leadership HESI

RN

- Assessment - Nursing Dx - Planning - Evaluation - Teaching - IVP meds/IVP pain meds - Blood transfusions - TPN feedings - Unstable pts - New admits - Can perform the tasks that an LPN or LVN can perform - Responsible for assessment and planning care, initiating teaching, and administering meds intravenously

Skills of the Nurse Manager

- Communication Assertive communication: A. clearly defined goals and expectations B. congruent verbal & nonverbal msgs C. critical to the directing aspect of management D. "I need" rather than with "You must." > Act as a liaison b/t clients & others > Engage in conflict resolution as needed w/ staff - Organization A. People B. Time C. Supplies > Plan overall strategies to address client problems > Review management outcomes - Delegation: ID roles/responsibilities to address client problems - Supervision: supervise care provided by others - Critical Thinking: serve as resource person to other staff - Motivation comes from w/in an individual. A nurse leader can provide an env that will promote motivation through (+) feedback, respect, & seeking input. L - Workplace violence, substance abuse, bullying, social media, & inappropriate nurse-client relationships are areas of concern that nurse managers must provide systems in place to educate staff for heightened awareness of these common behaviors, as well as providing mechanisms for reporting

LPN

- Data collection - Monitor - Observe - Reinforce teaching - IVPB - Monitor blood transfusion - Topical, PO, IM meds/pain meds - NGT, GT, JT feedings/meds - Insert, maintain, remove NGT & urinary catheter - Calculate & monitor IV flow rate - Maintain & remove peripheral IV - VS - Collect urine - Trach suctioning - Dressing change - Routine preop/procedure care - Stable clients - No new admits - Can perform not only the tasks that a UAP can perform, but also certain invasive tasks - Dressing changes, suctioning, urinary catheterization, and medication administration (PO, SQ, IM, and selected IVPB meds), according to the education and job description of the LPN or LVN. - Can also review with the client teaching plans that were initiated by the registered nurse.

collective bargaining

- Formalized decision-making process between representatives of management and representatives of labor to negotiate wages and conditions of employment. - When collective bargaining breaks down because the parties cannot reach an agreement, the employees may call a strike or take other work actions. - Striking presents a moral dilemma to many nurses because nursing practice is a service to people

UAP

- Hygiene - Bed bath - Dress - Serve & assist w/ eating - Turn client - Ambulation - Answer call light - Clean & sanitize room - Change linens - Mouth care & denture cleansing - No med admin - No sterile procedures - No unstable pts - No new admits noninvasive interventions, such as skin care, ROM exercises, ambulation, grooming, hygiene measures

Duty

- Obligation to use due care (what a reasonable, prudent nurse would do); failure to care for &/or to protect others against unreasonable risk. - Nurse must anticipate foreseeable risks. - EX: If a floor has water on it, the nurse is responsible for anticipating the risk for a client's falling.

delegation

- Process by which duties, tasks, and coordination of care are transferred to ancillary and assistive personnel, as well as other nurses. - Allowing a specific task to be performed that is not routinely performed. 2. Responsibility: obligation to complete a task. 3. Authority: right to act or command the actions of others. 4. Accountability: ability and willingness to assume responsibility for actions and related consequences. - Nurse transfers responsibility & authority for the completion of delegated tasks, but the nurse retains accountability.

Zika Virus

- Reported in many countries making it difficult to determine where the virus is spreading. - Reports of microcephaly in babies of mothers who had Zika virus while pregnant- special precautions for pregnant women. Travel to areas where Zika is spreading is not recommended. Woman & male partner discuss travel w/ HCP before traveling to areas with Zika since sexual transmission is possible. - Follow steps to prevent mosquito bites while traveling. - Remains in the blood of an infected person approximately 1 week.

Causes for Disciplinary Action

- Unprofessional conduct - Conduct that could adversely affect the health and welfare of the public - Breach of client confidentiality - Failure to use sufficient knowledge, skills, or nursing judgment - Physical or verbal abuse of a client - Assumption of duties without sufficient preparation - Knowingly delegating to unlicensed personnel nursing care that places the client at risk for injury - Failure to accurately maintain a record for each client - Falsification of a client's record - Leaving a nursing assignment without proper notification of the appropriate personnel

QI

- focuses on processes or systems that significantly contribute to client safety and effective client care outcomes - criteria are used to monitor outcomes of care and to determine the need for change to improve the quality of care

Organ Donation and Transplantation

- heart, lungs, and liver can be obtained only from a person who is on mechanical ventilation and has suffered brain death, whereas other organs or tissues can be removed several hours after death - donor must be free of infectious disease and cancer - Requests to the deceased's family for organ donation usually are done by the HCP or nurse specially trained for making such requests - acceptable: catholic, jehovah's witness - discouraged: orthodox - not allowed: islam, orthodox judasim (allowed w/ rabbi approval)

informed consent

- legal documents that indicate the client's permission to perform surgery, perform a treatment or procedure, or give information to a third party - must be informed, in understandable terms, of the risks and benefits of the surgery or treatment, what the consequences are for not having the surgery or procedure performed, treatment options, and the name of the health care provider performing the surgery or procedure - client who has been medicated with sedating medications or any other medications that can affect the client's cognitive abilities must not be asked to sign a consent. - signed freely w/out pressure - if client is declared mentally or emotionally incompetent, the next of kin, appointed guardian (appointed by the court), or durable POA can give consent - nurse is witnessing only the signature of the client on the informed consent form - can be waived for urgent medical or surgical intervention as long as institutional policy so indicates. - client has the right to refuse information and waive the informed consent and undergo treatment, but this decision must be documented in the medical record. - may withdraw consent at any time - informed by HCP

minors (<18)

