leadership ex 2
futile treatments
(medications, devices, or therapy) are those that are evaluated by the healthcare team, the family, or both as being nonbeneficial or harmful to the client inasmuch as they bring no benefit to the client
emergence of professional nsg
-1892 congress passed bill acknowledging the contribution of & granting pensions to nurses of the civil war -beginning of great increase in # of nsg schools & beginning of the moving of care from the home to the hospital or clinic -professional nsg education= considerate, skilled pt care that made hospitals acceptable to all ppl, not just the poor
greater involvement of the govt
-1935 govt providing grants in aid to assist in est. of public health -hospital survey & construction act of 1946 (hill burton act) = construction of many hospitals & other facilities -medicare: plan for those on SS & their dependents -medicaid: state health plans for certain low income individuals paid thru a combo of state & federal funds -medicare & medicaid est in 1965 -passage of pt protection & affordable care act of 2010 another major step to assure healthcare for all legal residents of US
charitable immunity for volunteers in healht settings
-1997 govt enacted volunteer protecting act; immunity from charges of simple negligence & allows charges for gross negligence only for volunteers in health clinics -State laws protecting volunteers may provide more protection but cannot limit the protection provided under federal law -doesnt mean a person can't sue but less likely that they could win -Legislation in some states requires that the clinic inform clients in writing that by accepting free care they are agreeing to the limited liability of the care providers.
nurse as witness to fact
-A witness to fact is an individual who has firsthand knowledge of the specific situation that forms the basis of the legal action. A witness to fact (also referred to as a lay witness) testifies to the exact situation and circumstances of the event or events in question.
medicare
-A: insurance that could be purchased to meet dr fees & outpt costs; automatic enrollment for those on SS; pays only for acute hospitalization and some time of rehab -B: for ppl 65+ & others getting SS payments; optional & a premium is deducted from SS check to pay; doesnt pay for any LTC or custodial care in nsg home; reimburses for dr care & out pt services based on fixed schedule of payments -D: covers rx drugs -admin thru CMS to process claims -may ppl pay for supplemental insurance to cover what medicare pt a & b dont pay; called medigap insurance
defamation of character
-Any time that shared information is detrimental to a person's reputation, the person sharing the information may be liable for defamation of character -written defamation is libal; oral is slander; defamation involves communication that's malicious & false -pts may charge that comments in chart adversely affected their care by prejudicing other staff against them; astute nurse will chart only objective info ; no opinionated terms like appears to be, is lying -can aslo be charged when comments/verbal statements are made regarding another health care provider
energy medicine
-BEM applications to the body, radiofrequency hyperthermia, radiofrequency diathermy, magnets, nerve stimulators, biofields (manipulators of energy fields originating within the body, reiki, therapeutic touch)
centers for medicare & medicaid services
-CMS announced in oct 2008 they wouldn't reimburse hospitals for costs associated w/ six srs hospital acquired complications -pressure ulcers, 2 HAIs (cath associated & UTI/CAUTIs, & staph septiciemia methicillin resistant) & 3 never events (air embolism, blood incompatibility, & foreign object left behind in surgical pt) -these are preventable complications & denying reimbursement provides strong incentive for quality improvement actions to avert them
categories improving client safety
-Creating and sustaining a culture of safety -Informed consent, life-sustaining treatment, disclosure, and care of the caregiver -Matching healthcare needs with service delivery capability -Facilitating information transfer and clear communication -Medication management -Prevention of healthcare-associated infections -Condition- and site-specific practices
regulation of nsg home care
-Federal Budget Act of 1987, government regulations mandate specific assessment tools; planning processes; standards of care, including the use of restraints and psychoactive medications; documentation systems used; and evaluation tools -data collected according to minimum data set (MDS) -visited by survey team responsible for ensuring adherence to regulatory stds; results of survey are public documents and must be displayed in each facility in place accessible to public & to residents who wish to review them
insitutional charitable immunity
-Historically, charitable immunity covered all the work of some hospitals and churches. -was granted if all the income for the institution was derived from charitable giving -
supervisory liability
-In the role of a clinical leader, charge nurse, unit manager, supervisor, or any other role that involves delegation, supervision, or direction of other people, the nurse is potentially liable for the actions of others -supervising nurse is responsible for exercising good judgment in supervisory role including making appropriate decisions about assignments & delegation of tasks -If an error occurs and the supervising nurse is shown to have exercised sound judgment in all decisions made in that capacity, the supervising nurse may not be held liable for the error of a subordinate -extent of the subordinate's responsibility would depend on his or her level of education and training; ppl w/ limited education or training might not be liable for some errors; more education they have the more liable
nsg homes
-LTC -give care & + living environment for pts who have the greatest # of deficits in ADLs (dressing, bathing, eating, toileting, ambulating) -nsg home that provides skilled care in nsg, PT, & speech thx = skilled nsg facility (SNF)
vertically integreated hc systems
