Exam 5 Blueprint: Culture 12-14 questions Pain 12-14 questions Palliation/Caregiving 12-14 questions Professionalism/Health Care Law 12-14 questions Math 3-4 questions. 5.1 Culture and Spirituality Chapter 9 & 35 1. Define and describe the concepts of “Culture” and “Spirituality.” Culture- the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions. ● Also refers to the ways of relating to one another, language, and manner of speaking, work and lifestyle practices, social relationships, values, religious beliefs, expression of thoughts and emotions. Spirituality- Awareness of one’s inner self and a sense of connection to a higher being nature, or some purpose greater than oneself. ● Includes personal beliefs, helps individuals achieve the balance needed to maintain health and well-being and to cope with changes in their health status. 2. Discuss the influence of spirituality on patients' health practices. Spirituality can have a positive impact on a patient’s health. It helps a person cope with anxiety, stress, and depression. Techniques such as relaxation, guided imagery, mindfulness training, and music reduce perceptions of pain and anxiety. Spiritual well-being has been shown to be a protection against psychosocial distress at the end of life. Because spirituality generates energy, it can help patients feel well and guide choices made throughout life. It enables a person to love, have faith and hope, seek meaning in life, and nurture relationships with others. 3. Recognize factors that influence culture and spirituality. ● Acute Illness Sudden illness can cause spiritual distress such as a patient who has a heart attack or someone who is in a car accident. The strength of a patient’s spirituality influences their ability to cope with and recover from sudden illness or injury. ● Chronic Illness Chronic illness can threaten a person’s independence, causing fear, anxiety, and spiritual distress. Successful adaptation provides spiritual growth. ● Terminal Illness Terminal illness can cause feelings of uncertainty about death which can put some people in spiritual distress. Help these patients gain a greater sense of control over their illness, whether they are in a health care setting or at home. ● Near-Death Experience A NDE is defined as a powerfully close brush with physical, emotional, and spiritual death. Pts who experience a NDE are usually reluctant to talk about it. 4. Apply the concepts of culture and spirituality in the context of nursing and health care. 5. Discuss nursing interventions designed to promote a patient's spiritual health. ● Use assessment data about the spirituality and spiritual behaviors or practices from caregivers of family members with chronic illnesses to identify areas of strength and support. ● When appropriate, encourage family caregivers to participate in spiritual behaviors or practices and encourage members from the caregivers' congregations to visit to enhance social support and reduce caregiver burden. ● Consider cultural differences and explore personal preferences when determining nursing interventions to enhance spiritual well-being. ● Inform caregivers of spiritual resources available in the community (e.g., parish nurses, community- or faith-based support groups, clergy, social services). ● Arrange for respite care to allow caregivers to attend religious services if desired to enhance social support and reduce caregiver burden. 6. Identify situations or factors that affect one’s culture and spirituality. ● Acute Illness Sudden illness can cause spiritual distress such as a patient who has a heart attack or someone who is in a car accident. The strength of a patient’s spirituality influences their ability to cope with and recover from sudden illness or injury. ● Chronic Illness Chronic illness can threaten a person’s independence, causing fear, anxiety, and spiritual distress. Successful adaptation provides spiritual growth. ● Terminal Illness Terminal illness can cause feelings of uncertainty about death which can put some people in spiritual distress. Help these patients gain a greater sense of control over their illness, whether they are in a health care setting or at home. ● Near-Death Experience A NDE is defined as a powerfully close brush with physical, emotional, and spiritual death. Pts who experience a NDE are usually reluctant to talk about it. 7. Describe cultural influences on health and illness. Health Disparities are a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Culture can affect someone's access to health care, health status, and disease risk factor. 8. Explain how the many aspects of culture affect a health care provider's ability to provide culturally congruent care. Culturally congruent care emphasizes the need to provide care based on an individual’s cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue. Cultural competence means that professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community. The process of cultural competence in delivering health care services is a culturally conscious model of care in which a healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of a client. 9. Describe steps toward developing cultural competence. 