategic collaboration - Evidenced-based regulation - Response to the marketplace and health care environment - Globalization of nursing

Dimensions of Patient Centered Care

- Respect for patient values, preferences and expressed needs - Coordination and integration of care - Information, communication, and education - Physical support - Emotional support - Involvement of family and friends - Transition and continuity - Patients need to know they that they can access care when needed (Picker Institute, n.d.)

American Nurses Association

- Scope and Standards of Practice (2015) - Code of Ethics (2015) - Social Policy Statement (2015)

Strategies to Promote EBP: Organizations

- Specific identification of the facilitators and barriers to EBP - Education and training to improve knowledge and strengthen beliefs related to the benefits of EBP - Creation of an environment that encourages an inquisitive approach to patient care

HIPAA -LEGISLATION ON HEALTH INFORMATICS

- THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) •1996 TO IMPROVE EFFICIENCY AND EFFECTIVENESS OF THE HEALTHCARE INFORMATION SYSTEM •SIMPLIFYING CLAIMS, DEVELOPING STANDARDS FOR DATA TRANSMISSION, IMPLEMENTING PRIVACY REGULATIONS •LIMITING THE WAYS THE HEALTH PLANS, PHARMACIES, HOSPITALS AND OTHER ENTITIES CAN USE CLIENTS' PERSONAL HEALTH INFORMATION •PASSWORD PROTECTION AND COMPUTERS

Recognize the value of the analyzing system and individual accountability when errors or near misses occur

- Trust of peers and management - Reporting unsafe conditions - Improvement

Describe the systems approach to patient care safety.

- User-centered design approaches. - Standardization to avoid reliance on memory. - Working conditions. - Avoid reliance on vigilance. - Training for teams. - Involve patients in their care. - Anticipate the unexpected. - Design for recovery. - Improve access to accurate, timely information. Safe: Avoiding injury and harm to patients Timely: Reducing waits Effective: Care based on evidence Efficient: Avoiding waste Equitable: Quality does not vary because of gender, ethnicity, socioeconomic factors, or geographic status. Patient-centered: Respectful and responsive care based on patient values

Nursing ethics

- Viewed as a subcategory of biomedical ethics; unique problems in relationships between nurse: patient, families, physicians and other HC professionals

Emergency Medical Treatment and Active Labor Act (EMTALA)

- Was included in the COBRA legislation of 1986 .- It was promulgated to combat the discriminatory practice of some hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of the high cost associated with diagnosing and treating these patients with emergency medical conditions. - While the Act applies to all Medicare participating hospitals, it protects anyone coming to a hospital seeking emergency medical services, not just Medicare beneficiaries. - EMTALA imposes strict penalties including fines and exclusion from the Medicare program for violations of the Act.

Describe the social context of nursing and impact of social image on profession of nursing.

- When nurses and nursing organizations do talk about their work, too often they intentionally project an inaccurate picture of nursing by using a "virtue" instead of a "knowledge" script. - When nursing groups give voice to nursing, they sometimes bypass, downplay, or even devalue the basic nursing work that occurs in direct care of the sick while elevating an image of "elite" nurses in advanced practice, administration, and academia.

Ethics

- the study of ideal human behavior and ideal ways of being (Masters, 2020). A branch of philosophy. - ANA: A systematic study of what is right and good measured against principles, virtues and core values of a profession.

Examine the role of information management in nursing practice.

- were are here to keep the patient information private. Information management is one of those ways

Identify factors that facilitate professional role development.

-Academic preparation: Obtains the least amount needed for licensure - Continuing education: Obtains the minimum continuing education units to maintain licensure - Level of Commitment: Continues with job as long as it meets his/her needs; expects reasonable work for reasonable pay; responsibility ends with shift

Identify foundational professional organizations.

-American Nurses Association (ANA) -National League of Nursing (NLN) -American Association of Colleges of Nursing -National Council of State Boards of Nursing

Identify the three domains of learning: cognitive, affective and psychomotor (Bloom taxonomy).

-Cognitive: learning includes the intellectual skills of knowledge acquisition, specifically remembering, understanding, applying, analyzing, evaluating and creating -Psychomotor: learning refers to learning skills and performance of behaviors or doing the skills themselves -Affective: learning requires a change in feelings, attitudes, or beliefs.

Summarize the ANA opinion in the Code of Ethics for Nurses including their interpretive statements.

-Conveys shared ethical values, obligations, duties and ideals of nurses individually and collectively -Provides an implied contract with the public -Informs society of the moral values and ideals by which it functions -Informs new professionals of the expected moral behaviors -Guides the profession in self-regulation -Provides a framework for ethical decision-making -Is unapologetic, aspirational and nonnegotiable

Describe the characteristics of patient-centered care (PCC) and family-centered care (FCC)- common components

-Coordination of care conferences which includes the patient and family, and IP team to discuss goals and discharge planning -Hourly rounding by nurses -Bedside reports -Use of patient care partner to participate in patient's support -Individualized care established on admission -Open medical record policy -Eliminating visiting restrictions -Allow family presence with a chaperone during resuscitation and other invasive procedures -Silence and a quiet and healing environment

Identify facilitators and barriers inherent to the US healthcare system and the impact on patient care outcomes

-Economic issues - OECD report - US spends 2 ½ times more than other OECD countries but our life expectancy is lower. •Impact of ever increasing costs on the average American's salary •Disparity •Cost shifting •High mortality rates - IMRs •Questionable insurance practices including selling of junk policies •Insurance regulatory issues

Discuss communication within the context of PCC and FCC.

-Effective communication between healthcare providers and the patient is an essential component of PCC (IOM, 2001). -Communicating effectively in all areas of practice and with members of the healthcare team including the patient and patient's support network, is an expectation of all registered nurses (ANA, 2015) - Open ending questions essential for PCC and FCC The Joint Commission new standard (2010) related to PCC communication: -Patient's oral and written communication needs -Preferred language -Hospital communicates in a manner that meets patients needs -A family member, friend, a partner can be present during the hospital stay for support

Discuss personal and professional behaviors that promote the profession of nursing.

-Essential and central to nursing, defined by many nurse theorists like Watson -Varies among cultures and differs in individuals -Caring can be doing for other people what they cannot do for themselves, care of medical problem, and competence in carrying out all - Comfort, Compassion, Concern, Coping Behavior, Empathy, Enabling, Health Consultant, Helping, Interest, Involvement, Kindness, Love, Nurturing, Presence, Protective, Restorative, Surveillance, Teaching, Touching, Trust, Sharing, Stimulating, Stress alleviating, Supportive - Comfort Needs are physical, psychological, social, and environment - Caring defined at FSUo Nurse's empathy for and connection with the patient.o The ability to translate these affective characteristics into compassionate, sensitive, appropriate care.

Describe the evaluation of PCC

-HCAHPS (H-CAPS) (Consumer Assessment of Healthcare Providers and Systems Hospital Survey -First standardized, national, publicly reported survey of patient's perspectives of hospital care -Intent was to have a standard instrument to measure patient satisfaction with the hospital experience -Questions focus on satisfaction with health care team, responsiveness, communication about medications, cleanliness, and quietness

Describe the importance of evidence-based nursing care.

