NURS 144 Midterm!!!

Professional nursing

protection, promotion, optimization of health and abilities, prevention of injuries

4 aims of nursing

1. Facilitate coping with disability and death

2. Promote health

3. Prevent illness

4. Restore health

responsibility

- associated with performance of duties

- duty to complete tasks

- ongoing

- can be shared among team

task focused

accountability

- state of being "answerable"

- duty to give account AFTER

- past oriented

- results focused

standards of care purpose

- established by Joint Commission, ANA, NLN

- Determine what a nurse should or should not do

Values

personal principles

morals

actual beliefs outside of personal principles

ANA code of ethics

- commitment to care

- promote and advocate

- responsibility and accountability

- engagement in advancing nursing practice

- respect for dignity and uniqueness of individual

- collaboration with healthcare team to promote wellness

Altruism

concern for the welfare of community

Autonomy

Self determination

Human dignity

respect for inherent worth

Nurses values

- examine your own values about life, death, health, illness

- do not impose your values onto your patient

nonmaleficence

do no harm

beneficence

what is in the patient's best interest

Justice

treating people equally

Fidelity

doing what you say you will do

Veracity

tell the truth

litigation

the process of bringing and tying a lawsuit

Statutory

formal written laws enacted by legislative bodies (nursing laws are this)

Public law

government is directly involved in

Private law

civil law

Tort

action or omission that harms someone

intentional tort example

fraud, assult

unintentional tort example

malpractice

4 Ds of malpractice liability

Duty to care - must show the nurse had relationship to care for the patient

Dereliction - must show that nurse failed to fulfill duty

Direct causation - must show breeches

Damages

Risk management Dos

- names of all involved

- Location, date, time

- equipment, medication involved

- factual statement

Risk management Don'ts

- assume

- blame

- DO NOT INCLUDE IN PT CHART

Main goals of the Patient Bill of Rights (1998)

1. Strengthen consumer confidence

2. Emphasizes patient centered care

3. Bolster patient information and education

Informed consent definition

I understand and I agree

Informed consent considerations

- capacity to consent

- expressed (oral or written)

- Implied - patient action

What does the patient understand and agree to by having informed consent?

- Nature of the treatment

- Alternatives

- Benefits

- Opportunity for questions

- Risks

Types advanced directives

- Living will

- Durable POA

- Healthcare proxy

- DNR

- DNI

- POLST (helps people who panic at EOL)

Why was HIPAA enacted in regard to health policy

so preexisting conditions cannot be a barrier to health insurance

Health

complete physical, mental, and social wellbeing

Wellness

actions taken by individuals to achieve their fullest potential

Chronic illness

an on-going illness, slow or gradual in onset; it has no known cure; it can be controlled and complications prevented with proper treatment

Acute illness

rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning

Maslow's Hierarchy of Needs

physiological, safety, love/belonging, esteem, self-actualization

Primary prevention

prevent illness from happening in the first place

ex. vaccines, education, illegalization of drugs

Secondary prevention

Early detection and intervention to prevent disease progression

ex. Blood pressure screening, cholesterol screening, colonoscopy screening

Tertiary prevention

managing existing disease to minimize complications

ex. rehab, medication management, support groups

Acute care (hospitalization)

brief admission to stabilize

Home health care

services delivered at home

long term care

nursing home that assist patients to live

advocacy

speaking up on behalf of the patient

assault

the threat of harm or causing fear of injury to another person, without any physical contact

battery

actual physical contact that causes harm or is offensive such as hitting or touching someone without consent

4 elements to prove negligence

"Dereliction of Duty Directly causing Damages"

negligence

not doing something you're supposed to do

communication

two-party, ongoing process involving the sending and receiving of a message

"self-talk" occurs during the process which may interfere with how the sender intended the message

verbal communication should include...

1. simplicity

2. clarity

3. timing and relevance

4. adaptability

5. credibility

nonverbal communication includes

- facial expression

- tone of voice

- movement

- appearance

- eye contact

- gestures

- posture

First impression percentages

55% body language

38% tone of voice

7% spoken word

Barriers to communication

- stereotype

- judgement responses (agree/disagree)

- defensiveness

- challenging

- false reassurance

Cultural considerations for communication

- language variations

- slang

- Translation may lose context

- eye contact

- nodding

- touch

- gestures

Quality improvement definition

systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups

Why is quality improvement important

- improves patient care

- healthy people/healthy communities

- affordable care

Safe (6 aims for HC improvement)

avoiding injuries to patients from the care that is intended to help them

Effectiveness (6 aims for HC improvement)

providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit

Patient-centered (6 aims for HC improvement)

providing care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions

Timely (6 aims for HC improvement)

reducing wait time that may result in harmful delays for both those who receive and those who give care

