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Professional Issues Flashcards

1. Explain concepts related to professional issues in emergency nursing. 2. List professional issues in emergency nursing practice. 3. Describe various professional issues in emergency nursing.

1
Q

4 ethical principles

A

autonomy
beneficence
nonmaleficence
justice

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2
Q

cultural considerations

A 
cultural assessment
cultural competence
communication
family presence
grief and loss
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3
Q

define evidence-based practice

A

conscious, explicit, and judicious use of current best evidence in making decisions about care of patients

based on clinical experience and research

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4
Q

validity

A

degree to which an instrument measures what it is intended to measure

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5
Q

reliability

A

degree to which an assessment tool or measurement produces consistent results

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6
Q

quantitative study

A

deductive process that uses numeric findings for quantification

examines relationships between variables and determines cause and effect

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7
Q

randomized controlled trial

A

large experimental research study designed to randomly assign patients to experimental and nonexperimental groups, comparing the results from one form of treatment against a control group that receives the standard of care.

gold standard of research

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8
Q

systematic review and meta-analysis

A

review of multiple studies on a particular topic that identifies and critically analyzes the best research and makes practice recommendations based on that analysis

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9
Q

cohort study

A

subjects who have a certain condition or receive a particular treatment are followed over time and compared with another group not affected by that condition

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10
Q

qualitative study

A

an inductive process involving interviews where words, not numbers, are used to give meaning to data.

involves interaction between researcher and subject

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11
Q

case study

A

study that generally highlights an unusual or interesting case a practitioner has encountered

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12
Q

define critical incident stress

A

can produce reactions that may interfere with or overwhelm a person’s ability to function or cope either at the scene or later

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13
Q

behavioral reaction to abnormal event

A

restlessness
irritability, moodiness
antisocial behavior
increased alcohol

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14
Q

cognitive reaction to abnormal event

A

poor concentration
confusion or uncertainty
nightmares

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15
Q

physical reaction to abnormal event

A 
vomiting, chills
HA
disrupted sleep
muscle tremors
chest pain
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16
Q

emotional reaction to abnormal event

A

depression and anxiety
intense anger
grief
guilt

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17
Q

critical incident stress management

A

multicomponent crisis intervention program

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18
Q

steps of debriefing in critical incident stress management

A 
introduction
details of event
emotional responses
personal reactions/actions
symptoms
instruction phase
resumption of duty
followup
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19
Q

defusing in critical incident stress management

A

20-45 min conducted w/in 12 hours of event

small number of people

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20
Q

debriefing in critical incident stress management

A

7-step process

1-3 days after event

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21
Q

benefits of lifelong learning

A 
promotes competence
enhances working knowledge
advances skills
improves pt healthcare
personal/professional development
career goals
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22
Q

define triage

A

to sort - the process of determining and prioritizing patients’ treatments based on severity of their conditions

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23
Q

two-tiered triage

A

initial ID of pts where delaying tx would be unsafe

those not needing immediate intervention are forwarded to an assessment nurse

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24
Q

triage bypass or direct bedding

A

when there are open beds, pt taken directly to room and initial assessment initiated

