Preceptor Exam 2 PDF

**Literal EXAM:** 1. **Definition of ethics:** a. **Ethics: systematic study of what a person's conduct & actions should be w/ regard to self, other human beings, and the environment;** it is the justification of what is right or good and the study of what a person's...

**Literal EXAM:** 1. **Definition of ethics:** a. **Ethics: systematic study of what a person's conduct & actions should be w/ regard to self, other human beings, and the environment;** it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are b. A system of moral conduct and principles that guide a person's actions in regard to right and wrong and in regard to oneself and society at large 1. **Characteristics of nursing ethical dilemmas (KNOW an EX)** c. **Being forced to choose between two or more undesirable alternatives** d. **Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action** e. Moral uncertainty/conflict an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is f. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop 2. **What to do if a patient refuses to sign consent? (KNOW the steps and what we should or should NOT do)** (I think i found it, but look in the book to see if you see it differently) **LMAO WHERE EVEN IS THIS???** g. Address their concerns, provide them will all the necessary information h. As RNs we must maintain open communication, show empathy, and respect the pt's autonomy i. Help them explore other options 3. **Ethical terms: autonomy, justice, confidentiality, utilitarianism, beneficence, nonmaleficence** j. **Autonomy:** Freedom of choice or accepting the responsibility for one\'s choice. i. Violation: grandma diagnosed with an illness and grandkids don't wanna tell her ii. Patients need to be informed or it violates their autonomy k. **Utilitarianism**: encourages decision making based on what provides the greatest good for the greatest number of people l. **Beneficence:** is where actions are taken in an effort to promote good iii. If pt refuses a procedure that will promote their health it violates autonomy and beneficence m. **Justice:** can be defined as seeking fairness or treating "equals" equally iv. A principle stating that equals should be treated equally & unequals should be treated according to their differences v. Insufficient community resources to meet the needs of a low income family is a violation of justice vi. Allocating a person's organs based on their worth to society violates justice n. **Nonmaleficence:** is where actions are taken in an effort to avoid harm o. **Confidentiality**: keep privileged information private 4. **Role of ANA code of ethics with interpretive statements** p. The code outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse. q. **Code of ethics with interpretive statements** was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. r. Not legally binding but it functions as a guide to the highest ethical practice standards for nursing and as an aide for moral thinking 5. **Purpose of healthcare laws and legislations** s. **Purpose: The primary purpose of law and legislation in medicine is to protect the patient and the nurse** t. Laws and legislation also define the scope of acceptable practice and protect individual rights u. Nurses who are aware of their rights and duties in legal matters are better able to protect themselves against liability or loss of professional licensure 6. **What type of law is the TN State Nurse Practice Act?** v. **TN State Nurse Practice Act is a type of statue/statutory law** vii. **The 51 State Nurse Practice Act defines and limits the practice of nursing.** w. **Statutes/statutory law** or legislative law-- established by congress, legislators, and city councils. 7. **Difference b/t civil, criminal, federal laws** x. **Civil:in nursing deals with legal issues between individuals, like malpractice or negligence, where a nurse might be sued for not providing proper care.** It\'s about resolving disputes and compensating for harm done, rather than punishing someone. viii. Consequence of guilty verdict: monetary damages 1. What is an example of committing a Civil Act? a. A nurse has violated a patient\'s rights and must pay a lump sum as compensation. y. **Criminal: Criminal law in nursing involves actions that are considered offenses against the state or public, such as theft, abuse, or practicing without a license**. These actions can lead to criminal charges, and if found guilty, the nurse might face penalties like fines, imprisonment, or loss of their nursing license. z. ix. - a. **Federal/administrative: The rules & regulation issued by the local, state, & federal gov** x. Federal law in nursing includes nationwide rules like patient privacy (**HIPAA**), anti-discrimination (**ADA**), and workplace safety (**OSHA**). These laws ensure nurses follow national standards and protect patient rights. xi. Clear and convincing standard xii. Consequences of guilty verdict: suspension or loss of licensure 8. **What to do when you discover a medication error as a nurse?