- may not give legal consent, must be obtained from a parent or the legal guardian - assent by the minor is important because it allows for communication of the minor's thoughts and feelings - Parental or guardian consent obtained except in: in an emergency; in situations in which the consent of the minor is sufficient (tx r/t substance abuse, testing & tx of STIs/HIV/AIDS, BC services, pregnancy, psychiatric services); an emancipated minor; or a court order or other legal authorization has been obtained - emancipated minor: has established independence from his or her parents through marriage, pregnancy, or service in the armed forces, or by a court order.

floating

- must not assume responsibility beyond their level of experience or qualification - should be given an orientation of the unit and the standards of care for the unit should be reviewed

NPA

- series of statutes that have been enacted by each state legislature to regulate the practice of nursing in that state - set educational requirements - distinguish b/t nursing & medical practice - define scope - requirements for protection of the public, grounds for disciplinary action, rights of the nurse licensee if a disciplinary action is taken, and related topics

managed care

- strategies used in the health care delivery system that reduce the costs of health care - emphasizes the promotion of health, client education and responsible self-care, early identification of disease, and the use of health care resources

Questions 2

1. By what authority may RNs delegate nursing care to others? 2. A UAP may perform care that falls within which component of the nursing process? 3. Which type of communication is necessary to implement a democratic leadership style? 4. What are the five rights of delegation? 5. Which tasks can be delegated to a UAP? A. Inserting a Foley catheter B. Measuring and recording the client's output through a Foley catheter C. Teaching a client how to care for a catheter after discharge D. Assessing for symptoms of a urinary tract infection 6. What are the essential steps of effective supervision? 7. Which of the following is an example of assertive communication? A. "You need to improve the way you spend your time so that all of your care gets performed." B. "I've noticed that many of your clients did not get their care today." 8. Common signs of substance abuse are clients complaining that pain medication does not relieve pain when administered by a certain nurse, frequent inaccuracies of controlled medication counts for a specific nurse, and client reports not taking pain medications but several doses are signed out for that client. 9. Common characteristics of bullying are refusing to work with others, yelling or cursing at peers, making degrading comments, and verbal abuse. 10. Workplace violence contributes to a high staff turnover rate and decline in client care.

setting priorities for client teaching

1. Determine the client's immediate learning needs. 2. Review the learning objectives established for the client. 3. Determine what the client perceives as important. 4. Assess the client's anxiety level and the time available to teach.

Answers 3

1. Disaster preparedness, disaster response, disaster recovery 2. Primary: Develop plan, train and educate personnel and public; secondary: Triage, treatment-shelter supervision; tertiary: Follow-up, recovery assistance, prevention of future disasters 3. To sort or categorize 4. Anthrax, pneumonic plague, botulism, smallpox, inhalation tularemia, viral hemorrhagic fever, ricin, sarin, radiation 5. Three infection control measures for Ebola include the following: A. Place the client in a single-patient room with a private bathroom. B. Wear full PPE. C. When there are copious amounts of blood and other body fluids, caregivers should wear additional PPE, including double gloves, disposable shoe covers, and leg coverings. 6. Notify appropriate health care providers, supervisors, and the CDC of clients with a suspected diagnosis of Ebola virus. 7. Delayed triage category indicates that the status of a client who has a serious life-threatening injury is not expected to deteriorate significantly in a few hours. 8. Inform couple that the Zika virus is probably transmitted via sexual contact and provide information regarding the possible transmission of the Zika virus resulting in the congenital defect to the fetus. Recommend obtaining information regarding travel from CDC travel line.

case management

1. Health care delivery strategy that supports managed care; it uses an interprofessional health care delivery approach that provides comprehensive client care throughout the client's illness, using available resources to promote high-quality and cost-effective care. 2. Includes assessment and development of a plan of care, coordination of all services, referral, and follow-up. 3. Critical pathways are used, and variation analysis is conducted. Case manager: a professional nurse who assumes responsibility for coordinating the client's care at admission and after discharge. Establishes a plan of care with the client, coordinates any interprofessional consultations and referrals, and facilitates discharge

HIPAA Client's rights

1. Inspect a copy of PHI. 2. Ask the health care agency to amend the PHI that is contained in a record if the PHI is inaccurate. 3. Request a list of disclosures made regarding the PHI as specified by HIPAA. 4. Request to restrict how the health care agency uses or discloses PHI regarding treatment, payment, or health care services, unless information is needed to provide emergency treatment. 5. Request that the health care agency communicate with the client in a certain way or at a certain location; the request must specify how or where the client wishes to be contacted. 6. Request a paper copy of the HIPAA notice.

conflict

1. Intrapersonal: Occurs within a person 2. Interpersonal: Occurs between and among clients, nurses, or other staff members 3. Organizational: Occurs when an employee confronts the policies and procedures of the organization

Questions 3

1. List the three levels of disaster management. 2. List examples of the three levels of prevention in disaster management. 3. Define triage. 4. Identify three bioterrorism agents. 5. Identify three infection control measures for Ebola. 6. Identify the agency to notify when providing care for a client with a suspected diagnosis of Ebola virus. 7. Describe the delayed triage category. 8. Describe travel recommendations for a couple preparing for in vitro fertilization.

