CH 21 managing patient care potter Flashcards
develops licensure examinations for registered nurses (RNs) and licensed practical nurses (LPNs) to ensure entry-level nurses can safely practice nursing.
National Council of State Boards of Nursing (NCSBN, 2018)
Building an empowered nursing team begins with the nurse executive, who is often a
chief nursing officer
within an organization is critical in uniting the strategic direction of an organization with the philosophical values and goals of nursing.
executive’s position (chief nursing officer)
is a clinical and business leader who is concerned with maximizing quality of care and cost-effectiveness while maintaining relationships and professional satisfaction of the staff.
- establish a philosophy for nursing that enables managers and staff to provide quality nursing care.
nurse executive
is focused on change and innovation through team development, 282serves as a mentor for staff, and develops and supports the moral agency of nurses
nurse manager who uses transformational leadership
spend time on the unit with the staff sharing ideas, empowering the staff, supporting opportunities to enhance the team, showing appreciation and recognizing team members for a job well done, and holding team members accountable
Transformational leaders
the professional nursing staff’s values and concerns for the way they view and care for patients.
A philosophy of care includes
have a shared vision that leads the team to a common goal
Contemporary nurse leaders
choose to serve others before they decide to become leaders.
Servant leaders (type of Contemporary relationship-based leadership)
interactional and relationship-based leadership styles
-create a positive work environment by fostering interaction and generating stability to create the energy a team needs to adapt to and grow with a constantly changing health care environment
Nurse managers who use
Their priority is putting the needs of others first and promoting personal growth and autonomy by ensuring their individual employee’s highest priority needs are met
Servant leaders (type of Contemporary relationship-based leadership)
is freedom of choice and responsibility for the choices
Autonomy
to create workplaces that promote better outcomes for patients and nurses
Effective nurse leaders often use transformational or relationship-based leadership
choose a leadership style consistent with their personalities. They are dedicated to their own growth and build strong relationships with others
-dedicated to their own growth and build strong relationships with others
Authentic leaders (type of relationship-based leadership)
is based on five model components—transformational leadership; structural empowerment; exemplary professional practice, new knowledge, innovation, and improvements; and empirical quality results
Magnet Recognition Program
has a transformed culture with a practice environment that is dynamic, autonomous, collaborative, and positive for nurses
hospital that is Magnet ® certified
has clinical promotion systems and research- and evidence-based practice programs.
Magnet hospital has clinical promotion
to produce a strong collaborative relationship among team members and improve patient quality outcomes
culture and empowerment combine
of nurse-patient relationship,
Nursing care delivery models contain the common components
used in some health care institutions are team nursing and primary nursing
2 classic nursing models
care is provided by a group of people led by an RN. The team often includes other RNs, practical nurses, and assistive personnel (APs).
-model requires effective team leadership, collaboration, and communication
team nursing (one of nursinf model)
one RN assumes the responsibility for a caseload of patients from admission to discharge. The same nurse provides care for the same patients throughout their hospitalization
- Total patient care is similar to primary nursing.
- working directly with patients, families, and health team members.
primary nursing
promotes mutual partnerships among the patient, family, and health care team to plan, implement, and evaluate nursing and health.
- patient or family member as the source of control and full partner in providing care
Patient- and family-centered care promotes
. is the health care leader that assesses patient needs, recognizes clinical changes, and directs care.
An RN
- Dignity and respect, ensuring that the care provided is given on the basis of a patient’s and family’s knowledge, values, beliefs, and cultural backgrounds
- Information sharing, meaning that health care providers communicate and share information so that patients and families receive timely, complete, and accurate information to effectively participate in care and decision making
- Participation, whereby patients and families are encouraged and supported in participating in care and decision making
- Collaboration, demonstrated by the health care leaders collaborating with patients and families in policy and program development, implementation, and evaluation and patients who are fully engaged in their health care
Institute for Patient-and Family-Centered Care identified four core concepts for patient-centered care
coordinates and links health care services across all levels of care for patients and their families while streamlining costs and maintaining quality
Case management
are often advanced practice nurses who, through specific interventions, help to improve patient outcomes, optimize patient safety by facilitating care transitions, decrease length of stay, and lower health care costs.
-accountable for cost management and quality
Case managers (defined better)
coordinates a patient’s acute care in the hospital and follows up with the patient after discharge, either to home, rehabilitation, or a long-term care setting.
-Case managers do not provide direct care.
case manager exact roles
is a component of the hierarchical level of decision making found in health care institutions
- allows decisions to be made at the staff level
Decentralization (hierarchical of decision making)
is the typical decentralized structure used within health care organizations today
Shared governance (type of decentralized structure)
managers and staff become more actively involved in making decisions to shape the identity and determine the success of a health care organization.
Shared governance (type of decentralized structure) (role)
are responsibility, autonomy, authority, and accountability.
Important elements of the decision-making process are
refers to the duties and activities that you are employed to perform.
Responsibility
a nurse makes independent decisions about the work of the unit such as scheduling or unit governance.
-it occurs in degrees
work autonomy (another type of autonomy)
refers to the legal ability to perform a task
-provides the power for a nurse to make final decisions and give instructions related to the decisions. You use authority to determine whether collaboration was successful
Authority
refers to individuals being answerable for their actions
Accountability
involves follow-up and a reflective analysis of decisions and an evaluation of their effectiveness
Accountability
establish and maintain care standards for nursing practice on their unit.
Staff committees establish (nurse manager supports staff involvement thru)
to encourage patient and family involvement in planning care, improve patient care coordination, and enhance communication among the health care team
interprofessional rounding (nurse manager supports staff involvement thru)
, you meet a patient’s physiological needs such as oxygen, food, water, sleep, and elimination first.
- then safety, security, belonging, esteem, and self-actualization.
Maslow’s hierarchy of needs
Assign high priority to first-level problems using ABC+VL (airway, breathing, cardiac and circulation problems, vital signs concerns, and life-threatening laboratory values) and attend to these immediately.
- Next address second-level problems, which immediately follow the first level and include concerns such as changes in mental status, untreated medical issues, acute pain, acute elimination problems, abnormal laboratory results, and risks.
- Then tend to third-level problems, which are health problems other than those at the first two levels, such as long-term issues in health management, rest, and family coping.
3 PRIORITy LEVEL ACCORDING TO THIS (IMPORTANT)
use of time means doing the right things
Effective
use of time means doing things right.
efficient
provides training for all health care staff to guide communication, increase team awareness, and eliminate barriers to patient safety
TeamSTEPPS® system
, which means I am C oncerned, I am U ncomfortable, and this is a S afety issue
CUS Tool (tool used in change of pt condition) way healthcare providers communicate
is the process of assigning part of your responsibility to another qualified person in a specific situation
Delegation
clinical reasoning, nursing judgment (e.g., the steps of the nursing process of assessment, diagnosis, planning, intervention, and evaluation or patient teaching), and critical decision making to APs
NEVER DELEGATE TO APS
attend to basic patient needs (e.g., hygiene, meal assistance, ambulation) while LPNs can provide basic direct nursing care (e.g., observe and report clinical changes, perform wound care, and ADLs).
AP scope/ things can delay to
basic direct nursing care (e.g., observe and report clinical changes, perform wound care, and ADLs).
LPNs can provide (scope to delay)
to the LPN
if a patient is stable, you delegate administration of medications (exception: IV medications in most states)
the taking of vital signs to the AP.
if a patient is stable, you delegate vital signs to
