1. Module 3 Fundamentals of Nursing

2. Nursing as a Profession • Criteria of a profession • Extended education • Body of knowledge • Provides a specific service • Autonomy in decision-making and practice • Code of ethics • Professional organization and publication • Disciplinary course of action

3. Definition of a Profession Discussion • How do you define the term profession? • What does the term professional mean to you? What behaviors would you expect? • How would you define nursing?

4. Definitions • Profession • Type of occupation that meets certain criteria that raise it above the level of an occupation • Professional • A person who belongs to and practices a profession • Nursing • The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980)

5. Nursing Education Requirements • Associate degree • Diploma • Baccalaureate degree • Master’s degree • Doctoral Degree

6. Role of the Professional Nurse • Provider of care • Assists the patient physically and psychologically • Communicator • Communicates verbally and in writing to patients, significant others, health professionals and the community

7. Role of the Professional Nurse(continued) • Teacher • Assists patients to learn and perform at a level necessary to restore, improve and maintain health status • Client Advocate • Represents the patient’s needs/wishes to others; acts to protect the patients by assisting them to exercise their rights

8. Role of the Professional Nurse (continued) • Counselor • Assists patients to recognize and cope with stressful problems, develop improved interpersonal relationships and promote personal growth • Change Agent • Assists patients to make modifications in their own behavior

9. Role of the Professional Nurse(continued) • Leader • Influences others to work together to accomplish specific goals • Manager of Care • Manages the care of individuals, families and communities

10. Role of the Professional Nurse (continued) • Member of the Discipline of Nursing • Models and values nursing, commits to professional growth, abides by the standards of practice and legal/ethical principles, conducts research, and strives to advance the profession of nursing.

11. Legal Basis for Nursing Practice • Nurse Practice Act • Provides laws that control the practice of nursing in each state • Mandates that, under the law, only licensed professionals can practice nursing • All states now have mandatory nurse practice acts

12. Legal Basis for Nursing Practice (continued) • Standards of Practice • Identify the minimal knowledge and conduct expected from a professional practitioner based on education and experience • Nursing practice is guided by legal restrictions and responsibilities regulated by state nurse practice acts • General standards have been developed by the American Nurses’ Association (ANA) • Practice is also guided by professional obligations

13. Types of Law • Statutory – created by legislators at state and federal level • Regulatory – created by administrative groups (ex: Board of Registered Nursing) • Common – used to resolve disputes between 2 persons based on principles of justice, reason and common good

14. Types of Law(continued) • Criminal law • Public law that deals with the safety and welfare of the public • 2 types include misdemeanors or felonies

15. Types of Law(continued) • Civil Law • Protects the rights of individuals in situations which generally involve harm to an individual or property • Negligence is failure to use care that a reasonable person would use under similar circumstances • Malpractice is professional negligence, misconduct, or unreasonable lack of skill resulting in injury or loss

16. Types of Law(continued) • Good Samaritan Act • Protects health practitioners against malpractice claims for care provided in emergency situations • Nurse is required to perform in a “reasonable and prudent manner” and within accepted standards

17. Legal Infractions Terms • Assault • Unjustifiable threat or attempt to touch or injure • Battery • Any intentional touching or injury without consent

18. Legal Issues Related to Nursing Practice • Review and discuss Legal Responsibilities of the Nurse on Study Guide 3 • Review and discuss the Patient’s Bill of Rights

19. Legal Issues Related to Nursing Practice • Informed Consent • Agreement to the performance of a procedure/treatment based on knowledge of facts, risks, alternatives

20. Informed Consent continued • Person giving consent must: • Be of sound mind and physically competent and legally an adult • Consent must be voluntary • Consent must be thoroughly understood • Must be witnessed by an authorized person such as the physician or a nurse

21. Informed Consent (continued) • The physician is responsible for obtaining the consent. • The nurse may witness the signing of the consent.

22. Consent of Minors • Consent of Minors • Minors 14 years of age and older must consent to treatment along with their parent or guardian • Emancipated minor • Is a person age 14 or older, who has been granted the status of adulthood by a court order or other formal arrangement • They can consent for treatment themselves

23. Potential Liability for Nurses • See Study Guide 5 “Areas of Potential Liability for Nurses” • Choose several to discuss as a class

24. Restraints • Restraints • A device used to immobilize a patient or extremity and restrain the level of activity

25. Restraints • 2 justifications for using restraints • To protect patients from injuring themselves • To protect others from the patient

26. Alternatives to Using Restraints • Before restraining a patient, alternatives must be used and documentation must state that these were tried and failed • Try to determine the cause(s) of the patient’s behavior • Eg: medication

