INTRO TO NURSING EXAM 2

Needs common to all people: physical, safety, psychosocial, spiritual

People's behaviors, feelings about self and others, values, and priorities all relate to physiologic and psychosocial needs.These basic human needs are common to all people, meeting these needs is essential for the health and survival of all people.A person can meet some needs independently, but most needs require relationships and interactions with others for partial or complete fulfillment.Satisfying one's needs often depends on the physical and social environment, especially one's family and community.

Types of advance directives and nurse's role

The registered nurse is responsible and accountable for assessing educational needs in respect to advance directives and to insure that the clients and staff members have the sufficient knowledge to make sound and knowledgeable decisions relating to these important aspects of client care. The living will. ... Durable power of attorney for health care/Medical power of attorney. ... POLST (Physician Orders for Life-Sustaining Treatment) ... Do not resuscitate (DNR) orders. ... Organ and tissue donation.

Steps to rise above moral distress

-Ask -Affirm -Assess -Act (see chart 4 A's)

Definitions of ethical dilemma and moral distress

In an ethical dilemma, two (or more) clear moral principles apply but support mutually inconsistent courses of action. Moral distress occurs when you know the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action.

Know the difference between intrapersonal/interpersonal/group/organizational communication

Intrapersonal- self talk, communication within a person Interpersonal- occurs between two or more people with a goal to exchange messages Group- small group, organizational communication, and group dynamics

Understand the legal responsibility and accountability of the practicing nurse

It is the nurses duty to understand their legal responsibilities

Know strategies for communicating with hearing impaired, visually impaired, cognitively impaired, unconscious patient, non-English speakers

(see screen shot) box 8-6

Understand adaptations when communicating with people from different cultures p.164, Box 8-4

(see screenshot of table 8-4)

Nurse as an advocate: representing the interest of the patient, promoting self-determination, whistle-blowing responsibility

*Advocacy is the protection and support of another's rights. This role is increasingly important because of patients' changing expectations and demands, and because in our increasingly market-driven health care economy there are no guarantees that the health care system will work to secure patient safety and health. Nurses who value patient advocacy make sure that their loyalty to their employing institution does not compromise their primary commitment to the patient, they give priority to the good of the individual patient rather than society, they carefully evaluate the competing claims of the patients autonomy and well being. *Promoting self-determination- Nurses as advocates must realize that they do not make ethical decisions for their patients. Instead, they facilitate their patients' own decision making. Nurses interpret findings for their patients, provide information to be considered, help them verbalize and organize their feelings, call in those people who should be involved in the decision making (e.g., family, primary nurse, health care provider, or clergy), and help patients assess all of their options. In this way, nurses advocate for the right of patients to make their own decisions concerning their health. *Whistle-blowing- Every nurse who witnesses unsafe care has a duty to patients to report it. However, for too long, nurses may have failed to speak up out of fear of retribution.

Differentiate between community health nursing and community-based nursing

*Community health nursing focuses on whole populations within a community. *Community based nursing is centered on the health care needs of individuals and families. Nurses practicing community based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered. Nurses providing community-based care must know about the location and specialties of health care providers, the availability and accessibility of services and supplies, and other public health services. Additional considerations include facilities (such as daycare or long-term care), housing, and the number and type of facilities providing services.

Know legal safeguards for practice/ways to avoid malpractice

*Developing and maintaining interpersonal communication skills *Respecting legal boundaries of practice *Following institutional procedures and policies *"Owning" personal strengths and weaknesses; seeking means of growth, education, and supervised experience to ensure continued competence for new and evolving responsibilities *Evaluating proposed assignments; refusing to accept responsibilities for which you are unprepared *Keeping current in nursing knowledge and skills *Respecting patient rights and developing rapport with patients *Working within the facility to develop and support management policies *Keeping careful documentation

Understand good documentation practices

*Document all clinical observations and critical diagnostics. *Document conversations with other providers regarding patient issues. *Document which specific health care provider was notified of which specific concerns at what specific time. *Document that the chain of command has been engaged when necessary. *Make sure that the medical record reflects that you pursued your concerns to resolution.