Unintentional torts

1. Negligence: Performing an act that a reasonable & prudent person would not perform; reasonableness 2. Malpractice: Negligence by a professional person that results in injury

Answers 2

1. State Nurse Practice Act 2. Implementation 3. Assertive communication skills 4. Right task, right circumstance, right person, right direction or communication, and right supervision 5. Delegation is as follows: A. Is a sterile invasive procedure and should not be delegated to a UAP B. Falls within the implementation phase of the nursing process and does not require nursing judgment. Evaluation of the intake and output (I&O) must be done by the nurse. C. Client teaching requires the abilities of a nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed and any symptoms reported by the client, but this does not replace assessment by the nurse. D. Assessment must be performed by the nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed or any symptoms reported by the client, but this does not replace assessment by the nurse. 6. Direction, evaluation, and follow-up 7. Examples: A. This is an aggressive communication, which causes anger, hostility, and a defensive attitude. B. Assertive communication begins with "I" rather than "you" and clearly states the problem.

answers 1

1. Sterile or invasive procedures 2. Would a reasonable and prudent nurse act in the same manner under the same circumstances? 3. Duty: Failure to protect client against unreasonable risk. Breach of duty: Failure to perform according to established standards. Causation: A connection exists between conduct of the nurse and the resulting damage. Damages: Damage is done to the client, whether physical or mental. 4. Conduct causing damage to another person in a willful or intentional way without just cause. Example: Hitting a client out of anger, not in a manner of self-protection. 5. Voluntary: Client admits self to an institution for treatment and retains his or her civil rights; he or she may leave at any time. Involuntary: Someone other than the client applies for the client's admission to an institution (a relative, a friend, or the state); requires certification by one or two health care providers that the person is a danger to self or others; the person has a right to a legal hearing (habeas corpus) to try to be released, and the court determines the justification for holding the person. 6. Vote, make contracts or wills, drive a car, sue or be sued, hold a professional license 7. Voluntary, informed, written 8. Alert, coherent, or otherwise competent adults; a parent or legal guardian; a person in loco parentis of minors or incompetent adults 9. The Good Samaritan Act 10. Inform the health care provider; record that the health care provider was informed and the health care provider's response to such information; inform the nursing supervisor; refuse to carry out the prescription. 11. Inform the health care provider or person asking the nurse to perform the task that he or she is unprepared to carry out the task; refuse to perform the task. 12. Apply restraints properly; check restraints frequently to see that they are not causing injury and record such monitoring; remove restraints as soon as possible; use restraints only as a last resort. 13. A patient must give written consent before health care providers can use or disclose personal health information; health care providers must give patients notice about providers' responsibilities regarding patient confidentiality; patients must have access to their medical records; providers who restrict access must explain why and must offer patients a description of the complaint process; patients have the right to request that changes be made in their medical records to correct inaccuracies; health care providers must follow specific tracking procedures for any disclosures made that ensure accountability for maintenance of patient confidentiality; patients have the right to request that health care providers restrict the use and disclosure of their personal health information, although the provider may decline to do so.

questions 1

1. What types of procedures should be assigned to professional nurses? 2. Negligence is measured by reasonableness. What question might the nurse ask when determining such reasonableness? 3. List the four elements that are necessary to prove malpractice (professional negligence). 4. Define an intentional tort, and give one example. 5. Differentiate between voluntary and involuntary admission. 6. List five activities a person who is declared incompetent cannot perform. 7. Name three legal requirements of a surgical permit. 8. Who may give consent for medical treatment? 9. What law protects the nurse who provides care or gives aid in an emergency situation? 10. What actions should the nurse take if he or she questions a health care provider's prescription—that is, believes the prescription is wrong? 11. Describe the nurse's legal responsibility when asked to perform a task for which he or she is unprepared. 12. Describe nursing care of the restrained client. 13. Describe six patient rights guaranteed under HIPAA regulations that nurses must be aware of in practice.

