NSG 110: Final Exam
Discuss the steps of nursing assessment
1. Collection of information from a primary source (the patient) and secondary sources (e.g., family members, health professionals, and medical record) 2. The interpretation and validation of data to ensure a complete database
Gould: stage 1
16-18 Individuals consider themselves part of the family rather than individuals and want to separate from their parents.
Gould: stage 2
18-22 Although the individuals have established autonomy, they feel it is in jeopardy, they feel they could be pulled back into their families.
Gould: stage 3
22-28 Individuals feel established as adults and autonomous from their families. They see themselves as well defined but still feel the need to prove themselves to their parents. They see this as the time for growing and building for the future.
Gould: stage 4
28-34 Marriage and careers are well established. Individuals question what life is all about and wish to be accepted as they are, no longer finding it necessary to prove themselves.
Gould: stage 5
34-43 This is a period of self-reflection. Individuals question values and life itself. They see time as finite, with little time left to shape the lives of adolescent children.
Gould: stage 6
43-50 Personalities are seen as set. Time is accepted as finite. Individuals are interested in social activities with friends and spouse and desire both sympathy and affection from spouse.
Gould: stage 7
50-60 This is a period of transformation, with a realization of mortality and a concern for health. There is an increase in warmth and a decrease in negativism. The spouse is seen as a valuable companion.
Watson
A holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. The theory integrates the human caring process with health environments, incorporating the life-generating and life-receiving processes of human caring and healing for nurses as their patients. The theory describes a consciousness that allows nurses to raise new questions about what it means to be a nurse, to be ill, and to be caring and healing. Transpersonal caring looks for deeper sources of inner healing to protect, enhance, and preserve a person's dignity, humanity, wholeness, and inner harmony. The model is transformative because the relationship influences both the nurse and the patient for better or for worse.
Leininger
According to transcultural nursing, the goal of nursing care is to provide care congruent with cultural values, beliefs, and practices. Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care.
Motivation to learn
Addresses the clients desire or willingness to learn
Explain why critiquing of the literature is a necessary step in evidence-based practice
After completing a thorough review and critique of the scientific literature, you might not have enough strong evidence to make a practice change. Instead you may find a gap in knowledge that makes your PICOT question go unanswered. When this happens, the best way to answer your PICOT question is to conduct a research study.
Acceptance
Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.
Learning environment
Allows a person to attend to instruction
Depression
Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.
Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well.
Anger
Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset.
Nurse-initiated interventions
Any treatment ,based on clinical judgement and knowledge, that a nurse performs to enhance patient outcomes; there are nurse-initiated, physician-initiated and collaborative interventions.
Resolution of an ethical problem Step 1
Ask the question, is this an ethical dilemma? If a review of scientific data does not resolve the question, if the question is perplexing, and if the answer will have relevance for areas of human concern, an ethical dilemma probably exists.
Principles of appropriate delegation:
Assess the knowledge and skills of the delegatee, Match tasks to the delegatee's skills, Communicate clearly, listen actively, provide feedback.
Level 1. Preconventional Morality: Stage 2 - Individualism and Exchange:
At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz's needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests.
Level 2. Conventional Morality: Stage 4 - Maintaining Social Order:
At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one's duty and respecting authority.
The Preoperational Stage
At this stage, kids learn through pretend play but still struggle with logic and taking the point of view of other people.
Level 3. Postconventional Morality: Stage 5 - Social Contract and Individual Rights:
At this stage, people begin to account for the differing values, opinions, and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards.
Holistic health models
Attempts to create conditions that promote optimal health. patients are considered to be the ultimate experts considering their own health and respect the patients subjective experience as relevant in maintaining health or assisting in health. Nurses recognize natural healing abilities of the body and incorporate complementary and alternative interventions such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, non pharmacological complements to traditional medical care. Can be used alone or along with conventional medicine.
Outcomes / Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient's care plan so that nurses as well as other health professionals caring for the patient have access to it.
Clara Barton
Battlefield nurse. Founder of the American Red Cross
Evaluation
Both the patient's status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.
Mary Mahoney
Brought forth an awareness of cultural diversity and respect for individual, regardless of background, race, color, or religion
Restorative
Cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care
Watson
Caring can be demonstrated and practiced. Caring consists of carative factors. Caring promotes growth. A caring environment accepts a person as he is and looks to what the person may become. A caring environment offers development of potential. Caring promotes health better than curing. Caring is central to nursing
Benner
Caring means the persons, events, projects and things matter to people.
