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74 Cards in this Set
- Front
- Back
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Implementation
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Implementation is completing coordinating care and the prescribed plan of care.
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Assessment
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Assessment is the collection of comprehensive data pertinent to the patient’s health and/or the situation.
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nursing code of ethics
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When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care for your patients. The code serves as a guide for carrying out nursing responsibilities to provide quality nursing care and the ethical obligations of the profession.
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Advocate
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An advocate protects the patient’s human and legal right to make choices about his or her care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns.
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Evidence-based practice
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Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
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examination for registered nurse licensure
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Registered nurse (RN) candidates must pass the NCLEX-RN® that the individual State Boards of Nursing administer. Regardless of educational preparation, the examination for RN licensure is exactly the same in every state in the United States. This provides a standardized minimum knowledge base for nurses.
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Contemporary nursing professional roles and responsibilities
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A) Caregiver
B) Autonomy and accountability C) Patient advocate D) Health promotion Each of these roles includes activities for the professional nurse. Each of these is used in direct care or is part of professionalism that guides nursing practice. Some nurses are lobbyists, but being a lobbyist is not expected of all professional nurses. |
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Advanced practice registered nurses
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Advanced practice registered nurse functions independently as a clinician, educator, case manager, consultant, and researcher within his or her area of practice to plan or improve the quality of nursing care for the patient and family.
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Health care reform
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Moving from an acute illness to a health promotion, illness prevention model
Health care reform also affects how health care is delivered. There is greater emphasis on health promotion, disease prevention, and management of illness. |
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nursing roles with prescriptive authority in their practice
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Nurse practitioners and certified clinical nurse specialists encompass the role and preparation of the advanced practice registered nurse. According to the American Nurses Association standards of practice, prescriptive authority may be granted to these nurses.
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using a computerized decision support system
example of which Quality and Safety in the Education of Nurses (QSEN) competency |
Using decision support systems is one example of using and gaining competency in informatics.
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Safety
Quality and Safety in the Education of Nurses (QSEN) |
Helping the patients understand the consequences and complications of multiple medications helps to build the competency in safety
(old couple with expired meds and 2 different practitioners) |
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genomics information
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Genomics describes the study of all the genes in a person and the interactions of these genes with one another and with that person’s environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions.
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nurse researcher
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The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He or she often works in an academic setting, hospital, or independent professional or community service agency.
Serves as a nurse consultant which decides to compare two types of treatment. ex. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. |
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In-service education
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In-service education programs are instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution.
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principle of patient-centered care focused on continuity and transition
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Nursing interventions focused on transition and continuity provide patients with information about medications to take, dietary or treatment plans to follow, and danger signals for which to look after hospitalization or treatment. These interventions also provide patients and families with health care resources after discharge.
Ex. The nurse is teaching the patient how to change the wound dressing at home |
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maintaining competency in nursing practice
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Maintaining ongoing competency is a nurse’s responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.
Ex. Attending a review course in preparation for the certification examination |
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preferred provider organization (PPO)
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Preferred provider organization (PPO) plans limit the enrollee’s choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance.
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nurse participating in primary care activities
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Primary care activities are focused on health promotion. Health-promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health-promotion activities keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes.
Ex. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester |
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Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit
example of nurses working on what issue in the health care system? |
Near-miss events are events that could have caused a problem with patient safety had they not been stopped before patient harm occurred. Nurses who investigate ways to prevent near-miss events work on issues surrounding patient safety.
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Magnet status recognition for a hospital
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Magnet status is a process and review in which hospitals participate that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.
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applying the principle of patient-centered care while focusing on alleviation of a patient’s fear and anxiety
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Interventions that focus on alleviation of fear and anxiety are related to allowing the patient and family time to express fears and concerns, understand the impact that illness will have on the patient’s ability to care for himself or herself, and often express worries about ability to pay for medical care. Identifying staff that can help with payment plans alleviates fear and anxiety.
Ex. “Let’s talk about the concerns that you have about going home.” |
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characteristics of managed care systems
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Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people stay healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.
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tertiary health care environment
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Tertiary health care is focused on treatment of disease and illness. Tertiary health care takes place in intensive care and subacute care units. Emergency departments are part of secondary acute care. Preventive and health-promotion activities are part of primary care.
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patient-centered care principle of physical comfort
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Interventions for the patient-centered care principle of physical comfort are focused on care that increases the comfort of the patient. Responding to patients’ need for pain medications and using nursing interventions that increase comfort are important. This is opposed to Teaching which is focused on the principle of continuity and transition; Scheduling appointments is an intervention for access to care.
