JURISPRUDENCE EXAM AQA 2023 with complete solution

CNO MISSION regulating nursing in the public interest 2 documents that provide the legislative framework for regulating nursing in Ontario: 1. Regulated Health Professions Act, 1991 2. Nursing Act, 1991 4 regulatory functions: 1. practice standards. 2. entry to practice. 3. quality Assurance Program. 4. enforcing standards 5 statutory committeess 1. Discipline 2. Fitness to Practice 3. Inquiries, Complaints, and Reports 4. Quality Assurance 5. Registration The Outreach Program provides ways for nurses to engage in _____________ ___________ by offering consultation and resources to help members practise according to the practice standards. nursing regulation COMPETENCY ASSUMPTIONS Entry-level RPNs possess the ________________ required to demonstrate the wide range of competencies in this document. knowledge COMPETENCY ASSUMPTIONS Entry-level RPNs are beginning practitioners whose level of autonomy and proficiency will grow through ______________ and ______________ from the interprofessional health care team. collaboration support COMPETENCY ASSUMPTIONS Entry-level RPNs are _____________ to practise safely, competently and ethically in situations of health and illness with individuals across the lifespan. prepared COMPETENCY ASSUMPTIONS Entry-level RPNs' practice decisions are _________-___________ and must take into account the environment, the client's circumstances and whether the client's needs can be met by the entry-level RPN. client-specific COMPETENCY ASSUMPTIONS Entry-level RPNs enter into practice with competencies that are _______________ across diverse practice settings. transferable COMPETENCY ASSUMPTIONS Entry-level RPNs have a _______________ ___________ in nursing, health and social sciences, ethics, leadership and research. knowledge base COMPETENCY ASSUMPTIONS Entry-level RPNs are committed to engaging in quality assurance practices, including ____________ _____________. Reflective Practice COMPETENCY ASSUMPTIONS Entry-level RPNs use ____________ _______________ skills to support clinical decision-making and reflect upon practice experiences. critical thinking The entry-level RPN is accountable for: All client __________ she or he provides. care The entry-level RPN is accountable for: All decisions about _____________ _________ to other care providers assigning care The entry-level RPN is accountable for: Knowing and recognizing her or his _______________ __________ (knowledge, skill and judgment) when making decisions and providing care to clients. competence level The entry-level RPN is accountable for: Actively identifying and asking ________________ of self, colleagues (including members of the Interprofessional health care team) and clients. questions The entry-level RPN is accountable for: The application of _____________ to ______________ via the use of critical thinking and problem-solving skills consistent with the RPN's educational preparation. theory to practice WHICH COMPETENCY STATEMENT? Demonstrates professional conduct; practises in accordance with legislation and the standards as determined by the regulatory body and the practice setting; and demonstrates that the primary duty is to the client to ensure consistently safe, competent and ethical care Professional Responsibility and Accountability WHICH COMPETENCY STATEMENT? Demonstrates competence in professional judgments and practice decisions by applying principles implied in the ethical framework, and by using knowledge from many sources. Engages in critical thinking to inform clinical decision- making, which includes both systematic and analytical processes, along with reflective and critical processes. Establishes therapeutic caring and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect Ethical Practice WHICH COMPETENCY STATEMENT? Demonstrates an understanding of the concept of public protection and the duty to practise nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public. Service to the Public WHICH COMPETENCY STATEMENT? Demonstrates an understanding of professional self-regulation by developing and enhancing one's competence, ensuring consistently safe practice, and ensuring and maintaining one's fitness to practise. Self-Regulation DEFINITION The obligation to answer for the professional, ethical and legal responsibilities of one's activities and duties. ACCOUNTABILITY DEFINITION Actively supporting a right and good cause; supporting others for speaking for themselves or speaking on behalf of those who cannot speak for themselves. ADVOCATE DEFINITION defining lines that separate the therapeutic behaviour of an RPN from any behaviour that, well-intentioned or not, could reduce the benefit of nursing care to clients, families or communities. BOUNDARY DEFINITION Individuals, families, groups or entire communities across the lifespan who require nursing expertise. CLIENT DEFINITION To work together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her or his scope of practice. COLLABORATE DEFINITION An organized group of people bound together by ties of social, ethnic, cultural or occupational origin; or by geographic location. COMMUNITY DEFINITION The ability of a nurse to integrate the professional attributes required to perform in a given role, situation or practice setting. Professional attributes