Definition of ethics and how ethics differ from morals, religion, law, custom, institutional practice

*Ethics is a systematic study of principles of right and wrong conduct and human flourishing. The ability to be ethical, to make decisions and act in an ethical manner begins in childhood and develops gradually. *It is important to distinguish ethics from religion, law, custom and institutional practices. The fact that an action is legal or customary does not in itself make the action ethically or morally right. *Morals refers to personal or communal standards of right and wrong.

Define family; know different types of family such as nuclear, blended, extended

*Nuclear- traditional type of family structure (two parents and children) considered ideal in which to raise children *Extended- consists of two or more adults who are related, either by blood or marriage, living in the same home. This family includes many relatives living together and working toward common goals such as raising children and household duties. *Blended- a family consisting of a couple and their children from this and all previous relationships.

Know the factors of a healthy community: Access to health services, A variety of services to meet the needs of all people, A safe and healthy environment

*Number and availability of health care institutions and services *Housing codes *Police and fire departments *Nutritional services for low-income infants, mothers, school-aged children (e.g., lunch programs), and older adults *Zoning regulations separating residential and industrial areas *Waste disposal services and locations *Air and water pollution *Food sanitation *Health education services and dissemination *Employment opportunities *Recreational opportunities *Violent crimes or drug use

Know how each element on the Hierarchy of Needs relates to one of the dimensions of humans (table 4-1, p. 71): i.e., Physical dimension relates to physiologic needs

*Physical dimension (physiologic needs)- breathing, circulation, temperature, food, fluids, elimination of waste, movement *Environmental dimension (safety and security) - housing, community, neighborhood, climate *Sociocultural dimension (love and belonging)- relationships w others, communication w others, support systems, being part of a community, feeling loved * Emotional dimension (self -esteem needs)- fear, sadness, loneliness, happiness, accepting self *Intellectual and spiritual dimension (self actualization needs) - thinking, learning, decision making, values, beliefs, fulfillment, helping others

State the provider, client and nurse's responsibilities for informed consent

*Provider- Provide details on treatment and alternatives to treatment, side affects etc. *Client- is able to decide for themself if they want treatment or not. *Nurse-confirm that a signed consent form is present in the patient's chart and to answer any patient questions about the consent. As a nurse you sign the consent form as a witness to having seen the patient sign the form, not as having obtained the consent yourself. You are a witness and make sure patient understands what they are signing and that they are acting voluntarily.

Understand the different functions of the family: physical, economic, reproductive, coping, socialization

*physical- family provides a safe, comfortable environment necessary for growth, development and rest or recuperation. *reproductive- have and raise children *coping- provide emotional comfort to family members and help members establish their identity and maintain it in times of stress *socialization- family teaches transmits beliefs, values attitudes and coping mechanisms, provides feedback and guides problem solving.

Define the term community and be able to state why communities are important

A person, as an individual and as a member of a family, is also a member of a community. The most basic definition of a community is a specific population or group of people living in the same geographic area under similar regulations and having common values, interests, and needs. A community may be a small neighborhood within a city or a large rural area, including a small town. Communities are based on shared characteristics of people, the area, social interaction, and familial, cultural, or ethnic heritage and ties. Within a community, people interact and share resources. The community environment affects the ability of the person to meet basic human needs. Many community factors affect the health of residents. A healthy community enables people to maintain a high quality of life and productivity. For example, a healthy community: offers access to health care services for all members of the community, which provide both treatment for illnesses and activities to promote health. has roads, schools, playgrounds, and other services to meet needs of the people in the community. maintains a safe and healthy environment. The health of a community's residents is affected by the social support systems, the community health structure, environmental factors, and facilities providing assistance for those in need of shelter, housing, and food. Examples of community factors affecting health are listed in Box 4-2 and are discussed further in the following sections.

Know types of torts (unintentional and intentional)

A tort is carrying out and act, or failing to act, against what is considered reasonable and acceptable, which results in injury or harm to a client. It exists to protect the public, to determine liability and to settle claims for illness or damages. An unintentional tort is when the nurse does not intent to cause harm but harm occurs as a result of situations such as malpractice and negligence. Intentional tort is when a nurse invades privacy, defamation and assault/battery.

