Leadership CMS Study Guide Part 3: Professional Responsibilities

confidentiality

the duty of the nurse to protect a client's private information. can be breached by inappropriate use of social media. depending on the circumstances, consequences, can include termination of employment, discipline by the board of nursing, charges of defamation or invasion of privacy, and even federal charges for violating HIPAA

witness

the nurse's role in the informed consent process is to ________ the client's signature on the form and to ensure that informed consent has been appropriately obtained

professional responsibilities

the obligations that nurses have to their clients. requires that nurses be knowledgeable in client rights, advocacy, informed consent, advance directives, confidentiality and information security, information technology, legal practice, disruptive behavior, and ethical practices

ethics committee

group of people with an institution that handles unusual or complex ethical issues

invasion of privacy, defamation, slander

nurses who disclose client info to an unauthorized person an be held liable for what?

caring, autonomy, respect, empowerment

what values are essential components of advocacy?

24 hours

within what time frame must the provider sign a verbal or telephone prescription after giving it?

the Joint Commission

accrediting body that helps develop and implement standards for nursing practice

quasi-intentional torts

acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character

state nurse practice acts

acts that govern nursing practice and help establish and enforce legal guidelines for nursing practice through a state board of nursing or other government agency. vary from state to state, so the nurse must be informed about their state's legal parameters of practice

sentinel event reporting

an unexpected occurrence involving death or serious or psychological injury, or the risk thereof; helps establish standards for nursing practice

ethical theory

analyzes varying philosophies, systems, ideas, and principles used to make judgments about what is right and wrong and good and bad

National Patient Safety Goals

augments core measures and promotes client safety through client identification, effective staff communication, safe medication use, infection prevention, safety risk identification, and preventing wrong-site surgery

DNR or AND (allow natural death) orders

written prescriptions by the healthcare provider that must be placed in the client's medical record in order to be honored. prior to administering these prescriptions, the provider consults the client and family.

competent adult

a person who can sign informed consent forms; a person who is capable of understanding the information provided by the healthcare professional who will be providing the service. must be able to fully communicate in return with the health care professional. includes emancipated minors.

unintentional torts

accidents or mistakes that are not planned or intended that result in harm to another. example: negligence, malpractice

circulatory, respiratory, brain stem

according to the Uniform Determination of Death Act, death is determined by one of two criteria. 1. irreversible cessation of _______ and _______ functions 2. irreversible cessation of all functions of the entire brain, including the ________.

privacy, confidentiality

clients have the right to _____ and _____ in relation to their health care info and medical recommendations

refusal of treatment

competent adults have this right, including a right to leave the healthcare facility without a prescription for discharge from the provider. if this occurs, client is asked to sign a document indicating that they understand the risk involved. if patient leaves the facility without a prescription for discharge, nurse must notify the HCP and discuss with the client the potential risks associated with leaving, including possible complications that could occur without treatment, possibility of permanent physical or mental impairment/disability, and possibility of other complications that could lead to death. nurse should then carefully document everything, and have the patient sign an AMA form

malpractice

failure of a person with professional training to act in a reasonable and prudent manner, which means actions that a person who has the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. issues that prompt these lawsuits can include failure to follow either professional or facility established standards of care, failure to use equipment in a responsible and knowledgeable manner, failure to communicate effectively and thoroughly with the client, and failure to document care that was provided

slander

defamation with the spoken word. example: a nurse tells a coworker that she believes a client has been unfaithful to the spouse

libel

defamation with the written word or photographs. example: nurse documents in a client's health record that a provider is incompetent

intentional torts

deliberate acts intended to cause harm. includes assault, battery, and false imprisonment

duty to provide care as defined by a standard

element necessary to prove negligence. care that should be given or what a reasonably prudent nurse would do

breach of duty (failure to meet standard)

element necessary to prove negligence; failure to give the standard of care that should have been given

breach of duty has potential to cause harm

element necessary to prove negligence; failure to meet the standard had potential to cause harm. the relationship must be provable

foreseeability of harm

element necessary to prove negligence; knowledge that failing to give the proper standard of care can cause harm to the client

