Unit II, Study Guide Learning outcomes

Nursing assessment: collecting comprehensive data that includes but not limited to physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual/transpersonal, and economic. Do it in a systematic and ongoing process while honoring the uniqueness of the person. Types of assessments are: 1: Initial: performed shortly after the client is admitted to a health care agency or service. The purpose is to establish a complete database for problem identification and care planning. The nurse collects data concerning all aspects of the clients health, establishing priorities for ongoing focused assessments and creating a reference baseline for future comparison. 2: Focused: the nurse gathers data about a specific problem that has already been identified. 3: Time-lapsed: scheduled to compare a clients current status to the baseline data obtained earlier. 4: Emergency: when the client has a physiologic or psychological crisis. Objective/subjective data: 1: Subjective: it is what you hear from the client. Use the clients own word in quotation marks. 2: Objective data: it is what you see. (grimacing, crying, etc). Sources of data are: 1: Client. 2: Family and significant others. 3: Client records. 4: Medical history, physical examination, and progress notes. 5: Consultations. 6: Laboratory and other diagnostic results. Purpose of observation, interview, and physical assessment: 1: Observation tells a lot. By just looking at your client you can tell if they are in pain, how they like certain things done etc. 2: Interview: you are getting the nursing history. Interview helps you to know you client better. It is vital to make a good impression because that will predict if the client will tell you things about their history. 3: Physical assessment: you are looking at the patient functional abilities for the assessment. You can do an assessment either head to toe, body systems review, or focused based on client complaint. Four methods used for a assessment are inspection, auscultation, percussion, and palpation. Priority assessment data: think carefully about the type of data needed to develop a satisfactory care plan. This also includes identifying data of a lower priority that you should not repeatedly collect. Know what you need when you are doing an assessment so you don't waste time. Some data to get are health orientation, developmental stage, culture, and the need for nursing. Reporting data: 1: Data should be reported verbally immediately whenever assessment findings reveal a critical change in the client's health status that necessitates the involvement of other nurses or health care professionals. 2: Always document!!! Common problems with data collection and how to overcome them are: 1: inappropriate organization of the database. 2: omission of pertinent data. 3: inclusion of irrelevant or duplicate data. 4: erroneous or misinterpreted data. 5: failure to establish rapport and partnership with the patient. 6: recording an interpretation of data rather than observed behavior. 7: failure to update the database.

Be able to define and describe nursing assessment (the types of assessment; objective/subjective data; sources of data; purpose of observation, interview, and physical assessment; identify priority assessment data; know when to report significant patient data; identify common problems with data collection and how to overcome those.

1: Native American and Alaska natives, - Heart disease. - Cirrhosis of the liver. - Diabetes mellitus. - Fetal alcohol syndrome. 2: African American, - Hypertension. - Stroke. - Sickle cell anemia. - Lactose intolerance. - Keloids. 3: Asians, - Hypertension. - Cancer of the liver. - Lactose intolerance. - Thalassemia. 4: Whites, - Breast cancer. - Heart disease. - Hypertension. - Diabetes mellitus. - Obesity. 5: Hispanics, - Diabetes mellitus. - Lactose intolerance. 6: Eastern European Jews, - Cystic fibrosis. - Gaucher's disease. - Spinal muscular atrophy. - Tay-Sachs' disease.

Common health problems in specific populations.

1: Physicians and hospitals: most medical care is delivered by fee-for-service private health care providers in solo or small group practices. Most hospitals were not-for-profit community hospitals. Health care providers, who were rarely employees of the hospital, wielded great power because hospitals depended on the patients whom health care providers admitted or referred for treatment. Hospitals need the help of physicians. 2: Multispecialty practice groups: it is better able to provide comprensive care. Health care providers from different specialties united to share income, expenses, facilities, equipment, and support staff. 3: Community health center: these centers emphasize on primary care and education. Their primary objective is to ensure that everyone who needs care has access regardless of the ability to pay. 4: Prepaid group practices: Health Maintenance Organization (HMO)- goal is primary care to reduce cost by prevent illness. Preferred Provider Organizaiton (PPO)- third party payer. 5: Accountable care organizations: they offer incentives to provide integrated, well-coordinated care to patients. They are made up of different organizations that come together to give the most efficient and high quality care for population served. 6: Medical homes: provides whole-person, accessible, comprehensive, ongoing, and coordinated patient-centered care 7: Medical neighborhoods: their focus is on meeting the needs of the individual patient but also incorporate aspects of population health and overall community health needs in its objectives.

Compare and contrast these health care delivery systems: physicians and hospitals, multispecialty practice groups, community health centers, prepaid group practices, accountable care organizations, medical homes, and medical neighborhoods

1: Acute pain: rapid in onset, varies in intensity and duration. It is protective in nature. Acute pain warns the person of tissue damage or organic disease and triggers autonomic responses such as increased heart rate, the fight-or-flight response, and increased blood pressure. 2: Chronic pain: may be limited, intermittent, or persistent. It lasts beyond the normal healing period. There may be periods of remission or exacerbation. It is poorly localized.

Compare/contrast acute and chronic pain

1: Varying cultures. 2: Racial and ethnic origin. 3: Religion. 4: Physical size, age, and gender. 5: Sexual orientation. 6: Disability. 7: Socioeconomic and occupational status. 8: Geographical location. (side note: cultural respect is critical to reducing health disparities and improving access to high-quality health care)

Concepts of cultural diversity and respect

1: Sexuality: sexuality can be an integral part of a person's identity and is present in a person's demeanor through actions, communications, and physical appearance. Factors that influence sexuality are: - Cultural. - Biological. - Sociopolitical - Legal. - Economic. - Religious and spiritual. - Historical. Factors that affect sexuality are: - Developmental considerations. - Culture. - Religion. - Ethics. - Lifestyle. - Health state. People also have health states that can affect their sexuality: - Chronic pain. - Diabetes mellitus. - Cardiovascular disease. - Disease of the joints and mobility. - Surgery and body image. - Spinal cord injuries. - Mental illness. - Medications. 2: Gender: it is not the same as biological sex or sexual orientation; they are distinct concepts. Gender is what you consider yourself to be. 3: Gender identify: the inner sense a person has of being male or female (or other), which may be the same as or different from that person's biological sex. Separate by: - Gender nonconformity. - Gender dysphoria. 4: Sexual orientation: refers to romantic, emotional, affectionate, or sexual attraction to other people. Types of sexual orientation are: - Heterosexual. - Gay or lesbian. - Bisexual. - Transsexual. - Asexual. - Questioning. 5: Sexual health: it is the integration of the somatic, emotional, intellectual, and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication, and love. It is a critical element for general health and well being.

Concepts of sexuality, gender, gender identify, sexual orientation, and sexual health

Physiologic needs: basic need to survive (ex. oxygen). They are the most essential and the highest priority. Safety and Security needs: have physical and emotional components. Physical safety and security is being protected from potential or actual harm. Love and Belonging: called a higher-level need. It is the process of understanding and acceptance of others in both giving and receiving love, and the feeling of belonging. Self-esteem needs: include the need for a person to feel good about themselves, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments. It facilitates the person's confidence and independence. Factors that affect it are role changes and body image changes. Self-actualization: include the need for people to reach their full potential through development of their unique capabilities. Always focus on the patients strengths and possibilities.

Describe each level of Maslow's hierarchy of basic human needs

Nursing in a community must be culturally competent and family centered so that they can provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Some interventions are: providing immunizations, prenatal care, health education, and medication supervision. Nurses also provide community services as volunteers (ex. screenings, educational programs, and blood drives) and as role models for health practices and lifestyles. Another intervention is teaching, using therapeutic communication, and involving the family/and or the community in the care of plan.

Describe nursing interventions to promote and maintain health of the individual as a member of a family and as a member of a community

It is a nurses primary ethical responsibility to keep patient information confidential. The patient has every right for that information to stay with you. If you say something that you aren't supposed to, that is a HIPAA violation and your patient won't trust you anymore.

Describe privacy, confidentiality and professionalism issues related to patient assessment

1: establish a natural focus 2: identify and learn from errors 3: raising performance standards and expectations 4: implementating safety systems and healthcare and expectations 5: pay for performance 6: penalties for excess readmissions

Describe strategies to increase access to affordable, high-quality care

Health: is a passive state. it is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. Each person defines health different by their values or beliefs. It incorporates the physical, intellectual, emotional, sociocultural, spiritual, and environmental aspects of the whole person. Wellness: is an active state of being healthy, including living a lifestyle that promotes good physical, mental, and emotional health. Dunn describes his model of high-level wellness as functioning to one's maximum potential while maintaining balance and a purposeful direction in the environment. The four B's are processes, which are a part of each person's perception of his or her own wellness state, that are Being (recognizing oneself as separate and individual), Belonging (being part of a whole), Becoming (growing and developing), and Befitting (making personal choices to befit oneself for the future). Illness: is a process in which the person's level of functioning is changed when compared with a previous level. This response is unique for each person and is influenced by self-perceptions, others' perceptions, the effects of changes in body structure and function, the effects of those changes on roles and relationships, and cultural and spiritual values and beliefs.

Describe the concepts and models of health, wellness, and illness.

Factors are: 1: age and development level. 2: family support networks. 3: financial resources. 4: cultural influences. 5: language deficits. 6: health literacy level. 7: physical maturation and abilities. 8: psychosocial development. 9: cognitive capacity. 10: emotional maturity. 11: moral and spiritual development. 12: knowledge, attitudes, and skills needed to be independent. 13: readiness to learn. 14: ability to learn. 15: learning strengths.

