I-Activity worksheet- Reading Reflections

Read about Nursing case management, then answer the following:

1. Write 5 things you learned from the topics/readings

Registered nurse can be a case manager
As a case manager, a registered nurse is responsible for coordinating care, identifying
resources, organizing services, making referrals, and connecting clients to the services they
require based on their biological, emotional, and social requirements as well as their spiritual
and cultural preferences.
There are four possible case management models used for patient care delivery systems

Collaboration and good communication are one of the most important in case management.

When planning care, nurses and other members of the healthcare team frequently work
collaboratively to ensure that the appropriateness, cost-effectiveness, and cost-benefit ratio are
taken into account without sacrificing the quality of the care or the best possible outcomes

In case management, not only the patient is to be assessed but also the equipment and
materials needed. (Though it applies in all filed of nursing, because nurses are flexible)
The registered nurse then makes sure that the client has access to the tools and materials
they need to take care of their current assessed needs. For instance, the patient might require a
CPAP machine, a sequential pressure device, oxygen therapy, oxygen supplies, a suctioning
machine, and/or sterile wound care items like sterile cloths.
In case management, nurses also provide cost effective care to the patients.
The nurse, together with others, must choose the treatments, interventions, and human
and material resources that are both the least costly and the most effective and suitable.

2. How will this affect you in your future career as professional nurse and as leaders /
Our clinical instructors always teaching us that nurses are flexible. Nurses can respond
immediately and think critically for the client and patient as well as for the team. Now that I
have read a lot in the readings, I can foresee that we can apply all of these in the future, the
good communication, collaboration, learnings about different method and models for the
quality care, and the initiative as a nurse.

3. Discuss some important innovations in:

a. Nursing education
There is always a need for innovation in nursing education to equip nurses to practice in
new conditions and change environments. As a result, nursing education needs to adopt
innovative approaches. Some of the new techniques include simulation and personal digital
assistants (PDAs). A teaching method called simulation includes simulating real life. Although
high-fidelity simulation is a popular teaching tool in many nations today
Simulation Program
Simulation is a teaching strategy that involves replicating reality. High fidelity
simulation is a growing teaching strategy today, and it has evolved to encompass incredibly
complex and engaging simulations. High-fidelity simulations engage students in active learning
environments that may improve learning, according to the National League for Nursing. The
use of simulation scenarios to engage students in problem-based learning pertaining to emergent
events, which are not always available or morally appropriate for inexperienced clinical
practitioners, results in the development of competencies in a secure environment (National
League for Nursing, 2004; Conrad et al., 2010). (Alinier et al., 2006; Jonas and Hegge, 2008).
Students can practice evaluation and intervention techniques without endangering
patients by simulating life-threatening situations and interacting with high-fidelity simulations
(Conrad et al., 2010). Although many nursing schools understand the benefits of learning
through simulation, integrating a simulation program into the curriculum is a difficult task
(Casey et al., 2010; Neuman et al., 2009).
Personal Digital Assistants (PDAs)
The practice of nursing takes place in a variety of settings, including home care, acute
care, and community care. Consequently, PDAs can be helpful in all of these areas (Craig,
2002). PDAs are used by clinical nursing teachers for student evaluation and record keeping.
PDAs are utilized for anatomical information, clinical assessment, pharmacological
information, language translation, computations, identification of normal laboratory values,
pediatric developmental milestones, medical sign language, medical dictionaries, growth
charts, and vaccine recommendations (Huffstuler et al., 2002; Lehman, 2003)
b. Nursing practice
In the health industry generally, and specifically for nursing, the concept of innovation
is stated as a process that has been developed, new techniques, technologies, and ways of
working. Innovation is described as "new techniques, technology, and ways of working
development process" by the International Council of Nurses (ICN). Tool, technology, and
process innovation can also apply to an organization's or an individual's attitudes, behaviors,
and other related topics. 2009 was designated as the year of innovation by ICN and the European
Union (EU), which increases the competitiveness of nations and scientific institutions overall
development and clarifies the unwavering goals.
According to reports, the most crucial instrument for the upgrade is innovation, which
improves the quality of life in the community. Innovation in the nursing profession; Due to the
complexity of the nursing and healthcare systems and the national requirement for patient
safety, more creative nursing practices are required in nursing and healthcare organizations.
In order to maintain and raise the standard of nursing care, innovation is essential.
According to ICN (2009), innovation in nursing practice has a vital role in terms of promoting
health, preventing disease, identifying risk factors, encouraging people to adopt preventative
behaviors, and managing new information to have qualified / techniques / services findings.
One of the most important things that directly affects the quality of the service when designing
nursing services is the submission and evaluation of the usage of novel tactics.
Examples of Innovation in nursing practice
There are numerous instances of innovation by nurses worldwide. During the 1800s,
Florence Nightingale, who is credited with founding modern nursing, emphasized the
importance and impendingness of change by saying, "A more livable world; which will not be
given to us, so without hesitation we should endeavor to build this world. As indicated by the
intensive care unit's contribution to environmental development and her demonstration of the
link between infetion and care, Nightingale established the first record in the nursing sector and
was the first person to create statistics globally.
Florence Nightingale discovered that one of the earliest instances of innovation,
"puerpal fever," which is tied to the environment, occurs after childbirth. She raised the issue,
"Is the home environment more lethal than the hospital environment after childbirth? " after
observing the mother death rates following childbirth caused by fever. Her research revealed
that there was a greater death rate in the home environment, and her creative thinking led to the
saving of many women's lives.
• According to the ICN (2009) report, Kambarami (1999) developed the "kangaroo care"
model as an innovative method because preterm care is regarded as a risky process when
the incubator is misused and it is also costly. The infant is placed on the mother's naked
chest in this model, which allows the mother to control the child's body temperature
through skin-to-skin contact, is affordable, safe, and adaptable to a variety of social
settings. As a result, it has long been utilized in numerous neonatal intensive care units.
• Jamie Rutherford, a nurse who received the 2009 invention prize and works in a renal
transplant center, came up with another breakthrough. She conducted research on
"transplantation of plasma exchange in patients undergoing filtration." Rutherford
created an innovation that minimizes the processing time combined with the two hours
of driving device connectivity because he was concerned about the pre-transplant
patients' problems and how they were losing time for filtration and dialysis plasma
exchange.
• A "creator" recognized by the nurses, Özlem Bekteş, created "Stomakit" as an
illustration of the innovation practiced by nurses in Turkey. The stomakit adapter is used
to cut the skin-protective stoma dressing equipment. It is employed in the upkeep and
care of colostomies, ileostomies, and urostomies. Since it is transparent, it enables
viewing of the content from across the stoma and may be readily, safely, and quickly
regulated. Additionally, because to its protective qualities, it offers a dry dressing area
and prevents the leakage of stoma content beneath the adapter side cutter.
Despite the fact that the identities of innovation in the nursing industry are there, it is
now more typical for nurses all over the world to perform unique ideas and services. It is
necessary to shine light on innovation and professional training, which has reinforced the
nursing profession in light of the world's rapid evolution. As a result, since innovation is
becoming more and more prevalent in all fields of work today, both commercial and
governmental institutions should support the innovative ideas and work generated by nurses,
and nurses working in this field should be promoted using the appropriate methods.

