Understanding Ethical Practice and Client Care in Nursing, Exams of Nursing

Download Understanding Ethical Practice and Client Care in Nursing and more Exams Nursing in PDF only on Docsity! Jurisprudence Exam Questions and Answers 2024(Verified Answers) CNO MISSION - answers regulating nursing in the public interest 2 documents that provide the legislative framework for regulating nursing in Ontario: - answers 1. Regulated Health Professions Act, 1991 2. Nursing Act, 1991 4 regulatory functions: - answers 1. practice standards. 2. entry to practice. 3. quality Assurance Program. 4. enforcing standards 5 statutory committees - answers 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. - answers nursing regulation COMPETENCY ASSUMPTIONS Entry-level RPNs possess the ________________ required to demonstrate the wide range of competencies in this document. - answers 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. - answers 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. - Answers prepared COMPETENCY ASSUMPTIONS The application of _____________ two ______________ via the use of critical thinking and problem-solving skills consistent with the RPN's educational preparation. - answers theory to practice WHICH COMPETENCY STATEMENT? Demonstrates professional conduct; practices 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 - answers 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 - answers 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. - answers 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. - answers Self-Regulation DEFINITION The obligation to answer for the professional, ethical and legal responsibilities of one's activities and duties. - answers 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. - answers ADVOCATE DEFINITION Defining lines that separate the therapeutic behavior of an RPN from any behavior that, well-intentioned or not, could reduce the benefit of nursing care to clients, families or communities. - answers BOUNDARY DEFINITION Individuals, families, groups or entire communities across the lifespan who require nursing expertise. - answers 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. - Answers COLLABORATE DEFINITION An organized group of people bound together by ties of social, ethnic, cultural or occupational origin; or by geographic location. - answers 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. - answers COMPETENCE 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. - answers 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. - answers NURSING STANDARDS What legislation governs health care information privacy in Ontario? - answers 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. - answers 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. - answers Quality of Care Information Protection Act (QOCIPA) What is the purpose of the Quality of Care Information Protection Act (QOCIPA)? - answers 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? - answers 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. - answers 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. - answers 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. - answers TRUE. TRUE OR FALSE. Nurses must report suspected child abuse. - answers 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? - answers 1. the receiving hospital nursing staff. These nurses are members of the answers 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 - answers AUTHORIZING MECHANISM DEFINITION formal process that transfers the authority to perform a controlled act - answers DELEGATION DEFINITION A client-specific order can be an order for a procedure, treatment, drug or intervention for an individual client - answers 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 - answers DIRECTIVE DEFINITION a prescription for a procedure, treatment, drug or intervention - answers 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? - answers 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." - answers SCOPE OF PRACTICE STATEMENT HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991? - answers 13 HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM? - answers 3 WHAT ARE THE 3 CONTROLLED ACTS THAT NURSES CAN PERFORM? - answers 1. Performing a prescribed procedure below the dermis or a mucous membrane. 2. Administering a substance by injection or inhalation. Nurses ensure that they are ________________ in both the cognitive and technical aspects of a procedure prior to performing it. - answers 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. - answers manage the outcomes 3 requirements of nursing documentation - answers 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. - answers NURSING CNO'S 7 ETHICAL VALUES - answers 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. - answers 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. - answers 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. - answers 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. - answers 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? - answers 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 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 someday. 