Professional Nursing Concepts Ch 1-6

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ANA definition of nursing
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“The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations”.
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Altruism
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the nurse shows concern for the welfare of patients, other nurses, and other health care providers.
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Autonomy
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i. Planning care in partnership with patients ii. Honoring the right of patients and families to make decisions about health care iii. Providing information so patients can make informed choices and decisions.
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Human dignity
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i. Providing culturally competent and sensitive care ii. Protecting the patient’s privacy iii. Preserving confidentiality of patients and health care providers; and iv. Designing care with sensitivity to individual patient needs.
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Integrity
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Acting in accordance with an appropriate code of ethics and accepted standards of practice
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Social Justice
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i. Supports fairness and non-discrimination in the delivery of care; ii. Promotes universal access to health care; and iii. Encourages legislation and policy consistent with the advancement of nursing care and health care.
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how professional nursing values are acquired.
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a. Acquired during socialization into nursing from code of ethics, nursing experiences, teachers, and peers. b. Traditions and cultural, ethnic, and religious groups
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Values
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something of worth; an enduring belief or attitude held dearly by a person about people, objects, ideas, or action
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Beliefs
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Interpretations or conclusions that one accepts as true
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Attitudes
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Mental positions or feelings toward a person, object, or idea
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the 7-step Patient Value Clarification Process.
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1. List alternatives 2. Examine possible consequences of choices 3. Choose freely 4. Feel good about the choice 5. Affirm the choice 6. Act on the choice 7. Act with a pattern
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What is the 7-step Patient Value Clarification Process.
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A process for a nurse to use when patients’ value system is detrimental to their health
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CARING
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promoting health, healing, and hope in response to the human condition
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INTEGRITY
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respecting the dignity and moral wholeness of every person without conditions or limitation
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DIVERSITY
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affirming the uniqueness of and differences among persons, ideas, values, and ethnicities
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EXCELLENCE
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creating and implementing transformative strategies with daring ingenuity
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Truth
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i. Faithfulness to fact or reality ii. Attitudes 1. Accountability 2. Authenticity 3. Honesty 4. Inquisitiveness 5. Rationality 6. Reflectiveness
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Florence Nightingale
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o Well educated o Holistic view of health: body, mind o Saved many lives in Crimean war o Focus on cleanliness & Nutrition o Founded first nursing school 1860 o Focused on data and outcomes o Layed foundation for evidence based practice: Notes on Nursing
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Dix and Barton
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recruited nurses in the civil war
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Mahoney
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initiated integration of Nursing
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Wald
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established Public Health Nursing
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Jewish doctors
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developed a hygeine code o Beliefs: Disease is a curse r/t sin
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Romans
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used slaves for nursing care
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Greeks
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Hippocrates (father of western medicine) wrote first medical text
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Christianity in Middle Ages
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o Wealthy women helped peasants o Deaconesses gave care in homes o Catholic convents founded religious orders o Reformation – convents closed
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Renaissance
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o Dark period for nursing o Prostitutes and prisoners served as nurses o Fighting, foul language, petty theft o Expansion of scientific knowledge o Divinci – anatomy o Small pox vaccine o Stethoscope developed o Began to think of disease prevention
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Colonial America
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o Little infrastructure to support nursing o Catholic nursing orders and slaves provided care
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Goldmark Report
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called for nursing education to be a separate from and precede employment- also advocated nursing licensure and proper training for faculty at nursing institutions
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Brown Report
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– recommended that nursing education programs be housed in universities- formed basis for evaluating nursing programs
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Hill Burton Act
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established federal funds to build more hospitals, at one point too many hospital beds- believe to cause shortage of nurses
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Accreditation of Schools of Nursing
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o National League for Nursing (NLN) o American Association of Colleges of Nursing (AACN)* o National Organization of Associate Degree Nursing (N-OADN)
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NLN
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promotes excellence in nursing education to build a strong and diverse nursing workforce o Represents all nursing programs
