Exam 1 Flashcards
1
Q
Florence Nightingale
A
concern for environment of the patient, including cleanliness, ventilation, temperature, light, diet and noise
2
Q
Faye abdullah
A
21-nursing care problems identified were based on research and can be used to determine patient needs and formulate nursing-focused care
3
Q
Wiedenbach
A
clinical nursing includes a philoscophy, a purpose, the practice, and the art. care is directed toward a specific purpose to meet the patient’s perceived health care needs
4
Q
Lydia Hall
A
the major outcome of nursing care is rehabilitation and feelings of self-actualization by the patient
5
Q
Jean Watson
A
clinical nursing care is holistic to promote humanism, health and quality of living. caring is universal and is practiced through interpersonal relationships
6
Q
Benner and Wrubel
A
a systematic description of stages of nursing practice: novice, advanced beginner, competent, proficient and expert
7
Q
Health Belief Model
A
- What people perceive or believe to be true about themselves in relation to their health.
- Current research supports that “self-efficacy” should be added as Health Belief Model
- explains why ppl do not use free healthcare services
8
Q
Health Promotion Model
A
Developed to illustrate how people interact with their environment as they pursue health
9
Q
Health-Illness Continuum
A
Views health as a constantly changing state with high-level wellness and death at opposite ends of a graduated scale or continuum
10
Q
Agent-Host environment Model
A
Views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person. Explains how certain factors place some people at risk for an infectious disease.
11
Q
Stages of Change Model
A
Precontemplation, Contemplation, Determination (commitment to action), Action (implementing the plan) and Maintenance, Relapse, and Recycling. Each time a person goes through the cycle, he or she learns from each relapse; referred to as the Upward Spiral
12
Q
Swanson
A
identifies five caring processes and defines caring as “a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.”
13
Q
QSEN competencies (6)
A
- patient-centered care
- teamwork and collaboration
- use of EBP
- quality improvement
- culture of safety
- informatics
14
Q
what is Health ?
A
= the state of optimal functioning or well-being
physical, social, and mental
subjective to the patient
influenced by a patient’s “health literacy”
motivated by the desire to increase a person’s well-being and potential
15
Q
how do nurse’s promote health?
A
identifying, analyzing, and maximizing each patient’s individual strengths
16
Q
what is the importance of understanding nursing practice acts and licensure?
A
nurses must have a license from that state to practice
many states have a CE requirement to renew a license.
the license can be suspended or revoked for not complying with the requirements
licenses can be revoked for professional misconduct, incompetence, negligence, chemical impairment, or criminal acts
roles continue to expand and be revised; nurses must stay up to date on specific changes in their state of practice
nurse Practice acts define a scope of practice for nurses in each state
17
Q
current trends in nursing and health care
A
- nursing shortages
- job opportunities are expanding outside the hospital
- technological advancement
- nurses collaborate more with other providers
- increased number of “healthcare homeless”
- policy and regulation impact
- shift to population-based
- increasing complexity of healthcare
18
Q
Nursing fatigue (3)
A
Compassion Fatigue = loss of satisfaction with care
Burnout = state of frustration with work environment that develops over time
Secondary Traumatic Stress = feelings of despair caused by transfer of emotional distress from victim to caregiver; often develops suddenly
19
Q
what is important for education to patients
A
- health promotion
- protection of patient rights (ex. informed consent)
- medication education (ex. Teach-back method)
- wound care
- identify risks (ex. fall, infection)
- home-care instructions
20
Q
describe the steps in implementing EBP
A
- cultivate a spirit of inquiry
- ask a burning question
- search for best evidence to answer the PICO
- clinical appraisal
- enough evidence: integrate into practice
21
Q
what is wellness
A
active state of being health and living a healthy lifestyle, mind, body and emotionally healthy
22
Q
what are the 4 illness behaviors?
A
- experiencing symptoms
- assuming the sick role
- assuming the dependent role
- achieving recovery and rehabilitation
23
Q
how to people measure health? how do people define health?
A
- how they feel
- absence or presence of symptoms
- their ability to carry out ADLs
- values and beliefs
- family, culture, community
- personal perception
24
Q
what are the 6 dimensions that can affect a person’s health-illness status
A
- physical dimension
- emotional dimension
- intellectual dimension
- environmental dimension
- sociocultural dimension
- spiritual dimension
25
In Maslow's hierarchy of needs, a basic need will:
- cause illness when it is unfulfilled
- fulfillment prevents disease or signals health
- meeting needs restores health
- needs are priority over desires
- when someone feels like something is missing, a need is unmet
- when someone feels satisfaction then needs are met
26
what do research and EBP outcomes do?
