NU270 Week 11 PrepU: Quality Improvement
In SBAR, what does R stand for? Reinforcing data Response Recommendations Report
Recommendations SBAR stands for situation, background, assessment, and recommendations. The other responses are incorrect.
The nurse on a busy acute care floor identifies that several clients with heart failure are being readmitted within 2 weeks of discharge. Which step in performance improvement is the nurse demonstrating? Planning a strategy using indicators Implementing a change Discovering a problem Assessing the change
Discovering a problem Discovering the problem by detecting that there are several readmissions with heart failure is the first step in the process of performance improvement. The next step would be to plan a strategy using indicators, which includes calling an interdisciplinary meeting. The team would then implement a change and, lastly, assess whether the change was effective.
"The levels of performance accepted by and expected of nursing staff or other health team members" defines: criteria. evaluation. standards. evidence-based practice.
standards. Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Criteria are "measurable qualities, attributes, or characteristics that identify skill, knowledge, or health status." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected client outcomes. Evaluation involves measuring how well the client has achieved the outcomes that were set forth in the plan of care.
Which of the following best reflects the rationale for evidence-based practice? A means to ensure quality care A process for accreditation A method for determining reimbursement A way to establish accountability
A means to ensure quality care Evidence-based practice (EBP) provides a means for ensuring quality care by identifying and evaluating current literature and research and incorporating the findings into client care. Quality assurance programs were developed and required for insurance reimbursement and for accreditation by the Joint Commission. The quality assurance programs sought to establish accountability to society on the part of the health professions for the quality, appropriateness, and cost of health services provided.
A nurse is reading a journal article about health information technology and the need for this technology to demonstrate meaningful use. Which information would the nurse anticipate reading about as reflective of meaningful use? Select all that apply. Improvement in health care quality Increased health disparities Greater client engagement Reduction in privacy breaches of client information Reduced health of populations
Improvement in health care quality Greater client engagement Reduction in privacy breaches of client information Meaningful use would be reflected by improved quality, safety, efficiency, and reduced health disparities; engagement of clients and family; improved care coordination and population and public health; and maintenance of privacy and security of client health information.
A nurse is documenting a variance that has occurred during the shift, and this report will be used for quality improvement to identify high-risk patterns and potentially initiate in-service programs. This is an example of which type of report? Incident report. Nurse's shift report. Transfer report. Telemedicine report.
Incident report. An incident report, also termed a variance report or occurrence report, is a tool healthcare agencies use to document anything out of the ordinary that results in or has the potential to result in harm to a client, employee, or visitor. These reports are used for quality improvement and not for disciplinary action. They are a means of identifying risks and high-risk patterns and initiating in-service programs to prevent future problems. A nurse's shift report is given by a primary nurse to the nurse replacing him or her or by the charge nurse to the nurse who assumes responsibility for continuing client care. A transfer report is a summary of a client's condition and care when transferring clients from one unit or institution to another. A telemedicine report can link healthcare professionals immediately and enable nurses to receive and give critical information about clients in a timely fashion.
Which are major premises of a quality-improvement (QI) program? Select all that apply. QI determines whether nursing standards are being upheld. QI programs may be mandated by some governmental agencies. QI focuses on processes rather than individuals. QI should ideally be performed 1 or 2 times per year. QI's focus is on ensuring excellence in care.
QI determines whether nursing standards are being upheld. QI programs may be mandated by some governmental agencies. QI focuses on processes rather than individuals. QI's focus is on ensuring excellence in care. The major premises of QI include a focus on processes and standards that lead to quality care. Numerous governmental agencies either encourage or require QI. It is an ongoing process that is not necessarily an annual or biannual event.
Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report? To document everyday occurrences To document the need for disciplinary action To improve quality of care To initiate litigation
To improve quality of care The primary reason to fill out an incident report is to improve the quality of care. Incident reports are not designed to be a means for disciplinary action. Incident reports are designed to identify actual or potential risks that can be addressed to improve quality of care. Incident reports are not intended to initiate litigation or document everyday occurrences.
