Test 1- Standards of Nursing Practice/Healthcare Delivery 94 Questions with Verified Answers
The practice of nursing is regulated by: - CORRECT
... [Show More] ANSWER State Nurse Practice Acts
What organization has legal authority to allow graduates of approved schools of nursing to take the licensing exam? - CORRECT ANSWER State Boards of Nursing
Who accredits hospitals and healthcare organizations - CORRECT ANSWER Joint Commision (JCAHO)
Who deals with legal stuff? - CORRECT ANSWER The state board.
Who provides the NCLEX? - CORRECT ANSWER NCSBN
Who represents nurses? - CORRECT ANSWER American Nurses Association
Nursing Education - Practical/Vocational - LPN/LVN - CORRECT ANSWER Usually about 1 year to 18 months in length. Requires the NCLEX PN exam to become licensed. Work under the direction of a registered nurse or primary care provider. Work in long term care settings or physician's offices . Don't usually see them in hospitals or acute care settings.
Nursing Education - Registered Nursing - Diploma - CORRECT ANSWER 3 year program typically hospital based. Main form until the 1960s. Modeled after the Nightingale Schools of Nursing. Hardly see any of these any more. Pretty intensive programs. A lot of clinical time. Because it was hospital based, you didn't have any degree, just a diploma.
Nursing Education - Registered Nursing - ADN - CORRECT ANSWER 2 year nursing program. Emerged during the nursing shortage of WWII.
Nursing Education - Registered Nursing - BSN - CORRECT ANSWER 8+ semesters where you do nursing and other college courses.
Nursing Education - Graduate - Master's Degree - CORRECT ANSWER 2 to 3 year program for advanced practice nurses to function in a more independent role.
Nursing Education - Graduate - Doctoral degree - CORRECT ANSWER DNP is intended to prepare nurses for advanced clinical practice. DNS and PHD are more research based.
Clinical Nurse Specialist (CNS) - CORRECT ANSWER Sometimes called a ClinSpec. Have expertise in an area of clinical specialization. Work in hospital or clinical setting but the role is varied.
Nurse Practitioner (NP) - CORRECT ANSWER Provide primary care to different populations depending on the specialty. Can work independently. Assess, diagnose, and treat disease and illness. Prescribe medications and can do treatment. Can provide approximately 80% of the care by physicians. Can not do surgery or deliver babies. Medicare will only reimburse 80% (but this is changing).
Certified Registered Nurse Anesthetist (CRNA) - CORRECT ANSWER Provide anesthesia and do pre-op screenings as well as post - op. Pricey malpractice insurance.
Certified Nurse Midwife -CNM - CORRECT ANSWER Different from someone who just calls themselves a midwife but isn't actually certified. Specializes in women's health. Provide pre natal care, perform uncomplicated deliveries, and provide post natal care.
Other Advanced Practice Roles include - CORRECT ANSWER Nurse educators, nurse researchers, and nurse entrepreneurs.
Continuing Education (CE) - CORRECT ANSWER Professional strategy to maintain current clinical knowledge. 36 states require continuing education courses to maintain license. Arizona is not one of them. Debate as to whether or not requiring continuing education will actually help nurses keep current. Many feel that it is more of an internal motivation.
In - Service Education - CORRECT ANSWER Programs offered at the work site. Provide education at the work site that is usually specific to the facility. Examples include computer education, fire safety, or specialty specific work.
Lifelong Learning - CORRECT ANSWER As Florence Nightingale emphasized, you need to stay up to date with nursing education and there are many ways to stay up to date.
National Counsel of State Boards of Nursing (NCSBN) - CORRECT ANSWER Non - profit organization through which boards of nursing interact and council on common issues; Develops NCLEX exam; Promotes uniformity in the regulation of nursing practice; Manages Nurse Licensure Compact.
Nurse Licensure Compact - CORRECT ANSWER There are 25 states and 6 pending. If a state participates in the compact, it means that if you get licensed in the compact state and you want to go work in a different compact state, you don't have to pay for an additional license. Arizona is part of the compact.
State Boards of Nursing - CORRECT ANSWER Define the practice of nursing; Establish Criteria that allow one to be considered an RN or LPN. Determine scope of practice for nurses; Have legal authority to allow graduates of approved schools of nursing to take the NCLEX.
