Chapter 1 Practicing the Science and the Art of Psychiatric Nursing
A client was admitted to a mental health unit after expressing a desire to commit suicide. The nurse reviews documentation regarding the client's care. Which information supports attention to the QSEN competency related to teamwork and collaboration? Client accepts offer to take a walk with the staff Client agreed to contract for safety with the staff Client escorted by staff to group session facilitated by art therapist Client denied any homicidal or suicidal ideations when assessed by the staff
Client escorted by staff to group session facilitated by art therapist Care being provided by members of various health care specialties, such as art therapy, would support the QSEN competency of teamwork and collaboration. The client accepting an offer to take a walk with the staff, agreeing to contract for safety with the staff, and denying any homicidal or suicidal ideations when assessed by the staff demonstrate attention to the QSEN safety competency. p. 5
The science of nursing includes incorporation of theory from what topic? Select all that apply. Implementation of therapy models Nursing research Caring for clients Neurobiology Psychology
Nursing research Neurobiology Psychology The science of nursing includes incorporation of theory from nursing research, neurobiology, and psychology. Implementation of theory models and caring are considered the art of nursing. p. 3
What QSEN standard is the nurse employing when basing care on respect for the client's preferences, values, and needs? Patient-centered care Evidence-based practice Safety Teamwork and collaboration
Patient-centered care The nurse basing care on respect for the client's preferences, values, and needs is employing patient-centered care. Evidence-based care incorporates research and clinical experience. Safety ensures that risks to the clients are minimized. Teamwork and collaboration involves working together with other members of the client's health care team. p. 5
What is the most important basis for treatment approaches in evidence-based practice? Policy Tradition Trial and error Scientifically sound methods
Scientifically sound methods A treatment approach based on scientifically sound evidence is known as evidence-based practice. Policy, tradition, and trial and error do not form the basis of evidence-based practice. p. 3
What is the most important basis for treatment approaches in evidence-based practice? Policy Tradition Trial and error Scientifically sound methods
Scientifically sound methods. A treatment approach based on scientifically sound evidence is known as evidence-based practice. Policy, tradition, and trial and error do not form the basis of evidence-based practice. p. 3
The nurse understands that trauma-informed care includes which key principles? Select all that apply. Showing cultural respect Avoiding retraumatization Promoting empowerment Maintaining a collaborative relationship Increasing success in coping with life challenges
Showing cultural respect Avoiding retraumatization Promoting empowerment Maintaining a collaborative relationship The key principles in trauma-informed care include cultural respect, avoidance of retraumatizing through the use of restraints or coercive practices, promoting empowerment, and maintaining an open collaborative relationship between client and provider. Care focused on increasing consumer success in coping with life challenges is part of the focus of the recovery model. p. 5
How does a nurse use holistic nursing techniques to help a client? Select all that apply. Teach effective coping skills. Arrange for financial support. Refer the client to the community support groups. Encourage the client to undergo tests and medical procedures. Provide information regarding specific treatments.
Teach effective coping skills. Refer the client to the community support groups. Provide information regarding specific treatments. Holistic interventions include helping the client to learn effective coping skills to manage psychosocial stressors. In this process, the nurse also encourages the client to develop supportive relationships, such as through engagement in community support groups. Empowering clients to realize their full potential and independence within the limitations of their illness should include providing thorough information about treatments and options. Although the nurse may provide resources to the client that may help him or her with financial support if needed, the nurse should not make such arrangements directly. The nurse should use client education to encourage and empower clients to make their own decisions regarding their medical care, including tests and procedures. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 5
Which statement by the nurse most clearly communicates the art of caring? "I will let your health care provider know that you do not want any more treatments." "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall." "I would like to sit down and listen to you, but I need to go check on another client." "I will stay with you throughout the procedure and keep you comfortable afterward."
