NSE 103 Midterm Review

NSE 101 - Readings Review

1. Introduction to Communication in Nursing

  • Definition of Communication:
    • Sharing information, ideas, feelings aimed at achieving mutual understanding.
  • Forms of Communication:
    • Verbal: Spoken words.
    • Non-verbal: Facial expressions, body language.
    • Written: Documentation, academic writing, electronic messages.

2. Models of Communication

  • Transmission Model:
    • A one-way process involving a sender and receiver, susceptible to noise and semantic issues.
  • Interaction Model:
    • A two-way communication that incorporates feedback, considering physical and psychological context.
  • Transaction Model:
    • Communication involves simultaneous sending and receiving, co-created, influenced by relational, cultural, and social contexts.

3. Theoretical Approaches to Nursing Communication

  • Trauma-Informed Approach:
    • Focuses on ensuring physical/emotional safety, offering choice/empowerment, and assessing for trauma presence.
  • Relational Inquiry:
    • Recognizes clients as relational beings, considers social systems, broader contexts.
  • Anti-Racist Approach:
    • Identifies and challenges systemic racism, addressing power imbalances and promoting neutrality.

4. Therapeutic Communication and the Client Interview

  • Therapeutic Communication:
    • The foundation of the nurse-client relationship, fostering healing and trust.
  • Legal Accountability:
    • Governed by the College of Nurses of Ontario (CNO) standards.
  • Interview Process Components:
    • Preparation: Review client charts, avoid unnecessary repetition.
    • Interviewing Techniques:
    • Open-ended Questions: Encourage storytelling.
    • Closed-ended Questions: Gather specific information.
    • Probing Questions: Clarify responses.
    • Communication Strategies: Active listening, silence, empathy, avoid false reassurance and avoidance language.
  • SURETY Model: Non-verbal Communication:
    • Sit at an angle, avoid crossing arms/legs, maintain relaxed posture, establish eye contact, appropriate touch, follow intuition.

5. Interprofessional Communication and Collaboration

  • Definition:
    • Communication between healthcare team members aimed at improving client safety and outcomes.
  • Communication as a Core Competency:
    • Supports role clarification, enhances team functioning, aids conflict resolution.
  • ISBAR Model:
    • Intro, Situation, Background, Assessment, Recommendation.

6. Civility and Safety

  • Civility:
    • Respectful engagement.
  • Incivility:
    • Includes bullying, horizontal violence.

7. Professional Conduct Ethics

  • Professional Communication:
    • Must be formal, respectful, truthful, accurate, using proper pronouns and formal greetings.
  • Social Media Responsibilities:
    • Obligated to follow the code of conduct.
  • Conflict Resolution:
    • Seen as an opportunity for growth, employing "I" statements and recognizing positive intent.
  • Legal Reporting Obligations:
    • Mandatory reporting of child abuse, elder abuse, and risk to client safety.

8. Chapter 2/3: Introduction to Health Assessment

Principles of Inclusive Health Assessment
  • Four Interconnected Principles:
    • Act of Humanity: Every assessment acts as a gesture ensuring clients feel they belong.
    • Moving Beyond Sameness: Avoid standardizing "normal," tailor assessments to individual clients.
    • Examining Personal Biases: Reflect on and unlearn personal biases.
    • Cultivating Safe Environments: Encourage a non-judgmental spirit of inquiry and collaboration on client goals.
Cultural Frameworks in Nursing
  • Cultural Sensitivity:
    • Nurse's awareness and understanding of a client's culture.
  • Cultural Competency:
    • Ability to provide effective care across diverse backgrounds, often criticized as a simplistic checklist.
  • Cultural Humility:
    • Lifelong self-critique and introspection addressing power imbalances.
  • Cultural Safety:
    • Nurses must acknowledge and challenge social structures affecting health equity.
Anti-Oppression Perspective
  • Definition:
    • A comprehensive commitment to social justice and human dignity.
  • Oppression vs. Privilege:
    • Oppression involves the unjust exercise of power, while privilege refers to unearned advantages.
  • Restorative Practice:
    • Acknowledges how systemic racism affects health and access to care.
  • Advocacy:
    • Prompted by anti-oppressive approaches, urging nurses to address discriminatory practices.
Practical Case Applications
  • Indigenous Clients:
    • Example of Joyce Echaquan highlights the need to recognize intergenerational trauma.
  • Black Clients:
    • Mireille Ndjomouo emphasizes systemic racism and the need to understand client distrust.
  • LGBTQI2SA+ Clients:
    • Case of Cody stresses the importance of using preferred names and terms for body parts.
Core Categories of the Subjective Health Assessment
  • Demographic/Biographic Data:
    • Includes name, gender identity/pronouns, contact information, occupation, and resuspension status.
  • Main Health Needs:
    • Client's reason for seeking care, recorded in their own words.
  • Current/Past Health History:
    • Covers chronic conditions, acute injuries, and childhood illnesses.
  • Mental Health:
    • Assessment of emotional wellbeing.
  • Functional Health:
    • Activities of daily living (ADLs) and instrumental ADLs such as managing medications and finances.
  • Preventative Treatments:
    • Information on current medications and vaccine status.
  • Family and Cultural Health:
    • Assessment of genetic risks.
Key Assessment Tools and Concepts
  • PQRSTU:
    • Proactive factors, Quality of symptoms, Region/radiation, Severity, Timing/treatment, Understanding.
  • Signs vs. Symptoms:
    • Symptoms: Subjective experiences reported by clients.
    • Signs: Observable phenomena that are subjective or objective.
  • Critical Findings: Data requiring immediate action.
Interviewing and Professional Responsibility
  • Influencing Factors on Professional Responsibility:
    • Includes personal fear of judgment.
  • Cultural Safety:
    • An atmosphere free of discrimination, requiring self-reflection and awareness.
  • Mandated Reporting:
    • Legal requirement to report abuse.
  • Concluding the Interview:
    • Involves summarizing and checking if the client has anything else to share, ensuring they feel heard and respected.

