RN Lesson 1 Management of Care

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Course RN: Review for the NCLEX-RN Examination v5.4 Start Date 28 Apr 2012 End Date 19 May 2012 In Progress

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Introduction and Diagnostic Pretest RN Lesson 1 Management of Care RN Lesson 2 Safety and Infection Control RN Lesson 3 Health Promotion and Maintenance RN Lesson 4 Psychosocial Integrity RN Lesson 5 Basic Care and Comfort RN Lesson 6A - Pharmacological and Parenteral Therapies RN Lesson 6B - Classification of Medications by Body System RN Lesson 6C - Classification of Medications by Health Status RN Lesson 6 Posttest (for all Lessons 6A-6C) RN Lesson 7 Reduction of Risk Potential RN Lesson 8A Cardiovascular RN Lesson 8B Respiratory RN Lesson 8C Neurological RN Lesson 8D Gastrointestinal RN Lesson 8E Genitourinary RN Lesson 8F Endocrine RN Lesson 8G Orthopedic RN Lesson 8H Oncology

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Delegation . 2. Learn more about the American Nurses Association (ANA). Visit the Web site of the National League for Nursing (NLN).RN Lesson 8I Emergency RN Lesson 8J Pediatrics RN Lesson 8K Complicated Obstetrics RN Lesson 8 Posttest (for all SubLessons 8A-8K) Self-check Practice Questions Bank 1 Self-check Practice Questions Bank 2 (Pharmacology) Self-check Practice Questions Bank 3 Self-check Practice Questions Bank 4 Self-check Practice Questions Bank 5 Self-check Practice Questions Bank 6 ---------- Not Started Not Started Not Started Not Started Not Started Not Started Not Started Not Started Not Started RN Lesson 1 Management of Care Concepts of Management and Supervision Review standards and/or position statements of the following agencies before delegating any nursing tasks  State board of nursing  National Council of State Boards of Nursing (NCSBN)  Nursing organizations  American Nurses Association (ANA)  National League for Nursing (NLN)  Health care institutions Use critical thinking in management situations Learn more about the National Council of State Boards of Nursing (NCSBN).

they have no scope of practice  assist in a variety of direct client care activities or tasks. bathing. groups and communities in both structured and unstructured health settings  associate degree prepared nurses are equipped to care for individuals in a structured health care environment  RNs cannot delegate the following activities to unlicensed assistive personnel (UAP):  assessment of clients  evaluation of client data  nursing judgment  client/family education/evaluation  nursing diagnosis/nursing care planning  licensed practical or vocational nurses (LPN/VN)  assist in implementing a defined plan of care and to perform procedures according to protocol  assessment skills are directed at differentiating normal from abnormal  competence to care for physiologically stable clients with predictable conditions  unlicensed assistive personnel (UAP)  because they are unlicensed.g. blood glucose levels)  perform indirect activities such as housekeeping. according to the specific state's nurse practice act  The delegator remains accountable for the task  Along with responsibility for a task. the nurse who delegates must also transfer the authority necessary to complete the task  The delegator knows how to perform the task being delegated  Delegation is a contractual agreement that is entered into voluntarily  Consider the scope of practice of nursing personnel  registered nurses (RNs):  baccalaureate prepared nurses are equipped to care for individuals. feeding. intake and output. Steps of delegation o Define the task o Match the delegatee to the task  determine that the task is within the scope of practice for the delegatee  nurse practice acts: each state defines nursing practice for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) o . toileting. weight. and obtaining measurements (vital signs. ambulating.. transporting people and stocking supplies 3. transferring. families. e. height.Definition of delegation: a process by which responsibility and authority for performing tasks are transferred from one individual to another who accepts that authority and responsibility o Delegation involves  Responsibility: an obligation to accomplish a task  Accountability: accepting ownership for the results or lack of  Authority: right to act or empower o Principles of delegation  A nurse can only delegate those tasks for which that nurse is responsible.

