Nursing Exam Study Guide Chapters 6-16

1. Define Nursing Accountability: Taking responsibility r/t patient care and consequences 2. What does it mean to be accountable as a professional nurse? List 3 reasons. Nurse practice act, nurse code, standards of care 3. Professionalism and Accountability mandate that nurses must work within our scope of practice/legal framework 4. What are the purposes of the State Board of Nursing? ● Safe guard nursing services for citizens of PA ● Preparation of RN and LPN ● Safe standards of nursing practice through: Examination and license of graduates of approved educational programs ● Endorsement from other jurisdictions through the regulations of nursing in this commonwealth ● Rules and Regulations ○ These have statutory authority which means they are the law ● Statements of policy ○ These are interpretive ● Informed opinions ○ Do not carry the weight of law and are considered individual responses ● They have the authority to enforce the Professional Nursing Law through the rules and regulations, policy statements and informed opinions ● Penna. Code 5. Professional License ● Protected by the Constitution ● Cannot be limited or revoked without due process ● State’s Administrative Procedure Act guides states in ensuring Due Process 6. Nurse Practice Act a. What is the Nurse Practice Act: Rulebook ◦ Acts administered by State Board of Nursing b. State Nurse Practice Acts: ◦ Establish entry requirements ◦ Set definition of practice ◦ Determines the abbreviations nurses may use ◦ Establish professional discipline ◦ May define the responsibilities of State Boards of Nursing 7. Enforcing Educational Requirements and Discipline a. State Board of Nursing set and enforce minimum criteria for nursing education programs b. Schools must have SBN approval to operate c. SBNs have the power to discipline a license d. Discipline: in order to protect the public e. Most frequent reason for discipline is …….. ● Actions Prompting Disciplinary Action ● Fraud ● Deceit ● Impairment…most common! ● Unprofessional Conduct ● Incompetence ● Criminal Acts ● The impaired nurse: …… 8. Legal Issues: Negligence a. A person suffers harm as the result of an unintended wrongful act by another b. Negligence: failure to act in a reasonable manner in a specific circumstance c. Negligence: “failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” 9. Legal Risks in Professional Practice a. Malpractice: negligence applied to the acts of a professional b. There is a legal duty to provide the patient with a reasonable standard of care c. Malpractice: “an improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position….to denote negligence or unskilled performances of duties when professional skills are obligatory.” (JCAHO,2003) d. Malpractice ● Malpractice does not have to be intentional ● Occurs through commission or omission ● Central question in malpractice charge is: ○ Was the prevailing standard of care met? ■ Standard of care reflects basic minimum level of prudent care ● Elements Necessary for Malpractice ○ Nurse has assumed the duty of care ○ Nurse has breached the duty of care by failing to meet the standard of care ○ Nurse’s failure to meet the standard of care caused the injury ○ Injury is proved e. Six Categories of Negligence That Result in Malpractice Lawsuits ● Failure to follow standards of care ● Failure to use equipment in a responsible manner ● Failure to communicate ● Failure to document ● Failure to assess and monitor ● Failure to act as a patient advocate 10. Legal Issues Common in Nursing Confidentiality ● Confidentiality: both a legal and ethical concern ● Protects private information about a patient during provision of medical services ● ANA Code of Ethics addresses obligations of confidentiality ● Nurses are not usually protected by statutorily protected privileged communications ● Nurses may be ordered to share information without patient consent ● Nurses have a duty to report certain information, such as abuse of a child 11. Review HIPPA a. Advanced Directives (AD): written instructions that describe an individual’s preferences in regards to medical interventions b. In PA called Advance Directive for Health Care Act. c. Many courts have found the patient’s right to privacy outweighs the state’s interest. d. Right to self-determination – most supreme exercise of this right occurs when patient consent to life sustaining treatments or refuse them e. Patient Self-Determination Act of 1991 requires acute & long-term facilities to: ● Provide written information to pts about their rights ● Ensure compliance with state laws on Ads ● Provide education on advance directives ● Document if pt has an Advanced Directive 12. Delegation: a. b. c. d. e. f. g. h. i. j. Assigning responsibility and authority for performing tasks to others Getting work done through others to accomplish a goal Delegation: Carries Legal and Safety Implications Giving someone authority to act for another A nurse's primary legal and ethical consideration is safe, effective care for patients Professional nurses retain accountability for acts delegated to another person There are five rights to ensure safe delegation of tasks to unlicensed assistive personnel (UAPs) Most debated area of delegation involves medication administration by UAPs 5 Rights of Delegation ● Right task ● Right circumstances ● Right person ● Right direction/communication ● Right supervision 4 A’s of Delegation ■ Assess: Needs of the patient; Competency of the personnel ■ Assigning: requires the ability to clearly communicate the parameters of the assignment ■ Authority: granting authority from the delagator to delagatee ■ Accountability: requires supervision to ensure task is completed correctly 3. Which of the following falls under the jurisdiction of the state board of nursing? 