-Organizations contracting to provide managed care are expanding their own control through the development of these systems; they provide every level of hc service -may have contracted physicians, laboratories, a hospital, a subacute facility, a rehabilitation facility, and a home care agency. -allows the contracting organization to offer managed care corporations a package that provides care at all levels for each enrolled member of the managed care plan for a capitated fee. -has incentive to ctrl costs by decreasing the use of high cost services & effectively using low cost ones
contributing factors in rising healthcare costs
-Price of new technology -Construction of new facilities -Higher survival rates, leading to greater need for costly intensive or long-term care -Growing population of older adults requiring healthcare -Rise in salaries for healthcare providers -High costs of drugs and health-related equipment
teamstepps
-Team Strategies and Tools to Enhance Performance and Patient Safety -program that helps an organization make changes resulting in efficient & respectful exchanges of info that improve pt safety & rn job satisfaction -targets 4 competencies: team leadership focusing on a positive environment, situation monitoring in which the entire team must be aware of the environment & team performance at all times, mutual support, & communication
statutory law
-a statute is a rule/regulation est. by a govt legislative authority -published in codes that are broken down into specific rules -includes constitutional law & enacted law -enacted law includes all bills passed by legislative bodies whether @ the local, state, or province or national level; ex. SS act -nurse practice acts in various states are ex. of enacted laws @ state level
types of community disasters
-acts of terror -disease; esp epidemic disease -drought -earthquake -fire -flood -food contamination -hazmat -hurricane -power outages -tornado
classification according to type of care
-acute care: illness needing stat hospitalization & provision of dx tests, tx, &/or monitoring that req. cont. availability of skilled nsg care; goal=recovery & restoration to previous level of funciton -long term acute care: illness that has stabilized but needs ongoing skilled care s/a vent support or care for major wounds; goals= correction of underlying problem -subacute care: care after initial recovery from an acute illness needing inpt care; goals=restore function for d/c to home; usually in diff unit in acute care hospital -skilled nsg care: care after initial recovery from acute illness but needing inpt care or following subacute care; goals=to restore function for d/c to home; usually at nsg home -custodial care: care needed bc of functional deficits in ADLs vs illness; care can be given at home, nsg home, or adult family home; goals=maintenance of function & max wellness w/ disability -hospice care: for terminally ill in last 6 mo before expected death; care in home or inpt hospice; goals=pt autonomy & relief of symptoms while supporting pt & fam toward peaceful death -ambulatory care: received needed health care then can be d/c to home; clinic or office; <24hr; goals= tx health problem & returning to independent living situation -home care: providers visit home for care, teaching pt & fam how to manage care @ home, & eval response to tx; goal= effective pt & family self care
criminal law
-addresses gen welfare of the public -may be punishable by imprisonment, parole conditions, a loss of privilege (such as a license), a fine, or any combo -misdemeanor is lesser infraction & punishable by a fine or jail for <1yr -felony reps a srs violation of the law & carries heavier fines & longer prds of imprisonment & in most srs cases execution
factors affecting dvpmt of hospitals
-advances in medical science -dvpmt of medical technology -changes in medical education -growth of the health insurance industry -greater involvement of the govt -emergency of professional nsg
serious reportable events
-adverse or never events
administrative rulings
-advisory opinion; made by a state board or by an attorney general provides a guideline based on an interpretation of the enacted & regulatory law r/t a specific situation -not considered a final legal decision & diff boards/ attorneys may have diff opinions; validity of opinion stands until the issue is brought before a court
classification of healthcare agencies
-agencies providing care classified according to length of stay, ownership, or type of service -one large entity may exist that includes mult. lengths of stay, types of service, & ownership patterns -used to plan for services, describe institutions, & allocate funding & reimbursement -Agencies may be classified as governmental (public), proprietary (private profit making), sole proprietorship, or nonprofit. -type of care is based on the acuity, which is the seriousness of the illness and the rate of change that is occurring; higher acuity=illness more srs and/or changing rapidly & demands more services
-safe practices
-agency for healthcare research and quality identified 30 safe practices that evidence shows can work to reduce or prevent adverse events & medical errors
care in assisted living
-all instrumental ADLs such as shopping, cleaning, meal preparation, and laundry are provided -resident expected to have some mobility & eat in a dining room except when person is temporarily ill -pts expected to manage their own meds & health needs but may be assisted w/ remembering to take the meds -help given w/ bathing, dressing, and other personal care prn; most care given by UAP -med aids; Some states are authorizing delegation to appropriately trained assistive personnel of selected nursing tasks, such as giving oral medications, for residents of assisted living. -board & care homes/adult family homes give assited living & some services similar to nsg homes; usually house 6 or less adults needing care
personal liability
-always legally responsible or liable for actions; personal liability not removed if a dr says they will take responsibility for an action contrary to best professional judgment
medication reconcilliation
-at admission involves careful documenting all the meds and dosages including prescribed meds, OTC meds, vitamin/mineral supps, and herbal products pt was taking prior to admit and compared w/ what has been ordered for current care -done at transition too; meds change when pt leaves an ICU; nurses on surg unit must be aware of meds a pt received while in the OR
