Ethical Issues

Ethical Issues 1. When the care required of a patient comes into conflict with the nurse’s personal beliefs, what situation exists? An ethical dilemma. 2. What is the role of the nurse manager in assuring ethical nursing practice on the unit? Select all that apply. Expert problem solver, implementing the best decision with attention to cost, primary decision maker, identifying desired outcomes. 3. When considering the MORAL decision making model, what step is the nurse engaging in when developing the plan of care? Affirming 4. According to the ANA code of ethics for nurses, what is the nurse’s primary commitment? The application of ethical standards to the delivery of patient care Module 5.01 Appropriate Delegation Situations 1. It is the charge nurse’s responsibility to effectively delegate and provide the right direction and communication for the delegated task for the staff nurses False 2. The nurse delegates a task to an incompetent individual. Who is held accountable for the outcome of the task? The nurse delegator 3. A nurse manager is considering delegating an important task. What steps should the manager take in the delegation process? Train the person delegated for the task, communicate what the task is, communicate the time frame in which the task should be completed, monitor the person until the task is done. 4. A new nurse leader has the opportunity to delegate to a member of the staff. What criteria should the nurse leader be sure are followed before doing this? The right task, right communication, right level of supervision, right person, right circumstance. 5. A charge nurse is delegating to an LVN/LPN. What would be considered improper delegation for the charge nurse to delegate? The employee is given highly detailed exact instructions to complete the task. Common Delegation Errors 1. In order to determine when not to delegate, the nurse needs an in-depth understanding of: The nurse practice act 2. Which of the following creates the potential for successful delegation as emphasized by the National Council State Board of Nursing? Effective Communication 3. Which of the following are delegation errors made by nurse leaders? Failure to delegate Failure to release control of task Failure to provide clear directions Failure to provide adequate directions Failure to follow up 4. A nurse is struggling with time management and thinks it might help alleviate stress and strengthen leadership skills if some tasks are delegated to unlicensed assistive personnel (UAP). What would be important for the nurse to consider when delegating to UAP? ● Qualifications of the person who will carry out the task ● What can and can't be delegated safely 5. A patient on a busy neurosurgical unit who just returned from surgery requires neurological checks every hour, but the nurse is too busy to do it and delegates this task to the unlicensed assistive personnel (UAP). What error in delegation has the nurse made? Improper delegation Culturally Competent Delegation 1. The diversity in the current health care work force affects how each member approach specific assigned goals which influences completion of delegation tasks. This is thought to be related to the: Differences in approach to task relation to priority setting 2. Elements that affect the nurse leader's ability to properly delegate to members of the diverse work force include which of the following? Social organization 3. A nurse is planning to delegate tasks to the transcultural team. What situation would be considered appropriate delegation to the team members? ● Holding a negative performance eval in private for a nurse whose cultural tradition puts emphasis on avoiding "losing face" ● Giving a task that requires independent thinking to a nurse who believes in an internal locus of control a a result of her cultural tradition ● Delegating the interviewing of a reticent patient to a nurse who is outgoing and inquisitive as a result of her cultural tradition 4. A nurse is to provide an in service training on cultural factors that influence delegation and enhance nursing care. Which step to acquiring cultural competence does the nurse determine will involve learning how to read verbal and nonverbal messages Learning specific communication strategies 5. A nurse is planning to delegate tasks to members of a transcultural team. Which tasks would the nurse consider environmental control when delegating to these members? Routine tasks that are done every day ● Tasks with a degree of predictability requiring independent thinking to accomplish ● Tasks that require imagination, vision, and strategic planning 6. A new nurse from a foreign country is training in the surgical unit. After working and meeting with the nurse, the charge nurse observes that there is a discomfort in making eye contact while speaking. What task would the charge nurse avoid delegating to this nurse? Educating a patient and ensuring full understanding 7. A nurse manager determines that a nurse on the team comes from a future oriented culture . What task may be best delegated to this nurse? Working on a strategic team plan for the unit Reducing Resistance to Delegation 1. The nurse leader should respond to resistance of authority in a calm but firm fashion True 2. A nurse leader identifies that a competent RN is incapable of completing a task that falls within the RN scope of practice. The RN's inability is due to