Role and Scope Exam 1 PDF

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Role and Scope Exam 1 

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Values—ideas or concepts that give meaning to individuals life—derived from societal norms, religion, family orientation; serve as framework for decision making and taking action in daily life Fidelity—keeping ones promise to the client about care that was offered Morals—the fundamental standards of right and wrong that an individual learns and internalizes; usually in early developmental stages Deontology—a system of ethical decision making; based on moral rules and unchanging principles Nonmaleficence—the nurses obligation to avoid causing harm to the client Justice—fair tx in matters of physical and psychological care and use of resources Ethical dilemma—problems for which more than one choice can be made, and the choice is influenced by the values and beliefs of the decision makers Beneficence—the care that is in the best interest of the client Autonomy—The ability of the client to make personal decisions, even when those decisions may not be in the clients own best interest Veracity—the nurses duty to tell the truth Utilitarianism (teleology)—the ethical system of utility; the greatest good for the greatest number and the end justifies the means Ethics—discipline dealing w/ what is good and bad and w/ moral duty & obligation A position is a group of tasks assigned to one individual. A job is a group of positions similar in nature and in skill level that can be carried out by an individual or a group. An occupation is a group of jobs, similar in type of work, usually found throughout an industry or workplace. A professional is one who belongs to and practices a profession. BEST PROFESSIONAL NURSES—well educated; minimum of a bachelor’s degree*** Morally unacceptable—bullying, harassment, intimidation, manipulation, threats or violence Everyone has the right to receive healthcare!!! The primary purpose of the National League for Nursing (NLN) is to maintain and improve the standards of nursing education o CONTINUING EDUCATION Nurses must pass a national licensure examination to demonstrate that they are qualified to practice nursing; Nursing licensure conducted by the individual state under the regulations contained in that state's nurse practice act. o establishes the scope of practice for professional nurses, as well as educational levels and standards, professional conduct, and reasons for revocation of licensure. American Association of Colleges of Nursing (AACN)—established to help colleges with schools of nursing work together to improve the standards for higher education for professional nursing.

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o Developed standards for the accreditation of baccalaureate 

American Nurses Association (ANA)— improving the standards of health and access to health-care services for everyone; improving and maintaining high standards for nursing practice; and promoting the professional growth and development of all nurses, including economic issues, working conditions, and independence of practice

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Advanced Directives o Client wishes regarding end-of-life care o PSDA (Patient Self-Determination Act) requires questioning upon admission o Living will: medical treatment if incapacitated – prolong life (CPR, Ventilation, feeding). o Durable power of attorney for health care: designates health care proxy (surrogate) – authorized to make decision for client.

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The National League for Nursing (NLN) and the American Nurses Association (ANA)— neither can be considered powerful when compared with other professional organizations, one reason for their lack of strength is that fewer than 10 percent of all nurses in the United States are members of any professional organization at the national level. An ethical dilemma problem occurs when something cannot be solved solely by a review of scientific data; it involves a conflict between two moral imperatives. The answer will have profound effect on the situation/client. When facing this situation, ethical decisionmaking is the process by which a decision is made about an ethical issue.

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The people who belong to the ethics committee vary somewhat from one institution to another, but they usually include a physician, a member of administration, an RN, a clergy person, a lawyer, and a person from the community. Members of ethics committees should not have any personal agenda that they are promoting and should be able to make decisions without prejudice on the basis of the situation and ethical principles.

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Code of ethics is not law but if consistently violated can result in reprimands, fines, suspension of licensure

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Leadership—engaged decision making connected to the actions used in clinical situations for which no standardized solution exists; Using one's individual traits and personal influence to interact constructively in resolving problems is a good definition of nursing leadership.

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Authoritative: These leaders make decisions for the group. They tend to motivate by coercion, with communication occurring down a chain of command. Staff work output is usually high, and this makes it a great style to have in crisis situations. MANAGER**** o Gives orders o Final decision is made by the leader alone

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Democratic: These leaders include the group when decisions are made. They tend to motivate by supporting achievements made by group members and they communicate both up and down the chain of command. Their staff's work output is usually good because cooperation is valued. LEADER**** o All group members equal o Final decision is based on group

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Laissez-faire (a French phrase meaning "leave it alone"): These leaders make few decisions, do very little planning, and rely on their staff's motivation to get jobs accomplished. Communication goes both ways, but work output may be low unless an informal leader emerges from within the group. However, this style may be effective with professional employees who have personal integrity and accountability. o Can lead to staff frustration o Leader avoids making decision

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Transformational leaders empower followers to assume responsibility for a shared goal or vision, and personal development is a secondary outcome. LEADER****

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Transactional leaders focus on immediate problems, maintaining the status quo and using rewards to motivate followers. MANAGER****

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Management—the process of guiding others through a set of derived practices and procedures; processes will be evidence based and may be routine; managers are generally

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appointed, hired, or otherwise given the responsibility; managing can also refer to control of one's own individual work and energies o Formal authority o Transactional o If person didn’t have the title “manager” would you still follow their rules?