critical pathway

1. clinical management care plan for providing client-centered care and for planning and monitoring the client's progress within an established time frame; interprofessional collaboration and teamwork ensure shared decision making and quality client care. 2. Variation analysis is a continuous process that the case manager and other caregivers conduct by comparing the specific client outcomes with the expected outcomes described on the critical pathway. 3. The goal of a critical pathway is to anticipate and recognize negative variance (i.e., client problems) early so that appropriate action can be taken and positive client outcomes can result

assignments

1. transfer of performance of client care activities to specific staff members (w/in authorized scope) 2. Guidelines for client care assignments a. Always ensure client safety. b. Be aware of individual variations in work abilities. c. Determine which tasks can be delegated and to whom. d. Match the task to the delegatee on the basis of the nurse practice act and any practice limitations (institutional policies and procedures, and job descriptions of personnel provided by the institution). e. Provide directions that are clear, concise, accurate, and complete. f. Validate the delegatee's understanding of the directions. g. Communicate a feeling of confidence to the delegatee, and provide feedback promptly after the task is performed h. Maintain continuity of care as much as possible when assigning client care.

causation

A connection exists between conduct and the resulting injury, referred to as proximate cause or remoteness of damage.

crime

A. An act contrary to a criminal statute. Crimes are wrongs punishable by the state & committed against the state, w/ intent usually present. The nurse remains bound by all criminal laws. B. Commission of a crime involves the following behaviors: 1. commits a deed contrary to criminal law. 2. omits an act when there is a legal obligation to perform such an act (refusing to assist w/ the birth of a child if such a refusal results in injury to the child). 3. Criminal conspiracy occurs when 2+ persons agree to commit a crime. 4. Assisting or giving aid to a person in the commission of a crime makes that person equally guilty of the offense (awareness must be present that the crime is being committed). 5. Ignoring a law is not usually an adequate defense against the commission of a crime (nurse who sees another nurse taking narcotics from the unit supply & ignores this observation is not adequately defended against committing a crime). 6. Assault is justified for self-defense. To be justified, only enough force can be used to maintain self-protection. 7. Search warrants required before searching a person's property. 8. crime not to report suspected child abuse

Intentional torts

A. Assault & BAttery 1. Assault: Mental/physical threat (forcing [w/out touching] a client to take a med/tx) 2. Battery: Actual & intentional touching of another, ww/ or w/out intent to do harm (hitting or striking a client). If a mentally competent adult is forced to have a treatment he or she has refused, battery occurs. B. Invasion of privacy: Encroachment or trespassing on another's body or personality 1. False imprisonment: Confinement w/out authorization 2. Exposure of a person: Exposure or discussion of a client's case. Applies to death 3. Defamation: Divulgence of privileged info or communication (through charts, conversations, observations) C. Fraud: Illegal activity & willful & purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. 1. Presenting false credentials for the purpose of entering nursing school, obtaining a license, or obtaining employment (falsification of records) 2. Describing a myth regarding a tx (telling a client that a placebo has no SE & will cure the disease, or telling a client that a tx or dx test will not hurt, when indeed pain is involved in the procedure)

Psychiatric Nursing

A. Civil procedures: Methods used to protect the rights of psych clients. B. Voluntary admission: Clients admit themselves to an institution for tx & retain civil rights. C. Involuntary admission: Someone other than the client applies for the client's admission 1. requires certification by HCP that the person is a danger to self or others. 2. Individuals have the right to a legal hearing w/in a certain # of hrs or days. 3. Most states limit commitment to 90 d. 4. Extended commitment is usually no > 1 yr. D. Emergency admission: Any adult may apply for emergency detention of another, but medical or judicial approval is required to detain anyone for observation, dx & tx for those clients whose behavior poses a danger to themselves or others. Length of admission time is based on state laws. 1. A person held against their will can file a writ of habeas corpus to try to get the court to hear the case & release the person. 2. The court determines the sanity & alleged unlawful restraint of a person. E. Legal & civil rights of hospitalized clients 1. wear their own clothes & keep personal items & a reasonable amt of cash for small purchases 2. individual storage space for 1's own use 3. see visitors daily 4. reasonable access to a telephone & opportunity to have private conversations 5. receive & send mail (unopened) 6. refuse shock tx & lobotomy F. Competency hearing: Legal hearing that is held to determine a person's ability to make responsible decisions about self, dependents, or property 1. Persons declared incompetent have the legal status of a minor—they cannot: Vote, Make contracts or wills, Drive a car, Sue or be sued, Hold a professional license 2. A guardian is appointed by the court for an incompetent person. Declaring a person incompetent can be initiated by the state or family. G. Insanity: accused is not criminally responsible for the unlawful act committed bc they are mentally ill. H. Inability to stand trial: not mentally capable of standing trial. He or she: 1. Cannot understand the charge against them 2. Must be sent to the psych until legally determined to be competent for trial 3. Once mentally fit, must stand trial & serve any sentence, if convicted

restraints

A. Clients may be restrained only under the following circumstances: 1. In an emergency 2. For a limited time 3. For the purpose of protecting the client or others from injury or from harm B. Nursing responsibilities 1. notify the HCP immediately that the client has been restrained. 2. required & imperative that the nurse accurately document the facts & client's behavior leading to restraint. C. When restraining a client, the nurse should do the following: 1. Use restraints (physical or chemical) after exhausting all reasonable alternatives. 2. Apply the restraints correctly & in accordance w/ facility policies & procedures. 3. Check frequently to see that the restraints do not impair circulation or cause pressure sores/injuries. 4. Allow for nutrition, hydration, & stimulation at frequent intervals. 5. Remove restraints ASAP. 6. Document the need for & application, monitoring, & removal of restraints. 7. Never leave a restrained person alone. - May constitute false imprisonment, esp if there is no documentation indicating specific reasons to prevent harm to the client or others. Freedom from unlawful restraint is a basic human right & is protected by law. Use of restraints must fall w/in guidelines specified by state law & hospital policy.