lack of training. Which of the following actions should the nurse leader take next? Assign a mentor or coach to the RN to achieve competence 3. The nurse leader understands when delegating, subordinate resistance should never occur among staff members. False 4. A charge nurse has delegated specific tasks to the team and feels as though one of the nurse is resistant to the task delegated. What might be reasons that the nurse is resistant? ● The nurse feels overloaded ● The nurse feels incapable ● The nurse has an inherent resistance to authority 5. A charge nurse is delegating to a staff member who is resistant to authority. After delegating a task to the staff member, what action should she have the staff member do to ensure completion? Ensure the staff member has a voice in how the task is completed 6. A member of a nursing team reports that being given too much to do, and that the member will not be able to complete the work on time. What action will the RN take to effectively manage this situation? Examine the workload and assist the individual in reprioritizing 7. What action can a nurse take to ensure that when delegating to UAP, creativity and independent thinking is encouraged for task completion? Provide consistent and constructive feedback Interprofessional Collaboration 1. What are some of the primary focuses of the health care interprofessional team? (Select all that apply.) ● Collaborative problem solving ● Reducing mortality rates ● Improving quality patient care ● Providing patient centered care ● Increasing professional experiences for health care workers 2. What is one challenge that the interprofessional team faces? Role confusion 3. Implementation problems are not common in multiprofessional teams because all health care workers typically like being part of a team. False 4. The role of the clinical nurse leader (CNL) is directly associated with the successful leadership of an interprofessional healthcare team. Which statements made by the CNL express the components of that role? (Select all that apply.) ● "I've worked with clients diagnosed with cardiac issues for nearly 15 years." ● "The unit nurses have talked with the family and identified a need for a social services consult." ● "We need to determine what, if any, safety issues exist related to this client's ability to ambulate independently." ● "I'll share the patient's care outcomes with the physical therapist today." 5. A client who experienced a traumatic musculoskeletal injury to the right arm was transported to the local hospital's emergency department. The initial care was delivered by an interprofessional team. What specialized, patient-focused care should this form of care delivery provide this patient? Effective communication between individual team members and with the patient will be a priority. 6. What factors are considered when determining the appropriateness of implementing care via the interprofessional team? Select all that apply. ● Skill of the attending staff ● The acuity level of the patient population ● The facility's yearly budget ● The complexity of the required patient care 7. Which statements demonstrate the patient benefits derived from care provided by an interprofessional team? (Select all that apply.) ● "We have been so pleased with the care my mother has been given while she is recovering from her fall." ● "The nurses all seem to really care about each of their patients." ● "The physical therapist and my nurse worked together to schedule my therapy before my wife came to visit." ● "My doctor, the nurse, the social worker, and the dietitian had a meeting with me today about my discharge plan." 8. In an interprofessional team, the role of a nurse leader is elevated from caregiver to include which essential responsibilities? ● Implementing a team approach to care delivery. ● Integrating all aspects of client care. ● Assuring client and client family satisfaction. ● Supporting client autonomy related to care decisions. ● Assuring the effective transition from facility to home care. Factors Contributing to Successful Teams 1. Which of the following is important for ensuring team collaboration efforts will be successful? Shared vision, role clarity, and use of effective communication 2. The case manager is part of the interdisciplinary team who is a nurse leader whose role is to _______. (Select all that apply) ● Coordinate patient care ● Evaluate options for patient care ● Monitor patient care ● Advocate for the patient 3. The bachelor's degree-prepared nurse is tasked with the need to understand interprofessional communication and collaboration in order to be prepared to improve patient health care outcomes. True 4. What is the best focused response when asked, "What does clear and efficient communication mean"? (Select all that apply.) ● A thorough handoff of the situation, including background, your assessment, and any recommendations. ● Checking for the receiver's understanding before moving on. ● Information is presented in language the receiver can understand 5. What factors contribute to the success of interprofessional teams? (Select all that apply.) ● Having role clarity ● Acknowledging the shared vision ● Forming clear and efficient communication 6. What does an interprofessional team member need to understand about role clarity for the team to be successful? The role and responsibilities of all teammates 7. What is considered to be