1. Approving or reject applications for new nursing education programs 2. Expanding the provisions of the nurse practice act 3. Reducing the provisions of the nurse practice act 4. Right to suspend the need for licensure of registered nurses (RNs) in times of extreme shortage 10. A nursing student got a thank-you card from a patient’s family and had another student take a photo of the student with the family. The student asks the nursing instructor if it would be alright to post the photo on Facebook. Which response by the instructor is best? 1. “Yes, as long as you ask the family if that would be OK.” 2. “I think that would be OK, but you should check hospital policy.” 3. “No, posting pictures of patients and families on social media sites is not acceptable.” 4. “No, that could lead to a malpractice suit by the patient or family.” 16. In which of the following situations should the legality of an informed consent be questioned? 1. Patient with dementia; consent given by spouse 2. Patient who received a preoperative dose of Demerol before giving consent 3. Patient who is anxious and asks many questions of the physician 4. Patient who expresses concern about the cost of the procedure 17. Which of the following is a nursing responsibility regarding informed consent? 1. Canceling the procedure if the patient has questions 2. Explaining the procedure, risks, and treatment alternatives 3. Serving as a witness, ensuring that the patient does not feel coerced into a decision 4. Ensuring that the physician has completely explained the costs of the procedure 18. Which of the following actions is acceptable as an exception to a nurse’s obligation regarding confidentiality? 1. Reporting certain diseases to public health authority 2. Discussing a patient’s care with someone who does not know the patient 3. Leaving printouts of lab reports on the desk in the physicians’ lounge as a convenience 4. Discussing a patient’s condition in a public place as long as the patient’s name is not mentioned 25. Which of the following is an important step in preventing legal action against the nurse? 1. Never make a mistake. 2. Deflect blame from yourself as much as possible. 3. Develop caring, therapeutic relationships with patients. 4. Avoid explaining care procedures to patients. ○ Chapter 8 Basic Fundamental Concepts of Professional Nursing Practice Concept 1: Person: An open system with human needs ● Individual man, woman, and child. ● Each individual is an open system with numerous subsystems. ● Each person is unique—determined genetically, environmentally, and experimentally Human needs—required for a person’s well-being ● Maslow (1954) Motivation and Personality: Human behavior is motivated by intrinsic needs. He identified five levels of needs. Maslow’s Hierarchy of Needs 1. Physiological needs—food, oxygen, rest, activity, shelter, and sexual expression 2. Physical and psychological safety and security—reasonably predictable environment with which one has some familiarity and relative freedom from fear and chaos 3. Love and Belonging—close intimate relations, social relations, a place in the social structure 4. Self-esteem—need to feel self-worth, self-respect, and self-reliance 5. Self-actualization—realized maximum potential Assumptions About Maslow’s Hierarchy of Needs • Basic needs must be at least partially satisfied before higher-order needs can become relevant to the individual. • Individuals meet their needs in different ways • The manner the needs are met and the extent by which these are considered needs vary according to each individual • Individualized nursing care Concept 2: Environment: The supra-system in which a person lives in. ● The environment can either promote or interfere with homeostasis and well-being of individuals. ● In Maslow’s hierarchy of needs, there is a dynamic interaction between a person’s needs (internal) and the satisfaction of those needs (often environmentally determined). ● Nurses have always been aware of the influence of environment on people ● ● ● Florence Nightingale—understood the elements of a healthful environment Concerns about the health of the public. Local, state, and national levels: Establish standards and regulations that ensure the safety of food, water, air, cosmetics, medications, workplaces, and other areas. Environmental Systems: ● Family system ○ Family defined ○ Nuclear and extended family ○ Challenges of the single-parent families ○ World War II and geographic mobility ● Cultural systems ○ Define culture: consists of attitudes, beliefs, and behaviors of social and ethnic groups that have been perpetuated through generations ○ Define Ethnocentrism: making judgements, usually negative, about another’s culture relative to one’s own ○ Patient-centered care and integrating cultural health beliefs ○ Astute nurses realize that integration of a patient’s cultural health beliefs into planning patientcentered care can make a strong impact on that patient’s desire and ability to improve his or her health. ● Family—defined as the patient defines family