NURS 2602 CHAPTER 5,6, 7
Which factors have led to an increased need for liability insurance for nurses?
-More floating and cross training coverage -Employer insurance coverage lower than judgments -More responsibility for supervising subordinate staff members -Failure for some employers to provide adequate defense for nurses
Which examples of nursing care are not consistent with professional standards and could lead to a malpractice claim?
-Not delegating the task to the correct personnel. -Disregarding the provider's order for patient treatment. -Failing to document the dose of medicine that was administered to a patient -Not calling the provider immediately when the patient's vital signs are abnormal
Patient Self-Determination Act (PSDA)
-Nurses are in a position to help patients and families understand this law and how it can assist them to have the end-of-life care they prefer. -applies to acute care and long-term care facilities receiving Medicare and Medicaid funds. -requires the health care facility to document whether the patient has completed an advance directive.
Which information is usually included in a state's nurse practice act (NPA)? Select all that apply. -Performance standards -Salary for a registered nurse -penalties for license violations -definition of the registered nurse role -practice behaviors that are prohibited
-Performance standards -penalties for license violations -definition of the registered nurse role -practice behaviors that are prohibited
Which is the intent of having workplace policies in health care organizations?
-Promoting compliance with nursing practices -Reducing various interpretations of work conduct -Acting as a resource for nurses to use as a reference when confused about a specific task
When a nursing contract is described as "at will," which statement about this is true?
"At will" is a contract clause that means the employer can terminate the employee, or nurse, at any time and without giving a reason; and the nurse has the right to quit without giving a reason.
Statutory Law
"statutes" those established through formal legislative processes. Every time the U.S. Congress or a state legislature or assembly passes legislation, the body of statutory law expands.
What four legal elements must be proven for a patient to successfully sue a nurse?
(1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages.
Malpractice may occur in two ways:
(1) by commission (doing something that that should not have been done) and (2) by omission (failing to do things that should have been done)
Gilligan's levels of moral development are
(1) orientation to individual survival; (2) a focus on goodness with recognition of self-sacrifice; and (3) the morality of caring and being responsible for others, as well as self
What are the three branches of government?
(1) the executive branch: charged to implement law and which includes the office of the president at its highest level (2) the legislative branch= charged to create law and which includes the U.S. Congress and other regulatory agencies that set law (3) the judicial branch= charged to interpret law and which includes the Supreme Court and federal court system
Kohlberg's Stages of Moral Reasoning: 2 Conventional
-characterized by moral decisions that conform to the expectations of one's family, group, or society or cultural group norms Stage 3 -makes moral choices based on what is pleasing to others Stage 4 -makes moral choices based on a larger notion of what is desired by society WHO: most adolescents and adults
Legislative Branch
-creates law -includes the U.S. Congress
Executive Branch
-implements law -includes the office of the president at its highest level
Judicial Branch
-interprets law -includes the Supreme Court and federal court system
Kohlberg's Stages of Moral Reasoning: 3 Post-conventional
-involves more independent modes of thinking than previous stages. -developed the ability to define his or her own moral values, Part of moral reasoning and behavior is based on a socially agreed-on standard of human rights -people create their own morality, which may differ from society's norms. WHO: only a minority of adults achieves this level
Common law:
-is decisional judges' rulings become law -every time a judge makes a legal decision, the body of common law expands
How to Protect Yourself from Lawsuits:
-perform a complete admission assessment for design a plan of care -Follow the manufacturers recommendations for operating equipment -Check equipment for safety before use -Notify a physician in a timely manner when conditions warrant it -Listen to a patients' complaint and act on them -document a patient's injury -Do a complete shift assessment -Question discharge orders when a patient's condition warrants it -Question incomplete or illegible medical orders -Provide a safe environment
What are nursing residency programs?
1-year programs that offer the new nurse graduate clinical and educational activities to facilitate the transition to professional practice and enhance competence, confidence, and professional development.
Ethical Decision Making Process
1. Clarify the ethical dilemma. 2. Gather additional data. 3. Identify options. 4. Make a decision. 5. Act. 6. Evaluate.
Nursing practice act in each state fulfills these objectives:
1. Defines the standards and scope of professional nursing 2. Describes the authority, power, and composition of the board of nursing 3. Defines educational program standards 4. Sets the minimum educational qualifications and other requirements for licensure 5. Determines and protects the legal titles and abbreviations nurses may use 6. Provides for disciplinary action of licensees for certain causes
Autonomous decisions are based on:
1. individuals values 2. adequate information 3. freedom from coercion 4. reason and deliberation
Which is the definition of meeting the standard of care?
