LPN Midterm Summer 2021

How many times per year does The Joint Commission mandate that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event?

-At least twice a year. -One of the drills or events must involve community wide resources and an influx of action or simulated patients to assess the ability of collaborative efforts and command structures. Health care organizations are required to take an "all hazards approach" to disaster planning.

Red tag

-Class I -Emergent patient -Immediate threat to life

Yellow tag

-Class II -Major injuries that require treatment -Patient who can wait a short time for care

Green tag

-Class III -Non-urgent "walking wounded" -minor injuries that do not require immediate treatment

Black tag

-Class IV -Expected and allowed to die

What are some examples of internal disasters?

-Fire -Explosion -Loss of critical utilities (e.g., electricity, water, computer systems, and communication capabilities) -Violence

Examples of situations where a patient would be classified as a black tag

-Massive head trauma -Extensive full-thickness body burns -High cervical spinal cord injury requiring mechanical ventilation

What are some examples of external disasters?

-Natural disasters such as hurricane, earthquake, or tornado -Technologic such as an act of terrorism with explosive devices -Malfunction of a nuclear reactor with radiation exposure

What is "NBC"?

-Nuclear -Biologic -Chemical threats

Examples of situations where a patient would be classified as a yellow tag

-Open fracture with a distal pulse -Large wounds that need treatment within 30 minutes to 2 hours

What is the nurse's role in responding to health care facility fires?

-Remove any patient or staff from immediate danger of the fire or smoke. -Discontinue oxygen for all patients who can breathe without it. -For patients on life support, maintain their respiratory status manually until removed from the fire area. -Direct ambulatory patients to walk to a safe location. -If possible, ask ambulatory patients to help push wheelchair patients out of danger. -Move bedridden patients from fire area in bed, by stretcher, or in a wheelchair; if needed, have one or two staff members move patients on blankets or carry them. -After everyone is out of danger, seek to contain the fire by closing doors and windows and using an ABC extinguisher (can put out any type of fire) if possible. -Do not risk injury to yourself or staff members while moving patients or attending to extinguish the fire.

Examples of situations where a patient would be classified as a red tag

-airway obstruction -shock -can not feel pulse in broken extremity

Examples of situations where a patient would be classified as a green tag

-closed fractures -sprains -strains -abrasions -contusions

What are the four core concepts for patient centered care?

1. Dignity and respect, ensuring that the care provided is given on the basis of a patient's and family's knowledge, values, beliefs, and cultural backgrounds. 2. Information sharing, meaning that health care providers communicate and share information so that patients and families receive timely, complete, and accurate information to effectively participate in care and decision making. 3. Participation, whereby patients and families are encouraged and supported in participating in care and decision making 4. Collaboration, demonstrated by the health care leaders collaborating with patients and families in policy and program development, implementation, and evaluation and patients who are fully engaged in their health care.

Two classic nursing models uses in some health care institutions

1. Team Nursing 2. Primary Nursing

TeamSTEPPS principles

1. Team Structure: Identify the complex parts of the health care system that have to work together effectively to promote patient safety. 2. Communication: Use structured processes to clearly and accurately exchange information among members of the health care team. 3. Leadership: Ensure that all members of the health care team understand the team's actions, receive information about changes, and have resources needed to perform their jobs. 4. Situation Monitoring: Actively assess any situation to gather information, improve your understanding, or maintain awareness to support the functioning of the team. 5. Mutual Support: Understand the responsibilities and workload of all team members so that you can anticipate and support their needs.

Value

A deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors. Values can change over times as we grow as individuals.

acute stress disorder

A disorder in which a person experiences fear and related symptoms soon after a traumatic event but for less than a month. Focuses on dissociative symptoms such as numbing, reduced awareness, depersonalization, derealization, or amnesia, experienced within the first month after a traumatic event; it is also a predictive of subsequent PTSD.

Assignment ( 172 NAC 99)

A licensed nurse appoints or designates another person the responsibility for performance of nursing interventions. Assignments are made to individuals who already have authority to provide nursing interventions either through licensure as a nurse or through delegation from a registered nurse. Assignment is not the transfer of authority.

Stable or predictable (172 NAC 99)

A situation where the individual's clinical and behavior status and nursing care needs are determined by a registered nurse or license practitioner to be non-fluctuating and consistent or where the fluctuations are expected and interventions are planned, including those individuals whose deteriorating condition is expected

Competence (172 NAC 99)

A state or quality of being competent or capable as a result of having required knowledge, skills and ability.