surgical permit

A. Consent to operate obtained before any surgical procedure, however minor it might be. B. Legally, the surgical permit must be: 1. Written 2. Obtained voluntarily 3. Explained to the client (informed consent must be obtained) C. Informed consent = procedure & tx/operation has been fully explained to the client, including: 1. Possible complications, risks, disfigurements 2. Removal of any organs or parts of the body 3. Benefits & expected results D. Surgery permits must be obtained as follows: 1. Witnessed by an authorized person, such as the HCP or a nurse. 2. Protect the client against unsanctioned surgery, protect the HCP & surgeon, hospital, & hospital staff against possible claims of unauthorized operations. 3. Adults & emancipated minors may sign their own operative permits if mentally competent. 4. Permission to operate on a minor or an incompetent or unconscious adult must be obtained from a legally responsible parent/guardian. The person granting permission to operate on an adult who lacks capacity to understand info about the proposed tx must be ID'd in a Durable POA or an Advance Health Directive.

Supervision

A. Direction/guidance 1. Clear, concise, specific directions 2. Expected outcome 3. Time frame 4. Limitations 5. Verification of assignment B. Evaluation/monitoring 1. Frequent check-in 2. Open communication lines 3. Achievement of outcome C. Follow-up 1. Communication of evaluation findings to the LPN or UAP and other appropriate personnel 2. Need for teaching or guidance

emergency care

A. Good Samaritan Act: Protects HCPs against malpractice claims for care provided in emergency situations (nurse gives aid at the scene to an automobile accident victim). B. A nurse is required to perform in a "reasonable & prudent manner.

Leadership and Management

A. Leader: individual who influences people to accomplish goals. B. Manager: individual who works to accomplish the goals of the organization. C. A nurse manager acts to achieve the goals of safe, effective client care within the overall goals of a health care facility

bioterrorism

A. Learn the symptoms of illnesses that are associated with exposure to likely biologic and chemical agents. B. Understand that they could appear days or weeks after exposure. C. Nurses & other HCPs would be the first responders when victims seek medical evaluation after symptoms manifest. First responders are critical in identifying an outbreak, determining the cause of the outbreak, identifying risk factors, and implementing measures to control and minimize the outbreak. D. Possible agents 1. Biologic agents: Anthrax, Pneumonic plague, Botulism, Smallpox, Inhalation tularemia, VHF 2. Chemical agents: Biotoxin agents- ricin; Nerve agents: sarin; Radiation Nursing Assessment A. Community-disaster risk assessment B. Measures to mitigate disaster effect C. Exposure symptom identification Nursing Plans & Interventions A. Participate in development of disaster plan. B. Educate the public on the disaster plan & personal preparation for disaster. C. Train rescue workers in triage & basic first aid. D. Educate personnel on shelter management. E. Practice triage. F. Tx injuries & illness. G. Tx other conditions, including MH H. Supervise shelters. I. Arrange for follow-up care for injuries. J. Arrange for follow-up care for psych problems. K. Assist in recovery. L. Work to prevent future disasters & their consequences.

prescriptions & HCPs

A. Nurse required to obtain a prescription (order) to carry out medical procedures from a HCP. B. Although verbal telephone prescriptions should be avoided, the nurse should follow the agency's policy and procedures. Employee receiving the prescription should write the verbal order or critical value on the chart or record it in the computer & then read back to HCP. C. If a nurse ?s a HCP's prescription bc he/she believes that it is wrong, the nurse should: 1. Inform the HCP 2. Record that the HCP was informed & record the HCP's response to such info 3. Inform the nursing supervisor. 4. Refuse to carry out the prescription. D. If the nurse believes that a HCP's prescription was made w/ poor judgment (nurse believes the client does not need as many tranquilizers as the health care provider prescribed), the nurse should: 1. Record that the HCP was notified & that the prescription was questioned 2. Carry out the prescription bc nursing judgment cannot be substituted for a HCP's judgment E. If a nurse is asked to perform a task for which he/she has not been prepared educationally or does not have the necessary experience, the nurse should: 1. Inform the HCP that he/she does not have the edu or experience necessary to carry out the prescription. 2. Refuse to carry out the prescription. F. The nurse cannot, w/out a HCP's prescription, alter the amt of drug given to a client. Nursing judgment cannot be substituted for medical judgment. - If the nurse carries out a HCP's prescription for which he/she is not prepared & does not inform the HCP of his/her lack of preparation, the nurse is solely liable for any damages. - If the nurse informs the HCP of his/her lack of preparation in carrying out a prescription & carries out the prescription anyway, the nurse & HCP are liable for any damages.

