lecture 2

Freud Oral Stage and anal stage

(birth to 18 months) Relief from anxiety through oral gratification of needs -pleasure is experienced from eating, biting, chewing, sucking. infants primary need is for security. - (18 mos to 3 yrs) Learning independence and control of sphinctre, with focus on the excretory function

Describe strategies to increase access to affordable, high quality care.

- Establishing a national focus to create leadership, research, tools, and protocols to enhance our knowledge about safety - Identifying and learning from errors by developing a nationwide public mandatory reporting system and by encouraging health care organizations and practitioners to develop and participate in voluntary reporting systems - Raising performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care - Implementing safety systems in health care organizations to ensure safe practices -pay for performance. -penalties for excess readmissions. government considers readmissions a prime symptom of overly expensive and uncooridinated helath system.

admissions

- hospital admissions and length of stay has decreased. -More patients are having surgery, diagnostic tests, and emergency care in ambulatory care settings or on a hospital outpatient basis. -To meet patients' health care needs during the admission process, nurses provide holistic care and establish the basis for how patients will respond to and evaluate the remainder of their stay. - in ambulatory patient receives health care services but does not remain overnight

Compare and contrast these health care delivery systems: care coordination

-Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services. -Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care. -nurses are critical to the sucess of any care coordination strategy.

Describe the role of nursing in meeting the challenges of health care reform.

-Changes taking place in health care give nurses the opportunity to help shape healthcare for the future -Nurses are becoming a stronger voice in addressing health related problems in our nation and proposing solutions -Nurses in greater numbers are increasing their education and becoming APRNs, now involved in primary patient care. -The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness. decesions made about how to best to design, delivery, finance, and evaluate health care.

Compare and contrast these health care delivery systems: prepaid group practices

-Either no fee or co-payment required. -Goal of primary care is reducing costs by preventing illness. Popular with managed care of large employers. -HMOs (health maintenance organizations) allow subscribers to receive medical services required through a group of affiliated providers. -PPOs (preferred provider organizations), allow third party payer (insurance company) to work with a group of providers to provide cheaper services in return for prompt payment and guaranteed patient volumes

Compare and contrast these health care delivery systems: medical homes

-Enhanced primary care model providing coordinated, comprehensive, whole-person care.-1960s, by American Academy of Pediatrics, became common in 2007 under PCMH (patient-centered _______ _____) view.-Advancement of nursing homes, raising standards since 2012.

Compare and contrast these health care delivery systems: multispecialty practice groups

-Late 1800s, Mayo Clinic founded in Rochester, MN.-Physicians of different specialties came together and shared income, expenses, facilities, ect. To provide better, more comprehensive care-Serve specific communities

Compare and contrast these health care delivery systems: accountable care organizations

-Originated from PPACA (patient protection and the affordable care act).-Provide incentives for doing well coordinated, integrated care instead of high volume of services.-Made up of hospitals, primary care settings, specialty care practices. Only one bill for all services received across all settings.

Compare and contrast these health care delivery systems: community health centers

-Regionalized services for vulnerable communities, emphasis on primary care and education. -Goal is for everyone to have access to care regardless of ability to pay. -Mary Breckenridge's clinic in rural KY was the first of its kind. -Nurses provide primary care.

Sources of Nursing Knowledge

-Tradition: passed from generation to generation -Authoritative: from experts and accepted as truth based on persons percieved expertiese. experienced nurse giving advice to a new grad. Traditional and authoritative are subjective -scientific: knowledge obtained through the scientific method (research). -historical knowledge:

intentional tort

-assault: threat/attempt to make bodily contact w/o consent -battery: carried out assault -false imprisonment -defamation of character -invasion of privacy, -fraud -a person committing an intentional tort is considered to have knowledge of the permitted legal limits of his or her words or acts