harm occurs

element necessary to prove negligence; occurrence of actual harm to the client

healthcare facility policies and procedures

establish the standard of practice for employees of an institution and can be founded in a facility manual that provides detailed information about how the nurse should respond to or provide care in specific situations and while performing client care procedures. nurses who practice according to these guidelines are legally protected if that standard of care still results in an injury

standards of care (practice)

established or legal guidelines for care that nurses base their practice on, which can be found in the nurse practice act of each state, in published standards of nursing practice by professional organizations like the ANA and specialty organizations like the American Association of Critical Care Nurses, accrediting bodies like the Joint Commission, originally mandated quality assurance programs, sentinel event reporting, Failure Mode and Effects Analysis, National Patient Safety Goals, and health care facility policies and procedures. guide, define, and direct the level of care that should be given by practicing nurses and are also used in malpractice lawsuits to determine if that level was maintained.

beneficence

ethical principle; care that is in the best interest of the client

justice

ethical principle; fair treatment in matters related to physical and psychological care and use of resources

fidelity

ethical principle; keeping one's promise to the client about care that was offered

autonomy

ethical principle; the ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest

veracity

ethical principle; the nurse's duty to tell the truth

nonmaleficence

ethical principle; the nurse's obligation to avoid causing harm to the client

deontological theory

ethical theory. decision-making based on obligations, duty, and what one considers to be right or wrong.

utilitarianism (teleological theory)

ethical theory. decision-making based on what provides the greatest good for the greatest number of individuals

Failure Mode and Effects Analysis

examines all potential failures in a design, including event sequencing risks, vulnerabilities, and improvement areas. helps establish standards for nursing practice

ethics

expected behavior of a certain group in relation to what is considered right and wrong

Nurse Licensure Compact (NLC, mutual recognition model of nurse licensure)

has been adopted by many states to address issues related to the increase in the electronic practice of nursing. allows nurses who reside in a designated state to practice in another designated state. nurses must practice in accordance with the statutes and rules of the state in which the care is provided. state boards can prohibit a nurse form practicing under this if the license of the nurse has been restricted by a board of nursing.

state boards of nursing

have the authority to adopt rules and regulations that further regulate nursing practice. laws and rules governing nursing practice can be accessed at their website. have the authority to both issue and revoke a nursing license. can revoke or suspend a nurse's license for a number of offense including practicing without a valid license, substance use disorders, conviction of a felony, professional negligence, and providing care beyond the scope of practice. also set standards for nursing programs and further delineate the scope of practice for registered nurses, license practical nurses, and advanced practice nurses

controlled substances

health care providers who are found guilty of misappropriation of __________________ also can be charged with a criminal offense consistent with the infraction

American Hospital Association (AHA)

identifies client rights in health care settings in the Patient Care Partnership

state-based practice model

if a nurse doesn't reside in a nurse licensure compact state, they have to practice under this model. they must maintain a current license in every state in which they practice.

mandatory reporting

in certain situations, health care providers have a legal obligation to report their findings in accordance with state law. includes suspected abuse of children and vulnerable persons, and certain communicable diseases

disruptive behavior

includes incivility, lateral violence, and bullying. the perpetrator can be a provider or a nursing colleague. consequences include poor communication, which can negatively affect client safety and productivity, resulting in absenteeism, decreased job satisfaction, and staff turnover. if allowed to continue, while likely escalate and may come to be viewed as acceptable in the unit/department's culture

false imprisonment

intentional tort. a competent person not at risk for injury to self or others is confined or restrained against their will. example: using restraints on a competent client to prevent their leaving the health care facility

battery

intentional tort. intentional and wrongful physical contact with a person that involves an injury or offensive contact. example: restraining a client and administering an injection against their wishes

assault

intentional tort. the conduct of one person makes another person fearful and apprehensive. example: threatening to place an NG tube in a client who is refusing to eat

durable power of attorney for health care (health care proxy)

legal document that designates a health care surrogate, who is an individual authorized to make health care decisions for a client who is unable. the person should be very familiar with the client's wishes. adjunct to the living will. can be a more effective way of ensuring the client's decisions about health care are honored