How many times per year does The Joint Commission mandate that nursing homes and other long-term care facilities have an emergency preparedness plan that is tested through drills or actual participation in a real event?

Annually to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents form the facility in a timely and safe manner.

How should a nurse prioritize patient care?

After forming a picture of a patients total needs, you set priories by deciding which patient needs or problems need attention first. To prioritize care, evaluate and weigh each competing task by reflecting on the following three questions: 1. Is this a life threatening situation? Will this patient or another patient be endangered if this task is not done immediately or is left for later? 2. Is this task essential to patient or staff safety? 3. Is this task essential to the patients plan of care? When prioritizing care, you need to understand the "big picture" of your patients problems and goals. Always give high priority to patent and caregiver safety (e.g., fall prevention, safe medication administration, and patient education needs). Use the following steps to classify problems into one of three priority levels, and use this information to help you set priorities: 1. Assign high priory to first-level problems using ABC+VL (airway, breathing, and circulation problems, vital signs concerns, and life threatening laboratory values) and attend to these immediately 2. Next address second-level problems, which immediately follow the first level and include concerns such as changes in mental status, untreated medical issues, acute pain, acute elimination problems, abnormal laboratory results and risks. 3. Then tend to third-level problems, which are health problems

Two-Challenge Rule

Allows a subordinate to take action if he or she has warned a superior about a safety issue multiple times and continues to be ignored

post-tramatic stress disorder (PTSD)

An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.

External Disaster

An event outside the health care facility or campus, somewhere in the community, which requires the activation of the facility's emergency management plan. The number of facility staff and resources may not be adequate for the incoming emergency department (ED) patients.

Internal Disaster

An event that occurs inside a health care facility or campus that could endanger the SAFETY of patients or staff. The event creates a need for evacuation or relocation. It often requires extra personnel and the activation of the facility's emergency preparedness and response plan (also called an emergency management plan).

Licensed Practical Nurse scope of practice (172 NAC 99)

At the direction of a registered nurse or licensed practitioner, a licensed practical nurse contributes to the nursing assessment and nursing diagnosis, participates in the development and implementation of the plan of care, and contributed to the evaluation of responses of care or the nursing care plan.

Registered Nurse scope of practice (172 NAC 99)

Based on independent, dependent, and interdependent functions, a registered nurse conducts and documents nursing assessments, utilized all data to identify and document responses to actual or potential health conditions and make a nursing diagnosis, develops and implements a plan of care, and evaluates responses to that plan of care.

Role of nurses in health care facility emergency preparedness and response

Before an event, nurses contribute to developing internal and external emergency response plans, including specific roles. During an actual disaster, the ED charge nurse, trauma program manager, and other ED nursing leadership personnel act in collaboration with the medical command physician and triage officer to organize nursing and ancillary services to meet patient needs. Telephone trees or automated group notification systems may be activated to call in ED nurses who are not working or scheduled to work.

Delegation (172 NAC 99)

The transfer of authority, responsibility, and accountability to perform nursing interventions from one individual to another.

Team Nursing

Care is provided by a group of people led by an RN. The team often includes other RN's, practical nurses, and assistive personnel. To be successful, this model requires effective team leadership, collaboration, and communication.

Decentralization

Degree to which decision-making authority is given to lower levels in an organization's hierarchy. Lower-level employees provide input or actually make decisions.

Ethical dilemmas

Ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion.

Standards for assignment (172 NAC 99)

Licensed nurses may assign the responsibility for performance of nursing interventions to other persons in the provision and management of nursing care. License nurses may also have nursing interventions assigned to them by licensed nurses or licensed practitioners.

Tasks an unlicensed person is allowed to do (172 NAC 99)

Non-complex nursing interventions through delegation from a registered nurse.

Nursing Intervention Complex (172 NAC 99)

Nursing interventions that require nursing judgement to safetly alter standard procedures in accordance with the needs of the individual; or require nursing judgement to determine how to proceed from one step to the next; or require the multi-dimensional application of the nursing process.

Nursing Intervention Non-Complex (172 NAC 99)

Nursing interventions which can be safety performed according to exact directions, do not require alternation of standard procedure, and for which the results and consumer responses are predictable.

Primary Nursing

One RN assumes the responsibility for a caseload of patients from admission to discharge. The same nurse provides care for the same patients throughout their hospitalization. It is typically not practiced today because of the high cost of an all-RN staffing model.

Hospital Incident Commander

Physician or administrator who assumes overall leadership for implementing the emergency plan

Triage officer

Physician or nurse rapidly evaluates each person who presents to the hospital, even those with triage tags in place.

