Delegation
Delegation
*What are the 5 rights of delegation?
**Right task
**Right circumstances
**Right person
**Right direction and communication
**Right supervision and evaluation
Nursing Ethical Principles
*What are they (6)?
2. Beneficence: Do what is best for pt.
3.Fidelity: Keep your promises
4. Justice: Provide fairness in care & resources
5. Nonmaleficence: Do no harm
6. Veracity: Tell the truth
Safety Measures
*Medical equipment safety
*Should be inspected by engineering dept on regular basis
*Tag malfunctioning equipment as broken, take out of use IMMEDIATELY, & notify appropriate dept.
Unplug by plug and NOT cord
Efficient Nursing Practice
*Good time management techniques
*Make time to prioritize & plan at the beginning of the shift
*Complete charting as soon as possible
*Group tasks
*Know when to delegate and ask for help
ABCDE Principles in Nursing
A (Airway)
B (Breathing)
C (Circulation)
D (Disability)
E (Exposure)
Delegation
*What tasks should the RN NOT delegate?
**Patient education, any task that requires nursing judgment, nursing assessment, and blood transfusions
Ethics
*What constitutes an ethical dilemma?
*Problem cannot be solved by reviewing scientific data
*Involves conflict between 2 moral imperatives
*Decision has major impact on staff/patient
Safety Measures
*Needlestick injuries: prevention and treatment
*Use retractable needles, needles with capping mechanisms, or needleless connections
*Injuries: notify supervisor asap, test pt and nurse for bloodborne illnesses, and file incident report
Information Security
*What is HIPPA?
*HIPPA ensures confidentiality of pt's health care information
**Only those responsible for pt's care may access the record, pt has right to copy of record, do not use pt names on public display boards
Refusal of Treatment:
*Who has the right to refuse treatment?
*Steps to take when patient want to leave AMA?
*Competent adults or emancipated minors have the right to refuse treatment. This includes pts involuntarily admitted.
*Steps for AMA:
1. Notify provider
2. Discuss risks of leaving with pt
3. Have pt sign AMA form and document refusal to sign.
Delegation
**What tasks can the RN delegate to a PN (LPN)?
*Medication administration, enteral feedings, urinary catheter insertion, suctioning, trach care, wound care, reinforcement of pt teaching
Ethics
*What is the role of an ethics committee?
*It is an interprofessional team that examines facts and supports patients/caregivers
*It doesn't offer legal support
*It doesn't impose a decision. Decision is always the family/patient's
Preventing falls
*Key pt teaching and nursing care
*Provide regular toileting
*Do not put all 4 side rails up
*Everything within reach that is needed
*Round hourly
Nursing Practice
*What is the role of the State Board of Nursing?
*Nurse responsibilities?
*BON: determines laws ad regulations governing nursing in the state (STATE NURSE PRACTICE ACT), ensures health care providers comply with state regs, issues & revokes nursing licenses
*Need to know the laws/regs that govern nursing in the state that they practice in, must have valid license, refuse to practice beyond their legal scope of practice
Informed consent
*Provider responsibilities
*RN responsibilities
*Provider responsibilities: Purpose, complete description of procedure, in pt's primary language, risks vs. benefits, other options for treatment, & no procedure
**RN responsibilities: confirm pt understands information given by provider, notify provider if pt has any questions or doesn't understand, verify pt is competent, & ensures pt signed voluntarily
Delegation
*What tasks can the RN delegate to Assistive Personnel (i.e. CNA)?
**Bathing, dressing, ambulating, toileting, feeding pts w/out swallowing precautions, positioning, VSS, bed making, I & Os, basic CPR
Patient Protection and Affordable Care Act
*Key provisions
*Protects the pt from annual and lifetime coverage limits
*Allows parents to insure child until 26 yo
*Can't be denied b/c preexisting conditions
*Protects pt from cancellation due to illness
Restraints
*Types
*Physical: vest, belt, mittens
*Chemical: sedative, antipsychotic
Impaired coworkers
*Nurse responsibilities
*Signs of impairment
*Nurse manager responsibilities
*Nurse responsibilities: MUST report suspicion to charge nurse immediately, do not confront
*Signs of impairment: Impaired coordination, difficulty focusing, bloodshot eyes, mood swings, ect
*Manager: Remove from work, safe transport, confidential
Informed Consent
*Who is authorized to give for another person?
*Parent or legal guardian of a minor.
*Durable power of attorney
*Spouse or closest relative, based on state law
*Court-specified representative
Prioritization of Patient Care and Delegation
**Must be done before delegation
1. Access before taking action
2. Prioritize unstable over stable
3. Prioritize acute over chronic
4. Prioritize systemic over local
5. Prioritize using ABCDE
Incident Reports
*What are they?
Important points
*Created when accident/unexpected event happens
*Used for quality improvement at facility
*Provide care to pt first
*Complete w/in 24 hours
*description of event in MR but nothing re. incident report
Restraints
*Key safety points
*Try alternatives FIRST (reorientation, supervision, diversions)
*In emergency, RN can place restraints-order ASAP
*Management: neurovascular checks Q 2 hrs, skin integrity, ROM, LEAST restrictive, 2 fingers between restraint and pt, belt restraint over cloths
Mandatory reporting
*What are the RNs required to report?
**Suspicion of abuse: child, elderly, domestic
**Nationally notifiable communicable diseases
Advance Directives
*Living will
*Durable power of attorney (DOPA)
*Providers orders
*Living will: communicates pt's wishes regarding medical treatment if pt becomes incapacitated.
*DPOA: pt designates a health care proxy to make medical decisions for him/her if they become incapacitated.
*Provider's orders: prescription for DNR (do not resuscitate) or AND (allow natural death)