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144 Cards in this Set
- Front
- Back
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Societal Influences on Nursing. Influence of today's health care delivery system=
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1) Demographic: Older people live longer, men in profession 2) Woman's Health Care Issues: Women needing mamagrams/Pap Smears 3) Human Rights 4) Medically Undeserved 5) Threat of Bioterrorism Rising health care costs, evidence based practice, nursing and biomedical research, nursing shortage |
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Institute of Medicine, To Err is Human (1999) Brought to light how many?
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Pt deaths and infections are caused by medical errors.
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Nurses make up 1/3 of Health Care Workers, T/F?
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True
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What does QSEN stand for? Who was it funded by? What was the main purpose behind QSEN?
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Quality and Safety Education for Nurses. Robert Wood Johnson Foundation. We want to create better health care for all Americans! Safety..there were too many medical errors happening
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In order to improve outcomes, clinicians and clients need to collaborate to form a treatment plan that is includes?
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EBP, client preferences
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Important aspects to Nursing Process/QSEN
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Quality Improvement, Safety, Informatics (Using Technology), and Root Cause Thinking, pt. centered care, teamwork and collaboration, EBP
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Quality Improvement
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To ensure that client receives appropriate care. QSEN defines as ability to "use data to monitor the outcomes of care processes and use improvement methods to design and test changes continuously to improve the quality and safety of health care systems."
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Safety:
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"Minimizing risk of harm to patients and providers through both system effectiveness and individual performance"
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Client safety is a _______, when health care is delivered
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Safety
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Client safety was identified as a priority by ?
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The Joint Commission, through launch of National Patient Safety Goals
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Joint Commission includes precautions including:
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Handwashing, proper identification of client, protection of suicidal clients from self-harm
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Informatics
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"Nurses ability to use information and technology to communicate, manage knowledge, mitigate error, and support decision making"
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Root Cause Thinking /Purpose
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RCT= Extension of the nursing process. Developed from a process called, root cause analysis. Purpose: To determine the underlying cause of a problem, fix it if possible, to prevent further problems from happening.
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Through the process of RCT, nurses work with?
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The client, family, + other disciplines to improve client outcomes by modifying/resolving underlying causes and improving the clients health. ACTIVELY synthesizing and gathering information from observation, experience, reflection, reasoning, communication, to determine underlying causes of client's current health status.
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After we determine the root cause, we want to?
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Work with the client to promote health. We want to use active listening, patient centered care, behavior changing techniques, + motivational interviewing to encourage clients to change their self-health care.
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Is Nursing an Art or Science?
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Both. Art= Creativity, adapt to situations, work with medium that is variable/out of nurse control. Science= EBP, tools have been tested/researched/screened, nursing diagnoses and care have been researched, nursing process has been researched
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Doctoral Options
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DNP (Doctorate of Nursing Practice/Clinically Based), Ph.D (Doctorate of Philosophy-Research based.), DNS: Doctor of Nursing Science (Also research based)
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Health Care Services Pyramid Includes:
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Primary, Secondary, and Tertiary Care
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Preventive Strategies to Maintain Wellness:
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Diet, Exercise (Everything you need to do to stay healthy)
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Primary:
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First line of health care. (Ex: Seeing your doctor,PCP a specialist to prevent problems. Like a check up)
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Secondary:
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When you are sick/in the hospital. You are IN A CARE environment. Having serious intervention, health care issue now requiring additional information from a specialist (Ex: Surgeries, hospitalizations)
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Tertiary
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Rehab (not always needed) Issue requires even MORE specialized care. Similar to Restorative, as we are trying to help the client return to previous state of wellness. We want to prevent reccourenc
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Continuing Care:
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Ongoing care that helps maintain level of wellness. Help chronically ill maintain highest level of wellness as possible (Disabled, functionally dependent, suffering a terminal illness) Can have type of care institutional or in the home
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Rehabilitation
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Attempts to restore clients to their fullest physical, mental, social, vocational, and economic potential. (Physical, occupational, speech therapy, as well as social services) We want to prevent reoccruence
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Adult Care Center
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May be associated with a hospital or nursing home/or operate independently -Offer services to patients in need of daily physical rehab, counseling for emotional, drug, alcohol addiction (Shower, Speech Therapy) -Helps keep them out of expensive care |
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Who is on the health care team?
