nurs310 exam 2

safe & competent nurse

nurse? "Blended Competencies" uKnowledge uEmotional Intelligence & Health

nurse practice act

uA statute enacted by each state legislature uDeveloped to protect the safety of the residents in that state uContains the scope of practice for registered nurses (RNs) & licensed practical nurses (LPNs) & tasks of Unlicensed Assistive Personnel (UAP) uEstablishes guidelines to help nurses assign and delegate care to and supervise other members of the health care team uNurses use the NPA to screen the appropriateness of roles, functions and interventions uStandards of Nursing Practice and Performance for RNs, LPNs, and APNs provide the benchmarks for excellence in nursing practice uIdentify the required knowledge, skills, judgment, ethics and the desired level of performance to practice safely uThe NPA defines the scope of practice for nurses in the state to protect public safety uScope of practice establishes boundaries between roles, functions, activities, and procedures performed by each member of the health care team Maryland: uMaryland is a progressive state uAdvance Practice RNs (APRNs) (nurse practitioners, nurse midwives, nurse anesthetist) have expanded role with autonomy to practice to the full extent of their education allowed by law u uBefore you move to a different state ~ check out that state's Nurse Practice Act for their rules and regulations related to authority, power, types of titles and licenses and its protections.

domains of learning & basic learning primciples

•Cognitive -Learning new information •Psychomotor Domain -physical/muscular skills -intellectual skills •Affective Domain - Beliefs, values, attitudes Feelings guide behavior

CLINICAL DECISION SUPPORT CDS

•Computerized information systems •Aims to improve •Diagnosis (Clinical prediction rules) •Prevention and disease management (routine care reminders to MDs/NPs, patients) •Treatment (electronic medication prescribing

common issue: low health literacy

•Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Healthy People, 2010) •HP 2020 does not discuss health literacy per se. -Now encumbered under Health Communication and Health IT -Ideas about health and behaviors are shaped by the communication, information, and technology that people interact with every day. Health communication and health information technology (IT) are central to health care, public health, and the way our society views health. •One half of all adults—lack the literacy skills needed to function adequately in a health care environment. -Are unable to reliably and consistently determine the proper dose of cold medicine for a child. -Are unable to read and understand informed consent documents. -Individuals with limited literacy come from all segments of society, and most are white, native-born Americans. Patients may ~ -Make excuses when asked to read; "I don't have my glasses" - Give incomplete history -Check "no" to avoid questions -Miss appointments -Make medication errors -Give incorrect answers when questioned about what they read •Reading levels -5th not 10th grade for educational materials - Assessment of Health Literacy: Newest Vital Signs (NVS) •https://www.pfizer.com/health/literacy/public-policy-researchers/nvs-toolkit •NVS - Tool •Screening tool-Test of Functional Health Literacy in Adults •Scores responses to reading a nutrition label (ice cream label)

evaluation

•Determines outcomes •Measures achievement - must have measurable goals/objectives Ask questions... "Show/tell me how you.... (return demo) "Let me see how you..... (return demo) "What are symptoms of hypoglycemia?" (Teach back) "How do you think you're doing?" (reflection)

Planning

•Develop teaching plan -Mutually predetermined behavioral outcomes -Set priorities with patient -Explain length of teaching session -Identify content to be taught •Identify measurable goals/objectives •SMART goals SMART - Specific, Measurable, Attainable, Realistic, Time-limited

Health Professions Education: A Bridge to Quality (IOM, 2003)

"All health professionals should be educated to deliver patient-centered care are members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics"

important elements of informed consent

. Disclosure Patient/surrogate has been informed of the (1) nature of the procedure, (2) risks (nature of the risk, magnitude, probability that the risk will materialize) and benefits, (3) alternatives (including the option of non-treatment), and (4) fact that no outcomes can be guaranteed. 2. Comprehension Patient/surrogate can correctly repeat in his or her own words that for which the patient/surrogate is giving consent. 3. Competence The patient understands the information needed to make this decision, is able to reason in accord with a relatively consistent set of values, and can communicate a preference. The surrogate (if needed) meets the above criteria, knows the patient's wishes to the extent that this is possible, and is free from undue emotional stress and conflict of interests. 4.Voluntariness The patient is voluntarily consenting or refusing. Care has been taken to avoid manipulative and coercive influences.

