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150 Cards in this Set
- Front
- Back
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qualitative research methods
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-phenomenology
-grounded theory -ethonography historical |
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quantitative
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-descriptive
-correlational -quasi-experimental -experimental |
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steps of quantative research
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- state research problem
define purpose of study review related literature formulate hypotheses and variables select research design select population and sample collect data analyze data communicate findings and conclusions |
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variable
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something measurable
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dependent variable
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variable being studied
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independent variable
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cause/condition identified
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hypothesis
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statement of relationships between independent and dependent variables
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data
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info researcher collects
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instruments
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devices used to collect and record
rating scale paper pencil |
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protecting rights of research subjects
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-infromed consent
-federal regulations -review boards |
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3 most common impediments to research
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- limited amt of subjects
-limited resources (personnel or money) - research not valued always- because not familiar |
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components of research journal
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-abstract
-intro -methods -results -discussion -references |
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evidence based practice
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- use of some form of substantiation in making clinical decisions
-evidence comes from tradition, authority, experience, error, logic, reason, research ex: handwashing, skin care, family presence in resuscitation |
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nursing research
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- improve client care
-enhance nursings scientific knowledge base - use findings in practice |
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nursing research steps
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- identify a problem
- conduct a literature review -formulate a research question or hypothesis - design a study - obtain consent -collect data -analyze data -share the info |
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major goal of nursing research
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- imrpove client care
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which of following is series of actions, changes or functions intended to bring about a desired result
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- process
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nurse who tests theory by examining theory itself and considering specific actions or ideas is using
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-deductive theory
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discover of how people desribe their own reality and how beliefs are related to actions ina social scene
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grounded thery
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law
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-standard or rule of conduct established and enforced by the government
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litigation
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-process of bringing and trying a law suit
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plaintiff
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-person brining suit
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defendant
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- person being acused of a crime
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types of law
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- public law
-private law -criminal law |
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public law
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- government is involved
- ex: can't vote till 18 |
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private law
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- regulations relationships among people
- civil suits |
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criminal law
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- federal crimes
-statutes -murder-theft |
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four sources of law
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- constiutions
- statutes -administrative law - common law |
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constitutions
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- serve as guide to legislative bodies
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statutes
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- enacted by a legislative body
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administrative law
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- empowered by executive officiers
-gov, president, |
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common law
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- judiciary system reconciles controveries
- creates body of laww - because always done it this way becomes law |
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legal regulation of nursing practice
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- nurse practice acts
- standards -credentialing |
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credentialing
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- accreditation
-licensure - certification |
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standards
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get from regulations, organizatins, ANA
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good samaritan acts
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- protect HCPS for doing good deeds
- CPR break ribs can't sue |
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Legal safeguards for nurse
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- informed consent
- contracts -collective bargaining - competent practice - patient education - documentation - adequate staffing -professional liability insurance -risk management programs - incident reports, JCAHO, sentinel events - pt bill of rights -good samritan laws |
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prof liability insurance
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- advised to carry own
- defrays all costs of defending nurse, including attorney - nursing fauculty and studnets also vulnerable to law suits - can be obtained through ANA, national student nurses assoc and private ins companies |
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legal responsibilities of students
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- nursing students are responsible for own actions and acts of negligence
- must be assigned learning experiences within their capabilities and be given reasonable guidance and supervision |
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clinical alerts
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- nurses duty to respond to all clients call lights not just those of assigned
- best defense against malpractice- knowing nursing responsibilities and the scope of practice of the members of your health team - assess pts for fall assessment - know meds you are administering , know why recieving, dosage range, adverse effects, toxicity leve,s, contraindications - document all nursing measures taken to protect client - monitor both phys and psych status of client - never discuss cliens in elevator cafe or other pub places |
