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