NUR 205 Objectives

Explain the elements of the communication process

1. Stimulus • What is bringing on this conversation? (having surgery tomorrow) 2. Sender/Encoder • (starts talking about issue) 3. Message • Tell me about the procedure/surgery 4. Medium/Channel of Communication • Auditory • Visual • Kinesthetic (touch/demonstrate) 5. Receiver • Receiving information

Explain the aims of nursing as they interrelate to facilitate maximal health and quality of life for patients.

1. to promote health: increase a persons well being and health potential 2. To prevent illness: avoid illness; achieve early detection; or maintain function within the constraints of an illness 3. To restore health: direct care for diagnosis or treatment of disease 4. To facilitate coping with disability or death-to facilitate an optimal level of functioning; provide quality end of life care

Discuss the contents of the ANA standards of practice and code of ethics

ANA: -defines the activities of nurses that are specific and unique to nursing -allows nurses to carry out professional roles, serving as protection for the nurse, the patient and the healthcare institution -each nurse is accountable for his or her own quality of practice and is responsible for the use of these standards to ensure knowledgebale, safe. and comprehensive nursing care Code of ethics:-the nurse practices with compassion and respect for inherent dignity, worth, and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or nature of health problems -nurses primary commitment is to the patient-nurse promotes, advocates for and strives to protect the health, safety and rights of the patient -nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse obligation to provide optimum patient care -the nurse owes the same duties to self as to others -nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conductive to the provision of quality health care and consistent with the values of the profession - nurse participates in advancement of the profession through contributions to practice, education, administration and knowledge development -collaboration -articulating nursing values and maintaining integrity of the profession and its practice

Defenses against infection

1. Bodys normal flora 2. Inflammatory response -protective mechanism that eliminates the invading pathogen and allows tissue repair 3. Immune response: attempts to protect and defend the body from foreign materials (antigen) and body makes antibodys (IgM with first exposure and then IgG)

describe what kind of data base needs to be collected based on the clinical situation

1. Initial assessment/complete database: complete health history and a full physical exam 2. Focused/problem centered: concerns mainly assessment on one problem or one body system 3. Ongoing/follow up databases: to assess identified problems at regular/appropriate intervals (on return visits/during hospital stay) in order to evaluate change 4. Emergency database: key data/assessment to immediate problem done in an emergency situation

Understand how the varying phases of the therapeutic relationship and interview utilize communication techniques

3 phases of a therapeutic relationship 1. Orientation phase -establish tone and guidelines for the relationships -identify each other by name (Mr., Mrs., Ms., Dr.) -clarify roles of both people -establish an agreement about the relationship and mutual understanding of what will occur in the relationship (trust) -goals of the relationship -when, where, and for how long each meeting will be -duration of the relationship -provide patient with an orientation to the healthcare system 2. Working phase (longest phase): Nurse-patient interactions are designed to ensure achievement of health goals or objectives that were mutually agreed upon -work together to meet the clients needs -provide whatever assistance is needed to achieve each goal or outcome (example: feeding, hygiene and counseling) -patient centered approach -evaluate the nursing interventions and modify as needed -motivating patients to learn and implement health promotion activities and to facilitate the patients ability to execute the nursing plan and to express feelings about any health problems 3. Termination phase -end of the relationship -should not be abrupt or unexpected -termination expectations should occur from the beginning of the relationship -reactions vary depending on: meaning assigned to it, length of the relationship, extent to which the outcomes were reached Interview 1. Introduction phase -set the stage: welcome the patient and use his/her name, introduce yourself and explain your role, indicate how long interview will take and if there will be a subsequent psychical exam, remove internal/external potential factors that could be barriers to communication, ensure comfort and put client at ease, describe the purpose and expectations of the interview, describe confidentiality, do not use diminutives during interaction 2. Working phase: -Open-ended questions: allow the patient a wide range of possible responses (encourages free verbalization)-beginning, to introduce a new section of questions, whenever the person introduces a new topic, tell me how i can help you, what brings you here today, tell me about your symptoms -Close-ended questions: limit answers, for specific information, fill in any details that the client left out -Validating questions: nurse restates what she/he heard or observed -Clarifying question: allows nurse to gain an understanding of patient comments -Reflective question: repeating what the patent said or describing the persons feelings -Sequencing questions: place events in chronological order -Directing question: used to obtain more information about a topic or to introduce a new aspect of a current topic 3. Conclusion: end gracefully; summarize what you, the nurse, have learned about the patients health history during the interview; thank the client for their time and cooperation

explain the phases in the system development lifecycle (SDLC)

A fundamental area of practice for nurse informaticists in any care setting is the system development lifecycle, or SDLC. The concepts or phases of the SDLC are very similar to the concepts of the nursing process but with an informatics or technology focus. SDLC requires focus in the areas of Analyze and Plan, Design and Build, Test, Train, Implement, Maintain and Evaluate,

Describe the teaching process: diagnosis

A knowledge deficit may contribute to other or actual or potential problems to its written as the etiology example: deficient knowledge r/t, health maintenance r/t, ineffective health management r/t, readiness for enhanced knowledge r/t examples of etiology: cognitive limitation, information misinterpretation, lack of interest in learning, unready to learn, lack of desire at this time, lack of recall, limited exposure to information (specify), unfamiliarity with information resources, limited practice skill

identify and apply pertinent nursing diagnoses related to client teaching

A knowledge deficit may contribute to other, actual or potential problems so its written as an etiology!! -deficient knowledge r/t COGNITIVE LIMITATION -health maintenance r/t LACK OF INTEREST IN LEARNING -ineffective health management r/t INFORMATION MISINTERPRETATION -readiness for enhanced knowledge r/t

Isabel Hampton Robb

A leader in nursing and nursing education; organized the nursing school at Johns Hopkins Hospital; initiated policies that included limiting the number of hours in a days work and wrote a textbook to help student learning; the first president of the Nurses Associated Alumnae of the United States and Canada (now American Nurses Association).

Elizabeth Smellie

A member of the original Victorian Order of Nurses for Canada (a group that provided public health nursing); organized the Canadian Women's Army Corps during World War II

Specialized care facilities: Mental health centers

A mental health center may be associated with a hospital or may provide services as an independent facility The services provided may be crisis centered or may involve long term counseling Patients receive outpatient care through a variety of interventions, including individual and group counseling, medications, and assistance with independent living. Crisis intervention centers are also mental health centers. They typically provide 24-hour services and hotlines for people who are suicidal, abusing drugs or alcohol, or in abusive situations. These centers also provide information and services for victims of rape and abuse In most communities needed mental health services are independently funded, and you may experience difficulty in matching existing resources with a patients or familys needs Nurses who work in mental health centers must have strong community and counseling skills and must be thoroughly familiar with community resources specific to the needs of patients being served in order to make appropriate referrals

Harriet tubman

A nurse and an abolitionist; active in the underground railroad movement before joining the Union Army during the Civil War

Louise Schuyler

A nurse during the Civil War; returned to New York and organized the New York Charities Aid Association to improve care of the sick in Bellevue Hospital; recommended standards for nursing education

Lavina dock

A nursing leader and women's rights activist; instrumental in the Constitutional amendment giving women the right to vote

explain the purpose of documentation

Accurate documentation of information is essential in order to communicate information to all members of the health team, to ensure legal accountability, and to demonstrate effective use of the nursing process and appropriate standards of care.

Role of nurses in primary care centers

Advanced practice registered nurses (APRNs): nurse practitioners, midwives Clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for patients who require health maintenance or health promotion activities Depending on state, APRNs may have their own offices and clinics to provide primary care and treatment to patients and refer only complex health problems to a physician Provided primary care services in offices and clinics -services include the diagnosis and treatment of minor illnesses, performing minor surgical procedures and providing obstetric care, well-child care, counseling and referrals

summarize the clients characteristics to consider when assessing teaching needs

Age and developmental -physical maturation and abilities -psychosocial development -emotional maturity -moral and spiritual development Teaching plans for older adults -identify language barriers -allow extra time -plan short teaching sessions -accommodate for sensory deficits -reduce environmental distractions Health literacy

summarize the client characteristics to consider when assessing teaching needs

Age and developmental factors -physical maturation and abilities -psychosocial development -emotional maturity -moral and spiritual development

