Module 3-Professionalism, accountability, communication and legal issues

When should reporting occur and the rules involved

1. any event that is outside the routine care of a client (medication error or missed prescription) 2. incidents involving workplace violence 3. ANy near-miss event such as expired med 4. any adverse event that occurs to a client, staff member or visitor 5. any sentinel event Rules: 1. INclude the names of individuals involved in event 2. use objective language (factual and actions taken) 3. INclude direct quotes 4. Report the event to supervising staff immediately 5. Follow all facility policies regarding documentation and reporting 6. COmplete th eincident report ASAP 7. Individual who discovers unexpected event is the one to file the incident NURSES ROLE: -document the assessment, interventions and outcomes surrounding the event in the client's medical record AND AVOID REFERRING TO THE INCIDENT REPORT DOC **by doing so, the facility is not required to share the incident report form in a court of law if there is a lawsuit (if they document the incident report, can be discoverable and used by client's legal counsel)

Essential components of therapeutic communication

1. Time: plan for and allow adequate time to communicate 2. Attentive behavior and active listening: conveying interest, trust and acceptance 3. Caring attitude: show concern and facilitate an emotional connection and support among nurses and clients, families and significant others 4. Honesty: open, direct, truthful, and sincere 5. Trust: demonstrate to client's and others they can rely on you 6. Empathy: convey and objective awareness and understanding of the feelings, emotions and behavior of clients 7. Nonjudgemental attitude

Analyze group dynamics within the classroom or clinical setting: chain of command

A nurse can initiate the chain of command to make an immediate supervisor aware of a situation, communicate issues, or to inform them that a process is outside or beyond their scope of practice -a nurse caring for a client would take concenr to charge nurse and escalate UP THE CHAIN OF COMMAND PRN -**document efforts as they move along the chain of command **If the client was harmed, anyone contacted in the chain of command who was unresponsive, unwilling or refused is held liable Bottom: AP, RN, Charge nurse, Unit Director or Hospital supervisor, Divisional director, Chief Nursing officer and lastly, CHief executive officer

The relationship of attendance and punctuality to work ethic

A nurse's failure to be punctual might force the rescheduling of a patient's procedure and could delay the patient's diagnosis, treatment, surgery, or discharge -On time: at the start of a nurse's shift, they are ready to begin -frequent absecne or tardiness may result in corrective action or terminate employment -anticipate absences and have a plan of action -avoid excessively long or unscheduled breaks -stay long enough to address needs of client and hand off work properly

Describe types of commitment: affective, normative, continuance

Affective commitment: an attachment fo a profession and includes identification w/ and involvement in the profession Ex: profession produces a satisfying experience, strong desire to continue, becomes involved w/ profession-specific organization and service activities Normative commitment: feeling of obligation to continue in the profession (having received benefits or having had a psoitive experience through engagement in the profession) ex: because of personal or family experiences Continuance: awareness of costs associated w/ leaving the profession ex: loss of income DO NOT MANIFEST THE SAME TIES TO THE PROFESSION

Process of socialization to nursing

As a student, they have not developed their Professional Identity Undergo professional socialization as they compare the informaiton, values and norms that they learned in the classroom w/ live observations and active egagement in the clinical setting -exposes the student to interactive network of nurses and other health care professionals -exposes them to an interactive network of nurses and other professionals

Outline the Nurse Licensure compact. The nurse practice Act

The nurse practice act: Decision making process 1. Is this act consistent w/ the NPA and board statements, rules and guidelines 2. Is this act authorized by provider's prescription or a protocol 3. Is this act supported by nursing or health related research and literature or a national organizations scope of standards 4. Do I posess the knoweledge and training and competency to safely carry out this act 5. Would a reasonable and prudent nurse do this? 6. Am I prepared to assume accountability for this act and the outcomes of doing so? ANY THAT IS NO, STOP YES FOR ALL, CONTINUE

Reporting incidence of disease

These diseases include: Anthrax, botulism, chlamydia, foodborne disease outbreak, hepatitis a-c, HIV, Influenza, Measles, Rubeola, Tuberculosis, Zika virus -it is required to report conlcusively diagnosed cases of these illnesses -vital to develop prevention and protection protocals STIs: responsibility of agency to locate and contact those who have had sexual contact w/ the infected individual to assess and coordinate treatment

