Professional Perspectives Final
Identify factors necessary to gain professional nursing autonomy. Traits of a profession nursing does not completely meet
(Trait 5) Educates its members in institutions of higher education (Trait 7) Members have a high degree of independence of practice (Trait 9) Members see it as their life's work or career
Nursing Responsibilities when Delegating
1. Assess the client 2. Know staff availability 3. Know the legalities in the nurse practice act 4. Know the job description 5. Educate the staff member
The Nurse Practice Act (NPA) regulates:
1. Authority, power and composition of a board of nursing. 2.Education program standards. 3. Standards and scope of nursing practice. 4. Types of titles and licenses. 5. Requirements for licensure. 6. Grounds for disciplinary action, other violations and possible remedies.
Ethical decision making model
1. Collect, analyze, & interpret data. 2. State the dilemma. 3. Consider all the choices of action. 4. Analyze advantage & disadvantage of each course of action. 5. Make the decision and act on it.
Identify the 4 elements of negligence/malpractice
1. Duty 2. Breach of Duty 3. Causation 4. Damages
Nurses Bill of Rights
1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. 2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements. 4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution. 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibility. 6. Have the right to work in an environment that is safe for themselves and their patients. 7. Have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice. Additional Rights:1. Nurses have the right not to be abused in any form by physicians, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and impartial manner by the nurse's employer. 2. Nurses have the right not to be exploited and abused by being floated to areas of practice that they are not familiar with. 3. Nurses have the right to refuse any assignment that they feel is unsafe. Such as when a nurse is assigned a patient load he/she feels is unsafe. A nurse is assigned to work in an area of nursing in which he/she is not familiar. A nurse knows that equipment/supplies are inadequate or not available.
4 Key Messages of the RWJF Future of Nursing Report
1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners w/ physicians and other HCPs in redesigning health care in US. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.
Effective letter writing for lobbying
1. One subject per letter, brief and clear. 2. Specify your support or opposition to the bill and refer to the issue and bill number. 3. State your position courteously, concisely and back it up with specific statistics or situations. 4. State your request for action clearly. 5. If you are a constituent of the legislator, say so. 6. Sign your name with professional title. 7. Send copies of your letter to key legislators.
Recognize the Agency for Healthcare Research & Quality (AHRQ) patient safety indicators.
1. Rate of Complications of Anesthesia. 2. Obstetric Trauma Rate - Cesarean Delivery. 3.Death Rate in Low-Mortality Diagnosis Related Groups (DRGs). 4. Pressure Ulcer Rate. 5. Death Rate among Surgical Inpatients with Serious Treatable Conditions. 6. Retained Surgical Item or Unretrieved Device Fragment Count. 7. Iatrogenic Pneumothorax Rate. 8. Central Venous Catheter-Related Blood Stream Infection Rate. 9. Postoperative Hip Fracture Rate. 10. Perioperative Hemorrhage or Hematoma Rate. 11. Postoperative Physiologic and Metabolic Derangement Rate. 12. Postoperative Respiratory Failure Rate. 13. Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate. 14. Postoperative Sepsis Rate. 15. Postoperative Wound Dehiscence Rate. 16. Accidental Puncture or Laceration Rate. 17. Transfusion Reaction Count. 18. Birth Trauma Rate―Injury to Neonate. 19. Obstetric Trauma Rate―Vaginal Delivery With Instrument. 20. Obstetric Trauma Rate-Vaginal Delivery Without Instrument.
8 Recommendations of the RWJF Future of Nursing Report
1. Remove scope of practice barriers. 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 3. Implement nurse residency programs. 4. Increase the proportion of nurses w/ a baccalaureate degree to 80% by 2020. 5. Double the number of nurses w/ a doctorate by 2020. 6. Ensure that nurses engage in lifelong learning. 7. Prepare and enable nurses to lead change to advance health (leadership positions). 8. Build an infrastructure for the collection and analysis of inter professional health care workforce data.
Traits of high reliability according to James Sellers' presentation
1. Understand what is going on 2. Get to the bottom of the problems 3. Look for weak links 4. Talk to your experts 5. Don't quit
What to include in an incidence report
1. identify the pt by name, initials, and hospital or identification number. 2. date time, and place of the incident. 3. description of the facts of the incident (no conclusions or blame). 4. incorporation of the client's account of the incident in quotes. 5. identification of all witnesses 6. identification of any equipment by number and any medication by name and dosage. 7. describe events objectively. 8. avoid subjective comments and personal opinions. 9. filed according to agency policy. *Never photocopy an incident report.* *Never put in the medical record that an incident report was completed nor include in the chart.*
Purpose of the ANA Code of Ethics for Nurses
A framework for decision making usually for an identified group. - Should be action oriented and usable on a daily basis. - Guides the conduct of the professional. - A written list of professional values. - ANA code revised in 2015.
