Nursing Exam 2

Staff communication

- A manager's greatest challenge, especially if a work group is large, is communication with staff. It is difficult to make sure that all staff members receive consistent, clear, accurate, and timely information. Lack of communication about planned changes often leads to mistrust among staff members. However, a manager cannot assume total responsibility for all communication. An effective manager uses a variety of approaches to communicate quickly and accurately to all staff. For example, many managers distribute biweekly or monthly newsletters of ongoing unit or agency activities. Minutes of committee meetings are usually in an accessible location for all staff to read or are sent to individuals via e-mail. When the team needs to discuss important issues regarding the operations of the unit, the manager conducts staff meetings. When the unit has practice- or quality-improvement committees, each committee member has the responsibility to communicate directly to a select number of staff members. Thus, all staff members are contacted and given the opportunity to provide input.

AHRQ key features of a "culture of safety"

- Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations - Blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment. - Encouragement of collaboration across levels of employees and disciplines to seek solutions to patient safety problems - Organizational commitment of resources to address safety concerns

Therapeutics communication techniques

- Active listening - Sharing observations -Sharing empathy - Sharing hope -Sharing humor -Sharing feelings - Using touch - Using silence - Providing information - Clarifying - Focusing - Paraphrasing - Validation - Asking relevant questions - Summarizing - Self-disclosure Confrontation

Hypothalamic-Pituitary-Adrenal (HPA) Axis

- As the initial surge of epinephrine subsides, the HPA axis is activated. Nonessential bodily functions are decreased. The intensity of the alarm stage makes it unsustainable for long periods of time. Once the threat has passed, the parasympathetic nervous system allows the body to rest. If the threat does not pass, the next stage (resistance) in the GAS model occurs.

Search for best evidence

- Ask experts for help - Nursing faculty - Librarians - Advanced practice nurses -Staff educators -Risk managers - Peer-reviewed article - Review for accuracy, validity, and rigor - Approved for publication by experts before it is published - Scientific literature databases and sources - SHU Library database (SHU IHS Library) - AHRQ, CINAHL, MEDLINE, PsycINFO, PubMed, Cochrane Database, World Views on Evidence-Based Nursing

Impaired consciousness

- Continue to use physical touch. Continue to communicate and teach the patient as though the patient can hear. Allow friends and family to stay and talk to the patient. Always speak before touching or providing care. Observe for nonverbal signs of pain (grimacing) or restlessness (constant movement). Use nonverbal signals, such as hand squeezes or eye movements, if the patient is able to provide them.

Characteristics of an effective leader

- Develop interpersonal trust and ensure effective communication with individuals and teams. - Have awareness of personal strengths and weaknesses, allowing vulnerabilities to show. - Take initiative and sustain motivation, especially during times of uncertainty. - Seek multiple perspectives and opinions to generate options and solutions when problem solving. - Rebound from setbacks with positivity. - Understand what they can and cannot change. - Schedule time and space to regularly reflect, recharge, and reframe. - Take responsibility for decisions. - Display caring, understanding, and empathy for others. - Motivate and empower others. - Identify the need to change and support change effectively. - Use different leadership styles (e.g., transformational, authentic, value-based) appropriately.

· General adaptation syndrome (GAS)-stages

- During the alarm stage the central nervous system is aroused, and body defenses are mobilized; this is the fight-or-flight response. During this stage rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. If the stressor poses an extreme threat to life or remains for a long time, the person progresses to the second stage, resistance. - The resistance stage also contributes to the fight-or-flight response, and the body stabilizes and responds, attempting to compensate for the changes induced by the alarm stage (Huether et al., 2020). Hormone levels, heart rate, blood pressure, and cardiac output should return to normal, and the body tries to repair any damage that occurred. However, these compensation attempts consume energy and other bodily resources. - In the exhaustion stage continuous stress causes progressive breakdown of compensatory mechanisms. This occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified, but the person's ability to adapt to the stressor diminishes ). Even in the face of chronic demands, an ongoing state of chronic activation can occur. This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load. A persistent allostatic load can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders

Communication - verbal techniques

- Establishing the nurse-patient helping relationship - Demonstrating respect and concern for the patient -Providing openings for patients to explore areas further - Allowing patients to confirm nurse's observations - Providing information to patients

Safety concerns in health care settings

- Falls - Restraints - Medication administration errors - Radiation exposure - Drug-resistant microorganisms - Procedural errors

Nontherapeutic communication techniques - Asking personal questions

- Giving personal opinions -Changing the subject - Automatic responses - False reassurance - Sympathy -Asking for explanations - Approval or disapproval -Defensive responses - Passive or aggressive responses - Arguing

Promoting a culture of safety

- Important for minimizing adverse events even as nurses perform complex and hazardous work - Nurses are professionally responsible for supporting a patient-centered safety culture - Just culture strives to identify root causes of safety concerns; human error or system flaw - Look at behaviors, not outcomes - Empowers nurses to report errors or near misses - Risky or reckless behavior - held accountable

Sympathetic-Adrenal Medulla (SAM)

- In SAM, the sympathetic nervous system is activated when vital signs increase. Blood shunts away from the digestive tract and kidneys to the muscles, heart, and lungs. Glucose is dumped in the bloodstream for more energy, pupils dilate to take in stimuli, hearing increases, and oxygen to the brain facilitates cognition. This all happens in a split second, explaining why people can dodge an attack or an oncoming car when the body has perceived a threat.

Qualities of effective leaders (Bennis)

- Integrity- clear ethical principles - Dedication-Spending time needed to accomplish task well - Magnanimity- Giving credit - Humility- respecting and appreciating others' contributions knowing that no one person is superior to another - Openness- They practice active listening with an open mind - Creativity- think creatively to arrive at a solution

Promoting a culture of safety - AHRQ elements

- Organizational Commitment- Organizational commitment of resources to address safety concerns - Acknowledgment of Nature of Activities-Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations - Blame-free Environment- A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment - Encouragement of Collaboration- Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems

PICOT questions

- Patient/Population/Problem- Population being studied (Describe the group as accurately as possible.) - Intervention (variable)- Intervention of concern (What is the main intervention or therapy being considered?) - Comparison- Comparison (Is there an alternative treatment to compare?) - Outcome- Outcomes related to the clinical idea (What was the clinical outcome of the study?) - Time- Time (How much time is needed to evaluate the effectiveness of the intervention or demonstrate the clinical outcome?)

Nursing metaparadigm (4 major concepts)

- Person - Health - Environment/Situation - Nursing

Qualitative Research

- Phenomenology - provides understanding of study population's "lived experience"; often used to study intangible experiences such as grief, loss, or hope - Ethnography - aims to understand cultural experiences from a specific population or study group; the study of people in their own environment, such as when a researcher lives among a tribal population - Grounded theory - explores a social process, such as how people cope with the diagnosis of a terminal illness; analysis and development of theories occur after all data are collected

Roy therosits

- Sister Callista Roy's (1970) Adaptation Model presents a method for nurses to help patients adapt to changes physiologically, in self-concept, in their role, and in interdependence. Adaptation occurs when the patient responds positively, leading to more favorable health outcomes.