c. Nursing leadership and management

Encourage Critical Thinking
If we ever find ourself or staff members saying, “Don’t ask why. Just do it!” then we
need to evaluate the type of climate in which we are functioning. An inquisitive frame of mind
is relatively easy to suppress in a work environment. Patients and staff members quickly
perceive a nurse’s impatience or defensiveness when too many questions are raised.Their
response will be to simply give up asking these questions.
Seek Out Educational Opportunities
In most organizations, first-line managers do not have discretionary funds that can be
allocated for educational purposes. However, they can usually support a staff member’s request
for educational leave or for financial support and often have a small budget that can be used for
seminars or workshops. Team leaders and nurse managers can make it either easier or more
difficult for staff members to further their education. They can make things difficult for the
staff member who is trying to balance work, home, and school responsibilities, or they can help
lighten the load of the staff member who has to finish a paper or take an examination.
Unsupportive supervisors have even attacked staff members who pursue further education,
criticizing every minor error and blocking their advancement. Obviously, such behavior should
be dealt with quickly by upper-level management because it is a serious inhibitor of staff
development.
Encourage New Ideas
The increasingly rapid accumulation of knowledge in health care mandates continuous
learning for safe practice. Intellectual curiosity is a hallmark of the professional. Every move
up the professional ladder should bring new challenges that enrich one’s work (Roedel &
Nystrom, 1987). As a professional, you can be a role model for an environment in which every
staff member is both challenged and rewarded for meeting these challenges. Participating in
brainstorming sessions, group conferences, and discussions encourages the generation of new
ideas. Although new nurses may think they have nothing to offer, it is important for them to
participate in activities that encourage them to look at fresh, new ideas.
Reward Professional Growth
A primary source of discontent in the workplace is lack of recognition. Positive feedback
and recognition of contributions are important rewards. Everyone enjoys praise and recognition.
A smile, a card or note, or a verbal “thank you”goes a long way with coworkers in recognizing
a job well done. Staff recognition programs have also been identified as a means of increasing
self-esteem, social gratification, morale, and job satisfaction (Hurst, Croker, & Bell, 1994).

II- Philippines Professional Nursing Practice Standards

1. Discuss the purposes of PPNPS.

The main goal of nursing standards is to advance, direct, and regulate specialized nursing
practice. The general public, employers, regulatory bodies, academic institutions, and other
stakeholders will all use the nursing standards.