When documenting the care of a client, the nurse is aware of the need to use abbreviations conscientiously and safely. This includes: limiting abbreviations to those approved for use by the institution. using only abbreviations whose meaning is self-evident to an educated health professional. ensuring that abbreviations are understandable to clients who may seek access to their health records. using only those abbreviations that are defined in full at another location in the client's chart.
limiting abbreviations to those approved for use by the institution. In addition to avoiding abbreviations that are prohibited by The Joint Commission, it is important to limit the use of abbreviations to those that are recognized and approved for use by the institution where care is being provided. The criterion of being "self-evident" is not an accurate or consistent basis for choosing abbreviations. Approved abbreviations need not be defined in full within the chart, and the client's potential understanding of abbreviations is not taken into account during the process of documentation. As a result, clients need the assistance of a member of the care team when reviewing their chart.
The nurse-manager of an outpatient facility isn't satisfied with discharge planning policies and procedures. Knowing other managers at similar facilities regarded as the "best" in the country, which steps should the nurse-manager take as part of a continuous quality-improvement process? Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility. Ask her staff nurses to investigate discharge policies and procedures at other outpatient facilities and recommend changes. Ask the nurse-managers at the best facilities for their policies and procedures so she can adopt them. Ask the staff nurses to form a task force to review and revise discharge policies and procedures.
Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility. Benchmarking is a good approach for the nurse-manager to take. Benchmarking is the process of comparing an organization's delivery of client care practices in one organization to those in the best health care organizations. Because the nurse-manager already has contacts at the best facilities, she's the most appropriate person to obtain the necessary information. The nurse-manager, however, shouldn't automatically change her policies and procedures to match those of the best facilities. Instead, she should evaluate the policies to determine which ones might be implemented at her facility. Then she and her staff should make appropriate recommendations for change. Asking her staff to form a task force is a good idea, but benchmarking saves time and effort and enables the nurse-manager to obtain information from excellent resources.
The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement? Assessment Planning Implementation Evaluation
Planning Establishing the outcomes and actions will help the client achieve the overall goals of care. Assessment is the careful observation and evaluation of a client's health status by the collection of data. Implementation is putting the plan into action, and evaluation is determining the client's responses to the care provided.
A mother brings an infant into the clinic for a well-baby visit. The mother reports being concerned at discharge from the hospital after giving birth about being able to get the infant to latch on for breastfeeding. Now, however, the mother reports success with breastfeeding. and the nurse finds that the baby is gaining weight appropriately. Which is an appropriate evaluative statement for this client? "Goal met" "8FEB2016. Goal met." "Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight." "8FEB2016. Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight."
"8FEB2016. Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight." The evaluative statement should include the time frame/date, a judgment as to whether the goal was met, and data to support the decision.
An informatics nurse specialist is conducting an in-service program for a group of staff nurses about this specialty. One of the nurses asks, "What exactly is nursing informatics?" Which response by the informatics nurse specialist would be most appropriate? "It involves working primarily with computers and programming codes." "It refers to the use of the electronic health record." "It combines nursing science with information management and analytical sciences." "It is a specialty that deals with online client educational programs."
"It combines nursing science with information management and analytical sciences." The ANA defines nursing informatics (NI) as "the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice." It is more than just working with computers or the electronic health record (although this is the core of informatics practice). Client education can be one component of a clinical information system with which nursing informatics may be involved.
An informatics nurse is assisting with the development of a new clinical information system that will be implemented in the facility. As part of the process, the team is evaluating the purpose of the system and the technological options available. The team is in which phase of the system development lifecycle? Analyze and plan Design Test Train
Analyze and plan During the analyze and plan phase, questions related to the purpose, the problem being solved, and the technological options available are addressed. Design addresses the display characteristics, whether the design supports or improves workflow, and recommendations for design based on evidence. The test phase involves how the components of the system work. The train phase involves teaching of the end users.