-Helps resolve problems in the clinical setting -Results in effective patient care and better outcomes -Contributes to the science of nursing through the introduction of innovation to practice -Keeps practice current and relevant by helping nurses deliver care based upon current best research - Decreases variations in nursing care and increases confidence in decision making -Supports The Joint Commission-readiness since policies and procedures are current and include the latest research -Supports high quality patient care and achievement of Magnet status

Discuss informatics competencies for nursing practice

-Includes nursing as well as other health specialties and addresses the use of information system in patient care -Domains of Clinical Informatics include the 3 areas - Health systems -Clinical Care -Information and communication technologies.

Identify barriers to the implementation of evidenced based care.

-Lack of value for research in practice -Difficulty in changing practice -Lack of administrative support -Lack of knowledgeable mentors -Insufficient time -Lack of education about the research process -Lack of awareness about research or EBP Research reports/articles not readily available -Difficulty accessing research reports and articles -No time on the job to read research -Complexity of research reports -Lack of knowledge about EBP -Lack of knowledge about the critique of articles -Feeling overwhelmed by the process -Lack of sense of control over practice -Lack of confidence to implement change -Lack of leadership, motivation, vision, strategy, or direction among managers

Identify levels of evidence

-Meta-analysis or systematic reviews of multiple well-designed controlled studies -Well-designed randomized controlled trials -Well-designed nonrandomized controlled trials -Observational studies with controls -Systematic review of descriptive and qualitative studies -Single descriptive or qualitative study -Opinions of authorities and/or reports of expert committees

The Trial Process for Civil Procedures

-Nurses are most often involved in civil cases related to malpractice or negligence. -Patient brings the case against the healthcare facility or nurse, who becomes the defendant.

Administrative Law (Regulations)

-Once a bill becomes law, that law is subject to further refinement by federal or state agencies. -Enacted statutory laws state what Congress or the State legislators want to accomplish and what activities should accomplish the goal. -Federal or state agencies carry out that activity by developing regulations that further define the law and establish procedures for administering the law -Examples: -A state nurse practice act might provide that APRN develop a formulary of medications they may prescribe -A state nurse practice act might require a criminal background check with fingerprinting -Most states require fingerprints, while some do not (n=6)NCSBN E-Compact -A state nurse practice act might require that RNs demonstrate continuing competence through the continuing education unit requirementDC requires 24 credits; VA requires 30 credits

Apply the concept of professional accountability to professional and legal standards related to informed consent, confidentiality and privacy

-Privacy is the right of a person/patient to be free from unwanted intrusion into their personal affairs. Informed Consent •A brief but complete explanation of the patient diagnosis and proposed treatment or procedure •The name and qualifications of the person who will perform the procedure or treatment •Information related to available alternatives to the recommended treatment •Information related to possible complications of the treatment or procedure •An explanation related to the patient's right to refuse treatment without having care discontinued -Confidentiality is the obligation of all HC providers

Articulate importance of proactively managing professional nursing career.

-Requires research and planning -Set realistic time frame for meeting your goals -Map skills obtained, skills needed and resources needed to obtain skills - Informed process requiring self-appraisal

Guidelines of IOM for clinical practice guideline development

-STANDARD 1: Establishing -STANDARD 2: Management of conflict of interest -STANDARD 3: Guideline development group composition -STANDARD 4: Use of systematic reviews -STANDARD 5: Establishing evidence and strength of recommendations -STANDARD 6: Articulation of recommendations -STANDARD 7: External review

Consider security and privacy issues related to EHRs Discuss information literacy skills needed for nursing practice

-There has been many breaches in security some intentional that were hacked other unintentional of maybe a nurse not logging off and leaving the information for others too see. -Nurse should be able properly use a computer and excellent proficiency.

Discuss the impact of work-related stress on whole self.

-you can feel burnout, feel always exhausted .

Explore personal beliefs and values and how they will impact your ability to provide patient-centered care.

....

Types of Advanced Directives

1) Living will - formal legal document that provides written directions concerning medical care to be provided in specific circumstances - Problems - don't stand up in court, may have questioned authenticity 2) Durable power of attorney - a written directive in which the designated person is able to make general or medical health care decisions for a patient; ethical dilemma; fear of making the wrong decision for someone

Process to make administrative law

1) Proposal of regulations 2) Consideration of proposed regulations 3) Adaptation of regulations with or without changes

NFORMATION LITERACY:HEALTH INFORMATION ONLINE (HONCODE

Find a site that you question it meets these criteria........ •AUTHORITATIVE. •COMPLEMENTARITY •PRIVACY •ATTRIBUTION •JUSTIFIABILITY •TRANSPARENCY •FINANCIAL DISCLOSURE •ADVERTISING POLICY

18 PHI IDENTIFIERS

1. Names; 2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. 3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; 4. Phone numbers; 5. Fax numbers; 6. Electronic mail addresses; 7. Social Security numbers; 8. Medical record numbers; 9. Health plan beneficiary numbers; 10. Account numbers; 11. Certificate/license numbers; 12. Vehicle identifiers and serial numbers, including license plate numbers; 13. Device identifiers and serial numbers; 14. Web Universal Resource Locators (URLs); 15. Internet Protocol (IP) address numbers; 16. Biometric identifiers, including finger and voice prints; 17. Full face photographic images and any comparable images; and 18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

Seven Themes About the American Health System

1. Paying more, getting less 2. Treating the whole person 3. Preventing disease 4. Overmedication 5. Overtreatment 6. An entrenched system 7. Reimbursement/cost

3 MAJOR AREAS FORMED THE TIGER INFORMATICS COMPETENCY MODEL

1.BASIC COMPUTER COMPETENCIES (SEE NEXT 2 SLIDES) 2.INFORMATION LITERACY •WEBSITE EVALUATION •USE OF ELECTRONIC DATABASES 3.INFORMATION MANAGEMENT •EHR •HANDHELD DEVICES •PERSONAL HEALTH RECORDS

PRINCIPLES AND TIPS FROM THE ANA AND NCSBN INCLUDE:

1.DON'T SHARE OR POST INFORMATION OR PHOTOS OF PATIENTS 2.MAINTAIN PROFESSIONAL BOUNDARIES WITH PATIENTS 3.DO NOT POST COMMENTS ABOUT EMPLOYERS, CO-WORKERS EVEN IF NAMES ARE OMITTED 4.DO NOT TAKE PHOTOS OR VIDEOS OF PATIENTS ON CELL PHONES OR DEVICES 5. REPORT BREACHES IN CONFIDENTIALITY OR PRIVACY 6. BE MINDFUL THAT POSTED CONTENT YOU BELIEVE IS PRIVATE AND ACCESSIBLE CAN BE DISSEMINATED TO OTHERS 7. BE AWARE THAT CONTENT DELETED FROM A SITE MAY STILL BE ACCESSIBLE OR RECOVERABLE

QSEN ENTRY-LEVEL INFORMATICS REQUIREMENTS

1.SEEK INFORMATION ABOUT HOW INFORMATION IS MANAGED IN CARE SETTINGS BEFORE PROVIDING CARE. 2.APPLY TECHNOLOGY AND INFORMATION MANAGEMENT TOOLS TO SUPPORT SAFE PROCESSES OF CARE 3.NAVIGATE THE EHR 4.DOCUMENT AND PLAN PATIENT CARE IN THE EHR 5.EMPLOY COMMUNICATION TECHNOLOGIES TO COORDINATE CARE FOR PATIENTS 6.RESPOND APPROPRIATELY TO CLINICAL DECISION-MAKING SUPPORTS AND ALERTS 7.USE INFORMATION MANAGEMENT TOOLS TO MONITOR OUTCOMES OF CARE PROCESSES 8.USE HIGH-QUALITY ELECTRONIC SOURCES OF HEALTHCARE INFORMATION

ANA (2015) Code of Ethics Provisions

1.The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 2.The nurses primary commitment is to the patient, whether an individual, family, group, community, or population. 3.The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. 4.The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and provide optimal care.