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AACN
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represents university and baccalaureate programs in nursing o Activities include educational research, government advocacy, data collection, publishing, and initiatives to establish standards for BSN and graduate degree o Concerned with development of standards and resources and promotes innovation, research, and practice to advance nursing education o Involved in accreditation of university nursing programs through its commission on collegiate nursing education o Only represents university-level nursing education programs
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STTI
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Not for profit international organization o Mission- to provide leadership and scholarship in practice, education, and research to improve the health of all people
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ANA
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organization that represents all RNs in the U.S. o Labor union- option for members to participate o Strategic imperatives- professional practice and excellence, healthcare and public policy, knowledge and research, unification, advocacy for workforce, and organizational effectiveness
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LPN
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o administration of treatments and medication o Assist with ADL o under the direct supervision of a RN, a licensed physician or dentist o May supervise CNAs in nursing homes and assisted living facilities
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RN
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o Assess & monitor health status o Plan, implement, evaluate nursing care interventions o Coordinate and oversee pt care o Anticipate risks and intervene to prevent complications o Focus on health promotion and patient education
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ARNP
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advanced registered nurse practitioner
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CNM
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certified nurse midwife- masters degree focuses on midwifery-pregnancy and delivery
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CRNA
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masters degree that prepares nurses to deliver anesthesia
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Clinical specialist
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masters degree offered in any clinical area-usually work in hospital settings
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Associate
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degree offered as culmination of a 2 year program that includes some liberal arts and sciences curriculum but focuses more on nursing
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Bachelors
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Health assessment, leadership/mgmt, research, public/community health/ teaching an advocacy
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Masters
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2 year program after receiving BSN
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PhD
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doctoral degree (doctor of philosophy) – usually involved in research- may be called doctor
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Doctorate (DNP)
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not a PhD program- practice focused doctoral degree program
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Advocate
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The nurse protects the client by preventing physical and/or chemical injury. o In the role, the nurse assists clients in expressing their rights whenever necessary. o The nurse also works to preserve clients’ legal and human rights in times of health and illness, and during the process of dying.
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Caregiver
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The nurse addresses the client’s holistic health care needs to promote health and the healing process. o In the role, the nurse administers treatment for specific disease processes and applies measures to restore the emotional and social well-being of the client.
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Critical Thinker
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Nurses use decision-making and critical thinking skills in conjunction with the nursing process. o Before actually delivering nursing care, the nurse determines the best method of care delivery for each client. o The nurse’s plan of care is based on consideration of all aspects of the situation and thinking through alternative strategies to achieve a number of possible outcomes.
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Communicator
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Open and consistent communication is vital for effective nursing practice. o The nurse must possess excellent communication skills to provide care, rehabilitation, teaching, comfort, and protection to clients.
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Manager
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Nurses are responsible for the management and coordination of client care. o Delegate, collaborate, consult o All nurses need good management skills, whether they supervise others in the provision of nursing care or whether they provide direct care themselves.
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Rehabilitator
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The nurse administers rehabilitative activities along with members of other disciplines such as physical therapists to ensure that a client returns to a maximal state of functioning . o When clients experience alterations in health, the nurse’s role is to promote client adaptation and coping.
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Researcher
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Nursing research provides the evolving body of knowledge and theory for our profession. o Nurse researchers may be employed in an academic setting, a community service, or an independent professional agency. o The nurse researcher usually conducts studies and investigates problems to improve client health and nursing care.
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Teacher
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the nurse provides clients and family members with information about health, treatment or therapy, and lifestyle changes. o the nurse determines if the client understands the information presented and reinforces the learning as necessary. o The nurse then evaluates the client’s progress towards health-related goals. o The nurse uses teaching methods that are compatible with the client’s knowledge, education, and literacy levels.
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Licensure
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is required by law to practice nursing in each state
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Certification & Credentialing
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o Not required by law o Certification of expertise in an area o Offered by specialty organizations and ANA
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AACN’s essential elements of BSN education.