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MD, DO: Lead health care provider NP, PA, CNMW, CNA: "Mid Level Providers" RT= Provide tx to support airway and breathing PT: Provide treatment to increase mobility and strength Occupational Therapist: Provide tx to improve ADL's and IADL's Speech Pathologists: Assess and tx's swallowing and speech PCT, CNA: Support nursing staff NEVER SIGN OFF ON ANYTHING UNTIL ITS DONE |
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Approximately how many medical errors are related to miscommunication?
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65%
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Other reasons why we may make errors?
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Hidden Agendas (Not sharing information), Passenger Syndrome (Letting others take charge), Halo Effect (Doctors make mistakes too!), Failure to follow up, Complacency
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Improving Communication Between HCT members:
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Clarify written communication and verbal (SOAPIE notes)
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What does SOAPIE stand for?
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Subjective, Objective, Assessment, Planning, Intervention, Evaluation
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TeamSTEPPS: Created by? What does it outline?
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Team Strategies and Tools to Enhance Performance and Patient Safety. Department of Defense. Outlines effective communication strategies between HCT
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Team STEPPS = (4)
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Brief: All team members get briefed prior to beginning care Call-Out: Get someone's attention fast, when pt. not doing well Check Back: Remember to check back on issues Cross-Monitoring: All members of the HCT are responsible for double checking each other Debrief: Group conversation about what was done well, what needs improvement Feedback: Constructive comments about events that transpired SBAR |
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How do I tell a provider that I disagree, what should I use? (CUS words)
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Concerned, Uncomfortable, This is a Safety Issue
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When you disagree: 2 Challenge Rule
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Need to voice your disagreement 2 times, THEN bring it to someone's attention. When someone disagrees with you, restate what they have said, to show you how you have heard them. Remember pt. safety= HIGHEST priority
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SBAR
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Situation (Current Situation), Background (Ex: Pt was refusing to take medications), Assessment, Request (What do you think needs to be done?
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Know the following ethic terms:
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Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Advocacy, Responsibility, Accountability, and Confidentiality
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Autonomy
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Freedom from external control. Commitment to include patients in decisions about all aspects of care. They have control over their health decisions too. We want to acknowledge and protect a patients independence (Ex: Surgeon going over information with patient prior to surgery- they have a right to know)
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Beneficence
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Taking positive actions to help others. Fundamental to nursing and medicine. Agreement to act with best interest of patient, and not of self. Nursing is a primary service to others.
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Nonmaleficence
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Avoidance of harm or hurt. Equal commitment to do no harm. We want to try and balance the risks and benefits while delivering care (Ex: Deciding for surgery vs. not)
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Justice
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Refers to fairness. Discussions about health insurance, hospital location and services, even organ transplants
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JUST CULTURE
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Refers to the PROMOTION of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. By fostering open discussion about errors, members of the health care team become informed participants, able to design new systems that prevent harm.
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Fidelity
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Refers to the agreement to KEEP PROMISES :) Nurses need to follow through on their interventions and actions
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Advocacy
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Refers to the support of a particular cause. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy
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Responsibility
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Respecting one's professional obligations and following through on promises. As a nurse, you are responsible for your actions
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Accountability
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The ability to answer for one's actions
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Confidentiality /HIPPA=
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Federal legislation= Health Insurance Portability and Accountability Act of 1996. Defines the rights and privileges of patients for protection of privacy
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Eustress
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Beneficial stress (Protective Stress) What do you do with this good kind of stress? Celebrate? Look ahead to the next challenge? :)!
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Burn Out
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Diminished interest, physical and mental exhaustion
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Who developed the Hierarchy of Needs?