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From the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit
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Turnover rate of nurses on the unit
Incidence of patient falls Number of certified RNs Nursing-sensitive outcomes are patient outcomes that are directly related to nursing care such as changes in patients’ symptom experiences, functional status, safety, psychological distress, and costs. They are also related to the environment in which nurses practice, which impact patient outcomes. For example, the nursing staff that implements strategies to decrease turnover on the nursing unit impacts overall hospital turnover rates. Nurses assume accountability and responsibility for the consequences of these outcomes. |
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appropriate goal for restorative care
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Restorative interventions focus on returning a patient to his or her previous level of function or a new level of function limited by his or her illness or disability. The goal of restorative care is to help individuals regain maximal functional status and enhance quality of life by promoting independence.
Ex. Patient will be able to walk 200 feet without shortness of breath |
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Diagnosis-related groups
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Diagnosis-related groups (DRGs) are grouped inpatient hospital services for Medicare patients. Each group has a fixed reimbursement amount, with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set amount for each patient based on the assigned DRG, regardless of patient’s length of stay or use of services. DRGs are part of the prospective payment system.
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Nursing informatics
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Nursing informatics is the use of information, data, and technology to communicate, manage knowledge, mitigate errors, and support decision making. It requires knowledge, skills, and attitudes from the nurse to be able to effectively use information and technology. Nursing informatics is focused on the organization, analysis, and dissemination of information.
When a nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions |
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principle of patient-centered care that is focused on respect, values, preferences, and expressed needs
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Patient-centered care that is focused on respect, values, preferences, and expressed needs focuses on treating the patient with dignity and respect. A component is to keep the patient informed and involved in decision making. Consider patient preferences and perspectives when planning care. An environment where the patient is respected focuses on quality of life.
Ex. -Pulling the curtain around the patient bed before changing the wound dressing on the patient’s leg -Allowing the patient to ask questions and express his or her concern about surgery -Working with the family to bring in ethnic foods that the patient prefers |
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Healthy People 2020 as a guide
provide prenatal care for underemployed and underinsured |
Increase life expectancy and quality of life and eliminate health disparities
By providing prenatal care to this group of women, the health professionals will improve the birth outcomes for the South American women’s children and in turn the children’s quality of life. Being underinsured represents a health disparity, and Healthy People 2020 aims to decrease this inequity. |
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Healthy People 2020 as a guide
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improve delivery of care to a community
Community assessment Implementing public health policies Increasing access to care Determining rates of specific illnesses Improved delivery of health care occurs through assessment of health care needs of individuals, families, and communities; development and implementation of public health policies; and improved access to care. For example, assessment includes systematic data collection on the population, monitoring the health status of the population, and accessing available information about the health of the community. |
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community health nurse
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Controlling and managing symptoms of any disease improve the patient’s quality of life. Assessing for and preventing risks and making educational programs available improve the level of health within a community. The example here was asthma, but managing chronic diseases in the community improves the overall level of health of that community. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family. It involves the safety needs, acute and chronic care of individuals and families, and enhancement of their capacity for self-care.
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nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources
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By teaching the community about available health care resources, such as the nearby clinic, and relevant illness prevention, such as immunizations, you increase the level of awareness not only about the disease but also about methods of treatment. As the community becomes more informed about the illness, prevention, and treatment methods, the health of the community increases.
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Vulnerable populations of patients
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Vulnerability is a likelihood to develop health problems due to an excess of risks, limited access to health care services, and dependence on others for care.
more likely to develop health problems as a result of Ex. Excess health risks, limits in access to health care services, and dependency on others for care |
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major public health problems commonly affecting older adults
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Substance abuse
Dementia Financial limitations The older-adult population frequently has restricted or fixed income levels and a higher percentage of chronic illnesses. Managing these illnesses further depletes the financial resources for the older-adult population, further increasing their risks for health problems. |
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nurses set up flu vaccine clinics in local churches and senior citizen centers.
which level of prevention? |
Tertiary intervention.
Flu vaccines are related to controlling the spread of a disease, in this case the flu. |
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The clinic is initiating a lead screening program.
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Secondary intervention.
Screening for lead levels is a health-screening program that leads to early-intervention activities. |
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Nurse as Counselor
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To convince a patient to participate in a smoking cessation program or any program that requires changing a behavior requires the nurse to act as a counselor to support the patient in changing a behavior (in this case a smoking habit). It means that the nurse does not educate the patient about the dangers of smoking; first he or she must actively counsel the patient to decide to change the behavior. Without support and counseling, the smoking cessation education may not be used effectively by the patient.
