Professional Nurse - Exam 2

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I am CONCERNED I am UNCOMFORTABLE This is a SAFETY ISSUE

Assertive Statements, CUS.

Knowledge Attitudes Performance

Team STEPPS - Three Core Tenets

Assessment Diagnosis +Outcomes Identification Planning Implementation Evaluation

The Nursing Process (ADPIE)

Board of Nursing/Nurse Practice Act

"Minimum mandatory standards" Some protect nurses. Some protect the public from errors/wrong practices done by the nurse.

C - Yellow-green drainage on the surgical incision

A nurse is assessing a client who is 48 hr postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider? A - Blood pressure 102/66 mmHg B - Straw-colored urine from an indwelling urinary catheter C - Yellow-green drainage on the surgical incision D - Respiratory rate 18/min

C - Identify the problem

A nurse manager has recently become aware of a conflict between the pharmacy and the staff nurses regarding sending and receiving medications. Which of the following actions should the nurse take first to resolve the conflict? A - Implement a resolution B - Brainstorm solutions C - Identify the problem D - Evaluate the results

A - "Let's talk about your concerns about the new policy."

A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate? A - "Let's talk about your concerns about the new policy." B - "Why didn't you voice your concerns before the new policy was implemented?" C - "Being open to change is an exception of the nurses who work on this unit." D - "You should support this policy change because it was based on evidence-based practice."

A - I noticed you have been late for work twice this week

A nurse manager plans to speak with a staff nurse who has been late for work several times. Which initial statement would best avoid creating defensiveness? A - I noticed you have been late for work twice this week B - You are letting your team down when you come into work late C - You have to be on time for work D - If you can't show up on time, you can't work here

Violence

Communication - Controlling, Labeling, Attacking

Silence

Communication - Masking, Avoiding, Withdrawing

Honest Mistakes

Communication Breakdown - Accidents/Errors, Inevitable

Undiscussables

Communication Breakdown - Risks that are seen but not addressed. Ex. Dangerous Shortcuts, Concerns about Incompetence/Disrespect "Should Not Happen"

Intercultural

Communication across cultural contexts. Ex. Nurse caring for Pt who primarily speak Spanish

Interpersonal

Communication between two or more individuals involving face-to-face interaction while all parties are aware of the other's ongoing basis.

Interprofessional

Communication between two or more members of the interdisciplinary healthcare team. Ex. Nurse to Physician

Persuasion

Conscious intent by one individual to modify the thoughts or behaviors of others. Ex. Convincing Pts with Tx Plan & Recommended Lifestyle

Negotiation

Dialogical discussion between two or more parties to arrive at an agreement about an issue. Ex. Salary increase with manager

Negligence

Failure to act as a reasonably prudent professional would have under similar circumstances.

Task Circumstance Person Direction/Communication Supervision/Evaluation

Five Rights of Delegation

Clear Concise Complete Correct Info

Four C's of Right Communication

1 - Self Determination 2 - Policies & Procedures 3 - Nurse Practice Act, Rules & Regulations 4 - Scope/Standards of Nursing Practice, Code of Ethics, Specialty Certifications

Model of Professional Nursing Practice Regulation - Four Tiers

Malpractice

Negligence on the part of a healthcare professional.

Introduction Patient Assessment Situation Safety Background Actions Timing Ownership Next

Nurse to Nurse Report. I PASS the BATON

Delegation

Opportunity to transfer duties or tasks to other members of the healthcare team that is beneficial for the patient and delegator.

Civility

Politeness or courtesy in speech and behavior that communicates respect for others and facilitates successful communication. Ex. Using full name, "you" > "we"

Incivility

Rude & disruptive behaviors that can progress to aggression, bullying, and violence. Ex. Elderspeak, Gossiping, Horizontal Violence

Monitor & Gather Data Stable Clients Basic Patient Care Report Status Care for Predictable Outcomes Reinforce RN Education

Scope of Practice - LPN

Initial Assessment Unstable Patients IV Push/Blood/TPN Accessing Central Lines Analyze Data/Critical Thinking Care Plan Education/Discharge Teaching

Scope of Practice - RN Duties

Ambulate, ROM, Hygiene, ADLs Feeding/Oral Care - Stable Pts VS & I/Os Positioning Transfer/Transport Report Status

Scope of Practice - UAP

enhanced Nurse Licensure Compact (eNLC)

Standardization of licensure requirements across states.

Call-Out

Strategy used to communicate important or critical information. Ex. ED giving out meds/VS status

Communication Leadership Situation Monitoring Mutual Support

Team STEPPS - Four Basic Skills

Win - Lose Lose - Lose Win - Win

Three Conflict Resolution Outcomes

Systemic > Local Acute before Chronic Actual before Potential Problems

Three Priortization Ideas

Bargaining

To make a series of offers and counteroffers about what each party will do, give, receive....unitl an agreement is reached and to the satisfaction of all. Ex. Taking Thanksgiving shifts for Weekend shifts

Non-Verbal

Unspoken communication composed of affective and expressive behavior. Ex. Eye Contact, Smiling, Personal Space

Check-Back

Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended.

D - I am concerned about the patient's respiratory rate of 10 and lethargy

Which statement best describes the "situation" in SBAR? A - Patient was admitted this morning and received morphine an hour ago. B - Would you like to order naloxone and oxygen? C - Patient had a respiratory rate of 16 and was alert prior to naloxone. D - I am concerned about the patient's respiratory rate of 10 and lethargy.

Clinical Judgement

A reflective and reasoning process that uses all available date and extensive knowledge to form a clinical conclusion.

C - Undiscussable

An operating room (OR) nurse observes a scrub nurse break a sterile field. The OR nurse ignores it and continues their work. Which communication breakdown does this best describe? A - An honest mistake B - Nonviolent Communication C - Undiscussable D - Open Communication

Standards of Practice

Authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently.

Accommodating Avoiding Collaborating Competing Compromising

Five Conflict Management Styles

1 - Assumed care for Patient 2 - Breached Duty of Care/Failure of Standard of Care 3 - Failure of Standard of Care resulting in injury 4 - Injury is Proved

Four Elements Proven - Negligence Case

Define - Practice of Nursing Sets - Education & Licensure Requirements Determines - Titles & Abbreviations Nurses can use Provides - Disciplinary Action for certain causes

Nurse Practice Act - Four Functions

Identify Situation Background Assessment Recommend Repeat

Nurse to Physician Report. ISBARR

Omission - Failure to do something that should have been done. Commission - Doing something that shouldn't have been done.

2 Types of Malpractice

Describe - Situation/Behavior Express - Feelings/Concerns Suggest - Alternatives Consequences - Impact on Goals

A constructive approach for managing and resolving conflict, DESC.

Clinical Reasoning

Decision making process grounded in professional thought process. Career long development.

Scope & Standards of Nursing Practice

Describes a competent level of nursing practice and professional performance common to all registered nurses. Establishes the legal standard of care.

Nonmaleficence

Do No Harm

Scope of Practice

Each discipline in an interdisciplinary team has a set of skills they can practice for their specific profession.


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