ATI Leadership
Priority Interventions
*first*: airway--obstruction, stridor --> need to establish patent airway BC 3-5 min without O2 = irreversible brain damage *Second*: breathing--apnea, dec RR --> reposition, administer nalaxone *hird*: circulation--hypotension, dysrhythmia, inadeq CO, compartment syndrome *Fourth*: disability--neurological deficits, stroke in evolution *Fifth*: Exposure--remove client's clothing to allow for a complete assessment or resuscitation
internal emergencies
- Loss of electricity - Loss of potable water - Damage related to fire, weather, explosion - Terrorist attack
documentation regarding restraints
- behaviors that make the restraint necessary - attempts to use alt and client's response -LOC -type of restrain & location -education to client and family -exact time of application and removal -client behavior while restrained -type and frequency of care (ROM, neurosensory checks, removal, integumentary checks) -client's response when restraint is removed -med admin
Critical Thinking
- used when analyzing client issues and problems - reflects upon the meaning of statements, examines available data, and uses reason to make informed decisions
Infants and toddlers--SUFFOCATION
-"back to sleep" -plastic bags out of reach -no co-sleeping -never leave unattended in bathtub -nothing in crib with baby
safe use of oxygen in the home
-"no smoking" sign in a conspicuous place near the front door of the home
Negotiation Strategies
-*avoiding/withdrawing*- both parties know there is a conflict, but refuse to face it. this is usually a lose/lose situation. -*smoothing*- one party tries to smooth another party by trying to satisfy the other party. this is usually a lose/lose situation -*competing/coercing* - one party persues a desired outcome at the expense of the other. this is a win/lose situation -*cooperating/accomodating*- one party sacrifices something, allowing the other party to get what it wants. opposite of competing. this is a lose/win situation. -*compromising/negotiating* - each party gives up something. to make it a win/win each party needs to give up something equally important.
Tasks that nurses may delegate to assistive personnel
-ADLs -Bathing -Grooming -dressing -toileting -ambulating -feeding (without swallowing precautions) -positioning -Routine tasks -bed making -specimen collection _-I&O -vital signs
Nurses role in ethical decision making
-An agent for the client facing an ethical decision -A decision maker for health care delivery
Nurse qualities for effective collaboration
-Good communication skills -Assertiveness -conflict negotiation skills -Leadership skills -Professional presence -Decision making & critical thinking
Characteristics of Managers
-Hold formal position of authority and power -Possess clinical expertise -Network with members of the team -Coach subordinates -Make decisions about organization function, including resources, budget, hiring, and firing
Democratic Leadership
-Includes the group when making decisions -Motivates by supporting achievements -Communication goes up and down the chain of command -when collaboration and cooperation are necessary
Lassiez Faire Leadership
-Makes very few decisions, little planning -motivation is responsibility of individual staff members -Communication up and down chain and btw members - work output is low -effective with professional employees
Tasks that nurses may delegate to practical nurses
-Monitoring findings (as input to the RN's ongoing assessment) -Reinforcing client teaching from a standard care plan -performing trach care -suctioning -check NG tube patency -admin enteral feedings -inserting a urinary cath -administering med (excluding IV in some states
Unintentional torts
-Negligence: practice or misconduct that does not meet expected standards of care and places the client at risk for injury (a nurse fails to implement safety measures for a client who has been identified as at risk for falls -Malpractice (professional negligence)
Nursing Role in Advocacy
-Nurses must ensure that clients are informed of their rights and have adequate information on which to base health care decisions -Nurses must be careful to assist clients w/making health care decisions and not direct or control their decisions -Nurses may need to mediate on the client's behalf when the actions of others are not in the client's best interest or changes need to be made in the plan of care -Situations that a nurse may need to advocate for clients or assist them to advocate for themselves: end-of-life decisions access to health care protection of client privacy informed consent substandard practice -Nurses are accountable for their actions even if they are carrying out a provider's prescription
Prioritization Principles
-Prioritize system before local ("life before limb"). -Prioritize acute (less opportunity for physical adaption) before chronic (greater opportunity for physical adaption). -Actual problems before potential future problems. --- -Listen carefully to clients and don't assume. -Recognize and respond to trends vs transient findings. -Recognize signs of medical emergencies and complications vs "expected client findings". -Apply clinical knowledge to procedural standards to determine the priority action.
