Leadership Learning Systems ATI

Leadership Learning Systems ATI                 If a nurse is caring for a local official, person of interest, celebrity and a reporter asks about their condition, per HIPAA, the nurse cannot share information to those not involved with care unless consent from the client is given. The nurse must refer this to the nursing supervisor. If a client is competent and is not involuntarily admitted, they have the right to refuse care and leave the hospital at any time. The nurse has a role to explain risks and injury prior to leaving and document that this information was received and notify the provider. If there is an environmental or mass casualty incident and clients must be discharged, only those who are stable for discharge and do not need additional monitoring should be considered to leave. Clients who need management of chronic disorders and are stable can go home too. If instructions can be given for long term devices such as fixators and PICC line care needs, these people can go home also. Complex care patients must stay as unstable. Win-yield strategy: both parties no longer resolve the conflict and they agree to whatever the nurse manager decides when ending conflict Win-win strategy: collaboration between both parties, no power struggle, both parties work together for a positive outcome from a common goal. Win-lose strategy: involves one party emerging and the other loosing. If the losing party continues the situation then it becomes competition. Lose-lose: two parties abandon struggle with conflict and take no action but the conflict still remains. Home safety to prevent SIDS: room sharing is good, co-sleeping is not, no blankets while sleeping because of suffocation, one pieces are okay, no bumper pads pillows and toys in the crib, baby only sleeps on back. Case managers have a purpose in coordinating and planning patient care, collaboration with the team, and monito costs and quality of care. This can happen starting at admission and continue through the stay and even at home. Not direct patient care. Can assist with discharge planning. Will not complete insurance claim forms. S/S of lithium toxicity is poor motor control and must be reported. Paternalism is a type of relationship that exists between the provider and client in which he provider knows what is best for the patient. The provider may withhold info from the client that may cause them distress however clients have a right to be informed. Clients have the right to request own medical records and given adequate care. Clients get 30 day notice to go to a LTC Clients can make independent choices and keep provider and change if needed if competent Email is a simple way for nurse managers to get communication to employees regarding education without embarrassing anyone in public. Links can help with scheduling. Never delay discipline with employees who do not follow protocol.                             If child or elder abuse is suspected, police, CPS, and social services should be contacted as nurses are mandatory reporters. (AKA, bruises diff stages, spiral fractures, burns, story not equaling injury). ADL assistance= OT= assists with fine motor movements Swallowing, speech issues= SLP Social worker= assists with access of client resources and education. Dietitian= helps with meals, nutritional needs and resources for preparing food. Restating the information in own words clarifies client understanding of teaching and allow for the nurse to see gaps in understanding. Questions may indicate the client is having trouble understanding teaching. Case manager has a role to plan and coordinate resources and services to continue care Charge RN focuses on daily patient activities. Surgeon has intraoperative focus and perioperative care management If an older client is at risk for falling, they should have a sitter placed with them for safety. Should never apply restraints, remind them to stay in bed as they may not remember. Incident reports are confidential documents used to improve client care. Never place them in a chart. Variance report Goes direct to risk manager. Planning process: goals created, expected outcomes and select interventions Evaluation: see if the goals or outcomes met and change as needed. Assessment: subjective nad objective data for critical thinking. Diagnosis: identification of health status or problems. When giving report, only include objective things and measurements. If a patient is wandering at night, there may be energy that needs to be burned off, no need to restrain these patients, just need to increase energy reduction. The nurse must know the degree of supervision the person they delegate tasks to can do. If coworker in impaired state, it goes directly to the manager to promote safety for patients. Never discuss the issue with the coworker as it causes defamation, conflict, and always never refuse patient care with the impaired person. Veracity= telling the truth about procedure or treatments. Spending time all patient equally= justice Responsibility= reporting one for not following safety guidelines. Can also mean creating equal schedules. Consent RN responsibility, witness signature, verify pt understanding and notify provider regarding patient questions Change theory= workers on unit participate in decision making for all and encourage staff input. Social worker= assists with community resources and housing. Spiritual support/ chaplain= assists with religious issues. PSDA requires hospitals to provide education for advance directive and rights about personal wishes. The RN can do this, does not need attorney, decision by patient can be changed.                           Variance report: done for any variation from the standard in care. Includes patients NPO eating when not supposed to. When assigning task, must provide PN/AP with type of task to be done, frequency, duration, and info about mechanics needed for task. Specific is better. Also include what to report if needed. AP’s can assist with transport patients for testing.If floating from other areas, restocking rooms can be challenging due to unfamiliar equipment. Never have another AP shadowing if staffing is low. Nurses should never discuss patients with those in public places as people not involved can hear in and is hippa violation. Includes cafes, lobbys, elevator. Does not include semi private rooms as if no other place to put patient, semi private is appropriate. Root cause analysis: done to determine deviations from standard of care and identify factors that resulted in errors. Stair handrails, 120f water heater, grasp plug, use icrowave or electric toaster to prevent safety events. AP= measure stable pt vitals RN: invasive stuff, triage, care plan, assessment, giving advice, interpret data, evaluation of care, NG tubes Effective healthcare conferences include other health professionals caring for the patient and their outcomes. Must address goals for patient, be nonjudgemental and respect opinions, resolve issues. LPN can care for stable patient only. RN get unstable patients Adult day care assists with assistance with adls when family is busy. Hospice= terminal illness 6 motnhs ALF= lives independently with minimal assistance with meals and meds Specific event examples can allow for objectivity to concerns. Lassiz faire leader= little support or guidance with minimal contribution Transformer leader creates enviroemnt with goals shared by staff to feel as if they are contributing to higher level of care. Democratic: gives moderate control over multiple members as facilitator and resource person Autocratic: controls and makes all decision with little freedom for members Any situation needing QI, assess and gather data! Survivor potential- know all the levels and who the prioritize first in MCI Nurse must serve as patient adovcates Child abuse: know what to look for and always report the abuse it is mandatory Preceptor nurses are mentors and serves as guides for nurses in relationships. No time frame, realistic goals are set. If an incident occurs, only present facts and assignments and vitals and provider and procedures done and patient response, not a story or a why. Conflict resolution of collaboration allows nurses to work together to figure out solution. Can be in meetings. Lab specimen transport is something that must be done especially if it require to be put on ice.                  Clients can refuse treatment and always speak to patient about concerns and inform the provider about withdrawal of consent. Measles= airborne isolation as these are small droplets. Know precautions used- heap filter 6-12 airflow, N95 (Know all precuations and what is used) Always address patient feelings rather than confidential information. Incident reports help to identify factors to imp lent improval opportunity for QI. NOT for staff blaming or litigation. Never place in the chart or nurses notes. If needed, alternative communication methods can be given to those who need it. Always face patient , speak slowly, moderate tone, and use 6th grade vocab Assault: attempt to threat or touch one without permission. Defamation: making false statements that damage repulation. Battery: unlawful touching of one that can cause harm. Neglect: failure to provide standard care If a patient gets hurt, before doing anything, assess the patient. When introducing change, always give a heads up and assemble task force to increase change control . I statements help confronted people with their own perceptos and feelings rather than being disrespectful. Nurses must respect patients when they refuse treatment and never offer into these deicisons Before delegation, the nurse or pn must be familiar with the task to define it based on completion, performance, and feedback. Uniform anatomical gift act always for one to donate organs if over 18, can be done in will with signature or thru state, revoking it can occur with 2 witnesses, nurses can be the witnesses If complications occur with pumps or IV, always stop the infusion or pump first before assessing further. If error is done even without injury, incident report must be done to determine types of incidents that occur.