Informed consent

permission to provide care given by the client after relevant info is provided Implied: obtained by observing the client's actions that indicate that they are complying ex: IV site, admin of pain meds, and an insertion of a urinary catheter Informed consenst is required for invasive procedures of surgery: colonoscopy, elective surgical procedure, and a scheduled cesarean section

Ethical issues: and common themes

stem cell research, late termination of pregnancy, medically assisted death, refusal of termination of care/treatment, care clients who have substance use disorder, clints have experienced abuse, care of clients in legal custody and allocation of scare resources Exposure to unethical practices Lack of autonomous decision making Hesitancy to address the unethical practices

Summarize various therapeutic communication techniques used by nurses to support clients

Effective communication is key to ensuring clients' safety. Aware of the client's vocabulary: avoid medical or nursing jargon especially with adolescents and children Credibility: nurses must be knowledgeabl, consistent, honest, confident and dependable Denotative and connotative meaning: words that have multiple meanings can cause miscommunication Clarity and brevity: shortest, simplest communication is most effective*** Timing and relevance: knowing when to communicate. Ex: when a client is uncomfortable, in pain, it can cause difficulty to convey the msg Pacing: the rate of speech ex: rapid could mean having no time for the client Intonation: tone of voice Nonverbal: Appearance, posture, gait: (first impression very important) Facial expressions, eye contact, gestures (eye contact conveys interest and respect but varies depending on culture) Sounds: crying or moaning have multiple meanings Territoriality, personal space Therapeutic communication: purposeful use of communication to build and maintain helping relationships w/ clients, families and significant others. Use these interactive skills to elicit and attend to client's feelings/ needs, express empathy and concern, obtain info and give feedback, intervene to promot efunctional behavior, evaluate client's progress toward desired goals

The duties and responsibilities of nursing students

Expected to be knowledgeable and competent in skills and w/ the values and standards specific to nursing -have a desire to represent nursing in a positive manner -professional commitement that motivates sutdents to comply and to prevent them from practicing beyond scope of practice

Strategies of the commitment process:

Exploratory: explore the positive aspects of the profession Testing stage: discover negative elements of the professions (assess their ability to deal w/ those negative elements -some never get beyond this stage Passionate stage: commitment which begins when they synthesize the positive and negative elements of the first two stages -become involved in student nursing associations, sserve as class officers or volunteer Quiet-and-bored stage of commitment: SETTLE INTO THE ROUTNE OF THE NURSING PROGRAM -middle or late stage -begin to see themselves as nurses and have integrated the difficulties as habit

Breach of nursing practice:

Failure to maintain standards of care, breach of client confidentiality and falsification of health records -recognize when we or our peers are fatigued and take action when substance use is known or susepcted Standards of care: ANA developed the nursing scope and standards of practice -Standards of practice: competent nursing care -Standards of professional performance: provide a description of competent behavior 1. INcludes ethics, cultually sensitive, effective communication, collaboration, leadership, continuing edu, evidence-basd practice, maintaining quality practice, evaluations of self and peers, correct utilization of resources, an dpracticing in a safe enviornment -need to gather all data for the nursing steps (ADPIE)

Purpose of HIPAA and how the PRivacy Rule cover protected health information

Federal law that protects an individual's identifying private information and personal health info -ONLY the client and those health care workers involved in the care of the client have access to their information -This applies to online and offline, on the phone or in a private or public space VIOLATING HIPAA CAN BREACH A CLIENTS RIGHT TO PRIVACY AND IS AN ETHICAL VIOLATION -Nurse: can face penalties such as termination, fines, loss of nursing license and exposure to litigation (can result in prison sentence) Social media: must avoid violating client confidentiality, cannot post client information (could result in a reprimand from the state board of nursing, civil and criminal penalties and possible termination)

How Boards of Nursing oversee licensure

For educational progrems, licensure requirements, scop of practice and grounds for disciplinary action, remediation or violations 1. Determiens the laws of practice of the Nurse Practice Act for licensed nurses within the state -Ensures they work within the defined laws, rules and regulations NURSES ARE HELD LIABLE AND RESPONSIBLE FOR KNOWING THESE GUIDELINES 2. The organizations that employ nurses have established policies and procedures that regulate and guide nursing practice within their establishments (define standards of care, responisbilities for e/ employee, recent graduates working permits and newly-licensed and experienced nurse 3. Each nurse is in control of their individual competence, decisions and actions -must think and act swifly, mindful of surroundings, look for areas of improvement