- quality improvement
- develop clinical reasoning
- identify when more research needs to be done
27
what are the 5 family functions?
1. physical support
2. financial/ economic support
3. reproduction
4. socialization
5. emotional support/ coping
28
Describe the 1st (most basic) Need on Maslow's triangle and how a nurse cares for this need.
physiological needs: air, water, food, shelter, sleep, clothing, reproduction, temperature
- ABCs, oxygen therapy, CPR, vitals, I/Os, elimination
29
Describe the 2st Need on Maslow's triangle and how a nurse cares for this need.
```
Safety Needs: personal security, employment, resources, health, property.
- safe movement and ambulation
- hand hygiene
- proper use of equipment
- proper medication administration
Emotional safety and security:
- patient education
- establishing trust
- allowing independence and decision making
- explaining procedures
- encourage spiritual practices
```
30
Describe the 3rd Need on Maslow's triangle and how a nurse cares for this need.
Love and Belonging: friendship, intimate family, sense of connection
- include family and friends in the care plan
- establish a nurse-patient relationship on mutual trust
- referrals to support groups
31
Describe the 4th Need on Maslow's triangle and how a nurse cares for this need.
Self-esteem: respect, self-esteem, status, recognition, strength, freedom
- respect patient's values and beliefs
- setting attainable goals
- facilitating family support
32
Describe the 5th Need on Maslow's triangle and how a nurse cares for this need.
Self-Actualization: desire to become the most one can be; maximizing potential
- focus on personal strengths and possibilities rather than problems
- provide direction and hope, teaching is aimed for maximizing potential
33
what are the 5 risk factors for decline of family health?
1. lifestyle -- inadequate dental care, altered nutrition, drug or alcohol dependence
2. psychosocial -- inadequate income for food or housing, poor childcare, emotional turmoil in home
3. environmental -- air, water, food pollution
4. developmental -- unmarried adolescent mothers lacking education, older people living on a fixed income
5. biologic -- birth defects, mental retardation, genetic predisposition to certain illness
34
what are some self-actualization behaviors?
- acceptance of self and others
- focus is on problems outside of self
- happiness and acceptance of others
- respect for all people
- can discriminate between good and evil
- creativity, problem-solving, interest pursuits
35
what is community based nursing?
= focused on the health of individuals and families
36
what is community health nursing?
= focused on the health of the whole population within a community
37
factors that affect community health?
- housing codes
- police/fire presence
- employment opportunities
- recreational activities
- violent crime/drug use
- food sanitation
38
what is a Prospective payment system (PPS)
hospitals providing care for patients on Medicare are no longer charged based on services provided. a standard payment is given based on grouping.
39
what are the 5 characteristics of High Reliable Organizations? what is their goal?
goal = care for the right patient, at the right time, consistent with EBP, and must be translated and given to the front-line staff
1. preoccupation with failure
2. reluctance to simplify
3. sensitivity to operations
4. deference to expertise
5. commitment to resilience
40
what are the current strategies National organizations use to increase access to services?
- establish a national focus
- mandate nationally reporting of errors to learn
- oversight organizations raise performance standards and expectations
- safety systems are implemented
41
what is the cornerstone of high reliabilty?
Standardization
42
what is the purpose of the Institute of Medicine (IOM)?
- oversees and give recommendations for safety and quality in the delivery of patient care
- raise performance standards
- implement safety measure in health care facilities
- focus on quality and safety that makes it less likely that patients will suffer unnecessary or harmful treatment
- save money on costs
43
What are the 8 clinical processes that the Reliable care Accountability Matrix to define expectations for standard practice?
