EXAM 1 fundamentals

Assessing Older Adults' Functional Levels: Instrumental Activities of Daily Living

-Ability to use the phone -Shopping -Food Preparation -Housekeeping -Laundry -Mode of Transportation -Responsibility for own medication -Ability to handle finances

Culturally Responsive Care: Personal Space

-Accepted conversation distance varies with ethnicity. -Men of all cultures usually require more space than women do. -Anxiety increases the need for space -Direct eye contact increases the need for space -Physical contact is used only if it has therapeutic purpose.

The Centers for Disease Control and Prevention (CDC)

-Administers a broad program related to surveillance of diseases and behaviors that lead to disease and disability. -Also publishes recommendations about the prevention and control of infections and administers a national health program.

Active Listening during assessment

active listening helps you hear what is going on in your client's mind, which is often as important as the physical assessment.

Illness Prevention Programs

directed at the client or the community, involves providing immunizations, identifying risk factors, and helping people take measures to prevent occurrences from happening.

SBAR: A

A = Assessment -Vital Signs -Pain Scale -Is there a change from prior assessments

Progress Notes

A chart entry made by all health professionals involved in a client's care -Numbered to correspond to the problems on the problem list and may be lettered for the type of data.

Planning the Interview and Setting: PLACE

A well-lighted, well-ventilated room that is relatively free of noise, movements, and distractions encourages communication. -A place where others cannot overhear or see the client is desirable

Nurse Communication: Process Recording

A word-for-word account of a conversation. -Can be taped or written, includes all verbal and nonverbal interactions of both the client and nurse. Once a process recording has been completed, it should be analyzed in terms of the content and meaning of the interaction based on communication theory. -Each of the nurse's statements is interpreted in terms of the communication skill used, with the rationale for and effectiveness of its use. Outcome should be increased awareness and insight regarding communication strengths, as well as identification of areas for future skills development.

Ethics

A) A method of inquiry that helps people to understand the morality of human behavior B) The practices or beliefs of a certain group C) The expected standards of moral behavior of a particular group as described in the group's formal code of professional ethics.

What does one have to gain from Continued Education?

A) Inform of new techniques and knowledge B) Attain expertise in specialized area, such as critical care nursing C) Provide essential info; Legal/ethical aspects of nursing.

Keys to the helping relationship

A) The development of trust and acceptance between the nurse and the client B) An underlying belief that the nurse cares about and wants to help the client.

Respect

An attitude that emphasizes the other person's worth and individuality. -Listening with an open mind to what the other person is saying, even if the nurse disagrees.

Introductory Phase 2. Clarifying the problem Skills

Attentive listening, paraphrasing, clarifying, and other effective communication techniques. -A common error at this stage is to ask too many questions, instead focus on priorities.

Using silence

Attentive silence may be preferable to a verbal response gives the patient an opportunity to reflect

Example of tertiary mental health prevention

An outreach program that follows individuals with mental disorders in the community to ensure that they adhere to their medication regimens.

Being Defensive: Description

Attempting to protect a person or health care service from negative comments. -Prevent the client from expressing true concerns. -Protect the nurse from admitting weaknesses in the health care services, including personal weaknesses.

SBAR: B

B = Background -State client admission diagnosis and date of admission. -State pertinent medical history -Provide brief summary of treatment to date. -Code status (if appropriate)

SBAR: B

Background: Provide information pertinent to the current situation, such as: -Admitting diagnosis -Date of admission -Important clinical information that relates to the call.

Passing Judgment: Description

Giving opinions and approving or disapproving responses, moralizing, or implying one's own values.

Acknowledging: Description

Giving recognition, in a nonjudgemental way, of a change in behavior, an effort the client has made, or a contribution to a communication. -May be with or without understanding, verbal or nonverbal

SOLER

Nonverbal skills that a nurse can use to portray emphatic presence.

Confrontation

Nurse points out discrepancies between thoughts , feelings, and actions that inhibit the client's self-understanding or exploration of specific areas. This is done empathetically, not judgmentally.

Loss of Client Property

Nurses are expected to take reasonable precautions to safegaurd a client's property, and they can be held liable for its loss or damage if they do not exercise reasonable care.

Beneficence

Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons.

International Council of Nurses: Code of Ethics - Preamble

Nurses have 4 fundamental responsibilities: 1) To Promote health 2) To prevent illness 3) To restore health 4) To alleviate suffering Inherent in nursing is respect for human rights: -cultural rights -the right to life and choice -to dignity and to be treated with respect Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups.

Emphatic listening and responding

Nurses must listen attentively and communicate in ways that indicate they have listened to what was said and understand how the client feels. -Nonverbal behaviors are also important.

Cultivate a spirit of Inquiry

Nurses need to be curious and willing to investigate how various practices compare and which might be best for a specific client

Planning the Interview and Setting: TIME

Nurses need to plan interviews with clients when the client is physically comfortable and free of pain, and when interruptions by friends, family, and other health professionals are minimal.

Ask Clinical Questions

Nurses should ask questions in standard format.

Cultural Competency: 5 Constructs: Cultural Knowledge

Obtaining a sound educational foundation concerning the various worldviews of different cultures.

PICO: O

Outcome of the intervention

Rehabilitation Centers

Play an important role in assisting clients to restore their health and recuperate. -Nurses coordinate client activities and ensure that clients are complying with their treatments. -This type of nursing often requires specialized skills and knowledge.

Moral Frameworks: Relationships-based (caring) theories

Stress courage, generosity, commitment, and the need to nurture and maintain relationships. -Judge actions according to a perspective of caring and responsibility. Ex: "My relationship to the client commits me to protecting him and meeting his needs, and I feel such compassion for him. I must try to help the family understand that he needs their support."

Giving information: Description

Providing, in a simple and direct manner, specific factual information the client may or may not request. -When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it.

Communication: Simplicity

Select appropriate, understandable, and simple terms based on the age, knowledge, culture, and education of the client.

Cultural Competency: 5 Constructs: Cultural Awareness

Self-examination of one's own prejudices and biases toward other cultures, and an in-depth explorations of one's own cultural/ethnic background.

Day Care Centers

Serve many functions and many age groups. -Provide care for infants and children while parents work. -Provide care and nutrition for adults who cannot be left at home alone but do not need to be in an institution. -Provide care involving socializing, exercising, and stimulation for the elderly. -Counseling and physical therapy. -Nurses may provide medications, treatments, and counseling.

HIPAA: Privacy Rule

Sets standards defining appropriate disclosure of protected health information. -This rule also gives clients new rights to understand and control how their health information is used

Planning the Interview and Setting: DISTANCE

Should be neither too small nor too great, because people feel uncomfortable when talking to someone who is too close or too far away -Most people feel comfortable maintaining a distance of 2 to 3 feet during an interview

Agreeing or disagreeing: Description

Similar to judgemental responses, agreeing or disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this. -Deter clients from thinking through their position and may cause a client to become defensive.

Helping relationship: Pre-Interaction

Similar to the planning stage before an interview. -The nurse has information about the client before the first face-to-face meeting. -Client's name -Address -Age -Medical history -Social history

How to write "Daily" and "every other day"

Simply, "Daily" and "every other day" Do not use: Q.D., QD, q.d., qd, Q.O.D., QOD, q.o.d., qod why: Mistaken for each other period after the Q mistaken for "I" and "O" mistaken for "I".

How to write "International unit"

Simply, "International unit" Do not use: IU why: Mistaken for IV or the number 10

How to write "unit"

Simply, "unit". Do not use: U, u why: mistaken for "0", number "4", or cc

Using Silence: Examples

Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts and feelings into words.

Nursing Ethics

Refers to ethical issues that occur in nursing practice

DAR: Action

Reflects planning and implementation and includes immediate and future nursing actions. -May also include any changes to the plan of care.

DAR: Data

Reflects the assessment phase of the nursing process and consists of observations of client status and behaviors, including data from flow sheets (vital signs, pupil reactivity). -The nurse records both subjective and objective data in this section

DAR: Response

Reflects the evaluation phase of the nursing process and describes the client's response to any nursing and medical care.

Rejecting: Description

Refusing to discuss certain topics with the client. -Often make the client feel that the nurse is rejecting not only their communication but also the clients themselves.

SOLER: R

Relaxed or natural. Taking time to respons, allowing pauses as needed, balancing periods of tension with relaxation. -Using natural gestures.

Closed questions

Restrictive and generally require only "yes' or "no" or short factual answers that provide specific information. -Often used when information is needed quickly, such as in an emergency situation. -Highly stressed person and the person who has difficulty communicating will find closed questions easier to answer than open-ended questions.

Provider of Service Rights

Right to adequate and qualified assistance as necessary Right to reasonable and prudent conduct from clients (e.g., provision of accurate info as required)

Employee or contractor for service Rights

Right to adequate working conditions (safe equipment and facilities) Right to compensation for services rendered Right to reasonable and prudent conduct by other health care providers.

SBAR: S

S = Situation -State your name, unit, and client name. -Briefly state the problem.

Communication: Clarity and Brevity

Saying precisely what is meant using the fewest words necessary. -simple and clear message -Communicate clearly so that all aspects of a situation or circumstance are understood.

SBAR: S

Situation: What is the situation you're calling about? Provide your name, health agency, client name, and brief information about the problem

Stages of an Interview: THE BODY

The client communicates what he or she thinks, feels, knows, and perceives in response to questions from the nurse. -Effective development demands that the nurse use communication techniques that make both parties feel comfortable and serve the purpose of the interview.

Documentation

The client's medical chart is a legal document and can be produced in court as evidence. -Nurses need to provide accurate and complete documentation of the nursing care provided to clients. -Failure to properly document can constitute negligence and be the basis for liability. -Insufficient or inaccurate assessments can hinder proper diagnosis and treatment, result in injury to the client.

Client Record: Legal Documentation

The client's record is a legal document and is usually admissible in court as evidence.