Achieving the expectations based on clinical evidence
2 types of deontologists
Act deontologists: determine the right thing to do by gathering all the facts and then making a decision Rule deontologists: emphasize that principles guide our actions
Types of nursing malpractice
Failure to Properly Assess Failure to Timely Communicate Failure to Take Appropriate Action Failure to Document Failure to Preserve Patient Privacy
types of nursing malpractice
Failure to Properly Assess Failure to Timely Communicate Failure to Take Appropriate Action Failure to Document Failure to Preserve Patient Privacy
Benner's Competent nurse
Feels competent, organized; plans and sets goals; thinks abstractly and analytically; coordinates several tasks simultaneously
Who first defined nursing?
Florence Nightingale In Notes on Nursing: What It Is and What It Is Not (originally published in 1859), stating, "And what nursing has to do ... is put the patient in the best condition for nature to act upon him"
Which describes the role that the American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) have in nurse practice acts?
Guides state nurses associations seeking revisions to nurse practice acts
How can the nurse maintain positive interpersonal relationships with patients?
Handling patients that become upset it is important for nurses to handle the issues right away and in the best, most compassionate way possible. This shows the patient that their concerns are heard and that they are not being ignored. In turn, this helps maintain a positive interpersonal relationship with the patient.
Benner's Novice nurse
Has little background and limited practical skills; relies on rules and expectations of others for direction
Benner's Advanced beginner nurse
Has marginally competent skills; uses theory and principles much of the time; experiences difficulty establishing priorities
Which describes collective bargaining?
Negotiating with employers as a group of nurses
_______________________ are hired by both the plaintiff and the defendant and will testify as to whether the nurse met the prevailing standard of care.
Nurse expert witnesses
Who has accountability for nurses in following the scope of practice guidelines in state nurse practice acts?
Nurses
Nurse Penalty
Nurses performing professional functions that harm the public, face penalties which eventually affect their licensure status
Martha Rogers Nursing Definition
Nursing aims to assist people in achieving their maximum health potential. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing's goals
Code of ethics nursing definition
Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities
What was Peplau's definition of Nursing after WW2?
Nursing is a significant, therapeutic, interpersonal process. Nursing is an educative instrument that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living
Dorothea Orem's Definition of Nursing
Nursing is perhaps best described as the giving of direct assistance to a person, as required, because of the person's specific inabilities in self-care resulting from a situation of personal health
What are the two types of Liability insurance policies?
Occurrence Policies: Cover injuries that occur during the period covered by the policy, whether or not the policy is still in effect at the time the suit is brought. Claims-Made Policies: Cover injuries only if the injury occurs within the policy period and the claim is reported to the insurance company during the policy period or during the "tail." A tail is an uninterrupted extension of the policy period and is also known as the extending reporting endorsement.
Benner's Expert nurse
Performs fluidly; grasps patient needs automatically; responses are integrated; expertise comes naturally
Advance Directive:
Written instructions recognized by state law describing an individual's preferences in regard to medical intervention should the individual become incapacitated
Common areas of risks:
medication errors, failure to monitor or respond to a patient, patient falls, failure to follow workplace procedures, and failure to supervise when delegating, among others.
3 types of ethics
metaethics, normative ethics, applied ethics
What is the minimum and maximum # of questions on the NCLEX-RN?
min:75 max:265
Who cannot give consent?
minors, patients under the influence, or patients with cognitive defects or impairments.
Magnet Hospitals
nationally recognized for promoting excellent environments for professional practice with strong recruitment programs and high retention rates, hospitals need to apply and are evaluated, and can publish research and put on conferences.
can LVNs and LPNs delegate tasks?
no
American Association of Legal Nurse Consultants
nonprofit organization that is dedicated to the professional enhancement of RNs who practice as consultants in the legal field.LNCs have additional education and experience regarding applicable legal standards and/or strategy to the evaluation of medicolegal cases or claims. LNCs can become board certified through the Legal Nurse Consultant Certified program
What if the nurse gives wrong medication but it doesn't do anything to the patient? Can the patient sue?
nurse has to make incident report but patient can't sue due to no damages
Peplau's Theory
nurse-patient relationship: Patient should participate in care
nurse expert witness
nurses in court
Plantiff
one who brings a court action against another
What's the most common reason nurses are disciplined by SBN?
practicing while under the influence of alcohol or other substance, often a narcotic taken ("diverted") from the workplace
Why do all nurses have same ethical code? (code of ethics)
protecting patients by establishing a clear standard by which nurses make ethical decisions and carry out their duties
Permissive law
protects and limits the use of the title granted in the law but does not prohibit persons from practicing the profession or occupation if they do not use the title. In other words, persons could practice nursing if they did not refer to themselves as a nurse.
