Intro to Nursing Final Exam

intrapersonal communication

communication with oneself

interpersonal communication

* the exchange of thoughts, feelings, and beliefs between two or more people
* the most common form of communication among nurses

small group

conversations with about 10 people or less

public

- talking to a large group
- as a nurse this may happen at a community center when presenting to people

electronic

emailing, texting, faxing, etc.

nontheraputic communication

- communication techniques, both verbal and nonverbal, that hinder the nurse-patient relationship
- ex. asking personal questions, defensive responses, arguing, false reassurance

theraputic communication

- Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.
- ex. sharing observations, empathy, providing information, clarity, paraphrasing, asking relevant questions (open and closed ended)

cognitive

- Includes all intellectual behaviors and requires thinking
- Teaching facts and concepts
- Working with a patient with COPD and teaching them about signs and symptoms, etc

affective

- Deals with expression of feelings and development of attitudes, opinions beliefs, or values
- More often has to do with coping
- Patient w copd has anxiety about having to stay on oxygen at home

psychomotor

- Involves acquiring skills that require coordination and integration of mental and physical movements
- Learn how to give injections, use a walker
- Best way to teach is through demonstration
- COPD patient is taught how to use the inhaler

environmental factors that impact learning

- darkened room interferes with a patient's ability to watch your actions, especially when demonstrating a skill
- a room that is cold, hot, or stuffy makes a patient too uncomfortable to focus on the information being presented
- quiet setting offers privacy; infrequent interruptions are best
- Make sure that the size of the room does not overwhelm the group

teach back

- a closed-loop communication technique that assesses patient retention of the information given during a teaching session
- ask the patient to explain material that was discussed, such as the role of diet and exercise in managing blood glucose levels, or to demonstrate a skill, such as self-monitoring blood glucose.

Maslow's Hierarchy of Needs

- physiological (oxygen, fluids, nutrition, shelter, sex), safety (physical and physiological), love/belonging, esteem, self-actualization
- the focus of care is on a patient's needs rather than on strict adherence to the hierarchy

primary prevention

- True prevention that lowers the chances that a disease will develop
- Health education, marriage and genetic counseling, sex education, immunizations, bicycle helmets, seat belts, and avoiding smoking

secondary prevention

- Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions
- Mammograms, colonoscopy, taking daily aspirin to prevent heart attack or stroke, modifying the work environment to allow injured client to safely return to work, prevent spread of communicable diseases

tertiary prevention

- Occurs when a defect or disability is permanent or irreversible
- Minimizes the effects of long-term disease/disability with a focus on rehabilitation; use of wheelchair or other assistive devices to support greater independence, cardiac or pulmonary rehabilitation

providing presence

- being with
- eye contact, body language
- tone of voice
- listening
- positive and encouraging attitude

knowing

- Avoid assumptions assess thoroughly, seek clues to clarify, engage with self/both
- Asking your patients questions, not making snap judgements. Normally performed during assessment

being with

- Conveying ability, sharing feelings, not burdening and being there
- Being emotionally present with the patient; it makes them more likely to open up

doing for

- Comforting, anticipating, performing skillfully, protecting and preserving dignity (protection: helping a patient ambulate to the bathroom) (dignity: closing the curtain when changing a patient)
- Performing some type of care for the patient by giving a heating pad or pain medication

enabling

- informing/explaining, supporting/allowing, focusing, generating alternatives, validating feedback
- providing education to the patient and the family especially during a time of transition such as when the patient is having a baby or when someone is dying

maintaining belief

- believing in/holding in esteem, maintain hope, offer realistic optimism, going the distance
- maintain realistic hope, if the patient wants to be visited by a rabbi or a priest the nurse accommodates for that

spiritual caring

- Spiritual health is achieved when a person can find a balance between his life, values, goals and belief symptoms and those of others
- Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness

relieving symptoms and suffering

- Performing caring nursing actions that give a patient comfort, dignity, respect, and peace
- Providing necessary comfort and support measures to the family or significant others
- Creating a physical patient care environment that soothes and heals the mind, body, and spirit
- Comforting through a listening, non-judgemental, caring presence

task oriented touch

- Educating the patient, performing the skill competently, and explaining the procedure as you go
- When performing any type or a nursing procedure

caring touch

- holding a patient's hand, giving a back massage, etc.
- Putting your hand on a patient to gently reposition them

