Exam 1 Flashcards
Florence Nightingale (4)
- First nurse epidemiologist
- Sanitary/hygiene reform/concerned with the environment of the patient
- “Notes on Nursing: What It Is, and What It Is Not” published in 1859; established the first nursing philosophy based on health maintenance and restoration
- Nicknamed the “lady with the lamp” during the Crimean War
Clara Barton (2)
- Founded the American Red Cross
- Known as the “Angel of the Battlefield” during the American Civil War (tended to soldiers on the battlefields, providing wound care, meeting their basic needs, and comforting them in death
Mary Mahoney (4)
- First professionally trained African-American nurse
- Concerned with the effect culture had on health care
- Brought forth an awareness of cultural diversity and respect of the individual.
- First African American nurse of the American Nurses Association (ANA)
Lillian Ward (5)
- Opened the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in New York City
- Advocate for poor individuals and communities
- Helped to found the Women’s Trade Union League in 1903
- Founded the Visiting Nurse Service of New York, a nonprofit home health care agency.
- First public health nurse in the United States
Dorothea Dix (3)
- Advocate for the rights of individuals with mental illness.
- Educator and social reformer for individuals with mental illnesses
- Superintendent of nurses for the Union Army in the Civil War.
Mary Breckinridge
- Founder of the Frontier Nursing Service, to provide professional health care to underserved populations in the Appalachian Mountains
- Nurse-midwife
Mary Adelaide Nutting (3)
- First nursing professor at Columbia Teacher’s College on 1906.
2 Instrumental in transitioning nursing education into universities; helped to develop a modern nursing program - Helped found the American Journal of Nursing, first nursing journal, in 1900
Professional Identity
A sense of oneself that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting and feeling like a nurse
Tacit Knowledge
knowledge you get on the job from preceptors or role models, experimental
Four interrelated concepts of Professional Identity
Communication
Leadership
Clinical Judgement
Ethics
7 interventions to build professional identity
-Hearing expectations clearly (very important especially during emergencies)
-Value debriefing and feedback from role models
-Engage in reflection
-Understand your own responsibilities for learning and be accountable for them
-Build relationships with those around you
-Develop personal self care habits
-Embrace any opportunity or experiences with patients
6 Qualities of a professional identity
Integrity
Humility
Compassion
Human Flourishing
Advocate
Self-efficacy
4 things nursing is
- art
- science
- ever-evolving profession
- professional set of standards of practice`
How is Nursing an art and a science?
Nursing is an art because it takes all the skills, knowledge and attitudes you will learn to deliver care artfully with compassion, caring and respect for each person’s dignity and respect.
Nursing is a science because it is based on evidence practice
5 things that make nursing a profession versus a job
- Specialized skill set and body of knowledge
- Unique role that includes accountability, autonomy
- Dedication to the profession (pride)
- Contract with the communities we serve that include compassion and caring
- Compliance with legal, ethical and practice standards
What does ANA set and who does it protect?
Standards of professional nursing practice and protects nurses
7 pieces of Code of Ethics
- respect for others
- commitment and advocacy for the patient
- accountability
- responsibility for practice (duty to self and duty to others)
- contributions to healthcare environments
-advancement of the nursing profession - promotion of community, world health, and nursing profession.
7 Roles of Nurses
Autonomy
Accountability
Caregiver
Advocate
Educator
Communicator
Manager
Autonomy (of nurse)
you can do it!! An essential element of the professional identity of a nurse is that they are able to perform independent nursing interventions (things nurses do to help a patient) without a medical order.
Accountability
you are responsible professionally and legally for the type and quality of nursing care provided. You must remain current and competent in nursing and scientific knowledge and technical skills.
Caregiver
help patients and families maintain and regain health, manage diseases and symptoms, and attain max functioning and healing.
You help patients set realistic goals and meet them.
Advocate
you protect your patient’s human and legal rights and provide assistance is asserting these rights. We are the voice of the patient many times when they can’t speak or don’t know what to ask.
Educator
Nurses teach patients and families. We explain disease processes, teach about medications, skills, reinforce learning , evaluate their learning process. Some are formal and planned and some are informal and unplanned.
