Enrolled Nursing Study Notes Flashcards
The Ministry of Health is?
Responsible for improving and promoting the health for all New Zealanders. MOH develops polices for health and disability sectors, provides leadership and has a regulatory role.
Name three person centred Nursing Models:
- Primary
- Individual
- Team
Planning is the process of:
Identifying nursing interventions and goals to achieve the desired outcome.
- sets goals
- establishes priorities
- determines interventions
- all purposed interventions must be written specifically and in adequate detail
How many district health boards in NZ?
20
Duty of care means the duty to provide care or to give care. True or false?
False- duty of care is a medical legal term and has a different meaning.
What are the Acts of Parliament
Where NZ Law is made applied and forced by legal government. Parliament has the power to make and unmake laws. Acts of parliament are referred to as legislation.
Nursing as a profession is
The regulation of practice both legally through legislation and ethically through a code of ethics
What are the 4 models of Nursing
Functional nursing (Task oriented) Team nursing (Person-centered) Primary nursing (Person-centered) Individual (Person-centered)
What is functional Nursing?
Task orientated - distributing tasks so all the patients needs are met
Types of nursing diagnosis
Problem focused
Risk diagnosis
Health diagnosis
Syndrome diagnosis
What does ISBAR stand for?
Introducing yourself Situation Background Assessment Recommended actions
What are the four domains of competency?
Domain 1: Profession Responsibility
Domain 2: Provision of nursing care
Domain 3: Interpersonal Relationships
Domain 4: Interprofessional health care and quality improvement
What are the four values NCNZ states that underpin professional conduct?
Respect
Trust
Integrity
Partnership
Nursing focuses on caring rather than curing. True or false?
True
Diagnosis is the process of
- Is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes.
- Helps nurses determine the plan of care for their patients
- Drive possible interventions for the patient, family, and community
- They are developed with thoughtful consideration of a patient’s physical/mental health assessment and can help measure outcomes or the patient’s care plan.
- Promotes patient safety by utilising evidence-based nursing research.
What is team nursing?
Person centred care -
Shift leader leads handover and advocates for the patients
4 components of Nursing theories
Person
Health
Nursing
Environment
What is implicit bias
An unconscious bias that refers to a Positive or Negative attitude towards race or stereotypes that influence or understanding or decisions
What is primary nursing?
Person centred care-
Everyone’s care plan goes through the primary nurse
Implementation is the process of
Putting the nursing care plan into action by using nursing actions and interventions
Tertiary care refers to
Health care for inpatients who stay in a hospital or health centre
The 4 values that underpin enrolled nurses are
Respect
Partnership
Integrity
Honesty
Components of a nursing care plan are
Nursing diagnosis (patient issues) , expected outcomes (goals), nursing interventions, rationales, evaluation
Nursing council are responsible for receiving and acting on complaints about the conduct of nurses. True or false?
True
What are the Maori principles
Mutual trust
Respect
Reciprocity
Whanaungatanga
Primary health care refers to?
GP
Dentist
‘First port of call’ directly in touch with community
Secondary care refers to
Health services provided by specialists eg outpatients
What is individual care?
Person centred care-
1-1 case load method
Evaluation is the process of
- Evaluating the results to determine whether the interventions were effective
- Evaluation allows the nurse to revise, modify, change the plan or terminate the plan.
- Evaluation occurs as problems are solved, diagnosis are revised and deleted if able from the nursing care plan
NCNZ defines nursing as:
Providing care
Providing advice
Supporting people to manage their health
NCNZ sets ongoing competence requirements and issues practicing certificates. True or false?
True
Assessment is the process of
Obtaining data about an individual
The code of rights is for the…
Consumer
What is civil law?
Disputes between individuals
Usually doesn’t involve police eg legal contracts
Document Format- what does SOAPIE stand for ?
Subjective Objective Assessment Planning Implementation Evaluation
What is the nursing process ADPIE?
Assessment Diagnosis Planning Implementation Evaluation
Nursing involves caring for
Individuals of all ages, families, groups and communities, sick, well and all settings
What is criminal law
Usually involved police and investigation eg murder
What is a high/fast heart rate called?
Tachycardia
Nursing Council and the Nursing Profession.
What are the 4 codes
Code of conduct - scope of practice
Code of ethics-NZNO
Code of Rights
Health Info Privacy Code
What are the three Acts the Nursing Council and the Nursing Profession follow?