living will

legal document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. often addresses types of treatments that have the capacity to prolong life such as CPR, mechanical ventilation, and artificial feeding. legal in all states, but state statutes and individual health care facility policies can vary. most state laws include provisions that health care providers who follow the health care directive in this document are protected from liability

client rights

legal guarantees that clients have with regard to their health care. clients retain their rights as individuals and citizens of the US. residents in nursing facilities that participate in Medicare programs also retain resident rights under statutes that govern the operation of these facilities. regardless of the client's age, nursing needs, or healthcare setting, each client has the right to be informed about all aspects of care and take an active role in the decision-making process, accept, refuse, or request modification to the plan of care, and receive care that is delivered by competent individuals who treat the client with respect.

informed consent

legal process by which a client has given written permission for a procedure or treatment to be performed. considered when the client has been provided with and understands the reason the treatment/procedure is needed, how the treatment/procedure benefits them, risks involved with the treatment/procedure, other options to treat the problem (including doing nothing), and risk involved if no treatment is chosen

torts

legal wrongs committed against a person. type of civil law that relates to the provision of nursing care. can be classified as unintentional, quasi-intentional, or intentional

Enhanced Nurse Licensure Compact (eNLC)

licensure model that was revised in 2017. aligned licensing standards (criminal history background checks) in an effort to bring more states into the compact. nurses have one multi-state license with the ability to practice in person or via tele-health in both their home state and other designated states

written consent

must be provided by the client for an invasive procedure or surgery

interpreter

needed when the person giving informed consent is unable to communicate due to a language barrier or hearing impairment

communicable diseases

nurses are mandated to report these to the proper agency (local/state health department) when a client is diagnosed according to the CDC. each state mandates which ones must be reported in that state. there are more than 60 that must be reported to public health departments to allow officials to ensure appropriate medical treatment of diseases, monitor for common-source outbreaks, plan and evaluate control and prevention plans, identify outbreaks and epidemics, determine public health priorities based on standards, and educate the community on prevention and treatment

privacy rule

part of HIPAA that requires that nurses protect all written and verbal communication about clients. only health care team members directly responsible for the client's care are allowed access to the client's records. nurses can't share info with other clients or staff not involved in the client's care. clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client request so read or have a copy of the record. no part of the client record can be copied except for authorized exchange of documents between health care institutions, such as during transfer from a hospital to an extended care facility or in the exchange of documents between a general practitioner and a specialist during a consult. client medical records must be kept in a secure area to prevent inappropriate access to information. using public display boards to list client names/diagnoses is not allowed. electronic records should be password-protected, and nurses must take care to prevent public viewing of the info. health care workers should only use their own passwords to access info. client info can't be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone. many hospitals use a code system in which information is only disclosed to individuals who can provide the code. communication about a client should only take place in a private setting where it can't be overheard by unauthorized people. walking rounds and taped rounds are discouraged

security and privacy rules

part of HIPAA that were enacted to protect the confidentiality of health care info and to give the client the right to control the release of information. provides specific rights such as the right to obtain a copy of your medical record and to submit requests to amend erroneous or incomplete info, the rights of clients to privacy and confidentiality, and includes a requirement for health care and insurance providers to provide written info about how medical information is used and how it is shared with other entities (permission must be obtained before information is shared)

e-health

part of informatics. clients can access their electronic health record. enables the client to make appointments online, review lab results, refill electronic prescriptions, and review billing info. goal of this is improved health outcomes due to 24 hour access by the client and provider to the client's health care info

ethical dilemmas

problems for which more than one choice can be made, and the choice is influenced by the values and beliefs of the decision-makers. common in health care and require application of ethical theory and decision-making. cannot be solved solely by a review of scientific data, involves conflict between two moral imperatives, and the answer will have a profound effect on the situation/client

information security

protecting an organization's information and information systems from unauthorized access, use, disclosure, disruption, modification, or destruction. protocols for nurses include logging off from the computer before leaving the workstation, never sharing a user ID or password with anyone, never leaving a client's chart or other printed/written protected health info where others can access it, and shredding any printed or written client info used for reporting or client care after it is no longer needed