1. Cultural awareness - process of conducting a self examination of one’s own biases toward other cultures and the in depth exploration of one’s cultural and professional background 2. Cultural Knowledge - process a health-care professional seeks and a sound educational base about a culturally diverse groups 3. Cultural skill - ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment. 4. Cultural encounter - process that encourages healthcare professionals to directly engage in face to face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. 5. Cultural Desire - motivation of a healthcare professional to “want to” engage in the process of becoming culturally aware , culturally knowledgeable. 10. Explain the importance of establishing caring relationships with patients to provide spiritual care. 5.2 Pain Chapter 44 1. Describe the physiology/psychology of pain. Pain is an observable activity in the nervous system in response to an adequate stimulus. Nociceptive pain is the protective physiologic series of events that bring awareness of actual or potential tissue damage. There are four physiological processes of nociception: ● ● ● ● Transduction Transmission Perception Modulation A patient in pain cannot not discriminate the process they are currently in but understanding the processes helps recognize factories that cause pain, symptoms that accompany it, and the rationale for selected therapies. 2. Discuss common misconceptions about pain. ● Patients who abuse substances (drugs or alcohol) overreact to discomforts. ● Patients with minor illnesses have less pain than those with severe physical alteration. ● Administering analgesics regularly leads to drug addiction. ● The amount of tissue damage in an injury accurately indicates pain intensity. ● Health care personnel are the best authorities on the nature of a patient’s pain. ● Psychogenic pain is not real pain. ● Chronic pain is psychological. ● Patients who are hospitalized experience pain. ● Patients who cannot speak do not experience pain. 3. Identify components of the pain experience. ● Age- Age influences pain, particularly in infants and older adults. ● Fatigue. Fatigue heightens the perception of pain and decreases coping abilities. ● Genes. Research on healthy human subjects suggests that genetic information passed on by parents possibly increases or decreases the person's sensitivity to pain and determines pain threshold or pain tolerance. ● Neurological Function. Any factor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease) affects the patient's awareness of and response to pain. 4. Explain how the physiology of pain relates to selecting interventions for pain relief. ● Acute pain is treated aggressively. ● Chronic pain is treated pharmaceutically by opiods and also by non pharmacological methods. 5. Describe the components of pain assessment. A – ask about pain regularly. Assess pain systematically. B – believe patients and family in their report of pain and what relieves it. C – choose pain control options appropriate for the patient, family, and setting. D – deliver interventions in a timely, logical, and coordinated fashion. E – empower patients and their families. Enable them to control their course to the greatest extent possible. 6. Be able to perform an assessment of a patient experiencing pain. Ask the patient about their tolerable pain level first. Ask the patient to rate the pain on a scale of 0 – 10. Determine if the pain is acute or severe. Ask them to describe the type of pain and the location. Ask them how long they have been having the pain. 7. Explain how cultural factors influence the pain experience. Cultural beliefs and values affect how individuals cope with pain. Individuals learn what is expected and accepted by their culture. 8. Describe guidelines for selecting and individualizing pain interventions. The nurse, patient, and family are often partners in pain management. Trying the least invasive pain management strategy first (that compliments the prescribed pain management measures) and then going more invasive if those do not work. 9. Explain various pharmacological approaches to treating pain. ● Analgesics Most common and effective method of pain relief. There are three types of analgesics: 1) Nonopioids Including acetaminophen and non-steroidal antiinflammatory 2) Opioids Traditionally called narcotics. Opioids are prescribed to moderate or severe pain mostly in severe trauma, postoperatively, short-term use of opioid medications (3-5 days) usually does not cause issues with side effects. 3) Adjuvants or co-analgesics Medications that enhance analgesics or have analgesic properties. They’re usually medications made to treat other conditions but also have analgesic properties. ● Patient controlled analgesia To avoid an erratic cycle of alternating pain and analgesia, a drug delivery system is a method of pain management that many patients prefer. It allows patients to self-administer opioids—usually morphine, hydromorphone, or fentanyl) with minimal risk of overdose. ● Topical and transdermal analgesics These include prescription, OTC creams, gels, sprays, liquids, patches, or peripheral neuropathy. ● Local anesthesia via Injection Local infiltration of an anesthetic medication to induce loss of sensation to a body part. ● Perineural Local Anesthetic Infusion This technique is used for a variety of surgical procedures ● Epidural Anesthesia A form of regional anesthesia; administered into the epidural space. 