** (all we could in find in book) b. One critical strategy for addressing errors in the health-care system is the need to increase both the mandatory and voluntary reporting of medical errors. 9. **What are the 5 elements of malpractice that must be present to prove "malpractice"?** c. **Standard of care:** the care that should be done d. AFTER the standard of care has been established: these are the elements of malpractice xiii. **Breach of duty:** failure to meet the standard of care xiv. **Foreseeability of harm:** not meeting the standard of care could cause harm xv. **Injury to the patient:** provable correlation between improper care and injury 2. Ex.: wrong dose of med causes seizures xvi. **Actual injury:** the injury occurred because of the defendant's actions 10. **Why are nurses at an increased risk for a malpractice suit?** e. They have **more authority and independence** in decision making f. They have **increased legal accountability** for decision making g. They are **performing more actions** that used to be in the realm of medical practice h. They are **making more money** i. More nurses are **carrying malpractice insurance** 11. **How to avoid/reduce the risk of malpractice suits/claims?** j. **Practice within the scope of the nurse practice act** k. **Observe and FOLLOW agency policies and procedures** l. **Follow evidence based practice** m. Always put patient's rights and welfare first n. Be aware of relevant law and legal doctrines o. Practice within the area of individual competence and upgrade technical skills constantly: xvii. Don't put an incident report in the chart or even reference that one was made xviii. It is the physician's responsibility to explain the procedure for informed consent 12. **Torts: intentional vs unintentional** p. **Torts:** legal wrongs committed against a person or property, independent of a contract, that render the person who commits them liable for damages in a civil action q. **Intentional tort**: direct invasion of someone's legal rights. r. **Unintentional tort**: an accident that results in injury, property damage, or financial loss due to a person\'s careless or reckless behavior xix. **Negligence** is considered to be an unintentional tort xx. **Assault** is threatening a person with the intention to carry out the threat, producing a reasonable apprehension of harm 3. **Simple assault:** a threat but no physical contact xxi. **Battery** is intentional and wrongful physical contact that results in harm, no matter how minor. xxii. **Assault & battery**: a threat that's carried out resulting in harm xxiii. **False imprisonment** is restraint of a person's movement by another xxiv. **Invasion of privacy:** xxv. **Defamation** xxvi. **Slander** 13. **Difference in criminal and civil act ()** s. **Criminal act:** these involve offenses against the state or society (patients) as a whole. Criminal acts include actions like theft, abuse, or practicing without a license, these acts can result in loss of license and imprisonment. t. **Civil act:** these involve disputes b/t individuals or entities and typically seek compensation for harm caused. Civil acts include actions like malpractice and negligence xxvii. A nurse has violated a patient\'s rights and must pay a lump sum as compensation. This is an example of committing **--- Civil Act** 14. **What happens when you have good time management? How does it impact the organization as a whole? (I MEAN WHAT ELSE COULD IT BE?)** u. You will have a good outcome, the day will be productive, and there will be effective communication 15. **How do you plan out your day as a nurse manager?** v. It is important for the nurse manager to appropriately **prioritize day-to-day planning to meet short-term and long-term unit goals** w. The nurse/nurse manager **must reprioritize** what tasks will be accomplished based on new information received x. Start the day by planning & update the plan as needed in order to improve productivity 16. **Priority setting:** y. **"Do now" = setting priorities; may utilize delegation** xxviii. **Priority setting** is perhaps the most critical skill in good time management because all actions we take have some type of relative importance. - This is important for both unit nurses and nurse managers. - Reflection of unit's day-to-day needs (budget, staffing, supplies - operational needs always come first) 17. **3 steps in time management** z. Allow for planning a. Complete highest priority first b. Finish one task before completing another 18. **Best time to improve productivity (what time of the day?)** c. **Start the day/morning:** by planning and update the plan as needed in order to improve productivity 19. **What is the biggest time waster that nurse managers have the LEAST control over?