peer assitance programs

provided by many health care facilities to help facilitate entry of employees with substance use disorders into a treatment program

social media

provides a mechanism for nurses to access current info about health care, enhances communication among nurses, colleagues, and clients and families, and provides an opportunity for nurses to express concerns and seek support from others. nurses must be cautious about the risk of intentional or inadvertent breaches of confidentiality

advance directives

purpose is to communicate a client's wishes regarding end-of-life care should the client become unable to do so. required by the Patient Self-Determination Act that all clients admitted to a health care facility be asked if they have them. if they don't, must be given written info that outlines their rights related to healthcare decisions and how to formulate these documents

defamation

quasi-intentional tort. false communication or communication with careless disregard for the truth with the intent to injure an individual's reputation. includes libel and slander

invasion of privacy

quasi-intentional tort. intrusion into a client's private affairs or a breach of confidentiality. example: the nurse releases the medical diagnosis of a family member to the press

advocacy

refers to nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. one of the most important roles of the nurse, especially when clients are unable to speak or act for themselves. nurses ensure that the client has the info needed to make decisions about health care. applies even when the nurse disagrees with the client's decisions. nurses also support and promote legislation that promotes public policies that protect clients as consumers and create a safe environment for their care. the nurse's role also includes mediating on the client's behalf when the actions of others are not in the client's best interest or changes need to be made in the plan of care

state laws

regulate the core of nursing practice. each one has statutes that define parameters of nursing practice and give the authority to regulate the practice of nursing to state boards of nursing

state laws

regulate who is able to give informed consent. vary regarding age limitations and emergencies

organ donation

regulated by federal and state laws. health care facilities have policies and procedures to guide health care workers involved with this process. can be stipulated in a will or designated on an official card. federal law requires health care facilities to provide access to trained specialists who make the request to client and/or family members and provide information regarding consent, what will be donated, and how burial/cremation will be affected. nurses are responsible for answering questions about the process and for providing emotional support to family members

consent

required for all care given in a health care facility

client

responsibilities regarding informed consent include giving informed consent. in order to do this, they must give it voluntarily without coercion, be competent and of legal age, or be an emancipated minor, and receive sufficient info to make a decision based on an informed understanding of what is expected

provider

responsibilities regarding informed consent include obtaining the informed consent by giving the client information about the procedure including: complete description of treatment/procedure, description of professionals who will be performing/participating in the treatment, description of potential harm, pain, and/or discomfort, options for other treatments and possible consequences of taking other actions, the right to refuse treatment, and the risk involved if the client chooses no treatment

nurse

responsibilities regarding informed consent include witnessing informed consent. they are responsible for ensuring the provider gave the patient the necessary info, ensuring the client understood the info and is competent, having the client sign the document, and notifying the provider if the client has more questions or does not understand any of the info provided. also responsible for documenting reinforcement of info originally given by the provider, questions the client had were forwarded to the provider, and the use of an interpreter

federal regulations

source of law that has a great impact on nursing practice. laws that affect nursing practice include HIPAA, the Americans with Disabilities Act, Mental Health Parity Act, Patient Self-Determination Act, Uniform Anatomical Gift Act, National Organ Transplant Act, and Emergency Medical Treatment and Active Labor Act

civil laws

source of law that protects the individual rights of people. includes tort law

criminal laws

source of law. subsection of public law that relates to the relationship of an individual with the government. violations can be categorized as either a felony (serious crime like homicide) or misdemeanor (less serious crime like petty theft). example: a nurse falsifies a record to cover up a serious mistake

ethical principles

standards of what is right or wrong with regard to important social values and norms

published standards of nursing practice

standards that are developed by professional and specialty organizations

Patient Self-Determination Act

stipulates that on admission to a health care facility, all clients must be informed of their right to accept or refuse care

ethical decision-making

the process by which a decision is made about an ethical issue. requires a balance between science and morality. steps: -identify whether the issue is an ethical dilemma -state the ethical dilemma, including all surrounding issues and individuals involved -list and analyze all possible options for resolving the dilemma, and review implications of each option -select the option that is in concern with the ethical principle applicable to this situation, the decision-maker's values and beliefs, and the profession's values set forth for client care. justify why that one option was selected -apply this decision to the dilemma and evaluate the outcomes

