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Discuss the process of selecting nursing interventions during planning and describe the role that communication plays in planning patient-centered care.
process of selecting nursing interventions characteristics of the nursing diagnosis goals and expected outcomes evidence base for the interventions Feasibility of the intervention acceptability to the patient your own competency. Role communication plays in planning patient-centered care Communication between the patient, patient's family, and other healthcare professionals will better set a realistic goal to fix the patients problem.
Describe how evaluation leads to discontinuation, revision, or modification of a plan of care.
Each time you evaluate a patient you determine if the plan of care continues or whether revisions are necessary. If your patient meets a goal successfully, discontinue that portion of the care plan. Also, when goals are not met, you identify the factors that interfere with their achievement. Usually, a change in the patient's condition, needs or abilities makes alteration of the care plan necessary.
Discuss how an individual's developmental stage creates safety risks
-Lifestyle -Cognitive -mobility status -sensory impairments -safety awareness -All age groups are subject to physical and mental abuse. Child abuse, domestic violence, and elder abuse are serious threats to safety.
Discuss the value of the Nursing Interventions Classification system in documenting nursing care.
1. Standardizing the nomenclature (e.g., labeling, describing) of nursing interventions; standardizes the language nurses use to describe sets of actions in delivering patient care Expanding nursing knowledge about connections among nursing diagnoses, treatments, and outcomes; connections determined through the study of actual patient care using a database that the classification generates Developing NIC language into software of health care information systems Teaching decision making to nursing students; defining and classifying nursing interventions to teach beginning nurses how to determine a patient's need for care and respond appropriately Determining the cost of services provided by nurses Standardizing a clear and consistent language to communicate the unique functions of nursing Linking with the classification systems of other health care providers
Explain the benefits of using the nursing outcomes classification and discuss the difference between a goal and an expected outcome.
A valuable resource in selecting patient outcomes is the Nursing Outcomes Classification (NOC), which links outcomes to NANDA International (NANDA-I) nursing diagnoses Goal broad statement that describes a desired change in a patient's condition, perceptions, or behavior Ultimate outcome to achieve Expected Outcome measurable change that must be achieved to reach a goal Patient behavior, physical state, or perception
Discuss how a nursing diagnosis guides nursing practice.
A nursing diagnosis provides the basis for selecting nursing interventions to achieve outcomes for which the nurse has accountability. Nursing diagnoses are developed based on data obtained during the nursing assessment and enable the nurse to develop the care plan. Tells what is wrong with the patient and what to do about it ****Framework so the nurses have something to work with and fix the problem.
Roy's Theory
Adaptation Help pts cope with or adapt to changes in physiological, self-concept, and role function "Adjustment of living matter to other livings and environment, Humans are biophysical beings with needs that are created with interrelated adaptive modes. Physiologic self concept, role function, interdependence
Describe the association between critical thinking and selecting nursing interventions and discuss the differences between protocols and standing orders.
Association between critical thinking and selecting nursing interventions. Critical thinking is necessary to consider the complexity of interventions, including the number of alternative approaches and the amount of time available to act. Before implementing a planned intervention, use critical thinking to confirm whether the intervention is correct and still appropriate for the patient's clinical situation. Always think before you act. Patients' conditions often change minute to minute. Protocols and Standing orders Standing orders primarily in a clinical setting Protocols primarily in an outpatient setting. A protocol is more of a guideline to follow for every patient, where as a standing order is specific for every patient.
Discuss the development of professional nursing roles.
Autonomy & Accountability Respect for an individual's right to make their own decisions initiation of independent nursing interventions without or with medical orders, if deciding to do something, take full responsibility, why it was important to do so Caregiver help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through healing process. Advocate protect patient's human and legal rights and provide assistance in asserting those rights if the need arises, act on behalf of patient. Educator ability to teach effectively improves patients' knowledge, skills, self-care activities and ability to make informed decisions, you identify patients' willingness and ability to learn, explain concepts and facts about their health. Communicator allows you to know patient (preferences, strengths, weakness, needs) Manager coordinates activities of members of nursing staff in delivering nursing care, uses appropriate leadership styles to create nursing environment for patients and staff that reflects mission and values of organization.
