NCLEX Kaplan Review Course- Legal, Management, and Cultural Issues
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| Informed Consent Req | Capacity, Voluntary, Info given in understandable manner, cannot sign if pt has been drinking alcohol or has been pre-medicated
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| Minors that can provide consent for tx? | Married minors; over a specific age for STDS, HIV, AIDS, or drug/alcohol tx/testing, emancipated &mature minors, minors seeking birth control, seeking outpatient psychiatric services or inpatient voluntary care, pregnant (sign for themselves &fetus), deli
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| Consent includes | explanation of tx and EO, anticipated risks/discomforts, potential benefits, alternatives, answer questions, statements that consent can be withdrawn at any time
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| Living wills | legal document signed by competent pt indicating tx or life saving measures to be used if pt ability to make decisions is lost due to terminal illness or unconscious state; indicates who is authorized to make healthcare decisions; legally binding in most
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| Durable power of attorney | permits competent adult to appoint surrogate or proxy in even pt becomes incompetent, provider must follow decisions stated in document, most states proxy can perform all legal actions needed to fulfill adult’s wishes
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| RN as pt advocate | actively supports pt rights, defend pt participation in decision affecting them, communicate pt needs to interdisciplinary team, safeguard pts autonomy and independence, provide pt with info about needs and available options
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| Negligence | UNINTENTIAL failure of individual to perform an act that a reasonable person would or wouldn’t perform in similar circumstances; can be an act of omission or commissions
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| Malpractice | professional negligence involving misconduct or lack of skill in carrying out professional responsibility
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| Assault | INTENTIAL threat to cause harm or offensive contact
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| Battery | INTENTIAL touching without consent
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| Accountability | rn is responsible for using reasonable care in practice; remains competent, nurse needs to participate in lifelong learning programs
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| Managed Care | goal to reduce health care costs, focuses on client outcomes, uses interdisciplinary approach, emphasizes costs, critical pathways used as foundation for activities and guide services that clients receive for specific health conditions
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| Continuous Quality Improvement | “quality assurance”;prevention focused care,organize incident reporting,managed by team of 5-10 ppl,SR mgt develops policy,coordinator provides process&mgt healthcare training,&team headed by a team leader evaluates&improves the process
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| Critical Pathways | reduce complications, cost, increase collaboration, improves quality of care, provides direction, orients staff to EO, modified by case mgr if EO not achieved, variances are tracked to note trends, interventions presented in groups
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| Variance | change in established plan that includes more, different, or fewer services to pt to achieve desired outcome
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| Variances | deviations from specific plans, info is included in database and used to evaluate services provided, CQI strategies are used to monitor variances
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| Case mgr | doesn’t provide direct pt care, supervises cared provide, coordinates, communicates, collaborates, solves problems, facilitates pt care for group of pts (10-15), follows pt from admission to d/c, notes variances from expected progress
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| Case mgt | identifies, coordinates, monitors implementation of services needed to achieves desired outcomes within specified time, involves principles of CQI, and promotes professional practice
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| Delegation | responsibility and authority for performing a task is transferred to another individual who accepts that responsibility and authority
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| Delegator remains ____________ for task | accountable
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| Can only delegate tasks nurse is _______________ for. | responsible
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| Responsibility | obligation to accomplish a task
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| Accountabililty | accept ownership for results or lack of results
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| In delegation, responsibility is ___________, in accountability, it is ________________ | transferred, shared
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| Responsibility is determined by: | practice acts, standards of care job description, policy statement
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| Steps for delegation include: | define task; determine who should receive task; identify what the task involves, determine its complexity; math task to individual by assessing skills and abilities; provide clear communication about you expectation regarding task, and allow questions
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| In order to delegate (10): | decscribe EO &timeline; tell delegatee how and how often task will be evaluated; provide reason for task; identify changes or incidents need to be brought to delegator’s attention; written report is needed, inform delegatee where to put the report; state
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| Identify_________for completeing task and risks | constraints
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| Obtain _________from delegatee to make sure they understand the taks to be performed and yoru expectations | feedback
