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Universal Student Hospital Orientation. A Collaborative Project of the Nassau Suffolk Coordinating Council of Nursing Education and Practice and the Nassau Suffolk Hospital Council Inc. Effective Fall 2010 Final Copy/Presented to NSHC 7-16-10. Introduction.

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Universal Student Hospital Orientation

A Collaborative Project of the Nassau Suffolk Coordinating Council of Nursing Education and Practice and the

Nassau Suffolk Hospital Council Inc.

Effective Fall 2010

Final Copy/Presented to NSHC


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  • This presentation is to be viewed by all student nurses in advance of beginning their clinical rotation annually.

  • It in no way replaces the site specific information that will be covered by faculty and or institutional personnel upon arrival in the institution.

  • Each school will send a letter to the individual hospitals they are using for student rotation attesting to the fact that the students have completed the program and scored an 80 or better on the post-test.

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Topical Outline

  • Asepsis/Infection Prevention

  • Culture

  • Environmental/Fire Safety

  • HIPAA/Confidentiality

  • National Patient Safety Goals

    • Medications

    • Communication

    • Environment

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  • Shared values, beliefs, customs, symbols

  • Learned and passed on

  • Provides meaning for group members existence together

  • Road map/blueprint to comprehend unwritten rules for living.

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Affiliation with a group often linked by:

  • Race

  • Nationality

  • Language

  • Common cultural heritage

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  • Belief that own cultural group’s belief and values are:

    • Superior

    • Most acceptable

  • Stems from lack of exposure or ignorance

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  • A fixed and distorted generalization made about all members of a group

  • Has negative results

  • No attempt to learn about the individual

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  • “An injury or damage resulting from some judgment or action of another in disregard of one’s rights” Webster’s Ninth CollegiateDictionary

  • Strongly held opinions about some topic or group of people

  • Stems from:

    • Ignorance

    • Misunderstanding

    • Past experience

    • Fear

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  • Acting on prejudice

  • Denying the other person’s fundamental right.

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  • HIPAA - Health Information Portability and Accountability Act

  • PHI - Protected Health Information

  • EVERY patient’s Right

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Ethical Issues in Health Care

  • Both legal and ethical principles apply in the delivery of health care, sometimes leading to conflicts:

  • Government Regulations

    • PSDA (Patient Self-Determination Act of 1991) – Federal Law

    • Patient Bill of Rights – NYS

    • Health Care Proxy Law - NYS

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Ethical Issues in Health Care (cont’d)

  • Patient’s rights under the law

    • Access to medical record

    • Patients with disabilities

    • Patient Self-Determination Act

      • NYS Health Care Proxy Law

      • Patient’s Bill of Rights

      • Informed Consent

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ANA Code of Ethics for Nurses

  • Make explicit the primary goals, values, and obligations of the profession of nursing. The code serves the following purposes:

    • It states the ethical obligations and duties of every individual who enters the nursing profession;

    • It is the profession’s nonnegotiable ethical standard;

    • It is an expression of nursing’s own understanding of its commitment to society.

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  • CDC

  • New York State Departments of Health & Education

  • Suffolk County Department of Health

  • Joint Commission

  • OSHA Blood borne Pathogen Standard

  • OSHA Tuberculosis Standard

  • EPA

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  • Contact

    • direct

    • indirect

  • Droplet

  • Airborne

  • Common vehicle

  • Vector borne

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Infectious Agent

Susceptible Host

(Person Likely To

Get The Disease)


(Host of Infectious Agent)


Portal of Entry

(How Infectious

Agent Enters the


Portal of Exit

(How Infectious

Agent Leaves


Means of


(How Infectious

Agent Travels)

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Antibiotic resistant organisms





ESBLs E.coli Klebsiella pneumoniaeOrganisms with Increasing ResistanceStreptococcal pneumoniaePseudomonas-Stenotrophomonas maltophiliaMultiply Drug Resistant TB

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Clostridium difficile

Leading cause of hospital acquired diarrhea

Antibiotics major factor

Spore forming

Difficult to kill – sterilization needed

Lasts in environment

Hand washing – alcohol based gel ineffective

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Single most important component of an Infection Prevention program

Hands must be washed with soap & water when:

Before and after contact with patients, body fluids, specimens, and contaminated or soiled item.

Between “clean” and “dirty” procedures on the same patient.

After removing gloves.

