NUR 205 Final
Nursing process vs. Teaching process Teaching Process
-Assess patient -Nursing Diagnosis (DX) -Learning Objectives (Outcomes/Goals) -Teaching plan (Develop Interventions) -Implement -Evaluate
Nursing process vs. Teaching process •Nursing process
-Assess patient -Nursing diagnosis (DX) -Identify Outcomes -Develop Interventions -Implement -Evaluate
Nursing process vs. Teaching process •Nursing process
-Assess pt -Nursing diagnosis (DX) -Identify Outcomes -Develop Interventions -Implement -Evaluate
Nursing process vs. Teaching process •Teaching Process
-Assess pt ---> motivation -Nursing Diagnosis (DX) -Learning Objectives (Id. Outcomes) -Teaching plan (Develop Interventions) -Implement -Evaluate
Describe and utilize appropriate interviewing techniques. Working Phase Open-ended questions to allow the patient a wide range of possible responses (encourages free verbalization)
-Beginning -To introduce a new section of questions -Whenever the person introduces a new topic -"Tell me how I can help you." -"What brings you here today?" -"Tell me about your symptoms."
Personal Territories
-Best to take cues from patients regarding how much personal or private space is needed -Public zone (12-25 feet) -Social zone (4-12 feet) -Personal zone (18 inches-4 feet) -Intimate zone (0-18 inches)
Mental status- emotional and cognitive functioning Four areas of mental status (ABCT) appearance
-Body posture/movements -dress/grooming/hygiene
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process Professional and Legal Regulation of Nursing Practice: organizations that improve the standards of nursing overall
-Centers for Disease Control and Prevention (CDC) -Employer Policy and Procedures -Educational Programs -The Nursing Process (A Coming Attraction)
Describe and utilize appropriate interviewing techniques. Working Phase Validating Question or Comment
-Nurse restates what she/he heard or observed -"At home you have been taking both a water pill and a blood pressure pill. Did you take them today?"
Describe and utilize appropriate interviewing techniques. Working Phase Directing Question or Comment
-Used to obtain more information about a topic or to introduce a new aspect of a current topic *IN LECTURE, therapeutic technique
Evaluation Ackly picture
-measure how well the patient has achieved desired outcomes -identify factors contributing to patient's success or failure -modify the plan of care, if indicated
Value her health sufficiently to stop smoking
affective goal
Susie King Taylor
afircan american nurse on battlefront of civil war
Types of Nursing Diagnoses Possible Nursing Diagnoses
describes a suspected problem for which additional data are needed (additional data are used to confirm or rule out the suspected problem *not on exam
Components of a Nursing Diagnosis Defining Characteristics
descriptors of a client's behavior that determine whether a nursing diagnosis is present. -They are directly or indirectly observable clinical cues (signs and symptoms)
Ambularm Device
device used for the patient who climbs out of bed unassisted and is in danger of falling. It is worn on the leg
Describe Nursing Informatics
a specialty that integrates nursing science, computer science and information science to manage and communicate data, and knowledge in nursing practice.
John D. Rockefeller
establishe first school of nursing for african americans in 1896 at atlanta bapist seminary (spelman college)
Discuss nursing leaders who influenced the development of nursing. Mary Breckinridge
established the Frontier Nursing Service (FNS) in 1925 in rural Kentucky to assist disadvantaged women and children; documented the impact of nursing services on improving the health of communities; well known for midwifery services
Nursing diagnosis should be derived from a single cure
false (clutering)
. Describe Informatics standards and ethics
follow APA standards
Components of a Nursing Diagnosis A Label
may include a qualifier (impaired, altered, decreased, ineffective, acute, or chronic). Altered skin, Ineffective coping
Establishing Outcomes Psychomotor
new skills
Discuss the contents of the American Nurses Association Standards of Practice and Code of Ethics. American Nurses Association Code of Ethics
nine codes established by the ANA, do not need to know the numbers associated with each code, but know the general idea
Seuxality profile- male
penis/testicular pain Discharge from penis Impotence Scrotal swelling/lumps Hernia Prostate problems Health promotion- frequency of self testicular exam
How to use the book
pg. 17 section 2 (green pages)-->. nursing diagnosis NANDA labels (include defining characteristics, related to factors)/ NOC (purple pages) ---> her example in class is impaired skin integrity on page 836
. Explain the phases in the System Development Lifecycle (SDLC)
pg. 489-492 in taylor 1. Analyze and Plan (is there a need for it?) 2. Design and Build 3. Test 4. Train (education on use) 5. Implement 6. Maintain 7. Evaluate
Establishing Outcomes Physiological
physical change in pt.
Nursing informatics video on d2l
under april 7th
Planning
•Identify nursing interventions: any treatment, based on clinical judgment and knowledge, that a nurse performs to enhance patient outcomes (what resources do you have as a student nurse to do this???)
Implementation: Aseptic Technique
•Includes all activities to prevent infection (or break the chain of infection) •Two categories -Medical asepsis—clean technique •Hand Hygiene most effective way to help prevent the spread of infectious agents (CDC, 2013) •Box 24.2 (Taylor, Lynn & Bartlett) Practicing Basic Principles of Medical Asepsis in Patient Care -Surgical asepsis—sterile technique
Interventions to Promote a Safe Institutional Environment •Preventing falls in the hospital
•Indicate fall risk on patient door, patient bracelet •Call light in reach •Nonskid shoes, bed low, wheels locked •Eliminate clutter •Orienting (reorienting) patient to Surroundings and Equipment •Bed alarm and restraint as needed
NIC: Oxygen Therapy
•Instruct patient to obtain a supplementary oxygen prescription before air travel or trips to high altitude, as appropriate •Consult with other health care personnel regarding use of supplemental oxygen during activity and/or sleep •Instruct patient and family about use of oxygen at home •Arrange for use of oxygen devices that facilitate mobility and teach patient accordingly •Convert to alternate oxygen delivery device to promote comfort as appropriate *example to show how specific it is
Safety Considerations for Neonate
•Recognize the dependence of neonate on caregiver •Proactively monitor environment -Monitor environment for choking hazards •Never leave the infant unattended •Use crib rails •Properly use car seats
Health Care Services for the Seriously Ill and Dying
•Respite care (care for the caregiver) •Hospice services •Palliative care
Nursing Process
•Review Assessment Data •Cluster the Data •Select possible nursing diagnoses •Differentiating among possible diagnosis •Identify appropriate diagnoses •Determine related factors •Discuss Nursing Diagnoses with client (Patient Centered Care)
Diagnoses Exercise on pages Examples we will see often
•Risk for Impaired Skin Integrity r/t prescribed bed rest •Impaired Skin Integrity r/t shearing forces AEB stage I pressure ulcer •Rape-Trauma Syndrome r/t sexual assault AEB repetitive nightmares and phobias •Acute Pain r/t unknown etiology AEB c/o pain in lower back
Nursing Diagnoses NANDA Labels
•Risk for Infection r/t presence of chronic disease; altered immune response; effects of medication (prednisone) •Activity Intolerance r/t effects of infectious process (generalized weakness) •Anxiety r/t high risk for infection; social isolation •Impaired Oral Mucous Membrane r/t ineffective dental hygiene, trauma; SE of medications .•Impaired Social Interaction r/t presence of communicable disease (AIDS)
Non- Therapeutic Communication Technique Example/Rationale Disagreeing
"I definitely disagree with what you're saying!" "I don't believe that!" Opposing to client's idea.
Non-Therapeutic Communication Technique Example/Rationale Advising
"I think you should..." "Why don't you..." Telling the client what to do. IN LECTURE
Non-Therapeutic Communication Technique Example/Rationale Reassuring
"I would not worry about that." Indicating that there is no cause of anxiety.
Non-Therapeutic Communication Technique Example/Rationale Rejecting
"Let's not discuss about that!" Refusing to consider or showing contempt for the client's ideas or behavior.
Non-Therapeutic Communication Technique Example/Rationale Probing
"Tell me more about your love story from the day you fell in love!" Persistent questioning the client. It is invasive, uncomfortable for most clients, and a threat to the client's right to privacy and confidentiality. Probing the client with questions that are not relevant to their health care and health-related concerns is never appropriate. IN LECTURE
Non-Therapeutic Communication Technique Example/Rationale Disapproving
"That's bad!" Denouncing the client's ideas or behavior.
Non-Therapeutic Communication Technique Example/Rationale Giving approval
"That's good!" Offering unnecessary approval, on the other hand, implies that the behavior being praised is the only acceptable one.
Non-Therapeutic Communication Technique Example/Rationale Agreeing
"That's right!""I agree!" Indicating accord with the client.
Non-Therapeutic Communication Technique Example/Rationale Interpreting
"What you really mean is..." "Unconsciously, you're saying..." Seeking to make conscious that which is unconscious, telling the client the meaning of his experiences.
Non-Therapeutic Communication Technique Example/Rationale Indicating the existence of an external source
"Who told you that you were God?!" Attributing the source of thoughts, feelings, and behavior to others, or to outside influence.
List the forms of communication. Intraprofessional communication
'mantra' or self reassurance, boost own confidence
Differentiate between intentional torts and unintentional torts Intentional
'you should know better' -Fraud (Misrepresentation) -Defamation (Hurts reputation)= slander (oral) and liable (written) -Assault and Battery (Assault: threat/Battery: the action) -False imprisonment (Trying to keep someone in the hospital) -Invasion of privacy (Say things you should not)
Interpreting Data
(analysis and synthesis)
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: ANA
- responsible for establishing standards and qualifications for practice, including patient teaching
Nursing process vs. Teaching process Teaching process
-Assess patient -Nursing Diagnosis (DX) -Learning Objectives (Id. Outcomes) -Teaching plan (Develop Interventions) -Implement -Evaluate
Nurse Practice Acts all have certain elements in common
- Define the legal scope of nursing practice - Establishes criteria for education and licensure of nurses - Identify violations that can result in disciplinary actions against the nurse - Exclude untrained or unlicensed people from practicing nursing - Create a state board of nursing - Make and enforce rules and regulations - Define important terms and activities in nursing - Provide legal requirements and titles for RNs and LPNs - Where do we find this information in Michigan??
Registered Nursing Education
- Diploma - Associates Degree in Nursing - Baccalaureate in Nursing
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: American Hospital Association
- Patient's Bill of Rights ensures that clients receive complete and current information
Nursing process vs. Teaching process •Teaching Process
-Assess patient -Nursing Diagnosis (DX) -Learning Objectives (Id. Outcomes) -Teaching plan (Develop Interventions) -Implement -Evaluate
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: Joint Commission
- accreditation mandates require evidence of patient education to improve outcomes
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: ICN (International Council of Nurses)
- endorses health education as an essential component of nursing care delivery
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: Pew Health Professions Commission
- puts forth a set of health profession competencies for the 21st century - over one-half of recommendations pertain to importance of patient and staff education
Role of the Nurse as Educator •Nurses function in the role of educator as:
- the giver of information - the assessor of needs - the evaluator of learning - the reviser of the teaching/learning method *•The partnership philosophy stresses the participatory nature of the teaching and learning process.
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: State Nurse Practice Acts
- universally includes teaching within the scope of nursing practice
What's wrong with this diagnosis? Alteration in bowel elimination: Constipation related to cancer of the colon
-AEB is not included -c/o --> could be last bowl movment
Therapeutic Communication Technique Example/Rationale Giving recognition.
-Acknowledging, indicating awareness. "Good morning Mr...." "You've finished your list of things to do." Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual.
Current CDC Guidelines •Transmission-based precautions—
-Airborne, Droplet, or Contact precautions -Used in addition to standard precautions for patients with suspected infection
Documentation •Confidentiality
-All information about patients is considered confidential -Client records are not accessible to insurance companies, significant others, research teams, or third parties without written permission of the client. -Requires client signature to get a copy of the record or have it sent to other people.
Describe and utilize appropriate interviewing techniques. Working Phase Clarifying Question or Comment
-Allows the nurse to gain an understanding of patient's comment -"Can you explain what you mean by that." -"I'm not sure what you mean when you say that."
What voluntary accreditation does MSU CON hold?
-American Association of Colleges of Nursing (AACN) -Commission on Collegiate Nursing Education (CCNE)
Therapeutic Communication Technique Example/Rationale Encouraging expression.
-Asking the client to appraise the quality of his or her experiences. "What are your feelings in regard to...?""Does this contribute to your distress?" Rationale: The nurse asks the client to consider people and events in light of his or her own values.
Therapeutic Communication Technique Example/Rationale Formulating a plan of action
-Asking the client to consider kinds of behavior likely to be appropriate in future situations. "What could you do to let your anger out harmlessly?" Rationale: It may be helpful for the client to plan in advance what he or she might do in future similar situations.
Self-Care Abilities/Functional Assessment
-Assess how they manage day-to-day activities (activities of daily living (ADLs)) -Respond to all items listed Document personal habits -How often they sower -Wash hair -Brush teeth
Nursing process vs. Teaching process Nursing process
-Assess patient -Nursing Diagnosis (DX) -Identify Outcomes -Develop Interventions -Implement -Evaluate
Nursing process vs. Teaching process Nursing process
-Assess patient -Nursing Diagnosis (DX) -Identify Outcomes/ Goals -Develop Interventions -Implement -Evaluate
Sources of Data
-Client (usually the best source with exceptions) -Significant Others (Good source, Maintain confidentiality) -Colleagues (ther health professionals are a valuable source of information) -Utilize client chart
Describe internal and external factors that impact the interview process. Dress
-Client should remain in street clothes during the interview -Nurse should meet the standards for setting for professional appearance
Types of Planning Ongoing Planning
-Client's health condition may change rapidly
Teaching Process: Examples of etiology (r/t):
-Cognitive limitation -Information misinterpretation -Lack of interest in learning -Unready to learn -Lack of desire at this time -Lack of recall -Limited exposure to information (specify) -Unfamiliarity with information resources -Limited practice skill
Establishing Outcomes Types
-Cognitive—increases pt. Knowledge -Psychomotor—new skills -Affective—change beliefs/attitudes -Physiological—physical change in pt. Remember CAPP
•TeamSTEPPS has five key principles •It is based on team structure and four teachable-learnable skills:
-Communication -Leadership -Situation Monitoring -Mutual Support
Therapeutic Communication Technique Example/Rationale Focusing.
