Professionalism, ethics & communication

What it meansSlides content

Professionalism (ATI): the actions, behaviors and attitudes that reflect the profession's core values, ethical principles and regulatory guidelines. Unprofessionalism: conduct that doesn't follow the standards of practice or the Code of Ethics.

Benner's novice to expert (1982)Slides content

Accountability vs responsibilitySlides content

Leadership stylesSlides content

A leader influences and inspires; a manager organizes the work. One person can be both.

The nurse's role in the organizationSlides content

• Roles: caregiver, care coordinator (case manager), educator, advocate, counselor, leader, mentor, researcher, change agent, critical thinker.
• Chain of command: report a concern to the next person up (for example charge nurse, then unit director, then supervisor) when it isn't resolved. AP means assistive personnel; PN, practical nurse; RN, registered nurse.
• Shared governance: nurses at every level share decision making about practice, quality and staffing.

Terms

• Ethics: principles that guide the moral behavior of a person or group. Morality: one person's own sense of right and wrong.
• Code of Ethics (ANA, American Nurses Association): rules for nurses on client privacy, conduct and behavior that protect clients and the profession.
• Nightingale Pledge (1893): a nursing oath based on the Hippocratic Oath, often recited at pinning; stresses ethics, safety and avoiding harm.

Ethical principlesSlides content

Professional nursing valuesSlides content

Ethical dilemmas and decision makingSlides content

An ethical dilemma is a choice where no option may be fully ethically acceptable. Ethical decision making works through the options using ethical principles.

1. Define the issue and assess risks: recognize when something feels off; handle urgent legal or reporting issues
2. Identify stakeholders: everyone relevant to the situation
3. Gather information to inform the decision
4. Reflect on personal biases about the people involved
5. Identify core principles and standards: professional codes, plus personal, religious, legal or organizational ethics
6. Consult resources: research, decision-making models, trusted colleagues

Laws to knowSlides content

Common HIPAA violations: unsupervised access to PHI, careless data disposal, denying clients access to their own PHI, disclosing PHI, losing PHI. Discussing a client in the elevator, posting a client's wound on social media, or opening the chart of a client you aren't caring for are all violations.

Criminal, civil and tort law

The nurse's legal dutiesSlides content

Modes and stylesSlides content

• Levels of communication: verbal (words), physical (body language), auditory (tone, volume, pace), energetic (presence) and emotional (feelings).
• Assertive: honest, clear, "I" statements, respects everyone's needs
• Aggressive: "you" statements, controlling, interrupts
• Passive: avoids conflict and self-advocacy
• Passive-aggressive: looks passive but shows anger indirectly (sarcasm, resentment)
• Influencers: cognitive, intellectual or developmental (dementia, autism spectrum disorder); psychosocial and physiological (hearing or vision loss, fatigue, anxiety, fear); situational and environmental (noise, lighting); cultural and demographic.

Communication modelsSlides content

Therapeutic vs nontherapeuticSlides content

Barriers and how to overcome themSlides content

Collaborative health careSlides content

A client-centered approach where different health care teams work toward a common goal. Interprofessional collaboration: two or more professionals share assessment data, plan care and include the client and family in decisions.

TeamSTEPPS: four key skills

• Leadership: guiding and coordinating the team
• Communication: sharing information clearly
• Situation monitoring: staying aware of the team and client
• Mutual support: helping and giving feedback

IPEC (Interprofessional Education Collaborative) competencies: values and ethics, roles and responsibilities, interprofessional communication, teams and teamwork.

What affects collaboration: individual traits (age, gender, personality, experience), professional roles (unclear roles, overlapping care), how people interact (attitudes, cohesion, shared goals, sharing knowledge) and the organization (resources, network size, leadership).

Consult vs referral; discharge planningSlides content

Discharge planning covers: home and the PCP, medications, education, follow-up appointments, when to call the provider, and readiness for discharge.

Methods of communicationSlides content

• Closed-loop communication: standard terms and steps so the receiver confirms the message was received and understood correctly.
• ISBARR (I-SBAR-R): Identify, Situation, Background, Assessment, Recommendation, Read back. Background is history, medications and advance directives, such as "admitted 2 days ago for pneumonia, history of heart failure."
• Handoff report: a structured report when care passes to another provider; best done at the bedside.
• Care transitions: moving a client between providers or settings. Secure messaging apps (such as TigerConnect) are another channel.

Incivility and conflictSlides content

Facility changes that prevent incivility: leaders own zero tolerance; onboarding teaches acceptable language and how to report; training for everyone; shared language about workplace violence; a culture of accountability; act on reports and share the results.

Five ways to manage conflict

• Cognitive rehearsal: picturing a stressful situation ahead of time and practicing how to respond.
• Emotional intelligence: recognizing, understanding and managing emotions: self-awareness, self-regulation, motivation, empathy and social skills.

InformaticsSlides content

Using information and technology to communicate, manage knowledge, reduce errors and support decisions. Examples: simulation, clinical information systems, monitors, glucometers, the EHR (electronic health record) and eMAR (electronic medication administration record), clinical pathways, telehealth. Concerns include errors in the EHR or eMAR, personal devices and privacy.

• EHR: a real-time digital chart the whole team can share (history, diagnoses, allergies, test results). Facilities also need a plan for documenting during EHR downtime.
• CPOE (computerized provider order entry): providers enter orders electronically, which cuts errors.
• Health literacy: whether the client can get, read and understand health information. Use plain language.

Documentation methodsSlides content

FACTSlides content

• Write what you can measure: "Client ate 50% of breakfast," not "ate well."
• Paper chart error: draw a single line through it, label it an error, and add your initials and the date. Never erase or cover it.
• Verbal and telephone orders carry risk: write them down, read them back, and the provider cosigns later.

Military timeSlides content

A 24-hour clock removes the a.m./p.m. mix-up: is "10:00" 1000 or 2200? It cuts documentation errors and is used everywhere in health care.

• a.m.: drop the colon, four digits: 9:15 a.m. → 0915
• p.m.: add 12: 2:20 p.m. → 1420
• Back to 12-hour: subtract 12 from 1300 and later: 1930 → 7:30 p.m.

More practice is in the Week 9 med math section.

Abbreviations: "Do Not Use"Slides content

Acceptable abbreviations are on the General and Charting abbreviations flashcards.

What EBP isSlides content

EBP (evidence-based practice) uses current research, expert knowledge and what matters to clients to make care decisions. It starts with a spirit of inquiry: wanting to know the best way to care for clients. Real examples: oxygen use in hypoxia, antibiotic stewardship, alarm fatigue protocols, fall prevention guidelines, pain management.

Six steps of EBP

1. Identify the problem (and write a PICOT question)
2. Search for credible evidence (review of literature)
3. Evaluate the findings
4. Implement the recommendations
5. Review how well they worked
6. Disseminate (share) the results

Levels of evidenceSlides content

• Credible sources: scholarly databases, peer-reviewed journals (reviewed by experts with similar training), abstracts; be cautious with websites; cite in APA (American Psychological Association) or AMA (American Medical Association) style.
• Critical appraisal: judging a study's validity, reliability and fit for your question.
• Clinical practice guidelines: evidence-based recommendations for managing diseases and prevention.
• Theory-practice gap: the gap between what research knows and what's done at the bedside.
• Nursing research follows the nursing process: assess (identify the problem), analyze (form the question), plan (design the method), implement (recruit and collect data), evaluate (analyze and share).