Before and after performing invasive procedures.

After using the bathroom.

Before eating.

When your hands are visibly soiled.

After coughing and sneezing.

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The alcohol based hand antiseptic should adequately wet hands. Allow to air dry. Alcohol gel is appropriate for hand antisepsis before and after patient care, except when the hands are visibly soiled. Do not use if the patient has C.difficile.

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Nurses Nail Care

  • Artificial nails, tips, wraps banned.

  • Natural nails ¼ inch long past fingertip

  • Intact nail polish-all healthcare workers that have pt. contact.

  • Neonatal nursery in Oklahoma babies died, PSAE infection, CDC, State DOH –tested staff –genotype for strain done and found 2 nurses, 1 with artificial nails and the other with long nails had same strain on nails.

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Recommended Hand Hygiene Technique

  • Handrubs

    • Apply to palm of one hand, Rub hands together coveringall surfaces until dry

    • Volume: based on manufacturer

  • Handwashing

    • Wet hands with water,apply soap, rub hands together for at least 15 seconds

    • Rinse and dry with disposable towel

    • Use towel to turn off faucet

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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The Occupational Health and Safety Administration requires the employer to protect employees from exposure and contamination from the blood and body fluids of another person.

The written Exposure Control Plan is found in the Infection Control Manual.


    • Standard Precautions

    • Housekeeping procedures to ensure cleanliness and sanitation

    • Hepatitis B vaccinations for employees at risk

    • Exposure evaluation and follow-up for exposure incidents

    • Hazardous material container warnings such as biohazard labels

    • Confidential, accurate employee medical records

    • Engineering Controls

    • Work Practice Controls

    • Selection and use of protective clothing

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Standard Precautions

Applies to all patients regardless of diagnosis or presumed infection status.

Apply to:

- blood

- all body fluids, secretions, and excretions except sweat regardless of whether or not they contain visible blood.

non-intact skin,

mucous membranes

Assumes that each person is potentially infectious and contagious.

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To protect yourself from exposure, you must wear BODY FLUIDSPersonal Protective Equipment (PPE)

Gloves (vinyl & latex)

gowns(fluid proof, fluid resistant)

protective eyewear

mask(surgical, non-surgical, respirator)

All PPE should be removedIMMEDIATELYand disposed of according to Hospital policy.

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Prior to entering the patient’s room: BODY FLUIDS1.Put on protective garments before entering the patient's room2.Put on mask3.Put on protective eyewear (if necessary)4.Put on gown, tie at neck and back5.Don disposable gloves Leaving the patient’s room:1.Remove protective garments before leaving the patient's room.2.Take off gloves, turning them inside out when removing. 3.Take off gown, turning back into front so that inside of gown is on the outside.4.Take off mask or respirator and eye protection.5.Discard in clear waste receptacle.6.Wash hands.


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Needle stick or sharp object injury:

Wash the area thoroughly with soap and water

If blood spills or splashes on your hands:

Wash hands thoroughly with soap and water

If blood spills or splashes in your eyes:

Be aware of location of eye wash station

Flush eyes with large amounts of water

Notify your Supervisor

Complete an incident report

Go to the Emergency Department within 30 minutes of the incident

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Reference Source: www.joint commission BODY FLUIDS. org

National Patient Safety Goals

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National Patient Safety Goals BODY FLUIDS

  • The purpose of the National Patient Safety Goals is to improve patient safety. The Goals focus on problems in health care, safety and how to solve them.

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Why Performance Improvement? BODY FLUIDS

  • The purpose of the Performance Improvement Program is to do the right thing at the right time, and for the right reasons, for our patients.

  • The Interdisciplinary Performance Improvement Program supports hospital departments and staff in achieving standards of “Excellence” and Patient Safety

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Dimensions of Performance BODY FLUIDS

Doing the Right Thing

  • Efficacy – Are we producing the desired effect?

  • Appropriateness – Are we doing the proper thing?

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Dimensions of Performance BODY FLUIDS

Doing the Right ThingWell

Are we doing the right things

  • Timely

  • Effectively

  • Safely

  • Efficiently

  • With Respect and Caring

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Patient Safety Facts BODY FLUIDS

  • Institute of Medicine reported that 44,000 to 98,000 people die in the US hospitals each year as a result of medical errors.