Describe the factors that should be assessed in the learning process

The process of patient teaching, which resembles the nursing process, consists of several steps that are necessary to provide teaching and to measure learning. Good communication skills and sensitively are important factors. Its goal is also to promote health, prevent illness, restore health, and facilitate coping. Nursing education is important. Steps of the teaching-learning process are: assess Learning Needs and Learning Readiness, diagnosis patient learning needs, develop learning outcomes, develop teaching plan, implement the plan, and evaluate the plan. Domains are: 1: cognitive: storing and recalling new information in the brain. (knowledge) 2: psychomotor: learning a physical skill. (action) 3: affective: changing attitudes, values, and feelings. (feelings) Developmental concerns: a patient's physical maturation and abilities, psychosocial development, and cognitive capacity. Other concerns are the emotional maturity, moral, and spiritual development. Specific principles are: COPE model: C: Creativity: it helps the family overcome obstacles to carrying out health care management and learning how to generate alternatives. O: Optimism: it helps the family caregivers learn how to view the caregiving situation with confidence. P: Planning: it helps the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty. E: Expert Information: it helps the family learn how to obtain expert information from health care providers about what to do in specific situations. This information empowers caregivers by encouraging them to develop plans for solving caregiving problems.

Describe the teaching-learning process, including domains, developmental concerns, and specific principles

Family roles: families are essential to the health and survival of the individual family members, as well as to society as a whole. The role of the family is to help meet the basic human needs of its members while also meeting the needs of society. Structures: each family is made differently. Some are married, single-parented, or divorced. You make up your own family. It is unique. Examples: 1: Nuclear family: traditional family with two patients and kids. 2: Extended family: includes aunts, uncles, and grandparents. 3: Blended family: families from two different places. You are adding from different families. 4: Single parent family: one parent with your kids. You are ever divorced, never married, or separated. 5: Family: anyone that lives together and provides emotional, physical, and financial support. Functions: provides environment for development and social interactions. The five major functions of a family are: physical, emotional, reproductive, socialization, and affective/coping function. Developmental stages: family/couple with children, family with adolescent or young adults, family with middle aged adults, and family with older adults. Tasks: it is a family life cycle. All families have certain basic tasks for survival and continuity, as well as specific tasks related to developmental stages throughout the life of the family. Health risk factors: family patterns of behavior, the environment in which the family lives, and genetic factors can all place family members at risk for health problems. Some risk factors are: lifestyle, psychosocial, environmental, developmental, and biologic.

Discuss family concepts, including family roles, structures, functions, developmental stages, tasks, and health risk factors

Awareness of the health literacy issue gives health care professionals the opportunity to support patients and families in overcoming barriers to health and empowering patients to take control of their health care needs. Nurses need to be deliberate and patient specific and provide the patient with health care information. We need to identify what patient have problems with health literacy to be effective in our job. Three strategies are: - Newest Vital Sign (NVS): it is a screening tool to assess health literacy. It improve communications between patients and providers, and can be administered during initial assessments to assess the patient's literacy skills involving both numbers and words. NVS uses a nutrition label from an ice cream container and a score sheet for recording the patient's answers to six oral questions that refer to the label. - The "Ask Me 3 Questions". It is an educational program intended to promote understanding and improve communication between patients and their providers. The three questions are: 1: what is my main problem? 2: what do I need to do? 3: why is it important for me to do this? - Understanding Personal Perception (UPP): it is a tool to evaluate the level of a patient's understanding of new health information. It uses a scale of pictures to detect if more education is needed.

Discuss strategies that improve health literacy and promote patient safety

Elements of a trans-cultural assessment are: 1: How are biomedical/scientific health care providers perceived? How do the patient and the patients family perceive nurses? What are the exceptions of nurses and nursing care. 2: What comprises appropriate "sick role" behavior? Who determines what symptoms constitute disease/illness? Who decides when the patient is no longer sick? Who cares for the patient at home? 3: How does the patient's cultural group view mental disorders? Are there differences in acceptable behaviors for physical versus psychological illnesses? 4: To what causes does the patient attribute illness and disease? 5: What are the patient's cultural beliefs about the ideal body size and shape? What is the patient's self-image compared to the ideal? 6: What name does the patient give to his or her health-related condition? 7: What does the patient believe promotes health? What is the patient's religious belief? How actively involved in the practice of this religion is the patient? 8: Does the patient rely on cultural healers? Who determines when the patient is sick and when the patient is healthy? Who influences the choice/type of healer and treatment that should be sought? 9: In what types of cultural healing practices does the patient engage in?

Elements of a trans-cultural assessment of health-related beliefs and practices

Important things to know: 1: Nurses need to be aware of their role if something happens. 2: Training is vital for health care workers and well as the community. 3: Nurses could have many roles. In addition to clinical expertise, nurses may be responsible for triage, various treatments, counseling, and assistance with distribution of resources. 4: Disaster preparedness is imperative at all levels. 5: The American Red Cross (2018) recommends a very straightforward plan of action for emergency preparedness: get a kit, make a plan, and be informed. 6: Emergency food, supplies, and medications should be assembled. 7: A communication routine should be established. 8: Sources for reliable information should be monitored when disaster strikes. Other preparedness are: 1: Addressing biological threats. 2: Addressing chemical threats. 3: Addressing radiation threats. 4: Addressing cyber terror. 5: Preparing for mass trauma terrorism. 6: Addressing psychological aspects of disaster. Be PREPARED for emergency situations. You never know when something might happen.

Emergency management plan - how to develop and evaluate

1: Values: enhancements of health or knowledge but be in the research. 2: Scientific validity: must be methodologically rigorous. 3: Fair subject selection. 4: Favorable risk-benefit ratio. 5: Independent review. 6: Informed consent. 7: Respect for enrolled subjects.

Evaluating the ethics of clinical research studies.

Evaluation: the nurse and patient together measure how well the patient has achieved the outcomes specified in the plan of care. When evaluating outcome achievement, the nurse identifies factors that contribute to the patients ability to achieve expected outcomes and, when necessary, modifies the plan of care. Based on the patients response to the plan of care, the nurse will decide to: 1: Terminate the plan of care when each expected outcome is achieved. 2: Modify the plan of care if there are difficulties achieving the outcomes. 3: Continue the plan of care if more time is needed to achieve the outcomes. The five classic elements of evaluation are: 1: Identifying evaluative criteria and standards (what you are looking for when you evaluate e.g. expected patient outcomes). 2: Collecting data to determine whether these criteria and standards are met. 3: Interpreting and summarizing findings. 4: Documenting your judgement. 5: Terminating, continuing. When evaluation reveals that the patient made little or no progress toward outcome achievement, the nurse needs to re-evaluate each preceding step of nursing process to try to identify the contributing factors causing problems with the plan of care. New assessment data might need to be collected, diagnoses may be added or altered, outcomes might need to be modified or rewritten, nursing orders may be changed, or evaluation may be targeted more frequently.

Evaluation - definition; purpose and relationship to the other steps of nursing process; how evaluation effects the care plan.

Nurses must evaluate the effectiveness of their interventions to promote environmental safety, prevent injury, and promote emergency preparedness. If the patient outcomes have been met, they should be about to: 1: Correctly identify real and potential unsafe environmental situations. 2: Implement safety measures in the environment. 3: Use available resources to obtain safety information. 4: Incorporate accident prevention practices into activities of daily living. 5: Remain free of injury.

Evaluation of the effectiveness of safety interventions

EBP is a problem-solving approach to making clinical decision using the best evident available. It blends both the science and the art of nursing so that the best patient outcomes are achieved. EBP may consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments, or surgical procedure. The use of EBP mandates the analysis and systematic review of research findings. Three essential elements of EBP are: 1: the integration of best research and other forms of evidence to guide practice. 2: viewing clinical expertise as a component in care effectiveness. 3: considering patients' preferences, values, and engagement in care decisions as essential to providing optimal evidence-based care to patient and their families.

Evidence-based practice in nursing - the rationale for its use, & the importance of life-long learning and the spirit of inquiry.

Human dimensions: factors that influence a person's health. Each dimension interrelates with each other and influence the person's behavior in both health and illness. The dimensions are physical, emotional, intellectual, environmental, sociocultural, and spiritual. Used for the care plan. Basic human needs: Maslow's pyramid. They are essential that must be met for emotional and physiologic health and survival. If the needs are met, one is considered to be healthy and if one or more needs aren't met, one has a increased risk for illness. Self-concept: incorporates how a person feels about themselves (self esteem) and the way they perceive their physical self (body image). Self-concept has both physical and emotional aspects and is a important factor in the way a person reacts to stress and illness, follows self-care health practices, and relates to others.

Explain how the human dimensions, basic human needs, and self-concept influence health, illness, and human flourishing.

To meet needs, a nurse uses assessment, diagnosis, planning, implementation, and evaluation. Locating the patient on the health-illness continuum and to incorporate the human dimensions and health models helps with meeting needs. It is only a framework or guideline but can help by prioritizing what needs to be met first.

Explain nursing care necessary to meet an individual's needs in each level of Maslow's hierarchy

Primary: is directed toward promoting health and preventing the development of disease processes or injury (ex. immunization clinics, family planning services, providing poison-control information, accident-prevention education, and education). Health risk assessments and teaching are a important part of preventive care for primary. Secondary: the goals are to identify an illness, reverse or reduce its severity or provide a cure, and thereby return the person to maximum health as quickly as possible. They focus on screening for early detection of a disease with prompt diagnosis and treatment if any are found (ex. examinations and Pap smears). Screenings are a major activity in secondary. (Direct nursing care interventions at the secondary level include administering medications and caring for wounds). Tertiary: begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning (ex. teaching diabetic patient ways to prevent and recognize complications and referring patients to support groups).

Explain the levels of preventive care.