27. Alternatives to Using Restraints (continued) • Physiological alternatives • Reposition the patient • Adjust medications to relieve pain • Cover IV tubes to “hide” the tube • Psychological alternatives • Provide appropriate visual/auditory stimuli • Increase visits from friends and family

28. Alternatives to Using Restraints (continued) • Environmental alternatives • Put items within easy reach • Place patient near the nurses’ station • Hire private duty nurse to stay with patient

29. Documentation of Restraint Use • Follow facility policies which protect you and them from legal actions • Document the patient evaluation process • Why restraint was needed • List behaviors • Alternatives tried

30. Documentation of Restraints(continued) • Document the requirement for an order or protocol authorizing the restraints • Physician’s order must be time limited • Verbal orders must be signed within time specified in facility policy • A PRN (as needed) order is never allowed

31. Documentation of Restraints(continued) • Document your on-going assessment and care of the patient • Nutrition • Hydration • Elimination • Special nursing services (ex: private duty nurse) • Follow policy regarding frequency/documentation of on-going assessment

32. Applying Restraints • Follow the manufacturer’s instructions • Apply to provide for as much movement as possible • Be careful that vest restraints are not put on backwards • Adjust the restraint so it is not so tight to reduce circulation or cause pressure ulcers

33. Applying Restraints (continued) • Tie the restraint to the bed frame, not the bed rail • Use a knot that will not tighten when pulled (ex: clove hitch) • Pad bony prominences when needed

34. Monitoring the Patient in Restraints • Follow facility protocol • Assess every 30 minutes • Remove the restraint for 10 minutes at least every 2 hours; assess for skin and neurological impairment; perform range of motion • Document restraint assessment on appropriate restraint assessment tool provided by the facility

35. Types of Restraints • Mitt restraint • Belt restraint • Jacket restraint • Wrist or ankle restraint

36. Using Restraints in Behavioral Health • Strict time limits • Adults: 4 hour limit • Children age 9-17: 2 hour limit • Children under age 8: 1 hour limit

37. Unusual Occurrence Incidents • Also known as incident reports • An incident is “any event that is not consistent with the routine operation of a healthcare unit or routine care of a patient” (Perry and Potter 2005)

38. Unusual Occurrence Incidents (continued) • Examples: • Accidental needle stick • Medication error • Patient or visitor fall • A physician’s order not being carried out by the nurse • Equipment malfunction

39. Unusual Occurrence Incidents (continued) • The report is a confidential record between the observer of the incident and the agency Risk Manager that documents the facts of the incident • It is an objective account of the occurrence and does not include opinions, judgments or blame

40. Unusual Occurrence Incidents (continued) • Complete a report even if there is no injury • Never document in the nurses’ notes that an incident report was completed.

41. Unusual Occurrence Incidents • Class Discussion: • Give some examples of incidents in which you would complete a report.

42. Ethical Terms (continued) • Code of Ethics – a written list of professional values and standards of conduct which provide a framework for decision-making • There are several codes of ethics that may be adopted; in the U.S. the ANA Code of Ethics is generally accepted (see study guide)

43. Ethical Issues in Nursing Practice • Making ethical decisions is a common part of every day nursing care • Ethical decision-making is a skill that can be learned

44. Ethical Terms • Ethics – systematic study of what “ought” to be done, the justification of what is right or good • Ethical Dilemma – situation that required a choice between two equally favorable alternatives

45. Ethical Concepts That Apply to Nursing Practice • Define and discuss the following concepts from the study guide • Morals • Values • Autonomy • Beneficence

46. Ethical Decision-Making Process 1. Clearly identify the problem 2. Consider the causative factors, variables, precipitating events 3. Explore various options for action • Select the most appropriate plan for dealing with the ethical dilemma • Implement decided course of action • Evaluate results/consequences

47. Ethical Decision-Making Activity • Choose an ethical dilemma from the study guide (Common Ethical Issues Involving Nurses) • Discuss your chosen dilemma using the 4 steps for solving an ethical dilemma on the previous slide.

48. Confidentiality • Nurses are legally and ethically obligated to keep information about patients confidential. • The tort invasion of privacy protects the patient’s right to be free from intrusion into their private affairs. • The ANA Code of Ethics also provides for a patient’s privacy.

49. Confidentiality - HIPAA • The American Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 and was required to be instituted in April 2003 • Requires that patient health information be available only to those with the right andneed to have this information

50. Confidentiality • Nurses role in maintaining confidentiality • Don’t discuss information where others might overhear • Protect computer screen from being viewed by visitors • Protect patient charts from being viewed • Do not share your computer ID or password • Access/transmission of patient information via internet requires strict scrutiny