Legal integrity Flashcards
(109 cards)
1
Q
What are the 3 parts of the pre-procedural verification?
A
- H and P and anesthesia assessment are complete
- Blood, implants and special equipment are available
- consent is accurate, signed and witnessed
2
Q
What are 5 factors for site marking?
A
- done outside of the OR
- Consistent mark used throughout hospital
- patient is not sedated and participates
- medical person participating in the procedure
- site verification of child happens with the parents
3
Q
What is informed consent?
A
an understanding between the physician and the patient. NOT the nurse and the patient
4
Q
What is the consent form?
A
it is the documentation of the informed consent
5
Q
Can a nurse do informed consent? consent form?
A
no; nurse cannot clarify understanding with questions from the patient. yes.
6
Q
Why does a site marking need to be done outside the OR?
A
because the patient needs to be participant in the marking
7
Q
What should a site marking not be?
A
an X (confusing)
8
Q
What is regulatory requirement for site marking and medical persons.
A
that medical person participating in the procedure. So it can be a resident who is physically there during the procedure?
9
Q
When does a time out occur?
A
prior to procedure and ideally prior to anesthesia
10
Q
Who does a time out?
A
by a designated person, in a standardized manner defined by the organization.
11
Q
What are 2 other things that should be included in the time out?
A
radiation timeout and fire risk assessment
12
Q
What needs to happen after timeout?
A
everyone needs to verbally respond “I agree”
13
Q
What should be defined at a hosptial if there is a discrepancy in the timeout?
A
a process for reconciling discrepancy is defined
14
Q
Why would you need to do 2 separate timeouts?
A
- changing physicians
- redraping
15
Q
If you have both physicians there to help, you are allowed to do what?
A
just one timeout
16
Q
What are the 5 elements of a valid consent?
A
- knowledge of the procedure
- understand possible complications
- understand the alternatives to surgery
- competent to give consent
- patient wants the procedure
17
Q
Before you go to next of kin, you have to have 2 things documented by the surgeon?
A
- the patient is not competent
- the patient will not return to competency before we need to go to surgery
18
Q
What is usually the next of kin?
A
spouse
19
Q
Consent may be what at any time?
A
withdrawn
20
Q
Order of priority for next of kin is according to what?
A
state
21
Q
Can the patient have versed, mask coming down, and can change their mind about the procedure?
A
yes
22
Q
A patient can always say no to surgery, but once in the OR what happens?
A
you can get charged
23
Q
You have to wait how long with narcotics before you can sign anything, including surgical consent?
A
wait the 1/2 life of the narcotic
24
Q
What are 3 things the perioperative nurse is responsible for in regard to informed consent?
A
- ensure there is a consent on the chart
- is the patient –> knowledge, willing, competent
- consent is properly signed and witnessed
25
Two witnesses sign on consent form if...
1. patient is unable to sign
2. telephone consent
26
what did the Civil Rights Act say in regard to consent?
People have the right to hear about their health care in their chosen language.
27
Interpreter cannot be
1. coworker
2. family member
28
If patient and physician have a shared native language, they can what?
have that conversation about the procedure
29
If patient and physician are both speaking a certain language, does the nurse need to understand?
no
30
Are 2 nurses allowed to sign if permission is given over the phone by a parent or next of kin?
yes
31
Are we allowed to believe a person if they are the legal guardian?
yes
32
You need be what to sign a consent form
competent
33
Who are 3 people that are competent to sign a consent form?
1. legal adult
2. minors require parent or guardian
3. emancipated minor - married and in armed forces
34
If you have a 16 year old parent that needs to sign consent for their infant, is that allowed?
yes
35
Is a 16 year old with an infant allowed to sign their own consent form?
no because they are not emancipated
36
What is an exception to consent? (don't need any paper)
1. pt. is unable to give consent and there is a threat to life, limb, function or organ
37
What must there be if there is an exception to consent?
must have documentation of emergency in staff notes
38
There is a zero tolerance for what?
workplace violence
39
What is part of workplace violence ?
1. intimidation
2. threat
3. physical attack
4. property damage
5. sexual harassment
6. bullying
7. harassment
40
What is the intent of workplace violence?
to be hurtful or dismissive to somebody
41
What is included in intimidation?
sarcasm, incivility
42
What is included in threats?
screaming
43
What is included in physical attack?
grabbing
44
What are 3 things included in bullying?
1. verbal attack
2. intent to be hurtful
3. withholding support
45
What is 1 thing included in harassment?
patronizing comments
46
What ultimately is workplace violence?
a patient safety issue
47
What are signs that someone is a victim of workplace violence?
1. decline in quality patient care delivery
2. stress related illness
3. low morale
4. poor teamwork
5. sleeplessness
6. increased absenteeism
7. poor performance
8. decreased self confidence
48
What are 2 important ANA code of ethics for nurses?
1. nurses practices with compassion and respect for every person to the patient and to each other
2. remain professional and civil - inclusion, connection, and community
49
What are the ethical principles in nursing?