Arizona State Board of Nursing Functions - CORRECT ANSWER Issue/Renew nursing licenses/NA certificates; Investigate complaints; Certify NPs, CNSs, and school nurses; survey rn/lpn/na programs; monitor nurses with board stipulations; conduct CANDO program
Board Stipulations - CORRECT ANSWER nurses who have gotten in trouble but are allowed to keep their license are monitored by the state board of nursing.
CANDO - CORRECT ANSWER Nurses who are addicted and they continue practicing but need to be in the 3 year program.
Licensure - CORRECT ANSWER Procedure varies among states (graduate from accredited school and pass NCLEX); Licenses can be revoked
Reasons why license can be revoked - CORRECT ANSWER Unprofessional conduct (failure to adhere to standards of care, patient abandonment, driving while intoxicated, child abuse, practicing outside of scope, etc); Malpractice/Negligence (being physically unsafe); Fraud (documenting home health visits that did not happen, falsifying medical records, cheating or assisting others to cheat); Conviction of a felony (if less than 5 years, the applicant is ineligible to apply for certification. If more than 5 years, case by case basis), Misdemeanor (provide information with application; case by case); Mental incapacity (mentally incompetent to a degree that is or might be dangerous. Mental illness that causes distortion of reality); Failure to report (mandated to report certain things like unprofessional conduct, physical or mental impairment, self report felony conviction or misdemeanor charge).
Nurse Practice Acts - CORRECT ANSWER Laws established by each state to regulate nursing practice; Designed to protect patients or society; Define minimum education, required certification, and practice guidelines.
Scope of Practice - CORRECT ANSWER Nurses must know and perform within their scope of practice; agency policies and procedures should follow scope of practice and standards of car; legal consequences for operating outside of scope.
Standards of Practice - CORRECT ANSWER What a reasonable and prudent nurse would do in a similar situation; AKA standards of care, standards of professional performance, and clinical guidelines.
Standards of Practice Derived From - CORRECT ANSWER Nurse practice acts - (mandatory standards- laws; Professional organizations (voluntary standards)
Other Guidelines for Nursing Practice- Institutional Policies and Procedures - CORRECT ANSWER Remember that they should follow the scope of practice and standards of care for nurses and cant exceed it.
Other Guidelines for Nursing Practice- Code of Ethics - CORRECT ANSWER International Council of Nurses (ICN) Code - respect for human rights and support nurses who refuse to perform things that conflict with care; American Nurses Association (ANA) Code -ethical obligations and duties of everyone that enters nursing
Other Guidelines for Nursing Practice- Patient Care Partnership - CORRECT ANSWER Like a patient bill of rights. Given to every patient when they come in. Informs them of what they should expect during their stay as far as their rights and responsibilities and what they should receive.
Federal Laws and Regulations Guiding Nursing Practice-Emergency Medical Treatment and Act of Labor Act (EMTALA) - CORRECT ANSWER Ensure public access to emergency services regardless of their ability to pay. Also called the "anti dumping law". Federal law that requires that all patients who come to the ER must be screened first regardless of whether they have insurance. Patients used to be just sent to the county hospital. Patients can not be transferred from private to public until they are deemed stable.
Federal Laws and Regulations Guiding Nursing Practice-Americans with Disabilities Act (ADA) - CORRECT ANSWER Ensures equal opportunitiy for persons with disabilities for employment. Holds true for nursing profession. HIV is considered a disability. If you are a healthcare worker with HIV, it is you right whether or not you want to disclose that. And you cannot refuse care if a patient is HIV positive.
Federal Laws and Regulations Guiding Nursing Practice-Patient Self Determination Act - CORRECT ANSWER Requires that healthcare agencies provide information for patients to make decisions in their care. Must have policy and procedure information about advance directives.
Federal Laws and Regulations Guiding Nursing Practice-Health Insurance Portability and Accountability Act (HIPAA) - CORRECT ANSWER Defines the patient's rights in regards to protecting health information.
State Laws and Regulations Guiding Nursing Practice-Nurse Practice Acts - CORRECT ANSWER Law that looks over nurse practices. Looked over by the state board of nursing.
State Laws and Regulations Guiding Nursing Practice- Mandatory Reporting Laws - CORRECT ANSWER Vary by state. As a nurse, you have to abide by your state mandatory reporting laws. In Arizona, you have the duty to report any incident of unsafe practice, unprofessional conduct, and abuse and neglect of a vulnerable person.
