Safe and Effective Care: Coordination of Care Ms. 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

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 13

Ethical Principles Autonomy Beneficence Confidentiality Fidelity Justice Nonmaleficence Paternalism Veracity 14

Ethical Issues Right to refuse treatment Behavior control – restraints Do not resuscitate orders Living will/Medical power of attorney 15

Legal/Ethical Considerations with Children Consent Documentation of parent/child interactions Informed consent for immunizations 16

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

Performance Improvement/Quality Assurance Total Quality Improvement Model (Continuous Quality Improvement)->philosophy of doing the right thing, the right way, the 1 st 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 18

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

Quality Care Maintaining High Quality Care –Good communication –Know client care needs –Collaboration with interdisciplinary team Consultation and referrals 20

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

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 23

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 24

Nurse’s Role (continued) Information Technology –Video/DVD/Books/Journals/CD/audio Useful for client teaching/nursing continuing education Remember copyright issues 25

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 26

Organ Donation Identify potential donors Notify appropriate personnel Maintain professionalism Demonstrate compassion Records kept with United Network for Organ Sharing (UNOS) 27

Questions? Let’s review NCLEX questions r/t Leadership and Management-Saunders 28