1. mortality
2. readmissions
3. LOS
4. HCAHPS
5. prevention of Cdiff
6. surgical site infections
7. CAUTIs
8. hand hygiene
44
what are some changes in care delivery? what is changing in care delivery to improve quality, readmissions, costs, fraud, health
- quality improvement tools (Lean Six Sigma, PDSA) to reduce waste and improve safety
- link interventions to valued outcomes
- all vital information needs to be provided through care coordination when a patient is transferred
- ICD-10 coding for billing, diagnosis, and classification
- improved measures for reducing fraud and abuse
- focus on target populations for long-term effect on disease prevalence and reduce health spending
45
Explain billing in Hospitals
until recently hospital billing was fee-for-service from solo or small group practices. these financial incentives reward doing more care, not necessarily better care. hospitals are mostly not-for-profit
46
Explain billing in multispecialty group practices
providers from different specialties unite to share income, expenses, facilities, equipment and staff. usually provide better, more comprehensive care (ex. Mayo clinic)
47
Explain billing in Community Health Centers
regionalized services for vulnerable geographic populations with an emphasis on primary care and education. access is given regardless of ability to pay. Relies heavily on nurses for primary care.
48
Explain billing in Health Maintenance organizations (HMOs)
A Prepaid Group Practice:
- subscribers receive medical services through group affiliated providers.
- may have copay
- patient does not have a choice on provider
- may be associated with Medicare
- Goal: use primary care to reduce cost and prevent illness
49
Explain billing in Preferred Provider Organizations (PPOs)
A Prepaid Group Practice:
- allows a 3rd-party payer to contract with a group of providers to give services at a lower cost in return for prompt payment and a guaranteed volume of patients and services.
- pay can use providers not in network
50
Explain billing in accountable Care Organizations (ACOs)
- made up of hospitals, primary care, and specialty care
- deliver the most efficient and high-quality care
- one bill is generated
- providers share in savings so it incentivizes them to provide integrated, well-coordinated care
51
Explain billing in Medical Homes to Medical Neighborhoods
Medical Neighborhood are still highly fragmented and lack resources and coordination to be successful.
- model of primary care that provides whole, ongoing, comprehensive care
52
what are the characteristics of coordinated care?
- patient and family involvement
- organization of patient care activities
- marshaling of personal and other resources needed to carry out all patient care activities
- nurses are often responsible for it
- nursing interventions must take into consideration how care goals will be met across multiple fronts
53
what is the MAIN aim of coordinated care?
```
patients get
the right care
at the right time
in the most efficient and cost-effective manner
by the right person
in the right setting
```
54
What are Diagnostic-Related Groups (DRGs)?
PPSs group hospital services into DRGs. reimbursement is a fixed price based on the illness severity, care provided, regional costs, and educational costs
55
what is Capitation?
providers receive a fixed payment per patient.
| Goal = best standards of care provided at the lowest cost.
56
What are Resource Utilization Groups (RUGs)
these mirror DRGs (which are mostly hospital based) but for long-term care settings
57
what is Managed Care?
providers and organizations try to manage costs, while remaining profitable. Hospitals usually absorb some costs of the severely ill when inpatient care, LOS, is prolonged beyond what insurance companies want to pay.
58
what are the nursing roles in primary care centers? What is the APRN role? What care can a patient expect to receive?
- makes health assessments, technical procedures, and provides education
- an APRN can provide care for specialized populations
- patient gets diagnosis, treatment, counseling, referrals
59
what are the nursing roles in Ambulatory Care centers? What is the APRN role? What care can a patient expect to receive?
- can administer meds, do technical procedures, provide teaching
- may be managed by an APRN
- patients do not need an appointment to go; breaks the barrier for uninsured and access
Goal = provide access to care for patients who can self-care at home
60
what are the nursing roles in Home health care? What care can a patient expect to receive?
- provides meds, physical care, teaches, supports family, collaborates with other providers to plana nd provide care
- patient can live comfortably in the home with help. qualifies as insurance early discharge
61
what are the nursing roles in extended care services? What care can a patient expect to receive?
- interviews patient to place them in an appropriate setting, provides direct care
- for patients with chronic illnesses or disabilities
- medical or non-medical: ex. aging in place
ex. dementia units
62
what are some specialized care centers?
1. mental health center
2. daycare
3. rural health center
4. schools
5. industry healthcare
6. homeless shelters
7. rehab centers
8. parish nursing
63
what is the role of nurses in health care reform?
- being a strong voice for protesting health-related problems and proposing solutions
- nurses are increasing their education
- more nurses now provide primary health care services in areas and to people long neglected
64
what is the function of community facilities? what are some examples?
```
= often nonprofit voluntary facilities financed with grants, donations, and fundraisers
- may charge minor fees
ex.