Summarizing and Paraphrasing: Description

Stating the main points of a discussion to clarify the relevant points discussed. -Useful at the end of an interview or to review a health teaching session. -Often acts as an introduction to future care planning.

Concreteness

The nurse must assist the client to be concrete and specific rather than speak in generalities. -I.E. When the client says, "I'm stupid and clumsy", the nurse narrows the topic to the specific by pointing out, "You tripped on the rug".

Working Phase: 2. Facilitating and taking action Tasks

The nurse plans within the client's capabilities and considers long- and short- term goals. The client needs to learn to take risks ( accept that failure or success may be the outcome). -The nurse needs to reinforce successes and help the client recognize failures realistically.

Preinteraction Phase: Tasks

The nurse reviews pertinent assessment data and knowledge, considers potential areas of concern, and develops plans for interaction.

Stages of an Interview: THE CLOSING

The nurse terminates the interview when the needed information has been obtained. -Closing is important for maintaining rapport and trust and for facilitating future interactions.

Cultural competence

The ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient.

Who should complete the incident report?

The person who identifies that the incident occurred should complete the incident report. -When an incident occurs, the nurse should first assess the client and intervene to prevent injury. -If a client is injured, nurses must take steps to protect the client, themselves, and their employer.

Credentialing

The process of determining and maintaining competence in nursing practice. -Includes licensure, certification, and accreditation.

Stages of an Interview: THE OPENING

The purpose: to establish rapport and orient the interviewee. -Can be the most important part of the interview because what is said and done at that time sets the tone for the remainder of the interview. -Establishing rapport is a process of creating goodwill and trust. -In orientation, the nurse explains the purpose and nature of the interview and what is expected of the client.

Home Health Care Agencies

The use of the home as a care delivery site. -Nurses and other staff offer education to clients and families and also provide comprehensive care to clients who are acutely, chronically, or terminally ill.

Congruent communication

The verbal and nonverbal aspects of the message match. -Clients more readily trust the nurse when they perceive the nurse's communication as congruent.

Rejecting: Example

"I don't want to discuss that. Let's talk about..."

Progress Notes: SOAP: S-Subjective Data

-Consists of information obtained from what the client says. -Describes the client's perceptions of an experience with the problem. -Included only when it is important and relevant to the problem.

Behavioral Determinants of health

-Patterns of overweight and obesity -Exercise norms -use of illicit drugs, tobacco, or alcohol

Using the Senses to Observe Client Data: Touch

-Skin Temperature and moisture -Muscle strength (hand grip) -Pulse rate, rhythm, and volume. -Pulpable lesions (lumps, masses, nodules)

Phases of the helping relationship

1. Pre-interaction 2. Introductory 3. Working (Maintaining) 4. Termination

International Council of Nurses: Code of Ethics - The ICN code

4 principle elements that outline the standards of ethical conduct.

Charting By Exception (CBE)

A documentation system in which only abnormal or significant findings or exceptions to norms are recorded -3 key elements: --Flow Sheets, Standards of Nursing Care, and Bedside access to chart forms.

Helping Relationship

A growth-facilitating process that strives to achieve three basic goals. 1. Help clients manage their problems in living more effectively and develop unused or underused opportunities more fully. 2. Help clients become better at helping themselves in their every day lives. 3. Help clients develop an action-oriented prevention mentality in their lives.

Two Aspects of Observing

A) Noticing the data B) Selecting, organizing, and interpreting the data

Autonomy

Ability to make decisions, working side-by-side with physicians

Using Silence: Description

Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response

PICOS

Adding Setting to PICO format

PICOD

Adding Study design to PICO format

PICOT

Adding Timeframe to PICO format

Health Promotion: Primary Prevention

Adequate and proper nutrition, weight control and exercise, and stress reduction.

Reflecting

All or part of the patient's statement is repeated and slightly rephrased

Rehearsing

Being too busy thinking about what you want to say. -Hinders therapeutic communication

Restoring Health: Diagnosis and Assessment

Blood Pressure, fecal exam

Using the Senses to Observe Client Data: Smell

Body or Breath Odors

In what ways is the role of the Care-Giver all-encompassing?

Care encompasses physical, psycho-social, developmental, cultural, and spiritual levels.

Client

Collaborator in care, engages advice or services of qualified provider.

PICO: C

Comparison of interventions

Integrate the evidence with clinical expertise and client/family preferences and values

Determine how evidence fits w/ clinical condition of client, available resources, policies, and client wishes.

Active Listening as an intervention

During Assessment, active listening helps you hear what is going on in your client's mind, which is often as important as the physical assessment.

FAME: E

Effectiveness

What kind of support shall the Nurse provide as counselor?

Emotional, intellectual, and psychological.

General Leads

Encourage the patient to continue

What is the purpose of Continuing Education for Registered Nurses?

Enhance knowledge/skills of practicing nurses. -Short, specific classes.

CBE: Flow Charts

Examples include Graphic records of a vital sign sheet, a head and face assessment in a daily nursing assessments record, and a braden assessment of the skin

Continuing Education

Experiences designed to enhance the knowledge or skill of practitioners

Benner's Stages of Nursing Expertise: Stage 5

Expert: Fluid, flexible, and highly proficient; Highly skilled. Intuitive and analytic ability in new situations. Inclined to take certain action because "It felt right".

FAME: F

Feasability

Employing Measures to enhance communication

First determine how the client can best receive messages: -by listening, looking, through touch, or through an interpreter. -Keeping words simple and concrete and discussing topics of interest to the client. -Using alternative communication strategies, such as word boards, pictures, or paper and pencil. -If the client's support person offers to interpret, it is important to ask the client's permission, for the sake of confidentiality.

Preventing Illness

Immunizations Prenatal and infant care Prevention of STDs

Promoting Health and Wellness

Improving nutrition and physical fitness Preventing alcohol/drug misuse Restricting smoking Preventing accidents and injury

Question and record verbal orders to avoid miscommunication

In addition to recording the time, the date, the primary care provider's name, and the orders; the nurse documents the circumstances that occasioned the call to the primary care provider, reads the orders back to the primary care provider, and documents that the primary care provider confirmed the orders as the nurse read them back.

Strive for therapeutic communication

In summary, it is essential for nurses to effectively utilize therapeutic communication techniques

What to include in a discharge summary

Include all services provided, the client's health status, outcomes achieved, and recommendations for further care.

Internal Standards of Care for nursing

Include the job description, education, and expertise as well as individual institutional policies and procedures.

External standards of Nursing care

Includes Nurse Practice Acts, Professional orgs. (ANA), Nursing specialty-practice orgs., Federal orgs and federal guidelines (e.g. the joint commission and medicare).

Just cause to remove Nursing License

Incompetent nursing practice, professional misconduct, or conviction of a crime such as using illegal drugs or selling drugs illegally.

Extended (Long-Term) Care Facilities

Independant living quarters for seniors, assisted living facilities, skilled nursing facilities, and extended care facilities.

Nursing Roles: Leader

Influence others to work together to accomplish a specific goal.

HIPAA: Standardized Numbers

Instead of each health care organization using different formats for identification, Standard identifiers are used. -For example, an employer's tax ID number or employer ID number is the standard for electronic transactions.

HIPAA: Electronic transfer of information

Instead of each health provider using its own electronic format to transact claims, etc., a national uniform standards is used to simplify such transactions.

Evidence-Based Practice

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. -As evidence changes, so must practice.

National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

Intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health care organizations to provide equitable care to all.

Hospice Services

Interprofessional health care service for the dying, provided in the home or another health care setting. -Improving or maintaining the quality of life until death. -Nurses serve primarily as case managers and supervise the delivery of direct care by other members of the team. -Clients are cared for at home, in hospitals, in freestanding facilities, or in skilled nursing facilities. -Nurse performs ongoing assessments of needs of the client and family and helps to find the appropriate resources and additional services for them as needed.

PICO: I

Intervention or therapy to consider for subject of interest.

Handoff Communication Tool: I-SBAR

Introduction, Situation, Background, Assessment, Recommendation

Moral Frameworks: Principles-based theories

Involve logical and formal processes and emphasize individual rights, duties, and obligations. -The morality of an action is determined not by its consequence, but by whether it is done according to an impartial, objective principle. Ex: Following the rule, "Do not lie", a nurse might believe he or she should tell the truth to a dying client, even though the physician has given instructions not to do so.

What does a Nurse Manager require?

Knowledge about organizational structure -Authority and accountability -Leadership -change theory -advocacy -delegation -supervision and evaluation

Factors Influencing communication process: Development

Knowledge of a client's developmental stage will allow the nurse to modify the message accordingly. -Using dolls/games to help explain procedure to 8 year old. -Well educated, middle-aged business executive may wish to have detailed technical information explained.

SOLER: L

Lean toward the person. People move naturally toward one another when they want to say or hear something -The nurse conveys involvement by leaning forward, closer to the client.

License

Legal permit that a govt agency grants to individuals to engage in the practice of a profession and to use a particular title. -Nursing licensure is mandatory in all states.

Nurse Practice Acts

Legally defines and describes the scope of nursing practice. -Legally controls nursing practice through licensing requirements. -An additional license may be required to practice as a midwife, anesthetist, or nurse practitioner. -Differ from state to state, although may be similar.

Legal Responsibilities of Student Nurses

Legally held to same standard of skill and competence as a professional RN Responsible for their own actions and are liable for their own acts of negligence. Must comply with the policies in the clinical setting

Acknowledging the patients feeling

Lets client know that their feelings are understood

Assessing: LEARN model: L

Listen actively with empathy to the client's perception of the problem

Moral Frameworks: Consequence-Based theories

Looks to the outcomes of an action in judging whether that action is right or wrong.

Being Specific and Tentative: Description

Making statements that are specific rather than general, and tentative rather than absolute

Rural Care

Manage a wide variety of clients and health care problems. -Nurse Practitioners are generally suited to these roles.

