question

Functional Nursing

answer

Nurses & staff assigned to groups of tasks Pro: Cost effective Con: Fragmented care

question

Team Nursing

answer

RN, LPN, NA assigned to group of pts Pros: Quality, team input Cons: Lack of continuity, requires strong leadership

question

Leaders/Managers need 3 skill sets

answer

Technical skills (includes knowledge & hands-on) People skills Conceptual skills

question

Levels of Nursing Management

answer

First Level Middle Management Upper Level Responsibility/authority ↑ with levels Accountability on all levels

question

At the staff nurse level of management

answer

a considerable amount of technical skill and clinical expertise is needed

question

more advanced conceptual skills are needed

answer

As one advances from lower levels to higher levels in the organization

question

Total Patient Care

answer

RN assumes total care for group of pts/shift Pros: Holistic, continuity during the assigned shift Cons: Cost, shift-based focus; lacks long-term continuity

question

Primary Nursing

answer

RN assumes 24 hr care for group of pts during the length of stay Pros: 1:1 care, autonomy, improved collaboration Cons: Cost? And requires strong working relationships with associate nurses

question

Case Management

answer

RN responsible for quality & pt outcomes Admit to discharge

question

Patient-Centered Care

answer

Core nursing value Interdisciplinary team w/assistive personnel functioning as a unit-based team to meet pts' needs

question

Collaborative Practice Model

answer

Nurse & physician work together

question

Purpose of NPA

answer

Protect health & safety of citizens Protect title of Nurse

question

The Nurse Practice Act and Scope of Practice

answer

Definition of the term "nurse" - RN/LPN/LVN/APRN Description of professional nursing functions Standards of competent performance Behaviors considered to be misconduct or prohibited practices Grounds for disciplinary action Fines & penalties Board may levy when NPA violated

question

Other components of NPA

answer

Licensure requirements/renewal Mandatory continuing education Criminal background checks Delegation rules NLC (compact) rules

question

NPAs written & passed by legislators

answer

Sunset legislation - must be reviewed by a specified date

question

Mississippi's Nurse Practice Act

answer

Known as Nursing Practice Law Accompanied by a second document which outlines the rules/regulations of how the MS BON administers the law - that document is known as the Administrative Code

question

Obtaining Licensure

answer

Application for initial licensure to one state MS - print application AL - online only Proof of SON program completion (official transcript) Criminal Background Check Register & take NCLEX-RN; NCLEX-PN once cleared by state (Authorization To Test - ATT); currently administered by PearsonVue http://vue.com/nclex/ State verification of license

question

Organizational Management

answer

Centralized/ Tall Decentralized/Flat* Matrix

question

Organizational Chart

answer

Defines lines of communication, authority, responsibility and supervision

question

Leaders

answer

select and assume their role

question

Managers

answer

assigned or appointed their role

question

Leadership

answer

a way of behaving: the ability to cause others to respond

question

Management

answer

a problem-oriented process with managers having to focus on both the organization and the staff or process they are managing

question

Autocratic

answer

My Way or the Highway

question

Democratic

answer

Our Way

question

Laissez-Faire

answer

Whatever

question

Management is the process of effectively working with people

answer

Required when 2+ people work toward a common goal

question

Management is a problem oriented process

answer

Four steps: planning, organizing, directing, controlling Akin to the nursing process

question

Military and government nurses

answer

As a U.S. government employee, nurses have to be licensed in only one state to practice across the country

question

Foreign nurse graduates

answer

Nurses who receive education in another country must take a special examination administered by the Commission on Graduates of Foreign Nursing Schools before applying for a license to practice in this country

question

Life-long Learning

answer

Mandatory in many states (29, including LA, AL) 10-30 hours per renewal cycle Online/self-study vs live participation May have specific programs (Blood borne Pathogens, Delegation)

question

MS - MNA House of Delegates passed resolution in Oct 2011

answer

in support of CE; now before the MS BON (proposal was for 20 hours per renewal cycle)

question

Advanced Degrees

answer

LPN-to-ADN transition programs RN-to-BSN and RN-to-MSN programs Graduate programs: MSN, APN, DNP, PhD

question

IOM's Future of Nursing Report

answer

"Increase the proportion of nurses w/ baccalaureate degrees to 80 percent by 2020."