abuse
-all 51 states require the report of suspicion of child abuse -some states mandate the report of vulnerable persons, such as older or dependent adults -nurses are required to report any suspicion of abuse following facility policy
report to provider
-assessment data integral to changes in client status -recommendations for changes in the plan of care -clarification of orders
when completing an incident report, include:
-client name and hospital number, date, time, location -factual description of incident and injuries incurred -names of witnesses to the incident and client or witness comments -corrective actions -name and dose of any meds or identification
informed consent guidelines
-consent is required for all care given in a health care facility. -the client provides implied consent when she complies w/ the instructions provided by the nurse. -for an invasive procedure or surgery, the client is required to provide written consent.
Evaluation of an employee's performance
-data should be collected over time and not just represent isolated incidents -actual observed behavior should be documented/used as evidence of satisfactory or unsatisfactory performance (anecdotal notes & are kept in unit manager or equivalent position's files) -peer review: begin with an orientation of staff to the peer review process, only part of data -employee should be given opportunity to provide input into the evaluation -private setting -provide opportunity for feedback
risks associated with restraints
-death by asphyxiation and strangulation -complications related to immobility, pressure ulcers, urinary and fecal incontinence, and pneumonia
Preschoolers and school-age children
-drowning: never swim alone and to wear a life jacket -motor vehicle injury: place children under 12 years in the back seat -sex education: begin education -firearms: keep firearms unloaded, locked up and out of reach; store bullets in a different location -play injury: not to run with candy or objects in mouth, remove doors from refrigerators or other potentially confining structures -burns: water heater no higher than 120F, teach dangers with matches, fireworks, firearms -poison: teach about hazards of alcohol, cigarettes, and prescription, non-prescription and illegal substances
A Home Safety Plan for fire
-emergency numbers near phone for prompt use -ensure that the number and placement of fire extinguishers are adequate and are operable -install and maintain smoke alarms in the home on every floor and routinely change batteries -set a time to routinely change the batteries in the smoke alarms -family exit and meeting plan
Interventions to deter disruptive behaviors
-environment of mutual respect btw staff -model approp behavior -make staff of inapp behav -avoid making excuses for disruptive behav -support zero tolerance for disruptive behav -establish mechanisms for open communication btw staff nurses and nurse managers -adopt policies that limit the risk of retaliation when disruptive behavior is reported
Infants and toddlers--FALLS
-keep crib and playpen rails up -never leave the infant unattended on changing table or other high surface -use gates on stairs -place bed in low
infants and toddlers--POISONING
-keep houseplants and cleaning agents out of reach -inspect and remove sources of lead, pain chips -place poisons, paint, and gas in locked cabinet -keep meds in child-proof containers and locked up -properly disclose of meds that are no longer use or are out of date
Adolescents
-motor vehicle/injury -burns
Guidelines for restraints
-must be ordered -should be ordered for the shortest duration necessary and only if less restrictive measures are not sufficient -a client may voluntarily request temp seclusion -restraints can be physical or chemical -if used, frequency of client assessments in regards to food, fluid, comfort, and safety should be performed and documented every 15-30 min -are used for the physical protection of client, other clients, or staff NEVER for convenience of staff, punishment, clients who are ext physically or mentally unstable, clients who cannot tolerate the decreased stimulation of a seclusion room -PRN prescriptions for restraints are not permitted
restraints should:
-never interfere with treatment -restrict movement as little as is necessary to ensure safety -fit properly -be easily changed to decrease the chance of injury and to provide for the greatest level of dignity
nursing responsibilities in regards to isolation/restraints:
-obtain prescription form provider -conduct neurosensory checks Q 2 hr (circulation, sensation, mobility) -offer food and drinks -means for hygiene and elimination -vitals -ROM of extremities -remove frequently -pad bony prominences -quick-release knot -loose enough for ROM and enough 2 fingers btw device and client -regularly assess the need for continued use of restraints -never leave the client unattended without the restraint
*components of privacy rule*