and does not necessarily involve “blood relatives.” ● Family system—the way the family functions with and within the environment and the dynamics between various members of the family ○ Most direct environmental influence on a person. ○ The family background can shape one’s adulthood but it is not determinative. ○ Nuclear and Extended Families ■ Nuclear family—parents and their children moved away from former sources of nurturing (older relatives such as grandparents, aunts and uncles) ■ Extended family—children were nurtured by a variety of relatives, as well as by their own parents ○ Since World War II- increased geographic mobility of families has changed the way extended family is involved in the lives of children because nuclear families may live across the continent or the world from other relatives ○ Single parents—life is challenging who must earn a living and fulfill the nurturing roles in the family ● Social systems ○ Social change and illness ○ Individuals are influenced by the social system. ○ Social institutions include family, neighborhood, school, churches, professional associations, civic groups, and recreational groups ○ Social support—emotional support, companionship, informational support, and material support ○ Poverty ■ Define poverty ■ What are poverty’s implications on health? ■ Poverty means living with deprivation and the scarcity of necessities such as food and adequate housing ■ Implications: ● People living in poverty have diminished access to health care for a variety of reasons ● Lack of money means inadequate nutrition and lack of basic health care, adversely affecting the health status of all family members. ● Food insecurity and hunger; poor transportation, inability to pay mortgage or rent, and inability to pay for utilities such as natural gas, water, and electricity ○ Community, national, and world systems ■ ○ ○ ○ ○ ○ ○ Nurses can contribute to a healthier world environment by supporting, promoting, and, when possible, participating in humanitarian responses to national and international disasters Social change ■ Holmes and Rahe (1967): people with many social changes that disrupt social support were more likely to experience illness in the following 12 months than people with few social changes Social support—means that a person belongs to a social network, feels loved and cared for, and can count on people for assistance Emotional support— comes in the form of concern for, affection, love, caring, encouragement, and conveying a sense of value to the person being supported Companionship— is a form of support that gives the supported person a sense of belonging and provides people with whom to share social activities Informational support is advice and guidance, the sharing of useful information Material support, also called tangible support, refers to financial help, providing material goods and/or services Which one of the following guiding principles helps explain nursing’s holistic approach? ● Nursing care can be provided in a variety of settings. ● Nursing care persists even in the absence of scientific research. ● Nursing care considers mind, body, and spirit. ● d. Nursing provides care regardless of a patient’s belief systems or culture. ● Concept 3: Health: A continuum WHO: Definition of Health refer to narrated powerpoint Pages 185-186 ● ● ● ● ● ● Health Belief Model ■ An evaluation of one’s vulnerability to a condition and the seriousness of that condition ■ An evaluation of how effective the health maintenance behavior might be ■ The presence of a trigger event that precipitates the health maintenance behavior Self-efficacy: Whether people considered altering detrimental health habits depended on their belief in themselves as having the ability to modify their own behavior. High beliefs in one’s self efficacy leads to efforts to change, low perceived self-efficacy leads to lack of change Holistic Nursing Care: Nourishes the whole person (mind, body, and spirit) Review the 8 beliefs Belief ○ Define ○ Attitudes and behaviors ○ Nonjudgmental attitude Belief systems—serve to guide thinking and decision making ○ Differences in beliefs like blood transfusion, vaccinations, etc. Chapter 10 ● Scientific method: systematic way of thinking about things and solving problems ● Bias: refers to systematic distortion of a finding from data, often resulting from a problem with the sample. Sample size should be wide range to test theory. If you only test one group your results will be biased. ● Quantitative research: standardized experimental designs with hypothesis, measurable variables and outcomes, and statistical analysis. CAN COUNT THE VARIABLES ● Qualitative research (Naturalistic inquiry or interpretivism): relies on data collection techniques like narrative interviews and participant observation. Variables not being manipulated. ○ Commonly used in social sciences where measurement of phenomena may not be possible. ● Other types: ethnography, phenomenology, and grounded theory ● Mixed methods—combination of qualitative and quantitative ● How do you apply the scientific method to practice? How can research findings be provided? Examples? ● Basic, clinical, and translational science ● Pure science: (bench science) summarizes and explains the universe without regard for whether the information is immediately useful- new knowledge ● Applied science: (clinical science) practical application of scientific theory and laws- also known as clinical science ● Translational research: conduit between bench research and bedside research ● Evidence-based practice is an element of critical thinking and a good means of improving clinical judgment. ● Focusing on evidence of effective interventions helps prevent nursing practice from deteriorating into routine or traditional care ● Ways to stay current and aware of new evidence: ○ Continuing education courses, professional conferences, journals, and membership in professional organizations Evidence-based nursing practice involves which of the following? (Select all that apply.) 