NUR 3212 Professional Development Foundations for Practice (Midterm Exam)

Specifically, Good Samaritan laws for nurses:

(a) Offer legal immunity and limit liability if a nurse helps at the scene of an accident. (b) Do not cover a nurse performing care outside of the scope of a registered nurse. In other words, Good Samaritan laws protect health professionals rendering aid in emergency situations only if the health professional is not guilty of gross negligence. That means that the provider must practice within their scope of practice and experience level and must not leave the patient without properly handing over care to a trained emergency professional, such as a paramedic or EMT.

How does the Texas BON legally define the scope of practice for a nurse?

(a) The observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes (b) The maintenance of health or prevention of illness (c) The administration of a medication or treatment as ordered by a physician, podiatrist, or dentist (d) The supervision or teaching of nursing (e) The administration, supervision, and evaluation of nursing practices, policies, and procedures (f) The requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an advanced practice registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157 (g) The performance of an act delegated by a physician under Section 157.0512, 157.054, 157.058, or 157.059 (h) The development of the nursing care plan

What communication techniques are best to practice?

1. Active listening 2. Sharing observations 3. Sharing empathy 4. Sharing hope 5. Sharing humor 6. Sharing feelings 7. Using touch 8. Using silence 9. Providing information 10. Clarifying 11. Paraphrasing 12. Validation 13. Summarizing 14. Self-disclosure 15. Confrontation

What communication techniques are to be avoided?

1. Asking personal questions 2. Giving personal opinions 3. Offering false reassurance or sympathy 4. Asking for explanations 5. Changing the subject 6. Delivering automatic, defensive, or passive-aggressive responses 7. Expressing approval or disapproval 8. Arguing

When preparing your report to hand off a patient to staff in the next shift:

1. Be Organized: Use an outline such as SBAR to help you give important information. 2. Be Prepared: Think about what you want to communicate ahead of time. 3. Anticipate: Anticipate the needs of the patient on the next shift.

Background (SBAR)

1. Give the patient's presenting complaint. 2. Give the patient's relevant past medical history. 3. Give a brief summary of the patient's background.

Situation (SBAR)

1. Identify the person to whom you are speaking. 2. Identify yourself, occupation, and where you are calling from. 3. Identify the patient by name and reason for admission. 4. Identify what is going on with the patient (chest pain, nausea, etc.)

When calling providers, remember to:

1. Implement independent nursing interventions before you call. 2. Think about SBAR before you call. 3. Have the chart in front of you before you call.

nursing is defined as a profession by:

1. Nurses (including nurse researchers, theorists, and leaders) 2. Professional nursing organizations such as the American Nurses Association (ANA) 3. Government (Federal and State Legislation) (a) Laws such as the Nursing Practice Act (b) Bodies such as the Board of Nursing (BON)

Recommendation (SBAR)

1. Provide an explanation of what you require, how urgently, and when action needs to be taken. 2. Make suggestions of actions to be taken. 3. Clarify what action you expect to be taken.

Assessment (SBAR)

1. Provide the patient's vital signs: heart rate, respiratory rate, blood pressure, temperature, oxygen saturation, pain scale, level of consciousness. 2. List any vital signs that are outside of parameters; what is your clinical impression? 3. Indicate the severity of the patient's condition and any additional concerns.

What are the five rights of appropriate delegation for the staff nurse?

1. Right Task 2. Right Circumstances 3. Right Person 4. Right Direction/Communication 5. Right Supervision/Evaluation

Types of IHCDs:

1. an organizational structure that follows economic imperatives (such as combining financing with all providers, from hospitals, clinics, and physicians to home care and long-term care facilities) An example is the Accountable Care Organizations (ACOs) that were developed in response to health care reform, with the intended goals of improving quality and decreasing costs of health care. 2. a structure that supports an organized care delivery approach (coordinating care activities and services into seamless functioning) An example is the Patient-Centered Medical Home, which strengthens the physician-patient relationship with coordinated, goal-oriented, individualized care. In this approach, a patient's primary health care provider is the coordinator/manager who enlists the skills and knowledge of health care professionals from various services. These professionals include nurses, medical assistants, nutritionists, social workers, pharmacists, hospice care providers, and other caregivers. Members of a Patient-Centered Medical Home care team are linked by information technology, electronic health records (EHRs), and system best practices to ensure that patients receive care how they want it and when and where they need it. Patient-centeredness is a unifying principle. It describes an ongoing, active partnership with a personal primary care physician or nurse practitioner who leads a team of professionals dedicated to providing proactive, preventive, and chronic care management through all stages of a patient's life

common HIPAA violations:

1. discussing patients in public areas 2. accessing the chart of a patient when you are not a part of their care team 3. disclosing information about a patient - via social media or any other means - to anyone other than the patient or their legal guardian

What does the acronym SBAR stand for?

1. situation 2. background 3. assessment 4. recommendation.

1. Which activity performed by a nurse is related to maintaining competency in nursing practice?

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the professional nursing council 4. Attending a review course in preparation for a certification examination

4. The nurse is working in a tertiary care setting. Which activity does the nurse perform while providing tertiary care?

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Conducting blood pressure screenings at a local food bank 2. Administering influenza vaccines for older adults at the local senior center 3. Inserting an indwelling catheter for a patient on a medical-surgical unit 4. Performing endotracheal suctioning for a patient on a ventilator in the medical ICU

9. Which of the following are common barriers to effective discharge planning? (Select all that apply.)

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Ineffective communication among providers 2. Lack of role clarity among health care team members 3. Number of hospital beds to manage patient volume 4. Patients' long-term disabilities 5. The patient's cultural background

3. Which of the following statements is true regarding Magnet® status recognition for a hospital?

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Nursing is run by a Magnet® manager who makes decisions for the nursing units. 2. Nurses in Magnet® hospitals make all of the decisions on the clinical units. 3. Magnet® is a term that is used to describe hospitals that are able to hire the nurses they need. 4. Magnet® is a special designation for hospitals that achieve excellence in nursing practice.

8. A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been addressed correctly?

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Patient and family involvement in referral 2. Timing of referral 3. Incorporation of referral discipline recommendations into plan of care 4. Determination of discharge date

5. A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient's restorative care?

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Patient will be able to walk 200 feet without shortness of breath. 2. Wound will heal without signs of infection. 3. Patient will express concerns related to return to home. 4. Patient will identify strategies to improve sleep habits.

2. Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.)

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local elementary school about the importance of immunizations

10. A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply.)

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. Reduction in nurse staffing requirements 2. Improved patient satisfaction 3. Reduction in patient falls 4. Increased costs 5. Reduction in patient use of nurse call system

6. Which of the following describe characteristics of an integrated health care system? (Select all that apply.)

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. The focus is holistic. 2. Participating hospitals follow the same model of health care delivery. 3. The system coordinates a continuum of services. 4. The focus of health care providers is finding a cure for patients. 5. Members of the health care team link electronically to use the EHR to share the patient's health care record.

7. The school nurse has been following a 9-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the student's family to learn more about social determinants of health that might be affecting the student. Which of the following potential social determinants should the nurse assess? (Select all that apply.)

1.4; 2. 1, 2, 5; 3. 4; 4. 4; 5. 1; 6. 1, 3, 5; 7. 2, 3, 5; 8. 2; 9. 1, 2; 10. 2, 3, 5 1. The student's seating placement in the classroom 2. The level of support parents offer when the student completes homework 3. The level of violence in the family's neighborhood 4. The age at which the child first began having behavioral problems 5. The cultural values about education held by the family

What does the acronym AIDET stand for?

A - acknowledgement I - introduction D - duration E - explanation T - thank you

How do patients give consent for medical treatment?