-only healthcare team members directly responsible for the client's care are allowed access to the patients records. >>nurses may not share information with other clients or staff not involved in the patient care -clients have a right to read and obtain a copy fo their medical record, and agency policy should be followed when the client requests to read or have a copy of the record -no part of the client record can be copied except for authorized exchange of documents between health care institutions >>transfer from a hospital to an extended care facility >>exchange of documents between a general practitioner and a specialist during a consult -client records must be kept in a secure area to prevent inappropriate access to information -client information may not be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone >>many hospitals use a code system in which information is only disclosed to individuals who can provide the code >>nurses should ask any individual inquiring about a client's health status for the code and disclose information only when that code is -communication should only take place in a private setting where it can not be overheard by unauthorized people >>change of shift reports are to be done at the bedside as long as the patient does not have a roommate and no unsolicited visitors are present >>*DO NOT* use: -->walking rounds or taped rounds
change-of-shift report
-performed w/nurse who is assuming responsibility for the client's care -describes the current health status of the client -informs the next shift of pertinent client care information -provides the oncoming nurse the opportunity to ask questions and clarify the plan of care -should be given in a private area
risk factors for falls in older adults
-physical, cognitive, and sensory changes -changes in the musculoskeletal and neurological systems -impaired vision and/or hearing -frequent trips to the bathroom at night because of nocturia and incontinence
Good Samaritan Law
-protect nurses who provide emergency assistance outside of the employment location -must provide standard of care that is reasonable and prudent -state laws vary as to when an individual may begin practicing nursing =
civil law
-protect the individual rights of people -one type that relates to the provision of nursing care is tort law
Legal practice
-provide safe, competent care -advocate for clients' rights -provide care that is within the nurse's scope of practice -discern the responsibilities of nursing in relation to the responsibilities of other members of the health care team -provide care that is consistent with established standards of care -shield oneself from liability
infants and toddlers--MOTOR VEHICLE INJURY
-rear-facing car seat until 2 years of age -use car seat with 5-point harness for infants and children -all car seats should be federally approved and be placed in back seat
Organ donation
-regulated by federal and state laws -donations may be stipulated in a will or designated on an official card -nurses are responsible for answering questions regarding the donation process and for providing emotional support to family members
Modifications to Improve Home Safety
-remove items that could cause the client to trip (throw rugs and loose carpets) -place electrical cords and extension cords against wall behind furniture -monitor gait & balance -grab bars near toiler and in the tub or shower, stool riser -nonskid mat in tub -nonskid footwear
transcribing medical prescriptions
-repeat back the prescription given, making sure to include the medication name (spell if necessary), dosage, time, and route. -question any prescription that may seem contraindicated due to a previous or concurrent prescription or client condition.
incident report
-should be completed asap and within 24 hours of incident -considered confidential & are not shared with pt -not placed nor mentioned in health care record -forwarded to risk management department or officer
Infants and toddlers--ASPIRATION
-small objects out of reach -no hard candy, peanuts, popcorn, or whole or sliced pieces of hot dog -do not place infant in the supine position while feeding or prop the infant's bottle
Types of audits
-structure audits- evaluate the influence of elements that exist separate from or outside of the client-staff interaction -process audits- review how care was provided and assume a relationship exists between nurses and quality of care provided -outcome audits- determine what results, if any, occurred as a result of the nursing care provided
infants and toddlers--BURNS
-test temp of formula and bath water -place pots on back burner and turn handle away from front of stove -supervise the use of faucets -keep matches and lighters out of reach -cover electrical outlets
Emotional Intelligence
-the ability of an individual to perceive and manage the emotions of self and others -developed through understanding the concept and applying it to practice in everyday situations
Clinical Judgement
-the decision made regarding a course of action based on a critical analysis of data -considers the client's needs when deciding to take an action, or modify an intervention based on client's response -used to: analyze date and related evidence, acertain the meaning of data and evidence, apply knowledge to clinical situation, determine client outcomes
bioterrorism
-the dissemination of harmful toxins, bacteria, viruses, and pathogens for the purpose of causing illness or death -examples include anthrax, variola, Clostridium botulism, and Yersinia pestis