Civil Law
recognizes and enforces the rights of individuals in disputes over legal rights or duties of individuals in relation to one another.
Voluntariness:
refers to the freedom the patient has to accept or reject alternatives.
Completeness:
refers to the quality of the information provided.
mandatory law
requires any person who practices the profession or occupation to be licensed
Which must be included in the explanation given by the provider for the patient to give informed consent?
risks, benefits, cost, side effects, and alternatives to the treatment/procedure
What are red rules?
rules that emphasize certain policies. They must be followed precisely and without variance. These rules cannot be broken. Breaking the rules can result in serious disciplinary actions, such as demotion, termination, or license suspension.Ex: using two identifiers to identify patient, or requiring the independent verification of a blood product by two nurses, to ensure that the blood is compatible with the patient prior to a transfusion.
Royal college of nursing definition
six defining characteristics: Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.
Paternalism
someone believes that he or she knows what is best for another person who is competent to make his or her own autonomous judgments about a course of action
what are virtues?
specific character traits, including truth telling, honesty, courage, kindness, respectfulness, compassion, fairness, and integrity, among others
What are ethics?
term used to reflect what actions an individual should take and maybe "codified," as in the ethical code of a profession -process oriented -involve critical analysis of actions
Assault
threat or attempt to injure
Purpose of Board of registered nursing
to protect the public, Safety. Establish scope of practice for nursing. Establishes clinical hours/theory hours needed to take NCLEX. Enforce nurse practice act. Nurses and administrators, educators, and consumers on board.
Battery
unauthorized physical contact that may or may not do harm
Principalism
uses the key ethical principles of beneficence, non-maleficence, autonomy, fidelity, veracity, and justice to resolve ethical dilemmas.
German philosopher Immanuel Kant
was a preeminent deontologist. He believed that an act was moral if its motives or intentions were good, regardless of the outcome.
Moral distress
when one knows the morally correct action to take but is unable to act as a result of internal constraints (such as lack of moral courage) or external constraints, including power differentials
Benner's Proficient nurse
Views patients holistically; recognizes subtle changes; sets priorities with ease; focuses on long-term goals
Why should nurse practice acts be revised and updated periodically?
-Communication methods may change that affect nursing practice. -New methods of health care delivery may be developed that affect scope of practice. -Philosophies about nursing change over time and may change the scope of practice.
The Medication Aide Certification Examination (MACE):
-also administered by the NCSBN, -certifies competency in administration of simple medications by UAP.
1997 Balanced Budget Act:
-authorized nurse practitioners and clinical specialists, beginning in January 1998, to bill the Medicare program directly for nursing services furnished in any setting.
Who publishes the Code of Ethics Nurses? -Institute of Medicine (IOM) -National League for Nursing (NLN) -American Nurses Association (ANA) -National Council of State Boards of Nurses (NCSBN)
-American Nurses Association (ANA)
Which is an example of failing to preserve patient privacy?
-Discussing a patient in the parking lot -Giving patient information to friends who call the hospital -Posting a photo of the patient on social media without naming the patient
What is professional socialization?
-begins during the period when students are in formal nursing programs and continues as they practice in the "real world." -process of internalization and development or modification of an occupational identity
HIPAA patient protections:
-Patients can see and obtain copies of their medical records, generally within 30 days of request, and can request corrections if they detect errors. May be copying and mailing costs. • Providers must give patients written notice describing the provider's information practices and explaining patients' rights. Patients must be asked to agree to these practices by signing or initialing the notice. • Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared.
Nurse practice acts include a number of essential statements or guidelines which fall under two main categories:
-Public Protection of State Health -Protection of the Title of Registered Nurse (RN)
Which is the reason why it is necessary to use a certified medical interpreter for consent instead of a family member?
-The family member may not understand medical terminology. -The family member may not feel comfortable asking for clarification from the provider. -The medical interpreter is certified in medical translation to interpret the information correctly. -There may be cultural barriers or family dynamics that make translating the information difficult to elders.
ICN definition of nursing 1960
-adopted from Henderson -the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.
Nurses have 4 fundamental responsibilities:
-promote health -prevent illness -restore health -alleviate suffering.
What are morals?