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 neighborhood. She is concerned for the children in the neighbourhood, her own as well as the others, and wonders what she should do. - answers 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? - answers Proper hand hygiene is the single most- important infection prevention and control practice. The spread of infection requires an _____________ ____________ - answers infectious agent The infectious agent needs a ______________ where it can live, grow and reproduce - answers reservoir The transmission of infection also requires a _______________ _________ - answers 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. - answers susceptibility How the infectious agent is transmitted from the reservoir to the susceptible host is called the ___________ of ___________________ - answers 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) - answers reservoir susceptible host route WHICH MODE OF TRANSMISSION? Direct contact transmission involves contact between the infectious agent and the susceptible host. - answers 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 DEFINITION a chemical agent with a drug identification number (DIN) used on inanimate (non-living) objects to kill micro-organisms. - answers DISINFECTANT DEFINITION a process that destroys or kills some, but not all, disease-producing micro-organisms on an object or surface. - answers DISINFECTION DEFINITION a circumstance of being in contact with an infected person or item in a manner that may allow for the transfer of micro-organisms, either directly or indirectly, to another person. - answers EXPOSED DEFINITION an agent that destroys micro-organisms, especially pathogenic organisms. A product with the suffix "-cide" indicates that it is an agent that destroys the micro- organism identified by the prefix (for example, virucide, fungicide, bactericide). - answers GERMICIDE DEFINITION the physical separation of infected individuals from uninfected individuals for the period of communicability of a particular disease. - answers ISOLATION DEFINITION microscopic organisms such as bacteria, virus or fungus, commonly known as germs, that can cause an infection in humans. - answers MICRO-ORGANISM DEFINITION thin sheets of tissue that line various openings of the body, such as the mouth, nose, eyes and genitals. - answers MUCUS MEMBRANES DEFINITION infection acquired in a health care setting. - answers NOSOCOMIAL INFECTION DEFINITION specialized clothing or equipment (for example, gloves, masks, protective eyewear, gowns) worn by an employee for protection against an infectious hazard. - answers PERSONAL PROTECTIVE EQUIPMENT DEFINITION interventions implemented to reduce the risk of transmitting micro- organisms from client to client, client to health care worker, and health care worker to client. - answers PRECAUTIONS CNO'S 8 RIGHTS - answers 1. right client, 2. right medication 3. right reason, 4. right dose, 5. right frequency, 6. right route, 7. right site, 8. right time; DEFINITION any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer. - answers MEDICATION ERROR DEFINITION giving the wrong medication - answers ERROR OF COMMISSION The administration of an allergen by oral, inhaled or other route in which a positive test is a significant allergic response (for example, anaphylactic shock). - answers Allergy challenge testing MEDICATION TERMS a prick/puncture procedure to determine allergies, if any. - answers ALLERGY TESTING MEDICATION TERMS an intracutaneous injection to desensitize to an allergen - answers DESENSITIZING INJECTION Because allergy testing and desensitizing injections carry a risk of adverse reactions, nurses must be able to do what? - answers recognize side effects, intervene in the event of complications (for example, difficulty breathing, rash or anaphylactic shock) and manage outcomes. MEDICATION TERMS Any type of drug that the federal government has categorized as having a higher-than-average potential for abuse or addiction. Such drugs are divided into categories based on their potential for abuse or addiction. - answers CONTROLLED SUBSTANCE MEDICATION TERMS A vaccine. - answers IMMUNIZING AGENT MEDICATION TERMS Medications and preparations that do not require a prescription; for example, herbal therapies and acetaminophen. - answers OVER THE COUNTER (OTC) DEFINITIONS A pharmacologically inert substance that has no physiological effect. - answers PLACEBO DEFINITION Medications that are prescribed and administered as needed. - answers PRN MEDICATION DEFINITION Dosages, frequencies or routes that are prescribed in ranges (for example, Gravol 50-100 mg for nausea). - answers RANGE DOSES Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give nurses the flexibility to administer the dose that best suits the assessment of the client. DEFINITION Administrating one's own medication. - answers SELF- ADMINISTRATION TRUE OR FALSE? A nurse cannot teach a PSW how to administer medication. - answers FALSE Nurses may teach UCPs medication administration, including the process of administration and documentation, as required. TRUE OR FALSE? If a nurse delegates medication administration to a PSW, they assume all the responsibilities related to med admin. - answers FALSE The nurse remains responsible for the: - ongoing assessment of the client's needs; - plan of care in conjunction with the health care team; - evaluation of the client's health status; and - effectiveness of the medication(s). ___________ is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem - answers Respect ________ ____________ is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that create closeness. - answers Professional intimacy ____________ is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client. - answers Empathy The nurse-client relationship is one of unequal ___________. Although the nurse may not immediately perceive it, the nurse has more _____________ than the client. - answers power power DEFINITION the misuse of the power imbalance intrinsic in the nurse-client relationship. It can also mean the nurse betraying the client's trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the client - answers ABUSE DEFINITION the nurse-client relationship is the point at which the relationship changes from professional and therapeutic to unprofessional and personal. Crossing a _____________ means that the care provider is misusing the power in the relationship to meet her/his personal needs, rather than the needs of the client, or behaving in an unprofessional manner with the client. - answers BOUNDARY DEFINITION In this approach, a client is viewed as a whole person. - answers CLIENT-CENTRED CARE DEFINITION relationship involves planned and structured psychological, psychosocial and/or interpersonal interventions aimed at influencing a behaviour, mood and/or the emotional reactions