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Nurse as Epidemiologist & Collaborator
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Initially when the nurse noticed an increase in the number of positive tuberculosis (TB) skin tests, she was comparing current data with previous data to track positive skin test rates. Once the increase was noted, she collaborated with the school nurse and other members of the health department to assess the entire school district.
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increasing the likelihood that the patient will accept a community nurse's suggestions
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To convince the patient to try the new technique, the patient has to change current practices. The best way to achieve this goal is to act as a change agent and apply principles to identify why the patient is resistant, hesitant, or reluctant; to support the patient in trying the new therapy; and finally to help the patient believe that the new therapy is consistent with personal health care goals.
Ex. Supporting the patient as she tries the insulin pump on a limited basis Identifying why the patient is reluctant to use the insulin pump The patient’s perception that the insulin pump is more consistent with her health care goals than insulin administration |
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a community assessment
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The correct order is (1) locale, (3) population, and (2) social systems.
To begin a community assessment the structure and geographical boundaries of the community are identified. Look at the structures in the community (e.g., schools, churches, types of residences). Next obtain data about the population and the demographics of the community. Who are the residents, what is the age range, and what types of ethnicity are represented? Finally review the social systems in the community. Although the number of schools and churches were obtained when reviewing the community structure, it is important to know what, if any, community services are provided by the schools and churches, including parenting classes, support groups, and play days. |
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determining some of the health needs of this population
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A) Identify which two health needs the immigrant population views as most important
B) Apply information from Healthy People 2020 C) Determine how the population uses available health care resources D) Identify perceived barriers for health care All of these assess the health care needs of this population. It is necessary to identify their priorities and try to meet them, applying information from reliable guidelines such as Healthy People 2020. How or if a population uses available health care resources and the perceived barriers for health care are all important. These elements help identify factors that promote or impede health care for this group. |
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goals of Healthy People 2020
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A) Assesses the health care resources within the community
B) Assesses the existing health care programs offered by the county health department C) Compares existing resources and programs with Healthy People 2020 goals The nurse must first assess for existing health care resources and educational programs in existence. Then he or she must compare these resources and programs with Healthy People 2020 goals. These processes determine if any new goals need to be added or updated. |
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The nursing paradigm
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The nursing paradigm focuses on person, health, environment/situation, and nursing. All the elements interact with one another, with the patient being central.
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A theory is a set of concepts, definitions, relationships, and assumptions that
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B) Explain a phenomenon.
Theories are designed to explain a phenomenon such as self-care or caring. A theory is a way of seeing through a “set of relatively concrete and specific concepts” and the propositions that describe or link the concepts. |
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Orem’s theory of self-care
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Orem’s theory of self-care provides a solid theoretical background for self-management for a variety of diseases. This theory shows the nurse how to direct the patient toward self-management to promote health and/or sustain wellness.
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Peplau’s theory when establishing the nurse-patient relationship
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A) An interaction between the nurse and patient must develop.
B) The patient’s needs must be clarified and described. C) The nurse-patient relationship is influenced by patient and nurse preconceptions. There is continual interaction by both the patient and the nurse throughout all phases of the nurse-patient relationship. The statement “The nurse-patient relationship is influenced only by the nurse’s preconceptions” is incorrect because the focus is only on the nurse. |
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Theory-based nursing practice uses a theoretical approach for nursing care. This approach moves nursing forward as a science. This suggests that
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here are multiple theories for the practice of nursing; these theories are tested to develop the evidence to describe or predict patient outcomes.
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To practice in today’s health care environment, nurses need a strong scientific knowledge base from nursing and other disciplines such as the physical, social, and behavioral sciences. This statement identifies the need for which of the following
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C) Interdisciplinary theories
As the health system evolves and the health care needs of the patient focus on health promotion, illness prevention, and treatment, more disciplines are involved in patient care. To be effective in practice nurses need to be aware of theoretical approaches of care arising from other disciplines and from nursing. |
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Theory that describes the life processes of an older adult facing chronic illness
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Developmental theories describe and predict behavior and development at various phases of the life continuum, as in the phase of older adulthood.
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components of systems theory
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Data related to system functioning = Feedback
Data entering the system = Input Product and information obtained from the system = Content End product = Output |
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Maslow’s hierarchy of needs
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The immediate priority is air, water, and nutrition. The patient needs to have sufficient air exchange, which might require oxygen administration. In addition the patient needs to have appropriate fluid balance and some nutritional supplement.
