You are a nurse researcher interviewing senior oncology nurses, asking them to describe how they deal with the loss of a patient. The analysis of the
... [Show More] interviews yields common themes describing the nurses' grief. This is an example of which type of study? An operating room nurse is talking with colleagues during a meeting. She asks, "I wonder if we would see fewer wound infections if we used chlorhexidine in- stead of povidone-iodine to clean the skin of our surgical patients? What does the P represent in this example of a PI- COT question? A nurse researcher is designing an exer- cise study that involves 100 patients who attend a wellness clinic. As the patients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or remain in the traditional program. The nurse plans to measure the patients' self-report of exercise before and 6 months after the program begins. What factor might in- Qualitative study. (A qualitative study involves inductive reasoning to develop generalizations or theories from specific observations or in- terviews. Historical research establishes facts and relationships concerning past events. Correlational research is explo- ration of the interrelationships among variables of interest without any inter- vention by the researcher. An experi- mental study involves the use of tightly controlled subject groups, variables, and procedures to eliminate bias and ensure that findings can be generalized to simi- lar groups of subjects.) Surgical patients. (Surgical patients are the patient popu- lation of interest (P) in the PICOT (pa- tient population, intervention, compari- son, outcome, time) question. The inter- vention is the cleaning of the skin, and the comparison of interest is between chlorhexidine use and povidone-iodine use. Operating room nurses are not an element of the PICOT question.) Sampling method. (Because the patients at the clinic are allowed their choice of the traditional ver- sus the new exercise program, the sam- pling in this study is not random sam- pling.) fluence the results of this study in an unfavourable way? The foundation of research is which of the following? A researcher gives a subject full and complete information about the purpose of a study. This is an example of which of the following? A new nurse on an orthopedic unit is assigned to care for a patient undergo- ing skeletal traction. The nurse asks a colleague, "What is the best practice for cleaning pin sites in skeletal traction?" This question is an example of which of the following? Scientific method. (The scientific method is the founda- tion of research and is the most reliable and objective of all methods of obtain- ing knowledge. Documentation, critical thinking, and evidence are not the foun- dations of research.) Informed consent. (Informed consent implies that the re- search subjects are given full and com- plete information about the purpose of the study, procedures, data collection, potential harms and benefits, and alter- native methods of treatment. Confiden- tiality rules guarantee that any informa- tion the subject provides will not be re- ported to people outside the research team. Bias is any personal opinion or judgement that may be interjected into the results. Anonymity means that the subject's name and identifying informa- tion would not be disclosed during the research study.) Knowledge-focused trigger. (A knowledge-focused trigger is a ques- tion regarding new information available on a topic. A problem-focused trigger is one faced while the nurse is caring for a patient or noting a trend. The PI- COT (population, intervention, compar- ison, outcome, time) format is a way to phrase a question to help clarify the question and the parts. A hypothesis is The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a quality im- provement project with the plan, do, study, act (PDSA) model. Which of the following is an example of the "do" step of that model? The nurse researcher obtains informed consent from participants in a study pri- marily for which reason? Which of the following is a priority goal for nursing research? a prediction about the relationship be- tween study variables.) Implement a new skin care protocol on all medical units. (The "do" step consists of selecting an intervention on the basis of a data review, implementing the change, and studying the results of the change. The "plan" step includes reviewing the avail- able data to understand existing prac- tice conditions or problems to identify the need for change. The results of the change are evaluated in the "study" step. The "act" step is the incorporation of the findings into current practice.) To ensure that the study subjects under- stand their roles in the study. (The conduct of research must meet ethical standards in which the rights of human subjects are protected. The re- search participants must be told about the study's purpose and procedure and their roles in the study. The researcher is always legally responsible for his or her actions. Control of variables is related to the study design, not to informed con- sent. Confidentiality is part of the ethical nature of research but is not the focus of informed consent.) Improving patient care. (Quality patient care is always the prima- ry focus of nursing practice. Cost control would be a benefit but is not the primary focus. Research is not about technology; many "old" procedures can be improved A clinical nurse develops a better way to secure an intravenous access device in a patient and wants to see whether it would benefit other patients. Which of the following should be the first step in initiating a study? The nurse researcher who obtains new knowledge regarding a procedure can most effectively share the information with the nursing profession by doing which of the following? through research. Although research is a professional function of nursing, it is not done to serve the profession.) Review current literature related to the clinical problem. (Review of the literature is the first step in the orderly research process to deter- mine what is already known about the problem. Recruiting patients occurs later in the process, after the nurse identifies the problem, researches the literature, and designs the