NURSING CONCEPTS TEST 3

Identify 5 ethical principles and an example of each

-An ethical principle is similar to a camera lens. -Camera lenses can have various magnification or filters; likewise, situations can be viewed differently, depending on the lens.

Define and describe the concept of Leadership

-An interactive process that provides needed guidance and direction. -Nurses are expected to exhibit leadership when delivering patient care and when working with others to address issues that affect the practice of nursing.

Describe the various roles of Nursing in health care organizations

-As the largest health care workforce, nurses are found in nearly all health care organizations. -Nurses provide the knowledge and skills necessary for the delivery of health care services. -The multiple roles that nurses play are found in health care organizations

Define and describe the concept of professionalism

-Assimilation of nursing skills and knowledge integrated with dignity and respect for all human beings. It incorporates the assumptions and values of the profession while maintaining accountability and self-awareness. -Refers to the attributes and behaviors of a nurse as a representative of the profession and as a health care professional. -Encompasses: Autonomy Knowledge Competence Profession-hood Accountability Advocacy Collaborative Practice Commitment

Name major attributes of health policy

-Authorized governmental institutions make the decisions -The decision-making process is subject to public review and input -Health policies address public policy goals

Recognize leadership styles and examples of each

-Autocratic -Democratic -Laissez-faire -Transactional -Transformational -Shared

Differentiate between federal and state laws that have implications to nursing

-Beginnings of medicare started in 1965 as well as disability - Social Security Act -EMTALA- basic act that says if someone shows up to hospital you can't refuse treatment -Patient have right to decide how they want to be treated - 1991 Patient -Self-Determination Act -Patients have to be insured medically - 2010 Patient Protection and Affordable Care Act -HIPAA 1996 -Licensing of professionals—scope of practice -Licensing of health care institutions -Laws relating to public health and disease prevention and control -Consent - treatment, surgery -Advanced directives -living wills -Physician-assisted suicide - most states its illegal

Identify 3 theoretical links to health care organizations and develop a basic understanding of each

-Bureaucracy: -Is a machine like collection of components to be coordinated -All organizations should be controlled centrally -Systems theory: -Focuses on social components that interact (e.g., people, relationships, roles) within the environment, technology, or structure; derived from the desires of the people who work for the organization -Complex adaptive systems are found in organizations that: -Have the ability to react and change when stimulated -Are responsive to changing trends -Transform, adapt, and adjust as needed -Organic and life-like

Describe the scope of safety, including categories of errors and examples of each and scope of errors and examples of each

-Categories of errors -Diagnostic -Treatment -Preventive -Communication -Scope of errors -Latent -Active

Define and describe health care law

-Collection of laws that have a direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and the recipients of health care. -Any law that affects how healthcare runs or is carried out

Fidelity

-Committed and faithful to relationship. We will take care of them

Define and describe Quality

-Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. -Are we following standards of practice and is it making a positive change in someone's outcomes? -Mostly measured by outcomes

Courts and the judiciary

-Determines rights in health policy disputes through judicial review (local, state and national); Complain of violation of policy then court carry out review

Discuss the underlying theory of quality including the Donabedian Model of Structure and Outcomes and the Donabedian Quality of Care Framework

-Donabedian Model of Structure and Outcomes -Organizational Characteristics: People, Equipment/Technology -Process: interactions between health care provider and patient (actual steps taken in delivering care), Results must be patient focused, must deliver results reliably (same results every time) -Outcomes: clinical outcomes, change in individuals and populations, patient perception of care or level of satisfaction, financial -Defined outcomes are the validators of the quality and effectiveness of medical care. Identifies ways to define, categorize, and measure quality. -We measure quality with outcomes

Recognize attributes of professionalism in the nursing profession

-Education -Clinical Judgments -Ethics -Comportment -Therapeutic Communication

Regulatory agencies

-Enforce the laws through a rule-making process; Actually carry out regulations; People at local health departments

Describe 4 ethical theories

-Ethics of Duty -Is the right thing to do so I do it -Ethics of Consequence -Is the greatest good for the greatest number to chose this course of action -Ethics of Character -Is based on life experiences and a willingness to reflect on our actions -Doing things based on background and what I believe -Ethics of Relationship -Is the nature and obligation inherent in human relationships. -I'm doing this bc of my relationship with this person

