Exam 2: PNR 205/PNR205 (NEW 2026/2027) Concepts of Leadership & Collaboration | Questions & Answers | Verified Correct Solutions | Guaranteed A – Fortis

Exam 2: PNR 205/PNR205 (NEW 2026/2027) Concepts of Leadership & Collaboration | Questions & Answers | Verified Correct Solutions | Guaranteed A – Fortis Q. Which advance directive allows a client to choose a proxy? ANSWER Durable Medical Power of Attorney Q. Which term describes a competent clients agreement to a procedure after the required information is explained? ANSWER Informed Consent Q. What is authorized consent? ANSWER Parents cannot give informed consent for the treatment of their children, but they can authorize treatment for their children up to a certain age; this is called authorized consent. Courts of law recognize that parents generally authorize what is appropriate for their children. In most states, "minor" is defined as younger than age 18. Some states allow minors to give their own consent for treatment of substance abuse, mental health problems, and sexually transmitted diseases (STDs). Emancipated minors (legal mechanism) are defined as those living on their own and managing their own finances or who are married and have children. They are competent to give their consent. Q. What is an example of statutory law? ANSWER Nurse Practice Act, which is governered by your states statues and ordinances. Q. A nurse is named in a civil lawsuit by a client. Which strategy (or prevention) did the nurse most likely not use? ANSWER Maintain good relationships with patients and families. This will protect you from most likely being named in a lawsuit. Q. rapport ANSWER A positive relationship Q. A nurse is accused of defammation by posting a letter in the facility newsletter. This is an example of which? ANSWER Libel - intentional tort Q. Defamation ANSWER Act of harming or ruining another's reputation Q. Slander ANSWER Spoken defamation. Anything verbal is slander. Q. Libel ANSWER written defamation. Letters, pictures, social media posts. It is considered an intentional Tort because you meant to do it. Q. Intentional tort ANSWER A wrongful act knowingly committed. Q. Which is an example of battery? ANSWER A client refused suction and is suctioned anyway. Q. Battery ANSWER unlawful touching of another person without consent Q. What is assault ANSWER Threat or attempt to make bodily contact with another person with our without the person's consent. If there is no PHYSICAL harm to the client then it is considered assault. Q. The nurse gives information to a family member who is not on the contact list. The nurse has done what? ANSWER Breached confidentiality Q. A cause and effect relationship exists between an act that resulted in harm to the client. This is an example of? ANSWER Proximate cause Q. proximate cause ANSWER Legal cause; exists when the connection between an act and an injury is strong enough to justify imposing liability. Q. Which are examples of civil law? ANSWER Intentional and unintentional torts Q. intentional tort ANSWER A wrongful act knowingly committed. Q. unintentional tort ANSWER negligence and malpractice Q. A nurse injects himself with a narcotic prescribed for the client this is an example of? ANSWER Unethical and illegal behavior Q. Encouraging a client to be involved in his care is an example of? ANSWER Autonomy Q. A student asks whats the difference between law and ethics? ANSWER Ethics are expected behaviors, law requires mandatory observance by the nurses. Q. An LPN is concerned about the legal aspects of delegation. What is the most important question for her to consider? ANSWER Does this task involve nursing judgement? Q. Which is an example of direct supervision by the RN? ANSWER The RN is present in the room when the LPN performs a treatment. Q. What will the state board of nursing do with a clients complaint once they receive it? ANSWER Review the complaint Q. Why are an organizations policies and procedures important? ANSWER They are necessary guidelines that must be followed Q. Which statement correctly describes delegation? ANSWER Delegation increases patient satisfaction Q. If allowed by the nurse practice act of the state who can an LPN delegate too? ANSWER CNA/UAP Q. A client is left sitting in the middle of their room without access to food, water or call bell. This is an example of? ANSWER False imprisonment Q. Before the LPN put down the clients siderail he check to see if the patients arm was clear. This is an example of? ANSWER nonmaleficence which means do no harm. Allow any harm to come to patient. Q. Fidelity ANSWER Be truthful to all. be true) includes HIPPA, for instance if we take care of a patient in the ER department and then they are transferred to med surg, they are no longer our patient and therefore we have no right or access to them challenges each practical/vocational nurse to be faithful to the charge of acting in the client's best interest when the capacity to make free choice is no longer available to the client. Q. Justice ANSWER Means treating all the same (fair to all) All patients have the right to the same care and treatment, even the frequent flier in the ER who may be coming into the ER to get their meds every month. Alcoholics, etc. Equality for all means that SPNs/SVNs and LPNs/LVNs must deliver fair and equal treatment to all clients, recognizing and avoiding personal bias. For example, each client with the same diagnosis should receive the same level of care. Q. A -------- leader is concerned with the task ANSWER Autocratic Q. Which best describes a laissez-faire style of leadership ANSWER I will let you decided the best answer Q. Which best describes a manager? ANSWER Planning and directing to meet client and instituitional outcomes. Q. Which best describes a leader? ANSWER Can be an informal role that is given to a person by a group of workers. Q. An individual is born with leadership skills and they cannot be learned. True or False? ANSWER False Q. Which best describes a democratic leader? ANSWER Shares responsibility and authority with employees Which involves varying your leadership styles to meet the demands of the work environment? Situational