Nursing fundamentals exam 3
5 right of Clinical Reasoning
***** Right cues Right action Right patient Tight time Right reason
Steps in Concept Mapping
1. Collect patient problems and concerns on a list. 2. Connect and analyze the relationships. 3. Create a diagram. 4. Keep in mind key concepts: the nursing process, holism, safety, and advocacy
Improving Healthcare system
Access to Healthcare Quality and safety Affordability Tele Health is making healthcare more assessable
community-based nursing
Acute and chronic care of individuals and families to strengthen their capacity for self-care and promote independence in decision making. need to have strong
Community Based Nursing
Acute and chronic care of individuals and families to strengthen their capacity for self-care and promote independence in decision making. - home health community heath center, patient home long term health centers 30% of all nurses Need to know resources
Nursing history
Assess for history of falls or accidents. Note assistive devices. Be alert to history of drug or alcohol abuse. Obtain knowledge of family support systems.
physical examination
Assess mobility status (BMAT) Assess ability to communicate Assess level of awareness or orientation Assess sensory perception Identify potential safety hazards Recognize manifestations of domestic violence or neglect
Five steps of the nursing process
Assessing- database, validate and communicate data Diagnosing- interpret and analyze data, identify strengths and weaknesses Outcome and planing- outcome developments, identify appropriate interventions Implementation- carry out plan, collect data and document Evaluation- measure outcome, determine whether met or not met or partially met goals
Nurses' Role in Health Care Reform
Changes taking place in health care give nurses the opportunity to help shape health care for the future. Nurses are becoming a stronger voice in addressing health-related problems in our nation and proposing solutions. Nurses in greater numbers are increasing their education and becoming APRNs. The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness.
Collaborative practice and Care coordination across settings
Community based nurse- home health community, health centers, patient home, long term healthcare centers 30% of nurses work in community based and need to know resources available to them Community Health nurse is about statistics as a whole community
ANA professional standard- Leadership Qualities
Contributes to environment, supports and maintains respect, trust and dignity Encourages Innovation- in practice and role performance to attain a personal/professional plans, goals and vision Communication- to manage change and address conflict Mentors- colleagues for the advancement of nursing practice and profession to enhance safe, quality healthcare Accountability- retains accountability for delegated nursing care Contributes to evolution- of the profession through participation in professional organizations Influences Policy- to promote health
Later adult years 65+
Ego integrity vs despair- change in productivity goals and evaluation of success, development of wisdom adjusting to decreasing physical status and health; adjusting to retirement
life changes in middle years
Employment Relationship with a spouse Relationships with adult children Relationships with aging parents Midlife transition
Democratic
Ensuring that all people have the same rights
Benefits of regular exercise in older adults
Exercise improves physical strength, overall stamina, mood, and mental health.
Trends and Issues in Health Care Delivery
Focus more on preventative care Knowledgeable and engaged consumers mobile Health
Theories of development #1
Freud- theory of psychoanalytic development unconscious mind the ego superego Piaget- theory of cognitive development how and what stages you go through Erickson- theory of psychosocial development
Factors Influencing Growth and development
Genetic history Prenatal, individual, and caregiver factors Environment and nutrition Health-illness state Culture
The Aging adult theories of aging
Genetic- genes control genetic clocks immunity- focuses on the functions of the immune system Cross-linkage- chemical reaction produces damage to DNA and cell death nuero endocrine plays huge role in T cells free radical- molecules with separated high energy electrons have adverse effects on adjacent molecules ex higher incidents of cancer if using high 02 and not needed cause free radicals
Patient Care Coordination
Goals and priorities Evaluate goals Establish timeline Evaluate success or failure- able to accomplish or not able to improve Use results
Reflection in action
Happens in the here and now of the activity and is also known as thinking on your feet
Reflection for action
Helps the person to think about how future actions might change as a result of the reflection.