1. autonomy
2. beneficence
3. nonmaleficence
4. justice
5. veracity
6. fidelity
50
Hint for exam: you can say you can have your own opinion let's keep it professional
51
Define autonomy
making decisions for yourself
52
define beneficence
contributing to the well being of another - doing good
53
define nonmaleficence
do no harm
54
define justice
fairness (doesn't matter if you have CEO's wife or homeless person)
55
define veracity
truthfulness/honesty. Creating a clear and accurate picture of something.
56
define fidelity
faithfulness to commitments. Integrity. That you know and practice by the standards of your profession
57
what is double effect
hurting but doing good. Surgery is a double effect
58
What is statuatory law?
made by legislative branch. Legal definition of something
59
What is an example of statutory law?
nurse practice act bc this is a legal definition of what your nursing license covers you to do in your state
60
What is common law? (not laws)
derived from principles rather than rules and regulations. Understanding of how you treat people.
61
What is also common law?
bill of rights. patient bill of rights
62
With common law, can someone sue for compensation?
NO
63
What is civil law?
based on rules and regulations
64
With civil law, can you sue for compensation?
yes
65
What is tort law?
is a type of civil law. a wrongdoing and it hurt someone (physically and emotionally and spriritually)
66
What is criminal law?
harmful to society
67
When hospitals are brought to court what is it usually?
tort action lawsuit
68
What does violating criminal law get you?
a fine or prison
69
define negligence
1. doing or not doing something a reasonable person would or would not do in similar situation
2. deviation from standard of care
70
negligence is an act
omission or commission
71
Can professional negligence be tried as malpractice?
yes; it's more severe
72
What is malpractice?
misconduct or lack of skill in carrying out job. you know you have done it wrong and you decided to do it wrong anyways
73
What are the 4 elements of malpractice? in order to have a successful malpractice
1. duty of care - you owed the patient something.
2. dereliction of duty - I didn't give them the good nursing care that they needed. Physical damages, emotional damages.
3. direct causation
4. damages
74
What are the most common types of torts?
intentional torts
75
What are torts?
1. assualt
2. battery
3. false imprisonment
76
Battery does not imply what?
does not imply harm
77
Doing surgery without consent is what?
battery
78
Define battery
touch without being permission
79
define assault
place person in fear of being touched
80
what is the difference between battery and assault?
you have to physically put your hands on them to be considered battery
81
define false imprisonment
unjustified detention. RESTRAINTS, documentation of relief.
82
true or false; they can sleep with restraints
no
83
No actual what is necessary for it to be considered an intentional tort?
no actual harm
84
What is a quasi intentional torts?
no intent to injure or cause distress to another person
85
What are 4 parts of quasi intentional torts?
1. patient abandonment
2. defamation of character
3. invasion of privacy
4. breach of confidentiality
86
What is an example of quasi intentional tort?
incorrect staffing for a necessary situation. Like doing a local case vs. sedation case. You need to have 2 RN's if you are doing a sedation case, like with versed. So the minute you give versed you are under the umbrella of patient abandonment
87
What is defamation of character?
trashing the patient. We address our coworkers when we hear this
88
What is invasion of privacy?
looking at a chart of a patient we are not taking care of
89
What is breach of confidentiality?
not talking about anyone in public
90
What should you do if you see someone you know that is on the schedule?
disclose to the patient. Do not talk about it outside the hospital
91
What is the purpose of nursing documentation?
provide goal directed care
92
what do you need to document?
nursing interventions : when, where and by whom
93
What does nursing documentation reflect:
1. of nursing care
2. of patient's responses
3. patient outcomes
94
Can you use abbreviations in documentation?
no
95
Can you use a leading 0? like 0.5
yes
96
Can you use a trailing 0's?
no, because it can be confused as 50 instead of 5
97
How should you deal with errors on documentation?
draw a single line through errors. do not erase.
98
when there is an electronic record, you need to what?
document as close to real time as possible
99
Hand offs must have what?
documentation of who care was released from and given to
100
What 2 things need to be included in hands offs?
1. standardized hand off tool - like SBAR
2. time for questions
101
The perioperative nursing data sets are what?
standardized vocabulary for perioperative nursing
102
the PNDS has been recognized by the ANA since what?
1990
103
what is the self determination act?
is what allows you to make decisions about your health care (i.e. i don't what blood products, i don't want this type of surgery - i want this type of surgery)
104
A patient has the right to end of life decisions even if it is what?
detrimental to their health
105
A DNR can withold what?
palliative care
106
Allow natural death allows for what?
tube feeds/palliative care
107
Hint: you can have a patient say that I want to have my hip repaired but i don't want to be intubated
if you do something that causes me to be hemodynamically ubstable you can let me go, don't give me atropine if my HR goes down
108
DNR/AND orders are between who?
patient and MD
109
Can a DNR/AND order be altered by a nurse?
no
