Exam #2

Canada health Infoway

Transforming health care in Canada through health information technology

Three Levels of Care: Secondary Care

Medical care provided by a specialist or facility upon referral by a primary care physician that requires more specialized knowledge, skill, or equipment than the primary care physician has. (For diagnosis and treatment)

What would be tertiary care in this example?

Referring her to an eye surgeon for removal of cataracts

Which of the following is the primary advantage of using computers while conducting nursing research

Analyzing the quantitative data

Empathy

understanding and validating the meaning the health care experience holds for the client, while ensuring that appropriate emotional distance from the client is maintained for objectivity and appropriate professional response

Power

unequal with the nurse having more authority and influence in the health care system

Informal Patient

voluntarily seek treatment or admission to hospital

Cultural sensitivity

way of approaching people who hold health beliefs different from one's own. A nurse with this characteristic is respectful of and open to others

Emotional Neglect

when a family member or loved one is repeatedly left alone, ignored or berated

Barries to Integration of Theory in Practice

-Language -Theory presents the ideal (nursing as it ought to be) -Theory based upon principles rather than practical methods -Organizational culture of practice (focus on 'cure' rather than 'care') -Conceptual level thinking

Which of the following characteristics represent the affective domain of the ABCs of cultural competence

-Openness -Desire to learn -Respect for other

While talking with the nursing supervisor, a staff nurse expresses frustration that an indigenous client always has several family members at the bedside. Which of the following actions is the most appropriate action for the nursing supervisor in this situation

Ask about the nurses personal beliefs about family support during hospitalization. *Start with before restructuring

A nurse notes that a client with dementia refuses to eat. Instead of informing the primary healthcare provider, the nurse threatens to force-feed the client, and proceeds to apply restraints in order to do so. What legal charges may be brought up against the nurse? Select all that apply

-Assault -Malpractice -False imprisonment

Types of Nursing Theories

-Grand nursing theories -Mid-range nursing theories -Nursing practice theories

4 foundations of the therapeutic nurse-client relationship

-Intimacy -Power -Respect -Trust Potential for power imbalance. Both should be equally heard bu more likely to believe HCP due to vulnerability of client

The nurse selects the family systems theory as a guide for providing care to a family. Which concept of this theory should the nurse use to maintain the stability of this family? Select all that apply.

-The whole is more than the sum or its parts -All parts of the system are interconnected -Systems can be organized into subsystems -There is a boundary between the system and the environment

3 strategies toward a Primary Health care system

-enhancing the delivery of care -cultural change (work within community) -building blocks for change

Guiding principles of primary health care

-person-centered -accessible -sustainable -collaborative -proactive -continuity of care -quality -accountable -equitable

Adult Guardianship and Trusteeship Act

-when a person is deemed to lack decision making capacity -when there is no personal directive naming an alternate decision maker

5 goals of PCN

1. Increasing the proportion of Albertans with ready accss to primary care 2. Managing access to appropriate round-the-clock primary care services (811 number) 3. Increasing emphasis on health promotion, disease and injury prevention and care of patients with complex problems or chronic disease 4. Improving coordination of primary care with hospital, longterm and specialy care 5. Facilitating use of multidisciplinary teams in primary health care

Mental Health Act 3 criteria

1. Person is suffering from a mental disorder 2. person is likely to cause harm to self or to suffer substantial mental or physical deterioration or serious physical impairment 3. person is unsuitable for admission to a facility other than as a formal patient (Not admitting yourself voluntarily, formally admitted under MHA) ALL MUST BE MET OR FORMAL PATIENT IS UNSUITABLE TO CONTINUE AT A FACILITY OTHER THAN AS A FORMAL PATIENT (IN THE CASE OF A RENEWAL CERTIFICATE, VALIDE FOR 24HRS, ANOTHER PHYSICIAN MUST DO ANOTHER ASSESSMENT)

Boundary violations

Act of abuse in the nurse-client relationship. A result of confusion between the needs of the nurse and those of the patient. Harmful/ distressful to the patient. Is abuse- physical, verbal, emotional, sexual, financial, neglect

Electronic Health Records

An individuals health record that is accessible online from many separate, interoperable, automated systems within an electronic network. Permit electronic data retrieval

What does a nurse understand by the competency called informatics?