Quality and Safety Education for Nurses (QSEN)
-began 2005 -identified the knowledge, skills, and attitudes needed by future nurses -used in nsg education to better prep nsg students for their role in improving quality & safety in system
discharge planning
-begins at admission -all nurses assume responsibility for ensuring that medical orders & nsg plans move w/ the pt to the next location -written materials that document orders & plans essential for accuracy -teaching all throughout process -when going home nurse is responsible for ensuring that needed referrals have been arranged and for providing d/c teaching
infection control
-bundles address each type of HAI; use of all practices in the bundle have shown to decrease incidence of the target infection -ex. preventing central line associated bloodstream infections (CLBSI); bundle includes the entire procedure for insertion, daily cleaning protocols, and protocols for use of line
assisted living facilities
-care for those needing help w/ ADLs -resident can maintain maximum independence and use a shared decision-making model to decide when additional help or support is needed. -less regulated than nsg homes but increasing regulation is expected -JCAHO provides voluntary accrediting process for these centers
integrative medicine
-combines mainstream medical thx and CAM thx for which there is some high quaility scientific evidence of safety and effectiveness
root cause analysis
-comprehensive processes that seeks to identify all the underlying factors that contribute to an error and to ID their role in causing the error -ex. if nurse was to give wrong med, what were all the aspects surrounding the error; was she interrupted, failed to follow 6 rights etc -many factors = error; ID factors first step to prevention
limits on a pts claim to negligence
-contributory negligence based on concept that the pt contributed to the injury by not acting prudently in that circumstance -prevents individual from receiving any compensation for injury 0comparative negligence the court determines what percent resulted form the pts negligence and what part rested w/ the nurse and reduce damage award accordingly
problems facing medicare & medicaid
-costs high & rising faster
common usage & custom
-courts empowered thru the concept of common law to examine the common usage & custom in a community for patterns that reflect the communitys stds for behavior -issue of safe med practice illustrates how common usage applies to nsg; neither statutes nor regulations are written about how to safely give meds
criminal law & nsg
-criminal action could result in loss of a job & license to practice nsg even when not prosecuted in court -errors that result in srs injury or death of a pt are investigated & may be prosecuted & tried by crminal courts; legal actions may be based on gross negligence, reckless endangerment, or criminal negligence -license may be temporarily withdrawn while being investigated; can be restored if innocent; if convicted revoked -nurses who do felonies s/a theft, abuse or deliberate harm charged for criminal laws and laws regulating nsg practice -nurses who commit felonies outside of the care setting can be prosecuted under criminal law & under law regulating nsg practice if the felony reflects on their fitness to practice nsg
nsg responsibility for medical orders
-critically examine orders -nruse has duty to understand pt plan of care and to communicate w/ drs -telephone orders discouraged; in emergencies -preferred method is nurse speak directly to prescriber write down order as received & then read back to prescriber for verification -prescriber then reviews & signs the order as soon as practical -when orders are entered into computer system by the nurse there is some method for the dr to verify the order @ next visit
institution and agency disaster response
-current pts will be d/c asap to open for beds for disaster victims or may be moved if institution is located in disaster area -units reorganized to enable acceptance and tx of multiple victims -nurses may be asked to move to EDs to help provide triage -call in system notifies staff not on duty they should report to work
judicial law
-decisional/case law; judicial decisions or rulings in court cases apply statutory, regulatory, & common law to situations -has power to examine the same or similar issue in a subsequent case & make a diff decision creating a new precedent -court rulings are binding within the jurisdiction of the particular court that determines them
common law
-derived from common usage, custom, & judicial law; judicial decisions or court rulings -less clear & exact -fluid changes over time
advances in medical science
-discovery of anesthesia & rapid progress in sx after -after colonial prd 2 med schools were est; before then drs learned through apprenticeship -germ theory improved medicine bc it started dvpmt of cleanliness/techniques that would sterilize or serve as antiseptics -discovery of sulfa in mid 1930s & abx in mid 1940s
diagnosis related groups
-drgs; 1983, when the federal government stopped using a fee-for-service reimbursement system for Medicare and introduced a PPS using diagnosis-related groups (DRGs) to determine the payment for each Medicare client admitted to the hospital. -designed to stop spiraling costs of medicare & correct inequities that made costs of care in one facility very diff from those in another -computerized analysis of costs that had been billed for hospitalized individuals in past & determination of an avg length of stay -actual DRG reimbursement amount is recalculated each year by CMS through a complex formula that considers the area of the country in which care was provided (eg, Northwest, Southeast), the urbanization of the area (eg, rural, suburban), and the type of care required.
fee for service payment
-each time a service is provided a fee is generated and then billed to the care recipient. The more services provided, the more fees charged
secondary prevention
-early identification of ehalth problems thru screenign and prevention of complications and adverse consequences of illness -Careful assessment and timely nursing intervention can prevent the formation of pressure ulcers, development of hypostatic pneumonia, and occurrence of falls.