-Concentrating on a single point. "This point seems worth looking at more closely." Rationale: The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client.
•Motivational interviewing
-Current evidence supports the effectiveness of MI for chronic-disease management, medication adherence, smoking cessation, weight-loss, and more. -Motivational interviewing is philosophically congruent with nursing practice as it is a patient- centered, non-judgmental, non-confrontational and non-adversarial approach to the care of people.
Past History: Past Injuries
-Dates/Accidents/Fractures/Penetrating wounds/Head injuries/Burns -How the patient recovered (any chronic problems)
Past History: Past Pertinent Medical History
-Dates/Serious or Chronic Illnesses
Age-related Factors Affecting Host Susceptibility •Pulmonary changes
-Decrease cough reflex -Decreased elastic recoil of the lungs -Decreased activity of the cilia -Abnormal Swallowing reflex
Variable Influencing Outcome Achievement Patient Variables
-Developmental stage -Psychosocial background
Financial Status: Concerns
-Do health care costs pose a financial burden? -Supports self and others? -Depends on sources (parents/spouse) for full or partial support
Documentation Incident or Adverse Occurrence Reports
-Document situations that have caused harm or have the potential to cause harm to clients, employees or visitors (I.e. med errors, client falls, accidental needle sticks). •THE REPORT IS NOT A PART OF THE CLIENT'S MEDICAL RECORD AND SHOULD NOT BE REFERENCED IN THE CLIENT'S RECORD.
Safety Event Reports(Incident or Adverse Occurrence)
-Document situations that have caused harm or have the potential to cause harm to patients, employees or visitors (i.e. med errors, client falls, accidental needle sticks) -The report is not to be referenced or placed in the patient's medical record. It is an internal form used to review what were the events prior to incident and is education of staff indicated.
Documentation •Corrections (for documentation not in an EHR)
-Draw single line through error and put your initials. No whiteout, erasures, or blackened
Current CDC Guidelines Transmission Based Precautions •Droplet
-Droplet—spread by large-particle droplets -Studies have shown that the nasal mucosa, conjunctivae and less frequently the mouth, are susceptible portals of entry for respiratory viruses •Precautions: Used for rubella, mumps, diphtheria, influenza, and the adenovirus in young children •Private room •Mask when working within 3 feet of patient
Stages of infection Prodromal Stage
-Early Signs and Symptoms of disease are present -Person is most infectious during the prodromal stag
Documentation •Brevity
-Eliminate all unnecessary words like "Patient"
Emergency Preparedness Disaster Resources Every institution should have a disaster plan in place which includes:
-Emergency supplies -Emergency planning for the disabled -Emergency shelter locations FEMA (Federal Emergency Management Agency)
Describe and discuss the importance and purpose of a complete and holistic health history in nursing practice. Purpose of Assessment
-Establish a database -Identify actual and potential problems -Focus on a specific problem -Determine immediate needs and prioritize -Determine the etiology (what can we do to help here as a nurse) of a problem -Determine related or contributing factors -Identify strengths as a basis for changing behavior -Identify the risk for complications -Recognize complications
Documentation •Legibility (for documentation not in an Electronic Health Record—EHR)
-Needs to be readable. Proper use of terms & correct spelling extremely is important.
Therapeutic Relationship: Orientation Phase
-Establish tone and guidelines for the relationship -Identify each other by name (Mr., Mrs., Dr., etc.) -Clarify roles of both people -Orient patient to room and environment -Establish and agreement about the relationship and mutual understanding of what will occur in the relationsip (Trust): 1) Goals of the relationship 2) When, where & for how long each meeting will be---"I will be meeting with you until you are discharged." 3) Duration of the relationship-Provide the patient with orientation to the healthcare system
Review of Systems Why do a review of systems?
-Evaluate past and present health state of each body system -To double check in case any significant data were omitted -To evaluate health promotion practices
Motivational Interviewing •Core Principles:
-Express empathy=understands and accepts the patient's experience -Develop a discrepancy= enhances the patient's awareness of the inconsistencies between the patient's unhealthy behavior and her or his personal goals and values in order to motivate them Ex: Nurse: A few weeks ago when we started meeting you shared with me some of the reasons you felt you needed to quit smoking. May we talk about those reasons? -Roll with resistance=doesn't directly oppose any resistance displayed by the patient. Ex: Nurse: It sounds like you don't want to commit to complete abstinence from smoking at this time. Where do you think we should go from here? -Support self-efficacy= he provider maintains and expresses to the patient a belief in the possibility of change, emphasizing the patient's ability to choose and carry out a plan to change her or his behavior. Ex: Client: I did not smoke at all last week. Nurse: Last time we met you were not sure you could go one day without smoking; how were you able to avoid smoking the entire past week?
Rapport Builders
-Factors that Promote Effective Communication -A feeling of mutual trust experienced by people in a satisfactory relationship -Specific objectives: purpose for the interaction -Comfortable environment -Privacy -Confidentiality -Patient vs. task focus -Utilization of nursing observations -Optimal pacing -Respecting personal space
Dispositional traits
-Factors that Promote Effective Communication -warmth and friendliness -Openness and respect -Empathy (Identifying with the way the other person feels) -Honesty, authenticity, trust -Caring -Competence
Communication: Noise
-Factors that distort the quality of a message -Distractors
Spiritual profile/value system FICA
-Faith and Belief -Importance -Community -Address in care
Restraints •Using Restraints
-Family members or Patient Sitters may be utilized to stay with patient -Restraints can cause complications -Follow policy related to removal of restraints and monitoring of patient -Often only considered as a last resort
Describe the historical background of nursing. Renaissance and reformation period (approximately 1350-1600) what were the social conditions?
-Famine, plague, filth, and crime ravaged Europe
Focus of Safety Assessments •Specific risk factors
-Fires -Poisoning -Suffocation and choking -Firearm injuries
Documentation •Signing
-First initial and full last name followed by SN (student nurse), MSU -Must sign every entry made (electronic signature may be automatic) -Don't sign anyone else's entry or document for someone else.
Therapeutic Communication Technique Example/Rationale General leads.
-Giving encouragement to continue. "Go on." "And then?" Rationale: General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for interaction.
List the forms of communication. Small group communication
-Group dynamics determine effectiveness -Effective groups have many members that are mutually respectful
Assertiveness
-Hallmark of professional nursing relationships, need to be distinguished from aggressive behaviors (Confidence) -Key: open, honest, direct communication. -Use of clear, concise "I" statements Basic components: -Having empathy -Describing one's feelings of the situation -Clarifying one's expectations -Anticipating consequences
Discuss clients' rights and their influence on nursing practice HIPPA
-Health Insurance Portability and Accountability Act (HIPAA) -ethical principles of nursing
Describe the historical background of nursing. The Colonial American Period (1700s) What were the conditions and what was the first hospital in the United States?
-Health care was deficient; life expectancy was low; plagues such as yellow fever and smallpox were a constant threat -Physicians were poorly trained and used crude methods of treatment, such as bleeding and purgatives -Through the efforts of Benjamin Franklin, Pennsylvania Hospital was the first hospital built in the United States in 1751
Post WWII legislation
-Hill burton -nurse training act of 1943
Nursing Process for Infection Control •Assessment
-History: previous infections, immunizations, what are Signs & Symptoms experiencing -Objective Data: fever, increased heart rate and respiratory rate, what else?
High-Performing Teams Teams that perform well:
-Hold shared mental models -Have clear roles and responsibilities -Have clear, valued, and shared vision -Optimize resources -Have strong team leadership -Engage in a regular discipline of feedback -Develop a strong sense of collective trust and confidence -Create mechanisms to cooperate and coordinate -Manage and optimize performance outcomes
Describe the historical background of Nursing Informatics
-Nightingale-recommended establishment of a statistical department in Navy -transition from industrial age to information age
Writing A Nursing Diagnoses Problem r/t unknown Etiology Example
-Noncompliance (medication regiment) r/t unknown etiology AEB refusal to take Rx meds
Describe internal and external factors that impact the interview process. Documentation:
-Note taking- be aware of focusing on paperwork and not on patient (Eye contact) -Tape recording and picture taking is NOT allowed
Describe how organized nursing arrives in the United States.
-Hospitals developed rapidly in US after 1850. -Became the transitional setting for women to legitimately work outside of the home and get out of the women "Spheres of Work" -Number of nurse training schools increased after the civil war -1900 to World War I: By 1910, most states passed legislation requiring nurse registration before entering practice, Required entry level for nursing students was upgraded to high school graduate, Nurse training programs were improved to include a more comprehensive course of study -World War I and the 1920s: Advances in medical care and public health, Improved hospital care and surgical techniques, Discoveries in pharmacology—insulin and the precursor to penicillin, Environmental conditions improved; serious epidemics of the previous century became nonexistent -Post World War II (1945-1950): By 1950, all states had adopted the State Board Test Pool, Number of nursing baccalaureate programs grew, Associate degree programs developed in community and junior colleges
Documentation •Completeness
-IF YOU DIDN'T CHART IT, YOU DIDN'T DO IT???? Is that true??
Planning for Prevention •Expected Outcomes/Goals: The Patient will...
-Identify risk factors (specify/individualize) -Utilize safety measures to prevent injury -Establish safety priorities with family members or significant others -Demonstrate familiarity with his/her environment -Identify resources for safety information -Prevent injury
Age-related Factors Affecting Host Susceptibility •Urinary tract changes
-Incomplete bladder emptying -Decreased sphincter Control -Benign prostatic hyperplasia (BPH) causing bladder outlet obstruction -Pelvic floor relaxation (due to decreased estrogen) -Reduced renal blood flow
Benefits of Patient Education
-Increases patient satisfaction -Improves quality of life -Ensures continuity of care -Decreases anxiety and maximizes independence -Costs savings: •Prevent illness that require expensive care •Pt. seek help sooner (i.e. recognizing complications) Earlier discharges and less readmissions (knowledge of
Therapeutic Communication Technique Example/Rationale Accepting
-Indicating reception "Yes." "I understand what you said." Nodding Rationale:
Mental status- emotional and cognitive functioning Four areas of mental status (ABCT) behavior
-Level of consciousness -Facial expressions: Smiles appropriately during conversation/expressions are appropriate for the conversation. -speech: Speaks coherently at average speed in complete sentences. Able to name chair, window and table without difficulty.
Describe and utilize appropriate interviewing techniques. Working Phase Close ended Questions
-Limits answers -For specific information -Fill in any details the client left out -"What medicines have you been taking at home?" -"When did your symptoms start?" -"Are you sad?"
Collecting Data : How to Listen
-Listen with the intent to understand (Keep an open mind) put aside your own opinion -Develop skill of empathic listening, take time to understand the other persons values and beliefs (frame of reference) so that you can define the true meaning of the message -Help clarify, elaborate and give additional pertinent information -Recognize these things to NOT do 1. Ignoring (not listening) 2. Pretending to listen (yes, right) 3. Selective listening (hearing only parts of why was said) 4. Listening attentively to the specific words (but not necessarily listening to the message
Documentation •Sequence & Timeliness
-Logically organized according to time -Make entries about nursing care as close to the time of delivery as possible.
Therapeutic Relationship: Working Phase
-Longest Phase (get information and identify goals/outcomes patient wants to achieve) -Nurse and patient interactions are designed to ensure achievement of health goals or objectives that were mutually agreed upon. -example: feeding, hygiene, mobility) -Provide teaching and counseling -Patient contered approach -Evaluate the nursing interventions and modify as needed
Age-related Factors Affecting Host Susceptibility Skin changes in the elderly
-Loss of elasticity -Increased dryness -Thinning of epidermis -Slowing of cell replacement -Decreased vascular supply
Barriers to Patient Education The nurse:
-Makes assumptions -Teaches before knowing who he/she is teaching -Talks, talks, talks.... -Lectures -Doesn't let the learner interrupt.... -Listens in a hurry -Ignores or makes light of the leaner's concerns -Teaches when the problem is not a lack of information
Therapeutic Communication Technique Example/Rationale Giving information.
-Making available the facts that the client needs "My name is...""These are your medications..." "Visiting hours are..." Rationale: Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect.
Manifestation of Infection Systemic Infection
-Malaise -Fever -Loss of appetite -Myalgia-Arthralgia -Nonspecific GI symptoms -Elevated WBC count -Elevated ESR
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
-National standardized hospital survey that measures patients perceptions of their hospital experience (ask about communication) -Compares hospitals -Center for Medicare and Medicaid (CMS)
Documentation •Terminology
-Use standard abbreviations. It saves time and space
Patients from Different Cultures
-Nurse's approach should be respectful, friendly and non-threatening -Ask and learn about their culture; their preferences; how they want you to help them -Be aware of verbal and nonverbal feedback -Speak slowly and distinctly (obtain a translator if needed)-Keep message simple
Discuss the concept of nursing advocacy, accountability, and responsibility.
