Test 6
four primary principles of ethical decision making ?
1) Autonomy 2)Justice 3)Beneficence 4)Veracity
Be able to modify your tone and facial expression)ex: upbeat bubbly nurse; "good morning "pt is not smiling and seem distress modify tone and ask whats wrong?
Adaptable
focus on own needs ( impatient when needs arent met)
Aggressive
national standard for disclosure of protected health information is ?
Privacy rule of HIPAA
causes of conflict in healthcare environment lack of understanding of value of all team members which tasks each team member is authorized to perform
Role boundary issues
dissemination of emergency alerts, public service announcements, communication within departments in the hospital.
TEXTING / USED FOR
includes appreciation for member contributions focuses on the " we " versus one- sided commands focuses on shared responsibilities
Team centered communication
opposed to social communication is essential for the establishment of a healthy nurse-patient relationship.
Therapeutic communications
when an individual confident in actions of another individual
Trust
Need to be proficient in verbal and written communication skills. Aware of body language (nonverbal) Competent in computer and electronic communication skills
Effective communication
system of moral principles or standards governing behaviors and relationships based on professional nursing beliefs and values
Ethics in Nursing
Nurses can make clinical decisions based on best research evidence , their clinical expertise , and healthcare preferences of their patients
Evidence - based practice
Be prompt Be accurate Be detailed Be neat Check spelling Chart chronologically Date & time at ___beginning___________ of each note Use black or blue pen Be ____objective_______ Chart only care you provide Record your signature!
Do's of effective documentation
goal is to protect the public health , safety, and welfare
BOARD OF NURSING
progress notes are written in DAR fomat D- data (what was assessed) A- action ( what was done about it ) R- response ( how did the patient respond to the treatment) advantages: patient centered provides a holistic view of patients needs provides a framework for nursing progress notes the three components do not have to be in any particular order
Focus charting
helping patient expand on and develop a topic of importance. Patient: "My wife says she will look after me, but I don't think she can, with the children to take care of, there always after her about something—clothes, homework, what's for dinner." Nurse: "Sounds like you are worried about how well she can manage."
Focusing
Upholding of what is just and fair
Justice
a kidney transplant is performed for a patient with the greatest need ? - equal / fair
Justice
Delegating to Unlicensed Assistive Personnel (UAP) different categories , each with diverse levels of training experience - certified _____ _____ / _____ - home health ____ -medical ____ - orderlies -_______ technicians
aides / assistants aide technicians surgical
Principles for delegating to UAP nurses must ____ patients first patient medically _____ or in _____ condition and not _____
assess stable chronic fragile
right to self-determination which process occurs with patients / relates to ?
autonomy informed consent
interpretation or conclusion that one accepts as ___true____.
belief
Meaningful use - Based on five pillars of health outcomes 1) improving ____ _____ 2) reducing _____ ____ among U.S. citizens , by improving ____ & ______ of care 3)ensuring the ______ & ______ of protected medical information 4)engaging ___ & their _____ in the pateints ____ 5) improving ____ & ____ ____
care coordination health disparities safety / quality security / privacy patients families care population / public health
Benefits of interprofessional collaboration care becomes patient ____ & patient ______ - patients empowered as informed consumers , actively collaborate with healthcare team in ______-_____ _____
centered / directed decision making process
provides structure for reporting and helps employees manage supervisory relationships hierarchy of authority & responsibility
chain of command
is the medium used whether it is face-to-face, recorded message, radio.
channel
started in Jan 2018 eventual goal is that same license can be used throughout the United States
new enhanced nurse licensure compact
withholding a medication for a client when his blood pressure is 88/50 is what principle ? - nurse do not do harm / benefits the patient
non- maleficence
error of any type that the patients or caregiver is notified is ?
patient right
Nurses ethical duty goes beyond beneficence to include nonmaleficence Nonmalefience is ?
requires nurses do no harm and safeguard patient risk of harm weighed against potential benefit
thoughts or communication that an individual keeps to themselves this communication occurs constantly and can interfere with your patient's ability to hear that message with you have this self -talk going on
self- talk
Benefits to the organization -
teamwork improves goals better care / increases patient satisfaction improves generally happier
if youre not english speaking with a different type of language primary language they have the right to get the information in their preferred language / blue telephones for interpreters one for patient one for you and the interpreter
to get information about your care in your preffered language ( patients right)
what is the primary goal in healthcare ?
to improve patient outcomes
why would I want to find database ?
to research / find evidence based practice examples or other topics
Voicing own feelings and wishes based on sound evidence without placing blame or raising the defenses of the individual your taking to ( nurse tech pateint needs to be turned every 2 hours ; I would like you to turn that patient to be turned every 2 hours, I think that the patient would benefit from . )
" I statements" techniques for assertive communication
What nursing values you have established this semester so far?
- washing hands - preventing spreading germs to others - safety measures -care provided is safe -admitting your mistakes ( honesty & integrity) - teamwork & collaboration ( takes a village of interprofessional to take care of patients ( patient is center care)
Right person
-assess and verify the competency of the team member -continually review the performance of the team member & determine competency of care -assess team member performance based on standards & re mediate if needed ex: new tech/ new nurse may need a lot of supervision the right experience / scope of practice
-recognize collaboration as key component of nursing practice - standard 10: specific competencies related to nurse's role in collaboration (referrals to doctors)
American Nurse Association standards of professional nursing practice
Purpose is to serve as Statement of __ethical____ ___obligation________and duties of nurse Profession's ____nonnegotiable___________ethical standard Nursing profession's statement of ____commitment____________ to society
American Nurses Association (ANA) Code of Ethics for Nurses
Right circumstance
Appropriate patient setting, available resources, and other relevant factors considered
-similar to hard copy written documentation , HIPAA rules apply to all documentation in the electronic medical record - just as with written documentation , patients have access to their medical records - individualized user I.D. & password used to access electronic medical record - never share your personal user I.D. & password with anyone or use someone else's user ID or password to access electronic medical records
Confidentiality & Electronic Medical Record
being congruent between verbal and nonverbal expression gains trust. ( when youre teaching pt how to care for colonstomy dont give them false hope even though you have a worried look let them know you may need help with this do you have family to help you with this?)