primary prevention
-efforts to prevent disease from occuring -aimed at stopping cause of disease -water treatment and sanitation -educating ppl on diets -immunizations -smoking cessation campaigns -help pts examine their options -Immunizations, fall prevention through strengthening and balance exercises, and activity programs to prevent social isolation and the accompanying depression serve as primary prevention interventions
employer liablility
-employer responsible for hiring qualified persons, establishing an appropriate environment for correct functioning, maintaining correct policies and procedures, and providing supervision or direction as needed to avoid errors or harm -if a nruse as an employee of a hospital is guilty of malpractice the hospital also may be named in the suit -doctrine doesn't remove any responsibility from the individual nurse, but it extends responsibility to the employer
fall prevention protocol
-environmental changes s/a bed or chair alarms, bed in low position, foam pads on floor, locating pt next to rn station -care modifications; toileting q2h, visual checks at least hourly, provision of assistance any time pt gets OOB
ch 8 key points
-ethics; moral philosophy; appreciation of individual values that are derived from societal norms, religion, & family orientation; we can better understand value system thru values clarificaiton -basic ethical concepts of beneficence, nonmaleficence, autonomy, justice, fidelity, veracity, & std of best interest -ethical theories of utilitarianism, deontology, natural law, and social equity and justice may be used to examine the implications of ethical decisions. -concept of justice expanded to include distributive justice that's applied in situations req. allocation of scarce resources -ethical decision making based on personal religious views -nurse's status as an employee, collective bargaining contracts, collegial relationships, the authoritarian and paternalistic backgrounds of healthcare, deliberations of ethics committees, and consumer involvement create pressures regarding ethical decision making. -basic framework for ethical decision making; identifying & clarifying the problem, gathering data, identifying options, making a decision, acting & assessing -commitment to personal exellence -if chain of command doesnt invoke response to voiced concerns whistle blowing can be done as last resort -chemically impaired nurse is concern to profession & danger to pts; legal obligation to report those nurses & assit them with finding sobriety -boundary violations when coworkers become involved w pts & their families -end of life issues; ANA code of ethics guides nruses to relieve suffering & despair to support quality end of life care instead of assisted suicide -Surrounding the discussion of right to die are many issues, including those related to client self-determination, futile treatment, withholding or withdrawing treatment, assisted death, and the right to refuse treatment
regulatory law
-executive or administrative law -rules & regs est. by govt agencies to carry out enacted laws -@ fed level CMS writes regulations governing payment of medicare & medicaid funds that are authorized thru legislation; at state level BON authorized thru enacted laws to est. & enforce rules & regs that govern the practice of nsg in that state -protect the safety of the public by defining stds for nsg education & practice
failure to rescue & nurses time at the bedside
-failure to rescue is the inability to prevent death after the dvpmt of a complication -failure to death has been tied to the amnt of time that the nurse spends at the bedside w/ decrease of failure to rescue when nurses spend more time at the bedside and less on other activities -if life threatening conditions are prevented or immediately treated before irreversible damage is done they need to be recognized; if early recognition is to happen, nurse must be with the client
sbar
-first 2 components address objective facts & relate succinct briefings regarding to pt situation; last 2 subjective info that can include opinion & specific intervention -builds pattern to relaying of info that allows receiver to quickly notice the omission & ask for correction
growth of health insurance industry
-first hospital insurance plan was initiated @ baylor university hospital in 1929 to seve needs of schoolteachers in dallas tx -formed model for blue cross plans around country; more ppl affording care after
Health Maintenance Organization (HMO)
-first managed care organizations that originated as an alt to traditional insurance plans & were nonprofit; first to provide payment for care aimed at preventing illness -built in incentive to emphasize preventive care & avoid costly hospitalization -flat charge/month covers routine preventive care; care for illness; hospitalization; & prescriptions; outpt care -enrollees responsible for copay; support part of cost of care and give consumer incentive to use services wisely
prospective payment
-fixed reimbursement amnt for all care req for a particular sx procedure, an illness, or an acuity category -predetermined amount is paid w/o regard to actual services required or the costs of those services in individual situations -same payment whether person is health & has uncomplicated stay or whether the person is in poor health & has complications that increase cost of care or length of stay -designed to provide an incentive for providers to control costs. -predictable costs -The system transfers the burden of risk (the probability that an individual may require extraordinary services) from the payer to the provider. Several specific types of prospective payment have particular significance for nurses. These are DRGs and resource utilization groups (RUGs).
public health agencies
-focus of health depts has been on broad community issues, communicable diseases, & infant & child health -focus on individuals who are at high risk & whose health affects entire community s/a ppl w/ Tb -responsible for community health issues, req. to have BSN; some agencies operate a variety of clinics s/a immunization clinics where RNs w/ ADN can give direct care
disease management
-focuses on providing EBP in care for an individual w/ a specific chronic illness
medicaid
-gives funds for hc for those dependent on public assistance & other low income ppl -costs shared between state & fed govts -state determines eligibility & level of coverage
classification according to ownership
-govt: local, county, state, or federal (includes military & VA facilities) -nonprofit organizations: religious & philanthropic groups & community organizations -proprietary corporation: stockholders own shares & the agency is managed for benefit of stockholders -sole proprietorship: individual person/family owns & operates the agency
pt safety during handoffs
-handoff; process in which info about pt is communicated from one provider to another in a consistent manner
essential characteristics of negligence
-harm: injury must have occurred to individual -duty:negligent person must have been in situation where he or she had a responsibility or duty towards the person harmed -breach of duty: found to have failed to fulfill responsibility; doing what should not have ben done (commission of inappropriate action) or failing to do what should have been done(omission) -causation: harm or injury shown to have been caused by breach of duty
access to primary health care
-hcp contacted initially by pts who seek care is pcp -fed govt considers fam practice specialists, pediatricians, internal med specialists, OBs, PAs, & NPs to be PCPs; PCP is mainstay of basic care for most -all states req. licensure of DRs, NPs, & other providers who are authorized to treat illness & prescribe drugs -pcp implements health maintenance activities that prevent need for more expensive care as well as provides care for common health problems -lack of access to primary care is big problem for those w/o insurance, unemployed, those in rural areas & economically disadvantaged areas in large cities, & those on welfare programs; results in delayed care until more complex issues come up -in urban areas lack of access to primary care results in inappropriate use of ER for routine illnesses
rights & responsibilities in healthcare
-health insurance portability and accountability act HIPAA -PHI is protected health info about a pts health or health care -all employees get trained on privacy rules -signigicant monetary penalties for breaches of privacy
nurse staffing
-higher RN staffing associated w/ less hospital related mortality, failure to rescue, cardiac arrest, hospital acquired pna, etc -nurse pt ratio associated w/ pt satisfaction ratings -poor staffing=poor outcomes, longer stays, ^ chance of pt death -ANA advocates problem solved by req. hospitals to set nurse staffing plans for each hospital unit based on changing conditions; pt acuity, pt numbers, nurse skills & experience, support staff, technology
time out
-immediate members of procedure team -communicate during time out and agree that the pt identity is correct as is the site and procedure to be done and isn't started until all questions or concerns are resolved -must be documented that it was done
classification according to length of stay
-in & out care: contact measured in mins vs hrs; ex office visits, ED visits, therapy sesh -short stay: care for acute conditions or tx that req. <24hrs of care & monitoring; ex dx tests or minimally invasive sx -acute care: hospitals where pts stay >24 hr but <30 days; stays shortened since advent of managed care & DRGs -long term care: care to pts for remainder of lives; includes services to pts w/ limited recovery needs, functional losses, chronic disease, mental illness, or major rehab (can take 30-90days)
preferred provider organizations
-include hospitals, nsg homes, corporations employing care providers, or groups of care providers who have cooperated to negotiate more successfully w/ third party payers for these special contracts -ensured # of pts and guaranteed income -exact structure and contractual arrangements are independently determined.