question

NPAs require certification

answer

of APNs and defines advanced practice some differentiate NPs & clinical nurse specialists

question

Master's degree is not required by all states

answer

but evidence of certification in specialty area is required. Specific provisions for prescriptive authority.

question

Certification - by non-governmental agencies

answer

American Nurses Credentialing Center (ANCC) - central organization for certification of nurses Certification Videos - American Nurses Credentialing Center - ANCC

question

Five Elements of Communication

answer

The sender The message The means The receiver The effect

question

Verbal Communication

answer

not just what was said, but how it's said, what was emphasized, what meaning does it have to the individual

question

Nonverbal Communication

answer

what are we doing when we say it.

question

Language barriers Cultural and generational barriers

answer

are we speaking the same language - do the words mean what we intend & are they being understood

question

Characteristics of Positive Communication

answer

Openness Empathy Supportiveness Positiveness Equality

question

Developing Trust

answer

Essential to effective communication between patient and nurse Enhanced by: Openness on the part of the nurse Honesty, integrity, and dependability

question

Developing Trust Achieved by

answer

Communicating clearly in language that laypersons can understand Protecting confidentiality Avoiding negative communication techniques such as blocking and false reassurance Being available to the individual

question

Nursing and interdisciplinary team members should share

answer

the essential element of trust

question

Communication Skills and Strategies: Using "I" Messages

answer

Fundamental component in accessible communication Comments that start with "You" put the receiver's defenses on alert "I" messages sound much less accusatory Allow the receiver to respond to the true message rather than start to mount a defense

question

Establishing Eye Contact

answer

Demonstrates undivided attention to the patient Important in communication with coworkers and interdisciplinary team members Avoidance can be interpreted a number of ways: shy, scared, insecure, preoccupied, unprepared, dishonest (and so on) Use of direct eye contact is a Western value In some cultures, avoidance of eye contact is a more appropriate social behavior

question

Keeping Promises

answer

Making and then breaking promises destroy trust in any interpersonal relationship Once a commitment is made, every effort must be expended to fulfill the expectation If the request is impossible to supply, explain the situation or circumstances

question

Expressing Empathy

answer

Ability to mentally place oneself in another person's situation in order to better understand the individual Understanding the experiences of the other person Enhances nurse's ability to help patient through a true understanding of what the individual is feeling and needs

question

Using Open Communication

answer

Open-ended questions or statements that require more information than yes or no Questions or statements that are phrased to require only one- or two-word responses may miss the mark entirely

question

Being Aware of Body Language

answer

Body positioning and movement send loud messages to others

question

Body Language Communication is enriched through

answer

An open stance such as holding arms at the side or out toward the patient rather than crossed Leaning toward the patient as if to hear more clearly, rather than away from the patient

question

What is the most important skill when communicating?

answer

Effective listener

question

A good communicator is an effective listener

answer

Twice as much information is gained by listening than talking Focus is solely on the speaker Establishes eye contact Displays body language that shows interest Avoids distractions Prepares probing questions that elicit other useful information

question

Computer-Based Communication

answer

Lacks nonverbal cues to aid in communication Beware: communication via computer can often be retrieved even after it has been deleted Clarification—important to ensure that the correct message is received

question

Communication Styles

answer

Assertive Aggressive Passive Passive-Aggressive

question

Assertive

answer

Pronounces own basic rights without violating rights of others States wants, needs, desires, and feelings using objective, direct comments Connotes style of positive declaration and confidence Preferred communication style for professional nurses To speak assertively: Be sure of the facts Carefully consider the options Exude confidence while making the observation, request, or point

question

Aggressive

answer

Claims basic rights in ways that violate the well-being of others Commanding, dominant, superior attitude Makes accusations that blame or put down others Conveys dominance and implies an inclination to start quarrels or fights