Medical Command Physician

Physician who decides the number, acuity, and resource needs of patients arriving from the incident scene to the hospital and organizing the emergency health care team response to the injured or ill patients. Responsibilities include identifying the need for and calling in specialty trained providers.

What is Life Safety Code?

Provides guidelines for building construction, design, maintenance, and evacuation.

Responsibility

Refers to a willingness to respect one's professional obligations and to follow through.

Accountability

Refers to answering for your own actions.

Confidentiality

Refers to health care team's obligation to respect patient privacy. Federal legislation known as the Health Insurance Portability and Accountability Act of 1996 mandates confidentiality and protection of patients' personal health information.

Debriefing

Two general types of debriefing, or formal systematic review and analysis, occur after a mass casualty incident or disaster. The first type is when critical incident stress debriefing teams provide sessions for small groups of staff to promote effective coping strategies. The second type of debriefing involves an administrative review of staff and system performance during the event to determine whether opportunities for improvement in the emergency management plan exist.

Accountability

Refers to individuals being answerable for their actions. It means that as a nurse you take responsibility to provide excellent patient care by following standards of practice and institutional policies and procedures. You assume responsibility for the outcomes of the actions, judgements, and omissions in providing that care. You are not accountable for the overall outcomes of patient care, but you are accountable for what you do. If you delegate a responsibility for example vital check to a CNA you are responsible to know what your patients vital signs are normally and for providing care appropriate care if the vital signs are not in the expected range.

Advocacy

Refers to the application of one's skill and knowledge for the benefit of another person. As a nurse you advocate for health, safety, and rights of patients including their right to privacy and their right to refuse treatment.

Responsibility

Refers to the duties and activities that you are employed to perform. A position description outlines your responsibilities as a professional nurse and your expected level of participation as a member of a nursing unit.

Authority

Refers to the legal ability to perform a task. It provides the power for a nurse to make final decisions and give instructions related to decisions.

Standards for delegation (172 NAC 99)

Registered nurses may delegate nursing interventions or tasks to be performed by unlicensed persons. A registered nurse retains accountability for the application of the nursing process and outcomes of care in making a delegation decision.

Standards for direction (172 NAC 99)

Registered nurses, licensed practical nurses, and licensed practitioners may provide direction in the provision and management of consumer care. The method and degree of direction may vary based upon consumer condition, the interventions to be applied, and the qualification and competency of the person providing the interventions. Registered nurses can provide direction to LPNS, care teams which may include other licensed health care professionals and CNA's. LPN's can provide direction to CNA's.

Servant Leadership

Servant leaders chose to serve others before they decided to become leaders. Their priority is putting the needs of others first and promoting personal growth and autonomy by ensuring their individual employee's highest priority needs are met.

SBAR communication

Situation Background Assessment Recommendation

What approach do nurse managers use and how does it work?

TEEAMS (Time, empowerment, enthusiasm, appreciation, management and support) approach. The nurse manager spends time on the unit with the staff sharing ideas, empowers the staff, is enthusiastic about seeking opportunities to enhance the team, shows appreciation and recognizes team members for a job well done, manages the tam and holds team members accountable, and provides support in the stressful health care environment.

TeamSTEPPS stands for

Team Strategies and Tools to Enhance Performance and Patient Safety

Licensed Nurse Competence (172 NAC 99)

The ability of the nurse to apply interpersonal, technical and decision making skills at the level of knowledge consistent with prevailing standard for the nurse's current nursing practice role.

Autonomy

The freedom of choice and responsibility for the choices. Independent decisions about patient care, plan patient care within the scope of professional nursing practice, and implement independent nursing interventions.

"Stand down" or deactivating the emergency response plan

The incident commander considers deactivating the emergency response plan when the last major casualties have been treated and no more are expected to arrive in numbers that could overwhelm the health care system. Before terminating the response, it is essential to ensure that the needs of the other hospital department have been met and all are in agreement to resume normal operations.

Accountability (172 NAC 99)

The licensed nurse is responsible and answerable for decisions and action or inaction of self or others, and for the resultant consumer outcomes related to decisions and action or inaction.

Direction (172 NAC 99)

The provision of guidance and supervision by a licensed nurse or license practitioner who is responsible to manage the provision of nursing interventions by another licensed or unlicensed person.

Supervision Direct (172 NAC 99)

The responsible licensed nurse or licensed practitioner is physically present in the clinical area and is available to assess, evaluate or respond immediately.