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| _________performance and results according to goals | monitor
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| Rule for determining delegatee | delegate to lowest person on hierarchy who has the required skills and abilities and who is allowed to do the task legally and according to the organization
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| Rights of delegation (6) | Right task, person, time, info, supervisions, follow-up
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| Delegation | empowers others, build trust, enhances communication and leadership skills, develops teamwork, increase productivity
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| LPN competence | assist with implementation of define plan of care, perform procedure to protocol, differentiate normal from abnormal, care for physiologically STABLE pts with PREDICTABLE OUTCOMES, knowledge of asepsis and dressing changes, ability to administer meds
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| UAP competence | assist with direct pt care activities (ADLs: bathing, transferring, ambulating, feeding, toileting, vitals, height, weight, I&O, housekeeping, transporting, stocking supplies), includes nurse aides, assistant, techs, orderlies, nurse extenders, scope of n
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| Chain of command | emphasis on vertical r/s (nurse reports to nurse mgr who reports to nursing supervisor
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| Nurse reports variance, problems, and concerns to next person with _________ in direct line in their area | authority
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| Purpose of documentation | promotes communication, maintains legal record, required for third party reimbursement
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| Characteristics of good documentation | legible, accurate, timely, thorough, well organized and concise, confidential, proper grammar and spelling, authorized abbreviations
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| Document changes by: | assess pt, notify MD, notify interdisciplinary team of changes in med plan, notify family or significant other, document in timely manner
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| Incident reports | statement of fact and pts physical response; accurate and comprehensive on any unexpected or unplanned occurrence that affects or could potentially affect a pt, family member or staff person
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| Incident report purpose | documentation and follow up, used to analyze the severity, freq, and cause of occurrence, analysis is the bases for intervention
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| How to chart incident | don’t include a reference to incident report; don’t use error or inappropriate, don’t include judgmental statements, chart follow up to adverse rxn, document pt rxn as status changes and shoe be continued until pt returns to original state
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| Sequence of incident reports | person discovers & reports & actual/potential risk; risk mgr receives report within 24 hrs; investigation of incident is conducted; referring MD and risk mgt committee consult together
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| Risk Manager | clarifies misinformation for pt and family, explains what happened to pt and family, pt is referred to appropriate resources, care is provided free of charge, all records, incident reports, follow up actions taken are filed in a central location
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| Common Situations Req Incident Reports: | med errors, complications from diagnostic or tx procedures, incorrect sponger count in surgery, failure to report change in pt condition, falls, pt is bu8rned, brake in aseptic tech, medical/legal incident
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| Medical/Legal Incident Examples | pt or family refuses tx as ordered and refused to sign consent, or pt or family voices dissatifisfactions with care and situation cannot be or has not been resolved
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| Change in shift report | reg scheduled, structured exchange of info, focuses on anticipated needs for pt in next 24 hrs, enable health care workers to organize work for specified time period, communicate concerns, provide continuity of care or consistent follow through
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| Shift reports/rounds include: | pt status, current care plan, responses to current care, things needing further attention
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| Reporting nurse describes what in shift report/rounds | actual/potential needs; how needs were addressed during previous shift; info about labs, tests, txs, & rn activities for next shift; reporting rn must legally communicate all facts relevant to care; info must be pertinent, current, & accurate
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| Shift Report/Rounds should NOT include: | info already known; descriptions of routines; rumors or gossip; opinions or judgments; pt info that does not relation to health condition, needs, or tx
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| How does the RN give rounds? | gather data to be discussed; avoid copying data in order to prevent errors and reduce time req.; use outline to organize report; provide in logical, uniform manner
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| How does the RN deliver rounds? | Pt info medical plan, nursing plan
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| What does the RN receive in shift report? | individual pt sx; discomfort; what has been done; what remains to be done; how pt has responded to tx and activities so changes can be made to meet needs
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| How does the RN receive shift report? | determine # pt,# staff available, anticipated admissions, transfers, discharges, pt critical condition, pt w/specific needs;complete assignment sheet for staff under ur supervision;write assignment on pt care worksheets;make a“to do”list for each shift