9. Documentation in Nursing

  • Definition and Importance of Documentation:
    • A record of the client's health status and provided care, crucial for communication and continuity.
  • Legal Obligation for Nurses:
    • Essential for safety, provides legal evidence, and ensures compliance with care continuity.
  • Professional Standards (CNO Principles):
    • Communication: Accurate, clear, comprehensive, individualized.
    • Accountability: Timely, complete, factual documentation.
    • Security: Protection of health information.
Legislative Framework
  • Personal Health Info Protection Act (PHIPA, 2004):
    • Governs health information use in Ontario.
    • Health Info Custodians: Providers managing health records, with ownership of physical records residing with institutions and information owned by clients.
    • Consent: Implied sharing within the team; express consent required for sharing beyond the team.
  • Types of Electronic Documentation Systems:
    • EMR: Electronic medical record for single organizations.
    • EHR: Electronic health record across organizations.
  • Data Types:
    • Structured Data: Using templates and checkboxes for ease of analysis.
    • Unstructured Data: Free text.
Documentation Methods
  • Narrative: Chronological documentation detailing what, when, who, and how.
  • Charting by Exception: Documenting only abnormal findings.
  • Nursing Process Documentation Methods:
    • DAR: Data, Action, Response.
    • APIE: Assessment, Plan, Intervention, Evaluation.
    • SOAP/SOAPIE: Subjective, Objective, Assessment, Plan, Intervention, Evaluation.
  • Components of the Health Record:
    • Admission Sheet: Demographic details.
    • Allergy Alerts: Important health alerts.
    • Medication Administration Record (MAR): Tracks all medications administered.
    • Flow Sheet: Monitors trends in vital signs, pain levels, input/output.
    • Kardex: Summary of daily care needs.
    • Discharge Plan: Clearly articulated in non-medical language, including follow-up instructions, medications, and indicators of when to seek additional help.
Future Trends in Documentation
  • Increased client involvement: Enhanced usage of personal health records.
  • Growing AI: Employed to support clinical decision-making and predictive analytics.
  • Nursing Considerations: Awareness of biases in AI systems and application of professional judgment.

10. NSE 103 EXAM REVIEW

Week 1 - Introduction to Assessment and Pain Assessment

  1. Describe the assessment phase of the nursing process:

    • Collecting:
      • Subjective Data: What the patient reports including symptoms, feelings, and health history.
      • Objective Data: What is observed/measured such as vital signs, physical exams, lab results, and behaviors.

  2. Describe related legislation specific to health assessment:

    • CNO Code of Conduct Principles:
      • Respecting the client’s dignity.
      • Providing inclusive and culturally safe care through cultural humility.
      • Ensuring safe and competent care with respect to the healthcare team.
      • Acting with integrity and maintaining public trust.
    • CNO Scope of Practice:
      • Defines legal accountabilities and appropriate assessment actions.
    • Regulated Health Professions Act, 1991:
      • Framework for professional regulation and public protection.
    • Nursing Act, 1991:
      • Defines nursing practice scope including controlled acts and regulations.