to different stimuli - answers PSYCHOTHERAPEUTIC RELATIONSHIP DEFINITION may include, but is not limited to, the person who a client identifies as the most important in his/her life. - answers SIGNIFICANT OTHER Nurses use a wide range of effective _____________ _____________ and _____________ __________ to appropriately establish, maintain, re-establish and terminate the nurse-client relationship. - answers communication strategies interpersonal skills Nurses work with the client to ensure that all professional behaviours and actions meet the _______________ needs of the client. - answers therapeutic Nurses are responsible for effectively establishing and maintaining the limits or ______________ in the therapeutic nurse-client relationship. - answers boundaries Nurses ______________ the client from harm by ensuring that abuse is prevented, or stopped and reported. - answers protect TRUE OR FALSE. It is acceptable for a nurse to spend extra time with one client beyond his/ her therapeutic needs. - answers FALSE. ■ hitting; ■ pushing; ■ slapping; ■ shaking; ■ using force; and ■ handling a client in a rough manner. - answers PHYSICAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ non-therapeutic confining or isolation; ■ denying care; ■ non-therapeutic denying of privileges; ■ ignoring; ■ withholding clothing, food, fluid, needed aids or equipment, medication, and/or communication. - answers NEGLECT WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sexually demeaning, seductive, suggestive, exploitative, derogatory or humiliating behaviour, comments or language toward a client; ■ touching of a sexual nature or touching that may be perceived by the client or others to be sexual; College of Nurses of Ontario Practice Standard: Therapeutic Nurse- Client Relationship, Revised 2006 ■ sexual intercourse or other forms of sexual contact with a client; ■ sexual relationships with a client's significant other; and ■ non-physical sexual activity such as viewing pornographic websites with a client. - answers SEXUAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ borrowing money or property from a client; ■ soliciting gifts from a client; ■ withholding finances through trickery or theft; ■ using influence, pressure or coercion to obtain the client's money or property; ■ having financial trusteeship, power of attorney or guardianship; ■ abusing a client's bank accounts and credit cards; and ■ assisting with the financial affairs of a client without the health care team's knowledge. - answers FINANCIAL TRUE OR FALSE. UNDER NO CIRCUMSTANCES SHOULD A NURSE PROVIDE CARE FOR A SEXUAL PARTNER. - answers FALSE. If a nurse's sexual partner is admitted to an agency where the nurse is providing care or services, the nurse must make every effort to ensure that alternative care arrangements are made. Until alternative arrangements are made, however, the nurse may provide care. TRUE OR FALSE. If a nurse does not have time to complete an act ordered to her, it is acceptable for her to delegate it to a PSW. - answers FALSE. They cannot delegate an act that has been delegated to them - sub- delegation TRUE OR FALSE. It is acceptable for a nurse to delegate a patient's standard dose insulin injection to a family member. - answers TRUE The RHPA includes an exception allowing UCPs to perform some controlled acts as long as they are considered to be routine activities of living. Procedures are considered to be routine activities of living when the need for, response to, and outcome of the procedure have been established over time and are predictable. For instance, administering the same dosage of insulin to a person with well-controlled diabetes over an extended period of time is a routine activity of living. It is not a routine activity if the dosage or type of insulin requires frequent adjustment. How many requirements must be met before a nurse can delegate to an UCP. - answers 10 significant risk, you would determine that it is not appropriate to get involved in this treatment. You would then explain your decision to the client. You have completed Levels 1 and 2 of a therapeutic touch program. In the acute care setting where you work, you have identified some clients you think could really benefit from this intervention. Is it acceptable for you to suggest it to them? - answers You may propose to a client the use of therapeutic touch if you have the knowledge to believe that the treatment would benefit the client, and therapeutic touch has been recognized by the acute care agency as an appropriate intervention. If the agency has not determined the appropriateness of this intervention, then you may advocate to have it recognized. In the long-term care setting where you work, some of the residents are prescribed herbal remedies by a physician who practises Chinese medicine. What are you accountable for in administering these substances? - answers You must balance client choice with professional responsibility. At a minimum, you would need information about the purpose, action and anticipated effects of the substance to fulfil your professional responsibility to assess the risks and benefits of providing this treatment in relation to the health status of the client. You would also be responsible for evaluating the effects of the treatment. If you had access to sufficient information to meet this expectation, then you may agree to provide this treatment. One way to achieve this would be to arrange for a team conference with the physician to develop a plan of care related to the administration of the prescribed herbal substances. TRUE OR FALSE? All conflict is negative. - answers FALSE. The experience of dealing with conflict can lead to positive outcomes for nurses, their colleagues and clients. Conflict between a nurse and a client can escalate if a client is: - answers a) intoxicated or withdrawing from a substance- induced state; b) being constrained (for example, not being permitted to smoke) or restrained (for example, with a physical or chemical restraint); c) fatigued