benefits of joining a professional organization

1.Developing leadership skills 2.Recognition via certification 3.Legislative lobbying power u"Other" benefits: uPublications & continuing education uGroup health & life insurance uNetworking uDiscounts - products & services deciding 1.What is the mission and the purpose of the organization? 2.Are the organization's purpose(s) compatible with my own ideas? 3.What activities does the association support? 4.What are the "other" benefits of membership? 5.Does the organization lobby for improved health care legislation? 6.Can I attend meetings and volunteer for activities?

System Optimization - includes strategies to...

1.Improve processes 2.Maximize effective use 3.Reduce errors 4.Reduce costs 5.Eliminate workflow inefficiencies 6.Improve clinical decision support 7.Improve end user skills and satisfaction Examples of EHR optimization •Updating nursing care plans •Creating alerts •Adding code status/allergies •Pre-populating data to prevent duplicate entries

MEANINGFUL USE OF EHR

1.Improve quality, safety, efficiency, and reduce health disparities 2.Engage patients and family 3.Improve care coordination and population and public health 4.Maintain privacy and security of patient health information Health Information Technology for Economic and Clinical Health (HITECH) Act - Billions of dollars spent to improve technology infrastructures in the U.S. RESULTS OF MEANINFUL USE 1.Better clinical outcomes 2.Improved population health outcomes 3.Increased transparency and efficiency 4.Empowered individuals 5.More robust research data on health systems

Teaching Strategies

1.Informal, targeted conversations 2.Observations during care delivery 3.Focus instruction on essential information 4.Keep it simple 5.Use conversation as opportunity 6."Teach-back" 7.Reinforce with appropriate educational materials

national student nurse assocaiton

1.Organize, represent and mentor students preparing for initial licensure as registered nurses and enrolled in baccalaureate completion programs 2.Convey standards and ethics of the nursing profession 3.Promote development of the skills needed as responsible and accountable nursing professionals 4.Advocate for high quality health care, advances in nursing education 5.Prepare nursing students to lead the profession in the future ●

WEBSITES VALIDITY CHECKLIST

1.Professional 2.Credible and error free 3.Identifies author with credentials 4.Published and copyrighted 5.Links to other sites to verify same information 6.References 7.Relevant topics 8.Information unbiased Current - Last updated

ANA american nurse associaton

1.Representing the nation's entire RN population 2.Dedicated to serving RNs and health care consumers uActivities include: uStandards of practice uEconomic and general welfare of nursing workplace uProjecting a positive and realistic view of nursing uLobbying - health care issues that affect nurses and the general public uPolicy initiatives pertaining to health care reform uRestructured health care system uExpanded role for RNs and APRNs in delivery of care uFunding for nurse education and training uRepresents ALL nurses in the US u~200,000 members (2015) - 4 million nurses (6%) uLabor union (optional for members) uVaries by state (MNA is not labor union) uPublishes The American Nurse uUndergraduate nursing students have the unique opportunity to become a subscriber for free uPromotes excellence in the nursing uCulture of camaraderie, mentoring, diversity, and respect for colleagues. uOffer continuing education programs uAdvocate for policy supporting the highest quality health care. uThere are over 50,00 RNs in Maryland uCurrent MNA membership - 2,234 (2.79%)

learning begins when a person identifies a need

1.What do you know about diabetes? 2.What concerns you most right now about your diabetes? 3.Can you tell me the three things you want to know before you go home? 4.Have you ever had to deal with a problem like this before? 5.Are there people to help you at home? 6.How do you like to learn?

quality and safety in nursing education QSEN

6 Core competencies 1.Patient centered care Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. 2.Evidence-based practice Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. 3.Quality improvement Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. 4.Teamwork and collaboration Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. 5.Safety Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. 6.Informatics : Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Interoperability

Ability of a system to exchange electronic health information across systems seamlessly to end users. •Individuals, families, providers can send, receive, find and use health information •Appropriate •Secure •Timely •Reliable •Shared decision-making

Strategy to Improve Patient-Provider Communication in Low-Literacy Situations

Ask Me 3" - encourages patients and families to ask three specific questions of their health care providers during every encounter 1.What is my main problem? 2.What do I need to do? 3.Why is it important for me to do this?