Client care assignments o Assign the right task o Assign the task to the right person o The LPN may assign tasks to the unlicensed assistive personnel or nursing assistants o Unlicensed assistive personnel (UAP) or nursing assistants cannot delegate to other UAPs or nursing assistants  NCSBN Learning Extension offers an online continuing education course called Delegating Effectively . . the nurse  only licensed individuals have a legally determined scope of practice  know the employer's role expectations  organizational charts  policies and procedures  job descriptions  competency requirements o Communicate clearly about expectations regarding the task  clearly state who will do what and by when it will be done  clearly state expected outcomes o Reach mutual agreement about the task to be completed  the delegator validates with the delegatee that an understanding exists regarding what is to be done and the expected outcomes  potential problems and solutions are discussed o Supervise the performance of the task  provide directions and clear expectations of how the task is to be performed  monitor performance of the task to assure compliance with established standards of practice. policies and procedures  intervene if necessary  ensure appropriate documentation of the task o Evaluate the delegation process  assess the degree to which nursing care needs of the client are being met  review the performance by the delegatee of the delegated task  determine the need for further instruction  determine the need to continue or withdraw the delegation o Provide feedback to individual on outcomes performance.com. review with the delegatee what went right as well as what went wrong with the process o Five rights of delegation  Right task  Right circumstances  Right person  Right direction/communication  Right supervision 4. Use the decision tree to help you to understand the concept of delegation and how to better manage and supervise others. For more information go to www.learningext. Read NCSBN's Working with Others: A Position Paper (2005). but not replace.standards of practice: the American Nurses Association (ANA) defines standards of practice for registered nurses  some nursing tasks can be delegated to unlicensed assistive personnel (UAP) to assist.

e. Performance Improvement & Quality Assurance o o o o Quality: the degree to which client care services increase the probability of desired outcomes and reduce the probability of undesired outcomes given the current state of knowledge Performance improvement/assurance: the process of attaining a new level of performance or quality that is superior to any previous level of performance or quality Total quality management: a philosophy that emphasizes a commitment to excellence throughout the organization Six characteristics of total quality management  Focus on customer. i.6. Communication skills and conflict resolution o Communication:  involves perception to receive a message  involves expectation .not winning or losing  focus on patient care interests  avoid emotional outbursts  include a third party when mediation seems the best choice  7. i.e. client  Focus on outcomes  Total organizational involvement .the unexpected may be ignored  makes demands on nurses to think and respond  is different than information o Types of communication  downward: used to relate organizational policy such as position description and rules and regulations  upward: include such things as staff meetings  lateral: between staff members. to coordinate activities  diagonal: staff from different levels work together on a project o Causes of conflict  inadequate communication  incorrect facts  unstable leadership or inadequate action plans  misunderstood roles or responsibilities  receiving directions from two or more delegators  lack of or limited staff input into decisions  inability to accept change  power issues o Prevention of conflict includes  allocating resources fairly  avoiding unexplained changes  clearly stating expectations  addressing staff fears o Dealing with conflict  take prompt action  help parties resolve conflict among themselves (communicate trust that parties can accomplish resolution)  maintain an objective approach  avoid criticism  use problem solving approach  provide privacy for sensitive issues  negotiate for agreements..

