Ch. 1 & 2 Flashcards
specialty practice of medical-surgical nursing includes
- promotion, restoration, or maintenance of optimal health for patients 18 years and older
med-surg nurses must have the knowledge, skills and attitudes to be:
- care coordinators
- caregivers
- transition managers (to home, hospital, rehab)
- patient educators
- leaders
- advocates for the patient and family
QSEN stands for
quality and safety education for nurses
the six QSEN competencies are
- provide patient-centered care
- promote safety
- collaborate with the interprofessional healthcare team
- implement evidence-based practice
- use quality improvement in patient care
- use informatics in patient care
what are the four professional nursing concepts?
- clinical judgement
- systems thinking
- health equity
- ethics
clinical judgement
- iterative process using nursing knowledge
- defined as the observed outcome of critical thinking and decision-making
- appropriate (“sound”) clinical judgement leads to positive outcomes
- inappropriate (“poor”) clinical judgement leads to risk or safety issues (for patients and/or staff)
systems thinking
- ability to recognize, understand, and synthesize interactions in a set of components designed for a special purpose
- transforms care and improves patient outcomes
- promotes patient safety and high quality care
health equity
ability to recognize differences in resources and knowledge
ethics
- addresses issues and questions about morality
- nurses follow: the ANA Code of Ethics
patient centered care
- the patient or designee is source of control and full partner
- preferences, values, and needs
- culturally competent care
- “family-centered care” - The Joint Commission
patient-centered care attributes
- respect for patients’ values, preferences, and expressed needs
- information, communication, and education
- physical comfort
- emotional support and alleviation of fear and anxiety
- involvement of family and friends
- transition and continuity
- access to care
special considerations and populations that are vulnerable
- cultural and spiritual
- older adults
- gender health
- military and veterans’ health
**need to make sure that these patients are ready for d/c and have FUPs upon d/c
care coordination
- deliberate organization of and communication about patient care activities
- facilitates appropriate, continuous health care to meet the patient’s needs
how does care coordination take place?
- takes place between two or more health care team members (including the patients)
care coordination: transition management
ensures safe and effective coordination and continuity of care as patients experience changes in health care status, health care providers, or health care setting
care coordination: case management
ensures high quality and cost-effective services and resources to achieve positive patient outcomes
7 foundations of safe transition management
- leadership support
- early identification of patients at risk
- thorough psychosocial assessment on patients
- multidisciplinary team involvement (nurses, MD, PT/OT, speech, respiratory support)
- patient and family engagement
- medication reconciliation (*also a safety goal)
- transfer of information (when patients are d/c- give them info that they need in their language- new meds, dressing changes, etc.)
The Joint Commission: Safe Transition Management
has 7 foundations of safe transition management
medication reconciliation is a __ process
formal evaluative process
medication reconciliation
- reconciled patient’s current meds: drug name, dose frequency, route, and purpose and should be done on all:
- admissions
- transfers
- discharges
- addresses duplications, omissions, and any possible interactions
safety
the ability to keep the patient and staff free from harm and minimize errors in care
best safety practices help reduce __ and ___
error and harm
nursing safety priority boxes
- critical rescue
- action alert
- drug alert
Just culture
blame-free approach
patients and families are safety partners with ____
health care providers and organizers
deviations from the standard of care
- adverse event (variation)
- sentinel event (severe variation)
- nurses and team members should not hesitate to report
a sentinel event is
a severe variation, that results in avoidable patient death or major harm
4 Interprofessional Education Collaborative (IPEC) competencies
- values/ethics for interprofessional practice
- role-responsibilities
- interprofessional communication
- teams and teamwork
examples of teamwork and collaboration as per the IPEC
- communication: SBAR, TeamSTEPPS
- delegation/supervision
SBAR is
formal method of hand-off communication between two or more health care team members
- nurse to nurse
- nurse to physician
SBAR (broken down)
S- situation
B- background
A- assessment
R- recommendation/request
TeamSTEPPS
a systematic communication approach for inter-professional teams designed to improve safety and quality
delegation is
- the process of transferring a selected nursing task or activity to a competent UAP (unlicensed assistive personnel)
requires accurate communication between nurse and UAP
delegation
who is responsible for the delegated task/activity?
the nurse who did the delegating, not that UAP
supervision is
the guidance or direction, evaluation, and follow-up by the nurse to ensure a task/activity is performed appropriately
- supervision by an RN is performed for APs, PCTs, NAs
who can the nurse delegate to?