1: Culture. 2: Ethnic variables. 3: Family, sex, gender, and age variables. 4: Religious beliefs. 5: Environment and support people. 6: Anxiety and other stressors. 7: Past pain experience.

Factors that may affect a person's pain experience

Racial and ethnic groups, poverty, gender: age, mental health, educational level, disabilities, sexual orientation, health insurance and access to health care.

Factors that play a role in health equity/disparities

1: out of pocket payment. Cash payment. 2: individual private insurance: members pay monthly premiums either by themselves or in combination with employer payments. Called third-party payers because insurance pays all or most of care. 3: employer-based private insurance: 61% of firms offered coverage to employees. About half with employer-sponsored coverage are covered by own employee (51%) and half covered as employee's dependent (49%). 4: government financing: four options are - Medicare: citizens over the age of 65 have medicare insurance for hospital care, extended care, and home health care. It includes permanently disabled workers and their dependents, if they are also qualified for social security benefits. Part A is for inpatient hospital costs and paid by federal government. Part B is voluntary, paid by monthly premium. pays for outpatient cost. - Medicaid: it is a federally funded public assistance program for people of any age who have low incomes. This coverage depends on individual state regulations. - Children's health insurance program (CHIP): helps states insure low-income children who are ineligible for Medicaid but can't afford private insurance. - Veteran's health administrations (VHA): it is the United States largest integrated health care system, consisting of 152 medical centers, 1,400 community-based outpatient clinics, community living centers, vet centers, and domiciliary. These places plus the people who provide care work within them to provide comprehensive care to more than 8.3 million veterans each year.

Four ways to pay for health care

Health-teaching interventions for patients of each age group and setting are: 1: Fetus, - Abstain from alcohol and caffeine while pregnant. - Stop smoking or reduce the number of cigarettes smoked per day. - Avoid all drugs, including OTC drugs, unless prescribed by a health care provider. - Avoid exposure to pesticides and certain environmental chemicals. - Avoid exposure to radiation. 2: Neonatal, - Wash hands frequently. - Never leave infant unsupervised on a raised surface without side rails. - Use appropriate infant care seat that is secured in the back seat facing the rear of the car. - Handle infant securely while supporting the head. - Place infant on back to sleep. 3: Infants, - Supervise child closely to prevent injury. - Select toys appropriate for developmental level. - Use appropriate safety equipment in the home. - Never leave child alone in bathtub. - Childproof the entire house. 4: Toddler, - Have poison control center phone number in readily accessible location. - Use appropriate car seat for toddler. - Supervise child closely to prevent injury. - Childproof house to insure that poisonous products, drugs, guns, and small objects are out of toddler's reach. - Never leave child alone and unsupervised outside. - Keep all hot items on stove out of child's reach. 5: Preschooler, - Teach child to wear proper safety equipment when riding bicycles or scooters. - Ensure that playing areas are safe. - Begin to teach safety measures to child. - Do not leave child alone in the bathtub or near water. - Practice emergency evacuation measures. - Teach about fire safety. 6: School-aged children, - Teach accident prevention at school and home. - Teach child to wear safety equipment when playing sports. - Reinforce teaching about symptoms that require immediate medical attention. - Continue immunizations as scheduled. - Provide drug, alcohol, and sexuality education. - Reinforce use of seat belts and pedestrian safety. 7: Adolescents, - Teach responsibilities of new freedoms that accompany being a teenager. - Enroll teen in safety courses (driver education, water safety, emergency care measures). - Emphasize gun safety. - Get physical examination before participating in sports. - Make time to listen to and talk with your adolescents (help with stress reduction). - Follow healthy lifestyle (nutrition, rest). - Teach about sexuality, sexually transmitted diseases, and birth control. - Encourage child to report any sexual harassment or abuse of any kind. 8: Adults, - Practice stress reduction techniques. - Enroll in a defensive driving course. - Evaluate the workplace for safety hazards and utilize safety equipment as prescribed. - Practice moderation when consuming alcohol. - Avoid use of illegal drugs. - Provide options and referrals to domestic violence victims. 9: Older adults, - Identify safety hazards in the environment. - Modify the environment as necessary. - Attend defensive driving courses or courses designed for older drivers. - Encourage regular vision and hearing tests. - If prescribed, ensure that eyeglasses and hearing aides are available and functioning. - Wear appropriate footwear. - Have operational smoke detectors in place. - Objectively document and report any signs of neglect and abuse.

Health-teaching interventions to promote safety for patients in each age group and setting (acute care, LTC, and home)

1: System: it functions best when members communicate, cooperate, and collaborate with others. 2: Referrals: is a person who recommends home care services and supplies the home health care facility with details about the patient's needs. 3: Reimbursement sources: they pay for home health care services. Medicare is the largest single payer of home care services. 4: Primary caregivers: they are the family. Hospitals are discharging patients faster but they are still sick so now the extra responsibly is put on the family members. 5: Legal considerations: they are privacy and confidentiality, the patient's access to health information, the patient's freedom from reasonable restraint, informed consent, and matters of negligence and malpractice. It is our job to make sure the patient knows about the Bill of Rights at the initial assessment. 6: Pre-entry and entry phrases of visits: - Pre-entry: collects patient data, schedules lists, and evaluates safety issues. - Entry: identifies needs and determines interventions. You also teach and document. 7: Documentation: a nurse documents care plans, the visit plan, and progress notes because they are routinely used by regulatory facilities and payer sources to see if needs are being met.

Home health (the system, referrals, reimbursement sources, primary caregivers, legal considerations, components of pre-entry and entry phases of visits, documentation)

Nurses can use knowledge of CHA by: 1: expand their practice to meet existing patient needs. 2: promote health. 3: Educating their patients. It is expected that CHA will become a larger part of practice for some nurses. Patients and the public need to know about the safe and effective use of CHA. As nurses, we need to be informed and knowledgable about CHA because many patient use them and might want to use them when they come to the hospital. Know the different types of CHA's and the benefits and drawbacks of them. Even if you don't use them personally/or don't agree with it, your patient might so you need to take the time to read about them.

How can nurses use knowledge of CHA and integrative health in providing patient care?

1: stay informed about current issues and pending legislation. 2: write or email members of congress to support legislation to improve nursing and patient care. 3: belong to and participate in nursing organizations. 4: document the outcomes of nursing care and develop a database to influence health care costs and quality of care. 5: participate in efforts to design and implement innovative health care delivery models. 6: be a leader in local, state, and national nursing and consumer groups. 7: advocate for the rights of all people for equal, affordable, accessible, and knowledgeable health care. 8: vote and encourage everyone to vote.

How nurses can make a difference in healthcare reform

Teaching and counseling are so vital for patients dealing with pain management. A well-informed person can cope better with the distress of pain and tends to experience less anxiety about pain. Teaching about pain should include: - family members so that they understand the concept of pain and are able to help the person in pain. - the nature and causes of pain. - explanation about a pain scale that can be used easily. - practice with this assessment tool. - assistance to set goals for comfort and either optimal function or recovery. Provide the patient and family with information about available resources, including reputable online sources for pain control and treatment, and encourage them to use them.

How teaching and counseling skills can be used to empower patients to direct their own pain management

Working with other health care providers when working with patients experiencing pain can be beneficial. Know when to use a PT, OT, RT etc. If you need help, don't be afraid to to ask.

How to collaborate with other health disciplines to promote pain relief

Create: you create a teaching plan to plan out what you are going to do on the patient. Set the goals and priorities so that you can implement your plan of care efficiently. Implement: requires interpersonal skills and effective communication techniques, as well as organizational and time management skills. Teaching can be a major part of the working phase of the helping relationship. Evaluate: the nurse and the patient TOGETHER measure how well the patient has achieved the outcomes specified in the care plan. Nurses need proof or feedback to make sure the patient has achieved outcomes. Some ways to know are: 1: cognitive, psychomotor, and affective. 2: asking direct questions. 3: analyze patients comments. 4: observation. Document: 1: summary of the learning need. 2: the plan. 3: the implementation of the plan. 4: evaluation results.

How to create, implement, evaluate, and document a teaching plan for the patient

1: Introduce yourself and use her name. Smile. Be kind. 2: Provide privacy. 3: Activity listen to your patient. 4: Maintain eye contact. 5: Maintain professional boundaries. 6: Treat them like you would like to be treated.

How to establish an effective nurse-patient relationship

As nurses we need to try to be culturally humble. We need to recognize what we don't yet know and be willing to learn what we need to know. Don't judge someone because they might be different from you. Embrace change. Every individual is different and unique. Provide the best care to everyone. Nurses need to understand: 1: Beliefs, values, traditions, and practices of the culture they are taking care of. 2: Culturally defined, health-related needs of individuals, families, and communities. 3: Culturally based belief systems of the etiology of illness and disease and those related to health and healing. 4: Our attitudes toward seeking help from health care providers. Guidelines to help are: 1: Develop cultural self-awareness. 2: Develop cultural knowledge and understanding of a patients culture. 3: Accommodate cultural practices in health care. 4: Respect culturally based family roles and cultural differences. 5: Avoid mandating change. 6: Seek cultural assistance. 7: Not assuming that the health care provider's beliefs and values are the same as the client. 8: Resisting judgmental attitudes such as "different" is not as "good". 9: Being open to and comfortable with cultural encounters. 10: Accepting responsibility for ones own cultural competency. When patient are in pain: 1: Recognize that each person hold various beliefs about pain and that pain is what the patient says it is. 2: Respect the patient's right to respond to pain in one's own fashion. 3: Never stereotype a patient's responses to pain based on the patient culture. 4: Be sensitive to nonverbal signals of discomfort, such as holding or applying pressure to the painful area or avoiding activities that intensify the pain. (Side note: ESFT model).