Communicator
essential to the nurse-patient relationship (know patient’s personality) and your relationship with everyone else you will work with . You will communicate with other nurses, patients, families, and other healthcare professionals
Manager
coordinates the activities of members of their group. As a nurse you will use appropriate leadership styles to talk to patients and other staff in order to coordinate safe, effective care for your patients.
What are the 6 ANA Standards of Nursing Practice?
- Assessment
- Diagnosis
- Outcomes Identification
- Planning
- Implementation (care coordination and health promotion/teaching)
- Evaluation
What differentiates APRN and RN?
- APRN have higher clinical knowledge and skills
Medical assistant (schooling and role)
- unlicensed personnel, nursing assistant, aide
- 3-6 months of education in hospital, technical college or community college
- VS, bathe, change linens, serve meals, weigh patient, get VS, I and O, etc
LPN/LVN (schooling, role, difference from RN)
-usually 12 months of education at a community college.
-Do treatments (lung care, feeding), skills, direct patient care. IV and meds (different for different states).
-No initial assessments during the day, no admit and discharge, no initial teaching; under RN
Registered Nurse (schooling, role, difference in levels)
-Associate degree or Bachelors Degree,2-4 years of education.
-All Assessment, Admission and Discharge, IV, skills, Community Focus, Teaching;
-BSN has more health assessment skills, community focus, and leadership
APRN vs graduate (similiarities and differences)
6-8 years of total education, can be masters or doctorly prepared. Differing degrees and tracks.
APRN–Practice Focused. Advanced clinical knowledge and skills.
PhD/graduate– not practice focused, research, teaching, etc.
6 Careers for nurses
- Staff RN
- Advanced practice Registered nurses (APRN) (includes CNS, NP, CNW, CRNA, RNFA)
- Nurse Administrator
- Nurse Researcher (PHD)
- nurse educator
-nurse informaticist
TNA
State board of nursing, Each state has a board of nursing, they are concerned for the public’s safety. They regulate nurse practice acts and licensing
Nurse Practice Acts
Every state has one and it says what a nurse can and can’t do that is different from the accepted national standard of practice for a nurse.
Five levels of Nursing Proficiency
Novice
Advanced beginner
Competent
Proficient
Expert
Why is a lack of nursing self-care important?
It can lead to
-Compassion fatigue causing lateral violence
-burnout
-secondary traumatic stress
Licensure vs. Certification
Licensure- nurses must be licensed in the state they practice in; TNA deals with licensure
Certification- Once you graduate from school, sit for boards and become a registered nurse you can start studying for a certification….usually need so many hours working in that area (EX: CCRN); ANCC deals with certification and this says you are an expert in that area
Continuing vs in-service education
Continuing- Some states require nurses to have Continuing education units (CEUs) in order to renew your license or keep your job (EX: topics such as wound care, diseases, medications, etc.)
In-Service- where you take a module or course, take a test, pay a fee and you get a card…some in-service counts as continuing education (EX: BLS certification, training on new hospital equipment)
What is QSEN and what do they believe?
- Quality and Safety Education for Nurses initiative
- collaboration will have positive impact on patient outcomes and improve quality of care
6 Quality and Safety Education for Nurses (QSEN) competencies
-patient centered care
-evidence-based practice
-safety
-teamwork/collaboration
-quality improvement
-informatics
The examination for RN licensure is the same in every state in the United States. This examination:
- Guarantees safe nursing care for all patients
- Ensures standard nursing care for all patients
- Provides the minimal standard of knowledge for an RN in practice
- Guarantees standardized education across all prelicensure programs”
3
Contemporary nursing requires that the nurse have knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples of these roles and responsibilities? (Select all that apply.)
- Caregiver
- Autonomy
- Patient advocate
- Health promotion
- Genetic counselor
1, 2, 3, 4
Health care reform will bring changes in the emphasis of care. Which of these models is expected from health care reform?
- Moving from an acute illness to a health promotion, illness prevention model
- Moving from an illness prevention to a health promotion model
- Moving from hospital-based to community-based care
- Moving from an acute illness to a disease management model
1
The nurse manager meets with the registered nursing staff about an increase in urinary tract infections in patients with a Foley catheter. The staff work together to review the literature on catheter-associated urinary tract infections (CAUTIs), identifies at-risk patients, and establishes new catheter care practices. This is an example of which QSEN competency?