Congruence factors influencing the communication process
contribute to our ________uniqueness___________ and susceptibility to some disorders.
Copy number variation (CNVs) -
be truthful, trustworthy, and honest.) If you are not going to be back in 10 minutes do not state that you are) tell them I have a couple of other patients to see I wont be back in another hour don't tell them unless you are going to follow through
Credibility
Stop documenting as soon as the error is noted to make correction Draw __one ______line through text written in error and write "Mistaken Entry" or "Error" above it with your initials next to it If error was made on electronic record, you must review facility's protocol for correcting
Documenting Errors
Mandates that __healthcare______ __organizations____________have written guidelines and policies Must at least have access to ethics professionals, but most facilities have interprofessional ethics committees.
Ethical requirements- Joint commission
Study and development of ethical standard - individual -community -professional Nursing (ANA code of ethics)
Ethics
"an integration of the best evidence available , nursing expertise, and the values preferences of the individuals, families and communities who are served "
Evidence - based practice
Aim = > to provide best possible care based on best available research Push for EBP => Institute of medicines 1999 report to Err is Human neither healthcare environment nor EBP is static sigma theta tau international honor society of nursing
Evidence - based practice
in state of Delaware you have to renew every ? 3 of those hours have to be about ?
2 years substance abuse ( significant in our state )
Assess patient's ability to ______cooperate __________ and make decisions Assess reliability of information provided by patient Assess patient's medical history and family situation __educate_____________ patient and family about their rights Monitor care for abuse of patient's rights Evaluate policies and procedures if patients' rights are violated Ensure that patients have the ____information______________ to make informed decisions Question other healthcare provides when care is ____being stereotyped________________ and not individualized Speak up for safe practice conditions
nurses responsibility - Advocacy
seeks answers to questions that will ultimately improve patient care
nursing clinical research
also referred to as charting or recording the main purpose is for effective communication among healthcare professionals
nursing documentation
Omnibusman Program State regulates
nursing homes homes for aged licensed facilities for disabled
team decision making must be directed at ____ of specific effort requires healthcare team to focus on _____ ____ ____, organize ______ accordingly
objectives patients priority needs interventions
student nurse ( chain of command ) => issues with nurse on the fllor => charge nurse => nurse manager
organizational chart
Process of interprofessional collaboration more coordination than communication each professional separate interventions separate plan of care
parallel functioning
focus on needs of others ( deny them self any power cause them to be frustrated)
passive
OBJECTIVES OF INTERPROFESSIONAL COLLABORATIVE PRACTICE - provide _____-_____ , _____-_____ care - enhance ____ of care across _____ of health - improve ___ & ____ satisfaction -provide high -______, cost-_____ , evidence- ____ care that improves ____ _____
patient directed patient centered continuity continuum patient family quality effective based patient outcomes
to have a personal representative , advocate, with you during your care family member or friend of your choice is ?
patient right
refuse care you have to what ?
patient right - to sign paperwork to go AMA agaisnt medical advice ( paperwork legally) takes away responsibility of care givers
right to informed consent for care is guaranteed by federal law / for any care
patients right
If you realize later in the shift that you forgot to document something earlier on the client's chart it is still okay to document but do it as soon as you realize. Any later than this, follow facility protocol Write the words ____late ___ ____entry______ next to the date and time prior to writing your note
Late entry
where do I find database ?
Library - dtcc library / specific to nursing
"interventions or testing that takes place using transportable , portable, or hand- held devices near the patient " - charting at the bedside increases efficiency decreases error
POINT OF CARE
Health care settings: point of entry into health care systems. Includes health maintenance services - routines physicals, immunizations, treatment of common acute illness, supports for psycho social needs . takes place in physicians offices , hospital based clinics, community health centers , public health service centers , churches, etc.
PRIMARY CARE
Process of interprofessional collaboration lowest level - each profession communicated with patient independent same or similar questions repetition overlap occurs
Parallel communication
By comparing genomes we can see just how alike different species are. Open access allows for many positive applications to our health and environment. Genomics is ___holistic___________, high-throughput, and resource generating.
Principles of Genomics
Patients are partners in care and involved in all aspects of care. ______Individuals____________ needs and values of each patient are recognized Patient's own experience and expertise are respected Patient's perspectives, beliefs, and culture are taken into ____consideration___________ during care Individualized/personalized health care
Principles of Patient-centered Care
List __different alternatives ( procedure) ___________ Examine possible consequences of choices Freely choose a course of action Feel good about the choice ___affirm______the choice Act on the choice Act with a __pattern____
Processes to Assist Patients in Clarifying Values:
Socialization into nursing _______________by established professional codes of ethics, faculty, other nurses Clinical and life experiences
Professional values developed
right supervision/evaluation
Provide appropriate monitoring, evaluation, intervention as needed, and feedback. NAP need to feel comfortable asking questions and seeking assistance.
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. -trafficking -disparities ( legslation => make sure that everyone is getting adquate care ) cultures racist not getting the same quality care as others important for us to speak up for these people
Provision 8
The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain integrity of the profession, and integrate principles of social justice into nursing and health policy. - pratice whatever field you like a lot join the organization & get yourself certified in that field
Provision 9
Communication ___planning__________ patient care Auditing health agencies (The Joint Commission) Research _education____________ Reimbursement (from insurance/government) Legal record (admissible in court) Healthcare analysis
Purposes of Maintaining Patient Records
Definition: Recognize the patient or designee as the source of ___control _____________ in providing compassionate and coordinated care based on respect for patient's 1.preferences, 2.values, 3.and needs.
QSEN - Patient Centered Care
Ideally, a dynamic interactive process in which patients work together with healthcare providers to meet patients ( involved in their care ) health objectives
QSEN PROJECT
identified teamwork and collaboration as two of the six competencies needed to achieve high quality patient care
QSEN PROJECT
mutual respect , true sharing of power and control are essential
QSEN PROJECT
what does QSEN stand for ?
Quality and Safety Education for Nurses Project
RN increasingly delegate components of nursing care - to other _____, _____, unlicensed _____ _____ - RN who delegates is ____ for choosing appropriately skilled _____ - RN who delegates must continually ____ provided by that _____
RN's LPNs assistive personnel accountable caregiver evaluate caregiver
The _______ is the third component of communication process is the listener. This is called the _______.