critical thinking

A. Nurses are accustomed to using the nursing process as the model for problem solving in client care situations. 1. Assessment: What are the needs or problems? 2. Analysis: What has the highest priority? 3. Planning a. What outcomes and goals must be accomplished? b. What are the available resources? 1. Nursing staff 2. Interdisciplinary team members 3. Time 4. Equipment & supplies 5. Space (client rooms, home environment, etc.) 4. Implementation a. Communicating expectations b. Is documentation complete? 5. Evaluation a. Were the desired outcomes achieved? b. Was safe, effective care provided? - Ask yourself: Which client is the most critically ill & unstable, likely to experience a significant change in condition, requires assessment by an RN? - Pt w/ an infection should not be assigned to share a room w/ a surgical or immunocompromised pt. - Nurse's client care management should be based on the nurse's abilities, individual client's needs, needs of the entire group of assigned clients. Safety & infection ctrl are high priorities.

HIPPA (Health Insurance Portability and Accountability Act)

A. Pertain to HCPs, health plans, & health clearing houses & their business partners who engage in computer-to-computer transmission of health care claims, payment & remittance, benefit info, & health plan eligibility info & who disclose personal health info that specifically IDs an individual & is transmitted electronically, in writing, or verbally. B. Pt privacy rights are of key importance. Pts must provide written approval of the disclosure of health info. HCPs must offer specific info to pts that explains how their personal health info will be used. Pts must have access to their medical records, & they can receive copies of them & request that changes be made if they ID inaccuracies. C. HCPs who do not comply w/ HIPAA or make unauthorized disclosures risk civil & criminal liability

levels of prevention in disaster management

A. Primary prevention 1. Participate in the development of a disaster plan. 2. Train rescue workers in triage and basic first aid. 3. Educate personnel about shelter management. 4. Educate the public about the disaster plan & personal preparation for disaster. B. Secondary prevention 1. Triage 2. Tx of injuries 3. Tx of other conditions, including mental health 4. Shelter supervision C. Tertiary prevention 1. Follow-up care for injuries 2. Follow-up care for psych problems 3. Recovery assistance 4. Prevention of future disasters & their consequences

Skills Needed by Change Agents

A. Problem-solving B. Decision-making C. Interpersonal relationships A. Interprofessional health care teams require: 1. Shared goals, commitment, accountability 2. Open & clear communication 3. Respect for expertise of all team members B. Critical pathways: 1. Interprofessional plans of care 2. Used for dx & care that can be standardized 3. Guides to track client progress 4. Do not replace individualized care C. Case management: 1. Coordinates care provided by an interprofessional team 2. Manages resources effectively 3. Uses critical pathways to organize care D. QA: 1. Involves CQI/TQM 2. Organized approach to the improvement of: a. Outcome achievement b. Quality of care provided Lewin's Change Theory: 1. Unfreezing: initiation of change 2. Moving: Motivation toward change 3. Refreezing: Implementation of change - Change causes anxiety. An effective nurse change agent uses problem-solving skills to recognize factors such as anxiety that contribute to resistance to change & uses decision making & interpersonal skills to overcome resistance. Interventions that demonstrate these skills include seeking input, showing respect, valuing opinions, building trust. - The Interprofessional Education Collaborative Expert Panel (IPEC) recommended development of 4 core competencies for interprofessional collaborative practice. Those competency domains among HCPs include 1. values/ethics for interprofessional practice; 2. roles/responsibilities; 3. interprofessional communication; 4. teams & teamwork.

Delegation

A. The authority, accountability, and responsibility of the RN based on the state NPA, standards of professional practice, policies of the health care organization, ethical-legal models of behavior. 1. Delegation: duties, tasks, & coordination of care are transferred to ancillary & assistive personnel, as well as other nurses. 2. Responsibility: obligation to complete a task. 3. Authority: right to act or command the actions of others. 4. Accountability: ability & willingness to assume responsibility for actions & related consequences. C. Nurse transfers responsibility & authority for the completion of delegated tasks but retains accountability. Involves ensuring that the 5 Rights of Delegation have been achieved. 1. Right task: Is this a task that can be delegated by a nurse? 2. Right circumstance: Considering the setting and available resources, should delegation take place? 3. Right person: Is the task being delegated by the right person to the right individual? 4. Right direction/communication: Is the nurse providing a clear, concise description of the task, including limits & expectations? 5. Right supervision: Once the task has been delegated, is appropriate supervision maintained? - Delegating to the right person requires that the nurse be aware of the qualifications of the delegatee: edu, training, skills, experience, demonstrated & documented competence. - UAP: do not perform invasive or sterile procedures. - RNs should give clear instructions—be specific, communicating the objectives of the delegated task & expected results. - You, the nurse, are responsible for its outcome. - Nursing process- assessments, analysis, dx, planning, evaluation- (any activity requiring nursing judgment) may not be delegated to UAP. Delegated activities fall w/in the implementation phase

consent

A. The law does not require written consent to perform medical tx. 1. Tx can be performed if the client has been fully informed about the procedure. 2. Tx can be performed if the client voluntarily consents to the procedure. 3. If informed consent cannot be obtained (unconscious) & immediate tx is required to save life or limb, the emergency laws can be applied. B. Verbal or written consent 1. When verbal consent is obtained, a notation should be made. a. describes in detail how & why verbal consent was obtained. b. placed in the client's record or chart. c. witnessed & signed by 2 persons. 2. Verbal or written consent can be given by: a. Alert, coherent, competent adults b. A parent/legal guardian c. A person in loco parentis (person standing in for a parent w/ a parent's rights, duties, & responsibilities) in cases of minors or incompetent adults C. Consent of minors 1. Minors 14+ must agree to tx along w/ their parent/guardians. 2. Emancipated minors can consent to tx themselves.