FAME: M

Meaningfulness

Restoring Health: Direct care

Medications, baths, specific treatments

Question any order that is illegible, unclear, or incomplete.

Mis-interpretations in the name of a drug or in dose can easily occur with handwritten orders. -The nurse is responsible for ensuring that the order is interpreted the way it was intended and that it is a safe and appropriate order.

Nonverbal behaviors indicating empathy

Moderate head nodding, a steady gaze, moderate gesturing, and little activity or body movement.

Assessing: LEARN model: N

Negotiate the plan of care by collaborating with the client and others

Do physicians or hospital admins set nursing curricula?

No, they are not involved

Communication Barriers

Non-therapeutic responses avoiding involvement do not use criticism, negativity, blaming, advising, or belittling comments with clients. Examples: Unwanted reassurance Changing the subject Giving advice Excessive questioning Probing Passing Judgement Stereotyping

Benner's Stages of Nursing Expertise: Stage 1

Novice: Student, performance is limited. Inflexible, and governed by context-free rules/regulations rather than experience.

Termination phase: Tasks

Nurse and client accept feelings of loss. The client accepts the end of the relationship without feelings of anxiety or dependence.

Introductory Phase: 3. Structuring and formulating the contract Tasks

Nurse and client develop a degree of trust and verbally agree about: A) Location, frequency, and length of meetings B) Overall purpose of the relationship C) How confidential material will be handled D)Tasks to be accomplished E) Duration and indications for termination of the relationship

Providers of Health Care

Nurses and health personnel from different disciplines who coordinate their skills to assist clients and their support people

Acculturation

Occurs when people incorporate traits from another culture.

Stereotyping: Description

Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid. -Categorize clients and negate their uniqueness as individuals

SOLER: O

Open posture. The nondefensive position is one in which neither arms nor legs are crossed. -Conveys that you wish to listen to what the client has to say

What level of care does a semi-dependent client require from his/her care-giver?

Partial-Care

Patient Bill of Rights

Patient has the right to be informed of all medical options!

Handoff Communication Tool: 5 P's

Patient, Plan, Purpose, Problem, Precautions, Physician (assigned to coordinate)

PICO: P

Patient, Population, or Problem of Interest

Six core competencies of Nursing

Patient-centered care Teamwork and Collaboration Evidence-Based practice Quality Improvement Safety Informatics

Handoff Communication tool: PACE

Patient/Problem, Assessment/Actions, Continuing (treatments)/Changes, Evaluation

Patient

Person waiting for or undergoing medical treatment and care

Benner's Stages of Nursing Expertise: Stage 4

Proficient: 3-5 years experience, holistic understanding of the client. Focuses on long-term goals.

Assertive Communication

Promotes client safety by minimizing miscommunication with colleagues. -Honest, direct, and appropriate while being open to ideas and respecting the rights of others. -"I" statements vs. "you" statements. e.g., "I am concerned about..." It is important for the nurse to be clear, concise, organized, and fully informed when verbally presenting the client concern.

4 Areas of Nursing Practice

Promoting health and wellness Preventing Illness Restoring health Caring for the dying

What defines the scope of nursing practice?

Protection of the public

Using Touch: Example

Putting an arm over the clients shoulder. Placing your hand on the clients hand

What are the universal values upon which healthcare is based?

Quality and Safety

Assessing: LEARN model: R

Recommend inclusive strategies

Nurse Practice Acts

Regulate practice of nursing

Citizen Rights

Right to respect by others of the nurse's own rights and responsibilities Right to physical safety.

OBRA act: Long-term care facilities

Rights of residents are recognized Use of psychotropics monitored.

State Boards of Nursing

Set minimum educational requirements for licensure

Palliative Care

Sometimes, people cannot be returned to health. This provides comfort and treatment for symptoms.

Whistle-blowing

The act of reporting a crime, tort, or unsafe practice. Many states have laws that prevent wrongful termination by employers for reporting.

Client Communication

The nurse must listen actively, observe nonverbal cues, and use therapeutic communication skills to determine that communication was effective.

Assimilation

The process by which an individual develops a new cultural identity. The process encompasses various aspects, such as behavioral, marital, identification, and civic.

Proxemics

The study of use of space. Most people feel comfortable maintaining a distance of 2 to 3 feet during an interview

Assuming

Thinking that you know what the client "really wants" without validation. -Hinders therapeutic communication

Primary Role of Nursing

To protect the patient (ethical obligation)

Filtering

Tuning out or only hearing certain things the client says. -Hinders therapeutic communication

Evaluating

Useful for both client and nurse communication

Gross negligence

Usually involves further injury or harm to the person.

International Council of Nurses: 5 Core Values

Visionary Leadership Inclusiveness Innovativeness Partnership Transparency

Clear and Accurate communication

Vital for clients needs to be met

ACEN (Independant body within NLN)

Voluntary accreditation for educational programs in nursing.

Rehabilitative care: Consideration

While it may begin in the hospital, it will eventually lead clients back into the community for further treatment and follow-up once health has been restored.

May a Nurse delegate patient care to other care givers?

Yes

Folk medicine

defined as those beliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than modern medicine's scientific base ex: special teas or "cures" (such as chicken soup), acupuncture

Health Promotion Activities

emphasize the important role clients play in maintaining their own health and encourage them to maintain the highest level of welness they can achieve.

Unprofessional conduct

includes incompetence or gross negligence, conviction for practicing without a license, falsification of client records, and illegally obtaining, using, or possessing controlled substances. -Having a personal relationship with a client : nurses are responsible for maintaining their professional boundaries

Nursing: Caring for the Dying

live as comfortably as possible until death Helping support persons cope w/ death Hospices specifically designed for this purpose

Traditional methods of maintaining HEALTH

physical, mental, and spiritual. -may include following a proper diet and wearing proper clothing, concentrating and using the mind, and practicing one's religion.

Non-maleficence

the duty to "do no harm".

Identifying

Focusing on your own similar experiences, feelings, or beliefs -Hinders therapeutic communication

Providing general leads: Examples

"Can you tell me how it is for you?" "Perhaps you would like to talk about...?" "Would it help to discuss your feelings?" "Where would you like to begin?" "And then what?"

Summarizing and Paraphrasing: Examples

"During the past half hour we have talked about..." "Tomorrow afternoon we may explore this further" "In a few days I'll review what you have learned about the actions and effects of your insulin"

Example of blocking communication

"I assumed Mrs. Stover was thinking about Christmas, changed the focus of the conversation from Mrs. Stover to myself and used a closed question too early in our conversation."

Changing topics and subjects: Example

"I can't talk now. I'm on my way for cofee break" Client: "I'm separated from my wife. Do you think I should have sexual relations with another woman?" Nurse: "I see that you're 36 and that you like gardening. This sunshine is good for my roses. I have a beautiful rose garden."

Using open-ended questions: Examples

"I'd like to hear more about that" "Tell me more..." "How have you been feeling lately?" "What brought you to the hospital?" "What is your opinion?" "You said you were frightened yesterday. How do you feel now?"

Offering self: Example

"I'll stay with you until your daughter arrives" "We can sit here quietly for a while; we don't need to talk unless you would like to" "I'll help you to dress to go home, if you would like"

Seeking Clarification: Example

"I'm puzzled" "I'm not sure I understand that" "Would you please say that again?" "Would you tell me more?" "I meant this rather than that" "I'm sorry I wasn't very clear. Let me try to explain another way"

Example of Facilitating Communication

"Mrs. Stover was quieter than usual. I mentioned this to her."

Being Specific and Tentative: Examples

"Rate your pain on a scale of zero to ten." "Are you in pain?" "You seem unconcerned about your diabetes"

Presenting Reality: Examples

"That telephone ring came from the program on television" "Your magazine is here in the drawer. It has not been stolen"

Passing Judgement: Example

"That's good/bad" "You shouldn't do that" "That's not good enough"

Stereotyping: Examples

"Two-year-olds are brats" "Women are complainers" "Men don't cry" "Most people don't have any pain after this type of surgery"

Testing: Examples

"Who do you think you are?" "Do you think I am not busy?"

Acknowledging: Examples

"You trimmed your bear and mustache and washed your hair." "I notice you keep squinting your eyes. Are you having difficulty seeing?" "You walked twice as far today with your walker"

Unwarranted Reassurance: Example

"You'll feel better soon." "I'm sure everything will turn out alright" "Don't worry"

Giving Information: Examples

"Your surgery is scheduled for 11 AM tomorrow" "You will feel a pulling sensation when the tube is removed from your abdomen" "I do not know the answer to that, but I will find out from Mrs. King, the nurse in charge."

The ICN Code: Elements of the code 3. Nurses and the Profession

- The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. - The nurse is active in developing a core of research-based professional knowledge. - The nurse is active in developing and sustaining a core of professional values - The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing. - The nurse practices to sustain and protect the natural environment and is aware of its consequences on health. - The nurse contributes to an ethical organisational environment and challenges unethical practices and settings

The ICN Code: Elements of the code 2. Nurses and Practice

- The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. - The nurse maintains a standards of personal health such the the ability to provide care is not compromised. - The nurse uses judgement regarding individual competence when accepting and delegating responsibility. - The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. - The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity, and rights of people. - The nurse strives to foster and maintain a practice culture promoting ethical behavior and open dialogue.

The ICN code: Elements of the code 4. Nurses and Co-Workers

- The nurse sustains a co-operative relationship with coworkers in nursing and other fields. - The nurse takes appropriate action to safeguard individuals, families, and communities when their health is endangered by a coworker or any other person. - The nurse takes appropriate action to support and guide coworkers to advance ethical conduct.