Know consequences/actions taken for an impaired nurse

About 1 in 10, or 10% to 15% of all nurses, may be impaired or in recovery from alcohol or drug addiction. The stresses involved in nursing and health care, combined with the availability of controlled substances, make nurses prime candidates for alcohol and drug addiction problems. Startlingly, more than half of all impaired nurses began abusing during their nursing education days. In the past, nurses with substance abuse problems usually were promptly punished by firing and license suspension. Today, substance abuse is recognized as a treatable disorder; the objective is to detect problems early and get nurses into treatment. The ANA strongly supports "alternative to discipline" or "peer assistance" programs.

What is a nursing compact/multistate license?

According to the NCSBN, a mutual recognition model of nurse licensure allows a nurse to have one license in his or her state of residency and to practice in other states (both physically and electronically) as well, subject to each state's practice law and regulation, unless otherwise restricted. This multistate nurse licensure model is governed by the Nurse Licensure Compact (NLC). All states that currently belong to the NLC also operate the single-state licensure model for those nurses who reside legally in an NLC state but do not qualify for multistate licensure. You must legally reside in an NLC state to be eligible for a multistate license.

Why is there a Bill of Rights for Registered Nurses? What does it say?

Advocacy on behalf of nurses and the profession has resulted in a tangible tool, the Bill of Rights for Registered Nurses, to aid in improving workplaces and ensuring nurses' ability to provide safe, quality patient care. The Bill of Rights is intended to empower nurses by making clear what is absolutely nonnegotiable in the workplace. The seven basic tenets of the Bill of Rights for Registered Nurses are: 1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. 2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements. 4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution. 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. 6. Nurses have the right to a work environment that is safe for themselves and their patients. 7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings (http://nursingworld.org/NursesBillofRights, used with permission).

What is the state Nurse Practice Act? How does it affect nursing practice?

All states and territories legislated a nurse practice act (NPA) which establishes a board of nursing (BON) with the authority to develop administrative rules or regulations to clarify or make the law more specific. It goes over scope of practice and violations that may result in disciplinary action.

What is the responsibility of the student nurse? What is the responsibility of the nurse instructor?

As a student nurse, you are responsible for your own acts, including any negligence that may result in patient injury. Moreover, you are held to the same standard of care as an RN. You are also responsible for being familiar with facility policies and procedures. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision. Because the status of patients can change rapidly, especially in an acute care setting, notify your instructor or a staff member of any significant changes in the patient's condition, even if you are unsure of the meaning of these changes.

What protections are offered by the Americans with Disabilities Act (ADA)?

At least 43 million Americans have physical or mental disabilities. Discrimination against such people persists in such crucial areas as employment, housing, public accommodations, education, transportation, communication, and health services. The 1990 Americans With Disabilities Act (ADA), amended in 2008, provides a broad definition of "disability" to cover any person who has a physical or mental impairment that substantially limits one or more major life activities or who has a record of such impairment. In addition to impairments that have traditionally been perceived as disabilities, the ADA also specifically protects people who have communicable diseases such as AIDS or HIV infection, people who are recovering from drug or alcohol addiction, and people who are regarded as being disabled, whether or not they are in fact disabled. The ADA imposes two requirements on businesses covered by the Act: it prohibits such entities from discriminating against people with disabilities and requires covered entities to "reasonably accommodate" people who are protected by the Act.

Know the channels of communication: Auditory, Visual, Kinesthetic

Auditory- hearing and listening Visual- Sight, observation and perception Kinesthetic- Procedural touch, caring touch (how you make a personal feel) (see table 8-1)

Know the responsibility of nurses to report abuse

Because of the unique nature of nurse-patient interactions, the nurse frequently has knowledge that a state requires to be reported, such as of child abuse, rape, or a communicable disease. Legislation varies; thus, nurses must know what needs to be reported in their local area and to what authority. Nurses are frequently the first members of the public to detect abuse. Abuse includes a physical, verbal, sexual, or emotional attack; neglect; and abandonment. Targets of abuse include infants, children, and adult men and women of all ages. Abusers are men and women of all ages, races, socioeconomic groups, and religious backgrounds. Nurses are obligated both ethically and legally to report abuse. In many states, the failure to report actual or suspected abuse is a crime in itself. Nurses are protected by law against suits from alleged abusers if they file a report of suspected abuse in good faith that turns out to be erroneous

Know how to develop conversation skills, listening skills and how silence may be used in communication