question

Passive

answer

Influenced or acted upon without acting in return Uses apologetic words with hidden meanings Seems disconnected and fails to say what is meant

question

Passive-Aggressive

answer

Avoids direct confrontation Manipulates others in order to achieve their personal goals Appears to be honest but undermine others through gossip, playing the victim, etc. Wins in situations by making others look bad

question

Proper Channels of Communication for Managing Practice & Client Related Issues

answer

Chain of Command SBAR CUS Hand-offs Professional Boundaries Workplace Civility

question

SBAR

answer

Situation Background Assessment Recommendation

question

CUS

answer

TeamSTEPPS® - a teamwork system developed by DOD's Patient Safety Program & AHRQ Communication system to improve patient safety & teamwork Concerned Uncomfortable Safety

question

Shift Change Report/ Hand-Offs

answer

Written Electronic Hand-written Oral Combination Use the previous shift's report to determine tasks and priorities

question

Shift Change Report

answer

Establishes general goals Communicates timed activities Aids in making assignments Determine who can perform Plan for continuity when possible Provides critical information, assessment information, evaluative information

question

Professional Boundaries & Workplace Civility

answer

Big issues in nursing - topics of research studies Know your "zone of helpfulness" with patients "Professional boundaries are the spaces between the nurse's power and the client's vulnerability." (NCSBN) Practice professionalism with co-workers Why do nurses "eat their young"?

question

Problem-Solving always involves

answer

a decision-making step

question

Problem-solving in nursing incorporates critical thinking

answer

where we add some creativity and professional judgment to the situation, maintaining both the art and the science of nursing.

question

Nursing Process

answer

Assessment Analysis/nursing diagnosis Development of plan Implementation of plan Evaluation/assessment

question

Problem-Solving Process

answer

Data gathering Definition of the problem Identification of alternative solutions Implementation of plan Evaluation of solution

question

One of the most important things you can do when trying to manage your time

answer

is to look at the big picture - know your overall goals - picture yourself as that nurse.

question

TIME MANAGEMENT

answer

Assessing how we are using our time right now - Examining "time attitudes" Analyzing time wasting behaviors Planning to develop better time management skills Goal setting Implementing for control Evaluating what works!

question

The Pareto Principle

answer

Clarify your vision Set goals Short-term Long-term Focus on activities that will get the max results

question

The 80-20 Rule

answer

80% of your work-related outcomes come from only 20% of your focused efforts 80% of your unfocused efforts result in only 20% of your outcomes

question

One tool or process you can use in setting priorities

answer

is the Pareto principle - also known as the 80-20 rule.

question

Focusing your efforts to achieve more

answer

Assess/Analyze your time Covey: 7 Habits of Highly Effective People

question

Deciding what should be done first influenced by:

answer

Urgency of a situation and the demands of others Closeness of deadlines and the existing time frame Degree of familiarity and easiness of the task Amount of enjoyment involved Consequences involved Size of the task and congruence with personal goals

question

Processes to assist in setting priorities:

answer

ABC approach: list all tasks and assign "A" to high-value items, "B" to medium-value items, and "C" to low-value items

question

Scheduling activities - Organizing

answer

Determine how much time spent on specific activity Tools to aid in scheduling activities: -Hourly time schedules -Weekly calendars -Monthly calendars -Semester calendars

question

Schedule activities to coincide with

answer

internal "prime" time when you concentrate best and external "prime" time when you deal best with people Schedules most useful when they are written down

question

Establishing to-do lists

answer

Keeps one focused on specific activities Reflects priorities and goals Revise daily

question

External Time Wasters

answer

Telephone interruptions; Drop-In visitors; socializing

question

Internal Time Wasters

answer

Lack of Self-Discipline Failure to Delegate Procrastination Indecision Personal Disorganization Perfectionism

