NSG 2113 midterm

Jeanne Mance:

Established Hotel-Dieu in Montreal. Cared for both aboriginals and settlers

Marguerite d'Youville:

established hospitals that admitted wealthy patients to fund the healthcare needs of people that couldn't afford it.

Florence Nightingale:

founder of infection control. Founder of modern schools of nursing.

Mary Agnes Snively:

- First diploma from a school of nursing in St. Catherines. - 1st director of CAN

First doctoral program

university of Alberta in 1991.

What is something that is unique to nursing care?

We are striving to promote health and wellness and increase the quality of life, not just fix an injury

Profession:

A self-regulated body of people that are licensed to participate within a scope of practice.

College of Nurses of Ontario (CNO)

1. Setting criteria for becoming a nurse

2. Administering QA programs

3. Providing a complaint and discipline process

4. Establishing standards

Registered Nurses' Association of Ontario (RNAO)

1. Meets with politicians

2. Funds development of nursing best practice guidelines

3. Analyzes political platforms during each election

4. Financial assistance with education

5. Legal protection

Ontario Nurses Association (ONA)

union- RN and NP only

Canadian Nurses Association (CNA)

- Political advocates for nurses on a national scale

- Used to write and administer the CNRE which is now the NCLEX

- Produces Codes of Ethics

4 Domains of Practice

1. Clinical practice

2. Administration

3. Education

4. Research

Canadian Health Care System

- To provide Canadians with reasonable access to medically necessary services without needing to pay at time of use

Medicare

- Provided to permanent residents, new immigrants and citizens of the country

Health Canada

- Federal department responsible for helping the people of Canada maintain and improve their health

Public Health Agency of Canada

- strengthen Canada's capacity to protect and improve the health of Canadians and to help reduce pressures on the healthcare system

Statistics Canada

- Produces statistics that help Canadians better understand their country

Canadian Institute of Health Research

- Responsible for funding health research in Canada

Canadian Institutes of Health Information

- Provides essential information on Canada's health care system and the health of Canadians

Federal Government

- Sets and administers national principles

- Assists in financing of health care services through transfer payments

- Delivers health services for First Nations and Inuit people, veterans, federal inmates, national defense and RCMP

- Provides national policy and programming to promote health and prevent disease

Provincial and Territorial Governments

- Develop and administer their own health care insurance plans

- Manage, finance, and plan insurable health care services and delivery

- Determine organization and location of hospitals or long-term care facilities;

- Reimburse physician and hospital costs

6 Principles of the health canada act

Public administration, comprehensiveness, universality, portability, accessibility, sustainability

User fees

requiring partial payment for insured health care services

User charges

requiring partial payment for uninsured health care services

Four pillars of primary health care

teams, access, healthy living, information

5 principles of public health care

public participation, appropriate technology, health promotion, intersectorial cooperation, accessibility

8 elements of primary health care

1. education on prevaling health problems and how to control and prevent them

2. Promotion of proper nutrition and food safety

3. Adequate supply of safe water and basic sanitation

4. Maternal and child health care including family planning

5. Immunization against major infectious diseases

6. Prevention and control of locally endemic diseases

7. Appropriate treatment of common diseases and injuries

8. Provision of essential drugs

Settings for health care delivery

institutional sector, community sector

Five levels of health care

1. Health promotion

2. Disease and injury prevention

3. Diagnosis and treatment

4. Rehabilitation

5. Supportive care

sources of revenue

1. Taxation

2. Out of pocket

3. Private health insurance

three levels of care

- Primary care: first contact with the healthcare system (GP)

- Secondary care: provision of a specialized medical service (specialist)

- Tertiary care: Specialized and highly technical care (surgery)

Sources of law

- Civil law (Quebec) - based on code

- Common law (Rest of Canada) - based on precedent

- Statute law

• Created by elective legislative bodies (parliament, provincial/territorial legislatures)

• Federal statutes apply throughout the country

Professional Regulation

- Provincial/territorial legislation grants authority to a nursing regulatory body

Tort

a civil wrong committed against a person or property

Intentional tort

willful acts that violate a person's rights

• Assault (ex. Threatening)

• Battery (ex. Improper use of psychiatric equipment)