The ICN Code: Elements of the code 1. Nurses and the people

- The nurse's primary professional responsibility is to people requiring nursing care. - In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family, and community are respected. - The nurse ensures that the individual receives accurate, sufficient and timely information in a culturally appropriate manner. - The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. - The nurse advocates for equity and social justice in resource allocation, access to health care, and other social and economic services. - The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness, and integrity.

Major Barriers to Communication

-Failing to listen -Improperly decoding the client's intended message -Placing your needs above the client's

Quality of care

-Adults aged 65 and over receive worse care than adults aged 18-44 for 39% of measures. -Blacks receive worse care than whites for 41% of measures -Asians, American Indians, and Alaska Natives received worse care than Whites for 30% of measures. -Hispanics received worse care than non-Hispanic Whites for 39% of measures. -Poor people received worse care than high-income people for 47% of measures.

Broad Opening Statements

-Allows the patient to set the direction of the conversation -Focuses the conversation directly on the patient

Using an interpreter

-Avoid asking a member of the family, especially a child or spouse, to act as interpreter. Client may not wish family to know extent of problem. -Be aware of gender and age differences; it is preferable to use an interpreter of the same gender as the client to avoid embarrassment. -Choose an interpreter who is politically or socially compatible with the client. -Address the questions to the client, not the interpreter. -Ask the interpreter to interpret as closely as possible the words used by the nurse -Speak slowly and distinctly, do not use metaphors. -Observe facial expressions and body language that the client assumes when listening and talking to the interpreter. -Be aware of individual expressions and colloquial words used in specific regions and acknowledge them when using interpreting services.

Verbal communication with clients who have limited English proficiency (LEP)

-Avoid slang words, medical terminology, and abbreviations -Augment spoken conversation with congruent gestures or pictures to increase the client's understanding. -Speak slowly, in a respectful manner, and at a normal volume. Speaking loudly does not help the client understand and may be offensive. -Frequently validate the client's understanding of what is being communicated. Smiling alone does not mean the client understands, may be trying to only please the nurse. -Use print resources that have been designed especially for clients with LEP

Assessing Older Adults' Functional Levels: Activities of Daily living

-Bathing -Dressing -Toileting -Transferring -Continence -Feeding

Blocks to listening: Hindering therapeutic communication

-Being concerned with yourself-the focus should be on the client.

Access to Care

-Blacks, Asians, Indians, Alaskans, Hispanics, and Poop people have worse access to care than whites and high-income people.

Cultural Health-Related practices: Hispanic

-Certain foods or medications upset hot-cold body balance. Try offering alternative foods or liquids for medications. Provide ice water upon request only. -Postpartum rest is valued -Sponge baths may be preferred after giving birth -Family members may want to spend as much time with the client as possible and provide nontechnical care. -Strong beliefs in fate and external control over events may lead to less adherence to medical regimens.

Excessive Questioning

-Client feels interrogated -use statements, whenever possible, rather than a barrage of questions -avoid questions with what, when, where -say "tell me what brought you to the hospital", rather than questions such as "what...or why did you end up in the hospital?"

Principle: Veracity Examples of Ethnic/ Cultural Variations

-Clients may not value truth-telling for life-threatening conditions, because this may eliminate hope and, therefore, hasten death. -Family members may request that the client not be told of his or her diagnosis.

Cultural Health-Related practices: Asian

-Coining and cupping: traditional medical practices. Should not be misinterpreted as abuse -Fevers may be treated by wrapping ill person in warm blankets and having him/her drink warm liquids. -Hot liquids, such as tea, may be preferred. Ice water should be provided upon request only. -Herbal remedies. Discuss the use of herbal remedies to avoid potential drug interactions. -Traditional Chinese medicine. Care must be taken to fully explain instructions to client.

Practice Guidelines: Home Health Care Documentation

-Complete a comprehensive nursing assessment and develop a plan of care to meet Medicare and other third-party payer requirements. -Write a progress note at each client visit, noting any changes in condition, interventions performed, client responses to nursing care, and vital signs. -Keep a copy of the care plan in the client's home and update it as the client's condition changes -Report changes in the plan of care to the primary care provider and document that these were reported. -Encourage the client or home caregiver to record data when appropriate. -Write a discharge summary for the primary care provider to approve the discharge and to notify the reimbursers that services have been discontinued.

Practice Guidelines: Long-Term Care Documentation

-Complete the assessment and screening forms and plan of care within the time period specified by regulatory bodies. -Keep a record of any visits and of phone calls from family, friends, and others regarding the client. -Write nursing summaries and progress notes that comply with the frequency and standards required by regulatory bodies. -Review and revise the plan of care every 3 months or whenever the client's health status changes. -Document and report any change in the client's condition to the primary care provider and the client's family within 24 hours. -Document all measures implemented in response to a change in the client's condition -Make sure that progress notes address the client's progress in relation to the goals or outcomes defined in the plan of care.

Progress Notes: SOAP: O-Objective Data

-Consists of information that is measured or observed by use of the senses (vital signs, lab/x-ray results)

Principle: Nonmaleficence Examples of Ethnic/ Cultural Variations

-Discussion of advance directives and issues such as cardiopulmonary resuscitation may be viewed as physically and emotionally harmful to the client. -Withdrawal of life support or withdrawal of futile or damaging treatments may be seen as decreasing length of life or hastening death.

Advantage to CBE system

-Eliminates lengthy, repetitive notes and it makes client changes in condition more obvious.

Planning the Interview and Setting: LANGUAGE

-Failure to communicate in language the client can understand is a form of discrimination. -If giving written documents to clients, the nurse must determine that the client can read in his or her native language. -Live translation is preferred since the client can then ask questions for clarification.

Focusing on Relevant Information During a Change-of-Shift Report

-Follow a particular order (e.g., room numbers in a hospital) -Provide basic identifying information for each client (e.g., name, room number, bed designation) Report information in the same order every time. -For new clients, provide the reason for admission or medical diagnosis (or diagnoses), surgery (date), diagnostic tests, and therapies in past 24 hours. -Include significant changes in client's condition and present information in order. -Provide exact information (6mg IV at 1500 hours) -Report client's need for special emotional support -Include current nurse-prescribed and primary care provider prescribed orders. -Clearly state priorities of care and care that is due after the shift begins -Be concise, don't elaborate on background data or routine care. -Incorporate a verification process to ensure that information is both received and understood.

The Public Health Service (PHS)

-Functions include conducting research and providing training in the health field, assisting communities in planning and developing health facilities, and assisting states and local communities through financing and provision of trained personnel.

Lifespan Considerations: Communication - Toddlers and Preschoolers

-Gain skills in both expressive and receptive language. -Allow time for them to complete verbalizing their thoughts without interruption -Provide a simple response to questions because they have short attention spans -Drawing a picture can provide another way for the child to communicate

Occupational Health Clinic

-Gaining importance as a setting for employee health care. -Safety and health education, annual employee health screening for tuberculosis, and maintaining immunization information. -Screening for hypertension and obesity, caring for employees following injury, and counseling.

Filling out an Incident report

-Identify the client by name, initials, and hospital or ID number. -Give the date, time, and place of the incident. -Describe the facts of the incident. Avoid any conclusions or blame. Describe incident as you saw it even if your impressions differ from those of others. -Incorporate the client's account of the incident. State the client's comments by using direct quotes. -Identify all witnesses to the incident. -Identify any equipment by number and any medication by name and dosage.

International adoption: Children who arrive in the US should be evaluated within 10-14 days for the following.

-Immunization history -Infectious disease, parasites, general health -TB exposure -Developmental history and status, including speech, language, motor, and social development. -Vision and hearing -Dental health

Physicians' Office

-In North America, a significant care setting. -Clients usually go here for routine health screenings, illness diagnosis, and treatment. -People seek consultation when they are experiencing symptoms of illness or when a significant other considers the person to be ill.

Factors affecting health care delivery

-Increasing number of older adults -advances in knowledge and technology -economics -increased emphasis on women's health -uneven distribution of health services -access to health insurance -Health care for the homeless and poor -HIPAA -Demographic changes

Affordable Care Act

-Individuals will be fined if they do not have health insurance. -Employers must offer insurance coverage if they meet specific requirements -Modified private health insurance plans to allow extended coverage for children and options for individuals with preexisting health problems. -Established a nonprofit patient-centered outcomes research institute to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments.

Lifespan Considerations: Communication - Infants

-Infants communicate nonverbally, often in response to body feelings rather than in a conscious effort to be expressive. -Infants' perceptions are related to sensory stimuli, so a gentle voice is soothing, for example, while tension and anger around them creates distress

National Institutes of Health (NIH)

-Institutes that focus on Drug Abuse, Alcohol Abuse and Alcoholism, and Mental Health Work with federal/regional/state agencies.

Characteristics of a helping relationship

-Is an intellectual and emotional bond between the nurse and the client and is focused on the client. -Respects the client as an individual, including: --Maximizing the client's abilities to participate in decision making and treatments. --Considering ethnic and cultural aspects --Considering family relationships and values. -Respects client confidentiality. -Focuses on the client's well-being -Is based on mutual trust, respect, and acceptance.

