Exam 2 study guide
Teaching and learning
Understand the teach-back method:
Way of checking by asking clients to state in their own words what they need to know or do about their
health. It is a way to confirm you have explained things in a manner your clients understand.
How to use/Strategies with using a medical interpreter:
Look at the client when talking (make eye contact) seat the interpreter next to or slightly behind client.
Do not ask family members or friends to interpret medical discussion and decisions. Ask medical
interpreter to leave a “cheat sheet” with phonetically spelled phrases.
Newest Vital Sign:
Healthy literacy assessment tool- uses a nutrition label & ask 6 questions about the content on the label
to assess health literacy
REALM- measures a person’s ability to read and pronounce medical and health related vocabulary from
three lists grauated in order from the most simple words to the most complex words
Learning Domains and strategies to use each domain:
Cognitive: thinking, understanding; knowledge. EX: lecture, simulation, and gaming
Psychomotor: physical task or behavior; skill. EX: demonstration, computer assisted instruction
Affective: emotions, values, feelings, attitudes. EX: group discussion, role-playing, role-modeling
Behaviors suggesting a literacy challenge:
Reacting to complex learning situations by withdrawal or avoidance, using the excuse of being too busy,
not interested, too tired. Claiming they lost, forgot reading glasses, becoming nervous when asked to
read, trying to memorize spoken information
Strategy to increase compliance with teaching:
Use the smallest amount of information to achieve behavioral objectives
Use multiple teaching methods and tools, include clients family in teaching
Considerations for culturally competent patient teaching:
Develop an understanding of the clients culture, work with a multicultural team in developing
educational programs, be aware of personal assumptions, biases, and prejudices, understand the core
cultural values of the client or group, develop written material in the client’s preferred language.
Legal issues
Reasons for suspending or revoking a license:
Drug or alcohol abuse, fraud, deceptive practice, criminal act, previous disciplinary actions, gross or
ordinary negligence, physical or mental impairments.
Student nurse standards and liability:
Student nurses are responsible for their own actions or lack of action, student nurses are held to the
same standard of care as registered nurse.
Do not misrepresent your role, do not act beyond your current scope of practice, do not put your
patients, selves, or colleagues at risk.
Intentional torts and be able to recognize examples of each:
Assault: threat or attempt to make bodily contact without consent. EX: threaten to hold patient down to
administer shot he/she refused
Battery: nonconsensual bodily contact with contact with another or anything attached to or held by the
other person. EX: Inserting a catheter after client experiences an injury
False imprisonment: unjustified retention or prevention of movement of another person without
consent. EX: putting the patient in restraints without provider’s order
Fraud: willful misrepresentation identity that cause harm or loss to a person or proper. EX: student
nurse pretending to be an RN; documenting guess or inaccurate intake volume
Defamation of character: derogatory remarks about another damaging the person reputation. EX: lying
Invasion of privacy: discussing patient information with people not entitled to the information. EX:
exposure of patients while caring for them in their room
Unintentional torts and recognize examples:
Negligence: performing an act that a reasonably prudent person under similar circumstances would NOT
do OR failure to perform an act that a reasonably prudent person under similar circumstances would do
Malpractice: related to a professional group which has standards of practice. A specialized type of
negligence- failure to meet a professional standard of cate. EX: not assisting a post op client with
ambulation and the client falls and fractures his/her hip
Best legal safeguard:
Competent practice
Respect legal boundaries of nursing practice, own personal strengths, and weaknesses, keep careful and
accurate documentation
Incident Report documentation/information:
Complete name of person and names of witness, factual account of incident, date, time and place of
incident, any equipment or resources being used, documentation by physician of medical examination
of person involved.
HIPAA:
Patients have a right to see and copy their health records as defined by the health care agency process,
to update their health record, to request correction of any mistakes, to get a list of disclosures, to
request a restriction on certain uses or disclosures (patient determines who is authorized to receive
information) to choose how to receive health information
Elements/conditions of liability:
Liability means legally responsible for one’s acts or omissions.
ALL FOUR OF THESE CONDITIONS MUST BE PRESENT FOR AN ORGANIZATION OR INDIVIDUAL TO BE
LIABLE
Duty: did the defendant have a professional obligation to the plaintiff
Breach of duty: did the defendant fail to perform the duty according to reasonable practice standards
Causation: did the defendants’ actions or inactions directly or indirectly cause harm to the plaintiff?
Damages: was there actual injury, harm, or damage to the plaintiff’s person or property?
Roles of nurses in Legal Proceedings:
Defendant: nurse is accused of malpractice, intentional tort, or crime.
Fact witness: nurse is a witness who knows something about the circumstances in this specific legal case
Expert witness: nurse not familiar with the case but is asked to testify if a reasonable nurse would act in
the same manner under the same circumstances.