Crime vs. Tort

-crimes are a violation of law, punishable by the state, considered an act against the public (society) -torts are wrongdoing actionable in civil court. usually being settled with money (individual person)

types of quantitive research

-descriptive, correlational, quasi-experimental, experimental

continuity of care

-one of the rpimary responsibilities of the nurse as a caregiver is ensureing continuity of care. -process by which ehalth care providers give appropriate, uninterupted care and facilitate the patients transition between different setting and levels of care. -smooth transition between ambulatory, or acute care, and home health care, or other types of health care in community settings. -requires good communicaiton -miscommunication can lead to errors in medicatoin and deficient plan of care

discrimiation and sexual harrassment

-protects employees from discrimination based on race, color, religion, sex, or national origin, and provides that pregnant women receive the same protection as other employees and applicants. -"unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature

Steps of EBP

1. Ask the clinical question. 2. Collect the best evidence. 3. Critique the evidence. 4. Integrate the evidence with ones clinical expertise and patient preferences and values in making a practice decision or change. 5. Evaluate the practice decision or change. 6. Share the outcomes of EBP changes with others.

ANA Standards of Practice

1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation standards allow nurses to carry out professional roles, serving as protection for the nurse, pt, and the institituion where health care is provided. -guidelines that identify what the client can expect to receive in terms of nursing care.

modes of value transmission

1. Modeling: learn high and low value from parents 2. Moralizing: taught value system by parents or an institution (chrch, school). 3. Laissez-Faire: children develop own by exploration 4. Rewarding/Punishing: rewarded good valued, punished for bad by parents. 5. Responsible Choice: explore competing values and to weight their consequences.

Kholberg's stages of moral development

1. Pre conventional-Obedience and punishment 2. Conventional- good boy/ nice girl 3. Post conventional- Social Contract

Four Elements of Liability

1. duty: obligation to use due care (what a resonable prudent nruse would do). 2. breach of duty: fialure to meet standard of care 3. causation: failure to meet standard of care actually caused injury 4. damages: harm/injury resulting to the patient. Liability must be established to prove malpractice.

Piaget's stages of cognitive development

1. sensorimotor: (2-3 yrs). basic reflexes. coordinates more than one pattern at a time to reach goal. 2. preoperational2/3-6/7): begining use of symbols, thorugh increased language skills and pic, to represent preschoolers world. 3. concrete operational: children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. logical thinking is developing. 4. formal operational:use of abstract thinking and decuctive reasoning.

Erikson's stages of psychosocial development

1. trust vs. mistrust: learns to rely on caregivers to meet basic needs of warmth, food, comfort. mistrust can result from unsafe, inconsistant care. 2. autonomy vs. shame and doubt: as motor/language skills develop, todler learns from env. and gains thorugh encouragement from caregivers to feed dress and toilet self. overprotective caregivers or high standards, shame and doubt may develop. 3. initiative vs. guilt: confidence gained, take the initiative in learning new activities 4. industry vs. inferiority: school aged children gain pleasure finishing projects and reciving recognition for accomplishments. 5. identity vs. role confusion: body changes. new roles, rebellion, aquires a sense of self and decides what direction to take in life. confusion when unable to establish identity and sense of directoin 6. intimacy vs. isolation: make commitments. fear of commitments results in isolaiton and lonlines.s 7. generativity vs. stagnation: concerned for the next generation and desiring to make a contribution to the world. if not met, stagnation occurs, person will become self absorbed with his/her needs 8. integrity vs. despair: reminiscence about life events provide a sense of fullfillment and purpose. sense of despair may prevail if person beleives they are failures before death.

latency stage

7-puberty (12), dormant sexual feelings -transition to the genital stage during adolescence. increasing sexual role identification with the parent of the same sex prepares the child for adult roles and relationships.