question

Organizing for control

answer

Personal organization is an important component of time management Avoid the stacked desk syndrome Practice "no detourism" to organize the mind Concentrate on one activity until it is accomplished Undertake and complete only one activity at a time Complete the task correctly the first time Learn the art of "wastebasketry"

question

4 D's Decision-making with e-mail

answer

Delete it Do it Delegate it Defer it

question

Organizing

answer

4 D's Decision-making with e-mail Phone call may be faster Allot a specific time Use for mail too

question

Avoiding procrastination

answer

-Identify the tasks that are being put off, and ask why -Determine whether the task could or should be done by someone else -Identify the consequences of the procrastination -Set priorities in relation to the task, and establish deadlines -Focus on one aspect at a time -Do not strive for perfection if 98% will be just as effective -Emphasize the benefits that are to be gained by completing the task

question

Steps to facilitate appropriate delegation

answer

Identify exactly what is to be delegated and why Select the best person for the task Communicate the assignment in detail Involve the person in establishing objectives and deadlines Give the person the authority needed to accomplish the task Provide adequate resources and support as needed Schedule regular times for progress reports Evaluate the process and progress Let the person do the job Enjoy having the delegated task completed

question

Controlling interruptions

answer

Most frequent causes of interruptions: telephone calls, meetings, and visitors Do not answer calls during times scheduled for other activities Managing visitors

question

Personal Use of Organizational Skills In the Clinical Setting

answer

Assess what you're doing now Set goals for your day Plan your interventions Organize! Complete the priority items first Evaluate

question

Clinical Day Organizational Tips

answer

ID tasks, obligations, activities Write them down (including documentation times) ID which ones are "timed" - (ex: meds) Prioritize according to importance Break down big tasks into more manageable tasks if able Work on most important first Cross them off as they're done Delegate tasks that can be Avoid accepting assignments beyond your capabilities Avoid the need to be perfect Control work interruptions Evaluate how effectively time was used

question

Prioritizing Patient Needs

answer

One very important prioritization framework is using Maslow's Hierarchy of Needs

question

Prioritizing by Covey's ABCD(E) Lists: A Tasks - Must Do

answer

Urgent and Important A1 - emergent situations A2 - any task which would cause serious discomfort or harm to pt if not performed urgently

question

Prioritizing by Covey's ABCD(E) Lists: B Tasks - Need to Do

answer

Important but not urgent Need to be completed at some point during shift, but can be delayed

question

Prioritizing by Covey's ABCD(E) Lists: C Tasks - Nice to Do

answer

No negative consequences if not completed Do only after A & B tasks done

question

Prioritizing by Covey's ABCD(E) Lists: D Tasks - Delegate the Task

answer

Is there is someone else available who can do the task? If so, delegate it. (At work, remember your accountable for any work delegated to unregistered staff).

question

Prioritizing by Covey's ABCD(E) Lists: E Tasks - Eliminate!

answer

Does this really have to be done at all? e.g. opening and reading junk mail, attending unnecessary meetings!

question

Prioritizing by Critical Thinking High level:

answer

ABCs Require immediate attention

question

Prioritizing by Critical Thinking Intermediate level:

answer

Significant but not life-threatening -Pain -Mental status change -s/sx infection -Other patient safety

question

Prioritizing by Critical Thinking Low level:

answer

Need to be addressed according to resources Disease management education Other health issues

question

Patient Safety Impacts Priorities

answer

Principles of infection control Cognitive impairments Impairments in mobility Family/caregiver presence

question

Assessment comes first

answer

when prioritizing

question

Nursing Diagnoses: High priority (Life-threatening)

answer

Impaired spontaneous ventilation Ineffective cerebral tissue perfusion Decreased cardiac output

question

Nursing Diagnoses: Medium priority (Unhealthy Consequences)

answer

Impaired wheelchair transfer ability Acute confusion

question

Nursing Diagnoses: Low Priority (Makes No Difference If Not Attended to This Day)

answer

Delayed growth & development Spiritual distress Risk for situational low self-esteem

question

Prioritizing within the Nursing Process Planning

answer

Prioritizing your nursing diagnoses Establishing realistic goals Patient preference

question

Prioritizing within the Nursing Process Implementation

answer

Prioritizing your nursing interventions Safety Facility standards

question

Guidelines for Appropriate/Effective Delegation - In the 1800's, Florence Nightingale wrote

answer

...to be in charge is certainly not only to carry out the proper measure yourself but to see that every one else does so too; to see that no one either willfully or ignorantly thwarts or prevents such measures...to ensure that each does that duty to which he is appointed.