when all other less restrictive means have been tried to prevent a client from harming self or others, the following must occur for seclusion or restraints to be used
-tx must be prescribed by provider based on face-to-face assessment -emergency: nurse may place client in restraints, must obtain a prescription form provider ASAP in accordance with policy (usually within 1 hr) -prescription must specify the reason for restraint, type, location, duration, and types of behaviors demonstrated by client -prescription allows only for 4 hr for adult, 2 hr for 9-17, 1 hr for younger than 9 -providers may renew for a max of 24 consecutive hours
passive smoking
-unintentional inhalation of tobacco smoke -exposure can put one at risk for numerous diseases including: cancer, heart disease, and lung infections -low-birth weight, prematurity, stillbirths, and SIDS have been associated with maternal smoking -smoking in presence of children is associated with development of bronchitis, pneumonia, middle ear infections, and an increase in frequency/severity of asthma attacks
actions nurses can take to promote open communication and de-escalate conflicts
-use "I" statements -focus on problem not personal differences -listen carefully -move escalating conflict to a private location or postpone the discussion until later time
GENERAL MEASURES to PREVENT FALLS
1) Call light location and use 2) Respond to call lights in a timely manner 3) Orient client to setting 4) Place client at risk for falls close to the nursing station 5) Ensure bedside table and frequently used items are within reach 6) Maintain bed in low position 7) For clients who are sedated or unconscious, bed rails are up, bed is kept low 8) Avoid the use of full side bed rails for clients who get out of bed without assistance 9) Provide clients with nonskid footwear 10) Keep floor free from clutter with a clear path to the bathroom 11) Keep assistive devices nearby after validation of use 12) Lock wheels on beds, wheelchairs and carts 13) Use chair or bed sensors for clients at risk for getting up unattended to alert staff
Elements necessary to prove negligence
1) duty to provide care as defined by a standard 2) breach of duty by failure to meet standard 3) foreseeability of harm 4) breach of duty has potential to cause harm (combines 2&3) 5) harm occurs
Generational characteristics
1925-1942: veteran -- supports the status quo, accepts authority, appreciates hierarchy, loyal to employer 1943-1960: baby boomer -- accepts authority, workaholics, some struggle with new tech, loyal to employer 1961-1980: gen X -- adapts easily to change, personal life and family are important, proficient with tech, makes frequent job changes 1981-2000: Gen Y -- optimistic and self-confident, values achievement, tech is way of life, at ease with cult diversity
grievances
A wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint. Grievances that cannot be satisfactorily resolved between the parties involved can require management by a third party. Facilities have a formal grievance policy that should be followed when a conflict cannot be resolved. The steps of an institution's grievance procedure should be outlined in the grievance policy.
Intentional torts
Assault and battery Defamation of character False imprisonment
assertive communication
Can be necessary during conflict negotiation. Allows expression in direct, honest, and nonthreatening ways that do not infringe upon the rights of others. A communication style that acknowledges and deals with conflict, recognizes others as equals, and provides a direct statement of feelings.
Novice nurse
Can be students or newly licensed nurses who have minimal clinical experience. They approach situations from theoretical perspective relying on context‑free facts and established guidelines. Rules govern practice.
Classes of fire extinguishers
Class A- combustibles such as paper, wood, upholstery, rags, and trash fires B- flammable liquids/gas fires C- electrical fires
prevention of falls
Complete fall-risk assessment; document identifiable risk; educate client/family of identifiable risk; lock wheels on bed; use chair/bed sensors
Malpractice (professional negligence)
Failure of a person with professional training to act in a reasonable and prudent manner.
steps in progressive discipline
First infraction: Informal reprimand. Manager and employee meet. Discuss the issue. Suggestions for improvement/correction. Second infraction: Written warning. Manager meets with employee to distribute written warning. Review of specific rules/policy violations. Discussion of potential consequences if infractions continue. Third infraction: Employee placed on suspension with or without pay. Time away from work gives the employee opportunity to examine the issues and consider alternatives. Fourth infraction: Employee termination. Follows after multiple warning have been given and employee continues to violate rules and policies.
Typical steps of the grievance process
Formal presentation of the complaint is in the proper chain of command. Formal hearing if the issue is not resolved at a lower level. Professional mediation if a solution is not reached during a formal hearing.