-provide standards of behavior that guide the actions of an individual or social group -established rules of conduct to be used in situations where a decision about right and wrong must be made. -Usually about behaviors (what to do what not to do) -learned over time and are -influenced by life experiences and culture
Kohlberg's Stages of Moral Reasoning: 1 Preconventional
-the individual's perspective is self-centered, and their wants or needs take precedence over right or wrong. Stage 1 -responds to punishment Stage 2 -the person responds to the prospect of personal reward WHO: children younger than 9 years of age, as well as in some adolescents and adult criminal offenders.
4 documents nurses should own
-their state nurse practice act -Nursing's Social Policy Statement: The Essence of the Profession. -Nursing: Scope and Standards of Practice. (ANA) -Code of Ethics for Nurses with Interpretive Statements (ANA)
Causes of reality shock
Absence of positive reinforcement (such as one gets from clinical faculty) and lack of frequent communication Lack of support, such as the availability of faculty that students have The gap between the ideals taught in school and the actual work setting The inability to provide nursing care effectively because of circumstances such as a heavy case load or time constraints
Which issues are legal in some states but opposed by the american nurses association?
Assisted suicide and capital punishment
Which are ways to reduce legal risk in the workplace?
Carefully planning patient assignments Creating positive interpersonal relationships with patients
CODE Moral Courage Model
Courage, Obligation to honor Danger management Expression and action.
Cohen's model of basic student socialization: Stage 3
Dependence/ mutuality: Reasoned appraisal; begins integration of facts and opinions following objective testing students' more reasoned evaluation of others' ideas, develop an increasingly realistic appraisal process and learn to test concepts, facts, ideas, and models objectively. Students accept some ideas and reject others. students begin to appreciate the nursing process in organizing care and begin to use more sophisticated critical thinking skills.
The nurse has to complete an incident report because of a patient injury. Which guidelines should the nurse follow when completing this incident report?
Describe, objectively, how the injury occurred. List the events that were witnessed prior to, during, or following the injury.
Cohen's model of basic student socialization: Stage 4
Interdependence: Collaborative decision making; commitment to professional role; self-concept now includes professional role identity, Faculty appreciate the maturity and trustworthiness that students exhibit when they reach this stage in their professional development. These students are often highly self-directed, seeking out learning experiences to maximize their knowledge before the completion of their formal education.
In which ways is the state board of nursing similar to the judicial branch of the United States government?
It can deny a license to an applicant. It can administer disciplinary action to a licensee.
Which statement describes the actions related to a law regarding nursing practice after it is amended?
It is enforced by the state board of nursing.
Patient Self Determination Act 1991
It requires the patient to be informed of their rights to make decisions such as refusing treatment and right to die options. The PSDA does not create new rights for patients but reaffirms the common-law right of self-determination as guaranteed by the Fourteenth Amendment. Under the PSDA, health care agencies must ask you whether you have advance directives and must provide you with educational materials about your rights under state law. -The PSDA applies to acute care and long-term care facilities receiving Medicare and Medicaid funds. According to the PSDA, acute care (hospitals) and long-term care facilities must do the following: 1. Provide written information to all adult patients about their rights under state law 2. Ensure institutional compliance with state laws on advance directives 3. Provide for education of staff and the community on advance directives 4. Document in the medical record whether the patient has an advance directive
________ is an exercise of the state's police power that the state legislature uses to protect the health, safety, and welfare of its citizens
Licensure
Americans with Disabilities Act of 1990
Major anti-discrimination law for disabled; requires access (ramps, braille, etc.) -provided a significant improvement in the lives of persons with a variety of mental and physical disabilities, recognizing their rights to participate fully in all aspects of society -prohibits discrimination against these individuals in employment
AIken Landmark Study 2003
More BSN bedside nurses creates a better outcome for patients.10% increase in BSN nurses had a 5% decrease in both likelihood of patients dying within 30 days on admission and the odds of failure to rescue. These researchers concluded that significantly lower mortality and failure to rescue rates were found in hospitals with higher proportions of bachelor in science of nursing (BSN) prepared nurses. They recommended that investments in public funds be made to increase the number of BSN-prepared nurses to substantially improve the quality of care in the country.
If a state board of nursing requires a nursing education program to be nationally accredited, how does this action act as a safeguard for the public?
Nationally accredited programs have stricter oversight, which sets a higher standard and expectation.
Cohen's model of basic student socialization: Stage 2
Negativity/ independence: Cognitive rebellion; diminished reliance on external authority students' critical thinking abilities and knowledge bases expand. They begin to question authority figures.
Which describes the difference between negligence and malpractice?