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• Emphasized patient-centered care • Interprofessional teams • Evidence based practice • Quality improvement • Patient safety • Informatics • Clinical reasoning/critical thinking • Genetics and genomics • Cultural sensitivity • Professionalism
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the characteristics of a profession and why nursing is a profession
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• Well-defined body of knowledge • Enlarge the body of knowledge through research • Educated in institutions of higher education • Apply knowledge providing services vital to society • Exalt service above personal gain • Freedom of action, professional growth, economic security • Practice autonomously • Enforce a Code of Ethics
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the ANA 6 essential features of professional nursing.
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• Caring relationship • Attention to the range of human experiences and responses • Integration of assessment data with knowledge • Application of scientific knowledge and use of judgment • Advancement of the profession through scholarly inquiry • Influence on social and public policy to promote social justice • Assurance of safe, quality, and evidence based practice
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the ANA Nursing’s Social Policy Statement
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Expresses the social contract between society and the profession of nursing…a framework for understanding professional nursing’s relationship with society and its obligation to those who receive professional nursing care.
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the IOM’s 5 core competencies for Health Care Professionals
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• Provide patient centered care • Work with interdisciplinary/interprofessional teams • Employ evidence based practice • Apply quality improvement • Utilize informatics
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essential nursing caring behaviors
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• Essential and central to nursing, defined by many nurse theorists like Watson • Varies among cultures and differs in individuals • Caring can be doing for other people what they cannot do for themselves, care of medical problem, and competence in carrying out all • Comfort, Compassion, Concern, Coping Behavior, Empathy, Enabling, Health Consultant, Helping, Interest, Involvement, Kindness, Love, Nurturing, Presence, Protective, Restorative, Surveillance, Teaching, Touching, Trust, Sharing, Stimulating, Stress alleviating, Supportive • Comfort Needs are physical, psychological, social, and environment • Caring defined at FSU o Nurse’s empathy for and connection with the patient. o The ability to translate these affective characteristics into compassionate, sensitive, appropriate care.
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professional nursing practice is influenced by standards of professional nursing.
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Set of nursing actions constituting safe and effective client care agreed on by groups of nurses expert in their area of nursing
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the purpose and functions of the Nurse Practice Act.
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• State Statute that defines and regulates the practice of nursing to protect the public o Define the scope and boundaries of practice o Create and empower a Board of Nursing to oversee licensee o Establish the requirements for licensure and entry into practice o Establishes standards for nurses utilized by courts o Violations result in civil or criminal prosecution
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the relationship between the state Nurse Practice Act and the requirements for nursing licensure and certification.
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The nurse practice act for each state establishes the requirements for licensure- some states have different requirements than others
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the role and responsibilities of the State Boards of Nursing.
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• Made up mostly of nurses • Are given authority by statutory law • Enforce Nurse Practice Acts o Regulate nursing practice, including requirements to enter practice and obtain and maintain a license (NCLEX, education, fee) • Oversee Schools of Nursing • Control Licensure o Requires a minimum degree of competency to ensure that public health, safety, and welfare are reasonably protected. • Discipline nurses
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Reprimand
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board issued a letter for a minor violation of the Nursing Practice Act, with no restrictions on the license
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Probation
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allows the licensee to practice as an RN under certain restrictions for a set period of time
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Suspension of License
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board has ordered the licensee not to practice as a RN for a set or indefinite period of time. Suspensions may be imposed in disciplinary actions, prior to a probation term, or may be imposed as the result of a violation of probation
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Revocation of License
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board revoked the license and the licensee no longer has the right to practice as an RN or use the title
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the practice of professional nursing as defined in the Florida Nurse Practice Act.
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“Practice of professional nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.
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the purpose of and requirements for nursing licensure.
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Passage of NCLEX, fees, criminal background check, CE contact hours within a specified time period, active employment for a specific number of hours within a specified time period (renewal), and number of hours of professional nursing activities (renewal).
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what all nurses can do to improve the image of nursing.