stages of team formation
Forming: -members of team get to know each other -the team leader defines tasks for the team and offers direction Storming: -conflict arises and team members begin to express polarized views. -the team establishes rules and members begin to take on various roles Norming: -the team establishes rules -members show respect for one another and begin to accomplish some of the tasks performing: -the team focuses on accomplishment of tasks
Federal Regulations
HIPAA ADA - Americans with Disabilities Act MHPA - Mental Health Parity Act PSDA - Patient Self Determination Act Uniform Anatomical gift act national organ transplant act
Steps in providing educational programs
Identify and respond: To identify need for knowledge or skill proficiency. Analyze: Deficiencies, and develop learning objectives to meet need. Research: Resources available to address learning objectives based on evidence‑based practice. Plan: Program to address objectives using available resources. 5. Implement: Program(s) at time conducive to staff attendance; consider online learning modules. 6. Evaluate: Use materials and observations to measure behavior changes secondary to learning objectives.
steps of the problem-solving process
Identify the problem - stayed it in objective terms, minimizing emotional overlay. Discuss possible solutions - brainstorming solutions as a group may stimulate new solutions to the old problems. Encourage individuals to think outside the box. Analyze identified solutions - the potential pros and cons of each possible solution should be discussed and attempt to narrow down the number of viable solutions. Select a solution - based on this analysis, select a solution for implementation. Implement the selected solution - a procedure and timeline for implementation checkoff me the implementation of the selected solution. Evaluate the solutions ability to resolve the original problem. The outcome surrounding the new solution should be evaluated according to the predetermined time line. The solution should be given adequate time to become established as a new routine before is evaluated. If the solution is deemed unsuccessful, the problem-solving process will need to be reinstituted and the problem discussed again.
resource management
Includes budgeting and resource allocation. Human, financial, and material resources must be considered. Budgeting is usually the responsibility of the unit manager, but staff nurses can be asked to provide input. Resource allocation is a responsibility of the unit manager as well as every practicing nurse. Providing cost‑effective client care should not compromise quality of care. Resources (supplies, equipment, personnel) are critical to accomplishing the goals and objectives of a health care facility, so it is essential for nurses to understand how to effectively manage resources.
Common causes of conflict
Ineffective communication. Unclear expectations of team members in their various roles. Poorly defined or actualized organizational structure. Conflicts of interest and variance in standards. Incompatibility of individuals. Management or staffing changes. Diversity related to age, gender, race, or ethnicity.
Standards of Care (Practice)
Legal parameters of practice, define and direct the level of care that should be given by a practicing nurse. They are used in malpractice lawsuits to determine if that level was maintained.
information security protocols
Logging off from the computer before leaving the workstation. Never sharing a user ID or password with anyone Never leaving a clients chart or written PHI where others can access it Shredding any printed or written client information used for reporting or client care after it is no longer needed
Young and Middle-Age Adults
MVA are leading cause of death and injury to adults
Authoritative Leadership
Makes decisions for the group. Motivates by coercion. Communication occurs down the chain of command. Work output by staff is usually high: good for crisis situations and bureaucratic settings. Effective for employees with little or no formal education.
Advanced beginner
Most new nurses function at the level of the advanced beginner. Practice independently in the performance of many tasks and can make some clinical judgments. Begin to rely on prior experience to make practice decisions.
intergroup conflict
Occurs between two or more groups of individuals, departments, or organizations and can be caused by a new policy or procedure, a change in leadership, or a change in organizational structure. Example: There is confusion as to whether it is the responsibility of the nursing unit or dietary department to pass meal trays to clients.
interpersonal conflict
Occurs between two or more individuals who are members of the same group
fire exitinguisher Pass sequence
P: pull the pin U: aim at the base of the fire S: squeeze the handle S: sweep the extinguisher from side to side, covering the area of fire
QSEN competencies
Patient-centered care Teamwork and collaboration EBP quality improvement safety informatics
Supervising
Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team
Delegating
Process of transferring authority and responsibility to another member of the health care team to complete a task, while retaining accountability
Delegation Factors
RNs cannot deligate the nursing process, client education, or tasks that require clinical judgment to LPNs or AP
RACE
Rescue: rescue and protect clients by moving to safer location Alarm: activate alarm and report Confine: close doors in windows and turning off any sources of oxygen and any electrical devices Extinguish: extinguish fire if possible using the appropriate fire ext
elements of assertive communication
Selecting an appropriate location for verbal exchange. Maintenance of eye contact. Establishing trust. Being sensitive to cultural needs. Speaking using "I" statements and including affective elements of the situation. Avoiding "you" statements that can indicate blame. Stating concerns using open, honest, direct statements. Conveying empathy. Focusing on the behavior or issue of conflict and avoiding personal attacks. Concluding with a statement that describes a fair solution.
