Nursing Delegation & HIPAA PDF

 Nurse aid: • Hang a bag of IV Fluids on a client it's outside of scope of his Practice. The nurse aid Cleary didn't have the credentials to do that. • This will be a Violation of delegation.  Newly admitted→ Unstable Cannot delegate.  Discharge→ You can delegate If he is stable.  Trending Vital...

 Nurse aid: • Hang a bag of IV Fluids on a client it's outside of scope of his Practice. The nurse aid Cleary didn't have the credentials to do that. • This will be a Violation of delegation.  Newly admitted→ Unstable Cannot delegate.  Discharge→ You can delegate If he is stable.  Trending Vital signs, evaluation of lab Values Cannot.  Initial assessment→cannot delegate.  Interpretation of EKG→Cannot delegate any evaluation or even interpretation. v What We Can delegate to LBN, LVN? • Do Secondary things. Follow up or reassessment. • Three days after Surgery with no new changes. • Delegate administration of S.C insulin to a diabatic Client, even IM injection. • We Can delegate "Maintaining an IV for Stable client Nothing new, nothing Change • We Can delegate monitoring IV fluid.  What We Cannot delegate to LBN, LVN?? • No IV Push medication. • Ne Starting or initiating blood transfusion. • No Center line drugs. • We Cannot delegate titrating on iv drip mean change the iv drip it's Unstable. v Delegation to UAPS: • UAP→unlicensed assistive Personnel. 11 v For UAPS WE Cannot do three things:  Teach -Assess -Do Medication v What Can UAP legally do on the Nclex:  Activities of daily living.  V→vital signs  A→ambulation VAPER  P→position changes  E→Eating Feeding  R-recording is input and output. o During hospital Stay UAP Never delegate anything to the Family members. o Can a family member walk grandma to the bathroom? No o Family member Wants to help with feeding after Client surgery or Stroke pt. No v IF there something illegal going on, what will you do?  Example: o Nurse taking opioid (Pain medication) to home what should you do? ▪ First report this to supervisor  If there is something illegal going on and will harm the Client, what will you do? o intervene Immediately 12 v« Lecture 3 » v ETHICS and Legal terms. v «HIPAA Violation» ‫انتهاك‬ v Which Violates HIPAA? o Always think about Safety.  Remember: Team members directly involved with care NO over sharing on the personal information. v NOT Violate HiPAA as :  Discussing with other nurse “that you’re giving a report to her in Semiprivate room as long as reasonable measure by closing curtain.  What about tell a visitor to wear a mask because the client on isolation  What about 15 years minor doesn’t need her parents know about ask for a prescription of Birth control? Since the client a minor less then 18 means the parents have the right to view her medical.  What about discussing a client Personal information in the nurse station?  Calling a client Full legal First and last name in the waiting room? v Violate HIPAA means as:  Over Sharing:  What about telling the hospital transporter very specific details about Labs, diagnose?  Chemo nurse from another unit who asked about client information stat that "this client my husband co-worker.  Sharing username and password to supervision even direct. 13  What about if a family needs Copy of report? we must ask the Client first v NCLEX Legal words:  1-abandonment ‫تخلى عن المريض‬  You left the client to die essentially.  defined as Leaving of a Client by anyone Who assume to care.  Example: o You're taking care of this Client, and you didn't give Someone a report or transfer care to another nurse you just left the unit. o leaving the unit on a family emergency without transferring Care or giving a report to another nurse abandonment  2-Negligence: ‫إهمال‬ • N For Not Caring. • Failure to provide adequate Care. ▪ Example: ▪ The nurse did not use a sterile technique prior to inserting a folly Catheter negligence. ▪ What if a nurse identifies the absence of Peripheral Pulses in the extremity or basically a Casted extremely in the morning and the nurse reports to the HCP early in the afternoon. ▪ What about with holding the diagnosis of Cancer From a Client because the son thinks the Parent Cannot handle the Cancer diagnosis this is negligence because the Client has the right to Know if thy dying or if they have Cancer. 14  Malpractice (fetal errors): • Bad Practice by a licensed professional • This results in provable damage to the client. ‫اي ضرر يمكن بالفعل‬ ‫اثباته‬ ▪ Example: ▪ RN Failed to Check the dose on a medication Vial which harmed the Client. v physical and verbal abuse:  1-Assault. ‫تهديد‬ ✓ Threat of harm. ✓ Not actual Physical harm, Just the threat.  2-Battery: ✓ You physically did Something to the client without their consent contact that Cause harm.  3-False Imprisonment: ‫تعمل للمريض حاجه مش عازوها‬ ▪ Think You're in prison with False imprison. You are Keeping Someone against their will. ‫شيء ضد رغبته‬ ▪ Using physical restraints, seclusion,‫ اعزاله‬or even Chemical restrains like a sedating drug. This For Stable Clients. Not included Client who are Unstable on Psychiatric unit. or even those on a suicide hold.  4-Defamation of Character: ‫تعليقات سخيفة‬ ▪ This includes making rude Comments, insulting remarks that harm a client's reputation and this is included written and spoken. 