Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 3
Issues in Nursing Practice
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Health-Care Delivery
 Health-illness Continuum
 Health-care Delivery Systems
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Integrated Care Delivery Network
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Factors Influencing HealthCare Change
 Changing Characteristics of American
Population




Increasing Population
Increasing Number of Older Adults
Increasing Number of Uninsured/Underinsured
Increasing Cultural Diversity
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Factors Influencing HealthCare Change (cont’d)





Evidence-based Practice
Health Information Technology
Robotics
Resistant Infectious Organisms
Nursing Informatics
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Safe Practice
 Joint Commission’s National Patient Safety
Goals
 Sentinel Events
 National Quality Forum
 Adverse Events (“Never events”)
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Safe Practice (cont’d)
 Hospital-acquired Conditions
 Medication Errors
 Distractions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Economic Issues
 Medicare and Diagnosis-related Groups
 Hospital-acquired Conditions and Present
on Admission Indicator Reporting
 Medicaid
 Managed Health Care
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Health-Care Team






Certified Nursing Assistants
Licensed Practical Nurses (LPNs)
Licensed Vocational Nurses (LVNs)
Registered Nurses
Certified Registered Nurse Anesthetists
Certified Registered Nurse Practitioners
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Health-Care Team (cont’d)






Clinical Nurse Specialists
Certified Nurse Midwives
Physicians
Physician Assistants
Pharmacists
Social Workers
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Health-Care Team (cont’d)






Dietitians
Physical Therapists
Physical Therapy Assistants
Respiratory Therapists
Respiratory Therapy Technicians
Occupational Therapists
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Health-Care Team (cont’d)
 Speech and Language Pathologists
 Health Unit Secretaries
 Student Nurses
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
LPN/LVN Role
Provides direct patient care under direct
supervision of physician, dentist, or
registered nurse
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Leadership in Nursing




Decision Making
Communicating
Motivating
Guiding Others
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Communication of Patient Status
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Leadership Styles




Autocratic
Democratic
Laissez-faire
Coaching
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Management Functions





Planning
Organizing
Directing
Coordinating
Controlling
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Leadership and Delegation for
LPNs/LVNs
 Leader/Manager for Care of Assigned
Patients
 Does Your State Allow LPNs/LVNs
to Delegate?
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
The Delegation Process
 Know Your State Practice Act Rules
 Identify Skills of Person Delegated to
 Use Five Rights of Delegation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Five Rights of Delegation





Right Task
Right Circumstances
Right Person
Right Communication
Right Supervision
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
LPN/LVN Career Options






Long-term or Acute Care
Home Health Care
Physician Offices
Clinics
Schools
Child Day-care Centers
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
LPN/LVN Educational Options
 Advanced Education




Associate’s Degree
Bachelor’s Degree
Master’s Degree
Doctorate
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ethics
 Ethics: Study of Traditions, Values, Beliefs
Related to People/Relationships
 Bioethics: Ethical Principles and Values
Applied to Human Life
 Ethical Questions: What Should/Ought We
Do?
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Morals
 Personal Values
 Standards Set by One’s Conscience
 Personal Choices of Good and Bad,
Right and Wrong
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Values
 Standards/Ideals/Concepts Giving Meaning
to Individual’s Life
 Derived from Societal Norms, Religion,
Family Traditions
 Guide Decisions and Actions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Ethical Obligations
 Responsibility to Practice Ethically
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
LPN/LVN Code of Ethics
 National Association for Practical Nurse
Education and Service (NAPNES)
 Professional Guide for Ethical Practice
 Public Statement of Ethical Principles for
LPNs/LVNs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Virtues
 One's Values, Morality, or Conscience
 Defines Who We Are
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Examples of Virtues







Fidelity
Veracity
Integrity
Compassion
Discernment
Trustworthiness
Respectfulness
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Rights
 Bioethical Issues Framed Within Rights
Context
 Examples
 Basic Human Rights
 Patient Rights
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Privacy Is a Patient Right
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ethical Principles




Autonomy
Beneficence
Nonmaleficence
Justice
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ethical Theories
 Utilitarianism
 Deontology
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Theological Perspectives
 Religious Traditions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ethical Decision-Making Steps
1. Identify Ethical Dilemma
2. Identify Stakeholders and Their Values
3. Gather and Verify Information
4. Examine Possible Actions and
Consequences
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ethical Decision-Making Steps
(cont’d)
5. Determine Ethical Foundation for Actions
6. Determine the Best Action with the
Strongest Ethical Support
7. Implement the Action
8. Evaluate the Outcome
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts
 Regulation of Practice of Nursing
 Administrative Laws
 Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts (cont’d)
 Nursing Liability and the Law
 Liability: Level of Responsibility That Society
Places on Individuals for Their Actions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts (cont’d)
 Criminal Law
 Regulates Behaviors for Citizens
 Civil Law
 Rules by which Individuals Seek to
Protect Personal and Property Rights
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts (cont’d)
 Civil Liability Suit
 Complaint
 Summons
 Torts
 Lawsuits for Civil Wrongs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts (cont’d)
 Malpractice
 Breach of Duty
 Negligence
 Injury Resulting from Failure of Wrongdoer
to Exercise Care
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Legal Concepts (cont’d)






Ensuring Patient Rights
Documenting Procedures
Following Institutional Policies
Personal Malpractice/Liability Insurance
Pursuing Continuing Education
Practicing per Current Nursing Standards
Copyright © 2011. F.A. Davis Company