Managing Patient Care
1. Nursing care delivery models; clinical application, Case Management; discharge planning, referrals
delivery models:
team nursing – work and help each other; starts w/ same level then going hig
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Managing Patient Care
1. Nursing care delivery models; clinical application, Case Management; discharge planning, referrals
delivery models:
team nursing – work and help each other; starts w/ same level then going higher in level if help is still needed; RN leads team of other RN’s, LPN & UAP; team lead creates care plan, coordination of team & provides care for required difficult skills (team for quality care of one pt)
total patient care – RN responsible for full care of one or more pt during shift; care can be delegated; works w/ pt, family & team members (charge nurse gives assignment)
primary nursing – one RN accountable/responsible for individual; to put more RN’s at bedside; assess pt, creates care plan & gives appropriate nursing interventions; communication is lateral(Rn gives the antibiotic, not transferring to another person)
Case management – works with continued care outside of acute care; coordinates outpatient care; helps keep cost down but still maintain quality (setting up pt for rehab)
2. Decentralized management; responsibility, autonomy, authority, accountability
3. Staff involvement; effective communication with staff, collaboration, professional development, In-services
4. Establishing priorities; high, intermediate and low; nursing implications
5. Delegation; rights of delegation, interventions that may/may not be delegated to LPN or UAP, interventions only the RN can perform
Ethics and Values
1. Ethics: autonomy, beneficence, nonmaleficence, justice, fidelity; clinical application
Code of ethics – govern by ANA; foundation & guideline of nursing; a collective statement about the group’s expectations & standard behavior
Responsibility – the will to respect an obligation & following through on the promise.
Accountability – answering for your own actions; being able to explain to pt & employer your actions
Confidentiality (HIPPA) – must maintain at all times; protects personal health info; fined for violation
2. Ethical dilemma; steps for solving an ethical dilemma; nursing implications
Respect your values and respect the values of others if they are different; you don’t have to agree but you have respect.
3. Ethical issues and minors
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Legal Implications in Nursing Practice
1. Sources of law; regulatory law, nurse practice acts, purpose, nurse role/responsibilities
Regulatory law or administrative law – (admin) reflects decisions made by state board of nursing (passing rules & regulations), (we are required to report incompetent or unethical conduct to board)
Common law – (judicial) decisions made in courts for legal cases (informed consent, negligence, malpractice, pt’s right to refuse treatment)
Statutory law is either civil or criminal
Civil laws – protects rights of people w/in society; gives fair & equitable treatment for violations or civil wrongs.
Criminal laws – protects society; gives punishment for crimes (defined by municipal, state, & fed legislation)
Two types of crimes:
Felony – serious crime; prison for over a year or death
Misdemeanor – less serious crime; fine or prison for less than a year
2. Standards of care; nursing policies and procedures
Standards of care- minimal acceptable requirements to practice; reflects knowledge & skills
American nursing association (ANA) – developed our standards to practice & policy
Nursing practice acts – define scope of nursing practice; difference between nursing & medical practice; education & license requirements
Joint commission act – accredited hospitals must have written nursing policies & procedures
3. Advance directives; living wills and power of attorney, nurse’s role, healthcare provider role
Advanced directives – 2 types; living wills & power of attorney
Living wills – written document that directs treatment for a pt’s wishes in case of a terminal illness or condition
power of attorney – legal document that gives the power for healthcare decision to a person or more than one if pt is no longer able to make decisions
Nurse’s role –
Healthcare provider role -
4. Public health laws; nurse role/responsibilities
We have to report any communicable diseases, necessary school immunization, anything that can reduce health risk for communities; the CDC (center of disease control & prevention) & OSHA (occupational safety health administration)
5. Regulatory laws, Common laws
Regulatory laws – (administrative law) your duty to report incompetent or unethical nursing conduct to the board of nursing
Common laws -(judicial decisions) mostly revolve around negligence & mal practice.
6. Intentional torts; assault, battery, false imprisonment- clinical application, nursing implications
Intentional – purposely violating someone’s rights
Assault – verbally threatening; harming the pt w/out consent.
Battery – touching without consent
False imprisonment – restraining someone without needing to
7. Unintentional torts; negligence, malpractice, clinical application
Negligence – falling below standard of care; the pt has to be harmed( not monitoring pt or making diagnosis, not notifying healthcare provider of problem, not following orders, not following 6 rights of medication, lost paperwork, no discharge instructions, no safety for at risk of falling pt’s, not following policies & procedures, not delegating & supervising properly)
Malpractice – “professional negligence”
8. Risk management/Quality improvement; incident reports, notification and documentation
Risk management – a system to make sure proper care is given by identifying potential hazards & removing them; requires good documentation.
• Identify possible risk
• Analyze risk
• Act to reduce risk
• Evaluate steps taken.
Incident reports – when an error is made it is reported; database gives information on issues w/ standard of care practices; issues can be corrected; alerts risk management of situation
Documentation is evidence of care the pt received; proof that nurse acted responsible & safely
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