A staff nurse on a busy pediatric unit would like to function effectively in the role of a leader. Which action would the nurse employ to be a leader? Follow unit and hospital policy in daily situations. Tell the staff on the unit how to do their job effectively based on current research and relevant experience. Encourage the staff to participate in the unit's decision-making process, and help the staff to improve their clinical skills. Ask the nursing administration for the authority to make decisions that will affect the staff.
Encourage the staff to participate in the unit's decision-making process, and help the staff to improve their clinical skills. A leader does not have formal power and authority but influences the success of a unit by being an excellent role model and by guiding, encouraging, and facilitating professional growth and development. A manager's formal power and authority within the organization are detailed in the job description. An autocrat is not interested in guiding or encouraging staff or in being an effective role model. A manager derives authority by virtue of the position within an organization.
A nurse manager in a pediatric intensive care unit notices an increase in healthcare-associated infections. What should the nurse manager do next? Gather data on possible reasons for this increase. Report the issue to the Centers for Disease Control and Prevention. Contact infection control to obtain infection rates of other units in the facility. Talk with the hospital administrator about the concerns.
Gather data on possible reasons for this increase. Gathering data about the reasons for infection or injury is within the scope of nursing practice. It wouldn't be appropriate for the nurse manager to contact infection control or the Centers for Disease Control and Prevention at this time. After gathering supporting data, the nurse manager should speak with the hospital administrator about concerns and findings.
When checking a client's medication profile, a nurse notes that the client is receiving a drug contraindicated for clients with glaucoma. The nurse knows that this client, who has a history of glaucoma, has been taking the medication for the past 3 days. What should the nurse do first? Continue to give the medication because the client has been taking it for 3 days. Hold the medication and report the information to the physician to ensure client safety. File an incident report because several other staff members have given the medication to the client. Find out whether there are extenuating reasons for giving the drug to this client.
Hold the medication and report the information to the physician to ensure client safety. The nurse should report the information to the physician because the client's safety may be endangered. The nurse shouldn't give the drug until clarifying the order with the physician. The fact that the client has taken the drug for several days doesn't guarantee that giving another dose is safe. Filing an incident report and finding out whether there are extenuating reasons for giving the drug wouldn't address client safety.
A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem? Reprimand the nursing personnel responsible for the clients when the falls occurred. Investigate the circumstances that contributed to client falls. Institute a new policy on the prevention of client falls on the unit. Determine if client falls have increased on other units in the hospital.
Investigate the circumstances that contributed to client falls. The most effective method to address the increased frequency of client falls (and to promote a positive working environment) would be to determine the circumstances that contributed to the clients' falls. Attempting to identify and reprimand individual nurses does not lead to an atmosphere of openness and honesty in determining the causes. Instituting a new policy to prevent falls is premature before identifying why the falls are occurring. It may be relevant later to determine if other units are having the same problem, but it is not necessary at this time.
A group of nurses on the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. This program is termed: Peer review Quality and Safety Education for Nurses (QSEN) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) American Association of Critical-Care Nurses (AACN)
Peer review Peer review is a process by which one nurse evaluates the performance of another to improve professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of health care systems. AACN strives to provide safe work environments. HCAHPS measures client satisfaction with health care.
Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? Nursing administration is in control of all decision-making. Most client outcomes have improved but are not at target range. Staff nurses are developing innovative solutions to problems. There is a decreased rate of retention among the nursing staff.
Staff nurses are developing innovative solutions to problems. A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.
Which organization audits charts regularly? The Joint Commission National League for Nursing American Nurses Association Sigma Theta Tau International
The Joint Commission The Joint Commission (TJC)audits client records regularly under specific guidelines that are announced annually and shared with each institution. TJC also encourages institutions to set up ongoing quality assurance programs. The National League for Nursing, American Nurses Association, and Sigma Theta Tau International are professional nursing organizations that provide services to nurses; they do not access client records. .