National Practitioner Data Bank

A federally established data bank that contains information on professional actions taken against physicians and other licensed healthcare practitioners. Healthcare facilities are required to check the data bank as part of their internal credentialing process.

conscientious objection

A personal appeal that to carry out a particular action that has been ordered by legitimate authority would be against one's own conscience. -is the refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's personal and professional ethical beliefs and standards. ANA supports right to refuse to participate.

medication reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery.

Compare and contrast these health care delivery systems: medical neighborhoods

Agency for Healthcare Research and Quality (AHRQ) defines a ________ ______________ as:-a PCMH, and other clinicians, providing care for patients within the nursing home as well as community and service organizations as well as state and local public health agencies.-Focusing on individual patient care while also incorporating community health needs as well as aspects of population health.

Define incident report and its purpose.

An incident report, also called a variance or occurrence report, is used by health care facilities to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor -These reports are used for quality improvement and should not be used for disciplinary action against staff members. -means of identifiying risks. ignorming risks causes more harm. -Incident reports improve the management and treatment of patients by identifying high-risk patterns and initiating in service programs to prevent future problems

Principles of Bioethics

Autonomy Nonmaleficence Beneficence Justice: fairness in care delivery and use of resources. Fidelity: fulfillment of promises. Veracity: commitment to tell truth.

Discuss selected trends and issues affecting healthcare delivery.

Changing demographics Increasing diversity Technology explosion Globalization of economy and society Educated and engaged consumers Increasing complexity of care Costs of health care Effects of health policy and regulation Shortages of key health care professionals and educators

Kohlberg's Theory of Moral Development

Developing children progress through a predictable sequence of stages of moral reasoning . a childs begnings of moral development result from caregiver child communicaiton during the early chilhood years as the young child tries to please his/her parents and other caregivers. learns rules set by authority figures.

Ethics vs. Morals

Ethics = group/professional standards Morals = personal standards

F-DAR

FDAR stands for Focus (F), Data (D), Action (A), and Response (R ) -It is a method of charting nurses use, along with other disciplines, to help focus on a specific patient problem, concern, or event. It is geared to save time and decrease duplicate charting. It is a great charting method for nurses who have a lot of patients and is easier read by other professionals. It gives other professionals a snapshot of what went on during your shift in a concise manner.

genital stage

Freud's last stage of personality development, from the onset of puberty through adulthood, during which the sexual conflicts of childhood resurface (at puberty) and are often resolved during adolescence). -12-20

sigmund freud theory

Freud's theory emphasizes the effect of instinctual human drives on behavior. Freud identified the underlying stimulus for human behavior as sexuality, which he called libido. Libido is defined as general pleasure seeking instincts rather than purely genital gratification -unconscious mind, ID, ego, superego

id, ego, superego, unconsious mind

Id: concerned with self gratification by the easiest and quickest avaliable means ego: conscious part of the mind that serves as mediator between ID and constraints of reality. so taht a person can live effectively within enviornment. superego: conscience. develops from ego during first year. praise versus punishments. internalization of rules and values so that sociall accepted behavior is practiced. -unconscious mind.: contains memories, motives, fantasies, and fears that are not easily recalled but that directly affect behavior

ISBARQ

Introduction Situation Background Assessment Recommendation Question and answer Introductions:people involved introduce themselves, roles, and jobs Qestins and answers: oppurtunity for quesiton and answers

ANA Code of Ethics

It is a succinct statement of the ethical obligations and duties of every person who enters the nursing profession. It is the profession's nonnegotiable ethical standard. It is an expression of nursing's own understanding of its commitment to society.

