chapter 1 Overview of Professional Nursing Concepts for Medical-Surgical Nursing Flashcards
Medical-surgical nursing
specialty practice area in which nurses promote, restore, or maintain optimal health for patients from 18 to older than 100 years of age
family
refers to the patient’s relatives and significant others in the patient’s life whom the patient identifies and values as important.
settings for med sure
acute care agencies, skilled nursing facilities, ambulatory care clinics, and the patient’s home, which could be either a single residence or group setting such as an assisted living facility.
The role of the nurse
care coordinator and transition manager, caregiver, patient educator, leader, and patient and family advocate
KSAs
knowledge, skills, attitudes, and abilities
The Institute of Medicine
highly respected U.S. organization that monitors health care and recommends health policy
Health Professions Education: A Bridge to Quality
identified five broad core competencies for health care professionals to ensure patient safety and quality care
Patient-Centered Care
“the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for [the] patient’s preferences, values, and needs”
family-centered care
emphasize the importance of including the patient’s support system as part of interprofessional collaboration.
Attributes of Patient-Centered Care
- Respect for patients’ values, preferences, and expressed needs
- Coordination and integration of care
- 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
Canadian nursing practice
includes culture from a safety perspective
integrative care model
increasing use of these therapies by consumers to maintain health and help manage chronic health issues
reflects nursing theories of caring, compassion, and holism to respect the diverse preferences and needs of patients and their families.
Care coordination
is the deliberate organization of and communication about patient care activities between two or more members of the health care team (including the patient) to facilitate appropriate and continuous health care to meet that patient’s needs
case management
process is to provide quality and cost-effective services and resources to achieve positive patient outcomes. In collaboration with the nurse, the CM coordinates inpatient and community-based care before discharge from a hospital or other facility.
Transition management
involves safe and seamless movement of patients among health care settings, health care providers, and the community for ongoing care to meet patient needs.
Medication reconciliation
is a formal evaluative process in which the patient’s actual current medications are compared to his or her prescribed medications at time of admission, transfer, or discharge to identify and resolve discrepancies.
This comparison addresses duplications, omissions, and interactions and the need to continue current medications.
Medication discrepancies
can cause negative patient outcomes, including rehospitalizations for medical complications.
Safety
is the ability to keep the patient and staff free from harm and minimize errors in care.
The scope of safety
can be described as unsafe, possibly causing harm or even death, or safe to prevent harm or negative outcomes.
Patient harm and errors generally occur as a result of
- Lack of clear or adequate communication among patient, family, and members of the interprofessional health care team
- Lack of attentiveness and patient monitoring
- Lack of clinical judgment
- Inadequate measures to prevent health complications
- Errors in medication administration
- Errors in interpreting authorized provider prescriptions
- Lack of professional accountability and patient advocacy
- Inability to carry out interventions in an appropriate and timely manner
- Lack of mandatory reporting
Best safety practices
reduce error and harm through established protocols, memory checklists, and systems such as bar-code medication administration
work-arounds
Working around safety systems is not acceptable and can increase the risk of error to patients and/or staff.
Nursing Safety Priority: Critical Rescue
emphasizes the need for action for potential or actual life-threatening problems.
Nursing Safety Priority: Action Alert
boxes focus on the need for action but not necessarily for life-threatening situations.
Nursing Safety Priority: Drug Alert
boxes specify actions needed to ensure safety related to drug administration, monitoring, or related patient and family education.
The Joint Commission (TJC) National Patient Safety Goals (NPSGs)
These goals require health care organizations to focus on specific priority safety practices, many of which involve establishing nursing and health system approaches to safe care.
culture of safety
provides a blame-free approach to improving care in high-risk, error-prone health care organizations using interprofessional collaboration.
adverse events
variations in the standard of care
sentinel event
is a severe variation in the standard of care that is caused by human or system error and results in an avoidable patient death or major harm.
To provide patient- and family-centered care, the nurse:
“functions effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care”
interprofessional health care team
includes the patient, family, nurses, unlicensed assistive personnel and other health professionals and their assistants needed to provide appropriate and safe, evidence-based care.
Teamwork four general competencies include:
- Values/Ethics for Interprofessional Practice
- Role-Responsibilities
- Interprofessional Communication
- Teams and Teamwork:
• Values/Ethics for Interprofessional Practice
Work with individuals of other professions to maintain a climate of mutual respect and shared values.
Role-Responsibilities:
Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and populations served.
• Interprofessional Communication:
Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease.
Teams and Teamwork:
Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and equitable.
Communication national patient safety goal
National Patient Safety Goal mandated that nurses communicate continuing patient care needs such as pain management or respiratory support to post-discharge caregivers for safe transition management.
SBAR
- Situation: Describe what is happening at the time to require this communication.
- Background: Explain any relevant background information that relates to the situation.
- Assessment: Provide an analysis of the problem or patient need based on assessment data.
- Recommendation/Request: State what is needed or what the desired outcome is.
STEPPS
stands for Strategies and Tools to Enhance Performance and Patient Safety
CUS words
State “I’m concerned; I’m uncomfortable; I don’t feel like this is safe.”
• Check backs:
Restate what a person said to verify understanding by all team members.
Call outs:
Shout out important information (such as vital signs) for all team members to hear at one time.
Two-challenge rule:
State a concern twice as needed; if ignored, follow the chain of command to get the concern addressed.
Delegation
is the process of transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation. This process requires precise and accurate communication. The nurse is always accountable for the task or activity that is delegated!
Supervision
is guidance or direction, evaluation, and follow-up by the nurse to ensure that the task or activity is performed appropriately.
Five rights to delegation
- Right task: The task is within the UAP’s scope of practice and competence.
