Class 1 Material

the 6 QSEN competencies

• patient-centered care

• teamwork & collaboration

• quality improvement

• safety

• evidence-based practice

• informatics

patient-centered care

• one of the QSEN

• the patient decides and is a full partner

• recognize the patent as the source of control

• take the patient’s preferences, values, and needs into consideration

what does QSEN stand for?

Quality and Safety Education for nuses

teamwork and collaboration

• one of the QSEN

• function well within the whole team

quality improvement

• one of the QSEN

• use data to improve the system

safety

• one of the QSEN

• reduce harm from the system and from you

evidence-based practice

• one of the QSEN

• best evidence, expertise, and patient values

informatics

• one of the QSEN

• use technology to support decision

disease

• a malfunction of a body process

• objective, diagnosed by a provider

• exists whether or not they feel sick

illness

• their experience of being unwell

• functioning is diminished

• can exist with no disease behind it

• acute vs chronic

risk factors of illness/disease

• genetic and physiological

• age

• environment

• lifestyle

what is assessment?

the deliberate and systematic collection of information about a patient to determine their current and past ehealth and functional status, and their coping patterns

5 types of assessment

• review of the clinical record

• health history

• physical examination

• functional assessment

• risk assessment

Activities of Daily Living (ADLs)

• bathing

• dressing

• feeding

• toileting

• grooming

• transferring

Independent Activities Daily Living (IADLs)

• finances

• transportation

• shopping and meals

• house cleaning

• communication

• medications

subjective data

• symptoms the patient reports

• pain, nausea, dizziness, fatigue

• feelings, worries, and perceptions

• chart it in the patient’s own words

• health history

• tells you where to LOOK

objective data

• signs you observe or measure

• vital signs, weight, intake and output

• exam findings and lab results

• behavior described, never interpreted

• physical examination (head-to-toe)

• tells you WHAT is happening

primary source

when the data comes from…

• the patient

• interview, observation, and examination

always your best source

secondary source

when the data comes from…

• family, with patient’s agreement first (HIPAA)

• the team, handoff report, and consults

• the record and the literature

the database baseline measurement

subjective + objective + record + diagnostics =

what do you do with the data?

• assess

• judge

• plan and act

• evaluate

what is the scope and standards of practice?

Assessment, Diagnosis, Planning and outcomes, Implementation, Evaluation (ADPIE)

what are the 4 physical asssessment techniques

• inspection

• palpation

• percussion

• auscultation

4 techniques of abdomen physical assessment

inspection, auscultation, percussion, palpate

Inspection

• one of the 4 physical techniques

• concentrated watching. Looking, listening, and smelling to tell expected findings from unexpected ones

Palpation

• one of the 4 physical techniques

• feel

what is most sensitive to temperature (palpation)

back of the hand

palpation light rules

• 1-2 cm

• surface texture and moisture

• superficial masses and tenderness

palpation deep

• 4 to 6 cm

• position, size, shape, mobility

• tenderness of organs and masses

nonnegotiables for palpation

• warm hands and short nails

• tell the patient before you touch

• same order every single time

• light first, then deep, tender areas

percussion

• one of the 4 physical techniques

• tapping the body surface to produce vibration. the sound reveals the density and size o what is underneath

tympany percussion

• loud and drum-like

• air in the stomach or bowel

resonance percussion

• loud and hollow

• normal healthy lung

dullness percussion

• soft and thud-like

• liver, full bladder, a mass

flatness percussion

• very soft and flat

• muscle and bone

auscultation

• one of the 4 physical techniques

• hearing

• need good hearing, quiet room, good stethoscope,

• describe every sound

assessing across culture

• health beliefs

• food and fasting

• touch and space

• other therapies

• decision making

• language

assessing the older adult

• slow your pace

• expect subtle findings

• watch for fatigue

• set up the room

• consider two visits

• NEVER RUSH THEM

patient safety

preventing patient injury that comes from the process of care itself

adverse event

an injury caused by care that delay discharge or causes disability

near miss event

an error caught before it caused harm. report it anyway

sentinel event

death, permanent harm, or severe temporary harm. triggers root cause analysis

never event

so serious it should never happen. wrong-site surgery, a retained object

just culture

ask what in the system allowed the error, not only who made it

purpose of therapeutic communicaiton

• builds the trust that makes honest data possible

• delivers education, comfort, and consent

purpose os SBAR and handoff

• moves information without losing any of it

• escalates a concern clearly enough to get action

SOLER (active listening) - what does the S stand for?

sit facing the patient

SOLER (active listening) - what does the O stand for?

open posture, arms uncrossed

SOLER (active listening) - what does the L stand for?

lean toward the patient

SOLER (active listening) - what does the E stand for?

eye contact, adjusted for culture

SOLER (active listening) - what does the R stand for?

relax; your tension becomes theirs

communication techniques that work with patients

• open-ended questions

• silence

• empathy

• reflecting and clarifying

• touch, with consent

what shuts communication down with the patients

• false reassurance

• asking why

• giving advice

• minimizing

• defending

what does the I stand for in I-SBAR-R

introduction

• your name, role, and unit

• say it even when you think they know

what does the S stand for in I-SBAR-R

situation

• who you are, who the patient is, what is happening now

what does the B stand for in I-SBAR-R

background

• diagnosis, history, treatments, allergies, code status

what does the A stand for in I-SBAR-R

assessment

• vital signs, your findings, and how serious you think it is

what does the first R stand for in I-SBAR-R

recommendation

• what you want to happen, stated specifically

what does the second R stand for in I-SBAR-R

read-back

• repeat the order or plan out

• this is what catches the error

the purpose of I-SBAR-R

• communication between medical professionals regarding a patient

• reduces errors and miscommunication