Intro to Nursing Exam 2

Primary Care

Prevention

Secondary Care

Screening

Tertiary Care

After the diagnosis with goal of rehabilitating to maximum level of function

Cultural Bias

-judging others that are different from one's own beliefs

-a predisposition to see people or things in a certain light

Definitions of Health

Health is a state of complete mental, physical, and social well-being

measured by morbidity (how frequent the disease) and mortality (number of deaths from a disease)

Holistic Health Model

patient centered care- mind, body and spirit

Internal health variables

patient's developmental stage, intellectual background, perception of functioning, emotional and spiritual factors.

External health variables

patient's family practices, socioeconomic factors, cultural background

Chronic Illness

At least one or more of the following:

-permananet change

-caused by irreversible alterations in normal A&P

-requires special patient education for rehab

-both: remission or exacerbation

Acute Illness

rapid onset illness that lasts a short time

Leininger's Nursing theory

Transcultural Care Diversity and Universality- emphasis on cultural competence, caring for each person as a unique person.

-incorporate patients' culture into healthcare, respect family roles, avoid mandating change and seek assistance from family members

QSEN (Quality and Safety Education for Nurses)

Patient-Centered Care

Teamwork and Collaboration

Evidence-Based Practice

Quality Improvement

Safety

Informatics

Cultural differences on health

reaction to pain, mental health, biological sex roles, language and communication, orientation to space and time, food and nutrition, family support, socioeconomic factors, health disparities,

Cultural influences on illness

-Natural illness (caused by dangerous agents)

-Unnatural illnesses (caused by failure to follow Gods rules)

-Healing is a gift from God

-Traditional healers

Illness behavior stages

1) Symptoms of Experience

2) Assumption of the Sick Role

3) Medical Care Contact

4) Dependent Client Role

5) Recovery or Rehabilitation

oppression

prolonged cruel or unjust treatment or control

Dorothea Orem's Self Care Theory

The nurse prescribes and regulates the nursing system based on the patient's self-care deficit

Sister Callista Roy's Adaptation Model

Nursing as a "humanistic discipline that emphasizes the person's adaptive or coping abilities."

Virginia Hendernson: Needs Theory

Assist the patient with activities until they recover or die

Maslow's Hierarchy of Needs

(level 1) Physiological Needs

(level 2) Safety and Security

(level 3) Love and Affection

(level 4) Self Esteem

(level 5) Self Actualization

Cultural Assessment

* Religious Preference

* Food Patterns

* Health Practices (immunizations)

culturally congruent care

care that fits a person's life patterns, values, and system of meaning

Health disparity

health difference closely linked to social, economic and environmental disatdvantage

Social determinants of health

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

IOM 5 Core Competencies

1. patient centered care

2. Work in interprofessional teams

3. Employ EBP

4. Apply Quality improvement

5. Utilize informatics

TJC Definition of Quality Improvement

-An approach to the continuous study and improvement of the process of providing health care services to meet the needs of patients and others and inform health care policy

-identify errors and hazards

To Err is Human 1999

focused on patient safety issues.

IOM's follow up:

-create national information infrastructure

-using common language to discuss safety and errors

-need to have data standards

-reporting systems

What is the Plan-Do-Study-Act (PDSA) cycle?

This is a cycle that can be used to implement a security strategy.

Plan: capture the problem or idea

Do: try out the change on a small scale

Study: analyse the information collected to understand the impact of the change, compare with the plan stage

Act: standarize your improvement or decide whether to make further change

IOM 6 Specific Aims for Changing the Health Care System

1.Safe

2.Effective

3.Efficient

4.Timely

5.Patient centered

6.Equitable

RIE model

Rapid Improvement effect: used for 5 days of intense activity

-set the scene, go and see

-map and analyse current process

-Design New process

-trial new process

-measure and report

TJC accreditation

Health care organizations voluntarily seek ____ ____ to demonstrate that they have achieved a "gold seal of approval" by following the quality and safety standards established.

Underuse

not prescriving or treating patient due to patient's lack of resources/insurance

Misuse

giving patient a med they do not need or that they are allergic to, ordering expensive tests such as MRI, when X-ray would have been sufficient

Overuse

patient prescribed multiple medications from several differnt doctors

Never miss

almost administering the wrong medication to a patient but caught while doing the 7 rights.