Ex. Pt has severe diarrhea and vomiting for the last week. He is weak, and his breathing is labored. Using Maslow’s hierarchy of needs, identify this patient’s immediate priority. |
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Theories
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Provides a structural framework for broad concepts about nursing = Grand theory
Addresses specific phenomena and reflect practice = Middle-range theory First level in theory development and describes a phenomenon = Descriptive theory Linked to outcomes (consequences of specific nursing interventions) = Prescriptive theory |
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Leininger’s theory
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Leininger’s theory of transcultural nursing focuses on the patient’s culture and the impact of culture heritage on health care needs and interventions.
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Henderson’s theory as a basis for theory based-nursing practice.
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A) Knowledge of nursing science
B) Knowledge of related sciences D) Knowledge of standards of practice Regardless of which particular nursing theory is selected, the nurse must use knowledge from nursing and related sciences, experience, and standards of practice when providing care. |
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Theory generation
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A) Builds scientific knowledge base of nursing
B) Discovers relationships of phenomena to practice D) Identifies observations about a phenomenon Theory-generating research identifies observations or describes phenomena. It contributes to the scientific knowledge base of nursing. Relationships of the phenomena to practice and testing specific phenomena are part of the theory-testing research activities. |
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Theory-based nursing practice
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Theory-based nursing practice does reflect nursing outcomes. For example, prescriptive theories address specific nursing interventions and predict the patient response.
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As an art nursing relies on knowledge gained from practice and reflection on past experiences. As a science nursing relies on
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A) Experimental research.
B) Nonexperimental research. C) Research from other disciplines. As a science, nursing relies on knowledge gained through research from nursing and other disciplines and scientifically tested knowledge applied in the practice setting. *It does NOT rely on professional opinions |
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Qualitative Research
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The data in this study were collected during interviews; information from the interviews was used to describe common themes and experiences of the parents. These are characteristics of qualitative research.
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A nurse who works in a newborn nursery asks, “I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding.” In this example of a PICOT question, the I is
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The Intervention in this PICOT question is playing peaceful music.
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Randomized controlled trial
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This is a randomized controlled trial because patients are randomly assigned into the control or treatment group.
ex. randomly assigns 100 patients who smoke and attend a wellness clinic into two groups. One group receives the standard smoking cessation handouts; the other group takes part in a new educational program that includes a smoking cessation support group. |
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nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. Their next step is to
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After completing an EBP project and evaluating its effectiveness, it is important to communicate the results with others.
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Implementing EBP
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2. Ask the burning clinical question.
6. Collect the most relevant and best evidence. 5. Critically appraise the evidence you gather. 1. Integrate the evidence. 3. Evaluate the practice decision or change. 4. Share the results with others. |
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the researcher provides full and complete information about the purpose of the study and gives the subjects the choice to participate or not participate in the study. This is an example of
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D) Informed consent.
The process of informed consent includes providing research subjects full disclosure about the study and provides the subject the opportunity to participate or not to participate in the study. |
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One nurse asks a colleague, “I wonder how best to measure pain in a child who has sickle cell disease?” This question is an example of a/an:
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Knowledge-focused trigger
Knowledge-focused triggers are questions about information available on a specific topic. |
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The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of “Do” from that model
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A) Implement the new skin care protocol on all medicine units.
In the Do step, the nurse selects an intervention and implements it. |
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A nurse researcher decides to complete a study to evaluate how Florence Nightingale improved patient outcomes in the Crimean War. This is an example of what type of research?
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Historical studies establish facts concerning past events.
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a nursing-sensitive outcome that the nurses need to consider measuring?
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Nursing-sensitive outcomes are outcomes that are sensitive to nursing care.
C) Number of patients who fall and experience subsequent injury on the evening shift |
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A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate?
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Rapid-improvement events are appropriate to use when a serious problem that affects patient outcomes exists and needs to be resolved quickly.
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The nurse finds out that the patient is a Jehovah’s Witness and cannot have blood transfusions because of religious beliefs. He or she notifies the patient’s health care provider and receives an order to give the patient an alternative to blood products. This is an example of:
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D) Considering the patient’s preferences and values while providing care.
Providing evidence-based practice requires that you take the patient’s values and beliefs into consideration while providing care. |
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While reviewing the study, one of the nurses states that it evaluates if newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse’s statement?
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The purpose statement includes research questions or hypotheses—predictions made about the relationship or difference between study variables (concepts, characteristics, or traits that vary within or among subjects).
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A research study is investigating the following research question: What is the effect of the diagnosis of breast cancer on the roles of the family? In this study “the diagnosis of breast cancer” and “family roles” are examples of:
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Variables are concepts, characteristics, or traits that vary within or among subjects.
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A nurse researcher is developing a research proposal and is in the process of selecting an instrument to measure anxiety. In which part of the research process is this nurse?
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During study design the researcher selects instruments to measure variables.
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