Henderson therorist

- Virginia Henderson (1966) defined nursing as assisting a patient to increase his or her independence. Her theoretical concepts were based on Maslow's Hierarchy of Human Needs and emphasize how nurses can assist in meeting patients' basic needs. She described the nurse's role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person).

Autonomy

- is freedom of choice and responsibility for the choices. Autonomy consistent with the scope of professional nursing practice maximizes a nurse's effectiveness. With clinical autonomy you make independent decisions about patient care, plan patient care within the scope of professional nursing practice, and implement independent nursing interventions

Research process - steps

1. Identify the question or concern. 2. Define the study. 3. Perform a literature review of current information known on the topic. 4. Decide on the hypothesis and identify important variables. 5. Select the type of study to be performed. 6. Select the population size, sample, and environment. 7. Conduct a pilot study (i.e., a small-scale preliminary study designed to assist in preparation of larger study). 8. Collect the data. 9. Analyze the data. Communicate the decisions

Evaluation research

A form of quantitative research. Study that tests how well a program, practice, or policy is working. When programs are unsuccessful, evaluation research identifies problems with the program and opportunities for change or barriers to program implementation. Example: Study measuring the outcomes of an informational campaign designed to improve parents' ability to follow immunization schedules for their children.

Staff education

A professional nursing staff needs to always grow in knowledge. It is impossible to remain knowledgeable about current medical and nursing practice trends without ongoing education. A nurse manager is responsible for making learning opportunities available, so staff members remain competent in their practice and empowered in their clinical decision making. This involves planning in-service programs, sending staff to continuing education classes and professional conferences, and having staff present case studies or evidence-based practice issues during staff meetings. Staff members are responsible for pursuing educational opportunities for relicensure/recertification and changing information regarding their patient population.

grand theory

Abstract and theoretical, broad, global; not specific, and difficult to test in nursing practice Examples of nursing theorists: Rogers, Roy, King, Nightingale, Orem, Watson, Neuman, Parse, Henderson

Grand

Abstract, broad in scope, complex; "What is nursing?"

theoretical knowledge

Acquired through reading, observing, and discussing concepts Stimulate thinking and create a broad understanding of nursing science and practice.

Patients with dementia

Ask family members or other caregivers about effective strategies they have used to increase cooperation from the patient. Gain as much insight into the lifelong habits of the patient to prevent disruption of familiar routines. Do not confront or continually reorient the patient because this can increase agitation. Reminisce with the patient. When the patient is refusing all requests, distract the patient with an activity, such as walking or folding clothes, and then reintroduce the request. Accept the patient's erroneous thought processes rather than continually correcting the errors because the patient's brain deterioration cannot process this information, leading to more confusion and agitation.

Preinteraction phase

Before meeting a patient: • Review available data, including the medical and nursing history (e.g., ability of patient to communicate, pathology of any speech mechanisms, medications affecting mood, reports of previous behavior problems). • Talk to other caregivers who have information about the patient. • Anticipate health concerns or issues that arise. • Identify a location and setting that fosters comfortable, private interaction. • Plan enough time for the initial interaction.

Neuman theorists

Betty Neuman's (1972) Systems Model includes viewing the patient's health holistically: physiologically, psychologically, sociologically, and developmentally. This theory is based on the holistic response to stress. The nurse helps the patient maintain stability through prevention and strengthening his or her lines of defense.

Nurse leadership roles

Care provider- Nurses must be able to plan, organize, deliver, and evaluate nursing care for patients in a variety of inpatient and outpatient settings Patient advocate- An advocate acts on behalf of patients to protect their rights and best interests. Case manager- , the case manager leads the health care team to identify issues and overcome barriers to increase patients' health and outcomes. Clinical Nurse leader- leadership in collaborating with other members of the health care team. They also provide leadership in high-quality patient care across a hospital unit by providing evidence-based practice and can educate patients and other health care staff. Nurse educator-The nurse in a nurse educator role provides direct leadership to other staff nurses and students. Financial Resource Manager- The nurse in a financial resource manager role helps manage financial resources by using supplies wisely, preventing waste, and controlling costs to manage charges for the patient. Nurses in all roles and settings have a responsibility to make fiscally sound decisions in the care of patients and families.

nursing theory

Conceptualizes some aspect of nursing to describe, explain, predict, or prescribe nursing care

Theory

Defining ideas or concepts • Explaining relationships among the concepts •Predicting outcomes

Descriptive

Describe phenomena and identify circumstances in which phenomena occur

Historical research

Descriptive research designed to establish facts and relationships concerning past events. Example: Study examining the societal factors that led to the acceptance of advanced practice nurses by patients.

Termination phase

During the ending of the relationship: • Remind the patient that termination is near. • Evaluate achievement of expected outcomes with the patient. • Reminisce about the relationship with the patient. · Separate from the patient by relinquishing responsibility for care. • Achieve a smooth transition for the patient to other caregivers as needed.

Resistance

During the resistance (or adaptation) stage, sustained and optimal resistance to the stressor occurs. Usually, stressors are successfully overcome and the body enters a state of recovery, repair, and renewal.

Nurse managers' approaches to support staff

Establishing nursing practice through problem-solving committees or professional shared governance councils - Interprofessional collaboration among nurses and health care providers.

· Evidence-based practice - definition

Evidence-based practice, the systematic process of finding, understanding, and applying the research, has become the basis for making decisions about clinical care in nursing. Evidence-based practice has four essential components: defining the problem, searching the literature, critiquing the literature, and applying the relevant literature to the appropriate scenarios or populations. One of the most important aspects of evidence-based practice is the ability to think critically. Each component of evidence-based practice requires critical thinking to effectively navigate the research necessary for application into nursing practice. Critical thinking is required to discern which literature is most applicable, valid, and trustworthy and how to apply the acquired knowledge into nursing practice. Evidence-based practice is a specific problem-solving approach that involves using the best evidence derived from high-quality research studies and patient care data together with the ultimate outcome of quality, patient-centered clinical nursing. Evidence-based practice in nursing leads to higher-quality care, more-effective care, reduced health care costs, and, ultimately, improved patient outcomes. It has also been shown to improve job satisfaction within the nursing discipline. Examples of evidence-based changes in nursing practice include using saline flushes instead of heparin flushes with peripheral intravenous lines, discontinuing the act of aspiration during an intramuscular medication injection, and discontinuing the placement of patients into Trendelenburg position if hypotensive

Nightingale theorist

Florence Nightingale's (1860) concept of the environment was the first nursing theory to focus on illness prevention and infection control through fresh air, pure water, efficient drainage, sanitation, and sunlight. She theorized that adaptations to the patient environment allowed for energy conservation and optimal healing

Roy

Focus: Adaptation Category: Grand theory

Nightingale

Focus: Environment as the focus of nursing care Category: Grand theory

King

Focus: Goal attainment Category: Grand theory

Pender

Focus: Health promotion Category: Middle-range theory

Abdellah

Focus: Patient-centered care Category: Grand theory

Henderson

Focus: Principles and practice of nursing Category: Grand theory

Neuman

Focus: Systems Category: Grand theory

Exhaustion

If stressors are not overcome successfully, the exhaustion stage occurs. The body's resources are depleted, and stress may become chronic. The toll that long-term increases in cortisol takes on the body can lower immunity and contribute to other types of vulnerability that have significantly detrimental physical effects on the body.

trauma

If symptoms of stress persist beyond the duration of the stressor, a person experiences a trauma

King theorists

Imogene M. King's (1971) Theory of Goal Attainment is based on patients' needs. The nurse and patient communicate together to set goals to achieve those needs. The nurse relies on the nursing process to assist in achieving the patients' health and wellness goals.