-marking the wrong body part for surgery but it was caught during the "time out" process

Sentinel event

severe harm caused to the patient (disability, death)

Hospital Acquired complication/conditions (HAC)

condition that occurs or the patient acquires while in the hospital

Never Events/Serious reportable events (SRE's)

wrong site surgery

Blame free culture

lack of accountability

What questions are asked during TJC root cause analysis?

1. mortality rates

2. length of stay

3. patient/family satisfaction

4. referrals to specialists

5. patient adherence

-environment of care, emergency medicine, human resources, infection control and prevention, leadership, life safety, medication management

Magnet Recognition Program

recognize organizations that achieve excellence in nursing practice

Benchmarking/score cards, surveys

hospital consumer assessment of healthcare providers and systems survey

ANA Nursing Code of Ethics

-set of principles that reflect the primary goals, values and obligations of the profession

-codes help nurses accomplish these goals to the extent they uphold them

Code:

-Advocacy

-Responsibility

-Accountability

-Confidentially

Purpose of ethics committees

■ Develop guideline and standards

■ Multidisciplinary (ie doctors, nurses, psychiatrists)

(advance directives, DNR)

Moral distress

occurs when the individual knows the right thing to do but personal or institutional factors make it hard to follow the right course of action

veracity

truthfulness, can be encountered when nurse doesn't tell patient full effects of tx thinking it will relieve anxiety/fear.

Beneficence

balance benefits against risk and cause of harm

ex: nurse encouraging exercise program for better lifestyle, but pt is at risk for MI

Justice

give each one due, act fairly. Used mostly in access to health care resources

-Do I have insurance? What type do I have? Where can I seek health care?

ex: in order to get organ transplant, one must be under certain BMI

Utilitarianism

Does the write or wrong thing depending on the consequence

fidelity

keep promises, to be faithful.

ex: "I'll be right back with your pain meds."

Autonomy

allowing patients and families to make health care decisions

ex: describing pro's and cons of surgery, up to pt to sign consent

Ethical nursing care- 5 step decision process

1. Assess the situation

2. Identify the ethical problem

3. Plan and weigh alternatives

4. Implement the decision

5. Evaluate the decision

Durable medical power of attorney

Legal written designation making another person responsible for one's medical decisions

HIPPA (Health Insurance Portability and Accountability Act)

ensures health confidentiality of patient

Patient rights

the right to safety, the right to be informed, the right to choose, and the right to be heard

informed consent

an ethical principle that research participants be told enough to enable them to choose whether they wish to participate

ethically relevant considerations

1. Balance between benefits and harm to patient

2. Disclosure, informed consent and shared decision making- Paternalistic model (clinicians decide what needs to be done) patient sovereignty model (patients express the right to be autonomous)

3. Norms of family life

4. relationship between clinicians and patients

5. professional integrity of clinicians

6. cost effectiveness and allocation

7. issues of cultural/religious variations

8. considerations of power

National Patient Safety Goals (NPSGs)

Goals issued by the Joint Commission to improve patient safety in healthcare organizations nationwide

10 main issues

-identify patients correctly

-improve staff communication

-use medicines

-use alarms safely

-prevent infection

-identify patient safety risks

-prevent mistakes in surgery

-prevent fall risk

-prevent bed sores

-patient safety risks

NPSG Goal 1

Identify patients correctly

Use 2 identifiers

-patients name

-patients DOB

Scan barcode, look at patients unique hosptial #

NPSG Goal 2

Improve staff communication

-report critical results of tests and diagnostic procedures in a timely manner

-hospital should have written procedures regarding

the definition of critical results, by whom and to whom results should be reported, acceptable length of time between availability and reporting of results

NPSG Goal 3

Improve the safety of using medicines

-label all medicines, medicine containers and other solutions before a procedure

-use precaution with patients who take blood thinners

-verify doses with another nurse-record and document what medicines patients are taking

NPSG Goal 4

Use of alarm safety

(BP, telemetry, SpO2, IV pumps, ventilatory, bed alarms, chair and floor alarms).

NPSG Goal 5

Prevent infection

-prevention of HAIs, prevention of infection of blood from central IV lines, from after surgery, prevention of catheter associated UTI(40%ofHAIs)

-hand hygiene!!!