Receiver decoder
directing ideas, feelings, questions, or content back to patient to enable them to explore their own ideas and feelings about a situation. Patient: "What can I do?" Nurse "What do you think would be helpful?" Do you think I should tell my husband
Reflecting
Sentinel events are ______ to the ____ _____. they keep a database that hospitals can access in order to change policies.
Reported Joint Commission
_______ is the fourth component of communication process
Response
actively listening for patients basic message and then repeating in similar words. Patient: "I couldn't manage to eat any dinner last night—not even the dessert." Nurse: 'You had difficulty eating yesterday?"
Restating or paraphrasing therapeutic communication techniques
- suicide of any patient receiving care , treatment, & services in a staffed around - the- clock- care setting or within 72 hours of discharge , including from the hospital's emergency department (ED) - unanticipated death of a full- term infant - discharge of an infant to the wrong family - abduction of any patient receiving care , treatment, & services
Sentinel Event
joint commission definition (2016) " is a patient safety event ( not primarily related to the natural course of the patients illness or underlying condition) that reaches a patient & results in any of the following : - DEATH -Permanent harm -Severe temporary harm
Sentinel Event
select understandable terms that are appropriate for knowledge, culture and education of patient) more simple: catherize to obtain urinalysis, we need to get a sample on urine collect it from your bladder
Simplicity
upholding of justice, what is fair, on social scale - Equal ( whats fair for everybody )
Social justice
Be aware of cultural behaviors (direct eye contact / viewed differently in other cultures)
Sociocultural characteristics factors influencing the communication process
using telecommunication technologies to allow patient access to care they might not otherwise be able to obtain
TELEHEALTH
assessment interpreting data making a nursing diagnosis creating a nursing care plan evaluating care effectiveness administering parenteral medications performing triage care of invasive lines inserting NG tubes patient education giving telephone advice
Tasks that may not be delegated to UAP
Benefits: access to health care is increased health outcomes are improved healthcare costs can be reduced may help with shortages of healthcare providers
Telehealth
Chemo center / mole is cancerous what kind of care ?
Tertiary
the nurse is providing diet & exercise education to a patient diagnosed with diabetes which prevention is this ?
Tertiary / already has the disease
Definition in Pearson: "acts to ___protect_________ the client and __defend_________ the client from harm". Part of ANA Code of Ethics and primary role for all nurses Patients in ____vulnerable____________ populations are especially in need for advocacy
The Nurse as a Patient/Client Advocate
expressed both verbally , non-verbally magnet hospitals foster respect among professionals
Trust
asking broad questions that invite answers that are longer than one or two words. "I'd like to hear more about that." " Tell me what brought you to the hospital ?"( did you sleep well last / yes or no)
Using Open-ended questions therapeutic communication techniques
Process of consciously identifying, examining, developing, individual values important in patient - centered care Helps nurses learn how to identify patient values Helps nurses distinguish patient values from their own ongoing process one model is unit - based discussion real-time opportunities for nurses to speak about ethics concern
Values Clarification
= If you have a tendency to say I'm sorry even when there is no call for it you should be aware and stop the behavior. An unnecessary apology immediately places the communicator in a somewhat submissive position. However, apologies should be given when warranted.
avoid apologizing when possible
. Failure to listen -not actively listening to patient just listening to words not understanding what theyre trying to communicate to us 2. improperly decoding the patients intended message - message is not decoded the way it was suppose to send mess encode patient receives they decode it ( something wrong went wrong) 3.placing the nurses needs above the patients needs. - you need to go to lunch, when you should be caring of your patient
barriers to communication
- work schedule & workload demands - patient preferences that might conflict with best practice care - lack of access to technology to find evidence when needed - limited knowledge in skills for finding & evaluating evidence
barriers to evidence- based practice
Delegation vs Dumping delegation should always be done in a way that : - provides greatest ____ to the ____ - makes best use of ___ of all ____ ____ - provides delegates with ______ for ____
benefit patient time staff members opportunity growth
ability to access / use evidence for a variety of sources that will help improve client care provides best evidence for evidence -based practice ensures credibility of the nursing profession provides accountability for nursing care , which support nursing as a professional discipline defining current best practice standards of nursing care
benefits of evidence - based practice
Called ____ _____ Gestures, facial expressions, touch Gestures, body movements, use of touch, physical appearance Conveys more about what patient is feeling, Rather than what the person actually says because it is controlled less consciously that verbal behavior. what form of communication is this ?
body language nonverbal
may include : - electronic health records - clinical decision support systems -bedside medication administration - computerized provider order entry (CPOE)
clinical information systems
multiple people can access give real time info support decision- making - shows trends,standard of care integrated into programs permits more time for care at bedside
clinical information systems
2 or more people working toward a common goal by combining skills,knowledge, and resources while avoiding duplication of effort
collaboration
Conflict prevention & management conflict is ______ in the workplace a normal part of work environment cannot be ____ - can be _____ responses to conflict depend on nurse's _____ skills although viewed as negative , conflict can be impetus for better ____, stronger ____ _____ , _____ _____
inevitable eliminated / managed leaderships communication team relationships healthy changes
Clarifying patients values: Nurses need to identify patients' values as those values ___________and relate to particular health problems
influence
Development Gender Sociocultural characteristics Values and perceptions Personal space Territoriality Roles and relationships Environment Congruence Interpersonal attitudes are factors that ?
influence the communication process
not officially appointed / age , seniority expert in something such as lung sounds
informal leader
Communicate , manage knowledge , mitigate error, and support decision making using information technology (QSEN,2010)
informatics
Process of interprofessional collaboration planned communication / unilateral decisions make own decisions but do communicate
information exchange
important for nurses to advocate for patients, if they not understand surgery & notify physician
informed consent
practitioners responsibility to explain diagnosis or condition that requires treatment , purpose of treatment, what patient can expect to feel or experience the intended benefits of the treatment possible risks or negative outcomes of the treatment abd advantages / disadvantages of possible alternatives to treatment
informed consent for surgery
increased emphasis in nursing community on value of _____ collaboration & practice to improve patient outcomes
inter professional
professionals from various disciplines along with support staff, patient,family members
inter professional
Verbal, nonverbal, written, and unwritten, planned or unplanned
interaction that occur through communication
what is HIPAA primary goal?