The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which statement about clinical practice guidelines are accurate? Select all that apply. Step-by-step guidelines are usually developed and based primarily on "how it has always been done before." The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.
The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. Clinical practice guidelines are systematically developed and intended to inform practitioners in making decisions about health care for CVA clients. They should be developed using research and review by experts in the clinical content. Potential users should also participate and provide feedback prior to implementation. The purpose of the guidelines is to review EBP articles and develop new practice guidelines rather that continuing practicing primarily on "how it has always been done before." Once developed, the guidelines must be continually reviewed and changed to keep pace with new research findings. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method or the effects of an intervention method.
A nurse gives a client the wrong medication. After assessing the client, the nurse completes an incident report. Which statement describes what will happen next? The facility will report the incident to the state board of nursing for disciplinary action. The incident will be documented in the nurse's personnel file. The nurse will be suspended and, possibly, terminated from employment at the facility. The incident report will provide a basis for promoting quality care and risk management.
The incident report will provide a basis for promoting quality care and risk management. Incident reports document unusual occurrences and deviations from care. Facilities use the internal documents to evaluate care, determine potential risks, or discover system problems that might have contributed to the error. This type of error won't result in a report to the state board of nursing or in the nurse's suspension. Some facilities do track the number of errors a nurse or a particular unit makes; the purpose of tracking errors is to provide appropriate education and to improve the nursing process.
A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report? To determine the nurse's fault in the incident To evaluate the quality of care provided and assess the potential risks for injury to the client To provide information to local, state, and federal agencies To evaluate the immediate care provided by the nurse to the client
To evaluate the quality of care provided and assess the potential risks for injury to the client An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. Incident reports determine how to prevent hazardous situations and serve as a reference in case of future litigation. Accurate and detailed documentation often helps to prove that the nurse acted reasonably or appropriately in the circumstances. It may not always serve as a method of determining the nurse's fault in the incident. The document does not evaluate the immediate care provided to the client but states the actions taken.
Facility policies on wound dressing selection refer the nurse to a dressing algorithm. The nurse anticipates that the algorithm will include: a step-by-step decision-making tree for dressing selection. a pictorial representation of various dressings. standing orders for wound care. guidelines for staging pressure injuries.
a step-by-step decision-making tree for dressing selection. Algorithms are step-by-step methods for solving problems. An example would be a decision tree for selection of wound care dressings based on type of wound.
A healthcare agency has set a plan to apply for accreditation. A nurse on the accreditation committee has been assigned to audit clients' medical records for appropriate documentation. What information would the nurse assess in the audit? evidence of home care and nursing follow-up for 6 weeks following discharge evidence of self-reflection from nursing and other care providers about the quality of their care evidence that nurses have set goals for improving future practice evidence that nursing interventions have been evaluated in terms of the client's response
evidence that nursing interventions have been evaluated in terms of the client's response The medical record serves multiple purposes, including a role in accreditation. Accreditors look for evidence of evaluation following interventions. The medical record is not the correct venue for nurses' self-reflection or personal goal-setting. Many clients do not require community-based follow-up after they have been discharged.
A client went missing from a long-term care facility and an emergency code was called. After a search of 1 hour, the client was discovered in a utility room that should have been inaccessible. When responding to this event, staff should: complete an incident report to determine who was primarily responsible for the event. document strategies in the client's health record for preventing future incidents. fill out an incident report, with the goal of preventing a similar event in the future. hold a facility-wide meeting to identify strategies for making improvements to the safety of residents.
fill out an incident report, with the goal of preventing a similar event in the future. Incident reports are primarily used to facilitate improvements, not to determine culpability. A client's health record requires skill to document the necessary behavior and results and allows for adapting nursing care planning; a client health record must not discuss aspects particular to the incident report or facility issues. Holding a meeting will likely be necessary or helpful, but does not replace the need to document the event in the form of an incident report.