Emotion-Focused Coping Techniques

In situations without a solution, emotion-focused coping techniques attempt to ease the emotional distress associated with a stressor. Emotion-focused coping strategies can be healthy or unhealthy, depending on what is used. Examples of emotion-focused coping strategies include (American Psychological Association, 2020): - Meditation or other relaxation techniques - Prayer - Positive thinking or reframing - Wishful thinking or avoidance - Self-blame - Seeking social support - Engaging in social withdrawal - Talking with mental health professionals

social communication

Informal interactions among friends, neighbors, and acquaintances. Usually occurs among people who know each other or are informally getting to know each other

Exploratory research

Initial nonexperimental study designed to develop or refine the dimensions of phenomena (facts or events) or to develop or refine a hypothesis about the relationships among phenomena. Example: Pilot study testing the benefits of a new exercise program for older adults with dementia.

Middle-range

Limited in scope and less abstract

Finding evidence

Literature reviews are an important aspect of evidence-based practice but can be time-consuming and overwhelming. Most hospital organizations have a medical library that employs librarians to help with clinical research. Databases have also been created to assist in literature reviews and finding journal articles.

Metatheory

Looks at the relationships of various components that make up the knowledge of a discipline

Interprofessional rounding-

Many agencies that focus on patient- and family-centered care conduct interprofessional rounding to encourage patient and family involvement in planning care, to improve patient care coordination, and to enhance communication among the health care team. During rounding, members of the team meet and share patient information, answer questions asked by other team members, discuss a patient's clinical progress and plans for discharge, and focus all team members on the same patient outcomes and goals. Interprofessional rounding improves decision making, nurses' job satisfaction, and quality of care. For interprofessional rounding to be successful, health care team members need to be flexible and open to ideas, questions, and suggestions offered by others.

Maslow theorists

Maslow's Hierarchy of Needs can be beneficial to nursing practice as this theory can assist the nurse to care for patients in any health care setting. The hierarchy of needs states that people cannot move to a higher level until basic needs are met. Maslow's needs are applied to each patient individually, as each patient's needs are different

Maslow

Maslow's hierarchy of basic human needs includes five levels of priority (e.g., physiological, safety and security, love and belonging, self-esteem, and self-actualization

Middle Range Theory

More specific, clear concepts, narrow focus, may be generalized to multiple settings, can be tested directly Examples of nursing theorists: Leininger, Peplau

Practice

Narrow in scope and focus

nontherapeutic communication

Negative, harmful interactions that are not focused on the patient's needs. Usually occurs among the patient, family members, and/or health care team in an unprofessional manner

Correlational research

Nonexperimental study that explores the interrelationships among variables of interest without any active intervention by the researcher. Example: Study examining the relationship between RNs' educational levels and their satisfaction in the nursing role.

Communication and Interpersonal Relationships

Nurses demonstrate caring by being with, doing for, and enabling patient well-being

interprofessional Team Leader

Nurses play an important leadership role when coordinating care of patients. The nurse works in collaboration with other health care team members such as health care providers and other allied health colleagues for the patient's benefit. As the member of the health care team that spends the most time with the patient, the nurse is usually the leader of this interprofessional team.

Paradigm

Pattern of beliefs used to describe the domain of a discipline

Nonverbal- Everything that does not involve spoken or written word

Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Territoriality and personal space

Domain

Perspective or territory of a profession or discipline • Knowledge of nursing practice, history, theory, education, research

Therapeutic communication

Positive, beneficial interactions that focus on the patient. Usually occurs among the patient, family members, and/or the health care team in a professional manner

Phases of nurse-patient helping relationship

Preorientation- Begins before the interaction Activities include preparing to meet the patient by reading the chart or assessment, thinking about and planning the interaction, and identifying possible areas to address -Orientation/Introductory Begins the nurse-patient relationship Activities include making introductions, setting roles and boundaries, observing/assessing patient, identifying patient's needs followed by validation from patient, establishing trust, and establishing a tentative timeline -Working Begins the process of the nurse and patient addressing and solving needs/problems Activities include creating and implementing plan of care, collaborating with others as needed, increasing rapport, using therapeutic communication to allow the patient to reflect on their illness and emotions, and explaining to the patient what is going to occur before and during any procedure or testing -termination Begins the process of ending the relationship Activities include saying "goodbye," summarizing and evaluating care and outcomes, and discharging the patient home, to another unit or facility, or to a caregiver

Concepts of professional communication

Respect- The nurse can convey respect verbally and nonverbally. Asking a patient's name preference during initial contact and using appropriate facial expressions and body language demonstrate respect. C Assertiveness- nurses demonstrates confidence and commands respect from patients and colleagues. Assertive nurses communicate regularly and use "I" statements. Advocacy- when defending the rights of patients, especially vulnerable patients, patients who cannot protect their own individual rights (anesthetized, comatose, confused), or those with whom the nurse disagrees philosophically. Professional boundaries- involve ethical and legal responsibilities that delineate the limits and responsibilities of nurses when caring for patients in any setting or facility.

immune response

Stress causes prolonged changes in the immune system, which can result in impaired immune function. As stress increases, the person is more susceptible to changes in health, such as increased risk for infection, high blood pressure, diabetes, and cancer

Experimental research

Study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. Example: RCT comparing chlorhexidine with povidone-iodine in reducing the incidence of IV-site phlebitis.

Descriptive research

Study that measures characteristics of people, situations, or groups and the frequency with which certain events or characteristics occur. Example: Study to examine RNs' biases toward caring for obese patients.