Factors contributing to falls
Intrinsic factors: -Reduced vision and hearing -Unsteady gait -Cognitive impairment -Acute and chronic illnesses -Effects of medication Extrinsic factors: -Lack of support equipment in the bathtub and at the toilet -Height of the bed -Floor conditions -Poor lighting -Inappropriate footwear -Improper or inadequate assistive devices Falls in young-old and more healthy old occur related to external reasons With increasing age and comorbid conditions, internal and locomotor reasons more likely age is non-modifiable
Incorporating principals of growth and development #1
Knowing the stages of cognitive, psychosocial, moral and spiritual development aware of whatever stage patient is in you educate them at that level
Knowledge Base
Knowledge sources transitional authoritative scientific Knowledge competencies cognitive technical interpersonal ethical/legal
Interpersonal Collaboration
More than just teamwork Mutual respect and shared values with all members of healthcare team know your role and role of others on your team effective and responsive communication Build relationships
Changes of Older Adulthood
PHYSICAL- weight and height loss, decline in vision and hearing COGNITIVE- diseases, dementia, Parkinson's, depression SOCIAL- death of loved ones, loss of income, declining self esteem
The home visit
Pre-entry phase nurse collects patient data Nurse reviews the data and scheduled visits Nurse evaluates safety issues ex. stairs unsanitary Entry Phase- nurse identifies needs and determines interventions nurse teaches the patient and caregivers documents care given in the home
Allocation of Resources
Primary- We don't focus enough on primary Secondary- immunizations Tertiary
Tools used for risk screenings
STEADI tool Morse fall skill- most used basic mobility assessment tool BMAT
Access to healthcare
Services that preserve and promote health and wellbeing through prevention, diagnosis, management and treatment of illness.Lack of healthcare may delay or inhibit diagnosis and treatment due to lack of health literacy, cultural influences, language barriers, socioeconomic status or gender/methodology of doctor. A problem is uninsured individuals, shortage of providers
access to healthcare
Services that preserve and promote health and wellbeing through prevention, diagnosis, management and treatment of illness.Lack of healthcare may delay or inhibit diagnosis and treatment due to lack of health literacy, cultural influences, language barriers, socioeconomic status or gender/methodology of doctor. CDC in 2018 reports 30.4 million of all ages are uninsured
Considerations When delegation Nursing care
State practice act Clients condition Complexity of the activity Potential for harm Predictability of outcome Other client Needs Capabilities of the UAP
Safety Considerations for Adolescents
Teach safe driving skills. Teach avoidance of tobacco and alcohol. Teach risk of infection with body piercing. Teach about guns and violence.
Safety, security, and emergency Preparedness
Terrorism Pandemics restraints Home safety evaluations
Leadership skills
The ability to guide or direct the actions of others commitment problem solving trust respectful accessibility Empathy- willing to listen and care about what is happening on the unit floor. Help Responsibility take note on what is needed on the unit and what the colleagues need
The case manager works in a facility that supports a participative leadership style. Which action should the nurse recognize as an example of democratic leadership style? The nurse implementing the physician's written orders for client care The unlicensed assistive personnel (UAP) taking vital signs for several nurses The dietitian completing a nutritional assessment for a registered nurse (RN) The interdisciplinary health care team collectively developing plans of care for clients
The interdisciplinary health care team collectively developing plans of care for clients
The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate? The medical practice act website A nurse mentor or a nurse preceptor A more experienced nurse working on the same unit The nurse practice act or facility's policy and procedures
The nurse practice act or facility's policy and procedures
Laissez-faire
a policy or attitude of letting things take their own course, without interfering.
Autocratic
absolute in power or authority
Transactional Leadership Style
based on maintaining control by rewarding good behavior and punishing negative or detrimental behavior
Elder Abuse and Neglect
estimated 10% of adults 60+ who live in the community are abused Victims most likely to be women young-old, lower income, or isolated, with a lack of social support Elder abuse includes physical, sexual psychological and emotional abuse, financial abuse or exploitation and neglect
Transformational Leadership
leadership that generates awareness and acceptance of a group's purpose and mission and gets employees to see beyond their own needs and self-interests for the good of the group
Care coordination Ring
meets patients needs and preferences in of high quality , high value care
Laisses-Faire Leadership
the leader relinquishes all power to the group
restraints
to physically restrict voluntary movement or use chemicals to revise/restrict resident behavior
leadership qualities
visionary critical thinker role model knowledgeable political awareness flexibility
safety event report (incident report)
-Must be completed after any accident or incident in a health care facility that compromises safety -Describes the circumstances of the accident or the incident -Details the patient's response to the examination and treatment of the patient after the incident -Completed by the nurse immediately after the accident -Primary concern is the patient's well being -Disclosure to patient - check agency policy -Not a part of the medical record
promoting safety across lifespan