Test

As part of the implementation for any new technology or even a small change to a current EHR, an overall testing plan is developed that includes the use of testing scripts. These test scripts, ideally developed in collaboration with nurses who will be using the technology, ensures that all components of the system are working as designed and will support workflow during interaction with the system

describe the phases of the nursing process and standards of care set by the ANA

Assessment, Diagnosis, Implementing, Evaluating, Documenting Standard 1: assessment -the nurse collects comprehensive data pertinent to the patients health or situation Standard 2: Nursing diagnosis -the nurse analyzes the assessment data to determine the diagnosis or issues Standard 3: outcome identification -the nurse identifies expected outcomes for a plan individualized to the patient or the situation Standard 4: planning -the nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes Standard 5: implementation -the nurse implements the identified plan, coordinates care delivery, employs strategies to promote health and a safe environment Standard 6: evaluation - the nurse evaluates progress toward attainment of outcomes

describe the teaching and learning process: Assessment

Assessment: -Sources of assessment information: primary source is patient and secondary source are medical records (provide a history of medical problems as well as documentation of the nursing assessment, diagnosis, physical exams, and interventions that have been performed), and families/SO Assessment parameters to review 1. knowledge, attitudes, and skills need to be independent 2. readiness to learn 3. ability to learn 4. learning strengths

Assessment: ability to learn and health literacy

Assessment: ability to learn -physical factors: do they have or require assissting devices, physical comfort -cognitive ability to learn -developmental considerations -level of education -literacy -communication skills -primary language -acuity of sense Health literacy: ability to understand and act on health information (to learn) -according to the information contained in a report by the Joint Commission (2007b) approximately half of the adults in the US, or 90 million people, lack the basic literacy skills (the ability to read and write) needed to function successfully in our society -teaching patient with low literacy: show pictures, engage in discussion, role-play, demonstrate, provide hands-on practice, emphasize key points in simple terms and provide examples, limit the amount of information in a single teaching session, reinforce information through repetition, teach back, avoid handouts with many pages-use pictures and few simple words, always be respectful-acknowledge that everyone has something they are not good at, use personal examples.

Assessment: readiness to learn

Assessment: readiness to learn 1. Motivation -internal impulse, emotional or physical (pain), that encourages patient to learn or change behavior -motivation is enhanced when: patients view themselves as susceptible to the disease, patients view the disease as a serious threat, patients believe there are actions they can take to reduce the probability of contracting the disease, patients believe that the threat of taking these actions is not as great as the disease itself

Describe the ethical principles as they relate to nursing

Autonomy-respect autonomy of others Nonmaleficence-doesn't harm Beneficence-benefits others Justice-treat others fairly Fidelity-faithful to promises we make to others Accountability Veracity-accuracy Privacy Confidentiality

compare and contrast factors that facilitate learning and those that are barriers to learning

Barriers: The nurse... -makes assumptions -teaches before knowing who he/she is teaching -talks, talks, talks, -lectures -doesn't let the learner interrupt -listens in a hurry -ignores or makes light of the learners concerns -teaches when the problem is not a lack of information Factors affecting patient learning -limited time due to rapid discharge -stress of illness, anxiety, sensory deficits -support networks -extent and complexity of needed behavioral changes -cultural influences -language barriers -low literacy levels -learning styles Family support networks and financial resources Cultural influences and language deficits Facilitate learning: teaching methods, role modeling, lecture, panel discussions, demonstrate and return demonstration, discovery, role playing, instructional materials and learning activities, audiovisual material, written materials, demonstration materials, programmed instructions, web-based instruction and technology, contractual agreements -teaching patients with low literacy: show pictures, engage in discussion, role-play, demonstrate, provide hands-on practice, emphasize key points in simple terms and provide examples, limit the amount of information in a single teaching sessions, reinforce information through repetition, teach back, avoid handouts with many pages-use pictures and few words, always be respectful acknowledge everyone has something they are bad at.

Mary Adelaide Nutting

Became the first professor of nursing in the world as a faculty member of Teachers' College, Columbia University; with Lavinia Dock, published the four-volume History of Nursing

identify barriers and benefits to technology

Benefits: improved patient safety, efficiency, decision supper and communication Barriers: cost, lack of adequate infrastructure and technological support, lack of user competency

discuss the epidemiology of trauma from burns, electricity and motor vehicle accidents

Burns -Most fatal home fires occur while people are sleeping, and most people who die in house fires die of smoke inhalation rather than burns -Fires are significant hazards for older adults. Factors such as confusion, forgetfulness, and diminished visual and olfactory senses place them at greater risk for burn injuries -Health teaching should include additional safety precautions if the older adult smokes in the home. Motor vehicle accident: -Adolescents are particularly at risk for motor vehicle accidents because they spend so much time in automobiles and are prone to distracted driving and driving under the influence. -Older adults are at risk for motor vehicle accidents by visual changes, slowed reaction time, and impaired thinking are realistic concerns Electricity -Electrical equipment can present a safety hazard to both the patient and health care provider when safety measures are ignored. Most electrical equipment in hospitals is with a 3-prong plug. The third prong, when inserted into a properly wired wall outlet, provides a ground for the piece of equipment.. A ground is a connection from an electricity source to the earth through which electrical leakage can be harmlessly conducted. -Many injuries and deaths from electrical shock can be prevented. Overloaded electrical circuits, faulty appliances, frayed wires, careless use of electrical equipment and handling of electrical devices and cord with wet hands or while wearing wet shoes can result in injury or death

Describe the status of nursing today

Challenges facing professional nurses -changing duties and responsibilities -severe nursing shortage -patient safety, accountability, and quality of care Core competencies required by professional nurses: critical thinking, communication, inter-professional collaboration, assessment, leadership, technical skills Knowledge required by professional nurses: -health promotion/disease prevention, information technology, public policy Consumer issues in health care -Access, quality, cost, accountability Changes in society: -aging population, intercultural population, generational differences in an aging workforce, high acuity and short staffing, need for a well-trained work force, average age of full time faculty 54 years of age, Nurse Reinvestment Act signed into bill August 2002 to provide funds for nursing education, recruitment and retention Affordable Care Act: -provide insurance to over 32 million previously uninsured Americans Robert Wood Johnson Foundation -nurses should practice to full extent of training -nurses should achieve higher levels of education -nurses should be full partners with physicians and other health care professionals to re-design health care in the US -improve health care workforce data collection to better assess and project workforce requirements Opportunities for professional nurses -opportunities to increase knowledge -evidence based practice -united effort to shape health care; influence policy -united effort to address the nursing shortage

describe the role of nursing in meeting the challenges of health care reform

Changes taking place in health care give nurses the opportunity to help shape health care for the future Nurses are becoming a stronger voice in addressing health-related problems in our nation and proposing solutions Nurses in greater numbers are increasing their education and becoming APRNs The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness

plan for goal-directed interventions to prevent infection or control the spread of infection

Demonstrate effective hand hygiene by... Identify the signs of an infection on March... Consume a minimum of 1500 cal.day by... Demonstrate proper display of soiled articles... Demonstrate stress-reduction techniques... Remain free of symptoms of infection

evaluate the patients achievement of 4 types of outcomes specified in the plan of care

Cognitive: repeat or apply information Psychomotor: demonstrate skills Affective: observe patient behavior and conversation Psychological: assessment skills to collect and compare data

begin to utilize strategies for documentation of health history

Collecting data -active processing -observing and listening to the client (also SO and family member): help clarify, elaborate, and give additional pertinent information; systematic series of mental actions to analyze and interpret the information -Learning to listen 1. listen with the intent to understand-keep an open mind, put aside your own paradigms 2. develop skill of emphatic listening; take time to understand the other persons frame of reference (values and beliefs) so that you can define the true meaning of the message 3. recognize your use of the following: ignoring, pretending to listen, selective listening; listening attentively to the specific words but not the meaning Active processing -translation-clear, succint, meaningful statements -reasoning: make mental connections of the data to diseases, health patters or the current situation. Inferences-attach meaning to data or reach a conclusion about the data; intuition and validation

Physician assistant

Conducting physical exams and suturing lacerations Completed a specific course of study and a licensing exam in preparation for providing support to the physician

discuss factors that influence communication and interviewing skills

Developmental level Gender Sociocultural differences Roles and responsibilities Space and Territory Physical, mental and emotional state Values Environment: comfort zone

Differentiate between intentional torts and unintentional torts

Crime: a wrong against a person or his/her property (considered to be against the public as well, punishable by state)-misdemeanor and felony Tort: a wrong committed by a person against another person or his/her property (subject to action in civil court) 1. intentional: fraud, defamation, assault and battery, false imprisonment, and invasion of privacy 2. unintentional: -negligence: occurs when harm or injury is caused by an act of either omission or commission by a layperson -malpractice: an act of negligence by a professional person as compared to the actions of another professional person in a similar circumstance. 4 elements that must be established to prove malpractice are: duty (an obligation to use due care), breech of duty (failure to meet a standard of care), causation (failure to meet standard of care resulted in injury), and damage (actual harm or injury)

describe strategies for implementing CDC guidelines for standard and transmission based precautions when caring for a patient

