Test 1

Florence nightingale

environmental theory (1860)

Virginia Henderson

Need Theory (1955)

Dorothea Orem

Self-Care Deficit (1971)

Hildegard Peplau

Interpersonal relations theory (1952)

Jean Watson

Theory of human caring (1979)

Sister Callista Roy

Adaptation Model (1970)

Environmental Theory

healing requires clean air, light, sanitation, warmth, and quiet

Assess your patient’s room for lighting, noise, clutter, temperature, etc.

consider home environment

nightingales’ data collection laid the groundwork for evidence-based nursing practice.

traces to social determinants of health (one of most urgent priorities today)

core question- What surrounds the patient?

Need theory

every person as 14 fundamental needs, from breathing to eating to worship

nurse’s role is to meet those needs when a patient can not, and to restore independence asap.

ask: which needs can this patient meet independently, and which can they not?

create a care plan that closes the gap, without creating unnecessary independence.

Henderson’s definition of nursing was adopted by the international council of nurses.

core question- What does this patient need?

Self Care Deficit

nursing is required only when a patient has a self care deficit

most nursing today is supportive-educative (patients go home and manage themselves.

Teaching is nursing.

there are three systems of nursing (wholly compensatory- coma patient completely dependent, partly compensatory- post op hip replacement work shared, supportive-educative- teach and support newly diagnosed diabetic)

core question- How much should I do for this patient?

Interpersonal Relations theory

the nurse-patient relationship is itself a form of treatment.

there are four phases: orientation, identification, exploitation, resolution

Peplau is considered the mother of psychiatric nursing. her phases of the therapeutic relationship are foundational in mental health.

Core question- What is happening between us?

Theory of human caring

Watsons 10 caritas process calls nurses to attend to the body, mind, and spirit.

be fully present with patient, put down everything and make eye contact

ask about meaning “what worries you most about this?”

attend to emotional needs, not just physical.

prioritize dignity and respect

selfcare for nurses is not optional, you can’t give what you don’t have.

Core Question- Who is this person, fully?

Adaptation Model

People are adaptative systems, nursing helps patients adapt more effectively across four modes: physiological (body adaptation), self-concept (change in how they see themselves), role function (change in role- parent, wife, worker), interdependence (shift in relationship)

don’t just ask what’s wrong, ask what is changing for the person in every dimension of their lives.

Core question- How is this patient adapting?

therapeutic communication is…

intentional and goal-directed, focused on the patient’s needs, based on trust and empathy, a clinical skill. it builds trust, reduces patient anxiety

nursing patient caring relationship is caring because…

you show genuine interest, you show empathy, you have respect for autonomy (they are the expert on their own lives), you show unconditional positive regard, you are a consistent presence

Phases of the caring relationship

pre-interaction: before you enter the room, review chart, check assumptions and biases.

orientation: introduce yourself, establish trust, explain role, set encounter expectation

working: active care delivery, Assessment, teaching, emotional support, goal collaboration

termination: closing the encounter or relationship intentionally, affirm progress, plan next steps

putting it all together- every patient encounter

enter the relationship>accept without judgment> listen actively> protect confidentiality>close intentionally

_____% of serious medical errors involve miscommunication during patient handoffs.

80%

What is the nurse’s role in communication?

Coordinator- the nurse synthesizes information from all disciplines and ensure the full picture reaches the right person

Advocate- Speaking for a patient when they can’t speak for themselves. Advocacy is not optional.

Communicator- the nurse delivers info to physicians, specialists, familes, and the next shift. the quality of communication effects patient safety.

SBAR

Situation (what is most urgently happening right now)

Background (what is the relevant clinical background)

Assessment (what do you believe is going on)

Recommendation (What do you need or suggest happens while waiting for physician)

7 principles of accurate documentation

accurate, timely, complete, legible, factual, confidential, corrected properly

effective hand off is:

structured around SBAR, done at bedside, specific about pending items, questions are asked

DESC Scripting

Describe, Express, Specify, Consequences

structured assertive response

Chain of command- escalation pathway for patient safety concern

bedside nurse(you)> charge nurse> Nurse supervisor> attending physician/medical director>chief of staff/administrator/risk management

urgent escalation chain

rapid response team

CUS words (concerned, uncomfortable, safety)

patient safety hotlines/reporting (complain hotlines)

Tuckman’s stages of group development

Forming, storming, norming, performing, adjourning

Forming- group stage

members meet, orient, test boundaries, everyone is polite, goals are unclear, high dependency on leader.

Storming- group stage

conflicts emerge, members challenge each other, question goals, resist structure, power struggles.

Norming- Group stage

group develops shared norms, roles clarify, trust grows, conflict becomes productive and less personal

performing- group stage

group is fully functional, members work interdependently, conflict is resolved quickly, energy focuses on goal

Adjourning- Group stage

the group disbands, project ends, staff transfer etc. members process the loss of a team that worked.

roles in groups

task roles (move group towards goal), maintenance roles (hold group together), disruptive roles (impede progress)

groupthink is,,,

when the group stops thinking critically to preserve cohesion. (agree with everything/stay quiet to keep everyone happy)

an effective team member is

situationally aware, contributive, accountable, dissenting when needed (speak up), invested in the group

the three fall types

accidental fall, Anticipated Physiological Fall, Unanticipated Physiological

Fall

Assessment tool for fall type 2- anticipated Physiological Fall

The Morse Fall Scale scores six clinical indicators to quantify a patient's risk for an anticipated physiological fall