Nursing 2U03: Test 1

Function of a nurse

assisting the individual, sick or well, in the performance of activities that contribute to health, recovery, or a peaceful death

Definition of nursing

(according to nursing act)

the practice of nursing

is the promotion of health and the

assessment of, the provision of, care

for, and the treatment of, health

conditions by supportive, preventive,

therapeutic, palliative, and

rehabilitative means in order to

attain or maintain optimal functio

Main nursing roles

clinical practice (bedside)

-Includes families, patients, groups, communities and population

education

administration

research

policy

Different types of nurses

RN, RPNs and NPs, all regulated by CNO

What is the difference between RN and RPN

Main difference is foundational education.

study from the same body of nursing

knowledge, RNs study for a longer period of

time, allowing for a greater depth and breadth

of foundational knowledge

Another difference between RN and RPN

level of autonomous practice

-The complexity and stability of the patient being cared for, and the environment, will determine the nursing needs.

As complexity increases and stability decreases there is greater need for the

knowledge and skill of the RN.

ie: care of a stable patient on a ward versus an unstable patient in an IC

What is an NP?

registered Nurses (RNs) in the Extended Class [RN(ECs)] with additional nursing education and experience. NP competencies build and expand upon RN competencies.

-Have legislated authority to diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform procedures

Types of roles

acute hospital setting, community, public health, primary care, hospice, visiting nurse, educator, researcher, administration, occupational health, private sector

What is a profession

An occupation whose work is based on the mastery of a complex body of knowledge and skills. It is a vocation in which the application of science or a practice of an art is used in the service of others. Members are governed by a code of ethics, commitment to competency, integrity and morality, altruism and promotion of public good.

• Considered autonomous in practice and have self-regulation

what is a professional

The primary duty is to the client to ensure

safe, competent, ethical nursing care.

• Demonstrates accountability,

responsibility, ensures safety of client,

models professional behaviour, advocates

for client, demonstrates critical inquiry,

collaborates with others, demonstrates

leadership, analyses and evaluates

practice

Attributes of professional

Knowledge, spirit of inquiry, accountability, autonomy, advocacy, innovation and visionary, collegiality and collaboration, ethicis and values

college of nurses of ontario

Regulatory body for nursing which protects public interest ensuring safe care.

• Self-regulated profession which is governed through CNO

• Must have a Certificate of Registration and College membership in order to practice in Ontario.

• Must practice in accordance of the Standards of Practice.

CNO: 4 Key functions

Article and promote practice standards

establish requirements for entry to practice

administer a quality assurance program

enforce standards of practice and conduct

Regulated health profession act: RHPA

consists of a scope of practice statement

and a series of controlled acts.

• Scope of practice is outlined in the Nursing

Act.

• There are 14 controlled acts which

regulated health professionals can perform

a portion or or all of depending on their

scope of practice. Nurses can perform 5 of

these acts

RHPA: controlled acts

. Performing a prescribed procedure below the dermis or a mucous

membrane.

2. Administering a substance by injection or inhalation.

3. Putting an instrument, hand or finger

i. Beyond the external ear canal

ii. Beyond the point in the nasal passages where they

normally narrow

iii. Beyond the larynx

iv. Beyond the opening of the urethra

v. Beyond the labia majora

vi. Beyond the anal verge

vii. Into an artificial opening into the body

4. Treating, by means of psychotherapy technique, delivered through

a therapeutic relationship, an individual’s serious disorder of

thought, cognition, mood, emotional regulation, perception, or

memory that may seriously impair the individual’s judgement,

insight, behaviour, communication, or social functioning.

5. Dispensing a drug

Nursing Act 1991

define the various classes of nurses that can be registered

outlines the regulations for entry to practice and title protection

outlines the regulations on initiating controlled act

Canadian nursing association

Act in the public interest forCanadian nursing and nurses,providingnationalandinternational leadership in nursing and health

•Advocate for a publicly funded,not-for-profit health system

•Advance nursing excellenceand positive health outcomes

•Promote profession-ledregulation

registered nurses of association of ontario (RNAO)

Foster knowledge-based nursing practice, promote quality

work environments, deliver excellence in professional development, and advance healthy public policy to improve health.

• We promote the full participation of present and future registered nurses, nurse practitioners and nursing students in improving health, and shaping and delivering health-care services.

• Lobbies the government on behalf of nurses; develops Best

Practice Guidelines for care delivery; provides educational resources for nurses

Canadian nursing student organization

To be the primary resource for Canadian nursing students.

• Influence and advance innovation and social justice in the nursing curriculum and the nursing profession

• Strengthening linkages and creating new

partnerships

CNO: practice standards

Nursing standards are expectations that contribute to public protection.

They inform nurses of their accountabilities and the public of what to expect of nurses.

Set the legal and professional basis of nursing practice.

Standards apply to all nurses regardless of their role, job description or area of practice

What are the CNO practice standards?

