Ch03.pptx

Book cover for Understanding MedicalSurgical Nursing, Seventh Edition. Chapter 3 Issues in Nursing Practice Copyright ©2023 F.A. Davis Company Learning Outcomes  Identify factors influencing changes in the health-care delivery system.  Describe safe health-care practices.  Explain the signifi...

Book cover for Understanding MedicalSurgical Nursing, Seventh Edition. Chapter 3 Issues in Nursing Practice Copyright ©2023 F.A. Davis Company Learning Outcomes  Identify factors influencing changes in the health-care delivery system.  Describe safe health-care practices.  Explain the significance of hospitalacquired conditions.  Describe four leadership styles.  Discuss the licensed practical nurse/licensed vocational nurse (LPN/LVN) role in leadership and delegation. Copyright ©2023 F.A. Davis Company Learning Outcomes (continued_1)  Describe importance of ethics in health care.  Discuss moral distress and its effect on nursing care.  List the steps of the ethical decisionmaking model.  Identify where the regulation of nursing practice is defined.  Explain mandatory reporting for health-care professionals. Copyright ©2023 F.A. Davis Company Learning Outcomes (continued_2)  Describe human trafficking indicators to report.  Describe the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Describe guidelines for professional use of social media.  Discuss how to provide quality care and limit liability. Copyright ©2023 F.A. Davis Company Chapter Concepts  Collaboration  Communication  Health Policy  Leadership and Management  Professionalism  Quality Improvement  Safety Copyright ©2023 F.A. Davis Company Health-Care Delivery Copyright ©2023 F.A. Davis Company Factors Influencing Health-Care Change  Evolving evidence-based practice  Changing characteristics of U.S. population • Increasing number of older adults • Increasing cultural diversity  Newly emerging viruses  Multidrug-resistant infectious organisms  Human trafficking awareness campaign Copyright ©2023 F.A. Davis Company Factors Influencing Health-Care Change (continued)  Technology • Electronic health records • Mobile health ‒ Digital apps, smartphones, tablets, remote patient monitoring • Robotics • Telehealth (smartphones, online video)  Nursing informatics Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice  The LPN/LVN will use information technology in client care. Copyright ©2023 F.A. Davis Company Safe Practice  Institute for Safe Medication Practices www.ismp.org/tools • • • • • Error-prone abbreviations Confused drug names Do not crush oral medications High-alert medications in long-term care Look-alike drug names distinguished by tall man letters Copyright ©2023 F.A. Davis Company Safe Practice (continued_1)  Institute for Safe Medication Practices www.ismp.org/tools (continued) • Initiative ‒ Weigh patients only in kilograms ‒ Medication doses calculated in kilograms ‒ Prevents mix-ups in pounds and kilograms Copyright ©2023 F.A. Davis Company Safe Practice (continued_2)  Medication errors • Increase with distractions • Interventions ‒ No interruption zones marked with brightcolored tape ‒ Wearing bright-colored vests/sashes ‒ Not interrupting others ‒ Avoiding own interruptions Copyright ©2023 F.A. Davis Company Safe Practice (continued_3)  Global initiative to prevent misconnections of medical tubing  See www.stayconnected.org  ENFit • New enteral tubing connector design • Incompatible with other types of tubing  See www.fda.gov/medicaldevices/medical-deviceconnectors/examples-medicaldevice-misconnections Copyright ©2023 F.A. Davis Company Safe Practice (continued_4)  The Joint Commission’s National Patient Safety Goals  The Joint Commission’s Sentinel Events  National Quality Forum • Serious reportable events • Health information technology safety Copyright ©2023 F.A. Davis Company Be Safe! Be Vigilant!  