10. Describe applications for use of non-pharmacological pain interventions. ● Discuss nursing implications for administering analgesics. ● Identify barriers to effective pain management. ● Evaluate a patient’s response to pain interventions. Evaluate patients' perceptions of the effectiveness of interventions used to relieve pain. Evaluating the effectiveness of a pain intervention requires you to evaluate the patient's pain after an appropriate period of time. 5.3 Palliation and Caregiving Chapter 36 1. Identify the nurse’s role when caring for patients who are experiencing loss, grief, or death. Compassion, attentiveness, patient centered care 2. Describe the types of loss experienced throughout life. ● Necessary loss - losses that are necessary as we age and go through life ● Maturational Loss - form of necessary loss and includes all normally expected life changes across the lifespan. Ex: college student not wanting to leave home, toddler experiences separation anxiety when starting preschool, child not wanting to lose a favorite teacher. ● Situational Loss - unpredictable external event. Ex: car accident w injury causing permanent physical changes not being able to return to work, school, loss of function. ● Actual Loss - Occurs when a person can no longer feel, hear, see, or know a person object. Ex: loss of body part, death of family member, or job ● Perceived loss - person experiencing the loss and is less obvious to other people. Ex: rejection from a friend which causes loss of confidence or status in social group. 3. Discuss the stages of grief as defined by Kubler-Ross, Worden, Bowlby and Rando. Kubler-Ross’ 5 stages of dying: 1) Denial The person cannot accept the fact of the loss; form of psychological protection. 2) Anger The person expresses resistance or intense anger at God, other people, or the situation. 3) Bargaining The person cushions and postpones awareness of the loss by trying to prevent it from happening. 4) Depression The person realizes the full impact of loss. 5) Acceptance The person incorporates the loss into their life. Bowlby’s Attachment Theory: ● Numbing Protects the person from the full impact of the loss. ● Yearning and Searching Emotional outbursts of tearful sobbing and acute distress. Physical symptoms in this stage: chest tightness, shortness of breath, a feeling of lethargy, insomnia, and loss of appetite. ● Disorganization and Despair Endless examination of how and why the loss occurred or expressions of anger at anyone who seems responsible for the loss. ● Reorganization Accepts the change, assumes unfamiliar roles Worden’s Grief Tasks Model ● Accepts the reality of the loss, experiences the pain of grief, adjusts to a world in which the deceased is missing, emotionally relocates the deceased and moves on with life. Rando’s “R” Process Model ● ● ● ● ● ● Recognize the loss React to the pain of separation Recollect and re-experience the relationship with the deceased Relinquish old attachments Readjust to like after loss Reinvest by putting emotional energy into new people Stroebe and Schut’s Dual Process Model ● Loss Oriented Grief work, dwelling on the loss, breaking connections with the deceased person, and resisting activities to move past the grief. ● Restoration Oriented Attending to life changes, finding new roles or relationships, coping with finances, and participating in distractions, coping with finances, and participating in distractions, which provide balance to the loss-oriented stage. 4. Describe characteristics of a person experiencing grief. 5. 6. 7. 8. ● Emotional , cognitive, social, physical, behavioral, and spiritual responses to death. Discuss variables that influence a person’s response to grief. ● Human development ● Personal relationships ● Nature of the loss ● Coping strategies ● Socioeconomic status ● Culture ● Spiritual and religious beliefs ● Hope Discuss factors contributing to unresolved grief. ● When individuals suppress or avoid grief ● Pressure to “move on” ● Shame and embarrassment about expressions of emotional pain ● Feeling you need to be strong to support others ● Common in workplace (only few days of grief leave) Plan nursing interventions used in caring for the dying client. ● Assist with end-of-life decision making ● Palliative Care ● Hospice Care ● Therapeutic Communication approaches ● Manage Symptoms ● Promote Dignity and Self-Esteem ● Maintain a Comfortable and peaceful environment ● Promote spiritual comfort and hope ● Protect Against Abandonment and Isolation ● Support the Grieving Family ● Facilitate Mourning Plan interventions to help the family feel understood and to facilitate grief work. Offer holistic, family-centered support, compassion, and education that incorporates the uniqueness of each patient. Educate family members about the symptoms the patient is likely to experience and the implications of their care. I.E