-Observation or prediction of potentially harmful situations so that harm can be avoided -Client education that empowers clients to protect themselves and their families from injury toddlers enter a stage of autonomy promoting exploration, often curious and independent have desire to things by themselves discipline helps toddlers learn inner control and understand limits Cognitive development can be promoted by allowing the toddler the opportunity to observe and imitate they usually love mimicking older siblings
Maintaining Emergency Preparedness
Addressing biological threats Addressing chemical threats Addressing radiation threats Addressing cyber terror Preparing for mass trauma terrorism Identifying disaster resources Addressing psychological aspects of disasters
Errors in decision making process
Bias failure to consider total situation Impatience
Causes of Accidental Injuries in Older Adults
Changes in vision and hearing Loss of mass and strength of muscles Slower reflexes and reaction time Decreased sensory ability Combined effects of chronic illness and medications Economic factors
Mental Impairment in Older Adults
Dementia Alzheimer disease Sundowning syndrome Cascade iatrogenesis
A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style? Autocratic Democratic Laissez-faire Transformational
Democratic
blended competencies of nursing
Developing Cognitive Competencies ➢Critical thinking ➢Nurses need to be independent thinkers
Factors affecting safety
Developmental considerations-each level has own set of risk Lifestyle recreational hobbies Mobility Sensory perception Knowledge Ability to communicate Physical health state Psychosocial health state
A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify? Directive leadership Participative leadership Shared governance Institutional governance
Directive leadership
ISBARQ method of patient hand-off
I - Introduction S - Situation B - Background A - Assessment R - Recommendation Q - Question and answer CUS I am concerned, I am uncomfortable I don't feel safe
Safety Considerations for Older Adults
Identify safety hazards in the environment. Modify the environment as necessary. Attend defensive driving courses or courses designed for older drivers. Encourage regular vision and hearing tests. Ensure hearing aids and eyeglasses are available and functioning. Have operational smoke detectors in place. Objective document and report any signs of neglect and abuse.
The Big Picture
Institute of Medicine (IOM) safe effective efficient Patient centered timely equitable
Moral and Spiritual Development of Older Adults
Kohlberg: Older adults have completed their moral development and most are at a conventional level. Spiritually, an adult may be at an earlier level, often at the individuative-reflective level. Many adults demonstrate conjunctive faith and trust in a greater power. Self-transcendence is characteristic of later life. most return to spirituality becomes their strength
Common Myths of the Older Adults (Ageism) 65+
Old age begins at 65 years. Most older adults are in long-term care facilities. Older adults are sick, and mental deterioration occurs. Older adults are not interested in sex. Older adults do not care how they look and are lonely. Bladder problems are a problem of aging. Older adults do not deserve aggressive treatment for illnesses.
DAME
Part of the fall risk scale for older adults D- drugs and alcohol A- age related issues M- medical issues E- environmental causes
QSEN competencies
Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics
Administrative Structure
Person whom you have concern with Nursing supervisor Nursing director Determine ladder of facility
Development of the Older Adult
Physiologic: all organ systems undergo some degree of decline, body less efficient Cognitive: does not change appreciably, may take longer to respond and react Psychosocial: Self-concept is relatively stable throughout adult life. Disengagement theory: An older adult may substitute activities but does disengage from society. Erikson: ego integrity versus despair and disgust; life review Havighurst: major tasks are maintenance of social contacts and relationships
Goal of nursing care in older adults
Promote independent function. Support individual strengths. Prevent complications of illness. Secure a safe and comfortable environment. Promote return to health. ADLs huge helps to return to a normal baseline
Assessment Tool: SPICES
S: Sleep disorders. P: Problems with eating or feeding. I: Incontinence. C: Confusion E: Evidence of falls. S: Skin breakdown.
Use of restraints
SHOULD ONLY BE USED AS A LAST RESORT AND USED ONLY WHEN ALL OTHER REASONABLE ALTERNATIVES FAIL. RESTRAINTS ARE A TEMPORARY MEANS OF ENSURING SAFETY. HEALTHCARE ORDER IS REQUIRED IN ALL CASES provider must rewrite order q24hours
Making decisions
Trial and error= no Scientific Data Intuitive problem solving Clinical thinking-intuitive, logical or both Creative thinking approach things logically using the nursing process
Heath care setting
Variety of settings (e.g., hospitals, medical clinics, home health agencies, HMOs, PPOs) HMOs have been most receptive to hiring
care coordination
a set of activities purposefully organized by a team to facilitate the appropriate delivery of the necessary services and information to support optimal health and care across settings and over time Aimed at reducing cost
Development task of middle adult hood 40-65
accept and adjust to physical changes reflecting and asking did i do ok maintain a satisfactory occupation assist children to become responsible adults adjust to aging parents relate to ones spouse or partner as a person physiologic- gradual internal and external physiologic changes occur Cognitive little change from young adulthood (decrease in motivation to learn) Psychosocial- time of increased personal freedom, economic stability, and social relationships also more strain from relationships
Improving the Healthcare System
access to healthcare quality and safety affordability Who should have healthcare and at what cost?
