N406 Unit 4 - Exam 1

ANA Standards of Nursing

- defines the activities of nurses that are specific and unique to nursing - defines nursing value and accountability to society

Assignment

- dividing workload to be done - describes entire set of tasks and responsibilities given to an individual - refers to workload given to licensed staff

What is the most important piece of evidence to have as a nurse?

- documentation

Assault

- threat to harm

Good Samaritan Law

- when administering emergency care, health care professionals are protected from civil liability

Elements of Malpractice

- duty: relationship; nurses responsibility to provide care in an acceptable manner - breach of duty: failed to provide care in acceptable manner - injury: damages; nurses act caused harm - proximate cause: reasonable cause and effect can be shown between the omission or commission and the harm

Actions that lower risk of malpractice

- families (public relations) - careful assessments - recognize significant data - appropriate nursing care plan - know and follow policies and procedures - proper interventions - identify at risk patients - appropriate delegation - awareness of safety issues

QSEN (Quality and Safety Education for Nurses)

Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics

Nursing Practice Act

- laws established by each state to regulate the practice of nursing - defines the scope of nursing practice - delineates the responsibility of nurses to the public - state boards of nursing role is to regulate nursing and ensure protection of the consumer

Most common causes of action against nurses

- medication administration - OB care - patient falls - surgery and related care - IV lines, catheters, and tube - failure to monitor - failure to communicate - intentional misconduct

Which step of the nursing process includes developing an individualized care plan, setting goals, and identifying expected outcomes?

planning

Collaborative problems

- certain physiologic complications that nurses monitor to detect onset or changes in status - nurses manage collaborative problems using physician/provider prescribed and nursing/prescribed interventions to minimize the complications of the event - they are the primary responsibility of the RN caring for the patient - the prescribed treatment comes from nursing, medicine, and other disciplines - they must be identified early so that preventative nursing care can be instituted early

Area of Liability for Nurses

- civil actions for malpractice, lack of informed consent, breach of contract - administrative actions against RN license - criminal actions

Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurse's title? A)Nursing care expert B)Clinical nurse specialist C)Nurse manager D)Staff nurse

- clinical nurse specialist

False Imprisonment

- confining an individual against his/her will either physically or verbally - examples: restraints, removing clothing for detainment

Libel

- A written defamation of a person's character, reputation, business, or property rights.

Malpractice

- a term for negligence pertaining to a professional

Breach

- a violation - types: - assessment: failure to gather and recognize findings, failure to communicate to supervisor or physician - planning: failure to set safe course for patient - intervention: failure to care for patient in a safe, effective manner

Tort

- a wrong committed by a person against another person or their property - nurse's action whether intentional or unintentional that causes harm to the client

Standards of Practice

- as defined by hospital policy and directed toward the ongoing commitment to quality improvement - as defined by federal and state mandates (ex: BRN standards of competent performance) - as demonstrated within the care community - as defined by individual job description

Delegation: Green Light Tasks

- most commonly delegated - non-invasive and non-sterile treatments - the collecting, reporting, and documentation of data (but not interpreting it) including: vital signs, height, weight, I&O, glucose monitoring, environmental situations, ambulating, positioning, turning, transportation of patient, personal hygiene and elimination, feeding, ADLs, reinforcement of health teaching planned and/or provided by the RN

Team approach to patient care

- must have affective communication to have a successful team - collective team works towards the goal of managing the patient's care as directed by the physician in conjunction with patient and family - must function within their scope of practice

Delegation: Yellow Light Tasks

- nursing tasks not usually within the scope of sound professional to delegate - sterile procedure: a wound or anatomical site which potentially can become infected - non sterile procedure: dressing or cleansing penetrating wounds/deep burns - care of broken skin: other than minor abrasions or cuts generally classified as requiring only first aid treatment

Delegation: Red Light Tasks

- nursing tasks prohibited from delegation - physical, psychological, and social assessment which require professional nursing judgement, intervention, referral, or follow up - formulation of the NCP and evaluation of the client's response to the care rendered - specific tasks involved in the implementation of the NCP which require professionals nursing judgment or intervention

Common Errors in Delegation

- overloading yourself - adapting to old patterns of behavior - unclear communications - failing to release control - yielding to pressure to delegate inappropriately

What should you keep in mind when delegating a task?