Patients in the last few days are likely to experience anorexia or feel nauseated by food, illness, excessive respiratory secretions, decreased activity, treatments, and fatigue decrease a patient’s caloric needs and appetite. Family members, distressed with the decline, often believe that they need to encourage the patient to eat. 9. Discuss the role of hospice in meeting the needs of a dying client and their significant others. Hospice is a philosophy and model for the care of redundant patients and their families at the end of life. It gives priority to managing a patient’s pain and other symptoms; comfort, quality of life, and attention to physical, psychological, social, and spiritual needs and resources. Hospice patients generally have 6 months left to live. There are eight core beliefs and services for hospice care: ● 10. Identify the criteria for hospice care. ● Patient usually has 6 months or less to live 11. List clinical signs of impending and imminent death. ● Increased periods of sleeping/unresponsiveness ● Circulatory changes with coolness and color changes in extremities, nose, fingers (cyanosis, pallor, mottling) ● Bowel or bladder incontinence ● Decreased urine output; dark-colored urine ● Restlessness, confusion, and disorientation ● Decreased intake of food or fluids; inability to swallow ● Congestion/increased pulmonary secretions; noise respirations (death rattle) ● Altered breathing (apnea, labored or irregular breathing, Cheyne-Stokes) ● Decreased muscle tone, relaxed jaw muscles, sagging mouth ● Weakness and fatigue 12. Describe nursing measures for care of the body after death. ● Confirm provider documented time of death and actions taken ● Determine if autopsy was requested ● Validate status of organ tissue donation ● Identify patient by using 2 identifiers ● Perform hand hygiene and apply disposable gloves ● Provide sensitive and dignified nursing care to patient and family 13. Discuss the nurse’s own grief experience when caring for dying patients. Nurses will experience grief and loss, and this can put them at high risk for compassion fatigue. Compassion fatigue can lead to a decreased ability to show empathy and feelings of frustration, anger, guilt, sadness, and anxiety. Physical, emotional, and spiritual exhaustion can result from seeing patients suffer. Take care of yourself, talk to each other, and find ways to decompress! Extra Vocab : ● Mourning - the outward, social expressions of grief and the behavior associated with loss. ● Bereavement - encompasses both grief and mourning and includes emotional responses and outward behaviors of a person experiencing loss. Allow people to talk about their loss, reassure them that feelings are normal. Dying Person’s Bill of Rights ● I have the right to be treated as a living human until I die ● I have the right to maintain a sense of hopefulness, however changing its focus may be ● I have the right to be cared for by those who can maintain a sense of hopefulness, however changing that may be ● I have the right to express my feelings and emotions about my approaching death in my own way ● I have the right to participate in decisions concerning my care ● I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals ● I have the right to not die alone ● I have the right to be free from pain ● I have the right to have my questions answered honestly ● I have the right to retain my individuality and not be judged for my decisions that may be contrary to beliefs of others. ● I have the right to expect that the sanctity of the human body will be respected after death ● I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and be able to gain some satisfaction in helping me face my death 5.4 Professional Identity Chapters 1 & 2 1. Develop a beginning knowledge base regarding the evolution of the nursing profession. ● Florence Nightingale Florence Nightingale developed the first nursing philosophy based on health maintenance and restoration. She also established the first place of formal training for nurses, The Nightingale Training School for Nurses at St. Thomas’ Hospital in London. She was the first nurse epidemiologist and one of the first people to connect poor hygiene to infection rates. ● Civil war to the Beginning of the Twentieth Century The civil war stimulated the growth of nursing in the United States. Clara Barton, the founder of the American Red Cross, cared for soldiers during the civil war. Other names of the civil war nursing era include: Dorothea Lynde Dix, Mary Ann Ball, and Harriet Tubman. The first african american nurse was Mary Mahoney. Isabel Hampton Rob was one of the founders of the ANA. ● Twentieth Century During the twentieth century nursing started becoming an offering at universities. During the twentieth century the Army and Navy corps were established. By 1920s nursing specialization became a thing. ● Twenty-First Century Today nurses are constantly revising nursing practice and school curricula to keep up with the ever changing culture. 