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• Be visible! • Be actively involved in policy and funding decisions, particularly any changes that impact nursing care but also broader healthcare issues
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Explain professional nursing boundaries
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• Professional boundaries are the spaces between the nurse’s power and the client’s vulnerability • Nurse should avoid these behaviors: o Self-disclosure of one’s own personal information, secretive behavior between the nurse and a patient, special treatment by nurse, selective communication, super nurse (the nurse thinks he or she is the only one who can care for the patient), you and me against the world thinking, and failure to protect the patient.
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negative impact on the image of nursing
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o Insecurity o Role confusion o Lack of professional confidence o Timidity o Fear o Sense of inferiority o Hospital policy o Perceived authority and directives of physicians o Historical role of nurses as handmaiden o Hierarchical structure of healthcare organizations o Threat of disciplinary action or legal action (afraid to speak up) o Nurse’s silence may have negative impact on patient care
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positive impact on the image of nursing
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o Power and empowerment o Visibility
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Values
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personal ideals and beliefs about worth that act as a guide to behavior
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Morals
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standards of conduct that represent the ideal in human behavior = how individuals ought to treat others
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Ethics
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a branch of philosophy that examines behavior to determine what constitutes good, bad, right and wrong behavior and provide guidance for action
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the purpose of ethical principles
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Establish common ground between nurse, patient, family, other health care professionals, and society to discuss ethical questions and make ethical decisions
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the organization responsible for ethical codes and standards of nursing practice.
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ANA
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Autonomy
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Principle of respect for the person, People are free to form judgments and actions as long as they do not infringe on others
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Beneficience
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To promote goodness, kindness, and charity, To abstain from injuring others and to help others further their well-being by removing them from harm
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Justice
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Moral rightness, fairness, or equity
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Nonmaleficence
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Implies a duty: Not to inflict harm, To abstain from injuring others, To help others further their own well-being by removing harm
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Veracity
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Principle of truth-telling
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Advocacy
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advocates for dignified and humane care
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the purpose of the ANA Code of Ethics
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Explains the primary goals, values, and obligations of the profession.
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provision 1 of the ANA Code of Ethics
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The nurse practices with compassion and respect for the dignity, worth, and uniqueness of every individual, unrestricted by social or economic status, personal attributes, or the nature of health problems
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provision 2 of the ANA Code of Ethics
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The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
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provision 3 of the ANA Code of Ethics
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The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. (Privacy, Confidentiality, Protection of participants in research, Standards and review mechanisms, Acting on questionable practice, Addressing impaired practice)
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provision 4 of the ANA Code of Ethics
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The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. (Acceptance of accountability and responsibility, Accountability for nursing judgment and action, Responsibility for nursing judgment and action, Delegation of nursing activities)
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provision 5 of the ANA Code of Ethics
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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. (Moral self-respect, Professional growth and maintenance of competence, Wholeness of character, Preservation of integrity)
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provision 6 of the ANA Code of Ethics
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The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. (Influence of the environment on moral virtues and values, Influence of the environment on ethical obligations, Responsibility for the health care environment)
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provision 7 of the ANA Code of Ethics
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The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. (Advancing the profession through active involvement in nursing and in health care policy, Advancing the profession by developing, maintaining, and implementing professional standards in clinical, administrative, and educational practice, Advancing the profession through knowledge development, dissemination, and application to practice)
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provision 8 of the ANA Code of Ethics
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The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. (Health needs and concerns, Responsibilities to the public)
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provision 9 of the ANA Code of Ethics
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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. (Assertion of values, The profession carries out its collective responsibility through professional associations, Intraprofessional integrity Social reform)
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principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society.
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• Privacy of the patient’s interests • Conflict of interest for nurses • Collaboration • Professional boundaries
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nursing responsibilities related to informed consent and who can give it
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Nurse goes and gets informed consent from patient for procedure it is the doctors responsibility to answer questions about the procedure and risk involved.
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Assault
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the threat or use of force on another that causes that person to feel reasonable apprehension about imminent harmful or offensive contact.