• Invasion of privacy

• False imprisonment (ex. Keeping someone captive)

Steps in admitting to a mistake

1. Inform the physician

2. Inform the patient

3. Incident report

4. Document things as honestly as possible

Consent must include (6)

- The nature of the treatment

- The expected benefits of the treatment

- The material risks of the treatment

- The material side effects of the treatment

- Alternative courses of action

- The likely consequences of not having the treatment

Types of consent

1. Expressed

- Directly given, either orally or in writing. It is positive, direct, unequivocal consent, requiring no interference or implication to supply its meaning

2. Implied

- Occurs often with nursing procedures (we don't ask if we can give them routine medications, we offer them)

- Patient has the right to refuse any treatments, procedure, medication

3. Included

- Unless it is not reasonable to do so in the circumstances, a health practitioner is entitled to presume that consent to a treatment includes:

a) Consent to variations or adjustments in the treatment

b) Consent to the continuation of the same treatment in a different setting

Exemptions to consent

1. Emergency

- Permits examination and treatment without consent in an emergency

2. Serious harm

- Permits submission to an assessment regardless of consent when a person has threatened to harm/ has harmed themselves or someone else

Two types of form

- Form 1: if a patient is going to commit suicide, they can intervene

- Form 2: a family member can go to a justice of the peace and get a form that allows for intervention

things to know when working with a UCP

1. Know the UCP is competent to perform the task

2. Ensure the UCP:

- Understands the extent of her/his responsibilities in performing the task

- Knows when and whom to ask for assistance

- Knows when, how and to whom to report the outcomes of the procedure

Legal liability issues in nursing practice

1. Short staffing

2. Floating

3. Physicians' orders

4. Dispensing advice over the phone

5. Contracts and employment agreements

Advanced directive

a mechanism enabling a mentally competent person to plan for a time when mental capacity is lost

legal responsibility to follow the laws enacted to protect the public health (3)

• Reporting suspected abuse and neglect

• Reporting communicable diseases

• Reporting other health-related issues enacted to protect the public's health

Steps in risk management (4)

1. Identify possible risks

2. Analyze risks

3. Act to reduce risks

4. Evaluate steps taken

8 professional standards

accountability, continuing competence, ethics, leadership, knowledge, knowledge application, relationship with client, relationship with colleague

2 things you do when patients request that certain information is not transmitted to other HCPs

1. Designated information cannot be transmitted to the designated provider

2. The designated provider must be informed that info was withheld at client's request

5 Steps to evidence-informed practice

1. Define the question

2. Collect the best evidence

3. Critique the evidence

4. Integrate the evidence

5. Evaluate the practice decision or change

7 Parts of a research report

1. Abstract

2. Introduction

3. Literature review

4. Purpose statement

5. Methods or design

6. Results or conclusions

7. Clinical implications

Knowledge Development in Nursing (5 things)

- Empirics (science)

- Esthetics (art)

- Personal knowledge

- Ethics (morals)

- Emancipatory (social/economic/empirical)

Principles of ethics

• Respect for persons and human dignity

• Concern for welfare

• Respect for privacy and confidentiality

• Justice

Five steps of the nursing process

1. Nursing assessment

2. Nursing diagnosis

3. Planning nursing care

4. Implementing nursing care

5. Evaluating nursing care

2 Phases of the nursing assessment process

1. Data collection (methods: interview, health history, physical examination)

- Oral report

- Examination

2. Data analysis (Steps: clustering data, differentiate, validate differentiation)

- Formulating nursing judgments

- Data clustering

- Data documentation

Phases of an interview

- Orientation phase - introduction

- Working phase - get data

- Termination phase - recap

What to avoid as a nurse

- Using authority

- Using professional jargon

- Using leading questions

- Talking too much

- Interrupting

- Asking "why" questions (sometimes required)

3 components of a Physical assessment

- Physical observation

- Physical examination

- Diagnostic and laboratory data

3 Types of diagnosis

- Medical diagnosis: a clinical judgment about the client in response to an actual or potential health problem (reasons for signs and symptoms)

- Nursing diagnosis: the identification of a disease condition based on specific evaluation of signs and symptoms (describing signs and symptoms)