"I will stay with you throughout the procedure and keep you comfortable afterward." "I will stay with you throughout the procedure and keep you comfortable afterward," conveys the art of caring to the client. "I will let your health care provider know that you do not want any more treatments," is a statement of advocacy. "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall," reinforces client safety. "I would like to sit down and listen to you, but I need to go check on another client," is inappropriate, because it makes the client feel that the nurse does not have time for him or her. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 6
Which statement by the nurse most clearly communicates the art of caring? "I will let your health care provider know that you do not want any more treatments." "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall." "I would like to sit down and listen to you, but I need to go check on another client." "I will stay with you throughout the procedure and keep you comfortable afterward."
"I will stay with you throughout the procedure and keep you comfortable afterward." This conveys the art of caring to the client. "I will let your health care provider know that you do not want any more treatments," is a statement of advocacy. "Push the call button when you need assistance to the bathroom, I want to assist you so you do not fall," reinforces client safety. "I would like to sit down and listen to you, but I need to go check on another client," is inappropriate, because it makes the client feel that the nurse does not have time for him or her. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 6
Which nursing statement illustrates the concept of client advocacy for a female client who was admitted after a suicide attempt? "The client has stated to me that she does not want to take the prescribed medication because she had adverse effects when it was prescribed previously." "During her admissions interview the client stated that she has had three other suicide attempts in the past." "Can you tell me more about your depression and your suicide attempt?" "I will take you on a tour of the unit and orient you to the rules."
"The client has stated to me that she does not want to take the prescribed medication because she had adverse effects when it was prescribed previously." By letting the health care provider know that the client does not want the treatment the health care provider is prescribing, the nurse has advocated for the client and her right to make decisions regarding her treatment. Past suicide attempts, depression, and giving a tour of the unit do not describe client advocacy. p. 2
What is an example of a nurse advocating for a client? Reducing psychosocial disability and improving role performance Giving of self while preserving the importance of self Using a systematic approach to the delivery of care Advising clients of their rights
Advising clients of their rights Advising clients of their rights is an example of client advocacy. Reducing psychosocial disability and improving role performance are concepts of the recovery model. Giving of self while preserving the importance of self is the theme for caring. Using a systematic approach to the delivery of care assists the nurse in utilizing evidence-based practice in the care of the client. p. 6
.According the American Nurses Association (ANA), advocacy in nursing includes a commitment to which factors? Select all that apply. Alleviation of suffering in death Clients' well-being Helping and trusting relationships Safety across the lifespan Nurturing individuals' beliefs
Alleviation of suffering in death Clients' well-being Safety across the lifespan According to the ANA, advocacy in nursing includes alleviating suffering in death and having a commitment to a client's well-being, and safety across the lifespan. Helping and trusting relationships and nurturing individuals' beliefs are two of the Ten Caritas (loving principles) identified by Dr. Jean Watson. p. 6
When using the internet to access resources and information on mental health treatment, what source is the most appropriate for obtaining evidence-based information? WebMD American Psychiatric Nurses Association Yahoo Healthline
American Psychiatric Nurses Association When using the internet to access resources and information on mental health treatment, the most appropriate websites are maintained by professional societies, textbook publishers, or well-known organizations with a reputation for evidence-based information. The American Psychiatric Nurses Association is a reliable source. WebMD, Yahoo, and Healthline are not the most appropriate websites for obtaining evidence-based information. p. 4
The nurse using the recovery model understands that the mandates of the model include what element? An individualized care plan at the core of consumer-centered recovery A hierarchical relationship between the nurse and the client Mental health care that is practitioner driven, with the nursing involved in all aspects of care Clinical practice guidelines used to increase quality and consistency of care and facilitate outcome research.