2. Enumerate then11 core competency for nursing practice, then choose to discuss the 3
most important core competency for you.
1. Safe & quality nursing practice
2. Management of resources & environment
3. Health education
4. Legal responsibility
5. Ethico – moral responsibility
6. Personal & professional development
7. Quality improvement
8. Research
9. Record management
10. Communication
11. Collaboration & teamwork

All of these competencies are important, but the three highlighted for me are , safe and
quality nursing practice, health education, and research.
 The first important for me is the safe and quality nursing care, it tackles firstly about the
illness or health status of an individual, family, or group. The safe and quality nursing care
promotes an over all care for the patients, the safe assessment of the disease, providing nursing
intervention. Secondly, health education the assessment in the nurses to ensure that they know how
to use the equipment properly, the development of health education for the clients and patients.
Lastly, the research; is important because this is the roots of our innovation. As the time pass by,
we are getting the treatments, practices, and even education easier that before because of the
research. Research can save lives of a million persons in the world that’s why it is the top three
important.

3. How will you explain patient safety?

The patient safety is our number one priority as a nurse. Patient is safe when he or she
is free from the other risk and possible contact with other disease and injuries. Patient is safe
when we apply the appropriate nursing intervention.

4. What are the implications of nursing standards in the practice of nursing and how will
the nurse keep or maintain the standards
If a nurse neglects to follow the established standards of practice and harms a patient,
they may be considered negligent. The majority of the time, a nurse is accused of being careless
and breaching a standard of care. In the medical industry, this is usually referred to as
malpractice.
If nurses administer medication incorrectly, neglect to monitor equipment, fail to warn
patients of known risks, or fail to protect patients from recognized dangers, they may be found
liable in medical malpractice lawsuits. Nurses are expected to thoroughly and accurately report
their observations and assessments of each patient in a timely manner. If they neglect to monitor
the patient's status or stay informed of any changes, they can be found to have been negligent.
Nurses have a duty to communicate any changes to the attending physician in order to protect
patients from harm. Additionally, disregarding state rules governing nursing practice regarding
the delegation of particular tasks to unlicensed individuals or inappropriately handling patient
identity may put a nurse in legal hot water.

5. What are the benefits of evidence-based practice?

Benefits to the field of nursing include:
Prioritizing the needs of patients. Although evidence-based nursing relies on research, it also
considers the desires of individual patients. Since one of the main tenets of nursing is focusing
on the patient’s needs, evidence-based practice helps you continue to improve patient outcomes
while weighing the preferences and experiences of each patient.
Better patient care decisions that also save nurses’ time. Evidence-based practice can save
time, as you can stop engaging in activities that have no known benefit to patients. For example,
nurses used to spend up to 20 minutes a day bathing each patient and changing their dressings,
until research revealed that some dressings are better left in place longer and that daily baths
don’t impact outcomes. (Of course, under some circumstances it may be indicated to perform
these practices daily or even more often; it depends on >the individual patient case.)
Examples of Evidence-Based Practice in Nursing
Through evidence-based practice, nurses have improved the care they deliver to patients. Key
examples of evidence-based practice in nursing include:
• Giving oxygen to patients with COPD: Drawing on evidence to understand how to
properly give oxygen to patients with chronic obstructive pulmonary disease (COPD).
 • Measuring blood pressure noninvasively in children: Using the auscultatory method
and then comparing the measurement against data obtained with the oscillometric
method as suggested by evidence.
• Using the correct intravenous catheter size: Recognizing the benefits of
using smaller-gauge catheters to improve patient comfort.
• Valuing the role of family members: Knowing that the recognition of family
involvement may lead to more efficient and effective care, as family members may
significantly influence how a patient presents symptoms to healthcare providers.
• Improving infection control practices: Understanding that wearing personal protective
clothing and practicing handwashing are key to infection control.
• Recognizing alarm fatigue: By reflecting on current practices, nursing staff can create
effective protocols ensuring that nurses who are desensitized to sound due to alarm
fatigue are monitoring patients correctly.

III- Ethico-legal moral consideration in nursing leadership and management

1.Explain what is nursing ethics and its purpose

The field of applied ethics that deals with nursing's moral aspects is called nursing ethics.
It belongs to the field of bioethics or health care ethics. In order to establish ethical norms,
define ethical aspects of nursing, and produce ethical guidance, three components of nursing
ethics must be considered in conjunction with one another.