NSPG Goal 6

Prevent infection that are difficult to treat

-MRSA

-C diff

-VRE

-CRE

Do hand hygiene, PPE, extended contact isolation

NPSG infection goal part 1

Prevent infection of central line associated bloodstream infection

Infection goal continued

Prevention of catheter associated urinary tract infection

NPSG Goal 7

prevent mistakes during surgery

-make sure the correct surgery is done for the correct patient

-mark the correct site on the patient's body

-pause before the surgery (time out) to make sure a mistake is not being made

NPSG Goal 8

Reduce the risk of falls

-assess patient for their fall risk

-implement fall risk reduction methods

-referral to phyiscial therapy

NPSG Goal 9

Prevent bed sores

NPSG Goal 10

Patient safety risks

OSHA

workplace violence, PPE, MSK injuries

Patients on contact isolation have:

direct and indirect contact (MRSA, major wound infections, herpes simplex, scabies, varicella zoster

PPE: gown and gloves

Patients on extended contact isolation have:

Cdiff, bacillus or norovirus

PPE: gown, gloves and mask

Patients on airborne precautions have:

smaller droplets (3-5 microns), tuberculosis, chicken pox, measles, covid 19, negative airflow

(PPE-HCP wears N95 mask, for varicella and rubella, must wear gloves and gown)

Patients on droplet precautions have:

larger droplets (>5 microns), influenza and bacterial meningitis

(PPE-HCP wear surgical mask if <3 feet from patient)

ATI Nursing Concepts- Nursing Roles

-Client-centered care (client is the focus, partner with family and cultural, ethnic and social background)

-nursing process

-therapeutic communication

-cultural competence/advocacy

ATI Nursing Process

-Assessment

-Analysis

-Planning

-Implementation

-Evaluation

Therapeutic Communication

-verbal (active listening, empathy, use of touch and silence, summarize client's statements

-nonverbal (eye contact, personal space, body posture, facial expressions, hand gestures)

Cultural competence

nurse must understand:

-differences between various cultures

-culture-specific perspectives

(health care, birth, death, other life experiences)

Advocacy

safe care, quality care. If you feel something is wrong, advocate for client

A student nurse assigned to clinical in a rehab setting is preparing to participate in a team meeting. Which shows the need for further teaching?

The provider will not be at the meeting because she is not a member of the interdisciplinary team.

-the provider is always a member of the interdisciplinary team

A student is developing plan of cae for client who has been diagnosed with cancer of the pancreas. Which resources are appropriate to use in development of evidence-based plan of care?

CINAHL, MedlinePlus, OVID

PDSA cycle

process of planning improvement strategies, implementation of those strategies analyzing the impact of the strategies, and making changes to strategies as needed

Process audit

the procedure of reviewing the standards that are followed in the delivery of care

Structure audit

evaluation or measurements of the impact environmental resources and influences have on the provision of care

outcome audit

analysis of the actual result, impact, of delivered care

root cause anlaysis

performed in response to a sentinel event by collecting and analyzing related data and outline corrective actions

Which of the following are client attributes that impact safety?

-lifestyle choices

-communication patterns

-cognitive awareness

Web-based information should be evaluated for which of the following?

-accuracy

-sponsorships

-currency

affective learning

characterized by a shift or change in attitudes or beliefs

psychomotor learning

integrates mental and physicial activities in the acquisition of skills

cognitive learning

use of intellectual skills to impart new knowledge to an individual

A nurse is making rounds on clients who were assigned to a team of nurses, to determine if charting and client care was completed. This nurse is demonstrating which leadership role of the nurse?

Coordinator

ABC

giving priority in the following order to a client experiencing an alteration in airway status, breathing pattern, or circulatory status

Nursing Process

giving priority to nursing actions that focus on collection of assessment data

Survival potential

giving priority to clients in a resource-limited setting who are severely injured but could live if supportive care is provided

Safety and risk reduction

giving priority to interventions that prevent a client from becoming injured

Least restrictive

giving priority to interventions that protect a client by using the most effective and least confining measures possible

a beginning student nurse is providing care for a client admitted with type 1 diabetes. Which statement needs further teaching?

"I will keep my communication with the client to a minimum."

Nursing knowledge is based on which of the following?

Nursing research and discipline-specific research