- patient's condition, including complications and stability - complexity of the assessment - intricacy of the task - capabilities of the UAP - amount of technology required - infection control and safety precautions - potential for harm - level of supervision - predictability of outcome - extent of patient interaction - environment

Delegation

- team leader identifies tasks to be delegated - team member's responsibility is to complete tasks AND report back to team leader - must be within practice scope - must be sure team member is competent and has equipment/supplies to do task - giving authority to unlicensed person for specific task in a specific situation

Standards of Care

- that which a reasonable, prudent practitioner with similar education and experience would do or not do in similar circumstances - how similarly qualified practitioners would have managed the patients care under the same or similar circumstances

Leadership

- the act of influencing and motivating a group of people to act in the same direction towards achieving a common goal - do not have delegated authority but obtain their power through other means - focus on group process, information gathering, feedback, and empowering others - have goals that may or may not reflect those of the organization

Negligence

- the act or failure to act as an ordinary, reasonable, prudent person, resulting in harm to the person to whom the duty of care is owed

Slander

- the action or crime of making a false spoken statement damaging to a person's reputation.

Management

- the process of leading and directing an organization to meet its goals through the use of appropriate resources - legitimate source of power due to the delegated authority - emphasize control, decision making, decision analysis, and results - greater formal responsibility and accountability for rationality and control than leaders

According to the ANA Social Policy statement and scope and standards of practice, what is nursing defined as?

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

Nursing Process

- uses by nurses to identify the client's strengths, limitations, and health care needs - to formulate a plan of care to address the health care needs - to evaluate the effectiveness of the plan to achieve established outcomes

Medication Administration Problems

- wrong med - wrong route - wrong dose - wrong time - failure to document injury from injections - allergies to medications - increased risk if unfamiliar with meds or floated to unfamiliar unit

Unlicensed Assistive Personnel (UAP)

-Includes CNAs, CMAs, and non-nursing personnel -Work under direct supervision of an RN or LPN -Specific tasks usually outlined in position description -Tasks may including feeding clients, preparing meals, lifting, basic care, measuring & recording vital signs, and ambulating clients - can not be assigned anything that requires nursing judgement - cannot care for unstable patients under any circumstances

The nurse manager of a 20-bed coronary care unit is not on duty when a staff nurse makes a serious medication error that results in a client's overdose. The client nearly dies. Which statement accurately reflects the accountability of the nurse manager? 1 - The nurse manager would receive a call at home from the on-duty nursing supervisor, apprising him/her of the problem as soon as possible. 2 - Because the nurse manager is off duty and not accountable for incidents that occur in his/her absence, he/she need not be notified. 3 - The nurse manager only needs to be informed of the incident when he/she reports to work on the next scheduled day. 4 - Although the nurse manager is off duty and not responsible for what happened, the nursing supervisor would call the nurse manager only if time permits.

1

The nurse is co-assigned with a licensed practical/vocational nurse (LPN/VN) to care for 20 clients on a skilled, long-term care facility. When working as a team, which nursing duties would the nurse delegate to the LPN/LVN? Select all that apply. 1 - Administer morphine sulfate 30 mg intramuscular every 4 hours as needed 2 - Hang 2 units of packed red blood cells 3 - Inject furosemide 40 mg intravenously daily 4 - Place a nasogastric tube for gastric decompression 5 - Calculate output every 8 hours and report to the health care provider 6 - Insert a 20-French Foley catheter.

1, 4, 6

What are the 5 rights of delegation?