How to provide culturally competent nursing care

A nurse's attitudes, biases, and prejudices regarding sexuality are readily transmitted to patients through their actions, manner of speech, and avoidance of certain circumstances or types of discussion. A nurse's knowledge about sexual issues can inhibit or promote discussions of sexual health. A nurse who does not have a sound knowledge base of reproductive anatomy and physiology, sexual response, sexual expression, and other issues surrounding sexuality will be unable to ASSESS, TEACH, or COUNSEL patients with sexual concerns. Goals for the nurse are: - Feel comfortable as a sexual being. - Develop self-awareness regarding sexual topics. - Develop communication skills that promote discussion of sexual concerns with patients. - Identify patients with problems related to sexuality and intervene competently and comfortably to meet these needs. - Practice responsible sexual expression.

How your personal beliefs and values about human sexuality might affect your nursing care

The community environment affects the ability of the person to meet basic human needs. A few aspects that affect the community are: the number and quality of health care services, sanitation, employment opportunities, health educational services, nutritional services, and violet crime/drug use. Also, social support systems, community health care structure, economic resources, environmental factors.

Identify aspects of the community that affect individual and family health

1: safe 2: effective 3: patient centered 4: timely 5: collaborative

Identify elements of a well-functioning health care delivery system

1: When performing a safety assessment, the nurse focuses on three categories: the person, the environment, and specific risk factors. 2: Assessment of the person consists of a nursing history and a physical examination.

Important assessment information for safety

1: Physiologic variations: certain racial or ethnic groups are prone to certain diseases or conditions. 2: Reactions to pain. 3: Mental health. 4: Gender roles. 5: Language and communication: one of the most culturally variable forms of nonverbal communication is eye contact. 6: Orientation to space and time. 7: Food and nutrition. 8: Family support. 9: Socioeconomic factors.

Influences that affect culturally respectful health care

1: General systems theory: it is a theory for universal application; it breaks whole things into parts to see how they work together in systems. It emphasizes relationships between the whole and the parts and describes how parts function and behave. Everything is contributing to the overall goal of the system. 2: Adaptation theory: adjustment of living matter to other living things and environment. It is a continuously occurring process that effects change and involves interaction and response. 3: Developmental theory: orderly and predictable growth and development from conception to death. Each of the stages you go through are unique. 4: Prescriptive theory: address nursing interventions and are designs to control, promote, and change clinical nursing practice. 5: Descriptive theory: describe a phenomenon, event, a situation, or a relationship.

Know the systems theory, adaptation theory, and developmental theory - how they are the same/different.

Health belief model: by Rosenstock. Concerned about what people perceive to be true about themselves in relation to health. Modifying factors for health include: demographic, sociopsychological, and structural variables. This model is based on three components: perceived susceptibility to a disease, perceived seriousness of a disease, and perceived benefits of action. Health promotion model: by Pender. It was developed to illustrate how people interact with their environment as they pursue health. Health-related behavior is the outcome of the model and is directed towards attaining positive health outcomes and experiences throughout the lifespan. Three variables are: activity related affect, commitment to a plan of action, and immediate competing demands and preferences. Behaviors may produce a positive or negative subjective response or affect. Health-illness continuum: it conceptualizes a person's level of health. It views health as a constantly changing state with high-level wellness and death on opposite sides. Also, it illustrates dynamic state of health adapts to internal and external environments. High-level wellness-good health-normal health-illness-death. Agent-Host-Environment model: by Leavell and Clark. It views interactions between a external agent, susceptible host, and environment as cause of disease. It is a traditional model that is limited when dealing with noninfectious disease.

Models of health and illness

Nursing diagnoses begins after the nurse has collected and recorded the client data. The purposes of diagnoses are: 1: Identify how a person, group, or community responds to actual or potential health processes. 2: Identify factors that contribute to or cause health problems (etiologies). 3: Identify resources or strengths that the person, group, or community, can draw on to prevent or resolve problems. How to identify priority diagnoses: look for anything that could be life threatening. ABC's are most important. If one of the nursing diagnosis could possibly kill the patients, that is the priority one to focus on. How to write a proper nursing diagnosis: there are three parts of a nursing diagnosis: 1: Problem. 2: Etiology: identifies the physiologic, psychological, sociologic, spiritual, and environmental factors believed to be related to the problem as either a cause or contributing factor. 3: Defining characteristics: the subjective and objective data. Guideline to help writing one: 1: phrase diagnosis as clients problem not a need. 2: check to make sure that client problem precedes the etiology and that the two are linked by phrase related to. 3: Defining characteristics follow the etiology and should be linked with as manifested by or as evidenced by. 4: write in legally advisable terms. 5: use nonjudgemental language. 6: be sure the problem statement indicates what is unhealthy about client or what the client wants to change. 7: avoid using defining characteristics, medical diagnoses, or something that cannot be changed in the problem statement. 8: reread the diagnosis to make sure that the problem statement suggests client outcomes and that the etiology will direct selection of nursing measures. Types of nursing diagnoses are: 1: Actual nursing diagnoses: anxiety. 2: Risk nursing diagnoses: risk for activity intolerance. 3: Wellness diagnoses: readiness for enhanced family coping. 4: Syndrome nursing diagnoses: post trauma syndrome. 5: Problem-focused diagnoses. Difference between medical and nursing diagnoses: 1: Medical: identifies diseases. They describe problems for which the physician directs the primary treatment. It remains the same for as long as the disease is present. 2: Nursing: describes problems. They focus on unhealthy responses to health and illness. It may change from day to day as the client responses changes.

Nursing diagnoses - definition; how to identify priority diagnoses; how to write a proper nursing diagnosis; types of nursing diagnoses; the difference between nursing and medical diagnoses.

1: Risk for contamination. 2: Risk for falls. 3: Risk for poisoning.

Nursing diagnoses for patients in unsafe situations

The top risk factors for all age groups are: 1: Falls: - Complete a risk assessment. - Declutter the rooms. - Wear nonskid footwear. - Keep bed at low position. - Lock the bed/or chair. - Indicate if the patient is at risk for falls by a ID band or something on the door. - Answer call lights fast. - Make sure everything is available to the patient within length. (side note: polypharmacy is a big risk factor for falls). 2: Poisoning: a few things that are important are, - Education. - People should have a PCC available. - Install a CO detector. - Side note: activated charcoal is the most effective agent for preventing absorption of ingested toxin. 3: Fires: to prevent fires from happening use the RACE model, - Rescue anyone in immediate danger. - Activate the fire code and notify appropriate person. - Confine the fire by closing doors and windows. - Evacuate patents and other people to safe area. 4: Suffocating and choking: important things to know are, - Education. - Supervise your kids. - Act fast (CPR etc). 5: Firearm injuries: - Keep the guns out of children hands. (lock the gun up, put it where they can't reach it).

Nursing interventions to prevent injury to all patients in all settings

The nursing process: 1: Systematically collects client data (assessing). 2: Clearly identify client strengths and actual and potential problems (diagnosing). 3: Develop a holistic plan of individualized care that specifies the desired client goals and related outcomes and the nursing interventions most likely to assist the client to meet those expected outcomes (planning). 4: Execute the plan of care (implementing). 5: Evaluate the effectiveness of the plan of care in terms of client goal achievement (evaluating). Characteristics of the nursing process are: 1: Systematic. 2: Dynamic. 3: Interpersonal. 4: Outcome oriented. 5: Universally applicable in nursing situations. Don't forget to document. Be accurate, concise, timely, and relevant. The five steps are: 1: Assessment: collection, validation, and communication of client data. The purpose is to make a judgment about the clients health status, ability to manage his or her own health care, and need for nursing. Plan individualized holistic care that draws on client strengths and is responsive to changes in the clients conditions. Activities are: nursing history, physical assessment, review of client record and nursing literature, consultation with the client's support people and health care professionals and continuously update and validate data. 2: Diagnosing: is an analysis of client data to identify client strengths and health problems that independent nursing interventions can prevent or resolve. The purpose is to develop a prioritized list of nursing diagnoses. Activities are to interpret and analyze client data, identify client strengths and health problems, formulate and validate nursing diagnoses, and develop prioritized list of nursing diagnoses. 3: Planning and outcome identification: is a specification of a clients outcomes to prevent, reduce, or resolve the problems identified in the nursing diagnoses, and related to nursing interventions. The purpose is to develop an individualized plan of nursing care, and identify client strengths that can be tapped to facilitate achievement of desired outcomes. Activities are establish priorities. Write outcomes and develop an evaluative strategy. Select nursing interventions and communicate plan of nursing care. 4: Implementation: is carrying out the plan of care. The purpose is to assist clients to achieve desired outcomes-promote wellness, prevent disease and illness, restore health, and facilitate coping with altered functioning. Activities are carrying out the plan of care, continue data collection, and modify the plan of care as needed. Document care. 5: Evaluating: is measuring the extent to which the client has achieved the outcomes specified in the plan of care; identifying factors that positively or negatively influenced outcome achievement; revising the plan o care if necessary. The purpose is to continue, modify, or terminate nursing care. Activities are to measure/assess how well the client has achieved desired outcomes, identify factors that contribute to the clients success or failure, and modify the plan of care (if indicated).

Nursing process - all the steps and what is involved in each. Be able to identify the components of each step.