A medication is specifically made for only one type of administration route. • It cannot be safely given by another route. • Dosage and drug makeup are specific to route. • Serious harm or death can occur. • IV medication cannot be given by nasogastric (NG) or percutaneous endoscopy gastrostomy (PEG) tube. Copyright ©2023 F.A. Davis Company  Economic Issues  Medicare and diagnosis-related groups  Medicaid  Hospital-acquired conditions and present-on-admission reporting • www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/HospitalAcqCond/ Hospital-Acquired_Conditions Copyright ©2023 F.A. Davis Company 14 Hospital-Acquired Conditions 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 urinary tract infection Copyright ©2023 F.A. Davis Company 14 Hospital-Acquired Conditions (continued_1) 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.Deep vein thrombosis/pulmonary Copyright ©2023 F.A. Davis Company 14 Hospital-Acquired Conditions (continued_2) 14.Iatrogenic pneumothorax with venous catheterization Copyright ©2023 F.A. Davis Company Nursing  Registered nurse (RN) • • • • • Doctor of nursing practice Nurse practitioner Certified registered nurse anesthetist Certified nurse midwife Clinical nurse specialist  LPN/LVN  Certified nursing assistant  Student nurse Copyright ©2023 F.A. Davis Company Health-Care Team  Physician  Physician assistant  Phlebotomist  Clinical laboratory technologist  Clinical laboratory technician  Radiologic technologist  Pharmacist  Pharmacy technician Copyright ©2023 F.A. Davis Company Health-Care Team (continued_1)  Dietitian  Dietetic technician  Respiratory therapist  Respiratory therapy technician  Physical therapist  Physical therapy assistant  Occupational therapist  Occupational therapy technician Copyright ©2023 F.A. Davis Company Health-Care Team (continued_2)  Speech and language pathologist  Activity director  Social worker  Chaplain  Health unit coordinators/secretary  Environmental service staff Copyright ©2023 F.A. Davis Company LPN/LVN Role  Provides direct patient care under direct supervision of RN, healthcare provider, or dentist Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_1)  The LPN/LVN will participate as a member of an interdisciplinary team. Copyright ©2023 F.A. Davis Company Leadership in Nursing  Influences  Motivates  Guides patient care  Promotes patient goal achievement Copyright ©2023 F.A. Davis Company Leadership Styles  Autocratic (authoritarian)  Democratic (participative)  Laissez-faire (delegative)  Coaching Copyright ©2023 F.A. Davis Company Group Participation Copyright ©2023 F.A. Davis Company Management Functions  Planning  Organizing  Directing  Coordinating  Controlling Copyright ©2023 F.A. Davis Company Continuous Quality Improvement (CQI) Copyright ©2023 F.A. Davis Company Leadership for LPNs/LVNs  Leader/manager for care of assigned patients Copyright ©2023 F.A. Davis Company Hand-Off Communication of Patient Status Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_2)  The LPN/LVN will provide and receive report. Copyright ©2023 F.A. Davis Company The Delegation Process  Does your state allow LPNs/LVNs to delegate?  Know your state nurse practice act.  Identify skills of delegatee.  Use NCSBN five rights of delegation. Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_3)  The LPN/LVN will monitor activities of assistive personnel. Copyright ©2023 F.A. Davis Company Ethics and Values Copyright ©2023 F.A. Davis Company Ethics  Ethics • Study of traditions, values, and beliefs related to people/relationships  Bioethics • Ethical principles and values applied to human life, and medical and biological research  Ethical questions • What should/ought we do? Copyright ©2023 F.A. Davis Company Morals  Personal values  Standards set by one’s conscience  Personal choices of • Good and bad • Right and wrong Copyright ©2023 F.A. Davis Company Values  Standards/ideals/concepts giving meaning to an individual’s life  Derive from societal norms, religion, and family traditions  Guide decisions and actions Copyright ©2023 F.A. Davis Company Nursing Ethical Obligations  Responsibility to practice ethically • Consider ethical codes, principles, and theories for your profession. • Consider facility policy and procedure. • Consider the best interest of the patient. Copyright ©2023 F.A. Davis Company LPN/LVN Code of Ethics  The National Association of Licensed Practical Nurses • Practice standards for ethical practice and conduct  The National Association for Practical Nurse Education and Service • Practice standards with ethical principles for LPNs/LVNs Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_4)  The LPN/LVN will practice in a manner consistent with code of ethics for nurses. Copyright ©2023 F.A. Davis Company Ethical Principles  Derive from moral theory  Purpose • Serves as framework for conduct • Offers a standardized approach to manage moral dilemmas Copyright ©2023 F.A. Davis Company Ethical Principles (continued)  Autonomy  Beneficence  Nonmaleficence  Fidelity  Veracity  Justice Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_5) The LPN/LVN will  Promote client self-advocacy.  