CONVERSATION SKILLS Sit when communicating Be alert and relaxed and take your time Keep the conversation as natural as possible Maintain eye contact Use appropriate facial expressions and body gestures Think before responding to the patient Do not pretend to listen Listen for themes in the patients comments Use silence, therapeutic touch and humor appropriately Observe Control tone of voice be flexible be knowledgeable be truthful keep an open mind be clean on concise LISTENING SKILLS When possible, sit when communicating with a patient. Do not cross your arms or legs because that body language conveys a message of being closed to the patient's comments. Be alert and relaxed and take sufficient time so that the patient feels at ease during the conversation. Keep the conversation as natural as possible, and avoid sounding overly eager. If culturally appropriate, maintain eye contact with the patient, without staring, in a face-to-face pose. This technique conveys interest in the conversation and willingness to listen. Indicate that you are paying attention to what the patient is saying by using appropriate facial expressions and body gestures. Be attentive to both your own and the patient's verbal and nonverbal communication. Think before responding to the patient. Responding impulsively tends to disrupt communication and listening. Do not pretend to listen. Most patients are sensitive to an attitude of feigned attention or to boredom and apathy. Listen for themes in the patient's comments. What are the repeated themes in the person's speech and behavior? What topics does the patient tend to avoid? What subjects tend to make the patient shift the conversation to other subjects? What inconsistencies and gaps appear in the patient's conversations? SILENCE You can use silence appropriately, allowing the patient to gather his or her thoughts and to proceed at his or her own pace to initiate a conversation or to continue speaking (Boyd, 2015). During periods of silence, you can reflect on what has already been shared and observe the patient without having to concentrate simultaneously on the spoken word. Periods of silence during communication can carry a variety of meanings: The patient might be comfortable and content in the nurse-patient relationship. Continuous talking is unnecessary. The patient might be trying to demonstrate stoicism and the ability to cope without help. The patient might be exploring inner thoughts or feelings, and a conversation would disrupt this. In effect, the patient is really saying, "I need some time to think." The patient might be fearful and use silence as an escape from a threat. The patient might be angry and use silence to display this emotion. The patient's culture may require longer pauses between verbal communication. In time, you might discuss the silence with the patient, especially if you wish to understand its meaning. Fear of silence sometimes leads to too much talking by the nurse. Also, excessive talking tends to place the focus on the nurse rather than on the patient. TOUCH Touch is a powerful means of communication with multiple meanings. It can connect people; provide affirmation, reassurance, and stimulation; decrease loneliness; increase self-esteem; and share warmth, intimacy, approval, and emotional support. It can also communicate frustration, anger, aggression, and punishment, and invade personal space and privacy. Because of the personal nature of touching, be sure to weigh the benefit of touch against the detrimental use of touch for each patient. Touch can be a powerful therapeutic tool when used at the right time. Anxiety or discomfort might result, however, when a patient does not understand the meaning of a tactile gesture or when the patient simply dislikes being touched.

Differentiate between Civil law and Criminal law

Civil law deals with the disputes between individuals, organizations, or between the two, in which compensation is awarded to the victim. Criminal law is the body of law that deals with crime and the legal punishment of criminal offenses.

Care-based approach: What is important?

Dissatisfaction with the principle-based approach to bioethics has led many nurses to look to care as the foundation for nursing's ethical obligations. The nurse-patient relationship is central to the care-based approach, which directs attention to the specific situations of individual patients viewed within the context of their life narrative. The care-based approach is essential to person-centered care. The care perspective directs that how you choose to "be" and act each time you encounter a patient or colleague is a matter of ethical significance. Ethics is not reduced to a decision to withhold or withdraw life-sustaining treatment. Characteristics of the care perspective include the following (Taylor, 1993): Centrality of the caring relationship Promotion of the dignity and respect of patients as people Attention to the particulars of individual patients Cultivation of responsiveness to others and professional responsibility A redefinition of fundamental moral skills to include virtues like kindness, attentiveness, empathy, compassion, reliability

Understand how "Ethics are a guide to action"

Ethical dilemmas arise when attempted adherence to basic ethical principles results in two conflicting courses of action. There is no foolproof method for identifying which principle is most important when there is conflict between competing principles. Popularized versions of the principle-based approach to bioethics have too frequently resulted in a type of "quandary ethics" that diminishes in importance the everyday ethical concerns of nurses (Taylor, 1997) and misleadingly suggests that how ethical dilemmas are resolved is unimportant, as long as a person can justify his or her recommendation with recourse to a principle. Thus, many health care professionals equate ethics with decisions about whether to "pull the plug," ignoring the ethical challenges involved in daily decisions about what constitutes an honest day's work, how respectful we are to others, how truthful, how responsible, and how compassionate.