protective touch

- Preventing the patient from hurting themselves
- Making sure the patient does not fall of the bed when cleaning them

autonomy

- ability to make independent decisions about actions that you can take as a nurse
- involves the initiation of independent nursing interventions without medical orders.
- telling a patient to cough or use the spirometer to help with breathing

caregiver

- providing active care
- help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process
- provide evidence-based nursing care to promote healing through both physical and interpersonal skills.
- Administering medication
- Feeding
- IV insertion
- Changing sheets

advocate

- protect your patient's human and legal rights and provide assistance in asserting these rights if the need arises. you act on behalf of your patient and secure your patient's health care rights
- fighting for their legal right
- Contacting the provider to explain a procedure

accountability

- responsible professionally and legally for the type and quality of nursing care provided. You must remain current and competent in nursing and scientific knowledge and in technical skills.
- responsibility for actions that you make
- Making a mistake and owning up to it
- Following up on any errors

educator

- explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning
- teaching patients how to do something
- How to administer insulin, how to put something on, etc

communicator

- allows you to know your patients, including their preferences, strengths, weaknesses, and needs
- transfer info clearly and competently to other health care providers
- making sure info is clear to HCP

manager

- oversees the unit as well as is a clinical expert
- establish an environment for collaborative patient- centered care to provide safe, quality care with positive patient outcomes.
- coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency

florence nightengale

- established the first nursing philosophy based on health maintenance and restoration
- lady with the Lamp
- first practicing epidemiologist
- organized first school of nursing
- improved sanitation in battlefield hospitals
- showed how effective fresh air, hygiene, and nutrition were treatment of wounded soldiers
- her biggest contribution was decreasing hospital acquired infections

clara burton

Founded the American Red Cross in 1881

dorthea lynde dix

- Revolutionized care for the mentally ill
- Best known for her patient advocacy in fighting to improve the conditions of jails and mental asylums in North America and Europe

mary mahoney

- First professionally trained African American nurse
- ANA award in her honor given biannually to nurse for recognition of contribution in interracial relationships in nursing

susan king taylor

- 1st black army nurse
- civil war nurse who published memoir Reminiscences of my Life in Camp with the 33rd United States Colored Troops, Latre 1st S.C. Volunteers
- first African American to teach children and adults openly in a school for former slaves in GA

lillian wald

- Founder of public health nursing
- As a civil rights activist, she insisted that all Henry Street classes be racially integrated
- In 1909, she became a founding member of the NAACP

mary brekenridge

- established frontier nursing services in 1925
- provided primary care to women and babies in Kentucky
- started first midwifery school in the US in 1939

virginia henderson

- wrote first nursing textbook
- most influential nurse of the 20th century
- Establishes tools that promoted nursing research
- considered the florence nightingale of her time

isabella hampton robb

- instrumental in establishing the National League for Nursing, International Council for Nurses, American Nurses Association
- 1st president of the ANA
- Founded the American Journal along with other nursing pioneers

mary adelaide nutting

the first nursing professor at Teachers College at Columbia and instrumental in moving nursing education into the university setting

QSEN (Quality and Safety Education for Nurses)

- addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments
- encompasses the competencies of patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics

patient centered care

- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.
- Not dictating how they should manage their care, being open to what they want as the patient, being aware of religious beliefs
- Involve family and friends in care. Elicit patient's values and preferences. Provide care with respect for diversity of the human experience.

teamwork and collaboration

- Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.
- Examples: Recognize the contributions of other health team members and patient's family members. Discuss effective strategies for communicating and resolving conflict. Participate in designing methods to support effective teamwork.

evidence based practice

- Integrate best current evidence with clinical expertise and patient and/or family preferences and values for delivery of optimal health care.
- Examples: Demonstrate knowledge of basic scientific methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the importance of regularly reading relevant journals

quality improvement

- Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
- Examples: Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gaps between local and best practices.
- Identify a problem or issue in a health care setting
- Problem-solving/troubleshooting by collecting and analyzing data
- Coming up with an intervention and assessing after

safety

- Minimize risk of harm to patients and providers through both system effectiveness and individual performance.
- Examples: Examine human factors, basic safety design principles, and commonly used unsafe practices. Value own role in preventing errors

informatics

- Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.
- Examples: Navigate an electronic health record. Protect confidentiality of protected health information in electronic health records.