The importance of documentation in home care

It is mandated by regulatory & federal agencies The plan of care accurately reflects the condition of the patient , the patient's functional limitations and safety needs, the need for skilled care, specific physician orders, anticipated progress, criteria for discharge, supplies needed, a visit schedule for all health care providers, and a list of support systems available

Havighurst's Developmental Tasks

Living and growing are based on learning, a person must continiously learn to adjust to changing conditoins. -learned behaviors as developmental tasks taht occur at certain periods in life. successful achievemnt lead to happiness and success in latera taks. unsuccessul taks leads to leads to unhappiness. Early Childhood: eat solid food, walk/talk. control the elimiaiton of body waste. right/wrong Middle Childhood: learn physical skills necessary for games, get along with agemates, reading/writing/math, personal independence. Adolescense-adult: accepting body and using effectively. musculine/femnine gender role, preparing for marriage and family life. preparing for career. middle Adulthood: accepting/adjusting to physical changes. assist children to be responsible adults, relating to spouse as person. adjusting to aging parents. Later Adulthood: adjusting to decrasing strength and health, retirement and reduced income, adjust to death of spouse.

reporting obligations

Nurses are obligated both ethically and legally to report abuse (physical, verbal,sexual, and emotional attack; neglect; and abandonment). In many states, the failure to report actual or suspected abuse is a crime in itself. Nurses are protected by law from law suits by alleged abusers if the report found to be false as long as it was filed in good faith. The nurse is responsible for knowing what needs to be reported in the local area and to what authority. -must know what is to be reported locally and to what authority.

controlled substances

Nursing responsibilities for controlled substances include storing them in special locked compartments and adhering to specific documentation responsibilities.

nursing theories

Nursing theory is developed to describe nursing. Nursing theory differentiates nursing from other disciplines and activities in that it serves the purposes of describing, explaining, predicting, and controlling desired outcomes of nursing care practices -general theory -adaptation theory -developmental theory

Laws affecting nursing practice

Occupational Safety and Health: National Practitioner Data Bank Reporting obligations Controlled substances Discrimination and sexual harassment Health Insurance Portability and Accountability Act (HIPAA) Restraints People with disabilities Legal issues related to death and dying (wills, advance directives)

Evaluate four basic ways in which health care is paid for.

Out-of-pocket payment -Individual private insurance -employer -based private insurance Government financing: Medicare - DRGs (diagnosis-related groups are payment plans that are based on patient classification categories) 65 and older Medicaid - People with very low income for people of any age; blind, olxer adults, disabled. Current budget considerations are to trim Medicaid expenditures by reducing benefits or placing patients into managed care programs.

Americans with Disabilities Act

Passed by Congress in 1991, this act banned discrimination against the disabled in employment and mandated easy access to all public and commerical buildings. -protects against communicable diseases discrimination: AIDS/ HIV

Occupation Safety and Health Act

Passed in 1970, to protect employees of companies from potential dangers of an unsafe environment that may exist in the workplace -ensure safe and healthful working conditions for men and women. The act, intended to reduce work-related injuries and illnesses, has affected health care facilities and has increased certain responsibilities for many nurses

Identify the members of the interdisciplinary healthcare team.

Physician, physician assistant:primarily responsible for the dx of illness and medical or surigcal tx of that illness. Nurse; unlicensed assistive personnel: supervise and coordinate direct care to patients and families. teach, perform resarch for cost effective care. Physical, occupational, and respiratory therapist: restore function or to prevent further disability in a patient after an injury or illness. OT: evalutes a patients functional level and teaching activities to promote self care in activities of dialy living. RT: trained in techniches to improve pulmonary function and oxygenation. Dietician:manages and plans for the dietary needs of patients. Speech therapist: help hearing impaired patinets speak more clearly. assist relearn those who had cva. Social Worker:assist pt and families dealing with the social, emotional, and enviormental factors that affect their well being. make referrals to appropriate ocmmunity resources. and provide assistance securing equipment and suplies. Pharmacist: licensed to formulate and dispense medications. preventy medication error. Chaplain/ spiritual care provider: respond to the spiritual needs of pts and families.