Outline the importance of reliability and accountability for the professional nurse: outside of scope, insubordination

Honoring committements (such as changing shifts), take responsibility for consequences, REFUSE ASSIGNMENTS ONLY WHEN NOT WITHIN SCOP OF PRACTICE and ***discuss situation immediately w/ the supervisor Insubordination: defiance of authority by refusing to complete assigned tasks and will be regarded as ground of dismissal CONFLICTS WITH PERSONAL BELIEFS AS A NURSE: speak to supervisor immiiately about conflicts w/ cultural beliefs or at soonest opportunity of employment

Ways to manage stress associated w/ commitment to a profession

1. Recognize their stress and how they respond to stress 2. They identify trigger situations that tend to provoke stress and find reduction techniques: -reducse tension and engage in quiet activities -direct energy outward (exercise) -overcome feelings of powerlessness and learn to increase assertiveness (say no) -Turn errors and failures into constructive learning experiences -recognizing that no situation is perfect and that limitations always exist -Improve organizational policies and procedures that generate stress -address workplace issues (participate in professional organizations) -Clarify their problems and reactions in counseling

Five rights of delegation

1. Right task: must be within the job description of the delegatee 2. RIght circumstance: ensure the client's condition is stable 3. Right person: the delegatee must have the ability and knowledge to perform the taks 4. Right directions and communications: nurse must communicate specific instructions to the delegatee (delegatee should clarify) 5. Right supervision and evaluation: responsible for monitoring and ensuring teh task is completed appropriately (evaluate client's outcome and proper doucmentation)

Sequential steps of the decision making process:

1. Is there an ethical dilemma (does the problem result from a differing set of values or a conflicting set of ethical principles?) -Does the problem have a clear right or wrong solution? 2. Clearly identify the ethical dilemma: identification of who specifically is affected by the dilemma and the actual problem that exists (NEED TO KNOW THIS BEFORE DISCUSSING SOLUTIONS) 3. Identify possible solutions 4. Apply ethical principles to the solutions: does it respect the client's autonomy more than another? Is one solution more beneficent than another? 5. Include all relevant individual and factors: the client, provider, the client's parter, social worker, part of teh team. -Include other members who are requested -SHOULD ALSO ENSURE THAT ALL POSSIBLE FACTORS SUCH AS LEGAL/FACILITY POLICIES HAVE BEEN CONSIDERED 6. Decide on a solution: if a decision cannot be reached, and if time allows, the team may revisit previous steps 7. Review the decision: has everything been considered? Has anyghing changed? Has anything been overlooked? New issues that may have arised 8. Put the decision into action: requires effective collaboration w/ team and everyone know their roles

Describe factors associated w/ professional commitment

1. A strong belief in and acceptance of the profession's code, role, goals, values and morals 2. Willingness to exerct considerable personal effort on behalf of the profession 3. Strong desire to maintian membership in the professoin 4. Pattern of behaviors congruent w/ the nurse's professional code of ethics

Ways to advoacte

1. Safegaurd the rights of the client by knowing what their wishes are 2. Edu the client on meds and treatments 3. Give the lcleint voice by helping them ask questions, get answers and understand 4. PRotect the client from harm 5. Communicate, propose, alternatives and take action for the client 6. Connect to resruces for meals, transport, prescriptions, financial assistance, or support groups 7. Error check and ask another nurse or pharmacist to verify meds and doses Advocate: informs a client of their righs, provides info, allows client to decide and supports their decision

The five essential professional values of nursing created by the Baccalaureate Edu for professional nursing practice: altruism, advocacy, human dignity, integrity, autonomy and social justice

Altruism: selfless concern and actions for the benefit of someone else Ex: rushing to help someone in need (sometimes ignoring risk to themselves and putting the needs of the client first) These nurses are empathetic and place themselves in the position of another and want to relieve another's pain Advocacy: when a selfless desire to help someone arises Human dignity: each individual, regardless of race, religion, gender, sexual orientation, culture, ethnicity, socioeconomic status, or any of our characteristics or personal preferences, has intrinsic value and should be respected and treated equally Maintaining privacy, showing respect, providing culturally competent care, and ensuring confidentially Ex: the nurse should ask the client what activities or cares they feel like they can perform independently and what activities they would like to be assisted with Integrity: nurse demonstrates honesty even when circumstances challenge the nurse's character Nurses as upholding the professional standards of the Code Continues throughout edu and career Autonomy: Right to self-determination Respect the client's right to make their own decision regarding their health care Social justice: awareness of the basic right to health and well-being of every individual Prioritize only based on emergency, not on race or other factors Ensures that anyone of any status has the right to health and happiness

