Nursing 115 TEST TWO – Flashcards

- professional standards of practice - Ethical conduct of members - Ensure high quality - Leadership opportunities - Meet present and future challenges

- Develop leadership skills - Certification - Research Opportunities - Defining practice standards and redefining policies - Legislative lobbying powers - Publications - Health/Life/Malpractice Insurance - Continuing Education

- Broad purpose organization - National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

- A program of the American Nurses Credentialing Center, which is a subsidiary of ANA. - Recognizes health care organizations that provide nursing excellence - Provides a vehicle for disseminating successful nursing practices and strategies - Recognizes quality patient care - Recognizes innovations in professional nursing practice - Provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive.

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

Main Purpose - Education - Oldest organization for nurses since 1893 - Advances quality nursing education - Concerned with quality nursing for all types of nursing programs - NLNAC - accredits nursing programs

- Law established through formal legislative processes - Nurse Practice Act: defines the authority of the State Board of Nursing * Defines the practice of nursing * Sets educational qualifications/requirements for licensure * Legal title abbreviations that nurses can use * Provides disciplinary action for licensees

1. Authority to administer the nursing practice act 2. Authority to adopt rules to administer the act 3. Authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure

Negligence in the profession

Failure to act as a reasonably prudent person would behave in specific circumstances

Threat; an attempt to make bodily contact with another person without their consent

Act carried out

Empower one to act for another

Voluntary; individual must be competent and have the capacity to understand. Patient must be given enough information understand; full knowledge authorization by the patient for care treatment or procedures. Must include the risks benefits, side effects, costs, alternatives (do not need consent if it is life threatening)

Protection of private information HIPPA

1. Practice in a safe setting 2. Communicate with other health professionals; open and clear communication - verbal and written 3. Delegate wisely 4. Meet the standard of care - technically competent; keeping up to date; be aware of peer expectation; participate as an equal on the health care team 5. Carry professional liability insurance Promote positive interpersonal relationships

By Exam By Endorsement - endorsed by the other State Boards of Nursing Nurse Licensure Compact - allows an RN to have one license (in the state of residence) yet [ractice in other compact states without an additional license; developed to improve the mobility of nurses

What actions an individual should take What should be done for people to live together Bible code of ethics (10 commandments) Process orientated and require a critical analysis Bioethics - application of ethical theories and principles to problems in health care Ethical Delimmas Ethical decision-making ANA Nursing Code Of ethics ICN (International Council of Nurses) Code of Ethics

Nursing profession informing society of principles/rules by which nurses function More emphasis is placed on patients right ANA Code for Nurses (code of ethics) -respect for human dignity -patients right to privacy -safeuards the patient and the public -Assumes responsibility and accountability -Maintains competence -Good Judgement/clinical decision-making -Professional development -Assists the profession in approving standards of nursing - High quality nursing care -Maintains integrity -Collaborates with other health care team members

-Called the international council of nurses code for nurses - 80+ nations - Respect for the life, dignity, and integrity of all people in a manner that is unmindful of nationality, race, creed, color, age, sex, political affiliation, or social status

- Provides standards of behavior - Established rules of conduct to be used in situations in which a decision about right and wrong must be made - Reflect how individuals or groups behave - Learned over time and are influenced by life experiences - Theories of moral development - Kohlberg

Often used interchangeably=Sometimes difficult to define and distinguish between the two

- Respect for others - Valuing every aspect of a person's life - Each individual is unique and equal to others - Foundation to all ethical principles

- Various Theories - Describes how a person deals with moral dilemmas from childhood to adulthood - Kohlbergs theory is utilized in MTC nursing program 9 years and adults: conform to expectations of family/groups/society - Independent thinking: defining own moral values (higher intellectual development)

- NLN states that "doing the right thing is simply how we do business" - Our actions reveal our commitment to telling the truth - Nurses must be guardians of the ethical treatment of patients - Every action and choice is thought to aim at something good