Resolution of an ethical problem Step 3
Clarify values. Distinguish among fact, opinion, and values.
Right Circumstances
Consider the appropriate patient setting, available resources, and other relevant factors. In an acute care setting patients' conditions often change quickly. Use good clinical decision making to determine what to delegate.
What challenges does health literacy place on the nurse as far as patient education?
Currently printed educational materials are often above the patient's reading level. Removing medical terms from health information lowers the reading level, but this often does not bring it to an acceptable level. Unfortunately health care professionals do not always address the gap between the patient's reading level and the readability of educational materials.This results in unsafe care. To ensure patient safety, all health care providers need to ensure that information is presented clearly and in a culturally sensitive manner.
Affective learning
Deals with expression of feelings and acceptance of attitudes, opinions, or values
Denial
Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely.
Physician-initiated interventions
Dependent nursing actions, involving carrying out physician-prescribed orders.
Ability to learn
Depends on physical and cognitive abilities, developmental level, physical wellness, and thought processes
Leininger
Describes the concept of care as the essence and central, unifying, and dominant domain that distinguished nursing from other health disciplines. The expressions, processes, and patterns of caring vary among cultures. Caring is very personal; thus its expression differs for each patient. For caring to be effective, nurses need to learn culturally specific behaviors and words that reflect human caring in different cultures to identify and meet the needs of all patients.
PICOT
Do patients who have had abdominal surgery (P) and who rock in a rocking chair (I) have a reduced incidence of postoperative ileus (O) during hospitalization (T) when compared with patients who receive standard nursing care following surgery (C)? Another example is: Is an adult patient's (P) blood pressure more accurate (O) when measuring with the patient's legs crossed (I) versus the patient's feet flat on the floor (C)?
Psychosocial Stage 5 - Identity vs. Confusion
During adolescence, children explore their independence and develop a sense of self. Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will feel insecure and confused about themselves and the future. Completing this stage successfully leads to fidelity, which Erikson described as an ability to live by society's standards and expectations
Psychosocial Stage 7 - Generativity vs. Stagnation
During adulthood, we continue to build our lives, focusing on our career and family. Those who are successful during this phase will feel that they are contributing to the world by being active in their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world. Care is the virtue achieved when this stage is handled successfully. Being proud of your accomplishments, watching your children grow into adults, and developing a sense of unity with your life partner are important accomplishments of this stage.
Oral Stage (Birth to 18 months)
During the oral stage, the child if focused on oral pleasures (sucking). Too much or too little gratification can result in an Oral Fixation or Oral Personality which is evidenced by a preoccupation with oral activities. This type of personality may have a stronger tendency to smoke, drink alcohol, over eat, or bite his or her nails. Personality wise, these individuals may become overly dependent upon others, gullible, and perpetual followers. On the other hand, they may also fight these urges and develop pessimism and aggression toward others.
Psychosocial Stage 3 - Initiative vs. Guilt
During the preschool years, children begin to assert their power and control over the world through directing play and other social interactions. Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt, and lack of initiative. When an ideal balance of individual initiative and a willingness to work with others is achieved, the ego quality known as purpose emerges.
The Sensorimotor Stage
During this stage, infants and toddlers acquire knowledge through sensory experiences and manipulating objects.
Dorothea Dix
Early nursing pioneer who revolutionized health care for the mentally ill.
Secondary
Emergency care, medical-surgical care, and radiological procedures for acute problems
Resolution of an ethical problem Step 7
Evaluate the plan over time.
Theory
Explains a phenomenon ( aspect of reality that people sense or experience)
What are some examples of non-verbal behavior?
Facial expressions, body language, touch, eye contact. etc
Family-centered care
Families have different personalities, life experiences, values, beliefs, education, and religious and cultural backgrounds. Care provided should be equal to all patients and flexible so that the needs and choices of families can be met.
Secondary
Focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complication or worsening conditions.
Watson's 10 Carative Factors
Forming humanistic-altruistic value system Instilling faith-hope Cultivating sensitivity to self and others Developing helping-trust relationship Promoting expression of feelings Using problem-solving for decision making Promoting teaching-learning Promoting supportive environment Assisting with gratification of human needs Allowing for existential-phenomenological forces
Resolution of an ethical problem Step 2
Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information.