is to provide patients with greater control over personal health care information ( who sees the protected information ) applies to written/ verbal / documented/ typed in computer
Getting too close and invading the personal space, wagging a finger in someone's face, glaring at the other person can all counter assertive words. By Maintaining open, assertive body language and keeping neutral voice, the nurse promotes shard decision-making and compromise. maintain open assertive body language, neutral voice ,compromise.
managing nonverbal communication
The ______ is next component of communication These are the words actually _____ or _____, body language that accompanies the words, and how the words are transmitted.
message spoken / written
Verbal/nonverbal/electronic/written ( form of verbal )
modes of communication
Benefits of Delegation benefits to nurse -
more time complex patient care increase organizational retention rate nurse job satisfaction
Benefits Effective and professional because it is based on _________ ____________. Improves communication and reduces stress by: Deescalating conflicts Improves outcomes reduces likelihood of any _____ _____
mutual respect angry encounters
form of verbal communication Notes, letters, email, text messages Has some limitations as it lacks _____ ____ ____ ____ ____ text from friend saying : "GET OUT OF HERE"- without understanding of context as shock or disbelief/ anger not having body language to rely its just the words Needs to have simplicity, brevity, clarity, relevance, credibility and humor. Should contain appropriate language ( reading level) and terminology, correct grammar( spelling is right) , logical organization and appropriate use and citation of resources. what form of communication ?
nonverbal Q companies verbal communication written communication
Leaderships is _______ management
not
Delegating to Unlicensed Assistive Personnel UAP function as " ______ ______ "
nurse extenders
multi state license . state of residence is where you apply for nursing license , but may practice in other states that are part of the nurse license compact
nurse licensure compact
Guidelines for successful delegation follow state ____ ____ ____ & facility's policies & procedures delegate only tasks for which you have both _____ , _____ follow state ___, ____ ____, _____ ____
nurse practice act accountability responsibility regulations , job descriptions , agency policies
THE NURSE AS A COLLABORATOR collaboration may occur : - between ____ - between _______ ____ & _______ - between healthcare providers from _____ professional backgrounds
nurses healthcare providers & patients different
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. -Giving input into the changes that are occuring ( issues going on ... doing research in that area to make it better ) -Giving presentations about nursing ( help the public know what a nurse is & what we do ) -Setting standards & evulating standards -Generating new policies ( health policy itself ) - ex: wearing helmets with bikes ( change in health policy )
provision 7
Process of interprofessional collaboration characteristics of effective interprofessional collaboration - common ____, goals ____ at outset - clinical ____ of each ____ - interpersonal ____ - _____ -_____ - valuing & respecting diverse , complementary ____
purpose identified competencies provider competencies humor trust knowledge
investigates a question through narrative data that explores the subjective experiences of human beings & can provide nursing with a better understanding of the patients perspective
qualitative research
OBJECTIVES OF COLLABORATIVE PRACTICE provide high - _______ , cost _____ , research - ____ _____
quality effective based care
All nurses should be involved in ____ _____
quality improvement
use precise measurement to collect data & to analyze it statistically for a summary & description of resulting findings
quantitative research
The Nonverbal channel of touch is used to establish a bond or connection with the ________. Nurses use a combination of _____ ___ with our _____ _____.
receiver therapeutic touch verbal messages
To decode means to _____ the message perceived by the _______ , and if the meaning of the decoded message matches the sender then communication has been__________.
relate/ sender effective
When you are being met with resistance to a request, repeating the request can be useful. However, each time the request is repeated, the power of the words is diminished. ( newly order for medication / the medication cannot be ready in 4 hours you repeat again I need the medication " how about you say how about I come and pick it up so it doesnt take long to be delievered "
repetition technique for assertive communication
volunteers for a specific study that meet all inclusions criteria , have been informed of all aspects of the study , and have signed informed consent
research participants / rights of nursing participants
OBJECTIVES OF COLLABORATIVE PRACTICE promote ____ & ______ between _____ & ____ team
respect communication client healthcare
Objectives of interprofessional collaborative practice promote mutual ____, ____, understanding between ____ & members of the ____ ______ team provide opportunities to ____ & _____ system - related issues, _____ develop interdependent ____, understanding among ____ & ____
respect communication patient health care address resolve problems relationships providers patients
- analyzing current protocols of care & their associated outcomes - comparing patient outcomes - identifying areas of improvement - researching factors that contribute to better outcomes - implementing change to improve outcomes - searching for trends in data to develop new protocols
responsibilities of a nurse in quality improvement
Differentiating delegation from assignment delegation => transfers _____ and _____ assignment => no transfer of _____ - reflects job _____, ____ needs - _______ needs
responsibility authority authority descriptions patient organizational
researchers develop a list of criteria for participants
rights of nursing research participants
Principles for delegating to UAP Task must: be considered ____ for this patient not required substantial scientific knowledge, ____ skills be considered ____ for the patient have ______ outcomes
routine technical safe predictable
leaders have the ability to ____ , ____ or _____ others.
rule guide inspire
Dermatologist is what kind of care ?
secondary
patient is admitted to a surgi- center for a colonoscopy what kind of care ?
secondary
the nurse is discussing results of a stroke risk assessment with a patient which prevention is this ?
secondary / risk assessment
the nurse is assisting with breast cancer prevention exams which prevention ?
secondary / screening
medical care that is provided by a specialist or facility upon referral by a primary care physician that requires more specialized knowledge , skills, or equipment than the primary care physician can provide. care can be delivered in hospitals , outpatient surgical centers , diagnostic centers, emergent care center, or specialist office. Most cost effective locations should be utilized .
secondary care
early detection & treatment of disease with the goal of limiting severity & adverse effects - screening for early detection & treatment of disease to prevent progression such as BP screenings
secondary prevention
Communication is a two-party process involving the _____ and the ____ of a message. This is an ongoing process: The receiver becomes the _____ and the original sender becomes the ____ .