- Right circumstances: The patient care setting and resources are appropriate for the delegation.
- Right person: The UAP is competent to perform the delegated task or activity.
- Right communication: The nurse provides a clear and concise explanation of the task or activity, including limits and expectations.
- Right supervision: The nurse appropriately monitors, evaluates, intervenes, and provides feedback on the delegation process as needed.
Evidence-based practice (EBP)
is the integration of the best current evidence and practices to make decisions about patient care. It considers the patient’s preferences and values and one’s own clinical expertise for the delivery of optimal health care
The highest levels of evidence
are systematic reviews and integrative or meta-analysis studies.
level of evidence (LOE) pyramid
that is commonly used to rate the quality (strength) or scope of available evidence.
EBP promotes
safety for patients, families, staff, and health care systems because it is based on reliable studies, guidelines, consensus, and expert opinion.
Quality improvement (QI), sometimes referred to as continuous quality improvement (CQI)
is a process in which nurses and the interprofessional health care team use indicators (data) to monitor care outcomes and develop solutions to change and improve care.
evidence-based practice improvement (EBPI) process
because the best sources of evidence are used to support the improvement or change in practice.
Plan-Do-Study-Act (PDSO)
- Identify and analyze the problem (Plan).
- Develop and test an evidence-based solution (Do).
- Analyze the effectiveness of the test solution, including possible further improvement (Study).
- Implement the improved solution to positively impact care (Act).
The steps of the more specific FOCUS-PDCA model are:
- Find a process to improve.
- Organize a team.
- Clarify the current process.
- Understand variations in current process.
- Select the process to improve.
- Plan the improvement.
- Do the improvement.
- Check for results.
- Act to hold the gain.
DMAIC
- Define the issue or problem.
- Measure the key aspects of the current process for the issue (collect data).
- Analyze the collected data.
- Improve or optimize the current process by implementing an evidence-based intervention/solution.
- Control the future state of the intervention to ensure continuity of the process.
Attributes of Quality Improvement
- Identify indicators to monitor quality and effectiveness of health care.
- Access and evaluate data to monitor quality and effectiveness of health care.
- Recommend ways to improve care processes.
- Implement activities to improve care processes.
Informatics and technology
are the access and use of information and electronic technology to communicate, manage knowledge, prevent error, and support decision making
Scope of Informatics and Technology
Most health care settings have information technology (IT) departments. The largest application of health care informatics is use of the electronic health record (EHR)
issue with Informatics and Technology
patient and family privacy may be at risk unless precautions are implemented.
Clinical judgment
is the process that nurses and other members of the interprofessional team use to make decisions based on interpretation of the patient’s needs or problems.
sound vs poor clinical judgement
“sound” clinical judgment (also referred to as sound judgment) leads to positive patient or staff outcomes. By contrast, inappropriate or “poor” judgment results in negative outcomes that can pose a risk to patient or staff safety.
Failure to rescue
is the inability of nurses or other interprofessional health team members to save a patient’s life in a timely manner when a health care issue or medical complication occurs.
Attributes of Clinical Judgment
- Assessment: Noticing
- Analysis: Interpreting
- Planning and Implementation: Responding
- Evaluation: Reflecting
Rapid Response Teams
save lives and decrease the risk for harm by providing care before a medical emergency occurs by intervening rapidly when needed for patients who are beginning to clinically decline.
intensivist
(physician who specializes in critical care)
hospitalist
(family practice physician or internist employed by the hospital)
ethics
is “a theoretical and reflective domain of human knowledge that addresses issues and questions about morality in human choices, actions, character, and ends
Applied professional nursing ethics
is about considering what is right and wrong when using clinical judgment to make clinical decisions.
autonomy
is also referred to as self-determination or self-management.
beneficence
which promotes positive actions to help others. In other words, it encourages the nurse to do good for the patient.
Nonmaleficence
emphasizes the importance of preventing harm and ensuring the patient’s well-being.
Fidelity
refers to the agreement that nurses will keep their obligations or promises to patients to follow through with care.
Veracity
is a related principle in which the nurse is obligated to tell the truth to the best of his or her knowledge. If you are not truthful with a patient, his or her respect for you will diminish, and your credibility as a health care professional will be damaged.
Social justice
the last principle, refers to equality and fairness; that is, all patients should be treated equally and fairly, regardless of age, gender identity, sexual orientation, religion, race, ethnicity, or education.
Health care organizations (HCOs)
are purposely designed and structured systems in which health care is provided by members of nursing and interprofessional teams
public HCOs
are owned by county, state, provincial, and federal governments; they are usually nonprofit and supported by tax revenue.
Private institutions
are typically owned by companies or organizations. Many of these agencies are for-profit HCOs, but others are nonprofit or not-for-profit.
Critical Care Access Hospitals (CAHs) are specially designated HCOs that must meet the following criteria:
- Be located in a rural area at least 35 miles away from any other hospital
- Have no more than 25 inpatient beds
- Maintain an annual average patient length of stay of no more than 96 acute inpatient hours
- Offer 24-hour, 7 day–a-week emergency care
either have common stable health problems or are referred to larger hospitals once their conditions are stabilized.
An HCO is characterized by its:
- Mission and philosophy
- Organizational structure
- Workforce (health care and ancillary)
- Patients
- Services provided
Health care disparities
are differences in patient access to or availability of appropriate health care services.
Attributes of Health Care Disparities
including geographic location, cultural variables, and resources. Language barriers
LGBTQ+
A good way of rethinking concepts of sexuality and gender is to think of each as existing along a spectrum rather than categorizing people into heterosexual/homosexual and male/female.
Include questions about gender identity and sexual activity as part of your patient’s health assessment