Current CDC guidelines 1. Standard precautions -used in care of all hospitalized patients -apply to blood, body fluids, secretions, excretions (excluding sweat), non-intact skin, mucous membranes 2. Transmission-based precautions -airborne, droplet or contact precautions -used in addition to standard precaution for patients with suspected infection

describe motivational interviewing including the principles and skills

Current evidence supports the effectiveness of MI for chronic-disease management, medication adherence, smoking cessation, weight loss and more Motivation interviewing is philosophy congruent with nursing practice as it is a patient-centered, non-judgmental, non-confrontational, and non-adversarial approach to the care of people MI builds upon therapeutic communication techniques and provides specific approaches and principles that enable collaboration with people once treatment decisions with a focus on offering choices rather than prescriptions Core principles: express empathy, develop a discrepancy, roll with resistance, support self-efficacy 4 communication skills needed: reflective listening, asking open-ended questions, affirming and summarizing

identify the behavioral, environmental, socioeconomic, developmental, cognitive, and physiological factors that affect safety

Developmental: each developmental level carriers its own particular risk. Health care needs and safety risks change as people progress from infancy to older adult stage. Education to promote awareness of potentially dangerous situations must begin as early as possible and continue throughout the life span Ability to communicate: Ability to communicate is basic to many safety practices. Nurse must assess any factors that influence the patients ability to send and receive messages. Fatigue, stress, medication, aphasia, and language barriers Sensory perception: Alterations in sensory perception can have a devastating effect on safety. Any impairment in sight, hearing, smell, taste, touch can reduce a persons sensitivity to the environment Knowledge: An awareness of safety and security precautions is crucial for promoting and maintaining wellness throughout the lifespan. Patients require a certain amount of knowledge to manage new equipment and unfamiliar processes Physical health state: Anything that affects patients physical health state potentially can affect the environment. When a person is automatically ill or in a weakened state, the focus of health care includes preventing accidents as well as promoting wellness and returning the person to a healthy state Psychosocial health state: Stressful situations tend to narrow a persons attention span and make the person more prone to accidents. Stress may occur over long periods of time but the effects tend to be more dangerous in the older adult; depression and social isolation Lifestyle (occupation, social behaviors and environment) -occupation: people who work in certain occupations may experience exposure to health hazards such as noise, chemicals, or vapors, or infectious agents -social behaviors: some people by nature are more trained to take risks and jeopardize their safety; stress, vulnerable populations -environment: pollutants, and high-crime neighborhoods which can affect physical and mental well-being

Role of Nurses in hospitals

Direct care providers Manager of other members of the health care team Administrator Clinical nurse specialist Patient educator In-service educator Researcher

Mary Agnes Snively

Director of the nursing school at Toronto General Hospital and one of the founders of the Canadian Nurses Association

Current CDC guidelines Transmission based DROPLET SPREAD

Droplet spread by large particle droplets Studies have shown that the nasal mucosa, conjunctivae, and less frequently the mouth are susceptible portals of entry for respiratory viruses Precautions: used for rubella, mumps, diphtheria, influenza, and the adenovirus in young children -private room -mask when working within 3 feet of patient

Train

Effective end-user training is a key element to an implementation success. EHRs are complex and multifaceted. They have linkages that require end-users to negotiate between different areas of the chart that can be confusing. Poor training can produce decreased efficiency, staff turnover, patient care errors, and poor-quality documentation followed by decreased billing revenue the development of training materiel needs nursing input to ensure that the technology supports nursing processes and workflows that will enable nurses to navigate the system as early as possible

Lilian ward

Established a neighborhood nursing service for the sick poor of the Lower East Side in New York City; the founder of public health nursing

Nora Gertrude Livingston

Established a training program for nurses at the Montreal General Hospital (the first 3-year program in North America)

Mary Breckinridge

Established the FNS/Frontier Nursing Services in 1925, health care services for rural Kentucky, The FNS is still in operation today and provides vital service to the rural communities of Kentucky.Breckenridge collected data that clearly documented a significant decrease in mortality with the nursing services provided by the FNS

Occupational therapist

Evaluate the patients functional level and teaching activities to promote self-care in activities of daily living They asses the home for safety and provide adaptive equipment if necessary

identify elements of a disaster plan

Every institution should have a disaster plan which includes -emergency supplies -emergency planning for the disabled -emergency shelter locations -FEMA (federal emergency management agency)

describe internal and external factors that impact the interview process

External: Physical setting -privacy, interruptions, environment -dress: client should remain in street clothes during the interview; nurse should meet the standards for the setting for professional appearance -documentation: note-taking (some is unavoidable but beware of focusing on paperwork but not patient), tape recording and picture taking is not allowed -noise Factors that promote effective communication -warmth and friendliness, openness and respect, empathy, honest, authenticity, trust, caring, competence -rapport builders: a feeling of mutual trust experienced by people in a satisfactory relationship-specific objectives for the purpose of interaction, comfortable environment, privacy, confidentiality, patient vs task focus, utilization of nursing observations, optimal pacing, respecting personal space

specialized care facilities: parish nursing

Expanding area of specialty nursing practice that emphasizes holistic health care, health promotion and disease-prevention activities Combines professional nursing practice with health ministry, emphasizing health and healing within a faith community Parish nurses function as health educators, resource and referral aids, and facilitators of lay volunteer and support groups Parish nurses reach out to the most vulnerable such as older adults those who have suffered a loss or change, single parents, and children

describe the types, purposes, and process of establishing expected outcomes and identifying appropriate interventions to achieve the outcomes

Expected outcome: the desirable end result of nursing care -includes subject, verb, performance criteria, target time (possibly a condition) -must be realistic or achievable -should be measurable, timed and can be directly observed -expected results should be acceptable to the client and be agreed upon (patient centered) -time frame: short term-1 hour to a week; long term is weeks to months Types of outcomes 1. cognitive: increases patient knowledge-within 1 day of teaching the patient they can list 3 benefits of this 2. psychomotor: new skills-by a certain date they will be able to perform a task 3. affective: change belief/attitude-by a date patient will verbalize why these values are important 4. physiological: physical change in patient Interventions: -monitoring the clients status -assisting the client who is partially unable to care for themselves -supporting clients who lack willpower, resilience or the movitation to care for herself -protecting -sustaining life and physical function Elements of an intervention: -need to make very specific so other nurses can follow -involves writing who, what, where, when, why, how -who: person proving care-nursing, RT, PT -what: care that will most effectively meet the clients needs -where: home, clinic, hospital; refers to the tie that care is delivers or the sequence of events -why: provides the rationale for care and includes evidence that the care will meet the clients needs -how: define the methods of interventions

plan interventions to prevent injury and promote safety in the acute care setting, the clients home, and the community

Expected outcomes/goals: the patient will... -identify risk factors (specify/individualize) -utilize safety measures to prevent injury -establish safety priorities with family members of significant others -demonstrate familiarity with their environment -identify resources for safety information -prevent injury Environment: interventions for home safety -education specific to members of the household (age and development) -remove safety hazards: medication/poisions, uneven walkways/stairs, frayed electrical cords, clutter, throw rugs, safety classes (CPR and swim) -utilize assistive and safety devices: smoke alarms, fire extinguishers, carbon monoxide detectors, grab bare/railing, adequate lighting, seat belts, adequate supervision, PPE, raised toilet, shower chair Interventions to promote a safe institutional environment -electrical equipment maintained in good working order and knowledge of operating -known and review safety procedures for fire and disaster -in care of a fire RACE and PASS. R(rescue), A(activate alarm), C(contain the fire), E(extinguish fire). P(pull), A(aim), S(squeeze), S(sweep) -utilize proper lifting techniques to prevent back injuries: safe-lifting/handling policies, lift teams and technologies and equipment -Preventing falls: indicate fall risk on patient door or bracelet, call light in reach, no skid shoes, bed low and wheels are locked, eliminate clutter, orienting patient surroundings and equipment, bed alarm and restraint as needed Interventions to promote a safe environment: hourly rounding -rounding every 1-2 hours reduces frequency of call light use, increases patient satisfaction and reduces fall -pain level, toileting, position changes, call light and phone in reach, bedside table next to bed, ask "is there anything else i can do for you", inform the pt when the next rounding will be

discuss the epidemiology of common injuries from falls, asphyxiation and poisoning