Department of Health & Human Services Other agencies committed to quality improvement:  The Joint Commission (read the Facts about Hospital Accreditation)  National Committee for Quality Assurance (NCQA)  Institute for Healthcare Improvement (IHI)  Agency for Healthcare Research and Quality (AHRQ)  Institute for Safe Medication Practices (ISMP) The focus is on improving quality of care and client safety through taking evidencebased practices (from computer information systems to different pain management protocols) and implementing them in various health care settings Standardized processes are the foundation for improvements Clinical guidelines . on the other hand. involves quality improvement with a change in the focus from Detection to prevention Reactive to proactive Correction of special causes to correction of common causes Problem-solving by authority to involving employees at all levels Almost all regulatory and voluntary accrediting agencies now require some form of quality management Regulatory agency: Centers for Medicare & Medicaid Services (CMS). including a(n): Identification of a problem Determination of the source and nature of the problem Assessment on how to effect improvement in the situation Designing policies for remedying the problem Implementation of those policies Quality management .o Multi-professional approach Use of quality tools and statistics for measurement Identification of key areas for improvement with an emphasis on SAFETY Mandated by the Joint Commission (formerly called Joint Commission on Accreditation and Healthcare Organizations)    Learn more about the Joint Commission's accreditation survey process. U. View the Joint Commission's 2010 National Patient Safety Goals.S. QUALITY IMPROVEMENT Quality assurance involves an evaluation of the conditions under which care was provided.

such as the critical care unit (CCU) or the post-anesthesia recovery unit (PACU) Primary nursing  The RN maintains a client load of primary clients  The primary nurse designs.Critical pathways Case management Nurses enable an organization to be successful in meeting standards facilitate collaborative practice with other health care professions to  identify problems  initiate change  monitor ongoing effectiveness of care Nursing Care Delivery Systems Functional nursing (task nursing)  Needs of clients are broken down into tasks  Tasks are assigned to various levels of health care workers according to licensure and skill  Example: RN gives medications and UAP give bed baths for one group of clients Team nursing  Most common nursing care delivery system  A team of nursing personnel provides total care to a group of clients  Team leaders supervise client care teams.A D elicious PIE A =Assessment D =Diagnosis P =Planning I = Implementation . LPN. LPN. graduate nurse. this type of care is provided in areas requiring high level of nursing expertise. less-experienced RN. less turn over. and fewer negative outcomes for patients Practice partnerships  An RN and an assistant (UAP. or nurse intern) agree to be practice partners  Partners work together on same schedule with same group of clients  Senior partner directs the work of the junior partner within the scope of each partner's practice Remember the steps in the Nursing Process . which usually consist of an RN. implements and is accountable for the nursing care of those clients during their entire stay on the unit  has the benefit of continuity of care but may not be feasible with varying schedules  has been found to result in greater nurse satisfaction. and UAP  Team leader reviews the client's plan of care and progress with team members during team conference Total client care (case method)  An RN is responsible for all aspects of care of one or more clients  The LPN may be assigned to assist the RN  Currently. more personalized care.

including admission. facilitate and evaluate client care for a group of clients o Case manager usually does not provide direct client care but coordinates care provided by licensed and unlicensed nursing personnel according to a critical path o Critical pathways are plans for providing care to the client and family  identify desired outcomes  state expected amount of time and resources to be used  focus on specific diagnoses or procedures that are high volume and or high resource use (and therefore costly)  promote collaboration among disciplines (health care professionals) o The essential components of case management include  collaboration of all health care team members  identification of expected patient outcomes with time frames  use of principles of continuous quality improvement (CQI) and variance analysis  promotion of professional practice o Client involvement and participation is key to successful case management The Case Management Resource Guide is a free. critical pathways and primary care guidelines. Differentiated practice o Identifies distinct levels of nursing practice based on defined abilities that are incorporated into job descriptions o Structures nursing roles according to education. experience.E =Evaluation 6. diagnostic testing and support services o Uses UAPs to perform delegated client care tasks . Client-centered care o The RN coordinates a team of multi-functional unit-based caregivers o All client care services are unit-based. and competency 8. Refer to the University of Texas Medical Branch Web site for examples of clinical practice guidelines. Case management o Model for identifying. 7. searchable database of health care services. communicate. problem solve. collaborate. facilities. coordinating. discharge. businesses and organizations. and monitoring the implementation of services needed to achieve desired client outcomes within a specified period of time o Organizes client care by major diagnosis or Diagnosis Related Group (DRG) o A collaborative health care team defines the expected outcomes of care and care strategies for a client population by defining critical paths o A registered nurse manager is assigned to coordinate.