-Nurses responsibility to provide care that is estabilished by standards of the profession -Being accountable means that the nurse is answerable for the outcomes of actions taken -To advocate for someone means to speak for that person when the person is unable to speak for themselves
Describe the mechanisms that influence the professional and legal regulation of nursing practice. Laws
-Occupational Safety and Health Acts (OSHA) -Controlled Substance Acts -Health Care Quality Improvement Act -Americans with Disabilities Act Prevent discrimination -Good Samaritan Laws (Protect you in a emergency situation if in scope of practice) -Civil Rights Act -Reporting Obligations (CDC) -Requirements for Wills, Durable Power of Attorney (advance directions) -Health Insurance Portability and Accountability Act (HIPAA)
Examples of What to teach?
-Orientation to the hospital and patient room -Basic anatomy, physiology, pathophysiology (i.e. course of the symptoms) -Medications, side effects, when to take -Diagnostic procedure, the what, when, why, how../meaning of their results -Goals of treatment plan -Steps to avoid or overcome complications -Length of Stay (LOS) questions -Home care, community resources & needed follow-up
Mental status- emotional and cognitive functioning Four areas of mental status (ABCT) cognition
-Orientation: Person (patient's name) Place(where they are) Time (date/day /year). -Attention span: Focuses on conversation without difficulty. -Memory: Immediate (intact AEB ability to recall four words) Recent (intact AEB ability to recall 24-hour diet) Remote (intact AEB ability to recall historical events/past health. -New learning: Able to recall four unrelated words (shoe, melon, table and police) without difficulty after 5, 10 and 30 minutes
Nursing Process Outcome Identification and Planning (from slide)
-Outcomes/goal setting -Prioritizing -Plan interventions that will achieve the desired outcomes based on Evidence based nursing -Confirm the plan with the client
Spiritual profile/value system
-Participation in rituals (prayers, communion, Sabbath, confession) -How do beliefs affect concept of health/illness -Does seeking health care interfere with their belief system (blood transfusion, organ donation, resistance to modern medicine). -See handout on D2L (FICA)
Professional Communication
-Patients, families, significant others -Members of the healthcare team
Psychological profile Self concept
-Perception of personal strengths -Areas that they want to improve -How do they think other people describe them -Current stress factors
Describe and utilize appropriate interviewing techniques. Working Phase Sequencing Question or Comment
-Place events in chronological order
Assessment Sources of assessment information:
-Primary source: Patients -Secondary source: Medical Records and Families/ SO
Describe internal and external factors that impact the interview process. Physical setting
-Privacy -Interruptions -Environment
Communication: Feedback
-Provides confirmation of the message -Evidence the receiver understands the intended message
Fire Interventions Race and Pass
-R rescue -A activate alarm -C contain the fire -E extinguish the fire -P pull -A aim -S squeeze -S sweep
Stages of infection Convalescent Period
-Recovery period from the infection
Manifestation of Infection •Localized Infection
-Redness/erythema -Swelling/edema -Pain -Heat -Loss of function -Elevated WBC count -Elevated erythrocyte sedimentation rate (ESR) ---> indicates inflammation
Describe the historical background of nursing. Renaissance and reformation period (approximately 1350-1600) What is the appeal of nursing?
-Religious orders became almost extinct as a result of dissension between Roman Catholic Christians and Protestant sects -Nursing no longer appealed to women of high social status; hospital care was regulated to common women, prisoners, thieves, and drunks -Nursing became an undesirable job with poor pay, long hours, and strenuous work that was considered menial
Describe and utilize appropriate interviewing techniques. Working Phase Reflective Question or Comment
-Repeating what the patient said or describing person's feelings -"You said that this is hard for you." -"You are feeling overwhelmed?"
Nursing Outcomes Classification (NOC) from the University of Iowa Outcomes Research Team (2004).
-Research-based -Standardized method of stating nursing-sensitive outcomes -Understandable to all health care professionals -They are measured on a scale to allow measuring neg. or positive changes or a lack of change resulting from nursing interventions
Variable Influencing Outcome Achievement Nurse Variables
-Resources -Current standard of care -Research findings -Ethical and legal guides to practice
Nursing Diagnoses Related to Safety •NANDA Labels
-Risk for injury -Risk for Trauma -Risk for Poisoning -Risk for suffocation -Risk for aspiration -Impaired home maintenance -Risk for disuse syndrome -Risk for falls
Current CDC Guidelines •Standard precautions—
-Used in care of all hospitalized patients -Apply to blood, body fluids, secretions, excretions (excluding sweat), non-intact skin, mucous membranes
Therapeutic Communication Technique Example/Rationale Consensual validation.
-Searching for mutual understanding, for accord in the meaning of the words. "Tell me whether my understanding of it agrees with yours." Rationale: For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. *IN LECTURE Validating Question or Comment -Nurse restates what she/he heard or observed -"At home you have been taking both a water pill and a blood pressure pill. Did you take them today?"
Characteristics of a Profession • Eight characteristics
-Service vital to human beings -Special body of knowledge -Services provided involve intellectual activities and individual responsibility and accountability -Practitioners receive education in institutions of higher learning -Practitioners have autonomy and control their own policies and activities -Practitioners are motivated by the services they provide and consider their work important to their lives (altruism) -Decisions and conduct guided by a code of ethics -High standards of practice are encouraged and supported by an organization
Therapeutic Relationship: Termination Phase
-Should not be abrupt or unexpected -Expectations for termination should be known from beginning ("I will be meeting you until you are discharged") -Reactions can vary→ depending on if goals were met, how long the relationship was, etc
Home Health Care •Services include:
-Skilled nursing assessment -Teaching and support of patients and family members -Direct care for patients
Types of Planning Discharge Planning
-Starts right away
Types of Planning Initial Planning
-Starts right away while doing assessment
Therapeutic Communication Technique Example/Rationale Setting limits.
-Stating expectations for appropriate behavior. -Nurse: "It seems that you are feeling unsure of how to behave right now." -Client: "What do you mean?" -Nurse: "Well, you are asking me a lot of personal questions. The reason you are here is because you have some health issues and problems. Tell me more clearly what brought you here to the clinic so I can help you?" Establishing behavioral parameters.
Nurse as Counselor •Counseling:
-The interpersonal process of assisting patients to make decisions that promote their overall wellbeing.
Stages of infection •Incubation Period
-The interval between the pathogen's invasion of the body and the appearance of symptoms of infection
ANA Standards of Practice, 2015 •Standard II. Nursing Diagnosis
-The nurse analyzes the assessment data to determine the diagnoses or issues
ANA Standards of Practice, 2015 •Standard I. Assessment
-The nurse collects comprehensive data pertinent to the patient's health or the situation
ANA Standards of Practice, 2015 •Standard IV. Planning
-The nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes
ANA Standards of Practice, 2015 •Standard VI. Evaluation
-The nurse evaluates progress toward attainment of outcomes
ANA Standards of Practice, 2015 •Standard III. Outcome Identification
-The nurse identifies expected outcomes for a plan individualized to the patient or the situation
ANA Standards of Practice, 2015 •Standard V. Implementation
-The nurse implements the identified plan, coordinates care delivery, employs strategies to promote health and a safe environment
Stages of infection Full Stage of Illness
-The presence of specific signs and symptoms indicates the full stage of illness.
Forms of nonverbal communication:
-Touch: to convey professional empathy -eye contact -facial expressions -body posture- open stance vs. closed stance -Avoid arms crossed -Gait -use of gestures -physical appearance -mode of dress and grooming -Sounds -Silence
Rest/sleep pattern
-Usual sleep and rest pattern—Time they go to bed. Time they get up. Naps? How many? Length? -Difficulty staying asleep? -Factors Interfering with Rest: light/noise/temp/environment/nocturia/Ability to fall back to sleep -Anything used to induce sleep Meds/ETOH/music/bath/warm milk/food/TV/deep breathing
Communicating with Patients who have special needs
-Visually impaired -Hearing impaired -Unconscious -Cognitively impaired
Describe and utilize appropriate interviewing techniques. Introduction Phase
-Welcome the patient and use his/her name -Introduce yourself and explain your role -Indicate how long interview will take and if there will be a subsequent physical exam -Remove internal/external potential factors that could be barriers to communication -Ensure comfort and put client at ease -Describe the purpose & expectations of the interview -Describe confidentiality -Do not use diminutives (honey, sweetie) during interaction
Evaluation intervention
-Were the interventions appropriate & implemented correctly?
The Planning Process Establish Priorities
-What needs to be done immediately and what can safely be postponed -Basic survival need to take first priority when your client has a threat to physiological integrity -Maslow Hierarchy of Needs
Past History: Geographic exposures
-Within and outside US -Document if they received immunization for travel
Documentation •Omissions (for documentation not in an EHR)
-Write to the end of the line as much as possible -Avoid writing outside of the margin -Draw line through any empty space to the right of the margin in order to prevent later entries from being made in front of signature.
Mental status- emotional and cognitive functioning Four areas of mental status (ABCT)
-appearance -behavior -cognition (Cognition: orientation, attention, recent and remote memory, serial 7s, spelling backward, insight and judgment) -though process and perceptions (Thought process: logic, reverence, organization, coherence, perceptions)
for a helping relationship dynamic
-both persons active participants -Characterized by an unequal sharing of information -focus on patients nedd
Healthcare-Associated Infections (HAI) •Exogenous:
-causative organism from other people
Three Learning Domains •Affective
-changing attitudes, values, and feelings
Occupational history
-chronological order -How long have they worked at the job? -What did his/her job entail? Hours? Safety? -Exposure to chemicals, noise, or temperature? -Physical activities- sitting standing, lifting, and/or driving -Job satisfaction and job stress -Any work related accidents or illnesses *Do not identify actual name of employer—this would be a HIPAA violation
Assessment
-collecting data -identifying cues and making inferences -validating data -organizing (clustering) data -identifying patterns/Testing first impressions -reporting and recording data (charting)
Healthcare-Associated Infections (HAI) •Endogenous:
-comes from microbial life harbored in the person
Diagnosis
-creating a list of suspected problems/diagnoses -ruling out similar problems/diagnoses and clarifying what is causing or contributing to them -determining risk factors that must be managed -identifying resources, strengths, and areas for health promotion
Sample Teaching Strategies and Learning Domains •Psychomotor domain
-demonstration, discovery, printed materials--> what does discovery mean?
Discuss nursing leaders who influenced the development of nursing. Lillian Wald
-developed a viable practice for public health nursing (The Henry Street Settlement) located in the Lower East Side of New York City -Purpose was to provide good baby care, health education, disease prevention, and treatment of minor illnesses. -Nursing practice at the Henry Street Settlement formed the basis for public health nursing in the United States Metropolitan Life Insurance Company
Nursing Process Outcome Identification and Planning (from image)
-establish priorities -identify expected patient outcomes -select evidence-based nursing intervention -communicate the plan of care *______ overall treatment plan *_______ nursing standards
Historical Foundations Organizations and Agencies Promulgating Standards and Mandates: National League for Nursing (NLN)
-first observed health teaching as an important function within the scope of nursing practice -responsible for identifying course content for curriculum on principles of teaching and learning
Healthcare-Associated Infections (HAI) •Iatrogenic:
-from a treatment or diagnostic procedure
Three Learning Domains •Psychomotor
-learning a physical skill
Sample Teaching Strategies and Learning Domains •Cognitive domain
-lecture, panel, discovery, written materials
florance nightengale helped inspire
-new york training school at bellevue hospital -nursing education in the diploma form
Healthcare-Associated Infections (HAI) Nosocomial:
-originating in the Hospital/Clinic
Teaching Process: Learning Objectives (Outcomes/Goals) Three components to make the objective clear & measurable:
-performance -conditions -identify outcome/goal PIC
Nurses and pateints work togehr as partners to:
-promote health -prevent disease/illness -restore -facilitate coping with altered functioning
Motivational Interviewing •Four Communication Skills needed:
-reflective listening -asking open questions -affirming (state as a fact) -summarizing
Sample Teaching Strategies and Learning Domains •Affective domain
-role modeling, discussion, audiovisual materials
Three Learning Domains •Cognitive
-storing and recalling of new knowledge in the brain
List the forms of communication. organization communication
.....
Discuss the contents of the American Nurses Association Standards of Practice and Code of Ethics. American Nurses Association Standards of Practice
1. Defines the activities of nurses that are specific and unique to nursing 2. Allows nurses to carry out professional roles, cerving as protection for the nurse, the patient, and the healthcare institution 3. Each nurse is accountable for his or her own quality of practice and is responsible for the use of these standards to ensure knowledgeable, safe, and comprehensive nursing care
Differentiate between intentional torts and unintentional torts Unintentional: Four elements that are established to prove malpractice
1. Duty- what a prudent nurse does 2. Breach of duty- failure to meet standards of care 3. Causation- what resulted due to the breach of duty 4. Damages- actual harm or; injury
The Joint Commission 2021 National Patient Safety Goals (Hospital)
1. Identify patients correctly 2.Improve Staff Communication - Get important test results to correct staff timely 3.Use medicines safely 4.Use alarms safely 5.Prevent infection 6.Identify patient safety risks 7.Prevent surgical mistakes
Describe and utilize appropriate interviewing techniques. 3 Phases
1. Introduction 2. Working Phase 3. Closing
Describe and utilize appropriate interviewing techniques. Three Phases of a Therapeutic Relationship
1. Orientation Phase 2. Working Phase 3. Termination Phase
Explain the aims of nursing as they interrelate to facilitate maximal health and quality of life for patients. Aims of nursing
1. Promote health (increase a person's well being and health potential 2. Prevent Illness (avoid illness; achieve early detection; or maintain function within the constraints of an illness) 3. Restore health (direct care for diagnosis or treatment of disease) 4. Facilitate coping with disability or death (to facilitate an optimal level of functioning; provide quality end of life care)
Explain the elements of the communication process. Berlo
1. The stimulus or referent 2. The sender or source of message (encoder) 3. The message itself -Verbal- pitch, tone, speed of statement -Nonberbal- body language (noise distracts from message) 4. The medium or channel of communication: -Auditory -Visual -Kinesthetic 5. The receiver (decoder) -Sends feedback back to sender
Data Cluster •A 20 year old male presents with cervical lymphadenopathy, a painful/sore throat, an increased oral temp. of 101.6 (with flushed hot skin) and lethargy. Diagnosed with mononucleosis What are the possible nursing diagnoses?