According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment? location, onset, alleviating factors, and aggravating factors quality, location, intensity, and family history nutritional deficiencies, onset, duration, and effects of pain intensity, variations, range of motion, and the client's goal for pain control
location, onset, alleviating factors, and aggravating factors Location, onset, alleviating factors, and aggravating factors are all essential components of a comprehensive pain assessment according to The Joint Commission's standards. Family history is not an essential component of a comprehensive pain assessment according to The Joint Commission's standards. Nutritional deficiencies are not an essential component of a comprehensive pain assessment according to The Joint Commission's standards. Range of motion is not an essential component of a comprehensive pain assessment according to The Joint Commission's standards.
Which guidelines define and regulate what the nurse may and may not do as a professional? state legislature facility policies and procedures standards of care nurse practice act
nurse practice act Each state legislature has enacted a nurse practice act. These statutes outline the legal scope of nursing practice within a particular state. State boards of nursing oversee the statutory law. State legislatures create boards of nursing within each state; the state legislature itself doesn't regulate the scope of nursing. Facility policies govern the practice within a particular facility. Nurse practice acts set educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scope of nursing practice in that state. Standards of care, criteria that serve as a basis for evaluating the quality of nursing practice, are established by federal organizations, accreditation organizations, state organizations, and professional organizations.
The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of: outcome evaluation. structure evaluation. process evaluation. nursing audit.
outcome evaluation. Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.
When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for? insomnia sedation increased thirst anxiety
sedation The side effects of benzodiazepines are sedation, confusion, restlessness, bradycardia, tachycardia, urinary retention or incontinence, and drug dependence. The nurse should observe the client for excessive sedation and should use benzodiazepines cautiously in clients with impaired kidney or liver function. Insomnia, increased thirst, and anxiety are common side effects in drugs used in recovery from chemical dependence, but are not most commonly associated with benzodiazepines.
The nurse's unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught? the percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity the quality of teaching by the nurses who educate the acute MI clients on the telemetry unit the amount of education the acute MI clients received on the telemetry unit the clients' perception of the quality of the discharge instructions
the percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity The unit council needs to assess the number of clients diagnosed with an acute MI on the telemetry unit who were actually taught about resuming sexual activity. The unit council needs to identify the number of clients who were taught, not the quality of the teaching. Only education about resuming sexual activity is pertinent to this performance improvement study. The nurses' assessment of the quality of client education isn't pertinent to this study either.
The unit nurse manager has just completed a workshop on best practices on documentation. Which statements made by the nurse would indicate that learning was effective? Select all that apply. "I will write, print, or type information legibly." "I will use only agency-approved abbreviations." "I will draw a straight line through any blank space." "I will stay logged in on the computer until the end of my shift." "I will elaborate on the details on my entry in the clients' records."
"I will write, print, or type information legibly." "I will use only agency-approved abbreviations." "I will draw a straight line through any blank space." Writing, printing, or typing information legibly will prevent the entry from losing its value for exchanging information if it is unreadable. Using only agency-approved abbreviations promotes consistency in interpretation. Drawing a straight line through any blank space will reduce the possibilities that someone else will add information to the current documentation. Staying logged in on the computer until the end of the shift is incorrect, as it is a security risk. Best practice is that the nurse logs off each time the nurse has completed an entry. Elaborating on the details on the entry in the clients' records is not in keeping with best practice. The entry should be brief but complete.
The nursing student is discussing the benefits of electronic charting with a precepting nurse who is frustrated with computerized documentation. Which statement by the student requires intervention from the nursing instructor? "You don't have to worry about trying to read poor handwriting." "The computer reminds the nurse to enter information and inhibits omissions." "You save time because you don't have to look for the physical chart." "You can make extra money with overtime pay with end-of-shift charting."