sending/ receiving sender / receiver
Communication Skills each member of healthcare team should be ____ to _____ in communication styles, effects of own style on collaboration
sensitive / differences
Nurse rarely, if ever, ______ _offer __ ______opinion______when patient asks they should : _______ question back to patient
shouldn't Redirect
the healthcare system should be : - safe -effective -patient- centered -timely -efficient -equitable the ______ aims of _____ ______
six / quality improvement
The sender who wishes to convey a message is considered the _____ ______ . The person must put the idea or reason into a form that can be________. Encoding involves the selection of specific _____ or _____ to ______ the message (what language and words to use, what tone and gestures in oral communication)
source encoder transmitted signs/ symbols transmit
advantages: easy for healthcare team members to locate different sections of the chart ( easy to find notes ) each disciplined charting is clearly identified disadvantage : patient information is scattered throughout the chart what kind documentation is this ?
source- oriented
Communication to the UAP - ____ tasks to be done for each _____ - ____ each task is to be ____ - expected ____ for each task such as _____ that must be reported immediately
specific patient when done outcomes parameters
"most people dont have any pain after this type of surgery" / pateint just had gallbladder surgery their level of pain is 10/10 - you have not seen that with other patients
stereotyping
Become aware of own values Be familiar with nursing codes of ethics seek continuing education opportunities respect values opinions responsibilities of other healthcare professionals strive for collaborative practice participate in or establish ethics rounds serve on institutional ethics committees are examples of ?
strategies to enhance ethical decisions in practice
informed consent for surgery : whoever is doing the the procedure is responsible for getting the informed consent examples .... explaining diagnosis , purpose of treatment, what to expect, benefits, possible negative outcomes, disadvantages, advantages. as a nurse you're a ?
surgeon / nurse practitioner witness / not your responsibility to get the consent
Require _____ assessment of patients overall physical appearance, posture, gait, facial expression, and gestures. Nonverbal ____ widely among cultures (smiling and handshaking are an integral part of an interaction and essential to establishing trust. However, other might perceive the same behavior as rude and frivolous).
systematic varies
taking vital signs attending to safety patients transfers , ambulation measuring , recording I& O weighing bathing feeding postmortem care gastronomy in established systems suctioning chronic tracheotomies performing simple dressing changes performing basic life support (CPR)
tasks that may be delegated to UAP
THE CONCEPT OF COLLABORATION successful collaboration requires that nurses - develop skills in communication , _______ - values roles, ______ of other team members - work to establish climate of ______ ______
teamwork responsibilities mutual respect
patient arrives at cancer center for weekly testing & chemotherapy session what kind of care ?
tertiary
patient is admitted to the hospital ICU after a motor vehicle accident what kind of care ?
tertiary / ICU is very specialized
the nurse is taking a patients BP during a cardiac rehabilitation exercise session which prevention is this ?
tertiary / already has the disease
specialized consultative care, usually on referral from primary or secondary medical care personnel , by specialist working in center that personnel and facilities for special investigation & treatment . complicated diagnostic or therapeutic procedures may be provided in a place of service such as hospital, rehabilitation center, oncology center, burn center, or extended care facility
tertiary care
restoring & decreasing disease related complications of an already established disease. maximization of recovery after an injury or illness - rehabilitation & palliative care
tertiary prevention
convenient form of communication
texting
Face to face, communication involves a sender, a message, a receiver and a response or feedback
the communication process
Nurse practice act is what ?
the law/ legal part
Consider both the choice of words and the tone of voice before speaking
thinking before you speak
standard and scope of nursing practice requirements for licensure and renewal - practice and continue education (30 contact hours ) grounds for disciplinary action
three basic components
Delegator can devote ____ to other tasks enhances _____, ____ of delegate difficult _____ skill critical ____ for _____
time skills abilities leadership skill nurses
miscommunication inaccurate information mistrust ambiguous role expectations ineffective leadership resistance to change are all examples of ?
typical causes of conflicts
insufficient coverage ex: typically covered screening test are not paid for by the plan - mammograms -immunizations - colonoscopy
under-insured
no insurance at all
uninsured
dont qualify for medicaid employers does not offer insurance cannot afford to purchase healthcare & education reconciliation act has helped
uninsured / financial concerns
THE NURSE AS A COLLABORATOR intrerprofessional teams - recognize each individuals professional ____, _____ - atmosphere of mutual ____ & ____ -open ____ , shared _____ _____
value contribution respect & trust discussion / decision making
beliefs about the truth and the ___worth_______of thoughts, objects, or behaviors.
values
Tell the truth Principle behind giving complete information for informed consent One principle behind timely and accurate documentation
veracity
recording a medication error to the charge nurse client and physician is what principle ?
veracity
Spoken or written word We need to consider: Pace, tone, (speaking slowly and softly may help clam and excited patient or anxious)
verbal
patient says to you what would you do in this situation ? what would you do ?
we cannot tell them what we would do, we are not suppose to do that are professionals and ethically not allowed. We cannot pose our values on them. we redirect the question back to the patient I think its important that you decide yourself. what is it youre concern about ? find out what concerns are . help them think about it more . Giving information they make their own decision.
Communication to the UAP - ___ is available as resource as needed - _____ and in ____ format a task report will be completed such as ____ or _____ format
who when what written verbal
a leader influences others to ______ ______ to ____ a specific ______ .
work together accomplish goal
Benefits of interprofessional collaboration _____ ____ _____ links interprofessional collaboration with improved patient outcomes - benefits ____,_____,____ delivery system
world health organization patients professionals healthcare
is communication a basic component of human relationships ?
yes
right task right circumstances right person right direction & communication right supervision are the ?