2. Discuss the three roles for which the Associate Degree in Nursing graduate is prepared to function as presented in the OSU-OKC philosophy statement. ● Knowledge encompasses the realms of science and theory ● Practice includes the mastery of technical skills and the notions of situated thinking and knowledge use; it means being able to engage in practice in a thoughtful, deliberate and informed way ● Ethical comportment involves the individual’s formation within a set of recognized responsibilities; it includes the notions of “good practice” and “boundaries of practice” 3. Describe the influence on professional nursing practice contributed by standards of professional nursing, professional organizations and professional roles. Standards of nursing practice: Assessment RN collects pertinent data and information relative to the healthcare consumer’s health or the situation Diagnosis RN analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues Outcomes Identification RN identifies expected outcomes for a plan individualized to the health care consumer or situation Planning RN develops a plan that prescribes strategies to attain expected, measurable outcomes. Implementation RN implements the identifies plan (coordinates care and teaches and promotes health) Evaluation RN evaluates progress toward attainment of outcomes 4. Explain the components of accountability and responsibility (to include delegation) as they relate to the professional nurse. Accountability means you are responsible professionally and legally for the type and quality of nursing care provided. Remaining current and competent in nursing and scientific knowledge and in technical skills is part of the responsibility of this piece. 5. Describe the various nursing roles in health care. ● Autonomy and Accountability ● Caregiver ● Advocate ● Educator ● Communicator ● Manager 6. Compare the educational programs available for professional registered nurse education. ● Clinical Nurse Specialist ● Nurse Practitioner ● Certified nurse midwife ● Certified Registered Nurse Anesthetist ● Nurse Educator ● Nurse Researcher 7. Identify a minimum of three characteristics of a profession and discuss how nursing demonstrates these characteristics. 8. Describe the influence of social and economic changes on nursing practices. ● Nurses’ self care ● Health care reform and costs ● Demographic Changes ● Medically Underserved 9. Describe the contribution of two professional nursing organizations to the advancement of nursing. -ANA (American Nurses Association) Professional Organization designed to protect and advance nursing. Their definition of Nursing is: Protection, promotion, and optimization of health and abilities; prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities, and populations. -ICN (International Council of Nurses) The International Council of Nurses is a federation of more than 130 national nurses associations. It was founded in 1899 and was the first international organization for healthcare professionals. Their definition of nursing is: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. It includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. 5.5 Health Care Law Chapter 23 1. Examine personal commitments and values in relation to the care of patients. 2. Describe resources relevant to the law that might be used in professional development and practice. ● Constitutional Law - derived from federal and state constitutions ● Statutory Law - Derived from statutes passed by US congress and state legislatures ● Civil laws - protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur. ● Nurse Practice Acts - civil state laws that define nursing and standards you must meet within individual states ● Criminal Laws- protect society and provide punishment for crimes ● Administrative law - regulatory law, more clearly defines expectations of criminal and civil law ● Common Law - originates from decisions that were made in a absence of law ● Case Law - decisions made in legal cases that were resolved in courts. 3. Define the following terms: Assault, Battery, Defamation of Character, Law, Libel, Malpractice, Negligence, Slander, Tort 1. Assault - intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact 2. Battery - is any intentional offensive touching without consent or lawful justification. 3. Defamation of Character - publication of false statements the result in damage to a person’s reputation. 4. Law 5. Libel - the written defamation of character 6. Malpractice - type of negligence 7. Negligence - is conduct the falls below the generally accepted standard of care of a responsibly prudent person 8. Slander - occurs when one speaks falsely about another. 9. Torts - civil wrongful acts or omissions made against a person or property. ○ Intentional torts , Quasi intentional torts, unintentional torts. 4. Describe examples of the sources and types of law in nursing practice. Constitutional law is derived from federal and state constitutions. Statutory law is derived from statutes passed by the U.S. congress and state legislature. Civil Law protects the rights of individuals and provides for fair and equitable treatment when civil wrongs or violations occur. Criminal Laws protect society, and provide punishment for crimes which are defined by municipal, state, and federal legislation. Common law originates from decisions that were made in the absence of law. Administrative law or regulatory law, more clearly defines expectations of civil and criminal laws. Case law describes decisions made in legal cases that were resolved in courts. 