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What is the nursing process?
a roadmap to determine how best to care for our patients and to provide the most patient centered care
Identify and describe the steps of the nursing process
Assessment (look for cues/gather data)
Analysis (create hypothesis/determine problem)
Outcomes Identification (SMART with pt./determine solutions
Planning (based on goals, create interventions)
Implement (act on interventions)
Evaluate (compare initial and current assessments/ whats better? whats worse?)
What is critical thinking?
use logic and reasoning to find strength and weakness of actions
Curiosity
Confidence
Explore feelings and thought
Fair minded
Insight: ego/sociocentricity
Independent thought
Intellectual humility
Integrity
Perseverance
Nonjudgmental
What is clinical reasoning?
formal and informal strategies to gather, analyze, and weight options
What is clinical judgment?
use critical thinking and decision making to generate evidence based solution to deliver safe patient care
What is health?
the state of complete physical,, mental, and social well being
What is wellness?
able to perform the best of your ability, adapt and adjust to situations and feeling of “everything is together”
What is illness?
impairment function of physical, emotion, social etc.
What is health promotion?
promote wellness and target alterations to health
Health Care Settings
Primary (avert disease i.e primary care office)
Secondary (treat disease i.e hospital)
Tertiary (max level of wellness while focusing on disease i.e ICU)
Restorative (get back to previous state i.e home care)
Health Care Finance
Medicare (65 and up, permanently disabled - must sign up)
Medicaid (state program for low income)
PPAC 2010 (low cost to increase access)
SCHIP (low cost for free child care, 19yo, uninsured)
Private (employment long term plans)
Health Care Team
Provider i.e MD
Nurse i.e RN
Unlicensed Assistant i.e CNA
Interprofessional Member i.e PT
Patient and Family
What can influence health care delivery?
Culture
Older people Needs
Population Demographics
Pattern of disease
Veteran needs
NPA
Nurse practice act (legal agreement btw nurse and patient in communities of MO law - policies and procedures related to nursing)
ANA Scope and Standards of Practice
explains nursing as a whole
ANA Social Policy
explains how nurses should/shouldn’t use social media
Code of Ethics
provisions and rules to determine how nurses should act and perform care
What are other sources of law nurses must follow?
Federal Regulations
Civil and Criminal Laws
State Laws
Types of Tort
Unintentional (negligence and malpractice)
Quasi Intentional (breaking HIPAA/confidentiality)
Intentional (battery, assault, false imprisonment)
HIPAA/Confidentiality
Health Info Portability and Accountability Act (provides privacy and safety/confidentiality)
Confidentiality - mindful of the things you tell to others about your pt.
Ethical Principles
Beneficence - do good
Autonomy - control
Nonmaleficence - no harm
Justice - fair
Fidelity - loyalty
Veracity - truth
What makes an ethical problem an ethical dilemma?
review of data isn’t enough
conflict is with 2+
answer will effect client majorly
Moral Distress
when actions being done don’t align with what the nurse thinks
PCC
Patient Centered Care
Compassionate
Coordinated
Diversity
Developmentally available
Equity
EBP
Holistic
Inclusion
Individualized
Just
Respectful
Intentional Presence
present in the moment
intentional
keep outside factors out
be aware and bring yourself back
Diversity
what makes everyone different i.e age, gender, culture, race, language
Equity
we are not all at the same place, provide resources for everyone meet the same goal
Inclusion
intentions and embracing differences to make pts. feel wanted, acknowledged, and respected
Culture
set of beliefs shared by a group passed down from other in that group
Subculture
groups inside a culture group
Assimilation
the reason cultures change, where they take on other practices or norms from other groups (+ or -)
Cultural Values and Beliefs
influenced by belonging to a certain culture i.e eye contact
Stereotyping
assuming
Ethnocentrism
thinking you are above someone
Discrimination
unfair/unjust
Prejudice
opinion about a group based on your beliefs
Bias
Implicit: unconscious
Explicit: conscious
Racism
belief that humans are biologically different based on their race
Sexual Orientation
who people are attracted to
Gender Identity
what they go by
Gender Expression
how they dress or act
Justice
treated the same
Social Justice
equal rights/treat everyone the same
Social Determinants
non health related issues that impact health outcome i.e where you work, where you sleep, where you eat
What is Patient Bill of Rights?