Negligence occurs when a person does not act reasonably; malpractice is a specific type of negligence that occurs when a medical provider fails to provide reasonable care.
Who can be given private information legally for reporting?
Priest or lawyer (for things like a gunshot wound or patient saying they committed murder)
Who can take vital signs?
RNs, APs,
The nurse wants to stay up to date on evidence to guide her nursing practices. How can the nurse stay current on evidence-based practices to meet the standard of care?
Receiving continuing education credits
Which actions are likely to cause a conflict between the employer's request and the nurses' professional code of ethics?
Requiring delegation of responsibilities to UAP Being asked to accept patient care assignments that are not deemed safe by the nurse
Nurse suspension
Revocation of a nursing licensed for a period of time; after the time or conditions of the suspension have been satisfied, the nurse is normally able to resume practice.
Gilligan's Stages of Moral Reasoning
She claimed Kohlberg didn't recognize women experience, that his research was from men and boys. Women scored lower on the kohlberg stages. -"the moral person is one who responds to need and demonstrates consideration of care and responsibility in relationships" -women view moral dilemmas in terms of conflicting responsibilities
Which statement defines a whistleblower?
Someone who reports wrongdoings in the workplace
Which group, besides unions, is qualified to act as a labor organization?
State nurses associations
All patients or their guardians (e.g., parents of minor children) must be given an opportunity to grant informed consent before treatment unless there is a life-threatening emergency. True or false?
TRUE
Certified nursing assistants (CNAs) may not refer to themselves as nurses. True of false
TRUE
What are the 2 types of torts?
Unintentional: This occurs when a person incurs harm or injury because of an unintended wrongful act by another individual. Includes: Negligence/Malpractice Intentional: This occurs when a person inflicts harm or injury on purpose. Includes: Assault Battery Defamation of Character False Imprisonment Invasion of Privacy Intentional Infliction of Emotional Distress
Nurses have the NCLEX, what do UAPs have?
The NCSBN has developed the National Nurse Aide Assessment Program (NNAAP) examination, a test of both cognitive and skill performance to certify nurse aide competency. The Medication Aide Certification Examination (MACE) also administered by the NCSBN, certifies competency in administration of simple medications by UAP. Regardless of certifications by UAP, it remains the responsibility of professional nurses to know the limitations of the particular assistive personnel under their supervision.
Nurse Probation
This is a predetermined amount of time in which a nurse is supervised and cannot have complaints filed against them.
Nurse Revocation
This is the highest level of penalty against a professional nursing license. This is a removal of licensure altogether and is usually imposed after repeated patterns of unsafe or unprofessional behavior are noted.
Cohen's model of basic student socialization: Stage 1
Unilateral dependence: Reliant on external authority; limited questioning or critical analysis
What is a tort?
a civil wrongdoing against a person
Whistleblowing
a term used in the workplace and refers to employees reporting wrong doings and concerning behavior, such as when something illegal, immoral, and/or unethical is witnessed.
1997 Balanced Budget Act
led to a balanced budget and to actual surpluses
Defendant
an individual or group being sued or charged with a crime
Moral Courage
an individual's capacity to overcome fear and stand up for his or her core values with awareness, despite the potential risk
Bioethics
application of ethical theories and principles to moral issues or problems in health care
The nurse attempts to administer medication to the patient, but the patient refuses to take it. The nurse tells the patient that if he does not take the medicine, he will not get any help if he rings the call bell during the night. Which type of tort is the nurse demonstrating?
assault
What are values?
attitudes, ideals, or beliefs that an individual or a group holds and uses to guide behavior. "Right and wrong", how one should behave, freely chosen, show what person thinks is important
In which ways is the state board of nursing similar to the Legislative branch of the United States government?
authority to adopt rules necessary to implement the act (note that rules are different from laws, which are made by the state's legislative body)
Martha Rogers
developed nursing process (promote health, prevent disease)
4 elements of malpractice
duty, breach of duty, causation, damages
Utilitarianism
based on a fundamental belief that the moral rightness of an action is determined solely by its consequence. -first described by David Hume
What can LVNs do?
can administer tube feedings, oral medications, change wounds
Three major types of laws govern American society:
common law, statutory law, and administrative law
Three major types of laws that govern American society:
common law, statutory law, and administrative law
3 elements for consent to be legally valid:
completeness (given full info), competency (patient understands everything), and voluntariness (freedom to accept or reject)
Administrative Law
created when the legislative branch of a government delegates authority to governmental agencies to create laws that meet the intent of a statute. Both federal and state administrative laws have the force and effect of statutory law
Moral reflection
critical analysis of one's morals, beliefs, and actions
Criminal Law
involves public concerns regarding an individual's unlawful behavior that threatens society, such as murder, robbery, kidnapping, or domestic violence.