Evolution of the Code

1893: "Nightingale Pledge" 1926: Suggested Code in the American Journal of Nursing (AJN) 1940: Tentative Code, AJN 1950: The Code adopted by ANA 1956, 1960, 1968, 1976, 1985, 2001: Revisions of the Code 2015: Major revision of the Code

ANA (2015) Code of Ethics Provisions cont..

5.The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6.The nurse, through individual and collective effort, establishes, maintains and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. 7.The nurse, in all roles and setting, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

ANA (2015) Code of Ethics Provisions cont..

8.The nurse collaborates with other health professional and the public to protect human rights, promote health diplomacy, and reduce health disparities. 9.The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain integrity of the profession, and integrate principles of social justice into nursing and health policy.

HIPAA

A SET OF RULES FOR HOSPITALS AND HEALTH CARE PROVIDERS TO ENSURE THAT MEDICAL RECORDS, MEDICAL BILLING, AND PATIENT ACCOUNTS MEET CERTAIN CONSISTENT STANDARDS FOR HANDLING, DOCUMENTATION, AND PRIVACY.

Ethical Dilemma

A situation in which an individual is compelled to make a choice between two actions that will affect the well being of a person or group -and both actions can be reasonably justified as being good or the goodness of the actions are uncertain. Dilemmas can arise from conflicts between nurses, other healthcare professionals , the healthcare organization and the patient and family.

Demonstrate ability to navigate professional organization websites to access key documents.

Got that :D

Advanced Directives

AD is a "written expression of a person's wishes about medical care, especially care during a terminal or critical illness" (Veatch, 2003) May be self-written instructions or may be prepared by someone else as instructed by the patient

Define quality assurance (QA).

Plans, policies, and procedures provide an administrative system to achieve quality goals. Lab services will satisfy medical needs for patient care

Confidentiality

APPLIES TO THE DATA - AN EXTENSION OF PRIVACY - PERTAINS TO IDENTIFIABLE DATA - AN AGREEMENT ABOUT MAINTENANCE AND WHO HAS ACCESS TO IDENTIFIABLE DATA - WHAT PROCEDURES WILL BE PUT IN PACE TO ENSURE ONLY AUTHORIZED PERSONS WILL HAVE ACCESS TO THE INFO - IN REGARDS TO HIPAA, PROTECTION OF PATIENTS FROM INAPPROPRIATE

privacy

APPLIES TO THE PERSON - THE WAY POTENTIAL PARTICIPANTS ARE IDENTIFIED AND CONTACTED - THE SETTING THAT POTENTIAL PARTICIPANTS WILL INTERACT WITH THE HEALTH CARE TEAM - THE METHODS USED TO COLLECT INFORMATION ABOUT PATIENTS - THE TYPE OF INFORMATION BEING COLLECTED

What Is an Ethical Code?

An ethical code is an identifying feature of a profession to: Facilitate professional self-regulation and accountability Describe obligations of client-professional and colleague-to-colleague relationships Serve as a guide for analysis, decision and action

BASIC COMPUTER COMPETENCIES

BASIC COMPUTER COMPETENCIES INCLUDE UNDERSTANDING THE CONCEPTS OF INFORMATION AND COMMUNICATION TECHNOLOGY, POSSESSING SKILL IN THE USE OF A COMPUTER AND MANAGING FILES, WORD PROCESSING, WORKING WITH SPREADSHEETS, USING DATABASES, CREATING PRESENTATIONS, WEB BROWSING, AND COMMUNICATING

Bioethics

Bioethics is a domain of ethics r/t moral issues in the field of healthcare

evidence-based practice

Collection, interpretation, and integration of valid research evidence, •combined with clinical expertise, •and understanding of patient and family values and preferences - to inform clinical decision making

Legacy of the Code

Commitment to service is the most precious ideal of the nursing profession. - The Code supports ideals of nursing's service. - The Code guides all nurses in living out the values and ideals of the profession. - The Code is a living, ongoing legacy of core values from Florence Nightingale in 1850 to 2015 and beyond.

Discuss Nurse of the Future concepts and core competencies.

Concepts:Definition- a term or label that describes a a term or label that describes a phenomenon (Meleis, 2004)phenomenon (Meleis, 2004) -Phenomenon can be empirical or abstract -Empirical can be observed or experienced through the senses can be observed or experienced through the senses -Abstract not observable Examples of nursing concepts include: -Health, stress, adaptation, comfort, transcendence.

Nurse of the Future: Nursing Core Competencies

Constant changes in knowledge, technology affect nursing practice and patient outcomes. To maintain competence nurses must commit to lifelong learning and workplace training. Nurses have a major role in building a safer healthcare system and improving the quality of care and patient safety.

ANA Guide to Nursing's Social Policy Statement: Understanding the Profession from Social Contract to Social Covenant

Content ◦Social Contract Theory ◦Nursing's social contract ◦Nursing as a Profession ◦Nursing as an Occupation, Vocation, Calling, and Profession ◦Broken Professions and How to Mend Them ◦Professions and the New Economy ◦Breaking Faith with the Public and Breach of Contract ◦Civic Professionalism◦Nursing: A Covenant of Care ◦Nursing: A Covenant of Care ◦Professional Identity Formation: Both Doing and Being ◦"Acting like a nurse is not enough. Being a nurse is required". ◦Globalization

ANA's Code of Ethics for Nurses with Interpretive Statements ("the Code")

Conveys shared ethical values, obligations, duties and ideals of nurses individually and collectively Provides an implied contract with the public Informs society of the moral values and ideals by which it functions Informs new professionals of the expected moral behaviors Guides the profession in self-regulation Provides a framework for ethical decision-making Is unapologetic, aspirational and nonnegotiable

Skills Required for EBP

Critical Thinking: •"Examination of ideas, assumptions, principles, arguments, conclusions, beliefs, actions" •Art of clarifying what you understand and what you don't know Critical Reading: •"Active, intellectually engaging process in which the reader engages in an inner dialogue with the writer" •First step-----Skim the article •Understand the researcher's purpose or intent •Analyze and understand parts of the article •Synthesize the whole article and each step of the research process

Identify the organizational structure and key components of the US healthcare system.

The US Department of Health and Human Resources _ Medicare, medicaid, Children's Health Insurance Program (CHIP), PPCA (Affordable care act)

HIPAA: PRIVACY RULE

DEFINES IDENTIFIABLE PROTECTED HEALTH INFORMATION (PHI), INCLUDING PATIENT IDENTIFIERS LIKE A PERSON'S NAME, BIRTHDATE, PICTURE, MEDICAL DIAGNOSIS, SOCIAL SECURITY NUMBER, ETC.