What is the first step in the problem solving process? Collect Data Which best defines an assignment? Work is distributed among team members for the shift Why is delegation important? Increases the effectiveness and efficiency of the LPN Which client would be the highest priority for care? A resident attempted to flee the building several times on the last shift. Which is not one of the rights of delegation? Right equipment Which decesion to delegate a nursing responsibility is incorrect? The nurse is unavailable to supervise Which duties should not be delegated Complex sterile technique procedures Which is not included in determining the level of competence for a delegation? What activities does the nurse dislike True or false a delegation can be refused True Which of the following statements indicate the best understanding of safe delegation? Delegated duty depends on state law, facility policies, resident condition. Which of the following priority actions best contribute to safe client assignment to UAP's? Job descriptions and skills checklist are used to clarify who is competent. When delegating a task what should not be included? Give partial directions Delegation is an easy skill to learn true or false False Ethics 1. Personal ethics and professional ethics. Professional ethics are things that are lawful that we can do. Ethics what is right or wrong. Ethics is what we should do. A system of standards or moral principles that direct actions as being right or wrong. Ethics is concerned with the ways people, either individually or as a group decide the following: What actions are right or wrong If one has the right to do something If one has the duty to do something Ethical responsibilities of Nursing Client Advocacy Accountability Owning up to my actions Colleague Reporting System based issues - new procedures Colleague Reporting For example narcotics are missing from the pixsys and your colleague is involve in it. It is your ETHICAL responsibility to report this. Because if you then do not report it and take the keys and move on to your shift it will look like you took the drugs and it will fall on you. This is part of the checks and balance system. System based issues/New procedures Personal vs Proffesional ethics Personal ethics provide personal guidelines for living. You ultimately choose what your personal code of ethics includes. Your personal code of ethics will influence your nursing ethics. Sometimes personal ethics conflict with the law. ( Your states Nurse Practice Act). Always look at your job description and if there is something in that job description that you do not personally agree with, then that may not be the setting for you. For example if you are against abortion and your job description states you are to be involved in abortion procedures this is an example of personal ethics versus professional ethics. Nonmaleficence do no harm Beneficence Do good, is what Im doing going to benifit my patient? Autonomy Free to choose, this includes privacy Thinking through all the facts Deciding of the basis of an independent thinking process Acting based on a personal decision Undertaking a decision voluntarily without pressure, direct or subtle from anyone else. An example would be a patient going into surgery and the nurse asks the patient if they are willing to take blood products during the surgery. Does the patient have the right to refuse blood products and just have the surgery? -YES Make sure the patient has enough information to make an informed decision. Beneficent Paternalism a disrespectful attitude toward the client and what the client has to contribute to personal care and recovery. It is an “I know what’s best for you” attitude that discounts the client’s knowledge of self. It can be used for good in an emergency situation such as obtaining a court order to save the life of a child’s against a parents wishes. Beneficent Paternalism is most used in extreme circumstances. Beneficent Paternalism DOES NOT support autonomy. Information is usually presented to a court in these circumstances. It should always be done in good faith because we as health care professionals are trying to do what it best for the child. In instance like this a disrespectful attitude as mentioned in the first sentence is a good thing. But it is still considered a disrespectful attitude. When is it justified? - Say for instance when a childs parents wont allow them to have blood products because of their religion and this is putting the childs life at risk. This is when it would be justified. The health care provider tells the patient what they should have. All the information is presented before a court of law. The states statues that apply to licensed persons and the situations in client care that could result in legal action. Where can I find them? The states statues that apply to licensed persons and the situations in client care that could result in legal action. Where can I find them? · Organizational rules and regulations · Obligations under the law · Professional groups (NAPNES) ( National Association for Practical Nurse Education) · Organizational policies and procedures · Your States Nurse Practice Act – Things that you can do as an LPN lawfully Your states Nurse practice act Things you can do as an lpn lawfully our guideline our To do list Should a facilities policies and procedures mirror what the State Nurse Practice Act says? Or should they be different?