Regulatory Agencies

Regulatory Agencies: -Oversight bodies in place to ensure health care quality and safety: -Centers for Medicare and Medicaid Services -Can say that if you aren't meeting the standards we are not going to pay for treatment of this patient -Ex. If a patient gets nosacomial infection(infection from hospital) they won't pay for treatment of that because hospital caused it -The Joint Commission - JCO -Talk to anyone on staff to gage how care is being delivered -They say you are or are not meeting standards; you can or you can't continue to practice

Describe Just Culture and its application in Nursing

-A health care system's value is in reporting errors without punishment -"Just culture" seeks to find a balance between the need to learn from mistakes and the need for disciplinary action against employees

Define and describe the health care organizations

-A purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations, or markets. -People + Purpose = Organizations

Understand the basic regulation of nursing practice in the state of Arkansas

-A state board of nursing holds the legal authority for nursing practice and regulates nursing practice through: -Establishing the requirements to obtain a nursing license -Issuing nursing licenses -Determining the scope of practice RN can do this but not this; the NP can do this and not this -Setting minimum education standards -Managing disciplinary procedures -List people who have committed infractions in state online

Describe an Accountable Care Organization

-Accountable care organizations (ACOs) are groups of doctors, hospitals and other health care providers who come together to provide coordinated care to their patients. -The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

Differentiate between a near miss, adverse event, and sentinel event

-Adverse event -Unintended harm by an act of commission or omission rather than as a result of disease process -Near miss -Error of commission or omission that could have harmed a patient, but harm did not occur as a result of chance -Sentinel event -Unexpected occurrence involving death or serious injury

Identify the process of health policy development

-Agenda setting A problem needs not be adressed -Policy formulation Here is a policy for the problem -Policy adoption This is a good policy lets adopt it -Policy implementation Policy put into practice -Policy evaluation Is it working or not?

Executive branch

-Executes and implements laws (federal and state); Look at regulation of law and policy

Identify consequences of failing to act in an ethically appropriate way

-Failure to act or respond in an ethically appropriate way has been linked to: -Serious and potentially dangerous errors -Personal stress -Professional burnout

Discuss the attributes of effective leadership, ensuring understanding of followers, communication and social power

-Followers -Most employees spend the greatest part of their work life as followers -Leaders are followers in some settings, activities, and situations -Effectiveness of leadership depends on the relationship between leaders and followers -Vision -Communication -Communication skills are essential for effective leadership, regardless of leadership style -Communication is influenced by leadership style (Autocratic-one-way/top-down, Democratic-two-way/giving-seeking, Transactional-communicate primarily about work/means to accomplish it, Laissez-faire-little communication with followers) -Decision making -Change -Social power -Leadership power comes from a variety of sources, such as the position held -Leadership style influences how leaders use power -Types of power include: -Coercive -Legitimate -Referent -Reward -Expert -Informational -Organizations benefit when followers are: -Confident -Honest -Credible -Committed to the organization -Able to manage themselves well

Describe the process for a Root Cause Analysis

-Formal process: -Define errors. -What was it? -Identify risks. -Ex. Medication error; medication name looked same as other medication name that was the intended one -Develop and test prevention strategies. Maybe we move those medications far away from eachother and put a warning -Implement and adopt strategies. -Did the strategies work? Did we reduce errors? -Discuss the model case as an example of root cause analysis. -Must be completed when an error happens

Briefly describe the image of nursing

-Gallup Poll finds nurses to be most trusted of 19 professions since 1999 except in 2001 -Nurses are admired for honesty and ethical standards

Define and describe health policy

-Goal-directed decision making about health that is the result of an authorized and public decision-making process. -Health policy includes those actions, nonactions, directions, and/or guidance related to health that are decided by governments or other authorized entities. -Policies can become law over time but not vice versa