15  5-Defamation of Character: ▪ It Could also Pertain to Coworkers. Written even spoke.  5-Libel: ▪ This is Written defamation of Character.  6-Slander: - ‫تسجيل كالم مش كويس‬ ▪ is Spoken, defamation of Spoke. ▪ Example: - The Nurse says I will restrain you to the bed to Keep you from getting out of bed «Assault » and Verbal threat. - What about Performing a procedure Without the Client, Consent « Battery»? - What about Chemically restrains a client who is competent and able to make their own decisions or to do that to prevent than from leaving the health care: - « Batter "and« False Imprisonment» - Force a client to take a medication that the client refuses in this case if the Client stable and not altered or non-Combative. This is: <Battery> - What about reading a letter your Coworker wrote about a nurse having an alleged relationship with a client on the unit: - < Libel> v Ethical key terms  Autonomy:‫يقدر ياخد قراره‬ • Think always in control with autonomy. 16 • This means the Client is given the right to make their own medical decision.  Advocacy: ‫يدافع عن المريض‬ • That means you're an advocate to Protect Clients health right, and even safety.  Beneficence: Think benefit with beneficence. We're benefiting The Client here.  Fidelity: ‫انك مخلص وبتدي كل حاجه ف معادها وانك بتعمل متابعه‬ • Staying Faithful, to follow through with your word. • If you say you’re ggoing to give a drug for pain medication, then following with that.  Justice: • Think You just treating People Fairly and equally.  Non maleficence: • To avoid causing harm <<No harm is Causing here>>  Veracity:  in Veracity is Very honest means tell the truth. v Examples: • Client Who reports the pain is 8 out of 10 and the nurse States he will return with Pain meds and Follow through the act: • (Fidelity) • Respecting the Client's right to refuse the treatment. • (Autonomy) but also your job educates them not Force. 17 • How about providing Care equally Regardless of race, gender, religion, even. Culture • (Justice) • How about Calling a family of a client to tell them that their loved one is critically ill and you're Caring For their needs. • (Beneficence) • How about reporting critical Changes in Client Critical Condition to advocate for Further treatment? • (advocacy) • What about double checking a drug dosage with another nurse to avoid a medication error. • (Non-maleficence) • How about questioning a provides order, who order too much of an antibiotic by accident and now this overdose can kiill the Clients Kidney? o This is both advocacies, advocating For Safety. o Non maleficence. • You are a nurse, and you accidentally Commit a medication error by luck, there no adverse effects, but still, you need to report the error. • « Veracity» • How about ensuring that time resources are distributed equally to Clients. You Just being Fair. Justice 18 v In Formed Consent:  Informed is Just getting information. Consent is deciding to do Something a voluntary decision.  Terms of safety: 1. Informed Consent is Just required before any invasive procedure and even any Surgery. 2. Informed Consent Confirm clients, voluntary decision to both the benefits as well as the risks. 3. For non-English Speakers they Cannot Consent without medical translator “It should be medical translator» not a family member. v Medical interpreter:  Consent must be given by a Competent adult. Competent in NCLEX include A health Care Surrogate, or (Power of attorney) or (Proxy) and parents or garden of a family if less than 18 years.  Can consent alone. • Less than 18, pregnant, if Marry, Substance abusees, or STI Members of military  Examples • Can a pregnant 16-Year-old Clint Who’s 36 Weeks with Painful Vaginal bleeding be Providing Consent by themselves Yes or no? Yes, this is a Competent adult. • How about a 14-Year-old Who’s Prescribed antipsychiatry medications without the parent Consent? Cannot give consent there must be assigned consent from a guardian before a minor is treated. As Long as it’s not emergency. 19 • Can a nurse Fluent in Spanish, translate for a native Spanish Speaker to obtain Consent? • No only medical interpreters who Know medical terminology.  Remember: ✓ Stay away from educating about the Procedure. Surgery he is the one will explain the Procedure. ✓ Nurses job only to Witness not to obtain.  Examples: ✓ Client is having a gall bladder removed and wants to talk about diet after the surrey. This nurses roles because we are not talking specific about the Surges. ✓ IF the Client wants to know about the surgery risks in this case this surgeon and providers roles. PHC v Nurses Role For informed consent: 1. Witness the consent. Not to obtain 2. Document both the date and the time the signature was obtained. 3. Assess and verify that the Client is Competent and Voluntarily sign.  Example: • What if a client who had a history of dementia but is alert and oriented times four, who gives Consent in this situation? ...... • What if a client States, I've changed my mind, I don't want to have Surgery. How Should the nurse respond in this case? I will notify your provider or your surgeon about your decision do not educate her. 20