- Collaborative problem: an actual or potential complication that nurses monitor to detect a change in client status (things that need to be addressed by a group of people)

Types of nursing diagnosis

- Actual nursing diagnosis: describes human responses to levels of wellness that have a readiness for enhancement

- Risk nursing diagnosis: describes human responses to health conditions or life processes that may develop

- Health-promotion nursing diagnosis: clinical judgement of motivation and desire to increase well-being by readiness to enhance specific health behaviours, such as nutrition and exercise

- Wellness nursing diagnosis: describes human responses to health conditions or life processes

How to write a nursing diagnosis (3 steps)

1. Diagnosis

2. Defining characteristics (subjective and objective signs and symptoms)

3. Related factors (causative factors influencing the problem)

Goals of care

- Client goal

• A specific, measurable behaviour or response reflecting client's highest possible wellness level and independence of function

- Short-term goal

• An objective client behaviour or response expected within hours to a week

- Long-term goal

• An objective client behaviour or response expected within days, weeks or months

SMART

S - Specific

M - Measurable

A - Attainable

R - Realistic

T - Timely or tangible

3 Types of interventions

- Nurse initiated

• Independent

- Physician-initiated

• Dependent

- Collaborative

• Interdependent

What is the standard of care?

- The minimum level of care acceptable to ensure high quality care

The evaluation process (5 elements)

1. Identify evaluative criteria and standards

2. Collect evaluative data

3. Interpret and summarize findings

4. Document findings and clinical judgements

5. Terminate, continue or revise the care plan

3 things that documentation should be

accurate, timely, chronological, complete

what is a record or chart

confidential permanent legal document

What is a report

oral, written, audiotapes exchange of information

Consultation

a professional caregiver providing formal advice to another caregiver

Referrals

arrangement for services by another care provider

Problem oriented medical record as a documentation system

problem list, care plan, progress notes

Source records as a documentation system

separate section for each discipline

Charting by exception

focuses on documenting deviations

Case managaement and critical pathways as a documentation system

incorporates a multidisciplinary approach to care

SOAP

subjective, objective, assessment, plan

SOAPIE

subjective, objective, assessment, plan, intervention, assessment

PIE

problem intervention evaluatoin

Focus charting (DAR)

data action response

4 types of reports

telephone, shift change, transfer, incident

SBAR

Situation, background, assessment, recommendation

4 phases for pharmacokinetics

1. absorption

2. Distribution

3. metabolism

4. excretion

7 routes of administration

1. inhalation

2. parenteral

3. epidural

4. intrathecal

5. topical

6. inhalation

7. intraocular

6 orders in acute care agencies

Routine, PRN, single, STAT, now, prescription

10 rights of medication administration

1. medication

2. dose

3. pt

4. route

5. time and frequency

6. documentation

7. reason

8. to refuse

9. pt education

10. evaluation

5 types of loss

1. necessary,

2. actual

3. percieved

4. maturational

5. situational

4 types of grief

normal, anticipatory, disenfranchised, complicated

Kubler-Ross's stages of grief

1. denial

2. anger

3. barganing

4. depression

5. acceptance

Bowlby's phases of mourning

1. numbing

2. yearning and seeking

3. disorganization and despair

4. reorganization

Worden's 4 tasks of mourning (TEAR)

t: to accept the reality of the loss

e: experience the pain of the loss

a: adjust to the new environment without the lost person

r: reinvest in the new reality

65-74 is called

young old

75-84

middle-old

85-99

old-old

100 and older

centenarians

110 and older

super-centenarians

WHO says that good health does what

good health adds life to years

ALC - Alternate level of care

when someone is taking up a bed in the hospital, but they do not require intense care

2 types of restorative care

1. continues the recovery from acute illness

2. addresses chronic conditions that affect daily functioning

2 key events from the birth date of new health promotion

1. release of EPP report

2. development of ottawa charter for health promotion

EPP report

began developing Canada's blueprint for meeting WHO's goal of health for all 2000

three health promotion approaches

1. biomedical

2. behavioural/lifestyle

3. socio-environmental

Domains of learning

1. cognitive

2. affective

3. psychomotor