List and understand personal factors that can influence communication

Factors influencing communication include level of development; biological sex; sociocultural differences; roles and responsibilities; space and territoriality; physical, mental, and emotional state; and environment.

Know Maslow's hierarchy of needs: Understand how it is used as a framework/guideline for priorities

From bottom to top (the bottom level must be met before the patient can attempt to fulfill the next level) *Physiological needs- most basic human needs for air, water, food, housing, sleep and sex *Safety needs- the need for a secure environment in which one can live, work and play *Love needs- a need to give and receive love *Esteem needs- a need to have high self esteem *Self- Actualization- a need for achievement and mastery

What rights do patients have under HIPAA? What are violations of HIPAA?

HIPAA is a federal law that protects and individuals private information and personal health info. Only the client and those health care workers involved in the care of the client have access to their information. A violations would be disclosing personal info without the persons permission. Violations can have both legal and ethical consequences. A breach in client confidentiality is an ethical violation of the clients right to privacy. Termination, fines, loss of license, litigation and prison consequences.

Know and understand the five elements necessary to prove Malpractice/negligence: Duty, Breach of Duty, Causation, Damage

Liability involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages. Duty refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse-patient relationship. Breach of duty is the failure to meet the standard of care. Causation, the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) actually caused the injury. Damages are the actual harm or injury resulting to the patient. Examples of these four elements are presented in Table 7-2. (see table 7-2)

Know the role of the State Board of Nursing regarding licensure

Licensure is a specialized form of credentialing based on laws passed by a state legislature. A license is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. Licensure is discussed in Chapter 1. In addition to successfully completing an accredited nursing program of study and passing the National Council Licensure Examination (NCLEX), to maintain a license in good standing a nurse must meet other requirements as determined by the state or territory. These requirements typically include good moral character, continuing clinical competence or continuing education, the absence of a criminal record, English proficiency, and compliance with specific provisions of the state's nursing laws. Some states require criminal background checks. State Boards of Nursing may revoke or suspend a nurse's license or registration for various reasons. Drug or alcohol abuse is currently the most frequent reason. Other reasons for revocation or suspension of a license or registration include fraud, deceptive practices, criminal acts, previous disciplinary action by other state boards, gross or ordinary negligence, and physical or mental impairments, including those resulting from aging.

What precautions should nurses take when using electronic communication/social media?

Look at ANA and NCSBN guidelines regarding use of social media. Cannot post about patients due to HIPPA, where you work etc. The risk for violating patient privacy and confidentiality exists any time a message is sent electronically. Health care agencies usually have security measures in place to safeguard e-mail and text communications. 1.Nurses must not transmit or place online individually identifiable patient information. 2.Nurses must observe ethically prescribed professional patient-nurse boundaries. 3. Nurses should understand that patients, colleagues, institutions, and employers may view postings. 4. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. 5. Nurses should bring content that could harm a patient's privacy, rights, or welfare to the attention of appropriate authorities. 6. Nurses should participate in developing institutional policies governing online conduct.

Know the role of the institutional ethics committee

Nurses and Ethics Committees An increasing number of health care institutions have developed ethics committees whose chief functions include education, policy making, case review and consultation, quality, and in some cases research. Some committees focus on clinical ethics and some on organizational ethics. These committees are well equipped to deal with the complexities of modern health care because they are multidisciplinary and provide a forum for different views to be aired without fear of repercussion. Increasingly, hospitals are hiring ethics consultants to address the ethical issues that arise in the care of patients. Nurses bring an important voice to the ethics committee or consultant. When clinical issues are being reviewed, nurses can help to ensure that the technical facts are understood, that the appropriate decision makers have been identified, that the patient's medical and overall best interests have been identified, and that the course of action selected from the alternatives is justified by sound ethical principles. Nurses' strong backgrounds in interpersonal communications allow us to contribute unique knowledge about the patient and family to the discussion and to facilitate the ethics committee's group dynamics. Nurses also play an important role in policy making. We are frequently able to identify what policies are needed to address recurring ethical concerns and to suggest needed modifications of existing policies.