Falls: -Age >65, history of falls, impaired vision or balance, altered gate or posture/impaired mobility, medication regimen, postural hypotension, slowed reaction time, weakness and physically frail, confusion or disorientation, unfamiliar environment -The morse fall assessment: history of falls, secondary diagnosis, ambulatory aid, Iv/Heparin lock, gait/transferring, mental status -ABCs of fall injury risk: A is age >85, B is bone (fractur or history of osteoporosis), C is anticoagulation or bleeding disorders, S is surgery during current episode of care -Major causes of falls in the home include slippery surfaces, poor lighting, clutter, and improperly fitting clothing or slippers. Installing hand rails in bathrooms and on staris, ensuring good lighting and discarding or repairing broken equipment around the home to prevent accidents. Calcium and vitamin D promote skeletal health and reducing risk of falling. Exercise also has a positive effect -Prevent falls in the hospital by indicating fall rise on patient door and patient bracelet, call light in reach, eliminate clutter, orienting (reorienting) patient to surroundings and equipment, bed alarm and restraint if needed Poisoning: -Children are treated for accidental poisoning, dosing errors, older adults accidentally overdosing -Factors that put children more at risk for exposure to toxic substances include unsafe storage in the home, spending time in environments other than the home, lack of attention on the part of the caregiver, the rise in multi-generational families, and the presence of multiple pharmaceuticals, vitamins, and dietary supplements in the home -younger children are more at risk to ingest household chemicals while older children are more at risk to swallow medicines in a suicide attempt -adolescents and young adults who experiment with drugs can experience accidental poisoning and death -An older adult might inadvertently take an overdoes of a medication because of confusion or forgetfulness, poor vision is also a factor in accidental poisoning -Poisoning may come from improper mixing of household substances, prolonged use of strong cleaning products, or malfunctioning household appliances (gas, oil, and kerosense heaters) that can release carbon monoxide. -Nursing interventions involve health education aimed at preventing accidental poisoning in the home. The focus of emergency treatment of poisoning is to stabilize vital body functions, prevent the absorption of the poison, and encourage excretion of the toxic substance. Activated charcoal is considered the most effective agent for preventing absorption of the ingeted toxin -Nursing education efforts can also change behaviors that place older adults at risk for medication-related poisoning. Asphyxiation: -Incidence is greater in children -in suffocation air does not reach the lungs and breathing stops -Common causes are drowning, chocking on a foreign object inhaled into the trachea, and gas or smoke poisoning -infants are at a higher risk for suffocation when they are sleeping -drowning is a form of suffocation -As a result of suffocation, unconsciousness, respiratory failure, and cardiac arrest can occur so CPR needs to be done immediately. When teaching patients the nurse should emphasize careful supervision of children and should outline specific situations that place children at risk for suffocation

assess the clients risk for injury

Fetus: optimize nutrition and healthy environment, avoid alcohol and other teratogens, stop or reduce smoking, avois unnecessary drug exposure, avoid pesticides and chemicals Neonate: -recognize the dependence of neonate on caregiver -proactively monitor environment-monitor environment for chocking hazards -never leave infant unattended -use crib rails -properly use car seats Toddler: childproof home environment, secure possible sources of poisoning, be alert to manifestations of child abuse, properly use care seats School aged child: avoid activities that are potentially dangerous, provide interventions for safety at home, school and neighborhood, teach bicycle safety, education regarding child abduction, encourage use of safety belts Adolescent: teach safe driving skills, teach avoidance of tobacco and alcohol, teach risk of infection (body piercing, tattoos and permanent makeup), teach about guns and violence, recognize and teach regarding bulling, suicide and illegal drug experimentation Adults: Recognize potential effects of stress and lifestyle on health, counsel about unsafe ineffective coping mechanisms (reliance on drugs or alcohol), counsel about domestic violence, work place-potential for injury Older adults: prevent accidents, orient person to surroundings (avoid falls), promote safe environment at home (fire alarms), use medication trays (avoid poisoning), schedule regular and vehicle maintenance, schedule eye exams and keep noise at a minimum

CDC guidelines current: Transmission based precautions AIRBORNE

More strigent than droplet precautions because light and stay suspended in the air longer Used for TB, varicella and rubeola Private room with negative air pressure Respiratory protection (high efficacy particulate air filter respirator or N95 respirator air filter certified by national institue for occupational safety and health for known or suspected TB)

describe the historical background of nursing informatics

Florence Nightingale recommended establishment of a statistical department in the navy Florence nightingale was the first informatics nurse who compiled and processed data to improve sanitation conditions in military hospitals during the Crimean war 100 years later computers were introduced into the healthcare system Transition from Industrial age to Information age -computers and software programming

Discuss nursing leaders who influenced the development of nursing

Florence Nightingale: -founder of professional nursing -demonstrated the value of aseptic technique and infection control procedures -honored for her contributions to nursing research - demonstrated the value of political activism to affect health care reform -established the first nursing school in england -honored as the founder of professional nursing services, initiated social services spent up to 20 hours each day providing nursing care -introduced principles of asepsis and infection control, a system for transcribing physicians orders and a system to maintain patient records -kept careful statistics-documented a decrease in the death rate of soldiers from 42% to 2% as a result of health care reforms that emphasized sanitary conditions Mary Seacole: Jamaican nurse who played a major role in the Crimean war; was denied the opportunity to join Nightingales nursing brigade because she was African american. Opened a lodging house with her won money to care for the sick and wounded soldiers. Contributed to control of the cholera epidemic through extensive knowledge in tropical medicine Dorothea Dix: Appointed to organize military hospitals, provide trained nurses, and disperse supplies; she received no official status or salary Harriet Tubman: worked as a nurse, scout, and spy for the union army. Conducted an "underground railroad" to lead slaves to freedom Sojourner Truth: abolitionist and nurse, advocate of clean and sanitary conditions so patients could heal Suzie King Taylor: worked as a full time nurse on the battlefront Clara Barton: American Red Cross Lillain Wald: public health nursing Mildreg montag: philosophical developer of ADN

discuss selected trends and issues affects health care delivery

Focus on preventative care -peoples health awareness and desire to be involved in their own health care have strongly influenced the delivery of health care services in our society -stress management programs, nutritional awareness, exercise and fitness programs, and anti-smoking and anti-drug campaigns are all examples of this trend Knowledge and engaged consumers -health care consumers are increasingly knowledgeable about health, prefer to control and make decisions about their own health, and want to be active participants in planning and implementing their health care. It is therefore critical for nurses to develop skills for creating successful partnerships with patients and their families -a down side is that many patients learn erroneous information from the internet. It is critical for nurses to discover what patients know about their health challenges, and to respectfully correct false or inappropriate information -patients are also concerned about access to services, the cost of those services and the quality of those services received. Consumers have become actively involved in the administration of health care facilities and have helped develop standards for care, patient rights, and cost-containment measure as protection for patients when they enter a health care setting Mobile health -patients can now access their medical records online, schedule appointments, and communicate with professional caregivers online. Tablets give access to electronic health record data, drug reference materials and other valuable data that in the past was only available in the office or hospital. Patients especially with chronic illnesses are using apps and smartphone devices that let them measure weight, blood pressure, blood glucose and more. -many nurses are filming teachable moments -this trend will only increase and provide more opportunities for nurses to provide effective, quality care

Mary Elizabeth Mahoney

Graduated from the New England Hospital for Women and Children in 1879 as America's first African American nurse

Linda richards

Graduated in 1873 from the New England Hospital for Women and Children in Boston, Massachusetts, as the first trained nurse in the United States; became the night superintendent of Bellevue Hospital in 1874 and began the practice of keeping records and writing orders

identify specific interventions needed to prevent transmission of infection, manage a client with a compromised immune system, and reduce the personal risk for infection

Hand hygiene Gloves (body fluids, secretions, contaminated items, open skin) Mask, eye protection, face shield, gown Client-care equipment Environment Sharps, dressings, linen Immunocompromised: Protective isolation (absolute neutrophil count is less than 1000) -private room -no visitors who are ill -visitors must wash hands -no standing water in the room Reduce personal risk for infection -identify and provide safer medical devices that reduce or eliminate injuries from sharps -involve health care workers in the selection process of these safer devices -provide engineering controls for sharps disposal containers, self-sheathing needles, and other safety devices to reduce or eliminate sharp injuries -educate employees regarding how to safely use these devices -develop a sharps injury surveillance log Any accidental exposures need to be reported -immediate management of the exposure site-wash the exposed area immediately with warm water and soap, flush mucus membranes or irrigate eyes -immediate, detailed report of the incident to the facility, with likely completion of an incident or injury report -baseline testing of the exposed person indicated with positive results from the source person; note is the exposed person is considered immune to HBV with documented positive titer and requires no further testing or follow up. -follow up testing -counseling sessions regarding safe practices to protect self and others

Identify and explain the components of a nursing health history and mental status assessment

Health history: -Start with biographical data (name, age, birth date, address, phone, gender, religion, race, occupation, marital status) -Occupational history: where have they worked and what did that job entail -Financial status: are health care costs a financial burden -Past history: hospitalizations, surgeries, injuries, illnesses, immunizations -Family profile -Relationships and environment -Teaching/learning/education -Socialization and leisure -Current health state -Psychological profile: self concept, stress factors, coping mechanisms -Spiritual beliefs -Self care/ rest and sleep -Sexuality -diet recall Mental status: Appearance, behavior, cognitive, and thought processes and perceptions

Describe the discuss the importance and purpose of a complete and holistic health history in nursing practice