1: Assessment: to complete an pain assessment you look at, (OLD CART). - Patients verbalisation and description of pain. - Duration of pain. - Location of pain. - Quantity and intensity of pain. - Quality of pain. - Chronology of pain. - Aggravating and alleviating factors. - Physiologic indicators of pain. - Behavioral responses. - Effects of pain on activities and lifestyles. Basic methods of assessing pain are: - Patient self-report. - Identify pathologic conditions or procedures that may be causing pain; consider physiologic measures (increased BP or pulse). - Report of family member, other person close to the patient or caregiver familiar with person. - Nonverbal behaviors: restlessness, grimacing, crying etc. - Physiologic measures: increased BP or pulse. - Attempt an analgesic trial and monitor results. Pain assessment tools are: - Wong-Baker FACES: cartoon faces. - Beyer oucher pain scale: pictures of kids in pain. - CRIES pain scale. For neonatal ages 0 to 6 months. - FLACC scale: Faces, Legs, Activity, Cry, Consolability. For infants and young children. - COMFORT scale. For critically ill peds patients. 2: Diagnosis: to diagnose pain you look at, - Type of pain. - Etiologic factors. - Behavioral, physiologic, affective response. - Other factors affecting pain stimulus, transmission, perception, and response. The three nursing diagnoses are: - Acute pain. - Chronic pain. - Labor pain. 3: Planning/outcome: when planning you want the patient to, - Describe a gradual reduction of pain, using a scale ranging from 0 (no pain) to 10 (pain as bad as it can be), clearly identifying numeric pain goals - Demonstrate competent execution of successful pain management program (specify) 4: Implementation: - Establish trusting nurse-patient relationship. - Manipulating factors affecting pain experience. - Initiating non-pharmacologic pain relief measures. - Managing pharmacologic interventions. - Reviewing additional pain control measures, including complementary and alternative relief measures. - Considering ethical and legal responsibly to relieve pain. - Teaching patient about pain. 5: Evaluating: - Check patient 20 to 30 minutes after giving patients medication. - It is ongoing. - Evaluation is directed toward the changing nature of the pain experience, the treatment modalities (pain management program), and the patient's and family's response to the care plan, all of which overlap. - Pain experience: the pain that the patient is experiences might change, so the nurse needs to evaluate if the patient still needs something. - Management program: patient and public safety are the priority. Watch to see if the patient still need the pharmacologic medication or if trying a non-pharmacologic is beneficial. - Patient and family response: the care plan is unsuccessful unless the patient and family are satisfied with the results.

Nursing process for pain

1: When assessing a patient, get a sexual history if, - Any inpatient or outpatient receiving care for pregnancy, STI, infertility, or contraception. - Any patient experiencing sexual dysfunction. - Any patient whose illness will affect sexual functioning and behavior in any way. There are four levels to a sexual history: - Level 1: part of the comprehensive health history, obtained by a nurse. - Level 2: sexual history, obtained by a nurse trained in sexuality. - Level 3: sexual problem history, obtained by a sex therapist. - Level 4: psychiatric/psychosocial history, obtained by a psychiatric nurse clinician. When obtaining sexual information get: - Description of the problem. - Onset and case of the problem. - Past attempts at resolution. - Goals of the patient. The nurse sets the tone of the interview. If you come off judgmental, the patient might not want to talk to you about their problems. (side note: always get a reproductive health history first, then get the sexual history). Factors to assess are: - Reproductive history. - History of sexually transmitted infections. - History of sexual dysfunctions. - Sexual self-care behaviors. - Sexual self-concept. - Sexual identify. - Sexual body image. - Sexual self-esteem. - Sexual role performances. - Sexual functioning. Use the BETTER model: - Bring up the topic of sexuality. - Explain that you are concerned with all aspects of patient's lives affected by disease. - Tell patients that sexual dysfunction can happen and that you will address their concerns. - Timing is important to address sexuality with each visit. - Educate patients about the side effects of their treatments and that side effects may be temporary. - Record your assessment and interventions in patient's medical records. 2: Diagnosing: there are two categories for diagnosing sexual problems: - Ineffective sexual pattern. - Sexual dysfunction. 3: Outcome identification and planning: there are specific outcomes that relate to sexuality, - Define individual sexuality. - Establish open patterns of communication with significant others. - Develop self-awareness and body awareness. - Describe responsible sexual health self-care practices. - Practice responsible sexual expression. 4: Implementation: when you are implementing remember these guidelines: - Establish a trusting nurse-patient relationship. - Teach about sexuality and sexual health: major goals of patient teaching involve effecting change in knowledge, attitude, or behavior. Part of the teaching is talking about sexual myths and promoting body awareness. Get to know your physical body; it is important for your sexual health. - Promote responsible sexual expression: there are forms of sexual expression, prevention of unwanted pregnancy, prevention of STI's, and sex education. - Consider contraceptions: there are behavioral methods (ex. charting methods for ovulation: temperature method, cervical mucus method, and calendar method), barrier method (ex. condom, diaphragm, cervical cap, vaginal sponge used with combination of spermicide agent), hormonal methods (ex. oral, Norplant system, implanon, Depo-Provera, Transdermal Contraceptive Patch, Vaginal Ring, Intrauterine Devices IUD), and emergency contraception methods: often called "morning after pill" and there are two ways to be provided: increased doses of specific oral contraceptive pills. It can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours). Most are up to 89% effective when taken within 72 hours after unprotected sex. They are less effective as time passes. The second way is insertion of a copper IUD within 5 to 7 days after unprotected intercourse. (ex. sterilization, future trends, female contraception, male contraception, and unisex reversible contraception). - Facilitate coping with special sexual needs. - Health care needs of lesbian, gay male, bisexual, and transgender people. - Advocating sexual needs of patients. - Counseling the patient regarding sexuality. - Abortion counseling. - Counseling in cases of abuse relationships and rape. 5: Evaluating: when evaluating, see if the effectiveness and interventions worked. Consider the following three factors: - Sense of well-being. - Functional ability. - Satisfaction with treatment.

Nursing process related to sexuality including: assessment, diagnoses, planning, implementation and evaluation

1: Hildegard Peplau: first published nursing theorist since Florence Nightingale. She created middle-range nursing theory of interpersonal relations. 2: Virginia Henderson: "First Lady of nursing". The need theory. Individuals have basic needs. The need to reach independence. 3: Faye Abdullah: 21 nursing care problems based on research and used to determine patient's needs and formulate nursing focused care. 4: Ida Jean Orlando: the nursing process. 5:Ernestine Wiedenbach: clinical nursing. Nursing as a art. 6: Lydia E. Hall: nursing rehabilitation. 7: Myra E. Levine: patient is center of nursing care. Focused on individuals wholeness from 4 conversion principles. 8: Martha Rogers: emphasis on science and art of nursing. 9: Dorothea Orem: all about self-care. 10: Imogene King: theory of goal attainment. 11: Betty Newman: the environment and the stresses it provides. 12: Sister Callista Roy: adaptive modes and responses. 13: Madeleine Leininger: had to do with transcultural nursing care. 14: Jean Watson: CARING. Promoting and restoring health, preventing illness, and caring for the sick. 15: Margaret A. Newman: theory was health as expanding consciousness. 16: Dorothy E. Johnson: behavioral system model. humans are made up of 7 subsystems. 17: Rosemarie Parse: health is a open process. nurses need to focus on quality of life. 18: Nola Pender: health promotion model. 19: Patricia Benner and Judith Wrubel: caring and skill development. 20: Katherine Kolcaba: assess and plan. about comfort.

Nursing theorist to know for test

S = sleep, easy to arouse: no action necessary. 1 = awake and alert; no action necessary. 2 = occasionally drowsy but easy to arouse; requires no action. 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose. 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

Opioid-induced sedation scale

P: patient, population, or problem of interest. I: intervention of interest. C: comparison of interest. O: outcome of interest. T: time.

PICOT format

1: Pharmacologic, - Analgesic administration: relieve pain. - Non-opioids analgesics: (acetaminophen: one of the safest and most tolerated and nonsteroidal anti-inflammatory drugs NSAIDs) - Drugs of choice for both acute and persistent moderate chronic pain. - Many of these drugs are over the counter. - Side effects are gastric, anti-inflammatory effect, GI bleeding and skin reactions, and a higher risk for MI or stroke. - Opioids or narcotic analgesics: all controlled substances (ex. morphine: most go to drug, codeine, oxycodone, meperidine: not used anymore because of side effects and its half life is short, hydromorphone, methadone: used for cancer pain and manage detoxification in opioid addition). - Effective in relieving pain that is peripheral/nociceptive in nature, such as acute pain due to injury, pain associated with rheumatoid arthritis, or cancer pain. - Most common side effects nausea, sedation, and constipation. Respiratory depression is a adverse effect of opioid use. - Adjuvant drugs: anticonvulsants, antidepressants, multipurpose drugs. - Used for other purposes but have been used to enhance the effect of opioids by providing additional pain relief. - Can reduce side effects of opioids or lesson anxiety about pain experience. - Used to treat acute pain resulting from surgery, burns, or trauma. 2: Non-pharmacologic, - Distraction. - Humor. - Music. - Imagery. - Relaxation. - Cutaneous stimulation. - Acupuncture. - Hypnosis. - Biofeedback. - Therapeutic touch. - Animal-facilitated therapy. 3: PCA pumps, local anesthesia, and epidural anesthesia. - Epidural: Epidural analgesia can be used to provide pain relief during the immediate postoperative phase (particularly after thoracic, abdominal, orthopedic, and vascular surgery) and for chronic pain situations. The anesthesiologist usually inserts the catheter in the midlumbar region into the epidural space between the walls of the vertebral canal and the dura mater or outermost connective tissue membrane surrounding the spinal cord. For temporary therapy, the catheter exits directly over the spine, and the tubing is positioned over the patient's shoulder, with the end of the catheter taped to the person's chest. For long-term therapy, the catheter is usually tunneled subcutaneously and exits on the side of the body or on the abdomen

Pharmacologic and non-pharmacologic pain relief measures

Our behaviors, feelings about ourselves and others, values, and priorities we set for ourselves.