- Rank ordering of personal values - Influence the behavior of individuals - Learned beliefs that help people choose among difficult alternatives - Vary among individuals - Enable people to resolve conflicts - Nurse must determine if their value system is ethical - Professional ethics outweigh personal ethics in a professional setting

- The public wants a say in matters affecting their healthcare - Guarantees certain rights and privileges to every hospitalized patients

1. Considerate and respectful care 2. Understandable information regarding diagnosis, treatment, and prognosis 3. Know the identity of health care member 4. Know the financial implications 5. Make decisions about the plan of care 6. Advance directive 7. Privacy (conversation and records) 8. Review his or her own records and have it explained =, except when restricted by the law 9. Hospital will make a reasonable response to the request of the patient 10. Ask and be informed of business relationships with the hospitals/educational institutions etc. 11. Consent to or decline in research studies 12. Reasonable continuity of care 13. Informed of hospital policies and practices relative to patient care

1. Clarify the dilemma 2. Gather additional data 3. Identify Options 4. Make a decision 5. Act upon the decision 6. Evaluate

Legal documents that indicate the wishes of adult individuals in regards to end of life issues In SC there are 2 advanced directives 1. Health Care Power of Attorney 2. Living Will Other types of advanced directives 1. Organ donation EMS DNR (do not resuscitate) order

1. The admin of meds is defined as: The act of preparing and giving drugs in accordance with the orders of a licenses physician or dentist as to drug dosage route and frequency; observing recording and reporting desired effects, untoward reactions and side effects of drug therapy; intervening when emergency care is required as a result of drug therapy; appropriately instructing the patient regarding his meds; recognizing accepted prescribing limits and reporting deviations to the prescribing physician or dentist

Subject to the rights of licensed physicians and dentists under their respective medical and dental practice acts, the administration of medications is recognized as the responsibility of a registered nurse or a licensed practical nurse as prescribed by the licensed physician or dentist . After June 30th, 1985 unlicensed nursing personnel shall not administer medications

The SC nurse practice act defines the practice of nursing to include the administration of medications. The admin of meds is defined as "the acts of preparing and giving drugs in accordance with the orders of a licensed physician or dentist as to drugs, dosage, route, and frequency; observing recording and reporting desired effects , untoward reactions and side effects of drug therapy; intervening when emergency care is required as a result of drug therapy.

is a critical nursing function based on the understanding of pharmacotherapeutics, biochemistry, and pathophysiology. In settings where nurses are employed to provide nursing care to clients, the regulations preclude the licensed nurse from delegating administration of medications to unlicensed assistive personnel.

there are settings and circumstances where individuals must take medications to maintain their health status where the regularly scheduled presence of a nurse is not required. Often these individuals may need assistance with taking their medications. Assisting an individual to take medication may include the acts of reminding the individual of the time to take the medication; opening the container that is properly labeled; or assisting the individual to place the medication in the mouth or properly apply the medication. In these settings, the defined caregiver (surrogate family member) may assist the individual with taking the medication. The Nurse Practice Act currently contains an exemption to the licensing requirement for gratuitous nursing provided by friends and family members of an individual and for the incidental care of the sick by domestic servants or persons primarily employed as housekeepers as long as they do not practice nursing according to this chapter.

• Human knowledge • Chaotic work environment • Unauthorized floor stocks • Using floor stock medications • Not following policies • Verbal orders • Human performance • Lack of personnel • IV solutions that are not premixed • Unnecessary use of medications • Lack of dose verification process • Math errors • Typographical mistakes • Poor handwriting • Acronyms

• Coined names • Multidose vials • Defective packaging • Similar packaging • Lack of dose limits • Similar drug names • Borrowing medications from a multiple-dose cart • Dangerous abbreviations (OD & QD for once daily) • Lack of interdisciplinary team review of medication errors • Unnecessary use of IVs, catheters, and nasogastric tubes • Lack of dosage check for high-risk drugs and pediatric patients' medications