- AP (assistive personnel)
- patient care technicians (PCTs)
- nursing assistants (NAs)
can all nursing activities be delegated?
no, not all can be delegated
- insert foley catheter
- draw blood
- give meds
*cannot be delegated ^
you cannot delegate what you can eat (evaluation, assessment, teaching)
5 rights of delegation
- right task
- right circumstances
- right person
- right communication
- right supervision
evidence based practice is
the integration of the best current evidence and practices to make decisions about patient care
- includes best evidence, clinical expertise, and patient preferences
- promotes safety
evidence based practice considers
- patient preferences and values
- one’s own clinical expertise for delivery of optimal health care
quality improvement is
indicators used to monitor care outcomes and develop solutions to change and improve care
- best evidence used to support practice changes
models for quality improvement
- PDSA- most commonly used
- FOCUS-PDCA
information and technology is used for (related to patient care)
- communication
- management knowledge
- prevention of errors
- support decision-making
examples of informatics
- electronic health record (EHR)
- computers used at the point of care
- handheld mobile devices
- use of devices and systems (ie. smart infusion pumps, bar-code medication administration, software systems)
- telehealth/telenursing
Tanner CJ model
Clinical Judgement model (2006)
- assessment: noticing
- analysis: interpretting
- planning and implementation: responding
- evaluation: reflecting
NCSBN CJMM
Clinical Judgement Measurement Model (2019)
6 cognitive skills of clinical judgement that can be measured
priority focus on safety and clinical judgement
- Rapid Response Team (RRT), or
- Medical Emergency Team (MET)
purpose of RRT
- intervenes for people at beginning of clinical decline
- can be used by family, mostly used by healthcare team
- decreases medical complications and number of arrests
who is on the RRT?
- respiratory therapists
- doctors, residents
- nurses on the floor/unit
- ICU nurses
- anesthesia
- pharmacist
failure to rescue
inability of health care team members to save the patient’s life in a timely manner
- occurs when the s/sx are NOT noticed/recognized and therefore action to improve patients condition is not implemented
health care disparities
- differences in access to and use of health care
- health care quality, health outcomes, and health insurance coverage
factors affecting health equity: social determinants of health (SDOH)
- neighborhood
- finances
- socioeconomic status
- education
populations with special needs
- older adults
- racial and ethnics groups
- LGBTQ population
attributes of ethics
- autonomy
- beneficence
- non-maleficence
- fidelity
- veracity
- social justice
autonomy
the right or condition of self-government
- the patients are able to make independent decisions
- nurses provide the patients with all the necessary information that is required to make an educated decision about their medical care without influencing the patient’s choice
beneficence
kindness and charity, which requires action on the part of the nurse to benefit others
non-maleficence
do no harm intentionally
- nurses must provide a standard of care to avoid/minimize risk, as it relates to medical competence
fidelity
keeping one’s promises
- the nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner
veracity
the ethical principle of being completely open and honest with patients, even if the truth causes distress
social justice
being impartial and fair
- nurses make impartial medical decisions, related to limited resources or new treatments regardless of economic status, ethnicity, sexual orientation, etc.
the health care system
health care
the inter-professional health care team includes
- physicians
- PAs
- APRNs
- Interns/Residents/Hospitalists
- RNs
- LPNs
- APs
- PT/OT
- SLP
- RDN
- LSW
- PharmD
- RT
- Radiology Tech
bedside report includes
- why is the patient here?
- what happened
- what is the patient on for meds/what has been done since admission
- PMH - what are we doing about it this admission?
- labs
- IV/meds/fluids
- plan of care
- injury/fall risk
- impairments
- pain/meds for pain - what are we doing for the patient today?
- what needs to happen for this patient to discharge?
SBAR: Situation
“what is happening right now?”
- identify yourself
- identify your patient, unit and room #
- brief summary of primary problem
SBAR: Background
“What has happened?”
- date of admission
- allergies
- code status
- recent set of vital signs
- list of current medications, IV fluids, lab work
- any studies done during this admission?
- treatment goals? plan of care?
SBAR: Assessment
“what you found (during your assessment)/what you believe the problem is.”
- current nursing assessment
- most recent set of vital signs
- relevant lab values
- how have you advanced the plan of care?