- · They should be the SAME. A facilities policies and procedures can be used in a court of law. These policies and procedures should be revised especially if your States Nurse Practice Act is revised. If you are practicing in multiple states you need to pay attention to The Nurse Practice Act for that state and the facilities policies and procedures as well. If we go into a patient’s home and it is messy should we provide care and should we be judgmental or non-judgmental? We should provide care and we should be non-judgemental Where can the LPN find the minimal competencies required to practice safely? In your states Nurse Practice Act. This states your scope of practice and your Nurse Practice Act will state your scope of practice. Content of the Nurse Practice Act · Functions of the states board of nursing general provisions · General procedures e.g. fees · Licensure process · Elements of unprofessional conduct · Information related to reasons for a suspended or revoked license · Impaired Professional program · General functions of the Licensed Practical Nurse · Definition of Nursing (Specific definition for practical nursing (LPN) and professional nursing (RN) · Standards of Nursing conduct · Organization approval and administration of nursing programs The board of Nursing does this. · Continuing education State board of nursing functions · Licensing and certifying (specialty certifications may be from related associations. e.g. NFLPN, NAPNES) nurses. NFLPN is The National Federation of Licensed Practical Nurses. The NAPNES is the National Association for Practical Nurse Education and Service · Setting Fees · Establishing standards for educational programs · Approving schools of nursing · Determining duration and renewal of licenses (some boards require continuing education credits for renewal of licenses) · Maintaing inactive status lists · Carrying out disciplinary actions for violations · Developing programs for impaired nurses · Suspending and revoking licenses and dealing with the appeal process Eight categories that can result in disciplinary action · Fraud and deceit (falsifying documentation) · Criminal activity · Negligence · Violation of the NPA (Nurse Practice Act) · Discipline by another jurisdiction · Incompetence · Unethical conduct (do not accept gifts from patients) if the gift is worth a certain amount, you cannot take it. According to OhioHealth policy, a nurse can accept a gift from a patient that is of "modest value" and shared with the entire unit, with a general guideline of being less than $30, and should not be in the form of cash or a cash equivalent; this is considered the most likely legal limit for a gift from a patient to a nurse in Ohio. · Alcohol and or/drug abuse If I do something what what is next? Disciplinary steps: · Complaint filed with the state board · Review of complaint · Investigation · Board proceedings - (The Nurse has the opportunity to respond) · Settlement conference · Formal administrative hearing · Alternative to discipline programs i.e. (substance abuse monitoring programs) · Board action · Emergency action i.e. (immediate suspension to protect the public pending a complete investigation) · Disciplinary action i.e. (fine or civil penalty, public reprimand with no license restriction, limitation of practice, suspension, revocation, provisions for remediation, education or monitoring. · Remediation Reporting and Enforcement · NURSYS (national database for verifying licenses and discipline actions for nurses) Employers will look to see what your license number is, if you have any disciplinary actions, and when your licenses expires. · National practitioner databank (if you are under disciplinary action your name will pop up in this database to potential employers) National Practioner Databank A data management system to track unfit healthcare practioners and restrict the ability of incompetent professionals to move from state to state without disclosure of previous incompetence. All state board of nursing entities are mandated to report disciplinary actions including probation, suspension and revocation of a nursing license to the NPBD. License Verification NURSYS · Can see your name · Can see your license number · Your expiration date · Any disciplinary actions Intentional Tort An intentional tort is intended to cause harm to the client (threat or actual physical harm) Unintentional Tort Did not mean to harm the client. “I did not mean to hurt the client” is no defense if you did not use the “six rights” and gave the client an incorrect medication, which caused injury. Six Rights of Medication Administration Right patient Right medication Right dose Right route Right time Right documentation Example of Chemical Restraint Benadryl to make the patient sleepy and to shut up, go to sleep, quit ringing their call light. For example Tylenol for codeine is prescribed for pain prn but the nurse uses it to make the patient sleepy and lay off their call light Examples of physical restraint Restraints of any kinds arm/wrist/ankles, chairs (if a patient cannot freely stand or sit, then this is considered a restraint. Even the chairs with the tables in front of them are considered a restraint) What type of abuse occurs when a person tries to undermine a persons feelings of self-worth? This is considered emotional abuse Physical abuse Would be hitting the patient Is assault an unjustified attempt or threat to touch someone? True or False? True Liability Is being responsible for something Liability in Nursing is associated with civil law and includes contracts, negligence, and intentional and unintentional torts The most common type of negligence in practical nursing relates to action or lack of action, not what was intended to be done. The four elements needed to prove negligence are: · Duty (is this patient assigned to me or not) (you owe a duty to the patient) · Breach of duty (care plan told us to do change our urinary cath every 30 days. (you breached that duty) because you did not follow this and changed it out at 40 days instead of 30 days) · Damages (say a bad kidney infection and life threatening emergency from sepsis) · Proximate cause (resulting in compensable damages) Duty refers to the nurses responsibility to provide care in an acceptable way. The nurse has a duty based on education, as well as the policies and standards of the place of employment. Breach of duty means that the nurse did not adhere to the nursing standard of care. What was expected of the nurse was not done (omission) or was not done correctly (commission). An expert nurse witness establishes the standard of care. Damages means that the client must be able to show that the nurses negligence injured him or her in some way. The client must prove actual damage. Proximate cause · means that a reasonable cause and effect relationship can be shown between