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Battery
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the actual intentional striking of someone, with intent to hrm, or in a rude and insolent manner even if the injury is slight.
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Civil Law
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law of private rights
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Criminal Law
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those statutes that deal with crimes against the public and members of the public, with penalties and all the procedures connected with charging, trying, sentencing, and imprisoning defendants convicted of crimes.
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Doctrine of res ipsa loquitur
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a doctrine of law that one is presumed to be negligent if he, she, or an organization/employer had exclusive control of whatever caused the injury, even though there is no specific evidence of an act of negligence, and without negligence, the accident would not have happened.
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Emancipation
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a child is a minor, and therefore under the control of his or her parents/guardian until her or she attains the age of majority (18 yrs) at which point he or she is an adult. In special circumstances, a minor can be freed from control by his or her guardian and given rights of an adult before turning 18. In most states the three circumstances under which a minor becomes emancipated are (1) enlisting in the military (which requires parent/guardian consent), (2) marrying (requires parent/ guardian consent), or (3) obtaining a court order from a judge (parent or guardian consent not required). A minor can also petition the court for this status if financial independence can be proven and the parents or guardian agree. An emancipated minor is legally able to do everything an adult can do, with the exception of actions that are specifically prohibited if one has not reached the age of 18. From a healthcare perspective, emancipated minors can sue and be sued in their own name, enter into contracts, and seek or decline medical care.
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Expert Witness
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a person within specific expertise and knowledge who can provide testimony to prove the standard of care. A nurse may serve as an expert witness for nursing care but not for medical care issues. Typically, the nurse is also a specialist in the specific area of care being addressed in the legal case
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False imprisonment
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confinement of a person against his or her will.
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Good Samaritan laws
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laws that protect a healthcare professional from being sued as a result of providing emergency care outside a healthcare setting. The provider must provide the care in the same manner that an ordinary, reasonable, and prudent professional would in similar circumstances, including following practice standards.
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Malpractice
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an act or continuing conduct of a professional that does not meet the standard of professional competence and results in provable damages to his or her patient.
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Negligence
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failure to exercise the care toward others that a reasonable or prudent person would under the circumstances.
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Proximate cause
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a cause that is legally sufficient to result in liability.
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Respondent superior
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a principal (employer) responsible for the actions of his, her, or its agent (employee) in the course of employment. This doctrine allows someone to sue the employee who is accused of making an error that resulted in harm. The patient also may sue the employer, the hospital, because the employer is responsible for supervising the staff member.
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Standards of practice
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minimum guidelines identified by the profession and healthcare organization policies and procedures. Expert opinion, literature, and research also may be used as standards. Standards are used in legal situations to assess negligence malpractice actions.
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Statutory laws
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the body of law derived from statutes rather than from constitutions or judicial decisions
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Tort
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a civil wrong for which a remedy may be obtained in the form of damages.
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the professional & legal sources of regulation of nursing practice
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State Nursing Practice Act and Board of Nursing Rules & Regulations: Define the scope and limitations of professional nursing practice
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Nurse Practice Act
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Legally defines and describes the scope of nursing practice
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HIPPA
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Intent of this law is to ensure confidentiality of the patient’s medical records; the statute sets guidelines for maintaining the privacy of health data
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American with Disability Act
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prohibits discrimination as a result of disability, including mental illness, if the person can complete the job requirements.
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OSHA
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includes working conditions, disposal, isolation procedures
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Comprehensive Drug Abuse Prevention and Control Act
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regulates drugs with high potential for abuse: narcotics, stimulants
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situations may constitute false imprisonment
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When a patient is threatened or his or her clothes are taken away to prevent him or her from leaving
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Fraud
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False representation of fact.
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Assault
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Any action that places another person in apprehension of being touched in a manner that is offensive, insulting or physically injurious without consent or authorization.
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Battery
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Actual willful touching of another person that may or may not cause harm.
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false imprisonment
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Restraining a person, with or without force, against that person’s wishes.