Death and end-of-life

Defining death Rational suicide Euthanasia Refusing or forgoing treatment Deciding for others Withholding treatment Terminal sedation Physician assisted suicide Palliative care Rule of double effect

Understand the legal aspects of delegation

Delegation is the process for a nurse to direct another person to perform nursing tasks and activities -5 Rights of delegation: task, circumstances, person, direct/communication, supervision and evaluation

Define evidenced based practice.

Delivering optimal health care through the integration of best current evidence, clinical expertise, and patient/family values

Where to look for evidence?

Electronic Resources: - National Library of Medicine - Cochrane LibraryNational Guideline Clearinghouse - Joanna Briggs Institute - Agency for Healthcare Research and Quality - Centre for Health EvidenceRegistered Nurses' Association of Ontario

Identify historical events and key people in nursing that have influenced healthcare and nursing.

Florence Nightingale( 1820-1910): -Founder of modern nursing -The Crimean Experience -The Political Reformer -Military Reforms -Nightingale School of Nursing -The Birth of Professional Nursing -Taking Health Care to the Community -Researcher Chadwick Report - 1837 Great Britain -found that there was a link between poor living standards and the spread and growth of disease. - A key proponent of sanitary reform, he recommended that the government should intervene by providing clean water, improving drainage systems, and enabling local councils to clear away refuse from homes and streets. Shattuck Report- 1850 Massachusettspublished in 1850 by the Massachusetts Sanitary Commission, reviewed the serious health problems and grossly unsatisfactory living conditions in Boston. Mary Mahoney:-First African American Nurse Clara Barton:-Who founded the American Red Cross Mary Adelaide Nutting:-Who was the first professor of nursingIsabel Robb- Established the ANA in 1911

Discuss the major payors in the US health care system.

The US Government

Examine barriers to effective communication.

Factors influencing communication: - Psychophysiological Physiological status, emotional status, age, developmental tasks, unmet needs, attitudes values about illness, personality - Relational context Level of trust, level of caring expressed, level of disclosure, the balance of power and control - Situational context Information exchange, goal achievement, problem resolution, expression of feelings - Environmental context Privacy and noise level, comfort and safety level, distraction level - Cultural context Educational level, language and self-expression patterns, customs and expectations

Describe nursing theorists and the key tenants of their theories.

Grand Nursing Theory: Imogene King -The Theory of Goal Attainment -Developed in the early 1960's -Views nursing as a process of human interaction -Describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals -Factors which can affect the attainment of goals are roles, stress, interaction, space, time, role, and communication Grand Nursing Theory: Martha Rogers -Rogers' theory emphasizes that a patient should be viewed as whole(mind, body and spirit) instead as parts -This model is applicable to practice with nursing care focused on pattern appraisal and patterning activities -Science of Unitary Human Being theory is used as a guide in nursing practice and can be used to create nursing intervention Grand Nursing Theory: Sister Callista Roy -The Roy Adaptation Model was developed in 1974. -The concepts: Roy Adaptation Model evaluates the patient in self concept mode, and interdependence mode aiming to provide holistic care. Propositions: Relational propositions Grand Nursing Theory: Dorothea Orem -Dorthea Orem (born in 1914) is the creator of the self-care deficit nursing theory which was developed between 1959 and 2001. -The theory is also known as the Orem's Model of Nursing -This grand theory is often used in rehabilitation or primary care environments. It encourages independence among patients. Grand Nursing Theory: Betty Neuman -Formed in 1982 -Focuses on the client system in relationship with stressors -Lines of defenses Flexible lines of defense Normal line of defense Lines of resistance -Flexible line of defense protects the normal line of defense. -Normal line of defense represents what the client has become or the usual wellness state -Stressors attack flexible line of defense then normal line of defense -The greater the quality of the client's system's of health, the greater the protection is provided by the various lines of defense Grand Nursing Theory: Dorothy Johnson -Johnson's Behavioral Systems Model, 1968 -The essential principles concepts and propositions: efficient and effective behavioral theory to prevent illness and integrate the patient holistically.

Describe fundamental elements of theory and the impact of theory and theoretical frameworks on nursing practice.

Grand Nursing Theory: Imogene King Person: A personal system that interacts with the interpersonal and social system. Environment:can be both external and internal. The external environment is the context in which humans can grow, develop and perform daily activities like in covid context: habit of sanitization, and hand washing and internal environments enable them to adjust to continuous external environment changes. For example: maintaining six feet distance, wearing a mask etc. health: dynamic life experience which implies continuous adjustment to stressor in the internal and external environment through optimum use of resources and benefits from them in daily living. Nursing: the process of interaction to help patients achieve their goals. Grand Nursing Theory: Martha Rogers Person: human beings are organized into unique energy fields and develops through three principles: helicy, resonancy, and integrality Environment: An energy field which is identified by pattern and manifesting characteristics separate from any given human energy field Health: health and illness are part of a continuum Nursing: promote synchronicity between human and environmental energy fields and to direct/redirect patterning of these fields in order to realize maximum health potential Grand Nursing Theory: Sister Callista Roy Person: the Roy Adaptation Model views a person as a "biopsychosocial being in continuous interaction with a changing environment" Environment: "includes focal, contextual, and residual stimuli" Health: "an anticipated dimension of human life and represents a health disease continuum" Nursing: Roy defines nursing as a science, requires the adaptation of knowledge (scientific) and bringing this adaptation of knowledge into the nursing field/career Grand Nursing Theory: Dorothea Orem Person: This theory mainly focuses on the patient's ability to perform self-care. Environment: The community and physical environment of a patient is easily accessible and fit to accommodate their needs in order for them to perform self-care. Health: Aiding to the patient's healthfully so that they are functioning well and able to communicate with others about their needs or assistance in order to stay healthy. Nursing: Nurses help assist patients in certain needs so that it is easier for the patients to meet their needs for self-care. Grand Nursing Theory: Betty Neuman Persons:Physiological, Psychological, Sociocultural, Developmental, Spiritual Variables. She connects all of these variables with the internal and external environments for each patient. Environment:Three relevant environments identified are the internal environment, the external environment, and the created environment The environment is seen to be the totality of the internal and external forces These forces surround a person in which they interact at a given time. The created environment is an example of an effort to delineate the holistic concept approach of the model in addition to spirituality Health: focuses on a "continuum" of wellness to illness. She equates this continuum with an optimal system ability. Nursing: Prevention should be used at intervention A nurse should be concerned with all potential stressors. Grand Nursing Theory: Dorothy Johnson Person: A biopsychosocial being who is a behavioral system with seven subsystems of behavior. Health: Efficient and effective functioning of system; behavioral system balance and stability. Environment: Includes internal and external environment. Nursing: An external regulatory force that acts to preserve the organization and integrity of the patient's behavior at an optimal level under those conditions in which the behavior contributes a threat to physical or social health or in which illness is found.

HITECH -LEGISLATION ON HEALTH INFORMATICS

HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT(HITECH) (2009) •FINANCIAL INCENTIVES TO GET HEALTHCARE ORGANIZATIONS TO ADOPT CERTIFIED EHR THROUGH 2016 •STAGE 1: DATA CAPTURE AND SHARING IN A STANDARDIZED FORMAT TO TRACK HEALTH CONDITIONS AND COORDINATE CARE •STAGE 2: ELECTRONIC TRANSMISSION OF PATIENT CARE SUMMARIES ACROSS MULTIPLE SETTINGS •STAGE 3: IMPROVING QUALITY, SAFETY, & EFFICIENCY TO IMPROVE HEALTH OUTCOMES AND POPULATION HEALTH

Identify MU resources available that support healthy student living.