or overstimulated; and/or d) tense, anxious, worried, confused, disoriented or afraid. Conflict between a nurse and a client can escalate if a client has: - answers a) a history of aggressive or violent behaviour, or is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance); b) a medical or psychiatric condition that causes impaired judgment or an altered cognitive status; c) an active drug or alcohol dependency or addiction; d) difficulty communicating (for example, has aphasia or a language barrier exists); and/or e) ineffective coping skills or an inadequate support network. Conflict between a nurse and a client can escalate if a nurse: - answers a) judges, labels or misunderstands a client; b) uses a threatening tone of voice or body language (for example, speaks loudly or stands too close); c) has expectations based on incorrect perceptions of cultural or other differences; d) does not listen to, understand or respect a client's values, opinions, needs and ethnocultural beliefs;12 e) does not listen to the concerns of the family and significant others, and/or act on those concerns when it is appropriate and consistent with the client's wishes; f) does not provide sufficient health information to satisfy the client or the client's family; and/or g) does not reflect on the impact of her/his behaviour and values on the client. professional judgment To manage conflict, a nurse can: implement a ____________ ______________ management plan; - answers critical incident To manage conflict, a nurse can: remain calm and ______________ the client to express his/her concerns; - answers encourage To manage conflict, a nurse can: __________ arguing, criticizing, defending or judging; - answers avoid To manage conflict, a nurse can: focus on the client's _________________ rather than the client personally; - answers behaviour To manage conflict, a nurse can: ____________ the client, the client's family and the health care team members in assisting with the behaviour and developing ______________ to prevent or manage it; - answers involve solutions To manage conflict, a nurse can: state that abusive language and behaviours are ______________, if the nurse believes this will not ______________ the client's behaviour; - answers unacceptable escalate To manage conflict, a nurse can: _________ ___________ from the client, if necessary (for example, to regain composure or to set personal space boundaries); - answers step away To manage conflict, a nurse can: leave the situation to develop a ________ ___ ________ with the assistance of a colleague if the client intends to harm the nurse - answers plan of care To manage conflict, a nurse can: protect themselves and other clients in abusive situations by ______________ services, if necessary - answers withdrawing Poor relationships among members of the health care team negatively affect the ___________ ____ ___________. - answers delivery of care DEFINITION Involving the client in making decisions based on the client's values, beliefs and wishes. - answers ANTICIPATORY PLANNING DEFINITION Any act or verbal comment that could isolate or have negative psychological effects on a person. Bullying usually involves repeated incidents or a pattern of behaviour that is intended to intimidate, offend, degrade or humiliate a particular person or group of people. - answers BULLYING DEFINITION Any sudden unexpected event that has an emotional impact that can overwhelm the usually effective coping skills of an individual or a group - answers CRITICAL INCIDENT DEFINITION Interpersonal conflict among colleagues that includes antagonistic behaviour such as gossiping, criticism, innuendo, scapegoating, undermining, intimidation, passive aggression, withholding information, The Health Care Consent Act (HCCA) An ___________________ determines client capacity to make a decision about admission to a care facility or a personal assistance service. Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) may be _________________. - answers evaluator evaluators The Health Care Consent Act (HCCA) The client has the ______________ to ask the Consent and Capacity Board (CCB) to review the finding of _________________. - answers right incapacity The Health Care Consent Act (HCCA) ______________ adjustments to a treatment plan for an incapable client can be made without having to seek repeated consent from a substitute decision- maker. - answers Minor The Health Care Consent Act (HCCA) One health care practitioner can propose a plan of treatment and obtain consent to the plan on _____________ of all the health care practitioners involved in the plan. - answers behalf The Health Care Consent Act (HCCA) When a health care practitioner finds a client is _________________ of making a treatment decision, the legislation requires the practitioner to provide the client with ___________________ about the consequences of the finding. This provision of information must be performed in accordance with __________________ established by the practitioner's governing body. - answers incapable information guidelines The Health Care Consent Act (HCCA) A _______________ ________________ acting as a substitute decision- maker is not required to make a formal statement verifying his/her status. The legislation does contain a __________________ of substitute decision-makers. - answers family member hierarchy The Health Care Consent Act (HCCA) A person's ________________ about treatment, admissions or personal assistance services may be expressed _____________, in ______________, in any other form, or they may be _______________. - answers wishes orally writing implied The Substitute Decisions Act (SDA) An individual may _______________ a specific person to make decisions about his/her personal care or treatment in the event that he/she becomes _______________. The person may also express his/her wishes about the kinds of decisions to be made or factors to ______________ decisions. - answers designate incapable guide The Substitute Decisions Act (SDA) The Office of the PGT is