include, but are not limited to, knowledge, skill, judgment, values and beliefs. COMPETENCE DEFINITION Descriptions of the expected performance behaviour that reflects the professional attributes required in a given nursing role, situation or practice setting. COMPETENCY STATEMENTS DEFINITION Activities that are considered potentially harmful if performed by unqualified people. CONTROLLED ACTS DEFINITION Reasoning in which one analyzes the use of language, formulates problems, clarifies and explains assumptions, weighs evidences, evaluate conclusions, discriminates between pros and cons, and seeks to justify those facts and values that result in credible beliefs and actions. CRITICAL THINKING DEFINITION Includes, but is not restricted to age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief and disability. CULTURE DEFINITION The formal process that transfers authority to perform a controlled act. DELEGATE DEFINITION At every stage of life, health is determined by complex interactions among social and economic factors, the physical environment and individual behaviour. They do not exist in isolation from each other. These determinants, in combination, influence health status. DETERMINANTS OF HEALTH DEFINITION Practice that is based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence, including client perspective, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data. EVIDENCE-INFORMED PRACTICE DEFINITION All people sharing a common health issue, problem or characteristic. These people may or may not come together as a group. POPULATIONS DEFINITION A relationship that is professional and ensures the client's needs are first and foremost. The relationship is based on trust, respect and intimacy and requires the appropriate use of the power inherent in the health care provider's role. The professional relationship between RPNs and their clients is based on a recognition that clients (or their alternative decision-makers) are in the best position to make decisions about their lives when they are active and informed participants in the decision-making process. THERAPEUTIC RELATIONSHIP DEFINITION Expectations that contribute to public protection that inform nurses of their accountabilities and the public of what to expect of nurses. These apply to all nurses regardless of their role, job description or area of practice. NURSING STANDARDS What legislation governs health care information privacy in Ontario? Personal Health Information Protection Act, 2004 (PHIPA) TRUE OR FALSE? PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care. TRUE Which legislation provides a broad protection to quality of care information produced by a health care facility or a health care entity, or for a governing or regulatory body. Quality of Care Information Protection Act (QOCIPA) What is the purpose of the Quality of Care Information Protection Act (QOCIPA)? To promote open discussion of adverse events, peer review activities and quality of care information, while protecting this information from being used in litigation or accessed by clients. What is personal health information? Personal health information is any identifying information about clients that is in verbal, written or electronic form. TRUE OR FALSE? Clients have to be named for information to be considered personal health information. FALSE. Information is "identifying" if a person can be recognized, or when it can be combined with other information to identify a person. Personal health information can also be found in a "mixed record," which includes personal information other than that noted above. TRUE OR FALSE? When a nurse learns information that, if not revealed, could result in harm to the client or others, she/he must keep this information confidential within the therapeutic relationship. FALSE. He/she must consult with the health care team and, if appropriate, report the information to the person or group affected. TRUE OR FALSE? Nurses must explain to clients that information will be shared with the health care team and identify the general composition of the health care team. TRUE. TRUE OR FALSE. Nurses must report suspected child abuse. TRUE Child and Family Services Act, 1990 requires all health care professionals to report suspected child abuse to the Children's Aid Society; the Health Protection and Promotion Act permits reporting of certain conditions to the Medical Officer of Health. Your client with an acquired brain injury has been stabilized and is being transferred to another hospital for continuing care. The client is unconscious. Her husband is aware of the transfer, but does not know it is happening today. You tried to reach him by telephone, without success. Before the client is transferred, you want to share information about the care she received and the current plan of care with the nurse who will receive her. The client's cost for this transfer is being covered by private insurance, so you also need to share personal health information with the insurance company. How much information can you share, and with whom, under these circumstances? 1. the receiving hospital nursing staff. These nurses are members of the health care team; therefore, there is implied consent for the sharing of information with them to provide health care. You can, therefore, share her personal health information. 