Documentation Don'ts

-Leave a blank space for a colleague to chart later. -Chart in advance of the event -Use vague terms -Chart for someone else -Record "patient" or "client" because it is their chart -Alter a record even if requested by a superior or a primary care provider -Record assumptions or words reflecting bias ("Complainer", "Disagreeable")

Open-Ended Questions: Advantages

-Let the interviewee do the talking -The interviewer is able to listen and observe -They reveal what the interviewee thinks is important -They may reveal the interviewee's lack of information, misunderstanding of words, frame of reference, prejudices, or stereotypes -They can provide information the interviewer may not ask for -They can reveal the interviewee's degree of feeling about an issue -They can convey interest and trust because of the freedom they provide

Good Samaritan Acts: Guidelines for nurses who choose to render emergency care

-Limit actions to those normally considered first aid, if possible. -Do not perform actions that you do not know how to do. -Offer assistance, but do not insist. -Have someone call or go for additional help. -Do not leave the scene until the injured person leaves or another qualified person takes over. -Do not accept any compensation

Communication during an Interview

-Listen Attentively, using all your senses, and speak slowly and clearly -Use language the client understands, and clarify points that are not understood. -Plan questions to follow a logical sequence -Ask only one questions at a time -Acknowledge the client's right to look at things the way they appear to him or her -Do not impose your own values on the client -Avoid using personal examples, "If I were you..." -Nonverbally convey respect, concern, interest, and acceptance. -Be aware of the client's and your own voice inflection, tone, and affect. -Sit down and talk with the client (be at even level) -Use and accept silence to help the client search for more thoughts or to organize them. -Use eye contact and be calm, unhurried, and sympathetic

Using the Senses to Observe Client Data: Hearing

-Lung and heart sounds -Bowel Sounds -Ability to communicate -Language spoken -Ability to Initiate conversation -Ability to respond when spoken to -Orientation to time, person, and place. -Thoughts and feelings about self, others, and health status.

Communication with Older Adults: Interventions directed toward improving communication

-Make sure that assistive devices, glasses, and hearing aids are being used and are in good working order. -Make referrals to appropriate resources, such as speech therapy. -Make use of communications aids, such as communication boards, computers, or pictures, when possible. -Keep environmental distractions to a minimum. -Speak in short, simple sentences, one subject at a time- reinforce or repeat when necessary. -Always face the person when speaking- coming up from behind may be frightening. -Include family and friends in conversation -Use reminiscing to maintain memory connections and to enhance self-identity and self-esteem in the older adult. -When verbal expression and nonverbal expression are incongruent, believe the nonverbal. -Maintain important meaningful things as much as possible.

Legal Responsibilities of Students: Minimizing chances for liability

-Make sure you are prepared to carry out the necessary care for assigned clients -Ask for additional help or supervision in situations for which you feel inadequately prepared. -Comply with the policies of the agency in which you obtain your clinical experience. -Comply with the policies and definitions of responsibility supplied by the school of nursing.

Facilitating communication: Clients who have problems with speech or language

-Manipulating the environment -Providing support -Employing measures to enhance communication -Educating the client and support person

Cultural Health-Related practices: African American

-Menstruation may be viewed as the body's way of clearing dirty and excess blood. too little flow may be viewed as "bad blood" staying in the body. -Herbal remedies, discuss use of herbal remedies to avoid potential drug interactions. - May avoid dairy products due to high incidence of lactose intolerance, check for family history. -Focus on present time may interfere with use of preventive medicine and follow-up care.

CLAS standards: Communication

-Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services -Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. -Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. -Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Using the Senses to Observe Client Data: Vision

-Overall Appearance (body size, general weight, posture, grooming) -Signs of distress or discomfort -Facial and Body Gestures -Skin color and lesions -Abnormalities of movement -Nonverbal demeanor (signs of anger or anxiety) -Religious or cultural artifacts

Before publishing anything online: PCA

-Pause and process (recognize potential for boundary crossing) -Choices (evaluate the situation and options) -Act accountably (professional conduct) -The need for nurses to behave professionally is constant, even when not officially working or during their own personal, online time.

Communication techniques: Working effectively with children and their families

-Play, the universal language, allows children to use other symbols, not just words, to express themselves. -Nonverbal children may be able to use drawing, painting, and other art forms to communicate. -Storytelling, in which the nurse and child take turns adding to a story or putting words to pictures, can help the child feel safer in expressing emotions and feelings. -Word games that pose hypothetical situations or put the child in control, such as "What if...?", "If you could...?" can help a child feel safer in expressing emotions and feelings. -Read books with a theme similar to the child's condition or problem, then discuss the meaning, characters, and feelings generated by the book. Movies or videos can also be used in this way. -Writing can be used by older children to reflect on their situation, develop meaning, and gain a sense of control.

Factors Contributing to Health Problems of the homeless or poor

-Poor Physical environment resulting in increased susceptibility to infections -Inadequate rest and privacy -Improper nutrition -Poor access to facilities for personal hygiene -Lack of social support -Few personal resources -Questionable personal safety (physical assault is a constant threat for the homeless) -Inconsistent health care -Difficulty with adherence to treatment plans

Therapeutic Communication

-Promotes understanding --Establishes a constructive relationship between the nurse and the client -Client and Goal Directed -Attentive Listening -Focus on the Client's needs --not your own

Intent of HIPAA Regulation

-Provides individuals with more control over their health information. -Establishes limits for appropriate use and release of health care information -Requires health care providers and their agents to comply with safeguards to protect individual privacy related to health care information. -Delineates a set of civil and criminal penalties holding HIPAA regulation transgressors accountable for actions if a client's health care privacy is violated.

Closed Questions: Advantages

-Questions and answers can be controlled more effectively -They require less effort from the interviewee -They may be less threatening, since they do not require explanations or justifications -They take less time -Information can be asked for sooner than it would be volunteered -Responses are easily documented -Questions are easy to use and can be handled by unskilled interviewers.

Documentation Do's

-Read the nurses' notes prior to care to determine if there has been a change in the client's condition -Be timely. A late entry is better than no entry; however, the longer the period of time between actual care and charting, the greater the suspicion. -Use objective, specific, and factual descriptions. -Correct charting errors -Chart all teaching -Record the client's actual words by putting quotes around the words -Chart the client's response to interventions. -Review your notes- are they clear and do they reflect what you want to say?

Guidelines from ANA and NCSBN for avoiding inappropriate use of social media

-Remember that the standards of professionalism are the same online as in any other circumstance. -Do not take photos or videos of clients on personal devices, including cell phones. -Maintain professional boundaries when using electronic media. -Do not transmit or place online individually identifiable client information -Report any identified breach of confidentiality or privacy.

Communication with Older Adults: Common physical/cognitive problems that necessitate nursing interventions

-Sensory deficits, such as vision and hearing -Cognitive impairment, such as in dementia -Neurologic deficits from strokes or other neurologic conditions, such as aphasia and lack of movement. -Psycho-social problems, such as depression.

Nurses' growing awareness of ethical problems has occured largely because of..?

-Social and technological changes - Nurses' conflicting loyalties and obligations

Lifespan Considerations: Communication - Adolescents

-Take time to build rapport with them. -Use active listening skills. -Project a nonjudgemental attitude and nonreactive behaviors, even when they make disturbing remarks.

Lifespan Considerations: Communication - School-Age children

-Talk to the child at his or her eye level to help decrease intimidation -Include the child in the conversation when communicating with the parents

Principle: Beneficence Examples of Ethnic/ Cultural Variations

-The client/family may expect health care providers to promote client well-being and hope, and provide treatment that will help prolong life.

Principle: Autonomy Examples of Ethnic/ Cultural Variations

-The client/family may expect the healthcare provider to respect their right to refuse a treatment. -Primary responsibility for decision making may rest with others, such as the family, elders, or religious community. -The family and community are viewed as affected by the client's condition and decisions as much as the individual is affected.

Progress Notes: SOAP: A-Assessment Data

-The interpretation or conclusions drawn about the subjective and objective data.

Progress Notes: SOAP: P- The Plan

-The plan of care designed to resolve the stated problem.

Closed Questions: Disadvantages

-They may provide too little information and require follow-up questions. -They may not reveal how the interviewee feels -They do not allow the interviewee to volunteer possibly valuable information -They may inhibit communication and convey lack of interest by the interviewer -The interviewer may dominate the interview with questions.

Two Advantages of Ambulatory Care Centers

-They permit the client to live at home while obtaining necessary health care. -They free up costly hospital beds for seriously ill clients.

Open-Ended Questions: Disadvantages

-They take more time -Only brief answers may be given -Valuable Information may be withheld -They often elicit more information than necessary -Responses are difficult to document and require skill in recording -Interviewer requires skill in controlling an open-ended interview -Responses require insight and sensitivity from the interviewer

Major Reasons for Cost Increases

-Total Population is growing, older adults especially. -Cost of prescription drugs increasing.

Ambulatory Care Centers *The term "ambulatory care center" has replaced the term "clinic" in many places.

-Used in many communities, most have diagnostic and treatment facilities that provide medical, nursing, laboratory, and radiologic services. -May or may not be associated with an acute care hospital. -Some provide services to people who require minor surgical procedures that can be performed outside the hospital.

Practice Guidelines: Reporting a Crime, Tort, or Unsafe Practice.

-Write a clear description of the situation you believe you should report. -Make sure that your statements are factual and complete. -Make sure you are credible. -Obtain support from at least one trustworthy person before filing the report. -Report the manner starting at the lowest possible level in the agency hierarchy. -Assume responsibility for reporting the individual by being open about it. Sign your name to the letter. -See the problem through once you have reported it.

Biological and genetic determinants of health

-family history of heart disease -inherited conditions such as hemophilia and cystic fibrosis

Social Determinants of health

-gender -socio-economic status -employment status -educational attainment -food security status -availability of housing and transportation -racism -health system access and quality

Environmental Determinants of health

-lead exposure -asthma triggers -workplace safety factors -unsafe or polluted living conditions

Elements of a written process recording

-the purpose of the visit, including the objectives for the conversation -a description of the environmental setting -a description of the client including health history and patient interactions -an exact written account of the verbal and nonverbal interaction -summary, analysis and evaluation of the interaction

By the end of the introductory phase, clients should be begin to:

1) Develop trust in the nurse 2) View the nurse as a competent professional capable of helping 3) View the nurse as honest, open, and concerned about their welfare. 4) Believe the nurse will try to understand and respect their cultural values and beliefs. 5) Feel comfortable talking with the nurse about feelings and other sensitive issues. 6) Understand the purpose of the relationship and the roles 7) Feel that they are active participants in developing a mutually agreeable plan of care.