"You can make extra money with overtime pay with end-of-shift charting." There are many benefits to electronic charting, though there may be some learning curves involved in knowing how to use electronic formats. It is incorrect to suggest that overtime pay can be earned with end-of-shift charting. Therefore, this statement requires intervention. The other statements are appropriate.
A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability? Administering the medication with the other evening medications Telling the client that the medication will be given the following morning Filling out an occurrence report and notifying the healthcare provider Documenting in the chart a narrative note about the occurrence
Filling out an occurrence report and notifying the healthcare provider Accountability means that when an error occurs, the nurse takes the proper actions to address it. In this instance, the nurse should fill out an occurrence form for follow-up and notify the provider, as the error may change outcomes in the client's condition. Administering the missed medications with the other evening medications may double up the dose or cause unexpected adverse effects with the other medications. Telling the client that the medication will be administered the following day is not acceptable, as the nurse is suggesting next actions without the provider's knowledge. Documenting in the chart in a narrative about the occurrence does not allow for the health care provider to be notified and aware of a change in the client's condition.
The National Center for Health Statistics uses data from healthcare agencies to issue quarterly and annual reports on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans? Healthy People 2030 The Joint Commission Agency for Healthcare Research and Quality Quality Indicators
Healthy People 2030 The Healthy People 2030 campaign provides an overall action plan to improve the health and quality of life of people living in the United States. The initiative includes leading health indicators for measuring the overall health of the U.S. population. The Joint Commission is an independent agency that accredits and certifies healthcare organizations and programs in the United States. The AHRQ is the organization that developed standardized quality indicators used to measure healthcare quality at the federal, state, and local levels. Quality indicators are not an initiative; they are standards for measuring healthcare quality.
The nurse is performing care for a client in the end stage of cancer. How can the nurse best facilitate the client and family's ability to cope? Select all that apply. Assist the client with activities of daily living (ADLs). Encourage the family to leave and let the nurse take over care. Inform the family that there is nothing they can do for their loved one. Assist the client and family with the preparation for end-of-life. Refer the client and family to hospice services.
Assist the client with activities of daily living (ADLs). Assist the client and family with the preparation for end-of-life. Refer the client and family to hospice services. Nurses facilitate client and family coping with altered function, life crisis, and death. Altered function decreases an individual's ability to carry out ADLs and expected roles, and it is appropriate for the nurse to assist in a previously independent client role. Nurses facilitate an optimal level of function through maximizing the person's strengths and potentials, through teaching, and through referral to community support systems such as hospice services. Nurses provide care to both clients and families at the end of life, and they do so in hospitals, long-term care facilities, hospices, and homes. Nurses are active in hospice programs, which assist clients and their families in multiple settings in preparing for death and in living as comfortably as possible until death occurs. Informing the family that there is nothing that they can do for their loved one creates further grieving and a feeling of loss and hopelessness.
As a nurse-manager of a medical-surgical unit reviews the month's risk-management data, she notices that a number of incident reports were completed because 6 p.m.(1800) medications were administered late. Dinner is served between 5:30 p.m. (1730) and 6 p.m. (1800). Staff take their dinner breaks between 5 p.m. (1700) and 6:30 p.m.(1830). Based on this information, which is the most appropriate action for the nurse-manager to take? Terminate the nurses responsible for failing to administer medications on time. Decide that the staff must postpone dinner breaks until at least 7 p.m. (1900). Decide that the kitchen staff must change the time they deliver supper trays. Investigate when medications are given, staff and client dinner times, the number of medications that must be given at 6 p.m. (1800), and staff availability between 5 p.m. (1700) and 6 p.m. (1800).
Investigate when medications are given, staff and client dinner times, the number of medications that must be given at 6 p.m. (1800), and staff availability between 5 p.m. (1700) and 6 p.m. (1800). An effective nurse-manager knows that to accurately evaluate risk-management findings, she must look at the entire process and the circumstances surrounding each incident. Terminating staff without such evaluation doesn't resolve all the problem's contributing factors. She shouldn't change dinner breaks or kitchen delivery times unless she has evaluated how these factors influence medication administration.