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Abraham Maslow: Tries to explain what people need to progress to SELF ACTUALIZATION
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Distress vs. Eustress
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Distress: Damaging Stress Eustress: Stress that protects Health |
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PTSD:
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An ACUTE stress disorder that begins when a person experiences, witnesses, or is confronted with a traumatic event
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Physical Response: Fight vs. Flight - READY FOR ACTION. Neurophysiological response involving: Medulla Oblongata, Reticular Formation, and Pituitary Gland. Explain Each
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Medulla: Pulse, Resp, BP increasing Reticular F: Increased Consciousness Pituitary Gland: Increased Cortisol Production |
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General Adaption Syndrome (3 Stages/Name + Describe)
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Can be triggered by PHYSICAL or EXTREME emotional stress. Alarm Reaction: Inc pulse, BP, Alertness Resistance Stage: Stabilization & Healing (Adaption to Stressor) (Resisting Stress) Exhaustion Stage: Unable to maintain adaption, loss of energy |
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Conversion
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The presense of physical symptoms d/t repressing anxiety, concerns (How the brain tries to protect you..converting it to a physical symptom instead
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Denial
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Refusing to acknowledge an extremely unpleasant emotion/circumstance
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Displacement
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Transferring feelings about something troubling to something that is less stressful (Ex: Taking out stress on kids)
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Dissociation:
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Emotionally/cog disconnecting from one's environment (people, situations) Amnesia= Not common, literally out of memories/waking up and not know who you are
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Regression
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Returning to a previous level of development to cope with stress (Kid!)
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Identification
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Copying anothers behavior, traits, qualities (Ex: Little boy acting like dad/competing for attention)
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Compensation
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Overemphasizing one quality or skill in attempt to cover up another area that the person feels is inadequate (Ex: Bravado when insecure)
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How does the WHO define health? 1947
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A state of complete PHYSICAL, MENTAL, AND SOCIAL well-being, not merely the absence of disease or infirmity"
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How does our paradigm/view shape our practice? Our belief system as nurses. What does "good health mean"?
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The highest level of wellness one may attain
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Does health mean the same for everyone?
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No- varies with pt's BASELINE health and what the pt desires
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Why do some people get sick and others don't?
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Risk factors (uncontrollable vs. controllable), age, gengetics, traumatic occurrence, environment, unsafe behaviors, occupational exposure, attitudes
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*WELLNESS VS ILLNESS PREVENTION* Nursing's goal with WELLNESS EDUCATION:
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To help PREVENT a decline in health, MAINTAIN current or higher level of wellness (May include stress management, exercise, holistic health) -We want to improve or maintain.. |
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ILLNESS PREVENTION
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Focused on a SPECIFIC THREAT (Getting immunizations, screenings for certain things, education, etc.)
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AMERICAN NURRSING ASSOCIATION (2010) DEFINITION OF NURSING
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THE DIAGNOSIS (NURSING) AND TREATMENT OF HUMAN RESPONSES TO ACTUAL OR POTENTIAL HEALTH PROBLEMS
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Examples of Potential Health Problems:
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-Smoking (Cancer), Eating Bad
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Passive vs. Active Strategies of Health Promotion:
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Passive
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5 Characteristics of the Nursing profession
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1) Extended Education 2) Body of Knowledge 3) Provides a SPECIFIC service 4) Has AUTONOMY 5) Incorporates a Code of Ethics |
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Requiring new nurses to pass the NCLEX exam is an example of which characteristic that all professions hold?
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BODY OF KNOWLEDGE
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List the different levels/types of nursing (4)
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1) LPN (Licensed Practical Nurse) -Still need the prereq's, but lower level of nursing. Can't do IV push, limited with clinical 2) Associate Degree Nursing (ADN) -2-3 years with limited clinical 3) Diploma RN (When nursing first started. From school, straight to unit) 4) Baccalaureate RN (New Trend/4 years, more advanced critical thinking) BSN IN 10 |
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Research shows that more BSN's on staff=
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Lower mortality and infection rates
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Who can't get promoted?
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LPNS and ADNS
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Define APN
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Advanced Practice Nursing. Ex: Certified Registered Nurse Anesthetist, Midwife, Clinical Nurse Specialist, Nurse Practitioner
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DNP, what do you NEED to be?