the greatest challenge to the implementation of an interprofessional primary health-care team? Overcoming the traditional provider-dominated role of determining patient care 8. In an interprofessional team, what do teammates need to understand in order to have a shared vision? ● Desired outcomes ● Potential challenges to meeting outcomes ● After-care options Lewin’s Change Theory 1. The nurse leader should identify the _______ forces prior to attempting to implement change. Restraining 2. Change should be immediately implemented if the need for change has been identified. False 3. Who developed a theory that provides nurse leaders with tools to become effective change agents? Kurt Lewin 4. You are the nurse manager of a medical surgical unit that is in need of a change in staffing rotation patterns. which will lead to major changes in how the unit is staffed. According to Lewin's Change Theory, what forces are in play to enact these changes? Driving forces 5. The unit manager of a medical surgical unit is transitioning the unit to electronic charting. According to Lewin's model, which of the following roles describes you as the change agent? The unfreezer 6. The charge nurse of a step down unit is implementing a new procedure for charting, which will impact all of the nursing staff. According to Lewin's Model of Change, the Movement stage can be more successful if certain things are considered by the change agent. ● Include all stakeholders ● Set target dates ● Implement the change 7. The oncology unit has recently experienced a higher than normal patient census, which is requiring that nurses pick up an additional patient. The hospital CFO has indicated that there are no additional funds available to hire additional full-time nurses. As such, the unit manager anticipates some behavioral responses by the stakeholders of change (nursing staff) within the unfreezing phase. What are some possible behavioral responses? ● Anger ● Withdrawal ● Discontentment 8. A single parent raising two children and relying on public transportation, is determined to become a registered nurse. What are the restraining forces in this situation? ● Relying on public transport ● Being a single mother ● Stress of being away from children Module 6.02 Strategies for Leading Change 1. Select the classic change strategies that nurse leaders use to apply the change process. ● Rational-Empirical ● Normative-Reeducative ● Power-Coercive Strategy 2. Which of the following is not included in the contemporary change process? Evaluation 3. The nurse leader should not only understand the change process but also understand how to adapt to various methods in order to become an effective change agent in their organizations. True 4. A nurse manager notices that supply carts are unorganized and could use some attention. What strategy can the manager use to help implement change in this area? Encourage input from subordinates for potential options 5. A nurse manager is assigned to a new unit due to issues of administrative mismanagement, which had resulted in staff becoming disillusioned as to the mission of the unit. As the unit manager, you are expected to develop new policies for the staff to follow. What is one of the greatest factors that may contribute to resistance of change on this unit? Lack of trust 6. The nurse manager for a medical surgical unit is implementing change in unit procedures as it relates to patient discharge. During the fourth phase of change known as action, the manager should incorporate the major component known as: Communication 7. A nurse leader recently transferred to a different hospital that is much older than the hospital at which the nurse was previously employed. After working in the new hospital for a month, the nurse leader believes it would be a great idea to brighten the rooms with a lighter paint job, obtain newer hospital beds and curtains, and hang some fun artwork. However, the nurse leader doesn't want to be perceived as a threat to the team. How could these ideas be presented to minimize resistance? ● Engage other nurses in a discussion about the benefits of exam room aesthetics, then present the idea ● Engage other nurses in a discussion about the benefits of exam room aesthetics, then solicit their ideas to improve aesthetics. ● Make over one of the exam rooms and use it as a test case to collect data on patient satisfaction, then present the data with the idea to the team if the experiment was successful 8. A nurse leader is thinking about approaching their manager with a new idea. To be properly prepared, the nurse leader should recognize this as a natural and unexpected response to change. Resistance Responding to Resistance to Change 1. Resistance to change should be expected True 2. Choose other factors that may evoke resistance to change ● Feelings of losing control ● Anxiety ● Weak proposal ● Timing 3. Which of these changes is likely to encounter the least resistance? Introducing a new type of IV pump 4. The nurse is a member of the nursing staff at a hospital that is undergoing significant organizational change. Which factor is the greatest contributor to the resistance encountered with organizational change? Employee mistrust of management 5. The charge nurse for a post-op treatment center believes that change needs to take place to make the nursing process smoother and the treatment center safer. The nurse's rationale for making change would include which reasons? (Select all that apply.) ● To improve staff productivity ● To reduce unnecessary workload. ● To solve an existing problem 6. A nursing staff member in the ED has noted where improvement of a procedure would bring about more efficiency. The staff member wants to share their idea with their supervisor. What would be the best option to facilitate the possibility of change? Schedule a meeting with your supervisor and submit a concise plan related to your idea for consideration. 