Ethics
A system of glued behaviors and beliefs that declare what is right or wrong and what ought to be. A system of morals for a particular group. Generally followed voluntarily due to lack of means of enforcement. Refer to rules provided by an external source.
Advantages of EHR vs paper
Accessible from remote sites. Accessible to multiple users at the same time. Provides reminders about completing information or carrying out protocols Reduces redundancy. Improves communication.
Lobbying
Activities designed to influence the decisions made by individuals in positions of authority
Strategies to improve the image of nursing.
Advertising Nursing: Advertising to prospective nurses and the public at the same time. Exemplar: Johnson & Johnson Campaign: Discover Nursing. Nurses must tell a credible compelling story about their work: 1. Nurses must inform the public. 2. Nurses must make public communication and education about nursing an integral part of their nursing work. 3. Nurses must communicate such that their knowledge is highlighted. 4. Nurses must make public communication and education about nursing an integral part of their nursing work. 5. Nurses must communicate such that their knowledge is highlighted.
Incidence Report
An agency record of an incident or unusual occurrence. Nurses are legally bound to report critical incidents. Example: pt falls and breaks their hip
Sentinel Event
An unexpected occurrence involving death or serious physical or psychological injury or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. *need immediate investigation and response*
Florida Nurses Association (FNA)
Annual lobby days to advocate for all nurses. Health policy special interest group. Local and regional activities to advocate for nursing. Coordinate events to education nurses in legislative efforts that will impact nurse. Coordinate events to influence health policy legislation.
Assault
Attempt or threat to touch another person unjustly. Any action that places another person in apprehension of being touched in a manner that is offensive, insulting or physically injurious without consent or authorization. *No actual touching of the person is required.* Require patient's knowledge. Assault requires a present ability to commit harm. Example: Nurse who threatens an injection or urinary catheterization.
Impact of WWII on nursing
Attempted to meet the demand of new nursing shortage by: 1. Giving full commissioned status to nurses. 2. Establishing the Cadet Nurse Corps by federal act in 1943: It forbade discrimination by sex, race, and so on; It set minimum education standards. 3. Recruiting inactive nurses back to the profession: Married or worked on a part-time basis. 4. Training volunteer nurses' aides--LPN programs grew from this program. Post War: 1. Nurses stayed in military. 2. Shortage in civilian hospitals. 3. Work & pay in private hospitals was poor. 4. Hospitals hiring LPNs & Aides.
Impact of Vietnam War on nursing
By mid-1960s, ADNs outnumbered BSNs. Technical nurses and community colleges. ADNs won the right to take the same licensing exam as diploma and BSNs. 5000 nurses in the war with ADN nurses being commissioned in the armed services. ADNs, Diploma nurses, and BSNs → all sit for the same licensing exam, NCLEX-RN → all titled RN but the educational prep is different.
Who can and can NOT give consent?
Can = a patient, parent, legal guardian, or representative provides or refuses consent for these individuals. Can't = a minor, under 18 yrs; the unconscious or person injured in such a way that they are unable to consent; a mentally ill person judged by professionals to be incompetent.
Key Skills for Delegation
Clear communication. Careful monitoring. Assessing the client. Knowing staff availability and skills. Knowing the job description. Educating the staff member.
Nurses role in informed consent
Client gave consent voluntarily. Signature is authentic. Client appears competent to give consent. Remind client they have the right to refuse after signature on form. *It is the physician's responsibility to get informed consent.*
Patient's Bill of Rights
Clients have the right to participate in their own care; emphasis is on client autonomy. Patients have the right to: 1. Considerate and respectful care. 2. Be informed about illness, treatments, outcomes, have questions answered. 3. Know the names and roles of those involved in care. 4. Consent or refuse treatment. 5. Have an advanced directive. 6. Privacy, confidentiality. 7. Review medical records.
Information
Consists of data that have been given form and have been interpreted. Ex. 102 is given additional data so that it becomes a 102 degree oral temperature of a 25 year old man taken at 9 AM
Impact of WWI on nursing
Created a great demand for nurses. Army and Navy nurse corps started but unable to keep up with demand. They began recruiting untrained from lower classes. Nursing leaders established the Committee on Nursing to help prevent lowering of standards. Red Cross started as a back-up for the Army and Navy nurse corps. Mostly hospital schools. Few university schools started. Physicians felt nurses were too well educated. Licensure started but did not change schools much. Most care still given in homes. 1918: Vassar Training Camp: Offered pre-nurse training; *Produced higher quality and better educated nurses than hospital schools*; First real push for higher education for nurses.
Participate in continuous development of cultural competence.
