Professional Nurse - Exam 2
I am CONCERNED I am UNCOMFORTABLE This is a SAFETY ISSUE
Assertive Statements, CUS.
Knowledge Attitudes Performance
Team STEPPS - Three Core Tenets
Assessment Diagnosis +Outcomes Identification Planning Implementation Evaluation
The Nursing Process (ADPIE)
Board of Nursing/Nurse Practice Act
"Minimum mandatory standards" Some protect nurses. Some protect the public from errors/wrong practices done by the nurse.
C - Yellow-green drainage on the surgical incision
A nurse is assessing a client who is 48 hr postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider? A - Blood pressure 102/66 mmHg B - Straw-colored urine from an indwelling urinary catheter C - Yellow-green drainage on the surgical incision D - Respiratory rate 18/min
C - Identify the problem
A nurse manager has recently become aware of a conflict between the pharmacy and the staff nurses regarding sending and receiving medications. Which of the following actions should the nurse take first to resolve the conflict? A - Implement a resolution B - Brainstorm solutions C - Identify the problem D - Evaluate the results
A - "Let's talk about your concerns about the new policy."
A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate? A - "Let's talk about your concerns about the new policy." B - "Why didn't you voice your concerns before the new policy was implemented?" C - "Being open to change is an exception of the nurses who work on this unit." D - "You should support this policy change because it was based on evidence-based practice."
A - I noticed you have been late for work twice this week
A nurse manager plans to speak with a staff nurse who has been late for work several times. Which initial statement would best avoid creating defensiveness? A - I noticed you have been late for work twice this week B - You are letting your team down when you come into work late C - You have to be on time for work D - If you can't show up on time, you can't work here
Violence
Communication - Controlling, Labeling, Attacking
Silence
Communication - Masking, Avoiding, Withdrawing
Honest Mistakes
Communication Breakdown - Accidents/Errors, Inevitable
Undiscussables
Communication Breakdown - Risks that are seen but not addressed. Ex. Dangerous Shortcuts, Concerns about Incompetence/Disrespect "Should Not Happen"
Intercultural
Communication across cultural contexts. Ex. Nurse caring for Pt who primarily speak Spanish
Interpersonal
Communication between two or more individuals involving face-to-face interaction while all parties are aware of the other's ongoing basis.
Interprofessional
Communication between two or more members of the interdisciplinary healthcare team. Ex. Nurse to Physician
Persuasion
Conscious intent by one individual to modify the thoughts or behaviors of others. Ex. Convincing Pts with Tx Plan & Recommended Lifestyle
Negotiation
Dialogical discussion between two or more parties to arrive at an agreement about an issue. Ex. Salary increase with manager
Negligence
Failure to act as a reasonably prudent professional would have under similar circumstances.
Task Circumstance Person Direction/Communication Supervision/Evaluation
Five Rights of Delegation
Clear Concise Complete Correct Info
Four C's of Right Communication
1 - Self Determination 2 - Policies & Procedures 3 - Nurse Practice Act, Rules & Regulations 4 - Scope/Standards of Nursing Practice, Code of Ethics, Specialty Certifications
Model of Professional Nursing Practice Regulation - Four Tiers
Malpractice
Negligence on the part of a healthcare professional.
Introduction Patient Assessment Situation Safety Background Actions Timing Ownership Next
Nurse to Nurse Report. I PASS the BATON
Delegation
Opportunity to transfer duties or tasks to other members of the healthcare team that is beneficial for the patient and delegator.
Civility
Politeness or courtesy in speech and behavior that communicates respect for others and facilitates successful communication. Ex. Using full name, "you" > "we"
Incivility
Rude & disruptive behaviors that can progress to aggression, bullying, and violence. Ex. Elderspeak, Gossiping, Horizontal Violence
Monitor & Gather Data Stable Clients Basic Patient Care Report Status Care for Predictable Outcomes Reinforce RN Education
Scope of Practice - LPN
Initial Assessment Unstable Patients IV Push/Blood/TPN Accessing Central Lines Analyze Data/Critical Thinking Care Plan Education/Discharge Teaching
Scope of Practice - RN Duties
Ambulate, ROM, Hygiene, ADLs Feeding/Oral Care - Stable Pts VS & I/Os Positioning Transfer/Transport Report Status
Scope of Practice - UAP
enhanced Nurse Licensure Compact (eNLC)
Standardization of licensure requirements across states.
Call-Out
Strategy used to communicate important or critical information. Ex. ED giving out meds/VS status
Communication Leadership Situation Monitoring Mutual Support
Team STEPPS - Four Basic Skills
Win - Lose Lose - Lose Win - Win
Three Conflict Resolution Outcomes
Systemic > Local Acute before Chronic Actual before Potential Problems
Three Priortization Ideas
Bargaining
To make a series of offers and counteroffers about what each party will do, give, receive....unitl an agreement is reached and to the satisfaction of all. Ex. Taking Thanksgiving shifts for Weekend shifts
Non-Verbal
Unspoken communication composed of affective and expressive behavior. Ex. Eye Contact, Smiling, Personal Space
Check-Back
Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended.
D - I am concerned about the patient's respiratory rate of 10 and lethargy
Which statement best describes the "situation" in SBAR? A - Patient was admitted this morning and received morphine an hour ago. B - Would you like to order naloxone and oxygen? C - Patient had a respiratory rate of 16 and was alert prior to naloxone. D - I am concerned about the patient's respiratory rate of 10 and lethargy.
Clinical Judgement
A reflective and reasoning process that uses all available date and extensive knowledge to form a clinical conclusion.
C - Undiscussable
An operating room (OR) nurse observes a scrub nurse break a sterile field. The OR nurse ignores it and continues their work. Which communication breakdown does this best describe? A - An honest mistake B - Nonviolent Communication C - Undiscussable D - Open Communication
Standards of Practice
Authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently.
Accommodating Avoiding Collaborating Competing Compromising
Five Conflict Management Styles
1 - Assumed care for Patient 2 - Breached Duty of Care/Failure of Standard of Care 3 - Failure of Standard of Care resulting in injury 4 - Injury is Proved
Four Elements Proven - Negligence Case
Define - Practice of Nursing Sets - Education & Licensure Requirements Determines - Titles & Abbreviations Nurses can use Provides - Disciplinary Action for certain causes
Nurse Practice Act - Four Functions
Identify Situation Background Assessment Recommend Repeat
Nurse to Physician Report. ISBARR
Omission - Failure to do something that should have been done. Commission - Doing something that shouldn't have been done.
2 Types of Malpractice
Describe - Situation/Behavior Express - Feelings/Concerns Suggest - Alternatives Consequences - Impact on Goals
A constructive approach for managing and resolving conflict, DESC.
Clinical Reasoning
Decision making process grounded in professional thought process. Career long development.
Scope & Standards of Nursing Practice
Describes a competent level of nursing practice and professional performance common to all registered nurses. Establishes the legal standard of care.
Nonmaleficence
Do No Harm
Scope of Practice
Each discipline in an interdisciplinary team has a set of skills they can practice for their specific profession.
