302 Exam 1

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?

1. review of data isn’t enough

2. conflict is with 2+

3. 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