Cultural competence as it relates to nursing is the provision of effective care for clients who belong to diverse cultures, based on the nurse's knowledge and understanding of the values, customs, beliefs, and practices of the culture. Primary skills required: Communication, Understanding, and Sensitivity
Libel
Defamation through printing, writing, or pictures. Example: charting pt is a prostitute or crazy
Nurse Practice Act
Derived from state statute. Purpose = protect the public. 1. Describe, authority, power, and composition of a board of nursing. 2. Licensing requirements for various levels and roles within nursing. 3. Defines nursing practice: scope and standards. 4. Defines restrictions, violations, penalties, and disciplinary actions. 5. Nursing education program standards. 6. Vary from state to state but have common elements.
Florida Nurse Practice Act its relationship with the Florida Administrative Code.
Derived from state statute. Purpose: Protects public. 1. Describe, authority, power and composition of a board of nursing. 2. Licensing requirements for various levels and roles within nursing. 3. Defines nursing practice: scope and standards. 4. Defines restrictions, violations, penalties, and disciplinary actions. 5. Nursing education program standards. 6. Vary from state to state but have common elements.
National League for Nursing (NLN)
Developed criteria for accreditation of baccalaureate nursing programs. Primary purpose - to maintain and improve standards of nursing education and improve development of all nursing services. Has a strong force in community health nursing, occupational health nursing, and nursing service activities.
Subculture
Develops when members of the group accept outside values in addition to those of their dominant culture. Any individual belongs to several subcultures.
Advantages and disadvantages of inter-professional teams
Disadvantage: "Traditional hierarchies" within the healthcare system may interfere with team members confidence in speaking up about patient options (ex: in a "team meeting" as opposed to an individual assessment). Advantage: This approach is more patient centered. The heightened communication between different areas allows for better assessment of gaps of knowledge and care of the patient.
Identify reasons for the increasing use of alternative and complementary healing practices
Dissatisfaction with conventional health care - I blame the hipsters. Desire for greater control over one's health. Desire for cultural and philosophical congruence with personal beliefs about health and illness. Belief in the effectiveness of alternative therapies. Individual's health status. Rising cost of conventional health care.
specific cultural and religious factors necessary in providing competent care for Orthodox Jewish patients
Don't be a jerk like the nurse in that video. Eat kosher foods on paper plates with plastic utensils and must wash hands before eating. Can't use modern technology (electricity based stuff) on the Sabbath (sundown on Fri-sundown on Sat). Blood = filthy, man can't soothingly rub their pregnant wife's back, if they're bleeding b/c they're unclean. Can't shake other hands with people of the opposite sex b/c "my wife gets jealous." Personal hygiene completed by someone of same sex. Both sexes must have their head covered even in the OR, but not necessarily with the head covering with which they came to the hospital. A paper OR cap is appropriate.
How do lobbyists make change?
Education and Public opinion With financial support. 1. Lobbyist are often supported (paid for) by PACs—Political Action Committees—the organizations or people supportive of the ideologies represented fund the activities of the lobbyist. Both ANA and FNA (Florida Nurses Association) have PACs.
Defamation of character
Either a false communication or a careless disregard for the truth that results in damage to someone's reputation.
Florida Student Nurses Association (FSNA)
Established to represent the needs of nursing students. Works closely w/the ANA. Consists of state chapters that represent nursing students. Main purpose - help maintain high standards of education in schools of nursing.
Breach of Duty
Failure to meet the standard of care. 1. Level or degree of quality considered adequate. 2. Internal standards: set by role & ed. of nurse or institution. 3. External standards: set by SBON, prof. org., federal guidelines. Examples: 1. Commission: you do something wrong = wrong medications given OR 50 units of regular insulin given rather than 5 units ordered. 2. Omission: withholding care or the truth = scheduled medication not given OR the nurse fail to note that a patient's thumb is warm to touch, red, swollen and painful.
Fraud
False representation of fact. Example: Unlicensed personnel misrepresenting as RN
Roles of lobbyists
Find sponsors for bills -what legislator may have a special interest in this? General considerations include: 1.Partisanship, 2.Self-interest, 3.Ideology. Influence legislators regarding pending legislation—thank supporter and try to earn votes of the legislators who may be undecided. Influence public opinion on pending legislation—some bills may be unfavorable in public opinion, so the lobbyist may be the public voice promoting the legislation.
Events that Medicare/Medicaid will no longer reimburse for beginning 2011
Foreign object retained after surgery. Air embolism. Blood incompatibility. Pressure Ulcers stage III and IV. Fall and trauma. Vascular-catheter related infections (central lines). Catheter associated UTIs. Manifestation of poor glycemic control.