A patient signs a consent form to receive care at a facility when establishing care. In the outpatient setting, this form is signed before the first office visit. In hospitals, it is signed upon admission to the hospital. The only exception is in emergency situations where consent for treatment is assumed (e.g., when a patient arrives at the emergency department via ambulance and is unable to communicate). There are certain situations where further consent above and beyond the initial consent for care is required. These include invasive procedures or surgery, administration of blood products, and participation in a research study. The nurse shares the responsibility for ensuring consent forms are signed before these situations occur. For example, if a blood transfusion is ordered by the healthcare provider, the nurse must ensure that a signed consent for blood products is signed and in the patient's chart before administering the blood transfusion. It is imperative, however, that the nurse understands that the responsibility for providing informed consent belongs to the healthcare provider (physician, physician assistant, or nursing practitioner). It is neither the responsibility nor the role of a registered nurse to explain the risks and benefits of a procedure, blood product, or research study to a client. Registered nurses can witness patients' signing of consent forms and should ensure that the consent forms are in the chart; responsibility for answering the patient's questions, however, lies with the provider. If a patient expresses the need for further information before a surgery, the registered nurse should inform the physician performing the surgery that further clarification is needed before the patient is allowed to sign the consent form.

Find the Rules and Regulations on the Texas BON website and open the document. Find the section titled "Standards of Nursing Practice." What is standard 3-A?

According to the Texas BON, (3) Standards Specific to Registered Nurses. The registered nurse shall assist in the determination of healthcare needs of clients and shall: (A) Utilize a systematic approach to provide individualized, goal-directed, nursing care by: (i) performing comprehensive nursing assessments regarding the health status of the client; (ii) making nursing diagnoses that serve as the basis for the strategy of care; (iii) developing a plan of care based on the assessment and nursing diagnosis; (iv) implementing nursing care; and (v) evaluating the client's responses to nursing interventions.

How do you communicate with patients that have special needs?

Aphasic or have Dysarthria: Allow time to listen and for patient to respond, ask closed ended questions (yes/no) and do not lie to a patient about understanding them. Hearing Impaired: Limit environmental noise, face patient, do not shout, and consider using letter boards if needed. Visually Impaired: Verbally identify yourself and anything you intend to do. Let the patient know when you are going to touch them.

A registered nurse has recently graduated from nursing school and is practicing in the intensive care unit. What is the most effective way for the nurse to stay abreast of best practices?

Continuing education

A nurse is interested in translating the most recent evidence based practice into clinical practice and taking a leadership role in their clinical setting. Which of the following educational paths would be the most appropriate?

Doctor of Nursing Practice (DNP)

Florence Nightingale is credited with developing which of the following theories of nursing?

Environmental Theory

How does a nurses commit an invasion of privacy?

If a healthcare professional shares a client's protected health information with unauthorized individuals such as employers or the media, the nurse is invading that person's privacy as well as violating HIPAA.​

Types of peer review:

Incident-Based Peer Review (IBPR) and Safe Harbor Peer Review (SHPR)

What is the role of the doctor of philosophy in nursing?

Increase nursing knowledge through research

the types of wrongful acts—or torts—that fall under the rubric of common law:

Intentional Torts Intentional torts are essentially conscious actions taken toward an individual. The principal types of common-law intentional torts of which nurses should be aware include assault, battery, and false imprisonment. Quasi-Intentional Torts Quasi-intentional torts are harmful acts against an individual based on speech (as opposed to touch). Examples of quasi-intentional torts include slander and libel, which are, respectively, saying or writing inaccurate information about another individual. This includes writing false information about colleagues in the patient's chart. So, it is important to document only the facts in a patient's chart without inserting personal opinion. Another important type of quasi-intentional tort is the invasion of privacy. Unintentional Torts Unintentional torts lack the intent to harm the client; however, despite the lack of intent, harm does occur to the client as the result of a nurse's negligence. Malpractice is a type of unintentional tort.

Patients can self-determine their healthcare by the following means:

Living Will: A legal document that directs the care of a patient in the event of serious illness. This is the patient telling us what they would or would not want done if they are unable to communicate. Health care proxy/Power of Attorney: A person designated to make medical decisions if/when the patient is unable, for example, in the case of serious illness or dementia. Do not resuscitate (DNR): An order whereby the patient officially uses the right to refuse resuscitation. There is documentation to complete, and it must be signed by the patient and physician before the DNR becomes active.

A recent graduate of a nursing program wants to practice in labor and delivery. What must this graduate complete prior to obtaining legal recognition as a registered nurse?