State Laws and Regulations Guiding Nursing Practice-Good Samaritan Laws - CORRECT ANSWER Protect nurses who provide emergency care off duty like stopping at the scene of an accident. Requirements for this law to work is that the assistance has to be voluntary. Also covers the failure to act.
Informed Consent - CORRECT ANSWER Grants freedom from bodily contact by another person unless consent is given. Required every time a patient comes in. A patient signs the form for admission and routine treatment and also any time there is a special procedure like surgery. Must be complete (needs full explanation of the procedure, risks, benefits, costs, consequences, etc), clear (the patient must understand), and voluntary (no threat of not consenting)
Consent in the event of an emergency - CORRECT ANSWER It is assumed that if you are able to consent, you would.
Nurse's Role in Consent - CORRECT ANSWER Sign the consent as a witness. Not legally responsible to explain treatment (physician's responsibility)
Competence for Consent - CORRECT ANSWER The patient needs to understand the consent and have the ability to make the decision. If not, state law determines who is next of kin.
Advance Directives - CORRECT ANSWER Gives individuals the right to receive treatment, make decisions about what you want or don't want prior to you not being able to make those decisions on your own. Wishes in the event that you are unable to communicate them.
Advance Directives- DNR/DNAR - CORRECT ANSWER No attempts are going to be made if they stop breathing. Physician writes the order that the patient does not want resuscitation or else it will be attempted.
Advance Directives-Living Will - CORRECT ANSWER What healthcare measure should or should not be provided if they become incapacitated. Do you want a feeding tube and if so, how long? As a patient, you can change this at any point.
Advance Directives-Durable Power of Attorney for Healthcare - CORRECT ANSWER Appoint someone to make medical decisions for you at the point that you cant make your own decisions.
Negligence - CORRECT ANSWER Failure to perform as a reasonable, prudent nurse would OR performing an act that a reasonable prudent nurse under similar circumstances would not do; Failure to follow standards of practice; No intent to harm is present (even if you don't intend to hurt them, you can still be negligent)
Malpractice - CORRECT ANSWER Professional form of negligence; Students are held to the same standards as RNs.
If someone takes a nurse to court and files a suit to prove malpractice, four elements are necessary to collect damages: - CORRECT ANSWER Existence of a duty (a nurse has a duty to the patient); Breach of duty (prove that there was some sort of breach); Causation (prove that the nurses act or failure to act caused an injury); Damages (if no injury occurred, they can not prove their case but they can still file a complaint with the state board of nursing)
Assault - CORRECT ANSWER Threat or attempt to make bodily contact with someone without consent.
Battery - CORRECT ANSWER An assault that is carried out.
Example of Assault/Battery - CORRECT ANSWER You tell the patient that they need to change into their gown and you come back and they are still in their street clothes and you tell them "if you don't change out into the gown, I will do it for you" would be assault. Actually doing it would be battery.
Morals - CORRECT ANSWER Private, personal, or group standards of right and wrong.
Ethics - CORRECT ANSWER A systematic study of tight and wrong conduct in situations where there are issues of morals or values
Bioethics - CORRECT ANSWER The application of ethical principles to healthcare
Nursing Ethics - CORRECT ANSWER Ethical questions that arise out of nursing practice.
Value Neutrality - CORRECT ANSWER An attempt to understand one's own values regarding an issue and when to know when to put them aside, when necessary, to become nonjudgemental when providing care to clients.
Beneficence - CORRECT ANSWER The duty to do or promote good.
Nonmaleficence - CORRECT ANSWER The twofold duty to do no harm and promote good.
Autonomy - CORRECT ANSWER A person's right to choose and his ability to act on that choice.
Justice - CORRECT ANSWER the obligation to be fair
Fidelity - CORRECT ANSWER Faithfulness
Veracity - CORRECT ANSWER The duty to tell the truth
Accountability - CORRECT ANSWER To be accountable for actions
Confidentiality - CORRECT ANSWER The process of keeping information private or secrete.
Ethical Issues in Health Care - CORRECT ANSWER AIDS, Abortion, Allocation of healthcare goods and services, Confidentiality/privacy, End-of-life issues, informed consent, organ donation, reproductive technology, compelling unwanted treatment
Primary and Preventative Care - CORRECT ANSWER Services to keep the patient well and prevent illness. A lot of the focus is on patient education and screening/early detection. Focus on health promotion, disease prevention, patient education, and screening/early detection. Examples include a healthcare provider's office and a mobile clinic.
