Nursing Delegation: Understanding Roles, Orders, and Procedures, Exams of Nursing

Download Nursing Delegation: Understanding Roles, Orders, and Procedures and more Exams Nursing in PDF only on Docsity! Nursing Professionalism TEST 2 Questions and Answers What are the 5 controlled Acts? - Correct answer 1)Below or in the dermis, mucus membrane, 2)Substance by injection/inhalation 3)Instrument/hand/finger i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, Iii. beyond the larynx, iv. beyond the opening of the urethra, v. beyond the labia majora, vi. beyond the anal verge, or vii. into an artificial opening into the body 4) dispensing 5)Psycho therapy treatment when can controlled acts be performed by nurses? - Correct answer Controlled acts can be performed by nurses if they are: physician, dentist, chiropodist, midwife or Nurse Practitioner (NP) Wht 7 exceptions to the controlled acts? - Correct answer Exception: Acupunture; nurses are allowed First aid At home: Injection or inhalation Instrument/hand/finger Student ADL Injection or inhalation Instrument/hand/finger Prayer Can pierce, circumcise, blood sample What is the statement of the Scope of Practice? - Correct answer 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. What are the four standard statements that must be considered when determining whether to perform a given procedure. - Correct answer Do i have authority? employer support? skill/knowledge/judgement? best interest of pt Can RNs and RPNs delegate the controlled act of dispensing a drug or treating, by means of psychotherapy technique. - Correct answer NOOOO Temporary class nurses _____ delegate (special class too) or received delegated orders - Correct answer cant RNs and RPNs _____ delegate and accept delegation if they are registered in the General, Extended or Emergency Assignment Class. - Correct answer can (T/F) Hopsital limit "initiation" even though nurses have permission. Must have order before doing something - Correct answer True exception: home health nurse (T/F) Only RN's can initiate and pass on procedure - Correct answer true What are the 6 thigns nurses must have; Nurse must have: (in accordance with policy and legislation) - Correct answer skills knowledge and judgement How to perform procedure safely If its safe for pt Pros and cons Out and be able to manage it Take full accountability What can be initiated by RN? - Correct answer 1. Care of a wound below the dermis or the mucous membrane by cleansing, soaking, irrigating, probing, debriding, packing or dressing. 2. Venipuncture to establish peripheral intravenous access and maintain patency using a solution of normal saline (0.9 percent) when the client Nurses _______ do other jobs when delegated by other healthcare professional - Correct answer can what is an order? - Correct answer how to perform an act. What is delegation? - Correct answer legal authority to perform something. If delegation doesnt include instruction then _____ ________________________ is needed - Correct answer direct order What task doesn't require delegation? - Correct answer ADL (Frequency established, outcome the same, need/response for procedure = its a ADL) can meds be delegated? exception: - Correct answer no Oral and topical meds can be delegated nurse failing to inform employer that their incompetent and an untrained student are both examples of _______ and they violate...... - Correct answer Misconduct: violates the professional standard Violates the Nursing Act and professional standard Can nurses delegate treating, by means of psychotherapy technique - Correct answer no What is included in delegation documentation? - Correct answer (a) the date of the delegation (b) the delegator's name, if the controlled act was delegated to the nurse (c) the delegatee's name, if the controlled act was delegated by the nurse, and (d) the conditions, if any, applicable to the delegation. times when documentation should be done - Correct answer Written regulation before act is performed at place of performance Written copy in client record at time of delegation At time of delegation or at reasonable time after What 7 terms need to be met before accepting delegated task? - Correct answer Skill + knowledge + judgement ;delegator Nurse client relationship Appropriate Delegatee knows if to contact if issue (safeguards) Delegator is allowed to delegate All condition are met Delegatee must What 10 terms need to be met before delegating a task? - Correct answer a controlled act for RN's Skill + knowledge + judgement ;delegator Nurse client relationship Appropriate Delegatee knows if to contact if issue (safeguards) Delegatee and skills 2nd stop if not ready (conditions to ensure its done safely) the nurse is satisfied that the delegatee is a person who is permitted to accept the delegation and is: ■ a nurse16 who has a nurse-client relationship with the client ■ a health care provider who has a professional relationship with the client ■ a person in the client's household, or ■ a person who routinely provides assistance or treatment for the client. Confident that delegatee has skills knowledge and judgement (if not nurse then is it appropriate) If delegate can do a controlled act then delegator must cease the delegation Document (only 1) Written regulation before act is performed at place of performance Written copy in client record at time of delegation At time of delegation or at reasonable time after define Cognitive requirements - Correct answer Ability to perform skills that demonstrate thinking capacity: cognitive: ■ Remember _______ from past experiences ■ Demonstrate _________ ________ skills ■ Demonstrate ________________ skills ■ Use reasoning to develop _____________ _______ ■ Exercise _______ ___ skills to develop professional judgment ■ Apply arithmetic skills and abilities to: ◗ Add, subtract, multiply and divide ◗ Calculate ratios, percentages and apply formulas - Correct answer ■ Remember information from past experiences ■ Demonstrate problem-solving skills ■ Demonstrate concentration skills ■ Use reasoning to develop professional judgment ■ Exercise critical thinking skills to develop professional judgment ■ Apply arithmetic skills and abilities to: ◗ Add, subtract, multiply and divide ◗ Calculate ratios, percentages and apply formulas define Sensory requirements Ability to utilize each of the following senses well enough to________ __________ and participate in educational activities: ■ Sight ■ Hearing ■ Touch ■ Smell - Correct answer Ability to utilize each of the following senses well enough to provide care and participate in educational activities: ■ Sight ■ Hearing ■ Touch ■ Smell Environment requirements Ability to function in the presence ________________ factors: - Correct answer Environment requirements Ability to function in the presence of each of the following commonly encountered and unavoidable environmental factors: ex of environmental factors - Correct answer ■ Noxious smells ■ Disease agents How to become a reflective practitioner? - Correct answer Self reflection; thinking daily Experiences and strengths Ask: what did i so well, manage situation, improvement, address in anual action plan Yes ask colleagues Group reflection: common goal, learning from each other, inform own assessment Insight on growth After reflecting: identify Learning needs, actions and implementation What is a comopetency? - Correct answer An observable ability of a RN at entry level the integrates the knowledge , skills and abilites and judgement to practice safely. purpose of ETP competencies - Correct answer Protect the public To promote and ensure safe, competent and ethical nursing in Ontario Practice reference Help RN understand expectations with the role Approval of nursing education program CNO uses competencies to evaluate BSCN programs and their ability to prepare students for nursing Registration and memberships Inform registration eligibility Continuing competence CNO-quality assurance program: nurses to self assessments yearly. Public information: The competencies inform the public, employers, and other health care providers about registered nursing practice, and entry level expectations Legal Reference The legal definition of nursing practice included in the Nursing Act, 1991 establishes the basis for the scope of practice in which any nurse may engage. The competencies are the expectations for RNs upon entry to practice in Ontario, and are used as a reference when evaluating the standard of care of registered nurses What are the 7 entry nurses prinicpels? - Correct answer Entry nurses prinicples Wont be as good as experienced RN Not afraid to seek guidance Up to date skill and abilites Provide safe, competent, ethical, compassionate care Critial thinking skills Theories, and nursing judgment Practice standards and ethics What are the competencies 101 (9)? - Correct answer Clinician Professional Communicator Collaborator Coordinator Advocator Leader Educator Scholar Explain the competencies Clinician Professional Communicator Collaborator Coordinator Advocator Leader Educator Schola - Correct answer Clinician Registered nurses are clinicians who provide safe, competent, ethical, compassionate, and evidence informed care across the lifespan in response to client needs. Registered nurses integrate knowledge, skills, judgment and professional values from nursing and other diverse sources into their practice. Professional Registered nurses are professionals who are committed to the health and well-being of clients. Registered nurses uphold the profession's practice standards and ethics and are accountable to the public and the profession. communicator Registered nurses are communicators who use a variety of strategies and relevant technologies to create and maintain professional relationships, share information, and foster therapeutic environments. Collaborator Registered nurses are collaborators who play an integral role in the health care team partnership. Coordinator Registered nurses coordinate point-of-care health service delivery with clients, the health care team, and other sectors to ensure continuous, safe care. Advocator Registered nurses are advocates who support clients to voice their needs to achieve optimal health outcomes. Registered nurses also support clients who cannot advocate for themselves. Leader Registered nurses are leaders who influence and inspire others to achieve optimal health outcomes for all. Educator Registered nurses are educators who identify learning needs with clients and apply a broad range of educational strategies towards achieving optimal health outcomes. Scholar Registered nurses are scholars who demonstrate a lifelong commitment to excellence in practice through critical inquiry, continuous learning, application of evidence to practice, and support of research activities. Confidentiality and Privacy Professional judgement define Information and Communication Technologies Show usage of _______________________________ ________________ (ex: fetal heart monitoring devices, ) Uses decision support tools (e.g. clinical alerts and reminders, critical pathways, webbased clinical practice guidelines, etc.) to assist clinical ____________ Uses ICTs in a manner that supports (i.e. does not interfere with) the ____________-________________ relationship. Describes the various components of __________ ___________ systems (e.g., results reporting, computerized provider order entry, clinical documentation, electronic (Medication Administration Records, etc.). Describes the various types of _________ ____________________ used across the continuum of care (e.g., EHR, EMR, PHR, etc.) and their clinical and administrative uses. Describes the benefits of informatics to improve health systems, and the quality of __________________ patient care. - Correct answer Use information and communication technologies in the delivery of patient care informatics - Correct answer computer, science nursing related information and knowledge and management of communication technologies to promote health among families. E Health and Telehealth - Correct answer state of mind to improve health care with info and communication some elements of nursing informatics - Correct answer collaboration doc and care planning client decision support tools EHR community and health population health management Its a specialty because it meets the criteria - Correct answer differentiated practice research program representation of the specialty mechanism for credentialing nurses in the specialty educational program for preparing nurses to preactise int he specialty formal programs: - Correct answer George Brown College ; health informatics Dalhousie Unicersity in Halifax; health informatics informal education: examples - Correct answer networking literature