- Health Practitioners Competence Assurance Act
- Health and disability commissioner Act
- Privacy Act
Who follows the three Acts of the Nursing Council and the Nursing Profession
Nursing Council of NZ
Health and Disability Commissioner
Privacy Commissioner
What are the roles of the NCNZ
- public safety
- Scope of practice/ domains
- Competence assessment
- Annual Practicing Certificate
- Disciplinary matters/complaints
- Education standards/School of nursing standards
- Code of conduct
- Guidelines for best practice (cultural safety/Treaty
Evidence of Safety to practice as an EN is demonstrated when…
The applicant meets the competence of all 4 domains
What should the RN take into account while making a professional judgment
- the health status of the health consumer
- the complexity of the delegated activity
- the context of care
- the level of of knowledge, skill, and experience of the person to perform the delegated activity
What does the word direction mean in nursing?
- The active process of directing, guiding, monitoring, and influencing the outcome of an individual’s practice
- Direction may be directly provided or indirectly
What is does deligation mean in nursing?
-The transfer of responsibility for the performance of an activity from one person to another with the former retaining accountability for the process and the outcome.
What is the RN responsible for?
- Assess the patients condition and workers skills
- Is delegation appropriate and safe in this context and for this patient
What does the RN must know?
- EN scope of practice and any conditions on scope
- HCA role description
- This will be different in every organisation and area
- Assess workers workload (NCNZ 2012)
What is the EN responsible for?
- Accountable for own actions or inactions
- Complete the activity
- Must not accept an activity that is beyond their capabilities or training
What should the EN inform the RN of?
- The activity is more complex than first thought
- Unsure of what to do
- There are changes in the patients condition
An EN can refuse to perform a task when
- Beyond scope of practice for EN eg IV drug administration
- Not enough direction from RN regarding task. Task is unclear
- Patient condition is unstable and unpredictable
What is the nursing process?
- Problem solving tool
- A series of planned steps that produces a particular end result
- Provides a framework for nursing care
- It is adaptable to different individuals and care settings
- A systematic approach
- It is NOT a theory
Nursing assessment consist of?
- A systematic collection of data relating to the patient
- Nursing history
- Physical assessment
- Review of the clients record/nursing literature
- Consultation with the clients support people and healthcare professionals
Assessment is done to
- Establish a baseline of information
- Determine the clients normal function
- Identify the health issue and determine the risk
- Determine clients strengths
- Provide data for the diagnosing phase
What is subjective data
- it is the persons unique perception, idea , experiences and sensations about an issue that they share with the nurse.
- what the client says
- what the family reports
What is objective data
- Consists of information that can be observed or measured directly by the nurse.
- Temperature
- Pulse
- Respiration
- Blood pressure
- Oxygen saturation
The purpose of a nursing diagnosis?
It is based on the patient’s current situation and health assessment
- Allow health providers to see the patient from a holistic perspective.
- Proper nursing diagnoses can lead to greater patient safety and care.
- Beneficial to nurses as they are to patients.
The differences between Medical and Nursing diagnosis are
- Nursing diagnosis is primarily handled through specific nursing interventions while a medical diagnosis is made by a physician or advanced healthcare practitioners
- Nursing diagnosis focuses on the patient’s overall care while medical diagnosis involves the medical aspect of a patient’s condition.
- A medical diagnosis does not change if the condition is resolved, and remains part of the patients’ health history forever.
- A nursing diagnosis generally refers to a specific period of time.
How do you set priorities
-What is the most significant problem for the patient
Ie can’t get out of bed, breathing problems, run out of night gowns
How do we implement interventions to achieve goals?
- The performance of activities that have been selected to achieve goals
- clients needs are reassessed continuously during this stage
Types of interventions
- Observations
- Prevention
- Treatments
- Health promotion
What are things we ask ourselves before we intervene
What do I delegate?
What do I do?
What is the relationship between the Te Tiriti o Waitangi/Treaty of Waitangi and health care in NZ
Partnership
Protection
Participation
Tino Rangatiratanga /self determination
Mana Taurite /Equity
What is the relationship between the treaty and health care in NZ
“Te whare tapa wha”- the four cornerstones of Maori health. It represents four dimensions of Maori well-being. If one becomes damaged, a person, or a collective may become unbalanced and subsequently unwell.