2. the insurance company. Express consent is required because this disclosure is not to a custodian and is not required to treat the client. Because the client is incapable of providing this consent, her husband (the substitute decision- maker) must provide express consent either in writing or verbally, before you share information. Since you cannot reach him, you may arrange her transfer. Once you obtain express consent from the husband, you may provide the information to an insurance company staff member. A man who received severe facial injuries in a motor vehicle crash arrives in your emergency room (ER). He is unable to communicate. No next of kin has come with him. A woman calls in distress and asks if her husband is a patient in your ER. She provides you with details that match the information on the man's identification. You believe she is the wife of the man with the facial injuries. Can you tell this woman that he is in the ER? Normally, a client would have an opportunity to request that the hospital not disclose that he is a client in the facility or his location within the facility. This information may be given out in this case, however, because it is reasonably necessary to provide care. Because the law permits disclosure that a person is a client in a facility, and his/her location and general health status, you may provide this information to the woman. PHIPA allows you to contact a friend or relative of an injured client for consent. You may provide more information if the woman indicates she is the person who can act as a substitute decision-maker for consent to treatment. Your client has reviewed his health record. You answered his questions to ensure he understood the record, but he wants corrections made to a consulting physician's note. What do you do? The issue is correcting a health record made by another health care professional. If the client requested a correction to your note, and you agreed with the correction the client requested, you could have the client write a correction and include it with the record or make the changes yourself. If you did not agree with the correction the client requested, then you can have the client make a note and append it to the record. You can then make a separate note regarding the client's request in the health record. A client does not have the right to correct an opinion or professional judgment by a health care professional. Because this is a note by another health care professional (the consulting physician), you cannot be certain about the accuracy of the information that the client wants corrected. You have two options in this case: you can either contact the health care professional who wrote the note and have this physician speak with the client about the corrections; or you can speak with the person responsible for ensuring compliance with PHIPA in your practice setting. You are an OHN. The manager of an employee who is your client has asked questions about the client's health condition. The manager has also asked if the client has medical notes to substantiate absences on particular dates. Can you provide this information to the manager? There are two issues here. The first is what is included in the definition of personal health information; the second is if a manager has access to personal health information. Medical notes to substantiate the employee's absences may be held in an employee's health file. If the medical note does not contain other personal health information (e.g., symptoms, treatment, diagnosis), then this information can be provided to the manager. Information concerning accommodation for the employee's needs may be given so the employer can make provisions to meet these needs. Accommodation information does not include the nature of the illness or the diagnosis. If there is personal health information included in the note, then the OHN can only provide the information that there were notes to substantiate the absences on the applicable dates. The manager is not entitled to any personal health information. This includes information about the nature of the illness, the diagnosis, the plan of treatment or any care provided; therefore, you cannot respond to any questions about the nature of the illness(es) or health condition(s). In this example, the nurse is the custodian and is responsible for maintaining the confidentiality of the client's personal health information. Providing information to the employer without the client's express consent is a breach of PHIPA. However, if a client would like personal health information to be given to the employer, then the client must give express consent to the nurse. In obtaining express consent, the nurse needs to clarify exactly which information the client is requesting be disclosed, and obtain written express consent that includes the employee's specific request. DEFINITION means by which the authority to perform a procedure is obtained or the decision is made to perform a procedure AUTHORIZING MECHANISM DEFINITION formal process that transfers the authority to perform a controlled act DELEGATION DEFINITION A client-specific order can be an order for a procedure, treatment, drug or intervention for an individual client DIRECT CLIENT ORDER DEFINITION an order for a procedure, treatment, drug or intervention that may be implemented for a number of clients when specific conditions are met and specific circumstances exist DIRECTIVE DEFINITION a prescription for a procedure, treatment, drug or intervention ORDER Which legislation contains a scope of practice statement that describes in a general way what the profession does and the methods that it uses? NURSING ACT WHAT IS "The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function." SCOPE OF PRACTICE STATEMENT HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991? 