1. pg. 79 (green pages)--> mononucleosis 2. Out of all the options this fits the best on what nurses can actual do with the patient on pg. 79: Acute Pain r/t enlargement of lymph nodes, oropharyneagel edema --> go to Acute Pain section in NANDA label 3. pg. 676 (NANDA labels) to make sure it sounds like the patient (need one defining characteristics)---> put related to factors that fit situation Problem, r/t Etiology, As Evidence By (AEB): Activity Intolerance r/t generalized weakness (or increased metabolic demands) AEB c/o fatigue Acute pain r/t biological injury AEB c/o pain Fatigue r/t stressors (disease state) AEB lethargy
Data Cluster 75 year old male patient MM had abdominal surgery 4 days ago. He has adventitious breath sounds in the upper lobes with diminished breath sounds in the lower lobes and an ineffective cough. Pulse OX=92% RA. Diagnosed with pneumonia. How would you write the Diagnosis?
1. pg. 94 (green pages) ---> pneumonia 2. Out of all the options this fits the best on what nurses can actual do with the patient on pg. 94: Ineffective Airway Clearance r/t inflammation and presence of secretions ---> must go to Ineffective Airway Clearance in NANDA labels pg. 130 (NANDA labels) to make sure it sounds like the patient (need one defining characteristics)---> put related to factors that fit situation Problem, r/t Etiology, As Evidence By (AEB): Ineffective Airway Clearance r/t presence of secretions AEB abnormal breath sounds This is a second one, but it is less common: Impaired gas exchange r/t decreased functional tissue AEB hypoxia (caution use due to r/t being developed)
Stages of infection
1. •Incubation Period 2. •Prodromal Stage 3. •Full Stage of Illness 4. •Convalescent Period
Question Asked In Class: % US GDP is spent on healthcare
17%
Nursing Education: BSN
1909 - University of Minnesota • 1924 - Yale • 4-5 year program which offers BSN degree. • About 550 nationally. • 16 programs currently in Michigan.
Question Asked In Class: % US GDP on healthcare
20%
What percentage of physicians practice primary health care today? Question Asked In Class:
20% (know part of the book- need more communication)
Nursing Education: Diploma
3 year program - 27-36 months • Originally based on Florence Nightingale's conception of nursing education • Apprenticeship model which frequently were established to fill nursing vacancies at the hospital • Importance of the nurses' home • Because these schools were hospital based, they did not offer academic credit. • The largest number of nurses in the United States held a diploma from a school of nursing until the 1990's • Currently no diploma schools exist in Michigan.
What percent of physicians practiced primary health care 50 years ago (moving toward specialities) Question Asked In Class:
50% (know the whole book)
Rapport Builders
A feeling of mutual trust experienced by people in a satisfactory relationship
Boolean Operators
AND, OR, and NOT used in search strings to refine (narrow) the scope of the search
Therapeutic Communication Technique Example/Rationale Silence.
Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Nurse says nothing but continues to make eye contact and conveys interest. Silence often encourages the client to verbalize, provided that it is interested and expectant. *IN LECTURE
Sexuality Profile-Female
Age of menses/menopause #pregnancies/#birth Vaginal itching/discharge Date of last period/# days of cycle amenorrhea/menorrhagia/premenstrual pain/dysmenorrhea/spotting Hormone replacement therapy with menopause Health promotion- last gyn. Exam and PAP
Therapeutic Communication Technique Example/Rationale Broad Openings
Allowing the client to take the initiative in introducing the topic. "Is there something you'd like to talk about?" "Where would you like to begin?" Rationale: Broad openings make explicit that the client has the lead in the interaction. *IN LECTURE it is called "open-ended questions"
Mary Mahoney (1845-1926)
America's 1st African-American professionally educated nurse Worked for acceptance of African Americans in nursing & for promotion of equal opportunities
Standards of Practice for Assessment
American Nurses' Association develops and disseminates Standards of Practice and Professional Performance (ANA, 2015). These define activities of nurses that are specific and unique to nursing. STANDARD 1. ASSESSMENT: The registered nurse collects comprehensive data pertinent to the patient's health or the situation. -Data is collected in a systematic and ongoing process -Data collection involves the patient, family, other health care providers and environment, as appropriate, in holistic data collection
Discuss nursing leaders who influenced the development of nursing. Clara Barton
American Red Cross
Therapeutic Communication Technique Example/Rationale Encouraging comparison.
Asking that similarities and differences be noted. "Was it something like...?"Have you had similar experiences? Rationale: Comparing ideas, experiences, or relationships brings out many recurrent themes.
Therapeutic Communication Technique Example/Rationale Encouraging description of prescriptions.
Asking the client to verbalize what he or she perceives. "Tell me when you feel anxious.""Do tell me what is happening?""What does the voice seem to be saying?" Rationale: To understand the client, the nurse must see things from his or her perspective.
The nursing process
Assessment Diagnosis Planning Implementation Evaluation
Evaluation: outcomes Physiological
Assessment skills to collect and compare data
Reasoning in data collection Inferences-
Attach meaning to data or reach a conclusion about the data
Describe the Ethical Principles as they relate to nursing Nine of them
Autonomy- patient has the right to make their own decisions Nonmaleficence- to do no harm Beneficence- promotion of good Justice- fairness and equality for all Fidelity- faithfulness to a person, cause, or belief (keeping a promise) Accountability Veracity- adhering to the truth Privacy confidentiality
. Identify barriers and benefits to technology
Benefits of tech: -improved patient safety -increased efficiency -improved decision support and communication Barriers of tech: -cost -lack of adequate infrastructure and technological support -lack of user competency Barriers •Security •Slowdown •Collapse •Viral contamination •Lack of adherence to internet policy standards Overcoming Barriers •Firewalls •Staff training, well-designed websites, adequate transmission access •Antivirus systems •Effective organizational policies and standards/procedures
Explain therapeutic and nontherapeutic communication techniques. non-Therapeutic communication techniques:
Blocks to Therapeutic Communication -Failure to perceive the patient as a human being -Failure to listen -Using clichés -Using questions requiring only "yes" or "no" answers -Asking "why" -Probing questions -Leading questions (questions that suggest a particular answer) -Giving advice -Being judgmental -Changing the subject -Giving false assurance -Gossip and rumor -Incivility -Bullying
Non-Therapeutic Communication Technique Example/Rationale Introducing an unrelated topic
Client: "I'd like to die!"Nurse: "Did you have visitors this weekend?" Changing the subject.
24 hour diet recall
Check packages/labels for nutritional info
Non-Therapeutic Communication Technique Example/Rationale Using denial
Client: "I'm nothing!" Nurse: "Don't be silly!" Refusing to admit that problem exists.
Describe the mechanisms that influence the professional and legal regulation of nursing practice. Certification
Certification: validates specialty knowledge, experience and clinical judgment -Usually for graduate programs Examples of Certifications in Nursing American Nurses Association -APRN, BC American Association of Critical Care Nursing -CCRN American College of Nurse Midwives -CNM American Association of Nurse Anesthetists -CRNA National Association of School Nurses -CSN
Healthcare Information Systems Two major types:
Clinical Information Systems (CIS) Administrative Information systems (AIS)
The NANDA list is a beginning list of suggested terms for health problems and may be identified and treated by nurses.
True
Example Nursing Diagnosis Statement
Case: Patient was not oriented to the room and needed to get up to the bathroom but didn't know how to ask for help. Case: 70 year-old recently diagnosed with Stage 2 Hypertension. •Case: 80 year-old with chronic heart failure and frequent readmissions. Interview reveals she feels "overwhelmed" with diet restrictions, medications, and constant need for follow up.
Identify historical factors that influenced the development of nursing. The Great Depression (1930-1940)
Caused a need for Legislation • "New Deal" enacted to rescue the country and provide for medical care and other services for the large numbers of indigent people • Social Security Act of 1935 affected health care and provided avenues for public health nursing
socialization/leisure patterns CAGE questionnaire
CAGE questionnaire C= have you ever thought you should CUT down on your drinking? A= have you ever been ANNOYed by criticism of your drinking? G= have you ever felt GUILTY about your drinking? E= do you drink in the morning (EYE-opener) One yes answer indicates hazardous drinking Two or more yes answers indicate ETOH abuse and dependence→ more info needs to be obtained
Describe computer and information literacy
CPU ROM- retains memory RAM- erases memory when turned off Data -little meaning by itself Information -data that has been interpreted, organized or structured -Accumulated as nurses perform and record ongoing assessment Knowledge -synthesis of information --> relationships are identified URL -uniform resource locator
Discuss nursing leaders who influenced the development of nursing. Dorothea Dix
Civil War -appointed to organize military hospitals, provided training for nurses, and disperse supplies; she received no official status and no salary for this position
Therapeutic Communication Technique Example/Rationale Placing event in time or sequence.
Clarifying the relationship of events in time. "What seemed to lead up to...?" Putting events in proper sequence helps both the nurse and client to see them in perspective. *IN LECTURE called "sequencing question or comment"
Non-Therapeutic Communication Technique Example/Rationale Belittling feelings expressed.
Client: "I have nothing to live for. I wish I was dead!" Nurse: "Everybody gets down in the dumps!" Misjudging the degree of client's discomfort.
Describe and utilize appropriate interviewing techniques. Closing Phase
Conclusion -Should end gracefully -"Is there anything else you would like to mention?" -Summarize what you, the nurse, have learned about the patient's health history during the interview -Thank the client for their time and cooperation
Teaching Process: Learning Objectives (Outcomes/Goals) conditions
Criteria: measurable outcome (i.e. how the learning is evaluated
the etiology of nursing diagnoses directs nursing interventions
True
Past History: Past Hospitalizations
Dates/Cause/Name of Hospital/How the condition was treated/How long in hospital. How the patient recovered (any chronic problems)
Past History: Past Surgeries
Dates/Type of surgery/Name of hospital/How person recovered
Therapeutic Communication Technique Example/Rationale Exploring.
Delving further into a subject or idea. "Tell me more about that." "Would you describe it more fully?" Rationale: When clients deal with topics superficially, exploring can help them examine the issue more fully.
Evaluation: outcomes Psychomotor
Demonstrate skills
Types of Nursing Diagnoses Wellness Nursing Diagnoses
Describes human responses to levels of wellness in an individual, family or community that have the potential for growth and/or the potential for enhancement to a higher state of well-being (must have an effective present status or function). other diagnosis are ACTUAL and RISK FOR
mildred montag
Developed the concept for associate degree in nursing programs in 1952
Explain therapeutic and nontherapeutic communication techniques. Therapeutic communication techniques:
Developing Conversation Skills -Control the tone of your voice -Be knowledgeable about the topic of conversation -Be flexible (based on patient needs) -Be clear and concise (one subject at a time) -Avoid confusing words that might have different interpretations -Be truthful -Keep an open mind -Take advantage of available opportunities (use all patient interactions to the fullest) Developing Listening Skills -Sit when communicating with a patient -Be alert and relaxed and take your time -Keep the conversation as natural as possible -Indicate you are paying attention (Maintain eye contact if appropriate) -Use appropriate facial expressions and body gestures -Think before responding to the patient -Do not pretend to listen -Listen for themes in the patient's comments
Discuss factors that influence communication and interviewing skills.
Developmental level -Rate of language development correlates with intellectual (cognitive development) Gender -Females tend to want to communicate problems and share feelings -Males want to fix and solve problems Sociocultural differences Roles and responsibilities Space and territoriality Physical, mental, and emotional state Values Environment: comfort zone
Therapeutic Communication Technique Example/Rationale Reflecting.
Directing client actions, thoughts, and feelings back to client. Client: "Do you think I should tell the doctor?" Nurse: "Do you think you should?" Reflection encourages the client to recognize or accept his or her own feelings.
Identify historical factors that influenced the development of nursing. Civil War
Dorothea Dix -Hospitals developed rapidly in US after 1850. -Number of nurse training schools increased after the war
Teaching/Learning/Education Profile
Education- highest degree completed→ give degree and year Developmental status→ can use Erikson/Levinson's Havighurst Must give evidence as to why client is in the stage desire/readiness to learn- specific info the client is asking about Current knowledge about their own condition(s)--> what do they know about condition/risk factors/family history of chronic disease Info you taught client → specific info on self breast exam, diet, stress modification Barriers to teaching/learning→ pain, effects of meds, HOH, vision, language, attention span
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process nursing organizations
Educational Preparedness for Nursing Practice Practical and Vocational Nursing Education Registered Nursing Education -Diploma -Associates Degree in Nursing -Baccalaureate in Nursing *education makes the nursing practice better
Therapeutic Communication Technique Example/Rationale Voicing doubt
Expressing uncertainty about the reality of the client's perception. "Isn't that unusual?""Really?" Another means of responding to distortions of reality is to express doubt.