7. After attending a health care research seminar, a registered nurse who works in the transplant unit became very interested in the ability of 3D printing to help save lives. The nurse would really like to raise awareness and see the hospital invest in a 3D printer. What are the different technical reasons for resistance that the nurse may encounter? (Select all that apply.) ● Lack of resources ● Underqualified personnel ● Budget Issues 8. A new nursing graduate has just started working in a hospital unit that has had difficulty in staff retention. Which type of resistance may be a result of changes that will occur despite the beliefs of the workforce? Cultural Steps to Implement Change 1. What is the role of the change agent? Seeks to lead or create change 2. The nurse leader is a change agent and needs to identify factors that lead to resistance of change. Identify factors of resistance: ● Lack of trust ● Poor timing ● Personal energy needed ● Comfort with the current way of completing goals or tasks 3. It is important for nurse leaders to establish a trusting relationship with those involved in the change process. True 4. A nurse leader is working in the ER when a patient presents with a deep head laceration requiring immediate suturing. The nurse leader went to the medical supply area for antibacterial ointments, gloves, and bandages. However, the nurse noticed that the medical supply cabinet was extremely disorganized, so it took much longer than it should have to find the necessary supplies. The next morning, the nurse leader began to ask team members if they had any input regarding the organization of medical supplies, and then began to brainstorm a few different ideas, such as rearranging the supplies and relabeling items. What is the next stage of change the nurse leader should address? Plan 5. A few months ago, a new nurse leader at a hospital discovered via EBP that tablet computers improved accuracy of documentation and decreased patient wait time. The leader noted that these outcomes are beneficial to the facility, staff, and patients as tablets provide portable access to patient electronic medical records. The nurse leader is currently in the planning stage. Which activities are part of the planning stage? ● Anticipating resistance to the change by less tech savvy staff. ● Determining the scope of the change of the project, a schedule for its implementation, and a budget to submit to administration for approval. 6. Last month, two nursing units were merged to save on staffing costs. The nursing manager is now inquiring among the staff about how the change is working and if any barriers remain. What stage of change is this? Integrate 7. A nursing staff member who is on a unit committee to bring about a planned change is currently in the integrating phase of change. What activities are associated with the integrating phase? ● Assessing how well the new process is accepted and becoming the new norm. ● Assessing how well the change is working against an established measurement for success. 8. As the nursing manager of a unit, which key steps should be performed before implementing a change effort? ● Encourage input from team members who would be impacted by the change. ● Investigate the magnitude and complexity of the intended change. ● Use a roadmap as a guide to complete the change Nurse Practice Act and Legal Liability 1. The American Nurses Association Code of Ethics is legally binding False 2. A nurse can have their license revoked if they provide patient care while under the influence of drugs or alcohol. True 3. Why should nurses be aware of the rights and duties of legal matters? They are better able to protect 4. What is the term used to identify the omission of doing something that a reasonable person would do, guided by the considerations that ordinarily regulate human affairs? Negligence 5. Which steps will help the nurse minimize the risk of nursing malpractice? ● maintaining liability insurance independent of that provided by the facility ● observing all facility policies and procedures when providing care ● attending relevant continuing education programs to upgrade clinical skills ● periodically reviewing the scope of practice for nurses 6. Which situations are necessary components for malpractice to occur? ● foreseeability of harm must exist ● the practitioner has failed to meet a standard of care, also called a "breach of duty" ● a standard of care must be in place whereby the provider has accepted duty for the patient ● a direct connection between care given and injury must be present 7. A nurse manager must be aware of what is happening on the unit to prevent injury to the patient and exposing the staff to a potential malpractice situation. What steps would the nurse manager take to accomplish this? ● providing disciplining those who provide inappropriate care ● regularly checking the credentials