The nurse is preparing to administer the second dose of ordered antibiotics to a client and notes that the first dose of medication is still in the automated medication-dispensing system. The medication administration record (MAR) does not show that the initial dose was given. What is the appropriate nursing action? Give the first and second doses of antibiotics. Call the pharmacy before notifying anyone else. Notify the health care provider. Proceed with the administration of the second dose.
Notify the health care provider. The nurse will notify the health care provider before administering medication, and follow internal policies regarding incident reporting. The nurse will receive information from the health care provider about new orders to make sure the client gets the right amount of medication. The pharmacy may be notified later.
A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply. The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. When the goal of making changes to the triage process in the emergency department is not met, the nurse discontinues efforts to force change. When met with resistance to change from the emergency department staff, the nurses involves management to force the changes.
The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. Nurses committed to healthier clients, quality care, reduced costs, and the personal satisfaction of knowing that they are actually making a difference (versus merely wishing things were different) value performance improvement. The four steps, according to Haase & Miller, that are crucial in improving performance include:1. Discover a problem.2. Plan a strategy using indicators.3. Implement a change.4. Assess the change; if the outcome is not met, plan a new strategy.
An informatics nurse specialist is working with the technology team to address errors in the clinical information system that was recently put into action at the facility. They are also addressing ongoing updates to the provider client lists. The nurse specialist and team are involved with which phase of the system development lifecycle? Implement Maintain Evaluate Analyze and plan
Maintain Once a system is up and running, it must be maintained. Tasks occurring during this phase include addressing errors and updating lists, such as provider client lists. Implement refers to the phase where the system is activated and put into use. Evaluate refers to the phase where it is determined if the system is meeting the objectives. Analyze and plan is the initial phase where the purpose and need for the system is determined. It also follows the evaluation phase where changes or improvements to the system may be identified.
Which statements are true about informatics in nursing practice? Select all that apply. Computers do not help with communication, but deter it because of the lack of personal interaction. Informatics only involves documentation of timely and accurate charting. Nurses should value technologies that support error prevention and care coordination. The use of informatics can help manage knowledge and mitigate error. Utilization of information services helps to support decision making.
Nurses should value technologies that support error prevention and care coordination. The use of informatics can help manage knowledge and mitigate error. Utilization of information services helps to support decision making. Traditionally, documentation consisted of timely and accurate charting. However, the QSEN updated definition is expanded and calls for using information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses should value technologies that support error prevention and care coordination.
A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care? Another nurse manager Another registered nurse with critical care certification One of the staff critical care physicians Another staff nurse from the medical-surgical unit
Another registered nurse with critical care certification Peer review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. Therefore, another registered nurse who is certified in critical care would be appropriate to evaluate a critical care nurse certified in critical care. A nurse manager and a critical care physician are at a higher level in the hierarchy than a staff nurse certified in critical care. A staff nurse without certification in critical care would also not be appropriate to evaluate a nurse with this certification.
The nurse's unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught? the percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity the quality of teaching by the nurses who educate the acute MI clients on the telemetry unit the amount of education the acute MI clients received on the telemetry unit the clients' perception of the quality of the discharge instructions
the percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity The unit council needs to assess the number of clients diagnosed with an acute MI on the telemetry unit who were actually taught about resuming sexual activity. The unit council needs to identify the number of clients who were taught, not the quality of the teaching. Only education about resuming sexual activity is pertinent to this performance improvement study. The nurses' assessment of the quality of client education isn't pertinent to this study either.
The nurse manager is concerned about the large number of teenage mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern? Create a new policy that will limit the number of teenage mothers the clinic can treat. Talk to each teenager who comes in to the clinic about ways to not get pregnant again. Conduct community-based research into the number of teenagers who have become parents over the last five years. Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy.
Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy. Transformational leaders create revolutionary change and inspire others to become involved with their cause or concern. Enlisting others to make a change in the community is an example of transformational leadership. Creating new policies to distract attention from the problem and talking individually to each teenager does not inspire others to become involved in the change. Conducting research may be a step taken when developing the community outreach project; however, conducting research does not involve others getting inspired to be a part of the change.
Which attribute is a benefit of health care providers using an evidence-based practice guideline? It directs research into forming a diagnosis and treatment for a certain condition. Once a practice guideline is well developed, it does not require modification. It uses one research method for delivery of care. With continued use, it will decrease healing time for clients.
It directs research into forming a diagnosis and treatment for a certain condition. Evidence-based practice guidelines often use methods to combine evidence from different studies to produce a more precise estimate of the accuracy of a diagnostic method or the effects of an intervention method. Practice guidelines require continuous updates as new research is conducted and supported. Practice guidelines are developed on numerous research studies. Not all research is directed toward healing time.
A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is appropriate for the nurse-manager to take? Explain to the primary nurse that a 6-week orientation is standard. Meet with the new nurse and the primary nurse and help set up an additional week of orientation. Meet with the new nurse and question the new nurse about deficits in performance. Schedule a staff meeting to find out if there are deficiencies or flaws in the orientation process.
Meet with the new nurse and the primary nurse and help set up an additional week of orientation. The nurse-manager is responsible for adequate orientation of new staff. A need for additional orientation does not mean that a nurse is not competent or that there are deficits in performance. Although a 6-week orientation may be standard, orientation periods should be individualized to meet the needs of the staff as well as provide the best client outcomes. Periodically reviewing and revising the orientation process is a good idea. However, in this case, the most appropriate course of action is to help the new nurse complete the orientation as efficiently as possible.
The nurse from the previous shift identified a client as a high risk for falls. The oncoming nurse finds the client on the floor at the beginning of the shift. The nurse assesses the client and notes no injuries. What is the best action by the nurse? Assist the client to a comfortable position on the floor, and ensure the call light is in reach. Place a fall-risk alert sign outside the client's room, and then notify the next of kin. Complete an incident report on the previous shift for allowing the fall, and then reassess the client's fall-risk level. Move the client to a safe position, and modify environmental factors that could have contributed to the fall. Documentation is unnecessary as no injuries occurred. Notify the health care provider, and document the fall in the chart, including location, injuries, the fact the health care provider was notified, and any changes to the care plan.
Notify the health care provider, and document the fall in the chart, including location, injuries, the fact the health care provider was notified, and any changes to the care plan. The nurse should notify the health care provider, then document the facts related to the fall, such as the location of the fall, health care provider notification, injury (if any), and necessary follow-up or changes in the care plan that occurred as a result of the fall. If an injury was present the client should remain where the fall occurred; however, if no injuries are noted the client should be assisted off the floor. The nurse should not include information that places blame on other health care members. The fall must be reported even if the client does not suffer an injury. Documentation of the incident in the client's chart is required.
The nurses at a health care facility were informed of the change to organize the clients' records into problem-oriented records. Which explanation could assist the nurses in determining the advantage of using problem-oriented records? Problem-oriented recording gives clients the right to withhold the release of their information to anyone. Problem-oriented recording makes it difficult to demonstrate a unified approach for resolving clients' problems among caregivers. Problem-oriented recording emphasizes goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers. Problem-oriented recording has numerous locations for information where members of the multidisciplinary team can make entries about their own specific activities in relation to the client's care.
Problem-oriented recording emphasizes goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers. Emphasizing goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers is an advantage of problem-oriented recording and is therefore correct. Giving clients the right to withhold the release of their information to anyone is a beneficial disclosure and is not an advantage for problem-oriented recording. Demonstrating a unified approach for resolving clients' problems among caregivers and having numerous locations for information where members of the multidisciplinary team can make entries about their own specific activities in relation to the client's care are examples of source-oriented recording.