Conduct a fall risk assessment in a health care agency setting.
Based on your assessment and knowledge of physiological and behavioral factors, anticipate a patient's fall risks when choosing fall prevention strategies. Involve patients and families in the selection of fall prevention strategies Always try restraint alternatives before using a restraint. Implement fall prevention protocols and provide patient and family education. staff assignments in close proximity, improved patient hand offs nurse toilet comfort safety rounds
Johnsons theory
Behavioral system Goal is to help pt attain/maintain balance, function, and stability in each of the subsystems
Analyze how caring affects the nurse-patient relationship.
Caring principles are foundational to the nurse-patient relationship and nursing practice as nurses provide care for patients and families in both health and illness. When patients can sense that health care providers are sensitive, sympathetic, compassionate, and interested in them as people, they usually become active partners in the plan of care. By caring the nurse can better perform these steps and build a better nurse patient relationship Nursing students identify caring and compassion as interventions that are essential components of nursing care and that need to be taught and practiced early in nursing education and emphasized in all clinical practice settings.
Identify ways to express caring through presence and touch.
Caring touch form of nonverbal communication, which successfully influences a patient's comfort and security, enhances self-esteem, increases confidence of caregivers, and improves mental well-being. You express this in the way you hold a patient's hand, give a back massage, or gently position a patient. When using a caring touch, you connect with the patient physically and emotionally. Protective touch form of touch that protects a nurse and/or patient. A patient views it either positively or negatively The obvious form of protective touch is in preventing an accident. holding and bracing a patient to avoid a fall) Therapeutic touch (TT) holistic, evidence-based therapy and is an approved complementary and alternative medicine method.
Discuss the influence of social, historical, political, and economic changes on nursing practices.
Changes in society, such as health care reform, changing demographic patterns, increases in the medically underserved population, and increased consumerism, affect the practice of nursing. Nurses are increasingly aware of the role of politics and its influence on the health care system. As a result, nurses are more aware of the profession's influence on health care policy and practice. Nurses' involvement in politics is receiving greater emphasis in nursing curricula, professional organizations, public health policy, and health care settings. Professional nursing organizations and State Boards of Nursing employ lobbyists to urge state legislatures and the U.S. Congress to pass legislation that will improve the quality of health care
Explain how defining characteristics and the etiological factor individualize a nursing diagnosis.
Choose interventions to alter the etiological (related to) factor or causes of the diagnosis. When an etiological factor cannot change, direct the interventions toward treating the signs and symptom. Are the observable assessment cues that promote nursing diagnosis? Cues have been found through research to support a specific NANDA-I approved nursing diagnosis. Each characteristic will have their own intervention.
Describe the complex nature of clinical judgment for nurses delivering patient-centered care for patients' improved safety.
Clinical judgment is complex when promoting safety because it requires understanding a patient's perspective of safety as well as the risks posed by any physical condition.
Explain the relationship of compassion to caring.
Compassion is the desire to identify with or sense something of another's experience, a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others.
Compare and contrast the educational programs available for professional registered nurse (RN) education.
Continuing education updates your knowledge about the latest research and practice developments, helps you to specialize in a particular area of practice, and teaches you knew skills and techniques, all of which are crucial factors to improving patient care. Continuing education involves educational programs offered by universities, hospitals, state nurses' associations, professional nursing organizations, and educational and health care institutions. Many states require a set number of continuing education hours as part of license renewal.
Discuss the critical thinking attitudes used in clinical decision making, and the importance of managing stress when making clinical decisions.
Critical thinking attitudes help you to know when more information is necessary and when it is misleading and to recognize your own knowledge limits. Confidence Independence Fairness Responsibility risk taking discipline integrity humility Creativity Stress over a prolonged period or when extreme can cause distress, leading to poor work productivity and impaired decision making and communication.
Discuss how advances in nursing science and evidence-based practice improve patient care.
Current and future practice need to be based on current evidence. With the use of evidence-based practice, today the general public is more informed about their health care needs, the cost of health care, best practices, and the incidence of medical errors within health care institutions. Emerging technologies provide more accurate, noninvasive assessment tools; help you implement evidence-based practices; collect and trend patient outcome data; and use clinical decision support systems. Genomic information combined with technology can potentially improve health outcomes, quality, and safety and reduce health care costs.