Health and Wellness events, programming, workshops, 1:1 health education consultations, monthly newsletter, written and online health education materials, check the website

Patient Education in Support of Patient-Centered Care

Historical perspective - NightingaleANA recognized patient education as the role of the professional nurse (1973) - The Joint Commission recognized pt. educ. as critical to patient care (1976) - ANA Score and Standards of Practice (2015) -"The nurse is responsible for the implementation of an identified plan" (Std. 5) -"The nurse employs strategies to promote health and a safe environment" - Competencies relate to the nurse providing health promotion education and health teaching. Patient education is both a professional expectation and a legal obligation of the nurse.

CURRENT AND FUTURE TRENDS

IN 2012, HOSPITAL VALUE-BASED PURCHASING (VBP) PROGRAM AND HITECH INCENTIVE PROGRAMS LINKING DATA AND EHR MEANINGFUL USE TO FISCAL REIMBURSEMENT IN ORDER TO MOVE THE HEALTHCARE SYSTEM TOWARD QUALITY AND SAFETY. •DATA RELATED TO PERFORMANCE AND QUALITY OF CARE AND USES THE DATA TO DETERMINE HOW MUCH A HOSPITAL GETS PAID FOR SERVICES •SPECIFIC TO NURSING PRACTICE/CARE: DISCHARGE INSTRUCTIONS, SERUM GLUCOSE LEVEL POST-OP CARDIAC PATIENTS COMMUNICATION WITH RNS AND MDS AND PATIENTS RESPONSIVENESS OF STAFF

AACN Essentials

INFORMATICS AND TECHNOLOGY-RELATED OUTCOMES FOR BSN GRADUATES

patient centered care

IOM - "providing care that is respectful of and responsive to individual patient preferences, needs, and values and enduring that patient values guide all clinical decisions" (2001) QSEN - defined in terms of the nurse recognizing "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" (2012) MA Depart of Higher Education - the nurse will provide holistic care that recognizes an individual's preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age, and culturally appropriate , safe, and effective care (2010)

Data and Trends

Individual - 7% Uninsured - 9% Medicare - 14% Medicaid - 21% Employer Health plan - 49% other public program - 1%

EPB Triad

Individual Clinical expertises and patient values and expectation to improve patients outcomes.

Moral Rights and Autonomy

Moral rights are defined as rights to perform certain activities. - Because they conform to accepted standards or ideas of a community - Because they will not harm, coerce, restrain, or infringe on the interests of others - Because there are good rational arguments in support of the value of such activities - Two types of moral rights: Welfare rights and Liberty rights - Informed consent- respect for autonomy and self-direction - Patient Self-Determination Act - Advance directives - Living will - Durable power of attorney

Morals

Morals are specific beliefs, behaviors and ways of being based on personal judgements derived from one's ethics.

Consider the role of informatics in nursing practice.

NI is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, and knowledge in nursing practice.

Describe the role of the nurse as an expert witness.

Normally used with Malpractice cases •Complex knowledge •"Standard of Care" •Clarify points of Knowledge using charts, models, & diagrams

nursing research

Nursing research is essential for the development of empirical knowledge that enables nurses to provide evidence-based nursing care (Melnyk & Finout-Overholt, 2005) •Nurses need research knowledge to improve nursing care Systematic, rigorous, logical investigation that aims to answer questions about nursing phenomena Two major categories of types of research -Quantitative -Qualitative

Discuss delivery of patient care in a complex healthcare system.

Orientation Phase: -Introductions and use of names and roles of the relationship -An agreement or contract that defines:•Goals of the relationship -Location, frequency, and length of the contacts -Duration of the relationship. Working Phase -Client is active participant, cooperative with activities that work toward mutually acceptable goals -Expresses feelings and concerns to nurse•Nurse provides any assistance needed to achieve goals e.g. counseling and teaching Termination Phase -Together determine which goals were accomplished or progress made -Client verbalizes feelings about the end of the relationship

PICO(T)

P: Patient, population, or problem I: Intervention, exposure, or topic of interest C: Comparison or alternate intervention O: Outcome (T): Time or timeframe

Definitions(Lorig, 2001)

Patient education: "any set of planned educational activities designed to improve patient's health behaviors, health status, or both" Patient teaching: "activities aimed at improving patient knowledge". Purposes of patient education are to maintain health, to improve health, or to slow deterioration in health. These purposes are met through changes in health-related behaviors or attitudes.

Discuss teamwork and collaboration in the context of quality and safety.

Refers to functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care

Interprofessional Teamwork and Collaboration

Refers to functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care (QSEN, 2007).

Research study and EPB process

Research study questions are tested with a design appropriate to the question and specific methodology (sample, instruments, procedures, data analysis) are used to "test" the research question. EBP compelling clinical questions are used to search the literature for already completed studies that you will critically appraise in order to answer the question

INFORMATION MANAGEMENT

•BIG DATA: NIH LIBRARY OF MEDICINE AND CMS •ELECTRONIC HEALTH RECORD (EHR) •CLINICAL DECISION SUPPORT SYSTEM (CDSS) •COMPUTERIZED PROVIDER ORDER ENTRY (CPOE) •BARCODE MEDICATION ADMINISTRATION (BCMA) •ADMISSION, DISCHARGE, AND TRANSFER (ADT) SYSTEMS •HANDHELD DEVICES - PDAS AND HIPAA ISSUES

Discuss the scope and standards of professional nursing practice.

Scope of practice describes the who, what, where, when, why & how of nursing practice •Nurse's duty is to function within the parameters of the scope of nursing practice •Evidence of Standards of Care Used in Court in Nursing Negligence & Malpractice Decisions - Standards of nursing practice = authoritative statements of the duties of all RNs - professional performance standards = expectations

The Standards of Practice (ANA, 2015)

Standard 1- Assessment Standard 2- Diagnosis Standard 3- Outcome Identification Standard 4- Planning Standard 5- Implementation Standard 6- Evaluation

The Standards of Professional Performance

Standard 7- Ethics Standard 8- Culturally Congruent Practice Standard 9- Communication Standard 10- Collaboration Standard 11- Leadership Standard 12- Education Standard 13- Evidence-based Practice and Research Standard 14- Quality of Practice Standard 15- Professional Practice Evaluation Standard 16- Resource Utilization Standard 17- Environmental Health

SOCIAL MEDIA AND BENEFITS OF HEALTHCARE INFORMATICS...