5 rights of delegation
a systematic & strict scientific process that tests hypotheses about health - related conditions & the processes of nursing care
Nursing research
Individual social traditions Cultural, ethnic, religious norms within family and associated groups - those around you -who you grew up with -community
personal values developed
QSEN 6 core competencies / PETSIQ 1) _____-______ care 2)_____ improvement 3)_____-______ practice 4) _____ & _______ 5)______ 6)______
1)Patient- centered 2)quality 3)evidence - based 4)teamwork & collaboration 5)safety 6)informatics
respecting of clients decision to discontinue chemotherapy when terminally ill ? - patient making decision
Autonomy
right to self determination right to refuse meds right to refuse care make decisions in their care - the right for patient to make their own decision about care
Autonomy
- lack of experience & confidence in developing strategies to promote evidence - based care -lack of support from supervisor & agency personnel - lack of access to continuing education programs - attitudes of individual nurses - resistance to change from traditional patient care routines
Barriers to Evidence- based practice
-lack of usual source of care - no primary care provider - lack of perception of need - patients unable to assess their need too see physician -uneven distribution of services - rural areas under-served
Barriers to access
Clarifying patients values: Ignoring a health ___professionals__________ advice ____inconsistent___________communication or behavior Numerous admissions to a health care facility for the __same______problem Confusion or uncertainty about which course of action to take
Behaviors that may indicate unclear values:
The actions one takes should promote good
Beneficence
administering pain medication to an older adult in severe pain ?is what principle ? - doing good ?
Beneficence
develop standards for professional competency promote rules & regulations for nursing practice granting and renewing licenses examine complaints about nurses and discipline unsafe nurses accrediting or approving nursing academic programs
Board of Nursing
I'd be happy to sit here for a while glances at the door; nurses action contradict; im very busy I need to leave by contrast the nurse says I can see how upset you're if you have the time I'm here to listen ( pt. feels that the nurse cares)
Can either reinforce or contradict what you are saying
Used only to document ____deviating________________ from the expected finding Three components: 1) Flow sheets 2) Standards of nursing care 3)__bed-side ____________ access to chart forms Advantages: Charting is simplistic with no ______________ Changes to client's condition stand out Disadvantage: Some nurses are not comfortable with this charting system
Charting by exception (CBE)
helping patient clarify an event, situation, or happening in relationship to time. Patient: "I vomited this morning." Nurse: "Was that after breakfast?" "I feel like Ive been asleep for weeks you had your operation on monday, today is tuesday. "
Clarifying time or sequence
( fewest words) (make sure you are direct, simple and direct)
Clarity and brevity
Process of interprofessional collaboration high level / upper level responsible for aspects of care direct patient to other providers when patient problems are beyond the initials providers expertise provider retain responsibility & accountability of own aspect of care
Co- management & referral
Forget Falsify Use __white ______ __out______ Scribble Chart for someone else Stereotype Wait until the end of the shift Chart __ahead_______ of time!
DON'T of effective documentation
Title 24 - chapter 19 is
Delaware's Nurse practice act
Title 24 - chapter 19 A ( multi- state license) is ? Live in Delaware / but work in Maryland
Delawares nurse practice act for nurse licensure compact
transference of responsibility , authority for an activity to a competent individual
Delegation
each functional unit of a ____DNA__________, but only 2% codes for protein.
Gene
the study of how DNA works.
Genetics
a set of ______instructions_______ needed to create an organism and is stored in cells like DNA.
Genome
inherent worth and uniqueness of individuals and populations first provision in the american nurse association code of ethics, b/c you're a human being youre valuable; when you take care of someone who has done a hideous crime you have to look beyond the crime and realize that person is a human being you need to take care of is an example of ?
Human dignity
this is a positive and powerful tool used in nurse patient relationships. Laughter can provide emotional and physical release, reducing tension. Timing is also important with humor and you have to recognize an inappropriate time)
Humor
acting in accordance with appropriate __codes___ __of __ _ethics________ and accepted standards of practice - Honest profession/ honest with what we document/ what we tell patients during report are examples of ?
Integrity
Nurses and ___people_______ Nurses and practice Nurses and the __profession______ Nurses and co-workers
International Counsel of Nurses (ICN) Code of Ethics
when two or more individuals show, feel honor or esteem toward one another
Mutual respect
this is when you can agree with criticism about something without becoming upset or angry. ( nurse manager gave you an evaluation although you are very caring I want to see your decision making abaility)
Negative assertion technique for assertive communication
Each states nursing law governing nursing practice in that state *enacted by states legislature *enforced by states board of nursing are examples of ?
Nurse practice Act
Collect assessment data from patients Develop care plans in collaboration with patient Initiate Interventions in the best interest of their patients Evaluate outcomes of the interventions Initiate changes that promote health Prevent Legal problems associated with nursing practice
Nurses who communicate therapeutic are better able to / therapeutic nurse patient relationship
Communication is an integral part of the nursing process. The nurse uses communication skills in each phase. consider language, sensory, development and cognitive deficits. Cultural values and practices may influence communication Impaired verbal communication ( whatever is going on with patient) outcomes ( communication ) expressive or receptive what you're going to do - Interventions to facilitate communication with your patient. Quiet room for limited distractions, interpreter, avoid any cultural barriers, select gestures with care that are appropriate. Evaluate whether the communication needs have been met. Was interpreter used to communicate effectively?
Nursing process Assessment Diagnosis Planning Implementation Evaluation
dont we look nice today I think you look nice today
ineffective effective
Assertive communicators can continue to improve one's skills by reviewing what was said and how the communication might have been handled differently to improve the outcome. This helps evaluate what went well, what didn't. Some people do not feel comfortable with assertive communication but practicing and doing self-evaluations, improves their skills. I did that well ... but I need to work on something else
Performing a post conversation evaluation
timing should be appropriate and pt. should be able to relate to what you're saying). pt may be fearful have many questions now that they have cancer you may want to wait about a surgery that is scheduled if you wait they'll be able to understand you better
Timing, relevance
1. info is urgent / patients health is at jeoparidy don not read in time 2. highly confiedentality info ( mental status , HIV status , chemical dependency ) 3. Labs data are abnormal
When not to use Electronic communication media
causes of conflict in healthcare environment particularly when team members did not hold selves accountable
accountability
nurses must assume _____, increased _____ in practice areas
accountability authority
Other strategies to prevent conflict ______ issues as they arise _____ destructive criticism treat other with _____ avoid _____ actively _____ to each other consider other's ____ of _____ , including _____ _____ & _____
address avoid respect arguments listen points view cultural beliefs values
OBJECTIVES OF COLLABORATIVE PRACTICE ______ & ______ system - related issues develop interdependent ______ & ______ among ____ & _____
address & solve relationships / understanding providers & clients
financial systems payroll & human resources systems contract management systems risk management systems quality assurance systems physician management system executive information systems materials management systems
administrative support systems
charting clinical documentation into structured fields allows for accuracy. ( power chart - vital signs, neurochecks) Email improves communication and continuity of patient care; email addresses do not change frequently as residential addresses. Social networks such as Facebook and twitter are less used in healthcare. Nurses use social networks through organizations such as American nurses Association. Social networks also used to share critically important information (influenza vaccinations, disasters,) Texting is another form of electronic communication = convenient
advantages of electronics
The assertive communicator strikes a balance between the __________and ____________ communicator
aggressive / passive
Benefits to the manager -
allows for more management functions unit functions better
concern for welfare and well-being of others
altruism
Values essential for the professional nurse
altruism, autonomy, human dignity, integrity, social justice
those who declare and affirm their opinions. However, they respect the rights of others to communicate in the same fashion
assertive
patient is eating their breakfast , you repeatedly look at the clock appears to the patient that the nurse is in a hurry makes them feel like a burden this is an example of ?
