Think like a nurse final

SBAR

Situation, Background, Assessment, Recommendation

Florence Nightengale accomplishments

• Hand Hygiene and Sanitation

• Schools/education in Nursing

• Data collection / Statistics

• Environmental effects of healing

• Wrote “Notes of Nursing.”

• Diligent and compassionate care “Lady with the Lamp”

Clinical Judgement Measurement Model

Recognize Cues, Analyze Cues

Prioritize Hypothesis, Generate Solutions

Take Actions, Evaluate Outcomes

Nursing Process

Assessment, Analysis, Planning, Implementation, Evaluation

Tanner’s Clinical Judgement Model

Noticing, Interpreting, Responding, Reflecting

Delegating a right

Right Task, Right Person, Right Circumstances, Right Direction and communication, and right, supervision, and feedback

Cultural Competence

Culture has a powerful influence on one’s interpretation of health and illness and response to health care. All clients have the right to be understood and respected, despite their differences. They have the right to expect health care providers to acknowledge that their perspectives on and interpretations of health are legitimate. Health care professionals must make a commitment to increase their knowledge, sensitivity, and competence in cultural concepts and care.

70% of all errors in healthcare are attributed to…

Communication

Name an activity/intervention the RN cannot delegate

Do not delegate what you can EAT!

Evaluate

Assess

Teach

Prevent Burnout

Deep Breathing, Humor, Mini-meditation, relaxation routines, reflection and analysis, take a break/walk

De - escalation strategy

Safety, support, retreat plan if the de - escalation is unsuccessful

Do: calm tones, short clear phrases (avoid medical ramble), Non-threatening body language, listen

Don’t: Interrupt, act or posture yourself in a threatening way, match the patient’s energy (Don’t get loud and exaggerative even if they are)

Workforce advocacy

• Be a participating member of your professional organization and 

• Advocate for orientation/cross-training and promotion models

• Participate in shared-governance (Nurse Practice or Unit Based Councils)

How you can support a patient/family

Be Present – you don’t have to know the right thing to say.
Listen – don’t make it about you.
Help them feel love. You can do this by really loving them ;) Pray in your heart for them. 

Calm, peaceful.

Ask direct questions when needed.

Before health education, the nurse must first assess a patients

Healthy literacy, learning preferences, learning barriers, cultural preferences, personal goals

Autonomy

Practitioners are relatively independent and control their own practices and polices

Code of Ethics

A guide code for decisions and conduct, ensuring moral standards

Professional Organization

An association that supports high standards and promotes the profession

Which profession can act under the title of nurse?

LPN, RN, LVN

What is the primary purpose of the code of ethics? (for nurses)

to guide nurses in their ethical decision making

Where does the code of ethics for nurses come from?

American Nurse Association

Cultural Assessment

Systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities

Cultural imposition

imposing your culture on others

What is a barrier to culturally competent care?

Stereotyping

Cultural humility

Lifelong commitment to self evaluation

One way to improve cultural competence:

Consider your patients culture before educating them

What to do when implementing a cultural accommodation?

Accommodate and record the preference

Who wrote, “To Err is Human?”

Institute of Medicine (IOM)

First step in effective patient communication

assess learning barriers and current knowledge

Miscommunication happens most commonly in

Hand offs

Management in patient education do for patient:

Minimize the effects of chronic disease

Improve communication

Shorter sentences

Listen and Respond to patient wishes

Basic health literacy check

Clear dosages and instructions

Effective leadership includes

Communicating openly

Encouraging others to speak up

Creating a safe Environment

Specific and relevant

What is the nurse’s role in obtaining the patients consent

Witness patient signing, advocate for the patient, determine all other factors to receive valid consent (age, disability)

Communication with disabilities

Reduce noice, aids, determine intellectual level

Effective communication

yes and no questions

Not report bullying is bad because

is perpetuates the bad behavior

Lateral violence

Senior nurse is mean to junior nurse

What should you do if someone is considering suicide?