Secondary Care - CORRECT ANSWER Majority is considered acute care. Focus on diagnosis and treatment of illness, health restoration. Acute care is immediate and short term care including that done by hospitals, surgery centers, and urgent care. The nurse's role in acute care include direct care providers, managers of a unit, supervisors, educators, etc.
Teritiary Care includes - CORRECT ANSWER Restorative care (rehabilitative care and home health care) and Continuing Care (long term care/extended care, hospice, and respite care)
Tertiary Care - Restorative Care- Rehabilitative care (sub acute care) - CORRECT ANSWER Comprehensive impatient care for the patient that is over the acute phase of the illness but still needs medical care and/or rehab; Goal oriented treatment- rendered immediately after or instead of acute hospitalization. Requires more intensive skilled nursing care than what they would get in LTC. Usually transitional - after the hospital but before they o home or continue to LTC.
Tertiary Care - Restorative Care- Home health - CORRECT ANSWER Appropriate when someone needs care that exceeds the care that the patient, family, or friends can provide. Most rapidly growing because it is really cost driven. Can significantly save on health expenses. Primary goal is the promotion of self care. Serves an increasing number of older adults with chronic illnesses but we are trying to help them get to the point where they can continue to take care of themselves at home. Nurses role: provide direct care but the big focus is family education.
Tertiary Care - Continuing Care - Long term care (LTC)/extended care - CORRECT ANSWER Skilled nursing facilities: ongoing skilled nursing care to patients who need assistance with ADLs. Different types like nursing homes, behavioral health facilities, rehab, assisted living, etc. Usually anticipated that it is going to be more than a month. Sometimes indefinitely.
Tertiary Care - Continuing Care - Hospice - CORRECT ANSWER Palliative and supporting care for dying patients and their families; goal is to promote comfort and quality of life.
Tertiary Care - Continuing Care - Respite Care - CORRECT ANSWER Gives primary caregivers time away from responsibilities
Regulatory Agencies- Arizona Department of Health Services (state department) - CORRECT ANSWER Speaking specifically about their division of license services. Licenses and monitor health care and child care facilities. They can shut facilities down.
Regulatory Agencies - Joint Commission (JCAHO) - CORRECT ANSWER Accrediting body. Voluntary process that the organization can prove an acceptable standard of practice. Required for medicare reimbursement and most insurance.
Healthcare Microsystem - CORRECT ANSWER Functional unit within a larger system; Consists of all front line staff and resources working together to improve patient outcomes
Nursing roles and Responsibilities - Provider of Care - CORRECT ANSWER Provide patient centered care, follow scope of practice, and directly care for patients.
Nursing roles and Responsibilities - Manager of Care - CORRECT ANSWER Nurse often serves as a coordinator for different members of the healthcare team and seek assistance appropriately.
Nursing roles and Responsibilities - Member of a Profession - CORRECT ANSWER We have to uphold a professional image and ensure that nursing is seen as the profession it is.
Nursing roles and Responsibilities - Patient Advocate - CORRECT ANSWER Involves speaking on behalf of the patient in order to protect his or her right to obtain needed information and services. Outlined in code of ethics for nurses.
National League of Nurses (NLN) - CORRECT ANSWER Establish and maintain a universal standard for nursing education.
American Nurses Association (ANA) - CORRECT ANSWER National and professional organization that represents RNs. Do a lot of lobbying and manage standards of nursing to promote quality care.
Arizona Nurses Association (AZNA) - CORRECT ANSWER Division within ANA.
Student nurses association of Arizona (SNAAZ) - CORRECT ANSWER Under the student nurses association.
Examples of Being a Patient Advocate - CORRECT ANSWER Respecting patient's right to refuse, maintaining confidentiality, and verifying and questioning orders.
Common Areas Requiring Patient Advocacy - CORRECT ANSWER End of life decisions, technological advances, and medical errors.
Delegation - CORRECT ANSWER Appointing a person to act on one's behalf; transfer responsibility while retaining accountability.
5 Rights of Delegation - CORRECT ANSWER Right task, Right circumstance, Right peron, right direction/communication, right supervision/evaluation
Acronym to remember 5 rights - CORRECT ANSWER TCPDS. Take Care. Please Delegate Safely. (T)ask, (C)ircumstance, (P)erson, (D)irection, (S)upervision. [Show Less]