An individualized care plan at the core of consumer-centered recovery. The nurse using the recovery model understands that the mandates of the model include understanding that an individualized care plan is to be at the core of consumer-centered recovery. The emphasis on the relationship between the nurse and the client is a partnership. Mental health care is to be consumer and family driven, with clients being partners in all aspects of care. Clinical practice guidelines are systematically developed statements based on literature review that appraise and summarize the best evidence to guide clinicians in making informed decisions. p. 5
Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of what? Assessing the performance Appraising the literature Acquiring literature Asking a question
Appraising the literature. Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of appraising the literature. Evaluating the outcomes, using clearly defined criteria and reports, and documenting results is an example of assessing the performance. Searching the literature for scientific studies and articles that address the issue(s) of concern is acquiring literature. Asking a question includes identifying a problem or need for change for a specific client or situation. p. 3
The nurse observes that a client diagnosed with major depression does not participate in any activity on the unit. Which of the 5 A's in the multistep process of integrating evidence-based practice into care is the nurse using? Appraise the literature Assess the performance Ask a question Apply the evidence
Ask a question. The nurse is asking a question. Asking a question includes identifying a problem or need for change for a specific client or situation. Evaluating and synthesizing the research regarding its validity, relevance, and applicability using criteria of scientific merit is an example of appraising the literature. Evaluating the outcomes, using clearly defined criteria and reports, and documenting results is an example of assessing the performance. Applying the evidence involves choosing an intervention based on the best available evidence with the understanding of the client's preference and needs. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 3
What attribute of the art of nursing is defined as being there for and in tune with the client? What attribute of the art of nursing is defined as being there for and in tune with the client? Advocacy Attending Caring Honoring
Attending Being there for and in tune with the client is the nursing art of attending. Advocacy involves speaking up for the client's causes and rights. Caring involves expressing empathic understanding. Honoring is one of the Ten Caritas (loving principles) identified by Dr. Jean Watson. p. 6
The nurse actively listens to a client while making eye contact and placing a gentle hand on the client's shoulder. What is the nurse demonstrating? Attending Advocacy Self-care Informing
Attending The nurse is demonstrating attending, which refers to an intensity of presence, being there for and in tune with the client. A client advocate is one who speaks for another's cause. Self-care is demonstrated when the nurse ensures his or her own well-being. The nurse is not informing the client, which would likely be nontherapeutic at this time. p. 6
According to Quality and Safety Education for Nurses (QSEN), which key characteristics prepare future nurses to improve the quality and safety of the health care system? Select all that apply. Attitude Compassion Professionalism Skills Knowledge
Attitude Skills Knowledge The overall goal of QSEN is to prepare future nurses to have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve quality and safety of the health care systems in which they work . Compassion and professionalism are not identified as KSA. p. 5
Evidence-based practice in nursing incorporates what factors? Select all that apply. Clinical research Nurse's treatment preferences Nurse's clinical knowledge Nurse's experience Client's preferences and desires
Clinical research Nurse's clinical knowledge Nurse's experience Client's preferences and desires Evidence-based practice in nursing incorporates clinical research, as well as evidence that is not found in research studies. The nurse's clinical knowledge and experience, as well as the client's preferences and desires, are also incorporated. Nursing treatment preferences are not relevant to evidence-based practice. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 3
When a nurse and a dietician work together to provide optimal nutrition to a client, what Quality and Safety Education for Nurses (QSEN) standard is most clearly being demonstrated? Patient-centered care Evidence-based practice Safety Collaboration and teamwork
Collaboration and teamwork The nurse and the dietician working together on behalf of a client are most demonstrating the standard of collaboration and teamwork. They should also incorporate patient-centered care, evidence-based practice, and safety into their collaboration. Test-Taking Tip: Multiple choice questions can be challenging, because students think they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 5
Considering administration of medications, which nursing activity is most closely related to evidence-based practice? Educating the client regarding the side effects of a newly prescribed antidepressant Confirming the client's identity prior to administrating a prescribed oral medication Determining the client's preference about when a medication prescribed once daily is administered Assessing the client for allergies