Meals on wheels
Older adult transportation
American Heart/Lung Association
Alcoholics Anonymous
```
65
what is the function of Public Health Services (PHS)?
- a federal health facility
- the medical branch of the coast guard
- the principle source of Native American health care
- CDC and NIH are part of the PHS
66
Where does the community-based RN work?
RN does NOT go into homes
| - schools, states, church, stores, homeless shelters
67
what is the role of the community-based nurse?
- focuses on needs by emphasizing comprehensive, coordinated, and continuous services
- anticipate and plan for care to be delivered across different health care settings
68
what are the characters of the community-based nurse?
- knowledgeable
- accountable
- independent
- an advocate
- educator
69
ISBARQ
```
I = introduction = ppl involved, their roles and jobs
S = situation = compliant, diagnosis, treatment plan, and patient's wants and needs
B = background = VS, mental and code status, list of meds, and lab results
A = assessment of situation
R = recommendation = identify pending lab results and what needs to be done over the next few hours and other recommendations for care
Q = questions
```
70
what populations need special care coordination for their health care needs?
- ppl with disabilities or multiple chronic conditions
- ppl with mental illness or substance abuse
- cultural, racial or ethnic minorities
- rural and urban poor, including homeless
- undocumented immigrants
71
what is a nurses role in admission?
- initial interview: staff provide info on legal and ethical parts of care and have patients sign consent forms for treatment and billing
- find out pt code status, advanced directives
- give patient Bill of Rights
- made assessments, collaborates with providers and other members of the clinical staff to make decisions about care
- helps patients understand their situation and what steps are to come
- orientation phase of the helping relationship
72
what is a nurses role in transfers?
- move or provide patient medical records
- notify other departments
- give/get report
- responsible for ensuring the comfort, safety, and teaching needs of the patient and family are met
73
what is a nurses role in discharge?
- verbal and written report is usually given when going to an extended care facilities
- nurses set mutual and realistic goals for discharge
- ensure that pt or family are knowledgeable, competent, and comfortable with any treatments that may be required at home
74
what is the criteria for a formal D/C plan and referral?
- lack of knowledge about treatment plan
- social isolation
- recently diagnosed chronic discharge
- major surgery
- prolonged recovery
- emotional or mental instability
- complex home care regimen
- financial issues
- lack of resources
- terminal illness
75
what education should a nurse give a patient before discharge?
- skills needed for home care should be demonstrated, practiced, and provided in writing
- general signs and symptoms of potential complications
76
what is thoughtful Person-Centered Care?
- reflective practice --> personal training
- RNs attributes: knowledge, expertise, QSEN
- clinical reasoning, judgment, decision-making
- patient-centered process: ADPIE
77
what are some theories of caring?
There is no universally accepted theory of caring.
- caring is universal and practiced through interpersonal relationships
- therapeutic relationship = when the relationship between the caregiver and the person being cared for is focused on promoting or restoring health and wellbeing
78
an RN must judge their knowledge to be:
1. C = complete
2. R = relevant
3. A = accurate
4. F = factual
5. T = timely
79
what is the difference between critical thinking and critical reasoning?
critical thinking = broad
ex. teamwork, collaboration, streamlining work flow
critical reasoning = specific
ex, pt care issues = determining, preventing and managing pt problems
80
what are the components of a Nursing Diagnosis?
Label
Definition
Defining Characteristics
Related Factors
81
what are the concept maps basic steps?
- collect patient problems and concerns a bit
- connect and analyze the relationships
- create a diagram
- keep in mind key concepts: the nursing process, holism, safety, and advocacy
82
what is the benefit of concept mapping?
- learners identify and graphically display in a diagram or drawing interrelationships between core concepts
- promotes critical thinking, the ability to recognize relationships and connection between data, and the ability to apply this knowledge to patient care
83
what is important to consider with assessments? what is a nursing assessment?
nursing assessments are focused on patient responses to health problems.
consider: developmental stages, culture, and need for nursing
84
describe the 4 phases of the interview
1. preparatory phase
- obtain data
2. introduction
- greet, include interventions for privacy, HIPPA
3. working phase
- set an agenda
- address the current problem
- head-to-toe assessment
- document findings
4. termination
- summarize findings for patient; avoid jargon
85
what are the components of a diagnostic statement?
```
P = problem statement
E = etiology
D = defining characteristics
```
