Nursing Basics (Class 1) (copy)

First class. Covers Tanner Model and The Joint Commission/Safety

Nursing

“The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy of individuals or populations.”

Essential Concepts

Core/fundamental values (Communication, evidence-based practice, health promotion, management of care, nursing process, patient-centered care, pharmacology, safety)

General Concepts

Topics to enhance learning experiences. (Biophysical, psychophysical, healthcare, and professional nursing)

Biophysical

* Acid-Base
* Cellular regulation
* Comfort
* Digestion
* Elimination
* Fluids and electrolytes
* Immunity
* Infection
* Inflammation
* Intracranial regulation
* Metabolism
* Mobility
* Nutrition
* Oxygenation
* Perfusion
* Perioperative care
* Sensory perception
* Sexuality
* Thermoregulation
* Tissue Integrity

Psychosocial

* Addiction
* Cognition
* Development
* Family
* Grief and loss
* Mood and affect
* Self
* Stress and coping
* Violence
* Reproduction

Professional Nursing

* Accountability
* Advocacy
* Clinical decision making
* Collaboration
* Ethics
* Health assessment
* Legal issues
* Professionalism

Healthcare

* Health care delivery systems
* Health policy
* Quality improvement
* Technology/Informatics

Clinical Judgment

An interpretation or conclusion about a patient’s needs, concerns, or health problems; and/or the decision to take action.

Clinical Reasoning

The process by which a nurse makes their judgements, by using the deliberate process and evidence based practice.

Tanner Model

* Notice
* Interpret
* Respond
* Reflect (In-action and On-action)

Noticing

The nurses’ expectation and initial grasp of the situation. (Barebones information.)

Noticing Example

A patient’s vitals are:

BP= 140/90

HR= 95

Interpreting

Analytical or intuitive interpretation of data.

Interpreting Example

A blood pressure of 140/90 indicates a high blood pressure.

Respond

Course of action (or lack thereof) based on interpretation.

Respond Example

Administer a vasodilator to lower a patient’s blood pressure.

Reflect-in-action

A nurse’s ability to “read” the patient. Response to the nursing intervention which can lead to adjustments based on the data found in the assessment.

Reflection-on-action

Reassessment of the response. Contributes to the knowledge gained or learned from the experience.

Reflection-in-action Example

Monitoring the patient for any side effects.

Reflection-on-action Example

Reassessing the patient’s BP and heart rate.

The Joint Commission

Regulate hospitals and assess them on patient safety. Run the “Speak Up” program which helps teach patients and family members how to advocate for themselves.

Safety Culture

An essential component of a successful patient safety system is a crucial starting point for hospitals striving to become learning organizations, as well as a general feeling of shared attitudes that foster patient safety.

Nursing Responsibilities in Safety Culture

* First priorities
* Value transparency, accountability, and mutual respect
* Avoid behaviors that undermine a culture of safety
* Collective mindfulness is present
* Do not deny or cover up errors
* Report and learn from patient safety events

Disruptions in Safety Culture

* Inappropriate words
* Shaming others for negative outcomes
* Unjustified negative comments
* Refusal to comply with practice standards
* Not working collaboratively or cooperatively with other members
* Creating rigid or inflexible barriers
* Not returning pages or calls promptly

Patient Safety/Adverse Event

An event, incident, or condition that could have or did result in (any) harm to a patient.

Omission

Harm caused by a lack of ______.

Commission

Harm caused by excess ______.

Sentinel Event (Never Event)

A patient safety event that reaches the patient and results in the following:

* Death
* Permanent harm
* Severe temporary harm

Examples of Sentinel Events

* Suicide while on suicide watch
* Discharging an infant to the wrong family
* Rape
* Reaction to the wrong blood type
* Loss of a limb
* Infant Abduction
* Surgery on the wrong body part

Close Call

A patient safety event that did not cause harm as defined by the term sentinel event.

Close Call Example

Giving a patient the wrong medication, but it passes through their system and does not cause any adverse reactions.

Hazardous Conditions

A circumstance (other than the preexisting condition) that increases the probability of an adverse event.

Trust-Report-Improve Cycle

Trust promotes reporting, which leads to improvement, which in turn fosters more trust.

what does a nursing assessment involve?

A combination of health history, observing, and performing a physical examination

why is it important to complete an assessment

It is ongoing so by completing it the nurse can go back and reassess to see what is working/what is not. This way the nurse can continue to meet any other upcoming health concerns, management, or change in status

what is the purpose of completing an initial assessment?

to quickly identify health concerns

when do you use Head to toe (comprehensive)

done daily, upon admission, and initial evaluation

when do you use Focused assessment (periodic)

home health visits, emergency evaluation, changes in evaluation

primary sources of data

Patients, caregivers or family (if minor or unable to speak them

secondary sources of data

family, caregivers, medical records, diagnostic data

subjective data

descriptions (verbal) that the patient gives to the provider

objective data

what nurses sees, hears, or feels (vitals, the temp of spin, etc.)

sitting position

supine position

prone position

inspection (what nurse should expect each area for)

* size
* shape
* color
* symmetry
* position
* abnormality