- Patient-centered care
- Safety
- Teamwork and collaboration
- Quality improvement
4
TNA vs ANA
TNA (aka “The State Board”) - concerned about public safety; reprimand you if you do wrong and can take your license
ANA- concerned about nurse safety and advocacy; set professional standards and practice
NLN
National League of Nursing
nursing education and simulation
NSNA
National Student Nurses Association
- interested in your rights as a student
Healthy People 2030 4 goals
- eliminate health disparities
- achieve health equity
- attain health literacy
- improve nation’s health and wellbeing
What is ethics? What does it reflect?
the study or examination of morality through a variety of different approaches.
How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person who you are and, ultimately, the professional who you will become.
Emotional Intelligence
ability to keep composure while experiencing emotions
Professional ethics (3)
Ethical standards and expectations of a particular profession
Held to a higher standard because of privileged role in society (what you say holds value)
Code of conduct
Three virtues of health professional ethics
Courage
Compassion
Commitment
Failure to act or respond in an ethically appropriate way has been linked to: (3)
Serious and potentially dangerous errors
Personal stress
Professional burnout
Basic Terms in Health Ethics
- Autonomy
- Beneficence
- Fidelity
- Justice
- nonmaleficence
Autonomy in Ethics
-commitment to include patients in decisions about all aspects of their key. It is a key feature of patient-centered care
-freedom from external control, must respect patient independence
Ex. informed consent, patient education, patient advocacy, right to refuse medication
Beneficence
Nurses practice in the best interest of helping others. The agreement to act with beneficence implies that the best interests of the patient remain more important than self interest. It implies that nurse practice primarily as a service to others, even in the details of daily work.
-patient interest> self-interest
Nonmaleficence
Maleficence means to harm or hurt, so nonmaleficence refers to the avoidance of harm or hurt. In nursing practice, we vow to do no harm to the patient.
-balance risks and benefits
Justice
fairness
ANA code of ethics describes (3)
-Nurse’s obligation to the patient
-role of nurse in healthcare team
-duties of nurse to profession and society
Fidelity
faithfulness, agreement to keep promises. Follow through on your promises and actions.
-loyalty
Just Culture
the promotion of open discussion without fear of recrimination whenever mistakes, especially those involving adverse events, occur or nearly occur
-find a balance between the need to learn from mistakes and the need for disciplinary action against employees
5 ANA code of ethics
-Advocacy
-Responsibility
-Accountability
-Confidentiality
-Social Networking
Advocacy
to support of a particular cause. Standing up for the health, safety and patient rights of others is an example.
Responsibility
the respect of one’s professional obligations and to follow through. Every agency that you we will go into in clinical has policies and procedures. Responsibility means that when you are in that agency you follow those policies and procedures. You agree to remain competent.
Accountability
means the ability to answer for one’s own actions. You need to make sure that your actions are explainable to your patients and your employer and everyone else involved who needs to know.
The Joint Commission
establishes national safety standards for hospitals
Confidentiality
health care team’s obligation to respect patient’s privacy from outside sources
- HIPAA( Health Insurance Portablity and Accountability Act of 1996) mandates confidentiality and protections of patient’s personal health information
Social Networking
cannot post anything inappropriate online
Tort
a civil wrongful act or omission made against a person or property.
Assault
an intentional tort. Assault is the intentional threat toward another person that places the person in reasonable fear of harmful, imminent or unwelcome contact
Battery
any intentional offensive touching without consent or lawful justification.
Malpractice is a…, what are the criteria of nursing malpractice (3)
type of negligence and is often referred to as professional negligence.
Criteria
1. Nurse had duty to care for patient
2. nurse breached duty”.
3. patient harmed as result of breach and the nurse did nothing about it.
Negligence
conduct that falls below the generally accepted standard of care of a reasonably prudent person.
-unintentional tort
False imprisonment
refers to unjustified restraint of a person;
-intentional tort
Invasion of privacy
-quasi-intentional tort
-protects a patient from the unlawful intrusion into into his or her affairs. HIPAA is meant to protect this
scope of ethics
Societal
organizational
bioethics/clinical
professional
personal
Culture
pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values that can occur among those who speak a particular language or live in a defined geographic region.
Culture impacts:
all aspects of life to include interpersonal relationships, family dynamics and childrearing practices.