Quantitative Research

Survey - obtains specific information about variables within a population (demographic information, social characteristics) - Needs assessment - identifies which specific variables are most beneficial to specific populations - Methodologic - focuses on the development of data collection instruments; time-consuming but very important for the development of quality instruments - Meta-analysis - reviews multiple different research studies on a specific topic in an attempt to enlarge the power of the results from more than just one study - Experimental study - establishes cause-and-effect relationships; usually extremely rigorous and controlled - Quasi-experimental study - similar to an experimental study but used when one of the variables cannot be rigorously controlled - Secondary analysis - involves asking new questions about previously collected data

Experiential Knowledge

The "art" of nursing, Based on nurses' experiences in providing care to patients (clinical knowledge)

laissez-faire leadership

The leader allows employees to make decisions, however the leader is still responsible for the decisions that are made. · Open-minded · Delegates decision making · Communicative

servant leadership

The leader builds a team through caring by putting others first and welcomes input in decision making. · Commitment to others · Listening · Trust · Caring and empathetic

democratic leadership

The leader includes employees in the decision-making process, but the leader normally maintains the final decision-making authority. · Actively engaged · Supportive · Accountable The leader solicits team members' opinions before decisions are made.

autocratic leadership

The leader tells his or her employees what to do and how to do it, without getting their advice. · Disciplined · Decisive · Confident

Bureaucratic Leadership

The leader uses a highly formalized set of processes, procedures, and structures. Rules, policies, and hierarchies form a clear set of expectations as well as an explicit chain of command. · Organized · Consistent · Focused

Theoretical/conceptual

Theoretical or conceptual definitions simply define a concept, much like what can be found in a dictionary, based on the theorist's perspective

Definitions

Theorists use definitions to communicate the general meaning of the concepts of a theory. Definitions may be theoretical/conceptual or operational

practice theory

Theory to bedside practice; guides nursing care of specific populations and situations; built on other theories Examples of nursing theorists: Barnard, Roper, Logan, Tierney

Depression

Unresolved anger may be expressed through violent, abusive behavior, whereas chronically suppressed anger may lead to physiologic changes, such as high blood pressure and gastrointestinal upset, or depression. - Have difficulty getting out of bed - Experience insomnia - Have a lack of energy for activities of daily living - Display a flat affect - Act chronically tired or withdrawn - Appear disheveled

Patient requiring special equipment

Use gestures, such as nods, shrugs, or eye movements, that communicate meaning (e.g., one blink for "yes" and two blinks for "no"). If the patient is completely paralyzed, do not use hand squeezes (patient will not be physically able to perform). Use assistive/electronic devices that can interpret gestures and eye movements and connect to computers.

Evaluating practice change

When evaluating the available evidence, you determine the value, feasibility, and usefulness of evidence for making a practice change. There are numerous critical appraisal guides available for nurses to use to evaluate the evidence using a structured format

Scientific method-Validity, Reliability, Generalizability, Bias

When performed correctly, you know whether a study supports the validity, reliability, and generalizability of a study's findings. In other words, when a nursing research study is performed correctly, you know if the findings apply to similar patients cared for (generalizability) and whether the same results will occur when the study is repeated under the same conditions (reliability). Valid findings exist when a study has followed all steps of the scientific method without bias. Nurse researchers use the scientific method to understand, explain, predict, or control a nursing phenomenon. Systematic, orderly procedures reduce the possibility for error. Although the possibility of error always exists, the scientific method minimizes the chance that a researcher's bias or opinion will influence the results of a study and thus the knowledge gained.

Orientation phase

When you and a patient meet and get to know each other: • Set the tone for the relationship by adopting a warm, empathetic, caring manner. Sit down next to the patient if possible. • Recognize that the initial relationship is often superficial, uncertain, and tentative. • Expect the patient to test your competence and commitment. • Let the patient know when to expect the relationship to be terminated. • Closely observe the patient and expect to be closely observed by the patient. • Begin to make inferences and form judgments about patient messages and behaviors. • Assess the patient's health status. • Prioritize the patient's problems and identify expected outcomes. • Clarify the patient's and your roles. • Form contracts with the patient that specify who will do what.

Working phase

When you and a patient work together to solve problems and accomplish outcomes: • Encourage and help the patient express feelings about health. • Encourage and help the patient with self-exploration. • Provide information needed to understand and change behavior. • Collaborate with the patient to set individualized outcomes. • Take action to meet the outcomes set with the patient. • Use therapeutic communication skills to facilitate successful interactions. • Use appropriate self-disclosure and confrontation.

Factors influencing stress and coping

adolescence, adulthood, and old age bring different stressors. The appraisal of stressors, the amount and type of social support, and coping strategies all depend on previous life experiences and affect how a person reacts to that stressor. Situational and social stressors place people who are vulnerable at higher risk for prolonged stress.

Second victim syndrome

affects health care providers when a medical error that results in significant harm to a patient and the patient's family occurs. Often overlooked, nurses who have been involved in such a medical error can sustain complex psychological harm that can lead to detrimental outcomes such as suicide.

Decentralization

allows decisions to be made at the staff level. potential for greater collaborative effort, increased competency of staff, increased staff motivation, and ultimately a greater sense of professional accomplishment and satisfaction

stressors

are physical, psychological, or social stimuli that can produce stress and endanger homeostasis

Assumptions

are the "taken-for-granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory. Assumptions are accepted as truths and are based on values and beliefs

informal

depends on knowledge, personal skills, and ability to persuade and influence others. The informal leader is a colleague and does not hold a formal position as a leader but is recognized as a leader by his or her peers.

Problem-Focused Coping Techniques- Problem

focused coping techniques attempt to alter or remove a stressor by direct confrontation. These strategies are neither inherently bad nor good; the benefit or lack thereof depends on how the patient uses them. Examples of problem-focused coping techniques include (American Psychological Association, 2020): - Hypervigilance (e.g., a student anxious about a test may engage in overstudying) - Generating possible solutions to a problem - Confronting others who are perceived to be, or actually are, associated with the stressor

Transformational leader

focused on change and innovation - Team development, mentor for staff, develops and supports moral agency of nurses - Empower, recognize, hold accountable

Transactional leadership

focuses on the daily progress of goals and is concerned with the day-to-day operations of the facility. Transactional leaders focus on a reward and punishment system using incentives and discipline to get the job done. In this style of task and outcome leadership, employees usually know exactly what is expected of their job performance. · Leadership styles - explanation, qualities

Communication - special considerations

hearing - Determine whether the patient uses a hearing aid, and check that the hearing aid, if used, is being used properly and that the batteries are charged. Minimize background noise as much as possible. Make sure that the area is well lit to improve the patient's ability to read lips. Speak as clearly as possible. Raise normal voice level only slightly, using low tones (not high tones). Stay within 3 to 6 feet of the patient to allow for observation of nonverbal cues. Avoid turning away from the patient while talking; facing the patient allows the mouth and facial expressions to be seen and interpreted correctly. Use a writing board, whiteboard, or computer as needed. Visual- Describing the location of objects or potential hazards in the room Using analog clock descriptors to specify location ("The phone is at 9 o'clock on the table.") and for eating ("The meatloaf is in the 6 o'clock position, and your mashed potatoes are at 9 o'clock.") Using available tools for communication, such as large print, Braille, audio, and e-books to facilitate patient education Speaking before touching or providing care to alert a blind patient to the nurse's presence Explaining in more detail about the procedure or assessment as it is taking place Keeping eyeglasses available at all times for patients who wear them

Transformational leadership

inspire others to follow their lead. They go above and beyond to transform the workplace and achieve organizational goals by motivating others.