Common Law
decisional (judges' rulings become law) Every time a judge makes a legal decision, the body of common law expands.
Negligence
failure to act as a reasonably prudent person would have acted in the same circumstances
Applied ethics
focus on specific difficult issues such as euthanasia, capital punishment, abortion, and health disparities
Normative Ethics
focus on the moral standards that regulate behaviors
Metaethics
focus on universal truths, and where and how ethical principles are developed
De Casterlé and colleagues study
found out that nurses typically were often poorly prepared to address ethical dilemmas and that nurses do not use critical thinking in making ethical decisions
In which ways is the state board of nursing similar to the Executive branch of the United States government?
has authority granted by the state to administer the nurse practice act.
3. Failure to communicate, including failure to:
• Notify a physician in a timely manner when conditions warrant it • Listen to a patient's complaints and act on them • Communicate effectively with a patient (for example, inadequate or ineffective communication of discharge instructions) • Seek higher medical authorization for a treatment
HIPPA patient protections:
• Patients are able to see and obtain copies of their medical records, generally within 30 days of their request, and to request corrections if they detect errors. Providers may charge patients for the cost of copying and mailing the records. • Providers must give patients written notice describing the provider's information practices and explaining patients' rights. Patients must be asked to agree to these practices by signing or initialing the notice. • Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared.
Defendant:
the nurse
What resource does that state board of nursing provide to nurses that contributes to the protection of the public? -State statutes -nurse practice act -position statements -standards for practice
-nurse practice act
Plaintiff:
-patient or someone acting on behalf of the patient who brings a claim of malpractice against a nurse (or other professional)
State boards of nursing (SBNs)
-regulatory bodies by which nursing practice acts are administered and enforced -does not have the authority to enlarge the law
Administrative laws:
-result when a person violates the regulations and rules established by administrative law. -EXAMPLE: nurse practices without a valid license or beyond the scope of nursing practice
Prescriptive authority:
-the legal acknowledgment of prescription writing as an appropriate act of nursing practice.
Confidentiality
-the protection of private information gathered about a patient during the provision of health care services.
Statutory laws (statutes):
-those established through formal legislative processes -every time the U.S. Congress or a state legislature or assembly passes legislation, the body expands
Who grants consent for a patient who is not competent?
the patient's spouse, next of kin, or court-ordered guardian or health care proxy.
What is the nurse responsible for when it comes to informed consent?
-to collaborate with the primary provider, most often a physician/ communicating the patient's need for further information to the primary provider -may witness a patient's signing of informed consent documents but is not responsible for explaining the proposed treatment -determining that the elements for valid consent are in place -providing feedback if the patient wishes to withdraw consent or grant consent previously withheld -advocacy
Negligence:
-tthe central issue in malpractice -the failure to act as a reasonably prudent person would have acted in the same circumstances.
NCLEX-RN:
-updated regularly -tests critical thinking and nursing competence in all phases of the NURSING PROCESS -computerized adaptive testing
Three functions of SBNs:
. Executive - with the authority to administer the nursing practice act 2. Legislative- with authority to adopt rules necessary to implement the act (note that rules are different from laws, which are made by the state's legislative body) 3. Judicial- with authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure
Five Rights of Safe Delegation
1. Right Task 2. Right Person 3. Right Circumstance 4. Right Communication/direction 5. Right Supervision
What professions have statutorily protected privileged communication?
attorneys and priests NOT nurses
What is battery?
the assault carried out: the impermissible, unprivileged touching of one person by another.
Autonomy:
the key ethical principle that supports voluntariness as foundational to informed consent
intentional torts include:
Assault Battery Defamation of Character False Imprisonment Invasion of Privacy Intentional Infliction of Emotional Distress
6 Major Categories of Negligence That Result in Malpractice Lawsuits:
1. Failure to follow standards of care 2. Failure to use equipment in a responsible manner 3. Failure to communicate 4. Failure to document, 5. Failure to assess and monitor 6. Failure to act as a patient advocate
1. Failure to follow standards of care, including failure to:
• Perform a complete admission assessment or design a plan of care • Adhere to standardized protocols or institutional policies and procedures (for example, using an improper injection site) • Follow a physician's verbal or written orders
Failure to act as a patient advocate, including failure to:
• Question discharge orders when a patient's condition warrants it • Question incomplete or illegible medical orders • Provide a safe environment
Which information should be included in patient documentation?