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Doctorate of Nursing Practice (clinically based) YOU NEED TO BE A NURSE PRACTITIONER
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Ph D: DNS:
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Doctorate of Philosophy, Doctorate of Nursing Science |
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What does a nurse do? (4)
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1) Educates patients and families 2) Diagnoses problems within the NURSING scope (nursing diagnosis) 3) Provides CARE within nursing scope 4) ADOVOCATE for health and wellness of client |
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How did nursing start/who really started the nursing profession? and what was she most famous for?
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Florence Nightingale. Her help in the Crimean War, separating "clean" from dirty and helping with soldiers. Provided emotional and physical care
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Clara Barton =
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A nurse who cared for people during the Civil War, + founder of the Red Cross
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Dorothea Dix
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Nurse Fought to help the impoverished mentally Ill (Dick- American Horror Story, Evan Peters ;) Helped create mental asylums, Superintended of Army Nurses
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Mary Elizabeth Mahoney- What did she help to create?
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African American RN, helped create ANA
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In the early _____, nursing education and creation of established practices emerged. But in ____, nurses started specializing and specialized organizations emerged
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1900, 1920
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Domain
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"The PERSPECTIVE" of a profession (EVERYTHING that the profession addresses)
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Paradigm
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YOUR world view, the perspective that YOU use to interpret events
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How does a nursing paradigm differ from others?
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Nursing is evidence based
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Define Ethics: + Who decides what is right/wrong for a group?
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Conduct and Character that reflects the greater good, rather than what is just good for the individual Those affected most by it |
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What happened during the 21st century?
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Nursing code of ethics, changes in curriculum, nursing happening in multiple care settings, nursing at those various levels
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Is Nursing an Art or Science?
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Both- Art: Creativity, adapt to situations Science: EBP, nursing diagnoses and care researched for many years, nursing process has been researched, tools tested |
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What 5 vocabulary words are encompassed into Ethics?
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Beneficence, Non-maleficence, AUTONOMY, JUSTICE and FIDELITY (A J Fuuuugs) |
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Define Beneficence |
Helping others
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Non-maleficence
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Doing no harm
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Autonomy
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We want patients to have the freedom to choose, so we need to give them informed decisions
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Justice
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Fare and equitable care whether they can pay or not
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Fidelity
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Keeping your promises and words to patients
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The Health Care Services Pyramid Includes
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The care ones (Primary, Secondary, and Tertiary)
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Primary, Secondary, and Tertiary Prevention (Interventions)=
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Primary: Doing things to stay healthy (To prevent getting Sick. You aren't stick yet) Going to the doctor, getting immunizations, working out Secondary: Sick already and you NEED treatment (Medications/Hospital) Tertiary: Rehab: Helping people get back on their feet |
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Primary, Secondary, and Tertiary CARE
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1) Primary: Seeing your doctor/you already have symptoms 2) Secondary: Needing to see someone with more expertise/specialist 3) Tertiary: Need MAJOR things done, ICU, Heart Surgery, Life and death situations |
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Adult Day Cares
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May be associated with a hospital or nursing home/operate independently -Services to patients in need of daily physical rehab, counseling emotional, drug, alcohol addiction |
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Assisted Living:
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Long-term care with a home environment, greater resident autonomy, allows residents to live in their own units without being alone (ADL's)
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Who is at the center of the health care team?
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Nurse
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All members of the health care team have a responsibility for?
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Patient Care & Safety
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What does a phlebotomist do? Chaplain?
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Draws Blood, Supports patients spiritual well being
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Approximately ___ of all medical errors related to?
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65%, miscommunication
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IOM + QSEN + JCAHO:
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National Patient Safety Guidelines- Showed importance of changing health care to improve patient safety
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What does communication result from?
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Fatigue, Wrong Expectations, Distracted, Hurrying, Lack of knowledge, Multitasking, Hidden Agendas, Passenger Syndrome, Excessive Professional Courtesy, Halo Effect, Complacency (Nobody really cares either way), Culture, Physical needs not met, failure to follow up
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Ways we can clarify information:
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Clarify WRITTEN comm via SIAPI notes, verbal through asking follow up questions, speak up when you see something concerning
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Define Team STEPPS/Who was it created by?+ Purpose
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Team Strategies and Tools to ENHANCE Performance and Patient Safety, created by Department of Defense; sets out effective communication strategies between HCT
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Team STEPPS include:
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Brief, Call-Out, Check Back, and Cross Monitoring, Debrief (group convo about what was done well, what needs improvement), feedback (constructive comments about events that transpired), SBAR (Situation, Background, Assessment, Request)
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Brief:
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All health care members get briefed prior to beginning care
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Call-Out
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Get someones attention FAST WHEN PATIENT not doing well
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Check Back
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Remember to check back on patient issues
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Cross Monitoring
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All members of the health care team are responsible for double checking each other
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How do I tell a provider I disagree?