disaster nursing

A. The role of the nurse takes place at all three levels of disaster management: 1. Disaster preparedness 2. Disaster response 3. Disaster recovery B. To achieve effective disaster management: 1. Organization is the key. 2. All personnel must be trained. 3. All personnel must know their roles

classic leadership styles

Authoritarian (autocratic): Aggressive Democratic: Assertive Laissez-faire: Permissive Situational: combination of styles based on current circumstances Bureaucratic: individuals motivated by external forces

triage

B. Goal: Sort pts; Maximize # of survivors by sorting the injured according to treatable & untreatable victims C. Primary criteria used 1. Potential for survival 2. Availability of resources > Red: Immediate; Life-threatening; Can't delay tx > Yellow: Delayed; Injuries w/ systemic effects & complications; delay 30-60 min > Green: Minimal; Minimal injuries w/ no systemic complications; Delay several hrs > Black: Expectant; Dying/dead; Catastrophic injuries Nursing Interventions & Roles in Triage A. Triage duties using a systematic approach such as the simple triage & rapid tx (START) method B. Tx of injuries 1. Render 1st aid for injuries. 2. Provide additional tx as needed in definitive care areas. C. Tx of other conditions, including MH 1. Determine health needs other than injury. 2. Refer for medical tx as required. 3. Provide tx for other conditions based on medically approved protocols. Shelter Supervision A. Coordinate activities of shelter workers. B. Oversee records of victims admitted & discharged from shelter. C. Promote effective interpersonal & group interactions among victims in shelter. D. Promote independence & involvement of victims housed in the shelter.

Injury/Damages

Failure to meet the standard of care, which causes actual injury or damage to the client (physical injury). Neither emotional nor mental injury is enough to prove malpractice

Breach of Duty

Failure to perform according to the established standard of conduct in providing nursing care

Ebola

Recommendations to HCPs - spread by direct contact w/ blood or body fluids of a person ill w/ or who has died from Ebola, or a person who has contact w/ objects like needles that have been contaminated. Also possible to be transmitted through semen - CDC implemented entry screening at five U.S. airports for travelers arriving from Guinea, Liberia, and Sierra Leone. Recommends that travelers from these countries be actively monitored for symptoms by state or local health depts for 21 d after returning from any of these countries. Recommended Infection Ctrl Measures - Only contagious after they start to have symptoms (fever, severe HA, muscle pain, diarrhea, vomiting, unexplained bldg). Nursing Interventions - Obtain a thorough hx, including recent travel. Use PPE. Monitor VS - Place client in strict isolation for 21 d using special precautions 1. Fever of greater than 38.6° C or 101.5° F, severe HA, muscle pain, vomiting, diarrhea, abdominal pain, unexplained hemorrhage; and 2. Epidemiologic risk factors w/in the past wks before the onset of symptoms, such as contact with blood or other body fluids of a client known to have or suspected to have EVD; residence in—or travel to —an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries. - Testing of clients with suspected EVD should be guided by the risk level of exposure, as described here: - CDC recommends testing for all persons with onset of fever within 21 days of having a high-risk exposure. A high-risk exposure includes any of the following: • Percutaneous or mucous membrane exposure or direct skin contact with body fluids of a person with a confirmed or suspected case of EVD without appropriate PPE • Laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate PPE or standard biosafety precautions • Participation in funeral rites or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate PPE - For persons with a high-risk exposure but without a fever, testing is recommended only if there are other compatible clinical symptoms present and blood work findings are abnormal (i.e., thrombocytopenia <150,000 cells/µL and/or elevated transaminases) or unknown. - Persons considered to have a low-risk exposure include persons who spent time in a health care facility where EVD clients are being treated (encompassing health care workers who used appropriate PPE, employees not involved in direct client care, or other hospital clients who did not have EVD and their family caretakers), or household members of an EVD client without high-risk exposures as defined earlier. Persons who had direct unprotected contact with bats or primates from EVD-affected countries would also be considered to have a low-risk exposure. Testing is recommended for persons with a low-risk exposure who develop fever with other symptoms and have unknown or abnormal blood work findings. Persons with a low-risk exposure and with fever and abnormal blood work findings in the absence of other symptoms are also recommended for testing. Asymptomatic persons with high- or low-risk exposures should be monitored daily for fever and symptoms for 21 days from the last known exposure and evaluated medically at the first indication of illness. - Persons with no known exposures listed earlier but who have fever with other symptoms and abnormal blood work within 21 days of visiting EVD-affected countries should be considered for testing if no other diagnosis is found. Testing may be indicated in the same clients if fever is present with other symptoms and blood work is abnormal or unknown. Consultation with local and state health departments is recommended. - If testing is indicated, the local or state health department should be immediately notified. INFECTION CTRL 1. Client placement: Clients should be placed in a single-client room (containing a private bathroom) with the door closed. 2. Health care provider protection: Health care providers should wear gloves, gown (fluid resistant or impermeable), shoe covers, eye protection (goggles or face shield), and a facemask. Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings. 3. Aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 filtering face piece respirator or higher), and the procedure should be performed in an airborne isolation room. • Environmental infection control: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is paramount, because blood, sweat, emesis, feces, and other body secretions represent potentially infectious materials. Appropriate disinfectants for Ebola virus and other filo viruses include 10% sodium hypochlorite (bleach) solution or hospital-grade quaternary ammonium or phenolic products. Health care providers performing environmental cleaning and disinfection should wear recommended PPE & consider use of additional barriers (shoe and leg coverings) if needed. Face protection (face shield or facemask with goggles) should be worn when performing tasks such as liquid waste disposal that can generate splashes. Follow standard procedures per hospital policy and manufacturers' instructions for cleaning and/or disinfection of environmental surfaces, equipment, textiles, laundry, food utensils, and dishware