A.P. format or by flow sheets  discharge summary relates the overall assessment of progress during treatment and plans for follow-up care. normal routine is presumed as having been done. and relax.A.Arrive at the testing center early so you have time to register. charting. 5.: problem-oriented charting.O. very quickly Methods (styles) of charting  narrative charting  the nurse records observations. or a client behavior  components of this type of charting include: information about the condition/problem.  A = assessment.E. what you observe. a treatment or procedure. what client tells you  O = objective. by narrative notes in the S. see. what you think is going on based on the data  P = plan. encouraging continuity of care  four parts  data base: the client's present health status  problem list: numbered list of health problem(s)  initial plan: plan to help overcome health problem(s)  progress notes: all disciplines chart on the same page  Source-oriented  most traditional type of charting.O.P. with different disciplines charting on separate forms  drawback: records become very bulky. and client's responses  P. become accustomed to your surroundings. a potential problem. comes from a medical model  S = subjective. data (including reactions from the client) in a sequential and chronological order  baseline charted every shift  source-oriented  S. Documentation o o Types of patient records  Problem-oriented medical record (POMR)  a decision is made on the nature of the client's problem or problems and these problems are assessed regularly  recorded using a standardized format.I. without any problems . etc. what you are going to do  Focus charting  charting on an acute condition. Bring the proper identification and your Authorization To Test (ATT). action. uses the nursing process  P = problem  I = intervention  E = evaluation  Charting by exception  uses flowsheets  emphasis on abnormal (or what is abnormal for this particular client).

Documentation has six key components . Documentation guidelines o General  check that you have the correct chart  record the facts as accurately as possible  chart as you go  never chart for another person  do not mention incident reports  avoid the use of abbreviations .CO-ACTS: C onfidential O rganized (chronologically) A ccurate C omplete T imely S ubjective and objective data 3. calls made to other health care professionals  write legibly .when in doubt. client responses to interventions. write it out!  all health care institutions have a list of accepted abbreviations  refer to the Joint Commission's official "Do Not Use" list of abbreviations  never alter a client's record (altering a client chart is a criminal offense)  six things that nurses must document  assessment  nursing diagnosis and client needs  interventions  care provided  client response to care  client's ability to manage continuing care after discharge o Legal guidelines for charting  electronic health record (EHR) charting  never share access or password with another person  change your password frequently  maintain confidentiality of documented information printed from the computer  carefully check your information before you press enter  access information for clients under your care only  log off when you are finished  date and time are automatically recorded  paper-ink  do  write in chronological order  use permanent black ink  chart the time and date for each entry  include consent for or refusal of treatment.

breathing. date and initial the change correct any errors in a timely manner erase. desires.learningext. The American Recovery and Reinvestment Act (ARRA) will require all health care facilities to use electronic medical records by 2014. Review the Joint Commission's Official "Do Not Use" List of abbreviations (last updated 3/5/2009) 6. go to http://www. and safety Get a good night's sleep the night before the test. For more information. Nurse Practice Acts o o Definition: passed by each state legislature to regulate the practice of nursing in that state Nurse practice acts define  Scope of practice  Education  Licensure .   cross through the error once. including Documentation: A Critical Aspect of Client Care . scratch out or use correction fluid (Liquid Paper or Wite Out®) document for others or change documentation by others leave blank spaces recopy any charting form make photocopies without permission do not      NCSBN Learning Extension offers several continuing education courses. circulation) of emergency care to guide decisions Mutual decision-making for priorities may be made with the client based on the client's physiologic needs.com. 7. Establishing Priorities o o o o o o Prioritizing: decisions of which needs or problems require immediate attention or action and which ones can be delayed until a later time if they are not urgent Needs that are life-threatening or could result in harm to the client if left untreated are high priorities Actual problems or needs have higher priority than potential problems or needs Problems or needs identified by client are of a higher priority Consider Maslow's principles (hierarchy of needs) or the ABCs (airway.