Purpose of collecting a health history is to establish a database and to identify actual and potential problems. Need to be able to recognize objective and subjective data Purpose of an assessment -establish a database -identify actual and potential problems -focus on a specific problem -determine immediate needs and priorities -determine related or contributing factors -identify strengths as a basis for changing behavior -identify the risk for complications -recognize complications

specialized care facilities: homeless shelters

Homeless shelters are usually living units, such as an apartments building or home, that provide housing for people who do not have regular shelter The homeless are at an increased risk for illness or injury because of factors such as exposure to the elements, exposure to violence, drug and alcohol addiction, poor nutrition, poor hygiene, and overcrowding. Services provided by nurses in homeless shelters include immunizing children, teaching pregnant woman, treating infections and illnesses, referring for diagnosis and treatment of STIs and providing information about maintaining health

compare and contrast settings and agencies that provide health care

Hospitals, primary care centers, ambulatory care centers and clinics, home health care, hospital at home, extended care, specialized care centers and settings, health care services for the seriously ill and dying, health care agencies

describe the course of an infection

INFECTIOUS AGENT: microorganisms that commonly inhabit various body sites are part of the bodys normal defense. However, if other factors interferfe a usually harmless organisms can generate an infection. Bacteria that normally cause no problem may be harmful in susceptible people=opportunistic. An infection is present once the person exhibits specific manifestations of the disease. RESERVOIR: The reservoir for growth and multiplication of microorganisms is the natural habitat of the organism. Other people, animals, soil, food, water, milk and inanimate objects. Some people who act as reservoirs for an infectious agent demonstrate signs and symptoms of the disease and others do not exhibit any manifestations (carriers). Rabies virus in animals, West Nile virus in animals, water, food, soil, people PORTAL OF EXIT: point of escape for the organism from the reservoir. The organism cannot extend its influence unless it moves away from the original reservoir. Common portals of exits in humans is respiratory, GI, and genitourinary tracts, as well as breaks in the skin MEANS OF TRANSMISSION: -an organism may be transmitted from its reservoir by various means or routes -direct contact requires close proximity between the susceptible host and an infected person or a carrier, and includes activities such as touching, kissing and sex -indirect contact involves personal contact with either: (1)a vector which is a living creature that transmits infectious agents to a human, usually an inset, or (2) an inanimate object called a formite such as equipment or countertops -microorganisms can also be spread through the airborne route when an infected host coughs, sneezes, or talks when an organism becomes attached to dust particles. Droplet transmission is similar to airborne transmission except airborne particles are less than 5mcm and droplet particles are bigger than 5mcm -proper hand hygiene and gloves can disrupt the transmission of dangerous bacteria from nurses to patients. PORTAL OF ENTRY: point at which organisms enter a new host. The organism must find a portal of entry to a host or it may die. The entry route into the new host is often the same as the exit route from the prior reservoir. The skin, urinary, respiratory and GI tracts are common portals of entry SUSCEPTIBLE HOSTS: Microorganisms survive only in a source that provides shelter and nourishment, and only if the microorganisms overcome any resistance mounted by the hosts defense. Susceptibility is the degree of resistance the potential host has to the pathogen. Hospital patients are often in a weakened state of health because of illness and have less resistance so they are more susceptible to infection

evaluate the outcomes that describe progress toward the goals of health protection nursing care

If patient goals have been met and evaluate criteria have been satisfied the patient will accomplish the following: -correctly use technique of medical asepsis -identify health habits and lifestyle patterns that promote health -state the signs and symptoms of an infection -identify unsafe situations in the home environment

appreciate the need for improved team work and collaboration amount of health care disciplines in the provision of safe and effective care

Improve staff communication -get important test results to correct staff in a timely manner Lifting teams to prevent injury Consulting physicians before using restraints

Dorothea dix

Served as superintendent of the Female Nurses of the Army during the Civil War; was given the authority and the responsibility for recruiting and equipping a corps of army nurses; was a pioneering crusader for the reform of the treatment of the mentally ill

Specialized care facilities: Daycare centers

Some center scare for healthy infants and children whose parents work, and some also care for children with minor illnesses. Eldercare centers and senior citizen centers provide a place for older adults to socialize and to receive care while family members work. Some daycare centers provide health related services and care to people who do not need to be in a healthcare institution but cannot be at home alone. Such centers provide services to older adults for physical rehabilitation, for people with special needs (eg cerebral palsy), and for chemical dependency and mental health Nurses who work in daycare centers administer medications and treatments, conduct health screenings, teach and counsel

describe types of planning for individual clients

Initial planning: this comprehensive plan addresses each problem listed in the prioritized nursing diagnosis and identifies appropriate patient goals and the related nursing care -performed by the nurse with the admission; nursing health history and physical assessment Ongoing planning: -clients health condition may change rapidly -carried out by any nurse who interacts with the patient. Chief purpose is to keep the plan up to date to facilitate the resolution of health problems, manages risk factors and promote function -the nurse caring for the patient uses new data as they are collected and analyzed to make the plan more specific and accurate -stating nursing diagnosis more clearly, developing new diagnoses, adjusting patient outcome to be more realistic, developing new outcomes and identifying nursing interventions Discharge planning: starts right away -nurse who worked more closely with patient -teaching and counseling so they can perform the tasks on their own

Describe nursing informatics

Integrates nursing science, computer science, and information science to manage and communicate data, information and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support their patients, nurses and other providers in the decision-making in all roles and settings, This support is accomplished through the use of information structure, information processes and information technology Integrating technology and informatics with nursing roles Use of technology and data to improve patient care

Discuss the concept of nursing advocacy, accountability and responsibility

It is the nurses responsibility to provide care that is established by standards of the profession Being accountable means that the nurse is answerable for the outcomes of action taken To advocate for someone means to speak for that person when the person is unable to speak for themselves

Describe the mechanisms that influence the professional and legal regulation of nursing practice

Legal regulations 1. Credentialing: refers to ways in which professional competence is ensured and maintained 2. Accreditation: mandatory and voluntary; process by which an educational program is evaluated and recognized as having met certain standards 3. Licensure: National Council Licensure Examination (NCLEX-RN) for entry level competence (moving to another state you do not have to retake the NCLEX) 4. Certification: validates specialty knowledge, experience, and clinical judgement Professional Regulations -CDC -employer policy and procedures -educational programs -the nursing process

identify the 8 parameters of a symptom or client health complaint

Location Character Quantity/Severity Timing Setting Aggravating or relieving factor Associated factors Patients perception

Home health care

May be provided through community health departments, visiting nurses association, hospital based care, managers, and home health agencies Most rapidly growing area of the health care system Driven by payment system of reimbursement-early discharge from hospitals Services include -skilled nursing assessment -teaching and support of patients and family members -direct care for patients More older people are living longer with multiple chronic illnesses and with sophisticated technology people can live relatively comfortably in their own homes

Discuss the MSU CON mission and vision

Mission: The mission of MSU CON is to enhance the health of the community by providing excellence in nursing education, nursing research and nursing practice. We will advance the profession of nursing and serve as an advocate for optimal healthcare for all people Vision: The MSU CON is a leader in creating positive change in healthcare outcomes locally, nationally, and globally through excellence in nursing education, research and practice

discuss the importance of recording significant information legibly, concisely, completely and sequentially

Needs to be readable. Proper use of terms and correct spelling extremely important

evaluate client outcomes and nursing interventions used to help the client reduce the risk for injury including restraints

Outcomes: -identify risk factors -utilize safety measures to prevent injury -establish safety priorities with family members or SO -demonstrate familiarity with his/her environment -identify resources for safety information -prevent injury Restraints: -can be physical or psychoactive drug -regulated by facility specific policy -unnecessary restraining can violate patients rights and be construed as assault or false imprisonment -the main reason for using restraints is to prevent patient injuries -a physicians order is required for the use of restraints and this order must include the type of restraint, duration of use, monitoring criteria, reason for use and removal criteria -family members of patient may be utilized to stay -restraints can cause complications -follow policy related to removal of restraints and monitoring of patient -often only considered as a last result restraint hazards: suffocation from entrapment, impaired circulation, altered skin integrity-pressure ulcers, diminished muscle and bone mass (recuperation time>immobilization time), fractures, altered nutrition and hydration, aspiration and breathing difficulties, incontinence, changes in mental status

Describe how nonverbal communication can impact the communication process

Nonverbal set of behaviors that conveys messages without words-body language -touch, eye contact, facial expressions, body posture, gait, use of gestures, general physical appearance, mode of dress and grooming, sounds and silence often help nurses understand subtle, hidden messages in what the patient is saying verbally. Nurses must be aware of the nonverbal messages they send as well

Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process

Nurse practice acts: laws established in each state in the US to regulate the practice of nursing. They differ from state to state but all have certain elements in common -Define the legal scope of nursing practice excluding unlicensed or untrained people -Establishes criteria for education and licensure of nurses -Identify violations that can result in disciplinary actions against the nurse -Exclude untrained or unlicensed people from practicing nursing -Create a state board of nursing -Make and enforce rules an regulations -Define important terms and activities in nursing -Provide legal requirements and titles for RNs and LPNs Profession and Legal requirements of nursing practice -CDC -Employer policy and procedures -educational programs -the nursing process Professional and legal regulation of nursing practice: defines the activities of nurses that are specific and unique to nursing. Allows nurses to carry out professional roles, serving as protection for the nurse, the patient and the healthcare institutions. Each nurse is held accountable for his/her own quality of practice

discuss the classification of nursing diagnosis

Nursing diagnosis provide the basis for receiving nursing interventions that will achieve valid patient outcomes for which the nurse is responsible Problem, r/t etiology, AEB

describe and utilize appropriate interviewing techniques

Obtain accurate and thorough information -gather data Utilize therapeutic communication QUESTIONS TO ASK -Open-ended questions: allow the patient a wide range of possible responses (encourages free verbalization)-beginning, to introduce a new section of questions, whenever the person introduces a new topic, tell me how i can help you, what brings you here today, tell me about your symptoms -Close-ended questions: limit answers, for specific information, fill in any details that the client left out -Validating questions: nurse restates what she/he heard or observed -Clarifying question: allows nurse to gain an understanding of patient comments -Reflective question: repeating what the patent said or describing the persons feelings -Sequencing questions: place events in chronological order -Directing question: used to obtain more information about a topic or to introduce a new aspect of a current topic

Design and build

Once through planning and analysis has resulted in an identified need for a new technology or an enhancement to a current system, the more granular work of designing begins Questions: "what should the screen display look like? How should it be laid out to be consistent with other screen layouts? Can the design support or improve the nurses workflow as mapped out during the analysis and planning phase?"

Margaret Sanger

Opened the first birth control clinic in the US; founder of planner parenthood federation

discuss the course of an infection, physiological defenses against infections, and chain of infection in relationship to infection control

Organism-->Reservoir-->Portal of exit-->Transmission-->Portal of entry-->Vulnerable hosts Infection control: Preventing infections in patients is a major focus of nursing

Mary Ann Bickerdyke

Organized diet kitchens, laundries, and an ambulance service, and supervised nursing staff during the Civil War

evaluate 4 basic ways in which health care is paid for

Out-of-pocket payment Individual Private Insurance Employer-based private insurance Government financing -Medicare: DRGs -Medicaid -Childrens Health Insurance Program Veterans Health Administration

discuss the nursing process as it relates to the teaching learning process

Patient teaching is approached most effectively using the steps of the nursing process The teaching-learning process and nursing process are interdependent

Discuss the clients rights and their influence on nursing practice

Patients have the following rights - see and copy their health record -update their health record -request corrections of any mistakes -get a list of disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations -request a restriction in certain uses or disclosures -to choose how to receive health maintenance -patient has the right to not be legally forced to remain in a health facility -every patient has the right to be free from invasion of his or her person

describe strategies to increase access to affordable, high-quality care

Pay for performance and penalties for excess readmissions

identify the members of the interdisciplinary health care team

Physician, advanced practice registered nurse, physician assistant, nurse, physical therapist, occupational therapist, speech therapist, social worker, pharmacist, respiratory therapist, dietitian, chaplain/special care provider, unlicensed assistive personnel

compare and contrast these health care delivery systems: physicians and hospitals, multispecialty practice groups, community health centers, prepaid group practices, accountable care organizations, medical homes, and medical neighborhoods

Physicians and hospitals: Under a fee-for-service arrangement (in which everything a provider "does" for a patient leads to a bill generated and a fee paid), financial incentives reward doing more care, and not necessarily better care. Multispecialty group practice: As new drugs and technologies proliferated, it become increasingly difficult for general practitioners of medicine to provide all the services their patients needed. Health care providers from different specialties untied to share income, expenses, facilities, equipment and support staff. The multispecialty group practice that resulted was better able to provide comprehensive care. Multispecialty centers developed to serve specific communities. Offering different types of medical specialty in one practice Community health centers: regionalized services for vulnerable geographic populations with an emphasis on primary care and education. Their primary objective is to ensure that everyone who needs care has access regardless of the ability to pay. Most of these services rely on nurses. Mary Brekenridges Frontier Nursing service successfully served a poor rural area. Community health centers save money every time an uninsured patient opts for an examination and treatment at the first sign of a health issue instead of waiting until a costly emergency room visit is the only option Prepaid Group practice: Health maintenance organizations are prepaid, group managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. There may be no additional out-of-pocket costs, or subscribers may pay only a small fee called a copayment. HMOs often have a primary goals to reduce costs by preventing illness. An HMO may employ all its providers, or it may be a group of clinicians in alliance who provide care as independent practitioners. Gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreeed to lower thier rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMOs network. Preferred provider organizations allow a third-party payer (facilities that pay health care providers for services provided to people such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of patients and services. Type of health plan that contracts with medical providers, such as hospitals and doctors to create a network of participating providers. You pay less if you providers that belong to the plans network. More flexibility when picking a doctor or a hospital. They feature a network of providers but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate Accountable care organizations: this new organizational structure is a departure from the traditional fee-for-service model of reimbursement. In the fee-for-service model providers are incentive to do more and more, but not in a coordinated manner. ACOs turn this model around by offering incentives to provide integrated, well-coordinated care to patients. ACOs are made up of several types of organizations that deliver care: hospitals, primary care settings, and specialty care practices. Together the organizations in an ACO come together to deliver the most efficient, and high-quality care for the population served; only one bill is generated that covers all the care delivered across the various settings. In addition, when providers deliver higher quality and more efficient care, they share in the savings from the delivering well-integrated care Medical homes: a medical home is an enhanced model of primary care that provides whole person, accessible, comprehensive, ongoing and coordinated patient-centered care; improves health outcomes, enhances the patient experience of care and reduces expensive unnecessary hospital care Medical Neighborhood: A patient centered medial home and the constellation of other clinicians providing health care services to patients within it, along with community and special service organizations as well as state and local public health facilities.

Describe the various levels of educational preparation in nursing

Practical and Vocational Nursing Education -established to teach graduates to give bedside nursing care to patients. Most programs are 1 year in length divided into 1/3 classroom hours and 2/3 clinical/lab. Take NCLEX-PN for licensure Registered Nursing Education -Diploma: first schools established to educate nurses-3 years -Associates degree: 2 year educational program -Baccalaureate: 4 year; built on general education base with concentration on nursing at upper levels Graduate education in nursing Continuing education: professional development expereinces designed to enrich the nurses contributions to health; CE are required for RN to maintain licensure In-service education: designed to increase knowledge and skills of the nursing staff

Physician

Primarily responsible for the diagnosis of illness and the medical or surgical treatment of that illness Granted the authority to admit patients to a health care facility bu the health care facility or institution itself and to practice care within that setting through such actions as prescribing medications, interpreting the results of laboratory and diagnostic tests, and performing procedures and surgery Hospitalists are health care providers who provide care to patients when they visit the emergency department or are admitted to the hospital. They communicate with the patients primary care provider but provide care while the patient is in the hospital

use the guidelines for writing nursing diagnoses when developing diagnostic statements

Problem is first r/t etiology which that identifies the factors that are maintaining the unhealthy state or response (contributing or causative factors) AEB: subjective and objective data that signals the existence of the actual or possible health problem impaired physical mobility r/t pain AEB c/o pain with limited ROM

Sojourner Truth

Provided nursing care to soldiers during the Civil War and worked for the women's movement

Jane adams

Provided social services within a neighborhood setting; a leader for womens rights; recipient of Nobel Peach prize in 1931

Analyze and Plan

Questions: "what is the purpose of this new technology or change to the current technology, what problem do we hope to solve, will it streamline nursing documentation of will it increase the burden of documentation?" Understand the organizational need and provide the supporting baseline data to justify the effort Tools and resources used may include need assessment tools, data analytics programs, or workflow diagrams

Specialized care facilities: rehabilitation centers

Rehabilitation centers specialize in services for patients requiring physical or emotional rehabilitation and for treatment of chemical dependency These centers may be free-standing or associated with a hospital The goal is to return patients to optimum health and to the community as independent members of a society Rehabilitation centers often use a multidisciplinary team composed of health care providers Encouraging independent self care within the patients capabilities

Describe the historical background of nursing

Renaissance and the reformation period there were major advancements in medicine (pharmacology, chemistry, and medical knowledge), but it was known as the dark ages of nursing because there were crude methods of doctors and nursing no longer appealed to women of higher status; nursing became an undesirable job. Nursing orders were established by the Sisters of Charity- recruited young women for nurse training, developed educational programs and cared for abandoned children. St. Vincent de Paul established the hospital to care for orphaned and abandoned children. Colonial america: -health care was deficient, life expectancy was low; plagues such as yellow fever and smallpox were a threat; physicians were poorly trained. Pennsylvania hospital was the first hospital established by Benjamin Franklin.