Describe the link between formal Nursing leadership and outcomes

-Goals of nursing leadership -Quality patient care -Creation of supportive practice environments for nurses -Nursing leaders are encouraged to use transformational leadership approaches -Increased job satisfaction, empowerment, and autonomy among nurses -Improved patient outcomes -Increased patient satisfaction -Increased patient safety -Fewer adverse events -Fewer complications

Identify 5 theories related to leadership and briefly describe each

-Great Man or Trait Theory -Behavioral Leadership -Situational and Contingency Theory -Charismatic and Transformational Leadership -Complexity Science and Leadership

Identify 3 aspects of ethical decision making

-Health care decisions that present an ethical dilemma are not made by individuals alone. -Health care organization's compliance officer and compliance committee are charged with the responsibility of ensuring that ethical standards are met. -Institutions have reporting mechanisms for unethical behaviors.

Name minor attributes of health policy

-Health policies are subject to ongoing review -Health policy goals change

Describe the transition of though in an organizational safety culture

-Historically, a culture of blame has existed; identify the clinical at fault, followed by disciplinary measures. -Now—the focus is on what when wrong rather than who to blame. -Culture of safety is needed to address errors and to prevent a reoccurrence.

Understand outside influence on policy decisions

-Interest, business, and advocacy groups MEDDLE AND CAUSE CORRUPTION BASTARDS -Pharmaceutical companies have a lot of money and are a type of interest group that can change and sway decision-making

Identify and describe the attributes of safety

-Knowledge -Focus of safety is on the execution of skills, as well as on technology and systems level -Includes application of knowledge; i.e. Critical Thinking -Skills -Nurses need to use tools to contribute to safer systems. -Attitudes -Nurses and other health care professionals need to value their roles in safety and collaboration

Identify ex of each category of health care organizations

-Mission Focus: Research, Education, Practice, Community -Financial Classification: For profit, Not-for-profit -Ownership: Public, private

Nonmaleficence

-Not harmful; inflicting the least amount of harm possible -Giving injections; drawing blood

Justice

-Not treating patients differently bc you like one more than other. Treat same

Identify components that affect Quality and describe the interaction between them

-Patient care outcomes -Patient satisfaction -Evidence-based care delivery -Delivery of safe care -Patient-centered care -Resource efficient

Beneficence

-Promoting well being of patient -If cancer patient wants to quit treatment nurse must comply

Name and describe examples of ethical issues in Nursing

-Protecting patients' rights and human dignity -Not respecting informed consent treatment -Providing care with risk to the health of the nurse -Using or not using chemical or physical restraints -Understaffing -Prolonging the living and dying process with inappropriate measures -Policies that could threaten the quality of care -Working with unethical or impaired colleagues

Identify the major attributes of Health Care Quality

-Safe -Avoidance of injuries; practice within standards of care -Effective -Offers services most important; addresses needs of populations served -If we have population infected with diabetes we are not going to focus on cancer care -Efficient -Transitions are coordinated; monitors costs; minimizes length of stay; work done well and with fewer resources -Hospital care to home care or hospital to clinical care -Transitions are where most errors can occur

Describe the scope of ethics, include 5 types of ethics and examples of each

-Societal Ethics - Society provides a normative basis for ethical behavior with laws and regulations. -Law is the minimum standard of behavior to which all members of society are held. -In nursing, legal standards include: Clinical standards of care Liability Negligence Malpractice -Organizational Ethics -Formal and informal principles and values guide the behavior, decisions, and actions taken by members of an organization. -Directs all aspects of an organization -Bioethics/Clinical Ethics/Research Ethics -Bioethics Ethical questions surrounding biological sciences and technology -Clinical ethics: Decisions made at the bedside -Research ethics: Conduct of research using humans and animals. -IRB regulates this -Professional Ethics -Ethical standards and expectations of a particular profession -Held to a higher standard because of privileged role in society -Code of conduct -Aimed at the highest ideals of practice -Personal Ethics -Continuously intersect with other categories of ethics. -Do not overlap perfectly; consequently, a potential for conflict exists. -Sources of ethics are not static and change over time.