Outline the phases of the therapuetic relationship and explain ways that nurses can develop therapeutic relationships (assessment, planning, implementation) and skills associated

Assessment: determine verbal and nonverbal communication needs. (those with hearing, vision or cognitive losses, unresponsive or aphasic -Consider physical status, developmental level Planning: minimize distractions, provide privacy, identify mutually agreed-upon outcomes, set priorities according to the client's needs, collaborate w/ other healthcare professionals prn, and plan adequate time for interventions Implementation: establish a trusting nurse-client relationship, provide empathetic responses and explanations by using observations, giving info, conveying hope and using humor -manipulate the environment -Have congruent verbal and nonverbal communication -Demonstrate empathic presence by appearing relaxed, comfortable, facing the client, open posture, leaning toward the client and maintaining eye contact) Skills: silence (allows time for meaningful reflection), presenting reality (helps clients distinguish what is real), active listening, asking questions, clarifying techniques: -Restating (using client's exact words), reflecting (directs the focus back to the client for them to examine their feelings), paraphrasing (restates the client's feelings and thoughts for them to confirm), exploring (allows the nurse to gather more info about important topics -Offering general leads, broad opening statements (enforces client to start and continue talking) -Showing acceptance and recognition (nonjudgmental) -Focusing: help client concentrate on what is important -Giving information provides factual details that the client might need for decision making -Summarizing: important points and reviews what the nurse and the client have discussed -Offering self: willingness to spend time with the client (can share limited personal info but the focus should return to the client asap--helps the client see that others share their experience -Touch: can communicate caring -Sharing feelings: ask clients to express feelings and help them identify those feelings (**Plan to discuss negative or angry feelings w/ peers or other support persons rather than the client) *****CAN ALSO SHOW CONCERNS TO CLIENT TO GAIN RAPPORT

Nursing process and advocacy

Assessment: establish unique relationships w/ their clients in the process determine level of understanding, interests, personal values, mental function Identificaition: identify their needs and personal beliefs. INforms/ explains so the client can make an informed decision Implementation: communicate the client's preferences to the rest of the interprofessional team (goals) Evaluation: outcomes are reviewed to see if what was expected or something else resulted (satisfaction of client, family, etc)

Ethical principles: justice, fidelity, beneficence, autonomy, veracity

Autonomy: refers to the nurse's obligation to respect the client's right to make their own decisions regarding their health care (right to refuse) Beneficence: nurse's obligation to minimize harm and practice in a way that benefits the client. Going above what is required Minimizing harm such as implementing fall precautions Ex: someone who is fearful they have cancer, sitting with them and providing comfort Nonmaleficence: obligation to do no harm If the client is at risk, do the benefits outweigh the risks? Ex: not administering meds that could be potentially harmful Veracity: nurse's obligation to provide truthful and accurate info to the client Strengthens the nurse-client relationship by establishing a sense of trust If they are asking questions, respond truthfully Fidelity: nurse's obligation to demonstrate loyalty, to keep promises, and to uphold commitments Following through w/ agreements or promises made to the client is critical to maintain the relationship Justice: nurse's obligation to provide treatment, care and resource allocation that is impartial, fair and equitable to all clients regardless of age, sex, race, or economic status Ex: three clients who all have the same blood type and all need a blood transfusion; however you only have one. You should collaborate w/ the providers and your supervisor to determine who has the most urgent need. BENEFICENCE: INCLUDES MEETING A CLIENT'S PHYSICAL, SOCIAL OR EMOTIONAL NEEDS

Barriers to effective communication and suggest strategies to reduce the risk of e/ barrier

Barriers to communication: -Asking irrelevant personal questions, offering personal opinions, stereotyping, giving advise, giving false reassurance, minimizing feelings, changing the topic, asking "why" questions or asking for explanations THIS CAN BE A BARRIER BECAUSE THE CLIENT MAY WANT TO ACT DEFENSIVELY -Challenging, offering value judgments, probing, responding approvingly or disapprovingly, being defensive -Testing, judging, offering sympathy, arguing -Making automatic responses, reacting w/ passive or agressive responses SITUATIONAL EX: person afraid to go home because they have a colostomy bag and was previously an avid swimmer TELLING THE CLIENT: YOUR DAILY ROUTINES WILL BE DIFFERENT WHEN YOU GET HOME GIVES THEM THE REALITY OF THE SITUATION ASKING AN OPEN ENDED QUESTION ABOUT THIER SUPPORT OFFERS FOR ADDITIONAL INFO iT SOUNDS LIKE YOU ARE NOT SURE HOW HAVING A COLOSTOMY BAG WILL AFFECT SWIMMING USES AN EFFECTIVE TECHNIQUE