  3. Clinical Judgment and Priorities of Care in Relation to Health Assessment:

    • Definition: Observed outcomes based on critical thinking and decision-making processes, ongoing use of knowledge to assess and prioritize concerns.
    • Clinical Reasoning:
      • Recognizing Cues: Identify abnormal findings.
      • Analyzing Cues: Understanding data in relation to health conditions.
      • Prioritizing Hypotheses: Determining where to start and care priorities.
      • Generating Solutions: Identifying multiple intervention options.
      • Taking Actions: Defining specific, suitable steps to take.
      • Evaluating Outcomes: Assessing the effectiveness of actions.
    • Levels of Priority:
      • First Priority: Life-threatening issues.
      • Second Level: Risk of deterioration.
      • Third Level: Non-urgent concerns.

  4. Guiding Approaches to Health Assessment:

    • Health Assessment Frequency: Varies by care type including primary care, long-term care, and acute care.
    • Types of Health Assessments:
      • Primary Survey: ABCs for rapid identification of deterioration.
      • Focused Assessment: Target specific concerns.
      • Head to Toe Examination: Comprehensive overview of client's well-being.
      • Brief Scan: Evaluate mobility, appearance, consciousness.

  5. Development and Concepts of Health Promotion:

    • Definition: Social/environmental strategies to enhance community health.
    • Broad Approaches to Health Promotion:
      • Behavioural: Focuses on lifestyle choices.
      • Relational: Context of social/environmental factors.
      • Structural: Impact of policies and socioeconomic conditions.

  6. Health Promotion Interventions and Education:

    • Involves education, counseling, advocacy (3rd level priority but integrated into all care).
    • Focus on prevention, empowering clients, ensuring participation through trauma-informed care, respect for autonomy, explanation, and permission.

  7. Components of a Primary Survey:

    1. Airway: Assess for blockages.
    2. Breathing: Evaluate respiratory rate, effort, O2 saturation.
    3. Circulation: Palpate pulse, assess blood pressure.
    4. Disability: Evaluate consciousness and response to stimuli.
    5. Exposure: Assess body temperature and skin condition.

  8. Best Setting and Approach for Assessment:

    • Ensure privacy, comfort, and quiet, well-lit environments; practice hand hygiene; use clean equipment.
    • Ensure bilaterally assess with appropriate equipment and methods.

  9. Providing Feedback to Clients:

    • Deliver clear, respectful, non-judgmental explanations, encourage inquiries while respecting cultural values and emotional state.

  10. Maslow’s Hierarchy of Needs in Assessment:

    • Self-Actualization: Personal growth, fulfillment.
    • Esteem Needs: Confidence, body image concerns.
    • Social Needs: Relationships and social support concerns.
    • Security Needs: Safety against risks, medication safety.
    • Physiological Needs: Basic survival needs, prioritized as necessary.

  11. Examination Techniques:

    • Inspection: Visual examination encompassing the olfactory sense.
    • Palpation: Touch for temperature, texture, tenderness, and lumps.
      • Light Palpation: For surface structures.
      • Deep Palpation: For deeper organs and masses.
    • Percussion: Tap to assess underlying structures (normal vs abnormal sounds).
      • Types of Sounds: Resonance (normal lung), dullness (solid organs), tympany (air-filled), flatness (bone).
    • Auscultation: Listening to body sounds (heart, lungs, etc.).

  12. Define Pain and Classify:

    • Definition: Subjective experience linked to emotional responses associated with actual/potential damage.
    • Types of Pain:
      • Acute vs. Chronic: Duration and intensity.
      • Nociceptive: Tissue damage.
      • Neuropathic: Nerve damage symptoms.
      • Nociplastic: Issues related to altered pain processing.
      • Referred Pain: Felt away from injury site.
      • Idiopathic Pain: Chronic pain with an unknown source.
    • Dimensions and Tools:
      • Subjectivity, physiology, observables such as the FLACC scale for nonverbal patients, behavioral pain scales, and numerical scales for assessments.

  13. Parameters of Comprehensive Pain Assessment:

    • Aspects to assess include frequency and timing, location, severity, reassessment indicators (self-report, behavior changes, physiological signs).

  14. Racial Disparities in Pain Assessment:

    • Note underassessment and inadequate treatment linked to systemic racism; emphasize self-report and acknowledge personal biases.

  15. Self-Report in Pain Assessment:

    • Considered the gold standard; central to social engagement and assumption avoidance.