Piaget theory of cognitive development

Piaget believed that learning occurs as a result of the internal organization of an event, forming a mental schema (plan) and serving as a base for further schemata as one grows and develops. Intellectual growth is a continual restructuring of knowledge to progress to higher levels of problem solving and critical thinking. Two continual processes of restructuring knowledge—assimilation and accommodation—stimulate intellectual growth in the child -assimilation: process of integrating new experiences into existing schemata -accomodatoin: alteratoin of existing though processes to manage more complex info.

The essential components of a pre-entry and entry phase of the home visit

Pre-Entry Phase: The nurse at the home care agency collects as much information as possible about the patient's diagnosis, surgical experience, socioecomical status, and treatments ordered; During the phone conversation the nurse can determine whether the patient's caregiver can answer questions related to the patients's and family's needs and can also learn about the patient's cognitive abilities, orentation, and care giver status Entry Phase: Second Phase; Nurse develops rapport with the patient and family, makes assessments, determines nursing diagnosis, establishes desired outcomes(w/ patient & family), plans and implements prescribed care, & provides teaching; Negotiating and honoring visit times, establishing a rapport w/ the patient and family, defining what nursing care will be provided, and teaching independence in self-care The importance of

Quantitative vs. Qualitative Research

Quantitative Research (quantity) is numerically collected data. Research designs in which events can be quantified so that the final data are numerical (for example, an experiment). The theory states relationships in mathematical terms. Qualitative research (quality) involves data that is descriptive and results in opinions. Research designs that use descriptive data such as written descriptions of people, including opinions and attitudes, and of events and environments.

SBAR

Situation: complaint, dx, tx plan, patients wants and needs Background: VS, mental and code status, list of med, lab results, pmh Assessment: Recommendation: what needs to be done over next frew hours, and other recommendations for care. identify pending las.

Compare and contrast these health care delivery systems: physicians and hospitals

Until recently, physicians were private/solo and had fee-for-service practice Most hospitals were not-for-profit, and physicians held a lot of power over hospitals because they were not employees Physicians had a lot of power because hospitals depended on physicians to admit patients or refer them for treatment The fee-for-service arrangement caused financial incentive for physicians doing more care, not necessarily better care

utilitarian vs deontologic

Utilitarian—the rightness or wrongness of an action depends on the consequences of the action Deontologic—an action is right or wrong based on rule, independent of its consequences

patient transfer

When a transfer occurs, the patient must readjust to new surroundings, a new roommate, new routines, and new people providing care. If the transfer is to a higher level of care, as in a move to the ICU, the patient and family often experience unfamiliar sights and sounds. A transfer to a long term care facility may not be desired by the patient or family but may be necessary if family members cannot provide care at home or if no other support people are available.

nursing ethics

a subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments

Bill of Rights for Registered Nurses

a tool to aid in improving work-places and ensuring nurses' ability to provide safe, quality patient care by making clear to agencies what is absolutely nonnegotiable in the workplace

Adaptation Theory/ developmental theory

adjustment of living matter to other living things and environment conditions. continiously occuring process. -outlines process of grouth and development of humans aas orderly, predictable, begining with conception and ending with death.

five values that epitomize caring professional nurse

altruism, autonomy, human dignity, integrity, social justice.

sentinel events

as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof -"sentinel" because they signal the need for immediate investigation and response. - wrong side surgery, suicide, operative/postoperative complications. -root cause analysis: digging deeper in event to determine what happened. determine where improvements can be made.

Erik Erikson pyschosocial theory

based on: stages of development development of goals or tasks psychosocial crises process coping

Summarize basic principles of growth and development

both are orderly and sequential, as well as continuous and complex -follow regular and predictable trends: cephalocaudal. proximal distal development. -both differentiated and integrated -different aspects of grow and development occur at different stages and at different rates, and can be modified. : muscle and b one grow most rapidly during first year of life. speach development (3-5yrs). sexual maturity begins in preadolescence. -pace of growth and development is specific for each person. child can learn to walk earlier. Asian children smaller than white children.

evidence-based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences -elements to EBP: -integration of best research and evidence to guide practice -viewing clinical expertise as a component in care effectivenss. -considering patients preferences, values and engagements in care decesions to provide optimal evidence based care to patients and families.