A nurse should use information and technology to communicate, manage knowledge, mitigate error and support decision-making

A client in the terminal stage of cancer is admitted to the hospital in severe pain. The client refuses the prescribed IM analgesic for pain because it puts her to sleep and she wants to be awake. One day, despite the clients objection, a nurse administers the pain medication, saying "You know that this will make you more comfortable." What could the nurse in this situation be charged with?

Battery

According to CARNA's (2011) document on 'Professional Boundaries for RN: Guidelines for the Nurse-Client Relationship' which of the following best exemplifies healthy boundaries in the nurse-client relationship?

Being aware of client vulnerability when providing care

Primary Health Care

Broader, promotion of health and SEDOH's. Philosophy of care. Whole of society approach to health that aims to equitably (fair and impartial) maximize the level and distribution of health and well-being by focusing on people's needs and preferences (both as individuals and communities) as early as possible along the entire continuum of care, and as close as feasible to peoples everyday environment. Considers the health care needs of clients, addresses the broader determinants of health, thus focusing on the comprehensive and interrelated aspects.

Mental Health Act

Describes actions the health system and/ or legal system can take at certain situations or critical situations in order to protect and/ or treat those w/ a mental disorder. When someone can be admitted to a facility against their will. Sometimes have to step in when client is unable to make decisions for themselves. How a person with mental disorder can be apprehended, detained and/ or given treatment in a hospital or in the community setting under specified conditions. Explains people's rights in these circumstances

Difference between PCN and FCC

FCC are specifically targeted at underserved communities, have more defined mandate to focus on SEDOHs and are expected to deliver all of their services under one roof rather than be spread across a region

Primary Care

First contact people have with the health care system, seek treatment, diagnosis, follow up for a specific health problem, or access routine screening like an annual check-up. Focus on illness/ chief complain. Own pt load and only deal with own pts.

Three Levels of Care: Primary Care

First point of contact a person has with the health system (Physicians office or ER)

Patricia Benner

From Novice to Expert - novice, adv beginner, competent, proficient, expert practitioner. can move in and out of the stages at different times The levels reflect a movement from reliance on abstract principles to the use of past concrete experience Propose that a nurse could gain knowledge and skills without every learning the theory Experience is a prerequisite for becoming an expert

What is a known purpose of nursing theories

Generating knowledge and directing nursing practice

Primary Care Networks

Groups of family doctors that work with AHS and other health professionals to coordinate the delivery of primary care services. Province wide and provincially funded. A network of doctors and other HCP Each PCN comprises one clinic with many physicians and support staff or several doctors in several clinics in a geographic area. Each PCN has flexibility to develop programs and provide services to meet specific needs of patients locally.

Quarternary care

Highly specialized care centres (Transplant surgery centre)

Three Levels of Care: Tertiary Care

Highly specialized medical care usually over an extended period of time that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities (Acute care hospital)

Theory is useful for nursing practice, education, and research. Which goal would a nurse researcher most likely have when using nursing theory?

Identify knowledge gaps in nursing

The nurse reviews potential theories to use as a guide for providing care to a family in the community. What should the nurse keep in mind as a major function of theory in family nursing

Improves nursing services provided to families

Community Treatment Orders (CTO)

Intended to support people in the community with severe and persistant mental disorder who have history of non-compliance with treatment. Treatment plan under supervision which persons is involved in making or at least informed of. Person can be apprehended on psychiatrist order if fails to comply, person has right to request review.

A nurse wishes to improve his or her cultural sensitivity while working with patients. Which action by the nurse would best indicate progress toward this goal?

Interact respectively with patients who have differing health beliefs

Hildegard Peplau

Interpersonal theory (4 phases) Defines the nurse/ patient relationship evolving through orientation, identification, exploitation and resolution. Nursing as a maturing force that is realized as the personality develops through educational, therapeutic ad interpersonal processes. Nurses enter into a personal relationship with an individual when a felt need is present -Very popular model with clinicians working with individuals who have psychological problems

Which of the following best describes electronic (ex. internet-based) courses?