the omission and commission of the nursing act and the harm to the client. Did the nurses negligent act cause the injury in question? What is the difference between battery and assault · Battery – To cause physical harm to someone · Assault – Unjustified attempt or threat to touch someone What are some examples of libel? · Writing a letter to the editor of a newspaper. · Posting on social media, messages and pictures. (Even if you got it from another page) Steps for bringing legal action · The client believes that the nurse has violated his or her legal rights. · The client seeks the advice of an attorney · The attorney has a nurse expert review the client’s chart to see whether the nurse has violated the nursing standard of care. It is determined that a standard of care has been violated, and a lawsuit is filed. This is why we want to take the time to document correctly. · The client (the complaintive files a complaint that documents the grievance (violation of rules). This is served to the defendant, the nurse. · The defendant responds in writing · The discovery period (pretrial activity) begins. Statements are taken from the defendant nurse, witnesses, nurse expert, client (plaintiff), and other caregivers. Policies and procedures of the health care facility are reviewed. · During the trial important information is presented to the judge or jury. A verdict (decision) is reached. The plaintiff (the client) has the burden of proof (evidence of wrongdoing) during the trial. The award in a malpractice case is to make the aggrieved person whole. There is generally a monetary settlement. This is where you need your malpractice insurance. · An appeal (request for another trial) can be made if either the plaintiff or defendant does not consider the verdict acceptable. Patient Care Partnership · The American Hospital association (AHA) developed The Patients Bill of Rights which was revised and renamed The Patient Care Partnership: Understanding expectations, rights and responsibilities. · This is an ethical rather than legal document for hospitals recommending ways to guarantee client rights. · It encourages a client to be a participant in their plan of care through collaboration with their care providers. HIPPA Health Insurance Portability and Accountability Act · The main focus of HIPAA is the protection of the client’s privacy. · Clients can file a complaint if they think their privacy has been violated. · HIPAA requires that all covered entities designate a privacy officer. · The Notice of Privacy Practices will provide information on how to contact the facility privacy officer to file a complaint. · The patient needs to make sure they get a hold of the privacy officer to file a complaint, not the charge nurse, not anyone else. · The “Notice of Privacy Practice should have the contact information for the privacy officer for the organization” What information can I give out? · Clients have a right to a copy of their medical records and to review the records upon request. Each facility determines the conditions the records can be reviewed. · The nurse will adhere to the minimum necessary rule to protect the client’s privacy. · The client’s name, address, and payor information are appropriate for the nurse to disclose to a vendor delivering supplies to a client’s residence · We throw away information with HIPPA information on it in the shredded bin!!!! · The minimum necessary rule – I only need to give out the minimum amount of information necessary. The clients right to consent · The client's right to consent to or refuse treatment is a significant example of client autonomy (right to choose). Informed Consent Must be obtained for invasive procedures ordered for therapeutic or diagnostic purposes. Informed consent means that the client is told the following in non-medical language: 1. Diagnosis or suspected diagnosis 2. Purpose and description of treatment 3. Expected outcome, expected benefits, and possible side effects or complications 4. Explanation of alternative treatments and their benefits, possible side effects, or complications 5. Names and qualifications of the people who will perform the procedure 6. Prognosis if treatment is not done (when known) 7. Answers to questions client wants clarified 8. Explanation that the client has the right to revoke written permission at any time If the patient agrees to all the above then you can sign as a witness to this before the procedure. Authorized Consenter A person who is assigned by a parent or guardian to speak with a doctor on behalf of a child Living Will · Legal document that describes the kind of medical treatments or life-sustaining treatments the person would or would not want if seriously or terminally ill. · Does not specify a person to make healthcare decisions · It is not legal in all 50 states **We cannot sign this, the legal department or social service department can however.** Durable Medical Power of Attorney · Legal document that is valid in all 50 states. · It names a health care proxy (anyone at least 18 years old) to make medical decisions if the client is no longer able to speak for himself or herself Do not resuscitate order instructs medical professionals not to perform CPR if breathing or heartbeat stops. This is a legal document. If we find a patient that has a dnr with no heart or blood pressure, should we go ahead and do cpr? No Removal of life support The physician must pronounce the client dead and document this status before the nurse turns off a ventilator. Failure to wait for this determination and documentation can be considered an act of murder and is both illegal and unethical Can we stop CPR if the patient is a full code and on a ventilator? No What are some unethical acts? · Giving a client a higher or lower than prescribed dose of pain medication · Accepting bribes/gifts can be seen as a bribe · Administering CPR to a client with a DNR Autocratic Leader a leader who has control and makes decisions with little or no consultation with others (Extreme) concerned with the task. Does not consider the employee. Whatever they says goes, its their way or the highway. Don't ask questions, I will