Safe and Effective Care Environment: Management of Care

A 71-year-old diabetic client is considering participating in a research study being performed about a new method of treatment for diabetic ulcers. Which question from the client is most appropriate when determining whether this client should sign informed consent? 1. What kinds of risks are involved in this study? 2. Will I be able to live at home during the study? 3. How much will I be compensated for the study? 4. Can my spouse be part of the study?

Answer 1 1. What kinds of risks are involved in this study? Some clients take part in research studies and although this is usually the client's choice, there still must be informed consent signed before starting. The client should find out as much about the study as possible by asking questions. It is appropriate for the client to ask about such conditions as what risks are involved with the study, how long the study will last, and whether or not there will be painful procedures associated with the study. 2. Will I be able to live at home during the study? This question is relevant if the client believes them to be important enough to ask, but are not some of the main components of a research study that must be contemplated before being considered 'informed'. 3. How much will I be compensated for the study? This question is relevant if the client believes them to be important enough to ask, but are not some of the main components of a research study that must be contemplated before being considered 'informed'. 4. Can my spouse be part of the study? This question is relevant if the client believes them to be important enough to ask, but are not some of the main components of a research study that must be contemplated before being considered 'informed'. Rationales:

According to the Institute of Medicine report Crossing the Quality Chasm, which of the following are included in the six identified major aims in providing quality healthcare? Select all that apply. 1. Safe 2. Effective 3. Timely 4. Equitable 5. Patient-centered

Answer: 1, 2, 3, 4, 5, Rationale: 1. Safe In 2001, the Institute of Medicine released a report called Crossing the Quality Chasm, which identified factors that contribute to quality care in the healthcare environment. According to the report, these factors best identify when quality care is being delivered. They include care that is safe, effective, patient-centered, timely, efficient, and equitable. 2. Effective In 2001, the Institute of Medicine released a report called Crossing the Quality Chasm, which identified factors that contribute to quality care in the healthcare environment. According to the report, these factors best identify when quality care is being delivered. They include care that is safe, effective, patient-centered, timely, efficient, and equitable. 3. Timely In 2001, the Institute of Medicine released a report called Crossing the Quality Chasm, which identified factors that contribute to quality care in the healthcare environment. According to the report, these factors best identify when quality care is being delivered. They include care that is safe, effective, patient-centered, timely, efficient, and equitable. 4. Equitable In 2001, the Institute of Medicine released a report called Crossing the Quality Chasm, which identified factors that contribute to quality care in the healthcare environment. According to the report, these factors best identify when quality care is being delivered. They include care that is safe, effective, patient-centered, timely, efficient, and equitable. 5. Patient-centered In 2001, the Institute of Medicine released a report called Crossing the Quality Chasm, which identified factors that contribute to quality care in the healthcare environment. According to the report, these factors best identify when quality care is being delivered. They include care that is safe, effective, patient-centered, timely, efficient, and equitable.

A nurse is caring for a client who may be in a domestic violence situation. What actions can the nurse perform that would uphold this client's privacy? Select all that apply. 1. Placing the client in a private room and keeping the door closed 2. Avoiding contact with authorities to disclose the information 3. Not calling the client's spouse to notify of the client's suspected situation 4. Only giving updates to the attending provider and those directly involved with the client's care 5. Filing an incident report about the client instead of contacting hospital administration

Answer: 1, 3, 4 Rationale: 1. Placing the client in a private room and keeping the door closed A nurse has a duty to uphold a client's privacy, but a client in a domestic violence situation also needs to be protected. The nurse must report the situation to the authorities, but can do so while still protecting the client. Ensuring the client is provided a private room in which to discuss the violence is one way in which the nurse can uphold the client's privacy. 2. Avoiding contact with authorities to disclose the information This is not an option. The authorities MUST be contacted when domestic violence is suspected, because nurses are mandatory reporters. 3. Not calling the client's spouse to notify of the client's suspected situation Calling the client's spouse is not the nurse's responsibility and has the potential to endanger the client if the spouse is the abuser. 4. Only giving updates to the attending provider and those directly involved with the client's care The nurse should maximize client privacy by only discussing the client's care with those who are directly involved in the case. 5. Filing an incident report about the client instead of contacting hospital administration A report must be filed with authorities, but this is not the type of information that goes in an incident report.

A woman with left-sided weakness needs assisted living. The woman's family plans to sell her home to pay for assisted living, but the woman refuses to sell because she feels that her family should pay the expenses. What should the nurse do at this time? 1. Carefully explain the woman's wishes to the family. 2. Ask the woman to share experiences about the house. 3. Arrange a meeting between the children and the woman. 4. Suggest using a power of attorney to deal with the children.

Answer: 2 Rationale: The nurse should ask the woman to share experiences about the house and act as her advocate. Listening to the woman helps the nurse to gather additional data, enhance the therapeutic relationship by preserving autonomy, and possibly help solve the problem. The woman has not asked the nurse to intervene on her behalf with the family, so explaining the woman's wishes to the family is not indicated. Also, arranging a meeting ignores her autonomy and forces the woman and family to confront one another. The nurse only arranges a meeting after the woman requests or agrees to it. Suggesting a power of attorney is counterproductive to advocacy.