Identify historical factors that influenced the development of nursing. Crimean War
Florence Nightingale/Mary Seacole has major roles during the war
Phases of the Interview vs therapeutic relationship
Interview •Introduction •Working phase •Closing Therapeutic •Orientation Phase •Working Phase •Termination Phase *interview actually occurs in the orientation phase
Health Literacy: Ability to Understand and Act on Health Information (To Learn)
Health Literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions (HHS) Twenty one percent of adults in the US possess low literacy skills Health literacy is the ability of people to read, understand and act on health care information. It is estimated that 50% of Americans have health literacy challenges. Must never assume people can read and write
Sexuality Profile
How are touch needs met—Holding hands/hugging/intimate relationship/pets Interest/Attitude—Involved in a relationship involving intercourse? Are aspects of sex satisfactory? Painful? Difficulty with ejaculation? Erection? Orgasm? Change in libido? Method of contraception? Aware of potential transmission of sexually transmitted infections? Concerns Voiced—Educational opportunity
Current health status Collect eight critical characteristics
Identify the eight parameters of a symptom or client health complaint. -Location -Character -Quantity or severity (0-10)- worst is 10 -Timing (happens at certain times?) -Setting -Aggravating or Relieving Factors -Associated Factor (anything goes along with the pain) -Patient's Perception (what do you think is going on?)
Writing A Nursing Diagnoses Problem, r/t Etiology, As Evidence By (AEB): Example
Impaired physical mobility r/t pain AEB c/o pain with limited ROM (no AEB with "Risk for" diagnoses r/t ---> related to c/o --> complaint of AEB ---> as evidence by
Antibiotic-Resistant Organisms
Indiscriminate use of Broad Spectrum antibiotics •MDRO= Multidrug-resistant organism •MDR-GNB= Multidrug-resistant gram-negative bacilli •MRSA= Methicillin-resistant Staphylococcus aureus: accounts for 60% of HAI •Vancomycin=VISA, VRSA, VRE •CRE=Carbapenem-resistant Enterobacteriaceae (i.e. Klebsiella species and E. Coli)
Communication: Verbal
Involves the use and exchangement of words to convey messages Talking -Nurses must be aware of what patients say and if their nonverbal cues reflect the verbal Writing -Make sure it is accurate, concise, and logical
Questions to Ponder Regarding Health Care—Questions that Pose Ethical Dilemmas
Is health care a right, a privilege, or a obligation of moral society? -Do people who engage in risky behaviors or who do not make necessary lifestyle changes deserve the same health care as people who live healthy lives? -Who should pay for health care needed by the unemployed and homeless?
Questions to Ponder........ Part 1
Is health care a right, a privilege, or a obligation of moral society? -Should citizens pay higher insurance premiums or taxes so that a drug addict who overdoses can have intensive care? -Should undocumented workers in the United states have the same access to health care as U.S. citizens
Mental status- emotional and cognitive functioning Four areas of mental status (ABCT) though process and perceptions
Is thought process consistent/logical Perceptions- is client aware of reality Screen for: -Anxiety -Depression -Suicidal thoughts -Mental health history
Quality and safety
It's a chilling reality - one often overlooked in annual mortality statistics: Preventable medical errors persist as the No. 3 killer in the U.S. - third only to heart disease and cancer - claiming the lives of some 400,000 people each year.
Discuss nursing leaders who influenced the development of nursing. Mary Seacole
Jamaican nurse who played a major role in the Crimean War -Was denied the opportunity to join Nightingale's nursing brigade because she was black -Opened a lodging house with her own money to care for sick and wounded soldiers -Contributed to control of the cholera epidemic through extensive knowledge in tropical medicine
Practical and Vocational Nursing Education
LPN/LVN
Identify historical factors that influenced the development of nursing. World War II
Legislation - Programs enacted to expand nursing education and increase the number of nurses in all military branches Advances in nursing - Nursing became an essential part of the military advance - Nurses recognized as an integral part of the military and attained officer rank in the Army Nurse Corps - (Note Penicillin in its usable form created, and immediately used during WWII)
Laboratory/Diagnostic Tests Indicating Infection %'s
Leukocytosis: Elevated white blood cell count -normal is 5000 to 10,000/mm3 -Differential count or percentage of each cell type •Neutrophils: ~ 60% - 70%: increase with acute infection. (trauma, MI, inflammation) •Lymphocytes: ~20% - 40%: increase in chronic bacterial and viral infections •Monocytes: ~ 2% - 8%: increase in severe infection •Eosinophil: ~1% - 4%: increase allergic and parasitic infection •Basophil: ~ 0.5% - 1%: unaffected by infections
Describe the mechanisms that influence the professional and legal regulation of nursing practice. NCLEX
Licensure: National Council Licensure Examination (NCLEX-RN) for entry level competence (if you move to another state, do you have to re-take the NCLEX in order to practice in that state?) You do not have to pass another NCLEX to go out of state (call state of board and they will want transcripts)
Metropolitan Life Insurance Company
Life insurance company that paid for or directly provided home nursing services for its beneficiaries and their families from 1909 to 1952. -Lillian Wald
Teaching Process Example Nursing Diagnosis (Dx)
Look in Ackley •Deficient Knowledge r/t •Ineffective health maintenance r/t •Ineffective health management r/t •Readiness for enhanced knowledge r/t
This type of hospital has been recognized for quality care, nursing excellence and innovations in professional nursing practice
Magnet designation
Past History: Immunizations
MMR, DPT, polio, Hep B, varicella, flu, pneumonia, TB *Give specific date of last tetanus (Tdap), TB skin test, and flu shot
Therapeutic Communication Technique Example/Rationale Clarifying.
Makes the meaning of client's message clear. Client: "Whenever I talk to my doctor, I feel so upset." Nurse: "Tell me what is making you upset?" Prevents nurse from making assumptions about client's message. *IN LECTURE
Therapeutic Communication Technique Example/Rationale Offering self.
Making oneself available. "I'll sit with you awhile." The nurse can offer his or her presence, interest, and desire to understand.
Differentiate between intentional torts and unintentional torts Unintentional
Negligence- occurs when harm or injury is caused by an act of either omission, or commission, by a layperson Malpractice- an act of negligence by a professional person as compared to the actions of another professional person in a similar circumstance. Four elements that are established to prove malpractice
assault and battery
assault includes a threat or attempt to injure, and battery includes the unlawful touching of another person without consent
Describe and utilize appropriate interviewing techniques. Working Phase Non-verbal patient data gathering skills
Non-verbal of patient data gathering skills -Physical appearance: "looked sick" -Posture: hunched over -Gestures: nodding, finger pointing -Facial expressions: alert, relaxed -Eye contact: lack of=shy, depressed,etc. -Voice: rate fast=anxious -Touch
Describe how nonverbal communication can impact the communication process.
Nonverbal set of behaviors that conveys messages without words -Body language Body language is a more reliable indication of a client's true message
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process Nurse practice acts
Nurse Practice Acts—laws established in each state in the United States to regulate the practice of nursing. They differ from state to state, but all have certain elements in common: -Define the legal scope of nursing practice -Establishes criteria for education and licensure of nurses -Identify violations that can result in disciplinary actions against the nurse
Therapeutic Communication Technique Example/Rationale Confronting.
Nurse's verbal response to incongruence between client's words and actions. Client: "I am so angry at her!" (Stated while smiling). Nurse: "You said you are angry, yet you are smiling?" Encourages client to recognize potential areas for change.
Describe the historical background of nursing. Renaissance and reformation period (approximately 1350-1600) what are nursing orders and what are two examples?
Nursing orders were established out of great concern for social welfare. -Sisters of Charity—recruited young women for nurse training, developed educational programs, and cared for abandoned children -St. Vincent de Paul—established the Hospital for the Foundling to care for orphaned and abandoned children
Nursing Outcomes Classifications
Nutrition Status: Food and Fluid Intake (1008) Oral Food Intake :1 2 3 4 5 Tube Feeding Intake: 1 2 3 4 5 Oral Fluid Intake: 1 2 3 4 5 Fluid Intake: 1 2 3 4 5 TPN Intake: 1 2 3 4 5 1=Not Adequate 4=Substantially Adequate 2=Slightly Adequate 5=Totally Adequate 3=Moderately
Evaluation: outcomes Affective
Observe pt behaviors and conversation
Therapeutic Communication Technique Example/Rationale Presenting reality.
Offering for consideration that which is real. "I see no one else in the room." When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real.
Therapeutic Communication Technique Example/Rationale Suggesting collaboration.
Offering to share, to strive, to work with the client for his or her benefit. "Perhaps you and I can discuss and discover the triggers for your anxiety." The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships.
Therapeutic Communication Technique Example/Rationale Summarizing.
Organizing and summing up that which has gone before. "So in summary...""Have I got this straight?" Summarization seeks to bring out the important points of the discussion and to increase the awareness and understanding of both participants. *IN LECTURE during conclusion phase
Medications
Over the counter (OTC), vitamins, minerals, herbs, suppositories, enemas All prescriptions How long, dose, frequency, route What it is, why they are taking it *Think about its interaction with other drugs and alcohols
Overview of the interview
Overview of the interview •Purpose: to obtain accurate and thorough information - Data collection (Health History) - Interviewing techniques utilized to obtain information - Therapeutic Communication - The interview occurs in Orientation phase of the Helping relationship
Definitions Teaching
Planned method (intervention) that involves sharing information and experiences to meet the intended learner outcome.
Types of Planning Examples
Planning for individuals (focus on) verses groups or client populations -initial planning -ongoing planning -discharged planning
Describe the various levels of educational preparation in nursing
Practical and Vocational Nursing Education Registered Nursing Education -Diploma -Associates Degree in Nursing -Baccalaureate in Nursing Graduate Education in Nursing Continuing Education -need a certain amount of hours to be able to teach nursing courses In-service Education -Based on healthcare institution -New EMR
Writing A Nursing Diagnoses Forms Used (3 part)
Problem, r/t Etiology, As Evidence By (AEB): Problem, r/t Etiology, secondary Pathophysiology Problem r/t unknown Etiology
Definitions Learning
Process by which a person acquires or increases knowledge or changes behavior in a measureable way as a result of the experience.
Relationships and Environment
Quality of Relationships—How do they get along with family. Ask about abuse/violence as an adult. Do this by asking if he/she has any concerns about his/her personal safety at this time. Support System—Who is their support system Home/Neighborhood/Usual Environment—Where do they live (type home and neighborhood) and with who (give ages, relationships—include pets). —Access to transportation —Involvement in community —Safety(do they feel safe, do they have, smoke detector, carbon monoxide detector fire extinguishers). —Adequate heating/cooling/utilities
Biographical Data
Race- biological traits Examples: AA (african american), C (caucasion), NA(native american), A (asian), PA (pacific islander), L (latino), Hispanic (H), ME (middle eastern) Religion- impact on health -Who to call for support -For example: Jehovah's Witness, Hinduism, Christian Science, Jewish, Mormon, Islam Marital status single=s, married=m, divorced= D, widow/widower= W, separated= SP Need to know length of time and number of times -E.G. M x 40 years, W x 1 year, M x 1month, SP 2 days Contact person- relationship to patient Insurance coverage Medicare for 65<, medicaid, HMO, VA, medicare-managed care, PPO, BCBS, AARP, private insurance, or none. May have primary and secondary insurance Source of information- client (note if the client is reliable
Current health status
Reason for seeking care (FOR worksheet- no current illness/no chief complaint) → HOPI (history of past illness knowledge/understanding of health problems (self-evaluation) Clients perception of their current health and quality of life -How do you define health? -How do you view your situation now? -What are your concerns? -What do you think will happen in the future? Limitation of function→ bathing, grocery shopping, driving, cooking "Who helps you out at home?" Management of limitation → equipment, resources, people Health/life goals -What are your health goals? -What do you want to do with your life? -Where do you see yourself in 5 years? 10 years? -Elderly patient → focus on what they want to do most with the rest of their life HEALTH PROMOTION ACTIVITIES → Taylor pg. 569 -AGE SPECIFIC screening -Last PE, PAP, Pelvic, dental, eye, hearing test Colonoscopy, mammogram, prostate exam -Wear sunblock, seat belt, helmet w biking/rollerblading/motorcycle
Evaluation: outcomes Cognitive
Repeat or apply information
Therapeutic Communication Technique Example/Rationale Restating.
Repeating the main idea expressed. Client: "I can't sleep. I stay awake all night."Nurse: "You have difficulty sleeping." The nurse repeats what the client has said in approximately or nearly the same words the client has used.
Writing A Nursing Diagnoses Problem, r/t Etiology, secondary Pathophysiology Example
Risk for Impaired Skin Integrity r/t decreased peripheral circulation secondary to diabetes (no AEB)
Therapeutic Communication Technique Example/Rationale Seeking information.
Seeking to make clear that which is not meaningful or that which is vague. "I'm not sure that I follow. Could you tell me more?" The nurse should seek clarification through interactions with clients.
Therapeutic Communication Technique Example/Rationale Translating into feelings.
Seeking to verbalize client's feelings that he or she expresses only indirectly. Client: "I'm dead."Nurse: "Are you suggesting that you feel lifeless?" Often what the client says, when taken literally, seems meaningless or far removed from reality.
