NCLEX Review Guide: Leadership Management, Ethical & Legal Nursing Practice, Advance Directives / Living Will

Delegation and Supervision

• Five Rights of Delegation: Right task, right person, right circumstances, right direction/communication, and right supervision/evaluation must all be considered before delegating any nursing task.
• Scope of practice determines what tasks can be delegated to unlicensed assistive personnel (UAP), licensed practical nurses (LPN), or registered nurses (RN) based on their training and competency level.
• The RN retains accountability and responsibility for all delegated tasks and must provide appropriate supervision and follow-up to ensure safe patient care.

Core Ethical Principles

• Autonomy respects the patient's right to make informed decisions about their healthcare, including the right to refuse treatment even if it may result in harm.
• Beneficence requires nurses to act in the patient's best interest and promote good, while non-maleficence means "do no harm" and avoid actions that could cause patient injury.
• Justice ensures fair and equitable treatment of all patients regardless of their background, while veracity requires truthfulness in all patient interactions.

Legal Considerations

• Mandatory reporting requirements include suspected abuse, neglect, communicable diseases, and unsafe healthcare practices to appropriate authorities as required by state law.
• Confidentiality protects patient health information under HIPAA, allowing disclosure only with patient consent or as legally required for treatment, payment, or healthcare operations.
• Malpractice occurs when four elements are present: duty owed, breach of duty, causation, and damages resulting from the nurse's failure to meet the standard of care.

Types of Advance Directives

• Living Will specifies the patient's wishes regarding life-sustaining treatments when they become terminally ill or permanently unconscious and cannot communicate their preferences.
• Durable Power of Attorney for Healthcare designates a healthcare proxy to make medical decisions when the patient lacks decision-making capacity, extending beyond just end-of-life situations.
• Do Not Resuscitate (DNR) orders specifically prohibit cardiopulmonary resuscitation efforts but do not restrict other medical treatments unless specifically stated.

Steps for Advance Directive Implementation

1. Verify the document's validity and ensure it's the most recent version
2. Confirm the patient's current decision-making capacity
3. Communicate the directive's contents to the healthcare team
4. Honor the patient's wishes as documented in the directive
5. Document all actions taken in the medical record