Four aspects of healthcare dependent on culture
-causal beliefs about health
-illness expression
-symptoms of illness
-taboos
Causal beliefs about health
Disease vs illness (disease is pathophysiology while illness perception is based on culture)
-some people may attribute to higher power, karma , medical conditions
Illness expression
-culture dependent (differences in pain verbalization)
Taboos
prohibited, forbidden action or behavior based on moral or religious cultural beliefs
Ex. STIs, mental illness, behavior disorders in children
Three attributes of culture
Culture is learned
Culture is constantly changing and adapting
Shared beliefs, values, and behaviors (language, rituals, customs, diet, dress)
Enculturation
process by which a person learns the norms, values, behaviors of a culture
Acculturation
process of acquiring new attitudes and values after contact with another culture
Assimilation
process of giving up and identity and absorbing identity of dominant group
-biculturalism is having both
Power Distance
acceptance of an unequal distribution of power as legitimate or fair vs illegitimate from the point of view of the less powerful.
Some cultures there is a more equal distribution of power and people have the expectation that their opinions will be heard and equally values.
Long term vs short term orientation
refers to the degree to which a culture is oriented to the futures and long-term rewards versus the degree to which a culture is oriented to the past or present.
-short term oriented is past oriented and favor tradition and social obligations
Individualism vs collectivism
the value of the culture on the degree of closeness and structure of social relationships, and on whether loyalties belong to immediate families or to the extended family. (independent vs interdependent)
Western Europe and the United States are considered individualistic whereas collectivism is seen is Asian countries and minority cultures in the United States (Latino/Hispanic)
Masculinity vs femininity
describes how gender roles are conceived and how greatly male and female roles differ.
Some societies place greater value on masculine attributes such as achievement, material success, and recognition verses more feminine attributes such as harmonious relationships, modesty and caretaker.
Religiosity
refers to how much religion permeates one’s day to day existence and to what degree religious practices can be separated from nonreligious practices.
Religion
-a personal set or institutionalized system of worship attitudes, beliefs, and practices
Culturally competent care means
conveying acceptance of the patient’s health beliefs while
1. sharing medical information
2. encouraging self-efficacy
3. strengthening the patient’s coping resources
RESPECT model of cultural competence development
Respect
Explanatory model of patient’s - and respect their decision
Sociocultural context
Power
Empathy
Concerns and fears around illness
Trust
Unconscious bias
bias we are unaware of and that happens outside of our control which is influenced by our personal background, cultural environment, and experiences
Purpose of Cultural Assessment (3)
helps nurses gain an understanding of the meaning of the illness to the patient, expectations the patient has regarding treatment and care, and the patient’s perception about the process.
4 Cultural Aspects to explore in patient assessment
Origin and family (birth place, cultural identities, parenting styles, family roles)
Communication (Language, respect, eye contact, space touch)
Personal beliefs on health/illness (meaning, locus of control, perception, treatment expectations, taboos)
Daily practices ( diet, spirtuality, religion, special rituals)
Relation between culture and health disparities
Some cultures are adversely affected groups of people are who systematically experience greater obstacles to health based on their racial, ethnic, or cultural group, religion, socioeconomic status, gender, age, etc.
Relation between family dynamics and culture
-goes hand-in-hand
-Family dynamics in many ways including the manner in which sick family members receive care, beliefs about sharing information with outsiders about a family member’s illness, gender roles, and beliefs about appropriate child rearing practices.
Relation between Spirituality and Culture
goes hand-in-hand
spirituality, which varies according to how much spirituality permeates one’s day to day existence, and the importance placed on spiritual practices.
Relation between communication and culture
Communication patterns, both verbal and nonverbal, are determined by cultural norms. Degree of personal space, eye contact and acceptability of touch all vary by cultures.
Stress and coping involves dealing with life’s difficulties and are largely culturally determined
Relation between culture and mood and affect
Mood and affect has a strong interrelationship to culture. Depression is the leading cause of non fatal disease burden and years of life lived with disability worldwide. The meaning and expression of fatigue is influenced by one’s culture.
Teach-back method
used to confirm that you have explained what patient needs to know in a manner they’ll understand
Which statements made by a nursing student about the teach-back technique show understanding of the technique? (Select all that apply.)
- “After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient’s ability to use the inhaler correctly.”
- “The teach-back technique is an ongoing process of asking patients for feedback.”
- “Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand.”
- “Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique.”