Supervision Indirect (172 NAC 99)

The responsible licensed nurse or licensed probationer is available through telecommunication or periodically for direct inspection and evaluation for direction, consultation and collaboration.

Morals

The term ethics and morals sometimes are used interchangeably. Morals usually refer to judgement about behavior, based on specific beliefs, and ethics refers to the study of the ideals of right and wrong behavior.

IES-R

a 22 item self administered questionnaire, written at the 10th grade reading level. A high score on any IES-R sub-scale indicated a need for further evaluation and counseling

Value

a deeply held personal belief about the worth a person holds for an idea, a custom, or an object. The values that a person holds reflect cultural and social influences.

Disaster Medical Assistance Team (DMAT)

a medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours. These individuals are apart of the National Disaster Medical System in the United States and because of this they act as federal employees when they are deployed and their professional license is recognized and valid in all states.

patient and family centered care

a model of nursing care in which mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered

code of ethics

a set of guiding principles that all members of a profession accept. The provisions of the Code of Ethics describe the nurses obligation to the patient, the role of the nurse as a member of the health care team, and the duties of the nurse to the profession and society. A few key principles in the code include advocacy, responsibility, accountability, and confidentiality.

disaster triage tag system

a system that categorizes triage priority by colored and numbered tags

Nonmaleficence

avoidance of harm or hurt

Personal Emergency Preparedness Plan

an individual plan that outlines specific arrangements in the event of disaster, such as childcare, pet care, and older adults care

Pandemic

an infection or disease that occurs throughout the population of a country or the world leads a vast number of people to seek medical care, even the "worried well". Although not yet ill, the "worried well" want evaluation, preventive treatment, or reassurance from a health care provider.

Hospital Incident Command System (HICS)

an organizational model for disaster management in which roles are formally structured under the hospital or long-term care facility incident commander, with clear lines of authority and accountability for specific resources

How is an EMPOWERED nursing team built?

begins with the nurse executive, who is often a chief nursing officer

Multi-casualty event

can be managed by a hospital using local resources

Case management

coordinates and links health care services across all levels of care for patients and their families while streamlining costs and maintaining quality.

"Go Bag"

disaster supply kit for the home and automobile with clothing and basic survival supplies, which allows for rapid response for disaster staffing coverage

National Veterinary Response Team (NVRT)

emergency animal care

International Medical Surgical Response Teams (IMSURTs)

establish fully functional fiel surgical facilities wherever they are needed in the world

Disaster

event in which illness or injuries exceed resource capabilities of a health care facility or community because of destruction or devastation

Transformational Leadership

is focused on change and innovation through team development. Nurses who lead using transformational leadership serve as a mentor for staff, and develop and support the moral agency of nurses. Transformational leaders spend time on the unit with the staff sharing ideas, empowering the staff, supporting opportunities to enhance the team, showing appreciation and recognizing team members for a job well done, and holding team members accountable.

Ethics

is the study of what is right and wrong in our conduct

Emergency preparedness

is to effectively meet the extraordinary need fro resources such as hospital beds, staff, drugs, PPE, supplies, and medical devices such as mechanical ventilators.

Disasters Mortuary Operational Response Teams (DMORTs)

manage mass fatalities

Medical Reserve Corps (MRC)

national network of volunteers organized locally to improve the health and safety of their communities.

Mass casualty event

overwhelms local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crisis

Justice

refers to fairness and the distribution of resources. Discussions about health insurance, hospital locations and services, and organ transplant generally are among the issues that cite the concept of justice.

fidelity

refers to faithfulness or that agreement to keep promises

Autonomy

refers to freedom from external control. In health care the concept applies to respect for the autonomy of patients. Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care. Involving patients in their decision of care is now a standard practice. We often demonstrate respect for the patient autonomy through the informed consent process. Another way nurses show respect for patient autonomy is by explain nursing procedures such as obtaining a blood pressure or administering medications.

Beneficence

refers to taking positive actions to help others

check back or closed loop communication

reinstate what a person has said to to verify understanding of information

Important elements of the decision making process are

responsibility, autonomy, authority, and accountability

Community Relations Officer

serves as a liaison between the health care facility and the media

Delegation

the process of assigning part of your responsibility to another qualified person in a specific situation

Shared governance

the typical decentralized structure used within health care organizations today. This structure creates an environment in which managers and staff become more actively involved in making decisions to shape the identity and determine the success of a health care organization.

Triage

to rapidly sort ill or injured patients into priority categories based on their acuity and survival potential