Techniques commonly used to close an interview

1) Offer to answer questions: -"Do you have any questions?" -"I would be glad to answer any questions you have" -Be sure to allow time for the person to answer/ 2) Conclude by saying: -"Well, that's all I need for now" -"Well, those are all the questions I have for now" -Preceding a remark with the word "well" generally signals that the end of the interaction is near. 3)Thank the client: -"thank you for your time and help. The questions you have answered will be helpful in planning your nursing care" 4)Plan for the next meeting: -"Let's get together again here on the fifteenth at 9am to see how you are managing then" 5)Express concern for the person's welfare and future: -"I hope all goes well for you" 6) Provide a summary to verify accuracy and agreement. -Helps terminate the interview -Reassures the client that the nurse has listened -Checks the accuracy of the nurse's perceptions -Clears the way for new ideas -Helps the client to note progress and a forward direction

American Association of Colleges of Nursing: 5 Competencies

1. Apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts. 2. Use relevant data sources and best evidence in providing culturally competent care. 3. Promote achievement of safe and quality outcomes of care for diverse populations. 4. Advocate for social justice, including commitment to the health of vulnerable populations and the elimination of health disparities. 5. Participate in continuous cultural competency development.

Incorporating cultural care into standard nursing care

1. Become aware of one's own cultural heritage 2. Become aware of the client's heritage and health traditions as described by the client. 3. Become aware of adaptations the client made to live in another culture. During this part of the interview, a nurse can also identify the client's preferences in health practices, diet, hygiene, and so on. 4. Form a nursing plan with the client that incorporates his or her cultural beliefs regarding the maintenance, protection, and restoration of health. In this way, cultural values, practices, and beliefs can be incorporated with the necessary nursing care.

Nursing Code of Ethics: Purpose

1. Inform the public about the minimum standards of the profession and help them understand professional nursing conduct. 2. Provide a sign of the profession's commitment to the public it serves 3. Outline the major ethical considerations of the profession. 4. Provide ethical standards for professional behavior 5. Guide the profession in self-regulation. 6. Remind nurses of the special responsibility they assume when caring for the sick.

3 Criteria for licensure

1. There is a need to protect the public's safety or welfare. 2. The occupation is clearly delineated as a separate, distinct area of work. 3. A proper authority has been established to assume the obligations of the licensing process (State Boards of Nursing)

4 C's of culture

1. What do you 'call' your problem? -"What is concerning/worrying you?" -"What do you think is wrong?" 2. What do you think 'caused' your problem? - Gets at the client's beliefs regarding the source of the problem. 3. How do you 'cope' with your condition? - "What have you done to try and make it better?" 4. What are your 'concerns' regarding the condition and/or recommended treatment? - "How serious do you think this is?"

Record : Also called chart or client record

A formal, legal document that provides evidence of a client's care and can be written or computer based. -All client records have similar information -Process of making an entry on a client record is called recording, charting, or documenting

Seeking Clarification: Description

A method of making the client's broad overall meaning of the message more understandable. -Used when paraphrasing is difficulty or when the communication is rambling or garbled. -The nurse can restate the basic message or confess confusion and ask the client to restate or repeat the message.

Perception checking: Description

A method similar to clarifying that verifies the meaning of specific words rather than overall meaning of a message

Interview

A planned communication or conversation with a purpose. ex: to get or give information, identify problems of mutual concern, evaluate change, teach, provide support, or provide counseling or therapy.

Neutral Question

A question the client can answer without direction or pressure from the nurse, is open ended, and is used in nondirective interviews. ex: "How do you feel about that?", "What do you think led to the operation?"

Planning the Interview and Setting: SEATING ARRANGEMENT

A seating arrangement in which the parties sit on two chairs placed at right angles to a desk or table or a few feet apart, with no table between, creates a less formal atmosphere, and the nurse and client tend to feel on equal terms.

Code of Ethics

A set of ethical principles that: a) is shared by members of the group b) reflects their moral judgments over time c) serves as a standard for their professional actions -Usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession.

Narrative Charting

A traditional part of the source-oriented record. -Consists of written notes that include routine care, normal findings, and client problems. -Chronologic order is frequently used. -When using narrative charting, it is important to organize the information in a clear, coherent manner.

Assessing: LEARN model: A

Acknowledge the importance of what is said and what it means

Restating or paraphrasing: Description

Actively listening to the client's basic message and then repeating those thoughts and/or feelings in similar words. -Conveys that the nurse has listened and understood the client's basic message and also offers clients a clearer idea of what they have said.

Two most common assessments for older adults

Activities of Daily Living and Instrumental activities of daily living.

Incident Report (also called unusual occurrence report)

An agency record of an accident or unusual occurrence. -Used to make all facts available to agency personnel, to contribute to statistical data about accidents or incidents, and to help health personnel prevent future incidents or accidents.

Practices that endanger the health and safety of clients

Alcohol and drug use, theft from a client or agency, and unsafe nursing practice -All should be reported.

Non-Assertive Communication: Submissive

Allow your rights to be violated by others. -Meeting the demands and requests of others without regard to your own feelings and needs because you believe your own feelings are not important.

Validating

Allows the patient an opportunity to express other unmet needs "just wanted to make sure there were any questions you had"

Helping relationship: Introductory Phase

Also referred to as orientation phase or pre-helping phase, it sets the tone for the rest of the relationship. -Client and nurse closely observe each-other and form judgments about the others behavior. -Goal is to develop trust and security within the nurse-client relationship. -Some social interaction may occur to put client at ease ("What a nice day it is and what they like to do at home")

Code of Ethics for Nurses: Accountability

Answerable to oneself and others for ones own actions

FAME: A

Appropriateness

When should a incident report be completed?

As soon as possible, and filed according to agency policy.

Using open-ended questions: Description

Asking broad questions that lead or invite the client to explore thoughts or feelings. -specify only the topic to be discussed and invite answers that are longer than one or two words

Probing: Description

Asking for information chiefly out of curiosity rather than with the intent to assist the client. -Considered prying and violate the client's privacy. -Places client in a defensive position

Testing: Description

Asking questions that make the client admit to something. -Permit the client only limited answers and often meet the nurse's need rather than the client's

Assessing Older Adults' Functional Levels

Assessing on an ongoing basis will provide guidelines for detecting needs for special care, resources, and services. -Helps to determine their level of independence and changes as they occur

SBAR: A

Assessment: Refers to the current condition of the client (e.g., VS, oxygen saturation, pain scale, level of consciousness) Any change in the assessment since the previous communication Indicate the severity of the problem

Open-Ended questions

Associated with the nondirective interview, invite clients to discover and explore, elaborate, clarify, or illustrate their thoughts or feelings. -Specifies only the broad topic to be discussed, and invites answers longer than only one or two words. -Useful at the beginning of an interview or to change topics.

Introductory Phase: 2. Clarifying the problem Tasks

Because the client initially may not see the problem clearly, the nurse's major task is to help clarify the problem.

Introductory Phase: 1. Opening the relationship Tasks

Both client and nurse identify eachother by name. When the nurse initiates the relationship, it is important to explain the nurse's role to give the client an idea of what to expect. -Nurse needs to help the client express concerns and reasons for seeking help -Vague, open ended questions, such as "What's on your mind today?" are helpful at this stage.

Getting off Track

Changing the subject if you become uncomfortable, bored, or tired. -Hinders therapeutic communication

What should you do when there is a change in a client's condition?

Chart it and show that follow-up actions were taken.

Unwanted Reassurance

Cliches such as "everything will be alright", or "you're doing just fine" Blocks further communication

Heritage inconsistent

Client has acculturated into the dominant culture of the modern society in which they reside.

Heritage consistent

Client identifies with their traditional cultural heritage

Recording: The Joint Commission requirements

Client record documentation is timely, complete. accurate, confidential, and specific to the client.

Giving common advice: Example

Client: "Should I move from my home to a nursing home?" Nurse: "If I were you, I'd go to a nursing home, where you'll get your meals cooked for you."

Restating or paraphrasing: Example

Client: I couldn't manage to eat any dinner last night - not even the dessert Nurse: You had difficulty eating yesterday Client: Yes, I was very upset after my family left.

Agreeing or Disagreeing: Examples

Client: I don't think Dr. Broad is a very good doctor. Nurse: He is head of the department of surgery and is an excellent surgeon.

Challenging: Examples

Client: I felt nauseated after that red pill Nurse: Surely you don't think I gave you the wrong pill? --- Client: I feel as if I'm dying Nurse: How can you feel that way when your pulse is 60?

Clarifying time or sequence: Examples

Client: I vomited this morning Nurse: Was that after breakfast? --- Client: I feel that I have been asleep for weeks Nurse: You had your operation Monday, and today is Tuesday

Probing: Examples

Client: I was speeding along the street and didn't see the stop sign Nurse: Why were you speeding? --- Client: I didn't ask the doctor when he was here Nurse: Why didn't you?

Perception checking: Example

Client: My husband never gives me any presents. Nurse: You mean he has never given you a birthday present or christmas present? Client: Well- not never. He does get me something for my birthday or christmas, but he never thinks of giving me anything at any other time.

Focusing: Examples

Client: My wife says she will look after me, but i don't think she can, what with the children to take care of, and they're always after her about something- clothes, homework, what's for dinner that night... Nurse: Sounds like you are worried about how well she can manage

Being defensive: Examples

Client: Those night nurses must just sit around and talk all night. They didn't answer my light for over an hour Nurse: I'll have you know we literally run around on nights. You're not the only client, you know.

Reflecting: Examples

Client: What can I do? Nurse: What do you think would be helpful? --- Client: Do you think I should tell my husband? Nurse: You seem unsure about telling your husband.

Non-Assertive Communication: Aggressive

Communication directed toward what one wants without considering the feelings of others. -Ineffective and leads to frustration for the nurse and the primary care provider.