question

Delegation Defined

answer

"The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. Example: the RN, in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall care." -----ANA (2005) Principles for Delegation

question

Concepts of RN Delegation

answer

Accountable to those they serve for providing competent, safe & effective care Accountable for supervising those to whom they have delegated tasks

question

RN Accountable for

answer

Act of delegating Supervising performance of delegated task Assessment & f/u evaluation Any intervention or corrective actions required

question

Delegatee accountable for

answer

Own actions Accepting delegation w/in parameters of training & education Communicating appropriate information Completing the task

question

The RN assigns or delegates tasks based on

answer

the needs and condition of the patient, potential for harm, stability of the patient's condition, complexity of the task, predictability of the outcome, and abilities [competencies] of the staff to whom the task is delegated.

question

ADVANTAGES OF EFFECTIVE DELEGATION

answer

Better time management Increased job satisfaction Better patient/family service More effective workload management Decreased stress Increased productivity Cost effectiveness Builds/demonstrates leadership Builds/ demonstrates communication skills More efficient use of resources

question

Resources for Delegation

answer

Nurse Practice Act is the legal authority for nursing practice in each state; there is where the Scope of Practice is written into law MS Mississippi Board of Nursing Publications#rules MS SBON Position Statement on Delegation Facility's protocols/policies/procedures Job descriptions

question

Delegation: 5 Rights

answer

Right task Right person Right circumstance Right communication/ direction Right feedback/ supervision

question

What can I delegate?

answer

Check Nurse Practice Act Check organization's standards

question

Is there anything I can't delegate?

answer

Check the law What belongs only to the RN's scope of practice

question

Cannot delegate

answer

Assessments that identify needs, problems, or diagnose human responses Any aspect of care planning Health counseling, teaching, or referrals to other health care providers Tasks that require nursing judgment Evaluation phase of the nursing process

question

Nurse Practice Act - each state has a nurse practice act that will define and determine what task can be delegated to what level of personnel.

answer

Determines the scope of practice for each position Issues standards of care that guide practice Renders official opinions which guide practice

question

Organization guidelines - each organization has statements that guide practice.

answer

Mission statement Policies and procedures (determine what can be done and what level of personnel can carry out the task) Job descriptions - identifies job responsibilities

question

The Right Circumstances

answer

What is the acuity/condition of pt? How can I determine the strengths and weaknesses of team members? Assign tasks based on strengths Encourage best care possible Ask about competency levels

question

The Right Communication

answer

How can I get the delegatee to understand what I want? Provide initial direction —Is it: Clear? Concise? Correct? Complete? (expected outcome)

question

Right Supervision/Feedback

answer

Timing of the feedback -as soon as possible after the task is completed Focus on the behavior/performance of the task Provide clear feedback addressing the completion of the task Use assertive "I" statements Ask for a restatement of the feedback from the delegatee so there is clear understanding of what was said Provide feedback privately with the delegatee Ask for feedback from the delegatee to clarify any concerns that person may have as well

question

LPN/LVN Scope of Practice

answer

Varies from state to state Some allow LPNs to delegate; others allow LPNs to assign. MS does not specify but does state: "LPNs may assume 'charge nurse' responsibilities: In nursing situations where rapid change is not anticipated and supervision is provided by a RN who is physically on the premises where the patient is having nursing care provided. In long-term units if RN supervision is available at all times for consultation.