HON Code of Conduct for Medical Websites

Authority •Gives qualifications of authors 2. Complementarity •Information to support, not replace, the provider-patient relationship 3. Confidentiality •Respect the privacy of site users 4. Attribution •Cite the source(s) and dates of medical information Justifiability •Site must back up claims relating to benefits and performance 6. Transparency •Accessibility, provide valid contact details 7. Financial disclosure •Identify funding sources 8. Advertising policy •Clearly distinguish advertising from editorial content

errors in decison making process

Bias Placing excess emphasis on the first data received Avoiding information contrary to one's opinion Selecting alternatives to maintain status quo Being predisposed to a single solution Stating the problem in a way to support one's choices Making decisions to support past choices Failure to consider the total situation Using inaccurate data Not clearly identifying the problem Failing to prioritize or rank the problems in order of importance Using unrealistic goals Impatience Failing to identify multiple solutions Incorrectly implementing the decision Failing to use appropriate resources

Implementation COPE

C: Creativity -Help the family overcome obstacles to carrying out health care management and learning how to generate alternatives. O: Optimism -Help the family caregivers learn how to view the caregiving situation with confidence. P: Planning -Help the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty. E: Expert Information -Help the family learn how to obtain expert information from health care providers about what to do in specific situations. This information empowers caregivers by encouraging them to develop plans for solving caregiving problems. Actively involve patient/caregiver in learning activity Include family or significant other Maintain positive learning environment

caring = nursing

International Association of Human Caring (IAHC): u uCaring is the human mode of being. uCaring is the essence of nursing and the moral imperative that guides nursing praxis (education, practice, and research). uCaring is both spiritual and human consciousness that connects and transforms everything in the universe. uCaring in nursing is action and competencies that aim toward the good and welfare of others. uCaring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity. uCare is culturally diverse and universal, and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices (www.humancaring.org). u

teach back method

Nurse: Tell me in your own words what you just learned.... Patient: You said that ...... Teach Back (1:55)

What thought processes' do nurses use?

Nursing Process - ADPIE u 2. Clinical competencies: uBackground knowledge - initially conceptual + experiences = builds knowledge base uTechnical competencies - initially basic + practice in a variety of settings = increased competency u 3. Critical Thinking Skills: goal-oriented thinking Application of the above to develop: ***"Clinical Reasoning" and "Clinical Judgement" skills u

other nursing laws

OSHA - Occupational Safety and Health Act (1970) uMust practice in a safe environment uReduce workplace injury and illness uHave appropriate equipment to do so uNurses can help by promoting health and safety precautions wherever they work. Mandated Reporting uState-level requirement uChild abuse, rape, or a communicable disease uAbuse of a vulnerable adult - nursing home, developmental delay Restraints - "long-term care facility residents have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience" ADA - American's with Disabilities Act Death and Dying - advance directives, do-not-resuscitate orders, assisted suicide, direct voluntary euthanasia, organ donation, etc.

strategies to improve health literacy

Oral communication 1.Focus on patient actions or behaviors leading to desired health outcome 2.Focus on need to know information 3.Be specific and concrete "Take one tablet with breakfast and one tablet with dinner every day." 4.Chunk and check 5.Teach-back Method - to assess patient understanding Print communication -Reinforce verbal instruction with printed information -User friendly, easy to read -Link pictures to simple age- and culturally-appropriate language

SKILLS NEEDED FOR INFO LITERACY

Skills required: •A need for information •The resources available •How to find information •The need to evaluate results •How to work with or exploit results •Ethics and responsibility of use •How to communicate or share your findings •How to manage your findings

ANA standards of practice

Standard 1. Assessment The registered nurse collects comprehensive data pertinent to the healthcare consumer's health or the situation. Standard 2. Diagnosis The registered nurse analyzes the assessment data to determine the diagnoses or issues. Standard 3. Outcome Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. Standard 4. Planning The registered nurse develops a plan of care that prescribes strategies and interventions to attain expected outcomes. Standard 5. Implementation The nurse implements the interventions identified in the plan Standard 5A. Coordination of Care Standard 5B. Health Teaching and Health Promotion Standard 5C. Consultation (Graduate Prepared Specialty or Advanced Practice Nurse) Standard 5D. Prescriptive Authority and Treatment (Advanced Practice Nurse) Standard 6. Evaluation The registered nurse evaluates progress toward attainment of outcomes. uDescribe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. uThe nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. uAccordingly, the nursing process encompasses significant actions taken by registered nurses and forms the foundation of the nurse's decision-making.