Physiologic and psychosocial relate to:

Planning/outcome identification, a nurse works with the client and family to: 1: Establish priorities. 2: Identify and write expected client outcomes. 3: Select evidence-based nursing interventions. 4: Communicate the plan of nursing care. A comprehensive plan of care includes any routine nursing assistance the client needs to meet basic human needs and describes appropriate nursing responsibilities for fulfilling the collaborative and medical plan of care. The plan of care is supportive of nursing's broad aims. The primary purpose of the outcome identification and planning step of the nursing process is to design a plan of care with and for the patient that, once implemented, results in the prevention, reduction, or resolution of patient health problems and the attainment of the patient's health expectations, as identified in the patient outcomes. There are three types of planning: 1: Initial planning: performed by the nurse with the admission nursing history and the physical assessment. This plan addresses each problem listed in the prioritized nursing diagnosis and identifies appropriate patient goals and the related nursing care. 2: Ongoing planning: carried out by any nurse who interacts with the patient. It's chief purpose is to keep the plan up to date to facilitate the resolution of health problems, manage risk factors, an promote function. The nurse used new data as they are collected and analyzed to make the plan more specific and accurate and effective. 3: Discharge planning: best carried out by the nurse who has worked most closely with the patient and family. Discharge planning starts at admissions and sometimes before. Identify a correctly written outcome: written outcomes are derived from the problem statement of the nursing diagnosis. For each nursing diagnosis in the plan of care, one outcome should be written. Outcomes should have the following: 1: Subject: the patient or some part of the patient. 2: Verb: indicates the action the patient will perform. 3: Conditions: specifies the particular circumstances in or by which the outcome is to be achieved. 4: Performance criteria: describes in observable, measurable terms the expected patient behavior or other manifestation. 5: Target time: specifies when the patient is expected to be able to achieve the outcome. The target time or time criterion may be a realistic, actual date, or other statement indicating time, such as before discharge, after viewing film, whenever observed. Differentiate physician, nurse, and collaborative interventions: 1: nurse: comes from the nursing diagnosis. These interventions are performed to: - Monitor patient health status and response to treatment - Reduce risks - Resolve, prevent, or manage a problem - Promote independence with activities of daily living - Promote optimum sense of physical, psychological, and spiritual well-being - Give patients the information they need to make informed decisions and be independent 2: Physician: is correlated to the medical diagnosis but the nurse carries it out because of the physician order. 3: Collaborative: come from the pharmacist, respiratory therapist, physician assistant etc. The nurse carries them out. Implementation guidelines: the evidence-based nursing actions planned in the previous step are carried out during this process. Implementation's purpose is to have the patient achieve valued health outcomes. You need to be organized and efficient. When carrying out the plan of care: 1: Determine the patient's new or continuing need for nursing assistance. 2: Promote self care. 3: Assist the patient to achieve valued health outcomes. A few important things to know is that you still need to collect ongoing data and do a ongoing risk assessment. Don't forget to DOCUMENT!

Planning/Outcome identification - definition, benefits and purpose; how to identify a correctly written outcome; differentiate nurse, physician and collaborative interventions; and implementation guidelines

The goal of QSEN is to meet the challenges of preparing future nurses who will have the knowledge, skill, and attitudes (KSA) necessary to continuously improve the quality and safety of the health care systems within which they work. Key points are: 1: Patient-centered care. 2: Teamwork and collaboration. 3: Evidence-based practice. 4: Quality improvement. 5: Safety. 6: Informatics.

QSEN

1: Quality-assurance: they are special programs that promote excellence in nursing. These range from small programs conducted by nurses on a small nursing unit to those developed for an entire institution, province, or country. They enable nursing to be accountable to society for the quality of nursing care. This program also respond to the public mandate for professional accountability. They help ensure survival of the profession, encourage nursing's fidelity to its moral and ethical responsibilities, and assist nursing to comply with other external pressures. There are two ways to insure quality: 1: Quality by inspection. 2: Quality by opportunity. Three components of quality-assurance: 1: Structure evaluation: focus on the environment. (buildings and facilities). 2: Process evaluation: action or activities. 3: Outcome evaluation: changes in health. 2: Quality-improvement: (also known as continuous quality improvement or total quality management) it is the commitment and approach used to continuously improve every process in every part of an organization with the intent of meeting and exceeding customer expectations and outcomes. - Focus on organizational mission. - Continuous improvement. - Customer orientation. - Leadership commitment. - Empowerment. - Collaboration/crossing boundaries. - Focus on process. - Focus on data and statistical thinking. Four key principles are: 1: Focus on systems and processes. 2: Focus on patients. 3: Focus on being apart of a team. 4: Focus on use of data.

Relationship between quality-assurance and quality-improvement programs

Risk factors for injury in each age group: 1: Fetus, - Abnormal growth and development. 2: Neonatal, (first 28 days of life) - Infection. - Falls. - ASSB. 3: Infant, - Falls. - Injuries from toys. - Burns. - Suffocating or drowning. - Inhalation or ingestion of foreign bodies. 4: Toddler: - Falls. - Cuts from sharp objects. - Burns - Suffocating or drowning. - Inhalation or ingestion of foreign bodies or poisons. 5: Preschooler: - Falls. - Cuts. - Burns. - Drowning. - Inhalation or ingestion. - Guns and weapons. 6: School-aged child: - Burns. - Drowning. - Broken bones. - Concussions (TBI). - Inhalation or ingestion. - Guns and weapons. - Substance abuse. 7: Adolescent: - Motor vehicle accidents. - Drowning. - Guns and weapons. - Inhalation and ingestion. 8: Adult: - Stress. - Domestic abuse. - Motor vehicle accidents. - Industrial accidents. - Drug and alcohol abuse. 9: Older Adult: - Motor vehicle accidents. - Falls. - Elder abuse. - Fires. - Sensorimotor changes.

Risk factors for injury in each age group; factors that affect safety in the patient's environment; and at risk patients.

1: Must be completed after any accident or incident in a health care facility that compromises safety. 2: Describes the circumstances of the accident or incident. 3: Details the patient's response to the examination and the treatment of the patient after the incident. 4: Completed by the nurse immediately after the incident. 5: Is not part of the medical record and should not be mentioned in documentation.

Safety event reports

1: Cognitive domain: lecture, panel, discovery, written material. 2: Affective domain: role modeling, discussion, audiovisual materials. 3: Psychomotor domain: demonstration, discovery, printed materials.

Sample teaching strategies are

1: Categories of pain, - Duration: acute or chronic. - Localization/location. - Etiology. 2: Sources of pain, - Nociceptive: initiated by nociceptors that are activated by actual or threatened damage to the peripheral tissue. - Cutaneous: superficial usually involves the skin or subcutaneous tissue. - Somatic: diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. - Visceral: poorly localized and originates in body organs in the thorax, cranium, and abdomen. - Neuropathic: originating from partially injured nerves or infection of the CNS. - Phantom: pain without demonstrated physiologic or pathologic substance. 3: Origin of pain, - Physical: cause of pain can be identified. - Psychogenic: cause of pain cannot be identified. - Referred: pain is perceived in an area distant from its point of origin. 4: Pain process, - Transduction: activation of pain receptors. Stimulators that are activated are: - Bradykinn: vasodilator that increases capillary permeability and constricts the smooth muscle. - Prostaglandins: hormone like substances that send additional pain stimuli to the CNS. - Substance P: sensitizes receptors on nerves to feel pain and increase the rate of firing nerves. - Transmission: conduction along pathways (A-delta and C-delta fibers). - Perception of pain: awareness of the characteristics of pain. (adaption make affect the perception of pain). - Modulation: inhibition or modification of pain. 5: Perception of pain, - Pain threshold. - Adaption. - Modulation of pain: neuromodulators, endorphins, dynorphins, and enkephalins. 6: Common responses to pain, - Physiologic: involuntary body responses. parasympathetic and sympathetic. - Behavioral: reflect body movements. Voluntary. - Affective: reflects moods and emotions. Physiological.

Specific elements of the pain experience

Stage 1: experiencing symptoms Stage 2: assuming the sick role: stage where you are taking medication and possibly going to see the doctor. Stage 3: assuming the dependent role: this stage is characterized by the patient's decision to accept the diagnosis and follow the prescribed treatment. You may need assistance with ADL's during this stage. plan Stage 4: achieving recovery and rehabilitation: Most patients complete this final stage of illness behavior at home.

Stages of illness behavior

The standards are: 1: Skilled communication. 2: True collaboration. 3: Effective decision making. 4: Appropriate staffing. 5: Meaningful recognition. 6: Authentic leadership. The seven crucial conversions are: 1: Broken rules. 2: Mistakes. 3: Lack of support. 4: Incompetence. 5: Poor teamwork. 6: Disrespect. 7: Micromanagement.

Standards for establishing and sustaining healthy work environments and the seven crucial conversations in healthcare

One important role is to take care of yourself so that you can give effective nursing care to others. Nurses need to be role models for their patients. Nurses also need to take the time to get to know themselves. To eliminate disparities in health care.

Summarize the professional role of the nurse in promoting health and preventing illness.

T: Tune into patient. E: Edit patient information. A: Act on every teaching moment. C: Clarify often. H: Honor patient as partner in education process.