Coping

is a person's cognitive and behavioral efforts to manage a stressor. The effectiveness of coping strategies is influenced by a variety of factors, such as a person's age, cultural background, individual circumstances, and past use of coping strategies.

Evidence-based practice Purpose, definition; outcomes-

is a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician's expertise, patient preferences and values, and available health care resources in making decisions about patient care. Put in simpler terms, EBP involves nurses addressing clinical problems by looking for the very best knowledge and scientific and clinical evidence that are available for treating or managing patient problems and implementing changes in practice. Research studies show that EBP enhances the patient experience and patient satisfaction, decreases cost, empowers clinicians, and improves patient outcomes. evidence-based practice (EBP) guides nurses' clinical judgments in making effective, timely, and appropriate clinical decisions. Nurses need to better understand the scientific reasoning behind why certain health care approaches are used, which ones work

anxiety

is a response to stress that causes apprehension or uncertainty. It differs from fear, which has an identifiable source of impending danger. Anxiety may manifest as vague nervousness or as a feeling of dread. Various levels and types of anxiety have been identified. - Mild anxiety- Mild anxiety can be motivational, foster creativity, and actually increase the ability to think clearly. For example, a person who experiences mild performance anxiety when acting in a play may have a heightened ability to remember lines or cues, which keeps the person at top performance level. - Moderate anxiety- Moderate anxiety narrows focus, dulls perception, and may challenge the person to pay attention or use appropriate problem-solving skills. Both mild anxiety and moderate anxiety are considered normal and are experienced by everyone on a regular basis. - Severe anxiety- Severe anxiety results in the inability to make decisions or solve problems, whereas panic (the highest level of anxiety) is associated with a multitude of physiologic changes as well as subjective feelings of extreme dread or terror. - Panic- Panic causes the affected person to become immobilized and unable to concentrate, communicate, or think in a rational manner. Panic attacks may be manifested as physical signs such as diaphoresis (sweating), chest pain, difficulty breathing, and palpitations.

Compassion fatigue

is a term used to describe a state of burnout and secondary traumatic stress. Secondary traumatic stress is the stress that health care providers experience when witnessing and caring for others who are suffering.

Concepts

is a thought or idea of reality that is put into words or phrases to help describe or explain a specific phenomenon. Concepts can be abstract such as emotions or concrete such as physical objects

Nursing research

is a way to identify new knowledge that can improve nursing practice, professional education and practice, and the use of nursing and health care resources effectively. Rigorous nursing research provides a scientific basis for nursing practice (clinical, educational, and administrative) and validates the effectiveness of nursing interventions. For example, nursing research with an educational focus can improve professional education and practice by revealing new educational approaches that improve learning outcomes.· is a way to identify new knowledge that can improve nursing practice, professional education and practice, and the use of nursing and health care resources effectively. Rigorous nursing research provides a scientific basis for nursing practice (clinical, educational, and administrative) and validates the effectiveness of nursing interventions. For example, nursing research with an educational focus can improve professional education and practice by revealing new educational approaches that improve learning outcomes.

Anger

is an emotion that involves antagonism toward another person or situation. It is evoked by a feeling of being wronged in some way. Anger actually prepares the affected person to "attack," physically or otherwise. - Healthy Anger- Healthy people seek ways to effectively channel or resolve feelings of anger through conflict resolution strategies, counseling, or active exercises. - Suppressed Anger- Unresolved anger may be expressed through violent, abusive behavior, whereas chronically suppressed anger may lead to physiologic changes, such as high blood pressure and gastrointestinal upset, or depression.

stress

is described as an actual or alleged hazard to the balance of homeostasis. It is often described as a physical, chemical, or emotional factor that produces tension in the body or the mind

appraisal

is how a person interprets the impact of the stressor. It is also a personal evaluation of the meaning of the event to what is happening and a consideration of the resources on hand to help manage the stressor.

Phenomenon

is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Examples of phenomena of nursing include caring, self-care, and patient responses to stress

Nursing actions that reflect caring

o Becoming sensitive and supportive to self and others. Being present and encouraging the expression of positive and negative feelings. Developing caring relationships. Instilling faith and hope. Promoting interpersonal teaching and learning. Providing nursing care needs in a supportive way. Respecting and allowing for spiritual expression.

Barrier to implementing

o Changes in health care are often made slowly because of multiple barriers that often prevent the implementation of EBP. To be an effective change agent and foster optimal patient care, you need to have a never-ending spirit of inquiry. Constantly questioning current practices and believing in the value of EBP lead to the consistent use of EBP in clinical nursing practice. For a health care agency to be successful at implementing and sustaining EBP changes, there must be a culture that promotes and supports a spirit of inquiry

Clinical care coordination

o Clinical judgment- nursing process o priority setting- organizational skills- organize care; example: Maslow's hierarchy of needs; patient expectations o use of resources- health care team o time management- learn how, where, and when to use time; delegating; complete one task before starting another o Evaluation- ongoing process; compare actual outcomes with expected outcomes

Elements of professional communication

o Courtesy- knock on the door before entering a patient's hospital or examination room and say hello and goodbye to patients. State your purpose, address people by name, and say "please" and "thank you" to team members as well as patients and families. o use of names- Always introduce yourself. o Trustworthiness- relying on someone without doubt or question. Being trustworthy means helping others without hesitation. o Autonomy and responsibility - being self-directed and independent in accomplishing outcomes and advocating for others. Professional nurses make choices and accept responsibility for the outcomes of their actions o Assertiveness- allows you to express feelings and ideas without judging or hurting others. Assertive behavior includes appropriate eye contact; nonverbal communication that reflects interest, honesty, and active listening; spontaneous verbal responses with a confident voice; AIDET - technique for providing accurate and timely communication to patients and families while focusing on excellent patient service -Acknowledge -Introduce -Duration -Explain -Thank you

Appraise evidence

o Critically reviewing and analyzing the available evidence requires a systematic approach. When evaluating the available evidence, you determine the value, feasibility, and usefulness of evidence for making a practice change. Review each source of evidence (article, clinical guideline, expert summary) to determine its value, feasibility, and utility of evidence for making a practice change. This requires you to review each source of evidence carefully to determine its scientific worth and the strength of any study methods (when appropriate), to identify the level of evidence from each source, to summarize your findings, and to determine whether the evidence is conclusive regarding your practice question

Building therapeutic relationships

o From therapeutic relationships to gathering relevant and comprehensive information about their patients. o Draw on theoretical knowledge about communication and integrate this knowledge with knowledge previously learned through personal clinical experience. o Interpret messages received from others to obtain new information, correct misinformation, analyze findings to make clinical judgments, promote patient understanding, and plan patient-centered care.