Explain the relationship of defining characteristics to assessment cues.
Defining characteristics are the observable assessment cues that cluster as manifestations of a problem-focused or health promotion nursing diagnosis. the cues have been found through research to support a specific NANDA-I approved nursing diagnosis
Describe the historical evolution of the nursing process, each of its five steps, and characteristics of the nursing process.
Developed by the American Nurses Association (ANA), the steps of the nursing process: Assessment involves the collection of as much information as possible about a patient, family, or community to learn as much as you can about each patient's health condition and health problem Analysis and Diagnosis use critical thinking skills (diagnostic reasoning process) to identify health status or problem of clients requires nurses to look at the data identify patterns or trends compare the data with expected stands or reference ranges arrive at conclusion to guide nursing care Outcome Identification Planning more complicated because it involves using critical thinking and decision making to form clinical judgments: reviewing a patient's nursing diagnoses and other collaborative problems prioritizing nursing diagnoses and problems setting outcomes to guide the plan of care choosing relevant interventions for patient care Nurses prioritize the nursing diagnoses and identifies goals that are realistic, measurable, and patient-focused, with specific outcomes. Implementation Must use problem solving skill, clinical judgement, and critical thinking to select and implement appropriate therapeutic intervention using nursing knowledge. Nurses initiate specific nursing interventions and treatments designed to help the patient achieve established goals and outcomes. Evaluation Nurses evaluate client's response to nursing intervention and form a clinical judgment about the extent to which client have met the goals out outcomes Nurse determines if the patient's goals are met, examines the effectiveness of interventions, and decides whether the plan of care should be discontinued, continued, or revised
Differentiate between nursing diagnosis and medical diagnosis and develop a nursing diagnosis for a patient in your clinical setting.
Diagnosis of a patient is a clinical judgment about an individual. A nursing diagnosis a clinical judgment made by a registered nurse to describe a patient's response or vulnerability to health conditions or life events that the nurse is licensed and competent to treat Medical diagnosis the identification of a disease condition based on a specific evaluation of physical signs, symptoms, and the patients' medical history. A collaborative problem is an actual or potential physiological complication that nurses monitor to detect the onset of changes in a patient's status.
Discuss the relationship of critical thinking to the nursing diagnostic process.
Diagnostic Process requires you to use Critical Thinking Applying critical thinking will make you more competent in making nursing diagnosis. Helps you to be thorough, comprehensive, and accurate. Collect data. Interpretation *Formulating a nursing diagnostic statement.
Florence Nightingales theory
ENVIRONMENTAL THEORY: promote healing and comfort Nurses should improve pts environment so that nature is able to restore a pt to health
Describe how a nurse assists patients in managing safety risks in the home.
Each room assessment covers topics such as adequacy of lighting (inside and outdoors) Condition of flooring and walking surfaces, presence of safety devices Alarms side rails on steps safety bars in bathtubs placement of furniture or other items that can create barriers. Know where medications and cleaning supplies are located. Additional assessment includes: the presence of locks on doors and windows. Modifications in the home environment easily reduce the risk of falls. Collaborate with patient and family caregivers to make changes based on their home fall risk assessment and the patient's risk factors. For example, remove all obstacles. furniture, piles of magazines or boxes) from halls and other heavily traveled areas.
Describe sources of diagnostic errors; identify nursing diagnoses from a nursing assessment; and explain the relationship of planning to assessment and nursing diagnosis.
Errors occur in the nursing diagnostic process during data collection, analysis of data clusters or patterns, and interpretation in choosing a nursing diagnostic statement The assessment findings you obtain will often apply to one or more nursing diagnoses. thoroughly interpreting assessment findings leads to a broader picture of a patients various health responses and how they are related Assessment of a patient will lead to a diagnosis. Based on the diagnosis the nurse can then make a plan to fix the patient's problem
Explain how theory is used in nursing practice.