ineffective communication
nurse unlicensed assistive personnel (UAP) complementary healthcare provider case manager dentist dietitian information technology expert (IT) occupational therapist paramedical technologist pharmacist physical therapist physician physician assistant respiratory therapist social worker speech therapist are all ? what does complementary healthcare provider do ? what does an occupational therapist do ?
collaborative members of the healthcare team - acupuncture, massage therapy , chiropractor - cutting( hand strength ) ,ADLs , how are you going to get your socks on ?picnhers do not bend over to ground when in recovery.
effective communication occurs only if each team member ____ to ____ each member's _____ ____, _____ member as ______.
commits understanding specific role appreciates individual
preventing conflict nurses must - _______ ______ to prevent misunderstanding -be able to identify potential _____ - manage their own ____ or _____ level
communicate clearly issues tension stress
right direction/communication
communicate verbally or in writing clear, concise description of the task, including its objective, limits, and expectations
Any means of exchanging information or feelings between two or more individuals.
communication
Process of interprofessional collaboration continuum of collaboration reflects levels of _____ & ____
communication & actions
Competencies Basic to Collaboration 1)effective _____ ____ 2)_____ & ______ feedback 3)mutual ______ 4)_____ 5)_______ making 6)_______ management
communication skills giving / receiving respect trust decision conflict
THE NURSE AS A COLLABORATOR nurses may also be involved in collaboration - to develop _____ initiatives - to ____ or revise ______ - to conduct _____-_____ _______
community write legislation health-related research
-Systematic & continuous actions that lead to measurable improvement in healthcare services & the health status of targeted patient groups - Focus on improving patient outcomes
concept of quality improvement
Confidence is essential to assertive communication. A choppy or weak tone of voice implies uncertainty. The nurse should maintain an air of confidence in order to help others see their needs and wants to as having merit. Make sure you know you have labs, vs, questions formed,
confidence technique for assertive communication
Process of interprofessional collaboration mid-range level maximize the efficiency of communication seeks to maximize sufficiency of communication
coordination & consultation
Collection of information
database
Assumes Responsibility => ________ assigns task but retains accountability => _______
delegate delegator
Right task
delegate task to appropriate levels of team members based on standards of practice, legal and facility guidelines
- Select appropriate communication strategies( speak langauge)
development factors influencing the communication process
Types of authority (power of command ) line authority - staff authority-
directs activity ( supervisor = > staff) advice support / not assigning tasks / more of supportive role
Patient confidentiality. HIPAA requires organizations to apply reasonable and appropriate safeguards when emailing PHI. Each Healthcare agency needs to have an email encryption system to ensure security. Socioeconomics = not everyone has a computer or cell phone to access the internet.
disadvantages of electronic communication
1. Source-oriented 2. Problem-oriented 3. Problems, interventions, evaluation (PIE) 4. Focus charting 5. Charting by exception (CBE) 6. Electronic (to be discussed in Informatics Lecture)
documentation systems
Information technology : Electronic Medical Documentation administration for president BUSH & OBAMA developed policies to promote use b/c electronic medical documentation : does what ? 1) reduces ______ 2) reduces _____ ______ 3)improves ____ of ______ provided
errors healthcare costs quality care
based on values of the group that holds that holds those standards
ethical standards
investigating a patient's feeling related to a subject or idea. Nurse: "Would you describe our experience with that in more depth? Or "Tell me more about your childhood." patient can talk more you can find out more about the subject
exploring
_____ _____ No part of the body is as expressive as the _____ is . Feelings of surprise, fear, anger, disgust, happiness and sadness can be conveyed by facial expressions. Nurses also need to be aware of their own expressions and what they are communicating to the patient. The nurse must learn to control expressions of fear or disgust in some circumstances. What would an example? disfiguring surgery ( looking facial expression of disgust) Eye contact is another essential element of facial communication however be aware of cultures who consider direct eye contact impolite or disrespectful.
facial expressions face
This is the Message that the receiver returns to the sender. Called ____. Can be verbal, nonverbal or both. (Nod, yawn) Allows the sender to validate that the intended message has been received and correctly and understood. this is what ?