charitable immunity
-individual or an organization is held to a lesser std of care because of the provision of charitable care.
privileged communication
-info thats shared by a pt w/ certain professionals but doesn't need to be revealed even in a court of law -person has privilege of not revealing info -Not all states recognize the nurse-client relationship as one in which privileged communication takes place; even those states that recognize nurse-client communication as potentially privileged do not consider all communication between clients and nurses to be privileged -only a court can determine if privilege exists in specific cases; if not then legally obligated to testify about the communication
health and medicine division
-institute of medicine; division of sciences, engineering, & medicine; private nonprofit that provide independent objective analysis & advice to nation & conduct activities to solve complex problems and inform public policy decisions r/t these subjects; help the goct and private sector make informed health decision by conducting research to provide reliable evidence -made in response to medical error concerns
Duty to report or seek medical care for a patient
-legal duty to ensure that the pt gets safe & competent care; req nurse to maintain an appropriate std of care and take action to obtain an appropriate std of care from other professionals when necessary -if rn assesses a pt and determines that the attn of a dr is needed but fails to make every effort to get that attn nurse has breached duty -failure to rescue is shorthand for failure to prevent a clinically important deterioration s/a death or permanent disability from a complication of an underlying illness or medical care & is considered a nsg sensitive outcome -reductions in failure to rescue rates are associated w/ low pt to nruse ratios
national pt safety goals
-made by joint commission -separate set of goals for each type of agency providing care; goals structured in same way for each type of agency and have consistent number system -accredited hospitals collect data on standardized or core performance measures to reduce sentinel events -integral to improving the quality of care provided to hospital pts and bringing value to stakeholders by focusing on actual results of care
health services in nsg homes
-majority of pts here are here bc of major deficits in self care abilities & need for ongoing care that is custodial in focus vs tx oriented -maintenance of funciton, independence, autonomy, & rehab are all goals -units designed for cognitively impaired are free of restraints & barriers to mobility; facility design & alarm systems prevent residents from wandering -some nsg homes have entire wings devoted to pts receiving posthospital care w/ goal as rehab to return to independent life
hospital as educational institutions
-many hospitals serve as clinical for ppl enrolled in colleges/universities that provide education for hcp's; include nsg students, lab sciences, nutrition, pharmacy, radiology & imaging, etc -grad medical educ includes residency programs for drs prepping for independent practice; residents get salary from hospital & responsible for providing services in return
consent for nsg measures
-may be verbal or implied; if nurse says will u turn and pt turns this is implied consent -pt free to refuse any aspect of care offered -Good nursing care requires that you use all means at your disposal to help the client comprehend the value of proposed care -refusal of care accepted only after pt has been given complete info
good samaritan laws
-meant to encourage anyone to render assistance in an emergency situation without fear of liability for simple negligence. -liable only for gross negligence -nurse rendering aid in emergency must behave as reasonably prudent nurse -professional responsibility to not abandon the person until care can be turned over to another competent person; professional may relinquish responsibility to EMS but not to a simple bystander
increasing safe med admin
-med errors are any preventable event that may cause or lead to iinapporpriate med use or pt harm while the med is in the ctrl of hc professionals, pts or consumers -elimination of ambiguous abbreviations, computerized physician order entry, computerized decisions support systems, computerized adverse drug event monitoring, barcode point of care med safety systems, & iv admin smart pumps
funding nsg home care
-medicare pays for limited days for pts who meet criteria regarding hospitalization & need skilled care or rehab rather than custodial care -long term care insurance pays part of costs too -state admin'd public assistance in the form of programs s/a medicaid pays for nsg home care when an individuals personal financial resources have fallen below state determined level -Payment for an individual resident may come from multiple sources with insurance paying a sum, personal resources (such as savings, Social Security, and/or pension) paying a portion, and Medicaid paying for the remainder.