Theory is the foundation for nursing practice. Theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting patient behaviors and outcomes provides a basis for research and practice and serves as a guide in providing safe, comprehensive, individualized care
Discuss the relationship of the nursing process to critical thinking, and the relationship between critical thinking and nursing assessment. Ch 16
For you to become competent in applying the nursing process, your assessment must apply to all components of critical thinking. Application of critical thinking enables you to be deliberate and systematic in collecting data about your patients recall prior clinical experiences, apply critical thinking standards and attitudes, and use professional standards of practice to direct your assessment in a meaningful and purposeful way
Grand theory
GRAND THEORY: Abstract, broad in scope, and complex, therefore require further clarification through research so that they can be applied to nursing practice;. does not provide guidance for a SPECIFIC nursing intervention. Provides the structural framework for general, global ideas about nursing EX: ightingale, Orem, Henderson, Johnson, Neumann, Abdellah, King, Roy, Watson, Rogers/parse/Newman
Kings theory
Goal attainment Help pts in their care by working with them to establish goals for attaining, restoring, or maintaining health. Ex: Encouraging patients to set outcomes for their recovery "king wants gold = GOAL". ART: Act, React, Transact = nursing is a process of human interactions, communicate to eachieve goals, explore and agree upon needs for how goal attainment is going to happen
Explain the relationship between clinical experience using critical thinking and how professional standards influence a nurse's clinical decisions.
Good clinical decision making requires you to investigate and analyze all aspects of a clinical problem and then apply scientific and nursing knowledge to choose the best course of action you must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient. With experience you learn to creatively seek new knowledge, act quickly when events change, and make quality decisions for patients' well-being
Describe the differences among health promotion, problem-focused, and risk nursing diagnoses.
Health Promotion Clinical judgment concerning a patient's motivation and desire to increase will being and actualize human health potential Only have defining characteristics. Problem-Focused Clinical judgment concerning an undesirable human response to a health condition/life process. Sufficient assessment data from the defining characteristics to establish the nursing diagnosis. Risk Nursing Clinical judgment concerning the vulnerability for developing an undesirable human response to health conditions/life processes. Do not have defining characteristics or related factors because they have not yet occurred. Have risk factors which help in planning preventive health care measures.
Discuss how to select environmental interventions for fall prevention for the hospital and home environment.
Hospital Environment Morse Fall Scale STRATIFY scale and the Hendrich II Fall Risk Model Familiarize the patient with the environment. Have the patient demonstrate call light use. Keep the patient's personal possessions within patient safe reach. Place the hospital bed in low position when a patient is resting in bed; raise bed to a comfortable height when the patient is transferring out of bed. Keep hospital bed brakes locked. Keep nonslip, comfortable, well-fitting footwear on the patient. Use night lights or supplemental lighting. Keep floor surfaces clean and dry. Clean up all spills promptly. Keep patient care areas uncluttered. Follow safe patient-handling practices. Home Environment Collaborate with patient and family caregivers to make changes based on their home fall risk assessment and the patient's risk factors. Remove all obstacles from halls and other heavily traveled areas, be sure that end tables are secure and have stable, straight legs, place nonessential items in drawers to eliminate clutter. pts with stumbling or tripping should never have small area rugs in the home and if used secure them with a nonslip pad or skid-resistant adhesive strips, carpeting on the stairs is secured with carpet tacks. history of falling and living alone recommend wearing an electronic safety alert device. Observe pts using assistive devices in the home to ensure the devices are held and used correctly and inform pt. about how to keep these devices in safe working order.
Explain the importance of using accurate evaluation measures, and the process of evaluating the outcomes of care for a patient.
Importance of using accurate evaluation measures Determines if the known problems have remained the same, improved, worsened, or otherwise changed. Process of evaluating the outcomes Examine the outcome criteria to identify the exact desired patient behavior or response. Evaluate a patient's actual behavior or response. Compare the established outcome criteria with the actual behavior or response. Judge the degree of agreement between outcome criteria and the actual behavior or response. If there is no agreement between the outcome criteria and the actual behavior or response, what is/are the barrier(s)? Why did they not agre
Develop a plan of care from a nursing assessment, and discuss the differences among independent, dependent, and collaborative nursing interventions.
Independent: Initiated by nursing. Do not require an order from another professional Based on scientific rationale Dependent Actions that require an order from a physician or other health care provider Advanced practice nurses may write dependent nursing interventions Collaborative Interventions: Interdependent Therapies that require the combined knowledge, skill, and expertise of multiple health care professionals. Ex. Interdisciplinary team meetings.