What does the nurse need to know when executing provider orders?

Nurses are legally responsible for carrying out the orders of a legitimate provider in charge of a patient unless a reasonable person would anticipate the order would lead to injury. Follow these guidelines: 1. Be familiar with the parties designated in your state's nurse practice act who can legally write orders for the nurse to execute. (For example, in many states, a physician assistant cannot legally write orders for the nurse.) 2. Be familiar with your institution's or facility's policy regarding provider orders. 3. Attempt to get all provider orders in writing. Verbal orders (VOs) and telephone orders (TOs) should be countersigned within 24 hours. Take the following steps to prevent errors caused by TOs:Limit TOs to true emergency situations when there is no alternative.Designate which nurses may take TOs (e.g., those who have more education and experience).Repeat the TO back to the provider for confirmation.Document the order, its time and date, the situation necessitating the order, the provider prescribing and reconfirming the order as it is read back, and your name. Indicate if the order is a VO or TO.When possible, have two nurses listen to a questionable TO, with both nurses countersigning the order. See Chapter 19 for additional guidelines on executing verbal, telephone, and fax orders. 4. The Joint Commission (2016b) now permits licensed independent health care providers to send orders via text messaging "as long as a secure text messaging platform is used and the required components of an order are included." To read more about The Joint Commission's position on sending orders by text message, visit www.jointcommission.org/assets/1/6/Update_Texting_Orders.pdf. 5. Question any health care provider order that is:AmbiguousContraindicated by normal practice (e.g., an abnormally high dose of medication)Contraindicated by the patient's present condition (e.g., as a patient's present condition improves, the patient may no longer need aggressive forms of treatment)

Know what it means to cultivate ethical agency

Nurses committed to high-quality care base their practice on professional standards of ethical conduct as well as professional values. The study of professional ethical behavior begins in nursing school, continues in formal and informal discussions with colleagues and peers, and culminates when nurses "try on" and adopt the behaviors of role models who practice professional nursing consistent with high ethical standards. How do nurses learn the standards for professional ethical behavior? At the very least, nurses should cultivate the virtues of nursing, understand ethical theories that dictate and justify professional conduct, and be familiar with codes of ethics for nurses and standards for professional nursing conduct. Moral Agency The fact that we want to be nurses does not automatically mean we have some natural ability to always do the ethically right thing because we know it is the right thing to do. This ability, moral agency or moral capacity, must be cultivated in the same way that nurses cultivate the ability to do the scientifically right thing when providing care.

What is the nurse accountable for when in a short staffing situation?

Professional nurses are responsible for delegating nursing activities, but although RNs may delegate elements of care, they do not delegate the nursing process itself. As a nurse, you remain accountable for any actions you delegate. Understaffing, sometimes called short staffing, is a problem that results in reduced quality of nursing care and may jeopardize patient safety. Temporary management solutions to understaffing, such as floating nurses from one unit to another, or asking (or mandating) nurses to work overtime or double (back-to-back) shifts, are ineffective because they can further jeopardize patient safety. A nurse in an understaffed facility will be held to a professional standard of judgment for accepting responsibility for work and for delegating nursing responsibilities to others. Thus, if a patient claims negligent care, a nurse claiming to have been overworked that evening because of an unrealistic assignment does not have adequate grounds for a legal defense. If patient injury results, the facility and nurse employee will most likely be named as codefendants. Some state nursing associations are using "protest of assignment forms" to track employer practices of routine understaffing.

Understand why each of these could be an ethical problem: Paternalism, deception, privacy/social media, confidentiality, allocation of resources, consent, technology issues, incompetent nurses/doctors, short-staffing, beginning of life issues, end of life issues

See screen shot (examples of ethical problems)

Understand and give examples of different family risk factors: Lifestyle, psychosocial, environmental, biologic

See screen shot. Box 4-1

Values of nursing as a profession (know definitions): Altruism, autonomy, human dignity, integrity, social justice

See table 6-1

State what SBAR is, how it is used; be able to identify what communication takes place in each phase of SBAR

Situation- patient in 302, vital signs, background on what happened to patient. Background- patients mental status, skin color, are they on oxygen, blood pressure etc. Assessment- this is what I think the problem is. Cardiac, infection, neurologic, respiratory etc. Recommendation- tests needed, change in treatment, antibiotics, etc.