Levels of communication

o Intrapersonal- self-talk o Interpersonal- one-on-one o small group- - outcome oriented; group dynamics o Public- audience o Electronic- audience

relationship-based leaders

o Servant leader - Choose to serve others before they decide to become leaders - Priority to put the needs of others first and to promote, growth and autonomy by ensuring their individual employees highest priority needs are met

Verbal- Spoken or written words

o Vocabulary o Denotative and connotative meaning o Pacing o Intonation o Clarity and Brevity o Timing and relevance

Burnout

occurs because of chronic stress. In nursing, burnout results when nurses perceive the demands of their work exceed perceived resources. It is manifested as emotional exhaustion, poor decision making, loss of a sense of personal identity, and feelings of failure.

conceptual framework

provides a way to organize major concepts and visualize the relationship among phenomena. Different frameworks provide alternative ways to view the subject matter of a discipline and represent the perspective of the author.

Quantitative

quantitative nursing research relies on methods that precisely measure and quantify a study's variables. Two examples of quantitative research are (1) a study dealing with a new pain therapy that quantitatively measures participants' self-reported pain severity and (2) a study testing different forms of surgical dressings to measure the extent of wound healing. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings

Lateral violence

refers to a deliberate and harmful behavior demonstrated in the workplace by one employee toward another. This includes health care providers engaging in bullying and potentially assaultive behaviors toward co-workers

Accountability

refers to individuals being answerable for their actions. It involves follow-up and a reflective analysis of decisions and an evaluation of their effectiveness. It means that as a nurse you take responsibility to provide excellent patient care by following standards of practice and agency policies and procedures.

formal leadership

refers to legitimate authority conferred by an organization (e.g., in the nursing role of director or supervisor).

internal validity

refers to the amount of confidence that what is being tested is not being influenced by any other factor or variables. Internal validity is the degree to which the independent variable is responsible for the outcome—how accurate are the results

Responsibility

refers to the duties and activities that you are employed to perform. A position description outlines your responsibilities as a professional nurse and your expected level of participation as a member of a nursing unit. reflects ownership and obligation. An individual who manages employees distributes responsibility, and the employees accept it.

external validity

refers to the extent to which the results of the research can be applied to all other situations or scenarios and groups of people.

Authority

refers to the legal ability to perform a task. It provides the power for a nurse to make final decisions and give instructions related to the decisions. You use authority to determine whether collaboration was successful.

ego-defense mechanisms

regulate emotional distress and thus give a person protection from anxiety and stress. They help a person cope with stress indirectly and offer psychological protection from a stressful event.

Theory testing

research determines how accurately a theory describes a nursing phenomenon. Testing develops the evidence for describing or predicting patient outcomes. A researcher has some preconceived idea as to how patients describe or respond to a phenomenon and generates research questions or hypotheses to test the assumptions of the theory.

Theory generating

research uses logic to explore relationships among phenomena. In theory-generating research an investigator makes observations (without any preconceived ideas) to view a phenomenon in a new way

Operational

state how concepts are measured

Qualitative

studies phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness or quality of life. This research method describes information obtained in a nonnumeric form. Data are typically gathered during interviews via recording of each subject. Then the recordings are transcribed into written transcripts, serving as the data for interpretation.

secondary appraisal

the process by which a person considers possible available coping strategies or resources, occurs at the same time. Stress occurs if the demands placed on the person by the event exceed the ability to cope.

Shared governance

typical decentralized structure used within health care agencies today. creates an environment in which managers and staff become more actively involved in making decisions to shape the identity and determine the success of a health care agency.

Nontherapeutic communication - impact

§ Blocking communication with patients § Discouraging the patient from expressing emotions openly § Making the patient feel defensive or requiring justification of actions § Shifting the focus away from the patient's health concerns and experiences § Belittling the patient's feelings and problems § Avoiding exploration of critical topics § Discouraging effective patient decision-making § Focusing on the problem and blaming rather than finding solutions, options, or insight

Implementing EBP - barriers

· -Despite known benefits, implementing evidence-based practice into nursing care is not always an easy task. Misperceptions about the difficulty of implementing evidence-based practice initiatives into a busy clinical environment have been cited as a major barrier for nurses when identifying changes that are needed in clinical practice. Other barriers include inadequate time, lack of leadership support, lack of organizational awareness of the importance of evidence-based practice, and access to evidence-based evidence, knowledge, and skill.

Steps of evidence-based practice

· Cultivate a spirit of inquiry within an EBP culture and environment. · Ask a clinical question in PICOT format. · Search for the most relevant and best evidence. · Critically appraise the evidence you gather. · Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision. · Evaluate the outcomes of practice changes based on evidence. · Communicate the outcomes of EBP decision or changes.