THE USE OF SOCIAL MEDIA TECHNOLOGY CREATES POSSIBLE OPPORTUNITIES FOR PATIENT-PROVIDER EXCHANGES (THRU TEXTING, EMAIL, OR OTHER VENUES) BUT RAISES NEW CONCERNS REGARDING DOCUMENTATION AND CONFIDENTIALITY

IMPACT OF LEGISLATION ON HEALTH INFORMATICS

THREE PRIMARY LAWS: - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) - PROVISIONS FOR PRIVACY AND SECURITY OF HEALTH INFORMATION -HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH (HITECH) ACT OF 2009 - PROVIDED FEDERAL MONEY IN THE FORM OF GRANTS TO ADVANCE USE OF HEALTH INFORMATION TECHNOLOGY (HIT) - PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 -Provided funding for HIT

Maturation of the Code

The Code was first adopted in 1950; it was periodically updated to reflect the changing context and practice of nursing. Early versions stressed: Nurse's obligation to carry out physician's orders Rules of conduct, moral character, hygiene Duty with skill and moral perfection Later versions stressed: Principles, especially respect for patient autonomy Nurse's obligation to the patient, including protection from the incompetent, unethical, or illegal practice

Common themes among the 3 definitions

The provision of care that is appropriate for each patient is based on the patient's preferences with the patient as partner on the healthcare team.

Role of Professional Organizations

They can provide -Resources - Information - Learning opportunities - Networking opportunities - Certification•Practice guidelines

Discuss the NIH's decision not to disclose its Superbug Outbreak.

To protect patient rights and wishes.

Nurse Practice Acts

•A nurse practice act has the goal of protecting the safety of the public who receive nursing care •Each state has statutes that govern the practice of nursing, while some differences exist state to state •Nurse practice acts define: •who must be licensed, •requirements for licensure, •duties of the licensed nurse, • grounds on which a license can be revoked or taken away

Define basic ethical concepts in the context of nursing practice.

Virtue Ethics- belief that people choose the right course of action because doing the right thing comes from a virtuous person's basic character Deontology- rule followers; duty most important Utilitarianism- Greatest good for greatest number of people Ethic of Care- based on feminist ethics; moral experiences of women; driven by compassion, caring, empathy, sympathy, concern for others Ethical Principlism- Autonomy, beneficence, non-maleficence, justice

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NURSING INFORMATICS COMPETENCIES

•AACN ESSENTIALS •QSEN COMPETENCIES •THE USE OF INFORMATION & TECHNOLOGY TO COMMUNICATE, MANAGE KNOWLEDGE, MITIGATE ERROR, AND SUPPORT DECISION- MAKING. •NURSE OF THE FUTURE CORE COMPETENCIES •TIGER COMPETENCIES (2004) •TECHNOLOGY INFORMATICS GUIDING EDUCATION REFORM •BASIC COMPUTER COMPETENCIES, INFORMATION LITERACY, AND INFORMATION MANAGEMENT

INFORMATION LITERACY: WEBSITE EVALUATION

•ACCURACY - ACCURATE, RELIABLE, FREE FROM ERROR •AUTHORITY OR SOURCE - CREDENTIALS OF THE AUTHOR OR THE REPUTATION OF THE HOSTING ORGANIZATION •EX:HTTPS://ADRENALFATIGUESOLUTION.COM •OBJECTIVITY •CURRENCY OR TIMELINESS: CURRENT OR DEAD LINKS? •COVERAGE OR QUALITY •USABILITY

NCLEX-RN Test - Related Content

•Advance directives •Advocacy •Client rights •Confidentiality & information security •Delegation •Ethical practice •Informed consent •Legal rights & responsibilities •Safe use of equipment

Discuss the concepts of work-day and work-life balance.

creating a balance were you can safe safe and secure with your work life and work day

Informed Consent

•A brief but complete explanation of the patient diagnosis and proposed treatment or procedure •The name and qualifications of the person who will perform the procedure or treatment •Information related to available alternatives to the recommended treatment •Information related to possible complications of the treatment or procedure •An explanation related to the patient's right to refuse treatment without having care discontinued

Recognize the relationship between personal health, self-renewal, and the ability to deliver sustained quality care.

if you take care of yourself you can give the best care to others :)

Moral reasoning

making decisions about how human beings ought to be and act

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Describe the US health care system in the context of major healthcare policies.

•50 million Americans without health insurance •Millions more underinsured •Exclusion of individuals with pre-existing medical conditions from mainstream health insurance •Financial waste in Medicare and Medicaid •Nursing shortage •Escalating Healthcare Costs vs. alarming drops in Quality of Care •Use nurse-led innovations. •Generate evidence and engage in research. •Expand the scope of practice. •Diversify the workforce. •Embrace technology. •Foster interprofessional collaboration. •Develop leadership at every level. •Be at the table.

ANA Code of Ethics

•Embracing the ethical demands of respecting the wholeness of the person, dwelling in a family and community. •Health is emphasized as a universal right, rather than a commodity to be bought and sold in the marketplace with little concern for equitable distribution, quality, and access to healthcare. •Gives voice to who we really at - at our core as we not only "do" but "be nurses". •Code of Ethics with Interpretive Statements •Moral provisions and standards for nurses to follow •Specific guidelines for: •Clinical practice •Education •Research •Administration •Aim of the document is for nurses to carefully and repeatedly reflect on the nine provisions for what they mean in your daily life as a nursing student or RN.

•Boards of Nursing (BON)

•Enforcers of the law •A nurse's license may be revoked by the state board of nursing if the nurse is convicted of a crime •BON use the preponderance-of-evidence rather than the higher standard of evidence required in criminal cases

Articulate the functions of the state boards of nursing

•Enforcers of the law •A nurse's license may be revoked by the state board of nursing if the nurse is convicted of a crime •BON use the preponderance-of-evidence rather than the higher standard of evidence required in criminal cases

Collaborative Practice Goals

•Enhance continuity across continuum of care. •Provide research-based, high-quality, cost-effective care that is driven by expected outcomes. •Promote mutual respect and communication between clients and healthcare team members. •Provide opportunities to resolve issues and solve problems.

Nurse's Role in Informed Consent

•Facilitating informed consent for patient care as a part of providing patient-centered care •Advocate for patient •Witness to patient signature •If there is a language barrier, an interpreter MUST be obtained •Patient's health literacy impacts informed consen

The U.S. Health Care System

•Financing and Insurance Mechanisms •Employer-based health insurance •(private) •Privately-purchased health insurance •(private) •Government programs (public) •State Employees Group •employees •Medicare •elderly and certain disabled people •Medicaid and CHIP •indigent, poor (if they meet the eligibility criteria), children

Nursing Licensure

•History of Licensure - Nightingale did not believe nurses should be recognized by a government body •Apprenticeship education-varied in length and quality of programs •Registered Nurse (RN) term is of historical vintage & reflects the period of permissive licensure •Education within educational institutions

Trends in Society and Health Care

•Incivility •Violence in the workplace •Mental health needs •Global aging •Nursing supply and demand •Consumerism •Complementary and Alternative Approaches •Technologic changes •Disaster Preparedness •Research Needs

Professional Accountability

•Informed Consent •Privacy is the right of a person/patient to be free from unwanted intrusion into their personal affairs. •Confidentiality is the obligation of all HC providers. ANA Code of Ethics Provision 3 •Delegation is the process for a nurse to direct another person to perform nursing tasks and activities (ANA & NCSBN) - Both legal and ethical considerations (ANA standard of professional performance-Standard 16 - Nurses are accountable and responsible for their delegation of nursing activities - Assignments consistent with NPAs - Organization policies - Standards of practice - 5 Rights of delegation: task, circumstances, person, direct/communication, supervision and evaluation

Zones of Personal Space

•Intimate zone •Family, children, friends, nursing procedures •Ask permission to touch •Personal zone- 18 in to 4 ft •Family, friends, interviewing, data gathering •May differ in various cultures, and personal preference •Take cues from the other person •Social zone: 4-12 ft •Casual acquaintances, work, social setting •Public zone: 12 ft+ •Strangers, speaking to an audience or group

Civil law

•Involves relationships between individuals, •Individuals & the government •Six categories: tort, contract, property, inheritance, family, & corporate law

Laws: Federal and State

•Laws evolve by accommodating to changes in society while adhering to the principles of the US Constitution •Three sources of law built on the Constitution •Statutory law •Administrative (or Regulatory) law •Case law Note: while federal law is administered the same way in all states. However, states might vary on how it interprets and implements laws. Therefore the interpretation of legal issues for nurses varies state to state.