Primary
Health promotion
Isabel Robb
Helped found the Nurses Associated Alumnae of the U.S and Canada in 1896 (became ANA)
Describe the components of a critical thinking model for clinical decision making
I. Specific knowledge base in nursing II. Experience III. Critical thinking competencies A. General critical thinking B. Specific critical thinking C. Specific critical thinking in nursing: nursing process IV. Attitudes for critical thinking Confidence, Independence, Fairness, Responsibility, Risk taking, Discipline, Perseverance, Creativity, Curiosity, Integrity, Humility V. Standards for critical thinking A. Intellectual standards Clear, Precise, Specific, Accurate, Relevant, Plausible, Consistent, Logical, Deep, Broad, Complete, Significant, Adequate (for purpose), Fair B. Professional standards 1. Ethical criteria for nursing judgment 2. Criteria for evaluation 3. Professional responsibility
Resolution of an ethical problem Step 5
Identify possible courses of action.
Cognitive learning
Includes all intellectual behaviors and requires thinking
Describe sources of diagnostic errors: Clustering
Insufficient cluster of cues Premature or early closure Incorrect clustering
Tertiary
Intensive care/ subacute care
Small group
Interaction with a small number of people
Public
Interaction with an audience
Transpersonal
Interaction within a person's spiritual domain
Psychomotor learning
Involves acquiring skills that require integration of mental and muscular activity
TEAM NURSING
Involves use of a team leader and team members to provide various aspects of nursing care to a group of patients. In team nursing, medications might be given by one nurse while baths and physical care are given by a nursing assistant under the supervision of a nurse team leader. Skill mixes include experienced and specially qualified nurses to nursing orderlies.The quality of patient care with this system is questionable, and fragmentation of care is of concern.
Nursing theory
Is a conceptualization of some aspect of nursing Communicates the purpose of describing, explaining, predicting, and/or prescribing nursing care
Latency Stage (age six to puberty).
It's during this stage that sexual urges remain repressed and children interact and play mostly with same sex peers.
The Concrete Operational Stage
Kids at this point of development begin to think more logically, but their thinking can also be very rigid. They tend to struggle with abstract and hypothetical concepts.
Level 3. Postconventional Morality: Stage 6 - Universal Principles:
Kohlberg's final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.
Basic human needs
Maslow's hierarchy of needs- psychosocial needs, safety and security, needs of love and belonging, self-esteem, self actualization.
Resolution of an ethical problem Step 6
Negotiate a plan. Negotiation requires a confidence in one's own point of view and a deep respect for the opinions of others.
Block and parish nursing
Nurses living within a neighborhood provide services to older patients or those unable to leave their homes. It fills in gaps not available in traditional health care system.
Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient's record.
Tertiary
Occurs when defect or disability is permanent and irreversible.
Intrapersonal
Occurs within an individual
Level 2. Conventional Morality: Stage 3 - Interpersonal Relationships:
Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships.
Interpersonal
One-to-one integration between 2 people
Lilian Wald and Mary Brewster
Opened the Henry Street Settlement, which focused on the health needs of poor people who lived in NYC
Mother Bickerdyke
Organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers
Five Interrelated Essential Elements (Roy)
Patiency- The person receiving care. Goal of nursing- Adapting to change. Health- Being and becoming a whole person. Environment. Direction of nursing activities- Facilitating adaptation.
Watson's Concepts
Person-Human being to be valued, cared for, respected, nurtured, understood and assisted Environment-Society Health-Complete physical, mental and social well-being and functioning Nursing-Concerned with promoting and restoring health, preventing illness
Vulnerable populations
Poor and homeless, Abused, Substance abusers, Mentally ill, Older adult, Immigrants
PRIMARY NURSING
Primary nursing refers to comprehensive, individualized care provided by the same nurse throughout the period of care. Primary nursing is a method of nursing practice which emphasizes continuity of care by having one nurse provide complete care for a small group of inpatients within a nursing unit of a hospital. This type of nursing care allows the nurse to give direct patient care.The primary nurse accepts total 24-hour responsibility for a patient's nursing care. Nursing care is directed toward meeting all of the individualized patient needs. The primary nurse communicates with other members of the health care team regarding the patient's health care. This care method is rejected by many institutions as too costly.
What is professional behavior & how does it relate to communication?