Teaching Process: Learning Objectives (Outcomes/Goals) identify outcome/goal
Short & Long term
Family Profile
Show at least three generations—2 previous, 1 current, and second generation if applicable (include brothers and sisters for current and immediate past generation) *NEVER USE PATIENT'S OR FAMILY MEMBERS NAMES ON GENOGRAM
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process Professional and Legal Regulation of Nursing Practice: Standards
Standards—ANA's 2010 Nursing: Scope and Standards of Practice (pg. 18 Taylor and Lillis) -Defines the activities of nurses that are specific and unique to nursing -Allows nurses to carry out professional roles, serving as protection for the nurse, the patient, and the healthcare institution
Types of Data
Subjective- Information provided by the client that you cannot observe directly. Objective - Characteristics about the client that you can observe directly.
Communication and safety
TeamSTEPPS
Agency for Healthcare Research and Quality (AHRQ)
The AHRQ mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. www.ahrq.gov
Helping relationship vs. Social relationship
The helping relationship = Professional -Does not occur spontaneously -Dynamic: both persons active participants -Characterized by an unequal sharing of information -Patient focus (**patient involvement improves the quality of care) Goal of nurse in a helping relationship is to assist the patient to identify and achieve outcomes -Separate from a friendship -Built on the patient's needs not on the needs of the helping person -Purposeful -Time-limited -Person providing assistance is accountable for the outcomes of the relationship and the means used to attain them
Code of Ethics for Nurses #8
The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
Code of Ethics for Nurses #4
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.
Code of Ethics for Nurses #5
The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. (take care of self)
Code of Ethics for Nurses #6
The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
Code of Ethics for Nurses #7
The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
Code of Ethics for Nurses #3
The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
Code of Ethics for Nurses #2
The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
Code of Ethics for Nurses #1
The nurse, in all professional relationships, practices with compassion and respect for inherent dignity, worth, and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems.
Interprofessionality
The process by which professionals reflect on the develop ways of practicing that provides and integrated and cohesive answer to the needs of the client/family/population. It involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient's participation.
Definitions Patient Education
The process of helping patients learn health-related behaviors to achieve the goal of optimal health and independence in self-care.
Code of Ethics for Nurses #9
The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
Differentiate between intentional torts and unintentional torts What is a tort?
Tort- a wrong committed by a person against another person or his/her property (subject to action in a civil court). A crime is against the public (misdemeanor/felony) punishable by the state
Collecting Data: Active Processing
Translating-clear and succinct meaningful statements Reasoning- make mental connections about data to diseases, health patterns, or current situation Intuition and validation
Question Asked In Class: US spend more on health care than any other nation in the world
True
Therapeutic Communication Technique Example/Rationale Open-ended comments.
Unfinished sentences that prompt the client to continue. Questions that cannot be answered with a one-word answer. "Tell me more about your pain." "Tell me about your family." Allows client to decide what content is relevant.
Therapeutic Communication Technique Example/Rationale Making observations.
Verbalizing what the nurse perceives. "You appear tense.""Are you uncomfortable when..?" Sometimes clients cannot verbalize or make themselves understood.
Therapeutic Communication Technique Example/Rationale Verbalizing the implied.
Voicing what the client has hinted or suggested. Client: "I can't talk to you or anyone. It's a waste of time."Nurse: "Do you feel that no one understands?" Putting into words what the client has implied or said indirectly tends to make the discussion less obscure.
Health Care Agencies
Voluntary agencies -Support groups Other government agencies -Public health service -Center for Disease Control and Prevention -Public health agencies
Past History: Allergies/Reactions (meds, food , environment)
YOU MUST ALWAYS DOCUMENT TYPE OF REACTION AND HOW IT HAS BEEN MANAGED
Kaiserworth
a german institution for training of nannies, governesses and nurses (florance was taught here)
Which is an example of cognitive learning
a patient describes how to portion food to maintain within a prescribed calorie range
Components of a Nursing Diagnosis Definition
a precise description (not documented in chart)
teach back method
allows patient to repeat back key concepts from teaching session to confirm understanding
article link to read
article you must read on and word doc on d2l: https://d2l.msu.edu/d2l/le/content/1284802/viewContent/10603208/View
Establishing Outcomes Affective
change beliefs/attitudes
Discuss nursing leaders who influenced the development of nursing. Sojourner Truth
civil war abolitionist and nurse, advocate of clean and sanitary conditions so patients could heal
Discuss nursing leaders who influenced the development of nursing. Susie King Taylor
civil war although hired in the laundry, worked full time as a nurse on the battlefront
replace high fat food goal?
cognitive goal
List the forms of communication. Interprofessional communication
communication between two people
Describe what kind of database needs to be collected based on the clinical situation. Initial assessment/complete database:
complete health history and full physical exam
Types of Nursing Diagnoses Syndrome Nursing Diagnoses
comprise a cluster of actual or risk nursing diagnoses that are predicted to be present because of a certain event or situation *not on exam
Describe what kind of database needs to be collected based on the clinical situation. focused/problem centered:
concerns assessment mainly on one problem or one body system
Discuss nursing leaders who influenced the development of nursing. Florence Nightingale
family -owned a lot of land (gentry) father was very well educated- close to parliament -unitarians- very socially progressive at the time; egalitarianism Early nursing career -Family opposed her interest in nursing at first, then she was permitted to pursue nurse training -1851—attended a 3-month nurse training program at the Institute of Deaconesses at Kaiserswerth, Germany Later Nursing Career -The Harley Street Experience- Excelled as an effective nursing -Crimean war contributions Accomplishments -helped during crimean war -Founder of professional nursing -Demonstrated the value of aseptic techniques and infection control procedures -Honored for her contributions to nursing research -Demonstrated the value of political activism to affect health care reform -Established the first nursing school in England -Honored as the founder of professional nursing services, initiated social services, spent up to 20 hours each day providing nursing care -Introduced principles of asepsis and infection control, a system for transcribing physician's orders, and a system to maintain patient records -Kept careful statistics—documented a decrease in the death rate of soldiers from 42% to 2% as a result of health care reforms that emphasized sanitary conditions
Legislation Nurse Training Act of 1943
first instance of federal funding to support nurse training
Legislation Sheppard-Towner Act
first legislation to assist special populations and provide public health nurses with resources to promote the health and well-being of women, infants, and children
socialization/leisure patterns
hobbies/interests- what the client likes to do alone or with others Social patterns- social obligations/considers self an introvert or extrovert Is time spent alone pleasurable or isolating? Use of alcohol, tobacco, drugs, marijuanaand caffeine→ amount/type/frequency and how the use has affected work of family Participation in formal activities→ church/clubs/sports teams/professional organization activity/exercise→ type/amount/method of warm-up Typical day→ time they get up/eat breakfast/leave for work or school/eat lunch/return home/eat dinner/evening activity/go to bed
Read this article
https://journals-sagepub-com.proxy2.cl.msu.edu/doi/pdf/10.1177/0898010110361523
The interview occurs in_______ phase the Helping (therapeutic) relationship
in Orientation phase
Establishing Outcomes Cognitive
increases pt. Knowledge
Who Initiates Nursing Interventions Nurse-Initiated Interventions:
independent of the physician (i.e. assist with activities, reduce risk of injury or infection, reposition patient)
Describe what kind of database needs to be collected based on the clinical situation. Emergency database:
key data/assessment to immediate problem done in an emergency situation
Chain of Infection
organism --> reservoir (where it lives and multiplies) --> portal of exit (exits reservoir) --> transmission --> portal of entry --> vulnerable hosts
Fall Risk Assessment The Morse Fall Assessment
over 45 --> high fall risk
Legislation Hill-Burton Act
provided funding to construct hospitals; created a hospital construction boom that increased the demand for professional nurses
walk lengths of hallway. goal?
psychomotor
Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, and the nursing process Credentialing and Accreditation
refers to ways in which professional competence is ensured and maintained
Psychological profile Coping mechanisms
steps taken to relieve stress -Label strategy as adaptive or maladaptive -Example: do they exercise, meditate, drink, smoke to calm down?
Question Asked In Class: Management of rare complex disorders
tertiary
Describe what kind of database needs to be collected based on the clinical situation. ongoing/follow-up database:
to assess identified problems at regular/appropriate intervals (on return visits/during hospital stay) in order to evaluate change
Discuss the Michigan State University College of nursing Mission and Vision Vision
to lead in developing knowledge through research and clinical scholarship, creating positive change in healthcare outcomes locally, nationally, and globally through excellence in nursing education, research, and practice
Discuss the Michigan State University College of nursing Mission and Vision Mission
to transform the health of diverse individuals and communities by providing innovative educational opportunities, cutting edge research, and increased access to high quality nursing practice
Who Initiates Nursing Interventions Collaborative Interventions:
treatments initiated by other providers (PT, OT, Pharmacist) and carried out by a nurse
Who Initiates Nursing Interventions Physician-Initiated Interventions:
within the scope of nursing practice but requires a physician's order for the nurse to implement.
Accidents and Exposures
•All accidents and exposures to infectious materials must be reported. •Failure to do so could result in personal jeopardy and loss of hospital support if an infection develops. •Steps to be taken immediately?
Documentation Types of purposes
•Communication •Quality Assurance/Quality of Care •Care Planning •Support Decision Analysis •Education •Legal Accountability/Historical Document •Reimbursement •Research
Nursing Education: ADN
• Dates from 1952. Mildred Montag was the philosophical developer. • Based in community colleges. • 2 year technical education. • About 900 nationally. • 36 programs currently in Michigan • Currently account for largest number of nurses who graduate with a basic education degree in nursing.
AHRQ Definition of the Patient-Centered Medical Home (PCMH)
•Comprehensive care •Patient-centered\Coordinated care •Accessible services •Quality and safety
Elements of an Intervention Who, what, where
• Need to make very specific so other nurses can follow. •Involves writing who, what, where, when, why, how. -Who; person providing care- nurse, RT, PT -What; care that will most effectively meet the client's needs -Where; home, clinic, hospital
What is TeamSTEPPS®?
•Consorted effort between the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense to develop a set of EVIDENCE based team competencies to improve teamwork, care quality and safety •TeamSTEPPS gives the team a common language •Bridges the divide; levels hierarchy •Includes patient as the core to care
Role of Nurse in Primary Care Centers
•Advanced practice registered nurses (APRNs): nurse practitioners, midwives, and clinical nurse specialists work independently or collaboratively with physicians to make assessments and care for patients who require health maintenance or health promotion activities •Depending on state regulations, APRNs may have their own offices and clinics to provide primary care and treatment to patients and refer only complex health problems to a physician
Focus of Safety Assessments Falls
•Age >65 •History of falls •Impaired vision or balance •Altered gait or posture, impaired mobility •Medication regimen •Postural hypotension •Slowed reaction time •Weakness and physically frailty •Confusion or disorientation •Unfamiliar environment
Identify Patients at Risk for Injury ABCS of Fall Injury Risk
•A = Age >85 •B = Bone (fracture risk or history of osteoporosis) •C = anti Coagulation or bleeding disorder •S = Surgery during current episode of care
•TeamSTEPPS: team structure and four teachable-learnable skills Mutual Support
•Ability to anticipate and support team members' needs through accurate knowledge about their responsibilities and workload.
•TeamSTEPPS: team structure and four teachable-learnable skills Leadership
•Ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources
Issues Related to Health Care
•Access to health care •Quality and safety •Affordability
The Joint Commission ORYX (Core Measure) What should be done? (policy regarding certain tasks)
•Acute Myocardial Infarction •Children's Asthma Care •Emergency Department •Hospital Outpatient Department •Hospital-Based Inpatient Psychiatric Services •Immunizations •Perinatal Care •Stroke •Substance Abuse •Tobacco Treatment •Venous Thromboembolism
Types of Nursing Diagnoses Actual Nursing Diagnoses
•describes human responses to health conditions/life processes that exist in an individual, family or community
Prioritize These!!!!
•Altered nutrition: less than body requirements, R/T nausea and vomiting AEB inability to digest food x 48 hrs •Hopelessness R/T coping with dx of terminal illness AEB verbalization •Self care-deficit (bathing/hygiene) r/t generalized weakness AEB •Ineffective breathing pattern related to obstructed airway AEB •Impaired physical mobility R/T to generalized weakness AEB inability to move in bed
ANA Standards of Clinical Nursing Practice
•American Nurses' Association standards consist of standards of care and standards of professional performance. Standards of care describe competent practice of nursing process. Standards of professional performance depict competent professional behaviors.
Nursing Process Components
•Assessment -Health History and Physical Assessment -Sources of data include; patient, family/significant others, patient record, other health care professionals, and nursing/healthcare literature •Diagnosis •Outcome Identification and Planning •Implementing (the interventions) •Evaluation
Safety Considerations for School-Age Child
•Avoid activities that are potentially dangerous •Provide interventions for safety at home, school, and neighborhood •Teach bicycle safety •Education regarding child abduction •Encourage use of seat belts
Change of Shift Report
•Basic identifying information about each patient •Current appraisal of each patient's health -Changes in medical condition and patient response to therapy -Where patient stands in relation to identified diagnoses and goals •Current orders (nurse and physician) •Summary of each newly admitted patient •Report on patient transferred or discharged
Implement/Evaluate: Teaching Promote Adherence
•Be certain that instructions are understandable and support patient goals. •Include the patient and family as partners in process. •Utilize interactive teaching strategies. •Develop interpersonal relationships with patients and their families.
Defense Against Infection
•Body's normal flora •Inflammatory response:-protective mechanism that eliminates the invading pathogen and allows tissue repair •Immune response -attempts to protect and defend the body from foreign material (antigen) and body makes antibody (IgM with first exposure, then IgG) Signs of Infection?