• Wrong drug/IV • Allergy to drug • Wrong drug for patient's disease • Incorrect administration technique • Wrong diluent (solution that mixes with a powdered drug) • Wrong dose • Excessive dose • Insufficient dose • Wrong concentration • Too-rapid IV flow rate • Omitted drug • Wrong patient • Wrong time • Wrong route • Wrong procedure or test • Violation of orders • Wrong label directions • Wrong preparation

• The Code of professional conduct (NMC, 2002) states that a nurse is personally accountable for their practice. Being accountable means being responsible for something or to someone. It also states that you must promote a health care environment conducive to safe, therapeutic and ethical practice whilst working within a team. Being competent means possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision. • The Scope of professional practice (UKCC, 1992) is based firmly on the Code, emphasizing that professional practice occurs in a context of continual change and development. It points out that practice must be sensitive, responsive and relevant to the needs of the individual patients. Our nursing role takes on countless responsibilities, centered on the patient wherein we are promoting a safe environment, working within our professional boundaries and maintain knowledge of our limitations. • The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. • The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. • The nurse is responsible and accountable for individual nursing practice and ......... an obligation to provide optimum patient care.

Advance Directives are legally binding documents that you can sign to specify the kind of treatment you desire or the type you wish to refuse in the event you are unable to express your wishes when medical treatment is deemed necessary by a health care provider. In South Carolina, there are two types of Advance Directives: Living Will and Health Care Power of Attorney.

When a patient is unable to give instructions about his/ her care and hasn't used any form of Advance Directive, the law specifies who can make such decisions: 1. Guardian appointed by Probate Court 2. Person given authority by the patient in some other legal way 3. Spouse (unless divorced or legally separated) 4. Parent or adult child of patient 5. Adult sibling, grandparent or adult grandchild of patient 6. Other blood relatives believed to have close personal relationship to patient.

You have the right to make all decisions about the health care you receive. If you do not want certain treatments, you have the right to tell your doctor, either orally or in writing, you do not want them. If you want to refuse treatment, but you do not have someone to name as your agent, you can sign a living will. Most patients can express their wishes to their doctor, but some who are badly injured, unconscious or very ill cannot. People need to know your wishes about health care in case you become unable to speak effectively for yourself. You can express your wishes in a health care power of attorney or living will. In a living will, you tell your doctor that you do not want to receive certain treatment. In a health care power of attorney, you name an agent who will tell the doctor what treatment should or should not be provided. The decision to sign a health care power of attorney or living will is very personal and very important. This pamphlet answers some frequently asked questions about health care powers of attorney and living wills. These documents will be followed only if you are unable, due to illness or injury to make decision for yourself. While you are pregnant, however, these documents will not cause life support to be withheld. If you do not have a living will or health care power of attorney that tells what you want done, you do not know what decisions will be made or who will make them. Decisions may be made by certain relatives designated by South Carolina law, by a person appointed by the court, or by the court itself. The best way to make sure your wishes are followed is to state your wishes .in a health care power of attorney, or sometimes, a living will. If you want to refuse treatment but you do not have someone to name as your agent, you can sign a living will. If you have questions about signing a health care power of attorney or living will, you should talk to your doctor, your minister, priest, rabbi, or other religious counselor, or your attorney. Finally, it is very important that you discuss your feeling about life support with your family. A health care power of attorney also should be discussed with the people you intend to name as your agent and alternate agents to make sure that they are willing to serve. It is also important to make sure that your agents know your wishes.

Yes The South Carolina legislature has approved forms for both a living will and a health care power of attorney. The living will form that the legislature approved is called a Declaration of a Desire for a Natural Death. You may be able to get these forms from the person who gave you this brochure.