Respect for persons

-Someone that is kind and respects patient views -Family wants life support and you respect their choice

Minor Attributes

-Structure: -The formal rules and policies that govern organizational practices and promote the effective management of materials and resources. -Necessary for the integration of diverse functions and activities across the organization. -Balance is key: supportive structures that minimize restraint -Each professional group has its own authority -Organizational Environment -Internal: Organizational culture (values, beliefs, practice), information systems (HR), Role responsibility, rules and practices -External: economic trends, new laws, government regulations

Identify roles of the professional nurse

-Team Leader/Interprofessionalism: Someone like an RN communicates with Physician, physical therapist, occupational therapist, social services, home care -Teach -Advocate -Assess -Manage Care -Collaborate with other members of health care team

Advisory Bodies

-The Institute of Medicine -Advisory body that gathers information and based on findings here is what needs to happed in nursing -The National Quality Forum -The National Database for Nursing Quality Indicators -The National Center for Nursing Quality -Nursing-specific advisory bodies -Here is what the research says, here is what will help improve your quality -Don't cut funding, just suggestion bodies

Discuss the underlying theory of safety including the swiss cheese model of accident, human factors and crew resource management

-The Swiss Cheese Model of Accident Causation shows how errors occur when situational factors align, despite multiple layers of safeguards for the prevention of errors. Human Factors: -Study of the interrelationships among people, technology, and the work environment. -Consider the ability or inability to perform tasks while attending to multiple things at once. -Work of nurses in acute care environment is very complex. -Focus is on supporting health professionals and eliminating hazards. Crew Resource Management: - Six critical components: 1. Situational awareness 2. Problem identification 3. Decision making by generating alternative acceptable solutions 4. Appropriate workload distribution 5. Time management 6. Conflict resolution

Name examples of health policies

-The creation of public health policy is a responsibility of government and is a means for protecting the public. Policy is: -Goal oriented -Public -Authoritative nature Examples: -Tobacco control- protect public from 2nd hand smoking -Broad-based policies, such as smoking bans and laws -Targeted laws, such as child safety seat laws -Educational requirements, such as vaccinations for child care and school attendance -Community-wide interventions, such as water fluoridation

Describe Sigma Theta Tau

-The mission of the Honor Society of Nursing, Sigma Theta Tau International, is advancing world health and celebrating nursing excellence in scholarship, leadership, and service -STTI membership is by invitation to baccalaureate and graduate nursing students who demonstrate excellence in scholarship and to nurse leaders exhibiting exceptional achievements in nursing.

Legislation

-The process of introducing, adopting, changing, or repealing law -Sometimes it's federal or a state thing -Process of making or changing laws

Regulation

-The process of putting laws into action through the establishment of rules. -Taking laws that are in place and carrying them out

Litigation

-The process of seeking help through the courts to address a perceived wrong -Something happened in regulation process (violated law or infraction) so now we have to litigate -Take care of wrongs

Describe the categories of health care organization

-The significance of this perspective is that all people involved with a health care organization have the capacity to create, innovate, and make meaningful contributions toward producing the dynamic, living social system. -Are driven by the need to provide a broad spectrum of care in a variety of settings to diverse consumers. -Must be efficient. -Must adapt and be innovative to survive.

Define and describe Ethics

-The study or examination of morality through a variety of different approaches -How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person who you are and, ultimately, the professional who you will become.

Liability

-Vicarious liability -Employer liable for the acts of its employee if the employee was acting as an agent of the employer and the actions resulted in injury within that scope of employment

Describe 2 theories related to Health Policy

1. Values -National and state health policy reflect societal values. -Fairness and efficiency are two competing values often at the heart of health policy decision making. -Not efficient and hard to balance the two 2. Dynamic Tension -A dynamic tension exists with access to health care, health care cost, and health care quality. -Changing one of these variables can improve or lessen the effectiveness of another -All play a role together

Differentiate between nurses and patients description of a professional nurse

How nurses describe a "professional nurse": -Highly experienced -Well-educated, with a minimum of a bachelor's degree -Certified in a specialty area -Innovative -Confident -Passionate about nursing How patients describe a "professional nurse": -Good interpersonal skills -Critical thinking ability -Empathetic, caring practices