Writing Outcomes Bad example
•Broad Statements •Improve nutritional status •Decrease pain •Increase self-care abilities
Other Safety Interventions: Restraints
•Can be physical or psychoactive drugs •Regulated by facility specific policy •Unnecessary restraining can violate patients' rights and be construed as assault or false imprisonment •The main reason for using restraints is to prevent patient injuries. •A physician's order is required for the use of restraints •This order must include the type of restraint, duration of use, monitoring criteria, reason for use and removal criteria.
Nurses' Role in Health Care Reform
•Changes taking place in heal care give nurses the opportunity to help shape health care for the future •Nurses are becoming a stronger voice in addressing health-related problems in out nation and proposing solutions •Nurses in greater numbers are increasing their education and becoming APRNs •The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness
Trends to Watch in Health Care Delivery
•Changing demographics •Increasing diversity •Technology explosion •Globalization of economy and society •Educated and engaged consumers •Increasing complexity of care •Costs of health care •Effects of health policy and regulation •Shortages of key health care professionals and educators
Safety Considerations for Toddler/Preschooler
•Childproof home environment •Secure possible sources of poisoning •Be alert to manifestations of child abuse •Properly use car seats
NIC: Oxygen Therapy Part 1
•Clear oral nasal and tracheal secretions as necessary •Restrict smoking •Maintain airway patency •Set up oxygen equipment and administer through heated humidified system •Administer supplemental oxygen as ordered •Monitor position of oxygen delivery device •Instruct patient about the importance of leaving oxygen delivery device on •Periodically check oxygen delivery device to ensure that the prescribed concentration is being delivered •Monitor the effectiveness of oxygen therapy (ABGs, pulse oximetry) *example to show how specific it is
Collaborative Problem
•Clinical problem that cannot be solved by you alone. -Requires medications and treatments -Requires other health care professionals -There is an overlap between medical and nursing diagnoses -You work interdependently with all health team members needed to solve the problem *not on exam
nursing literature data warehouses
•Cochrane Systematic Revi •Cumulative Index to Nursing and Allied Health Literature (CINAHL) •MEDLINE •Web of Science There are also private and public databases
Measures to Reduce Incidence of Hospital Acquired Infections (HAI)
•Constant surveillance by infection-control committees and nurse epidemiologists •Written infection-prevention practices for all agency personnel •Hand hygiene recommendations •Infection control precaution techniques •Maximizing Patient's physical condition •Minimize using invasive medical devices: urinary catheter, venous access catheter, etc....or remove as soon as possible.
Current CDC Guidelines Transmission Based Precautions Plus
•Contact Precautions Plus •Similar precautions to the basic Contact Precautions. -Private room -Gloves -Gown •Used specifically with Clostridium difficile (C. diff.**). •Hand sanitizer does not kill C. diff., so hands must be washed with soap and water when entering or exiting room. •Bleach wipes must also be used in place of the purple-top wipes as these are the only thing that kill C. diff. bacteria.
Current CDC GuidelinesTransmission Based Precautions Contact Precautions
•Contact Precautions—spread by direct or indirect contact •Indirect transmission •Hands of healthcare personnel may transmit pathogens after touching an infected or colonized body site on one patient or a contaminated inanimate object •Patient-care devices (e.g., electronic thermometers, glucose monitoring devices) •Instruments that are inadequately cleaned between pts. •Clothing, uniforms, laboratory coats, or isolation PPE •Used for methicillin-resistant Staphylococcus aureus (MRSA**), vancomycin-resistant (or intermediate-resistant) Staphylococcus aureus (VRSA, VISA), vancomycin-resistant enterococcus (VRE**), and Clostridium difficile (C. diff.**). -Private room -Gloves -Gown if contact with infectious agent likely
Evaluation what is done during revising
•Continue the plan or revise the diagnosis, expected outcomes, or interventions.
Documentation What not to chart
•DON'T DOCUMENT OPINIONS OR BIASED STATEMENTS " Patient is a stupid old man", "Patient is a nasty person who is seeking health care.", "Patient is a smelly....." •DON'T make entries suggesting an error or unsafe practice. "Doctor caused the patient to die" •DO use objective measurable terms. •DO report failure of client to follow treatment regimens & to take medications or receive treatments, & the rationale given by the client
Specialized Care Centers and Settings
•Daycare centers •Mental health centers •Rural health centers •Schools •Industry •Homeless centers •Rehabilitation centers •Parish nursing
North American Nursing Diagnosis Association (NANDA) Definition of Nursing Diagnosis
•Definition: Nursing Diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes that provides the basis for definitive therapy toward achievement of outcomes for which a nurse is accountable (NANDA-I, 2005).
NUR 205 Objectives
•Demonstrate an understanding of organizational structure, mission, vision, philosophy, and values of the College of Nursing and assigned facilities •Describe state and national statutes, rules, and regulations that define and authorize professional nursing practice and other health care professions including scope of practice, education, and licensure •Articulate the need to pursue excellence in practice, lifelong learning, and professional engagement to foster professional growth and development
Outcomes The patient will:
•Demonstrate effective hand hygiene by..... •Identify the signs of an infection on March.... •Consume a minimum of 1500 cal/day by... •Demonstrate proper disposal of soiled articles •Demonstrate stress-reduction techniques •Remain free of symptoms of infection
NUR 205 Objectives Related to Teaching
•Demonstrate the application of beginning nursing care (including psychomotor skills) for efficient, safe, compassionate, and patient-centered care of adults •Demonstrate behaviors consistent with professional nursing practice based on the standard documents of the curriculum •Use professional and therapeutic communication (including written, verbal, nonverbal, and technological) effectively to support safe nursing practice
NUR 205 Objectives The Nursing Process
•Describe state and national statutes, rules, and regulations that define and authorize professional nursing practice and other health care professions including scope of practice, education, and licensure •Demonstrate the application of beginning nursing care (including psychomotor skills) for efficient, safe, compassionate, and patient-centered care of adults
Evaluation
•Determine the client's progress toward the attainment of expected outcomes -Reassess the client -Compare your findings to the expected outcomes -Determine the client's status
Evaluation does what?
•Determine the effectiveness of nursing care
Factors Affecting Safety
•Developmental considerations •Ability to communicate •Sensory perception •Knowledge •Physical health state •Psychosocial health state •Lifestyle (occupation, social behavior, environment)
Role of Nurses in Hospitals
•Direct care providers •Manager of other members of the health care team •Administrator •Clinical nurse specialist •Patient Educator •In-service educator •Researcher
Documentation Formats
•Documentation formats (within types of nursing documentation) are different formats depending on the facility -Source-oriented records (narrative) -Problem-oriented medical records (SOAP) -PIE charting -Focus Charting (DAR or DAE) -Charting by Exception -Case Management Model (critical pathways or variance charting -Computerize Documentation (Electronic Medical Records: EMRs or EHRs)
Environment: Interventions for Home Safety
•Education specific to members of the household (age and development) •Remove safety hazards -Medication/poisons -Clutter -Uneven walkways/stairs -Throw rugs -Frayed electrical cords -Safety classes (CPR, swim) •Utilize assistive and safety devices -Smoke alarms -Seat belts/car -Fire extinguishers -Adequate supervision -Carbon monoxide detectors -Personal protective equip -Grab bars/railings -Raised toilet seat -Adequate lighting -Shower chair
Laboratory/Diagnostic Tests Indicating Infection
•Elevated erythrocyte sedimentation rate (ESR)-Help detect conditions associated with acute and chronic inflammation, including infections, cancers, and autoimmune diseases •Presence of pathogen in urine, blood, sputum, or draining cultures (Gram Stain and Culture and Sensitivity) -Cannot diagnose and treat based on symptoms
Emergency Preparedness
•Environmental Disasters - floods, hurricanes, earthquakes.... •Biological threats - Biological Agents of concern related to Mass Casualties (See page 781 - Table 27-2 Taylor, Lynn, & Bartlett). •Chemical threats - Chemical agents of concern (see page 780 Taylor, Lynn, and Bartlett) •Nuclear threats •Terrorism - Nuclear and Cyber
Institute of Medicine's 4-Tierd Strategy to prevent Medical Errors
•Establishing a national focus •Identifying and learning from errors •Raising performance standards and expectations •Implementing safety systems in health care organizations
Evaluation Types of outcomes
•Evaluation of 4 types of outcomes -Cognitive—Repeat or apply information -Psychomotor—Demonstrate skills -Affective—Observe pt behaviors and conversation -Physiological—Assessment skills to collect and compare data CAPP
Documentation what are the sections?
•Every patient has an EHR/chart and the chart goes with the patient as he/she leaves the floor •The EHR/chart is divided into sections: -History and physical -Nursing admission notes/care plan -Progress notes -Physician orders -Flow sheets (vitals/I & O/assessments) -Lab/x-ray -Nursing notes -Medication records -Other (OR/PT/OT/Resp. therapy/Case Management) *just know that there are different ways of charting. Do not need to know specific like SOAP
Establishing Outcomes Example
•Example: Knowledge deficit related to lack of experience in giving insulin. -Client will know how to correctly inject insulin by discharge (too broad) -Client will state the steps needed to self-administer insulin by discharge -Client will correctly administer insulin to himself by discharge
Interventions to Prevent Transmission
•Examples of Standard Precautions -Hand Hygiene*** -Gloves (body fluids, secretions, contaminated items, open skin) -Mask, eye protection, face shield, gown -Client-care equipment -Environment -Sharps, dressings, linen, etc.
Patient Protection and History of Affordable Care Act
•Expand coverage, control health care costs and improve health care delivery system •Provide Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty, beginning in 2014 •Provide a new way to get health insurance (Health Insurance Marketplace) -Designed to help people more easily find health insurance that fits their budget
Establishing Outcomes
•Expected Outcome; the desirable end result of nursing care. -Includes a subject, verb, performance criteria, target time (possibly a condition) -Must be realistic or achievable -Should be measurable, timed and can be directly observed. -Expected results should be acceptable to the client and be agreed upon (Patient Centered) -Time Frame: Short term- 1hour-1week, Long term- weeks to months.
CMS Hospital Acquired Condition Initiative Part 2
•Falls and trauma --.Fracture -Dislocation -Intracranial Injury -Crushing Injury -Burn -Other Injuries •Manifestations of poor glycemic control •Catheter-associated UTI •Surgical site infection following CABG, Bariatric surgery and certain orthopedic procedures •DVT/PE •Iatrogenic Pneumothorax with Venous Catheterization (CMS, 2013)
Considerations for Successful Patient Teaching
•Forming contractual agreements -Formal and informal •Consider time constraints -Nice to know vs. need to know (what comes first?) •Scheduling -Short and many vs. long and few •Group vs. Individual teaching •Manipulating the physical environment •Promoting Compliance •Effective Communication
Examples of Wellness Diagnoses
•Health Seeking Behaviors (Readiness for enhanced self health management) •Readiness for enhanced nutrition •Readiness for enhanced family process •Readiness for enhanced spiritual well-being •Readiness for enhanced self care
Historical Foundations of the Nurse Educator Role
•Health education has long been considered a standard care-giving role of the nurse. •Patient teaching is recognized as an independent nursing function. •Nursing practice has expanded to include education in the broad concepts of health and illness.
Nurse as Educators Promote the following Outcomes:
•High-level wellness and related self-care practices •Disease prevention or early detection •Enhance recovery time from trauma or illness with a reduction in complication rates •Enhanced ability to adjust to developmental life changes and acute, chronic, and terminal illness •Family acceptance of lifestyle necessitated by illness or disability
Health Care Settings
•Hospitals •Primary care centers •Ambulatory care centers and clinics •Home health care •Hospital at home (higher level) •Extended care •Specialized care centers and settings •Health care services for the seriously ill and dying •Health care agencies
Purposes of the Diagnosing Step
•Identify how an individual, group, or community responds to actual or potential health and life processes •Identify factors that contribute to, or cause, health problems (etiologies) •Identify resources of strengths upon which the individual, group or community can draw on to prevent or resolve problems
Teaching Plans for Older Adults
•Identify learning barriers •Allow extra time •Plan short teaching sessions •Accommodate for sensory deficits • Reduce environmental distractions
Factors Affecting Host Susceptibility Risk for Infection
•Intact skin and mucous membranes •Nutrition •Body's white blood cells •Immobilization •Age related changes predisposing to infection •Immunizations (Double benefit of flu shots: body combats flu by excreting protein to fight it but these proteins accumulate and block blood vessels therefore not only help prevent flu but also may help decrease risk for MI) •Level of fatigue •Stress level •Use of invasive medical devices
Questions to Ponder........ Part 2
•Is health care a right, a privilege, or a obligation of moral society? -If 20 people need a heart transplant and only on heart is available, who decides who gets another chance at life and how should these decisions be made? -Is someone who pays for national television coverage to ask for an organ for one's child any more deserving than someone who has been waiting months for such a transplant
Teaching Strategies
•Lecture •Discussion •Panel discussion •Demonstration •Discovery •Role playing •Audiovisual materials •Printed materials •Programmed instruction •Web-based instruction
Factors Affecting Patient Learning
•Limited time due to rapid discharge •Stress of illness, anxiety, sensory deficits •Support networks •Extent and complexity of needed behavioral changes •Cultural influences •Language barriers •Low Literacy levels •Learning styles
Motivational Interviewing Purpose:
•MI builds upon therapeutic communication techniques and provides specific approaches and principles that enable collaboration with people on treatment decisions with a focus on offering choices rather than prescriptions. It is used for a counseling role which can be long or short term
Prioritize
•MM has lung cancer and is struggling to breathe, nauseated from chemotherapy, too weak to rise from bed unassisted, and aware that he will die in a short time.