The agent named in a health care power of attorney can make the decisions about your healthcare. A living will only tells the doctor what to do if you are permanently unconscious or if you are terminally ill and close to death. A health care power of attorney is not limited to these situations. A living will affects life support only in certain circumstances. A living will only tells the doctor what to do if you are permanently unconscious or if you are terminally ill and close to death. A health care power of attorney is not limited to these situations. Permanently unconscious means that you are in a persistent vegetative state in which your body functions, but your mind does not. This is different from a coma, because a person in a coma usually wakes up, but a permanently unconscious person does not. A living will can only say what treatment you don't want. In a health care power of attorney you can say what treatment you do want, as well as what you do not want. With a living will, you must decide what should be done in the future, without knowing exactly what the circumstances will be when the decision is put into effect. "With a health care power of attorney, the agent can make decisions when the need arises, and will know what the circumstances are. An Ombudsman as designated by the State Ombudsman, Office of the Governor, 1 must be a witness if you sign a living will when you are in a hospital or nursing home. An Ombudsman does not have to be a witness if you sign a health care power of attorney in a hospital or nursing home.

The best way to be sure you are allowed to die a natural death is to sign a health care power of attorney that states the circumstances in which you would not want treatment. In the South Carolina form, you should specify your wishes in items (6) and seven (7). You may not have a person that you can trust to carry out your desire for a natural death. If not, a living will can insure that you are allowed to die a natural death. However, it will only do so if you are permanently unconscious or terminally ill and close to death.

You should sign a Health Care Power of Attorney and not a living will. The South Carolina Health Care Power of Attorney form allows you to say either that you do or that you do not want life sustaining treatment. A living will only allows you to say that you do not want life sustaining procedures.

If you previously signed a living will or health care power of attorney, even in another state, it is probably valid. However, it may be a good idea to sign the most current forms. For example, the current South Carolina living will form covers artificial nutrition and hydration whereas older forms did not.

A health care power of attorney is a specific form of durable power of attorney that names an agent only to make health care decisions. A durable power of attorney may or may not allow the agent to make health care decisions. It depends on what the document says. The agent may only be able to make decisions about property and financial matters.

You must be eighteen years old to sign a living will. Two persons must witness your signing the living will form. A notary public must also sign the living will form. If you sign a living will while you are a patient in a hospital or a resident in a nursing home. a representative, as designated by State Ombudsman, Office of the Governor1 must witness your signing. There are certain people who cannot sign the document. The living will form tells you who cannot be witnesses. You should read the living will form carefully to be sure your witnesses are qualified.

You should appoint a person you trust and who knows how you feel about health care. You also should name at least one alternate, who will make decisions if you agent is unable or unwilling to make these decisions. You should talk to the people you choose as your agent and alternate agents to be sure they are willing to serve. Also, they should know how you feel about health care.

Each form contains spaces for you to state your wishes about things like whether you want life support and tube feeding. If you do not put your initials in either blank, tube feeding may be provided, depending upon your condition. Be sure to read the form carefully and follow the instructions.

Keep the original in a safe place where your family members can get it. You also should give a copy to as many of the following people as your are comfortable with: your family members, your doctor, your lawyer, your minister or priest, or your agent. Do not put you only copy o these documents in your safe deposit box.

You may revoke (cancel) your living will or health care power of attorney any time. The forms contain instructions for doing so. You must tell your doctor and anyone else who has a copy, that you have changed your mind and you want to revoke your living will or health care power of attorney.

- professional standards of practice - Ethical conduct of members - Ensure high quality - Leadership opportunities - Meet present and future challenges

- Develop leadership skills - Certification - Research Opportunities - Defining practice standards and redefining policies - Legislative lobbying powers - Publications - Health/Life/Malpractice Insurance - Continuing Education

- Broad purpose organization - National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

- A program of the American Nurses Credentialing Center, which is a subsidiary of ANA. - Recognizes health care organizations that provide nursing excellence - Provides a vehicle for disseminating successful nursing practices and strategies - Recognizes quality patient care - Recognizes innovations in professional nursing practice - Provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive.