professional conferences types of special interest groups - Correct answer Special interest groups Information science and computer organizations Heatlh computing organizations User groups Local groups dose the Canadian Nurses Association offer certification exams? - Correct answer yes what is American certification requirements - Correct answer Nursing license BSCN 2 yrs 30hrs (in 3yrs) continuing education 2000hrs or 1000hrs with 12 semester hrs from graduate program Graduate program 200hrs 20 contact hours of continuing education past 2yrs careers in informatics - Correct answer case management clinical data repostitories clinical system care mapping HIS- client focused - Correct answer Client focused- pt care processes (documentation, reporting) HIS- departmental - Correct answer Departmental- operational needs (pharmacy, medical records) Health Information System - Correct answer Health informtaion system -information systemmanage clincial administrative aspects of jhealt care Goal: improve outcome and reduce error compenents of EHR - Correct answer - Data capture- collecting data - Storage- where data is storaged - Information processing (decision support tool) - Information communication-sharing - Security Privacy: right to info private from HCP Confidentiality: not shared with others Security: others can access - presentation info Canada Health Infoway priorites - Correct answer 1) Complete work underway in Electronic Health Records, Telehealth, and Public Health Surveillance 2) Implement Electronic Medical Record (EMR) systems in physician offices and Provider Order Entry systems in hospitals 3) Deploy Wait Time Management Systems 4) Implement Consumer Health Solutions to support self-care 5) Integrate Chronic Disease Management systems, starting with diabetes Computer literacy Nursing - Correct answer Access information and evaluate effectiveness Address privacy, confidentiality, security And basic computer stuff phase 1,2,3 - Correct answer Mainframe era: everyone sharing 1 computer (bank, military) Electronic Numerial Intergrator and Computer PC era One person and one computer Ubiquitous many computers to many people (internet, VR) quick and dirty - Correct answer domains (org, ca) explore related links grab useful info brute force - Correct answer www. school or term .ca Influencing Factors - Correct answer Influencing Factors - fiscal constraints - population ageing (largest group and more health problems) - the social determinants of health; poverty especially among POC - Geography; Indigenous people are futher from healthcare services and remote care is beneficial - Migration pattern (moving from 1 area to another) - Language barrier for those new to Canada Stress from immigration declines health T/F Hospitals have private boards and make there own decisions. They dont share patient data, making it difficult to share information - Correct answer true is evidence informed data used in private? - Correct answer no Saskatchewan: doctors are _________________ ____________________ that follow health insurance polices (fee for service). After strike they have the opportunites to ______ patients or _______________, not government. There now publicly paid and privately self employied minimal interference from gov - Correct answer Saskatchewan: doctors are independent contractors that follow health insurance polices (fee for service). After strike they have the opportunites to bill patients or insurance not government. There now publicly paid and privately self employied minimal interference from gov Canadian lessons: what does canada values - Correct answer equity, solidarity, values Healthcare provider Role - Correct answer Healthcare provider Role User participation new models, asking questions Campaigns to reduce overuse treatment Public support and the use of EBP Advisory panels; investigations What needs to be done to help Indigenous health care - Correct answer Evaluate residential school impact Culturally safe health care system Indigenous Canadians in Health care Flaws in healhcare - Correct answer Long wait times Care w/o meditech Indigneous treatement (poor literacy, more culture) How to achieve effective collaborative practice:? Confusion? - Correct answer Strong sense of their own identity Confidence in their role Some express their role as its tasks (too much overlap) Workers must identify knowledge, expertise, education care delivery models define models of care - Correct answer organize the work of caring patients based on client needs and staff skills total patient care model what is it? pros and cons? - Correct answer nurse responsible for total care of pt for shift pro: therapeutic relationship con: Not practical; need more nurses then unregulated provided Nurses cant get help from other health care providers Fragmentation= broken into small pieces functional nursing - Correct answer specific tasks for each team member. pro: lots of clients helped con: lots of protocols no controls for nurse, non therapeutic relationship, team nursing - Correct answer nurse lead teams care for pts pro: max care, team work con: Time spent leading Fragmentation Good leader RN Expensive vigoros staff members Sometimes it confusion to have so many people involved Primary Nursing - Correct answer nurse is the leader and makes plan of care. pro: Trusting relationship nurses and client and family More authority Holistic care apporach Work with family con:Not goof for 12hr shifts Not goof for pt work Not good when there is shortage Good for RN staffing client centered care - Correct answer pro: convenient or fast services con: decentralize and less RN RIW - Correct answer Resource Intensity Weights- estimate cost of resources Translaate case mix data into cost Determine unit cost for atypical case Identify priorites by CMG for use management New program to examine process CMG - Correct answer CMG; case mix groups case are similar to resources. tyope of client to resources LOS - Correct answer length of stay case management: - Correct answer clincial pathway - Correct answer measures expected course and outcomes for a certain type of client (sometimes physician order inclueded) clinical practice guidelines - Correct answer evidence based statement in (prevention, diagnosis etc) which care is safe and isnt. case management - Correct answer coordinates care, creates goals and compares then with outcome.