-The patient's overall status -Care provided to the patient -Specific time that medicine was administered
What are the two ways malpractice can occur?
1. by commission (doing something that should not have been done) 2. by omission( failing to do things that should have been done)
Nurses are estimated to misuse drugs and alcohol at approx. the same rate (10 to 15%) as the general population. True or false?
TRUE
A patient has an elevated heart rate and says she feels tired. When examining the patient's chart, the nurse discovers that the patient's heart rate was not recorded on the previous shift. Which statement should the nurse use to document this information?
The patient reports feeling tired. The heart rate is 97 beats per minute. Vital signs were last taken at 1300 hours.
Which is the reason why compliance programs are an important part of a hospital organization?
They help to promote safe patient care. They identify potential concerns and risks within an organization. They give employees an opportunity to report wrongdoings in the workplace.
A nurse observes a physician regularly performing unnecessary procedures on elderly patients. Which action should be done before the nurse moves forward with "whistleblowing"?
Think about reporting options Evaluate one's own weaknesses Identify a support system to have at work Assess the severity of the issue being reported
Nurses have the duty to report......?
or disclose certain information such as suspected abuse or neglect of a child (or elder, in some states), gunshot wounds, certain communicable diseases, and threats toward third parties.
What is the most common reasons that nurses are disciplined by SBNs?
for practicing while under the influence of alcohol or other substance (narcotic)
Nurse practice act controls....?
scope of practice, education requirements, Legal title and abbreviations, and disciplinary action of licenses. It updates to provide new scope of practice/new developments with amendments
Who governs the practice of nursing?
state governments
Competency:
takes into account the capability of a particular patient to understand the information given and make a choice.
Licensure by endorsement:
-endorsement-means that RNs may practice in different states w/out having to take another licensing examination. Valley nurses used this program to Help after Hurricane Katrina
What is the appropriate body to resolve a complex ethical question about patient care at the institutional level? -ethics committee -professional mentor -the joint commission (TJC) -American Nurses Association (ANA)
-ethics committee
Nursing Practice Act
-exist in every state -define the scope of practice of professional nursing -blueprint of what nurses can and cannot do
Health Insurance Portability and Accountability Act (HIPAA) of 1996:
-first federal privacy standard governing protection of patients' medical records.
Delegation:
-giving someone authority to act for another -RN is responsible for determining that the delegated person (delegatee) is competent to perform the delegated act.
"captain of the ship" doctrine.:
-implied that the physician is ultimately in charge of all patient care and thus should be responsible financially.
State nurse associations:
-instrumental in updating the state nurse practice act by lobbying its state legislators
Which statements describe the purpose of mandatory licensure? 1.Protection for the public 2.Protection for licensed nursing personnel 3.To prohibit unlicensed personnel from using the title of "nurse" 4.To ensure that nurse practice acts are reviewed and revised periodically 5. To regulate the educational requirement for nursing licensure in each state
1,2,3
Which events require an incident report to be filed? 1. A patient dies unexpectedly. 2. There is a fire in one of the break rooms. 3. A patient gets injured while in the hospital. 4. A patient has an allergic reaction to medication. 5. The IV medication pump does not function properly. 6. An x-ray indicates that a patient's cancer has metastasized.
1,2,3,4,5
Which statements describe the responsibilities of the state board of nursing to the nursing profession? 1. Enforces nurse practice acts 2. Reviews and revises nurse practice acts 3. Creates and administers nurse practice acts 4. Changes laws related to the practice of nursing 5. Clarifies provisions and adds amendments to the nurse practice act
1,2,3,5
Which statements describe functions of state boards of nursing that help protect the safety of the public? 1. Establishing standards of nursing practice 2. Establishing a pay scale for licensed nurses 3. Censuring incompetent or unsafe practitioners 4. Regulating conditions and requirements for licensure 5. Reviewing and making amendments to scope of practice guidelines 6. Prohibiting unlicensed persons from providing services reserved for those with a license
1,3,4,5,6
3 major conditions of informed consent:
1. Consent must be given voluntarily. 2. Consent must be given by an individual with the capacity and competence to understand. 3. The patient must be given enough information.