1. The use of the best evidence available supporting the interventions 2. The use of randomized controlled trials only versus qualitative studies 3. The expertise of the professional nurse 4. Resources to identify practices that have traditionally been used in nursing practice 5. The preferences of the individual patients and their families IOM Report To Err is Human ● ● ● ● Explain the importance of near-misses. What are Near-Misses? Can you give examples? Safety: Freedom from accidental injury Error: Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim Two primary dimensions to consider: 1. Safe care is consistent with current knowledge and customized/individualized to meet patient needs and requirements 2. Factors within the external environment also have an impact on safety 3. What do these two elements mean in the clinical setting? Types of Errors 1. Diagnostic 2. Treatment 3. Preventive 4. Other Many errors go undocumented or are not reported due to staff fear of reprisal, lack of adequate systems to report, limited staff education about safety and report process, and lack of computerized surveillance systems. 1. Error or delay in diagnosis, use of outmoded tests or therapy 2. Error in performance of a procedure, avoidable delay in treatment 3. Failure to provide prophylactic treatment, inadequate monitoring 4. Failure to communicate, equipment failure Other Types of Errors: 1. Active error: Occur at the level of the frontline, when work is done and effects are felt almost immediately 2. Adverse error: An injury resulting from a medical intervention or in other words it is not due on to the underlying condition of the patient 3. Error of commission: Doing some action that results in harm, e.g., administering wrong drug 4. Error of execution: Correct action does not proceed as planned 5. Error of planning: Original planned action is not correct 6. Iatrogenic injury: Harm to the patient that is caused or originates from care management 7. Latent error: Errors removed from the direct control of the operator and include things such as equipment problems, environmental, management decisions 8. Near-miss: An errors of commission or omission that could harm a patient but does not cause harm or serious harm. Errors of commission or omission that could harm a patient but do not ○ A near-miss is still important to report! 9. Sentinel event: An unexpected occurrence involving death or serious physical or psychological injury or risk of this Be able to apply examples Adverse Events: Questions to Ask: • Who discovered or reported the event—role rather than names? • How was it discovered? What happened—the type of adverse event? • • Where in the care process was the event was discovered, or where did it occur? • When did it occur? • Who was involved—functions, not names? • Identify the advantages and disadvantages of mandatory reporting. • Describe how root cause analysis is used? Why—the most dominant cause based on a preliminary analysis? • • What is the severity of the event? • Was the event preventable? • If product involved, what is the product information (blood, devices, drugs)? What is the patient information (age, gender, ethnicity, diagnoses, procedures, and co-morbid • conditions)? Root Cause Analysis Definition of Root causes: ● Specific underlying causes. ● Causes that can reasonably be identified ● Causes management or practitioners have control to fix. ● Causes for which effective recommendations for preventing recurrences can be made. ● Root-cause analysis results should then be explored including: It is important to recognize that a single root cause is often an oversimplification. “The real purpose is to use the incident to reveal gaps and inadequacies in the healthcare system” (Vincent, 2003, p. 1051). ● ● ● Root causes are underlying causes ○ Goal is to identify specific underlying causes. Better when more specific. Root causes are those for which effective recommendations can be generated Medication Administration Recommendations ○ Use standard processes for medication doses, dose timing, and dose scales in a given patient unit ○ Standardize prescription writing and prescribing rules ○ Limit the number of different kinds of common equipment ○ Implement physician order entry Examples of some of the patient safety practices and targets in the report are: handwashing compliance, nosocomial infections, central venous catheter insertion, prevention of surgical site infections, pre-anesthesia checklists, identification bracelets, prevention of pressure ulcers, pain management, nurse staffing, fatigue and safety, and much more. Promoting and implementing safety practices are also discussed and information about practice guidelines, critical pathways, clinical decision support systems, educational techniques to change provider behavior, and much more are included