Quality and Safety Education for Nurses (QSEN)
addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments we need to help drive healthcare
AMA
against medical advice- nurses should try and explain the risk involved in leaving (AMA)
basics for teaching plan for older adults
aging is a norm process, and chronic illness is a pathologic process, but both often occur at same time Meeting expenses of health care is often difficult- med cost, hospitalizations, and cost of special equipment and supplies Family members must learn to cope with needs of the ill person Family must adapt to psychological stressors Ask the 3 questions why is it important why do i need this
Leading cause of death in middle adulthood
cancer and cardiovascular disease unintentional injury poisoning motor vehicle accidents and falls diabetes COPD stroke Cerebrovascular causes
Blending competencies
cognitive technical interpersonal ethical/legal What resources to carry with you Can always tap into other ppl on unit more experience nurses. Think about potential problems common problems working with faulty conceptions allow bias color your thinking, base experience on 1 single experience need to go beyond that critically think beyond it. If you're asked to do something without knowing how look it up in policies and procedures to protect you. Policy and Procedure need to we where we looking Cluster of data in chart that led you to believe whats going on
Clinical reasoning Model
consider pt situation Collecting cues and info then process the info Looking for clusters of info to see what the situation is Inferences using subjective info and inferring about what is going on go in with à open mind Look collect are you getting the situation right TRENDS look into it Decide is this a problem Are you going to monitor more closely Reflect and say did we get it right Beginning for us to think about all info going on and connect the dots
middle adult years (40-65)
generativity vs stagnation- establish of career, relationships, family, and societal engagement; development of care achieving social and civic responsibility; accepting and adjusting to physical changes
Principals of growth and development
growth is orderly, development includes physical, cognitive, psychosocial, individual differences, critical periods continuous and complex follow regular and predictable trends are both differentiated and integrated aspects occur at diff stages and rates, and can be modified pace is specific for each person
Concepts of Growth and Development
growth- an increase in body size and changes in the body cell structure, function, and complexity Development- an orderly pattern of changes in structure, thoughts, feelings or behaviors resulting from maturation, experiences and learning
Reflection on action
occurs after the fact and involves thinking through a situation that has occurred in the past
Reflective practice
occurs when the caregiver has a profound awareness of self, and one's own biases, prejudgments, prejudices, and assumptions, and understands how these may affect the therapeutic relationship
Development of the adolescent
peer relationships are particularly influential during adolescent babysitting offers an opportunity of practice formal adult skills Development of self identity in adolescence involves talents and becoming emotionally independent A primary development task of adolescence is to achieve new and more mature relationships
Promoting safety across lifespan preschoolers ages 3-6 school aged children
play involves development of skill, games with rules and competitive activities school aged children are aware of and understand sequence of events making friends is important to school aged children
Safety considerations for middle adults
remind them of effects stress on lifestyle and health Counsel about unsafe health habits Counsel about domestic violence - phone accessible car keys and gas tank full copies of important paper work children able to call for help have evidence of abuse
Institute of Medicine (IOM)
safe, effective, patient centered, timely, efficient and equitable medical care
Health problems in the middle adult
subject to physical and emotional health problems associated with lifestyle behaviors along with family histories, and environmental factors. -recovery takes longer RA, OBESITY, ALCOHOLISM AND DEPRESSION CARDIOVASCULAR DISEASE
Role of nurse promoting health in middle adulthood
teach the dangers of substance abuse, smoking and alcoholism eating a low in fat diet and cholesterol teach importance of regular exercise. Health screenings colonoscopy q10 years physical examinations q1 year <50 bone density exam
housing options for older adults
•Home modifications •Homesharing •Accessory apartments •Elderly cottage housing opportunities •Senior retirement communities •Continuing care retirement communities •Assisted living- comes in and and helps them live on own •Board and care homes; nursing homes •Adult family and group homes Long term care facilities 66000 yearly medicare will only cover small portion
personal attributes
•Open minded •Value of person •Self awareness and knowledge •Personal responsibility •Motivation •Leadership skills •Bravery Value person, dont be closed off, listen to patient and family, Own your personal responsibilities
Collaborative Care: the Health Care team
•Physician; physician assistant •Nurse; unlicensed assistive personnel •Physical, occupational, and respiratory therapist •Dietitian •Speech therapist •Social worker •Pharmacist •Chaplain/spiritual care provider PT works on muscle and skeletal OT- Help person be as independent as possible, ADLs (activities of daily living) To speak with collaborative care don't need doctors order but to get a consult you will need a DR order.