- “When doing my patient teaching, I will use plain language to make the material easier to understand for the patient.”
1,2,3,4,5
A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman’s health? (Select all that apply.)
- Medicaid insurance
- Annual screening
- Mother’s history of breast cancer
- Lack of transportation
- Woman’s age
1,4,5
Ethnicity
A category of people who identify with each other based on common ancestral, social, cultural, or national experiences. Ethnicity is primarily an inherited status.
-common ancestry that leads to shared values and beliefs
Race
a family, tribe, people, or nation. People groups who share certain distinctive physical traits
-not biologic
Sexual orientation
a person’s sexual identity in relation to the gender to which they are attracted, and gender identity
-respect pronouns
Spirituality
factors relating to or demonstrating one’s belief or devotion to God, a higher being, or one’s spirit or soul as an entity separate from their physical body.
The very first step in becoming culturally competent and providing culturally congruent care is ______.
cultural awareness and acknowledging your own biases
Health Disparity
inequality or difference between the health status of a disadvantaged group such as people with low incomes and wealth and an advantaged group such as people with high incomes and wealth. Members of the disadvantaged group bear a burden of disease, injury, and violence that is out of proportion to the size of the group
-closely linked with social, economic, or environmental difference
Blue phone in hospital means?
It is for interpreter
Social determinants of Health
SDOH are the conditions in which people are born, grow, live, work, and age. This includes conditions within a health care system.
10 factors of SDOH
-age
-race/ethnicity
-socioeconomic status
-access to nutritious food
-transportation resources
-religion
-sexual orientation
-level of education. literacy level
-disability (physical and cognitive)
- geographical location (e.g., access to health care).
Stereotyping
The process by which people acquire and recall information about others based on race, sex, religion, etc., leads to prejudice; what you say or think
Prejudice
Unjustified negative attitude based on a person’s group membership;
Discrimination
When a person acts on prejudice and denies another person one or more of their fundamental rights (food, sleep, healthcare, happiness)
Transcultural Nursing Theory
-written by Madeline Leininger
-Goal is to provide culturally congruent care (care that fits a person’s life patterns, values and system of meaning)
- Goal was not to teach nurses about groups of people but rather to ask people about their culture and then treat them accordingly
5 steps to develop cultural competence
1) Cultural awareness
2) Cultural desire
3) Cultural encounters
4) Cultural knowledge
5) Cultural skills
Cultural desire
The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities.
-involves caring and willingness to learn
-accept differences and build on similarities
LEARN Model for cultural desire
Listen (nonjudgementally)
Explain (your view)
Acknowledge( their view and similarities and differences
Recommend (include patient)
Negotiate (note treatment benefits with cultural lens)
Cultural awareness
An in-depth self-examination of one’s own background, recognizing biases, prejudices, and assumptions about other people
Cultural Encounter
Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication
Cultural knowledge
-Sufficient comparative knowledge of diverse groups
-exposing oneself to other cultures and being motivated to learn rather than simply learning facts on every culture (patient storytelling is useful tool)
Cultural Skills
Ability to assess social, cultural, and biophysical factors that influence patient treatment and care, use RESPECT model
-includes culturally based assessment and education
Safety
freedom from accidental injuries;
involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur
Safe Care is:
avoiding injuries to patients from the care that is intended to help them, involve[s] making evidence-based clinical decisions to maximize the health outcomes of an individual to minimize the potential for harm
Information available to patients and families for transparency
System’s performance on safety
Evidence-based practice
Patient satisfaction
6 components of Crew Resource Management
Six critical components:
Situational awareness
Problem identification
Decision making by generating alternative acceptable solutions
Appropriate workload distribution
Time management
Conflict resolution
What is CRM?
Crew resource management
-training developed in aviation with focus on standardizing procedures and communication to ↑ efficiency and ↓ errors; emphasis on human role in high- stress work
5 characteristics of a High Reliability Organization
-Sensitivity to operations (situational awareness)
-Focused on predicting and preventing rather than reacting to errors
-Reluctance to simplify
-Deference to expertise vs. hierarchy
-Commitment to reliance (contain error and return to work)
4 Human factors which play into safety
-individual performance (ability to perform tasks)
-multitasking
-distraction
-complacency
Reason’s Swiss Cheese Modelof Accident Causation
The model shows how errors occur when situational factors align, despite multiple layers of safeguards for the prevention of errors.