Nurses Roles

•Leader •Caregiver •Advocate •Manager •Need to know:•How to delegate, supervise, motivate, and communicate with other nurses, health care team, and unlicensed personnel. •Inter- and intra-professional collaboration in the continuity of care from admission to discharge and through rehabilitation •ANA (2015) states: Collaboration is a professional healthcare relationship that is grounded in a reciprocal and respectful recognition and acceptance of each partner's unique expertise, power and sphere of influence and responsibilities.

Explore the role of the professional nurse as a member of the healthcare team.

•Leader •Caregiver •Advocate •Manager •Need to know: How to delegate, supervise, motivate, and communicate with other nurses, health care team, and unlicensed personnel. •Inter- and intra-professional collaboration in the continuity of care from admission to discharge and through rehabilitation •ANA (2015) states: Collaboration is a professional healthcare relationship that is grounded in a reciprocal and respectful recognition and acceptance of each partner's unique expertise, power and sphere of influence and responsibilities.

Legal Aspects of Reporting Abuse

•Legal Requirements to Report: •Child Abuse •Adult Abuse

Government's Roles in the U.S. Health Service System

•Major financier of health care delivery •Determine reimbursement rates to providers who render Medicare / Medicaid services •Regulates through licensing personnel and health care establishments •Health policy

Function and Composition of BONs (Board of Nursing)

•The boards of nursing (BONs) that comprise NCSBN protect the public's health and welfare by assuring that safe and competent nursing care is provided by licensed nurses. BONs achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing. •59 members

Understand the elements of malpractice and negligence

•Malpractice & Negligence are not intentional actions or inactions Negligence: failure to act as a reasonably prudent person would have acted in a specific situation (layperson) - A finding of negligence occurs when the nurse owes a duty to a patient & breaches an ordinary standard of care known by laypersons - A negligence lawsuit does not require an expert witness Malpractice: failure of a professional to use such care as a reasonably prudent member of the profession would use under similar circumstances, which leads to harm - Malpractice is professional negligence - Found to have a duty to care, breached the duty to care by not adhering to the expected standard of care, caused injury to the patient - Patient survived the harm - Wrongful death - patient did not survive - Lawsuit requires an expert witness - Damages are awarded •Nurses can be both negligent & guilty of malpractice (do carry Malpractice insurance) •Respondeat superior - healthcare organization/employer responsible too

Articulate strategies for avoiding legal problems.

•Manage stress •Adhere to standards of care •Follow and know your institution's policies and procedure •Work in environments that encourage examination of incidents •Change systems to lower the risk of malpractice •Always practice within the professional standards and statutory scope of your practice - know your Nurse Practice Act!

Avoiding Malpractice and Negligence

•Manage stress •Adhere to standards of care •Follow and know your institution's policies and procedure •Work in environments that encourage examination of incidents •Change systems to lower the risk of malpractice •Always practice within the professional standards and statutory scope of your practice - know your Nurse Practice Act!

ANA PRINCIPLES FOR SOCIAL NETWORKING

•NURSES MUST NOT TRANSMIT OR PLACE ONLINE INDIVIDUALLY IDENTIFIABLE PATIENT INFORMATION •NURSES MUST OBSERVE ETHICALLY PRESCRIBED PROFESSIONAL PATIENT−NURSE BOUNDARIES •NURSES SHOULD UNDERSTAND THAT PATIENTS, COLLEAGUES, INSTITUTIONS, AND EMPLOYERS MAY VIEW POSTING

ANA principles for social networking cont...

•NURSES SHOULD TAKE ADVANTAGE OF PRIVACY SETTINGS AND SEEK TO SEPARATE PERSONAL AND PROFESSIONAL INFORMATION ONLINE •NURSES SHOULD BRING CONTENT THAT COULD HARM A PATIENT'S PRIVACY, RIGHTS, OR WELFARE TO THE ATTENTION OF APPROPRIATE AUTHORITIES •NURSES SHOULD PARTICIPATE IN DEVELOPING INSTITUTIONAL POLICIES GOVERNING ONLINE CONTACT

BON

•National Council of State Boards of Nursing (NCSBN) developed the Nurse Licensure Compact - statutory agreement between and among states to permit nurses who are residents of one state to have the privilege of practicing in another state without acquiring a license in a second state - subject to the provisions and laws of the other state •NCSBN generates the initial licensure exam

Negligence and Malpractice

•Negligence: failure to act as a reasonably prudent person would have acted in a specific situation (layperson) •Malpractice: failure of a professional to use such care as a reasonably prudent member of the profession would use under similar circumstances, which leads to harm - Form of negligence addressing negligent conduct of professionals - Situation dependent - Form of negligence -Malpractice defined most often by: - State nurse practice act- Institutional policies - Federal guidelines- The Joint Commission Standards

Trends in Nursing that Present Challenges and Opportunities •

•Nurse shortage •Nurse faculty shortage •Nursing practice and workplace environment •Nurse retention •Complexity of nursing work •Nursing education

Client-Nurse Helping Relationship

•Orientation Phase •Introductions and use of names and roles of the relationship •An agreement or contract that defines: •Goals of the relationship •Location, frequency, and length of the contacts •Duration of the relationship. •Working Phase •Client is active participant, cooperative with activities that work toward mutually acceptable goals •Expresses feelings and concerns to nurse •Nurse provides any assistance needed to achieve goals e.g. counseling and teaching •Termination Phase •Together determine which goals were accomplished or progress made •Client verbalizes feelings about the end of the relationship

Trends in Consumerism

•Patient's Bill of Rights American Hospital Association (1973) •Consumerism—where patients now have more control over their health care experiences •The Patient Care Partnership (2003)(What to expect during your hospital stay) •High-quality patient care •Clean and safe environment •Involvement in your care •Protection of your privacy •Preparation of you and your family for when you leave the hospital •Help with your bill and filing insurance claims32

Conclusions

•Prevention of legal problems •Communication is key •Nurses have inherent duties to be informed •Nurses have legal duties •Nurses are required to be competent

What professional values do you think need to be part of professional nursing?