ANA Standards of Professional Performance

Standard 7. Ethics The registered nurse practices ethically. Standard 8. Culturally Congruent Practice RN practice is congruent with cultural diversity and inclusion principles Standard 9. Communication The registered nurse communicates effectively in a variety of formats in all areas of practice. Standard 10. Collaboration The registered nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice. Standard 11. Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession. Standard 12. Education The registered nurse attains knowledge and competence that reflects current nursing practice. Standard 13. Evidence-Based Practice and Research The registered nurse integrates evidence and research findings into practice. Standard 14. Quality of Practice The registered nurse contributes to quality nursing practice. Standard 15. Professional Practice Evaluation The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. Standard 16. Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective and financially responsible. Standard 17. Environmental Health The registered nurse practices in an environmentally safe and healthy manner. uDescribe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resource utilization, and environmental health. u All registered nurses are expected to engage in professional role activities, including leadership, appropriate to their education and position. uRegistered nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers, and ultimately to society.

System Usability

The extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction" (National Institute of Standards and Technology, 2017) •Ease of use •Intuitive •Supportive of workflow •Saves time •Reduces errors •Improves end user satisfaction

ANA DEFINTION OF NURSING INFORMATICS

The specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice." Florence Nightingale - first nurse informatician (NI) She displayed data in interesting ways to tell the story of health issues during Crimean War and to effect change in nursing care. INFORMATIC TERMS •System usability •System optimization •Standard terminologies •Interoperability •Security and privacy

criminal background check

uAct: Each applicant for licensure shall submit a full set of fingerprints to the BON for the purpose of obtaining a state and federal criminal records check pursuant to <state statute> and Public Law 92-544. The <state agency responsible for managing fingerprint data> may exchange this fingerprint data with the Federal Bureau of Investigation (FBI). uRule: All individuals convicted of a sexual offense involving a minor or performing a sexual act against the will of another person shall be subject to a BON order for evaluation by a qualified expert approved by the BON. If the evaluation identifies sexual behaviors of a predatory nature the BON shall deny licensure. uOther criminal convictions may be reviewed by the BON on a case by case basis to determine eligibility for licensure

5 rights of critical thinnking

uAnyone can develop these skills by practicing, nurturing, and reinforcing them over time. To start, nurses can focus on the 'five rights' of clinical reasoning (also known as critical thinking): 1.Right cues are the available patient information (i.e., handoff reports, patient history, previous nursing/medical assessments), current clinical assessment data, and the recall of nursing knowledge. 2.Right patient refers to the process of identifying and prioritizing a patient at risk of critical illness or a severe adverse event. 3.Right time means nurses identify clinically at-risk patients promptly and carry out nursing interventions at the right time and in the right sequence. 4.Right action occurs when the nurse decides which part of the plan takes priority, who should carry out the nursing actions, which procedures and policies are involved, and who should be notified. 5.Right reason indicates that the reasoning is ethical, legal, and professional. ''Right" may refer to the right conclusion being reached, or it may refer to the process, or preferably both.v

elements of medical malpratice

uAnyone suing a health care provider, including a nurse, for malpractice must prove four elements in order to prevail: 1.Duty, 2.Breach of duty, 3.Causation, 4.Damages or harm uSuing parties must demonstrate that the provider they are suing had a duty to the patient, that the provider breached that duty, and that the breach of that duty was the cause of actual harm to the patient.

professional liability insurance

uBest safeguard = professional competence uReasons for purchasing a personal professional liability insurance policy uProtection of the nurse's best interests If the nurse is named as a defendant in a malpractice action along with the facility uLimitations of employer's coverage uAn employer's policy covers the nurse only within the confines of the work (ANA, 1990) A policy provides benefits not usually covered in employer policies, such as coverage for assault, first aid expenses, violations of the HIPAA, libel or slander, depositions, property damage, and license protection benefits.