Describe and compare direct and indirect nursing interventions and discuss the relationship between critical thinking and evaluation.
Indirect care interventions treatments performed away from a patient but on behalf of the patient or group of managing a patient's environment safety and infection control documentation interprofessional collaboration Direct care interventions treatments nurses provide through interactions with patients or a group of patients. medication administration insertion of a urinary catheter discharge instruction counseling during a time of grief
Examine the therapeutic benefit of listening to patients.
It is a planned and deliberate act in which the listener is present and engages the patient in a nonjudgmental and accepting manner. When listening to patients you are showing a sense of understanding. You are listening, processing, and conveying back that understand to the patient. True listening leads to knowing and responding to what really matters to a patient and family. By listening the nurse can form a mutual relationship with the patient
Describe the components of a critical thinking model for clinical decision making, and skills used in nursing practice.
Knowledge base Information that is specific to nursing and comes from Basic nursing education Use of evidence-based practice. CEUS Advance degrees Experience Decision making ability derived from opportunities to observe, sense, and interact with clients, followed by active reflection. Understand of clinical situation Recognize and analyze cues. Incorporate experience. Competencies Applying nursing process to make nursing judgment. Proficient to perform nursing skills Attitudes Mindsets that affect how nurses approach a problem. Confidence Independence Fairness Responsibility Risk-taking Disciple creativity standards Model for comparing care to determine acceptability, excellence, and appropriateness.
Compare and contrast theories on caring.
Leininger's transcultural caring described the concept of care as the essence and the central, unifying and dominant domain that distinguishes nursing from other health disciplines Watson's nurse patient relationship care before cure Watson's theory of caring is a holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. Swansons theory caring by incorporating knowing Striving to understand an event as it has meaning in the life of the other. being with Being emotionally present to the other doing for Doing for the other as he or she would do for self if it were at all possible Enabling Facilitating the other's passage through life transitions (e.g., birth, death) and unfamiliar events maintaining belief Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning.
Middle rang theory
MIDDLE-RANGE theory: more limited in scope and less abstract. Addresses a specific phenomenon and reflect practice (administration, clinical, or teaching) EX: Peplau, leininger, banner, Kolcaba, pender, American association of care nurses, melees, sawyer, im, messiahs and schemer j
Discuss common environmental hazards and methods for preventing them.
MVA All infants and toddlers ride in the back seat with a rear facing only seat and rear facing convertible seat until they are 2-year-old, or they reach the highest weight to height allowed by the manufacturer of the car safety seat. the risk of motor vehicle accidents is higher among 16- to 19-year-old drivers than any other age-group, with motor vehicle crashes being the leading cause of death for this age-group. Older-adult drivers are keeping their licenses longer and driving more miles than in the past. Age-related decline in vision and cognitive functioning (ability to reason and remember) and physical changes affect driving abilities of some older adults. Poison great risk for toddlers, preschoolers, and young school age children who often ingest household cleaning solutions, medications, or personal hygiene products. A poison control center is the best resource for patients and parents needing information about the treatment of accidental poisoning. Falls Falls have been a major health problem, ranking as the second leading cause of accidental or unintentional injury deaths worldwide. risks of falls history of falling reduced vision orthostatic hypotension lower extremity weakness gait and balance problems urinary incontinence improper use of walking aid and the effects of various medications... physical hazards that led to falls inadequate lighting barriers along normal walking paths and stairways loose rugs and carpeting and a lack of safety devices in the home. Fire Unintentional, careless fires are the third most common type of fires, often involving improper disposal of cigarettes or use of candles. Disasters floods, Tsunamis Hurricanes Tornadoes wildfires bioterrorism biological agents (microbes or toxins) Transmission of pathogens Pathogens and parasites pose an ongoing threat to an individu
Describe the nurse's responsibility in elder abuse reporting.
Mandated reporter, soc341
Identify factors to assess before and during placement of patients in physical restraints.