e. the state board of nursing imposes penalties (in order of severity)  on probation  censured  reprimanded  license suspended  license revoked  Don't Confuse these! Scope of Practice . i. Standards of Nursing Practice and Standard of Care o o The American Nurses Association (ANA) publishes its Standards of Nursing Practice.institutional policy and procedure documents 8. Legal Responsibilities o o Negligence: legally. which defines the responsibilities of the RN to all clients for quality of care Each institution sets standards of care.o Professional misconduct  negligence  the impaired nurse  the nurse who violates boundaries Administered by the board of nursing in each state  The nurses must know how their state defines professional misconduct  For professional misconduct. 9.established by the nursing profession..determined by a state's Nurse Practice Act Standards of Practice . the American Nurses Association Standard of Care . both across the institution and for specific clinical populations Learn more about the Standards of Nursing Practice by visiting the National League for Nursing (NLN) and American Nurses Association (ANA) web sites. a breach of the duty to provide nursing care to the client  Malpractice is professional negligence  The unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not perform in a similar set of circumstances Negligence involves four legal concepts:  Duty: nurses have a legal obligation to provide nursing care to clients .

be objective  File a report according to the policies and procedures of the institution Boundary violations  Definition: actions that overstep established interpersonal boundaries and meet the needs of the nurse rather than the client. NCSBN Learning Extension offers continuing education courses on Professional Accountability and Legal Liability for Nurses and Disciplinary Actions: What Every Nurse Should Know . . For more information on this and other available courses. 10. The client must prove that the nurse not only committed a breach of duty but that this breach of duty was the proximate cause of any damages incurred by the client. specific times.learningext.com. go to www. reasonable standard of care under the circumstances (includes errors of omission or commission) Proximate cause:  relationship between the breach of duty and the resulting injury  the injured party must prove that the nurse's action or omission led to the injury Damages: the injury and the monetary award to the plaintiff  A former client sues a nurse for negligence. o Professional Misconduct The impaired professional  Remember that the impaired nurse is compromising client care  Be sure that the problem exists and can be proven  Communicate specific concerns to appropriate persons such as a nurse manager or risk manager  Document incidents in terms of behaviors.  Guiding principles in determining professional boundaries  nurse is responsible for setting and keeping boundaries  nurse must avoid simultaneous professional and personal relationship with a client  nurse must avoid flirtation o Learn more about the American Nurses Association's Code of Ethics for Nurses. dates . under similar circumstances Breach of duty: failure to provide expected.   must meet a reasonable and prudent standard of care under the circumstances  must deliver care as any other reasonable and prudent nurse of similar education and experience would.

and all other available courses. please go to www. For more information about this course. and the other courses that are available.com. For information on this. Advance directives o As part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. go to http://www.learningext. 11.learningext. this requires states to provide written information to clients outlining their rights to make health care decisions o These rights include:  the right to refuse or accept treatment  the right to formulate advance directives o Nurses and other members of the health care team are required to  assess the clients knowledge of advance directives and their status regarding the advance directive process  provide information and assistance to the client in developing advance directives  plan care that incorporates the clients decisions regarding advance directives Three common advance directives are:  living will: identifies what a client wishes for his care should he become unable to communicate these wishes .NCSBN Learning Extension offers a continuing education course called Ethics of Nursing Practice . o Client Rights Privacy  Confidential information may only be released by signed consent of the client  Unauthorized release of client data may be an invasion of privacy  Health Insurance Portability and Accountability Act of 1996 (HIPAA)  provides individuals with access to their medical records and more control over how their personal health information is used  provides privacy protection for consumers of health care  Health care workers must release information when a court orders it or when statutes require it (as in child abuse or communicable diseases)  Special regulations apply to release of information about psychiatric illness or HIV Learn more about HIPAA from the US Department of Health & Human Services NCSBN Learning Extension offers a continuing education course called Patient Privacy . Congress established the Patient Self-Determination Act. 2.com.