invasion of privacy

the release of client health information to others without the client's consent. one of the fundamental rights of client care. may result from the improper use of social media

informatics

the use of computers to systematically resolve issues in nursing. use of technology in health care is increasing (laptops for documentation, use of an automated medication dispensing system) and most forms of communication are in the electronic format. allows the nurse to access databases on diseases and medications and to use them as a teaching tool when educating clients. beneficial for clients with visual impairments. also allows nurses to review meds, diseases, procedures, and treatments using an electronic format

immediate supervisor (charge nurse)

to ensure client safety, at the time of the infraction in which a nurse suspects that a coworker is using alcohol or other substances while working, to whom should the nurse report the concern?

implied consent

type of consent that is adequate for most aspects of nursing care. provided by the client when they comply with the instructions provided by the nurse. example: nurse is preparing to administer a TB skin test, and the client holds out their arm for the nurse

incivility

type of disruptive behavior that is defined as an action that is rude, intimidating, or insulting. includes teasing, joking, dirty looks, and uninvited touching

bullying

type of disruptive behavior that is persistent and relentless and is aimed at an individual who has limited ability to defend themselves. occurs when the perpetrator is at a higher level than the victim, such as a nurse manager to a staff nurse. abuse of power makes the recipient feel threatened, disgraced, and vulnerable. example: a nurse manager demonstrates favoritism for another nurse by making unfair assignments or refusing a promotion

lateral violence (horizontal abuse/hostility)

type of disruptive behavior that occurs between individuals who are at the same level within the organization. example: a more experienced staff nurse can be abusive to a newly licensed nurse. common behaviors include verbal abuse, undermining activities, sabotage, gossip, withholding information, and ostracism

cyberbullying

type of disruptive behavior using the Internet or other electronic means

negligence

unintentional tort. practice or misconduct that does not meet expected standards of care and places the client at risk for injury. example: nurse fails to implement safety measures for a client who has been identified as at risk for falls

malpractice

unintentional tort. professional negligence. example: a nurse administers a large dose of medication due to a calculation error, and the client has a cardiac arrest and dies

Uniform Determination of Death Act (UDDA)

used to assist with end-of-life and organ donor ethical issues. provides two formal definitions of death that were developed by the National Conference of Commissioners on Uniform State Laws. a determination of death must be made in accordance with accepted medical standards

health information systems

used to manage administrative functions and clinical functions. clinical portion of the system is often referred to as the clinical information system and can be used to coordinate essential aspects of client care. in order to comply with HIPAA regulations, each health care facility has specific policies and procedures designed to monitor staff adherence, technical protocols, computer privacy, and data safety

Internet

valuable tool for clients to review current medications and health questions, especially for clients who have chronic illnesses. nurses should instruct clients to only review valid and credible websites by verifying the author, institution, credentials, and how current the article is.

morals

values and beliefs held by a person that guide behavior and decision-making

Good Samaritan laws

vary from state to state. protect nurses who provide emergency assistance outside of the employment location, but the nurse must provide a standard of care that is reasonable and prudent.

parents of a minor, legal guardian, court-specified representative, client's health care surrogate (health care proxy/durable power of attorney for health care), spouse or closest available relative (state laws vary)

what are some examples of individuals who are authorized to grant consent for another person?

end-of-life decisions, access to health care, protection of privacy, informed consent, substandard practice

what are some situations that may require nurses to advocate for clients or help them in advocating for themselves?

date and time, dosage, frequency, route, signature of nurse and provider

what are the necessary elements of a prescription that must be included when transcribing a phone or verbal order?

federal regulations, criminal/civil laws, state laws, licensure

what are the sources of law that govern nursing practice and conduct?

living will, durable power of attorney for health care

what are the two components of an advance directive?

document it in the record

what should the nurse do if the client refuses to sign an AMA form but wants to leave AMA?

risk-taking, vision, self-confidence, articulate communication, assertiveness

what skills are essential components of advocacy?