describe computer and information literacy

Requirement with accreditation and NCLEX that graduates of a BSN have some computer literacy Binary code: software programs are written in binary code -language which a computer is programmed for and how it communicates with computer Standardized languages: so we can speak to each other and we can understand the computer. ANA recognizes 18 standardized languages

describe the assessment of a client who is at risk for infection, an actual infection, and responses to infection

Risks: Intact skin and mucous membrane Nutrition Bodys WBC Immobilization Age related changes predisposing to infection Immunization Level of fatigue Stress Level Use of invasive medical devices Actual infection: -Localized infection: redness/erythema, swelling/edema, pain, heat, loss of function, elevated WBC count, elevated erythrocyte sedimentation rate (ESR) -Systemic infection: malaise, fever, loss of appetite, myalgia, arthralgia, nonspecific GI symptoms, elevated WBC count, elevated ESR Responses to infection: -Neutrophils: increases with acute infection -lymphocytes: increase in chronic bacterial and viral infections -Monocytes: increase in severe infection -Eosinophil: increase in allergic and parasitic infection -Basophil: unaffected by infections

specialized care facilities: schools

School nurses are often the major source of health assessment, health education and emergency care for the nations children. Schools nurses provide many different services, including maintaining immunization records, providing emergency care for physical and mental illnesses, administering prescribed medications, conducting routine health screenings (eg vision, hearing, scoliosis) and providing health information and education

Physical therapist

Seeks to restore function or to prevent further disability in a patient after an injury or illness Use various techniques to treat patients including massage, heat, cold water, sonar waves, exercises and electrical stimulation

Current CDC Guidelines for patients with confirmed or positive SARS-CoV-2

Should wear a facemask when being evaluated medically Health care personnel should adhere to standard, contact and airborne precautions, including the use of eye protection (eg goggle or a face shield) when caring for a patient with SARS-COV-2 infection. These precautions incluse the use of PPe, including NIOSH-approved N95 respirators, gowns, gloves, face shield/eye protection. This includes but is not limited to surgical N95 respirators.

Specialized care centers and settings

Specialized care centers and settings provide services for specific population or group They are usually located in the easily accessible locations within a community

Nurse

Supervise and coordinate direct care to patients and families They teach the patient and family self-care and conduct research to ensure cost effectiveness and quality of care Nurses coordinate the services of other health care providers

Describe the teaching process: Teaching plan (develop interventions)

Teaching strategies: lecture, discussion, panel discussion, demonstration, discovery, role playing, audiovisual material, printed materials, programmed instruction, web-based instruction, consideration for success. -formal contractual agreements: formal and informal -consider time constraints: nice to know vs need to know -scheduling: short and many vs long and few -group vs individual teaching -manipulating the physical environment -prompting compliance -effective communication

describe TeamSTEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety Consorted effort between the Agency of Healthcare Research and Quality and Department of Defense to develop a set of evidence based team competencies to improve teamwork, care quality and safety Gives the team a common language Bridges the divide; levels hierarchy Includes patient at the core of care Evidence-based teamwork system aimed at optimizing patient care by -improving communication -improving teamwork skills among healthcare professionals, including frontline staff

Describe how organized nursing arrived in the United states

The Civil War -no army nurses and no organized medical corps when the war began-call for volunteers -Post civil war: hospitals increased rapidly, became the traditional setting for women to legitimately work outside of the home; number of nurse training schools increased after the war (offered little classroom education, on-the-job training occurred in hospital wards)

Identify historical factors that influenced the development of nursing

The Harley Street Experience -Position of Superintendent for 14 months between August, 1853 and October 1854 -Importance of egalitarian and competent caring-no religious means test -Excelled as an effective nursing administrator -Understood the importance of the environment in healthcare -Early documented example of women working for a woman The Crimean war -Florence Nightingale -Bad conditions-she was called in and at first denied but then accepted -purchased medical supplies, food and linens; set up a kitchen; instituted laundry services; instituted social services; spent up to 20 hours each day providing nursing care The Civil War -no army nurses and no organized medical corps when the war began so there was a call for nurses to volunteer -dorothea dix -post civil war clara barton with american red cross -hospitals developed rapidly, nursing increased WW1: -advances in medicine -nurses served honorably -Mary breckenridge -shepard towner act: first legislation to assist special populations and provide public health nurses with resources to promote health and well-being of women, infants and children The Great Depression -american economy was disintegrated and nurses were forced to join the ranks of unemployed -New deal: enacted to rescue the country and provide medical care and other services for the large numbers of indigent people -social security act of 1935 affected health care and provided avenues for public health nursing. Social security act was for federal grants to states for maternal and child welfare services. Vocational rehabilitation services for the handicapped, medical care for crippled children and blind people to strengthen public health services WW2: -legislation: programs enacted to expand nursing education and increase the number of nurses in the military branch -nursing became an essential part of the military service; nurses recognized as integral part of the military and attained officer rank Post WW2: -unemployment dropped -nurses demonstrated value to the armed services during the Korean war; emerged as a true profession with minimum national standards for nursing education; BSN grew and ADN grew too -legislation: nurse training act of 1943 was the first instance of federal funding to support nurse training; hill-burton act provided funds to construct hospitals; created a hospital construction boom that increased the demand for professional nurses Nursing in 1960s -Legislation: community mental health centers act, medicaid, medicare -impact on medicare reimbursement: hospital occupancy increased, resulting in an increased need for hospital nurses; nursing embraced the hospital setting Nursing in the 1970s -influenced by the womens movement -hospitals continued to be focus of nursing education and practice -nurses were instrumental in developing community programs, including hospice programs, birthing centers and adult day care centers Nursing in 1980s -increasing number of homless and indigent; emergence of AIDs -spiraling health care costs became an issue. DRG system for reiumbursement was instituted; hospitals were forced to enhance efficiencies and reduce patients length of stay; medical care continued to advance Nursing in 1990s -growing concern about health of the nation -exposure to hazardous materials -focus moved from acute care to prevention and primary care; emphasis on outpatient, ambulatory, and home services

identify how altered health protection can affect a clients health maintenance, anxiety, fear and social interaction

The current CDC standard precautions treat al people in a similar manner and greatly minimize the psychological trauma of feeling unclean and undesirable, which often occurred with earlier measures. However, sensory deprivation and loss of self esteem may occur with transmission based precautions. Friends and relatives, as well as health care personnel may be inclined to spend less time with patient because they are afraid they will contract the disease or because of the inconvenience of donning, wearing, then doffing the required PPE. This may lead to inconsistent recording of vital signs, irregular documentation and less patient monitoring on the part of the caregivers. Research has also verified that patients placed in isolation because of the presence of a communicable disease may suffer unintended consequences such as an increase in incidents of depression and/or anxiety, fewer and shorter visits from health care providers and a decrease in satisfaction. Nursing measures help to prevent the sensory deprivation and loss of self-esteem associated with isolation precautions.

explain therapeutic and nontherapeutic communication techniques

Therapeutic techniques 1. Developing conversational skills -control the tone of your voice -be knowledgeable about the topic of conversation -be flexible (based on patients needs) -be clear and concise (one subject at a time) -avoid confusing words that might have different interpretations -be truthful -keep an open mind -take advantage of available opportunities (use all patient interactions to the fullest) 2. Developing listening skills -sit when communicating with a patient -be alert and relaxed and take your time -keep the conversation as natural as possible -indicate you are paying attention (maintain eye contact if appropriate) -use appropriate facial expressions and body gestures -think before responding to the patient -do not pretend to listen -listen for themes in the patients comments Nontherapeutic techniques -failure to perceive patient as a human being -failure to listen -using cliches -using questions requiring only yes or no answers -asking why -probing questions -leading questions -giving advice -being judgmental -changing the subject -giving false assurance -gossip and rumor -incivility -bullying

Describe the relationship between nursing education and practice

The knowledge base for nursing practice includes diagnosis, interventions and evaluation of outcomes from an established care plan. In addition, the nurse integrates objective data with knowledge gained from an understanding of the patients or groups subjective experience, applies scientific knowledge in the nursing process, and provides a caring relationship that facilitates health and healing

identify nursing diagnoses for patients who have or are at risk for infection

The potential for infection or the presence of an infection in a patient suggests possible nursing diagnosis The focus of nursing care depends on a nursing diagnosis that accidentally reflects the patients condition Ex: risk for infection r/t presence of chronic disease

Describe the teaching process: learning outcomes/ goals

Three components to make the objectives clear and measurable: performance, conditions, identify outcome/goals Learning outcomes are measurable and serves as a guide for planning evaluation methods: "avoid foods, beverages and over-the-counter medications in the evening that contain caffeine" instead of nursing outcomes which is like "teach the patient about foods and beverages that contain caffeine"