Monitor a patient closely -every 15 minutes for a violent patient and every 2 hours for a nonviolent patient) - vital signs -skin integrity underneath the restraint -nutrition -hydration -circulation to an extremity -range-of-motion (ROM) -hygiene -elimination needs. -cognitive functioning -psychological status -and need restraint. Remove restraints periodically per agency policy. Continuously assess patients who are violent via audio or video monitors when available.
Conduct an assessment of mobility alterations that pose risks for falling.
Muscle weakness, paralysis, abnormal gait, and poor coordination or balance are major factors in placing patients at risk for falls. Immobilization predisposes patients to physical deconditioning and emotional hazards, which in turn further restrict mobility and independence. Physically challenged are at greater risk for injury when entering motor vehicles and buildings that are not handicap accessible. Use BMAT to help determine patient ability to walk
Discuss the influence of organizational culture on interdisciplinary collaboration.
Organizational culture affects how well teams collaborate. Organizational culture includes leadership, communication processes, shared beliefs about the quality of clinical guidelines, and conflict resolution. A culture that bolsters collaboration among nurses, physicians, and other health care providers is needed to merge the unique strengths of all disciplines into opportunities to improve patient outcomes. Effective communication and good teamwork are ways to reduce medical errors and prevent adverse patient outcomes
Identify evidence-based alternatives to restraints for patients who are alert, oriented, and low risk.
Orient patients and family members to the environment; explain all procedures. Provide companionship and supervision; use trained sitters; adjust staffing and involve family. Offer diversional activities: music, puzzles, activity aprons, folding towels. Use ideas of the patient and/or family. Assign confused or disoriented patients to rooms near nurses' stations and observe frequently. Use de-escalation, time-out, and other verbal intervention techniques when managing aggressive behaviors. Provide visual and auditory stimuli (e.g., family pictures, a clock, music). Remove cues that promote leaving the room (e.g., close doors to block the view of stairs; do not allow inpatients to wear street clothes). Promote relaxation techniques and normal sleep patterns. Institute exercise and ambulation schedules as allowed by patient's condition. Attend frequently to patient's needs for toileting, food and liquid, and pain management. Camouflage intravenous lines with clothing, stockinette, or Kling gauze dressing. Evaluate all medication effects and ensure timely and effective pain management. Discontinue bothersome treatments (e.g., nasogastric tubes or Foley catheters) as soon as possible. Use protective devices such as hip pads, helmet, skidproof slippers, and nonskid strips near bed.
Describe how use of a PICOT question can influence a patient's plan of care and discuss criteria used in priority setting.
P = Patient population of interest Identify patient by age, gender, ethnicity, and disease or health problem Intervention of interest Which intervention is worthwhile to use in practice Ex. Treatment, diagnostic test C = Comparison of interest What is the usual standard of care or current intervention used now in practice Outcome What result do you wish to achieve or observe as a result of an intervention Time What amount of time is needed for an intervention to achieve an outcome Amount of time to change quality of life Ordering of nursing diagnoses or patient problems using notions of urgency and importance to establish an order for nursing interventions. Organization of a vision of desired outcomes for a patient Rank an order of importance from nursing diagnosis **Classifying patients (changes as patient's condition and needs change, sometimes within minutes)
Abdellahs theory
Patient centered care Nurses address problems to meet pts physical, psychological, and social needs and should strive to KNOW each pt.
Describe assessment activities that identify the psychosocial status of patients as it pertains to their safety.
Perceptions of safety -Tell me what it means to feel safe. -Describe any changes you think should be made to improve your safety at work and at home. Lifestyle -Do you use any assistive devices, such as a wheelchair, walker, or cane, to help you move or get around? Did someone show you how to use them safely? (Have patient demonstrate use.) -Describe for me any difficulties you have with bathing, dressing, or toileting. -Explain how you prepare meals at home (e.g., use stove and appliances safely). -Describe the types of social activities you engage in. Medication history -Which medications (prescription, over the counter, herbal) do you take? -Has your doctor or pharmacist reviewed your medicines with you in the last year? -Describe for me any side effects that you have after taking your medications. History of falls -Have you ever fallen or tripped over anything in your home? Have you had any near misses? -Tell me what you think caused you to fall. Which activity were you performing before the fall? -Have you ever sustained an injury from a fall? What was it and how did it happen? -Did you have any symptoms right before you fell? What were they? Home maintenance and safety -Who does your simple home maintenance or minor home repairs? -Do you feel safe in your home? Describe anything in your environment that makes you feel unsafe. -If you have an emergency at home, whom can you call for help?