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violence abuse and neglect
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- includes domestic violence, child abuse, elder abuse, sexual abuse and neglect
- nurses are mandated reporters - need to report abuse |
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americans with disabilities act
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- prohibits disrim on basis of disbaility in employement
- may not refuse to hire nurse with disabilities if qualified and able to fulfill essential functions of work role |
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impaired nurse
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- practice been affected because of chemical abuse
- high levels stress and easy access make easy - primary concern is pt - critically importnat nurses problem identified quick -stay late, come in early, lots of narcotics for pts when she is around |
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unprofessional conduct
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- incompetence or gross neg
- conviction for practicing without a license - falsification of pt records - illegally obtaining, using or posessing controlled substances -having personal relationship with pt - violation ethical codes - breach conficdnetiality -fraud refusing to care for pts with specific socioeconomical background or cultural orig |
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reasons for suspending or revoking license
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- drug or alcohol abuse
- fraud or deceptive practice -criminal acts - previously disc actions gross or ordinary neg - physical or mental impairments |
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incident report
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- agency record of accidnet or unusal occurence
- used to make all facts available to agency personnel to contribute stat data about incidents or accidens and help healht personnel prevent future incidents or accidents -internal document |
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criminal law
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- crime- misdemeanor, felony
- tort |
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misdemanor
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- punishable by fines or less than one year imprisonment
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crime
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- wrong against a person or his property as well as the public
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felony
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-punishable by imprisonment for more than one year
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tort
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- a wrong comitted by a person against another person or his or her property
- intentional - unintentional |
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intentional
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- assualt and battery
- defamation of character - invasion of privacy - false imprisonment - fraud |
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unintentional
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- negligence
- malpractice |
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role nursings in legal proceedings
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- defendant
-fact witness -expert witness |
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best defense in license invest
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- early legal counseling
- character and expert witnesses -thorough prep for all proceedings - documentation |
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informed consent
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- cant get from mentally incapacitated person
- invasive procedures that have risk - person who does procedure should get informed consent - you can aswer questions, get appropriate person to expalin procedure must make sure pts receive info in way they understanding- language barrier, deaf - under 18- parental - invasive action- cardiac catherization - is a process |
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express consent
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- may be either oral or written agreement
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implied consent
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- when pts non verbal behavior indicates agreement
-position for injection - emergency medical care |
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nurses role in consent
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- nurses often asked to obtain signed consent form
- not responsible for explaining the procedure - resp for wtinessing pts signature on form |
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rns signature confirsm
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- pt gave consent voluntary
- signature is authentic - pt appears competent to give consent - be a pt advocate |
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malpractice
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-negligence by a professional
-professional failure to carry out or perform duties that result in injury - operating outside scope of practice - results in restituiton filed as civil tort - rarely criminal - malpractice insurance |
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five steps of nursing process
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- assessing
-diagnosing - planning -implementing - evaluating - ADPIE |
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characteristics of nursing process
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- systematic
- dynamic - interpersonal - outcome oriented - universally applicable |
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four blended skill
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- cognitive skills
-technical skills - interpersonal skills - ethical/legal skills |
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cognitively skilled nruses
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- offer scientifc rationale for pt plan of care
- select nrusing interventions most likley to yield desired outcomes - use critical thinking to solve problems creatively |
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technically skilled nurses
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- used technical equiptment with competece and ease to achieve goals with minimal stress to pts
- creatively adapt equiptment and techn procedures to needs of pts in diverse circumstances |
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interpersonally skilled nurses
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- working well with others
- how react with pts, personable, working closely and collaboratively |
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ethnically and legally skilled nurses
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- trusted to act in ways that advance interests of pts
- accountable for practice - act as effective pt advocates - mediate ethical conflict among pt, significatn others and health care team |
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considerations when faced with problem
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- how approcah problem
- what knowledge need - what could go wrong if implement something - where resources are - critique care after - how you could have done bettter/improved |
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characteristics interpersonal caring
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- promotion of dignity and respect of patients
- centrality of the caring relationship - mutual enrichment of both participants in the nurse-patient relationship |
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ETHICAL and legal skill
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- developing accountability
- reporting incompetent, unethical, or illegal practice |
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concept maps
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- asess and analyze data
- generate nursing diagnoses - way to schematically put oout |
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critical thinking
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- clinical reasoning