the dvpmt of hospitals in the US
-mid-1700s almshouses (poorhouses) provided food & shelter for homeless/poor & served as homes for aged, disabled, mentally ill, & orphaned -pest houses built at this time also to isolate ppl w/ contagious diseases; cholera, smallpox, typhus, yellow fever, scarlet fever -were crowded & unsanitary w/ insufficient heat & ventilation; high cross contamination & mortality -ppl w/ $$ cared for at home -1st hospital in philly in 1751 (Benj Franklin urged it to be built); he believed public duty to give care to poor, lonely, sick, & insane -NY hosp in NYC est in 1773 to prevent spread of infectious diseases brought by sailors & immigrants -massachusetts gen hosp in boston opened in 1816 & new haven in CT 1826 -early hospitals cared for ppl w/ acute illnesses & injuries but didn't admit mentally ill; 1st mental ward in pennsylvania 1752; cruel inhumane tx in mental hospitals; dorothea dix reformed mental health care
funding assisted living
-not supported w/ medicare & doesnt have to meet stringent regulatory stds of legislation -public assistance s/a medicaid or other programs can give some support when the alternative would be expensive nsg home care for which state would be responsible -most is paid by pt or fam
client empowerment
-nurses can empower others when they assur the pts they have the info necessary to make choices
hospital services for pts and fams
-outpt vs inpatient -both medicare & medicaid are billed differently for outpt care than inpt -medicare pays for nsg home care after hospitalization req. that the person be admitted as an inpt w/ minimum 3 day hospital stay otherwise medicare pay is denied for a nsg home stay even if it meets the stds for recovery & return to home
jean watson theory alert
-philosophy and science of caring; focused on ways nruses care for their pts -key to theory was the belief that holistic approach was vital to the practice of caring in nsg -use of nsg process to create framework for care
institutional policies, protocols, & procedures
-policies give guidance in proper actions to be taken in specific situations, ID the individuals responsible for taking action, & may est. specific timelines for action; est policies may be considered the std of practice for that agency & common law(bc usage) by the court & can be important for legal decisions -policies may protect the institution & employees from legal difficulties if based on current practice & sound legal advice -protocols provide list of actions for managing a specific problem that may involve use of more than one procedure; often include aspects of care that might be part of the medical orders for pt care -specific institutional procedures outline steps in a particular task; ex steps taken to flush a cvc to maintain patency; procedure for nsg would be developed by the relevant nsg committee or sometimes by a clinical nurse specialist -purpose of policies, protocols, & procedures is to ensure that there is consistent sound practice in institution; need to be updated
tertiary prevention
-preventing long term disability & restoring functional capacity -rehab
malpractice
-professional negligence; liability resulting from improper practice based on standards of care required by the profession for which the person has been educated -harm that occurred to this person or to the property must be based on a failure to act as a prudent professional and in accordance with professional standards in the situation -In general, all nurses within a facility are considered to have a duty toward all patients and even toward visitors, in case of emergency, and are expected to act on behalf of the institution in that regard. -breach of duty is failure to act as a prudent professional according to the std of care for the profession -present only if breach of duty was the cause of the harm
federal safety legislation
-pt safety & quality improvement act passed in 2005 w/ goal of improving pt safety by encouraging voluntary & confidential reporting of events that adversely affected pts -law provided protection for individually identifiable healthcare data that might be used to assess safety concerns and created and provided for the certification of pt safety organizations to collect & analyze confidential info reported by providers -set up plan for a network of pt safety databases that could be used for research & development w/o fear of disclosure of data to provide technical assistance to facilitate work on safety
the long term care facility
-refers to any diff care settings that involve coordination of the entire multidisciplinary team to provide counseling, nsg care, rehab, nutrition support, social services, & sometimes special ed programs over mos to yrs -LTC includes nsg homes, assisted living centers, adult care homes (board and care), chronic disease hospitals, psych hospitals, group homes for those w/ dvpmt disabilities or chronic mental health problems
managed care organizations
-refers to any system for "a system of health care (as by an HMO or PPO) that ctrls costs by placing limits on physicians fees & by restricting the pts choice of physicians -managed care plan ctrled by payer (insurance company), include both payers & providers, or be a business entity -group of primary providers/independent practice association may contract w/ managed care organization to provide services for a preset fee per individual in program; also may directly provide healthcare and therefore employ many hc workers including nurses -point of service plans are managed care plans that allow an individual the option of going outside of the plan for services that the plan doesn't or will not provide -pcp monitors & restructs use of sercices by the pt; the dr sees the pt first and then determines whether referral or dx services are needed; may result in delay or denial of needed care
dorothea dix
-reformed mental institutions in US -not a nurse she was a teacher -volunteered as a nurse in civil war
civil law
-regulates conduct between private individuals or businesses & enforced thru courts as damages or monetary compensation -private individuals or groups may bring a legal action/lawsuit to court for break of civil law; judge of court results in plan to correct the wrong & may award a monetary payment to wronged party
pt self determination act
-required that on admit to any healthcare service pt be given opportunity to determine what lifesaving or life prolonging actions they want carried out -psda reqs agency to provide adequate info for the pt to make an informed decision regarding these important matters
strategies to increase nurses time at the bedside and benefits
-rounding hourly; pts understand rn will be around regularly therefor don't use bell as often -conducting bedside change of shift report: saves time and allows nurse coming on duty to ask questions and improves pt safety by involving pt -streamlining documentation: improved pt safety & saves time -addressing med admin inefficiencies: electronic med admin records & bedside med admin improve safety & remove inefficiencies -using std tools for handoff to provide effective communication -supplies in close reach: reduces time spent hunting & gathering supplies -outsourcing d/c f/u calls; assigning others tasks of f/u calls to d/c pts -seeking dr input to assure success of project -asking nurses what will help nurses
resource utilization groups
-rugs; determines payment for nsg home pts -Unlike the hospital prospective payment, which is a flat amount for the entire hospital stay, the prospective payment for nursing home care is a fixed daily rate; daily rate includes all services including meds & tx pt needs -actual daily rate of reimbursement to nsg home is avg of the RUGs for all residents referred to as the case mix -basis for determining to which RUG a nsg home resident will be assigned for reimbursement purposes is the comprehensive MDS prepped by the RN