** d. **Paperwork overload:** Could be uncontrollable for managers since they have so much they need to address (the thing they have the **LEAST control over**) 20. **Bran's 12 habits to master time management** 1. Strive to be authentic 2. Favor trusting relationships 3. Maintain lifestyle that gives you maximum energy 4. Organize day by your biorhythms (pay attention to regular fluctuations in your physical and mental energy levels throughout the day and schedule tasks accordingly\_ 5. Set very few priorities and stick to them 6. Turn down things inconsistent with your priorities 7. Set aside time for focused effort 8. Always look for ways of doing things better and faster 9. Build solid processes 10. Spot trouble ahead and solve problems immediately 11. Break goals into small units of work and think only about one unit at a time 12. Finish what is important and stop doing what is no longer worthwhile 21. **Figure 9.1** e. **Leadership Roles** xxix. Is self-aware regarding personal blocks and barriers to efficient time management xxx. Recognizes how one's own value system influences his or her use of time and the expectations of\ followers xxxi. Functions as a role model, supporter, and resource person to others in setting priorities for goal\ attainment xxxii. Assists followers in working cooperatively to maximize time use xxxiii. Prevents and/or filters interruptions that prevent effective time management xxxiv. Role models flexibility in working cooperatively with other people whose primary time management\ style is different xxxv. Presents a calm and reassuring demeanor during periods of high unit activity xxxvi. Prioritizes conflicting and overlapping requests for time xxxvii. Appropriately determines the quality of work needed in tasks to be completed f. **Management Functions** xxxviii. Appropriately prioritizes day-to-day planning to meet short-term and long-term unit goals xxxix. Builds time for planning into the work schedule xl. Analyzes how time is managed on the unit level by using job analysis and time-and-motion studies xli. Eliminates environmental barriers to effective time management for workers xlii. Handles paperwork promptly and efficiently and maintains a neat work area xliii. Breaks down large tasks into smaller ones that can more easily be accomplished by unit members xliv. Utilizes appropriate technology to facilitate timely communication and documentation xlv. Discriminates between inadequate staffing and inefficient use of time when time resources are inadequate to complete assigned tasks 22. **How to increase the likelihood that information is interpreted correctly?** g. **Multiple communication methods** should be used. This increases the likelihood the message is being interpreted correctly 23. Non-verbal communication (ex; body language) vs verbal communication h. **Nonverbal communication: is most times MORE reliable than verbal communication** xlvi. (eye contact, posture, space, facial expression, etc) is generally considered more reliable than verbal communication because it indicates the emotional component of the message xlvii. Ex: "i\'m not mad" but they're standing with their arms crossed and their eyebrows furrowed (they're obviously mad and you know that because of their nonverbal communication) i. **Verbal communication**: involves the use of spoken words to convey information, express feelings, and build relationships with pts. It is essential in providing clear instructions, explaining procedures, and ensuring the pts understand their care plans j. Communication is perhaps the MOST critical leadership skill 24. **What things affect the quality of organizational communication?** k. Leader-managers must **assess organizational communication.** l. Leader-managers must **understand the organization's structure and recognize who will be affected by decisions.** m. Communication must be **clear, simple, and precise.** n. Communication is **not a one-way channel.** o. Senders should **seek feedback** regarding whether their communication was accurately received. p. **Multiple communication** modes should be used, when possible, if a message is important. q. Managers should **not overwhelm subordinates with unnecessary information.** 25. **Types of communication (assertive, passive, aggressive) → multiple questions on this** r. **Passive**: occurs when a person suffers in silence, although he or she may feel strongly about the issue. Thus, passive communicators avoid conflict, often at the risk of bottling up feelings which may lead to an eventual explosion xlviii. **Ex**: A nursing tech suffers in silence regarding task assignment conflicts s. **Passive-aggressive**: an aggressive message presented in a passive way. Their communication may say yes when they want to say no, often becoming sarcastic or complaining about others xlix. Most dangerous co-worker t. **Aggressive**: is generally direct, threatening, and condescending. It infringes on another person's rights and intrudes into that person's personal space. l. Ex: A physician becomes threatening and condescending when the nurse refuses to follow a medication order which would result in harm to the patient li. **Actions to take when responding to an aggressive person** 4. Reflect, repeat the assertive message, point out the implicit assumption, restate the message by using assertive language, and question u. **Assertive**: Reduces stress, improves productivity, & contributes to a healthy workforce. Allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person's rights. lii. This is the GOAL - **Uses "I" statements in assertive** 5. We want to be assertive 6. Direct eye contact, and a calm voice 7. The best option 8. Is not rude or insensitive behavior, but is having an informed voice that insists on being heard. 