•Pursuit of Excellence •Scholarship •Ethical Reasoning •Respect •Leadership •Compassion •Service •Social Justice/Advocacy

Transition to Professional Practice

•Role discrepancy •Reality shock

PROTECTING PATIENT HEALTH INFORMATION

•SECURITY ISSUE IN HC INDUSTRY DUE TO NUMEROUS BREACHES •US AVERAGES 1.4 BREACHES/DAY - RESULTING IN: •NEARLY HALF OF ALL BREACHES WERE CAUSED BY INTERNAL USERS AND ARE UNINTENTIONAL •80% OF INTERNAL BREACHES ARE ATTRIBUTED TO HEALTHCARE WORKERS •ARTICLE (WILES, 2018) TO TELL OR NOT TO TELL

Evidence of Standards

•Statutes (Nurse Practice Act) •Agency regulations •Accreditation standards •Facility documents •Manufacturer's instructions •Nursing literature Expert testimony

Boards of NursingDisciplinary Categories

•Substandard Nursing Practice, Unethical Actions, Poor Judgment....................... •Destruction or alteration of patient records •Physical patient abuse •Failure to follow policy •Significant medication errors •Controlled substance violations or dependency •Impaired mental or physical incapacity •Inappropriate management decisions •Practicing beyond the scope of practice •Sexual misconduct •Patient or employer abandonment

The Act imposes three primary requirements on Medicare participating hospitals that provide emergency medical services.

•The hospital must provide an appropriate medical screening exam to anyone coming to the ED seeking medical care; •For anyone that comes to the hospital and the hospital determines that the individual has an emergency medical condition, the hospital must treat and stabilize the emergency medical condition, or the hospital must transfer the individual; and •A hospital must not transfer an individual with an emergency medical condition that has not been stabilized unless several conditions are met that includes effecting an appropriate transfer.

Background

•The professions of law and nursing are both devoted to helping client and society •A harmonious interaction between the areas of law and nursing are necessary for achieving effective outcomes •Advanced state of technology creates many legal, ethical, moral and financial issues for consumers and HC providers. •Patients are more aware of their legal rights •Laws serve as a guiding force - •for guidance to occur laws must be developed •for implementation to occur - laws must be enforced

Describe the functions of the law as they relate to nursing practice.

•The professions of law and nursing are both devoted to helping client and society •A harmonious interaction between the areas of law and nursing are necessary for achieving effective outcomes •Advanced state of technology creates many legal, ethical, moral and financial issues for consumers and HC providers .•Patients are more aware of their legal rights •Laws serve as a guiding force -•for guidance to occur laws must be developed •for implementation to occur - laws must be enforced

Civil laws that commonly affect nurses include tort & contract law

•Torts can be intentional or unintentional-Assault, Battery, False Imprisonment, Defamation of Character, Fraud, Invasion of Privacy •Unintentional tort usually occurs when the nurse does not act within the reasonable standards of nursing care.

BASIC COMPUTER COMPETENCIES

•WEB BROWSING •COMMUNICATION •EMAIL •LISTSERV GROUPS AND MAILING LISTS •SOCIAL MEDIA * •TELEHEALTH

Describe theoretical frameworks of nursing that are consistent with your personal belief system.

■Conceptual Model - a set of concepts, and statements that integrate the concepts into meaning (Fawcett, 1994) ■Propositions -statements that describe relationships among events, situations, or actions (Meleis, 2004) ■Assumptions -also describe concepts or connect two concepts and represent the values, beliefs, or goals (Meleis, 2004) -When assumptions are challenged, they become propositions

Terminal Sedation

●"When a suffering patient is sedated to unconsciousness...the patient then dies of dehydration, starvation, or some other intervening complication, as all other life-sustaining interventions are withheld." ●Has been used in situations when patients need relief of pain to the point of unconsciousness.

Deciding for Others

●A surrogate, or proxy, either is chosen by the patient, is court appointed, or has other authority to make decisions ●Three types of surrogate decision makers: - Standard of substituted judgment - Pure autonomy standard - Best interest standard

Physician-Assisted Suicide

●Act of providing a lethal dose of medication for the patient to self-administer ●Oregon Nurses Association special guidelines related to the Death with Dignity Act - Maintaining support, comfort, and confidentiality. - Discussing end-of-life options with patient and family. - Being present for patient's self-administration of medication and death. - Nurses may not administer the medication. - Nurses may not refuse care to the patient or breach confidentiality.

Common Ethical Issues in Nursing and Healthcare

●Allocation of healthcare resources ●Breaches of confidentiality ●Work environment - bullying and violence ●Autonomy and informed consent, PSDA, Advanced directives ●Organ transplantation (procurement and allocation) ●Beginning of life decision making ●Genetic/Genomic testing ●Death and end-of-life

Palliative Care

●Approach that improves the quality of life of patients associated with life-threatening illness, through prevention and relief of suffering ●Do-not-resuscitate order: - There is no medical benefit that can come from cardiopulmonary resuscitation (CPR). - The person has a very poor quality of life before CPR. - The person's life after CPR is anticipated to be very poor.

End-of-Life Decisions and Moral Conflicts with the Nurse

●Communicating truthfully with patients about death due to fear of destroying all hope ●Managing pain symptoms because of fear of hastening death ●Feeling forced to collaborate relative to medical treatments that in the nurses' opinion are futile or too burdensome ●Feeling insecure and not adequately informed about reasons for treatment ●Trying to maintain their own moral integrity

Explain ethical issues related to nurses' relationships with patients, families and colleagues.

●Nurse-physician relationships - Stein (1967) hierarchical relationship - By the 1990s nursing had unilaterally stopped playing the game -Inspired by civil rights, higher education & women's movements ●Nurse-nurse relationships -Workplace bullying, intimidation, harsh criticism, sabotage, and abuse among nurses -Speak up to protect patients from the unethical, incompetent, or impaired practice of another nurse ●Nurse-patient-family relationships -Unavoidable trust-patient needs health care and has no option but to trust nurses and HC professionals -Professional boundaries-limits that protect the space between the nurse's professional power and patient's vulnerabilities; each person in the relationship has a sense of legitimate control -Dignity- a situation in which a person's capabilities can be effectively applied e.g. child, elder, physical/mental impairment -Patient advocacy-identifies patients unmet needs and follows up to address the needs appropriately -Equity, social justice, initiating and supporting actions to meet needs

Rational Suicide

●Self-slaying ●Categorized as voluntary active euthanasia ●Person has made a reasoned choice of rational suicide, which seems to make sense to others at the time: - Realistic assessment of life circumstances - Free from severe emotional distress - Has motivation that would seem understandable to most uninvolved people within the community

Professional Ethics and Codes

●The Nightingale Pledge (1893) ●Nursing Ethics: For Hospital and Private Use (1900) ●ICN's Code of Ethics for Nurses (1953, 2012) ●ANA's Code of Ethics for Nurses (1950, 2015) A common theme is the importance of nurses delivering compassionate patient care aimed at alleviating suffering. Applies to all nurses in all settings and roles. Shared values of respect, privacy, equality & advocacy; includes nurse's moral self-respect

Euthanasia

●Types of euthanasia: - Active euthanasia - Passive euthanasia - Voluntary euthanasia - Nonvoluntary euthanasia ●Blending of types may occur

Definitions of Death

●Uniform Determination of Death Act definition of death: "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem is dead. A determination of death must be made in accordance with accepted medical standards." ●Traditional, whole-brain, higher brain, personhood.

Rule of Double Effect

●Use of high doses of pain medication to lessen the chronic and intractable pain of terminally ill patients even if doing so hastens death ●Critical aspects of the rule: - The act must be good or at lease morally neutral. - The agent must intend the good effect not the evil. - The evil effect must not be the means to the good effect. - There must be a proportionally grave reason to risk the evil effect.