Final exam CB 253

coping

adjusting to unusual demands or stressors

giving a greater effort and using greater energy needed in ADLs

stress

a state of changing that occurs automatically as a result of physical, mental, and emotional stresses that cause positive and negative emotions and have physical and mental effects

acute stress

most common, occurs for short period of time
reaction to a real or perceived demand, threat, or pressure
eliminate stress response

episodic acute stress

self inflicted or in regular chaos
common among type A personalities
taking on unrealistic assignments

chronic stress

perceptual or sustained demand, threat or pressure harmful to health
continuous
long-term stress, no hope

physiological stressor

injury, illness

psychological/emotional stressor

occupation, relationship, academic

problem-focused coping

HEALTHY:
generating solutions to reduce or eliminate identified stressors action is taken to manage or change situation or circumstance associated with stressor
eliminating or reducing harm from stressor

emotion-focused coping

HEALTHY:
emphasizes regulation of emotional response
maintaining emotional control through self-regulating thinking and behavior
no change, but control

meaning-focused coping

HEALTHY:
draws on values beliefs, and goals to modify personal interpretation and response
conversation with reliable person to find meaning of situation

UNHEALTHY coping

not addressing the problem
ignoring the problem
abuse of alcohol, drugs, or bad eating habits

Florence Nightingale

crimean war era
founder of modern nursing, hygienic practices

Harriet Tubman

civil war
conductor of underground railroad saving 300+ lives
volunteered for Union Army to care for African American soldiers
founded Harriet Tubman Home for Aged

Walt Whitman

1819-1892
journalist + poet
during civil war volunteered as nurse for union army after visiting his brother in an army hospital
wrote poem "The Wound-Dresser"

Mary Elizabeth Mahoney

1845-1926
first black professional nurse US

Lillian Wald

1865-1940
public health nurse
Henry Street Settlement

Mary Brewster

Henry Street Settlement

Clara Barton

1881
started red cross

Mary Adelaide Nutting

1st nursing professor at Columbia Teacher's College
moved nursing education into universities

Mary Breckinridge

founder of Frontier Nursing Service

concepts of metaparadigm of nursing

1: optimal functioning of the human being, person, or patient
2: how people interact w/environment
3: healing of illness and health promotion
4: nursing role

metaparadigm

an overarching set of concepts broad conceptual boundaries of a discipline

Hildegard Peplau

roles played by the nurse and the interpersonal process between nurse and patient

Virginia Henderson

assisting individuals to gain independence in relation to performance of activities contributing to health or its recovery

Betty Neuman

assist w attaining and maintaining maximum wellness focused on patients response to stressors and strengthening their lines of defense

Jean Watson

based on caring, w nurses dedicated to health and healing TRANSPERSONAL CARING

novice

no experience, rigid adherence to rules or plans little situational perception, no discretionary judgement, beginning of analytical decision making

advanced beginner

more sophisticated rules beginning situational perception

competent

working 2-3 years, more analytical thinking, lacks speed and flexibility sees action at least partly in terms of longer term goals, conscious deliberate planning

proficient

experiences to make decisions, situations seen holistically and most important perceives deviations from normal pattern decision making less labored, uses maxims for guidance meaning of which varies according to situation

expert

no longer relies on rules, guidelines or maxims, intuitive grasp of situations based on deep tacit understanding, analytic approaches used only in novel situations or when problems occur, visions of what is possible

What is the nurse practice act?

provides the scope of practice defined by each state or jurisdiction and set forth the legal limits of nursing practice

who regulates the nurse practice act?

the Board of Nursing

What does the nurse practice act do for the public?

regulates and protects the public from practitioners who are a risk to the health, safety, and welfare of the citizens within state board jurisdiction

what are the roles of the nurse?

leader, manager, researcher, collaborator, educator, advocate, delegator, change agent, care provider