What are the 4 cornerstones
Taha wairua (the spiritual dimension) Taha whanau (family) Taha hinengaro (mind/mental health) Taha tinana (physical health)
What is the Nursing Health System
- Is overseen by the MOH
- Is complex and includes many organisations and structures
- Provides services (by individuals and organisations) that contribute to health and social care in NZ
- Largely publicly funded
What are the three types of health care providers
Primary- Community-based health services ie doctors, dentists, and pharmacists. You need to contact them for almost all of your health needs.
Secondary- Medical specialist provided care ie cardiologist and speech therapist. If you need secondary healthcare services your GP or another primary healthcare provider will refer you to a specialist
Tertiary- specialist services for inpatients (patients who stay in hospital or healthcare centre) These provide treatment for the seriously ill.
What is Nursing documentation?
The termdocumentationrefers to any written or electronically generated information that describes the care or service provided to an individual or group.
Health records include paper documents or electronic documents such as emails, audio or images (including video or digital images).
What are some forms of Nursing documentation?
- Progress notes
- Nursing, medical and allied health admission and discharge formats
- Observation charts
- Incident reports
What is effective professional communication in Nursing?
Effective teamwork among healthcare professionals is a global focus for improving quality and safety in health care.
What can happen if there isn’t effective communication?
Breakdown in communication and teamwork among healthcare professionals is a major cause of preventable patient harm
Deficient teamwork communication results in poorly coordinated and fragmented care.
What can happen if there is effective communication?
Effective teamwork not only increases healthcare quality and safety but is associated with a positive work environment, job satisfaction, and commitment
Improving teamwork has the potential to have greater effects than other measures to increase the safety and quality of health care (Barrow et al, 2015).
How do we format a handover?
- State patient’s demographics ie name, age, location
- Describe complaint or medical history ie admission, surgical date
- Describe the patient’s response to treatment
- State any tubes that the patient may have ie iv, NGT. State any drains ie IDC, wounds
What is the rationale for information obtained during handover?
- Ensures the patient is identified and the multidisciplinary team caring for the individual
- It gives a general overview of the patient
- Identifies the patient’s response to treatment to ensure the treatment is effective or ineffective, in either continuing the treatment or changing the treatment plan.
- Information regarding tubes and drains is accurate to ensure any changes in the patient are identified in a timely manner.
How are dilemmas avoided in Nursing?
Nursing relies on moral premise of caring.
Nurses have a commitment to do good.
Society’s expectation is that nurses are moral agents in their provision of care.
They have a responsibility to conduct themselves ethically in what they do and in how they interact with people receiving care, their whānau and others
What are four versions of restraint?
- Personal
- Chemical
- Environmental
- Physical
What are the definitions of restraint?
- Physical restraints are used to limit movement; examples include lap belts, hand mitts, and vests. Removing mobility aids from an individual and using bed rails are also examples of restraint. Restraining devices are used to prevent individuals from harming or from harming others; however, they pose a risk of physical and psychological harm and death.
- Personal restraint is where a nurse (or another service provider) uses their own body to intentionally limit the movement of a patient/consumer.
- Environmental restraint is when an individual is prevented from leaving an environment; for example, the use of secure units.
- Chemical restraint is whereby particular medications are administered to restrict movement, modify behaviour or cause sedation. These medications can cause adverse outcomes such as falls and reduce the quality of life for an older person.
How does EN, using the scope of practice, work on the relationship between the scope of the RN and the interprofessional health team?
- Using the information obtained from the assessment process to develop a plan of care to meet the health needs of the individual.
- Promoting independence.
- Supporting the patient.
- Assisting with activities to enhance the quality of life.
- Encourage informed choice.
Where would you find the radial artery?
Your radial pulse can be taken on either wrist. Use the tip of the index and third fingers of your other hand to feel the pulse in your radial artery between your wrist bone and the tendon on the thumb side of your wrist.
How much do you pump the cuff?
30 mml higher (no more than 40) than your estimate systolic
Define Nursing Theory
Nursing theory is a system of concepts and practices. An idea put forward towards a patients care.
Define Nursing Model
A nursing model is an idea put into action. A model can be thought of as a way of representing reality.
Stages of healing
(A)hemostasis, (B) inflammation, (C) proliferation, and (D) remodeling.
What are the antidotes for Warfarin and Heparin?
vitamin k and protamine sulfate