Purpose of Client Records

Communication, planning client care, auditing health agencies, research, education, reimbursement, legal documentation, and health care analysis are all kept on file.

Retirement and Assisted Living Centers

Consist of separate houses, condominiums, or apartments for residents. Residents live relatively independently. -Facilities offer meals, laundry services, nursing care, transportation, and social activities. -Intended to meet the needs of people who are unable to remain at home but do not require hospital or nursing home care.

Secondary Prevention Health Care

Consists of diagnosis and treatment

Primary Prevention Health Care

Consists of health promotion and illness prevention

Tertiary Prevention Health Care

Consists of rehab, health restoration, and palliative care.

Transcultural Nursing

Focuses on providing care within the differences and similarities of the beliefs, values, and patterns of cultures.

Caring and warmth

Convey a feeling of emotional closeness, in contrast to an impersonal approach. -Caring conveys deep and genuine concern for the person. -Warmth conveys friendliness and consideration.

Providing Support

Convey encouragement to the client and provide nonverbal reassurance, perhaps by touch if appropriate. -Ask for clarification when necessary -Open-ended questions in obtaining accurate information about the effectiveness of communication. -Body language should convey acceptance and approval

American Anthropological Association (AAA)

Defines race as an idea created by western Europeans following exploration across the world to account for differences among people and justify colonization, conquest, enslavement, and social hierarchy among humans.

Heritage Assessment Interview

Depicts the questions to ask when conducting a heritage assessment. -Designed to enhance the process in order to determine if clients are identifying with their traditional cultural heritage. May be used in any setting and is used to facilitate conversation and help in the planning of cultural care.

Office of Management and Budget (OMB)

Determines federal standards for reporting race. -racial categories "should not be interpreted as being primarily biological or genetic in reference" -Race and ethnicity may be thought of in terms of social and cultural characteristics as well as ancestry.

Reflecting: Description

Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation.

Changing topics and subjects: Description

Directing the communication into areas of self-interest rather than considering the client's concerns. -These responses imply that what the nurse considers important will be discussed and that clients should not discuss certain topics.

Rehabilitative care

Emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives.

Cultural Competency: 5 Constructs: Cultural Encounters:

Engaging in face-to-face cultural interactions with persons from diverse backgrounds, and learning to modify one's existing beliefs to prevent possible stereotyping.

Clarification

Ensure patient's message is understood can make client's statement more understandable

National Partnership for Action to End Health Disparities (NPA)

Established to mobilize a nationwide, comprehensive approach to combating health disparities and to move the nation toward achieving health equity. -Goal is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders.

Bioethics

Ethics as applied to human life or health -Decisions about abortion or euthanasia

Assessing: LEARN model: E

Explain what you think you heard/ ask for clarification

SOLER: E

Eye contact. Mutual eye contact, preferably at same level, recognizes the other person and denotes willingness to maintain communication. -In other cultures, too much eye contact, especially with someone in a position of authority is out of order.

Therapeutic Communication vs. Social Relationship

Formal: -Focus on patient -More formal use of touch, "asking permission" -Active Listening, focus on patients goals/ problems -Working relationship Social: -More humorous -Less formal use of touch, "more options" -"Coffee date"

Judging

Framing what you hear or see in terms of your judgement about the client as being immature/depressed, etc. -Hinders therapeutic communication

Progress Notes: SOAP format

Frequently used; An acronym for subjective data, objective data, assessment, and planning.

Challenging: Description

Giving a response that makes clients prove their statement or point of view. -The nurse is failing to consider the client's feelings, making them feel it necessary to defend a position.

Hospitals

General: Medical, Surgical, obstetric, pediatric, and psychiatric services. Acute Care: Provides assistance to clients who illness and need for hospitalization are relatively short term.

magico-religious health belief

Health and illness are controlled by supernatural forces. -Illness is the result of "being bad" -Getting well is viewed as dependent on the will of god. -"If it is god's will, I will recover" Treatment: A man who experiences headaches after being told that a spell has been placed on him may recover only if the spell is removed by the culture's healer, and he may, in fact, not need a scientific intervention.

Clarifying time or sequence: Description

Helping the client clarify an event, situation, or happening in relationship to time.

Focusing: Description

Helping the client expand on and develop a topic of importance. -Focus may be an idea or a feeling; however, the nurse often emphasizes a feeling to help the client recognize an emotion disguised behind words.

Presenting Reality: Description

Helping the client to differentiate the real from the unreal

Directive Interview

Highly structured and elicits specific information. -The nurse establishes the purpose of the interview and controls the interview, at least at the outset. -Frequently used to gather and give information when time is limited (e.g., in an emergency)

holistic health belief

Holds that the forces of nature must be maintained in balance or harmony. -Human life is one aspect of nature that must be in harmony with the rest of nature. -When the natural balance is disturbed, illness results. Treatment strategy that is consistent with the client's beliefs may have a better chance of being successful. -Be careful not to judge different as wrong. examples of holistic beliefs: Native american Medicine wheel -physical, mental, emotional, and spiritual balance.

Examples of Client controlled Privacy

How to access medical records, restricted access by others, request changes, and learn how they have been accessed.

Human Genome Project

Humans are 99.9% alike. Genetic variations related to geographic ancestry do not correlate with the socially constructed racial classifications; there are no genetically discrete races.

Question any order a client requests

If a client has been receiving an IM injection tells the nurse that the HCP changed the order from an injectable to an oral medication, the nurse MUST recheck the order before giving the medication.

CBE: Bedside Access to chart forms

In the CBE system, all flow hseets are kept at the client's bedside to allow immediate recording and to eliminate the need to transcribe data from the nurses' worksheet to the permanent record.

Focus Charting

Intended to make the client and client concerns and strengths the focus of care. - Date and time, focus, and progress notes. -The progress notes are organized into (D) data, (A) action, and (R) response, referred to as DAR. -Provides a holistic perspective of the client and client's needs.

Handoff Communication Tool: I PASS the BATON

Introduction, Patient, Assessment, Situation, Safety Concerns, Background, Actions, Timing, Ownership, Next.

Carrying out Physician's orders

It is the nurses responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescriber. -Clarification from any other source is unacceptable and regarded as a departure from competent nursing practice.

Traditional methods of restoring HEALTH

Physical, mental, and spiritual. -may include the use of herbal remedies, exorcism, and healing rituals.

Traditional methods of protecting HEALTH

Physical, mental, and spiritual. -may include wearing protective objects, such as amulets, avoiding people who may cause trouble, and placing religious objects in the home.

Safety-Net Hospitals

Provide a significant level of care to low-income, uninsured, and vulnerable populations.

Crisis Centers

Provide emergency services to clients experiencing life crises. -24-hour telephone service. -Direct counseling to people at the center or in their homes. -Primary Purpose: To help people cope with an immediate crisis and then provide guidance and support for long-term therapy. -Nurses need well-developed communication and counseling skills. Must immediately identify the problem, offer assistance to help the individual cope, and perhaps later direct the individual to resources for long-term support.

Giving Information

Provide meaningful and valuable information to the client, can establish an atmosphere of helpfulness and trust "Make sure client understands this medication that I'm giving him" (Formal Teaching)

Nurse and Physician Communication: SBAR

Provides a standardized framework for communicating important information. Can be used by nurses in almost all forms of communication, including: -when calling a primary care provider about a change in a client's condition -providing shift reports -giving reports on clients being transferred -sending clients for procedures.

HIPAA: Security Rule

Provides for a uniform level of protection of all health information. -This rule requires health care orgs and providers to ensure the confidentiality, integrity, and availability of all electronic protected health information (ePHI)

Using Touch: Description

Providing appropriate forms of touch to reinforce caring feelings. -Nurse must be sensitive to the differences in attitudes and practices of client and self.

Manipulating the Environment

Quiet environment with limited distractions will make the most of the communication efforts of both the client and the nurse. -Sufficient light will help in conveying nonverbal messages. -Calm, relaxed environment. -Acknowledge and praise the client's attempts at communication

SBAR: R

R = Recommendation -State what you would like to see done or specify that the care provider needs to come and assess the client. -Ask if health care provider wants to order any tests or medications -Ask health care provider if she or he wants to be notified for any reason -Ask, if no improvement, when you should call again.

Non-Directive Interview

Rapport-building interview, the nurse allows the client to control the purpose, subjective manner, and pacing.

SBAR: R

Recommendation: What is your recommendation for resolving the problem or what do you need from the health care provider? e.g., come see the client, transfer to another unit, or an order for another medication

Information protected under HIPAA that may not be initially perceived as health information

Social Security number, Name, Adress, Phone Number, e-mail address, and fingerprints, age.

Example of Rehabilitative care

Someone with an injured neck from an automobile crash may have restrictions in the ability to perform work or daily activities. If temporary, care can assist the client in returning to form. If permanent, it can assist in adjusting how activities are performed in order to maximize efficiency.

Educating the client and support people

Sometimes clients and support people can be prepared in advance for communication problems. Ex: Before an intubation or throat surgery, explaining anticipated problems, the client is often less anxious when problems arise.

Communication: Pace and Intonation

Speaking slowly and softly to an excited client may help calm the client. -Manner of speech modifies the feeling and impact of a message.

CBE: Standards of Nursing Care

Specific standards of nursing practice that identify the minimum criteria for client care regardless of clinical area. ex: "The nurse must ensure that the unconscious client has oral care at least q4h"

Elderspeak

Speech style similar to baby talk that gives the message of dependence and incompetence and is seen as patronizing by older adults. "Are we ready for our bath?" "Honey/grandma"

SOLER: S

Squarely face the other person. Adopt a posture that indicates involvement. -This position says "I am available to you"

Offering self: Description

Suggesting one's presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse's attention.

Giving common advice: Description

Telling the client what to do. These responses deny the client's right to be an equal partner.

Genuineness

The ability to be real or honest with another. -Must be based on a solid relationship that is real empathic and not phony.

