Cardiac/Vascular Nurse Exam Secrets Study Guide (35 page)

Some of the most common areas of nursing malpractice include medication errors, inadequate assessment or monitoring of the patient (including allowing a patient to fall), performing activities for which the nurse has not been trained, and failure to communicate and document events or follow proper procedure.

Major tenets of the federal Health Insurance Portability and Accountability Act (HIPAA) legislation

HIPAA expands on a patient’s basic right to know that his/her personal health information is held in confidence and only shared on a “need to know” basis that is clearly defined for the patient. If knowledge of the patient’s information is required for those outside of the patient’s direct care, it cannot be provided without his/her specific consent. It requires all persons and institutions with access to this information to practice high levels of protection for that information. Every healthcare institution is required by law to establish and enforce policy and procedure that enforces patient confidentiality.

Being a patient advocate

The American Nurses Association (ANA) regards patient advocacy as a basic cornerstone that helps define the profession of nursing. Advocacy denotes the nurse’s commitment to promoting optimal health and safety for his/her patient (whether that is an individual, group or community). Nurses assume the responsibility of preserving a patient’s basic rights for informed care that promotes the highest quality of life. This standard is maintained in communication and cooperation with all healthcare team members providing treatment, education, pain relief, comfort and safety while avoiding harm to the patient.

Consumerism, paternalism and patient advocacy approaches toward promoting change

Consumerism: This impersonal view presents the patient with the cost-effectiveness and anticipated outcomes of various treatments but does not take into account personal belief systems.

Paternalism: The care provider, or other influential person in the patient’s life, assumes the role of parent and tries to dictate the patient’s healthcare decisions for him/her.

Patient advocacy: The healthcare provider works directly with the patient, involving him/her in making decisions about what is best at any given time and respecting these wishes. Being an advocate involves creating a therapeutic relationship, presenting options and promoting understanding that allows the patient to make an informed decision and, as needed, defending the patient’s decisions to other care providers or individuals in his/her life who might question or try to negate the power to be in control of his/her own health.

Ethical decision making

The most important aspect of ethical decision making is the fact that these decisions are not made by just one person. When an ethical dilemma exists, the problem is brought to the attention of a committee of which the nurse and the patient, or his/her representative if incapacitated, are members. Questions addressed would include an in-depth analysis of all the facts; then options are presented and prioritized. Paramount to any decision made should be consideration for the patient’s wishes. Once a decision is reached the nurse must act as a patient advocate and facilitate actions related to that decision regardless of his/her personal feelings about the dilemma.

Leadership

Leadership is the personal characteristics or qualities that an individual uses to influence others to achieve set goals. Key characteristics and qualities associated with a leader include working well with others, facilitating communication, and motivating others. Leadership styles include autocratic, participative, laissez-faire, transactional, and transformational. Autocratic leadership uses power to influence members of a team. Participative leadership uses a democratic process for decisions among team members. Laissez-faire leadership involves minimal guidance from a leader and provides little feedback to team members. Transactional leadership focuses on daily activities and is comfortable with the status quo. Transformational leadership involves a vision and commitment to meet a team’s goals.

The leader works well in a group/team setting and is able to coordinate patient care with multiple groups and areas of healthcare.

He/she promotes communication between all members of the group, streamlining and coordinating care (participative leader).

A leader appropriately motivates the team toward common goals, emphasizes and rewards productive work environments (transactional leader).

A leader appropriately motivates the team toward positive change as needed (transformational leader).

The leader provides respect, support and encouragement to all contributors and listens to all voices before making final decisions.

Of the generally recognized leadership styles, those possessing a participative or transformational style appear to have the best outcomes in healthcare and interdisciplinary settings. Unfavorable leadership methods tend to be autocratic (firm control with little group input) and laissez-faire (hands-off, unmotivated leadership).

Positive attributes of a mentor

A mentor is a role model and a guide to successful care and skill building experiences. He/she exhibits higher knowledge and experience than the individual he/she is guiding. The mentor is not in a leadership role over the student, but is seen as a more experienced equal. He/she does not take over and make decisions for the student; rather he/she provides options and information to help the student make positive decisions on his/her own. The mentor is honest and trustworthy, supportive, has effective communication and teaching skills and is respected by those he/she is leading to higher skill levels.

How to delegate appropriately

There are 5 basic responsibilities associated with delegating.

• Right Task: The task must be clearly defined and achievable.
  
• Right Circumstances: Can the task be completed in a timely manner? Are the needed tools easily accessible?
  
• Right Person: Is the person giving direction within his/her scope of practice to delegate the task, and is the person being asked to complete the task able to complete it within his/her own scope of practice?
  
• Right Communication: Is the task and the expected outcome clearly outlined so that both parties understand what needs to be done?
  
• Right Supervision: Appropriate monitoring, intervention and accountability needs to be maintained regardless of who is ultimately assigned the task.
  