  16. Conducting a Pain Assessment:

    • Screen all clients using PQRSTU and appropriate pain scale; assess and document functional impacts.

11. Week 2 - Vital Signs and Blood Pressure

  1. Components of Vital Signs:
    • Vital signs consist of Temperature, Pulse, Respirations, Blood Pressure, and often Oxygen Saturation.
  • Pulse:
    • Rate: Measured in beats per minute (bpm).
    • Rhythm: Regular or irregular patterns.
    • Force: Pulse strength scaled 0-3+.
    • Equality: Compare bilaterally to evaluate peripheral circulation.
  • Blood Pressure:
    • Systolic BP: Pressure during heart muscle contraction.
    • Diastolic BP: Pressure during heart muscle relaxation.
    • Pulse Pressure: Difference between systolic and diastolic readings, reflecting cardiac output and vascular resistance.

2. Definitions & Reasons for Measurement

  • Pulse Measurement:
    • Used to assess cardiac function, detect arrhythmias, monitor treatment responses, and establish baseline.
    • Normal range: 60-100 bpm; bradycardia is
  • Blood Pressure Measurement:
    • Measures arterial pressure critical for cardiovascular health assessment and detecting hypertension/hypotension.
    • Normal BP range: 90-<130 systolic, 60-<80 diastolic.

3. Related Terms

  • Pulse Pressure: Difference reflecting arterial compliance.
  • Orthostatic Hypotension: Presenting with significant BP drops upon standing.
  • Auscultatory Gap: Temporary loss of Korotkoff sounds leading to potential inaccuracies.
  • Korotkoff Sounds: Phases of sounds indicating BP readings through stethoscope.

4. Responding to Trends in Vital Signs

  • Key indicators: Gradual increases in BP, sudden drops, or rising pulse alongside falling BP should prompt reassessment.

5. Techniques for Taking Vital Signs

  • Pulse Assessment: Use radial pulse; count accurately for rhythms.
  • Blood Pressure (Manual Technique): Preparation involves appropriate client positioning and cuff sizing with essential steps defined.

6. Factors & Common Measurement Errors

  • Factors: Age, stress, hydration levels impact pulse and BP readings.
  • Common errors include using incorrect cuff sizes and arm positioning difficulties.

7. Vital Signs Contextualization

  • Vital signs should be interpreted and communicated in the context of a client's baseline for proper care decisions.

8. Remote Monitoring and Communication

  • Explore remote monitoring for community settings; ensuring communication pathways are established for significant findings.

9. Indicators of Client Distress

  • Changes in vital signs may indicate underlying pain, anxiety, or acute illness needing immediate attention.

10. Radial, Carotid, and Brachial Pulses

  • Methodologies for assessing different pulse points based on clinical circumstances are outlined for optimal use.

11. Week 3 - Measurements and Vital Signs

  1. Anthropometric Body Measurements (Adults & Children):
    • Definition includes assessments of body size, proportioning, and composition.
    • Measurements include weight, height, BMI, waist/hip circumference, waist-to-hip ratio, and waist-to-height ratio.
    • Purpose: Monitoring growth and identifying potential health risks.

2. Definitions, Related Terms, and Reasons Measured

  • Respirations Measurement: Assesses respiratory function, normal ranges vary by age.

3. Assessment Techniques & Rationale

  • Varied assessment protocols for vital signs promote accurate data collection.

4. Factors & Measurement Errors

  • Common measurement errors should be recognized to ensure accurate vital sign assessments.

5. Recognizing & Responding to Cues and Trends

  • Lay emphasis on the importance of monitoring trends in health indicators over isolated values.

6. Chapters 6 & 7 Main Points

  • Focus on anthropometric measurements and purpose of vital signs with better context evaluation in clinical decision-making.

7. Week 4 - Musculoskeletal System

Introduction to MSK System
  • Functions include body support, enabling movement, and blood cell production among other roles.
Neurological Component
  • Muscle movement reliant on nervous system architecture with important cranial and spinal nerve roles.
Subjective Assessment
  • Exploration of patient history leading to tailored assessment priorities.
Objective Assessment
  • Techniques involve thorough inspection, palpation, range of motion assessments, and manual muscle testing.
Health Promotion and Disease Prevention
  • Guidelines for health maintenance, ergonomic practices, and dietary considerations to promote musculoskeletal health.
Chapter 9: Musculoskeletal System Assessment — Main Points
  • Reinforcement of MSK study topics consolidating the understanding of anatomy, techniques, and overall assessments integral to nursing education.