Objectives of the Nursing Practice Act:
1. Defines the standards and scope of professional nursing 2. Describes the authority, power, and composition of the board of nursing 3. Defines educational program standards 4. Sets the minimum educational qualifications and other requirements for licensure 5. Determines and protects the legal titles and abbreviations nurses may use 6. Provides for disciplinary action of licensees for certain causes
4. Failure to document, including failure to note in the patient's medical record:
• A patient's progress and response to treatment • A patient's injuries • Pertinent nursing assessment information (for example, drug allergies) • A physician's medical orders • Information about telephone conversations with physicians, including time, content of communication between nurse and physician, and actions taken
Failure to assess and monitor, including failure to:
• Complete a shift assessment • Implement a plan of care • Observe a patient's ongoing progress • Interpret a patient's signs and symptoms
. Failure to use equipment in a responsible manner, including failure to:
• Follow the manufacturer's recommendations for operating equipment • Check equipment for safety before use • Place equipment properly during treatment • Learn how equipment functions
In which situation might a nurse manager use the state nurse practice act?
-When creating an in service about licensure renewal for her staff -When a nurse's license has expired, but the nurse is scheduled to work -When a nurse on that unit questions a task she is told to delegate to an UAP -When developing policies on the nurse manager's unit and she is unsure who is allowed to perform the task
What is assault?
-a threat or an attempt to make bodily contact with another person without the person's consent. -Assault precedes battery -causes the person to fear that battery is about to occur
Nurse Licensure Compact (NLC)
-eNLC allows an RN to have one license (in the state of residency) yet practice in other compact member states w/out an additional license in the state of employment -the nurse is subject to the nursing practice act in the state where she or he is practicing,
Code of Ethics For Nurses:
1. Establishes nursing's non-negotiable ethical standards 2. Expressing nursing's own understanding of its commitment to society 3. Stating the ethical values, obligations, duties, and professional ideals of nurses
According to the PSDA, acute care (hospitals) and long-term care facilities must do the following:
1. Provide written information to all adult patients about their rights under state law 2. Ensure institutional compliance with state laws on advance directives 3. Provide for education of staff and the community on advance directives 4. Document in the medical record whether the patient has an advance directive
What are the five rights to ensure safe delegation?
1. Right task: Is the task appropriate for delegation in a specific care situation? 2. Right circumstances: Is delegation appropriate in this case? Consider the patient's health status, care delivery setting, complexity of the activity and delegate's competency, and available resources, and determine any other relevant factors. 3. Right person: Can the nurse verify that the person delegated to do the task is competent to complete this task? 4. Right direction/communication: Has the RN given clear, specific instructions? These include identifying the patient clearly, the objective of the task, time frames, and expected results. 5. Right supervision/evaluation: Can the RN or other licensed nurse provide supervision and evaluation of the patient and the performance of the task?
Elements of a malpractice action:
1. The professional (nurse) has assumed the duty of care (responsibility for the patient's care). 2. The professional (nurse) breached the duty of care by failing to meet the standard of care. 3. The failure of the professional (nurse) to meet the standard of care was the proximate cause of the injury. 4. The injury is proved.
Which is true about state nurse practice acts? 1.All states follow the same nurse practice acts. 2.State boards of nursing provide oversight of nurse practice acts. 3.State nurse practice acts define and protect the profession of nursing. 4.All state nurse practice acts define minimum educational requirements for licensure. 5.A nurse who lives in one state and works in another state is bound to the standards set by the resident state's nurse practice act.
2,3,4
Which individual is responsible for interpreting the data if an RN delegates a nursing task to a certified nursing assistant (CNA)?
the RN
What are the 6th myths of social media?
• Myth 1: Posts and photos are private and accessible only to the intended recipient. • Fact: They can be reposted, "retweeted," and otherwise disseminated in ways completely beyond your control. • Myth 2: Once content has been deleted, it is no longer accessible. • Fact: There is no "erasing" digital content. Cached versions and screenshots of posts and photos are available. Even sites such as Snapchat in which content quickly "disappears" retain digital evidence of the content. • Myth 3: No harm is done if patient information is disclosed only to the intended recipient. • Fact: This is still a breach of confidentiality, just as if you used spoken words to share private information about patients. As soon as you write or tell something, you have lost control of the message. You cannot control what happens to the information you have passed along. • Myth 4: It is acceptable to refer to a patient by a nickname, room number, or diagnosis/condition. • Fact: This still remains a breach of confidentiality and is disrespectful to the patient. • Myth 5: If your patient is posting about his or her health condition, you may also post about it. • Fact: The patient can say or write anything about himself or herself; however, this does not in any way release you from the obligations of confidentiality and HIPAA regulations. • Myth 6: Social media blurs the distinction between one's professional and personal lives. • Fact: This is an illusion. Professional boundaries are still firmly in place, although social media may cause you to believe that they are not.