Major Types of Professional Associations

uBroad purpose uSpecialty practice uSpecial interest

Nursing specialties

uCovered by the RN scope and standards uSpecific standards add greater clarity for a specific practice area

Good Samaritan Law

uDesigned to protect health care providers when they give aid to people in emergency situations uA nurse at the scene of an automobile accident may give emergency care without fear of a legal suit if such care appears necessary, unless care is given in a grossly negligent manner uState laws vary uCovered vs only certain acts covered uSome states = legal obligation to help another (except in employment situations) uNurses may have an ethical responsibility to assist in emergency situations uExpectation = use good judgment to determine emergency exists and to give care that a reasonably prudent person with a similar background and in similar circumstances would provide. MD good samaritan law: uA member of the general public cannot be held civilly liable for any act you do (or acts you should do but don't do) when providing assistance or medical aid at the scene of an emergency. uThis law covers individuals as long as the aid provided is rendered in a "reasonably prudent manner," and done without the expectation of a fee or other compensation. The Good Samaritan has to relinquish care to a certified first responder when they arrive.

Issues that Challenge Nursing Competence

uFatigue uImpaired Nurses uInformed Consent uContracts uCollective Bargaining uAdequate Staffing u"Just Culture" uPatient Rights uStudent Liability uPatient Education uExecution of Provider Orders uDelegating Nursing Care uDocumentation uSocial Media uWhistleblowing uIncidence Reports uSentinel Events Never Event

duty to rescue

uIn common law, nurses have a duty to rescue (duty to help) someone if uthe nurse created the danger from which the person needs to be rescued—in other words, the nurse's negligence created the dangerous situation. uthe nurse started helping the person—in other words, other people might not intervene because they see that the nurse has already done so, requiring the nurse to finish the rescue once started. uthe nurse has a special relationship with the person in need, creating a special duty. uMaryland has no "Duty to rescue"

National Council of State Boards of Nursing (NCSBN)

uPosition Statement, "Nursing Regulation and the Interpretation of Nursing Scopes of Practice" uState/territory NPAs provide the legal basis for the regulation of nursing activities uState boards of nursing are responsible for interpreting the legal scope of nursing practice uNon-profit organization uRepresents BON in 50 states, District of Columbia, four US territories uStates work together on issues (regulation, public health, safety, welfare, licensure, examination) uFunctions: 1.Develop NCLEX exams 2.Policy analysis for regulation of nursing practice 3.Licensure Data Dissemination 4.Research 5.Forum for information exchange uOne major function of the SBON is the licensure of nurses uTelehealth and health care organizations with practices in more than one state complicate this function u Nurses frequently live in one state and work in another uTo address this licensure issue, the multi-state licensure compact agreement or mutual recognition model of practice was designed

bon authority catergories

uQuasi-executive - authority to administer the NPA uQuasi-legislative - authority to adopt rules necessary to implement the act uQuasi-judicial - In addition to grant licenses , it also has the authority to deny, suspend or revoke a license or deny application for licensure

RAISE THE BAR

uReading Nursing: Scope and Standards of Practice, 3rd Ed uAssessing the document and contemplating what it means to you and your practice uIntegrating Scope and Standards of Practice, 3rd Ed into practice by developing culturally congruent care in every situation and setting uSharing the word and encouraging other nurses to integrate Scope and Standards of Practice, 3rd ed into practice uExcelling in using knowledge and conducting and applying research to achieve the highest quality, evidence-based care

MOLST - Maryland Orders for Life-Sustaining Treatment

uThis is a portable and enduring medical order form covering options for cardiopulmonary resuscitation and other life-sustaining treatments uThe Maryland MOLST order form: uConsolidates important information into orders that are valid across the continuum of care uStandardizes definitions uReminds patients and providers of available treatment options uIncreases the likelihood that a patient's wishes regarding life-sustaining treatments are honored throughout the health care system uLINK to Form: https://marylandmolst.org/docs/MOLST%20MM3%202013%20FINAL%20PROPOSED%2072613%20POSTED%2021714-no-instructions.pdf