Determining the client's preference about when a medication prescribed once daily is administered A noteworthy concept of EBP is that the approach utilized in nursing incorporates more than clinical research. Evidence is not limited to what is found in research studies, but also incorporates the nurse's clinical knowledge and experience, as well as the client's preferences and desires. EBP is associated in this case with determining the client's preference regarding the administration of the medication. Confirming the client's identity is associated with client safety. Medication education is considered important to client safety as well as a client right. Assessing the client for allergies is also part of safety. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 6
What is a potential barrier to nurses practicing the art of caring and comforting a client? Inadequate education Lack of evidence-based data Economic strain Overstaffed units
Economic strain Economic strain is one barrier to the practice of caring and comforting, because nurses are burdened with greater workloads and higher acuity clients. Inadequate education, lack of evidence-based data, and overstaffing are not barriers to caring and comforting a client. p. 6
A hospitalized client is on a therapy plan, and the nurse must evaluate the current treatment. Which institution-specific clinical practice resource will the nurse use to integrate evidence-based practice (EBP) into the client's care? Researching current medication options using internet resources Reviewing decision points for therapy planning provided by clinical practice guidelines Using a clinical algorithm in the form of a decision tree to review treatment approaches Implementing a clinical pathway to provide expected outcomes using a measurable format
Implementing a clinical pathway to provide expected outcomes using a measurable format Clinical pathways are the only resources specific to the institutions using them. However, clinical practice resources for implementation of EBP can include internet resources, clinical practice guidelines, and clinical algorithms. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 4
What is the most challenging barrier to recognizing and using evidence-based practice for a new graduate practicing nursing in the psychiatric mental health area? Nurses may find it difficult to find the time to find and evaluate the research. Not all nursing problems can be solved by scientific experiments. Only a small amount of higher-level research is available. Inadequate education is provided to prepare nurses for the process.
Inadequate education is provided to prepare nurses for the process. The most challenging barrier is that the new graduate may be inadequately prepared by his or her undergraduate program. A lack of time and the fact that not all problems can be solved by scientific experiments are less common problems. There is a large amount of higher-level research available. p. 4
What information does the Diagnostic and Statistical Manual of Mental Disorders contain? Mental health coding system Research data Practice guidelines Clinical algorithms
Mental health coding system The Diagnostic and Statistical Manual of Mental Disorders ( DSM) is a reference book containing the mental health coding system. The DSM does not contain research data, practice guidelines, or clinical algorithms. p. 3
The nursing unit that uses data to monitor client outcomes is addressing which competency? Evidence-based practice Quality improvement Safety Patient-centered care
Quality improvement The utilization of data to monitor client outcomes is an example of addressing quality improvement. This does not address evidence-based practice, safety, or patient-centered care. p. 5
In what type of study are participants randomly assigned either to receive one of the different clinical interventions or to receive no treatment? Single descriptive study Randomized controlled trial Single nonexperimental study Systematic review
Randomized controlled trial Participants that are randomly chosen to receive one of the different clinical interventions or be in a control group with no treatment are in a randomized controlled study. A single descriptive study and a single nonexperimental study do not have a control group and are nonexperimental research that lacks the manipulation of an independent variable, random assignment of participants to conditions or orders of conditions, or both. A systematic review is a report on the relevant literature of a particular topic. p. 3
In what type of study are participants randomly assigned either to receive one of the different clinical interventions or to receive no treatment? Single descriptive study Randomized controlled trial Single nonexperimental study Systematic review
Randomized controlled trial. Participants that are randomly chosen to receive one of the different clinical interventions or be in a control group with no treatment are in a randomized controlled study. A single descriptive study and a single nonexperimental study do not have a control group and are nonexperimental research that lacks the manipulation of an independent variable, random assignment of participants to conditions or orders of conditions, or both. A systematic review is a report on the relevant literature of a particular topic. p. 3
What is the most appropriate element of nursing to be implemented into a drug addiction program? Clinical practice guidelines Attending Recovery model Quality and Safety Education for Nurses (QSEN)
Recovery model The recovery model is the most appropriate due to the fact that the focus is to primarily manage symptoms, reduce psychosocial disability, and improve role performance. Clinical practice guidelines, attending, and QSEN will inform care offered under the recovery model. p. 5
What is the most appropriate element of nursing to be implemented into a drug addiction program? Clinical practice guidelines Attending Recovery model Quality and Safety Education for Nurses (QSEN)
Recovery model. The recovery model is the most appropriate due to the fact that the focus is to primarily manage symptoms, reduce psychosocial disability, and improve role performance. Clinical practice guidelines, attending, and QSEN will inform care offered under the recovery model. p. 5
