ACCCN'S Flashcards
Consider the leaders to whom you are exposed in your work environment and identify the characteristics they display that influence patient care. Reflect on whether these are characteristics that you possess or how you might develop them.
honesty,
integrity,
equity
justice when dealing with staff; commitment to the organisation/department; credibility; wisdom; courage; and the ability to make difficult decisions and role model organisational/departmental values.
All registered nurses are expected to demonstrate leadership in clinical practice. Reflect on what leadership activities you undertake as part of your role. What strategies could you use to evaluate and further develop your leadership skills?
Strategies to evaluate your leadership skills include:
i) using active reflection as a regular strategy to self-evaluate your performance; ii) seeking input from your peers and line managers.
Strategies to assist with further developing leadership skills include:
i) participation in continuing education programs that have a focus on leadership; ii) looking for opportunities to work in different roles that require a higher level of leadership skills or where there is more opportunity to exercise your existing leadership skills.
A colleague who has been working in ICU for the past 3 years indicates that they are interested in moving beyond a role in direct patient care and would like to eventually move into a clinical leadership position. What strategies might you suggest they investigate to position them well for the future?
Strategies that might be useful to consider when planning changes to the focus of a nursing career include:
i) locating position descriptions of nursing
leadership roles in areas such as advanced clinical practice, education, research and management and making note of the listed essential and desirable criteria, then making a list of what you might need to do in order to meet these criteria;
ii) exploring higher education options. For advanced clinical practice you might want to consider a coursework masters in your specialty area. For research specialisation you could consider doing a higher degree by research. Alternatively, adult education or health professional education postgraduate courses might be useful.
Consider the role that you have within critical care and examine the influence that research has on that role. How might you use research to inform your practice more effectively? Are there strategies that you could implement to influence the research that is undertaken so that it meets your needs?
(i) journal club,
(ii) forums such as local review of the quality of care with discussion about evidence-based strategies to improve it, (iii) encouragement and support of nurses undertaking Masters or PhDs to design projects that meet local needs or areas of interest.
Reflect on your practice and experience over the past year. What professional development activities have you undertaken and what new knowledge and skills have you developed?
Professional development activities might include, but are not limited to, in-service education, conference and workshop attendance, undertaking a formal program of study at university, critically reading journal articles and successfully completing continuing education assessment related to journal articles. New knowledge and skills that may be developed include, but are not limited to, understanding policy, clinical knowledge and skills, strategies to integrate research into practice and leadership skills.
Identify the three approaches suggested by the Research and Development Corporation to economic decision making in the ICU when assessing treatment options.
a Benefit–risk
b Benefit–cost
c Implicit
Identify the three fundamental steps in the budget process.
a Budget preparation and approval
b Budget analysis and reporting
c Budget control or action
List the main nursing activities identified in the Nursing Activity Scale 2003.
1 Monitoring and titration
2 Laboratory, biomedical and microbiological investigations
3 Medication, vasoactive drugs excluded
4 Hygiene procedures
5 Care of drains, all (except gastric tube)
6 Mobilisation and positioning
7 Support and care of relatives and patient
8 Administration and managerial tasks
9 Respiratory support
10 Care of artificial airways
List the criteria that should be included in the evaluation of a new product.
a Safety b Performance c Quality d Use e Cost–benefit analysis f Cleaning g Regulatory control h Adaptability to future technological advancements i Service agreements j Training requirements
Patients transferred from ICU to the ward may have complex care needs. In your hospital, if a follow-up service was planned, how do you think this should be developed?
• Who should deliver the service – nurse-led, doctor-led or combination?
• When and where should this be delivered and how could such a service be tailored to meet
individual need?
• How would you identify individual need?
• What tools would you use to assess patient recovery?
• What are the key referral specialties you would liaise with?
• What are the main governance issues around developing a new service and how would you deal with these?
Review the evidence for psychological assessment and management of patients after a critical illness and intensive care admission.
here is a range of assessment tools. The choice should be based
on demonstrated reliability and validity, ease of administration and burden to the patient.
A combination of measures to assess anxiety, depression, post-traumatic stress and cognitive impairment should be used. Many of these measures can be used as screening tools but are useful in identifying those at-risk patients who should then be referred for a diagnostic assessment. Management will depend upon existing services and should follow a recognised treatment pathway.
What are the educational implications for staff in relation to supporting the physical and psychological problems patients experience after ICU?
There are several educational implications that need to be addressed either during undergraduate programs or as continuing professional development activities. First, increase awareness of the problems. The challenges of caring for patients throughout a hospital after ICU discharge result in ward staff having limited experience and understanding
of the consequences of critical illness. For example, lack of awareness of the exhaustion and fatigue patients experience may mean that they have unrealistic expectations of what patients are able to do. Second, ward staff should be familiar with the potential interventions or ‘tailored’ rehabilitation programs to support patients and families.
List the benefits and risks of faecal containment devices.
Benefits of the use of faecal containment devices include management of faecal incontinence, prevention of incontinence-associated pressure injuries, prevention of spread of infection.
Risks include leakage of faecal matter due to poor placement, blockage and overflow of faecal matter if appropriate aperients are not administered, rectal bleed from pressure from the device balloon incorrectly placed.
Outline the ICU patient preparation for transfer to the operating theatre.
(a) Obtain patient procedure consent and updated clinical records.
(b) Determine with the intensivist and anaesthetist what current therapies will continue and which can be temporarily suspended and in what timeframe related to the operative procedure (e.g. enteral nutrition, fluid replacement regimes, sedatives may be changed, anticoagulants suspended).
(c) Set up transport monitoring with appropriate parameters for your patient.
(d) Set up transport ventilator with appropriate parameters for your patient.
(e) Ensure gas supply for transport ventilator and batteries for transport ventilator and monitor and infusion pumps are satisfactory.
(f) Set up additional oxygen cylinder with suction facilities and manual ventilation set on the patient’s bed.
(g) Ensure all patient devices are secured to the patient and devices on the bed such as urinary drainage bags are suitably positioned for transport.
What criteria do you use to evaluate the positioning in bed of your patients?
(a) Patient comfort;
(b) patient actual, and sense of, security;
(c) device and equipment safety; and
(d) therapeutic benefit of the position.