Appraising the Evidence

· Evidence-based practice o Purpose, definition; outcomes- is a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician's expertise, patient preferences and values, and available health care resources in making decisions about patient care. Put in simpler terms, EBP involves nurses addressing clinical problems by looking for the very best knowledge and scientific and clinical evidence that are available for treating or managing patient problems and implementing changes in practice. Research studies show that EBP enhances the patient experience and patient satisfaction, decreases cost, empowers clinicians, and improves patient outcomes. evidence-based practice (EBP) guides nurses' clinical judgments in making effective, timely, and appropriate clinical decisions. Nurses need to better understand the scientific reasoning behind why certain health care approaches are used, which ones work, o Barrier to implementing- Changes in health care are often made slowly because of multiple barriers that often prevent the implementation of EBP. To be an effective change agent and foster optimal patient care, you need to have a never-ending spirit of inquiry. Constantly questioning current practices and believing in the value of EBP lead to the consistent use of EBP in clinical nursing practice. For a health care agency to be successful at implementing and sustaining EBP changes, there must be a culture that promotes and supports a spirit of inquiry Steps of evidence-based practice- · Cultivate a spirit of inquiry within an EBP culture and environment. · Ask a clinical question in PICOT format. · Search for the most relevant and best evidence. · Critically appraise the evidence you gather. · Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision. · Evaluate the outcomes of practice changes based on evidence. · Communicate the outcomes of EBP decision or changes. o PICOT question (component of each) · P = Patient population of interest o Identify patients by age, gender, ethnicity, and disease or health problem. · I = Intervention or area of interest o Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)? What area of interest influences a desired outcome (e.g., complementary therapy, motivational interviewing)? · C = Comparison intervention or area of interest o What is the usual standard of care or current intervention used now in practice? · O = Outcome o What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, or patient perception)? Make an outcome statement nondirectional. For example: "Does use of chlorhexidine affect incidence of CLABSI?" instead of "Does the use of chlorhexidine reduce incidence of CLABSI?" A directional outcome may limit the articles in your search. · T = Time o What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)? Search for best evidence- § Ask experts for help § Nursing faculty § Librarians § Advanced practice nurses § Staff educators § Risk managers § Peer-reviewed article § Review for accuracy, validity, and rigor § Approved for publication by experts before it is published § Scientific literature databases and sources § SHU Library database (SHU IHS Library) § AHRQ, CINAHL, MEDLINE, PsycINFO, PubMed, Cochrane Database, World Views on Evidence-Based Nursing o Appraise evidence- Critically reviewing and analyzing the available evidence requires a systematic approach. When evaluating the available evidence, you determine the value, feasibility, and usefulness of evidence for making a practice change. Review each source of evidence (article, clinical guideline, expert summary) to determine its value, feasibility, and utility of evidence for making a practice change. This requires you to review each source of evidence carefully to determine its scientific worth and the strength of any study methods (when appropriate), to identify the level of evidence from each source, to summarize your findings, and to determine whether the evidence is conclusive regarding your practice question o Evaluating practice change - When evaluating the available evidence, you determine the value, feasibility, and usefulness of evidence for making a practice change. There are numerous critical appraisal guides available for nurses to use to evaluate the evidence using a structured format · Scientific method Validity, Reliability, Generalizability, Bias-When performed correctly, you know whether a study supports the validity, reliability, and generalizability of a study's findings. In other words, when a nursing research study is performed correctly, you know if the findings apply to similar patients cared for (generalizability) and whether the same results will occur when the study is repeated under the same conditions (reliability). Valid findings exist when a study has followed all steps of the scientific method without bias. Nurse researchers use the scientific method to understand, explain, predict, or control a nursing phenomenon. Systematic, orderly procedures reduce the possibility for error. Although the possibility of error always exists, the scientific method minimizes the chance that a researcher's bias or opinion will influence the results of a study and thus the knowledge gained. o Types of research (Box 5.3, pg. 65) § Exploratory research: Initial nonexperimental study designed to develop or refine the dimensions of phenomena (facts or events) or to develop or refine a hypothesis about the relationships among phenomena. Example: Pilot study testing the benefits of a new exercise program for older adults with dementia. § Evaluation research: A form of quantitative research. Study that tests how well a program, practice, or policy is working. When programs are unsuccessful, evaluation research identifies problems with the program and opportunities for change or barriers to program implementation. Example: Study measuring the outcomes of an informational campaign designed to improve parents' ability to follow immunization schedules for their children. § Descriptive research: Study that measures characteristics of people, situations, or groups and the frequency with which certain events or characteristics occur. Example: Study to examine RNs' biases toward caring for obese patients. § Historical research: Descriptive research designed to establish facts and relationships concerning past events. Example: Study examining the societal factors that led to the acceptance of advanced practice nurses by patients. § Experimental research: Study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. Example: RCT comparing chlorhexidine with povidone-iodine in reducing the incidence of IV-site phlebitis. § Correlational research: Nonexperimental study that explores the interrelationships among variables of interest without any active intervention by the researcher. Example: Study examining the relationship between RNs' educational levels and their satisfaction in the nursing role. · Nursing and scientific approach o Quantitative- quantitative nursing research relies on methods that precisely measure and quantify a study's variables. Two examples of quantitative research are (1) a study dealing with a new pain therapy that quantitatively measures participants' self-reported pain severity and (2) a study testing different forms of surgical dressings to measure the extent of wound healing. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings o Qualitative- studies phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness or quality of life. This research method describes information obtained in a nonnumeric form. Data are typically gathered during interviews via recording of each subject. Then the recordings are transcribed into written transcripts, serving as the data for interpretation. · Nursing research- is a way to identify new knowledge that can improve nursing practice, professional education and practice, and the use of nursing and health care resources effectively. Rigorous nursing research provides a scientific basis for nursing practice (clinical, educational, and administrative) and validates the effectiveness of nursing interventions. For example, nursing research with an educational focus can improve professional education and practice by revealing new educational approaches that improve learning outcomes. · Translational- focuses on "testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health". It is also called implementation science. The purpose of studies in translation research is to test implementation strategies in real-world settings to determine which strategies work best among diverse patient groups in various contexts to promote use of EBP Outcomes- Outcomes research helps patients, health care providers, and those in health care policy make informed decisions based on current evidence .Outcomes research typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients. · Performance improvement (PI) - examples Table 5.4 (p. 70) might be helpful to compare of EBP, research, and PI Evidence-Based Practice Research Performance Improvement Purpose Use of information from research, professional experts, personal experience, and patient preferences to determine safe and effective nursing interventions with the goal of improving patient outcomes. Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; it may or may not improve patient care. Improves local work processes to improve patient outcomes and efficiency of health systems; results usually not generalizable. Focus Implementation of evidence already known into practice. New knowledge is generated to find answers for questions that are not known about nursing practice. Measures effects of practice and/or practice change on specific patient population. Data sources Multiple research studies, expert opinion, personal experience, patients Subjects or participants have predefined characteristics that include or exclude them from a study; researcher collects and analyzes data from subjects. Data from patient records or patients who are in a specific area such as on a patient care unit or admitted to a particular hospital. Who conducts the activity? Practicing nurses and possibly other members of the health care team Researchers who may or may not be employed by the health care agency and usually are not a part of the clinical health care team Employees of a health care agency such as nurses, physicians, pharmacists Is activity part of regular clinical practice? Yes No Yes Is IRB approval needed? Sometimes Yes Sometimes Funding sources Internal, from health care agency Funding is usually external, such as a government grant. However, larger health care organizations often have internal grants available from their foundations. Internal, from health care agency · Validity of research internal-refers to the amount of confidence that what is being tested is not being influenced by any other factor or variables. Internal validity is the degree to which the independent variable is responsible for the outcome—how accurate are the results External-refers to the extent to which the results of the research can be applied to all other situations or scenarios and groups of people. · Research process - steps 1. Identify the question or concern. 2. Define the study. 3. Perform a literature review of current information known on the topic. 4. Decide on the hypothesis and identify important variables. 5. Select the type of study to be performed. 6. Select the population size, sample, and environment. 7. Conduct a pilot study (i.e., a small-scale preliminary study designed to assist in preparation of larger study). 8. Collect the data. 9. Analyze the data. 10. Communicate the decisions. Research methods - Quantitative- -Survey - obtains specific information about variables within a population (demographic information, social characteristics) - Needs assessment - identifies which specific variables are most beneficial to specific populations - Methodologic - focuses on the development of data collection instruments; time-consuming but very important for the development of quality instruments - Meta-analysis - reviews multiple different research studies on a specific topic in an attempt to enlarge the power of the results from more than just one study - Experimental study - establishes cause-and-effect relationships; usually extremely rigorous and controlled - Quasi-experimental study - similar to an experimental study but used when one of the variables cannot be rigorously controlled - Secondary analysis - involves asking new questions about previously collected data Qualitative- - Phenomenology - provides understanding of study population's "lived experience"; often used to study intangible experiences such as grief, loss, or hope - Ethnography - aims to understand cultural experiences from a specific population or study group; the study of people in their own environment, such as when a researcher lives among a tribal population - Grounded theory - explores a social process, such as how people cope with the diagnosis of a terminal illness; analysis and development of theories occur after all data are collected · Evidence-based practice - definition Evidence-based practice, the systematic process of finding, understanding, and applying the research, has become the basis for making decisions about clinical care in nursing. Evidence-based practice has four essential components: defining the problem, searching the literature, critiquing the literature, and applying the relevant literature to the appropriate scenarios or populations. One of the most important aspects of evidence-based practice is the ability to think critically. Each component of evidence-based practice requires critical thinking to effectively navigate the research necessary for application into nursing practice. Critical thinking is required to discern which literature is most applicable, valid, and trustworthy and how to apply the acquired knowledge into nursing practice. Evidence-based practice is a specific problem-solving approach that involves using the best evidence derived from high-quality research studies and patient care data together with the ultimate outcome of quality, patient-centered clinical nursing. Evidence-based practice in nursing leads to higher-quality care, more-effective care, reduced health care costs, and, ultimately, improved patient outcomes. It has also been shown to improve job satisfaction within the nursing discipline. Examples of evidence-based changes in nursing practice include using saline flushes instead of heparin flushes with peripheral intravenous lines, discontinuing the act of aspiration during an intramuscular medication injection, and discontinuing the placement of patients into Trendelenburg position if hypotensive. · Implementing EBP - barriers -Despite known benefits, implementing evidence-based practice into nursing care is not always an easy task. Misperceptions about the difficulty of implementing evidence-based practice initiatives into a busy clinical environment have been cited as a major barrier for nurses when identifying changes that are needed in clinical practice. Other barriers include inadequate time, lack of leadership support, lack of organizational awareness of the importance of evidence-based practice, and access to evidence-based evidence, knowledge, and skill. · PICOT questions - Patient/Population/Problem- Population being studied (Describe the group as accurately as possible.) - Intervention (variable)- Intervention of concern (What is the main intervention or therapy being considered?) - Comparison- Comparison (Is there an alternative treatment to compare?) - Outcome- Outcomes related to the clinical idea (What was the clinical outcome of the study?) - Time- Time (How much time is needed to evaluate the effectiveness of the intervention or demonstrate the clinical outcome?) Evidence - finding-Literature reviews are an important aspect of evidence-based practice but can be time-consuming and overwhelming. Most hospital organizations have a medical library that employs librarians to help with clinical research. Databases have also been created to assist in literature reviews and finding journal articles. Appraising-Appraising the evidence is another crucial step in the literature review process and involves asking questions like these: - Can the evidence found be used for making decisions about care and care processes? - Does the evidence relate to the proposal or question at hand? - Is the research article supporting the evidence valid; do the results seem true? - Was there rigor to the study's methodology? - Are the results reliable? Would the same results be found with a different population group? - Do the outcomes apply to the question or concern at hand? - Is it feasible to conduct the same experiment within the organizational culture or hospital of current employment? - Has personal bias been eliminated?