in this AHRQ report. IOM: Crossing the Quality Chasm: The reports identify six major improvement aims that need to be considered by all healthcare providers. The report describes six dimensions of patient-centered care, which were identified by Gerteis et al. (1993; as cited in IOM, 2001, p. 49). The dimensions are: (1) respect for patients’ values (cultural, ethnic, and religious), preferences, and expressed needs; (2) coordination and integration of care; (3) information, communication, and education; (4) physical comfort: (5) emotional support—relieving fear and anxiety; and (6) involvement of family and friends. How does this apply to your patient care? 1. Safe—avoiding injuries to patients from the care that is intended to help them. The critical elements are: (1) Patients should not have to repeat information as they go through the healthcare system or go from system to system. (2) The health care system and process should be seamless and utilize an interdisciplinary approach. (3) Health care providers need to have knowledge about their patients. (4) Patients need to be informed and participate in their care; and (5) When complications occur, patients need to be informed and involved in decision-making to resolve complications. How does this apply to your patient care? 2. Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively). Effective care implies evidence based health care with integration of best research evidence, clinical expertise, and patient values (Sacket et al., 1996). Nursing is incorporating evidence based practice in the clinical setting, and nursing education must provide content in this area so that graduates are able to understand and participate in evidence-based practice within health care organizations as employees. 3. Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. The key focus is on the patient’s experience of illness and health care. It is quite clear that patients are entering the health care system more informed than in the past due to the easy accessibility of health information. Patients need support in their efforts to be more informed, and nurses have long been advocates of patient education. There is, however, a problem in that nurses have little time for patient education today or time to guide patients to needed information. This problem needs to be resolved —from both the nursing education and practice perspectives. 4. Timely—reducing waits and sometimes harmful delays for both patients who receive and those who give care. When patients encounter problems with timeliness it can lead to physical harm and more frequently to emotional stress. It does affect the patient’s trust in the system. 5. Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy. Better use of resources reduces costs and makes resources more available to those who need them. 6. Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socio-economic status. Chapter 4 explores the critical issue of health care disparity. Aiken’s Article Identify the following: · Objective of the study · Survey Variables · Results and Conclusion of the Study · Limitations of the study 1. What were the variables examined? The variables examined in this research included an annual survey from the Pennsylvania department of health showing the specific education levels for nursing staff and patient mortality within a thirty-day of admission. Patient and hospital characteristics, including size, teaching status, and level of technology, were considered as variables. 2. What did the results reveal? The results indicated that increased highly educated nursing staff, especially with bachelor’s degrees, led to a decrease in the likelihood of patient mortality. 3. What conclusions did the authors draw from the results? The study concluded that hospitals with higher educated and experienced staff, nursing staff with baccalaureate level or higher, led to lower mortality rates in surgical patients What are the initial, and important in nursing research? Ans: identify problem, ..variable, .. -Quantitative and Qualitative conduct research ?... I pick balance…. -Benefit of union? Select all apply, benefit, hour, pay -what is Aikne article objective? More BSN degree reduce the risk patient motility - Another question about Aiken article - Select all apply near-missed error - Allow you to practice multiple states: Ans: nurse license compact ( I pick that) - Synt-error -which statement is malpractice? RN give NG tube when patient is supine -legal definition of nursing can be found? Ans- state nurse practice act, nurse - which nursing action that nurse can share and not violate HIPPA? Ans: report a certain disease to public health care -only 50% nurse patient ratio.