Provide for privacy needs; maintain client confidentiality. Copyright ©2023 F.A. Davis Company Ethical Theories  Utilitarianism • The rightness/wrongness of the OUTCOME is the most important aspect to consider when decision making.  Deontology • The rightness/wrongness of the ACTION is the most important aspect to consider when decision making. Copyright ©2023 F.A. Davis Company Theological Perspectives  Religious traditions  Source of values and morals Copyright ©2023 F.A. Davis Company Ethical Decision-Making Process: 8 Steps 1. 2. 3. 4. 5. 6. 7. 8. Identify ethical dilemma. Identify stakeholders and their values. Gather and verify information. Examine possible actions and forecast the consequences of each action. Determine ethical foundation for actions. Determine which action is best, with the most compelling ethical support. Implement action. Evaluate outcome. Copyright ©2023 F.A. Davis Company Legal Concepts Copyright ©2023 F.A. Davis Company Regulation of Nursing Practice  Licensed health-care profession  Goal: To protect the public and foster competent practice  Regulated by state boards of nursing • Nurse practice acts ‒ Laws define scope of practice ‒ Vary by state • The licensing authority may sanction one’s license for legal or behavioral violations. Copyright ©2023 F.A. Davis Company Regulation of Nursing Practice (continued)  Violations • • • • Unprofessional conduct Incompetence Conviction of a crime Misuse of controlled substances  License sanctions • Suspend • Revoke Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_6) The LPN/LVN will provide care within the legal scope of practice. Copyright ©2023 F.A. Davis Company Be Safe! Be Vigilant! (continued_1)  Do not go into work after drinking alcohol, even if it was the night before. • It takes time to metabolize alcohol. • Men metabolize alcohol faster than women (especially petite women). • Menses may increase time needed to metabolize.  Agencies have zero tolerance for alcohol.  Termination will occur if random Copyright ©2023 F.A. Davis Company Be Safe! Be Vigilant! (continued_2)  Prescription medication • Keep a current prescription for the active medical condition.  Prescribed controlled substances • Cannot work under the influence when substance affects your ability to work safely in order to protect your patients. Copyright ©2023 F.A. Davis Company Required Licensure Reporting  Application for state licensure • Prior misdemeanor or felony convictions ‒ Explain how you complied with 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 non-reporting sanction. Copyright ©2023 F.A. Davis Company Mandatory Reporting  Mandated reporting laws • Vulnerable populations ‒ Children, older adults, disabled, mentally impaired • Known or suspected abuse • Inform appropriate state agency Copyright ©2023 F.A. Davis Company Mandatory Reporting (continued)  Examples of abuse • • • • • • Physical Sexual Verbal Emotional Financial/economic Neglect Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_7)  The LPN/LVN will follow regulation/policy for reporting specific issues (e.g., abuse, neglect, gunshot wound, communicable disease). Copyright ©2023 F.A. Davis Company Human Trafficking Awareness  Victims utilize health system to access treatment for medical needs. Copyright ©2023 F.A. Davis Company Human Trafficking Indicators  Patient afraid, shy, submissive  Patient has no identification  Someone answering for patient  Coached dialogue  Someone making decisions for patient  Someone never leaving patient alone  Lack of adequate clothing/possessions Copyright ©2023 F.A. Davis Company Human Trafficking Awareness (continued_1)  Abuse signs • Mental, physical, sexual, torture  Physical and psychological indicators • Chronic physical issues ‒ Headaches, back pain, stomach or abdominal pain • Mental health issues ‒ Confusion, disoriented, depression, anxiety • Signs and symptoms of abuse and neglect ‒ Bruising, dehydration, malnutrition, Copyright ©2023 F.A. Davis Company Human Trafficking Awareness (continued_2)  If you suspect human trafficking • Do not alert victim or confront trafficker. • Confirm suspicions with health-care team. Copyright ©2023 F.A. Davis Company Human Trafficking Awareness (continued_3)  Report to • Local law enforcement • U.S. Department of Homeland Security Tip