5. Identify a variety of legal regulations that influence nursing practice. ● Affordable Care Act (PPACA) Characterized by 4 main themes in nursing practice: 1) Consumer Rights 2) Affordable Health Care Coverage 3) Increased Access to Care 4) Quality of Care that meets the needs of patients ● Emergency Medical Treatment and Active Labor Act (EMTALA) Prohibits transfer of patients from private to public hospitals without appropriate screening and stabilization. It’s created to prevent “patient dumping.” ● Health Insurance Portability and Accountability Act (HIPAA) ● Health Information Technology Act (HITECH) ● Americans with Disabilities Act (ADA) ● Mental Health parity and Addiction Equity Act (MHPAEA) ● Patient Self-Determination Act (PSDA) ● Nurse Practice Act ● Informed Consent and Health Care Acts ● Good Samaritan Laws ● Public Health Laws ● Uniform Determination of Death Act 6. Describe the legal responsibilities and obligations of nurses regarding HIPAA (Health Insurance Portability & Accountability Act of 1996), Advance Directives, Living Wills and Emergency Medical Treatment. Under HIPAA, it is the nurses responsibility to ensure the patient’s rights to privacy and confidentiality. Avoiding talking about patient information in hallways and public areas, don’t write patient information on the message board in the patient's room etc. (pg. 308) An Advance Directive is a document in which the patient instructs others tasks to do before, during, and after their death. They include a statement of the patient’s wishes if a respiratory or cardiac arrest occurs and a copy of the patient’s durable power of attorney for health care. (pg. 310) Living Wills include information about a patient’s preferences regarding end-of-life care. Some include physician orders about sustaining life, such as use of enteral feedings, whether to initiate CPR on cessation of breathing etc. It’s important as the nurse to thoroughly read through the living will. (pg. 310-311) The Emergency Medical Treatment and Active Labor Act (EMTALA) prohibits transfer of patients from private to public hospitals without appropriate screening and stabilization. It’s created to prevent “patient dumping.” 7. Discuss the establishment of standards of care, and list various sources for these standards of care. (Pg. 2) Standards of nursing practice from the ANA: Assessment RN collects pertinent data and information relative to the healthcare consumer’s health or the situation Diagnosis RN analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues Outcomes Identification RN identifies expected outcomes for a plan individualized to the health care consumer or situation Planning RN develops a plan that prescribes strategies to attain expected, measurable outcomes. Implementation RN implements the identifies plan (coordinates care and teaches and promotes health) Evaluation RN evaluates progress toward attainment of outcomes 8. Discuss the purpose of a state board of nursing. ● A state board of nursing holds the legal authority for nursing practice and regulates nursing practice through : Establishing the requirements to obtain a nursing license, issue a nursing license, determining the scope of practice, setting minimum education standards, managing disciplinary procedures. 9. Discuss client rights and their influence on nursing practice. 10. List and define the four elements needed to prove negligence. ● The nurse (defendant) owed a duty of care to the patient (plaintiff) ● The nurse did not carry out or breached that duty ● The patient was injured due to the breach in that duty ● Damages or remedies are allowed under state law to “make a person whole” in the eyes of the court. 11. Identify areas of potential liability in nursing practice. (pg. 317) ● Students or RNs practicing outside of their scope of practice or performing skills not checked off by the appropriate person/group. ● “Floating” nurses who do not alert the supervisor of inadequate education or experience regarding a patient’s care and/or do not get properly oriented to that unit. ● A nurse not properly assess if they can take an assignment based on the 6 reasons they can refuse* and abandoning the patient. *1) the nurse lacks the knowledge or skill to provide competent care 2) care exceeding the NPA is required 3) health of the nurse (or nurse’s unborn child) is directly threatened by the type of assignment 4) orientation to the unit has not been completed and safety is at risk 5) the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds 6) the nurse’s clinical judgement is impaired as a result of fatigue, resulting in a safety risk for the patient 12. Discuss actions that can be taken to safeguard one's own nursing practice. Risk management measures can be taken to safeguard one’s own nursing practice; Identifying possible risks, analyzing them, acting to reduce the risks, and evaluating the steps taken to reduce them. (pg. 317) 13. Discuss accountability and legal responsibilities in nursing.
