This category of questions falls under the broader umbrella of Safe and Effective Care Environment and asks you to make relevant decisions about nursing care. Your objective should be to determine the most effective way to deliver optimal care that preserves the health and safety of patients and personnel. These are some of the concepts of which you will need to have knowledge to make the decisions asked by the questions about particular scenarios.
Advance directives are legal documents that specify the wishes of patients regarding their care if they were to become incapacitated and unable to communicate on their own. Examples of advance directives include living wills, healthcare proxies, plans for organ donation/anatomical gift, and Durable Power of Attorney for Healthcare (DPAHC).
In 1990, Congress passed the Patient Self-Determination Act. This bill requires that upon admission to a hospital, nursing home, home health agency, or other healthcare institution, patients must be advised of the right to accept or refuse care as well as their options for advance directives. If a patient already has an advance directive, the nurse may help document this in the patient’s chart. If not, the nurse may be involved in educating the patient on what advance directives are and discuss the patient’s healthcare goals for the future. This may also include the patient’s wishes for organ donation or making an anatomical gift as specified in the Uniform Anatomical Gift Act.
Advance directives help ensure that a patient’s wishes are carried out by the healthcare team. As a nurse, you will need to incorporate advance directives into your patient’s care plan. This may include determining if a patient needs one, facilitating conversations with family members, as well as educating staff members who may not be familiar with what advance directives are. You must also ensure that copies of advance directives are placed in the patient’s chart.
Advocacy, which is promoting or acting on behalf of the interests of another, is at the heart of nursing. Nurses are advocates for their patients. Their duties can be varied and diverse; they may include education and explanation of various diagnoses, tests, and results to patients and their loved ones, making sure the care plan is executed in a timely and safe manner, as well as serving as source of information and communication between various members of the healthcare team. At times, you may need to seek the opinion of those involved in patient care, but with expertise outside of medicine, such as a social worker or dietician.
Delegation is an essential nursing skill. No matter how good or efficient you are as a nurse, you will need help to complete all aspects of patient care on a daily basis. The key to delegating success is finding the appropriate person to help, clearly explaining the assignment, and maintaining responsibility for the outcome while providing proper support and supervision.
Some tasks should never be delegated to non-professional staff. These include: nursing assessment and examination, diagnosis, care goals or progress plans, and interventions that require advanced knowledge, training, and skills.
Prior to delegating a task, it’s helpful to consider the five “rights” of delegation:
Tasks that are usually acceptable to delegate are those with unchanging protocols, such as feeding, bathing, transferring, and dressing. Delegation should only be considered in stable patients. Never delegate tasks when the patient is unstable, when the outcome is uncertain or unpredictable, or when the tasks require complex or complicated knowledge or technical skills.
As a nurse, you are a leader. Being a good leader means that you have the ability to unite a team of caregivers to complete tasks to reach an overall goal—which is to provide exceptional care to your patients.
As a nurse, you may be asked to supervise a variety of nursing staff members. These may include other RNs, licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and nursing assistive personnel (NAPs). You may be responsible for coordinating the tasks of the nursing team. This will require clear communication, adequate follow-up, active listening, technical knowledge of all aspects of the supervised work, problem-solving, and conflict resolution skills when these needs arise. A supervisor can evaluate the skills and abilities of each team member, especially with regard to time management, and use this knowledge to more effectively delegate appropriately. Likewise, these skills will also be necessary and useful for performance evaluations of those you supervise.
Nurses are responsible for developing, implementing, and revising care plans that help patients reach and maintain their independence after they are discharged from medical care.
Case management as a nurse not only involves patient care in your facility but also includes helping patients find and utilize post-care resources. You will help your patient do this by identifying his or her individual needs and discussing his or her goals. Effective case management ensures the patient’s safety and also considers options that are cost-effective for the patient.
When possible, incorporate evidence-based findings into your patient’s care plan. Regularly review the research within medical literature to maintain the most current level of knowledge and familiarize yourself with any newly advised standards of care. Also, don’t hesitate to access local professionals who may have the knowledge you need to manage a case.
In addition to initiating the care plan, it will be your job to revise it at times as well. Discussing the care plan with your patient will help you identify if changes are necessary and evaluate his or her individual needs. You must also provide information on medications that must be continued, repeat labs or imaging tests that are necessary for care, and any follow-up visits that are needed after discharge.
The nurse is responsible for not only explaining and educating patients on condition and treatment options but also informing them of their rights as patients upon admission to the hospital or other healthcare facility. The right to accept or refuse care is specified in the Patient Self-Determination Act. The nurse needs to be familiar with other healthcare laws that govern and protect a patient as well.
HIPAA stands for the Health Insurance Portability and Accountability Act. It was designed to protect a patient’s personal information such as his or her name, social security number, birth date, and sensitive medical information, such as a diagnosis or treatment received. Only those involved in direct patient care, insurance reimbursement, or patient management can access and share this information.
Adopted by the President’s Advisory Commision on Consumer Protection and Quality in the Healthcare Industry, this document specifies what each patient’s rights and responsibilities are as recipients of healthcare. It includes:
Information disclosure—the right to accurate and easily understood information about healthcare providers, facilities, and health plans
Choice of providers and plans—the right to choose healthcare providers that give high-quality care when needed
Access to Emergency Services—the right to have evaluation and stabilization by emergency services when and wherever needed (These services may be given without authorization and must be given without financial penalty.)
Participation in treatment decisions—the right to be informed of all treatment options and make decisions about one’s care (This right also extends to other healthcare proxies should the patient not be able to make decisions.)
Confidentiality of health information—the right to speak privately with healthcare providers and have all healthcare-related information kept private (This also includes the right to access, read, and copy one’s own healthcare record.)
Complaints and appeals—the right to a fast, fair, and objective review of a complaint against a healthcare plan, provider, care personnel, or facility
Consumer responsibilities—specifies that a patient must disclose relevant information about medications and past illnesses to his or her healthcare provider
Your duty as a nurse is to ensure that your patient understands his or her rights and responsibilities under the Patients’ Bill of Rights, including the right to informed consent. You also are responsible for evaluating your patients’ understanding of privileged communication and duty to disclose as it pertains to informed consent. You must also assess other healthcare team members’ knowledge of patients’ rights and provide education to them as needed.
Collaboration, in this case, is defined as the interdisciplinary interaction between the various areas of healthcare. Nurses work with physicians, social workers, dieticians, pharmacists, and many other healthcare specialties to achieve proper patient care. Collaboration requires integration, cohesiveness, and teamwork. As a nurse, you will often have the closest contact with the patient, and you must be ready to initiate interdisciplinary discussions based on your observations and patient-given information. In effect, you will serve as the central point of contact for your patient’s collaborative healthcare team.