study. Experimenting with new nursing procedures that have not been tested or approved is a risk to patients. Surveys are designed to obtain information from large study populations and would not be a first step in the re- search process.) Communicating the research findings in a professional journal. (Publication of research results provides other nurses with the scientific back- ground of the study before they apply its findings in practice. Study subjects and setting should be similar in order to repli- cate a study. Nurses should not change from accepted to unproven ways of pro- viding care without careful research and collaboration with colleagues. Experi- menting with new nursing measures is inappropriate and may place a patient at risk.) Assisting with data collection. (A nurse who is new to practice has not developed the experience required Nurses who are new to practice can best contribute to nursing research by doing which of the following? A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the following would be appropriate to use? The nurse involved in scientific research effectively analyzes the information col- lected and determines a course of nurs- ing action by doing which of the follow- ing? for research but can begin at the less complicated level of data collection. An experienced researcher is more quali- fied to identify problems for formal re- search, although input from all levels of nursing is valuable. Nurses with doctor- al-level training are typically prepared for obtaining financial backing. A Cana- dian Nurses Association position paper cites a master's degree as qualification for preparing nurses to implement re- search-based change in nursing prac- tice.) Evaluation research. (Evaluation research is aimed at find- ing out how well a program, practice, policy, or procedure is working. A sur- vey is a study of a large group to iden- tify general information, opinions, atti- tudes, or perceptions. A grounded theory is developed through the collection and analysis of qualitative data. Experimen- tal research involves collecting informa- tion about human subjects who are as- signed to a control group and a compar- ison group.) Using critical thinking. (Critical thinking involves analyzing the data, learning, and problem solving to come up with a course of action. Tradition limits the ability to learn new ways and overlooks what research has to offer. The advice of experienced practitioners may limit research because experience may mean doing things the same way they have been done for years. Using person- A nurse manager is researching the ef- fects of staff shortages on job satisfac- tion among new graduates. Which of the following would be the most effective way to gather data? Which of the following could be a barrier to nursing research? al opinion overlooks the objective data that are available.) By interviewing staff nurses on the unit regarding their perceptions. (A qualitative research study can be car- ried out effectively, in this case, in order to explore and describe the perceptions of staff nurses about staff shortages and their job satisfaction. Through narrative interviews, the participants' perceptions can be compared, and common char- acteristics can be discovered. It is diffi- cult to collect data about perceptions or feelings without talking to those involved. Quantitative survey and experimental re- search involves precise measurements and would not be of use in this study of perceptions. Although obtaining sug- gestions for possible solutions could be useful, it does not help to identify the problems on this specific unit. The data must be collected first.) Shortage of professional nursing staff. (Shortage of staff could mean less time and personnel to conduct and participate in research. Nursing teams that have teamwork skills can aid research. The desire to change is an incentive for re- search. Pressure from higher levels in the organization is also an incentive for research.) Social justice. (The concept of social justice is also re- lated to a concern for equitable distrib- ution of resources, like the principle of An advanced-practice nurse in the com- munity has completed a research project showing that follow-up care for women who have experienced gestational dia- betes is not adequate. As a member of an interdisciplinary team, the nurse writes a policy guiding follow-up stan- dards for all postpartum women. In ef- fecting change, the nurse would be in- volving which principle? It may seem redundant that health care providers pledge to "do no harm" to pa- tients. The purpose of this oath is to re- assure the public that the health care team will work to heal patients with as little pain and harm as possible. Which principle underlies this pledge? A child's immunization may cause dis- comfort during administration, but the benefits of protection from disease out- weigh the temporary discomforts. Which principle applies to this situation? justice, but goes beyond this, encourag- ing the nurse to seek ways to effect a change in the larger health care system and societal structure in order to create greater equity for all. In this example, the nurse is moving toward this in the actions of writing a policy. Autonomy is the ability to operate independently. In this case, the nurse is working as part of an interdisciplinary team and not focus- ing on upholding a patient's autonomy. Ethics of care is a philosophy of care not specifically referred to here.) Nonmaleficence. (Nonmaleficence means not causing harm. Beneficence means providing the best care possible. Accountability refers to answerability for one's actions. Re- spect for autonomy means allowing pa- tients to choose their own course of care.) Beneficence. (Beneficence means doing or promoting good for others. Commitment to benef- icence helps guide difficult decisions. Balancing the risks between the tem- porary pain of an injection and the ex- tended benefits is an example. Fidelity means being true to one's work. Non- maleficence means doing no harm. Re- spect for autonomy means giving allow- ing patients to choose their own course of care.) Fidelity. (Fidelity means keeping the promises If the nurse assesses a patient for pain and then offers a plan to manage the