MS1 Chapter 3

• Factors influencing changes in the health-care delivery system:

  • Evolving evidence-based practice
  • Changing characteristics of U.S. population
  • Increasing number of older adults
  • Increasing cultural diversity
  • Newly emerging viruses
  • Multidrug-resistant infectious organisms
  • Human trafficking awareness campaign
• Safe health-care practices:

  • Institute for Safe Medication Practices www.ismp.org/tools
  • Error-prone abbreviations
  • Confused drug names
  • Do not crush oral medications
  • High-alert medications in long-term care
  • Look-alike drug names distinguished by tall man letters
• Significance of hospital-acquired conditions:

  • Foreign object retained after surgery
  • Air embolism
  • Blood incompatibility
  • Stage 3 and 4 pressure ulcers
  • Falls and trauma injuries
  • Manifestations of poor glycemic control
  • Catheter-associated urinary tract infection
  • Vascular catheter-associated infection
• Four leadership styles:

  • Autocratic (authoritarian)
  • Democratic (participative)
  • Laissez-faire (delegative)
  • Coaching
• Licensed practical nurse/licensed vocational nurse (LPN/LVN) role in leadership and delegation:

  • LPN/LVN provides direct patient care under direct supervision of RN, health-care provider, or dentist
• Moral distress and its effect on nursing care
• Mandatory reporting for health-care professionals
• Human trafficking indicators to report
• Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Guidelines for professional use of social media
• How to provide quality care and limit liability
• Collaboration
• Communication
• Health Policy
• Leadership and Management
• Professionalism
• Quality Improvement
• Safety
• Health-Care Delivery services provided from birth till death
• Factors influencing health-care change:

  • Technology
  • Electronic health records
  • Mobile health
  • Digital apps, smartphones, tablets, remote patient monitoring
  • Robotics
  • Telehealth (smartphones, online video)
  • Nursing informatics
• Management Functions:

  • Planning
  • Organizing
  • Directing
  • Coordinating
  • Controlling
• Continuous Quality Improvement (CQI)
• Leader/manager for care of assigned patients
• Hand-Off Communication of Patient Status
• The Delegation Process:

  • Does your state allow LPNs/LVNs to delegate?
  • Know your state nurse practice act
  • Identify skills of delegatee
  • Use NCSBN five rights of delegation
• Linking NCLEX-PN® to Practice: The LPN/LVN will provide and receive report
• Linking NCLEX-PN® to Practice: The LPN/LVN will monitor activities of assistive personnel
• LPN/LVN Certification Options:

  • Post-licensure
  • Pharmacology
  • Long-term care
  • IV therapy
  • https://napnes.org/site/
• Ethics:

  • Study of traditions, values, and beliefs related to people/relationships
  • Bioethics
  • Ethical questions: What should/ought we do?
• Morals:

  • Personal values
  • Standards set by one’s conscience
  • Personal choices of good and bad, right and wrong
  • Moral distress: distress experienced when knowing the right thing to do but being unable to carry it out because of institutional constraints
• Values:

  • Standards/ideals/concepts giving meaning to an individual’s life
  • Derive from societal norms, religion, and family traditions
  • Guide decisions and actions
• Nursing Ethical Obligations:

  • Responsibility to practice ethically
  • Consider ethical codes, principles, and theories for your profession
  • Consider facility policy and procedure
  • Consider the best interest of the patient
  • Guided by the law and the standards of the profession as well as a professional code of ethics
• LPN/LVN Code of Ethics:

  • The National Association of Licensed Practical Nurses
  • Practice standards for ethical practice and conduct
  • The National Association for Practical Nurse Education and Service
  • Practice standards with ethical principles for LPNs/LVNs
• Linking NCLEX-PN® to Practice: The LPN/LVN will practice in a manner consistent with code of ethics for nurses
• Ethical Principles:

  • Derive from moral theory
  • Purpose: Serves as framework for conduct
  • Offers a standardized approach to manage moral dilemmas
• Ethical Principles:

  • Autonomy: the right of self-determination, independence, and freedom founded on the notion that humans have value, worth, and moral dignity
  • Beneficence: proposes that actions taken and treatments provided will benefit a person and promote welfare
  • Nonmaleficence: "do no harm"
  • Fidelity: the obligation to be faithful to commitments made to self and others
  • Veracity: virtue of truthfulness
  • Justice: based on fairness and equality
• Ethical Theories:

  • Utilitarianism: the rightness/wrongness of the OUTCOME is the most important aspect to consider when decision making
  • Deontology: the rightness/wrongness of the ACTION is the most important aspect to consider when decision making
• Ethical Decision-Making Process (8 Steps):

  1. Identify ethical dilemma

  2. Identify stakeholders and their values

  3. Gather and verify information

  4. Examine possible actions and forecast the consequences of each action

  5. Determine ethical foundation for actions

  6. Determine which action is best, with the most compelling ethical support

  7. Implement action

  8. Evaluate outcome
• Legal Concepts:

  • Regulation of Nursing Practice:
  • Licensed health-care profession
  • Goal: To protect the public and foster competent practice
  • Regulated by state boards of nursing
  • Nurse practice acts define scope of practice and vary by state
  • Violations may lead to license sanctions such as suspension or revocation
• Be Safe! Be Vigilant!:

  • Do not go into work after drinking alcohol, even if it was the night before
  • Men metabolize alcohol faster than women
  • Agencies have zero tolerance for alcohol and termination may occur if random alcohol test is not zero
  • Prescription medication should be kept current for the active medical condition
  • Cannot work under the influence of prescribed controlled substances that affect your ability to work safely