- based nursing process - intuiton, logical , knowledge, skills look at patient to a point - constantly re-evaluating what done for client |
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an age greater than ---
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65, risk factor for fall
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teaching about guns and violence
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safety consideration for adolescents
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factors contributing to falls
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- age greater than 65
- history of falls - impaired vision or balance - altered gait or posture, impaired mobility - medication regimen - postural hypotension - slowed reaction time - confusion or disorentiation - unfamiliar environment |
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nursing process restraints
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- assess need for restraint
- planning- review instiutional policy for restraints and phys order - delegation- may delegate the application of ordered restraints and their temporary removal for skin assessment and care to a UAP who have been trained in their use . |
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UAP restraints
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- application
- temporary removal for skin assess but cannot assess skin - care of skin |
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alternative measures can you use to protect the patient from increased risk for harming him/herself or others
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- bed alarms
- sleeve covering IV - anticipate toileting -educate family, ask to stay if they can |
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ambularm device
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- alarm on patient leg, pressure sensitive
-know when they get out of bed |
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physiologic hazards associated with restraints
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- suffocation from entrapment
-impaired circulation - altered skin integrity- pressure uclers - diminished muscle and bone mass - fractures - altered nutrition and hydration - aspiration and breathing difficulties - incontience - changes in mental status |
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RACE
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R- rescue anyone in immediate danger
A- activate the fire code and notify appropriate person - C-confine the fire by closing doors and windows - E- evacuate patients and other people to safe area |
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prevent poisoning
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- childproof containers
- call poison control immediately to know what chemicals are made of - use activated charcol ipicak induces vomiting not use widely anymore because burns esphagous |
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preventing suffocation
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- smoke detectors
- co2 monitors- health education - CPR- looka t home saftey checklist |
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preventing injhury firearsm
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- raising awareness gunshot injuries
- provide information to parents to keep guns out of childrens hands |
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decreasing equipment related accidents
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- only for intended use and be familiar with equipment
- handle equipment with care so as not to damage it - use three prongs plugs - do not twist or bend electric cords - alert to signs equipment faulty - be alert to wet surfaces |
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preventing procedure- related accidents
national patient safety golas |
- accuracy of pt info
- effectiveness of communication among caregivers - safety using meds - risk of health care associated infections - accurately and completely reconcile meds across continuum - reduce risk of pt harm resulting from falls |
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filing incident report
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- confidential internal document
- pts response - details the examand treatment of pt after incident -incident report reported immediately |
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bacteria, viruses, fungi
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infectious agent
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reservoir
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natural habitat of organism
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point of escape from organism
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portal of exit
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direct contact, indirect contact, airborne route
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-means of transmission
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point at which organisms enters new host
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- portal of entry
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susceptible host
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- must overcome resistance mounted by host defenses
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Types of infection
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- colonization
- local infection - systemic infection - acute -chronic |
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colonization
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bacteria is somewhere, it entered body but no symptoms
- typhoid mary , asymptomatic |
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local infection
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- cut or wound infected, inflammation, red, hot, may have pus
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systemic infection
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- widespread
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bacteremia
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- systemic infection caused by bacteria
- produce, fever malase, in system |
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septeciemia
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- riproaring infection thoughtout body
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acute
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lasts short period of time
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chronic
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- several weaks or months
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means transmission
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- direct
- indirect |
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direct
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- contact
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indirect
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- vehicle borne, vector borne
- airborn |
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vehicle borne
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surface with HIV on it, on table not on pt
- stuck with needle- vehicle is needed |
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portal exit
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- resp
- GI -GM - breaks in skin -blood and tissue |
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portal entry
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- often same as exit
- urinary -resp -GI - skin - usually enters same way it exist |
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immune deficiency conditions
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- meds- steriods
- cancer- cehmo AIDS/HIV |
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Stages of infection
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incubation period
prodromal stage full stage of illness convalescent period |
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incubation period
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organism is growing and multiplying
- been infected, growing |
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prodromal stage
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- person is most infectious, vauge and non-specific signs of disease
- low grade feve,r not sick enough to stay home |
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full stage of illness