Informed consent – elements:
A competent adult has the right to consent to treatment and to decide whether it is necessary and
advisable. RN’s do not obtain consent. Nurse is responsible for making sure the consent form is on the
patient’s chart and answering patient questions about consent.
Disclosure: of the procedure, risks, benefits, and alternatives
Comprehension: patient can describe in their own word what they are consenting too
Competence: patient can comprehend the situation and making decisions
Voluntariness: patient was not manipulated or coerced into consenting or refusing
Good Samaritan laws:
Any medically licensed person who in good faith renders emergency care at the scene of an accident or
emergency to the victim will not be liable for any civil damages.
Four sources of law:
1.
2.
3.
4.
U.S. & state constitutional law: foundation for ALL U.S. & state laws. EX: bill of rights
Statutory law (legislative body) EX: Georgia nurse practice act
Administrative law (admin agencies) GA board of nursing
Common law (judicial interpretation) precents from pervious court decisions most law involving
malpractice is common law
Criminal Law compared to Tort Law
Law is a standard rule of conduct established and enforced by government designed to protect the
rights of the public.
Criminal law: Wrong against a person or the persons property as well as the public
Misdemeanor: punishable by fines or less than 1 year imprisonment
Felony: punishable by imprisonment for more than 1 year
Tort law: rights, obligations, and remedies, provided to someone who has been wronged by another
individual
Spirituality
Understand atheist beliefs and how to respect those beliefs:
Atheists deny the existence of a higher power. All individuals deserve respect for what they choose to
believe in.
Common characteristics of major religions:
How can a nurse meet spiritual needs:
Be ovservant for sudden changes in spiritual practices, sudden interest in spiritual matters, sleep
disturbances and mood changes. Enchance spiritual health, encourage use of spiritual resources. Help
the patient in determining if spiritual needs were met
Understand how to support a client who has asked you to pray for him/her
Spiritual distress actions by a client
Anger towards a higher power, inner conflict about reliefs, inability to find meaning hope love peace etc
Spirituality definition
Anything that pertains to a person’s relationship with a nonmaterial life force or a higher power,
spirituality does not require a religious affiliation.
Organizing, Prioritizing, and Delegating
Accountable care organizations definition and examples:
Model of care emerging post ACA. Emphasizes the pay-for-performance vs fee-for service model. Work
as a team. Ex medical homes and medical neighborhoods
Leaving Against Medical Advice (AMA)
Patient is legally free to leave. Patient must sign a release form, signature requires a witness, form
becomes part of medical record
Varying healthcare settings (primary, ambulatory, hospitals, etc) – understand what each is and be
able to recognize examples:
Primary: preventive care and treatment of minor health problems
Ambulatory: specialist clinics, same day surgery center, urgent care, nurse admin meds
Hospitals: serious illness or injury, complex disease treatment and management
Levels of care – understand each and recognize examples
Primary: preventive care and treatment of common health problems. Ambulator care- think primary
care provider
Secondary care: problems requiring specialized care for a brief period of time for a serious injury
Teriary care: complex disease treatment and management often requires in patient hospitalization
transferring a client within the hospital
Move patient’s personal belongings to a new room, transfer patient chart, care plan and meds, give
verbal report to the nurse in the new area
Nursing care delivery models – recognize four class care models and examples of each
Total patient care: nurses performs ALL patient care. Advantages: patient receives unfragmented care,
easy communication at shift change. Disadvantage: requires higher number of RNs. Most often seen in
critical care.
Functional patient care: Care team assigned to specific function for multiple patients. RN assesses
patients. LPN gives oral meds. PCA takes vital signs and assist with ADLs. Advantages: patient care is
efficient and economic manner. Disadvantages: care may feel fragmented
Team patient care: similar to functional nursing but the activities of each team member are coordinated
by an RN. Advantage if RN is a strong leader it works. Disadvantage: care may still appear fragmented
Primary nursing: planning, directing, and evaluating a patient’s care. Potential fo rcomprehensive care
plans. Dis: larger number of RNs required lots of responsibility on RN
Nursing care delivery models – recognize four class care models and examples of each
Nurse salary expenses are the largest single budgetary item. The number and type od caregivers are
matched to the patient care needs to provide safe care
Total patient care, functional nursing, team nursing, primary nursing
Hospice vs palliative vs respite care
Hospice: holisitic approach to caring for the patient and family
Palliative care: prevent suffering and maximize quality of life for any seriously ill patient. Provided in any
setting
Respite Care- Care provided to caregivers of homebound ill, disabled or older adult patients
What type of patients should an RN take care of vs an LPN
LPN: Suctioning, monitor I&O, inserting cath, admin meds except IV
RN: ADPIE
Task that an RN can delegate to an unlicensed assistive personnel (UAP)
Vitals, ADL’s collecting specimens
How to prioritize tasks as an RN: what to consider first when prioritizing client statements