Exam 2 Flashcards
Systems theory
defined as a set of interrelated parts, in which each part is necessary to the whole; comprised of input, throughput, output, evaluation, feedback.
systems in nursing practice consists of person, environment, and health.
ie. family, cultural, social, community, nation, and world systems.
Members of the healthcare team
physicians>physician assistants>patient care technicians (unlicensed member of nursing staff)>licensed practical nurses>dieticians>pharmacists>technologists>respiratory therapists>social workers>physical therapists>occupational therapists>administrative support personnel
Healthcare delivery system
categories of health care services: health promotion and maintenance, illness prevention, diagnosis and treatment, and rehabilitation and long-term care
classification of health care agencies: government, state, local, voluntary, not-for-profit, and for-profit agencies
Organizational structures in health care
board of directors>chief executive officer>medical staff>medical staff governance>chief nursing officer>nursing staff>nursing staff governance
Health beliefs model
evaluation of one’s vulnerability to, and seriousness of, a condition
individuals/groups perception of how effective the health behavior might be
the presence of a trigger event that precipitates the health maintenance behavior
JCAHO
formed in 1992
joint commission on accreditation of healthcare organizations
nonprofit; serving as the nation’s predominant standard-setting and accrediting body in U.S. health care
IOM five core competencies
to promote patient safety
- provide patient-care vs. focus on disease/illness
- work in interdisciplinary teams
- employ evidence-based practice
- apply and make effective quality improvement
- use informatics
IOM report on the future of nursing
nurses should practice to the full extent of their education/training
nurses should achieve higher levels of education
nurses should be full partners with physicians and other health care professionals
effective workforce planning and policy require better data collection
3 ways humans fail
perception (ie. perceive we’ve picked up the correct dose of medication)
assumption (ie. assume the other RN correctly programmed the heparin infusion)
communication (ie. forget to relay key information when giving patient report to the next RN)
Collaboration of team members
collaboration is working jointly with other professionals which involves civil behavior, willingness to work together, supportive attitude and behaviors of the organization
The collaborative process
identify stakeholders
identify problems to be solved
identify barriers or roadblocks to solutions
clarify desired outcomes
clarify the process that will be sued to accomplish task
identify who will be responsible for each step in the task
evaluate the degree of success in meeting the goals and generating a solution
Therapeutic use of self
originated from Hildegard Peplau (theory of nursing)
3 phases:
orientation- introduction and development of trust
working- accomplishes tasks towards goals
termination- ends the relationship therapeutically and constructively
Communication theory
communication is the exchange of thoughts, ideas, or information at the heart of all relationships
levels of communication: verbal, nonverbal, congruent and noncongruent
Operations in the communication process
3 factors:
perception>evaluation>transmission
these factors are influenced by many variables
Criteria for successful communication
feedback, appropriateness, efficiency, flexibility
Quality improvement/assurance
ensures the delivery of quality client care
demonstrates the efforts of health care provider to deliver quality care
focuses on assessing/measuring performance
ensures that performances meets standards
takes action for change when care does not meet standards
FMEA
failure mode effect analysis
a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change
steps: failure modes (how?), failures causes, failure effects (consequences?)
Sentinel events
a type of FMEA
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof and they signal the need for immediate investigation and response
Failure to rescue
a type of FMEA
refers to cases where caregivers fail to notice or respond when a patient is dying of preventable complications in a hospital
Rapid response
a type of FMEA
purpose is to identify and treat patients before the patients’ condition deteriorates to the point that CPR is needed
Root cause analysis
a method of problem solving that tries to identify the root causes of faults or problems that if eliminated , could reduce the risk of similar errors in the future.
data on errors should be compiled, disseminated, and assessed periodically.
Acute illness
characterized by:
severe symptoms
relatively short-lived in duration
could become fatal if left untreated
usually return to previous state of health
complications may result in chronic conditions
Chronic Illness
characterized by:
gradual development
on-going treatment
continuation throughout pt.’s life
varying severity and outcomes of conditions
no usual return to previous state of health
may occur as periods of exacerbation and remission
in U.S.:
increase of chronic illness r/t sedentary lifestyles, obesity, and aging population
more people die from chronic rather than acute illnesses
Stages of adjustment to illness
disbelief and denial irritability and anger attempting to gain control depression and despair *due to disruption of normal routine acceptance and participation
a person may not hit all stages
Influences on illness behavior
internal: dependence vs. independence coping ability resistance of body to give up resilience spirituality external: past experiences culture communication patterns personal space norms role expectations values reaction to prescribed medications ethnocentrism
Families and illness
characterized by: behavioral and emotional changes changes in family roles disturbed family dynamics results in increased patient and family stress
Stress
may results in the development and/or prolongation of illness interventions: recognize stressors eliminated as many stressors as possible relaxation techniques patient education
Open system
promotes exchange of matter, energy, and information with other systems and the environment
ie. all living systems
Homeostasis
dynamic balance within and between systems
when adaptation is unsuccessful, disequilibrium sets the stage for illness/disease
Maslow’s human needs hierarchy
Level 1: physiological survival Level 2: safety and security needs Level 3: needs for love and belonging Level 4: self-esteem needs Level 5: self-actualization
Level of health care services provided
primary: care rendered at the point at which a patient first enters the health care system ie. health promotion
secondary: involves the prevention of complications from disease ie. surgical centers
tertiary: those requiring long-term care or rehabilitation services ie. burn center
IOM
created in 1970 to serve as a source of science-based advice on matters of biomedical science, medicine, and health
focus is on healthcare professions education that emphasizes interdisciplinary care rather than working in isolation, not on specific healthcare professions
To err is human
this IOM report fueled a systems approach to improving healthcare with nurses identified as key stakeholders
98,000 deaths/year due to unnecessary medical errors
IOM safety initiatives
medication administration patient identification surgical time-outs electronic medical records communication: SBAR
Types of program evaluation
formative: evaluation for purpose of assessing whether objectives are met or planned activities are completed (progress); during program; may be on-going
summative: evaluation to assess program outcomes or as a follow-up of program activities (efficiency); after program.
Key to evaluation
documentation
Hope
a multidimensional concept that provides comfort while enduring life threats and personal challenges
Variations of grief
normal- process of coping
complicated- prolonged, difficult grieving process
anticipatory- letting go before lost occurs
disenfranchised- unsupported grief