6 primary leadership styles
-Autocratic leadership democratic leadership -laisses-faire leadership -quantum leadership -transactional leadership -transformational leadership
Discharge planning needs
-Lack of knowledge of the treatment plan -Social isolation -Recently diagnosed chronic disease -Major surgery -Prolonged recuperation from major surgery or illness -Emotional or mental instability -Complex home care regimen -Financial difficulties -Lack of available or appropriate referral sources -Terminal illness know what they may need when they go home Who does your grocery shopping Do you have food at home want to start dc planning right away so you get case manager on board
Paying for HealthCare
-Out-of-pocket -individual private insurance -employer-based private insurance -Government Financing (medicare, medicaid, chip, veterans) medicare-65+, dialysis qualify for medicare Medicaid- disabled covered through DSDI low social economics
Conflict Resolution Strategies
-open communication among staff is needed -de-escalate the situation with open communication and problem-solving strategies -use "I" statements -listen carefully to what other people are saying, try to understand their perspective -move conflict that is escalating to private location -share ground rules
A nurse manager has asked the staff to create a plan to improve patient outcomes. In the past, the staff have not met deadlines. How can the nurse manager use transactional leadership style to ensure that the deadline is met? Ask politely. Demand efficiency. Give extensions as needed. Offer 2 days of paid vacation.
Offer 2 days of paid vacation.
Care Coordination
coordination of services provided to patients before they enter a health care setting, during the time they are in the setting, and after they leave the setting •Health care providers and hospitals •Multispecialty Group Practice •Community health center •Prepaid group practice •Accountable care organizations •Medical homes to medical neighborhoods
On a medical unit, the nurses complain that they have no voice in the decisions that are made in the operation of the unit. The nurses state they are always told by the nurse manager to perform tasks instead of being asked. Which of these best describes the leadership style of the nurse manager? Autocratic Democratic Laissez-faire Nondirectional
Autocratic
The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care? Higher nurse retention Longer patient stays Better patient outcomes Improved job satisfaction scores
Better patient outcomes
Care transitions Hospital; to patients home or to a skilled nursing facility and sometimes back to hospital
Care Coordination nurses responsibility so patient receives the right care, at the right time in the most cost effective manner, by the right person in the right setting
care coordination
Care transition: a continuous process in which a patient's care shifts from being provided in one setting of care to another Central responsibility of all health care professionals, and especially nurses Aim: Link patients with resources in the community to enhance their well-being Improve information exchange Reduce fragmentation and duplication of services
Care Transitions and nurses role during these transitions
Care transitions is a continuous process in which a patients care shifts from being provided in one setting of care to another- poorly managed can diminish health and increase cost
Nurse role in minimizing use of restraints
Educate nurse, nursing students, unlicensed personnel, other members of the interdisciplinary team, and family caregivers on the appropriate use of restraints and seclusion, and on the alternatives of these restrictive intervention. Ensure sufficient nursing staff to monitor and individualized care with the goal of only using restraint with no other visible option available. Ensure policies and environment support services are in place to provide feasible alternatives to physical and chemical restraints. Move progressively toward a restraint free environment while providing a therapeutic sanctuary for all. Enforce documentation requirements and education about what should be documented. Explore the ethical implications overstraining patients with nursing students and discussed the need for institutional policy that clarifies when, where, and how patients are to be restrained and monitored while restrained. Be aware of implications of allowing the application of restraints in healthcare settings. The nurse administrator should make consultation available to nurses, including ethical consultation about decisions to restrain. Develop clear policies on accepted national standards to guide decision making regarding restraints.