the government department that deals with ____________ ____________ and _________________ _____________. - answers personal care property matters The Substitute Decisions Act (SDA) other suitable person available and willing to be appointed. - answers Public Guardian and Trustee (PGT) DEFINITION Anything done for a therapeutic, cosmetic or other health-related purpose. - answers TREATMENT DEFINITION A plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a person has and is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person's health condition. - answers PLAN OF TREATMENT DEFINITION A series or sequence of similar treatments administered to a person over a period of time for a particular health problem. - answers COURSE OF TREATMENT DEFINITION Assistance with, or supervision of, hygiene, washing, dressing, grooming, eating, drinking, elimination, ambulating, positioning or any other routine activity of living. It may also include a group or plan of personal assistance services. - answers PERSONAL ASSISTIVE DEVICE DEFINITION A legal document in which a capable person gives someone else the authority to make decisions about his/her personal care in the event that he/she becomes incapable. The document could also contain specific instructions about particular treatment decisions. - answers Power of attorney for personal care DEFINITION The same as the power of attorney for personal care, except relating to decisions about property. - answers Continuing power of attorney for property According to College of Nurses of Ontario (CNO) standards, nurses are accountable for __________ ______________ whether the intervention or service relates to a treatment (as defined in the HCCA or as required in common law), admission to a facility, or the provision of a personal assistance service. - answers obtaining consent Consent is required for any treatment except treatment provided in certain ______________ _____________. - answers emergency situations The consent must: ◗ __________ to the treatment being proposed; ◗ be ____________; ◗ be ____________; and ◗ not have been ______________ through misrepresentation or fraud. - answers relate informed voluntary obtained The health care practitioner who proposes the treatment is responsible for taking ______________ __________ to ensure that treatment is not administered without ______________. - answers reasonable steps consent If consent to admission to a care facility is required by law, then consent is needed in all cases except in a _____________ _____________. - answers crisis situation If a person is incapable, and there is no other substitute decision- maker, who is the substitute decision-maker of last resort. - answers the PGT Treatment in an emergency can be provided immediately if the person is _____________ of giving consent and provides the consent. - answers capable Treatment in an emergency can be provided immediately if communication can't take place because of a ____________ ____________ or _____________, and reasonable efforts to overcome these have been made, but a ___________ will prolong the suffering the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm, and there is no reason to believe the person does _______ ___________ the treatment. - answers language barrier or disability delay not want Treatment in an emergency can be provided immediately if incapable with respect to the treatment decision but a __________________________ is available to give consent. - answers substitute decision-maker Treatment in an emergency can be provided immediately if incapable with respect to a treatment, a substitute decision-maker is not readily ___________, it is not ___________ ____________ to obtain a consent or refusal from the substitute, and a __________ will put the person at risk of sustaining serious bodily harm. - answers available reasonably possible delay DEFINITION if the person is experiencing severe suffering or is at risk of sustaining serious bodily harm if the treatment is not administered promptly. - answers EMERGENCY An examination or diagnostic procedure that is a treatment may be conducted without ____________ if it is reasonably necessary to determine if there is an emergency. - answers consent Admission to a care facility without consent may be authorized if: - answers 1. the person who has been deemed incapable requires immediate admission as a result of a crisis; and 2. it is not reasonably possible to obtain immediate consent or refusal on the incapable person's behalf. 5 Steps to obtaining consent - answers Step 1 Assess capacity. Step 2 Provide emergency treatment or crisis admission. Step 3 Inform the client that a substitute decision-maker will make decision. Step 4 Identify a substitute decision-maker. Step 5 Obtain consent from the substitute decision-maker. If a health practitioner or evaluator finds that a person is incapable of making a decision about a treatment or admission to a care facility, consent must be obtained from a _________________________ - answers substitute decision-maker Hierarchy of substitute decision-makers - answers 1. Guardian of the person — appointed by the court. 