Chapter 3: issues in nursing practice

Question 1

factors influencing heath care change

Answer 1

• changing characteristics of US population
• increasing population
• increasing number of older adults
• increasing cultural diversity
• evidence based practice
• multidrug resistant infectious organisms
• emerging viruses
• human trafficking awareness campaign
• technology: EHR, mobile health (tablets, smartphones, telehealth, apps, etc), remote pt monitoring, robotics
• nursing informatics

Question 2

safe practice: medication errors

Answer 2

• increase w/ distractions
• interventions
• no interruption zones marked w/ bright colored tape
• wearing bright colored vests/sashes
• not interrupting others
• avoiding own interruptions

Question 3

sentinel events

Answer 3

• fatal or serious injury or death that could have been prevented

Question 4

a medication is specifically made for only ______type of admin route

Answer 4

ONE;
can ask hcp for alternate route such as someone who cannot take pills or is NPO, but cannot put IV medication in water and have them drink it

Question 5

economic issues

Answer 5

medicare and diagnosis related groups
medicaid
hospital acquired conditions and present on admission reporting
managed health care

Question 6

14 hospital acquired conditions

Answer 6

1. foreign object retained after surgery
2. air embolism
3. blood incompatibility
4. stage 3 and 4 pressure ulcers
5. falls and trauma injuries
6. manifestations of poor glycemic control
7. catheter associated UTI
8. vascular catheter associated infection
9. surgical site infection following coronary artery bypass graft (mediastinitis)
10. surgical site infection following bariatric surgery for obesity
11. surgical site infection following certain orthopedic procedures
12. surgical site infection following cardiac implantable electronic device
13. DVT/PE w/ knee/hip replacement
14. Iatrogenic pneumothorax w/ venous catheterization

Question 7

the delegation process

Answer 7

• can delegate down, not up, make sure the UAP is within scope of practice, understands what you are asking, you have to follow up to see if it was done and what the results were
• know state nurse practice act
• identify skills of delegate
• use five rights of delegation

Question 8

ethics

Answer 8

study of traditions, values, and beliefs, related to people/relationships

Question 9

bioethics

Answer 9

ethical principles and values applied to human life

Question 10

ethical questions

Answer 10

what should/ought we do?

Question 11

morals

Answer 11

personal values
standards set by one’s conscience
personal choices of good and bad, right and wrong

Question 12

values

Answer 12

• standards/ideals/concepts giving meaning to individual’s life
• derived from societal norms, religion, and family traditions
• guide decisions and actions

Question 13

ethical principles

Answer 13

autonomy
beneficence
nonmaleficence
fidelity
veracity
justice

Question 14

utilitarianism

Answer 14

outcomes most important elements for making decisions

Question 15

deontology

Answer 15

actions/attitudes based on duty

Question 16

theological perspectives

Answer 16

religious traditions
source of values and morals

Question 17

ethical decision making steps

Answer 17

• identify ethical dilemma
• identify stakeholders and their values
• gathe and verify information
• examine possible actins and consequences
• determine ethical foundation for actions
• determine best action w/ strongest ethical support
• implement action
• evaluate outcome

Question 18

regulation of nursing practice

Answer 18

• licensed health care profession
• goal: to protect the public
• regulated by state boards of nursing
• nurse practice acts: laws define scope of practice, vary by state
• license sanctioned for violations

Question 19

violations

Answer 19

• unprofessional conduct
• incompetence
• conviction of a crime
• misuse of controlled substances

Question 20

license sanctions

Answer 20

suspend
revoke

Question 21

prescription medication

Answer 21

current prescription for current condition required

Question 22

prescribed controlled substances

Answer 22

cannot work under the influence when substance affects your ability to work safely to protect your pts

Question 23

prior misdemeanor or felony convictions

Answer 23

• may have a harder time getting a job or no able, or not able to do pt care
• when applying for state licensure: explain how you complied w/ court’s orders, tell why it will never happen again
• after licensure, report within 30 days of: address change, any conviction occurring anywhere, if in doubt report to avoid nonreporting sanction

Question 24

mandatory reporting

Answer 24

vulnerable populations: children , older adults, disabled, mentally impaired
- known or suspected abuse
- inform appropriate state agency

Question 25

examples of abuse

Answer 25

physical sexual verbal emotional financial/economic neglect

Question 26

human trafficking awareness

Answer 26

- victims utilize health systems to access tx for medical needs - indicators to look for: pt has no identification, someone answering for pt, someone making decisions for pt, someone never leaving pt alone

Question 27

physical and psychological indicators of human trafficking

Answer 27

chronic physical issues: headaches, back pain, stomach or abdominal pain

Question 28

mental health issues and human trafficking

Answer 28

memory loss, depression, and anxiety

Question 29

signs and symptoms of abuse and neglect and human trafficking

Answer 29

bruising, malnutrition, submissive behavior

Question 30

if human trafficking suspected

Answer 30

- do NOT alert victim or confront trafficker - confirm suspicions w/ healthcare team - report to local law enforcement

Question 31

health insurance portability and accountability act of 1996

Answer 31

- civil/criminal liability for healthcare workers who wrongfully disclose pt's health information - violation penalties include: disciplinary action by employer, fines, sentenced up to 10 years in prison, sued by pts

Question 32

social media and hipaa

Answer 32

- always protect pt health info from unathorized disclosure - keep professional and personal life separate - employrs review social media sites - examples: unauthorized access to medical records, taking unathorized photos of pts on personal electronic devices (pediatric pts require parental consent), posting pt info to social media such as lab studies, photos, x rays

Question 33

nursing liability and the law

Answer 33

liability established by law for wrongful actions - criminal law: regulates behaviors for citizens among society, imprisonment/fines - civil law: basis for malpractice and common negligence, monetary recovery for injuries

Question 34

torts

Answer 34

lawsuits for personal injury

Question 35

civil liability suit

Answer 35

complaint summons: must be answered by employer or nurse

Question 36

malpractice

Answer 36

- the breach of a professional duty - applies to nurses perforing nursing duties on the job

Question 37

negligence

Answer 37

liability arising from an injury that results from a person's failure to exercise due care

Question 38

limiting liability

Answer 38

- ensuring patient rights - following institutional policies - practicing by current nursing standards - documenting procedures appropriately - pursuing continuing education