Copies of any advance directives should be kept on file in the physician's office and in the hospital.  Although it is recommended. and witnessed by two people who are not related and are not potential heirs or a health care provider. if any. it is sometimes called a "health care declaration" or a "health care directive" in some states. type of life-prolonging medical care should be provided if he or she becomes terminally ill. Anyone age 18 and older may prepare advance directives. a person does not need a lawyer to draw up a living will. Advance directives are legal documents that allow someone to convey his or her decisions when he or she is unable to make a decision. . the order must be written by a physician. or in a vegetative state. do not resuscitate (DNR) status: this has been expanded to include identification of medications that may be given without any defibrillation attempts (comfort measures only)  follow the facility policy on obtaining and implementing DNR orders  generally. permanently unconscious. some facilities may have a policy to allow verbal orders under specific conditions  the order must be communicated clearly to all personnel caring for the client  the client or her or his health care proxy can withdraw the order at any time  a nurse who attempts to resuscitate a client with a valid DNR order may be committing battery ADVANCE DIRECTIVES The Patient Self-Determination Act of 1990 requires hospitals to inform their patients about advance directives. dated. Advanced directives include Living wills Durable power of attorney for health care Living will A living will is a legal written document.  durable power of attorney for health care decisions: the client has appointed a person to make decisions about their care if they are unable to do so.  A living will should be signed. A person indicates what.

g.. dated physician's order specifying the type of restraint/safety device and a time limit Types of restraints/safety devices  chemical . and witnessed document naming another person to make medical decisions should someone be unable to make a decision at any time.  Although it is recommended. The document is also known as a "health care proxy" or "appointment of a health care agent.competent clients may refuse treatment." The named person may be called a "health care agent" or "surrogate. corporal punishment. dated. e. involuntary seclusion. paralytics  physical ." . Guidelines for Restraints Laws and accreditation guidelines The Omnibus Budget Reconciliation Act (1997) states that freedom of restraints is a right by all clients across care settings The Social Security Act states: "Free from restraints is the right to be free from physical or mental abuse. This document goes into effect when the physician declares that a person is unable to make his or her own medical decisions. even life-sustaining treatment Freedom from safety devices/restraints Physical restraints/safety devices require a signed.  Most states do not allow the appointed agent to act as a witness. not just at the end of life. and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. surgery or artificial nutrition and hydration.vest restraints. side rails Use the least restrictive form of restraint/safety device Know agency guidelines for use of restraints The nurse must document three factors  why restraints/safety devices were used  how the client responded  whether the client needs continued restraints/safety devices Restraining clients without consent or sufficient justification may be interpreted as false imprisonment. a person does not need a lawyer to draw up a durable power of attorney for health care." This document includes instructions about treatment one wants or wishes to avoid.A living will goes into effect when the person is no longer able to make his or her own decisions.central nervous system depressants. All states legally recognize some form of advance medical directive Refusal of treatment . Durable power of attorney for health care Durable power of attorney for health care is a signed.