Aims of Teaching and Counseling Patient education is the process of influencing the patient's behavior to effect changes in knowledge, attitudes and skills needed to:
•Maintain and promote health •Prevent illness •Restore health •Facilitate coping
Nurse as CounselorGuidelines to Patient Counseling
•Make everyone feel comfortable in the situation and surroundings •Counseling may be formal or informal •Use interpersonal skills of warmth, friendliness, openness, and empathy •Caring is fundamental in the counseling role
Home Health Care
•May be provided through community health departments, visiting nurses' associations, hospital based case managers, and home health agencies •Most rapidly growing area of the health care system •Driven by payment system of reimbursement—early discharge form hospitals
CMS Hospital Acquired Condition Initiative Part 1
•Medicare will no longer pay hospitals when a patient is harmed by one of the listed conditions if it was hospital-acquired: •Foreign object retained after surgery •Air embolism •Blood incompatibility •Stage III and IV Pressure Ulcers •Vascular Catheter-Associated Infection
NIC: Oxygen Therapy Part 2
•Monitor patients ability to tolerate removal of oxygen while eating •Change oxygen delivery device from mask to nasal prongs during meals as tolerated •Observe for signs of oxygen-induced hypoventilation •Monitor for signs of oxygen toxicity and absorption atelectasis •Monitor equipment to ensure that it is not interfering with the patient's attempts to breathe •Monitor patients anxiety related to oxygen therapy •Monitor for skin breakdown from friction of oxygen device •Provide oxygen when patient is transported *example to show how specific it is
Interventions
•Monitoring the client's status •Assisting the client who is partially or fully unable to care for himself •Supporting client's who lack willpower, resilience, or the motivation to care for herself. •Protecting •Sustaining life and physical function
Current CDC Guidelines Transmission Based Precautions •Airborne
•More stringent than droplet precautions because light and stay suspended in the air longer •Used for tuberculosis, varicella and rubeola •Private room with negative air pressure •Respiratory protection (high-efficiency particulate air filter respirator or N95 respirator certified by National Institute for Occupational Safety and Health for known or suspected TB) COVID is airborne precautions
Assessment: Readiness to learn Motivation
•Motivation: -Internal impulse, emotional or physical (pain), that encourages pt. to learn or change behavior Motivation is enhanced when: -Patients view themselves as susceptible to the disease -Patients view the disease as a serious threat -Patients believe there are actions they can take to reduce the probability of contracting the disease -Patients believe that the threat of taking these actions is not as great as the disease itself.
Teaching Process: Example Incomplete Learning Objectives (Outcomes/Goals)
•Mrs. Avery will understand about DM before discharge from the health care facility •On the day before discharge (February 13, 2015), Mrs. Avery will develop a breakfast, lunch, and dinner menu by selecting foods from an American Diabetes Association (ADA) food list that meets the recommended nutritional servings for her prescribed diet.
Nursing Intervention Classification (NIC)
•NIC is a system that is a standardized method of identifying nursing interventions. •NIC was developed at the University of Iowa •NIC uses a standardized language appropriate for computerized client information systems to describe the component of client care that is nursing practice.
Factors Affecting an Organism's Potential to Produce Disease
•Number of organisms• Virulence -organism's ability to overcome the host's defenses and cause disease •Integrity of host immune system •Length and intimacy of contact between host and microorganism
Use of Surgical Asepsis
•Operating room, labor and delivery areas •Certain diagnostic testing areas •Patient bedside -e.g., for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine (keeping the needle of an injection sterile)
Safety Considerations for the Fetus
•Optimize nutrition and healthful environment •Avoid alcohol & other teratogens during pregnancy •Stop or reduce smoking •Avoid unnecessary drug exposure •Avoid pesticides and chemicals
Implementing
•Organize resources •Anticipate unexpected outcomes/situations •Promote self-care: teaching, counseling, advocacy •Assist patients to meet health outcomes
Paying for Health Care
•Out-of-packet payment •Individual private insurance •Employer-based private insurance •Government financing -Medicare: DRGs -Medicaid -Children's Health Insurance Program (CHIP) -Veteran's Health Administration (VHA)
Strategies to Promote Quality of Care
•Pay for performance •Penalties for excess readmissions (sent home someone---> make sure they are actually ready for home)
Age and Developmental (Pedagogy vs Andragogy)
•Physical maturation and abilities •Psychosocial development •Cognitive capacity •Emotional maturity •Moral and spiritual development
Collaborative Care: The Health Care Team
•Physician; physician assistant •Nurse; unlicensed assistive personnel •Physical, occupational and respiratory therapist •Dietitian •Speech pathologist •Social worker •Pharmacist •Chaplin/spiritual care provider *Review Page 258 Taylor, Lynn, & Bartlett (2019)
Health Care Delivery Systems and Care Coordination
•Physicians and hospitals •Multispecialty group practices (higher level specialty hospitals) •Community health centers •Prepaid group practice -Health Maintenance Organizations; Preferred Provider Organizations •Accountable care organizations •Medical homes to medical neighborhoods
Assessment: Ability to learn Factors:
•Physiological factors -Do they have or require assistive devices? -Physical comfort, etc. •Cognitive ability to learn •Developmental considerations •Level of education •Literacy •Communication skills •Primary language •Acuity of senses
Safety Considerations for Older Adults
•Prevent accidents •Orient person to surroundings (avoid falls) •Promote safe environment at home (fire alarms) •Use medication trays (avoid poisoning) •Schedule regular home and vehicle maintenance •Schedule eye exams, and keep noise at a minimum...
Levels of Health Care
•Primary health care (common health problems) --> urgent cares, family practitioner •Secondary health care (more specialized clinical experience)--> hospitals, EDs, surgery units •Tertiary health care (rare and complex disorders) --> medical centers *Page 246, Taylor, Lynn, & Bartlett 2019
Writing A Nursing Diagnoses What abbreviations mean
•Problem •(NANDA label) •Impaired physical mobility + specific problem description •Impaired Physical Mobility: inability to walk •Etiology and AEB •r/t (related factors) •r/t etiology may also have a secondary (2) pathophysiology (she says not to worry about this) •r/t knee-joint stiffness and pain secondary to muscle atrophy •AEB= data supporting DX (what would AEB be?)
Establishing Outcomes
•Problems related to outcome identification and planning -Failure to involve the patient -Insufficient data -Dx developed from insufficient data -Outcomes stated to broad -Failure to write nursing orders clearly -Inaccurate nursing orders -Failure to evaluate and update plan
•TeamSTEPPS: team structure and four teachable-learnable skills Situation Monitoring
•Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning
Strategies to Reduce Health Care Costs/Reimbursement and Regulation
•Prospective payment system: DRGs and RUGs (how long you stay in the hospital--> unnecessary acute care admission--> too expensive) -RUGs: resource Utilization Groups for skilled nursing facilites •Capitation and managed care (maximum insurance will pay) •Bundled payments (pay many different people for a hospital admission) •Rate Setting (MRI may cost something different somewhere else) •Comparative effectiveness analysis (compare outcomes) •Increasing patient cost sharing (do tests on patients that are actually needed to save money)
Other Precautions Isolation
•Protective Isolation—used for immuno-compromised patients (absolute neutrophil count < 1000) -Private room -No visitors who are ill -Visitors must wash hands -No standing water in the room
Documentation Purpose
•Purpose: Accurate documentation of information is essential in order to communicate information to all members of the health team, to ensure legal accountability, and to demonstrate effective use of the nursing process and appropriate standards of care.
Interventions to Promote a Safe Institutional Environment •Electrical Equipment Maintained in Good Working Order and Knowledge of Operating •Know and Review Safety Procedures for Fire and Disaster -Know what to do in case of fire:
•RACE •PASS
Safety Consideration for Adults
•Recognize potential effects of stress and lifestyle on health •Counsel about unsafe ineffective coping mechanisms (reliance on drugs or alcohol) •Counsel about domestic violence •Work place - potential for injury
Types of Nursing Diagnoses Risk for Nursing Diagnoses
•describes human responses that may develop in a vulnerable person, family, or community. The plan is aimed at preventing the problem
Interventions to Promote a Safe Environment (Meade, Bursell & Ketelsen, 2006) •Hourly Rounding
•Rounding every 1-2 hours reduces frequency of call light use, increases patient satisfaction, and reduces fall •Pain level •Toileting •Position changes •Call light and phone in reach •Bedside table next to bed •Ask "Is there anything else I can do for you?" •Inform the pt when the next rounding time is eg.1 hr
Institute of Medicine's 6 Outcomes for the 21st Century Health Care System
•Safe •Effective •Efficient (timely) •Patient Centered •Timely •Equitable (do not have this in the US)
Characteristics of a Continuously Learning Health Care System
•Science and Informatics •Patient-Clinician Partnership (patient must be involved too) •Incentives (incentives for good outcomes) •Continuous Learning Culture (what evidence supports)
Types of counseling
•Short-term •Long-term
Teaching patients with low literacy
•Show pictures •Engage in discussion •Role-play. •Demonstrate •Provide hands-on practice. •Emphasize key points in simple terms and provide examples. •Limit the amount of information in a single teaching session •Reinforce information through repetition. •Teach back!! •Avoid handouts with many pages - use pictures with few simple words instead. •Always be respectful - acknowledge that everyone has something they are not good at. Use a personal example.
Writing Outcomes good example
•Specific Outcomes •Client will gain 5 lbs. by October 31. •Client will rate pain as less that 3 on a 0-10 scale by 10/31 •Client will be able to feed self by the end of the week.
•TeamSTEPPS: team structure and four teachable-learnable skills Communication
•Structures process by which information is clearly and accurately exchanged among team members
Physiologic Hazards Associated With Restraints
•Suffocation from entrapment •Impaired circulation •Altered skin integrity — pressure ulcers •Diminished muscle and bone mass -Recuperation time >>> immobilization time •Fractures •Altered nutrition and hydration •Aspiration and breathing difficulties •Incontinence •Changes in mental status
Manifestation of Infection in immuno-compromised patients •Leukopenia: Low WBC count
•Symptoms can be delayed or absent in this population •Normally low WBC; will only see small rise in white count. •Low grade temperature or very minor rise in temperature.
Teaching Acronym
•T - tune into the patient •E - edit patient information •A - act on every teaching moment •C - clarify often •H - honor the patient as partner in the education process
Safety Considerations for Adolescents
•Teach safe driving skills •Teach avoidance of tobacco and alcohol •Teach risk of infection -body piercing, tattoos and permanent make-up •Teach about guns and violence •Recognize and teach regarding bullying, suicide, illegal drug experimentation
Nursing process vs. Teaching process Teaching process
•Teaching Process -Assess patient -Nursing Diagnosis (DX) -Learning Objectives/ Goals -Develop Interventions (Teaching plan) -Implement -Evaluate
TeamSTEPPS® What does it stand for?
•Team Strategies and Tools to Enhance Performance and Patient Safety
The Joint Commission
•The Joint Commission surveys health care organizations to assess certain dimensions of the organization's performance. The demonstration of these characteristics indicates that the organization is likely to provide high-quality care.
Safety Considerations Throughout Life
•There are inherent risks associated with each stage of development. •These risks are based upon the cognitive and physical changes seen in each developmental stage of life
Patients Rights
•To see and copy their health record •To update their health records •To obtain a list of disclosures •To request a restriction of certain uses or disclosures •To choose how to receive health information
Extended-Care Facilities
•Transitional subacute care •Assisted living facilities •Intermediate long-term care •Homes for medically fragile children •Retirement centers •Residential institutions for mentally or physically disabled •Aging in place
Interventions to Promote a Safe Institutional Environment
•Utilize Proper Lifting Technique to Prevent Back Injuries -Safe-lifting/handling policies -Lift Teams -Technologies and Equipment
Strategies to Reduce Health Care Costs/Changes in Care Delivery
•Utilizing quality improvement tools to reduce waste ad improve safety •Improving transitions across settings •Making the delivery of medical services more efficient and less costly •Eliminating unnecessary costs such as fraud and abuse •Improving population health (health promotion)
Evaluation -Assessment
•Was assessment accurate & thorough?
Evaluation -Diagnosis
•Was the diagnosis derived from the data & did it accurately identify the problem?
Evaluation -Planning
•Were expected outcomes measurable, realistic?
Assessment: Learning strengths
•What is the patient's best learning style -Reading, demonstrate then re-demonstrate, etc. •High motivation -Do they want to learn? •Strong network of support? •Successful learning in the past
Teaching Process: Learning Objectives (Outcomes/Goals) performance
•What the patient will do/what is expected
Elements of an Intervention When, where, how
•When; refers to the time that care is delivered or the sequence of events required •Why; provides the rationale for care and includes evidence that the care will meet the client's needs •How; defines the methods of interventions
Trends
•expanding scope and depth of nurses' practice responsibilities •consumers demanding more knowledge and skills for self-care •demographic trends influencing type and amount of health care needed • recognition of lifestyle related diseases which are largely preventable •health literacy increasingly required •advocacy for self-help groups
Trends Affecting Health Care Social, economic, and political forces that affect a nurse's role in teaching:
•growth of accountable care organizations and the patient centered medical home •increased attention to health and well-being of everyone in society - shift to PHC focus •cost containment measures to control healthcare expenses
TeamSTEPPS® is an evidence-based teamwork system aimed at optimizing patient care by:
•improving communication •improving teamwork skills among health care professionals, including frontline staff
Components of a Nursing Diagnosis Related Factors (r/t):
•states what is causing or contributing to the Nursing Diagnosis (what the nurse can treat)