- patient’s response?
- is the patient stable? unstable? worsening?
SBAR: Recommendation
“what would you like done/suggest”
- what do you need from this individual?
- suggestions to advance plan of care
- any new/urgent needs that need follow-up?
- any orders need to be changed or reviewed?
critical rescue
emphasizes the need for action for potential or actual life-threatening problems
- action is needed for potential or life threatening conditions
action alert
focus on the need for action but not necessarily for life-threatening situations
- patients at risk for blood clots, post op patients, obese or immobile patients
- not critical but want to pay attention
drug alert
specify actions needed to ensure safety related to drug administration, monitoring, or related patient and family education
adverse event examples
- allergic reaction
- falls with no harm
- pressure ulcer/skin breakdown
- catheter associated UTI
- med error with no harm
sentinel event examples
- falls with major harm/death
- med error with harm/death
adverse event
a variation in care- something happened that wasn’t supposed to happen, but does not cause harm/not major harm or death
what does the acronym “do not delegate what you can E.A.T.” mean?
do not delegate what you can can evaluate, assess, or teach
- do not hand off these tasks to APs, PCTs, NAs
- evaluation, assessment, and teaching is a nurses job- do not hand of these jobs
why is clinical judgement important?
prevents errors
patients often have subtle s/sx _____ days prior to cardiac arrest
1-3 days
examples of autonomy
- informed consent
- refusal of medication
primary care
- where healthcare starts
- you go to your PCP to get referred to someone else
in patient care
taking care of patient in hospital
community health care
going out in the community
- nursing home
- senior center
- visiting homes
managed care
has to do with insurances
- nurses don’t do much with this
- case management and billing needs to know
medical homes
type of health care model that some health care organizations use
- not a physical home
long term care
nursing home
skilled facility
Physician (MD or DO)
diagnoses and treats injuries or illness and addresses health maintenance
- examines patients, takes PMH, prescribed meds, orders, performs, and interprets diagnostic tests
- care delivered according to a medical model delivery
Physician Assistant (PA)
masters level prepared providers
- examines patients, takes PMH, prescribed meds, orders, performs, and interprets diagnostic tests
- care delivered according to a medical model delivery
- delivers care under supervision of an MD/DO
Advanced Practice Registered Nurse (APRN)
prepared by education and certification to assess, diagnose and manage patient problems, order tests, and prescribe medications
- nurse practitioners
- nurse mid-wives
- nurse anesthetist (CRNA)
- clinical nurse specialists (CNS)
Interns/Residents/Hospitalists
“baby” Physicians/APRNs
Registered Nurse (RN)
practices professional nursing as defined by individual state’s board of nursing and performs roles of caring, teaching, collaborating, advocating, and researching
Licensed Practical Nurse (LPN)
- 1 year of education
- cant hang blood, or give IV antibiotics
Assistive Personnel (AP)
any assistive personnel trained to function in a supportive role, regardless of title, to whom nursing responsibility may be delegated.
- CNAs
- certified medical assistants
- patient care techs
- certified medication aides
- home health aides (UAPs- unlicensed assistive personnel)
Occupational or Physical Therapist (OT,PT)
OT: helps patients develop, recover, improve, and maintain ADLs through therapy
PT: uses treatment techniques to promote movement, reduce pain, restore function, and prevent disability
Speech/Language Pathologist (SLP)
assess, diagnoses, treats, and helps to prevent communication and swallowing disorders
- swallow evals
Registered Dietitian Nutritionist (RDN)
a food and nutrition expert who educates individuals about nutrition and healthy eating habits
- may administer medical nutrition therapy and manage food service operations in a system
- speak to patients about the diet that they need to have
- give thorough education on diet
Licensed Social Worker (LSW)
helps people solve and cope with problems in their everyday lives
- if patient can’t afford to take their meds and health is declined
- get LSW involved to find resources to help the patient
Pharmacist (PharmD)
dispenses prescription medications and offers expertise in the safe use of drugs
- assistance with meds
Respiratory Therapist (RT)
treats breathing disorders, manages ventilators and artificial airways, and educates about lung disease
- in charge of nebulizer treatments, O2 equipment (vent mask/high flow)
Radiography Technologist
captures images of internal organs, soft tissues, and bones using x-ray equipment
- x-ray, CT scan, MRI