Line: 1-866-347-2423 • National Human Trafficking Resource Center Hotline: 1-888-373-7888 • Text HELP or INFO to BeFree (233733)  For additional information on human trafficking, or to report concerns • Visit www.dhs.gov/blue-campaign Copyright ©2023 F.A. Davis Company Health Insurance Portability and Accountability Act of 1996 (HIPAA)  Civil/criminal liability for health-care workers who wrongfully disclose patient’s health information  Violation penalties • • • • Disciplinary action by employer Fines Sentenced up to 10 years in prison Sued by patients Copyright ©2023 F.A. Davis Company Social Media and HIPAA  Always protect patient health information from unauthorized disclosure!  Keep professional and personal life separate.  Remember: There could be serious consequences.  Employers review social media sites.  Visit ww.ncsbn.org/NCSBN_SocialMedia.p Copyright ©2023 F.A. Davis Company Social Media and HIPAA Examples  Unauthorized access to medical records  Taking unauthorized photos of patients on personal electronic devices • Pediatric patients require parental consent.  Posting patient information to social media • Laboratory studies • Photos Copyright ©2023 F.A. Davis Company Nursing Liability and the Law  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 Copyright ©2023 F.A. Davis Company Nursing Liability and the Law (continued_1)  Torts • Lawsuits for personal injury  Civil liability suit • Complaint • Summons ‒ Must be answered by employer or nurse ‒ Tell your boss if you receive one! Copyright ©2023 F.A. Davis Company Nursing Liability and the Law (continued_2)  Malpractice • The breach of a professional duty • Applies to nurses performing nursing duties on the job  Negligence • Liability arising from an injury that results from a person’s failure to exercise due care Copyright ©2023 F.A. Davis Company Limiting Liability  Ensuring patient rights  Following institutional policies  Practicing by current nursing standards  Documenting procedures appropriately  Pursuing continuing education Copyright ©2023 F.A. Davis Company Privacy Is a Patient Right Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice (continued_8) The LPN/LVN will advocate for client rights and needs. Copyright ©2023 F.A. Davis Company Review Question #1 The nurse recognizes that which of these factors are influencing health-care changes? Select all that apply. 1. Increasing cultural diversity 2. Evolving evidence-based practice 3. Non-resistant infectious organisms 4. Technology 5. Decreasing older population 6. New emerging viruses Copyright ©2023 F.A. Davis Company Review Question #1 Answer Correct Answer: 1, 2, 4, 6 Copyright ©2023 F.A. Davis Company Review Question #2 The nurse is preparing to administer medications. Which methods does the nurse implement to reduce medication errors? all thatzones. apply. 1. Use noSelect interruption 2. Interrupt preparation to round with provider. 3. Use kilograms for metric medication doses. 4. Avoid interrupting others. Copyright ©2023 F.A. Davis Company Review Question #2 Answer Correct Answer: 1, 3, 4 Copyright ©2023 F.A. Davis Company Review Question #3 A patient, age 72, instructs the nurse not to inform family members of a new Alzheimer diagnosis. The nurse in respecting this request uses which ethical 1. Autonomy principle? 2. Beneficence 3. Fidelity 4. Nonmaleficence Copyright ©2023 F.A. Davis Company Review Question #3 Answer Correct Answer: 3 Copyright ©2023 F.A. Davis Company Review Question #4 The nurse cares for a suspected human trafficking victim. The nurse uses which of these to report the data supporting the suspicion? Select all that apply. A. Facebook B. U.S. Department of Homeland Security Tip Line C. Local law enforcement D. National Human Trafficking Resource Center Hotline E. Twitter Copyright ©2023 F.A. Davis Company Review Question #4 Answer Correct Answer: 2, 3, 4 Copyright ©2023 F.A. Davis Company Review Question #5 What action can the nurse legally perform under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)? Select all that 1. Share details of patient careapply. on social 2. 3. 4. 5. 6. media. Keep patient health information confidential. Take pediatric patient photo with cell phone. Access laboratory reports of a relative. Post x-ray images on social media. Report coworker access of an employee Copyright ©2023 F.A. Davis Company Review Question #5 Answer Correct Answer: 2, 6 Copyright ©2023 F.A. Davis Company