Nursing: Scope and Standards of Practice, 3rd Edition

uVoluntary standards - not mandated by law uScope of Practice Statement describes uWhat - uNursing is defined as the protection, promotion, and optimization of health and abilities, uPrevention of illness and injury, uFacilitation of healing, uAlleviation of suffering through the diagnosis and treatment of human response, and uAdvocacy in the care of individuals, families, groups, communities, and populations. uScope of Practice Statement describes uWho- All RNs, including graduate level-prepared RNs and APRNs, educated, titled, and actively licensed to practice nursing . uWhat - The definition of nursing that follows provides a succinct, inclusive, and descriptive characterization of nursing. uScope of Practice Statement describes uWhen and Where - Whenever there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education - anytime, anywhere. uWhy - Nursing's response to the changing needs of society to achieve positive healthcare outcomes in keeping with nursing's social contract with and obligation to society. uScope of Practice Statement describes uHow - The ways, means, methods, and manners nurses use to practice professionally uAdherence to the nine provisions of the 2015 Code of Ethics for Nurses With Interpretive Statements uApplication of the nursing process

what is the teaching process & nursing vs teaching process

•A systematic, sequential, scientifically based planned course of action •Consists of two major interdependent operations: -Teaching -Learning •Parallels the nursing process

USES OF PATIENT PORTALS

•Access medical history and other health information •Complete various forms and questionnaires online •Communicate securely and conveniently with providers •Request prescription refills •Pay bills •Review lab results •Schedule appointments •Receive reminders for appropriate screenings •Enter clinical data, such as blood pressure, glucose levels, weight, Fitbit data, and other activity tracking data •Review progress notes •Access educational materials based on diagnosis or procedure BENEFITS: 1.Better health outcomes 1.Chronic condition management 2.Timely access to care 3.Patient retention 4.Patient-centered medical home recognition

BIG DATA TO EDUCATE

•Allows visualization and interaction •Readily updated for accuracy

EHR (electronic health record)

•An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization." BENEFITS •General •Nursing •Health Care Providers •Healthcare Enterprise •Consumer Payer

teaching considerations

•Audiovisual aids -Color combinations for aging eyes •Contrasting colors •Avoid blues, greens, and shades of purple -Avoid raising voices for hearing impaired •Language and style based on age, geographic location •Need to include parents for children; family/caregiver for adults •Integrate play, art, music, kinesthetic therapy as appropriate •Medication effects -Analgesics (sedation) -Diuretics (frequent bathroom breaks) •Fatigue levels - teach small units of information; take breaks

HEALTHCARE ANALYTICS

•Captured and stored data are extracted to identify trends and opportunities for improvement •Drives clinical transformation •Assess organizational effectiveness EXAMPLES Clinical - How many pts with CHF discharged home with 5 meds? Populations-Can we get a list of all pts with knee replacements who were discharged home with in home PT? Administrative-What staffing ratios are recommended based on pt. acuity? Financial-Has revenue increased after implementing an electronic billing

Adult Education: Malcolm Knowles1913 - 1997

•Distinctive conceptual basis for adult education •Self-directed learning •Move from educating people to helping them learn •Education must be free to respond to need, wherever discovered! Five assumptions about characteristics of adult learners 1.Self-Concept - from dependent to self-directed 2.Past experiences to draw from 3.Must be ready to learn - r/t task or role 4.Orientation to learning - apply NOW 5.Motivation to learn - internal Self-concept: As a person matures his self concept moves from one of being a dependent personality toward one of being a self-directed human being 2. Experience: As a person matures he accumulates a growing reservoir of experience that becomes an increasing resource for learning. 3. Readiness to learn. As a person matures his readiness to learn becomes oriented increasingly to the developmental tasks of his social roles. 4. Orientation to learning. As a person matures his time perspective changes from one of postponed application of knowledge to immediacy of application, and accordingly his orientation toward learning shifts from one of subject-centeredness to one of problem centeredness. 5. Motivation to learn: As a person matures the motivation to learn is internal

how to use bloom's wheel

•Each piece of the pie represents a different level -Choose the level - start with the lowest for someone learning something for the first time •In that wedge - move out to choose the appropriate verb -Explain, Discuss, Restate... The patient will restate the common side effects of metoprolol prior to discharge. •Move further out to choose assessment strategy - how you will measure the effectiveness of your teaching... Learning Objective - The patient will demonstrate the proper technique to self-administer insulin subcutaneously before discharge. How the nurse will measure the effectiveness of teaching (was the goal met/unmet/revised?)- The nurse will measure the effectiveness of the teaching by observing the patient self-administer the insulin, with minimal cues. This is called "Return Demonstration."

