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12 & 15-Lead ECG's

12 & 15-Lead ECG's



Module 1. Professionalism and the Healthcare Setting

Module 1. Professionalism and the Healthcare Setting



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    12 & 15-Lead ECG's 12 & 15-Lead ECG's Document Transcript

    • PROFESSIONALISM, ETHICS, AND LEGALITIES Professionalism is defined as the personal appearance, characteristics, and conduct exhibited by a professional person. This image is perceived superficially in the way a person dresses and speaks; on a deeper level, it is noticed by how a person behaves. Appearance, Hygiene, Health - a clean, wrinkle-free uniform (or conservative street clothes), lab coat, closed-toe rubber-sole shoes, clean hair (tied if longer than shoulder length) and fingernails, fresh breath, and the use of antiperspirant, all contribute to professional perception. Many healthcare facilities have strict “no-scent” policies for their staff. Integrity – the honesty required to do the right thing regardless of circumstances. A phlebotomist may often work independently - follow and respect the correct procedures for blood collection in all circumstances. Motivation – view the workplace as a challenging environment; be willing to perform each and every task with a positive attitude. Compassion & Empathy – show sensitivity to a patient’s needs; offer reassurance in a caring manner. Body language and non-verbal communication have more influence on a patient’s response than words alone. If body language messages differ from verbal messages, the patient may not listen, follow directions, or cooperate fully. Give the patient full attention, make them comfortable, and use their proper name. Dependability – be punctual, reliable, and take personal responsibility for your own actions ETHICS Ethics are defined as morally desirable behaviors that conform to standards of right and wrong, and in all cases avoid harming the patient. Ethical guidelines include the patient’s welfare, confidentiality, and rights. The patient has the right to be treated with respect and dignity Be diplomatic and tactful when dealing with a patient, particularly in stressful situations. Be honest and considerate – the patient is the reason for your employment. The patient has the right to refuse the ECG measurement A patient may refuse to have an ECG done based on personal reasons. If the patient is a child, both the child and the parent must be cooperative. Give an honest explanation of the procedure. Stress the importance of ECG measurement. Try to convince the patient that the procedure is necessary; emphasize the fact that the physician needs the information to assess current health status. If the patient is still uncooperative, do not Page 2 of 7
    • proceed. Request that a member of the nursing staff, supervisor, or patient’s physician speak to the patient. The patient has the right to know the purpose and result of their tests from the physician. Patients will frequently ask why a test is done. Diplomatically explain that there are many reasons for these tests to be done, and the patient’s physician is the best one to answer any questions. Do not, under any circumstances, give test results to a patient without specific instructions from the physician. The patient has the right to confidentiality regarding ECG results and medical treatment Do not discuss a patient’s results, diagnosis, prognosis, or medical treatment with anyone except the patient’s physician (or a nurse on behalf of the physician) under any circumstances. This includes discussion with co-workers, in the elevator, at lunch, or anywhere that confidential information may be overheard. Confidentiality is the cornerstone of ethical professionalism, and is both an ethical right and a legal right. LEGALITIES Lawsuits in the health care industry are more common due to increased consumer awareness. Traditionally, physicians and healthcare providers were considered above reproach; this is no longer the case. A person performing any medical procedure without reasonable care and skill can and will be held legally responsible for their actions. Legal actions in a health care facility are usually considered under the jurisdiction of civil law. Civil law involves action between two individuals, organizations, or corporations. A civil wrong is committed against an individual or property, and may be intentional or accidental. Damages may be awarded in a court of law. Some examples follow. A healthcare professional who performs a medical procedure without patient consent can be charged with assault and battery. Assault is the act or threat of intentionally causing another to be fearful or apprehensive of immediate harm. The person committing the assault must have the ability to carry out the threat. Battery is the intentional harm or offensive touching of a person without legal justification or consent. Intentional harm includes removing a person’s clothing without consent, grabbing an object away from a person, or permanent disfigurement. The staff member must have consent from the patient to obtain an ECG measurement. It may be written consent, verbal consent, or implied consent. For example, after the procedure is explained, the patient undresses and lies on the table as directed – this is considered implied consent. The explanation must be given in non-technical terms in a language that the patient understands - an interpreter may be required. Page 3 of 7
    • Entering through a patient’s closed door in a hospital without knocking or asking permission first is an invasion of privacy. Negligence is the unintentional harm inflicted through carelessness or failing to do something that should be done. It occurs when a person can see that their actions may cause unreasonable harm to another. Releasing medical information to unauthorized persons (insurance agents, police officers, news reporters, paparazzi) without physician permission and patient consent is a breach of confidentiality. Confidentiality is especially difficult if the person is a friend, relative, or coworker of the patient. Release of private information may cause humiliation, embarrassment, or job loss. Sensitive areas such as drug screening, sexual issues or HIV status are good examples. The question “Who owns the medical record?” may arise. The record itself is the property of the physician/facility - they have the right to restrict its removal. The information in the record is the property of the patient, and can be obtained on request. Traditionally, the