tell you what to do. Democratic Style Leadership employees encouranged to give input and aid in decision making. (Midpoint) balances concern with task and employee. A nice balance between autocratic and Laissez Fair Style. Laissez Fair Style Leadership · (Extreme) concerned with the employee, gives very little direction. Assignment Distribution of work that each staff member is responsible for during a given work period (Tasks). Assignments are tasks. Activities are consistent with job position and description, legal scope of practice, and educational background Delegation Transfer of responsibility for the performance of an activity from one individual to another while accountability for the outcome is retained by the delegator. • Before you delegate the client must be assessed (data gathered) on their condition. Make sure the patient is stable before delegating a task to a UAP. • CNA/UAP cannot delegate • Delegation once accepted can not be transferred • Delegatee can refuse delegation. For proper delegation they must voluntarily accept the task being delegated • Use the nursing process when delegating It is up to the LPP/Nurse To make sure a task has been carried out by a UAP Rights of Delegation 1. Right task/duty 2. Right circumstance, is the person stable? 3. Right person 4. Right direction and communications and that the uap understands what you are communicating. 5. Right supervision and evaluation Some routine tasks to delegate to Nursing Assistants • Personal care, including hygiene, dressing, toileting, grooming, and skin care • Feeding and hydration • Basic restorative skills, including transfer, positioning, ambulation, and maintaining range of motion • Measuring and recording vital signs, height and weight, and intake and output • Assistance with elimination, including catheter care • Maintaining safety factors, including fall prevention, application of heat and cold, and infection prevention • Collecting specimens of urine and stool Can a UAP intrepret BP Readings? No Examples of duties not to delegate • Sterile technique procedures: Nursing assistants do not have training in sterile technique. • Crisis situations (you must be there): An example of a crisis situation is a resident who develops chest pain. • Although nursing assistants can collect simple data, they have not been trained to make decisions about or interpret those data. For example, nursing assistants cannot evaluate results of capillary blood glucose monitoring or determine when vital signs need to be rechecked. • Duties that are not part of your legal scope of practice may never be delegated. Your legal scope of practice is your assisting role in the nursing process. What is delegation is refused • Nursing assistants have the right to refuse a delegated duty. The LPN/LV charge nurse, collaborating with the RN, then uses questioning (why?) to determine if the team member feels unqualified or simply does not want to do the activity. • Feeling unqualified is a training problem; not wanting to do an activity is an attitude problem. Change of shift report · Baseline Report · Involves a quick visit of each resident to compare the status with the status reported at the change of shift · Consider the scope of practice of the person you are giving report to. Am I giving this report to an RN and LPN or a UAP? How can the LPN increase employment opportunities? • Obtain certifications-IV, long-term care, wound care • Attend seminars • Enroll in a leadership course • Inservice programs • Read books and articles • Network • Increase your knowledge!!!! • Just applying for another position does not increase your employment opportunities. Five rights of delegation right task right circumstance right person right direction/communication right supervision/evaluation Mandated reporter a person who is required by law to report maltreatment "Nurses ARE mandated reporters!!!" Suicidal ideations Child abuse Abuse Neglect, etc If a patinet has a reaction after being given a shot We have to report this. If a patient has a gunshot wound We are required to report this as a mandated reporter Ethical principal of nonmalificence The obligation of not to harm the patient. Right to self determination Autonomy Providing fair and equal treatment Justice Ethical prinicipal of beneficent paternilism Healthcare professional undertakes actions designed to limit autonomy. The nurse practice act guides the nursing practice of every nurse. True or False? True Negligence is taking proper care in providing the services that is needed by the patient. True or False? False Ethical principal of beneficence To act for the benefit of the patient and support Ethical principal of autonomy Right to self determination Ethical principal of justice Providing fair and equal treatment to all clients An example of beneficence Dr's order are questioned we are doing good for the patient by making sure they are receiving the right drug/treatment. We are advocating for the patient. It is okay to question an order, do not assume!!!!! example of nonmaleficence Lowering the bed to the lowest position, call light in reach after completing. NONMALEFICENCE means to DO NO HARM!!! Example of autonomy A client decides which treatment options they want. Opposite of autonomy ( to decide for oneself) Beneficence paternalism (Where you do not decide for yourself but the physician does) Does Beneficence paternilism demonstrate autonomy? Yes or No No Example of justice ICU nurse spends equal amount of time with heroin OD patient as she does with brain aneurysm patient Is lowering the bed and giving access to a calllight an example of nonmalifecence? True or False? True What is the definition of beneficence Doing good for the patient, questioning a order for example. IS AMA (Against medical advice) allowing the patient to choose? Yes or No Yes Three examples of what we must report as mandated reporters in addition to abuse. 