13 HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM? 3 WHAT ARE THE 3 CONTROLLED ACTS THAT NURSES CAN PERFORM? 1. Performing a prescribed procedure below the dermis or a mucous membrane. 2. Administering a substance by injection or inhalation. 3. Putting an instrument, hand or finger beyond the external ear canal, the point in the nasal passages where they normally narrow, the larynx, the opening of the urethra, the labia majora, the anal verge, or into an artificial opening into the body. WHAT ARE THE TWO CONDITIONS BY WHICH AN RPN CAN PERFORM A CONTROLLED ACT? 1. if initiated (see Appendix D) in accordance with conditions identified in the regulation; 2. if the procedure is ordered by a physician, dentist, chiropodist, midwife or NP. WHAT ARE THE EXCEPTIONS to the Need for Authorization UNDER WHICH AN RPN CAN PERFORM OTHER CONTROLLED ACTS? 1. EMERGENCY 2. STUDENT PRACTICING UNDER AN AUTHORIZE PERSON 3. when treating a member of a person's household and the procedure is within the second or third controlled act authorized to nursing; 4. when assisting a person with his/her routine activities of living and the procedure is within the second or third controlled act authorized to nursing; or 5. when treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment. There are four standards, each with accompanying indicators, that describe a nurse's accountabilities when performing any procedure, whether or not it requires delegation, what are they? 1. Appropriate health care provider 2. Authority 3. Competence 4. Managing Outcomes STANDARD STATEMENTS Nurses must consider each situation to determine if the performance of the procedure promotes safe client care, and if it is ______________ for a nurse to perform the procedure. appropriate STANDARD STATEMENTS Nurses ensure that they have the appropriate _______________ before performing procedures. authority STANDARD STATEMENTS Nurses ensure that they are ________________ in both the cognitive and technical aspects of a procedure prior to performing it. competent STANDARD STATEMENTS Prior to performing procedures, nurses ensure that they are able to identify the potential outcomes of procedures, have the authority and competence to ____________ the ________________ , or have the resources available to manage those outcomes. manage the outcomes 3 requirements of nursing documentation 1. documentation presents an accurate, clear and comprehensive picture of the client's needs, the nurse's interventions and the client's outcomes. 2. documentation of client care is accurate, timely and complete. 3. safeguard client health information by maintaining confidentiality and acting in accordance with information retention and destruction policies and procedures that are consistent with the standard(s) and legislation. DEFINITION therapeutic relationship that enables the client to attain, maintain or regain optimal function by promoting the client's health through assessing, providing care for and treating the client's health conditions. NURSING CNO'S 7 ETHICAL VALUES 1. client well-being; 2. client choice; 3. privacy and confidentiality; 4. respect for life; 5. maintaining commitments; 6. truthfulness; 7. fairness. TRUE OR FALSE? All nurses must respond to situations in the same way. FALSE. Not all nurses experience the same situation in the same way, and a situation that causes conflict, uncertainty or distress for some nurses may be straightforward for others. TRUE OR FALSE? Ethical disagreements between nurses are acceptable. TRUE. There is room for disagreement among nurses on how they weigh the different ethical values. But above all, nurses need to choose ethical interventions that meet the needs of clients. TRUE OR FALSE? It is always possible to find a conflict resolution that meets everyone's satisfaction. FALSE. It is not always possible to find a resolution to a conflict that satisfies everyone. At these times, the best possible outcome is identified in consultation with the client, and the health care team works to achieve that outcome. Nurses may still not be individually satisfied with the resolution; in this case, they need to examine why they're unsatisfied, and consider the possibility of taking follow-up action. TRUE OR FALSE. Clients are always the best people to make decisions about their own health. TRUE. If a client is competent, then they are the best person to make choices about their health, but... if a client is deemed incompetent, they a nurse must consult a substitute decision-maker WHAT SHOULD A NURSE DO IF THEY DISCOVER THAT A CLIENT'S WISHES CONFLICT WITH THEIR OWN PERSONAL VALUES? When a client's wish conflicts with a nurse's personal values, and the nurse believes that she/he cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation. If no other caregiver can be arranged, the