Deontology
Formalistic, principle, duty-based system. Principles are based on those fundamental values that undergird all major religions- are universal. Focused on right and wrong. Principles echo those in the Bill of Rights. Categorical Imperative - it is not the result of the act that makes it right or wrong, but the principles by reason of which act is carried out. Advantages: Useful in health care because it holds that an ethical decision based on principles will be similar in different situations- has consistency. Terms and concepts are similar to those used by the legal system-most people are familiar with them. Emphasis is on rights, duty, principles and obligations. Forms the basis for codes of ethics. Disadvantages: May be difficult to make decisions when principles conflict. Used in its pure form, deontology does not allow for exceptions. May be a difficulty to determine where the principles originate.
American Nurses Association (ANA)
Fosters high standards of nursing practice and promotes the educational and professional advancement of nurses. Has established code of ethics for nurses. Defines nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and tx of human response, and advocacy in the care of individuals, families, communities, and populations.
Legislation
Governs health policy at the federal, state and local level. The affordable care act would be an example of federal health policy. Public health services would be an example at the state and local levels.
American Hospital Association (AHA)
Has formally acknowledged RNs are critical to ensuring good client care. Wants to fill vacant nursing positions at any cost. Resists the move toward mandatory staffing ratios, characterizing them as "over simplistic" solution to a complex problem. Patient Bill of Rights.
Purpose of an incidence report
Help health care personnel prevent future incidents. To assist in developing policies and procedures to improve practice and quality of care. Make all the facts available to agency personnel. Contribute to statistical data about incidents.
American Association of Colleges of Nursing (AACN)
Helps colleges and schools of nursing work together to improve standards of higher education. Works through the CCNE to develop accreditation standards.
Disadvantages of EHR vs paper
High start-up cost. Steep learning curve. Subject to glitches. Unresolved issues about privacy and access.
Various uses for Telehealth and how these may improve pt care
Informed decisions produce better outcomes. The person with more information has an advantage. Physicians examine and treat clients from distant sites with video cameras, thus saving money by exchanging office visits for online appointments. Used in emergency rooms. Telesurgery. Serves remote populations.
Causation
Injury directly as a result of the breach in duty. Therefore, no breach in duty then no injury would have occurred. Examples: 1. Hypoglycemia resulted from overdose of insulin and patient died. 2. Patient allergic to penicillin and it was given to patient that caused acute allergic reaction and patient died. 3. Failure to note the S/Sx of an infection leads to amputation of the thumb.
Interdisciplinary approach to pt care
Integrate separate discipline approaches into a single consultation. The patient-history taking, assessment, diagnosis, intervention and short/long-term management goals are conducted by the team, together with the patient, at the one time. The patient is intimately involved in any discussions regarding their condition or prognosis and the plans about their care. A common understanding and holistic view of all aspects of the patient's care ensues, with the patient empowered to form part of the decision-making process, including the setting of long and short-term goals. Individuals from different disciplines, as well as the patient themselves, are encouraged to question each other and explore alternate avenues, stepping out of discipline silos to work toward the best outcome for the patient.
Primary purpose for the QSEN project
It addresses the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work. Mission: The (QSEN) Institute: Building nursing's capacity to continuously improve the quality and safety of health care.
What is meant by Standard of Best Practice?
It is a type of decision made about an individual's health care when that individual is unable to make an informed decision for himself or herself. Based upon what the HCPs and/or family decide is best (beneficence vs. paternalism). Important to consider the client's expressed wishes. 1. Durable power of attorney for health care (DPOAHC). 2. Living will. 3. Advance directives.
Is nursing a profession?
It's pretty close but still lacking in a few areas. Main area is education. It will be hard to claim that nursing is a full profession - until the entry level is a BS degree. Public still does not see nursing as a profession.
Recognize principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society.
Kindness goes a long way. Be professional and classy. Respectful and considerate. Idk the actual answer to this so I'm just kind of bull-shatting it rn.
Mabel Keaton Staupers
Leader of vision, determination, and courage, she helped break down color barriers in nursing at a time when segregation was entrenched in this country. Dedicated to improving the status of black nurses and promoting better health care for black Americans, she was instrumental in organizing the first private facility in Harlem, New York, where black physicians could treat their patients.
Cultural Orientation
Learning process starts at birth and continues throughout the lifespan. Behaviors, beliefs, and attitudes are transmitted from one generation to the next. Expressions of culture are primarily unconscious. Have a profound effect on an individual's interactions and response to the healthcare system.
LACE model
Licensure Accreditation Certification Education
Purpose of and requirements for nursing licensure
Licensure is a legal act by the state to recognize that licensed person is safe to practice. Primary function is to protect public safety. Establishes only minimal levels of competency. Each state can establish its own criteria in its state practice act (most are similar). Current movement toward national licensure.
Negative impact on the image of nursing
Limited recognition of nursing as scientific; Nursing struggles to attract qualified students and keep current practitioners; External/internal factors influencing nurse's voice; Victimization of nurses/colleagueship; Nurses' silence impacts patient care; Visibility impacts consumers and how they view nurses.