1973, patients have autonomy and confidentiality
Cultural Competence
Attitude
Awareness
Skills (communication)
Knowledge
Cultural Humility
we don’t know all culture, study them and know them
Patient Advocacy
standing up for your patient when they cant for themselves
What does ANA say about communication?
“communication is an integral part of nursing”
What are the levels of communication?
Intrapersonal = self talk
Interpersonal = between 2 people
Public = presentations
Small group = support group
Types of Communication
Verbal (20%) = use words
Nonverbal (80%) = tone of voice, appearance, facial expressions, etc.
Communication Styles
Passive - others needs before own, apologetic
Aggressive - shouting, violate others rights
Assertive = convey message without disrupting others
Communication Barriers
Jargon - medical terms
Lack of Attention - center on pt.
Distractions - limit them
Light - so they can see faces head on
Hearing/Speech Issues
Language
Culture - personal space zones
Psych Barriers - stress
Physiological - pain
Physical - face to face
Perception - respect, non judgmental
What are the zones of personal Space
Personal 1.5ft-4ft
Intimate 2.5ft
Social 4-10ft
Public 10+ft
Types of Listening
Passive - something else on your mind
Active - all ears and eyes on patient
Competitive
Therapeutic Techniques
open ended questions, active listening, silence, offering yourself, accepting
Nontherapeutic Techniques
using passive or aggressing response, stereotyping, asking why
What adaptation can you make for children? adolescents? older adults?
Children - include playing, stuffed animals
Adolescents - give them choices
Older adults - be aware of cognitive barriers
What to do with a hearing impairment?
touch, position towards them for lip reading, allow time to respond, simple short sentences, assist with devices
What do you do when someone primary language is not English?
get an interpreter
What do you do when someone uses ASL?
look at them when speaking and get an interpreter
What to do when there is a vision impairment?
provide assistive devices, sit in front of them, limit glare, enough light, touch
Other Communication Disorders
APHASIA
expressive
fluent - wernicks area, can say things just doesn’t make sense
non fluent - brockas area, difficult to find words
receptive
dont understand what is being said
what is the difference between ineffective and effective communication?
EFFECTIVE
clear, respectful, professional
INEFFECTIVE
incivility
bullying
lateral violence
Empathy vs Sympathy
Sympathy you say you feel how they do, trying to be nice, but Empathy you actually do know because you went through it
Interprofessional Communication
how we can share info in order to influence patient centered care with others
Communication Builders
warmth, friendliness, openness, respect, empathy, honesty, competence, care
Communication Blockers
judge, failure to listen, stereotypes, disrespect, assuming, interrupting, why questions, defensive
ISBARR
communication tool to aid in safe handover of patient information
Identify, Situation, Background, Assessment, Recommendation, Readback
Bedside Shift Report
introduce
access medical record
use ISBARR
conduct assessment
review tasks
identify patient concerns
CUS
concerned, uncomfortable, safety issue
Caring Model Feedback
used to address inappropriate actions
Interprofessional Team Members
nurse, pharmacist, social worker, LPN, lab tech, registered dietician, etc.
Principles of Team Dynamics
shared goals
clear roles
mutual trust
effective
measurable
Conflict Management Styles
Compete (my way or hwy)
Avoid
Collaborate (high assertive
Acknowledge (notices conflict but gives it to other
Compromise (conflict can quickly occur again though)
Conflict Strategies
recognize, proactive, active listen, calm, define problem, seek solution
Types of Bias
Implicit - belief about a thing outside of conscious awareness
Explicit - deliberate holds beliefs against
Confirmation - seeking info to confirm beliefs
Note 
Flashcard (74)