SBAR

consistent, clear, structured, and easy-to-use method of communication between health care personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations. -SBAR provides a framework for communication between members of the health care team about a patient's condition. It is an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.

sources of law

constitutional law: federal and state constitutions indicate how the federal and state governments are created. relatively few laws. guides to legislative body statutory law: legislative body enacts statutory law. must keep within both federal and state constitution. nurse practice acts for example, administrative law: executive officers (president, mayor, govenor) administer facilities that are responsible for law enforcement. BON common law: court made law. malpractice is common law. based on stare decis, let the decesion stand.

Deductive versus inductive reasoning

deductive: one examines a general idea and then considers spcific actions or ideas inductive: (opposite) one builds specific ideas or actions to conclusions about general ideas

Nurse Practice Act

defines the legal parameters of professional and practical nursing each state has their own nurse practice ac by broadly defining the legal scope of nursing practice each nurse is expected to care for patients within defined practice limits. . -NPA sets education requirements for the nurse, distinguish between nusing practice and medical practice, and define scope of practice.

wills

describes the intentions of a testator (the one making the will) to be carried out upon death.

Ensuring Informed Consent

disclosure: pt has been informed of the nature of prodcure, risks, benifits, no guarenteed outcomenes comprehension: pt can repeat that which the pt is giving consent competence: pt understands info to make decesion, is able to reason voluntariness: voluntary consenting or refusing. also an altered pt cannot sign an informed consent form (alcohol/drugs/morphine/sedatives). nureses role is witnessing procedure. nurse does not answer questions about the procedure.

patient handoffs

handoffs—transferring responsibility for a patient from one caregiver to another with the goal of providing timely, accurate information about a patient's care plan, treatment, current condition and anticipated changesQ

ambulatory care

health care settings located in areas that are convenient for people to walk into and receive care; may be provided in hospitals, clinics, or centers -Ambulatory facilities include physician and nurse practitioner offices, clinics, hospital outpatient services, emergency departments (EDs), and same-day surgery centers

Compare and contrast settings and agencies that provide health care.

hospital: public or private. profit or nonprofit. 20-100s beds. most hospitals provide emergency care, surgery, diagnostic test, and patient education. Inpatien/outpatient services. hospitals employ most nurses. primary care centers: PCP provides primary care health serviices in offices and clinics. services include dx, tx of minor illnesses; minor surgical procedures, referrals. ambulatory care centers: may be in hospitals or freestanding. facilities that deliver outpatient medical care. urgent care, doctors office, dialysis center. -home health care: visiting nurses' associations, hospital-based case managers, and home health facilities. provide skilled nursing assessment, teaching, and support of patients and family members, and dir4ect care for patients. more comfortable at home. -extended care services: provide medical and nonmedial care for people with chornic illnesses or disabilities. assist with activities of daily living for people of any age who are unable to live independently.

phallic stage

increased interest in sex differences and in his/her own sex. -child experiences conflict and resolution of that conflict with aprent of same sex (oedipus/electra complex). curiosity of genitals increases during this stage -3-7

human development

is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning

discharge plannaing

is to ensure that patient and family needs are consistently met as the patient moves from a care setting to home. -includes educatoin, setting goals for pts. know relevent drug infor: name, dosage, purpose, effect, time to take, possible side effects.

restraints

long-term care facility residents have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat medical symptoms -can lead to false imprisonment.

moral distress vs. ethical dilemma

moral distress: when you know the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. moral resilience: developed capacity to respond well to morally distressing experiences and to emerge strong. ethical dilemma: two ore more clear moral principles apply but support mutually inconsistent course of action. No correct decisionq exists

unintentional tort

negligence: performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. malpractice: generally used to describe negligence by professional personnel The nurse may not intend to cause harm, but harm results nevertheless.