2. Someone who has been named as an attorney for personal care. Informed consent does not always need to be ______________, but can be oral or implied. - answers written Nurses who obtain consent have a professional ___________________ to be satisfied that the client is capable of giving consent - answers accountability Also, nurses are professionally accountable for acting as _____________ ______________ and for helping clients __________________ the information relevant to making decisions to the extent permitted by the client's capacity. - answers client advocates understand If the nurse proposing a treatment or evaluating capacity to make an admission or personal assistance service decision determines the client is __________________ of making the decision, then the nurse _______________ the client that a substitute decision- maker will be asked to make the final decision. This is __________________ in a way that takes into account the particular circumstances of the client's condition and the nurse-client relationship. - answers incapable informs communicated If there is an indication that the client is uncomfortable with this information, then the nurse ________________ and _________________ the nature of the client's discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the client of his/her _______________ to apply to the CCB for a review of the finding of incapacity, and/ or for the ________________ of a representative of the client's choice. - answers explores clarifies options appointment If there is an indication that the client is uncomfortable with the finding of incapacity when the finding was made by another health care practitioner, then the nurse _______________ and ________________ the nature of the client's discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the health care practitioner who made the _________________ of incapacity and discusses appropriate _____________-_____. - answers explores clarifies finding follow-up The nurse uses _______________ ______________ and _______________ __________ to determine whether the client is able to ________________ the information. For example, a young child or a client suffering advanced dementia is not likely to understand the information. It would not be reasonable in these circumstances for the nurse to inform the client that a substitute decision-maker will be asked to make a decision on his/her behalf. - answers professional judgment common sense understand The nurse uses professional judgment to determine the scope of ______________ ______________ to assist the client in exercising his/her options. The nurse documents her/his actions according to CNO's Documentation, Revised 2008 practice standard and agency policy. - answers advocacy services DEFINITION learned values, beliefs, norms and way of life that influence an individual's thinking, decisions and actions in certain ways. - answers CULTURE TRUE OR FALSE. responding A nurse, working as a community case manager, visited the home of a toddler with severe physical and developmental delays. She explained to the parents that with their consent she would refer the child to a physiotherapy and occupational therapy program that would help the child be more independent. The parents refused, saying that it was their duty to care for their child because the child's condition is punishment for having conceived before they were married. They were not supportive of a program to increase independence. The nurse was upset and felt the parents were not acting in the child's best interests. - answers The nurse did not understand the family's initial refusal of treatment. After reflection and discussion with colleagues, she realized that her personal and professional values of independence were causing her to feel upset with the parents' refusal. She decided to explore with the family their goals for their child. In doing this, she learned that the parents wanted their child to become stronger and have fewer infections. When the same therapies were described as a means of meeting these goals, the parents were quite willing to participate. The program was developed to meet the goals that the family identified as important. Clients differ in their ___________________ of health, well-being and quality of life, as well as their ______________ for treatment and who they consider appropriate providers of care. - answers definitions goals The client is a woman who has developed a very good relationship with the nurse in the community health clinic. On a visit, she asks the nurse how to arrange for the excision of female genitalia for a member of her community. - answers Regardless of her personal feelings about female genital excision, the nurse needs to understand the meaning of this custom for the client, which is linked to values about family purity and family honour. The nurse, however, also knows that the practice is illegal in Canada. The nurse needs to inform the client, in a nonjudgmental manner, of the potential risks and harm associated with the practice and of the legal implications. By exploring the custom and providing education and support to the woman, the nurse has a better chance of preventing a practice that carries considerable risk of harm. A client from a First Nations community requests that a sweetgrass ceremony be performed in the hospital as part of the treatment. The ceremony involves chanting and burning some substances, which will result in small amounts of smoke (similar to that of burning an incense stick). The nurse's initial reaction is that something like this has never been done, and that it is against hospital policy. However, she also understands the significance of this ritual for the client. The nurse raises the issue with the unit administration and, with the support of colleagues, explores the potential impact on other clients. The nurse also reviews relevant fire policies and consults with appropriate staff in other departments. It is determined that any risk to other clients can be removed by transferring the client to a private room. This is done, and the ceremony is performed. - answers The nurse's commitment to client-centred care prompts her to explore ways of meeting the client's needs within the limits of the hospital setting. Lack of experience and fear are two of the most common barriers to providing culturally sensitive care. Through collaboration with other colleagues, the nurse is able to address the assumption that it cannot be done and to determine ways of meeting client needs without exposing other clients to discomfort or risk. The nurse succeeds in meeting the needs of her client, not only because of her creativity, but because she takes responsibility for influencing policies and procedures in the practice setting. ________________ can be essential in situations in which a language barrier exists between the nurse and the client - answers Interpreters TRUE OR FALSE. A nurse