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

Main Purpose - Education - Oldest organization for nurses since 1893 - Advances quality nursing education - Concerned with quality nursing for all types of nursing programs - NLNAC - accredits nursing programs

Statutory Law: - Law established through formal legislative processes - Nurse Practice Act:

Defines the authority of the State Board of Nursing * Defines the practice of nursing * Sets educational qualifications/requirements for licensure * Legal title abbreviations that nurses can use * Provides disciplinary action for licensees

1. Authority to administer the nursing practice act 2. Authority to adopt rules to administer the act 3. Authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure

Malpractice - Negligence in the profession Negligence - Failure to act as a reasonably prudent person would behave in specific circumstances Assault - Threat; an attempt to make bodily contact with another person without their consent Battery - The act carried out. Delegation - Empower one to act for another Informed Consent - Voluntary; individual must be competent and have the capacity to understand. Patient must be given enough information understand; full knowledge authorization by the patient for care treatment or procedures. Must include the risks benefits, side effects, costs, alternatives (do not need consent if it is life threatening) Confidentiality - Protection of private information HIPPA

1. Practice in a safe setting 2. Communicate with other health professionals; open and clear communication - verbal and written 3. Delegate wisely 4. Meet the standard of care - technically competent; keeping up to date; be aware of peer expectation; participate as an equal on the health care team 5. Carry professional liability insurance Promote positive interpersonal relationships

SC State Board of Nursing

endorsed by the other State Boards of Nursing

allows an RN to have one license (in the state of residence) yet [ractice in other compact states without an additional license; developed to improve the mobility of nurses

What actions an individual should take What should be done for people to live together Bible code of ethics (10 commandments) Process orientated and require a critical analysis Bioethics - application of ethical theories and principles to problems in health care Ethical Delimmas Ethical decision-making ANA Nursing Code Of ethics ICN (International Council of Nurses) Code of Ethics

application of ethical theories and principles to problems in healthcare

- Provides standards of behavior - Established rules of conduct to be used in situations in which a decision about right and wrong must be made - Reflect how individuals or groups behave - Learned over time and are influenced by life experiences - Theories of moral development - Kohlberg

- Respect for others - Valuing every aspect of a person's life - Each individual is unique and equal to others - Foundation to all ethical principles

- Various Theories - Describes how a person deals with moral dilemmas from childhood to adulthood - Kohlbergs theory is utilized in MTC nursing program 9 years and adults: conform to expectations of family/groups/society - Independent thinking: defining own moral values (higher intellectual development)

Legal documents that indicate the wishes of adult individuals in regards to end of life issues In SC there are 2 advanced directives 1. Health Care Power of Attorney 2. Living Will Other types of advanced directives 1. Organ donation EMS DNR (do not resuscitate) order

1. Clarify the dilemma 2. Gather additional data 3. Identify Options 4. Make a decision 5. Act upon the decision 6. Evaluate

The public has a say in their health care rights and privileges are granted to every hospitalized patient.

professional ethics outweigh personal ethics in a professional setting.

• The Code of professional conduct (NMC, 2002) states that a nurse is personally accountable for their practice. Being accountable means being responsible for something or to someone. It also states that you must promote a health care environment conductive to safe, therapeutic and ethical practice whilst working within a team. Being competent means possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision.

the administration of medications is recognized as the responsibility of a registered nurse or a licensed practical nurse as prescribed by the licensed physician or dentist . After June 30th, 1985 unlicensed nursing personnel shall not administer medications

.• Wrong drug/IV • Allergy to drug • Wrong drug for patient's disease • Incorrect administration technique • Wrong diluent (solution that mixes with a powdered drug) • Wrong dose • Excessive dose • Insufficient dose • Wrong concentration • Too-rapid IV flow rate • Omitted drug • Wrong patient • Wrong time • Wrong route • Wrong procedure or test • Violation of orders • Wrong label directions • Wrong preparation

give drug in accordance to orders: drug, dosage, route, frequency as well as observing recording, and reporting desired effects, untoward reactions, and side effects and intervening when neccesary