question

Summary: Delegator

answer

As the delegator, the RN must See the big picture in the care of the assigned patients Select the appropriate activities to delegate Select the appropriate staff to carry out the activities Clearly communicate the expectations and required follow up Follow up periodically while the task is being completed Evaluate and provide feedback on the effectiveness of the delegation to staff

question

Accurate & Reliable Information via the Internet

answer

Nurses must me techno-savvy (have proficiency in information systems & technology) to keep up Trends in computing Research advances New devices, monitoring equipment, sensors, and "smart body parts" Payment incentives for Electronic Health Records Consumer demands

question

Accurate & Reliable Information via the Internet (cont'd)

answer

Open access Material looks legitimate Specific criteria useful in evaluating a website Authority with regard to the topic Author and author's credentials Author's contact information

question

Objectivity

answer

Is the purpose of the website clear? Is the information factual or opinion? Is the information primary or secondary in origin? Who is sponsoring the site?

question

Accuracy

answer

Look for documentation and referencing Compare information on the website with other sources

question

Currency

answer

Look for dates Compare the last update with current literature

question

Usability

answer

Is the site well designed, stable, and easy to use? Content should be error-free and readable by the intended audience

question

How to Protect yourself

answer

Know your state laws affecting nursing practice. Follow your state's nurse practice act rules & regulations. Deliver safe, competent nursing care that follows accepted standards of care. Develop & use your critical thinking abilities & skills.

question

Civil Law

answer

protect the rights of the individual in our society; encourage fair & equitable treatment among people

question

Two types of Torts (Civil Wrongs)

answer

Intentional Torts Unintentional Torts

question

Intentional Torts

answer

Assault Battery Invasion of Privacy Defamation of Character - making or publishing false statements that result in damage to a person's reputation a. Slander b. Libel False Imprisonment

question

Unintentional Torts

answer

Negligence - conduct that falls below the standard of care: "Failure to use the degree of care that a reasonable person would use under the same or similar circumstances." Malpractice - is professional negligence

question

Intentional Torts in Nursing Practice

answer

Definition Direct violation of a person's legal rights Plaintiff does not have to prove that the nurse breached a special duty or was negligent Consequences include fines and punitive damages but may rise to the level of criminal acts

question

Assault and battery

answer

Assault is causing a person to fear that he or she will be touched without consent Battery is the unauthorized touching or the actual harmful or offensive touching of a person and may rise to the level of a crime Nurse should ask patient's permission before initiating any procedure and document permission granted, particularly those of an invasive nature.

question

Defamation of character

answer

Libel is defamation caused by written work; nurses subject to libel for subjective comments written in the medical record Slander is defamation caused by spoken word; nurses subject to slander when they repeat subjective comments about patients in public places

question

False imprisonment

answer

Unlawful restraint or detention of another person against his or her wishes Nurse has no authority to detain a patient even if there is likelihood of harm or injury

question

Invasion of privacy

answer

Person's private affairs (including health history and status) are made public without consent Nurse has a legal and ethical duty to maintain patient confidentiality publishing photos without consent disclosing confidential information

question

Intentional infliction of emotional distress

answer

Nurse's behavior is so outrageous that it leads to the patient's emotional shock

question

Elements Necessary to Prove Negligence

answer

Duty to provide care as defined by a standard Breach of duty by failure to meet standard Foreseeability of harm Breach of duty has potential to cause harm (combines 2 & 3) Harm occurs

question

Health Insurance Portability and Accountability Act of 1996

answer

ensures confidentiality of a patient's medical records sets guidelines for maintaining the privacy of health data

question

Any institution that collects/stores protected health information (PHI) is required to

answer

name a privacy officer, provide employee training implement HIPAA policies and procedures

question

Standards of Care

answer

Establish the standard of practice for employees Detailed information about how the nurse should respond to or provide care in specific situations and while performing client care procedures Helps protect nurse if that standard of care still results in an injury Nurses must be familiar with and adhere to their institution's p/p

question

Informed Consent

answer

HCP has duty to disclose information Mandated by federal statute and state law Information that must be disclosed Duty CANNOT be delegated to the RN If nurse has reason to believe that patient has not given informed consent, the provider should be immediately notified In no case should the nurse attempt to convey information required for informed consent

question

Information that must be disclosed

answer

Nature of the therapy or procedure Expected benefits and outcomes Potential risks

question

Incident reports:

answer

records made of unexpected or unusual incidents that affected a client, volunteer, or visitor in a health care facility.