Differentiate credentialing and certification

Certification in a specialty area deomonstrates a mastering of knowledge, education and skills as well as the motivation and passion to deliver quality client care -practicing at an elevated level of excellence -distinguish themselves through a commitment to lifelong learning and self improvement Eligibility: 1. Years of experience within a set population, fees, review of study material and passing exams ex: advanced diabetes management, advanced oncology certified nurse, certified emergency nurse, cardiac medicine

Differentiate considerations related to communication throughout the lifespan

Children: assess the child's level of development teaching: primary health care, health promotion, and illness and injury prevention -teaching plan directed toward caregiver -seek to establish trust -address any concerns or fears -allow time for questions -use props to demo treatment tools: have children visit the treatment rooms, dress up (have children touch and dress up in clothing), coloring books (help to prepare for treatment), dolls, puppet play and health fairs older adults: focus on health promotion, disease management, and illness and injury prevention essential to explain treatments and medications -need for follow up, nutrition, physical activity, use past experiences to help them learn, allow adequate time for digesting information, use large black print on matte print, must evaluate teaching and learning in client

Differentiate considerations related to therapeutic communication throughout the lifespan

Children: use simple, straightforward language -Be aware of nonverbal msgs (especially sensitive to nonverbal communication) -Be at the child's eye level and incorporate play Geriatric: recognize that many older adults require amplication of sound -Make sure assistive devices are available -Minimize distractions and face clients when speaking -Speak in short and simple sentences -Allow plenty of time for clients to respond -Ask for input from caregivers or family to determine communication deficits and how to effectively commun Cultural: -Provide an interpreter -Address the client directly when the interpreter is present -Provide edu materials and instructions in the client's language

Legal implications: Client abandonment

Client abandonment: if they desert a client for whom they have established a nurse-client relationship w/o ensuring the continuation of care by another nurse ex: failure to provide report to another nurse prior to leaving, and sleeping while assigned 1. Physical or psychological health is endangered 2. Actions of nurse are directly responisble for any harm 3. The client will have decreased risk of harm 4. the risk of harm TO THE NURSE is outweighed by the benefit IN SOME CASES, RISK OF HARM TO THE NURSE TAKES PRECEDENCE OVER ex: highly contagious client w/o PPE -the nurse should notify the charge nurse or nursing supervisor that they are unqilling to accept this assignment ***should ensure the care of client has been passed to another nurse before obliagation to client can be discharged

Factors that influence nursing practice and accountability

Comfort: assessing the patient's level of comfort Assess patint's reported level of comfort at least once per shift Document patient's comfort level and any nursing interventions Evidence-based practice: accountable for practice within an EBP environment Develop a clinical question using the format of EBP COnduct a literature search Select appropriate nursing interventions based on evidence Health, Wellness, Illness and injury: Assessing the patients current level of health and wllness then providing teaching, interventions and referrals Assess patients current overall health, including biphysical, cognitive, psychologic and spiritual components Providing teaching on health promotion and illness prevention and measures specific to patient's risk factors Refer patients to counselors, clergy, dietitians, physical therapists, support groups, an dother outside resources Safety: keeping patients safe Identify and address safety hazards in the healtchare environment Assess patients risk for varius types of injury outside healthcare enviornmnet Appropriate, teach patients about actions that can reduce risk of injury Teaching and learning: patient edu, staying up to date w/ latest evidence, providing current and accurate teaching Asses patient and family learning needs Asses readiness for learning Read current journal articles and attend workshops or seminars that provide up to date info Trauma: accountable for taking action to prevent further harm Assess signs of prior physical, emotional or sexual abuse Assess for both risk of abuse an dsuicide risk Be aware of warning signs of abuse or suicide