must obtain consent before using an interpreter in the presence of a language barrier between he/she and the client. - answers TRUE When using interpreters to communicate with clients, nurses need to obtain client consent, be sensitive to the issues surrounding interpretation and ascertain that the interpreter is appropriate for the particular client situation. TRUE OR FALSE. Rules of confidentiality do not apply to interpreters. - answers FALSE. available for scheduled nursing visits. The care plan indicates that the nurse will knock at the neighbour's door at the start of each visit, the neighbour will accompany the nurse to the client's apartment, and the nurse will use the interpreter to promote communication throughout the visit. - answers The care planning demonstrates a thoughtful process, responsive to the client's needs. There is evidence of the nurse consulting with the client and supporting the client's choice of an interpreter. The nurse stresses confidentiality and respects the neighbour's schedule by providing a list of planned visits. A couple comes to a walk-in clinic with a young child who is crying and tugging at his ears. The couple has recently come to Canada, but understands English well enough that the nurse feels language is not an issue. An assessment reveals that the child has an infection in both ears, and the couple is given a prescription for an antibiotic and Tylenol drops for fever and pain. The situation is fairly routine, and an interpreter is not considered necessary. The parents are informed about the diagnosis and treatment, and they nod in understanding. The next day the couple returns with the child whose condition seems to have worsened. There is now pink discharge from both ears, and the entire family is in distress. An interpreter is called to assist. Through the interpreter, the nurse learns that the parents had the prescription filled promptly, and they understood the child was to be given the medicine every four hours. They had been administering the antibiotic orally, but since they had treated previous ear infections with ear drops, they had administered the Tylenol drops in the child's ears. - answers This example illustrates the importance of confirming that accurate communication has been achieved. To reduce the chance of confusion, the nurse could have demonstrated how to measure, and then administer, both medications. Culturally appropriate client education materials would also have been helpful. A woman, 35, is admitted to the general medical unit. While in the hospital, she expresses concern about her partner's ability to care for her children. She also appears worried about how she will manage at home after she is discharged. The nurse suggests that perhaps a family meeting is necessary and offers to contact her husband. The nurse further suggests that maybe the client's mother, who has called often to inquire about her daughter, should be involved in the meeting. - answers The nurse has made an assumption that the client's partner is male and that the relationship with the mother is one that will be supportive to the entire family. For many couples in a homosexual relationship, the issue of family can be sensitive. For some people, "family" is often their chosen family as opposed to kin. By using the word "partner," and asking the client who would be appropriate for a family meeting, the nurse shows openness and a nonjudgmental attitude. A home care client has lost sensation and mobility in her legs. On a home visit to provide wound care for a severe burn on the sole of her left foot, the nurse discovers a picture of St. Francis of Assisi covered in plastic and carefully placed between the layers of bandage around the foot. The client describes the picture as a relic that can prevent or positively influence life's problems, and that St. Francis is known for healing animals and people. She believes that placing the picture in the dressings will help the wound to heal. - answers In considering the client's preference, the nurse considers the risk of harm. In this instance, the request may be unusual, but does not pose a threat to the client if the relic is cleansed appropriately and wrapped in gauze. The spiritual benefits of the relic to the client should be recognized. A nurse is providing direct care to an elderly woman newly diagnosed with angina. She has been prescribed nitroglycerine to manage her angina attacks. The client reveals to the nurse her firm belief that her illness is caused by the "evil eye," a glance cast upon her by another to cause this condition. She shows the nurse her own remedy, which she claims will lift the curse of the evil eye and cure her. - answers The nurse assesses the client's remedy for possible health risks, such as a high sodium content. As well, the nurse negotiates with the client to take the nitroglycerine. In doing so, the nurse will need to be vigilant to potential objections the client may have to taking the medication. The goal is to have a plan of care that includes the remedy for the evil eye, but also includes the appropriate use of the nitroglycerine. The nurse and the client may not fully understand each other's preferences, but are willing to accommodate both interventions. A 35-year-old client is diagnosed with chronic renal failure and has started peritoneal dialysis. Maintaining adequate protein intake is an essential part of the client's ongoing treatment, and animal protein is the recommended source. The client is a Hindu by religion and has been eating eggs, chicken and goat all his life. However, since the commencement of dialysis, he has stopped eating these foods and has become a vegetarian. He tells the health care team that he wants to become a good Hindu so that God will help him with his ordeal. He says that the client becomes incapable of expressing those wishes. - answers ADVANCED DIRECTIVE The goal of end-of-life care is to _______________ the quality of living and dying, and ________________ unnecessary suffering. - answers improve minimize