Holes are latent and active errors
___________________: did not provide care correctly
Commission
________: did not provide care
ommission
Adverse event and examples
Unintended harm by an act of commission or omission rather than as a result of underlying disease process or condition
Ex. post-operative infection, hospital acquired conditions (CAUTI, CLABSI), prolonged hospitalization that does not result in permanent harm or death
Near miss
Error of commission or omission that could have harmed a patient, but harm did not occur as a result of chance, prevention , or mitigation
Prevention vs mitigation in near miss
Prevention: error identified before reaching patient
Mitigation: error reached patient but intervention reduced consequences
Sentinel event
unexpected occurrence involving death or serious physical or psychological injury or risk there of
-loss of limb or function
What do sentinel events signal?
the need for immediate investigation and
response.
4 Categories of errors
Diagnostic
Treatment
Preventive
Communication
Communication error
lack of communication, lack of clarity, or breakdown in communication
Diagnostic error
due to delay in diagnosis, failure to order indicated tests, failure to respond to the results of findings of monitoring or testing.
Treatment error
results from performing an operation, procedure, or test; administering a treatment; medication errors; or an avoidable delay in treatment or response to abnormal finding.
Preventive error
failure to provide prophylactic treatment and inadequate monitoring or follow-up of treatment
What does placement of errors help us understand?
Cause or etiology of healthcare errors and improvements
Active Errors
Errors made by those who are providing care, responding to patient needs at the point of care ( unsafe behaviors )
-sharp end
Latent errors
hidden or inactive contributing factors in health care; organizational, contextual, or design-related errors ( procedural, systemic, policy)
-blunt end
Latent failure
occurs when there is a defect in a system that does not immediately lead to an accident but creates a situation in which a triggering event may lead to an error
Culture of safety
shift from identifying fault to establish blame to acknowledging and reporting errors and near misses to improve system
Three attributes of safety
knowledge
skills
attitudes (shared responsibility)
4 interrelated concepts of safety
health care quality
communication
collaboration
care coordination
Health care quality
defined as “defined as identifying the gap that occurs between ideal care and actual care delivered”
3 benefits of standardized communication
i. Ensure safe handoff between providers or between settings
ii. Provides clear direction in seeking and sharing information among health care providers
iii. Facilitate collaborative behaviors for advocating to prevent errors from occurring.
3 challenges to patient safety
i. ineffective communication
ii. Hierarchy - not valuing what everyone brings to the table
iii. destructive behavior
4 safety-enhancing technologies
- Barcodes
- CPOE
- Medication pumps
- automatic alerts and alarms
Four skills for safety
Effective use of technology
Standardized practices
Effectively use strategies to reduce risk of harm to self or others
Effective communication ( #1 cause of unintentional patient harm)
Two factors that create a culture of safety
- open communication amongst healthcare team
- Organizational error-reporting systems
RCA
root cause analysis
-process of identifying the cause and allocation of responsibility and accountability
Nurse’s role in safe medication administration (6 parts)
-Follow 7 rights of drug administration
-Assess patient’s ability to self-administer medications
-Monitor side effects
-Do not delegate any part of the medication administration process to nursing assistive personnel (NAP)
-Educate patient and families about medications
-implement nursing process to integrate medication therapy into patient care
Medication error
any preventable event that may cause inappropriate medication use or jeopardize patient safety
• report all that reach patient including near misses error
Medication error reporting process
- Assess the patient’s condition ( safety 1st ! )
- Notify the HCP of the incident immediately
- Report the incident to the nurse manager, supervisor, or charge nurse
- Complete an incident or occurrence report (Do not include any reference to an incident in the medical record (due to legality))
Medication reconciliation
healthcare team compare medication that patient is currently taking with what patient should be taking and any newly ordered medications
Process of Medication reconciliation
- Identify and resolve orders that are duplicated and omitted
- Evaluate risk for unintended medication interactions
- Create and maintain an accurate and current list of all patient medications
Three technologies for medication safety
-Unit doses (single dose packages)
-Automated medication dispensing systems (AMDs)
-Bar-code medication administration (BCMA) system
4 Steps to prevent medication errors
Follow the seven rights of medication administration
Prepare medication for only one patient at a time
Use at least two patient identifiers
Review the patient’s allergies
3 Factors contributing to medication errors:
Technology work arounds
Design of medication labels
Medication distribution systems
7 rights of medication administration
Right medication
Right dose
Right patient
Right route
Right time
Right documentation
Right indication/reason
6 patient rights
- to be informed about their care
- to make decisions about their care
- to refuse care
- to be listened to by their caregivers
- to receive info in a way that meets their individual needs
- to be informed of errors; transparency
When are side rails not a restraint? (3)
- when they ↑ patient mobility and stability when moving into or out of bed
- if patient can freely exit the bed and move in it
- to prevent sedated patient from falling out
Most common restraint
side rails
When is a medication order required?