Magnet Recognition Program
The American Nurses Credentialing Center (ANCC) established this to recognize health care organizations that achieve excellence in nursing practice. Health care organizations that apply for Magnet status must demonstrate quality pt care, nursing excellence, and innovations in professional practice. The Magnet Model has 5 components: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovations and Improvements, and Empirical Quality Outcomes. They have to show achievement of the 14 forces of magnetism. Status for 4-year period -- must maintain established standards and submit an annual report
advance directives
The purpose of advance directives is to communicate a client's wishes regarding end-of-life care should the client become unable to do so.
Mass Casualty Incident (MCI)
a catastrophic event that overwhelms local resources multiple resources (federal and state) are necessary to handle the crisis
Durable power of attorney for health care
a legal document that designates a person to make health care decisions on behalf of a patient in the event the patient becomes incapacitated
impaired coworkers
a nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate substance use disorder has a duty to report the coworker to the appropriate manger. each state has laws and regulations that govern the disposition of nurses who have substance use disorders. criminal charges could apply.
Criminal law
a subsection of public law and relates to the relationship of an individual with the govt
seizure
a sudden surge of electrical activity in the brain that affects how a person feels or acts for a short time -can occur at any time during a person's life and can be due to epilepsy, fever, or a variety of medical conditions -partial seizures: due to electrical surges in one part of the brain -generalized seizures: involve the entire brain
Leadership
ability to inspire others to achieve a desired outcome
external emergencies
affect a facility indirectly and include severe weather, volcano eruption, collapses.....
Factors that affect a client's ability to protect himself
age (pediatric and older adult clients are at greater risk) mobility cognitive and sensory awareness emotional state lifestyle and safety awareness
Factors that contribute to client's risk of injury
age and developmental status mobility and balance knowledge about safety hazards sensory and cognitive awareness communication skills home and work environment community medical and pharmacological status
disaster
an even that can cause serious damage, destruction, injuries, and death
discharge planning
an interprofessional process that starts at admission
transfers
can be transferred from one unit, department, or one facility to another must be maintained as the client moves from one setting to another
beneficience
care that is in the best interest of the client
nursing role in case management
coordinating care facilitating continuity of care improving efficiency of care and utilization of resources enhancing quality of care provided limiting unnecessary costs and lengthy stays advocating for client and family
Case management
coordination of care provided by an interprofessional team from the time a client starts receiving care until no longer receives services
decision-making styles
decisive: team uses a minimum amount of data and generates one option flexible: the team uses a limited amount of data and generates several option hierarchical-team uses a large amount of data and generates one option integrative-team uses a large amount of data and generates several options
Older adults can be at an increased risk for falls due to:
decreased strength, impaired mobility and balance, endurance limitations, and decreased sensory perception visual acuity, generalized weakness, orthopedic problems (diabetic neuropathy), urinary frequency, gait and balance problems (parkinson's disease, OA,arthritis) and cognitive dysfunction AE of meds (orthostatic hypotension, drowsiness) also increase risk for falls
Hazardous material
employees have the right to refuse to work in hazardous working conditions if there is a clear threat to their health
Transformational leaders
empower followers to assume responsibility for a communal vision, and personal development is a secondary outcome
Seizure precautions
encompass all nursing interventions to protect the patient from traumatic injury, position for adequate ventilation and drainage of oral secretions, and provide privacy and support following the seizure -rescue equipment (o2, oral airway, suction) -saline lock for IV access if client is at high risk for experiencing a generalized seizure -inspect environment and remove unnecessary items -assign client to a room close to nurse's station -assist client at risk with ambulation and transfers to reduce the risk of injury -nothing in mouth in event of seizure -do not restrain during seizure, ensure safety by lowering client to floor, protect head, remove nearby furniture, provide privacy, place on side, loosen clothing -in event of seizure: stay with client, protect from injury, call for help -note duration and sequence and type of movement -after: explain what happened to client and provide comfort, understanding, and a quiet environment for recovery -document
Ethical Practice
ethics: based on an expected behavior of a certain group in relation to what is considered right and wrong morals: values and beliefs held by a person that guide behavior and decision-making ethical theory: analyzes varying philosophies, systems, ideas, and principles used to make judgments about what is right and wrong ---> utilitarianism (teleological theory) => decision-making based on what provides the greatest good of the greatest number of individuals ---> deontological theory => decision-making based on obligations, duty, and what one considers to be right or wrong
justice
fair treatment in matters related to physical and psychosocial care and use of resources
Transactional Leaders
focus on immediate problems, maintaining the status quo and using rewards to motivate followers
principles of case management
focuses on managed care of the client through collaboration of the health care team in acute and postacute settings goal: to avoid fragmentation of care and control cost
referrals
formal request for service by another care provider
Expert nurse
have garnered our wealth of experience so they can view situations holistically and process information efficiently. Make decisions using an advanced level of intuition and analytical ability. Do not need to rely and rules to comprehend the situation and take action.