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defamation
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Either a false communication or a careless disregard for the truth that results in damage to someone’s reputation.
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Invasion of privacy
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Unreasonably intrudes on the client’s private affairs
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Negligence
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nurse is judge against an ordinary, reasonable, prudent layperson would do or not do in similar circumstances.
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Malpractice
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Professional person is judged against professional standards and practices of another reasonable, prudent professional person with similar circumstances and background
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Intentional tort
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There must be a volitional or willful act by the defendant. The defendant must intend to bring about the consequences or appear to have intended to bring about the consequences. There must be causation: Cause and Effect relationship.
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Unintentional tort
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Negligence and Malpractice
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5 C’s to prevent lawsuits
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Caring, Competency, Communicating, Charting, Committed to prevention of medical errors
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Caring
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Treat me with respect, Listens to me with patience and understanding, Seems to care about my emotional well being, Has encouraged me to ask questions, Has made efforts to get to know me as a person
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Competency
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Know your obligations and responsibilities, legally, ethically, professionally and incorporate into daily practice. Stay current and practice within your scope of practice and personal competence areas. Provide good quality of care.
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Communicating
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To other health care provider, To different departments, Patient advocate, Self advocate
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Charting
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Document care timely and accurately
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Committed to prevention of medical errors
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Healthy environment lead to less medical errors.
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Summarize Harvard Medical School’s recommendation for medical errors.
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o Tell the patient and family what happened. o Take responsibility o Apologize at once o Explain what will be done differently in the future.
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Plaintiff
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bring the suit. must demonstrate an actual harm or injury resulted in breach in duty.
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Defendant
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person against whom a lawsuit is filed. must show that the plaintiff is unable to prove the 4 elements of negligence or malpractice liability.
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the purpose of incident reports & why, when, & how to do them
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• Purpose: to assist in developing policies and procedures to improve practice; improve quality of care. • Why: Nurses are legally bound to report critical incidents. • When: Do when a critical incident occurs. • How: Describe events objectively. Avoid subjective comments/personal opinions.
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reasons to carry professional malpractice insurance
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• Protects the individual nurse when a lawsuit is filed. • Provides independent representation by an attorney. • Pays for judgments up to the policy limit. • May include representation in licensure actions. • Provides compensation to client if harmed.
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deposition and how it can be used
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Testimony under oath, sworn statement. Purpose: assist opposing counsel in preparing for the court case.
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standards of care and why they are important
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• Term used to designate what is accepted as “reasonable under the circumstances” and as a “measuring scale” for the “the degree of skill, care, and judgment used by an ordinary prudent RN under similar circumstances.” • Based on: State Regulations, State Statutes, National Standards, Academic curricula, Certification criteria, Hospital policies and procedures. • Failure to abide can lead to a malpractice claim accusing the nurse of negligence and making the nurse legally accountable and liable for the damages which occurred.
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the importance of legal documentation in patient medical records
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Medical records can be used in a court of law as evidence. It is important to document accurately and objectively when writing in patients documents.
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objectives of quality improvement programs.
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• Continually understand and measure quality of care in terms of structure, or the inputs into the system, such as patients, staff, and environments; process, or the interactions between clinicians and patients; and outcomes, or evidence about changes in patients’ health status in relation to patient and community needs • Assess current practices and compare these practices with relevant better practices elsewhere as a means of identifying opportunities for improvement. • Design and test interventions to change the process of care, with the objective of improving quality. • Identifying errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification and human factors training. • Both act as an effective member of an interdisciplinary/interprofessional team and improve the quality of one’s own performance through self-assessment and personal change.
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the nurse’s legal responsibilities with regard to reporting abuse
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Child Abuse Prevention and Treatment Act and Reporting Statutes: Mandate reporting specific health problems and suspected or confirmed abuse Health professionals must report under penalty of fine or imprisonment for failing to do so: • Infant and child abuse • Dependent elder abuse • Specified communicable diseases

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