Hendersons theory
Principles and practice of nursing Assist pts with 14 acticies until patients meet these needs for themselves or they help pts have a peaceful death "think of 'Hindered' when you are hindered you need something Need theory/ nurse need theory
Explain how professional nursing organizations affect both the profession and the standards of care.
Professional nursing organizations have an impact on educational standards and certifications, specialty practice, consumerism, and patient advocacy. For example, some professional organizations focus on specific areas such as critical care, advanced practice, maternal-child nursing, oncology, and nursing research. These organizations seek to improve the standards of practice, expand nursing roles, and foster the welfare of nurses within the specialty areas.
Dorothea OREMs theory
SELF-CARE DEFICIT theory: used when feeding or bathing a patient until the patient can do this independently Nurse continually assess a pt's ability to perform self-care and intervenes as needed to ensure that pts meet physical, psychological, sociological, and developmental needs "Orem -> self care -> oral -> floss -> flossing if a form of self care. Self care is a human need, nursing (nurses) design interventions to sustain health, and reciover from illness or injury"
Describe the consultation process and explain the relationship of implementation to the nursing diagnostic process.
Six Steps to Consultation: Identify the general problem area Direct consultation to the right professional Provide consultant with relevant info about problem Do not prejudice or influence consultants. Be available to discuss consultant's findings and recommendations Incorporate consultant's recommendations into care plan
Explain the SMART approach to writing goal and outcome statements and correctly write an outcome for a goal of care.
Specific/Singular Measurable Descriptive terms: quality, quantity, frequency, length, or weight. Avoid "normal", "stable", "acceptable Attainable Mutually set with the patient. Nurse and patient agree on the direction of care. Realistic Realistic goals provide patients with a sense of hope, motivation, and accomplishment Timed Time frame for each goal and expected outcome Ex. "Patient will ambulate in the hall 3 times a day by 4/22.
Discuss the steps for revising a plan of care before performing implementation and define the three implementation skills.
Steps for revising a plan Revise data in the assessment column to reflect the patient's status. Date any new data to inform other members of the health care team of the time that the change occurred. Revise the nursing diagnoses. Delete nursing diagnoses that are no longer relevant and add and date any new diagnoses. It is necessary to revise related factors and the patient's goals, outcomes, and priorities. Date any revisions. Revise specific interventions that correspond to the new nursing diagnoses and goals. Revisions need to reflect the patient's present status. 4. Choose the method of evaluation for determining whether you achieved patient outcomes. Three Implementation Skills Cognitive the application of critical thinking in the nursing process Interpersonal Develop a trusting relationship, express a level of caring, and communicate clearly with a patient and his or her family Psychomotor (technical) the integration of cognitive and motor activities For example, when giving an injection you need to understand anatomy and pharmacology (cognitive) and use good coordination and precision to administer the injection correctly (motor).
Describe ways to prevent procedure-related accidents.
Strictly following policies and procedures or standards of nursing practice prevent these accidents. Staff need to be aware that distractions and interruptions contribute to procedure-related accidents and need to be limited, especially during high-risk procedures. Ex: intravenous (IV) medication administration.
Explain the role critical thinking and clinical judgment play in planning care for a patient's safety needs.
Successful critical thinking requires a synthesis of knowledge, experience, critical thinking attitudes, and intellectual and professional standards. Critical thinking allows nurses to anticipate the needs of patients and make conclusions about available data. Ongoing process
Neuman theory
Systems Nurses view pt as being an open system that is in constant energy exchange with both internal and external environments "New perspective, theory of health as expanding consciousness. Total person approach. Likes to reduce stress or other adverse conditions that are detrimental to health"
Discuss a nurse's responsibility in making clinical decisions, and how reflection improves a nurse's capacity for making future clinical decisions.