Differentiate between clinical leadership and interprofessional leadership

Clinical Leadership: -Expert nurses who are role models and positively influence others to improve care -Create a positive atmosphere, foster teamwork, and show respect for others -Who are they? -Staff nurses, clinical educators, advance practice nurses Interprofessional Leadership: -Leadership that goes beyond the discipline of nursing -May include multiple services, such as -Vice president for patient care services -Reduces the use of redundant services -All effective nurse leaders participate in an interprofessional work environment

Legislature

Creates laws and determines appropriate funding (state and federal); Add flouride to water and here is money amt you have

Describe professionalism in nursing related to education, engagement in the profession and professional behaviors

Education: -Regulation related to education and licensure -Graduate from state board-approved nursing program -Increase educational level of nursing workforce -Institute of Medicine (IOM) recommendations -By 2020, 80% of nurses should have earned a baccalaureate degree -By 2020, there should be double the number of doctorally prepared nurses -Lifelong learning (continuing education/certification) Engagement in Profession: -Involvement in local committees or organizations related to nursing -Involvement in state and/or national nursing organizations -mentorship Professional Behaviors: -Has current knowledge of emerging trends in health care -Maintains awareness of world heath issues and political decisions affecting health care -Has ethical comportment -Incorporates evidence in care(evidence-based practice)

Describe the 5 traditional legal disciplines and examples of each

Five traditional legal disciplines: -Tort law Harmful touch of a patient; nurse not changing gloves and spreading infection -Contract law IF APN and you say you can cure them but you dont follow through and they sue you -Property law Data and electronic databases -Constitutional law It has been decided by legal system that a woman can terminate pregnancy -Criminal law Nurse dealing drugs

Identify examples of formal and informal leadership

Formal vs. Informal

Identify 6 groups of stakeholders in health care law

Healthcare law affects all these people and all these people contribute to it: -Workforce Nurses, patient care technicians, all people -Providers People who treat and prescribe: NP, nurse assistant, physicians -Agencies Not people providing care but those regulating it: CDC -Consumers Anyone who is or will receive healthcare -Payers and Payees Health insurance Government -Health Care Organizations Any organization that provides healthcare: hospital, clinic, nursing home

Identify and describe the major and minor attributes of health care organizations

MAJOR ATTRIBUTES Purpose: -To help others by providing health care services, regardless of the profit status or the ownership arrangements. -Is further determined by the organization's mission, vision, and values. -Specialized health care workforce: -Provide highly specialized care. -Provide care that is complex with a narrow margin for error -Use an interprofessional approach to treat the whole patient -Have little tolerance for errors or mistakes that are potentially life-threatening or costly. -Requires extensive education and experiential learning of workers (NURSING SCHOOL) -Public trust: -Is a social contract between the public and the organization. -Fraud and abuse allegations and national corporate chains of for-profit institutions impact this trust.

Define and describe the concept of safety

The prevention of health care errors and the elimination or mitigation of patient injury caused by health care errors.

Describe and understand four elements that must be satisfied to prove malpractice

To prove malpractice there have to be 4 things in place: Duty- it is my job to do something specific Breach- I did not do my job but something else Causation- By doing or not doing what I did it had potential to cause harm in patient Harm- It did actually cause harm; patient suffered in some way -If something doesn't actually cause harm it is not malpractice -Nursing says what standard should be and nurse has to follow that standard

Discuss error reduction, including types of errors

Types of errors: -Errors of execution -Failure of a planned intervention -Failure to complete an action as intended -Variations from the standards of care -Errors in health plan -Wrong diagnosis; wrong treatment plan -More about provider -Errors can represent a system failure or failure by one or more members of the health care team. -Nursing is more about errors of execution

Identify and understand the recommendations from the "FUTURE OF NURSING" report

http://iom.nationalacademies.org/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/nursing-infographic.jpg Recommendations: -Removal of scope-of-practice barriers -Nurses to lead and collaborate -Nurse residency programs -Eighty percent of nurses with a BSN by 2020 -Double the number of nurses with a doctorate degree by 2020 -Nurses engaged in lifelong learning -Preparation and enabling of nurses to lead changes to advance health -Workforce data collected and analyzed

Understand the basics of the Affordable Care Act

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