—I pick “false” - when you earn nursing license, you cannot revoke without due process… Ture or False? -What is state nurse practice act? what is Aikne article objective? More BSN degree reduce the risk patient motility - Another question about Aiken article Chapter 11-Nursing Judgement\Clinical Judgement ● ● ● ● ● ● Open-minded, recognizes alternative ways of seeing problems, and has ability to assess assumptions, implications, and consequences. Reflective thinking is an active process valuable in learning and changing behaviors, perspectives, or practices. Critical thinking in nursing is undergirded by the standards and ethics of the profession. Nurses who think critically are engaged in a process of constant evaluation, redirection, improvement, and increased efficiency Nursing Process ■ Assessment—gather information or data about the individual, family, or community. ■ Analysis and identification of the problem ■ Planning ● Bloom’s taxonomy and domains of learning (cognitive, psychomotor, and affective domains) ● Goals should be agreed on by both nurse and patient. ■ Implementation of planned interventions ● Occurs when nursing orders are actually carried out. ■ Evaluation ● The nurse examines the patient’s progress in relation to the goals and outcome criteria to determine whether a problem is resolved, is in the process of being resolved, or unresolved. Clinical Judgement consists of informed opinions and decisions based on empirical knowledge and experience. ○ Knowing the limitations of your expertise is an important aspect of clinical judgment. A patient is in respiratory distress and placed on oxygen. Which is the most appropriate short-term goal? 1. Nasal cannula remains in place. 2. Patient completes morning care and eats breakfast. 3. Patient verbalizes that he is breathing better after lunch. 4. Patient maintains an oxygen saturation of 90% during the shift. Chapter 14 ● Healthy People 2020: sets and monitors national health objectives building on lessons learned in the previous decade ● Major Categories of Health Services: Health promotion and maintenance, including early detection, illness prevention, diagnosis and treatment, rehabilitation and long-term care ● Illness prevention services address health problems after risk factors are identified ● Health promotion services seek to prevent development of risk factors ● Rehabilitation services help restore the patient to the fullest possible level of function and independence after injury or illness ● Rehabilitation with disease management services focuses on helping patients understand and manage chronic conditions ● Long-term care provides services that the patient or family cannot provide but at levels that maintain individual independence as long as possible ● Subacute care services—goal-directed, comprehensive, inpatient designed for acute illness, injury, or exacerbation of disease process ● Board of Directors- CEO- Medical Staff- Nursing ● Continuous quality improvement and total quality management ○ These systems focus on establishing procedures for ensuring high-quality patient care ○ Performance improvement. ● Health care disparities are differences in access to and the quality of health care provided to different populations ● Goal: Deliver consistent, comprehensive care by identifying one nurse who is responsible, has authority, and is accountable for patient outcomes. ● · Role of the primary nurse: 24-hour accountability for care outcomes. ● · Nurse Manager Role: Reducing spending does not have to mean sacrificing quality patient care. ■ o Become cost-conscious ■ o Provide excellent care and be advocates for patient’s personal finances ■ o Question unnecessary or repetitive tests, suggest generics, and detect problems early to avoid repeated hospitalizations ■ o Organize and streamline flow of patients for maximum efficiency. 4. Health promotion differs from illness prevention in that health promotion 1. addresses identified health problems. 2. occurs before the identification of disease risk factors. 3. identifies and ameliorates a health problem. 4. returns an individual to optimal functioning after an illness. 14. An agency that provides inpatient care related to less complex conditions and does not require high-technology monitoring or complex diagnostic procedures is providing which level of care? 1. Subacute care 2. Primary care 3. Secondary care 4. Tertiary care 16. Which of the following is a responsibility of many nurse executives (chief nursing officers)? 1. Recruiting, hiring, and training new staff 2. Managing day-to-day staff scheduling 3. Managing budget for assigned unit 4. Participating as a member of the board of directors 19. Differences between treatment outcomes for different populations are known as 1. health care outcomes. 2. population variability. 3. treatment choices. 4. health care disparities. 20. A contributing factor to health care disparities may be 1. genetic factors. 2. provider bias. 3. standard treatment options. 4. diagnostic differences. 21. Which of the following is not recognized as part of the role of the nurse as a member of the health care team? 1. Patient advocate and educator 2. Collaborator and provider of care 3. Manager of care and resources for a group of patients 4. d. Performance of physician functions under direct supervision of a physician 23. A nurse caring for a preoperative patient is told by the patient, “The doctor just had me sign a paper. I wish I knew what it was all about.” The nurse goes to report this to the physician. The nursing role adopted by the nurse is 1. provider of care. 2. counselor. 3. change agent. 4. patient advocate. 30. Which of the following is a characteristic of the patient-centered care model of nursing care delivery? 1. It is easily explained to patients because it is based on traditional models of nursing care. 2. Communication among team members is not required to make the model work. 3. A multidisciplinary team emphasizes continuum of care and focuses on the patient’s right to individualized care. 4. It decreases the number of registered nurses required to provide care. 3. How can staff nurses play an important role in controlling health care costs? (Select all that apply.) 