Professional appearance, demeanor, and behavior are important in establishing trustworthiness and competence. They communicate that you have assumed the professional helping role, are clinically skilled, and are focused on your patients. Nothing harms the professional image of nursing like an individual nurse's inappropriate appearance or behavior.A professional is expected to be clean, neat, well groomed, conservatively dressed, and odor free. Visible tattoos and piercings are not acceptable in the professional setting. Professional behavior reflects warmth, friendliness, confidence, and competence. Professionals speak in a clear, well-modulated voice; use good grammar; listen to others; help and support colleagues; and communicate effectively. Being on time, organized, well prepared, and equipped for the responsibilities of the nursing role also communicate professionalism.
Right Supervision/Evaluation
Provide appropriate monitoring, evaluation, intervention as needed, and feedback. NAP need to feel comfortable asking questions and seeking assistance.
TOTAL PATIENT CARE
RN is responsible for all aspects of care for one or more patients during a shift of care. Care can be delegated. RN works directly with patient, family, and health care team members.
What is active listening
Requires the listener to feed back what they hear to the speaker, by way of re-stating or paraphrasing what they have heard in their own words, to confirm what they have heard and moreover, to confirm the understanding of both parties.
Orem
Self-care comprises those activities performed independently by an individual to promote and maintain person well-being. Self care agency is the individual's ability to perform self care activities. Self- care deficit occurs when the person cannot carry out self-care.The nurse then meets the self-care needs by acting or doing for; guiding, teaching, supporting or providing the environment to promote patient's ability
Anal Stage (18 months to three years)
The child's focus of pleasure in this stage is on eliminating and retaining feces. Through society's pressure, mainly via parents, the child has to learn to control anal stimulation. In terms of personality, after effects of an anal fixation during this stage can result in an obsession with cleanliness, perfection, and control (anal retentive). On the opposite end of the spectrum, they may become messy and disorganized (anal expulsive).
Level 1. Preconventional Morality: Stage 1 - Obedience and Punishment:
The earliest stage of moral development is especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment.
The Formal Operational Stage
The final stage of Piaget's theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas.
Genital Stage (puberty on)
The final stage of psychosexual development begins at the start of puberty when sexual urges are once again awakened. Through the lessons learned during the previous stages, adolescents direct their sexual urges onto opposite sex peers, with the primary focus of pleasure is the genitals.
Psychosocial Stage 1 - Trust vs. Mistrust
The first stage of Erikson's theory of psychosocial development occurs between birth and one year of age and is the most fundamental stage in life. Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child's caregivers. If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.
What is the best way a nurse can increase a family's response to stress/crisis?
The nurse needs to understand how the illness has affected the family structure and the support the family requires and what the patients illness mean to the family members and family functioning. Asses the family functions such as the ability to provide emotional support for member, the ability to cope with current health problems or situations, and the appropriateness of its goal setting and process towards achievement of developmental tasks.Always recognize and respect the families cultural background
Diagnosis
The nursing diagnosis is the nurse's clinical judgment about the client's response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications.
Roy
The person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput).The output can be either adaptive responses or ineffective responses
Phallic Stage (ages three to six)
The pleasure zone switches to the genitals. Freud believed that during this stage boy develop unconscious sexual desires for their mother. Because of this, he becomes rivals with his father and sees him as competition for the mother's affection. During this time, boys also develop a fear that their father will punish them for these feelings, such as by castrating them. This group of feelings is known as Oedipus Complex. Later it was added that girls go through a similar situation, developing unconscious sexual attraction to their father. Although Freud Strongly disagreed with this, it has been termed the Electra Complex by more recent psychoanalysts.
Right Person
The right person is delegating the right tasks to the right person to be performed on the right person.
Right Task
The right task is one that you delegate for a specific patient such as tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk.
Psychosocial Stage 2 - Autonomy vs. Shame and Doubt
The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control. Erikson believe that learning to control one's bodily functions leads to a feeling of control and a sense of independence. Other important events include gaining more control over food choices, toy preferences, and clothing selection. Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt. Erikson believed that achieving a balance between autonomy and shame and doubt would lead to will, which is the belief that children can act with intention, within reason and limits.
School health
These are comprehensive programs that include health promotion principles throughout a school curriculum. They emphasize program management, interdisciplinary collaboration, and community health principles.
Community health centers
These are outpatient clinics that provide primary care to a specific patient population (e.g., well-baby, mental health, diabetes) that lives in a specific community. They are often associated with a hospital, medical school, church, or other community organization.
Nurse-managed clinics
These clinics provide nursing services with a focus on health promotion and education, chronic disease assessment management, and support for self-care and caregivers.
