Fundamentals Exam #1 Review

Historical Figures in Nursing

  • Clara Barton: Identified as the founder of the Red Cross.

  • Florence Nightingale: Known for her contributions to infection control and the importance of documentation in nursing practice.

  • Dorthea Dix: Recognized as a significant Mental Health Advocate.

Regulatory and Professional Standards

  • American Nurses Association (ANA): This organization is responsible for setting the National Standards of Practice.     - Nurse Practice Act (NPA): Determines the legal scope of practice for nurses.     - State Board of Nursing (BON): Exercises authority over licensure and disciplinary actions; adapts the NPA for state-level regulation.

  • Authorization to Test (ATT): This authorization is valid for a duration of 90 days90\,\text{days}.

Healthcare Policy, Finance, and Insurance

  • Affordable Care Act (ACA): Its primary goals are to increase access to and the affordability of health care.

  • Medicaid: Health coverage designed specifically for low-income individuals.

  • Medicare: Age-based health insurance program.     - Part A: Covers inpatient services.     - Part B: Covers outpatient services.     - Part D: Covers medications.

  • Over the Counter (OTC): Refers to medications available without a prescription.

  • Diagnosis Related Groups (DRG): A system used to classify hospital cases for payment. Classifications are based on:     - Diagnosis (Dx)     - Age     - Gender

  • Insurance and Service Fees:     - Copayment: A fixed fee that is due at the time of service.     - Precertification: A requirement for insurance approval before a specific service is provided.

Patient Safety and Quality Management

  • Sentinel Event: Defined as an unexpected occurrence involving death or serious physical or psychological injury.     - All sentinel events must be reported to The Joint Commission (TJC).     - Examples of Sentinel Events:         - Blood transfusion errors.         - Wrong surgical site procedures.         - Suicide occurring within a healthcare facility.         - Infant abduction.

  • Quality and Safety Education (QSEN) Competencies:     - Patient-Centered Care     - Teamwork & Collaboration     - Quality Improvement     - Evidence-based Practice     - Safety     - Informatics (Technology)

Nursing Informatics and Technology

  • Technology Examples:     - Smart IV Pumps: Utilized for precise medication delivery.     - Electronic Health Record (EHR): The digital version of a patient's medical history.

  • Advantages of Informatics:     - Improves overall communication.     - Provides direct patient care and facilitates knowledge sharing.

  • Disadvantages of Informatics:     - Requires significant time and effort.     - Associated with "lots of retracting."

Interpersonal Relationships and Therapeutic Communication

  • Peplau’s Four Phases of Interpersonal Relationships:     1. Orientation: The phase where the client seeks help.     2. Identification: The phase involving role establishment.     3. Exploitation: The active working phase of the relationship.     4. Resolution: The termination phase of the relationship.

  • Communication Styles:     - Passive: Indirect communication style.     - Passive-aggressive: Secretive communication.     - Aggressive: Hostile communication.     - Assertive: Open and direct communication; the goal for professional interactions.

  • Therapeutic vs. Nontherapeutic Communication:     - Therapeutic techniques: Use of silence, open-ended questions.     - Nontherapeutic factors: Letting the speaker's emotions or frustration interfere.

  • Motivational Interviewing (OARS):     - O: Open-ended Questions     - A: Affirmations     - R: Reflective Listening (Active)     - S: Summarizing

  • Medical Interpreters: Nurses must know and follow medical interpreter guidelines when communicating with patients who have language barriers.

Factors Affecting Communication and Clinical Interventions

  • Factors Affecting Communication:     1. Physiological: Vision or hearing impairments, and conditions like Autism Spectrum Disorder.     2. Cognitive: Factors limiting understanding or processing.     3. Emotional: High levels of anxiety.     4. Environmental: Excessive noise.

  • Interventions to Improve Communication:     - Face the client directly.     - Remove background noise.     - Ensure the light is on.     - Speak slowly and articulate clearly.

Clinical Assessment: Pulse Measurements

  • Pulse Quality Scale:     - 00: Absent     - +1+1: Weak     - +2+2: Normal     - +3+3: Strong     - +4+4: Bounding

  • Pulse Deficit:     - Requires 22 nurses assessing the patient at the same time.     - One nurse performs Apical Auscultation using a stethoscope.     - One nurse performs Radial Palpation.     - A difference within 55 is considered normal.

Specialized Care Models

  • Hospice Care: End-of-life care intended for patients with a prognosis of ≤6 months\le 6\,\text{months}.

  • Palliative Care: Focused on comfort care and symptom (Sx) relief, regardless of the stage of the disease.