RN

assess health conditions, function independently, ADPIE

LPN

contributing to assessment of health status of individuals or groups, function dependently under RN or physician always

unprofessional conduct

crime that has bearing on one's ability to practice competently

professional conduct

a compilation of ethical rules designed to guide the nurse in making the correct decision in difficult patient-care situations

standard 1 assessment

the RN collects comprehensive data important to the client health

standard 2 diagnosis

RN analyzes assessment data to determine diagnosis or issues

standard 3 outcomes identification

RN identifies expected outcomes for a plan individualized to patient or situation

standard 4 planning

RN develops plan that prescribes strategies and alternatives to attain expected outcomes

standard 5 implementation

RN implements the identified plan
a- coordination of care
b- teaching health promotion
c- consultation
d- prescriptive authority and treatment

standard 6 evaluation

RN evaluates progress toward the attainment of outcomes

standard 7 ethics

RN practices ethically

standard 8 education

RN attains knowledge and competency that reflects nursing practice

standard 9 evidence-based practice and research

RN integrates evidence and research into practice

standard 10 quality of practice

RN contributes to quality nursing practice

standard 11 communication

RN communicates effectively in all areas of practice

standard 12 leadership

RN demonstrates leadership in professional practice setting and profession

standard 13 collaboration

RN collaborates w health care consumer, family and others in the conduct of nursing practice

standard 14 professional practice evaluation

RN evaluates her or his own nursing practice in relation to professional practice standards and guidelines relevant statues rules and regulations

standard 15 resources

RN uses resources to plan and provide nursing services that are safe effective and financially responsible

standard 16 environmental health

RN practices in an environmentally safe and healthy manner

who makes up the healthcare team?

nurse, LPN, PCA, CAN, APRN
physician, primary care, specialists, surgeons
PATIENT/FAMILY is the center
PT, RT, recreational therapy, RD, CST
chaplaincy, social work, psychology, psychiatry

What is inter professional practice

when multiple health workers from different professional backgrounds, work together w patients, families, care-givers, and communities to address local health care needed to deliver highest quality care

What did the IOM report “To err is human” find as contributors to medical errors?

concerns about quality of US healthcare system
48k-98k Americans die each year due to medical errors
lack of teamwork, collaboration, and communication
costly healthcare yet poor outcomes

What are the competencies associated with Inter professional Education?

shared goals, clear roles, effective communication, measurable processes and outcomes, mutual trust

values and ethics, roles, responsibilities, IPC, and teams/teamwork

Critical thinking

ability to apply higher order cognitive skills and disposition to be deliberate about thinking (open minded or intellectually honest) leads to action that is logical and appropriate

clinical reasoning

ability to focus and filter clinical data to recognize what is most and least important so nurse can identify if actual problem is present

clinical judgement

combines critical thinking, clinical reasoning, and repetitive decision making skills of the nurse

clarity

easily understood

accuracy

true and correct way

precision

providing sufficient detail

relevance

focusing on facts and ideas directly related to topic

depth

beneath surface of topic or problem to identify and manage related complexities

breadth

considering a topic, problem, or issue from every relevant view point

logic

using mutually supportive and sensible combination of thoughts and facts to form a conclusion

significance

concentrating on most important information

fairness

thinking or acting in accord w reason and without bias

inductive reasoning

likely conclusion
probability
reasonable confidence
making inference based on widely accepted facts or premises

deductive reasoning

certainty
guaranteed
conclusion
proof
making an inference based on observation often sample

methods for improving critical thinking skills

discussions w colleagues
emotional intelligence
audible verbalization of thoughts
literature review
intentional application of knowledge
concept maps
simulation
role playing
written work

self care in nursing

make a plan, make a commitment

What happened to Sue Sheridan family, what could have prevented it, and what is she doing now?

both loved ones had poor health outcomes, one died, one left with serious health issues. cofounded and is past president of Parents of Infants and Children with Kernicterus

What are the barriers to team performance?

lack of time, hierarchy, defensiveness, conflict, fatigue, inconsistency, team membership, workload, lack of role clarity, distractions

What are the four core skills of team performance?

leadership, communication, situation monitoring, mutual support

What are the three team related outcomes?

knowledge, attitudes, performance

What are the common traits of high performing teams?

hold shared mental models, have clear roles/responsibilities, have clear valued and shared visions and optimize resources, strong team leadership, engage in regular discipline of feedback, develop strong sense of collective trust and confidence, create mechanisms to cooperate and coordinate, and manage and optimize performance outcomes

What defines a team?