Difference between civil misconduct and criminal

Criminal law: prosecutor has burden of proof to show a nurse has violated a criminal standard (punish defendants and deter future crim) Civil lawa; deals with disputes between individuals or between an individual and an organization -Civil cout: victim is awarded compensation Because a criminal court does not compensate victims for a preventable harm, a nurse can be defendant in botha criminal and a civil case

Laws that affect the nursing practice: ICN code of ethics and Emergency Medical Treatment and Labor ACT

ICN Code of ethics: addresses the duty of care, the practice of nursing, professional responsibilities and collaborative relationships 1. The nurse should provide compassioante care and respect the client 2. The nurse should recognize e/ client is unique, has worth, and deserves to be treated w/ dignitiy 3. The nurse should be an advocate for e/ client's rights and needs 4. The nurse should promote and protect the health and safety of each client 5. Nurse should demonstrate authority, accountability and responsibility 6. The nurse should promote health and provide best care 7. The nurse should maintain competence, practice the accepted values of the nursing profession an dpromotea healthy and safe enviornment 8. SHould adhere to ethical principles 9. should promote profession through research and inquiry 10. the nurse should participate in the development of standards of practice and policies 11. The nurse should collaborate w/ othe rmembers of the interprofessional team to protect the rights of all individuals and decrease health disparities 12. THe nurse should promote the integrity Emergency Medica l Treatment and Labor Act: enacted to direct emergency medical personnel to provide equal care to clients entering the emergency department regardless of their insurance or financial status -CANNOT TURN AWAY CLIENTS FOR REASONS SUCH AS BEING UNDER OR UNINSURED 1. All clients must have a medical screening evaluation 2. If the client is, in fact, experiencing an emergency, the hospital must stabilize the client (if they cannot provide the specific treatment, they must be transferred) 3. In the event the client cannot be stabilized in the ED, a physician or another qualified medical professional must verify and sign-off transfer (benefits of transfer outweigh the risks of transferring an unstable patient) EX: if there is a burn patient and the ED that specializes in trauma is further away, they would go to closest and they would attempt to stabilize before transfer HIPAA

Legalities of mandatory reporting and situations that require mandatory reporting

If a nurse notices the client's nurse failed to conceal their info on a computer: 1. Log the client's nurse out of the computer 2. Reporting the incident to the facility's privacy officer, talking w/ the client's nurse to identify how the incident occured and inform them of the problem, provide additional HIPAA and confidentiality to the clients nurse to reduce risk

Reporting incidents: near miss and sentinel

Incident records: medication admin errors, missed prescriptions by the provider, equipment failures, client falls and near misses and sentinel events Near-miss: occurence of an incident in which no harm or injury occured Sentinel event: resulted in permanent disability, temporary severe injury or death **required to report -serves to prevent further harm, provide info surrounding the event to help improve the processes in the future (NON PUNITIVE) ex: anethesia-related event (airway management/ error), care managment event (client fall, restraint, pressure injury), criminal event (assault, false imprisonment), enviornmental event, product or device event, protection event (client elopment, infant abduciton, self-harm), Suicide (also within 72 hours of discharge), surgical or invasive procedure events

Advanced directives: will and power of attorney. The nurses role

Legal documents in which a client's decision related to health care are documented -Normally seen with aging population and growing number of clients who have dementia Durable power of attorney, living will, Do not intubate and organ donation form are included FEDERAL LAW REQUIRES: health care institutions to provide clients w/ the forms necessary to complete and advance directive REASONS THEY DON't: not necessary until a seroius illness or english is a second language Living will: document where a client can clearly state which treatments they wish to have performed if they become incapacitated Durable power of attorney can appoint an indidivual to make health care decisions on their behalf if they are unable to NURSES ROL: 1. Encouraging clients to have frequent ongoing discussions with their care provider and the individual the client wishes to make decisions for them (to communicate wishes) 2. The client's wishes and the surrogate should be documented 3. Determine the client's lieteracy level and need for assistance 4. Identify and clarify any misconceptions the client may have 5. Providing info to the client about what an advanced directive is and its importance (often fall to the nurse) 6. communicate the client's status regarding an advance directive is important

Mandatory reporting of maltreatment

Legislation mandates that certain officials have a legal duty to report inof that can prevent maltreatment an dprovide safety -Licensesd nurses are mandatory reporters Reporting of maltreatment: must be reported to the appropriate agency ex: 1. Physical maltreatment or denying food, shelter, or comfort 2. Neglact, denial or delaying of care 3. Verbal or emotional maltreatment 4. Sexual maltreatment 5. Financial exploitation 6. EDU maltreatment or neglect 7. Lack of protection from harm -Older adults and children are at risk -if investigation reveals maltreatment is not present: a nurse is acting in good faith -IF IT IS FOUND: nurse should inform any charge nurse, unit manager, and staff nurse assigned to the client of the findings