of current nursing staff ● arranging for relevant staff in-services regarding the operation of equipment ● assuring adequate staffing 8. What information is accurate when describing the Nurse Practice Acts? ● when considering the law, they are an example of a statute ● they identify actions that fall outside of the nurse's scope of practice ● they need to be consistent with applicable federal statures ● they focus on the practice of the professional nurse Patient Rights, Privacy, and Informed Consent 1. Informed consent can be given if the patient verbalizes understands prior to receiving a complete explanation of medical-surgical treatment options False 2. Litigation is the process of bringing forth and trying a lawsuit True 3. HIPAA gives the nurse leader a platform in which the nurse leader can prevent conflicts resulting from ineffective communication among staff members and patients True 4. What must a person giving informed consent for surgery or a procedure fully comprehend in order to give informed consent? ● expected complications or potential side effects that may occur as a result of the treatment ● expected or desired outcomes ● the risks involved ● the procedure to be performed 5. How can the nurse manager best minimize the personal risk for legal liability? Creating a work environment that prioritizes patients needs 6. Which legal act gives patients the right to determine their desired end-of-life care? patient self-determination act 7. The health insurance portability and accountability act ensures strong privacy protections for the patient without threatening access to which areas of care? ● exchange of patient info among appropriate health care providers ● health care plans ● health care clearinghouses 8. Which behaviors by a nurse can result in suspension or revocation of the nursing license? ● being convicted of professional negligence ● a felony conviction for drug use ● practicing on an expired nursing license ● failing to report an incident of substandard nursing care Introduction to Legal Terminology 1. Nurses should be concerned with the various laws and statutes that govern health care True 2. A wrong committed against another person or property is a tort. True 3. The person who generates the lawsuit is the defendant False 4. Which statement is true regarding the Good Samaritan law? ● Protection provided is generally limited to emergency situations. ● The provider may not exceed scope of practice limits. 5. A nurse is arrested for possession of illegal drugs. What kind of law governs this type of activity? Criminal 6. What term is used to identify the type of law that covers most incidences of malpractice? Tort Laws 7. Which type of law regulates the practice of nursing? Civil Law 8. A nurse does not assist with ambulation for a postoperative patient on the first day after surgery. The patient falls and fractures a hip. What charge might be brought against the nurse? Negligence Nursing Legislations 1. A nurse would be considered liable if he or she fails to report a witnessed violation of the nurse practice act. True 2. Choose the legal safeguards nurses can refer to and practice to prevent litigation against them. ● competent practice ● patient bill of rights ● risk management programs ● informed consent ● documentation 3. Nurse leaders are responsible for licensing nurses? False 4. Which of the following legislations guarantees overtime? Fair Labor Standards Act (FLSA) 5. What is the primary focus of the Health Insurance Portability and Accountability Act (HIPAA)? The patient’s right to confidentiality 6. What is the nurse manager's focus when addressing issues represented by Title VII? Civil rights of staff and patients 7. Which labor standards were set in place by the Fair Labor Standards Act? ● illegal employment of minors ● maximum of an 80-hour regular pay period ● minimum wage ● guaranteed paid overtime 8. What is the focus of the Patient Self-Determination Act (PSDA)? ● educating patient regarding the role of a health-care proxy ● providing pts w/ written info about health care durable power of attorney ● informing pt's about advance directives (AD) ● educating staff concerning end-of-life issues 9. The equal Employment Opportunity Commission defines discrimination as including which forms of discrimination? ● sexual harassment ● pay/compensation ● age ● race or color Legal Safeguards 1. The nurse acts as the patient advocate with regard to informed consent True 2. What is the nurse's best safeguard against legal prosecution? Competent practice 3. A nurse explains the informed consent form to a pt who is scheduled for heart bypass surgery. Which elements are considered essential to the effective establishment of informed consent? ● competence of the patient must be determined prior to consent ● comprehension of the info by the pt or guardian ● full disclosure of info regarding the procedure 4. The nurse manager has an obligation to act as advocate for which entities? ● staff ● patient ● themselves ● profession 5. What rights do patients have? ● informed consent ● respectful care free of discrimination ● protection of their privacy ● right to end treatment w/out physician consent 6. Which statement is true about an incident report? ● the chart should contain all the variables related to the incident ● a disclosed incidence report can be subpoenaed in court ● the document is generally considered confidential