genomics

- a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that person's environment
- when combined with technology it can potentially improve health outcomes, quality, and safety and reduce health care costs

emerging technology

- provide more accurate, noninvasive assessment tools; help you to implement evidence-based practices; collect and trend patient outcome data; and use clinical decision support systems.
- will assist you to communicate, provide care for, and build relationships with your patients. Telehealth, e-visits, and devices that allow your patient to phone in pertinent health information are examples of technology that open new venues for providing care.

national patient safety goals

- Aim to improve patient safety by focusing on problems in health care safety and providing actions that help to solve them or prevent them from occurring
- Identify patients correctly
- Improve staff communication
- Use medicines safely
- Use alarms safely
- Prevent infection
- Identify patient safety risks
- Prevent mistakes in surgery

identify patients correctly

Use at least two ways to identify patients. For example, use the patient's name and date of birth

use medicines safely

making sure to follow the 6 rights of medication distribution

use alarms safely

- Pay attention to the alarm
- When cardiac monitor starts to beep, get up and go assess
- Set alarm parameters appropriately

prevent infection

- Wash hands
- Make sure to wear appropriate PPE

improve staff communication

-Get important test results to the right staff person on time.
- Effectively communicating info to the right provider
- Don't wait to report things

prevent mistakes in surgery

Doing a "time out" (whole team gets together to verify right patient and right procedure)

falls

- Older adults
- People with mobility issues
- Blood pressure medications, diuretics, opioids

chemical exposures

Chemotherapy, anesthesia, cleaning supplies and disinfectants

workplace safety

- bullying, name calling, verbal threats, and physical injury
- the act or threat of violence, ranging from verbal abuse to physical assault, directed toward persons at work or on duty
- the impact of workplace violence ranges from psychological issues (e.g., posraumatic stress disorder [PTSD], compassion fatigue) to physical injury or death

procedure related accidents

- nurse fails to do a nursing intervention or procedure correctly
- result of healthcare provider action
- medication error, improper application of a device or performance of a nursing procedure, such as wound care or catheter insertion using wrong technique

equipment related accidents

- equipment is no functioning correctly
- malfunction, misuse or electrical hazard from faulty equipment

fires (at home)

- careless smoking, especially when people smoke in bed at home
- improper use of candles
- improper use of cooking equipment and appliances
- stoves
- space heaters

patient's home environment

- Perform hazard assessment
- Walk through the home with the patient and discuss how he or she normally conducts daily activities and whether the environment poses problems
- Help individuals focus on avoiding losses and reducing their risk for injury associated with disasters

client safety questions

- Do you use any assistive devices, such as a wheelchair, walker, or cane, to help you move or get around?
- Which medications (prescription, over-the-counter, herbal) do you take?
- Have you ever fallen or tripped over anything in your home? Have you had any near misses?
- Who does your simple home maintenance or minor home repairs?

patient teaching (fires)

- RACE and PASS
- Drill and evacuation plan
- Alarms, extinguishers, exits, and oxygen shut off valve

RACE

rescue, alarm, contain, extinguish

PASS

Pull, Aim, Squeeze, Sweep

patient teaching (falls)

- Follow fall protocols
---Hourly rounding (used to prevent falls and to check on pts), yellow fall risk bands/signage, non-slip socks, room assignment
- Patient-centered care
---Do you need a gait belt? low bed? bedside commode?
- Assistive aids
---Walker, cane, crutches, safety bars in bathroom/showers, wheelchairs

restraints

- Last resort!!!
- Pt are more likely to injure themselves when in restraints
- attempt alternatives such as exercise, hobbies, frequent checks, family, bed and chair alarms
- Obtain a doctor's order
- Ongoing assessment/documentation needed
- Patient and family teaching

restraints must meet one of the following

- Reduce risk of injury from falls
- Prevent interruption of necessary therapy (traction, IV therapy, nasogastric feeding)
- Prevent confused or combative clients from removing life-support
- Reduce risk of injury to others by the client

seizures

- Can cause the pt to injure themselves
- Nothing in their mouth
- Turn them to the side
- Observe and make sure there is nothing dangerous in their area

radiation

- Limit exposure, lead aprons, tracking devices
- Working in interventional radiology (measures put in place to make sure radiation exposure is limited