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25
team triage
nurse/provider licensed independent provider exam orders
26
five-level triage
recommended ESI -severity -resource consumption
27
Canadian Triage and Acuity Scale
CTAS | based on arrival time to time seen by RN or provider
28
four-level triage
life threatening emergent urgent nonurgent
29
three-level triage
emergent urgent nonurgent
30
goal to triage
w/in 5 min of arrival | 2-5 min process
31
triage process
``` across-the-room assessment subjective data/interview VS objetive data severity rating safety, security documentation ```
32
define patient safety
avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from processes of healthcare
33
define error
failure of planned action to be completed as intended of commission, omission, or execution
34
leadership report in culture of safety
``` error-reporting systems root cause analyses culture surveys audits surveillance just culture safety rounds near misses ```
35
technology in culture of safety
``` EMRs electronic reporting systems computerized order entry smart pumps barcodes standardized order sets ```
36
teamwork and communication in culture of safety
interdisciplinary training | standard methods of pt handoff
37
pediatric considerations in culture of safety
inadequate training weight-based dosing medicine dilution communication
38
medication recommendations in culture of safety
limit number of concentrations, dose strengths standard instructions oral syringes vs IV syringes
39
forensic evidence collection
nursing science and legal procedure involving victims and perpetrators of abuse, violence, and trauma
40
examples of forensic cases
``` bioterrorism disasters MVCs missile injuries burns workplace violence elder and child maltreatment sexual assault intimate partner violence ```
41
steps in evidence collection
assessment evidence collection documentation
42
general principles of evidence collection
gloves avoid damaging evidence evidence in paper bags or cardboard boxes secure evidence for law enforcement
43
if pt is DOA and not resuscitated
``` do not remove clothing wrap pt in white sheet do not give belongings to family notify law enforcement paper bags over hands wrap bullets in gauze ```
44
define palliative care
comprehensive approach to a life-threatening or terminal condition
45
goals of palliative care
alleviate physical, psychological, emotional, and spiritual suffering and promote quality of life
46
advanced directive
guide to patient wishes with end-of-life care, written when pt is competent and becomes effective when pt loses decision-making capacity state-by-state differences flexible, can be changed/revoked
47
living will
declaration of wishes regarding what treatment individual does and does not want applied
48
durable power of attorney for healthcare
designates a surrogate decision maker when an individual is unable to make own decisions. may include limits or parameters for what types of medical treatment must be followed by surrogate
49
durable power of attorney for finance
identifies a person to manage financial matters including health insurance and medical bills
50
POLST
order that addresses what lifesaving measures should NOT be initiated may limit CPR/intubation but does not withhold/limit comfort measures
51
types of pain
somatic visceral neuropathic
52
areas of somatic pain
skin, subQ, bone, muscle, blood vessels, connective tissue
53
characteristics of somatic pain
localized constant achy
54
areas of visceral pain
organs | linings of body cavities
55
characteristics of visceral pain
poorly localized diffuse cramping
56
areas of neuropathic pain
central and peripheral nervous systems
57
characteristics of neuropathic pain
poorly localized shooting, burning sharp numbness, tingling
58
N-PASS
neonatal pain, agitation and sedation scale
59
FLACC
for children's pain ``` Face Legs Activity Cry Consolability ```
60
numeric pain rating scale
some peds, adults
61
picture pain scale
for multiple age groups
62
PAINAD
pain assessment in advanced dementia
63
organ procurement for death/imminent death in hospital
only organ procurement staff may approach family
64
Uniform Anatomical Gift Act
regulatory framework for the donation or organs, tissues, and other human body parts in the US follows state law
65
Uniform Determination of Death Act
irreversible cessation of: - circulatory/resp fxns - all fxns of entire brain
66
reasons to notify medical examiner
``` homicide, suicide unintentional injury/death death w/in 24 hours of admission admitted in comatose state death of minor ```
67
once a patient is declared dead...
care not directed by EM provider orders are written by Organ Procurement Officer (OPO) are valid and should be followed
68
how long after asystole can procurement occur?
up to 10 hours
69
procedure for preserving body if donating organs
keep body refrigerated if donating eyes: - elevate HOB 20 degrees - tape eyelids with paper tape
70
postmortem care
``` in ME cases, leave tubes cover large wounds w/ gauze clean sheets, gown sensitive to family proper ID before releasing body ```
71
define EMTALA
law written to protect patients who are transferred to assure their appropriate stabilization, care, and placement
72
transport considerations
prevent aspiration with NG vascular access blood products Foley?
73
considerations during air transport
air expands with altitude consider gas-filled organs consider air-filled equipment maybe chest tubes even for small pneumothorax
74
define delegation
transfer of responsibility for performance of a task from one individual to another while retaining accountability for outcome
75
define handoff
transition of care between equals or to higher level of care
76
what to communicate in handoff
CC or diagnosis test results care provided and response care to be completed
77
how to safely and effectively handoff
standardized tools include pt and family education and training
78
types of handoff
internal/shift report admission boarding transport
79
four factors of malpractice
duty breach of duty proximate cause injury
80
express consent
general consent given by patient, legal guardian, or family member for genera/low-risk care and procedures
81
implied consent
pts with life-threatening conditions who cannot give consent because of condition are implied to be giving consent
82
involuntary consent
to provide treatment to patients who are deemed not competent
83
informed consent
for high-risk/invasive procedures that requires certain disclosures
84
disclosures in informed consent
procedure description alternatives risks benefits
85
can nurses witness informed consent?
yes, if they witness the entire consent process
86
consent with minors
parents give consent if refusing life-saving tx, consider legal counsel for court order
87
consent with nonparticipating hospitals
if gatekeeper refuses tx due to insurance refusal of tx remains the responsibility of the patient
88
AMA
ensure competency explain risks of leaving sign release
89
consent when in custody of law enforcement
consent with individual pt under arrest can refuse care some laws can override
90
reasons for mandatory reporting
``` crimes suicides suspected maltreatment some communicable diseases deaths special circumstances ```
91
symptom surveillance
``` communicable disease outbreaks plan to identify, contain recognize clusters of sx isolation reporting ```
92
purpose of documentation
communication among healthcare professionals and record of patient progress
93
documentation requirements
minimum requirement varies by institution J.Co has standards trauma centers have requirements state laws
94
define quality improvement
formal approach to analysis of performance and systematic efforts to improve it PDSA RCA
95
HIPAA
protected health information may be used by the medical provider only for treatment, payment, and healthcare operation activities communication with pt or authorized rep release to law enforcement in specific circumstances
96
four steps of disaster preparedness
mitigation preparedness response recovery
97
mitigation in disaster preparedness
before and after emergency determine risk mitigate/lessen impact HVA
98
preparedness in disaster preparedness
``` before an emergency mutual aid agreements 96 hours of self-sustainment incident command plan alternatives ```
99
response in disaster preparedness
during emergency warning of impending disaster hospital may be isolated until help arrives
100
recovery in disaster preparedness
after emergency return to normal operation hours, days, weeks, months
101
disaster triage
START, jumpSTART limited resources maximize care most good for most people

CEN (12 decks)

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