The professional nurse must be able observe changes in patients, recognize potential problems, identify new problems, and take immediate action that is most suitable for the patient. Requires lifelong learning and the ability to acquire relevant experiences that can be reflected on to improve nursing judgment Reflection allows you to think about your previous thinking to make your future thinking better. Reflection asks these questions: How often do you think back on a situation? Why did that occur? How did I act? What could I have done differently? You're focusing on determining the purpose or meaning of why something happened to make better future decisions.
Explain how nursing standards affect nursing care.
The scope and standards of practice guide nurses to make significant and visible contributions that improve the health and well-being of all individuals, communities, and populations (ANA, 2015) ADPIE 1. Assessment The registered nurse collects pertinent data and information relative to the healthcare consumer's health or the situation. Diagnosis The registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues. Outcomes Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. Planning The registered nurse develops a plan encompassing strategies to achieve expected outcomes. Implementation The registered nurse implements the identified plan. Evaluation The registered nurse evaluates progress toward attainment of goals and outcomes.
Describe the indicators of a nurse's ability to evaluate nursing care, and explain the relationship among goals of care, expected outcomes, and evaluative measures when evaluating nursing care.
They work together to determine how the patient is doing and how the care plan being effective. Goals of care is a statement where the patients' needs to met Expected outcomes are something you can measure to see if the goal is reached Evaluative measures are assessment skills and techniques to determine if the known problem have remained the same Four indicators reflecting a nurse's ability to perform evaluation: Examine the results according to clinical data collected Compare achieved effect with goals and expected outcomes Recognize errors. Understand a patient situation, participate in self-reflection, and correct errors.
Rogers/parse/Newman
Unitary being / human becoming / expanding consciousness Pts are a unique, dynamic energy in constant energy exchange with the environment; nursing care focuses on helpin gthew pts use their OWN potential to identify and alter personal rhythms/patterns to promote and maintain health "Parse -> Person -> one individual. Human becoming theory of nursing. Individual continues to interact with the environment and participates in managing health. additionally nursing care is based on pt's individual perspective of health and care & their indiviudla quality of life" "Rogers: theory of unitary human beings. Mr. Rogers -> Tv show mr rogers neighborhood. Unitary: single: he was the sole host of his hole. Nursing interventions are directed toward repattering human environmental fields or assisting in mobilixing inner resources
Explain the rationale for vulnerable populations being at risk for threats to safety.
Vulnerable populations are especially at risk for alternations in safety because of reduced access to health care, fewer resources, and increased morbidity. These vulnerable groups most affected include infants, children, older adults, individuals who have difficulty communicating, and individuals who have a low-income or are homeless.
Discuss the evidence about patients' perceptions of caring.
When patients sense that health care providers are sensitive, sympathetic, compassionate, & interested in them as people, they usually become active partners in the plan of care. They also decide to return to a specific health care facility.
Discuss the role that caring plays in the nurse-patient relationship.
builds trust by being available & attentive to patients' disposal. Caring is one of the foundations of nursing practice. Because caring is part of the nursing profession, nurses are the one that contributes the most significant impact on patient recovery. improves the health and wellbeing of patients.
Discuss the roles and career opportunities for professional nurses
provider or care (RN) APRN master's degree or Doctor of Nursing Practice (DNP) degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice Clinical Nurse Specialist (CNS) is an APRN who has graduate preparation (master's degree or doctorate) in nursing and is an expert clinician in a specialized area of practice. Nurse Practitioner (NP) is an APRN who has graduate preparation (master's degree or doctorate) in nursing. NPs provide primary, acute, and specialty health care to patients of all ages and in all types of health care settings. Certified Registered Nurse Anesthetist (CRNA) an APRN with advanced education from an accredited nurse anesthesia program Nurse Educator works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. Nurse educators need experience in clinical practice to provide them with practical skills and theoretical knowledge. Nurse administrator responsible for management of the nursing staff in a health care agency. Nursing administration begins with positions such as clinical care coordinators and assistant nurse managers. Nurse researcher Conducts evidence-based practice, performance improvement, and research to improve nursing care and further define and expand the scope of nursing practice
Explain the significance of nursing process to nursing practice and profession.
to identify a client's health care status, and actual or potential health problems, to establish plans to meet the identified needs, and to deliver specific nursing interventions to address those needs. A dynamic, continuous, client-centered, problem-solving, and decision-making framework that is foundational to nursing practice.