NCLEX-RN exam

Social determinants of health (SDOH):

Neighborhood and built environment, health and health care, social and community context, education, and economic stability

Which of the following is NOT an advanced practice nursing role?

Nurse Manager Nurse Manager Nurse Practitioner Nurse Midwife Certified Registered Nurse Anesthetist

Which of the following is NOT considered one of the issues facing healthcare delivery for nurses?

Nursing Surplus Nursing Surplus Healthcare disparities Practice Competency Nursing Shortage

A client was recently discharged from the hospital and is receiving nursing care, physical therapy and speech therapy through home health services. What level of care is this?

Restorative

A client present to the emergency department of their local hospital. What level of healthcare is this considered?

Secondary or Tertiary?

What year was the first Nursing Practice Act passed in Texas?

The first Nursing Practice Act (NPA) was enacted in 1909. The NPA has been regularly updated by the Texas Legislature since the inception of the legislation to meet changing patient and healthcare needs within the state and to reflect changes within the profession of nursing (such as recognizing the role of the advanced practice nurse).

four challenges facing nursing in the upcoming years:

The first is the aging baby boomer generation, which will have increased health care needs and thus require more health services and increasingly more complex nursing care. The second is the shortage and uneven distribution of physicians, particularly primary care physicians, which increases the health care that nurses will need to provide. The third is the accelerating rate of nurses' retirements due to an aging nursing workforce, which results in loss of experienced nurses' knowledge and skills in all areas of practice. The fourth is the uncertainty of health care reform with each new government administration that is elected, which results in changes in roles for nurses within the health care system.

What is the purpose of the Texas Board of Nursing (BON)?

The purpose of the board of nursing is to protect the public. The stated "mission of the Texas Board of Nursing (BON) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely." In other words, the Board of Nursing does not exist to advocate for the interests of nurses, rather to regulate nursing within the state.

A nursing student asks the nurse about the purpose of the state board of nursing. What is the best response by the nurse?

The state board of nursing acts to protect the public

How do nurses know their "duty" to their patients?

They can start by consulting the state nursing practice act, which outlines the responsibilities and role (scope of practice) of registered nurses for that state. Additionally, professional organizations such as the American Nurses Association (ANA) publish standards of care. The ANA's standards of nursing care are available in the textbook. If a nurse practices in a specialty setting such as the operating room, the professional organization for that specialty area will have additional best practices and standards of care available. Lastly, all nurses should know the policies and procedures for the facility in which they practice. For example, if a nurse is preparing to complete a nursing procedure in a hospital, he or she should review the hospital's policy and procedure before performing the planned task. Following facility policies and procedures protects the nurse!

Restraints should only be used in the following circumstances:

To protect the patient from physical harm when less restrictive measures have been unsuccessful with the written order of a healthcare provider such as a physician, physician assistant, or nurse practitioner. Restraints should not be used as a first-line measure, and the least restrictive restraints should always be utilized first. If restraints are necessary, the nurse should follow individual facility policies for application and documentation. A provider order is always required to apply restraints, and these orders are only effective for 24 hours. Additionally, the nurse must assess the patient who is restrained hourly to ensure that the needs of the patient are being met and that the restraints are still applied appropriately and not causing harm to the patient. Restraints that are causing an escalation in patient behavior should be removed.

What are consequences for a nurse following violation of a civil or common law?

Violations of civil and common law are subject to consequences such as financial penalties rather than criminal charges. They can also result in malpractice suits and limitation or suspension of a nurse's license by the state board of the state board of nursing.

Notes on Nursing

a book published by Florence Nightingale in 1860 that outlined the importance of personal hygiene and providing an ideal environment for a patient to experience healing (Nightingale's Environmental Theory)

missing person

a client that is not in the anticipated treatment location and has not stated that they are leaving

false imprisonment

act of holding a person against his or her will without a legally justifiable reason

assault

an intentional threat against another person

protected health information (PHI)

any information regarding a patient's health status, healthcare, or payment for healthcare that can be traced to a specific patient. It may be accessed only by: 1. Healthcare providers directly involved in patient care. 2. The patients themselves. 3. Any family members or friends to whom patients have given access in writing.

battery

any touching of a patient without his or her consent

Loretta Ford and Henry Silver

began the first nurse practitioner program at the University of Colorado in 1965

In Texas, two types of death may be declared:

cardiopulmonary death and brain death. A registered nurse or advanced practice nurse can determine cardiopulmonary death as long as it is in accordance with the policies and procedures of the organization for which they are employed. Only a qualified physician can determine brain death.