Identify elements of a well-functioning health care delivery system.

new health system for the 21st century," the Institute of Medicine (IOM) called for six outcomes, envisioning a system that is safe, effective, efficient, patient-centered, timely, and equitable.

Role of the nurse in ensuring continuity of care and coordinating care between and among health care settings and the home

nurse is often the one who helps the patient and family make a smooth transition from one care setting to another. Continuity of Care: Ensue a smooth transition between ambulatory or acute care and home health care or other types of health care settings in the patient's community. Continuity depends on excellent communication as patients move from one caregiver or health care site to another -Coordinating Care: The AIM is to link patients with resources in the community to enhance their well-being , improve information exchange, and reduce fragmentation and duplication of services

ambulatory care amdission

patient health hx, physical exam, screening tests, teaching, and admission procedures are completed prior -pts arrive, have procedure, go home if recovery satisfactory.

Qualitative Research Methods

phenomenology: dexcribe experiences as they are lived by the subject being studied. grounded theory: discovery of how people describe their reality and how their beliefs are related to their actions in a social scene. the findings are grounded in the data from sujects and used to formulate concepts and to generate theory of experience ethnography:used to examine issues of a culture that are of interest to nursing historical: examines events of the past to increase understanding of nursing profession today.

respite care, hospice, palliative

planned short-term care, usually for the purpose of relieving a full-time informal caregiver -hospice: palliative care and support care for serious providing physical, social, spiritual care for dying people, thier families and loved ones(3-6 months time frame) -palliative care: not restircted for end of life. may be givien in conjuction with medical tx and in all types of helath care setting. (6+ months.) typically occurs in a hospital.

private (civil) law vs criminal law (public law)

private- relationship amoung people criminal law: concerns state and federal criminal statutes

evidence-based practice essential elements

problem-solving approach to making clinical decisions, using the best evidence available 1. the integration of best research and evidence to guide practice 2.viewing clinical expertise as a component in care efectiveness. 3. considering patients preferences, values, and engagement in care decisions as essential to providing optimal evidence based care to patient and their families.

Qualitative Research

research that relies on what is seen in field or naturalistic settings more than on statistical data -At its core is the idea that reality is based on perceptions, which differ for each person and change over time. new insight, new perception

hospital admission

scheduled: admitting staff collects info and applies the patient an ID band. Admitting office then notifies the unit of admission. -admitting nurse is responsible for safety, comfort, and well being upon arrival to the unit. -admitting nurse then completes the admission procedure. verify with patient if family may be present. medicaiton reconciliation form.

never events

serious but preventable surgical errors (that should never occur) - surgery on the wrong side, wrong pt, leaving a FO after sx, discharging an infant to wrong person. -follwoing guidlines greatly reduces them from occuring.

Code of Ethics for Nurses

statements of the professionals' values and beliefs, which are based on ethical principles -guide for the expectaions and standards of a profession. -A code of ethics is a set of principles that reflect the primary goals, values, and obligations of the profession.

Patient's Bill of Rights

summary of a patient's rights regarding fair treatment and appropriate information -it addresses the expectations, rights, and responsibilities of the patient while receiving care in the hospital, and ranges from "high-quality hospital care" to "helping prepare you and your family for when you leave the hospital." -

care coordinator

the care provider (nurse case manager, social worker, community health worker, or lay person) who is responsible for identifying a person's health goals and coordinating services and providers to meet those goals

general systems theory

theory that organizations are a system composed of many subsystems and embedded in larger systems, and that organizations should develop communication strategies that serve both -how to break whole things into parts and then to learn how the parts work together in "systems". emphasizes relationship between whole and parts and describes how parts funciton and behave.

Theory vs Concept

theory: group of concepts that describe a patter of reality. concepts: like ideas are abstract impressions organized into symbols of reality. concepts decribe objects, proper4ties and events in relationship among them.