It is more difficult to establish a sense of community

Protection for Persons in Care Act (PPCA)

Law promoting prevention and reporting abuse of adult albertans who receive care or support services. Applies to alberta hospitals, nursing homes and lodges, group homes, mental health facilities. Exclude family or volunteers who provide care/ support and services that are no paid by public funds like home care, correctional facilities, student housing, doctor's offices, etc.

A new graduate nurse is working in a busy ER of a hospital, situated in a culturally diverse area of the city.What can assist her to be culturally sensitive?

Learning about the attitudes toward health care and traditions of the different cultures in the area

Family Care Clinics (FCC)

Local, team-based primary health delivery organizations. Provide individual and family-focused primary health care services tailored to meet the health needs of a community. Staff coordinate range of primary health care services that cover an individuals entire lifespan. Provide access to most appropriate member of the health care team to address their health and social needs, extended hours of service and same day access. Team members: Family physician, nurse practitioner, RN, dieticians, pharmacist, mental health professionals, etc. All under one roof Provide non-emergency primary health care services like diagnosis and treatment, screening, immunization, health promotion, chronic disease prevention, and management, links to other health and community agencies

Virginia Henderson

Need theory (14 basic needs) was based in practice and her education. Emphasized the importance of increasing a clients independence to promote their continued healing process after hospitalization One of the first to mark the difference between nursing and medicine Assist person in performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strengths, will or knowledge. Get inside the skin of each of her patients in order to know what he needs

A client who has a very low hemoglobin is refusing blood because of religious reasons. What is the most appropriate action by the nurse?

Notify the primary healthcare provider of the clients refusal of blood products. Respecting choice

Martha Rogers

Nursing as both a science and an art Unitary Human Beings (Grand Theory) Nursing seeks to promote symphonic interaction between the environment and the person -strengthen the coherence and integrity of the human beings and to direct an redirect patterns of interaction between the person and the environment for the realization of max health potential -Strongly influence by her early grounding in arts and background of science along with her keen interest in space

Nursing Metaparadigm

Nursing practice is a synthesis of the interaction among the four concepts of person, health, environment, and nursing

Which nursing theorist introduced the use of a therapeutic relationship between a nurse and a client?

Peplau (Psychiatric Nurse)

Grand nursing theory

Philosophical underpinnings (ex: self-care, interpersonal relationships, caring) -Critique: Little effort to analyze or evaluate their theories, broad scope and nebulous, inability to be operationalized

Which of the following situations would constitute a breach of confidentiality?

Posting a picture of a client of FB

Which of the following is a purpose of primary health care that would be familiar to a nurse practicing alongside several physicians in a clinic?

Preventative care

What term is used to describe care that is client directed, and encourages community participation and intersectoral cooperation?

Primary health care

Mrs. Olivier, 75, has been experiencing fatigue and difficulty breathing for the past three days and decides to seek out medical attention. What would be the most appropriate care agency for her at this time?

Primary health care provider (Family physician or at a physicians office/clinic)

Which of the following is the challenge most associated with the use of an electronic client record system?

Privacy

An inpatient client, whom the treatment team has determined to be a danger to self, gives notice of intention to leave the hospital. What information should the nurse recognize as having an impact on the treatment team's next action?

Provincial law determines how long a psychiatric facility can hold a client

Which nursing action is not likely to cause legal issues?

Refraining from leaving the client during a staffing shortage

An older, confused client is being cared for at home by an adult child who works full-time. The client has lost weight and is wearing soiled and inappropriate clothing. The home care nurse suspects elder neglect. What should the nurse do?

Report suspicion of neglect by the adult child to adult protective services

Nursing Informatics

Science and practice integrates nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families, and communities worldwide ex: Netcare, booking and tracking COVID

Sally has a family history of cataracts and early glaucoma in female members. Her family physician refers her to Dr. Carlson, an ophthalmologist. This referral is an example of what level of health care?