Peer Review Committee

consist of health professionals who monitor the quality and use of healthcare services

Emergency Medical Treatment and Active Labor Act (EMTALA)

ensures that patients presenting for emergency care are assessed and stabilized within the capabilities of that facility before transferring a patient to another facility

nurse anesthesia

evolved throughout the Civil War in 1861, the first advanced practice role within nursing that involved the administration of anesthesia during surgeries

Good Samaritan laws

exist to encourage health professionals to stop and provide aid in emergency situations without the fear of liability

Virginia Henderson

expansion of the Nightingale's Environmental Theory that describes 14 activities of the nurse that aid in healing: (1) breathing (2) eating/drinking (3) elimination (4) movement/positioning (5) sleep/rest (6) clothing (7) body temperature (8) hygiene (9) safety (10) communication/socialization/play (11) practice of faith (12) learning

Mary Eliza Mahoney

first African American nurse in the United States in 1879

Jane Rignel, Linnie Leckrone and Irene Robar

first three women to receive the Citation Star (now known as the sliver star) in 1918 (WW1)

Clara Barton

founded the Red Cross in the United States in 1862

Lillian Wald and Mary Brewster

founders of the Henry Street Settlement which led to the development of community nursing in 1893

administrative law

government agencies are entrusted by the U.S. Congress or state legislatures to make policies An example of this is the rules and regulations set by the Texas Board of Nursing. The Board of Nursing is a state agency that gains its power to regulate nursing from the Nursing Practice Act.

Integrated health care delivery (IHCD)

is a network of health care organizations that work together to provide a continuum of health services to a defined population with intended outcomes of better aligning resources, improving quality, and controlling costs

How do nurses avoid claims of falsely imprisoning patients?

it is imperative that nurses understand the appropriate use of restraints Such cases of false imprisonment do not apply to patients who have been deemed unable to make their own decisions by court order or who are under arrest

statutory law

law(s) passed by the U.S. Congress or state legislatures

abandonment of care

legal term that implies that a healthcare professional has prematurely stopped caring for a client

Health Insurance Portability and Accountability Act (HIPAA)-1996 and the related Health Information Technology for Economic and Clinical Health Act (HITECH)-2009

limit who has access to a patient's medical record and protected health information (PHI)

Lieutenant Mary Louise Roberts

nicknamed the "Angel of Anzio" and the first woman to receive the silver star in 1945 (WW2)

malpractice

occurs when a healthcare professional does not perform his or her duty competently, which ultimately causes harm to the patient

Incident-Based Peer Review (IBPR)

occurs when there is concern regarding a nurse's conduct or qualifications at the facility, and this concern is reported to the peer review committee. The peer review committee then gathers facts on the situation and follows established guidelines and criteria (outlined by the board of nursing) to determine whether the nurse and the situation should be reported to the board of nursing. These guidelines are detailed in the board's Minor Incidents, Rule §217.16 (Links to an external site.). Some of the particularly notable minor incidents listed in the document are: (a) Any error that contributed to a patient's death. Criminal conduct defined in NPA 301.4535. (b) A serious violation of the board's Unprofessional Conduct Rule §217.12 (Links to an external site.) involving intentional or unethical conduct such as fraud, theft, patient abuse, or patient exploitation.

Patient Self-Determination Act (PSADA)

outlines a patient's right to self-determine their healthcare, even if they are unable to communicate.

The U.S. health care system has six levels of care for which health care providers offer services:

preventive, primary, secondary, tertiary, restorative, and continuing health care

civil law

protect the civil rights of individuals The right to fair and equitable treatment is an example of civil law.