nurse must provide the immediate care required. If no other solution can be found, the nurse may have to leave a particular place of employment to adhere to her/his personal values. WHICH ETHICAL VALUE? facilitating the client's health and welfare, and preventing or removing harm. CLIENT WELL-BEING WHICH ETHICAL VALUE? self-determination and includes the right to the information necessary to make choices and to consent to or refuse care CLIENT CHOICE WHICH ETHICAL VALUE? limited access to a person, the person's body, conversations, bodily functions or objects immediately associated with the person PRIVACY AND CONFIDENTIALITY WHICH ETHICAL VALUE? means that human life is precious and needs to be respected, protected and treated with consideration RESPECT FOR LIFE WHICH ETHICAL VALUE? keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings. MAINTAINING COMMITMENTS WHICH ETHICAL VALUE? speaking or acting without intending to deceive. TRUTHFULLNESS TRUE OR FALSE. Omissions are as untruthful as false information. TRUE. WHICH ETHICAL VALUE? allocating health care resources on the basis of objective health-related factors FAIRNESS TRUE OR FALSE. In regards to ethical concerns, sometimes the best possible outcome may be the one that is least bad. TRUE. Sometimes a completely good outcome is impossible One of Joanne's clients in the psychiatric unit, John, confides to her that he is fascinated by young children, boys and girls. He tells Joanne he is afraid that he will hurt a child some day. Joanne brings that information to the team. A short time later, John is discharged. Some weeks following his discharge, Joanne notices that John is the ice-cream vendor in her neighbourhood. She is concerned for the children in the neighbourhood, her own as well as the others, and wonders what she should do. A. ASSESS There is no absolute duty to respect confidentiality. Confidential information can be disclosed when a person(s) is at serious risk. However, it is preferable if the client discloses the information. Joanne decides that she needs to know more about John's clinical situation and sees John's psychiatrist the next time she is working. The psychiatrist shares Joanne's concerns. With the information she has, Joanne thinks the dilemma is whether she should break client confidentiality to protect children from the threat of serious harm. Joanne is also concerned about John's well-being, now that he is living in the community and has found employment. As well, by disclosing confidential information, she will not have maintained a commitment to a client. Try to meet both her obligation to protect the public and to protect her client's confidentiality and well-being. Working with the mental health care team, Joanne would arrange for John to be assessed by the team to determine whether he poses a danger to children at this time. If the team determines that John poses a serious danger to children, it must then decide how to respond to this situation. John could be an involuntary client unless he agreed to be admitted to a psychiatric facility. If it were found that John does not pose a danger, then there is no justification to disclose confidential information. With this option, Joanne can begin to meet her obligations to the client and to the public. What is the simplest and most important practice a nurse can do to reduce contamination and spread of infection? Proper hand hygiene is the single most- important infection prevention and control practice. The spread of infection requires an _____________ ____________ infectious agent The infectious agent needs a ______________ where it can live, grow and reproduce reservoir The transmission of infection also requires a _______________ _________ susceptible host Factors that influence a person's ________________ include age; general physical, mental and emotional health; the amount and duration of exposure to the agent; and the immune status and inherent susceptibility of the individual. susceptibility How the infectious agent is transmitted from the reservoir to the susceptible host is called the ___________ of ___________________ mode of transmission Transfer requires a route for the infectious agent to exit the _____________ (a portal of exit), a mode of travel to the ________________ _______ (a mode of transmission) and a ___________ to enter the susceptible host (a portal of entry) reservoir susceptible host route WHICH MODE OF TRANSMISSION? Direct contact transmission involves contact between the infectious agent and the susceptible host. CONTACT TRANSMISSION WHICH MODE OF TRANSMISSION? involves contact of the conjunctivae or mucous membranes of the nose or mouth of a susceptible host with large particle droplets (larger than five microns) that contain an infectious agent DROPLET TRANSMISSION WHICH MODE OF TRANSMISSION? Food, water or medication contaminated with an infectious agent can act as a ________________ for transmission when consumed VEHICLE WHICH MODE OF TRANSMISSION? Small particle residue (five microns or smaller) of evaporated droplets may remain suspended in the _________ for long periods of time, or dust particles may contain an infectious agent. AIR WHICH MODE OF TRANSMISSION? insects may harbour an infectious agent and transfer it to humans through bites (for example, West Nile virus). VECTORBORNE