for every medications that the nurse will administer to a patient
How many times to compare medication label to MAR?
3
When to administer “on call” medication?
when the operating room staff members notify you that they are coming to get a patient for surgery.
When to administer STAT? now?
Administer STAT immendiately; now within 90 minutes
When to administer time critical medications?
within 30 minutes before or after the scheduled time
When to administer antibiotics
30 minutes before or after they are scheduled to maintain therapeutic blood levels.
When to administer routinely ordered non time-critical medications?
1 to 2 hours before or after the scheduled time or per agency policy.
5 things that should be on medication order
Drug name
Dose strength
Route
Frequency
If PRN—Indication for use
What counts as a restraint?
any chemical (drugs not to treat patient’s condition), manual method, physical, mechanical device, or material or equipment that immobilizes or reduces the ability of a patient to move freely unless to prevent harm during activity
-THEY ARE TEMPORARY
How often to monitor patient in restraints?
Every 15 minutes for violent behavior
Every 2 hours for nonviolent behavior
When can restraint be used? (4)
Reduce the risk of patient injury from falls
Prevent interruption of medical therapy such as traction, IV infusions, nasogastric (NG) tube feeding, or Foley catheterization
Prevent patients who are confused, disoriented, combative from removing life-support equipment
Reduce the risk of injury to others by the patient
What needs to happen for safe restraint use? (4)
-face-to-face physician order within 24 hrs (60 minutes if violent)
- use all alternatives before restraint —-NO PRN
-use least restrictive alternative
-select alternative based on patient situation
Restraints may lead to: (8)
-pressure injuries
-pneumonia
-constipation
-incontinence
-loss of self-esteem
-humiliation
-agitation
-death (restricted breathing and circulation
10 things to monitor while patient in restraints
-Vital signs
-Skin integrity
-Nutrition
-Hydration- offer water
-Extremity circulation (2 fingers)
-Range of motion (ensure call light placement in reach)
-Hygiene
-Elimination needs
-Cognitive functioning and Psychological status
-Need for restraint
2022 National Patient Safety Goals set by TJC: (6)
-Identify patient correctly
-Improve staff communication
-Use medicines safely
-Prevent infection
-Identify patient safety risks
-Prevent mistakes in surgery
8 Alternatives to restraints
-de-escalation
-trained sitter (companionship and supervision)
-Move patient closer to nurse’s station
-Distraction
-Frequent observations and attention to needs
-Bed alarms/chair alarms (no slip socks, low bed)
-Family involvement
-discontinue bothersome treatment ASAP
9 risk factors for falls
-History of falling
-Being 65 and over
-Reduced vision
-Orthostatic hypotension
-Lower extremity weakness
-Unsteady gait
-Urinary Incontinence
-Improper use of walking aids
-Effects of various medications
11 pieces for fall prevention
- Fall risk assessment (conducting routinely per agency policy)
- Hourly/purposeful rounding
- Identify fall risks (Apply yellow color-coded wristbands to identify fall risks; Fall risk wheel on door)
- Adaptation of the environment (Remove excess furniture and equipment; Safety bars near toilets)
- Reduce the number of psychoactive medications
- Attention to postural hypotension
- Established elimination/toileting schedules
- Call lights within reach
- Bed safety alarms or motion detectors
- Use of assistive devices (walkers, canes, wheelchairs (brake locks), )
10 Management of foot problems and footwear (rubber-soled shoes or slippers) - Assign Physical therapy for balance, strength, gait
Prevention of falls from orthostatic/postural hypotension
- Place bed in the lowest position
- Practice of dangling the patient for 5 minutes on the side of
the bed before ambulating.