preventing errors during care transitions
Huge this is when most errors or miscommunication happen Teaching is priority at admission Admitted through er or direct admit Help flow of ed and get pt to floor in timely manner get in chart look at patient so what that nurse is telling you matches the chart if a home admission or er so you know what to expect when you get them Make sure room is ready to land pt especially if on o2 suction 0 the bed this matters so we have right base line hight and weight important bc pharmacy wont give meds until in See pt as soon as on floor heath admission health profile do you use walker and assisted device o2 at home Done within 24hrs of patient getting in to pt profile Key medication reconciliation most accurate med history of patient Most accurate info doses meds when when you last take them Do you take your meds as prescribed they might not for many reasons cost saving measures or makes them sick Do med reconciliation on any transmission from admitting to home if patient in ICU down grades to tele do another med reconciliation
A registered nurse serves as the chair of the Nursing Practice Committee for the hospital. The meetings of this committee do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chair's leadership style could be most accurately termed what? Laissez-faire Decentralization Democratic Autocratic
Laissez-faire
Medicare
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government. For more information regarding Medicare and its components, please go to http://www.medicare.gov.
If a restraint is deemed necessary for safety, what is the nurses role in terms of ensuring the client safe use of the restraint?
Nursing interventions may be used to reduce confusion or agitation and provides safe environments.
Leaving AMA (Against Medical Advice)
Patient is legally free to leave. Choice carries a risk for increased illness or complications. Patient must sign a release form. Patient is informed of risks prior to signing form. Patient's signature must be witnessed. Form becomes part of medical record. Anyway confused cant leave just want out of there with sound mind we have to legally let them leave Should understand leaving carries risk and complication Have to sign AMA release form any they are signing they understand the risk and have it witnessed
Planned Change an 8 step process
Recognizing- symptoms that indicate a change is needed and collect dATA Identifying- the problem to be solved through a change Determining/analyze-alternate solutions to the problem select a course of action from possible alternatives Plan- for making a change Implement- the selected course of action to effect the change Evaluate- the effects of the change Stabilize-the change
Patient referrals
Referring the patient to another facility of physician when further treatment or testing is necessary good for 60 days reassessed after to continue or discontinue
Care transitions
Refers to the movement of patients between health care locations, providers, or different levels of care within the same location as their conditions and care needs changes. Admission transfer discharge Medication reconciliation done at all stages of care transition Most errors happen during care transitions(miscommunication)
RACE
Rescue anyone in immediate danger Activate fire code system and notify appropriate person Confine the fire by closing doors and windows Evacuate patients and other people to a safe area
Health Care for seriously ill and dying
Respite care- primarily for person providing care to loved one and caregiver needs a break Hospice services- less than 6 months to live to qualify for hospice, to help free patient of pain and provide comfort, and die in dignity Palliative care- multiple conditions, death isn't soon but need help managing health conditions to live a quality life with the condition
A nurse manager best demonstrates effective leadership characteristic by which action? Being very structured and rigid with the unit flow Knowing all information about the unit processes Indicating an interest in becoming a role model Sharing a vision for the unit and enlisting support
Sharing a vision for the unit and enlisting support
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? The complexity of the activity, age of the UAP, and predictability of the outcome Predictability of the UAP, the amount of time required for the task, and RN's skill level The stability of the patient's condition, potential for harm, and complexity of the activity The context of the other patient needs, the desired outcome, and autonomy of the patient
The stability of the patient's condition, potential for harm, and complexity of the activity
Blended Competencies, clinical reasoning and processes of Person centered Care
about you starting to develop self as nurse with clinical reasoning by the Process of reflection. get over own bias judgement Open honest openly able to reflect on yourself Use own judgement constantly reflect on experience
democratic leadership
also called participative leadership, is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. Participants are encouraged to develop their skills and strengths within the group. The group and leader work together to accomplish mutually set goals and outcomes. As professionals, nurses generally respond well to this style of leadership when they are the followers and feel more comfortable when they are the leaders of democratic groups. Group satisfaction and motivation are excellent benefits of this style. In situations in which a rapid response is essential, however, a democratic approach to leadership that requires gathering the input of team members may slow decision making.