2. Give all the ethical principles and briefly explain each.

The ethical principles that nurses must adhere to are the principles of justice, beneficence,
nonmaleficence, accountability, fidelity, autonomy, and veracity.
• Justice is fairness. Nurses must be fair when they distribute care, for example, among
the patients in the group of patients that they are taking care of. Care must be fairly,
justly, and equitably distributed among a group of patients.
• Beneficence is doing good and the right thing for the patient.
• Nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath. Harm
can be intentional or unintentional.
• Accountability is accepting responsibility for one's own actions. Nurses are accountable
for their nursing care and other actions. They must accept all of the professional and
personal consequences that can occur as the result of their actions.
• Fidelity is keeping one's promises. The nurse must be faithful and true to their
professional promises and responsibilities by providing high quality, safe care in a
competent manner.
• Autonomy and patient self-determination are upheld when the nurse accepts the client
as a unique person who has the innate right to have their own opinions, perspectives,
values and beliefs. Nurses encourage patients to make their own decision without any
judgments or coercion from the nurse. The patient has the right to reject or accept all
treatments.
• Veracity is being completely truthful with patients; nurses must not withhold the whole
truth from clients even when it may lead to patient distress.
3. Make a Venn diagram for malpractice and negligence

4. How nurses will avoid lawsuits/crimes / legal accountabilities?

• Know your own strengths and weaknesses. Don't accept responsibility that you aren't
prepared for. If you make an error, claiming that you weren't familiar with the unit's
procedures won't protect you against liability.
• Refuse assignments you can't safely perform. We may be assigned to work in a
specialized unit, which is reasonable as long as we’re assigned duties we can perform
competently and as long as an experienced nurse in the unit assumes responsibility for the
specialized duties. Assigning you to perform total patient care in the unit is unsafe if we
don't have the skills or expertise to plan and deliver the care.
• Delegate safely. Exercise great care when delegating duties because we may be held
responsible for subordinates. Inspect all equipment and machinery regularly and be sure
that subordinates use them competently and safely. Report incompetent health care
personnel through the facility's chain of command.
• Get clear orders. Never treat any patient without orders from his health care provider
except in an emergency, and don't practice outside the scope of license. For example, only
physicians, physician assistants, and nurse practitioners prescribe or dispense medication,
as defined in each state's laws.
• Don't carry out an order from a health care provider if they have any doubt about its
accuracy or appropriateness. Follow the facility's policy for clarifying an ambiguous order.
Document the efforts to clarify the order and note whether it was carried out.
• Be particularly careful with medications. Medication errors are the most common and
potentially most dangerous of nursing errors. Make sure as a nurse, use the “five rights” of
medication administration: right patient, right drug, right dose, right route, right time.
• Stay on your patient's good side. Trial attorneys have a saying: “If you don't want to be
sued, don't be rude.” Always remain calm when a patient or his family gets upset. Patients
need to know the truth about mistakes and complications, but they should communicate
this information with discretion and sensitivity.
 • Don't offer opinions (ever). Avoid offering opinion when a patient asks, just reply the
facts.
• Before you sign read! Never sign our name as a witness without fully understanding what
we're signing as well as the legal significance of our signature.
• Stick to the FACTs. From a legal standpoint, documenting care is as important as giving
the care. If a procedure wasn't documented, the courts assume it wasn't done. Make sure
that document all observations, decisions, and actions. The patient's chart, when taken into
the courtroom, is a nurse's best evidence of the care given. The documentation should
follow the FACT rule: Factual, Accurate, Complete, and Timely.
• Do the right thing. Don't let a patient undergo a surgical procedure unless we're satisfied
he's given proper informed consent. Never force a patient to accept treatment he's expressly
refused. Don't use equipment that we haven't been taught to use.
• Use restraints as a last resort. Follow guidelines from the Joint Commission on
Accreditation of Healthcare Organizations, our state, and our facility about using restraints.
Use them only as a last resort; if we must use them, apply and check them correctly,
following our facility's policy and procedure. Document exactly the restrained patient's
status; the need, number, and kind of restraint used; and the reason for its use. An omission
or failure to monitor a restrained patient may result in a malpractice claim.
• Prevent patient falls. Patient falls are a very common area of nursing liability. Patients
who are elderly, infirm, sedated, or mentally incapacitated are the most likely to fall. The
best way to avoid liability is to prevent falls from occurring in the first place. Institute a
fall-prevention protocol in your facility and stick to it.
• Be familiar with advance directives. Be aware of our state's laws about advance
directives, such as living wills and durable power of attorney. Patients should be queried
about their advance directives on admission, and their wishes should be noted on their
chart.
• Follow facility policies and procedures. Be familiar with the policies and procedures of
the facility where we work. If they're sound and we follow them carefully, they can protect
us against a malpractice claim.
• Provide a safe environment. When providing care, don't use faulty equipment. Clearly
mark the equipment as defective and unusable. After repairs are made, don't use the
equipment until technicians demonstrate that it's operating properly. Document the steps
you took to handle the problems with faulty equipment to show that you followed the
facility's policy and procedures.

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