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- presence of specific signs and symptoms of disease
- all signs and symptoms |
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convalescent period
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- recovery from infection
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factors affecting risk for infection
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- integrity of skin and mucous membranes
- pH levels of GI and GU tracts - integrity and number of body's WBC - age, sex, race and heredity - immunizaitons, natural or acquired - level of fatigue - nutritiion and general status - stress level - use of invasive or indwelling medical devices |
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transient bacteria
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attached loosley on skin, removed with ease
- hygiene,k hand sanitizer |
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resident
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found in creases in skin, requires frictin to brush and remove
- surgical scrb |
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aseptic technique
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- includes all activities to prevent or break the chain of infection
- two categories medical asepsis surgical asepsis |
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medical aspesis
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clean technique
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surgical asepsis
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sterile technique
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Lab data indicating infection
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- elevated WBC
increase in specific types WBCS- leukocytes - elevated erythrocyte sedimentation rate -- red cells more indicates nfection - presence of pathogen in urine, blood, sputum, or draining cultures |
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normal WBC values
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-5 to 10 thousand
elevated = infection |
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transmission barriers
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- hand hygiene
- barrier techniques - sterilization - discontamination - disposing of waste appropriately - personal protectiv equiptment gloves, gowns, masks, proective eye |
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body's defense against infection
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- normal flora- usually skin, trasient, staph on skin everywhere
- inflamm response- WBCS to area - immune - two types |
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inflammation
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- destroys or dilutes agent
- prevents furtehr spread - promotes repair of damaged tissues |
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5 signs of inflammation
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- pain
swelling redness heat impaired function of the part- it hurts - symptom but not always bad thing |
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hand hygiene
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- before nad after direct contact with pts
- before and after using gloves - before inserting urinary cath, IV or invasive devices - if moving from contaminated bpdy site to clean body site - after contact with objects- including equiptment located in pts environment |
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PPE
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gloves
gown mask protective eye equiptment |
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which of following body substances most easily transmits HIV
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blood and semen
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standard precautions
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- used in care of all hospitalized pts
- apply to blood, body fluids, secretions, excretions, non-intact skin, mucous membranes |
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transmission based precautions
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- used in addition for pts with suspected infection
-airborne -droplet -contact precautions |
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neutropenic precautions
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- healthy caregver
- restrict visits sick fam members -avoid standng collection of water in room no flowers, no humifers |
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healthcare associated infections
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- nosocomial
- infection that can develop during pts hospitalization or after discharge - prevent by keeping first line of defense infact- skin and mucous membranes |
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measures reduce incidence of nosocomial infections
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- constant surveillance of infection control committes and nurse epidemiologist
-written infection prevention practices hand hygiene infection control precaution keepign pt in best poss phys condition |
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contributing factors
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- endogenous- within person
-exogenous- environment - iatrogenic infection- get infection just because you are you, your own body - cdiff becasue got rid of normal flora - compromised host - innaprop use antibiotics- too much bactreria, MRSA adapts to drug |
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strategies to protect pt
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-meticulous hand hygiene
-use indwelling cath and iv only when essential and remove asap -follow antibiotic protocol - place pt with multidrug resistant organisms in private room - disinfect high touch surfaces in pts room |
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characteristics of data
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-purposeful
-complete -factual and accurate -relevant |
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sources of data
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- pt
-significant -patient record - other HCPs - nursing and other health care literature |
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4 phases of nursing interview
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- prepatory phase
- introduction - working phase - termination |
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prepatory
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-go in and review data before meet them
- what you need to know about pt, ex: from OR |
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introduction
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- introduce in professional manner
- ask what refer to them as - first impression crucial |
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working phase
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- gather data, all info needed
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termination
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-closes convo
- tell them have everything and will be back |
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closed questions
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-elcit specific info
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open-ended questions
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- allow patient to verbalize freely
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reflective questions
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- encourage patient to elaborate on thoughts and feelings
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direct questions
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- validate or clarify information
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when to verify data
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- when discrepancy btw what person is saying and what nurse is observing
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documenting
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- whenever possible use pts own words
- avoid non specific terms subject to individual interpretation or definition |
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documentation
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- not computerized
- done in ink - put what pt says in quotes -subjective waht they tell you -objective - what you observe, cold hard fact - do not make abbreviations |