Efficient (6 aims for HC improvement)

avoiding waste, including waste of equipment, supplies, ideas, and energy

Equitable (6 aims for HC improvement)

providing care that does not vary in quality because of personal characteristics such as gender, ethnicity or geographic location

Federal Quality Improvement Initiatives

Developed indicators and documentation for quality of care

- National database of nursing quality indicators (NDNQI)

- Patient safety and quality: an evidence-based handbook for nurses

- National patient safety goals

- Patient protection and affordable care act (PPACA or ACA)

- National strategy for quality improvement in health care

State and Local Quality Improvement Initiatives

- Under affordable care act - states have some part in providing state health insurance to low-income people

- Community health centers (CHCs)

Aspects of community health centers (CHCs)

- serve medically underserved area or population

- comprehensive primary care

- fees on sliding scale

Intraprofessional assessment

- within a group who have similar positions to identify areas of improvement (nursing)

peer reviews (intraprofessional assessment)

assess other nurses in a safe, nonpunitive environment

Audits (intraprofessional assessment)

examination of records to verify accuracy and proper use

Outcomes management (intraprofessional assessment)

links medical interventions to patient outcomes using patient experiences

Interprofessional assessment

between multiple disciplines, i.e. nursing, physicians, dieticians, physical therapists, social services

Utilization review (interprofessional assessment)

use of resources to determine areas of overuse, underuse and misuse (required by Medicare and the joint commission)

Benchmarking

compares performance of individual to organization industry standards

Never event

A serious incident or error that should not happen if proper safety protocols are followed

Sentinel event

a patient safety event that results in death, permanent harm, or severe temporary harm

root cause

reason why something has happened so that preventative measures can be implemented

Continuous quality improvement

structured process for involving personnel in planning

Goal of teaching and learning

help people to have healthier lives

- one of the ANA standards of practice for nurses

- maintain and promoting health

- prevent illness

- restore health

- facilitate coping

attributes of learning

- an experience that occurs within the learner

- personal meaning and relevance

- consequence of experience

- collaborative, cooperative

- process that builds on past learning and experience

- intellectual and emotional

Cognitive domain of learning

patient can remember and understand

Affective domain of learning

changing attitudes, values, feelings

Psycomotor

learning a physical skill

6 Functions of clinical judgement

1. recognize cues

2. analyze cues

3. Prioritize hypothesis

4. generate solutions

5. take action

6. evaluate outcomes

Recognize cues

notice important information about client (assessment)

this includes gathering information from

- patient statements

- vital signs

- physical assessment

- medical history

- lab values

- observations from others

- environment

Analyze cues

Nurses look for relationships between cues to understand what is happening with the patient and what nursing problems may be present

Look for:

- patterns

- missing information

- inconsistencies

Nursing diagnosis

translate clustered cues to a patient problem

it...

- identifies a client's response to a medical condition

- assigns meaning to clustered cues

- provides basis for nurses to describe patient care

- provide basis for nursing interventions

Prioritize cues

once nursing diagnoses are written, problems must be prioritized

prioritization criteria:

- ABCCs

- Maslow's hierarchy of needs

- Safety/risk for harm

- acute vs chronic

- unstable vs stable conditions

Generate solutions

SMART goals (specific, measurable, attainable, realistic, time-bound) Client will _______ nurse will ______

Take action

- client focused

- scope of practice

- standard of care

- nurse practice act

- code of ethics

Evaluate outcomes

determine if the implemented intervention met the goal

thermoregulation

- one method of homeostasis

- body's regulatory process that balances heat production and heat loss

- core temperature stays constant

- 96.8 - 100.4F is normothermia

hypothalamus

sends signals out to body to regulate temperature

- sensors in the skin let the body know the regulatory system has to kick in

- receptors on the skin detect temperature and send message to hypothalamus

Physiological process to warm the body

- shivering increases heat production

- sweating is inhibited to decrease heat loss

- vasoconstriction decreases heat loss

Physiological process to cool the body

- sweating (diaphoresis)

- vasodilation

mechanism of heat loss

body temp too high, capillaries dilate and more blood gets to skins surface

radiation

heat is moving from the body into the atmosphere

convection

water flowing over you, air moving over you, cooling you

evaporation

body wet from sweat/in a pool, water evaporates

conduction

body is touching something colder than itself (body on operating table)

Normothermia (afebrile)

96.8F-100.4F (36C-38.5C)