Secondary Care

Dorothea E. Orem

Self care theory Wholeness of developed human structures and of bodily and mental functioning. Physical, psychological, interpersonal, and social aspects. People should be self-reliant and responsible for their own care and the care of others in their family Person's knowledge of potential health problems is necessary for promoting self-care behaviours Defined nursing as an art, helping service, and a technology

Betty Neuman

System Model Focuses on the response of the client system to actual or potential environmental stressors and the use of several levels of nursing prevention intervention for attaining, retaining, and maintaining optimal client system wellness. Defines the concern of nursing is preventing stress invasion If stress if not prevented then then nurse should protect the clients basic structure and obtain or maintain a max level of wellness Provide care through primary, secondary, and tertiary prevention modes

A hopsital provides mainly what level of health care?

Tertiary

A nurse is assessing an older adult Aboriginal woman who is being treated for HT. During the assessment, what important information should the nurse remember about cultural aspects?

The assessment should include information regarding cultural practices and beliefs regarding meds, treatment, and healing

A client on the psychiatric unit is noisy, loud and disruptive. The nurse informs the client, "Unless you're quiet, you'll be isolated and put in restraints, if necessary." How can this interaction be described in relation to the law?

The information given to the client is actually assault

Which of the following nursing actions is most indicative of sterotyping

The nurse advocates for bronchodilators to be prescribed for all newly admitted Black clients *Painting everyone the same based on their ethnicity

Which of the following is the most appropriate nursing response when a client insists that the practitioner use a treatment method discovered on an internet website?

The treatment must be examined to see if its appropriate

Which of the following best defines nursing informatics

The use of computer information systems in the practice of nursing

A client attending a mental health clinic is being assessed for a community treatment order (CTO). The nurse informs the client about a right to which of the following? Select one.

To be examined by two physicians

The nurse reviews various standardized terminology before entering client data in the electronic medical record. What is the purpose of the review?

To ensure that client information is meaningful to other health care professionals

Madeleine Leninger

Transcultural Theory Goal of nursing is to provide care congruent with cultural values, beliefs, and practices. Care is the essence of nursing and the dominant, distinctive and unifying feature No cure without caring but that there may be caring with curing Work towards an understanding of care and the values, health beliefs and life-styles of different cultures which will form the basis for providing culture-specific care

The nurse is entering a client's data in the Electronic health record. What action should the nurse take to minimize ambiguity and confusion

Use consistent, codified terminology

When performing a cultural assessment with a client of a different culture, which of the following actions is the initial action to be taken by the nurse

ask the client about any affiliation with a particular cultural group

Boundary crossing

brief excursions across boundaries that may be inadvertent, thoughtless or even purposeful if done to meet a specific therapeutic need for the client. They encompass actions and behaviours that deviate from an established professional boundary. Intent is not to harm patient but to help. Can learn from and reflect

Which of the following terms refer to characteristics of a group whose members share a common social, cultural, linguistic, or religious heritage

ethnicity

Battery

intentional act of causing physical harm to someone, don't have to warn the victim or make him fearful before you hurt them for it to count as battery. Physical and emotional abuse, actually physically harming. Punching, kicking, slapping, pushing, pinching.

Assault

intentional act of making someone fear that you will cause them harm, you do not have to actually harm them to commit assault, threatening, emotional abuse enducing fear. Not physically harming

Professional intimacy

intergral to the care nurses provide, and includes physical, mental, spiritual, and social care with knowledge of the client's personal information

Medical neglect

nursing home staff is failing to provide the necessary treatment, medication, or prevention for a whole host of known needs for elderly patients, including ensuring patient mobility movement to prevent bedsores among others

Formal Patient

patient detained in a facility under tha MHA on the authority of two admission certificates or two renewal certificates

Negligence

physical abuse, financial abuse, emotional abuse, or neglect

Cultural humility

recognition that one will never master all information about another culture

physical neglect

resident hygiene or basic needs

Mental Disorder

substantial disorder of thought, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life

Cultural competence

the ability to interact effectively with people of different cultures and requires a certain level of knowledge about those cultures