Physicians' offices
They provide primary health care (diagnosis and treatment). Many focus on health promotion practices. Nurse practitioners often partner with a physician in managing patient population.
Occupational health
This is a comprehensive program designed for health promotion and accident or illness prevention in the workplace setting. It aims to increase worker productivity, decrease absenteeism, and reduce use of expensive medical care
Psychosocial Stage 8 - Integrity vs. Despair
This phase occurs during old age and is focused on reflecting back on life. Those who are unsuccessful during this stage will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair. Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death.
Psychosocial Stage 4 - Industry vs. Inferiority
This stage covers the early school years from approximately age 5 to 11. Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their abilities to be successful. Successfully finding a balance at this stage of psychosocial development leads to the strength known as competence or a belief our own abilities to handle the tasks set before us.
Psychosocial Stage 6 - Intimacy vs. Isolation
This stage covers the period of early adulthood when people are exploring personal relationships. Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will form relationships that are committed and secure. Erikson believed that a strong sense of personal identity was important for developing intimate relationships. Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression.
Swanson
This theory describes caring as constant with 5 categories or processes. Swanson defies caring as a nurturing war of relating to a valued other toward whom one feels a personal sense of commitment and responsibility. This theory supports the claim that caring is a central nursing phenomenon but not necessarily unique to the nursing practice. Provides direction for how to develop useful and effective caring strategies. Each of the caring processes has definitions and sub dimensions that serve as the basis for nursing interventions.
What is the primary purpose of a nursing diagnosis
To recognize the patients response to an illness or situation based on the nurses observation
Bargaining
Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.
Primary
True prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy.
Resolution of an ethical problem Step 4
Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion.
Right Direction/Communication
You give a clear, concise description of the task, including its objective, limits, and expectations. Communication needs to be ongoing between the registered nurse and NAP during a shift of care.
A nursing diagnosis
a clinical judgment about individual, family, or community responses to actual and potential health problems or life processes that the nurse is licensed and competent to treat
Health belief
addresses the relationship between persons beliefs and behaviors. Helps you understand factors influencing patients perceptions, beliefs, and behavior to plan care that will most effectively assist patients in maintaining or restoring health and preventing illness.
DRGs, or diagnostic related groupings
are how Medicare and some health insurance companies categorize hospitalization costs and determine how much to pay for any particular hospitalization. Rather than paying the hospital for what it spent caring for a hospitalized patient, Medicare pays the hospital a fixed amount based on the patient's DRG or diagnosis. If the hospital can treat the patient while spending less than the DRG payment, it makes a profit. If the hospital spends more than the DRG payment treating the patient, it loses money.
Objective data
are observations or measurements of a patient's health status.
Subjective data
are your patients' verbal descriptions of their health problems.
Florence
believed role of nurse was to help the body recover & then remain free from disease. organized the first school of nursing. 1st practicing epidemiologist; used statistical analysis to show the connection between poor sanitation & disease (cholera and dysentery)
Health promotion
defines health as a positive, dynamic state, not merely the absence of disease. Directed at increasing a patients level of well-being. Describes the multidimensional nature of persons as they interact with their environment to peruse health. Notes that each person has unique personal characteristics and experiences that affect subsequent actions.
Cultural care accommodation
help adapt to or negotiate for a beneficial health status, or face death Cultural care re-patterning; help restructure or change lifestyles that are culturally meaningful
Cultural care preservation:
help maintain or preserve health, recover from illness, or face death
Prospective Payment System (PPS)
is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).
A medical diagnosis
is the identification of a disease condition based on a specific evaluation of physical signs, symptoms, the patient's medical history and the results of diagnostic tests and procedures.
What is health literacy?
the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.
Discuss the criteria used in priority setting.
urgency of the problems, the patient's safety and desires, the nature of the treatment indicated, and the relationship among the diagnoses.
Describe sources of diagnostic errors: Interpreting
• Inaccurate interpretation of cues • Failure to consider conflicting cues • Using an insufficient number of cues • Using unreliable or invalid cues • Failure to consider cultural influences or developmental stage
Describe sources of diagnostic errors: Labeling
• Inaccurate interpretation of cues • Failure to consider conflicting cues • Using an insufficient number of cues • Using unreliable or invalid cues • Failure to consider cultural influences or developmental stage
Describe sources of diagnostic errors: Labeling
• Wrong diagnostic label selected • Evidence that another diagnosis is more likely • Condition a collaborative problem • Failure to validate nursing diagnosis with patient • Failure to seek guidance