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Medical Error BODY FLUIDS

  • Medical Errors happen when something that was planned as part of medical care doesn’t work out, or when the wrong plan was used in the first place

  • They can happen during even the most routine tasks

  • Most errors result from problems created by today’s complex healthcare system; but errors also happen when we don’t communicate well

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  • Most medical errors are preventable

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Nurses – The Patient Safety “Ace” BODY FLUIDS

A – Advocate

C – Caregiver

E - Educator

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Nurses the Patient Safety “ACE” BODY FLUIDS


Assure that our policies and procedures are executed as intended

Report unsafe practices

Speak Up for our patients

Coordinate Care


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Nurses the Patient Safety “ACE” BODY FLUIDS

Care Giver

Practice within our scope of practice

Assess and communicate effectively

Create effective plans of care

Execute our plans of care

Create safe environments

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Nurses the Patient Safety “ACE” BODY FLUIDS


Teach patients & families to participate in their care

Inform them about their illness

Infection control practices



Safety Precautions

After Hospital Care

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NPSG - Improve the Accuracy of Patient Identification BODY FLUIDS

  • Use two patient identifiers when providing care, treatment or services (administering medications, handling specimens, during surgery, blood transfusions, procedures and other treatments).

  • It is necessary to know what the institution you are in is using as their two identifiers. Additionally you must know how the institution handles those who are hearing impaired or non-verbal.

    • Ask patient to state name and date of birth

    • Check information against a source document

    • Utilize the Surgical & Invasive Procedure Protocol

      Perioperative Check List and Verification,

      Surgical Site Marking,


    • Specimen Containers are labeled in the presence of the patient

    • Two persons verify blood transfusions

      Never use the patients room number or physical location as an identifier!

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NPSG – Improve the Effectiveness of Communication Among Caregivers

  • Telephone Orders and Test Results are written down and verified with a “Read-back” – get confirmation!

  • Do Not Abbreviate: Morphine, Magnesium, Daily, Every Other Day, Heparin, Coumadin, Unit, International Units, Both Eyes, and

  • Always Use Leading Zeros, Never Use Trailing Zeros

  • Measure and Improve the timeliness of reporting and receipt by the caregiver of Critical Test Results & Critical Values.

  • Standardize approach to “hand off” communication & includes opportunity to ask and respond to questions; verifying information was understood

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NPSG - Improve the Safety of Using Medications Caregivers

  • ‘Look-alike/Sound-alike’ drugs used in the organization are identified & actions taken to prevent errors involving the interchange of these drugs.

  • Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field. Discard unused liquids.

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NPSG - Improve the Safety of Using Medications Caregivers

  • Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.

    • Defined anticoagulation management program

    • Use oral unit-dose or pre-mixed infusions

    • Establish monitoring practices

    • Use approved protocols

    • Utilize INR for monitoring

    • Utilize a food/drug interaction program

    • Assess baseline and ongoing laboratory testing

    • Staff, patients and families are educated to anticoagulation therapy

    • Anticoagulation Safety Practices undergo evaluation

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Reduce the Risk of Healthcare Acquired Infections Caregivers

  • Comply with current Centers for Disease Control and Prevention (CDC) Hand Hygiene guidelines.

  • Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a healthcare acquired infection.

  • Implement evidence-based practices to prevent

    • health care-associated infections due to multi-drug resistant organisms in acute care hospitals.

    • central line associated infections.

    • surgical site infections

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NPSG- Accurately and Completely Reconcile Medication Across the Continuum of Care

  • Obtain and document patient’s current medications upon admission/entry

  • Compare the list to those ordered and resolve discrepancies

  • Communicate a complete list of the patient’s medications to the next provider of service when transferred to another setting, service, practitioner or level of care within or outside the organization. The next provider checks the medication reconciliation list again to make sure it is accurate and in concert with any new medication to be ordered/prescribed.

  • The complete list of medications is provided to the patient on discharged from the organization.

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NPSG – Reduce the Potential of Patient Harm Resulting from Falls

  • Implement a fall reduction program that includes

  • An evaluation as appropriate to the patient, the setting and services provided;

  • patient, family and staff education;

  • and program effectiveness

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NPSG – Encourage patients’ active involvement in their own care as a patient safety strategy

  • Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.