9. Ex: Standing up when someone is talking down to you (physically being on the same level) 26. **Stages of group formation (norming, storming, etc.)** v. **Forming**: interpersonal relationships formed, expectations defined, directions given w. **Storming**: competition and disagreement, conflict, and resistance to recommendations of the group leader liii. Comfy enough to bounce ideas off each other x. **Norming**: consensus evolves as group cohesion develops y. **Performing**: work gets done, problems are solved z. **AI** (these are a little more clear): liv. 1\. **Forming**: The group comes together and gets to know each other. lv. 2\. **Storming**: Members start to push boundaries, and conflicts may arise. lvi. 3\. **Norming**: The group begins to establish norms and work more cohesively. lvii. 4\. **Performing**: The group works efficiently towards achieving its goals. 27. **What do managers need to do to facilitate group productivity when there is a problem with a group?** a. **Group leaders must be able to manage member roles so that individuals do not disrupt group productivity through management and not suppression.** b. **Managers must be well grounded in group dynamics and group roles because of the need to facilitate group communication and productivity within the organization. Individual roles include:** lviii. **Aggresso:**. Expresses disapproval of others' values or feelings through jokes, verbal attacks, or envy lix. **Blocker**: Persists in expressing negative points of view and resurrects dead issues lx. **Recognition seeker**: Works to focus positive attention on himself or herself lxi. **Self-confessor**: Uses the group setting as a forum for personal expression lxii. **Playboy**: Remains uninvolved and demonstrates cynicism, nonchalance, or horseplay lxiii. **Dominator**: Attempts to control and manipulate the group lxiv. **Help seeker**: Uses expressions of personal insecurity, confusion, or self-deprecation to manipulate sympathy from members lxv. **Special interest pleader**: Cloaks personal prejudices or biases by ostensibly speaking for others 28. **Stages of conflict** c. **Latent conflict:** Underlying issues exist but aren\'t yet visible lxvi. Ex: when nurses are short staffed/staffing crisis d. **Perceived conflict**: Awareness of the conflict begins, but it hasn\'t yet escalated. lxvii. Ex: Staff reports the problem to management lxviii. No emotions in this stage lxix. Pointing out potential outcomes e. **Felt conflict**: Emotional responses to the conflict start to develop. lxx. Anxiety of staff when the manager doesn't increase staff - Becomes emotional (fear, mistrust, anger, anxiety) for some folks f. **Manifest conflict:** The conflict becomes visible and may involve confrontations lxxi. Overt conflict, manager calls meeting with staff to discuss problem lxxii. Reaction is taken - some people withdraw or become competitive, some seek conflict resolution g. **Conflict aftermath**: The conflict is resolved, and the outcome impacts future interactions lxxiii. Result → staff is increased or people quit 29. **What resolution strategy of conflict is when one sacrifices their own belief to let someone else win?** h. **Cooperative/Accommodating**: the person cooperating gives for the other lxxiv. During conflict, when one person sacrifices their beliefs in order to let the other person \"win" 30. **Difference in accommodation, collaboration, compromise, conflict smoothing, avoidance, competing, etc.** i. **Compromising**: each party wins j. **Competing**: one party pursues what they want regardless of the other k. **Cooperative/Accommodating**: the person cooperating gives for the other. During conflict, when one person sacrifices their beliefs in order to let the other person \"win" l. **Smoothing**: one party attempts to stop the anger towards the other m. **Avoidance**: both parties realize there is a conflict but don't acknowledge it lxxv. Leads to poor morale and a non-productive unit n. **Collaborating**: assertive and cooperative means everyone wins 31. **Intra/interpersonal, intragroup** o. **Intrapersonal**: within the person lxxvi. Clarifying contradicting values of wants/needs or what the right thing to do is p. **Interpersonal**: between two or more people (with differing values, goals, or beliefs) lxxvii. Defined by the source of the conflict lxxviii. Therapeutic communication is the best way to resolve