Teaching acronym

1: Mind-body practices: uses a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms. Types are: - Relaxation. - Meditation: four elements are: quiet location, specific comfortable posture, focus of attention, and open attitude. - Guided imagery. - Yoga: Indian practice of meditative stretching and posing. - Qi Gong: very slow, gentle physical movements, similar to tai chi, that cleanse the body and circulate chi. - Tai Chi: a slow, flowing Chinese practice that improves balance. - Acupuncture: the insertion of hair-thin needles into points along the body's meridians, or energetic pathways, to stimulate the flow of energy throughout the body; proven helpful for post-surgical pain and dental pain, among other types. Restores the balance of yin and yang. You need 1 hour of uninterrupted time. - Chiropractic health care: you use: heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, counseling about diet, weight loss, other lifestyle factors, and dietary supplements. - Aromatherapy: uses essential oils. Ginger and peppermint for nausea and lavender and chamomile for insomnia. 2: Natural products: botanical agents (herbs) and nutritional supplements are chemical compounds that are ingested with the hope of achieving a therapeutic goal. Nutritional supplements are chemical compounds that contain ingredients (vitamins, minerals, enzymes, amino acids, essential fatty acids) believed to promote health. 3: Other CHA's: these are whole medical systems. Types are: - Ayurveda: one of the worlds oldest medical system. From India. Used to integrate and balance the body, mind, and spirit. Include universal interconnectedness among people, their health, and the universe; the body's constitution and life forces. - Shamanism: mostly widely practiced medical system. Illness is in the spirit world. The medicine man or woman access the spirit. - Traditional Chinese Medicine: this view is based on the ancient Chinese perception of humans as microcosms of the larger surrounding universe interconnected with nature and subject to its forces. - Homeopathy: "like cures like" the notion that a disease can be cured by a substance that produces similar symptoms in healthy people. "law of minimum dose" the notion that the lower the does of the medication, the greater its effectiveness; many homeopathic remedies are so diluted that no molecules of the original substance remain. - Naturopathy: belief that health is a dynamic state of being that provides abundant energy for people to deal with life in our complex society.

The beliefs about the origin of disease and health promotion of each of the main categories of CHA.

In collaborative practice, you are working together with others to build a safer and better patient centered and community population oriented US health care system.

The definition of collaborative practice - what is involved and what is the goal

Florence Nightingale started nursing to what it is today. During the 20th century, nursing leaders realized that research about the practice of nursing was necessary to meet the health needs of modern society. During the 1950's and 1960's, nursing research was recognized as important. Early studies provided the basis for the development of nursing practice standards and the most effective educational preparation for registered nurses. The 70's and 80's focused on clinical research. The nursing process was studied as well. The goals of nursing research are: 1: Improve care of people in clinical settings. 2: Study people and the nursing process. - education. - policy development. - ethics. - nursing history. 3: Develop greater autonomy and strength as a profession. 4: Provide evidence-based nursing practice. The national institute of nursing research goals are: 1: Build a scientific foundation for clinical practice. 2: Prevent disease and disability. 3: Manage and eliminate symptoms caused by illness. 4: Enhance end-of-life and palliative care. Two other high priority was: 1: Promoting innovation: technology to improve health. 2: 21st-century nurse scientists: innovative strategies for research careers. (National Institute of Nursing Research)

The evolution of nursing research.

Coordinating care is a mechanism to make sure that patients get the right care at the right time in the most efficient and cost-effective manner, by the right person in the right setting. The aim is to link patients with resources in the community to enhance their well-being, improve information exchange, and reduce fragmentation and duplication of services.

The importance of coordinating care through admissions, transfers and discharges in the various healthcare settings (hospital, ambulatory care, home health care)

1: Physician: a doctor. 2: Physician assistant/nurse practitioner (APRN): patient advocates who provide evidence-based care to improve healthcare delivery and patient outcomes. 3: Physical therapist: ambulatoy care. Getting a patient up. 4: Occupational therapist: activities of daily living. (brushing teeth). 5: Speech therapist: (can do with swalling) 6: Social worker: support families and individuals through difficult times. They provide safeguards from harm. They help improve outcomes in peoples lives and do a lot of education. 7: Pharmacist: medication. 8: Respiratory therapist: helps with breathing. Oxygen. 9: Dietitian: food. 10: Chaplin/spiritual care provider: gives guidance and counseling. 11: Unlicensed assistive personnel: CNA's and LPN's

The members of the interdisciplinary healthcare team and their roles

Roles are: 1: make everyone feel comfortable in the situation and surroundings. 2: counseling can be formal or informal. 3: use interpersonal skills of warmth, friendliness, openness, and empathy. 4: caring is fundamental. Types of counseling are: 1: Short term: situational crisis. It focuses on immediate problem or concern. 2: Long term: developmental crisis. The patient might need counseling for days, weeks, or months. 3: Motivational interviewing: it is evidence-based counseling approach that involves discussing feelings and incentives with the patient. ALWAYS consider patient's cultural background in motivational counseling.

The nurse's role as a counselor and how it is used to motivate a patient in health promotion

A nurse coach's role is to explore the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals. It uses discovery to identify the patient's personal goals. A process includes: 1: establish relationships and identifying readiness for change. 2: identifying opportunities, issues, and concerns. 3: establishing patient-centered goals. 4: creating structure of the coaching interaction. 5: empowering and motivating patients to reach goals. 6: assisting the patient to determine progress toward goals.

The role of the nurse coach in promoting behavior change

The four concepts are: 1: The person: the most important concept. The person always comes first. 2: The environment. 3: Health. 4: Nursing.

The significance of the four concepts common to all nursing theories.

1: Sources of nursing knowledge: there are three sources, - Traditional: passed down from generation to generation. Often based on subjective data. - Authoritative: comes from an expert, accepted as truth based on person's perceived expertise. Often based on subjective data. - Scientific: obtained through the scientific method (research). New ideas are tested and measured systematically using objective criteria. 2: Types of nursing knowledge: there are three types, - Science: knowledge in and of nursing. - Philosophy: the study of wisdom, fundamental knowledge, and processes used to construct life. It is the way that nurses prepare for patients. - Process: conceptual frameworks and theories. 3: Historical influences of nursing knowledge: there are two historical influences, - Historical influences: Florence Nightingale. - Societal influences: schools of nursing.

The sources of, types of, and historical influences on - nursing knowledge.

Steps in implementing EBP are: 1: Cultivate a spirit of inquiry. 2: Ask the burning clinical question in PICOT format. 3: Search for and collect the most relevant best practice. 4: Critically appraise the evidence. 5: Integrate the best evidence with one's clinical expertise and patient preference and values in making a practice decision or change. 6: Evaluate the outcomes of the practice decision or change based on evidence. 7: Disseminate the outcomes of the EBP decisions or change.

The steps in implementing evidence-based practice which promotes excellence in nursing.

1: Hospitals: public or private, profit or nonprofit. 61% of nurses are still employed by hospitals but that number is decreasing. 2: Primary care centers: happens in offices or clinics. Services include the diagnosis and treatment of minor illnesses; facilities, and in conjunction with family members performing minor surgical procedures; and providing obstetric care, well-child care, counseling, and referrals 3: Ambulatory care centers and clinics: managed by APRN. Located in convenient areas like shopping malls or other community agencies. 4: Home health care: one of the most rapidly growing areas of the health care system. Nurses do assessments and provide physical care. Also interacting with family. 5: Extended care: provide medical and non medical care for people with chronic illness or disabilities that may be days to years. Nurses help with the activities of daily living. 6: Hospital at home: provides safe and effective hospital like care at home. Specialized care centers and settings: 1: Day cares: nurses help with administrating medication and treatment, help with health screenings, teach, and council. 2: Mental care centers: may be crisis centered or long term care. Nurses who work here have to have strong communication and counseling skills. 3: Rural care centers: are run by APRN's that serve as primary health provider. 4: Schools: school nurses are major source for health assessment, health education, and emergency care for kids. 5: industry: 6: Homeless shelters: the main goal for a nurse is education. 7: Rehabilitation centers: patients require physical or emotional rehabilitation. The goal is to return patients to optimal function of health. The role of the nurse includes direct care, counseling, and teaching. 8: Parish centers: it is an expanding area that emphasizes holistic health care, health promotion, and disease-prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Nurses function as health educators, resource and referral aids, and facilitators of lay volunteer and support groups. They reach out to those most vulnerable. Health care services for seriously ill and dying: 1: Respite care: the main purpose is to give the primary care giver some time away from taking care of their family members. Medicaid and most insurance companies don't pay for respite care. 2: Hospice care: the nurse provides emotional support to the family and patient daily. 3: Palliative care: it is not restricted to the end of life and can be used from the point of initial diagnosis. This care anticipates, prevents, and treats suffering.

The types of healthcare settings/facilities: How are they different/the same; Role of the nurse in each

1: Quantitative research: involves concepts of basic and applied research. You are researching numbers. It is objective. - Types of quantitative research are: 1: Descriptive: to explore and describe events in real-life situations, describing concepts and identifying relationships between and among events. Normally has little or no prior research. 2: Correlational: to examine the type and degree of relationships between two or more variables. The strength of relationship varies from -1 to +1. 3: Quasi-experimental: to examine cause-and-effect relationships between selected variables; often conducted in clinical settings. 4: Experimental: to examine cause-and-effect relationships between variables under highly controlled conditions; often conducted in a laboratory setting. - Steps are: state research problem, define purpose of study, review related literature, formulate hypotheses and variables, select research design, select population and sample, collect data, analyze data, and communicate findings and conclusion. - Terms are: 1: variables: something that varies and has different values to be measured. - Dependent: the variable being studied. - Independent: causes or conditions that are being manipulated to determine effects of dependent variable. 2: Hypothesis: statement of relationship between dependent and independent that researcher is trying to find. 3: Data: information the researcher collects. 4: Instruments: devices used to record and collect data. They should be reliable and valid. 2: Qualitative research: is conducted to gain insight by discovering meanings. It is also based on a belief that reality is based on perceptions that differ for each person and change over time. The focus of the researcher is that it primarily analyzes words or narratives rather than numbers. It is subjective. - Types are: 1: Phenomenology: is to describe experiences as they are lived by the subjects being studied. 2: Grounded theory: is the discovery of how people describe their (own reality) and how their beliefs are related to their actions in a social scene. 3: Ethnography: developed by the discipline of anthropology, it is used to examine issues of a culture that are of interest to nursing. 4: Historical: examines events of the past to increase understanding of the nursing profession today.