Purposes for professional organizations and benefits of belonging to professional organizations
Main vehicles in development of educational and practice standards, initiation of licensure, orientation of advanced practice, and general improvement in level of care provided. Purpose: support and help nurses lead in developing and adopting innovative, pt-centered care models; engage nurses with other areas to increase knowledge, representation, and collaboration. Benefits: increases the number of votes, increases funding to have voice heard, increases influence in the political policies.
Health priorities
May vary from regions. We do know that childhood obesity is an epidemic in our nation, so that topic has garnered federal, state, and organizational attention. Another priority may be mental health care and access.
Battery
Most common intentional tort within nursing practice. Actual willful touching of another person that may or may not cause harm. Harmful or unwarranted contact with the patient-plaintiff. Right to be free from un-consented invasions of the person. Example: Lack of consent for treatment, sexual battery
Florence Nightingale
Mother of modern nursing. Nightingale laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world.
Mary Breckinridge
Nation's foremost pioneer in the development of American midwifery. The founder of the Frontier Nursing Service. She saw the rate at which women died during childbirth in rural areas and discovered the reluctance of physicians to provide maternity services to those areas. She fought to train and educate nurses to provide the services to these women that physicians often would not.
Staff safety issues in the healthcare workplace envirnoment
Needlesticks (need safe needle devices). Back injuries. Violence (crime, customers, worker on worker, spillover of DV). Chemical exposure: OSHA. A culture of safety and blame-free work environment (w/accountability).
Impact of The Great Depression on nursing
No money for private duty nurses. Nurses moved to hospital care - Many worked for room & board. FERA (Fed Emergency Relief Admin)—1933, FDR—"The New Deal": 1. Plan to put 10k nurses to work in hospitals, clinics, & public health. 2. Lack of qualified nursing faculty delayed the development of graduate education. 3. Men and minorities not accepted into the profession.
Re-evaluation of nursing education post-WWII
Not professional. NLN became responsible for accrediting schools of nursing. Increased interest in baccalaureate education. Slow development of graduate education. 1952: development of nurse technician program in community colleges: Provide intermediate-level technical care at the bedside, Not intended to be professional nursing.
Duty
Nurse-Patient relationship: patient depend on nurse for quality competent care. Begins when patient assignment is accepted. Ends when transfer of responsibility to another qualified healthcare professional. - Cannot be lawfully abandoned. Limited duty to assist patient in times of crisis and imminent harm. Examples: 1. Nurse responsible to administer appropriate dose of insulin. 2. Nurse responsible for monitoring and timely reporting of changes in patient's condition.
Impact of Civil War on nursing
Nurses were considered handmaidens, attendants who carried out tasks for the sick and injured. No organized care system for sick and wounded. Many untrained female volunteers who followed the armies around: 6k in the North, 1k in the South. Female volunteers providing care were not appreciated by medical corps. Then Civil War opened hospitals and health care to large numbers of women. In 1869, AMA (American Medical Association) decided that well-trained nurses might be useful: 1. Wanted them under the control of the medical societies. 2. Every hospital should have a nursing school. 3. Number of schools increased rapidly. 4. PROBLEMS: Students were free labor under control of hospital admin; Long hours, poor conditions, and no time off; No classroom instructions, std of care lowered to meet staffing needs
Nursing informatics
Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.
How law and policy affect nursing care delivery
Nursing Practice → Governed by the Nurse Practice Act (Chapter 464 of Florida Statute) → Written by legislators as bills → Interpreted and implemented by the board of nursing
Evaluate one's own need for self-care
One needs self-care to avoid burnout syndrome: a state of emotional exhaustion that results from accumulated stress. Most likely to experience burn out: More intelligent than average. Hard-working, idealistic and perfectionist.
Nursing Pin
Outward sign to others that represents university values and goals. First modern nursing pin was worn by Nightingale during the Crimean War. Badge of Excellence. Nursing graduates wear as evidence of successful completion of program.
Damages
Plaintiff must demonstrate an actual harm or injury resulted in breach in duty. Generally the courts do not allow lawsuits based only on negligently inflicted emotional injuries. Examples: 1. Patient's demise (due to overdose of insulin). 2. Loss of the thumb seriously limits the patient's use of hand.
State Boards of Nursing (SBON)
Purpose = enforce the Nurse Practice Act. A. clarifying and interpreting NPA by promulgating rules and regulations. 1. who can use the title: ARNP, CNM, CRNA, CN, RN,GN, LPN, GPN...2. setting license application procedures. 3. determining responsibility for any regulations governing expanded practice for nurses. 4. disciplinary actions such as fines, probation, suspension, and revocation of license. B. holds and conducts disciplinary hearings
Nursing Lamp
Pushing back the darkness. Eternal flame, dispelling darkness and evil. "Lady of Light." Symbol of learning and knowledge seeking. Symbol of care and devotion as nurses minister to the sick and injured. Before the lovely Thomas Edison invented the lightbulb, nurses would walk around with lamps to do rounds and check on their pts
Changes brought about post WWII
Rapid increase in technology and medical knowledge. Expanded healthcare services. Increased population. Baby-boom in hospital deliveries. Nurses became involved in other areas of health care. MDs became dependent on hospitals for support services. Increased demand for highly qualified and educated nurses in specialty units (OB, ICU, OR, Peds, etc.).
