Safe and Effective Care:Coordination of CareMs. Marcia Natelborg

Advance Directives

• Document completed by competent client• Identifies wishes regarding future acceptable

health care• Designate another person to make these decisions

when they can no longer do so• Includes

– Living will– Durable Power of Attorney

Advocacy

• Process where nurse assists client to grow/develop toward self determination

• Emphasizes– Caring– Autonomy– Respect– Empowerment

Client’s Rights

• Patient’s Bill of Rights• Americans with Disabilities Act• Confidentiality

– Health Insurance Portability And Accountability Act (HIPAA) of 1966

Concepts of Management and Supervision• Leadership-> behaving to influence others to

respond because they want to (not have to)– Components: knowledge, self-awareness,

communication, energy, goals, action– Focus-> development of members

Concepts of Management and Supervision

• Management-> problem-oriented process focused on activities to achieve group goals– Supplies structure, resources, direction – Phases: planning, organizing, staffing, directing,

controlling– Styles-> autocratic, laissez-faire, democratic

Concepts of Management and Supervision

• Communication-> sending, receiving, & interpreting written, face-to-face, and non-verbal information

• Conflict-> when there are 2 opposing views, feelings, expectations, or divergent issues– Can occur within individual, between individuals,

between groups– Can be managed

Delegation and Prioritization

• Delegating-transferring authority to perform a task to another team member while maintaining accountability

• Assigning-transferring authority, accountability, & responsibility to another member of team

• Supervising-monitoring progress toward completion of delegated tasks

• Accountability-moral responsibility for consequences of actions

5 Rights of Delegation

• Person• Task• Circumstances• Direction and communication• Supervision and evaluation • RN cannot delegate: nursing process, unstable

clients

Referral Process

• Notify MD of client’s needs• Provide consult provider pertinent information• Nurse supports family with consultations

Establishing Priorities

• Requires decision-making based on evidence obtained:– During report– Through review of reports/documentation– Continuous/accurate collecting data

Types of Law and Courts

• Sources of Law: Constitution, statute, administrative agencies, court decisions

• Types of Law– Criminal Law

• Felony-major• Misdemeanor-minor

– Civil laws• Tort law

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Legal and Ethical Issues

• Civil Law (Law of Torts)– Revolves around violation of person’s rights by

another– Includes

• Unintentional torts – malpractice• Intentional torts

– Assault and battery– False imprisonment (behavior control)

• Quasi-intentional torts– Defamation of character– Slander– Libel– Invasion of privacy

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Ethical Principles

• Autonomy• Beneficence• Confidentiality• Fidelity• Justice• Nonmaleficence• Paternalism• Veracity

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Ethical Issues

• Right to refuse treatment• Behavior control – restraints• Do not resuscitate orders• Living will/Medical power of attorney

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Legal/Ethical Considerations with Children

• Consent• Documentation of parent/child interactions• Informed consent for immunizations

Informed Consent

• Obtained after complete disclosure from health care provider about procedure to be performed

• Must include– risks and benefits– Expected outcomes– Potential complications/side effects– Alternate treatments/therapies

• Nurse-witness signature, provide clarification of info only

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Performance Improvement/Quality Assurance• Total Quality Improvement Model (Continuous

Quality Improvement)->philosophy of doing the right thing, the right way, the 1st time, with problem intervention planning = quality outcomes

• Quality of Care – Includes protecting clients from:– Incorrect treatments or procedures– Accidents– Nosocomial infections– Incorrect or incomplete orders– Inadequate or incompetent care

Performance Improvement

• Quality Improvement, Quality Control• Process to identify and resolve deficiencies• Focus on outcomes• All employees involved

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Quality Care

• Maintaining High Quality Care– Good communication– Know client care needs– Collaboration with interdisciplinary team

• Consultation and referrals

Variance/Incidence/Occurrence Report

• Event occurring outside expected norm of client stay, unit functioning, organizational processes– Report event– Complete report– Do not put in chart or document it

• Examples?

Case Management

• Collaborative process • Involves assessment, planning, facilitation,

advocacy• Uses options of services to meet clients health

care needs through communication and available resources

• Promotes quality, cost-effective outcomes• Nurse helps minimize fragmented care

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Nurse’s Role

• Standards of nursing practice– Provide guideline for public safety– Should be used in all care decisions

• Responsibilities– Practice must be within scope of:

• Standards of Practice• Nurse Practice Act• Policies of facility

– Client care in safe manner– Staff education

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Nurse’s Role (continued)

• Information Technology– Definitions

• All forms of information– Computer– Video/DVD– Books/journals– CD/audio

• Way to disseminate information to everyone

– Computer• Used for recording client records• Internet-finding information• Security issues

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Nurse’s Role (continued)

• Information Technology– Video/DVD/Books/Journals/CD/audio

• Useful for client teaching/nursing continuing education• Remember copyright issues• www.copyright.gov/circs/circ1.html

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Cultural and Religious Issues

• Must consider when planning care• Must help meet spiritual needs of clients

– Contact clergy, priest, etc.– Allow client to practice rituals/customs as appropriate

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Organ Donation

• Identify potential donors• Notify appropriate personnel• Maintain professionalism• Demonstrate compassion• Records kept with United Network for Organ

Sharing (UNOS)

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Questions?

• Let’s review NCLEX questions r/t Leadership and Management-Saunders