1. Gunshot wounds 2. Drug Reaction 3. Suicide ideation If a patient wants us to sign off on their living will paperwork what do we do as nurses? No, ask for charge nurse, legal or case worker Morals are concerned with dealing with right or wrong behavior (conduct) and character. Individual autonomy Means self rule Individual rights mean the ability to assert one's rights Client advocacy speaking or acting on behalf of others to help them gain greater independence and to make the health care delivery system more responsive and relevant to their needs Accountability The word accountability means that you are answerable to yourself, to your assigned client and their family, to your supervisor, the health care team, and to your instructor who evaluates your work. Client safety reporting Report peers, supervisors, or any team members for behaviors that are potentially harmful to clients (e.g., impaired at work because of alcohol and/or other drug use, stealing client's medication, substituting water or normal saline for injectable narcotics, leaving unstable clients unattended in the shower, sleeping while on duty, and verbal or physical abuse). System based issues Identifying system-based issues is essential to providing safe high-quality care (e.g., if new procedures are implemented without appropriate education and training on all shifts, you need to notify administration and suggest a plan to ensure safe practice). Privacy Is both an ethical and legal issue. Student practical nurses are discussing the concept of ethics. Which of the following statements indicate the practical nursing student’s best understanding of the concept of ethics? An understanding prior to the meanings of words such as right, wrong, good, bad, ought, and duty is important to ethical decision-making." The nursing profession has evolved over time. Which statement best describes how the nursing profession has evolved? Nursing discovered its unique role in providing care to the whole client, not just the diseased part, using evidence to make decisions. A parent has refused a blood transfusion for their 2-year-old son, but the health care provider has asked the court to overrule their refusal. What is the nurse's best response? . "In your child's case, beneficent paternalism (explain term) overrules respect for your autonomy." After seemingly successful treatment for depression and a serious suicide attempt, a client will be in court this morning to be reviewed for release. The client tells the SPN/SVN, "As soon as I get out, I am going to kill myself. Promise me you won't tell anyone." What is the best ethical SPN/SVN action? . Despite respect for the client's autonomy, ensuring a safe environment is essential. The SPN/SVN reports the client's comment to their supervisor. SPN/SVN are discussing the steps necessary to make an autonomous decision. Which statements indicate that the SPN/SVN understand the steps of autonomous decision-making? (Select all that apply.) a. Voluntary without pressure b. Fair to all parties involved d. Nurse provides evidence to assist the client in decision-making Law has to do with regulations that control the practice of nursing Activities of daily living The basic activities a person usually accomplishes during a normal day, such as eating, dressing, and bathing. Basic Nursing Care Nursing care that can be performed safely by the LPN/LVN, based on knowledge and skills gained during the educational program. Includes ADL and skilled nursing procedures. Modifications of care are unnecessary, and client response is predictable. Basic Client situation The client's clinical condition is predictable. Medical and nursing orders are not changing continuously. These orders do not contain complex modifications. The client's clinical condition requires only basic nursing care. Complex Nursing situation The client's clinical condition is not predictable. Delegated Medical Act During a delegated medical act, a health care provider's order is given to an RN, an LPN, or an LVN by a health care provider, dentist, or podiatrist. Delegated responsibility (nursing act). A nursing activity that is transferred from a licensed nurse to a delegate. The delegatee must be competent to perform the activity and verbally accepts responsibility for the assignment. Direct Supervision With direct supervision, the supervisor is continuously present to coordinate, direct, or inspect nursing care. The supervisor is in the building. General supervision Under general supervision, a supervisor regularly coordinates, directs, or inspects nursing care and is within reach either in the building or by telephone. Professional Nurse In many states, the professional nurse is defined as the RN. Negligence The nurse does not do what a reasonable, prudent nurse would do in a similar situation. Negligence includes serious risk to the health, safety, or physical or mental health of a client. (This may include client injury. Injury can be physical, emotional, or spiritual.) "failure to use such care as a reasonably prudent and careful person would use under similar circumstances." Violation of the NPA Some states' NPAs list specific violations (e.g., unprofessional conduct, such as becoming personally involved with a client). Incompetence Examples include failure to meet generally accepted standards of nursing practice; negligence; and a nurse's mental disability that would interfere with client safety. Unethical conduct Examples include a breach of nurse-client confidentiality; refusal to provide nursing care for someone because of race, creed, color, national origin, disease, or sexual orientation; violation of the ethical code for LPNs/LVNs; and failure to maintain nursing competence. interstate endorsements for nurses who choose to work in other states. This means that it is possible to work in another state without repeating the NCLEX-PN® examination, after you meet that state's criteria for licensure by endorsement. Multi State licensure agreement with another state that says if you're licensed in one state your licensed in another Nursing standard of care is your guideline for good nursing care. The phrase "you are held to the nursing standard of care" has important legal implications. The standard is based on what an ordinary, prudent nurse with similar education and nursing experience would do in similar circumstances. Written policies and procedures The