  • Provide patients and families with information regarding infection control practices

  • Describe to patients the methods used to prevent adverse events in surgery (Universal Protocol)

  • Encourage patients to report concerns

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NPSG – The organization identifies safety risks inherent in its patient population

  • The organization identifies patients at risk for suicide and addressed the patient’s immediate safety needs and most appropriate setting for treatment

  • The organization provides information such as a crisis hotline to individuals and their family members for crisis situations.

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NPSG – Improve recognition and response to changes in a patient’s condition

  • The organization selects a suitable method that enables healthcare staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening.

  • The organization empowers staff, patients, and/or families to request additional assistance when they have a concern about the patient’s condition.

  • Hospitals developed the Rapid Response Team (RRT) to attend to patients with a change in condition.

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Universal Protocol to Prevent Wrong Site, Wrong Procedure, Wrong Person Surgery

  • Pre-operative verification – active patient identification with 2 identifiers and source document

  • Utilize the pre-operative checklist

  • The person performing the procedure should mark the operative site for procedures involving right/left distinction, multiple structures (fingers/toes/lesions), or multiple levels (spinal surgery)

  • Conduct a ‘Time Out’ immediately before starting the procedure – active communication among all team members to verify patient, procedure, implant and site.

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Safety Wrong Person Surgery

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FIRE Safety Wrong Person Surgery

Everyone’s Responsibility

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Environment of Care Wrong Person Surgery

  • The environment of care refers to key elements and issues that are significant in how the hospital operates related to patients, families, visitors and employees.

  • Hospitals have a Safety Management Plan that addresses all Joint Commission, OSHA and NYS Department of Health requirements.

  • The objective is to free of hazards and work performed in a safe manner with the have a physical environment reduced risk of injuries and hazards. This is accomplished through the EOC Committee whose purpose is to identify and reduce safety risks at each hospital.

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Seven Areas of Environment of Care Wrong Person Surgery

  • Safety Management

  • Security Management

  • Hazardous Material and Waste Management

  • Emergency Management

  • Fire Prevention Management

  • Medical Equipment Management

  • Utilities Management

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Safety Wrong Person Surgery

  • Preventing Injuries is the focus of all Hospital Safety plans.

  • If you are injured while in clinical , you should:

  • Notify both your faculty member and manager of unit. Report to Employee Health Services (EHS) if the injury is not serious and it is during the week.

  • If the injury is serious, report to the Emergency Department after informing your faculty member.

  • You must complete an Incident Report form and any additional paperwork required by your school and return it to EHS.

  • If the injury or accident involves a patient or visitor:

  • You must document the incident on a incident report and the patient’s Medical Doctor should be notified.

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Environmental Security Wrong Person Surgery

  • The Security Program addresses security issues related to staff, patients and visitors on the grounds of the specific hospital. As students you are visitors to the facility and must adhere to all rules and regulations.

  • To minimize security risks:

  • All students and faculty are required to wear ID Badges at all times and the ID badge must be visible.

  • Please bring minimal personal belongings to the units and leave valuables at home or locked in your car.

  • The Hospital Security staff is visible on the grounds and conduct routine patrols.

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Emergency Codes Wrong Person Surgery

  • Each hospital has different Emergency Codes

  • Your faculty member will review the following:

  • Medical Emergency

  • Fire Drill

  • REAL Fire

  • Bomb Threat

  • Abduction of a child

  • Decon Hazmat Team (Bioterrorism)


  • Internal/External Disasters

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Class of Fires Wrong Person Surgery

  • Class of Fires: A- B-C

  • Class A: Fires are ordinary combustibles (wood, paper, plastic and rubber)

  • Class B: Fires are flammable liquids/chemicals (grease, oil and petroleum)

  • Class C: Fires are electrical fires (TV, VCR, computers, etc.)

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- Wrong Person Surgery

Types of Extinguishers


pressurized water


dry chemical or C02


multipurpose dry chemical

Types of Extinguishers

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Fire Bells Wrong Person Surgery

Your response when you hear the fire bells:

  • Listen

  • Count bells

  • Determine location by checking the alarm chart located above every alarm box

  • Listen to the overhead page

  • If the fire is in your location, follow the RACE plan.

  • If your area is above, below or adjacent to the point of origin, close all doors, remove items from the corridors, have patients return to their rooms and listen for overhead pages of status of situation.