national quality forum
-set ntnl priorities, endorse ntnl consensus stds for measuring & publicly reporting on performance & promoting attainment of ntnl goals thru education & outreach -created and endorsed list of srs reportable events/adverse/never events to increase public accountability & consumer access to critical info about health care performance
hx of nsg home
-social security act of 1935= private (for profit) nsg homes emerged -post war the hill burton act of 1946 supported hospital construction and included voluntary nonprofit nsg homes -since 1950 govt funding for nsg home increased & govt regulation ^^ -in 50s & 60s deinstitutionalization mvmt (alot of older ppl w/ dementia d/c from mental hospitals) affected nsg homes & they began to assume role of providing specialized care for older adults -by 1960s nsg homes were est.; reputation was bad; negligent; abuse; misuse/embezzlement of their funds= more regulations by govt -major reason for admission to nsg home today is functional dependence in terms of basic ADLs & cognitive impairment rather than a medical dx
clinical pathway
-std tool hospitals use to monitor outcomes; aka critical path, care map or anticipated recovery path -describes the optimum progression thry the system of the pt w/ a particular health problem
rn role in supporting healthy communities
-support and advocate for political measures that would improve the health of the community; includes contacting reps at at all levels and advocating for important health related laws or projects -being active as a community service volunteer in a homeless shelter, school, or other community agencies.
ex of potential sentinel events
-sx on wrong body part -tubing & catheter misconnections -OD w/ anticoagulants -death from tx related or med error -pt suicide happening in setting where around the clock care is given -assault, rape, or homicide of pts or visitors perpetrated by staff, other pts, visitors, or intruders -maternal death -d/c of infant to wrong fam -unprofessional provider behavior
case mgmt
-technique used to efficiently move an individual requiring major health services through the system resulting in more effective use of services and reduced cost -experienced health professional w/ knowledge of available resources who oversees or monitors a case to ensure that necessary care is instituted promptly & provided in cost effective setting -RNs in this role monitor care as it is provided, ensuring appropriate referrals are made, changes in plan of care are instituted appropriately, & care follows est. stds -CMSA provides system for certifying professional case managers -may work as internal case managers where they operate within only one part of the system (eg, managing cases from admission through discharge in a nursing home or hospital) or they may manage cases across all phases of care from outpatient through hospitalization, rehabilitation, and back to outpatient-external case managers -case mgmt systems ensure that delays in pt transfer or breaks in communication dont happen & that costs are minimized -often act as adovates for pts in the system
universal protocol
-to reduce incidence of wrong site, wrong procedure, or wrong person -must be followed by all accredited hospitals & sx centers -3 steps taken before sx: preprocedure verification process, marking the procedure site, & performing time out -A standardized list is used for the preprocedure verification process, which includes checking for coexisting health problems that might be of consequence and assuring that medications, supplies, blood, and fluids needed before, during, and after the surgery have been obtained -sites marked unless it's on bilateral structures by licensed independent practitioner who is accountable for the procedure
traditional indigenous system exampls
-traditional oriental medicine -qi gong -acupuncture -hermal meds -oriental massage -ayurvedic meds -native american med -other folk med systems
transition planning
-transitions are the mvmt of the pt from one environment to another s/a from home care to hospital, hospital to nsg home, one unit to another -planning refers to the planning process that takes place to assure that the pts well being is maintained throughout the time of transition
military & other federal hc
-tricare is healthcare program for uniformed service members; army, air force, navy, marines, coast guard -dhhs provides direct health care services thru the indian health service which operates hospitals, health centers, school health centers, health stations, & urban american indian health centers & provides payments to community providers where no IHS facilities are present -VA operates many clinics, hospitals, & nsg homes for vets; benefits are comprehensive
understanding todays hospital
-type of care is based on the acuity, which is the seriousness of the illness and the rate of change that is occurring -provide education to a wide variety of healthcare workers and to the community
continuity of care
-uninterrupted process across settings in which a person seeks care
healthy people 2020
-vision: all ppl live long healthy lives -mission: identify nationwide health improvement priorities, increase public awareness and understanding of the determinants of health disease and disability; provide measureable objectives and goals at all levels; engage mult sectors to take actions that are driven by the best available evidence; identify critical research & data collection needs -goals: eliminate preventable disease, disability, injury, & premature death; achieve health equity, eliminate dispairites, and improve the health of all groups; create social and physical environments that promote good health for all; promote healthy development and healthy behaviors across every stage of life
community based nursing
-wide variety of settings other than inpt institutions in which nsg is practiced -public health, home healht, ambulatory care, occupational health, school nsg -cost effective -req. effective comm & collab -pt is in charge; pt decides to work w/ the nurse, to accept or reject advice and suggestions, and to enter and leave healthcare -nurse serves as an educator, a guide, a resource person, and an advocate -care family centered & culturally competent -nurses must be aware of community health organizations, knowledge about availability & accessibility of services & supplies, and familiar w/ location and specialty of providers -belief of pt empowerment
tort
-wrongful act not including a breach of contract or trust that results in injury to anothers person, property, reputation, or the like and for which the injured party is entitield to compensation, a civil wrong committed against a person or the persons property -may be physical, psychological, harm to livelihood, or some other less tangible value, s/a harm to reputation -intentional tort is one which outcome was planned although the person involved may not have believed that the intended outcome would be harmful to the other person; preventing pt from leaving ama bc of concern for them but it interferes w/ liberty -unintentional tort is an action causing harm to another person or property that was not intended to happen; negligence
roles of hc workers
Although the major health occupations provide academic education with legal licensure and a defined scope of practice, many of the allied healthcare providers have much less defined roles, which creates concerns about how education or training is provided and how the role is regulated. For some, regulations and requirements may differ from state to state. National organizations that provide accreditation for allied health educational programs serve to provide standardization of some occupations.