agency that employs the individual provides a standard of nursing care that must be followed. Read the policies of the agency to find out whether or not verbal directions are supported by written policies. If a question about care ever comes up in court, a lawyer will use the agency's policy and procedure manual as one guide to expected behavior. Custom An unwritten, usually acceptable way of giving nursing care. Expert witnesses, not coworkers, would be called to testify to "the acceptable way." Common law is called judge-made law because it originates in the courts. Common law is one way of establishing standards of legal conduct and is useful in settling disputes. Statutory law is law developed by the legislative branch of the state and the U.S. Congress of the federal government. Criminal action involves people and society as a whole. It involves relationships between individuals and the government. It is unlikely for nurses to be involved in criminal action. Misdemeanor is the least serious charge and can result in a fine or prison sentence of generally no more than 1 year. This criminal act might include taking $100.00 from a client for an emergency personal need. Felony is a serious offense with a penalty that usually ranges from more than 1 year in prison to death; for example, when the nurse injects a client with a lethal drug to hasten death or removes life support before the client has been pronounced dead by the health care provider. Civil action protects individual rights and results in payment of money to the injured person (e.g., a back injury was sustained during a fall because spilled urine was not wiped up. preponderance (majority) of the evidence. common law Judge made law Durable power of attorney IS valid in ALL states a living will is not defamation Act of harming or ruining another's reputation Malpractice the legal name for professional negligence, means negligence by a professional, in this case an LPN/LVN. Four elements needed to prove negligence Duty breach of duty, damages, and proximate cause are the four elements that must be present to cause an action for negligence against a nurse. Depositions are used to gather information under oath (fact finding). Once the deposition is scheduled, provide information on where and how you can be reached. The deposition usually takes place in an attorney's office. You may be able to request that it be in your attorney's office. Personal liability holds us responsible for our own behavior, including negligent behavior. What does a person see when they look up a nursing license license number Expiration date Any disciplinary actions Vicarious liability means responsibility for actions of another because of a special relationship with the other. Instituitional liability is vicarious liability. It assumes that the health facility provides certain safeguards to keep the client from harm. This includes a safe facility to prevent physical harm (e.g., adequate supervision of staff, adequate staffing, and safe equipment). Confidentiality in health care refers to the nondisclosure of information regarding clients. Patient care partnership Want a patient to take part in their care Patient information that must be revealed Communicable Disease, Vaccine-related adverse reactions, Criminal Acts, Equipment-related injuries, When there is a clear and present danger, Abuse and neglect of a patient, Incompetence or unprofessional acts Client compentency has both a legal meaning and a clinical meaning. Some clients' rights issues are based on proof of competence or incompetence within the court system. Legal competency refers to a client who is: • Eighteen years old or older. • A pregnant or married woman. • A self-supporting minor (referred to as a legally emancipated minor). • Competent in the eyes of the law (incompetence is determined by the court). Clinical competency refers to a client who is able to do the following: • Identify the problem for which he or she is seeing the health care provider. • Understand the options for care and the possible consequences. • Make a decision. • Provide sound reasons for the option he or she chooses. Health "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Healing the process of making or becoming healthy again Wellness Process of self-care achieved by making choices leading to a healthy life. Health Promotion behavior motivated by the desire to increase well-being and optimize health status. Healthy people 2020 Is an initiative designed to track over 10 year increments the risk factors and personal behaviors related to tobacco use, substance abuse, responsible sexual behavior, mental health, immunizations, and injury and violence prevention. Risk Factors Things that will raise the likelihood of a disease. Risk Reduction Steps taken to reduce likeliness of disease. Acute Illness typically characterized by an abrupt onset and short duration (6months) Chronic Illness Characterized by a loss or abnormality of body function that lasts longer than 6 months and requires ongoing long-term care. Primary Prevention Instituted before disease becomes established by removing the causes or increasing resistance establishes disease. Secondary Prevention is undertaken in cases of latent disease. Tertiary Prevention treatment or rehabilitation stage of preventive care. Social Determinants of Health variables that affect health, are affected by resource distribution throughout the world. Health Belief Model • Developed by Hochbaum, Rosenstock, and Kegels. • Explores how patients' attitudes and beliefs predict health behavior. • Self-efficacy was added o Belief in one's ability to perform a task. • Used as a measure for determining the patient's readiness and motivation to act. • Three primary components o Individual's perception of susceptibility to illness o Individual's perception about the seriousness of the illness o Probability that the individual will act to prevent avoidable health risks. Basic Human needs Model • Maslow's Hierarchy of needs o Describes the relationships between the basic requirements for survival and the desires that drive personal growth an development. o Five levels to