feedback response
Access to healthcare : insurance coverage provided for individuals through employers with large numbers of employees, but portion of coat paid by employees increasing
financial concerns
Being able to find some area on which both parties agree and build from there. Both the nurse and physician can agree they want to maintain patient safety through careful monitoring of patient's condition ... This gives a starting point. Both wanting the patient to have the optimal outcomes; start with something that you both agree on " sleep deprived patient" nurse asking for vital signs patient should not be interupted at night so they can sleep "
fogging techniques for assertive communication
appointed / body organization / authority
formal leader
Benefits of the delegate -
gain new skills enhance job description appreciative
Active listening interpreted differently between men and women. Use preferred name and pronoun especially with transgender individuals. promote a therapeitic atmospehere & safe
gender factors influencing the communication process
the study of a genome and it's environment
genomics
Hand and body gestures may emphasize and clarify the spoken work or they may occur without words to indicate a particular feeling. What are some examples? ringing hands ( nervous, scared, ( pacing back and forth) cannot talk ( raise on finger for yes two fingers for no )
gestures
includes : laws, regulations, government agency guidelines, position statements , resolutions, judicial decrees, and budget priorities
health policy
refers to the actions taken by government bodies & other societal actors to attain specific health- related goals
health policy
why is health policy relevant to nursing ? impacts - _______ practice - ______ -______ -______ _ _____ access to _____ - ______ policies & ______
health policy impacts - nurses' practice - staffing -education -standards -roles -patients' access to healthcare -organizational policies & procedures
Nurse may delegate to them as employees of ____ _____
healthcare provider
participants have the rights to : 1) know _____ their information will be used 2)know ____ privacy protocols will be _____ 3) ____ participation in the research study at _____ _____
how what / initiated end / any time
-discipline best able to address patients needs _____ given ____ ____ _____ held ____ for providing interventions in timely manner - starting with clear definition of the ______
identified priority in planning responsible problem
Benefits of interprofessional collaboration quality of care ____ , everyone ultimately _____ - adherence to ______ regimens ____ - lengths of stay ____ - overall cost to system ____
improves benefits therapeutic increases decreases decline
child abuse - known or suspected child abuse or neglect
in state of Delaware mandatory to report
medical practitioners that you reasonably believe to be guilty of unprofessional conduct or unfit to practice
in state of Delaware mandatory to report
self reporting - arrest indictment or info charging you with a crime substantially related to the practice of nursing conviction including any verdict of guilty or no contest of any crime substantially related to the practice of nursing
in state of Delaware mandatory to report
unsafe nursing practice or conditions
in state of Delaware mandatory to report
you are not very clear I did not understand you. Can you say it again?
ineffective effective
you haven't eaten anything on your plate I see that you did not eat anything. How are you feeling?
ineffective effective
Its time for us to get ready for your family visit Its time for you to get ready for your family's visit.They'll be here soon
ineffective effective
Mr. smith, you should get ready for your bath now Mr. Smith I'd like you to get ready for your bath now
ineffective effective
You frequently miss your appointment I noticed that you have missed several appointments. Is something the matter ?
ineffective effective
To be informed about the ____care___ you will receive To get important information about your care in your preferred __language_______ ( written & verbal ) - intepreter To get information in a manner that meets your needs, if you have vision, speech, hearing or mental impairments To make __decisions__________about your care To ____refuse______ care To know the names of the caregivers who treat you To safe care To have your ____pain____ addressed To have the right care that is free from discrimination To know when something goes wrong with your care ( drop a tube of blood, they have to draw again ) / patient falls notify family / medication errors To get a list of all your __medication__________ To be listened to To be treated with curtesy and respect To have a personal representative, _____advocate_______, with you during your care. Family member or friend of your choice
patients rights
_______ ______ clothing can convey social and financial status, culture, religion. Charms and jewelry may be worn for decorative or for health protection. When symbolic meaning of an object is unfamiliar, the nurse can _____ about the ____ of the _____ It will help the nurse gain a better understanding of patients Beliefs. An example: Lack of grooming may indicate loss of self-esteem or depression/ Taking shower may signal patient feeling better
personal appearance inquire significant object
____ & _____ The way individuals walk and carry themselves often are indicators of self-concept, mood and health. The nurse clarifies the meaning of the observed behavior by describing to the patient what the nurse sees and then asks what it means. An example: "You look like it really hurts you to move. I'm wondering what your pain level is, and if you might need something to make you more comfortable?
posture & gait
PCP / MOLE TEST is what kind of care ?
primary
patient attends community health fair at local mall what kind of care ?
primary
patient has an outpatient visit to see a nurse practitioner for bronchitis what kind of care ?
primary
patient visits his family physician for his annual physical exam what kind of care?
primary
the nurse assists with flu vaccinations for patients in a local nursing home which prevention is this ?
primary / immunization
care focused on health promotion & illness prevention. prevention of the initial occurrence of disease or injury - providing education , administering immunizations, advocating for access to health care
primary prevention
the nurse offers a smoking cessation workshop which prevention is this ?
primary/ no disease identified ( patient education )
Four Components include: 1. Database 2. Problem list 3. __plan__ _of__ ___care______ 4. Progress notes SOAP- subjective, objective, assessment, plan of care SOAPIER -adds interventions, evaluation, revisions to care plan Referred to as POMR or POR Advantage: Encourages _____collaboration______________ among healthcare team and care is organized based on problem list Disadvantages: Requires frequent ___updating _______ Inefficient due to need to repeat some necessary information
problem oriented medical record
Principles for delegating to UAP Nurses must : - know , understand agency ____,____ about delegation - know ____ of practice , ____, ____ for each discipline on the team - be aware of individuals variations in ____, _____ - _____ if unsure of abilities - _____ reporting expectations - create ____ atmosphere
procedures policies scope knowledge skills ability training observe clarify positive
follow delegation ____ & key ____ for delegating accept delegations only when you clearly ____ the ___, ____ ____, _____ requirements , other _____
process behaviors task time frame reporting expectations
any information that identifies the patient is ?
protected health information of HIPAA
options for patients who feel their rights have been violated patient advocates in hospitals and large provider agencies many states have offices to assist clients with issues related to patient right in long term care - omnibusman program state regulates nursing homes homes for aged licensed facilities for disabled
protecting patients right
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. - unique attributes ( patient centered care) -dignity & worth ( best same quality of care ) -a murder compared a nun => treat them the same
provision 1
The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. - patient => not one individual person, person doesn't live in isolation look at whole family dynamic ( you're a nurse taking care of a dementia pateint, are you able to allow that patient to take meds by themselves safely ( no ) ) - evulate the patient who can take of the patient - who can take the patient to the doctor appoitment? food to the house? how is that patient needs being met around them? - home health aide could potientally come in and help. - mom with the child - population => the measles outbreak
provision 2
The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. advocate => you speak up for them, help their rights ( protect their rights)
provision 3
The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. - we are responsible to give the best care ( physican orderes medication that is out of range, you give it => youre still accountable for it )
provision 4
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth - Getting BSN ( furthering education ) - getting certified in nursing practice ( 2 years )
provision 5
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. - ethical environment = > responsible to call people out when they're not giving ethical bound care ( call them out, speak up, giving your voice )
provision 6