essential elements of malpractice
Harm to an individual Duty of a professional toward an individual Breach of duty by the professional Cause of harm is the breach of duty
recognizing impaired nurse
Mood swings Slurred speech Tardiness and frequently leaving work environment Frequent days off for implausible reasons Noncompliance with acceptable policies and procedures Deteriorating appearance Inconsistent job performance Inadequate documentation Involvement in discrepancies of controlled substances in the workplace Alcohol or marijuana on breath Poor judgment, concentration Dishonesty Belligerence to supportive inquiries
leading health indicators for healthy ppl initiatives
Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to healthcare
capitation
System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.
organizational culture
The culture of an organization is a product of its history, its mission and values, its beliefs and customs, the structure of the organization, and the manner in which providers of healthcare carry out their roles
informed consent contains info on
The nature of the decision/procedure Reasonable alternatives to the proposed intervention The relevant risks, benefits, and uncertainties related to each alternative Assessment of client understanding
utilatarianism
actions that are right when they contribute to the greatest good
using acuity measures to determine costs
acuity in this context refers to the severity of illness and the rapidity of change in the client, and thus the intensity of medical and nursing care and other therapies required.
sentinel event
an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof -srs adverse outcomes is defined as instances of error that have the potential for serious harm or death to the pt
homeopathy
based on the belief that exposure to extremely small quantities of either the substance causing an illness or a related substance will stimulate a cure
manipulative and body based practices
chiropractic, massage thx, reflexology
ethics
deals w/ values r/t human conduct w/ respect to the rightness & wrongness of certain actions & to the good/bad of the motives and ends of such actions
deontology
defines actions as right or wrong
Which of the items listed is not a procedure-related accident?
ground level fall
biologically based practices
herbal meds, special diets, food supps, vitamins, biologic substances s/a bovine & shark cartilage
unconventional western system ex
homeopathy, naturopathy
suit prone clients
identified by overt behavior in which they are persistent faultfinders and critics of healthcare providers and of all aspects of care. They may be uncooperative in following a plan of care and sensitive to any perceived slight. the very dependent person who uses projection to deal with anxiety and fear. These individuals tend to ascribe fault or blame for all events to others and are unable to accept personal responsibility for their own welfare.
triage
involves the initial screening of victims for the purpose of prioritizing tx and making the most effective and efficient use of both human and material resources
advance directives
legal documents stating the wishes of individuals regarding healthcare in situations in which they are no longer capable of giving personal informed consent
expert witness
nder Rule 702 of the Federal Rules of Evidence (accepted in the federal courts and many state courts), is defined as "a witness qualified as an expert by knowledge, skill, experience, training, or education who may testify in the form of an opinion or otherwise." An expert nurse witness may have long experience in a particular area of practice, be certified in the area, possess higher education in the area being considered, or have other evidence of special expertise.
liability
obligation or debt that can be enforced by law; person legally liable usually is required to pay for damages to the other person
culture of safety
one in which trust and mutual respect encourage health care providers to report errors, near misses, and other adverse events w/o fear of retribution
gross negligence or reckless endangerment
person's behavior is defined as "failure to use even the slightest amount of care in a way that shows recklessness or willful disregard for the safety of others"
disaster mgmt
plans that are in place designating the community's response to a disaster
health dispairities
preventable differences in access for and care of disadvantaged populations
cultural relativism
principle that what an individual believes and does makes sense in terms of his or her own culture.
mind body medicine
relaxation exercises, hypnosis, meditation, dance, prayer, visualization, biofeedback
mind body medicine
seeks to control physical processes through the mind's capacities. In addition, it treats emotional concerns.
naturopathy
the natural agents used in treating disease, such as food, exercise, air, water, and sunshine. The naturopathic physician treats people by recommending changes in lifestyle, diet, and exercise and promoting the use of vitamins and herbs.
social equity
the role of social & economic factors like race, gender, class & ethnicity
paternalism
unilateral decisions that often imply that the decision maker knows what is best for the pt; caring for pt but not allowing them to have rights or responsibilities
whistle blowing
when an employee or past employee reports a violation of the law that is considered fraud or abuse so that it may be investigated by the state or federal government
alternative medicine
when health care approaches are used in place of conventional medicinal care
complementary care
when used along w/ conventional medicine