Continuity of care
coordination of services provided to patients before they enter a health care setting, during the time they are in the setting, and after they leave the setting Really important SBAR- detailed accurate when hand off important tool is SBAR When were transferring pt to diff care communication is critical
Reliable Care Accountability Matrix (RCAM)
created to define the critical core clinical processes for eight specific domains of quality outcomes and define expectations for standard practices 8 KEY AREAS OF MEASUREMENT ARE Mortality Readmissions Length of stay LOS Hospital consumer assessment of healthcare providers and systems (HCAHPS) Hand Hygiene Prevention of C-diff Surgical site infections Catheter- associated urinary tract infections (CAUTIs) Only warm water and soap clean off spores and equipment must be cleaned with bleach Clean Cath 2x a day Every unit has secret shoppers to watch hand hygiene go in clean hands come out of room wash hands
adolescent to adult years
genital stage- reaching full sexual maturity identity vs role confusion (adolescence)- exploration for personal identity and sense of self; develop fidelity Intimacy vs isolation( young adult)- develop happy relationships and a sense of commitment, safety and caring; develop love achieving gender- specific social role; achieving emotional independence; acquiring a set of values and an ethical system to guide socially responsible behavior; preparing for marriage, family and a career
Change Theory
guides the development of health interventions UNFREEZING-> MOVING-> REFREEZING 1st stage unfreezing- of change 2nd stage- moving change 3rd stage- refreezing the good change
autocratic leadership
involves the leader assuming control over the decisions and activities of the group. It is often an efficient process, yet many people may resent this leadership approach when used regularly. Staff and team members have limited opportunity to contribute suggestions and participate in organizational decisions. High staff turnover and burnout are more common with this style of leadership.-
Medicaid
is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.
Care coordination definition
is the deliberate organization of patient care activities between two or more participants, including patient, involved in inpatient care to facilitate appropriate delivery of healthcare services. often managed by the exchange of info among participants responsible for diff aspects of care
Developing Leadership Responsibilities
mentorship preceptorship nursing organizations continuing education
Patients-centered care
occurs when actions and processes are directed toward reducing or eliminating patient vulnerabilities. the ability to meet needs in a caring and attentive manner), individuation (the ability to personalize care according to the patient's feelings, preferences, and desired level of involvement), coordination (the ability to promote communication among other nurses and the patient) proficiency (the ability to provide knowledgeable, skillful nursing care). These interventions are consistent with and similar to the processes identified in Hobbs' conceptual model. The desired health outcomes were trust in nurses (the patient's confidence that the care was appropriate, reliable, and as successful as possible) authentic self-representation (the patient's sense that he or she has shared authentic, truthful information about him or herself), optimism (the patient's beliefs that he or she has made appropriate treatment choices and is hopeful about treatment outcomes), sense of well-being (the patient's positive emotional state).
Preschool to early school years
phallic stage- resolving oedipal/electra complex Proportional stage- increase language, understanding of life events and relationships Initiative vs guilt- develop of interpersonal skills thorough activities with others; develop purpose Learning sex differences; forming concepts; getting ready to read
personal attributes a nurse needs to begin to develop to promote clinical reasoning skills
Clinical reasoning - term usually referring to ways of thinking about patient care issues (determining, preventing, and managing patient problems); for reasoning about other clinical issues (teamwork, collaboration, and streamlining workflow); nurses usually use critical thinking. Open mindedness- this may also be termed humility. Are you open to learn what your patience, families, and colleagues have to teach you? A profound sense of self of the value and person- do you believe that everyone, literally everyone, matters? Can you think of anyone who deserves less than your best care effort? Are you willing to go to bat for the most vulnerable in our midst? Are you committed to learning how to advocate for these not well served by today's health care system? Self-awareness and knowledge of your own beliefs and values- Do you know what you believe, why you believe it, and the consequences of your belief? Are you sensitive to how your beliefs and values influence your professional relationships? A sense of personal responsibility for your actions- At the end of the day, will people (your patients and team) be better because of their experiences with you? Are you committed to using your personal expertise, or time and power to coordinate all care for patients and family's needs?Motivation to do what you do to the best of your ability because you care about the well-being of those entrusted to your care- Does love get you up and motivate your study and practice? Do you want to be the person best for those who will count on you? Leadership skills- have you tried to use your influence to help others attain valued goals? Are you committed to using leadership strengths with patients, families, and colleagues to achieve valued health goals? Bravery to question the system- When the care plan isn't working for a patient on your I'm environment is interfering with your ability to give good care, are you willing to challenge the status quo, and can you do this effectively?