accommodation

a. Accommodators neglect their own needs, goals, or concerns (unassertive) while trying to satisfy those of others. b. Accommodators obey and serve others and often feel resentment and disappointment because they "get nothing in return."

avoidance

a. Avoiders are unassertive and uncooperative. b. Avoiders do not pursue their own needs, goals, or concerns, and they do not assist others to pursue theirs. c. Avoiders postpone dealing with the issue

competition

a. Competitors pursue their own needs and goals at the expense of others. b. Competitors also may stand up for rights and defend important principles.

compromise

a. Compromisers are assertive and cooperative. b. Compromisers work creatively and openly to find the solution that most fully satisfies all important goals and concerns to be achieved.

EBP

approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care

mission

communicates in broad terms its reason for existence; the geographical area that the organization serves; and attitudes, beliefs, and values from which the organization functions

decentralization

distribution of authority throughout the organization to allow for increased responsibility and delegation in decision making; decentralization tries to move the decision-making as close to the client as possible

Nonmaleficence

do no harm

Beneficence

duty to do good

to prove negligence

duty, breach of duty, causation, damages

justice

equitable distribution of potential benefits & tasks determining the order in which pts should be cared fir

decision making

identifying a problem and deciding which alternatives can best achieve objectives.

SBAR

includes up-to-date information about the client's situation, associated background information, assessment data, and recommendations for care, such as treatments, medications, or services needed.

fidelity

keep promises

centralization

making of decisions by a few individuals at the top of the organization or by managers of a department or unit, and decisions are communicated thereafter to the employees.

Goals and Objectives

measurable activities specific to the development of designated services and programs of an organization

problem solving

obtaining information and using it to reach an acceptable solution to a problem.

autonomy

respecting the rights of others to make their own decisions

veracity

truthfulness

principles of delegation

▪ Delegate the right task to the right delegatee. Be familiar with the experience of the delegatees, their scopes of practice, their job descriptions, agency policy and procedures, and the state nurse practice act. ▪ Provide clear directions about the task and ensure that the delegatee understands the expectations. ▪ Determine the degree of supervision that may be required. ▪ Provide the delegatee with the authority to complete the task; provide a deadline for completion of the task. ▪ Evaluate the outcome of care that has been delegated. ▪ Provide feedback to the delegatee regarding his or her performance.

guidelines for prioritizing

▪ The nurse and the client mutually rank the client's needs in order of importance based on the client's preferences and expectations, safety, and physical and psychological needs; what the client sees as his or her priority needs may be different from what the nurse sees as the priority needs. ▪ Priorities are classified as high, intermediate, or low. ▪ Client needs that are life-threatening or that could result in harm to the client if they are left untreated are high priorities. ▪ Nonemergency and non-life-threatening client needs are intermediate priorities. ▪ Client needs that are not related directly to the client's illness or prognosis are low priorities. ▪ When providing care, the nurse needs to decide which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent. ▪ The nurse considers client problems that involve actual or life-threatening concerns before potential health-threatening concerns. ▪ When prioritizing care, the nurse must consider time constraints and available resources. ▪ Problems identified as important by the client must be given high priority. ▪ The nurse can use the ABCs—airway-breathing-circulation—as a guide when determining priorities; client needs related to maintaining a patent airway are always the priority. ▪ If CPR is necessary, the order of priority is CAB—compressions-airway-breathing—this is the exception to using the ABCs when determining priorities. ▪ The nurse can use Maslow's Hierarchy of Needs theory as a guide to determine priorities and to identify the levels of physiological needs, safety, love and belonging, self-esteem, and self-actualization (basic needs are met before moving to other needs in the hierarchy). ▪ The nurse can use the steps of the nursing process as a guide to determine priorities, remembering that assessment is the first step of the nursing process.