lxxix. Common sources: miscommunication or one person's perception q. **Intergroup**: between two or more groups 32. **Difference in flattery, hidden agenda, inappropriate behavior/questioning, and compromise** r. **Flattery**: is another technique that makes true collaboration in negotiation very difficult. The person who has been flattered may be more reluctant to disagree with the other party in the negotiation, and thus, his or her attention and focus are diverted. s. **Hidden agenda:** the covert intention of the negotiation t. **Inappropriate behavior/questioning**: asking personal questions, making judgmental comments, invasion of privacy, and unprofessional conduct u. **Compromise**: each party wins 33. **Prospective payment system** v. **Prospective payment system**: HCP are paid a predetermined fixed amount for each episode of care (this amount is set in advance) w. It controls healthcare costs and encourages efficiency and cost-effectiveness in healthcare delivery 34. **Value based purchasing** x. **VBP**: strategy used by healthcare payers to promote quality and value in healthcare services. y. Links payments to quality of care provided, reward healthcare for delivering high-quality care z. Encourages continuous improvement and accountability in healthcare delivery 35. **Hallmark of effective quality management programs** a. **Support** from top-level administration b. **Commitment** by the organization in terms of fiscal and human resources c. **Quality goals** reflect search for excellence rather than minimums d. Process is ongoing (**continuous**) 36. **Who are the patients\' safety goals designed by?** e. **Joint commision (\#47)** 37. **What is the Leapfrog group?** f. **Leapfrog group was established** to help minimize risks to patients, the standards and expectations of oversight groups, insurers, and professional groups have been raised g. **One such effort is the Leapfrog Group,** a growing conglomeration of non--health-care Fortune 500 company leaders who are committed to modernizing the current health-care system. h. **EVB leapfrog initiatives:** lxxx. **Computerized physician-provider order entry (CPOE)** 10. Ex: A HCO has a rise in medical errors. Which Leapfrog initiative should they implement? b. Computerized physician--provider order entry lxxxi. Evidence-based hospital referral lxxxii. ICU physician staffing (IPS) lxxxiii. The use of national quality forum, endorsed safe practices 38. **NDNQI (national database of nursing quality indicators)** i. **NDNQI**: was founded by the ANA in 2001 to examine the relationships between nursing and patient outcomes (tracks up to 19 nursing-sensitive quality measures, providing actionable insights based on structure, process, and outcome data) j. ​​Hospitals participate in NDNQI through focused surveys to measure nursing quality, improve nurse satisfaction, strengthen the nursing work environment, assess staffing levels, and improve reimbursement 39. **AHRQ**: (pg. 162) k. **The Agency for Healthcare Research and Quality** (AHRQ, 2013) developed the Guide to Patient and Family Engagement in Hospital Quality and Safety to help patients, families, and health professionals work together as partners to promote improvements in care. l. The Guide (AHRQ, 2013) outlines four strategies hospitals can use to connect with patients and families, including the following: lxxxiv. **Encourage** patients and family members to participate as advisors lxxxv. **Promote** better communication among patients, family members, and health-care professionals from the point of admission lxxxvi. **Implement** safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports lxxxvii. **Engage** patients and families in discharge planning throughout the hospital stay. 40. **Total quality management** m. Aka continuous quality improvement (CQI) n. Based on the premise that the individual is the focal element on which production and service depend o. **Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving** 41. **Benchmarking** p. **Benchmarking:** The process of measuring products, practices, or services against best-performing organizations 42. **EVB-practice** q. Integrates the best available research evidence with clinical expertise and the pt values to make decisions about the care of individual patients. This approach helps ensure that patient care is based on the latest and most reliable evidence, leading to better outcomes and improved pt satisfaction. 43. **Clinical practice guidelines (CPG)** r. **CPGs or standardized clinical guidelines** provide diagnosis-based, step-by-step interventions for providers to follow in an effort to promote high-quality care while controlling resource utilization and costs. s. Clinical pathways reflecting evidence based practice 44. **What is a standard?** t. **A standard is a predetermined level of excellence that serves as a model to follow** u. Performance is measured against predetermined standards v. Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care