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
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.
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.
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.
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.
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.
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.
Components of a Primary Survey:
Airway: Assess for blockages.
Breathing: Evaluate respiratory rate, effort, O2 saturation.
Circulation: Palpate pulse, assess blood pressure.
Disability: Evaluate consciousness and response to stimuli.
Exposure: Assess body temperature and skin condition.
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.
Providing Feedback to Clients:
Deliver clear, respectful, non-judgmental explanations, encourage inquiries while respecting cultural values and emotional state.
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.
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.).
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.
Parameters of Comprehensive Pain Assessment:
Aspects to assess include frequency and timing, location, severity, reassessment indicators (self-report, behavior changes, physiological signs).
Racial Disparities in Pain Assessment:
Note underassessment and inadequate treatment linked to systemic racism; emphasize self-report and acknowledge personal biases.
Self-Report in Pain Assessment:
Considered the gold standard; central to social engagement and assumption avoidance.
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
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 <60 bpm, tachycardia is >100 bpm.
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
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.