the pyramid o Physiological needs are more immediate and therefore greater importance. • Humanistic Approach o Promotion of human welfare o Focuses of strengths of patient rather than weaknesses or illness. Health Promotion Model • Developed by Pender and colleagues. • Defines health as a positive, dynamic state of well-being rather than absence of disease in the physiological state. • Focus is on three areas: o Individuals characteristics and experiences o Behavior specific knowledge and affect o Behavioral outcomes • The concepts that define the model are: o Health promotion: behavior motivated by the desire to increase well-being and optimize health status. o Health protection: Intentional behaviors aimed at circumventing illness, detecting it early, and maintain the best possible level of mental and physiologic function within boundaries of illness. Holistic Model • Based on the philosophy that a synergistic relationship exists between body and environment. • Holistic care approach to applying healing therapies • Holistic model focuses on the interrelatedness of body and mind. o Body knows how to heal itself given the proper support. • Patient is an active participant in the healing process, rather than a passive receiver. • Use of natural healing remedies and complementary interventions. • Rapidly growing due to: o Demand for alternative and complementary interventions o Internet o Health care costs o Expectations of management of their own health - Nursing educational programs have changed due to nursing shortage and have made improvements competencies a priority. - Salary gap between LPNs and RNs have lessen. - NLN recognizes the important role LPN have in the nursing team. What are some statements that relate to nursing in the 21st century? Collecting data Implementing interventions What can the LPN do independently in the nursing process? Initial assessment Creates a nursing diagnosis using NANDA Creates care plan Implement the plan Evaluate the outcome Oversees the LPN What are the RN's responsibilities in the nursing process? Assessing the patients understanding of their condition and priorities for change. What should the LPN consider before collaborating with the RN on the patient's plan of care? LPN reinforces patient teaching. What is the LPN's role in patient teaching? Fall precautions Non-skid socks Assisting with ambulating Elevating the HOB Incentive spirometer Deep breathing exercises Oxygen Providing proper hospital bracelets (limb alert) Compression devices Order for anticoagulant (Enoxaparin sodium) for postop patient What are some examples of safety the nurse can implement? Study identified agreed upon LPN task and use terms such as judge, recognize, determine, and appraisal for their scope of practice. What does the US Department of Vocational education conclude in their study on LPN tasks and what terms were used to identify their scope of practice? What should the nurse do when a vital sign measurement does not agree with past measurements? Data that only the patient can feel and will tell you. Example: pain or headache What is subjective data? What you observe and can measure Example: vital signs, intake and output. What is objective data? Knowledge about their condition Noncompliant patients should be assessed for? Measurable and related to the problem. Outcomes should be? Report it to the RN During implementation, if the LPN recognizes that a change is needed to the care plan the LPN should? Not patient specific All parts of the care plan may not be relatable to the patient's condition. Standardized care plans When is the most common time during the nursing process an LPN will reinforce client teaching? the entire plan of care diagnosis including the related to portion Be patient specific Goal oriented Focus on identified outcomes Nursing interventions should include? Asking questions that typically require yes, no, or one word answers. Example: are you hot or cold? Did you eat today? What is closed communication? Open ended questions requiring more than a one word answer. Example: can you describe your pain? What is open communication? Situation Background Assessment Recommendation Identify each part of the SBAR What is active listening Restating clarifying reflection paraphrasing Disciplined attention What are situational influences that may affect communication? How do men and women differ in communication? What is positive listening? What are some ways the book mentions for positive communication? What factors affect communication? What are the behavior styles? What body stances might a person have displaying each behavior style? What are some examples of judgmental behavior? What are some examples of empathy? the nurse's assigned patient first before assisting a colleague and promotes a positive attitude even when challenged with time or patient constraints. Assertive behavior advocates for? state their name and position (Identify-I am an LPN) before asking the client to state their name When entering a client room a nurse should? What is considered sexual harassment? Confront the harasser first What should the nurse do when faced with sexual harassment? What are some environmental factors that might increase the risk of becoming a victim of workplace violence? What is cultural competence? Cultural sensitivity? What are some negative effects on culture such as ethnocentrism, prejudice, stereotyping, discrimination? What are the 3 major health beliefs? How do Hmong regard illness? Regarding world religions, what are some areas specific to: Buddhism, Jehovah's Witness, Hinduism What is the nurse's role if a patient requests prayer and or baptism? What is the reason for your call. Identify yourself, unit, pts name, and problem. Situation (SBAR) Admitting diagnosis, date of admission, current status (vitals, medications, allergies, IV fluids, code status) Background (SBAR) What do you think is going on based on the data findings (should collaborate with the RN as needed) For example: is the problem life threatening? Assessment (SBAR) Goals of care, what's needed to be done including a consult, medication order, transfer. Recommendation (SBAR)