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Fire Safety Wrong Person Surgery

RemovePatients from danger

Announce - Activate Alarm

ConfineClose Doors

ExtinguishWith Proper Fire Extinguisher

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Pull Pin Wrong Person Surgery

Aim @ fire

Squeeze Handle

Swish side to side

Fire Safety

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Extinguishing a Fire Wrong Person Surgery

  • How do you extinguish a fire?

  • The fire extinguisher is your primary means of extinguishing a small fire, but first you have to identify the type of fire.

  • Identify type of fire: A, B or C and Identify the size. Extinguish only the small fires.

  • Select appropriate type of extinguisher. Be sure it is MRI compatible.

  • Know how to use the extinguisher

  • PPull the pin

  • The small metal pin located near the top of the extinguisher.

  • AAim nozzle at the base of the fire

  • Aim the extinguisher at the base of the fire

  • SSqueeze the handle

  • Holding the extinguisher tightly, squeeze the handle of the extinguisher

  • S Sweep side to side at the base of the fire

  • Using a sweeping motion, move the extinguisher from side to side. Stand 6 to 8 feet from the fire when you start spraying.

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Customer Service Wrong Person Surgery

General Guidelines:

  • Introduce yourself and your role

  • Make eye contact

  • Greet the patient by their surname

  • Explain all procedures and actions

  • Ask if any further assistance is needed before leaving the room

  • Smile

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D Wrong Person Surgeryefine Our Image

  • Professional respect begins with having self-respect and respecting our own profession

  • Value Nursing and project that image daily

  • Take ourselves seriously and dress the part

  • Recognize and promote the value of what we do

  • Believe in ourselves and our colleagues

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Professional Image Wrong Person SurgeryHow is Image Defined?

  • Description

  • Portrayal

  • Attitude

  • Popular Conception

    • Usually projected through the Mass Media

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The Essence of Nursing Wrong Person Surgery

  • Nightingale in her Notes on Nursing, wrote, “nursing’s most important work is caring” (1859).

  • Reading Nightingale one is struck by the simplicity of her message and its continued applicability to the health care system of today.

  • Enjoy your clinical experience this semester and your future careers as nurses

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Complete the following Post-Test Wrong Person Surgery

Complete the 20 question post-test found on the following Slides 72-76.

Fill in your answers on the separate answer sheet found on Slide 77.

Print out your completed answer sheet and submit to your clinical instructor.

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Nassau Suffolk Coordinating Council of Nursing Education and PracticeUniversal Student Hospital OrientationName: ______________________School: ____________________Date: _______________________

Matching: Cultural Competence Please Use Separate Answer Sheet

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True/False Practice

7. Ethical issues in healthcare include legal principles and governmental regulations, but do not include the ANA Code of Ethics, which are optional in the acute care settings. (True/False)

8. Infection prevention strategies include hand washing and personal protective equipment. (True/False)

9. Alcohol based hand gel is appropriate for al situations. (True/False)

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True/False Practice

10. Standard Precautions apply to all patients, regardless of diagnosis or presumed infection status. (True/False)

11. You should always contact your instructor immediately if you sustain a needle stick. (True/False)

12. National Patient Safety Goals focus on problems in healthcare, safety and how to solve them. (True/False)

13. The National Patient Safety Goals improve communication among caregivers via a standardized approach to hand off communication. (True/False)

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True/False Practice

14. According to the National Patient Safety Goals, all medications should be labeled. (True/False)

15. Fire Safety is everyone’s responsibility and response to a fire within the health care system is facilitated by the RACE acronym. (True/False)

16. Patient confidentiality is every patient’s right and legislature protecting these rights include HIPPA (Health Information Portability and Accountability Act) and PHI (Protected Health Information).


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True/False Practice

17. ACE stands for Advocate, Caregiver and Educator. (True/False)

18. Preventing injuries is the focus of all Hospital Safety plans.


19. The nursing professional image is enhanced when nurses value nursing and project that image daily and promote the value of the nursing profession. (True/False)

20. Customer service includes greeting patients by their first names and referring the patients to support staff for toileting needs.


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1.____ 6.____ Practice

2.____ 7.____

3.____ 8.____

4.____ 9.____

5.____ 10.____

11.____ 16.___

12.____ 17.___

13.____ 18.___

14.____ 19.___

15.____ 20.___

Suffolk Coordinating Council of Nursing Education and PracticeUniversal Student Hospital Orientation Post-TestName: ______________________ School:Suffolk County Community CollegeDate: ___________ANSWER SHEET