school years
Concrete operational stage- develop logical thinking; incorporates others perspectives; uses abstract thinking and deductive reasoning; test beliefs to establish values Formal operational stage- adopts life guiding values or religious practice Industry vs inferiority- self esteem based on feedback from others; develop competence Learning physical skills; learning to get along with others; developing conscience and morality; developing fundamental skills in reading, writing and math develop concepts related to everyday living; achieving personal independence; attitudes toward social groups, institutions and toward oneself
Collaborative practice
what happens when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care
Allocation of resources
where should our healthcare dollars be spent? Need to focus more on preventable care than secondary and tertiary-----> costly can be prevented using primary care. If more people were insured they would use primary care to manage illness it can prevent having to go to er or hospital stays
Magnet Hospitals
• Recognized by ANCC • Measure the strength and quality of nursing • Where nursing delivers excellent patient outcomes, have a high level of job satisfaction, low staff nurse turnover, appropriate grievance resolution • Indicated nursing involvement in data collection and decision making in patient care • Value staff nurses all about improving nursing care
What are some problem solving strategies nurses use to make patient-centered decisions, what are benefits and risk, and what is QSEN and why is it important to helping develop clinical reasoning skills
The QSEN competency emphasizes recognition of the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients' preferences, values, and needs. KSA K- integrate understanding of multiple dimensions of person-centered care; Patient, family, and community preferences and values: coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity. S- Elicit patient values, preferences, and expressed needs as a part of the clinical interview, implementation of care plan, and evaluation of care. A- Value seeing health care situations "through the patients' eyes".
Community Health nursing
The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations uses statistics as a whole community
Reasons for resistance to change
Threat to self Lack of understanding Limited tolerance for change Disagreements about the benefits of change Fear of increased responsibility
HEalth care and delivery system
complex, dynamic, constantly changing; past 10-15 yrs managed care, primary care provider; services provided by a wide variety of licensed/ non-licensed staff
health care delivery system
complex, dynamic, constantly changing; past 10-15 yrs managed care, primary care provider; services provided by a wide variety of licensed/ non-licensed staff
Clinical reasoning, judgement, and decision making
is the process for analyzing a situation, making a judgment, deciding on possible alternative reasons, and choosing an action to be taken. It is built on a foundation of knowledge, experience, and the personal attributes of the person doing the reasoning. Critical thinking is fundamental in the process of clinical reasoning. Care can become ritualistic and depersonalized when nurses fail in clinical reasoning.
Role of nursing manager
is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families.
quantum leadership
moves beyond the traditional modes previously experienced by all levels of workers; spawned by the impact of the information age on work and the worker
Reflective practice leading to personal learning
occurs when the carrier has a profound awareness of self; awareness of one's own biases, prejudgments, prejudices, and the assumptions; and understands how these may affect the therapeutic relationship. The awareness is developed through the process of reflection, thinking back on what has occurred for the purpose of learning in order to improve.
infancy and toddlerhood
oral stage- focus on sucking biting chewing and swallowing anal stage- focus on bowel bladder control, anus becomes the center of gratification Sensorimotor stage- basic reflexes, develop more than one thought at a time; begins to reason and anticipate events Trust vs mistrust- uncertainty; develop hope Autonomy vs shame and doubt( toddler)- exploration of the limits of abilities; develop of will- Learning to talk, to walk, to control bowels
Quality and Safety Education for Nurses
prepare nurses so they can continuously improve the quality and safety of the health care systems within which they work Right care for right person at the right time 44000-98000 people die from preventable medication errors
ANA professional standards
standard 11 Leadership -contribute to environment -encourage innovation -communicates -mentors= new nurses/co-workers -accountability -contribute to innovation -influences policy
Nurses can make a difference in Health care Policy and Reform
staying informed about current issues and pending legislations write/email members of congress to support legislation to improve nursing and patient care belong to and participate in nursing organizations document outcomes of nursing care and develop a database to influence heath-care cost and quality of care participate in efforts to design and implement innovative health care delivery methods be a leader in local, state and national nursing consumer groups advocate for the rights of all people for equal affordable and knowledgable healthcare Hospitals paid by quality of care
The Readability Care Accountability Matrix (RCAM)
the measure of quality outcomes measured by Mortality Readmissions Length of stay LOF Hospital consumers assessment of healthcare providers and systems (HCAHPS) Hand hygiene Prevention of C-diff Surgical site infection Catheter- associate with uti (CAUTIs)
Leadership qualities
visionary Critical thinker Role model- will respect and want to follow knowledgable- up to date on current practices Political awareness- belongs to some professional organization Flexibility- nurses environments change daily