Extended care facilities

Transitional subacute care Assisted living facilities Intermediate long-term care Homes for medically fragile children Retirement centers Residential institutions for mentally or physically abused Provide medical and nonmedical care for people with chronic illnesses or disabilities and assist with activities of daily living for people of any age who are physically or mentally unable to care for themselves independently Aging in place: patients remain in their homes or move to a living space, like an apartment, while they are still physically able to care for themselves and then have access to services that are a part of the health care community as needed as long as they live

distinguish between related nursing diagnoses for the client at risk for injury

Unsafe situations and patients at risk are reflected in the nursing diagnosis and care plan. The statement of the patient's actual and potential health status must be followed by the appropriate contributing factors or risk factors to individualize the nursing care plan. 1. Risk for contamination (nursing dx): R/T... -chemical contamination of food and water -flaking, peeling surface in presence of young children -ingestion of contaminated material -unprotected exposure to radioactive material -use of noxious material without effective protection 2. Risk for falls (nursing dx): R/T... -Absence of stairway gate or window guard (children) -difficulty with gait -inadequate supervision -insufficient knowledge of modifiable factors -use of restraints 3. Risk for poisoning (nursing dx): R/T... -access to dangerous products -access to pharmaceutical agents -insufficient knowledge of pharmaceutical agents -occupational setting without adequate safeguards -insufficient vision

state the purpose of using appropriate medical terminology and standard abbreviations when documenting care

Use standard abbreviations-save time and space Brevity: eliminate all necessary words

Current CDC guidelines transmission based CONTACT PRECAUTIONS

spread by direct or indirect contact Indirect transmission -hands of healthcare personnel may transmit pathogens after touching an infected or colonized body site on one patient or a contaminated inanimate object -patient care devices (eg electronic thermometers, glucose monitoring device) -instruments that are inadequately cleaned between patients -clothing, uniforms, laboratory coats or isolation PPE Used for Methialin-resistant Staphylococcus aureus (MRSA), vancomycin resistant (or intermediate resistant) staphylococcus aureus (VRSA, VISA), vacomycin resistant enterococcus (VRE), and clostridium difficile -private room -gloves -gown if contact with infectious agent likely

identify the 5 key principles of TeamSTEPPS

team structure, communication, leadership, situation monitoring and mutual support

List the forms of communication

Verbal and Nonverbal

Clara barton

Volunteered to care for wounds and feed Union soldiers during the Civil War; served as the supervisor of nurses for the Army of the James, organizing hospitals and nurses; established the Red Cross in the United States in 1882

assessment: learning strengths and what to teach

What is the patients best learning style -reading, demonstrate then re-demonstrate High motivation -do they want to learn Strong network of support Successful learning in the past What to teach -orientation to the hospital and patient room -basic anatomy, physiology, pathophysiology (course of the symptoms) -medications, side effects, when to take -diagnostic procedure, the what, when, why, how/meaning of their results -goals of the treatment plan -steps to avoid or overcome complications -length of stat (LOS) questions -home care, community resources, and needed follow ups

identify priorities for planning client care

What needs to be done immediately and what can safely be postponed Basic survival need to take first priority when your client has a threat to physiological integrity Maslows Hierarchy of Needs 1. physiologic needs 2. safety needs 3. love and belonging needs 4. self-esteem needs 5. self actualization needs

describe informatics standards and ethics

the nurse promotes, advocates for and strives to protect the health, safety and rights of the patient

What is not nursing informatics

tinkering with computers functioning in a circumscribed, traditional IT role

respiratory therapist

trained in techniques that improve pulmonary function and oxygenation RTs may also be responsible for administering a variety of tests that measure lung function and for educating the patient about the use of various devices and machines prescribed by the health care provider

speech therapist

trained to help hearing impaired patients speak more clearly, to assist patients who have had a stroke to relearn how to speak, and to correct or modify a variety of speech disturbances in children and adults. Speech therapists also diagnose and treat swallowing problems in patients who have had a head injury or a stroke

Chain of infection control from reservoir to portal of exit

transmission-based precautions sterilization of use of disposable supplies

evaluate

With expertise, guidelines, and tool still emerging in this area organizations are beginning to address the evaluation of health IT

Chain of infection control from transmission to portal of entry

adequate refrigeration hand hygiene use pesticides to eliminate vectors

What is informatics

bridges professional practices with information sciences pursuit of making people better at what they do

Chain of infection control from portal of exit to transmission

dry intact dressing hand hygiene wear gloves if contact with bodily fluid cover nose and mouth when sneezing

Interventions to prevent transmission-examples of standard precautions

hand hygiene gloves (body fluids, secretions, contaminated items, open skin) mask, eye protection, face shield, gown client-care equipment environment sharps, dressings, linen

Chain of infection control from organism to reservoir

hand hygiene sterilization antibiotics/antimicrobials

chain of infection control from portal of entry to susceptible hosts

hand hygiene wear gloves use masks and appropriate protective gear proper disposal of needles/sharps

Unlicensed assistive personnel

help nurses provide direct care to patients may have the title of nursing assistants, orderlies, attendants or technicians

chain of infection control from susceptible hosts to infectious agent

immunizations screen health care staff

implement

implementation refers to the activities surrounding the activation of the new technology or "flipping the switch" to begin using the new functionality in the EHR the planning for this phase includes ensuring all testing has been completed, end users have been education, and support resources are ready for any questions that arise

pharmacist

licensed to formulate and disperse medications keeping a file of all patient medications and for informing the health care provider when a potential or actual medication error in prescribing has occurred or when prescribed drugs may interact adversely

specialized care facilities: rural health centers

located in geographically remote areas that have few health care providers. Many rural centers are run by APRNs who serve as the patient's primary health provider for the care of minor acute illnesses as well as chronic illnesses Patients who are seriously ill or injured are given emergency care and then transported to the nearest large hospital Nurses who practice independently may do so in collaboration with a health care provider

dietitian

manages and plans for the dietary needs of the patients, based on knowledge about all aspects of nutrition. Can adapt specialized diets for all the individual needs of patients, counsel and educate individual patients, and supervise the dietary services of an entire facility

specialized care facilities: industry

many large industries have their own ambulatory care clinic staffed primarily bu nurses Occupational health nurses in industrial clinics focus on preventing work-related injury and illness by conducting health assessments, teaching for health promotion (eg stopping smoking, eating sensibly, using safety equipment, exercising regularly), caring for minor accidents and illnesses, and making referrals for most serious health problems

Maintain

once the new technology is up and running, the maintenance phase begins. Keeping a system up and running requires ongoing allocation of resources and attention to detail -ongoing updates to hospital and ambulatory orders preference lists -ongoing updates to hospital and ambulatory medication preference lists -ongoing updates to provider patient lists -ongoing updates to scheduling blocks -monthly first data bank-loads -error work queue maintenance -quality checks -months updates

discuss the rational for client teaching

patient education is the process of influencing the patients behavior to effect changes in knowledge, attitudes and skills needed to: maintain and promote health, prevent illness, restore health, facilitate coping Promote high level of wellness and related self-care practices, disease prevention or early detection, enhance recovery time from trauma or illness with a reduction in complication rates, enhanced ability to adjust to developmental life changes and acute, chronic and terminal illness, family acceptance of lifestyle necessitated by illness or disability

describe the teaching process: implement and evaluate

promote adherence (the extent to which a person behavior corresponds with the agreed upon recommendations from a health care provider; inclusive and active patient) -be certain that instructions are understandable and support patient goals -include the patient and family as partners in process -utilize interactive teaching strategies -develop interpersonal relationships with patients and their families Sample teaching strategies and learning domains: 1. cognitive domain: lecture, panel, discovery, written material 2. Affective domain: role modeling, discussion, audiovisual materials 3. psychomotor domain: demonstration, discovery, printed materials

Advanced Practice Registered Nurse (APRN)

registered nurse educated at the masters or post-masters level in a specific role and for a specific population Whether they are nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives APRNs are often primary care providers and are at the forefront of providing preventative care to the public

identify elements of a well-functioning health care delivery system

safe, effective, efficient, patient centered, timely, equitable

Current CDC guidelines Transmission based CONTACT PRECAUTIONS PLUS

similar precautions to the basic contact precautions -private room, gloves, gown used specifically with Clostridium difficile hand sanitizer does not kill C. diff so hands must be washed with soap and water when entering a room bleach wipes must also be used in place of the purple-top wipes as these are the only thing that kills C.diff bacteria

social worker

social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being they make referrals to appropriate community resources and provide assistance with securing equipment and supplies

Chaplain/spiritual care provider

spiritual care providers identify and respond to the spiritual needs of patients, families, and other members of the interdisciplinary team They may be members of the clergy, pastoral care workers with graduate degrees or lay volunteers