Analyze hos the nursing profession promotes accountability and summarize the components of professional accountability

Need to perform their assigned skills, report if they were delegated a task outside of scope and do it with evidence-based Standards of practice are established by the Joint COmmission, American Nurses Association, the National League for nursing Ex: need to make decision on if the patient was educated enough, can they send them home yet? If they perform home care improperly, nurse is responsible. Should: request an order for home healthcare to continue the teaching and follow up until the patient is comfortable on their own -teach a family member to perform the dressing change if the patient is not able to do so -Arrange for the patient to travel to an outpatient nursing facility to help change dressings Specialized edu: have passed NCLEX, most rns have bachelors Body of knowledge: expertise that is expanding and ongoing research Service orientation: service to others as a matter of tradition (rules, policies and codes of ethics help guide) Code of ethics: respect for worth and dignity of all people, must do what is right, strive to maintian integrity Autonomy: independence or freedom (regulate itself and set standards of practice for its own members) ex: how a organization runs, do they follow regulation? What is their legal authority? Autonomy nurses: accountability for actions and adhering to work policies while establishing freedom in doing their job Professional organization: establishes social, political and economic arrangements that give professionals the means to control their professional affairs

Good Samaritan laws

Nurse does not have legal obligation to provide care to anyone outside of their employment obligations -when they choose to do so, this falls under this law -protect/ encourage ppl to provide aid in the event of an emergency REQUIREMENTS: 1. Nurse will not be protected if care is rendered w/o due care or w/ disregard of the safety o f the individual (GROSSLY NEGLIGENT) 2. THe nurse cannot know of any medical or other condition of the person to whom they are providing care 3. No compensation

Differentiate privacy and confidentiality. What are teh six principles of social networking

Physical seclusion, protection of personal information and identify and the ability to make autonomous decisions all refer to privacy Not disclosing info w/o the person's permission is referred to as confidentiality Principles (ANA) 1. Nurses should not transmit or post any identifiable client info 2. Nurses should maintain professinoal boundaries if communicating w/ a client through social media 3. Nurses should expect posted info to be viewed by the client, peers and supervisors 4. Nurses should use privacy settings provided by social platforms to keep personal versus professional info separate 5. Nurses should advocate for client's rights and report and instances of client info or communication on social media in violation of legal and ethical standards 6. Nurses should work w/ their employer to devlop effective policies and procedures to ensure professional communication w/ clients

What are the components of professionalism within the practice of nursing and what are some examples of how the nurse uses professionalism

Professional behaviors: convey professionalism by adhering to dress codes, maintaining calm demeanors, refraining from inappropriate electronic media use and demonstrating strong work ethic Teaching and learning: nurses attain and expert level of nursing practice by actively engaging w/ both on-the-job learning opp and formal edu programs Competence: nurses demo competence through rigorous app of university accepted standards of care and evidence-based practice Collaboration: communicate/ work respectfully w/ others Advocacy: accountable for advocating for client safety and needs at all times in all settings (REDUCE RISK AND IMPROVE PATIENT OUTCOMES) Caring interventions: exemplifying a positive attitude and demo compassion and cultural awareness for pateints' needs Ethics: adhering to accepted nursing standards and considering ethical implications for actions (protect clients and demo integrity)

Describe the influence of attitude and enthusiasm in the work environment

Refrain from pessimism and arrogance. Accurate self-assessment of strength and weaknesses as well as acceptance of feedback from others promotes safety and growth

Strategies to prevent incidents of professional negligence. Informed consent and what info to provide client