Principles of bioethics (know definitions/examples): Autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, privacy, confidentiality

The principles offer general guides to action. All things being equal, we ought to act at all times in a manner that respects the autonomy of others, does not harm, does benefit others, treats others fairly and is faithful to the promises we make to others. It is rarely that simple and people see benefits and harm differently. See table 6-2

Understand how the following affect community health: Social support, Community health structure, Economic resources, Environmental factors

Social Support- support system made up of all ppl who help meet financial, personal, physical, and emotional needs. Family, friends and neighbors also churches and organizations provide the best social support within a community. Community health structure- directly affects the health of the people living within it. Size and location of community often determines what services are available. ex- rural residents might have to travel long distances for care. (see screenshot ) Economic resources- personal finances and health care insurance coverage affect persons access to health care services within a community. Many part time and unskilled jobs provide no insurance, Affordable Care Act aims to provide improved health security. Environmental factors- environment of community can either have helpful or harmful effects on health. Quality of air and water differs across communities. Environmental barriers to accessing health care within a community may include lack of transportation, distance to services, and location of the services.

Know the nurse's responsibilities when witnessing a will

State and provincial laws regulate requirements for wills. The person who makes a will is called the testator. A will describes the intentions of a testator (for who will manage the estate and how property is to be disposed) to be carried out upon his or her death. A person who receives money or property from a will is called a beneficiary. Depending on state law, nurses may be asked occasionally to witness a testator's signing of his or her will and should be familiar with the following guidelines: The witness should feel sure that the testator is of sound mind—that is, that the testator knows what he or she is doing and is free of the influence of drugs that could distort thinking. The witness should feel sure that the testator is acting voluntarily and is not being coerced in any way concerning the terms of his or her will. Witnesses should watch the testator sign the will, and they should sign in the presence of each other. State law indicates how many witnesses must acknowledge the testator's signature on a will; two or three witnesses are most commonly required. Witnesses to the signature on a will do not need to read it, but they should be sure that the document being signed is a will and not some other type of document. In most states, a person who is a beneficiary in a will is disqualified from being a witness to the testator's signature.

Know personal and cultural considerations regarding touch, eye contact

Tactile sense has been studied seriously as a form of nonverbal communication only since the 1960s. Touch is a personal behavior and means different things to different people. Familial, regional, class, and cultural influences largely shape tactile experiences. Factors such as age and sex also play a key role in meanings associated with touch. Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. Communication often begins with eye contact. A glance, for example, is often an attention-getting method to open conversation. In many cultures, eye contact suggests respect and a willingness to listen and to keep communication open. Its absence often indicates anxiety or defenselessness, or avoidance of communication. Some view eye contact as the nonverbal communication that reveals a person's true nature. However, some Asian and Native American cultures view eye contact as an invasion of a person's privacy. In other cultures, people are taught to avoid eye contact or, out of respect, not to make eye contact with a superior. In addition to the messages sent by eye contact, the eyes carry other nonverbal messages. For example, the eyes fix in a stare during anger, tend to narrow in disgust, and ordinarily open wide in fear. Some people who experience fear might be unable to speak and only their eyes will send the message of anxiety. A blank stare can indicate daydreaming or inattentiveness.

What is in the ANA Code of Ethics?

The "registered nurse integrates the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015a) to guide nursing practice and articulate the moral foundations of nursing." The criteria that follow are derived from the Provisions of the Code of Ethics, reinforcing the importance of every nurse being familiar with the Code. Box 6-1 American Nurses Association Code for Nurses 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 2. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. 4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6. The nurse through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

What responsibilities do nurses have when caring for a patient in restraints? What are patient's rights regarding restraints?

The Nursing Home Reform Act of 1987 states that long-term care facility residents have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat medical symptoms. When caring for a patient who requires restraints, be sure that you are familiar with your institution's policies and the guidelines set forth by The Joint Commission. Safe use of restraints is discussed in Chapter 27. Also see the discussion of restraints earlier in this chapter under the heading "False Imprisonment."