1. Right task- can it be delegated 2. Right Circumstance- Should it be delegated 3. Right person- can this person do the task 4. Right direction/ communication- is the task being conveyed in a clear manner 5. Right supervision- is the task being followed up on once complete.

Which circumstance would exempt the nurse from professional negligence following an error in drug administration to a client? 1. Not knowing the drug was contraindicated for this client 2. Lack of harm to the client as a result of the errant drug administration 3. Confirmation by a coworker that the dosage was correct 4. The dosage was inaccurately dispensed by the pharmacy

2

A nurse manager is delegating the revision of the units educational policies to staff nurses. What is the best instructional guidance the nurse manager can offer? 1. let me know if you need anything 2. complete the revision in 6 weeks 3. give me your suggestions and I'll decide if I like that 4. tell me what you think after looking at everything that has been done

2. complete the revision in 6 weeks

A float nurse is assigned to a surgical unit. The nurse is receiving 2 clients from the postanesthesia care unit (PACU) at the same time. When delegating tasks to other PACU personnel who are not known to the nurse, which question would be most important to ask? 1. What is your highest educational level?2. How long have you worked on this floor? 3. Are you comfortable in performing the tasks being assigned? 4. Who provided you the unit training?

3

The nurse is notifying the health care provider via telephone of a change in condition of a client diagnosed with an exacerbation of asthma. Arrange the nursing statements in order as they would be communicated using the SBAR method. All options must be used. 1. Respirations are now 32 breaths/minute. The pulse oximeter is 89%. Lungs reveal wheezing in all lung fields. Slight nasal flaring is noted 2. Mr. Smith was admitted yesterday with an exacerbation of asthma. He typically controls his asthma with oral medication and inhalers at home. He is ordered albuterol treatments twice daily. Oxygen is prescribed at 2 L 3. Hello. My name is Nurse Jones from Unit D 4. I recommend that we increase his oxygen dose and prescribe an extra albuterol treatment 5. I am notifying you because Bob Smith has become increasingly more short of breath with audible wheezing this afternoon.

3, 5, 2, 1, 4

Which is an example of the role of an informal leader? 1. verifying an adequate staff coverage for shift 2. feeling out a discipline form on a nursing assistant 3. encouraging a peer to join a committee 4. attending a hospital wide policy meeting

3. encouraging a peer to join a committee

A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement? A) By liaising with the members of the interdisciplinary care team B) By critically appraising the outcomes of care that is provided C) By integrating the patient's preferences into the plan of care D) By documenting care in the electronic health record in a timely fashion

B Evaluation of outcomes is central to the QSEN competency of quality improvements

Reviewing and integrating evidence and research findings into practice is included in the standards of professional performance. T or F?

True

A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurse's compliance with the nurse practice act demonstrates adherence to which of the following? A)National Council of Nursing's guidelines for care B)National League for Nursing's Code of Conduct C)American Nurses Association's Social Policy Statement D)Department of Health and Human Service's White Paper on Nursing

C

Quality improvement in care delivery requires which components? Select all that apply. a. Leadership commitment b. Continuous improvement c. Total client care by the nursing unit d. Focus on data collection e. Focus on the mission of the organization

a. leadership commitment b. continuous improvement d. focus on data collection e. focus on the mission of the organization

Which nursing process component involves collecting subjective and objective data about the patient?

assessment

Which components of the nursing process represents the synthesis of assessment data and formulates a client's need?

diagnosis

Which component of the nursing process is "last," but can lead to any stage of the nursing process due to the process's cyclical nature?

evaluation

Which component of the nursing process uses key words like "intervene, start, delivery" to describe actions related to the process?

implementation

The nurse educator is planning a teaching session for nursing students related to the treatment and management of gestational diabetes. The nurse educator arranges for a dietitian, pharmacist, and physician assistant to participate in the lesson plan. Which professional nurse competency is the nurse educator demonstrating?

interdisciplinary teamwork

Battery

involves physically touching a client without their consent and causing harm