types of disruptive behavior
incivility: -action that is rude, intimidating, and insulting Lateral Violence: -occurs between workers who are at the same level within the organization bullying behavior: -persistent and relentless and is aimed at an individual who has limited ability to defend themselves -perpetrator is at a higher level than the victim cyberbullying: -disruptive behavior using the internet or other electronic means
Safety risks based on age and developmental status
infants & toddlers--risk for injury due to a tendency to put objects in their mouth and form hazards encountered while exploring their environment preschool and school-age -- face injury from limited or underdeveloped motor coordination adolescents--can stem from increased desire to make independent decisions, and relying on peers for guidance rather than family
Quasi-intentional torts
invasion of privacy: intrusion into a client's private affairs of a breach of confidentiality defamation of character: false communication or communication with careless disregard for the truth with intent to injure an individual's reputation ---> Libel ---> slander
fidelity
keeping promises and commitments made to others
living will
legal document that expresses client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues
informed consent
legal process by which the client has given written permission for a procedure or treatment to be performed witness the client's signature on informed consent form and to ensure that the informed consent has been appropriately obtained seek assistance of an interpreter
food poisoning
major cause of illness in the U.S. -proper HH, ensuring that eggs, meat and fish are cooked to the correct temperature; handling raw and cooked food seperately to avoid cross-contamination; not using the same container, cutting board, or utensils for raw and cooked foods; refrigerating perishable items; washing raw fruits and vegetables before peeling, cutting, or eating; and not consuming unpasteurized dairy products or untreated water are measures that can prevent food poisoning
signing an informed consent form
must be signed by competent adult emancipated minors (independent of parents, married minor) can provide informed consent for themselves
Client's rights
must ensure that clients understand their rights must protect clients' rights during nursing care
communicable disease
nurses mandated to report to the proper agency (local health department, state health department)
Proficient nurse
nurses who have a significant amount of experience upon which to base their practice. Enhanced observational abilities allow nurses to be able to conceptualize situations more holistically. Well-developed critical thinking and decision-making skills allow nurses to recognize and respond to unexpected changes
Competent Nurse
nurses who've been nurses for 2-3yrs. demonstrate increasing levels of skills and proficiency and clinical judgment. exhibit the ability to organize and plan care using abstract and analytical thinking. can anticipate the long-term outcomes of personal actions
intrapersonal conflict
occurs within the individual because of actual or perceived pressures from incompatible goals or expectations
individuals authorized to grant consent for another person
parent of a minor legal guardian court-specified representative client's health surrogate (individual who has the client's durable power of attorney for health care/health care proxy) spouse or closest available relative (state laws vary)
Maslow's Hierarchy of Needs
physiological, safety, love/belonging, esteem, self-actualization
communication tools
poor communication --> lead to adverse outcomes, sentinel events
accident and injury prevention
preventing injury is a major nursing responsibility
performance appraisal
process by which a supervisor evaluates an employee's performance in relation to the job description for that employee's position as well as other expectations the facility can have
Negotiation
process by which interested parties: resolve ongoing conflicts, agree on steps to take, bargain to protect individual or collective interests, pursue outcomes that benefit mutual interests
consultant
professional who provides expert advice in a particular provide expertise for clients who require specific type of knowledge or service
informed consent responsibilities
provider: obtain consent client: gives informed consent nurse: witness informed consent
cost-effective care strategies
providing clients with needed education to decrease or eliminate future medical costs associated with future complications promoting the use of evidence-based care resulting in improved client care outcomes promoting cost-effective resource management
Behavorial change strategies
rational-empirical: manager provides factual information to support the change, used when resistance to change is minimal normative-reeducative: manager focuses on interpersonal relationships to promote change power-coercive: manager uses rewards to promote change, used when individuals are highly resistant
emergency designations
red-fire pink-newborn/infant/child abduction orange-chemical spill blue-medical emergency gray-tornado black-bomb threat
advocacy