Data
Raw and unstructured facts. Ex. the numbers 102 and 104 are raw data (by themselves, these numbers have little meaning because they lack interpretation)
Strategies in self-care and handling stress to prevent burn out.
Recognize the signs of burnout: extreme fatigue, exhaustion, frequent illness, overeating, headaches, sleeping problems, physical complaints, alcohol abuse, mood swings, emotional displays, anxiety, poor quality work, anger, guilt, depression. Manage stress and time. Set personal goals.
Types of adverse events, which must be reported to the Florida Agency for Healthcare Administration & the time frame for doing so.
Report w/i 15 days: 1. The death of a patient. 2. Brain or spinal damage to a patient. 3. The performance of a surgical procedure on the wrong patient. 4. The performance of a wrong-site surgical procedure. 5. The performance of a wrong surgical procedure. 6. The performance of a surgical procedure that is medically unnecessary or otherwise unrelated to the patient's diagnosis or medical condition. 7. The surgical repair of damage resulting to a patient from a planned surgical procedure, where the damage is not a recognized specific risk, as disclosed to the patient and documented through the informed-consent process. 8. The performance of procedures to remove unplanned foreign objects remaining from a surgical procedure.
False imprisonment
Restraining a person, w/ or w/o force, against that person's wishes; can be verbal, physical, or chemical. Some cases justify detainment: hospital have a common law duty to detain persons who are confused or disoriented; mentally ill persons if they are a threat to themselves or others; or persons with contagious disease who can be threat to society. Example: use of restraints, preventing the person from leaving the hospital.
Nursing cap
Roots in early Hebrew, Greek, and Roman cultures. Symbol of service worn by Deaconesses. Different cap for each school. Rank and status determined by banding. By 1980's, no longer required.
Goal setting in quality improvement process
Safe - avoid injuries to patients during care. Effective - evidence based care. PT Centered - be respectful/responsive to patient. Timely - reducing waits and delays. Efficient - avoid wasting equip, supplies, energy. Equitable - care doesn't vary in quality based on personal characteristics.
Explain how to provide patient-centered, culturally competent care that encourages patient autonomy
Same ish don't impose your belief, ask how they want things done etc etc
Slander
Spoken defamation. Example: statement re: STD, contagious disease, crime
The benefits in the development of a universally agreed-upon nomenclature and taxonomy for nursing clinical information and management data.
Standardized nursing terminologies are defined as a "common language, readily understood by all nurses, to describe nursing care." These benefits include: better communication among nurses and other health care providers, increased visibility of nursing interventions, improved patient care, enhanced data collection to evaluate nursing care outcomes, greater adherence to standards of care, and facilitated assessment of nursing competency. Implications of standardized language for nursing education, research, and administration are also presented.
Ways to be an advocate
Start at the bedside...be a voice for your patients and for your colleagues. Volunteer to sit on committees at work. Serve as a board member to organizations or groups of interest in the community. Engage your community in social media or start a blog. Volunteer to work on political campaigns of candidates supportive of nursing. Run for political office.
Knowledge
Synthesis of data and information. Ex. knowing that an oral temperature of 102 is higher than normal for a 25 yo man. Combining that info with an understanding of human physiology and pharmacology, the nurse is able to decide what treatment should be given.
Utilitarianism
Teleological, consequentialism, situation ethics. Major principles: greatest good for the greatest number, the end justifies the means, no set rules or principles to govern day-to-day decisions. All decisions depend on the situation. Moral decisions exist to serve a purpose: the greatest good for the greatest number of people. Group "happiness" or good supersedes the good of the individual. Advantages: Easy to use in most situations. Built around the individual's needs for happiness. Fits well into a society that does not like rules. Can justify decisions based on the happiness principle. Fits well into a society oriented toward behaviorism. Disadvantages: Raises subjective questions: like to whom does happiness apply? Groups? Individuals? and what is happiness? What is the greatest good? How are good, harm, benefit, and greatest quantified? Who decides? Also, Most reject "means justifies the end" principle. Creates problems in health care because of distributive justice.
Root-cause Analysis (RCA)
The Joint Commission requires use to investigate the processes and systems that contribute to a sentinel event. A tool that helps identify and clarify the bottom line factors that precipitate an error or near miss. It focuses on systems and processes, not on individual performance. - The process repeatedly digs deeper into an issue by asking "Why" questions until no additional logical answers can be identified. - A team of people representing the areas that are involved in an event is brought together to do this analysis. - The team begins with a standardized template called an Ishikawa diagram, also known as a fishbone diagram or cause and effect diagram.