2 or more people who interact dynamically, interdependently, and adaptively towards a common valued goal, have specific roles or functions, and have a time-limited membership

What are strategies to involve the patient in their care?

include patients in bedside rounds, conduct handoffs at bedside, provide communication tools for patient so they can communicate with the care team, involve patients in key committees, actively enlist patient participation

What are the clinical team responsibilities when working with patients and their
families?

listen to patients and families, assess patients preferences regarding family involvement, ask patients about their concerns, speak to them in LAY TERMS, allow time for patients and families to ask questions, ask for their feedback, give them access to relevant info, encourage patients to proactively participate in patients care

What are the patient and family responsibilities as a part of the

provide accurate patient info, comply w prescribed plan of care, ask questions/voice concerns regarding plan of care, monitor report changes in patients conditions, manage family members, follow instructions of clinical team

What are the parts of the multi team system?

patient, core team, contingency team, coordinating team, ancillary and support services, administration

What are the roles of the different parts of the multi team system?

core team: group of care providers who work interdependently to manage a set of assigned patients from pint of assessment to disposition
contingency team: time limited team formed for emergent events
coordinating team: compromising the work area members who are responsible for managing the operational environments supporting core team
ancillary services: provide direct task specific time limited care to patients
support services: provide indirect service focused tasks which help to facilitate the optimal health care experience for patients/families
administration: establish/ communicate vision, develop policies and set expectations for staff related to teamwork and define culture of organization

What is a sentinel event? What was the root cause of 66% of sentinel events according to a report by the Joint Commission?

anything that causes death or severe harm to a patients in a healthcare setting, ineffective communication caused 66% of sentinel events

What are the standards of Effective communication? Be able to identify them in an example.

complete: communicate all relevant info
clear: convey info that's plainly understood
brief: communicate info in concise matter
timely: offer and request info in an appropriate timeframe, verify authenticity, validate, or acknowledge info

What are challenges to communication?

language barrier, distractions, physical proximity, personalities, workload, varying communication styles, conflict, lack of info verification, shift change

ISBARR- Know the components and be able to identify them in an example

Introduction
Situation
Background
Assessment
Recommendation
Readback

What are the different handoff techniques?

I PASS THE BATON

ANTICipate

I PASS

SHARQ

What are the types of team leaders?

designated: person assigned to lead organize a team, establish clear goals, facilitate open communication and teamwork among members
situational: any team members who has skills to manage situation at hand

What are the characteristics of effective team leaders?

define, assign, share, monitor, and modify plans, review team performance, establish "rules of engagement" manage + allocate resources effectively, provide feedback regarding assigned responsibilities + progress toward the goal, facilitate info sharing, encourage team members to assist each other, facilitate conflict resolution, model effective teamwork

What should be considered when defining the plan?

time (enough to complete tasks and activities), people (necessary knowledge and skills), equipment (working and available), info (necessary info collected and reviewed)

Define briefs, huddles, and debriefing.

briefs: sharing plan beforehand (between clients and agencies)
huddle: "touch base" meetings (start of a work day before shift)
debrief: informal info exchanged during feedback session, recounts key events what went right what went wrong how to fix for next time (after critical events)

What is the leaders role in conflict resolution

facilitate conflict resolution to avoid compromising patient safety + quality of care, don't allow interpersonal or irrelevant issues to negatively affect team, helps team members master conflict resolution technique

What are the components to situational monitoring and which are individual outcomes vs team outcomes?

situation monitoring (individual skill)
situation awareness (individual outcome)
shared mental model (team outcome)

What are the critical elements to monitor for patient safety? (STEP mnemonic)

-Status of the patient (history, vital signs, meds, exam, care plan, mental state)
-Team members (fatigue, workload, task performance, skill & stress level)
-Environment (facility info, admin. info, HR, triage acuity, equipment)
-Progress toward goal (huddle, status of patient, goal of team, task/actions need completed, plan still appropriate)

Know and be able to identify the I’M SAFE checklist

I: illness
M: med (CAN'T WORK ON NARCOTICS)
S: stress
A: alcohol and drugs
F: fatigue
E: eating & eliminating (bathroom to prevent UTI)
Team safety

What are the conditions that undermine situational awareness?

failure to: share info w team, request info from others, direct info to specific team members, include patient or fam in communication, utilize resources fully, maintain documentation, know and understand where to focus attention, know and understand plan, inform team members of plan changes