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| Functional Nursing | involves a task approach to pt care, w/major tasks being delegated by charge RN to individual member of team;goals are concerned w/work productivity at the lower possible cost;task generally are assigned to lowest skilled paid workers who are available
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| Teaming Nursing | generally led by RN whos responsible for assessing,developing nursing dx,planning,&evaluating pt plan of care;member works fully w/i the realm of their educational&clinical expertise;member is accountable for pt care&outcomes of care delivered;characteriz
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| Primary Nursing | focuses on pt outcomes as opposed to nursing tasks; is concerned with keeping the rn at the bedside, actively involved in pt care, while panning goal-directed, individualized care
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| Ethics | principles of right/wrong;governs r/s w/others;used to id solutions to problems arising from conflicts;base on personal beliefs&cultural values that guide decision making &determine conduct;diversity increase need to understand ethical principles increase
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| Ethical Dilemma | conflict between two or more ethical principles with no correct decision, rn must take a choice between two alternatives and usually result of differences in cultural or religious beliefs
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| Ethical Reasoning | process of thinking though what one should do in an orderly and systematic manner to provide justification for actions base on principles
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| Ethical Principles of Nursing | Autonomy, beneficence, nonmalefience, justice, veracity, confidentiality, fidelity
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| Autonomy | support of pt independence to make decisions and take action for themselves
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| Beneficence | duty to help others by doing what is best for them; for refusal of care, autonomy overrides beneficence
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| Nonmaleficence | “do no harm”; act with empathy toward pt and staff without resentment or malice; violated by acts performed in bad faith or with ill will, or when making false accusation about pt or employee
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| Justice | use available resources fairly and reasonably
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| Veracity | communicate truthfully and accurately
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| Confidentiality | safeguard the pts privacy
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| Fidelity | following through on what the rn says will be done; carefully attending to the details of pt care
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| Ethical Reasoning Process | (RAIDSE) Recognize a moral issue, Analyze facts, Identify the dilemma, Decide on possible alternative actions, Select specific action, Evaluate the effectiveness of the action
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| Behaviors for handling complaints | use active listening without interrupting or arguing; don’t get defensive; ask pt what is expected for solution to problem; explain what you can and cannot do to solve problem; agree on specific steps that will be taken and determine a timeline
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| Tort | legal wrong against a person or his property INTENTIONALLY
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| Fraud | attempt to mislead in any form (recording vitals that were not taken, BG that weren't obtained)
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| Witnessing Consent of Care | RN responsible for witnessing informed consent &can legally witness a will if asked by the pt; RN NOT responsible for getting informed consent, even if RN gets pt to sign; its MD responsiblity; RN documents &communicates info regarding pt care to MD
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| Code of Ethics for Nursing discusses the ________ and ________ of the RN | obligation; duties
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| RN practices with ________ and ________ for the dignity, worth, and uniqueness of the individual, unrestricted by social or economic status, personal attributes, or the nature of the disease | compassion; respect
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| RN is committed to pt, whether pt is an individual, a family, or a community; RN must respect pt wishes to have family involved in _______________ | decision making
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| RN is expected to promote the protection of the pt and protect the ________ , ________ , and ________ of the pt | health; safety; rights
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| RN responsible for and ________ to delegate tasks consistent with optimal pt care; RN expected to be aware of ________ and ________ of other healthcare workers | accountable; roles; responsibilities
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| RN expected to preserve ________ and ________ to maintain ________ and to continue personal and professional growth; in other words, RN will abide by state regulations of continuing education to keep license | integrity; safety; competence
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| RN participates in activities that improve the conditions of work environment and responsible for promoting activities that foster ________ ________ in nursing | ethical values
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| RN participates in the advancement of the profession through education, ________ , and development of nursing knowledge | research
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| RN ________ with others in health community to meet client needs | collaborates
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| RN responsible for maintain the integrity of nursing and its practice and for shaping social policy through________ ________ . | professional organizations
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