State how communication affects each step of the nursing process

The ability to communicate with patients, other nurses, and other health care professionals is essential for effective use of the nursing process. Knowledge of the communication process and effective communication techniques is fundamental to all steps of the nursing process. At the same time, the nursing process provides the guidance and direction needed to communicate in a professional manner clearly, effectively, and compassionately. (read chapter 8, pages 158-159)

Understand how the family is an essential consideration in nursing care

The nurse can help reduce risk factors with activities that promote health for all family members at any level of development. Recall that each person has his or her own definition of health, based in part on family beliefs and values about health and illness. The nurse assists both the person and the family to meet basic human needs. Examples of stage-specific risk factors and nursing interventions to promote health in the family are shown in Table 4-2. Nurses may carry out such activities themselves or may refer the individual or family to other health care providers. Health promotion activities and nursing actions can reduce the risk for illness and facilitate healthy behaviors at any age within the family life cycle.

What is an incident/variance/occurrence report? What should the nurse know about it?

They are used by health care facilities to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor. These reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks. More harm than good results from ignoring mistakes. Incident reports improve the management and treatment of patients by identifying high-risk patterns and initiating in-service programs to prevent future problems. These forms also make all the facts about an incident available to the facility in case of litigation. Increasingly, facilities use paperless computer-based reporting systems that are secure, timely, efficient, and effective. These may also offer online help and formal education and serve as a valuable tool for data analysis. The nurse responsible for a potential or actual harmful incident or who witnesses an injury is the one who completes the incident form. This form should contain the complete name of the person or people involved and the names of all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident. *do not put in the patients record bc can be used in court*

Definition of values, how values are formed and transmitted

Values are beliefs about the worth of something, about what matters, that act as a standard to guid one's behavior. The amount of time, passion and money you devote to relationships, work, study, fitness, leisure and experiences reveals something about the importance you attach to these endeavors. They are formed during a lifetime involving influences from the environment, family and culture. Common modes of value transmission include modeling, moralizing (taught complete value system that allows little opportunity for them to weigh diff values), laissez-faire (explore values on own, no guidance and may lead to confusion), rewarding/punishing (rewarded for demonstrating values of parents and punished for the opposite), and responsible choice (encourage to explore competing values with support and guidance offered).

How should nurses respond to disruptive behaviors and communication?

When disruptive behavior occurs, it is best to respond assertively and address the issue directly with those involved. If this is not possible, ask to speak to the person in private and address any disrespectful remarks or behaviors. Nurses should factually document the occurrence of any bullying behaviors and speak to a nurse-manager if the behavior continues (Gessler, Rosenstein, & Ferron, 2012). Facility administrative policies and procedures should be implemented to deal with individual situations in a constructive manner. Addressing disruptive behaviors requires the determination that bullying and other behaviors and inappropriate communication will no longer be tolerated in order to promote a healthy work environment. The previously discussed standard from The Joint Commission (2008) regarding preventing disruptive behaviors in health care facilities includes the following key recommendations:

Know the difference between certification and licensure

Whereas licensure measures entry-level competence, certification validates specialty knowledge, experience, and clinical judgment. Nursing certification is offered by many U.S. professional organizations, including two primary organizations: the American Association of Critical-Care Nurses, which represents the specialty with the largest number of certified nurses, and the American Nurses Credentialing Center (http://www.nursecredentialing.org/Certification.aspx), a subsidiary of ANA, which began certifying nurses in 1974. The latter is the largest and most prestigious nurse credentialing organization in the United States and has certified more than a quarter million nurses since 1990. Although certification, which involves special testing, is voluntary, nurse specialists are increasingly becoming certified. Certification is one means to demonstrate advanced proficiency and a commitment to ensuring competence in the context of the current U.S. health care crisis, evidenced by daily reports of unsafe care, rising litigation, escalating costs, and a worsening nursing shortage.

List and understand blocks to communication

failure to verbalize, failure to perceive, failure to listen, changing the subject, giving false assurance, gossip & rumor, disruptive behavior, incivility and bullying.

State what nurses need to be aware of regarding nonverbal communication and body language...what happens when verbal/non-verbal messages conflict?

nonverbal communication- physical gestures, body language. For example, not making eye contact shows not being engaged in the conversation, slouching or crossing arms also shows not being engaged. When verbal/non-verbal messages conflict, the nonverbal or physical messages tend to outweigh what is being said verbally.

Know the developmental stages of the family and what risk factors exist at each stage

see table 4-2 screenshot