DEFINITION when, in the opinion of the health care team, the client is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health or the client refuses the treatment that is available. - answers EXPECTED DEATH DEFINITION Care that aims to relieve client suffering and improve the quality of living and dying. It strives to help clients and families address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears. - answers PALLIATIVE CARE DEFINITION An invasive and immediate life- saving treatment that is administered to a client who has a sudden unexpected cardiac or respiratory arrest. It may include basic cardiac life support involving the application of artificial ventilation (such as mouth-to-mouth resuscitation and bagging) and chest compression. It may also include advanced cardiac life support, such as intubation and the application of a defibrillator. - answers RESUSCITATION DEFINITION What a capable person expresses about treatment, admission to a care facility or a personal assistance service. - answers WISHES TRUE OR FALSE. The most recent wishes a client expresses while he or she is capable prevail over any earlier wishes the client may have given. - answers TRUE. When assisting clients in making choices and articulating their wishes about end-of-life care, nurses are guided by two core themes: - answers COMMUNICATION IMPLEMENTATION Nurses communicate the goals of care and treatment by: using professional ________________ to determine how the interprofessional team needs to be involved in discussions about the client's end-of-life care wishes; - answers judgment Nurses communicate the goals of care and treatment by: _________________ whether the client has sufficient and relevant information to make an ________________ decision about treatment and end-of-life care, including ____________________; - answers assessing informed resuscitation Nurses communicate the goals of care and treatment by: providing an opportunity to discuss, identify and review the client's end-of-life care ________________; - answers wishes Nurses communicate the goals of care and treatment by: identifying the client's wishes about preferred treatment and/or end-of-life care as ___________ ________________, while considering the client's condition and the degree to which the therapeutic nurse-client relationship has been established; - answers early as possible Nurses communicate the goals of care and treatment by: identifying and using appropriate _______________ ______________ when Nurses communicate the goals of care and treatment by: _______________ for the creation or modification of practice-setting policies and procedures to support client choices during treatment and end- of-life care, based on College documents. - answers advocating Nurses implement a client's treatment and end-of- life care wishes by: ensuring that the creation of the plan of treatment has involved both the ________________ _______ and the _________, and that the client has given informed consent for the plan of treatment before implementation; - answers interprofessional team and the client Nurses implement a client's treatment and end-of- life care wishes by: acting on behalf of the client to help clarify the plans for treatment when: - answers ■ the client's condition has changed and it may be necessary to modify a previous decision; ■ the nurse is concerned the client may not have been informed of all elements in the plan of treatment, including the provision or withholding of treatment;21 ■ the nurse disagrees with the physician's plan of treatment;22 and ■ the client's family disagrees with the client's expressed treatment wishes;23 Nurses implement a client's treatment and end-of- life care wishes by: initiating treatment when: - answers ■ the client's wish for treatment is known through a plan of treatment and informed consent; ■ the client's wish is not known, but a substitute decision-maker has provided informed consent for treatment; or ■ it is an emergency situation, there is no information about the client's wish, and a substitute decision-maker is not immediately available; Nurses implement a client's treatment and end-of- life care wishes by: not initiating treatment that is not in the plan of treatment, except in emergency situations, when: - answers ■ the client has not given informed consent, and/or the plan of treatment does not address receiving the treatment; ■ the incapable client's wish is not known, and the substitute decision- maker has indicated that he or she does not want the client to receive the treatment; ■ the attending physician has informed the client that the treatment will be of no benefit and is not part of the plan of treatment that the client has agreed to. In this situation, the nurse is not expected to perform life-sustaining treatment (for example, resuscitation), even if the client or substitute decision-maker requests it; or ■ the client exhibits obvious signs of death, such as the absence of vital signs plus rigor mortis and tissue decay; Nurses implement a client's treatment and end-of- life care wishes by: __________________ in a written plan of treatment all information that is relevant to the implementation of the client's wishes for treatment at end of life; - answers documenting Nurses implement a client's treatment and end-of- life care wishes by: __________________ the client's wish for no resuscitation even in the absence of a physician's written do-not-resuscitate (DNR) order; - answers following Nurses implement a client's treatment and end-of- life care wishes by: engaging in the following when a client's death is expected or unexpected: - answers ■ identifying whom to notify when the client dies; ■ identifying the most appropriate category of health care provider to notify the family; ■ identifying the client's and family's cultural and religious beliefs and values about death, and management of the body after death;24 ■ identifying whether the family wants to see the body after death; and ■ documenting according to policies and procedures;