pain, which principle encourages the nurse to monitor the patient's response to the pain management plan? Nurses agree to be advocates for their patients. The practice of advocacy calls for the nurse to do which of the follow- ing? When many people share the same val- ues, it may be possible to identify a phi- losophy of utilitarianism. Which of the following statements is a principle of util- itarianism? Relational ethics suggests that ethical dilemmas can best be attended to by focusing on attention to which of the fol- lowing? that are made. If the nurse offers to man- age pain, then the nurse needs to follow through and ensure that the pain is con- trolled. Beneficence means taking pos- itive actions to help others. Nonmalefi- cence means doing no harm. Respect for autonomy means allowing patients to choose their own care.) Assess the patient's point of view, and prepare to articulate this point of view. (As an advocate, the nurse needs to un- derstand the patient's point of view and then be prepared to verbalize that point of view to others involved in the patient's care. Understanding the law, seeking ad- vice from a manager, and ensuring that prescribers' orders are completed cor- rectly can all help in advocacy, but they are not themselves acts of advocacy.) The value of something is determined by its usefulness to society; this concept is also known by the guiding principle of "greatest good" for the greatest number of people. (According to a utilitarian system of ethics, the value of something is deter- mined by its usefulness for the greatest number of people.) Relationships. (Relational ethics focuses on the role of relational context or the experience of the relationships in shaping moral deci- sions.) Nurses develop a relationship with the patient that is unique among all health In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? Ethical dilemmas often involve a conflict of opinion. Once the nurse has deter- mined that the dilemma is ethical, which of the following would be a critical first step in negotiating the difference of opin- ion? Which of the following sets forth ethical principles for professional nursing prac- tice in a clinical setting? care providers. (Nurses generally interact with patients over longer intervals of time than do health care providers in other disciplines. Because nurses are often involved in personal care, patients and families re- veal information not always shared with physicians or others.) Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. (The process of resolving ethical dilem- mas is similar to the nursing process. The first step is gathering all relevant information. Then the group will proceed through assessment, planning, imple- mentation, and evaluation.) Code of Ethics for Registered Nurses of the Canadian Nurses Association. (The Code of Ethics is an ethical guide embodying professional values and standards established by nurses and the Canadian Nurses Association to maintain the highest standards for the nurse's conduct in practice. The code gives a broad overview of the appropri- ate and inappropriate roles of the reg- istered nurse. Standards of care written by field experts are guidelines that direct the usual pathway of patient manage- ment under certain circumstances. Good Samaritan laws are laws that prevent an individual from suing another person who tries in "good faith" to assist that individual in an accident.) Which of the following statements con- cerning informed consent is correct? Withdrawal of food and hydration at the end of life is an ethical issue that nurses may face, particularly if a patient is near death or in a vegetative state. Which of the following is an accurate statement that the nurse could reveal to the pa- tient's family? The experience of "moral distress" is captured by which of the following state- ments? To distinguish an ethical problem from other types of problems encountered, the nurse should be aware that which of the following statements about ethical problems is true? he goal of informed consent is to protect the patient's right to autonomy. (The patient's right to autonomy is the basis of informed consent. Informed con- sent applies to all treatments, not just those related to surgical procedures.) It is appropriate to withhold food and flu- ids only after careful examination of the patient's status because artificial hydra- tion may not be benefiting the patient. (The research literature related to with- drawing food and fluids at the end of life is not conclusive enough to support either withdrawing or not withdrawing food and hydration. Rather, a clinician's decision should be based on the goals of care of the patient and family and a careful assessment of the patient's com- fort. At the end of life, when the body is shutting down, individuals may lose their desire for food and fluids. Force-feeding can sometimes harm a patient.) Moral distress occurs when inconsisten- cy exists between a nurse's beliefs and values and how he or she is able to act. The answer is not determined by logical deduction. (The characteristics of an ethical prob- lem include the lack of a logical con- clusion, lack of scientific support for ei- ther choice or support for both choices, differences in valuing by staff and the patient that might result in harm or in options that are less than the best, and After researching the scientific literature and confirming that an issue is an ethical dilemma, which of the following should the nurse do next? Which of the following represents utilitar- ian allocation of scarce resources? hen the nurse describe a patient as "that nasty old man in 354," the nurse is ex- hibiting which of the following? Values clarification is a process that in- volves which of the following? Which of the following are true regarding advance care planning? (Select all that apply.) an answer that involves several areas of human concern.) Perform a values clarification Distribution of resources to achieve the greater good of the larger group. Gender bias and ageism Appraising one's personal values that arise from careful reflection. A. It includes the expression and com- prehension of a patient's beliefs and val- ues. Correct B. It is a multidimensional process that involves