Examples of Informatics Use in Today's Nursing Profession

•Electronic health record - EHR •Telehealth •Mobile devices •Patient portals •Data analytics •Technologies for educating nurses in academic settings •Technologies for conducting research

Ready to Learn...but... First the nurse needs to be ready to teach!

•Examine how your values, attitudes and beliefs may come into play •Use caring behaviors that show understanding and respect for patient •Develop the art of active listening •Be "with" your patient/attending •Have the knowledge to teach

State Board of Nursing (SBN)

•Governmental agency •Implements the state's Nurse Practice Act •Recommends changes to state regulation and changes the act when appropriate •Purpose is to protect the health and safety of the citizens of the state •Responsible for holding licensed nurses to the scope and standards of practice BON & ADMINSTRATIVE rULES uThe BON regulates the nursing profession by establishing standards for licensure and practice, and adopting policies to strengthen nursing practice uNurses should be aware of their obligation under their state BON administrative rules. mARYLAND BOARD OF NURSI G •MBON website •The Code of Maryland Regulations (COMAR), is the official compilation of all administrative regulations issued by agencies of the state of Maryland, including the Maryland Nurse Practice Act (NPA) Link - http://www.dsd.state.md.us/COMAR/ComarHome.html

SECURITY & PRIVACY

•Health Insurance Portability and Accountability Act (HIPAA) 1996 •Right to examine and obtain a copy of PHI •American Recovery and Reinvestment Act of 2009 (ARRA) •Right to an electronic copy of EHR •Right to have a copy directly transmitted to any designated entity •Patient Protection and Affordable are Act (ACA) of 2010 •Often referred to as "Obama-care" HIPAA = landmark legal protection of personal health information •Data Safety Box 20-3 p.496- Password recommendations •Never share your password •No well manage site will ask for your password •Don' t reuse passwords •Use passwords that are easy to remember but hard to guess •Use at least 8 characters •Consider using strong authentication or multifactor authentication •Consider using a password manager •CERNER, EPIC and Meditech are example of EHR systems. •Will be using DocuCare at school of nursingV

Emerging Areas in the Field of Informatics

•Health care analytics •Data visualization •Predictive analytics •Big data •Shared models of care •Clinical decision making

Bloom's Taxonomy, blooms wheel

•How to write measurable, meaningful learning objectives (to guide your teaching) •Level of comprehension: -Remember/Knowledge - lowest level -Understand/Comprehension -Applying -Analyzing -Evaluating -Creating/Synthesizing - highest level level of verbs: •Each of the levels of Bloom's taxonomy is associated with verbs -Use the verbs to write your learning objectives

assess learner needs

•Identify the learner •Choose the right setting •Collect data about the learner •Collect data from the learner •Involve members of healthcare team •Prioritize needs •Determine availability of resources

motivation

•If a patient does not want to learn, it is unlikely that they will •A social need, connection, self-esteem/approval •Driven by desire for achievement or competence •People are motivated to return to normalcy

licesning powers

•Licensure process is a police power of the state - the use of the term "nurse" is mandated by law •Mandatory law •Licensure •Disciplinary action •Nursing Disciplinary Diversion Act (ANA, 1990) - •Mental health issues or drug/alcohol effects Maryland Board of Nursing Rehabilitation program- renewal & activation: uLicensing applicant must report: uCriminal conviction, nolo contendere plea (no contest), Alford plea, deferred judgment, or other plea arrangements in lieu of conviction uStatus of all nursing licenses, including any BON actions taken or any current or pending investigations uSubstance use disorder in the last five years uActions taken or initiated against a professional or occupational license, registration or certification and uCurrent participation in an alternative to discipline program

characteristics of adult learners

•Likes choices •Adjusts less easily to distractions •Suffers more from being deprived of success •Varied learning styles/preferences •Needs abilities and achievements honored •Difficulty remembering isolated facts •More rigid in thinking; set pattern of behavior •Needs a safe environment, acceptance & respect •Requires more time to perform learning tasks but learning ability is unchanged

assess readiness to learn : physical, emotional, experiential, knowledge readiness