infancy interventions

- keep objects out of the baby's sleep area
- they should be immunized and have regular checkups
- never leave the child alone

preschooler interventions

- teach children to swim
- teach them not to speak with strangers
- teach them to cross a sidewalk

school age children interventions

- teach bicycle safety
- don't allow them access to firearms
- teach them to not handle electrical equipment unsupervised

adolescent interventions

- provide examples of how to behave, set expectations, and provide education to minimize risks to the adolescent's safety
- be prepared to teach adolescents and their parents the measures needed to prevent accidents and injury
- promotion of good problem-solving abilities
- restricted access to highly lethal means of suicide

adult interventions

- classes to help quit smoking
- stress management, including employee-assistance programs
- encourage adults to exercise regularly, maintain a healthy diet, practice relaxation techniques, and get adequate sleep

older adult interventions

- reduce patients' risk for falls and other accidents and compensate for the physiological changes of aging
- Provide information about neighborhood resources to help an older adult maintain an independent lifestyle

world view

- a set of assumptions that begins to develop during childhood and guides how one sees, thinks about, experiences, and interprets the world

health disparities

- a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
- Poor health status, disease risk factors, poor health outcomes, and limited access to health care
- Negatively affect groups of people who have systematically experienced social or economic obstacles to health

emic

- insider point of view
- The nurse has an ... world view of professional postpartum care but is an outsider to the Korean culture. As such, the nurse is not aware of the meal's significance to the patient.

etic

- outsider point of view
- the Korean patient has an ... world view of American professional postpartum care and assumes that the seaweed soup is available in the hospital because, according to her cultural beliefs, the soup cleanses the blood and promotes healing and lactation

iceberg analogy

a tool that helps you to visualize the visible and invisible aspects of your world view and recognize that the same applies to your patients

social determinants of health

- the conditions in which people who are born grow, love, work, and age
- conditions shaped by access to power resources and money
- include factors such as age, race, ethnicity, socioeconomic status, access to nutritious food, transportation resources, religion, sexual orientation, age, level of education. literacy level, disability (physical and cognitive), and geographical location

spiritual well being

- Having meaning and purpose in life
- Experienced a hard situation in life and continues to persevere
- Transcendent relationship between an individual and God or a higher being
Positive connections with others

marginialized groups

- more likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems, and the clinical care they receive
- Gay, lesbian, bisexual, or transgender; people of color; people who are physically and/or mentally challenged; and people who are not college educated

spiritual distress

- impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself
- a disruption in the life principle that pervades a person's entire being and transcends the person's biologic and psychosocial nature"
- Acute illness, chronic illness, terminal illness, near death experience

Faith
Importance (of spirituality)
Community
Address (which intervention you will use)

FICA: evaluates spirituality and is closely correlated to quality of life.

SWB (Spiritual Well-Being Scale)

has 20 questions that assess a patient's relationship with God and his or her sense of life purpose and life satisfaction

newborn health promotion

- All newborns are screened (for hearing) to identify life threatening conditions before symptoms begin
- Teaching parents about car seat use is an essential component of discharge
---Car seat should be in the back seat and rear facing
- Cribs should meet government standards for the safety of the newborn

infant health promotion

- Nutrition
- Breast-feeding
---Can introduce solid foods 1 month in 1 food at a time
- Immunizations
- Sleep

toddler health promotion

- Nutrition
---Lifelong eating patterns develop during this time
---Make sure they are familiarizing themselves with healthy foods

- Toilet training
---Does the toddler have the necessary physical and cognitive skills to use the toilet
---Takes a lot of patient and consistency

preschooler health promotion

- Nutrition
---Become picky with what they eat

- Sleep
---Should be sleeping 12 hours a night
---Kids start to have nightmares

- Vision
---Vision screening is important!!
---Strabismus- two eyes can't focus on the same object

school age children health promotion

- Perceptions
- Health education
- Health maintenance
- Safety
- Nutrition
- Encourage children to get the HPV vaccine at age 11

adolescents health promotion

- Health education
- Minority adolescents
- Gay, lesbian, and bisexual adolescents

young adults health promotion

- healthy eating and exercising
- encourage adults to perform monthly skin, breast, or male genital self-examination
- safe sex practices
- prenatal care