Effective communication

Listening

Listening is often overlooked as an important communication skill because it seems natural to many. It is actually a learned skill that allows the communicator to overcome barriers such as stress, anger and distraction to truly process all aspects of the message being conveyed by the other party. It enables problem identification, sensitivity to emotions, relieves stress and facilitates problem solving. Active listening is a two-way process that allows both parties to express their thoughts and feelings with the knowledge that they will be heard and the other person truly wants to understand the message and work for resolution.

Assertiveness

Assertiveness should not be confused with aggression, a negative communication method used to manipulate and control interactions rather than collaborate and share respect. Assertiveness empowers the communicator to feel comfortable speaking freely and defending his/her own thoughts and feelings in a given situation using “I” statements. The assertive communicator also processes others’ opinions and uses “you” statements in a positive manner. He/she is not passive or silent when there is a need to speak out, but uses positive language that is appropriate to the situation and those who will be listening and trying to understand.

CARE method for dealing with conflict.

The CARE approach stands for Clarify, Articulate, Request and Encourage.

Clarify: Be specific in identifying the problem that needs to be addressed.

Articulate: Clearly define the reason(s) why a particular behavior or attitude is a problem.

Request: Define an acceptable means of change that will help resolve the problem.

Encourage: Offer support and respect toward others as you work together on creating change and resolving conflict.

Regardless of the other party’s behavior, it is the nurse’s personal responsibility to act with calm respect and dignity in the face of confrontation in order to facilitate positive change rather than contributing further to the problem.

Steps toward win-win conflict resolution

· Identify the need that is not being met rather than placing blame for dissatisfaction and frustration. Be specific in defining problem parameters.

· Acknowledge differences of opinion and attempt to see the problem from all perspectives.

· Involve all parties that are affected by the problem while searching for a solution.

· Remember that win-win solutions may not always be what one person considers the easiest or most obvious. Base the solution on what reaches the greatest compromise and satisfaction for all concerned.

· Agree on the action to be taken with all other involved parties.

· Plan for the success of the solution with goals and definitions of roles and expectations.

· Review the plan and solution’s effectiveness after it has been carried out to identify areas of further improvement or recognize the need to re-address the problem.

Roles of a cardiac rehabilitation nurse

Clinician: Uses the nursing process to devise individualized care plans for his/her patients.

Collaborator: Works with other professionals to facilitate comprehensive care that meets the patient’s needs.

Educator: Identifies the learning needs of the patient and facilitates positive health changes through providing knowledge and encouragement toward better wellness.

Manager: Identifies needs and coordinates care with other professions to provide comprehensive services and acts as an advocate for the patient’s healthcare choices.

Researcher: Continually seeks creative and effective ways to improve the quality of care that can be provided to the patient.

Basic keys to providing competent and culturally sensitive nursing care

Care should always be specifically geared to the individual patient. Do not make assumptions about his/her needs or wishes based on personal views or previous interactions and circumstances.

Take time to identify the patient’s unique cultural values and belief systems before establishing care goals.

Nursing interventions enable and include the patient and the primary decision maker about his/her own care, according to his/her cultural values and belief system.

Nurses and the care they provide should never reflect a personal judgment regarding the patient’s culture or unique beliefs.

Key components of a helpful and therapeutic nurse-patient relationship

The nurse and patient should both be actively working together on a common goal regarding the patient’s healthcare and recovery. The plan of action, means and evaluation of the intervention are completed jointly.

The patient should feel respected by the nurse and understand his/her privacy will be protected in order to encourage an involvement in his/her own care.

Emotional bonds may form but should be kept in proper context and boundaries. There will always be a beginning, middle and end to a nurse-patient relationship.

The nurse must be prepared on all levels—mental, physical and emotional—to be a positive, patient and helping influence in the relationship.

Collaboration and coordination among healthcare team members

Tools developed for this specific purpose in a healthcare setting include practice guidelines to help define each participant’s role in care and clinical protocols or pathways to focus care and clarify procedures and strategies to be followed. The goal is to create a team where the members understand their own, and each other’s, role within the group, understand the goals of the team, share responsibility, reach collective decisions and actively include the patient and his/her family in the care process. An effective collaboration effort includes all stages of care, from assessment of needs to action, communication and evaluation of goals upon completion. A primary key is streamlined communication and respect for each individual’s unique contribution. The nurse often plays a primary role as mediator and advocate for the patient, making sure he/she understands the purposes and joint goal of the group and its members.

Coping

Coping is a mechanism that is used by an individual to deal with internal and external factors that arise. It involves continuously changing one’s behavioral and cognitive actions to deal with challenging circumstances. Coping is an evolving process that involves an individual changing their actions based on internal and external factors. The functions of coping include reducing stress, maintaining equilibrium, facilitating independence, enhancing personal decision making, meeting external demands, managing stressors, avoiding negative self evaluation, and maintaining a stable psychosocial state. Coping varies from one individual to another but includes the above functions.