What is informed consent
A legal process by which a client provides written permission for a procedure or treatment to be performed. Consent is considered to be informed when the client has been provided with and understands the treatment/procedure
What the client should understand/be explained
Reason the treatment or procedure is needed
How the treatment or procedure will benefit the client
Risks involved if the client chooses to receive the treatment or procedure
Other options to treat the problem, including the option of not treating the problem
Risk involved if the client chooses no treatment
The nurse's role in the informed consent process
Witness the client's signature on the informed consent form and ensure that informed consent has been appropriately obtained
Seek language assistance services if the client does not speak and understand the language used by the provider
Informed consent Guidelines
Consent is required for all care provided in a health car facility
The client provides implied consent when they comply with the instruction provided by the nurse
Kind of procedure that consent is needed
For invasive procedure or surgery (provided written consent)
Who else can give informed consent
State laws regulate who can give informed consent. Laws vary regarding age limitations and emergencies.
The nurse must verify that consent is informed and witness the client sign the consent form
Signing an informed consent
Must be signed by a competent adult
Emancipated minors (minors who are independent from their parents (a married minor)can provided informed consent for themselves)
Must be able to understand and able to fully communicate in return with the health care professional
Individuals authorized to grant consent for another person
Parent of a minor
Legal guardian
Court-specified representative
Client's health care surrogate(individual who has the client's durable power of attorney for healthcare/heath care proxy
Spouse or closet available relative (state laws vary)
What the provider should inform the client
Complete description of the treatment/procedure
Description of the professionals who will be performing and participating in the treatment
Description of the potential harm, pain, and/or discomfort the might occur
Options for other treatment and the possible consequences of taking other actions
The right to refuse treatment
Risk involved if the client chooses no treatment
To give informed consent, the client must do the following
Give it voluntarily
Be competent and of legal age, or be an emancipated minor. (If the client is unable to provide consent, an authorized person must give consent)
Receive sufficient information to decide based on an informed understanding of what is expected
The nurse should job/ role and responsible for (informed consent)
Witness informed consent
Ensuring that the provider provided the client the necessary information
Ensuring that the client understood the information and in competent to give informed consent
Having the client sign the informed document
Notifying the provider if the client has more questions or does not understand any of the information provided (provider will be the one giving clarification)
The nurse documents the following (informed consent)
Reinforcement of information originally given by the provider
Questions that the client had were forwarded to the provider
Use of an language assistance services
Priority setting
It requires decisions to be made regarding the order in which:
Clients are seen
Assessments are completed
Interventions are provided
Steps in client procedures are completed
Components of client care are completed
Time management
Organize care according to needs and priority
Use time saving strategies
Spending time developing a plan of care will save time once the plan is implemented
Complete one task before starting a new one
Systemic vs. Local
EX: Prioritize a client in shock over a client who has a local injury
Acute Vs. Chronic
EX: Prioritize a client with a new injury over a client who has a long term illness
Actual vs. Potential
EX: Prioritize administration of medications to a client with acute pain over ambulating a client for DVT prevention
Listen Vs. Assume
EX: Prioritize listening to clients understanding of a new illness
Recognize Trends Vs. Transient finding
EX: Recognize gradual deterioration
Complication Vs. Expected Findings
EX:Prioritize a change in condition for a new stroke vs. expected residuals from a past stroke
Apply clinical knowledge to standards
EX: Prioritize medications with timing implications vs. prophylactic medications
Maslow's Hierarchy
Physiological (the normal function of living organisms and their parts)needs take priority
ABC Framework
Three basic needs for sustaining life (in order)
Airway-highest priority
Breathing- Needed for blood oxygenation to occur
Circulation- Needed for oxygenation blood to reach tissues
Safety/ Risk reduction
Give priority to the most imminent risk
How significant is the risk in comparison to other options?