Research insurance coverage for malpractice and consider purchasing a separate policy -Diligently follow the rules, guidelines, policies, and procedures for the facility and state in which they work -Review the proteciton coverage of employer -Be knowledgeable about the Nurse Practice Act -Put the client first in practice Informed consent: permission to provide care (must be given voluntarily w/o coercion by others) 1. Proposed treatment or procedure 2. Who will perform the treatment/ procedure 3. The purpose 4. The expected otcomes 5. The benefits 6. Risks associated 7. Alternatives to the particular treatment 8. Benefits and risks associated w/ alternatives **NURESES ROLE IS TO VERIFY AND WITNESS THAT THE CLIENT OR LEGAL REPRESENTATIVE SIGNS THE CONSENT IN THEIR PRESENCE AND SHOULD VERIFY THE CLIENT HAS ADEQUATE KNOWLEDGE TO THE DECISION Informal (implied) consent or informed consent Implied: obtained by observing the client's actions that indicate that they are complying ex: initiation of an IV site, admin of pain med, and insertion of a urinary cather Informed: required for invasive procedures*** -provider is required to provide edu to the client about the risks, benefits ex: colonoscopy, elective surgical procedure, and a scheduled sesarean section

SBAR method

Situation Background Assessment Recommendations: avoid breakdowns in communication, uniform communication procedures

The different types of educational nursing programs

Specialized education: those who earn a hospital diploma or an associate's bachelor's, master's, or doctorates -Pass the national council licensure (NCLEX) -Many require RNs to have a bachelor's degree (RN-BSN program)

Describe the National Council of State Boards of Nursing

State boards of nursing and the nursing COde of Ethics reinforc e professional behaviors. -State boards have the authority and responsibility to review, investigate and act on complaints -NCSBN states that it is the duty of the individual boards of nursing to protect the public and can take disciplinary action against a nurse for unprofessional conduct -can be outside the workplace such as DUI -accidental release of information on social media, BON may investigate reports of inapproriate discoluses made on social media by evaluating: 1. unprofessional conduct, unethical, breach of confidentiality, mismanagement of client records, revealing privledged communicaiton, and moral turpitude

Tort of law and its implication for nursing

Tort: carrying out an act, or failing to act against what is considered reasonable and acceptable (results in injury or harm to a client) -Protects the public, determines liability and settles claims for illness or damages -Includes unintentional and intentional torts Unintentional: the nurse does not intent to cuase harm (malpractice and negligence) Malpractice: nurse fails to meet standards of care Negligene: when the nurse is found to have breached their duty of care resulting in client injury or suffering -Malpractice insurance is designed to protect nurses from financial burdens, licensing restricitons and loss of work Intentional tort: invasion of privacy, defamation, and assault and battery. Assault: when a client is made to feel fearful of harm or offensive contact (threateend w/ restraints) Battery: act that results in harm or injury to client (restraining a client or touching the client by inappropriately doing so or operating on the wrong body part) TREATED AS A CRIMINAL OFFENSE

Strategies to avoid unprofessional behaviors

Unprofessional: belittling someon's opinion or using patronizing language, negative or disparaging nonverbal messages, engagning in constant criticism, scapegoating and fault-finding -Engaging in eltism about experience, edu or practice are -undermining someone's activities or causing unnecessary disruption -Emotional outbursts -Being reluctant to answer qeustions -Pitting staff members against one another and creating rumors

Examples of behaviors that may be interpreted as sexual harassment and strategies to avoid them

Unwelcome sexual advances, requests for sexual favors or other verbal or physical conduct of sexual nature Avoidance: 1. Lift a patient's breast to bathe the chest or to place leads when performing and electrocardiogram is best to use the back of the hand -Explain the procedure and seek patient's permission

Summarize generational differences in work ethic

Veterans (1925-1944) work ethic: sacrafice and hard work are rewarded, seniority is important to advance career, value loyalty, respect authority, like working in teams w/ designated leaders, prefer personal forms of communication -can be valued for the wisdom and organizational history (know how to operate w/o tech) Baby boomers: 1945-1960: are workaholics, embrace sense of professionalism, self-worth closely tied to work ethic, question authority, status quo can be transformed by working together, and desire financil prosperity but long to make significant contribution -valued for their clinical and organization experiences (used as a coach) Generation X: 1961-1980: seek challenges, are self-directed, expect instant access to fino, desire employment in which they can create balance in work and perosnal life -Prefer managers to be mentors and coaches and desire more control over their own schedule VALUED FOR INNOVATIVE IDEAS AND CREATIVE APPROACHES TO UNIT ISSUES AND PROBLEMS Millennnials: 1981-200s -Collaborative, open-minded, achievement-oriented -Expectation of daily feedback, igh maintenance -Potential to become the highest producing workforce in history, and personal smart devices a necessity for dialy life VALUED FOR THEIR UNDERSTANDING OF TECH AND INSIGHTS ON HOW TO USE IT IN PRACTICE