Confidentiality and

Privacy: Personal Health

Information

• Documentation

• Scope of Practice

• Discontinuing or declining

to provide care.’

Medication

• Nurse Practitioner

• Therapeutic Nurse-Client

Relationship

• RN Prescribing

• Code of Conduct

review!!

RNO; code of conduct

Nurses respect the dignity of patients and

treat them as individuals

• Nurses work together to promote patient

wellbeing

• Nurses maintain patients’ trust by

providing safe and competent care

• Nurses work respectfully with colleagues

to best meet patients’ needs

• Nurses act with integrity to maintain

patients’ trust

• Nurses maintain public confidence in the

nursing profession

McMaster Reflective practice model

look at slides

key components of mcmaster model

Each student comes to the learning experience with expectations influenced

by their lived experience and belonging to communities.

• They engage in new lived experiences with their tutor in the process of

becoming, through acting and knowing.

• Factors that influence this evolution include knowledge, role modelling, Ways

of knowing and political, economic and social structures.

• Outcomes include courage, respect for others and open mindedness.

• Ways of Knowing (Empirical, Ethical, Personal, Aesthetic, Emancipatory

The “What” Model

Developed by Rolf et al. 2001.

Simple, 3 step approach to

reflective practice

Three components: What, So

What and Now What.

Cyclical process that focuses on

action

What happen?

This question prompts the

reflector to describe the

experience.

Involves detailing what

happened, who was involved,

and the context of the situation.

• What happened?

• What was my role in the situation?

• What were the key events?

• What did I observe?

So what?

This question moves beyond

description to analysis.

It encourages the individual to

consider the meaning and

implications of the experience.

• So what does this mean?

• So what did I learn from the experience?

• So what was the significance of the

experience for me and others?

• So what were my feelings during the

experience, and how did they influence

my actions?

Now What?

This question focuses on the

future, prompting the

individual to think about how

they will apply what they have

learned.

Now what will I do differently in the

future?

Now what steps do I need to take to

improve?

Now what actions will I take as a result of

this reflection?

Now what further learning or

development do I need?

Clinical judgement

An interpretation or conclusion

about a patient’s needs, concerns,

or health problems, and/or the

decision to take action (or not),

use or modify standard

approaches, or improvise new

ones as deemed appropriate by

the patient’s response

clinical reasoning

The process by which nurses...make their

judgments, and includes both the deliberate

process of generating alternatives, weighing

them against the evidence, and choosing the

most appropriate, and those patterns that

might be characterized as engaged, practical

reasoning

The gist of clinical reasoning and judgment

In other words, RNs arrive at a clinical judgment through the process of clinical reasoning

Clinical judgemnt model

noticing, interpreting, responding and reflected

Noticing

Knowing the

patient through

understanding

narrative, patient’s

usual patterns

help the nurse to

notice changes.

Factors of noticing

Context: setting, situation, experience of nurse

and patient; knowing the pattern of responses

Background: understanding the narrative of

the patient

Relationship: between the nurse and patient

These combine to inform our expectations and

initial grasp of the situation

Interpreting

Combination of Reasoning patterns analytical,

intuitive and narrative thinking.

Helps to understand key information, prioritize and

what to pay attention to and what to ignore.

What is going on here?

Weighing the option

Responding

Deciding on a course of action and

taking that action.

Think about the rationale for your

actions

How did you decide on the best

option?

Do you use a standard approach, or do

you need to modify it to fit the

situation?

Observe the outcome, patient

response

Refelection

in action and on action

In action

observe and respond to the

patient’s response to your

actions/interventions

“reading the patient

On action

reflect on what worked and

what didn’t; clinical learning

to improve clinical knowledge

in similar future interaction

Learning plan

A learning plan is an agreement between

student and tutor spelling out in detail what

the student intends to learn (learning goals

and questions), how this will be accomplished

(resources and activities) and within what

period of time, the evidence that will

demonstrate the student has accomplished

the learning goals and resolved the learning

questions, and how this evidence will be

evaluated (evaluation criteria)

Nursing documentation

An important component of nursing practice that occurs within the client's health record .It is used to monitior a client’s progress and communicate with other care providers. It also reflects the nursing care that is provided to a client monitor

why do we document

1. Communication (with other providers)

2. Accountability (dont get sued)

3. Security/legislative requirement (needs to be kept for 10 years)

4. Quality improvement (if something is consistly wrong, see if intervention is being done well)

5. Research (chart auditing, seeing chart data)

6. Funding and resource management (workload tool, if you are always busy, you might get more funding. staff, etc)

CNO: Documentation practice standard (2008)

explains the regulatory and legislative requirements for nursing documentation

Communication

Accurate, clear and comprehensive

Accurate, clear and comprehensive

documentation reflects all aspects of care provided; needs, interventions, outcomes (all aspects of care)

objective and subjective data

significant communication with family members/significant others

Informed consent

Written charting includes a full signature and designation (Mac L2, Mac L3, Mac L4)

use approved abbreviation

objective data

what you see, feel, hear, smell

subjective data

what the patient states (goals, concerns, symptoms). What is said as evidence in quotations

