Page 2 Management of Care Study Guide for the NCLEX-RN® exam

Management

A nurse often functions as the manager of the heathcare team. You must know the roles and responsibilities of each team member, and you will serve as a liaison between the team and the patient. You are a frontline problem-solver: you will need to use conflict resolution skills to settle problems both between team members and between your patient and the team. Developing an overall strategy for handling problems is key to your success in this role. Supervision of properly delegated work is also a key function of a nurse as a manager.

Confidentiality and Information Security

A nurse’s role includes both maintaining confidentiality and taking steps to ensure a patient’s privacy is maintained. Understanding HIPAA (the Healthcare Insurance Portability and Accountability Act) is crucial to this end. You should take steps to ensure only authorized personnel have access to the medical record, and that sensitive, private patient information is kept out of public view. This also includes conversations that may relay this type of information to unauthorized persons. Intervention may be necessary if you observe these types of breaches from other healthcare team members.

Continuity of Care

Continuity of care refers to the proper communication of information between different departments and agencies, from one agency to another, to ensure that all parties (including the patient) agree upon and understand the patient’s healthcare goals. The nurse must understand the proper procedures for admission, transfer and discharge to and from a facility, as well as the proper forms or referral paperwork that is required in the patient’s medical record. You will also be responsible for following up on any unresolved issues for your patient and forwarding this information to the appropriate agency or department such as lab or imaging results. You may also need to be prepared to give report to the patient’s new nursing staff.

Priorities

Each day in your nursing work, you will utilize your ability to prioritize. You will need to establish care priorities for individual patients as well as prioritize your assigned patients as a group.

Guidelines to Use

There are many frameworks that may be used in developing priorities. They may include:

ABCs—airway, breathing, and cardiovascular or circulatory system

Maslow’s hierarchy—physiologic needs, then safety and security, love and belonging, self-esteem and self-actualization

Agency policies—protocol dictated by the regulations of your facility

Time—being efficient and delegating when appropriate

Patient and family—taking the time to understand your patients and their families in order to better assess individual needs and prioritize your care duties for the day

Patient activityreport, which can be a valuable tool in planning your priorities for the day (Likewise, adjusting your priorities based on patient’s needs and activities will help you get your work done most efficiently.)

Medication priorities—managing care according to any strict schedule of patient medication

Priority Indicators

Your assessment skills and ability to triage patients’ needs based on your findings will help you prioritize appropriate interventions and give care to those who are unstable and need immediate attention. This is especially true if you have multiple patients. Patients demonstrating these conditions will have priority:

Post-surgery—These patients require frequent monitoring of vital signs as well as fluid and pain management.

Baseline status deterioration—Any change from baseline requires immediate life-sustaining intervention and assessment as to the underlying cause.

Shock—Patients in shock require targeted intervention based on the underlying cause and measures to reverse the physiologic changes triggered by shock.

Allergic reaction—Immediate pharmacologic intervention is necessary for patients exhibiting signs of allergic reaction.

Chest pain—Patients with symptoms of chest pain need immediate cardiac monitoring, pharmacologic intervention, and close monitoring for cardiovascular deterioration.

Post-diagnostic procedure—Some diagnostic procedures (i.e., cardiac or vascular imaging) will require temporary but close, frequent monitoring.

Unusual symptoms—Patients with unusual symptoms should be assessed more frequently for worsening or change in their symptoms.

Equipment malfunction—Patients with malfunctioning IVs, tubing, or other care equipment will require immediate attention and more frequent follow-up.

Ethical Practice

Each day you work as a nurse, you will be required to use the basic principles of morals and ethics to judge your actions and behavior as right or wrong. The American Nurses Association (ANA) has a Code of Ethics that you need to know as well. This code provides the ethical guidelines that define the values and standards for the nursing profession. Understand the following ethical principles:

Autonomy—a person’s right to make his or her own decisions

Beneficence—doing what is in the best interest of another

Justice—providing equal, fair, and impartial treatment

Nonmaleficence—acting in a manner that avoids harm

Fidelity—maintaining faithfulness to ethical principles and to the ANA Code of Ethics for Nurses

Virtues—integrity, honesty, trustworthiness, and compassion, which are standards of nursing

Confidentiality—maintaining the privacy of another’s personal information

Accountability—maintaining responsibility for one’s own actions

Informed consent means that a patient has been appropriately counseled on all the risks and benefits of a particular test or treatment before being asked to agree to it.

Components

There are four main components of informed consent:

  • a detailed explanation of the procedure or treatment
  • a detailed explanation of the known risks and benefits of the procedure or treatment (Specifically, the risk of death or potential serious injury should be included if applicable.)
  • a discussion of all possible alternative procedures or treatments
  • a discussion of what the potential ramifications are if the patient refuses the procedure or treatment being considered

Obstacles

As a nurse, you will facilitate the process of informed consent. This may include evaluating whether or not the patient is capable of giving informed consent (mental competency, minor, etc.) and identifying the proper person (parent, legal guardian, etc.) to act on the patient’s behalf. You may also serve as a witness of informed consent, and you must ensure that it occurs prior to the proposed treatment or procedure. You must advocate for your patient by ensuring they have adequate information to give informed consent. This may include providing a translator or written materials in the patient’s native language. You must also make sure that any refusal of care is properly documented in the medical record.

Information Technology

Information technology can improve patient care by allowing expedient access of authorized providers to a patient’s entire medical record. It can improve patient safety and health outcomes, and it may also be used to enhance patient education and care.

EHR

Electronic health records (EHRs) are computer-based versions of a patient’s paper chart. They include all the personal information of the patient, demographics, insurance information, medical notes, test results, past medical history, medications, immunizations, and vital signs. EHRs can facilitate care between authorized users involved in patient management because they allow instant access to all necessary medical information. They may also be helpful either directly or indirectly to other care-related activities such as quality management and outcomes reporting.

eMAR

Electronic medication administration records are systems that use electronic tracking systems (i.e., barcodes, etc.) to track medications from order to patient administration and integrate this information into the patient’s EHR. eMARs have been shown to improve patient safety and outcomes by greatly reducing medication administration errors.

Guidelines

Nurses working with these types of information technology systems will need to have a thorough understanding of how each works in order to use them properly and efficiently. The rules of patient confidentiality also apply to accessing and transmitting electronic health records. You need to learn, understand, and maintain all the privacy requirements for confidential patent information that are specific to the facility in which you work.