1369r])  Social Security Act Requirements For. Hospital Conditions of Participation: Patients' Rights. Final Rule (42 CFR Part 482) Review the Joint Commission FAQ sheet about Restraint and Seclusion. which includes time frames for reevaluation and reordering of restraint or seclusion for an adult and a child Policies and procedures The restraint must be necessary to:  meet the client's therapeutic needs  ensure the safety of the client or others There are two categories of restraints and there are different rules and restrictions for each type  behavioral  medical Health care providers can legally restrain a client under certain conditions defined by the law and by the health care facility's policies and procedures  use of restraints must be accompanied by the health care provider's orders.S.C. and Assuring Quality of Care in. including why the restraint is being used and the client's response Remember that death can result from improper use of restraints Restraints are a LAST RESORT Informed consent Basic requirements  capacity  voluntariness  information The client must understand  purpose of the procedure and expected results  anticipated risks and discomforts  potential benefits  any reasonable alternatives  .C. except in an emergency  there can be no "standing orders" or "PRN" orders for restraints  physicians or licensed independent practitioners (LIP) are required to see and evaluate the need for a behavioral restraint or seclusion within 1-hour of the initiation of the intervention  physicians or licensed independent practitioners (LIP) are required to see and evaluate the need for a medical restraint within 24 hours of the initiation of the intervention  restraint orders must be updated according to policy (commonly every 24 to 48 hours) The least restrictive type of restrain must be used first Training about restraints is required for all staff who have direct contact with clients There must be documentation of attempts at restraint alternatives General guidelines when restraints are used The client must be closely monitored when restrained Restraints should be released periodically and the skin integrity of the area checked for breakdown Document all pertinent details.S. 1395i-3])  Social Security Act Medicare and Medicaid Programs. Skilled Nursing Facilities (Sec.Social Security Act Requirements for Nursing Facilities (Sec. 1819 [42 U. 1919 [42 U.

reprimand. suspension or revocation of the license. go to http://www.the ethical duty to tell the truth  Confidentiality  Fidelity . Points to Remember Nursing practice is governed by legal restrictions and professional standards. What a nurse can do depends on the nurse practice act in the state in which the nurse is licensed. Standards of nursing practice apply to all nurses in all practice settings. and the other courses that are available.learningext. experience. nursing education. The state board of nursing has the authority to impose a penalty for professional misconduct.recognizes that clients are not discharged from care but moved across the continuum to another level of care Ethics in Nursing Ethics A theory or system of moral values. faithfulness and honoring commitments   Learn more about the American Nurses Association's Code of Ethics for Nurses. NCSBN Learning Extension offers a continuing education course called Ethics of Nursing Practice . Penalties include probation. and publications of professional nursing associations and accrediting groups. individuals must integrate the values of the profession with their own values Ethical principles  Respect for others  Autonomy  Nonmaleficence .com. censure. but the nurse should confirm consent and answer the client's questions Transition planning .do good and avoid evil  Justice  Veracity . To avoid negligence: Know the standard of care . that consent may be withdrawn at any time The care provider has the legal obligation to obtain informed consent for medical treatment. Standards of care are based on facility policy and procedure. Each state defines what constitutes professional misconduct. For more information about this course. based on the ideas of right and wrong It governs our relationships with others A code of ethics provides standards and values for a profession.loyalty."do no harm"  Beneficence .

scorecards. course progress reports or other topics check out the FAQ section on the Web site . It is at the discretion of each health care facility as to whether or not this is done. Ethical dilemmas result from conflicts in values. Please note the Ref # of the question and include it in your request. To learn more about exam scores. Always check the policy of your facility. The RN must monitor delegated tasks and evaluate the outcomes. retaking the exam. A relative or heir to the estate should never be the witness to the signing of an advance directive. Ethics guide the nurse toward client advocacy and the development of a therapeutic relationship. An effective leader modifies his/her style according to the situational requirements.Deliver care that meets the standard and follows the facility's policies and procedures Document care accurately and in a timely manner The only employee of a health care organization who may be the legal witness to the signing of an advance directive is a clinical social worker. Final responsibility for any delegated task resides with the RN. Become familiar with the NCLEX Test Plan's distribution of questions and use this to make notes. If you would like to review your Scorecard again you can click 'Previous Page' below. If you have questions about specific exam questions go to Ask the Instructor and submit a request.” Use the “I need to review” list to help you to select the questions where you need more practice. like “I can recall” or “I need to review. End of the Module This is the end of this module please click 'Close Module' at the top right to save your progress.

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