Nursing care delivery models

· Help patients achieve desirable outcomes team- Care is provided by a group of people led by an RN. To be successful this model requires effective team leadership, collaboration, and communication primary- One RN assumes the responsibility for a caseload of patients from admission to discharge. patient-centered- The patient or family member as the source of control and full partner in providing care. case management- coordinates and links health care services across all levels of care for patients and their families while streamlining costs and maintaining quality. focused on achieving patient outcomes within effective time frames and with available resources

PICOT question (component of each)

· P = Patient population of interest o Identify patients by age, gender, ethnicity, and disease or health problem. · I = Intervention or area of interest o Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)? What area of interest influences a desired outcome (e.g., complementary therapy, motivational interviewing)? · C = Comparison intervention or area of interest o What is the usual standard of care or current intervention used now in practice? · O = Outcome o What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, or patient perception)? Make an outcome statement nondirectional. For example: "Does use of chlorhexidine affect incidence of CLABSI?" instead of "Does the use of chlorhexidine reduce incidence of CLABSI?" A directional outcome may limit the articles in your search. · T = Time o What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

QSEN competencies

· Promoting a culture of safety § Important for minimizing adverse events even as nurses perform complex and hazardous work § Nurses are professionally responsible for supporting a patient-centered safety culture § Just culture strives to identify root causes of safety concerns; human error or system flaw § Look at behaviors, not outcomes § Empowers nurses to report errors or near misses § Risky or reckless behavior - held accountable · AHRQ key features of a "culture of safety" Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations Blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment. Encouragement of collaboration across levels of employees and disciplines to seek solutions to patient safety problems Organizational commitment of resources to address safety concerns · Promoting a culture of safety - AHRQ elements Organizational Commitment- Organizational commitment of resources to address safety concerns Acknowledgment of Nature of Activities-Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations Blame-free Environment- A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment Encouragement of Collaboration- Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems · Safety concerns in health care settings § Falls § Restraints § Medication administration errors § Radiation exposure § Drug-resistant microorganisms § Procedural errors · QSEN competencies (also review Cronenwett article) - Patient-Centered Care- Provision of patient-centered care engages the patient (and/or designated caregivers) in active partnerships that promote health and safety. - Teamwork and Collaboration- All members of the team, operating within their scope of practice, provide a well-rounded approach to care for the patient. Communication within this team minimizes safety risks associated with handoff among health care providers and during care transitions - Evidence-based Practice (EBP): engaging in ongoing education about best practices keeps the nurse's practice current and relevant. Questioning the rationale for routine approaches to care drives the nurse back to the evidence to determine if this is still best practice. - Quality Improvement (QI)- Using improvement methods noted through the QI process helps nurses continuously improve quality and safety of care. Using defined tools (flow charts, algorithms, etc.) helps ensure that the standard of care is followed each and every time. - Safety- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. - Informatics- Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Motivational interviewing

· a technique that encourages patients to share their thoughts, goals, beliefs, fears, and concerns with the aim of changing their behavior. provides a way of working with patients who may not seem ready to make behavioral changes that are considered necessary by their health practitioners.

Translational

· focuses on "testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health". It is also called implementation science. The purpose of studies in translation research is to test implementation strategies in real-world settings to determine which strategies work best among diverse patient groups in various contexts to promote use of EBP Outcomes- Outcomes research helps patients, health care providers, and those in health care policy make informed decisions based on current evidence .Outcomes research typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients.

Metatheory type

• - is an area of study that looks at the relationships of various components that make up the knowledge of a discipline. These include philosophical, theoretical, and empirical components and provide a broad overview of discipline. Metatheory is used to derive theories and theoretical concepts Grand-Abstract, broad in scope, complex

Primary appraisal

• Evaluating an event in terms of personal meaning is primary appraisal. Appraisal of an event or circumstance is an ongoing perceptual process. Stress results when a person identifies an event or circumstance as a harm, loss, threat, or challenge.

Purpose of nursing theories; research

• Research validates, refutes, supports, and/or modifies theory, while theory stimulates nurse scientists to explore significant issues in nursing practice The relationship between nursing theory and nursing research builds the scientific knowledge base of nursing, which is then applied to practice. Nurses better understand the appropriate use of a theory to improve patient care as more research is conducted. The relationships among the components of a theory often help identify research questions and determine the overall design of a study. For example, nurse researchers used Peplau's interpersonal theory as the framework for a project to improve the communication within a health care team.