Safe Harbor Peer Review (SHPR)

protects nurses from employer retaliation as well as licensure action when the nurse requests a peer-review process. Nurses (LVN, RN, or APRN) can request safe harbor when they feel they are being asked to take on an unsafe patient assignment (more patients than is typical for that unit), perform a task outside of their scope of practice or skill level, or partake in an illegal activity. Safe harbor must be declared and the paperwork filed before a nurse accepts responsibility for a patient assignment (by taking a shift report). Likewise, if a nurse completes a skill outside their scope of practice, safe harbor cannot be claimed retroactively.

Americans with Disabilities Act (ADA)

protects those with physical and mental disabilities from discrimination. One important aspect for the healthcare setting is the requirement to provide interpretation services to patients that do not speak English as a first language. All hospitals/clinics should have access to interpretation services. This should not be a family member. Family members cannot be relied on the accurately interpret information, especially medical terminology.

scope of practice

refers to the actions or skills a healthcare provider can perform based on educational preparation and licensing

Florence Nightingale

staggeringly lowered the mortality rate at the Barrack's hospital in Scutari, Turkey from 42.7% to 2.2% during the Crimean War in 1854 through implementation of sanitary conditions and good nutrition

Where is the Catheter-Associated Urinary Tract Infections (CAUTI) prevention tool found?

the American Nurses Association (ANA) website

Which organization provided this contemporary definition of nursing? "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, groups, communities, and populations."

the American Nurses Association (ANA), a premiere nurses' professional organization in the United States

Invasion of Privacy

the common law equivalent to HIPAA

common law (judicial precedent)

the result of judicial decisions made during legal cases, based on custom or precedent rather than on written statutes or codes Informed consent and malpractice is an example of common law.

Nursing Practice Act

the scope of practice for registered nurses outlined by the state

Nightingale's Environmental Theory

this theory of nursing describes the role of the nurse as placing the patient in the best possible environment for healing to occur

against medical advice (AMA)

when a client chooses to leave a treatment setting before discharge orders are entered by a healthcare provider

Preventive care

• Adult screenings for blood pressure, cholesterol, tobacco use, and cancer • Pediatric screenings for hearing, vision, autism, and developmental disorders • HIV screening for adults at higher risk • Wellness visits • Immunizations • Diet counseling • Mental health counseling and crisis prevention • Community legislation (seat belts, car seats for children, bike helmets)

Discharge planning for patients and their caregivers involves these elements:

• Determining the appropriate post-hospital destination for a patient. A case manager or social worker usually selects this setting based on a patient's health care needs, self-care capacity, insurance, and place of residence. • Identifying a patient's needs for a smooth and safe transition from the acute care hospital/post-acute care agency to the patient's discharge destination. Nurses, therapists, health care providers, and dietitians usually identify these needs. • Beginning the process of meeting a patient's needs while the patient is still hospitalized, with approaches such as early mobility protocols, health education, and new medication regimens.

Primary care (health promotion)

• Diagnosis and treatment of common illnesses • Ongoing management of chronic health problems • Prenatal care • Well-baby care • Family planning • Patient-centered medical home care

Some tips for making a successful referral include the following:

• Engage the patient and family caregiver in the referral process, including selecting the care provider. Explain the reason for the referral, the service to be provided, and how the service will be provided. • Make the referral as soon as possible. • Give the care provider receiving the referral as much information as possible about the patient. This can avoid unnecessary duplication of assessment (e.g., current vital signs or pain status) and omission of important information. • The care provider, such as a physical therapist, social worker, dietitian, or radiologist, will make recommendations for the patient's care. Learn these recommendations and incorporate them into the treatment plan as soon as possible.

Tertiary care

• Highly specialized: intensive care, inpatient psychiatric facilities • Specialty care (such as neurology, cardiology, rheumatology, dermatology, oncology)

Continuing care

• Long-term care: assisted living, nursing centers • Psychiatric and older-adult day care

Restorative care

• Rehabilitation programs (such as cardiovascular, pulmonary, orthopedic) • Sports medicine • Spinal cord injury programs • Home care

Secondary (acute care)

• Urgent care; hospital emergency care • Acute medical-surgical care: ambulatory care, outpatient surgery, hospital • Radiological procedures