refers to nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care
continuity of care
refers to the consistency of care provided as clients move through the health care system enhances the quality client care and facilitates the achievement of positive client outcomes
Conflict Resolution
result of opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals
Timing of audits
retrospective audits- after client receives care concurrent audits- while client receives care prospective audits- predict how future client care will be affected by current level of services
5 rights of delegation
right task right circumstance right person right direction/communication right supervision/evaluation
essential components of advocacy
risk-taking, vision, self-confidence, articulate communication, assertiveness caring, autonomy, respect, empowerment
Disciplinary Action
should be presented in writing, and corrective action should be based on institutional policy regarding disciplinary actions and/or termination of employment -notify charge nurse, unit manager, and documentation
stages of conflict
stage 1-latent conflict (awareness of potential situations that can create conflict) stage 2-perceived conflict (those affected are discussing the situation but at an impersonal matter) stage 3-felt conflict (those affected become personally involved) stage 4-manifest conflict (those involved begin to take action) stage 5-conflict aftermath (those involved recognize the positive and negative outcomes in how the situation was managed)
Ethical Principles
standards of what is right/wrong with regard to important social values and norms
cost-effective
strategies that achieve optimal results in relation to the money spent to achieve those results "getting your money's worth"
Cost Containment
strategies that promote efficient and competent client care while also producing needed revenues for the continued productivity of the organization
refusal of treatment
the Patient Self-Determination Act (PSDA) stipulates that staff must inform clients they admit to a health care facility of their right to accept or refuse care. if client refuses a tx. they sign a document indicating he or she understands the risk involved with refusing and that they have chosen so. when clients decide to leave the facility against medical advice the nurse notifies the provider and discusses with the client the risks to expect when leaving the facility prior to discharge. nurse then ask client to sign an "Against Medical Advice" form and documents the incident.
Competence
the ability of an employee to meet the requirements of a particular role at an established level of performance
autonomy
the ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest
Clinical Reasoning
the mental process used when analyzing the elements of a clinical situation and using analysis to make a decision
veracity
the nurse's duty to tell the truth
Nonmaleficence
the nurse's obligation to avoid causing harm to the client
Nurse's role in continuity of care
the nurse's role as coordinator of care includes the following: facilitating the continuity of care provided by members of health care system, acting as representative of client and as liason when collab with provider as the coordinator of care, the nurse is responsible for: admission, transfer, discharge, and postdischarge, initiation, revision, and eval of plan of care, report client status to other nurses, coordinate dc plan, facilitate referrals and use of community resources
Socialization
the process by which a person learns a new role and the values and culture of the group within which that role is implemented
Management
the process of planning, organizing, directing, and coordinating, the work within an organization.
Assigning
the process of transferring authority, accountability, responsibility of pt, care to another health care member.
Documentation
to facilitate continuity of care includes the following: graphic records that illustrate trending of assessment data such as vital signs, flow sheets that reflect routine care completed and other care-related data, nurses' notes that describe changes in client status for unusual circumstances, summaries that serve as quick references for client care information,
informatics
use of computers to systematically resolve issues in nursing
Fire Safety
usually due to problems related to electrical or anesthetic equipment; unauthorized can also cause fire -all staff must know: location of exits, alarms, fire extinguishers, and o2 turnoff valves; make sure equipment doesnt block fire doors; know evac plan
carbon monoxide
very dangerous gas bc it binds with hemoglobin and ultimately reduces the oxygen supplied to tissues in the body -cannot be seen, smelled, or tasted -indications: nausea, vomiting, headache, weakness, and unconsciousness
Reporting Incidents
• Records made of unexpected, unusual incidents that affect client, employee, volunteer, visitor • Cannot be subpoenaed by client or used as evidence in lawsuits -examples where an incident report should be filed: med errors, procedure/tx errors, equipment-related injuries/errors, needlestick injuries, client falls/injuries, visitor/volunteer injuries, threat made to client or staff, loss of property (dentures, jewelry, personal wheelchair)