The types of research methods (quantitative and qualitative) - how they compare/contrast.

S: specific. M: measurable. A: attainable. R: realistic. T: Time bound.

Tool for writing goals and outcomes.

1: ability to pay 2: location of facilities

Two major factors influencing provision of health care in U.S.

1: Females, - Inhibited sexual desire. Assessment priorities are: - Assess for use of oral contraceptives or other hormonal therapy, use of alcohol or certain medications. - Assess for history of sexual abuse, rape or incest, depression, or other sexual dysfunctions. - Assess any other contributing or relationship factors. - Dyspareunia: painful intercourse. The cause is usually physical, although psychological problems such as fear and anxiety can cause pain. Assessment priorities are: - Assess for history of diabetes, hormonal imbalance, vaginal infection, endometriosis, urethritis, cervicitis, or rectal lesions. - Assess for use of antihistamines, alcohol, tranquilizers, or illicit drugs. - Assess the patient's ability for vaginal lubrication during the sexual act. - Assess the patient's use of coital positions. - Assess the use of cosmetic or chemical irritants to the genitals, such as deodorant tampons, contraceptive creams or jellies, or condoms. - Perform physical assessment of internal and external genitalia. - Assess any other contributing factors. - Vaginismus: rare condition in which the vaginal opening closes tightly and prevents penile penetration. Vaginismus is due to involuntary spastic contractions of the muscles at and around the vaginal opening and the levator ani muscles. The cause of vaginismus may be physical, psychological, or both. Assessment priorities are: - Assess knowledge regarding anatomy and sexual response. - Assess the pattern of sexual activity: how often, level of arousal, orgasm. - Assess the presence of other sexual dysfunctions. - Assess for history of sexual abuse, trauma, or rape. - Assess the patient's feelings regarding her partner. - Assess any other causative factors, such as fear of pregnancy, anxiety, or guilt. - Perform physical assessment of internal and external genitalia. - Orgasmic dysfunction: Assessment priorities are: - Assess knowledge regarding sexual response cycle and anatomy. - Assess the communication pattern between the patient and her partner. - Assess the usual sexual pattern and behavior between the patient and her partner. - Assess any other contributing factors. - Vulvodynia: chronic vulvar discomfort or pain characterized by burning, stinging, irritation, or rawness of the female genitalia that interferes with sexual activity, is particularly problematic because little is known about its cause or treatment. 2: Males, - Erectile dysfunction: Also called impotence. It is the inability of a man to attain or maintain an erection to such an extent that he cannot have satisfactory intercourse. It can be physiologic or physiological. Assessment priories are: - Assess for history of diabetes, spinal cord trauma, cardiovascular disease, surgical procedure, or alcoholism. - Assess for use of certain medications such as antihypertensives, antidepressants, or illicit drugs. - Determine degree of mental depression that may be present. - Obtain specific information regarding the degree of impotence, length of time of disorder, or continuing life factors. - Premature ejaculation: condition in which a man consistently reaches ejaculation or orgasm before or soon after entering the vagina. Assessment priorities are: - Assess what patient defines as his dysfunction and ability to control ejaculation. - Assess any causative relationship factors such as anxiety, guilt, lack of time, or new partner. - Delayed ejaculation: refers to a man's inability to ejaculate into the vagina, or delayed intravaginal ejaculation. Assessment priorities are: - Assess for history of neurologic disorders, Parkinson's disease, or use of certain medications. - Use the same assessment priorities as for premature ejaculation.

Types of sexual dysfunction and the assessment priorities for each

1: knowledge, skills, and attitudes. 2: readiness to learn. 3: ability to learn. 4: learning strengths. 5: making sure instructions are understandable and support patient goals. 6: includes patient and family in process. 7: utilize interactive teaching strategies. 8: develop interpersonal relationships with patients and families.

What are factors that influence patient compliance (adherence) with the therapeutic plan

1: Abstract. 2: Introduction. 3: Method. 4: Results. 5: Discussion. 6: References.

What are the components of a research journal?

1: Complementary health approaches (CHA): are interventions that can be used with conventional medical interventions and thus complement them. This is not a medicine. - CHA's seek ways to improve health and well-being or relieve symptoms associated with chronic, even terminal illnesses or the side effects of conventional treatments for them. - It is a holistic health philosophy or a transformational experience that changes one's worldview and wanting greater control over ones own health. Three categories of CHA's are: - Mind-body practices. - Natural products. - Other CHA's. Most frequently used CHA's are: - Nonvitamin, nonmineral, natural products. - Deep breathing exercises. - Yoga. - Chiropractic or osteopathic manipulation. - Meditation. - Massage. 2: Integrative health (IH): is a combination of complementary health and conventional health approaches in a coordinated way. This is not a medicine. This care is uses the combination on allopathic medicine and CHA. 3: Allopathic/conventional medicine: (biomedicine) traditional medical care. It is dominant for about 100 years. Spearheaded remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools. It is effective when aggressive treatment is needed for emergency or acute care situations. Characteristics are: - Illness occurs in either the mind or body, which are separate entities. - Health is the absence of disease. - The main cause of illness are pathogens. - Curing seeks to destroy the invading organism or repair the affected part. - Emphasis is on disease and high technology (drugs, surgery, and radiation are key tools).

What are the differences in: CHA, integrative health and allopathic/conventional medicine?

1: Biotoxins. 2: Blister agents/vesicants. 3: Blood agents. 4: Choking/lung/pulmonary agents. 5: Blood agents. 6: Incapacitating agents. 7: Long-acting anticoagulants. 8: Metals. 9: Nerve agents. 10: Organic solvents. 11: Riot control agents/tear gas. 12: Toxic alcohols. 13: Vomiting agents.

What chemicals are used for mass destruction?

1: Critical thinking: a broad term which includes reasoning both outside and inside of the clinical setting. It is your ability to focus your thinking to get the results you need in various situations. Clinical reasoning and clinical judgement are key pieces of critical thinking in nursing. Use clear focused thinking to achieve the result. Involves reflection and creative thinking. Critical thinking is affected by ones beliefs and values. 2: Clinical Reasoning: a specific term that usually refers to ways of thinking about patient care issues (determining, preventing, and managing patient problems). For reasoning about other clinical issues (teamwork, collaboration, and streaming work flow), nurses usually use critical thinking. Involves reflection and creative thinking. 3: Clinical judgment: refers to the result (outcome) of critical thinking or clinical reasoning-the conclusions, decision, or opinion you make.

What is involved in critical thinking/clinical reasoning and judgment

1: Medical diagnosis. 2: Pathology of disease. 3: Diagnostic labs/tests. 4: Therapeutic needs. 5: Therapeutic nursing goals. 6: A single sign or symptom tells. 7: Invalidated nsg inference.

What is not a nursing diagnosis.

1: Take charge of your health. 2: Talk with your health care providers when making any decisions about using complementary health approaches. Your health care providers can give you advice based on your medical needs. 3: If you are thinking about using a CHA therapy, learn the facts. Is it safe? Does it work? 4: Find out what scientific studies have been done. It is not a good idea to use a CHA therapy simply because you have seen it in an advertisement or on a website or because people have told you that it worked for them. 5: Keep in mind that the number of websites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading. To evaluate the quality of a website, take a look at who runs the site, who pays for it, and the purpose of the site. Also, check out where the information comes from, how it is selected, and how current it is. 6: Scientific research on many CHA therapies is relatively new, so information about safety and effectiveness may not be available for every therapy. However, many studies of CHA treatments are underway, and researchers are always learning more about CHA. 7: You can find reliable information on CHA through the National Institutes of Health's National Center for Complementary and Integrative Health (NCCIH).

What should the public and our patients know about complementary health approaches and integrative health to be informed consumers?

Acute illness is a rapid onset of symptoms and lasts only a relatively short time (ex common cold). They do not normally require medical treatment. Chronic illness has four characteristics: 1: it is permanent change (ex diabetes). 2: it causes, or is caused by, irreversible alterations in normal anatomy and physiology. 3: it requires special patient education for rehabilitation. 4: it requires a long period of care or support. Chronic illnesses usually have a slow onset and may have periods of remission and exacerbation. A patient can have both acute and chronic illness at the same time (ex. diabetes but have a acute illness of low blood sugar).

compare and contrast acute illness and chronic illness.

1: Community based nursing care 2: Continuity of care 3: Care coordination 4: Collaborative practice

four concepts essential to nursing care of patients within and across healthcare settings

Essential components of continuity of care include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the plan of care; considering individual, family, and community resources; and evaluating the effectiveness of care. 1: provide appropriate, uninterrupted care and facilitate patients transition between different settings and levels of care. 2: ensure a smooth transition between ambulatory or acute care and home health care or other types of health care settings in patients community. 3: excellent communication as patients move from one caregiver or health care site to another. 4: is big with discharge planning. 5: by using the SBAR or ISBARQ

how the nurse ensures continuity of care between/among healthcare settings

Qualities are: knowledgeable and skilled, independent in making decisions, and accountable. Roles are: providing care from one level to another with one setting to another, providing interventions, managing acute/chronic illness, promoting self-care, being an advocate, coordinator, and educator.

the qualities and roles of the community based nurse