employer would be responsible for the actions of the employee within the scope of employment (even if the employee was at fault.) The main premise was that the employer provided the proper training and had deeper pockets (let the one with the money pay). However, with recent expansion of individual duties and responsibilities, the employee has more opportunity to practice beyond their original training. If the employee is performing outside their scope of training or duties, that employee may be held solely responsible for illegal actions - as an adult, they are liable and legally responsible. (Many employees purchase professional liability insurance through their professional organization.) Work professionally as the best way to avoid lawsuits. Some tips to remember: obtain informed consent beforehand stringently follow accepted procedures and policies accurately record all patient information document any incidents or occurrences immediately listen and respond in an appropriate manner to a patient’s request ask questions (and get answers) about any unfamiliar procedure or policy participate in continuing education and training to maintain proficient skills perform at the standard of care established by provincial, national, and professional guidelines Page 4 of 7
    • THE HEALTH CARE SETTING The main source of health care services for patients is the outpatient/ambulatory facility. Services range from simple routine procedures to highly specialized care, and include physician offices, dental offices, health clinics, pharmacies, and surgical centers. Primary care physicians offer initial assessment and related treatment. They may work with nurses, nurse practitioners, physician assistants, laboratory assistants, and phlebotomists. A physician may be a solo practitioner, who has shared referral arrangements and on-call duties with another doctor, or the physician may be in group practice, where resources, facilities, staff, income, and expenses are shared by several doctors. Secondary care may be delivered in outpatient/ambulatory facilities. Procedures such as routine surgery, treatments for emergencies, and diagnostic/therapeutic radiology are available in both freestanding ambulatory facilities and many hospitals. In most cases, the primary physician has referred the patient for secondary (specialist) care. In-patient facilities require patients to stay overnight or longer. Acute and chronic care hospitals, nursing homes, rehabilitation centers, and extended care facilities, are examples. The in-patient facility may be non-profit community based (university teaching hospital, religious-affiliated organization) or a public facility which is financed and operated at the local, provincial, or federal level (military/veterans hospital, mental institution) A primary or secondary care physician may use an outside laboratory for testing, or there may be an on-site laboratory at the physician’s workplace. Most physicians combine the two. Routine, common, convenient, or inexpensive lab tests may be performed on-site. Expensive or sophisticated tests, tests that require automated equipment or special supplies, highly skilled staff, or a long time to complete, may be done at an outside laboratory. Outside laboratories include hospitals, government facilities, and privately owned commercial labs. Testing can be done relatively quickly, reliably, and at a reasonable cost. Some tests require high-tech equipment, specialized knowledge, or are rarely requested. These tests may be sent to a reference laboratory for testing. The collection and testing of a patient specimen will follow one of three routes: the specimen is collected and tested in a physician’s office or clinic; the specimen is collected in a physician’s office, transported, and tested at an outside laboratory the patient is given a test requisition form to take to an outside laboratory where the specimen is collected, transported, and tested Page 5 of 7
    • The phlebotomist will work closely with both the outside laboratory and the on-site lab (if available). A basic knowledge of the relationship that exists between the phlebotomist’s workplace and the laboratory setting is essential. Hospital Organization Hospitals are usually large organizations with complex internal structure. In recent years, healthcare personnel have been reduced, but available services has remained essentially the same. Cross-training of staff, emphasis on patient-focused service, and the merging of distinct departments into a more streamlined, user-friendly system, is the projected outcome. Medical Staff - Primary Physicians, Specialists, Residents, Interns Patient Care Services - Direct patient care, assessment, medications, and treatment as prescribed by a physician. Staff includes Registered Nurse (RN), Nurse Practitioner, Registered Practical Nurse (RPN), Bachelor of Science Nurse (BsN), Certified Nursing Assistant (CNA), Patient Care Technician (PCT), Receptionist Emergency Department (ER) – medical emergencies, manage acutely ill/injured patients Intensive Care Unit (ICU) – provides increased patient care due to a fragile patient condition Surgery – operative procedures to repair injuries, cure disease, or correct defects/deformities Cardiology – performs ECG, holter monitoring, stress testing Electroneurodiagnostics – performs EEG, sleep studies, brain wave mapping to diagnose and monitor neurophysiologic disorders Pharmacy – prepares and dispenses medications requested by physicians, assists medical staff on indications and contraindications of drugs Support Services – Housekeeping, Dietary, Central Supply, and Health Information Records Occupational Therapy – assists the development of patients who may be mentally, physically, or emotionally unable to maintain daily living skills Physical Therapy – provides individually designed treatment plans and therapy to patients who have been diagnosed with a physical impairment Page 6 of 7
    • Respiratory Therapy – diagnoses, treats, and monitors patient lung capacities, lung deficiencies and provides oxygen therapy Diagnostic Imaging – X-rays, ultrasound, computed tomography, magnetic resonance, and positron emission tomography Clinical Analysis Area – many hospitals have downsized the clinical lab to a STAT or Core Lab. Routine chemistry, hematology, and any test required immediately to make an accurate assessment or initiate treatment in the acutely ill patient is performed here. Microbiology and tests of lower priority are sent to the private commercial lab. Page 7 of 7