Relationship between the state Nurse Practice Act and the requirements for nursing licensure and certification
The Nurse Practice Act is an official resource for Standards of Care Associated with licensure and certification. Standards of care: 1. A legal concept all nurses should understand. 2. A measure of behavior. 3. Accepted reasonable practice of care. 4. Failure could endanger health and more. 5. Malpractice actions.
Electronic Health Records
The electronic version of a patient's chart. Provides instant information to authorized users. Can be created and continually managed by authorized providers. Critical health information can be shared. Consist of all clinicians who are involved with the patient's care.
Provision 8
The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. NURSES GET IN FORMATION (WITH OTHER PEOPLE I GUESS)
Confidentiality
The nurse does not reveal personal or health-related information concerning the patient without either the patient's consent or sufficient cause. Only those directly involved in care should know details. Do not discuss patient conditions in public places. HIPAA: 1. Mandates the development of a centralized electronic database with health records for every person in US. - Attempt to simplify & standardize electronic forms required for claims for services. 2. Federal law protects patient confidentiality in medical records.
Provision 4
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. WE ARE RESPONSIBLE AS NURSES.
Provision 5
The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. WATCH YOSELF. Show me whatcha workin' with.
Provision 6
The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. DON'T BE A MESSY NURSE. clean up clean up everybody clean up.
Provision 7
The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. ADVANCE (is not as cool as vitality)
Provision 3
The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient. get up, stand up (Bob Marley) for what it right for your patient.
Provision 2
The nurse's primary commitment is to the patient, whether an individual, family, group, or community. PATIENT COMES FIRST!
Provision 1 of the ANA Code of Ethics for Nurses
The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems. R-E-S-P-E-C-T! Find out what it means for me.
Fidelity
The obligation of an individual to be faithful to commitments made to self and others. - A devotion to one's duties and obligations. - Fidelity is the main support for the concept of accountability. - Fidelity exists on several levels at the same time. Ex. Nurse asked to work an extra shift: fidelity to self vs. employer, profession, and client.
Justice
The obligation to be fair to all people. Distributive justice. 1. The right of persons to be treated equally regardless of race, sex, marital status, social standing, economic level, or religious belief. 2. Can be expanded to deal with the rights of groups in society. 3. Allocation of scarce resources. - Equal access to healthcare for all. - Pancreas transplant for an alcoholic vs. immunize all children in a state.
Provision 9
The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping of social policy. can't come up with something clever for this. NURSES MAKE THEIR OWN REPUTATION
Veracity
The requirement that HCPs tell the truth and do not intentionally deceive or mislead- Truthfulness. Exception: may be violated when harm will come to the patient from telling the truth. - Exception is overused. - Use of placebo medications- how do you feel?
Non-maleficence
The requirement that the HCP do no harm to patients either intentionally or by accident. - Requires nurses to protect those who cannot protect themselves. - Think about it: is temporary harm permitted for a greater good?
Beneficence
The requirement that the primary goal of health care and nursing is to do good for others. - One of the oldest of the ethical requirements in health care. - Goes beyond minimal safe care.
Autonomy
The right of self determination, independence, and freedom of decision. Limitation to autonomy- when one individual's autonomy interferes with another individual's rights, health, or well-being. Example: 1. Contagious diseases. 2. Mother who refused seizure medicine, but drives and transports others. 3. Parents refuse treatment for kids due to their religious belief.
Timing for successful lobbying
There are key times in the bill-becomes-a-law process that your communication with your legislator is especially needed. 1. When the bill is introduced. 2. When the bill is assigned to committee. 3.When the bill is coming to the "floor". 4. After the vote.
Adverse Event
Unintended harm to the patient from the viewpoint of the patient. An adverse event attributable to an error is a preventable adverse event.~ IOM: An injury caused by medical management rather than the underlying disease or condition of the patient.~~ Florida Statute 395.0197: An event over which health care personnel could exercise control and which is associated in whole or in part with medical intervention rather than the condition for which such intervention occurred~
Invasion of privacy
Unreasonably intrudes on the client's private affairs. Examples: 1. HIPAA violation 2. Unnecessarily exposing a client during transportation 3. Share photographs of wounds and other medical condition. Not an absolute right—can and may be required by law to be breached in certain situations such as child, spousal, or elder abuse; gunshot wounds; knife wounds; rape; communicable diseases; suspected crimes
Rules or policy
Usually developed by agencies charged with carrying out legislation. Federal Health and Human services, is now developing the rules and guidelines for how the Affordable care act is to be carried out
Policies, procedures, and clinical guidelines
Usually, developed by professional organizations or businesses that govern what is a standard of care for healthcare delivery.