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No—manager

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Yes—leader

Leaders—emerge from situations; INSPIRE; have the ability to accept criticism; establish clear goals and outcomes o BECC—Believe, Encourage, Challenge, Corrected o Transformational

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Followership—is being part of the group that is being led or managed; effective follower not only contributes to the good of the team but provides feedback to the manager or leader in order to identify problems and find solutions to them

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Emotional intelligence—the possession of social skills, interpersonal competence, psychological maturity, and emotional awareness devoted to helping people work well together; helps sees others in a positive light; ability of an individual to perceive and manage the emotions of self and others. Nurses must be able to perceive and understand their own emotions and the emotions of their clients and families in order to provide real client-centered care. o Have self-awareness: You can identify the emotions you are feeling and you know how they may be altering your perceptions. o Manage emotions: Your negative emotions -anger, fear, and passiveaggressiveness, can be avoided. o Motivate yourself: You are inwardly rather than externally driven. o Be empathetic: You value differences in viewpoints and don't side with one group versus another. o Handle relationships: You are socially appropriate

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Emotional intelligence is also an important characteristic of the successful nurse leader, as this leader will have insight into the emotions of members of the team; understands the perspective of others and will encourage constructive criticism and be open to new ideas.; able to maintain focus while multitasking; manages emotions and channels them into a positive direction, which in turn helps the team accomplish its goals.

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An emotionally intelligent leader will refrain from judgement until facts are gathered***

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Quality improvement (QI)—systematic and continuous actions that lead to measurable improvements in health-related services and in the overall health and/or safety of individual patients.

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Quality management—the use of performance standards and ongoing quality improvement efforts to achieve high levels of patient safety and satisfaction. The Institute of Medicine (IOM) identified over 98,000 patient deaths were attributed to medical error**

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The IOM states: that ALL patient care must be safe, effective, patient-centered, timely, efficient, and equitable The risk management department look at medical errors, patient falls, pressure wounds, hospital acquired infections, etc., in an attempt to do "damage control" and rectify problems

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Occasionally nurses do not report problems due to fear of punishment or job security. Short staffing, 12-hour shifts, floating to other units, etc. - all contribute to nurses' anxiety. Making an error and failing to report it is a common, but potentially deadly, situation.

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ANA—CODE OF ETHICS o A guide for nurses to provide consistent and quality care; ethical obligations  Provisions  1—respect and compassion

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2—commitment: primary is the patient/family 3—advocacy: protects rights, health, and safety of pt 4—accountability and responsibility for practice: decisions and actions are consistent with obligation for optimal patient care 5—duty: to self and to others (patient) 6—ethical 7—professional 8—collaborator: works to protect human rights 9—integrity

Risk management o Includes aspects of detection, education, and intervention o High risk areas include:  Medication errors  Complications from tests and treatments  Falls  Refusal of treatment or refusal to sign treatment Sentinel event—an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. o Serious injury includes loss of limb or function. o Sentinel events are not the same as errors. o Indicate the need for immediate investigation and response.

Never Events—these are reasonably preventable medical errors that occur in the hospital. o The Centers for Medicare & Medicaid Services (CMS) will no longer pay for costs resulting from Never Events.  DVT/PE post total hip replacement/knee replacement  Foreign body retained PO  Suicide inpatient or within 72 hours dc  Unanticipated Infant death  Infant dc to wrong family  Abduction of any pt  Rape/Assault  Wrong pt, site, procedure  Blood incompatibility  Stg. III or IV pressure ulcer  CAUTI  Central line associated blood stream infection (CLABSI)  Surgical site infection

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The Agency for Healthcare Research and Quality (AHRQ)—goal is to measure those improvements in terms of client outcomes, decreased mortality, improved quality of life, and cost-effective quality care. o Safety and quality: risk reduction by promoting quality care o Effectiveness: improved health outcomes by using evidence to make informed health care decisions o Efficiency: translating research into practice to increase access and to decrease costs

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