1. Becoming aware of cost of supplies 2. Questioning the need for unnecessary or repetitive tests 3. Suggesting the use of brand-name medications to support the economy 4. Handwashing to prevent infections 5. Assuring that the payment method is identified on admission Chapter 15 ● What is the difference between power, authority, and influence? ● Health policy—private or public rules, regulations, laws, or guidelines that relate to the pursuit of health and delivery of health services ● Policy decisions reflect the values and beliefs of those making the decisions. ● Nurses join organizations to ○ network with colleagues ○ pursue continuing education and certification opportunities. ○ Stay informed on professional issues. ○ develop leadership skills ○ influence health policy ○ Work collectively for job security. ● Nurses may choose to join unions to ○ work collectively. ○ have control over their practice and workplace ○ work to equalize power between management and staff. ○ What is a closed shop v open shop? ● Benefits of joining an Organization ○ Developing leadership skills, ANCC offers a range of certifications, Political activism, Direct reimbursements for NPs, Coalition to support specific issues ● What is a politically active nurse citizen? ● Mentors actively teaches, encourages, and critiques the process of growth and change in the learner. . A nurse who lobbies state legislators to support a change in the scope of practice in nursing is engaging in 1. power sharing. 2. setting policy. 3. politics. 4. legislative power. 4. Which of the following is an effective method for the practicing nurse to achieve leadership skills? 1. Becoming active in professional organizations 2. Changing jobs frequently to improve skills 3. Learning about collective bargaining 4. Avoiding involvement in politics 6. A nurse has applied for a job and during the interview was told that the health care facility is a “closed shop.” What does that phrase mean to the nurse? 1. The nurse must join a union to be employed there. 2. The nurse can join the union if desired, but it is not required. 3. This facility is closed to all union activities. 4. The facility is negotiating with several unions for control of the employees. 9. A nurse has registered to vote, voted in primary and regular elections, and participated in public forums related to budget reductions that could result in the reduction of the numbers of school nurses. The nurse is known as a 1. nurse citizen. 2. nurse activist. 3. nurse politician. 4. nurse clinician. 11- A nurse was appointed to a governing board of a governmental agency and then ran for an elective office. The nurse is known as a 1. nurse citizen. 2. nurse activist. 3. nurse politician. 4. nurse clinician. Chapter 16 ● What are some healthy responses to true caring for self? ● Professional organizations ○ Provide up-to-date information. ○ Provide ways to keep practice current. ● Incivility is manifested a bullying between colleagues and between faculty and students in academic settings ○ Incivility occurs when people are stressed and feel powerless. ○ Incivility can briefly give a sense of control or power (often, misplaced and misguided). ● Stress—associated with work overload, inadequate staffing, and intense feelings generated by caring ● Nurses must take positive, effective, united action to ensure the basic dignity and safety of practicing nurses. ● Occupational Safety and Health Administration (OSHA) ○ It regulates work environment and has a whistleblower protection program to protect from retribution ● Pharmacogenetics —genetic variants that affect drug metabolism help determine correct drug dosing ● ANA Agenda for the Future ○ Health care is a basic human right, and universal access to a standard package of essential health services should be provided to all citizens and residents ○ The development and implementation of health policies should aim for safe, effective, patient centered, timely, efficient, and equitable care based on outcomes and research ○ The health care system must turn away from the overuse of expensive, technology-driven, acute, hospital-based services and turn toward a more balanced system with emphasis on communitybased and preventative services ○ A single-payer system is the most desirable option for financing a reformed health care system (ANA, 2008). What is true about genetics and nursing practice? 1. In the future, all drugs will be genetically based. 2. Nurses will need competence in genetics. 3. Genetic diseases will become more prevalent. 4. All genetic conditions can be identified prenatally. 3-What are some recommendations for self-care for nurses in the workplace? (Select all that apply? 4. Wash hands consistently. 5. Use sharps disposal containers. 6. Use adequate help or mechanical devices for lifting. 7. Demand mental health screening for all visitors and patients. 8. Reduce the need for working double shifts. 5. Which of the following are including in the basic beliefs set forth in the ANA’s Nursing’s Agenda for the Future? (Select all that apply.) 1. Health care is a basic human right. 2. Health policies should be based on outcomes research. 3. Government should be the only health care insurer. 4. Health care should provide more balance by including preventive and community care. 5. All people should have access to an all-inclusive package of health care.