Assessment/ Data collection first
Information must be gathered before you can intervene
Survival Potential
Mainly used in mass casualties- gives priority to clients who have a reasonable chance of survival
Least Restrictive/ Least invasive
Maintain client safety while using least restrictive methods
Evidence- Based Practice
Use interventions that are researched based
Transfers
Clients can be transferred from one unit, department, or one facility to another
Continuity of care must be maintained as the client moves from one setting to another
What should be communicated when transferring a client
Client medical diagnosis and care providers
Client demographic information
Overview of health status, plan of care, and recent progress
Alterations that can precipitate an immediate concern
Most recent vital signs and medications, including when a PRN was given
Notification of assessments or client care needed within the next few hours
Allergies
Diet & activity prescriptions
Presence of or need for specific equipment or adaptive devices (oxygen, suction, wheelchair)
Advance directives and whether a client is to be reuscitated in the event of cardiac or respiratory arrest
Family involvement in care and health care proxy if applicable
Types of leadership styles
Autocratic/Authoritarian, Democratic, or Laissez- faire
Autocratic/Authoritarian
Makes decisions for the group
Motivates by coercion
Communication occurs down the chain of command, or from highest management level downward through other managers to employees
Work output by staff is usually high: good for crisis situations and bureaucratic settings
Effective for employees with little or no formal education
Democratic
Includes the group when decisions are made
Motivates by supporting staff achievements
Communications occurs up and down the chain of command
Work output by staff is usually of good quality when cooperation and collaboration are necessary
Laissez- Faire
Makes very few decisions and does little planning
Motivation s largely the responsibility of individual staff members
Communication occurs up and down the chain of command and between group members
Work output is low unless an informal leader evolves from the group
Effective with professional employees
Types of Leader
Transactional, Transformational, Laissez-faire, Bureaucratic, and Situational
Transactional leaders
Focuses on immediate problems, maintaining the status quo and using rewards to motivate followers
Transformational leaders
They empower and inspire followers to achieve a common long-term vision
Laissez-faire leaders
They're permissive and encourage decison making to take place throughout the group
Bureaucratic (Authentic) leaders
Inspires others to follow them by modeling a strong internal moral code
Situational leaders
Are flexible and can adapt their leadership style based on the situation at hand, often combining both autocratic and democratic leadership styles
Critical Pathways
Can be used to support the implantation of clinical guidelines and protocols
These tools are usually based on cost and length of stay parameters mandated by prospective payment systems (Medicare & Insurance companies)
Who uses critical pathways
Case managers often initiate it but are used by many members of the interprofessional team
What clinical pathways are specific to
To a diagnosis type and outline the typical length of stay and treatments
When a client requires treatment other than what is typical and requires a longer stay(Critical pathways)
This is document as variance along with information describing why the variance occurred
Reporting of Variance
Evaluate response to error/ occurrence
Identify need/situation where reporting of incident/event/irregular occurrence/ variance is appropriate
Stage 1: Latent Conflict
The actual conflict has not yet developed; however, factors are present that have a high likelihood of causing conflict to occur.
Stage 2: Perceived Conflict
A party perceives that a problem is present, though an actual conflict might not actually exist.
Stage 3: Felt Conflict
Those involved begin to feel an emotional response to the conflict.
Stage 4: Manifest Conflict
The parties involved are aware of the conflict and action is taken. Actions at this stage can be positive and strive towards conflict resolution, or they can be negative and include debating, competing, or withdrawal of one or more parties from the situation.
Stage 5: Conflict Aftermath
Conflict aftermath is the completion of the conflict process and can be positive or negative.
Conflict Resolution Strategies
Open communication among staff and between staff and clients can help defray the need for conflict resolution.
When potential sources of conflict exist, the use of open communication and problem-solving strategies are effective tools to de-escalate the situation
Delegating and Supervising
A licensed nurse is responsible for providing clear directions when a task is initially delegated and for periodic reassessment and evaluation of the outcome of the task.
Who RN's delegate
RNs must be knowledgeable about the applicable state nurse practice act and regulations regarding the use of PNs and APs.
RNs delegate tasks so that they can complete higher level tasks that only RNs can perform. This allows more efficient use of all members of the health care team. QTC
Who PN's can delegate
PNs can delegate to other PNs and APs.
Delegation Factors
Nurses can only delegate tasks appropriate for the skill and education level of the health care team member who is receiving the assignment.
RNs cannot delegate the nursing process, client education, or tasks that require clinical judgment to PNs or APs.
PN and RN scope of practice differs from state to state, and it is important to know and comply with the state’s practice rules where the nurse is employed.
Delegation and Supervision Guidelines
Use nursing judgment and knowledge related to the scope of practice and the delegatee’s skill level when delegating.
- Use the five rights of delegation.
- What tasks the nurse delegates (right task)
- Under what circumstances (right circumstance)
- To whom (right person)
- What information should be communicated (right direction/communication)
- How to supervise/evaluate (right supervision/evaluation)
Examples of tasks delegated to PN's
Monitoring findings (as input to the RN’s ongoing assessment)
Reinforcing client teaching from a standard care plan
Performing tracheostomy care
Suctioning
Checking NG tube patency
Administering enteral feedings
Inserting a urinary catheter
Administering medication (excluding IV medication in some states)
Examples of tasks delegated to AP
Activities of daily living (ADLs)
Bathing
Grooming
Dressing
Toileting
Ambulating
Feeding (without swallowing precautions)
Positioning
Routine tasks
Bed making
Specimen collection
Intake and output
Vital signs (for stable clients!!)