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I am CONCERNED, I am UNCOMFORTABLE, and this is a SAFETY issue
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What is the two challenge rule
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Need to VOICE YOUR DISAGREEMENT TWO times, then if nobody is listening, bring it to somebody elses attention.
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What is our HIGHEST priority?
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Patient Safety
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SBAR:
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Situation (at present), Background (Ex: Patient was refusing to take her meds), A: Nursing Diagnoses R: What do you think needs to get done?
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For each section of QSEN: KSA=
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Knowledge, Skills, & Attitudes
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QSEN (Patient Centered Care)
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Recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect, patient preferences, values, and needs
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List the 5 other aspects of QSEN
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Teamwork and Collaboration, EBP, Quality Improvement, Informatics, and Safety
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Root Cause Analysis:
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Asking the 5 whys, helps you to identify the ROOT cause of a problem. Can help you to discover all the potential or real causes which result in failure or problem
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Maslow Hierarchy of Needs tries to explain what people need in order to get to?
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Self Actualization
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Eustress=
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Stress that PROTECTS your health, whereas distress is damaging
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POST-TRAUMATIC STRESS
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An ACUTE stress disorder that begins when a person experiences, witnesses, or is confronted with a traumatic event
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What part of the brain causes increased pulse, resp, and BP?
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Medulla Oblongata
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What part of the brain leads to increased consciousness?
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Reticular Formation
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What gland releases cortisol production?
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Pituitary Gland
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Theory
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Explains a phenomenon, tries to clarify a cause, relationship
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Nursing Theory
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Conceptualization of some aspect of nursing' communicates the purpose of describing, explaining, predicting, or prescribing nursing care
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Who the hell was Betty Neuman?
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Came up with the SYSTEMS model- A diploma RN who worked in hospitals, industry, schools, became a nursing instructor
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Why did she come up with the systems model/theory?
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To "help nursing students understand how to approach patient care"
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Assumptions: Clients are DYNAMIC (always changing), they have a NORMAL range of responses, with stressors attacking the FLEXIBLE lines of responses+normal lines?
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Whatever
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For Neuman, prevention=
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Intervention
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What is pain?
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An unpleasant SENSORY and EMOTIONAL experience associated with actual or potential tissue damage?+ WHATEVER THE PATIENT SAYS IT IS. PHYSICAL AND COG ELEMENTS TO IT
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Which type of pain is often associated with depression?
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Chronic
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Explain the 3 types of pain
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Acute, Chronic, and Referral Pain
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Acute Pain
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SHORT term ( caused by injury, labor, short term event ex: dislocation) |
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Chronic:
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Caused by underlying illness that will not get better quickly, so treatment will just aim at controlling the symptoms
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Referral Pain
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Pain caused in one area of the body is interpreted by the brain to be from a NEARBY body part (ex: ear pain secondary to sore throat)
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Define Noicioreceptive (Somatic vs. Visceral)
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SPECIFIC pain receptors are stimulated
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Somatic Pain
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Felt on skin, joints, ligament, bones, muscles, (Inflammation under these sites)- usually can determine the SPECIFIC source of pain
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Visceral Pain felt?
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Abdomen/Hallow Organs (Can be dull, hard to find)
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Define NON Niocioreceptive (Neuropathic & Sympathetic)
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Nerve shooting off pain signals Neuropathic: Injury to nerve (MS, phantom limb, etc) Causes random firiing of nerve signals =MOST PAINFUL = NON NOCIORECEPTIVE/NEUROPATHY |
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Sympathetic Pain
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Injury to LIMB causes injury to NERVE (usually area becomes so sensitive that muscle weakens away)
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