•Physical Readiness -Measures of ability -Complexity of the task -Environmental effects -Health status Gender •Emotional Readiness -Anxiety Level -Support System -Motivation -Risk-taking behavior -Frame of mind -Developmental Stage - child, adolescent or adult •Experiential Readiness -Level of aspiration -Past coping mechanisms -Cultural background -Locus of control -Orientation •Knowledge Readiness -Present knowledge base -Cognitive ability -Learning disabilities -Learning styles -

sigma internatinal honr society of nursing

•Provides leadership and scholarship in practice, education and research to enhance the health of all people. •Support professional development of members who strive to improve nursing care worldwide. •Membership for students based upon completion of 1.2 of the nursing curriculum, GPA, and class standing for Baccalaureate Students

Naming the Learning Need: NANDA Nursing Diagnosis

•Reflects learning needs based on evaluation of health knowledge, affective and psychomotor needs -Deficient knowledge -Ineffective health maintenance -Ineffective therapeutic regimen -Noncompliance

SMART goals

•Specific on what is to be completed •Measurable to monitor progress •Achievable/attainable must be within the ability of the patient and care giver •Realistic within the ability of the patient and care giver •Time-specific set a time frame/deadline for completion

when do nurses teach

•Step 1 - Listen to your patients and their families... -Every interaction is an opportunity to teach -Keep education patient centered -Begin teaching at the first patient encounter

TEACHING INFO LITERACY

•Steps involved •Planning research or posing a question •Organizing a way to search for the answer •Finding resources - databases, Websites •Evaluating the resources and thinking critically about them •Who made the message and why? •What is left out of the message? •How might others view the message differently? •Expressing information learned in meaningful ways

TELEHEALTH & MOBILE TECHNOLOGIES

•Telehealth: the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. •Telemedicine: the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. •Telecare: refers to technology that allows consumers to stay safe and independent in their own homes. PATIENT PORTALS: •Patient engagement tool •Accessible from home computer or smartphone •Expand clinician access

standards for client education

•The Joint Commission sets standards for client and family education •Meeting standards requires collaboration among health care professionals nurses teach patients how to •Cope with acute health problems •Prevent complications and promote recovery •Promote self-care and independence in chronic illness •Make informed decisions about health practice and treatment choice

INFORMATION LITERACY

•The ability to recognize when information is needed and have the ability to identify, locate, evaluate and use effectively the information •Depends upon individuals' skills, complexity of health information and how it is communicated IMPORTANT BC: •Promotes problem solving approaches and thinking skills •Asking questions and seeking answers •Finding information •Forming opinions •Evaluating sources and making decisions •Fostering successful learners, effective contributors, confident individuals and responsible citizens COMPONENTS: •Identifying/recognizing information needs • Determining sources of information • Locating or searching for information • Analyzing and evaluating the quality of information • Organizing, storing or archiving information

Genetics and Genomics: Precision Medicine

•The field of genomics has the potential to significantly change the way health care is delivered. •Genomics play a role in 9 of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes, and Alzheimer's disease (WHO, 2004). •Because genomic health care is heavily dependent on data storage and interpretation, no other area is better suited than informatics to support this evolving work. Informatics is a tool that impacts effective care, timely care, and allows each of us to care.....for a human being.

Purpose of Professional Organizations and Associations

•To judge competency •To perform social functions •To provide a vehicle to keep up with changes, challenges •To work toward needed changes

learning styles

•Visual: relies on sight to take in information •Auditory: relies on hearing information •Reading: relies on reading or writing to understand new information •Kinesthetic: Hands-on approach to learning •Listening/reading (cognitive) •Observing (auditory/visual) -Venipuncuture How-to •Doing (psychomotor) Try this at home -