Communication: Factual

do not use vague terms (appears, seems, apparently)

No opinions (ex. client seems anxious, patient is difficult)

Reflective of observation not unfound conclusions

Accountability: acccurate, timely and complete

in a timely manner, completing as soon as possible after, the care or event

handwritten documentation is legible and completed in permanent (blue/black) ink

date and time that care was provided and when it was recorded

documenting in chronological order

indicating when an entry is later

ex, 10:45. I did vital at 10:15

do not wait til the end of shift especially things that can change rapidly such as vitals and physcial assessements

Accountability: accurate, timely and complete written documentation

do not leave empty lines; if there are empty lines, draw a line through (paper charting)

never deleting, altering or modifying anyone else’s documentation

the individual who perfomed the action or observed the event completes the documentation

when correcting errors ensure that the original information remains visible/retriable (draw single line through and initial)

Security

ensuring that relevant client care information is captured in a permanent record

accessing only information for which the nurse has a professional need to provide care

maintaaning cofidentality of client health information, including passwords (i.e client information not to leave facilty)

Obtaining consent from patient to disclose information outside the circle of care

ensure the secure and confidental destruction of documents that are no lonegr in use

Abbreviations

see slide 14

Types of documentation

electronic, computerized

flow sheet (vital signs, intake and output)

care plan/critical pathways (CHF and COPD)

narrative

documentation framework

documentations framework

Problem orientated: data is organized bu patient problem or dignosis

DAR: data (objective/subjective), action and response, There most important thinga that happen, what did you do and what did the patient say/react ex. chest pain, gave them meds, they felt less pain (1/10)

SOAP: subjective data, objective data, assessment, plan (This is what doctors do)

Subjective data: what does the patient tell us

symptoms, feelings, perceptions and concerns

object data: what we see

observable and measurable

-vital signs

-physical assessments

lab results

chain of infection

infectious agent

reservoir

portal of exit

mode of transmission

portal of entry

susceptible host

need all six to get someone sick

Infectious agent

most common: bacteria and fungi

1. Infectious Agent:

 Bacteria, Viruses, Fungus, Parasite, Prion

 Essentials of Bacterial growth:

• Nutrient

• Moisture

• Temperature

• pH (acidity or alkalinity)

• Oxygen (aerobic bacteria only)

Risk factors:

cleaning practices, sharing rooms, sharing equipment, poor hand hygiene by health

care workers

reservoir

A place where an organism/pathogen can survive but may or

may not multiply.

 ie. Animals, food, water, insects even inanimate objects

Risk factors:

cleaning practices, sharing rooms, sharing equipment, poor hand hygiene by health

care workers, cleaning practice

portal of exit

how to leave the reservoir

Exits in the human body include

body openings

Mouth, Nose, Rectal, Vaginal,

Urethral, Ostomies, Breaks in skin /

wounds

• Pathogens carried through

the portals through:

 Blood

 body fluids (urine, feces)

 excretions (pus, wound)

 Secretions (semen)

 Saliva / sputum

 Mucus

Risk factors:

Wounds, body fluids, shared equipment

mode of transmission

this is where we can remove/break the chain, the other factors can only be controlled

e

• Direct contact: between the infectious agent and the susceptible host.

• Indirect contact: between a susceptible host and a contaminated intermediate

object (fomite) such as a needle, instrument or other equipment

• Modes include contact, droplet (sneeze), airborne (dust), vehicle (instrument,

food), vector (insect)

Risk factors:

Shared rooms and equipment, poor hand hygiene

Portals of entry

.

• Organisms can enter the body through the same routes they use to exit

• Body openings (GI, mucous membranes, respiratory)

• Breaks in skin

• Breaks in mucous membranes

• Needle piercing the skin

• Devices (ie. catheter; longer in place – greater risk

Risk factors:

Devices: IV, catheter; wound

Susceptible host

person in hospital

Risk factors:

Impaired immunity or physiology, Secondary health problems - ie diabetes, Poor

nutritional status, Altered normal body flora – antibiotic use, Age (children and

elderly more at risk), Exposure to infectious agents, Invasive procedures, Tissue

injury or inflammation, Altered ph of secretion

risk assessment

The first step in the effective use of

Routine Practices is to perform a risk

assessment. A risk assessment must be

done before each interaction with a

client/patient/resident or their

environment in order to determine

which interventions are required to

prevent transmission during the

interaction, because the

client/patient/resident’s status can

change.

4 MOMENTS FOR HAND HYGIENE

beofre intial patient enviornment contact (entering room)

before asptic procedure (dressing change)

after body fluid exposure

after patient envionrment contact (walk out of room, wash hands)