health care providers. Correct C. The patient's family is not included in this planning. D. Patients can also identify surrogate decision makers, should they become unable to make their own health care decisions. Correct E. The number of unwanted medical in- terventions is increased. F. This approach remains underutilized in health care. Correct Advance care planning (ACP) is a multi- dimensional process that involves health care providers in discussion with pa- tients to ensure that they clearly un- Advance care planning (ACP) The nurse recognizes which correct in- terpretation of advance-directive provi- sions? The nurse notes that the health care unit keeps a list of patients' names at the front desk in clear view so that health care providers can more efficiently lo- cate patients. The nurse knows that this action is a violation of which of the fol- lowing? Nurses are bound by a variety of laws. Which of the following descriptions of types of law is correct? A patient who is confused is left alone in bed with the side rails down and the bed in a high position, and the patient falls and breaks a hip. In legal terms, what has occurred? Battery defined Assault defined derstand their illness, its trajectory, and available treatment options. ACP in- cludes the expression and comprehen- sion of a patient's beliefs and values and the translation of these beliefs and val- ues into medical decisions. During the ACP process, patients can also identify surrogate decision makers who can act if they become unable to make their own health care decisions. Despite its bene- fits, ACP remains an underutilized tool in health care. A proxy directive allows an appointed person to make health care decisions when the patient is in an incapacitated state. Common law tort relating to invasion of privacy. Statutory law is created by elected leg- islatures, such as the provincial or terri- torial legislature that defines the nursing practice act. Negligence Battery is the actual unlawful touching of another, whether threat of harm is includ- ed or not. Assault is the threat to engage in harmful or offensive contact. Civil tort When the nurse signs a form as a wit- ness, the nurse's signature shows which of the following regarding the patient? Most litigation involving hospital care is related to which of the following situa- tions? A patient can be admitted to a mental health facility and treated without his or her consent under which of the following circumstances? A civil tort is a civil wrong committed against a person or property. An example of a tort involving property would be to lose the patient's dentures by misplacing them. The patient has signed that form and the witness saw it being done. (indicates only that the person signing the form was indeed the person whose name was on the form. The witness does not have to know whether the patient was fully informed or not. The witness- ing agent is indicating no judgement about the level of cognitive function of the patient by signing as a witness. The nurse should assess for coercion, but the signature of the witness is not an acknowledgement of having performed such an assessment. If the witness feels that someone is forcing a patient to sign, however, then the witness may refuse to sign, and the contract is then void (un- less a different witness signs).) The nurse follows an order that is incom- plete or incorrect. The patient has threatened to harm him- self or herself or others. (police officers (or other authorized par- ties) may bring the patient to a health care facility for examination and treat- ment without the patient's consent. The next of kin cannot override a patient's autonomy. Although a psychotic episode may have potential untoward effects, the The best way for a nurse to avoid being li- able for negligence might be to do which of the following? (Select all that apply.) A nurse is sued for failure to moni- tor a patient appropriately. Which state- ments are correct about professional negligence lawsuits? (Select all that ap- ply.) A. The nurse is the plaintiff. B. The person filing the lawsuit has the burden of proof. C. The defendant must prove injury, damage, or loss. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. The nurse must follow standards of care to avoid potential litigation such as neg- ligence suits. Which of the following de- scribe a potential nursing malpractice situation? (Select all that apply.) patient must be the one to consent to treatment.) - Follow standards of care. - Give safe, competent care in a caring manner. - Document assessments, interventions, and evaluations as soon as possible af- ter performing them. B. The person filing the lawsuit has the burden of proof. Correct D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. Correct (The plaintiff, the person filing the suit, has the burden of proof and must prove that a breach in the prevailing stan- dards of care caused an injury. The nurse would be a defendant in this case. The plaintiff, not the defendant, must prove injury, damage, or loss.) 1. Failure to question a health care provider about the appropriateness of a patient order. Correct 2. Failure to make a nursing diagnosis. Correct 3. Failure to properly use medical equip- ment ordered for patient monitoring. Cor- rect 4. Failure to follow the "seven rights" of medication administration. Correct 5. Failure to provide discharge instruc- tions. Correct 1. Student nurses, like all other nurses, are accountable for their own actions. *Correct* 2. The institution where a student is A nursing student is unsure about the legal liability of using skills associated with placement as a student. Which of the following is true about legal liability for a nursing student? placed has no responsibility to monitor the actions of a student. 3. It is the nursing instructor's role to inform patients that they are being cared for by a student nurse 4. Usually faculty members are respon- sible for instructing and observing stu- dents; however, there are some situa- tions in which staff nurses may share these responsibilities. *Correct* 5. Nursing students should never per- form tasks they have not been taught; in- structors should supervise all new skills that are being performed. *Correct* [Show Less]