Multidisciplinary approach to pt care
Utilize the skills and experience of individuals from different disciplines, with each discipline approaching the patient from their own perspective. Most often this approach involves separate individual consultations. These may occur in a "one-stop-shop" fashion with all consultations occurring as part of a single appointment on a single day. It is common for multidisciplinary teams to meet regularly, in the absence of the patient, to "case conference" findings and discuss future directions for the patient's care. Multidisciplinary teams provide more knowledge and experience than disciplines operating in isolation.
Dorothea Dix
Was a social reformer in mental health care. She fought tirelessly to change how mental health services were delivered and forced the world to recognize the deplorable conditions of mental health hospitals. Results were gradual but she did see asylums built in many states and others improved.
Margret Sanger
Was an American birth control activist, sex educator, and nurse. She popularized the term birth control, opened the first birth control clinic in the United States, and established Planned Parenthood. Her efforts contributed to the landmark U.S. Supreme Court case which legalized contraception in the U.S.
Discuss the impact of the therapeutic use of self on the nurse-patient relationship
What does it involve? Understanding Neutrality/empathy, caring, and trust. How do you do it? With rapport, insight, patience, humor, energy, honesty, voice and body language. It is "the exploitation of personal characteristics which are of benefit to the therapeutic relationship." The conscious way of exploiting your personal characteristics to meet the patient's needs etc. If my pt is a child who is afraid I'm going to use my friendly side and be kind. It wouldn't be right to be sassy and sarcastic in that opportunity.
Legality of Delegation
When nurses delegate nursing tasks to non-nurses, the RNs are always legally responsible for supervising that person to ensure that the care given meets the standards of care. Legally, the power to delegate is restricted to professionals who are licensed and governed by a statutory practice act.
Important ethical issues in the use of informatics in health care
Who owns the client's healthcare data? Individual rights versus social good? Unauthorized sharing of healthcare information is unethical and, since HIPAA, also illegal. - The code of ethics prohibits unauthorized or unnecessary access to client information. - Confidentiality is the basis of trust in a therapeutic relationship. Accidental or intentional damage to paper and EHR include: Floods, fires, earthquakes, electrical surges/power outages, acts of terror.
Basic lobbying activities
Written communication using letters or emails. Lobbying visits to the legislator in his/her district office. Attendance at FNA Lobby Days at the capitol. Participation in legislative receptions.
RN-to-BSN
already practicing RN w/ ADN or diploma going back to school to receive bachelor's degree. *already passed NCLEX-RN.*
ADN
associates degree in nursing. 2 yrs to get RN license. don't graduate w/ bachelors - may inhibit you when trying to gain higher positions.
Wisdom
based on experiences??
Salad bowl (multiculturalism)
cultures cling tenaciously to their traditional cultural practices and languages-minimal attempt to "fit in"
Melting pot (acculturation)
cultures try to "fit in" to the dominant culture by shedding the trappings of their native culture
Education
formal preparation in graduate degree or post-graduate certificate programs
Certification
formal recognition of knowledge, skills, experience demonstrated by achievement of set standards. demonstrates attainment of increased knowledge, higher than the minimal level of competency indicated by licensure (ICU nurse).
BSN-to-MSN
graduate program, usually for teaching or nurse managers
Licensure
granting authority to practice. form of legal certification (must pass NCLEX-RN). regulatory method through each state through the NPA and Administrative Rules (disciplinary activities). is a legal act by the state to recognize that licensed person is safe to practice.
Culture
group's acceptance of a set of attitudes, ideologies, values, beliefs, and behaviors that influence the way that the members of the group express themselves
Diversity - Secondary characteristics
harder to identify, such as socioeconomic status, education, occupation, length of time away from country of origin, gender issues, residential status, and sexual orientation
Cultural expression
language; spirituality; works of art; group customs and traditions; food preferences; response to illness, stress, pain, bereavement, anger, and sorrow; decision making; and even world philosophy
Law
man-made rules of conduct that protect society
Positive impact on the image of nursing
nursing is the most trusted profession
MSN-to-DNP
practice doctorate, usually for those who want to practice as nurse practitioners (ARNP)
Purpose of informed consent
provides client with complete information prior to obtaining agreement by client to accept a course of treatment or procedure
Health policy
refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society
MSN-to-PhD
research doctorate, usually for nursing research or education
Accreditation
review and approval by agency for educational degree or certification program in nursing
BSN
std 4 yr university/state school approach. have to sit for NCLEX-RN after. (accelerated program for those already w/ a bachelor's degree).
Obligation
the demand made on an individual, a profession, a society or a government to fulfill and honor the rights of others
Diversity - Primary characteristics
those that are more obvious, such as nationality, race, color, gender, age, and religious beliefs