Cultural Competency: 5 Constructs: Cultural Skills

The ability to collect culturally relevant data regarding the client's health in a culturally sensitive manner.

The principle of Utility

The act which brings the most good and the least harm to the greatest number of people. -This approach is often used in making decisions about the funding and delivery of health care.

Key Elements for Effective Handoff Communication

The communication should include the following: -Up-to-date information -Interactive communication allowing for questions between the giver and receiver of client information. -Method for verifying the information (e.g., repeat-back, read-back techniques) -Minimal interruptions -Opportunity for receiver of information to review relevant client data (e.g., previous care and treatment)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The first nationwide legislation to protect privacy for health information.

What is the goal of tertiary prevention?

The goal is to help people move to their previous level of health or to the highest level they are capable of given current health status.

Cultural competency: 5 Constructs: Cultural Desire

The motivation to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters.

Demographic Changes

The number of single-parent families and alternative family structures have increased markedly. -Recognition of cultural and ethnic diversity of US is also increasing.

Working Phase

The nurse and the client begin to view each other as unique individuals. 2 major Stages: -Exploring and understanding thoughts and feelings -Facilitating and taking action The nurse helps the client to explore thoughts, feelings, and actions and helps the client plan a program of action to meet pre-established goals.

Working Phase: 1. Exploring and understanding thoughts and feelings Tasks

The nurse assists the client to explore thoughts and feelings and acquires an understanding of the client. The client explores thoughts and feelings associated with problems, develops the skill of listening, and gains insight into personal behavior.

Question any order if the client's condition has changed

The nurse is considered responsible for notifying the primary care provider of any significant changes in the client's condition, whether the primary care provider requests notification or not. ex: severely depressed respirations or rapid pulse.

Code of Ethics for Nurses: Responsibility

The specific accountability or liability associated with the performance of duties of a particular role

Tertiary Mental health prevention: Considerations

These programs can reduce acute psychiatric hospital admissions and long-term institutionalization and enable individuals with mental disorders to live independently.

End-of-Life care consideration

This care may be conducted in many settings, including the home.

Employee or contractor for service responsibilities

To fulfill the obligations of contracted service with the employer To respect the employer To respect the rights and responsibilities of other health care providers

Citizen Responsibilities

To protect the rights of the recipients of care

Provider of Service Responsibilities

To provide safe and competent care commensurate with the nurses preparation, experience, and circumstances. To inform clients of the consequences of others for whom the nurse is responsible. To remain competent.

Therapeutic Communication: Examples of Techniques

Using Broad Opening Statements Acknowledging the patients feelings Sharing Observations Reflecting Clarifying Using Silence Giving information Validating

Unwarranted Reassurance: Description

Using cliches or comforting statements of advice as a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client.

Providing general leads: Description

Using statements or questions that A: encourage the client to verbalize B: choose a topic of conversation C: facilitate continued verbalization

Leading Question

Usually closed, used in a directive interview, and thus directs the client's answer. ex: "You're stressed about surgery tomorrow, aren't you?", "You will take your medicine, won't you?" -Gives the client less opportunity to decide whether the answer is true or not. -Create problems if the client gives inaccurate responses, can result in inaccurate data.

Morality

Usually refers to private, personal standards of what is right and wrong in conduct, character, and attitude. -First clue to the moral nature of a situation: guilt, hope, or shame. -Nurses should distinguish between morality and law. An action can be legal but not moral Ex: Full resuscitation of a dying client.

Subacute Care Facilities

Variation of inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. -Generally more intensive than long-term care and less intensive than acute care

Important Note regarding Medicare and Medicaid

Will reimburse only for the skilled services provided that are reported to the primary care provider.

Common Themes in Nursing Practice

-Art and Science -Client-centered -Holistic and individualized -Health Promotion -Helping Profession

What is the role of the Board of Nursing?

-Issues Nursing Licenses -Hands down disciplinary actions -Protects the public -Monitors Nursing Programs

Concerns Regarding Sole Reliance on research for EBP

-Often done under very controlled circumstances, which is very different from real-world scenarios. -Limits creativity (one solution to problem) -May Ignore life events important to individual -Not all published research is robust and flawless -Cost is not often included in traditional research studies

Research findings should be what?

Accurate, dependable, and free from bias

Benner's Stages of Nursing Expertise: Stage 2

Advanced Beginner: Marginally acceptable performance, recognizes meaningful "aspects" or a real situation. Has experienced enough real situations to make judgement about them.

Clinical Nurse Specialist

Advanced degree or expertise, considered to be an expert in a specialized area of practice.

Mary Mahoney

America's first black trained nurse

Linda Richards

America's first trained nurse

Nursing Roles: Teacher - Process of teaching

Assess clients learning needs and readiness to learn Set Specific learning goals in conjunction w/ client Enact teaching strategies Measure clients learning

Nursing Care-Giver: Purpose of Supportive-educative care?

Assist client in attaining highest level of health and wellness

Virginia Henderson: Definition of Nursing

Assist individual, sick or well...

Nursing Roles: Change Agent

Assists client to make modifications in behavior. -Change in system, such as clinical care, if it is not returning client to good health.

Standards of Professional Performance

Behaviors expected in professional role.

Benner's Stages of Nursing Expertise: Stage 3

Competent: 2-3 years experience, organizational and planning abilities. Differentiates important from less-important, coordinates multiple complex care demands.

National Council of State Boards of Nursing

Conducts practice studies and creates the NCLEX-RN

Restoring Health overview

Direct Care Diagnosis and Assessment Consultation w/ other HCPs about client problems Teaching Recovery Activities Client Rehab

Nursing Roles: Manager

Delegate nursing activities to ancillary workers and other nurses, and supervise/elevate their performance.

Standards of Practice

Describes the responsibilities for which nurses are accountable

In-Service Education

Designed to upgrade the knowledge or skills of current employees with regard to the specific setting, usually less formal in presentation

What should the Nurse focus on (with client) as counselor?

Developing new attitudes, feelings, and behaviors by encouraging client to look at alternative behaviors, recognize choices, and develop sense of control.

American Nurse Association (ANA): Definition of Nursing

Diagnosis and treatment of human responses to actual or potential health problems (human response) Example: Pain, sleeping problems, infection, fever.

Licensure Required to be RN

Diploma Associate Degree Baccalourete Brogram

Sources of Payment: Medicaid

Health insurance for people who require financial assistance.

Nursing Roles: Counselor

Help a client to recognize and cope w/ stressful psychological or social problems. -Develop improved interpersonal relationships -Promote personal growth

Nursing Roles: Care-Giver

Engage in activities that assist client physically and psychologically while maintaining client's dignity.

Research

Entails using formal and systemic processes to address problems and answer questions.

Professional Organizations

Establish educational criteria for program accreditation

Clinical Expertise, Patient Values & Preferences, Best evidence ------->

Evidence Based Practice

Nursing should consider what of interventions and plans?

FAME

Health Promotion

Focuses on maintaining normal status without consideration of diseases

American Nurses Association

Fosters High standards of nursing practice and promotes the educational and professional advancement of nurses so that all people have better nursing care.

National League for Nursing

Fosters the development and improvement of all nursing services and nursing education. -Non nurses can be members (unique!)

What level of care does a dependent client require from his/her care-giver?

Full-Care

Implement and evaluate outcomes of Intervention

Gather all relevant data indicating whether or not intervention was successful. If outcomes varied from those reported in the evidence, this evaluation can help determine the reasons for the variable responses and will contribute to improving the evidence available for future situations.

Sources of Payment: Medicare

Health insurance for older adults

Search for the best evidence

Identify key terms that facilitate identifying relevant evidence in the literature

Nursing Roles: Communicator

Identify problems and communicate these problems to other members of HCP team. -Clear and Accurate communication!

Role of the Client Advocate

Protect the client! -Relay their request for info to HCP -Assist client in exercising their rights -Help Client speak up for themselves!

Good Samaritan Act

Protects HCPs who provide assistance in emergencies from malpractice.

What is the purpose of the OBRA act?

Protects the quality of life for residents in care facilities

International Council of Nurses

Provides an organization through which associations can work together for the mission of representing nursing worldwide, advancing the profession, and influencing health policy.

Nursing Student in Clinical Setting

Refrain from performing any technique or procedure for which one hasn't been trained. Refrain from performing any deliberate action or omission of care that creates unnecessary risk of injury to client, self, or others.

Patient Self-Determination Act (PSDA)

Requires that every competent adult be informed in writing about his or her rights to accept or refuse medical care.

Findings from what are often given the most weight in the decision making process?

Research Studies

Florence Nightingale: Importance

Started trend of using Statistics w/ Nursing: Epidemiology (Tracking Diseases)

Who controls the practice of Nursing?

State boards of nursing and professional nursing organizations.

Nursing Roles: Teacher

Teach clients about their health and procedures to perform or restore/maintain their health

Telenursing

Telecommunication to provide nursing at a distance

What should a nurse possess in order to be a productive leader?

Understanding needs and goals that motivate people Knowledge to apply leadership skills Interpersonal skills to influence others

Whom should the Nurse also teach aside from the patient/client?

Unlicensed assistive personnel (UAP) to whom the nurse delegates care, as well as sharing general expertise with other HCPs.

Telehealth

Use of medical information exchanged from one site to another via electronic communications to improve clients health status.

Florence Nightingale: Definition of Nursing

Using environment of pt. to assist in recovery

Nurse Practice Acts

Varies among states, it is your responsibility to know the act that governs your practice.

What is the purpose of the Nurse Practice Acts?

To protect the public.

Vocational Nursing Programs (9-12 months): Practical Nurses

Work under supervision of RN in numerous settings, LPNs usually provide direct technical care to clients. LPNs have shifted away from acute care settings to long-term care facilities.

Critically appraise the evidence

determine most valid, reliable, and applicable evidence.