Direct questions, explore the details of any plan, document verbalism quotes and identify risk factors, tone of calmness, help them find resources.

Close ended questions are helpful

when asking someone if they are considering suicide

What statement used to avoid blaming

I statements

Effective conflict resolution

o Using "I" statements to avoid blaming
o Don't raise voice to assert
o Discuss alternative solutions
o Acknowledge and validate the other person's feelings
o Negotiate a solution
o Summarize
o Follow Through

Prioritizing tasks

Based on importance or urgency

When should you avoid procrastination

always. (especially on essential tasks)

First step in time management

identify goals and priorities

How can you maximize productivity?

Block time for focused spurts of work

What can you do to better manage your time?

Reminders, eliminate distractions, to do lists

Managing Stress

Practice relaxing techniques like deep breathing
Engage in regular exercise
Balance between work and leisure
Mindfulness
Yoga

What can create better resilience and coping?

Healthy lifestyle

What is ergonomic injury

Repetitive strain disorder

What is the nurse educator’s role?

assessing the pt's learning need and readiness
individualization
demonstrating procedures, NOT performing medical procedures

What is advocacy for?

Nurses rights, Practice environment

What organization is a leader in advocating for nurses?

American Nurses Association

What nursing issues have been addressed?

nursing shortages, active decision making: shared governance model

What is the shared governance model?

encourages nurses to make decisions and promote autonomy and accountability (purpose is to avoid unnecessary errors)

What does the Nursing Practice Act state?

states that the nursing practice act (nurse's scope of practice) must evolve alongside the changing roles of the nurse

Who is protected by the Nursing Practice Act?

The patient

HIPAA

a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed.

Where is HIPAA trained?

in every healthcare system and facility

When is it ok to break the privacy of a patient?

when abuse is suspected

Is verbal abuse towards an annoying patient considered malpractice?

YES

Are nursing textbooks a law governing nursing practice?

No

Whistleblower

Reporting a workplace concern to a state agency responsible for regulation of the hospital

Shared governance

nurses controlling their professional practice

Clinical Judgement and Self Care

During the reflective phase of clinical judgement, nurses should consider whether their actions were effective

Self care is crucial for nurses; taking a sick day to tend to emotional health rather than working while tired.

Nurses must prioritize their well-being to ensure patient safety

Patient Privacy and HIPAA Compliance

• knock on door

• Abuse, child, elderly report it

• HIPAA guidelines

• Patients may request copies of their health records under HIPAA rules

• Effective patient communcaiton, lisnteing to them.

Cultural Competence vs. insensitivity

Cultural competence involves awareness, knowledge, and skills

Cultural insensitivity: failure to recognize respect, or understand the cultural backgrounds, beliefs, and practices of others.

The first step in providing cultural competent care is to perform a cultural assessment

Beliefs, Values, and Practices

Cultural humility

requires a commitment to self-evaluation

Patient education and communication is required and the primary goal of that is to

enhance quality of life and self care abilities

Nurse should assess patients learning needs and develop individual teaching plans based on these 2 things…

Culturally competent education requires considering patients’ cultural beliefs

Effective patient communication includes clear verbal and written instructions, avoiding medical jargon (Acronyms)

Conflict resolution and time management

Following through on agreed solutions is crucial for resolving conflicts

Effective time management begins with identifying goals and priorities

Workforce advocacy and ethical responsibility

Aims to promote a safe and supportive work environment for nurses

Ethical responsibility to advocate for safe working conditions (ANA code of ethics)

The primary goal of the workforce advocacy program

is to foster an optimal professional work environment

Legal and ethical issues in nursing

• patient consent for medical procedures

• reporting suspected child abuse is a legal obligation

• failure to document patient care accurately can lead to malpractice claims

Nurses should not administer medications that they believe are unsafe, following the chain of command for reporting concerns

Charge nurse, unit manager/director, house supervisor, chief nursing office, administration