question

Incidents that require a report include but are not limited to:

answer

Medication errors Procedure/treatment errors Equipment-related injuries/errors Needlestick injuries Client falls/injuries Visitor/volunteer injuries Threat made to client or staff Loss of property

question

Mandatory Reporting

answer

Child Abuse - all 50 states + D.C. Elder and Vulnerable Adults Abuse Unsafe/Impaired Peers - patient safety first; follow your facility's chain of command Compliance Breaches (Ex: Medicare/Medicaid fraud; unlawful restraint) Communicable Diseases (CDC/ State DOH) Gun shot wounds Near Misses Sentinel Events

question

Rejecting Unsafe Assignments

answer

Nurse is accountable for the outcomes of his/her actions in carrying out nursing duties Some states have mandatory staffing and overtime laws Follow chain of command Use assertive communication Be clear as to your competencies Document

question

DNRs and ANDs

answer

Statutes grant adults the right to refuse extraordinary medical treatment when no hope of recovery Patient's wishes are made known through execution of a formal document known as the living will Medical and physician directives Document that lists desire of patient in a particular scenario If properly executed, provides physician with immunity from claims of negligence in the patient's death

question

"Do not resuscitate" orders

answer

Written by physician on the basis of directives by the patient Nurses have absolute duty to respect patient's DNR orders A lawfully executed DNR order must be followed

question

Durable power of attorney for health care:

answer

document that authorizes patient to name the person who will make the day-to-day and end-of-life decisions when he or she becomes decisionally incompetent

question

Unless a "do not resuscitate" (DNR) or "allow natural death" (AND) order is written

answer

nurse should initiate CPR when a client has no pulse or respirations.

question

Written order for a DNR or AND

answer

must be placed in client's medical record.

question

Provider consults

answer

client and family prior to administering a DNR or AND.

question

Additional orders by primary care provider

answer

are based on client's individual needs and decisions and provide for comfort measures to relieve symptoms.

question

Nursing responsibilities regarding advance directives include:

answer

Providing written information regarding advance directives Documenting the client's advance directives status Ensuring that advance directives are current and reflective of the client's current decisions Informing all members of the health care team of the client's advance directives

question

Organizational Resources R/T Safety/Ethical/Legal Issues

answer

Supervisors/Organizational Chart Risk Managers Human Resources Compliance Officer Privacy Officer Advisory Boards Medical Directors Hospital attorney Security Plan

question

TJC Sentinel Event reporting

answer

Root cause analysis To determine systems failures to prevent future occurrences

question

Eliminate Never Events

answer

Medicare & Insurances won't pay for hospital-acquired infections

question

The Professional Nurse and Patient Safety

answer

Answers for improved patient safety require all care providers to pull together to review critical circumstances and learn from key events Nurses' challenge is to make patient safety a personal priority

question

Two significant nursing functions closely influence patient safety and quality

answer

Monitoring for early recognition of adverse events, complications, and errors Initiating deployment of appropriate care providers for timely intervention and response/rescue of patients in these situations

question

National Database of Nursing Quality Indicators (NDNQI)

answer

Indicators that strongly affect clinical outcomes Two major purposes - Provide comparative data to health care organizations to support quality improvement activities - Acquire national data for better understanding of link between nurse staffing and patient outcomes

question

Quality indicators

answer

Nursing hours per patient day Staff mix (RNs, LPNs/LVNs, UAP) Hospital-acquired pressure ulcers Falls/injury resulting from falls Nurse staff satisfaction/RN survey Pediatric/neonatal only: pain assessment and peripheral IV infiltration Psychiatric only: physical/sexual assault

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