Exam 2 "hints" Flashcards
What does the ANA say about nurses and how they are professional beings?
Speaks to the nurses obligation to: The client, to self, to colleagues, and to the nursing profession
Gives us information like social policy and the nurse practice act
Includes safety, EBP, and quality of care
What is non-maleficence?
avoiding actions that bring harm to another person
What is the beginning of therapeutic communication?
Introduction
establishment of trust
How do you use therapeutic communication?
build rapport with the client
identify clients feelings problems and goals
autonomy
the individuals right to self determination
beneficience
doing the greatest amount of good and avoiding harm
confidentiality
respect for another’s privacy, not divulging info that was given in confidence
maleficence
act of committing harm
What is HIPPA?
Health Insurance Portability and Accountability Act was designed to protect an individuals health records and info
What happens to us as nurses if we do not adhere to HIPPA?
penalties for failure to comply involve a substantial fine, prison term, or both
How does communication begin?
the interview process
Phase 1: orientation
Phase 2: Working
Phase 3: Termination
What is cultural competence?
a set of cultural behaviors and attitudes integrated into the practice methods of a system, agency, or its professionals that enables them to work effectively in cross cultural situations
What are the 8 domains of cultural competence?
governance
leadership
workforce
communication
language assistance
engagement
continuous improvement
accountability
How do we understand different cultures and get more awareness about them?
become knowledgable
recognize barriers
develop techniques to foster communication and utilize resources
What is QSEN?
Quality and Safety Education for Nurses
prepares future nurses to provide safe, quality, patient centered care and team collaboration in a clinical practice
What does client centered care mean and all we do as a nurse?
includes client’s individual preference, values, beliefs and needs
client has right to self determination
advocate for client
What did the Joint Commission do in accrediting?
National patient safety goals
TJC also regulates hospitals and evaluates safety fro accredidation
5c’s
What are the national patient safety goals?
identify patients correctly
improve effective communication
improve safety of high alert meds
ensure correct site, correct procedure, correct patient surgery
reduce risk of health care associated infections
reduce risk of patient harm from falls
What are the 6C’s
clear
concise
complete
concrete
courteous
correct
What are the reasons medical errors occur?
miscommunication
errors are usually system problems
due to fatigue or handoff errors
under reporting of med errors
What is evidence based practice?
implementing nursing interventions based on sound clinical research and professional judgement in real-time situations
Why do we use evidence based practice?
provide the best care to clients by using the best evidence to guide practice
What is the IOM to err is human?
a report that expressed not all humans are perfect and will continue to make errors, but it is up to the health care system to identify what leads to errors so that improvements cam be made
What is a near miss?
when a patient is exposed to a harmful situation but DOES NOT experience harm (either through luck or early detection)
What is a preventable adverse effect?
due to error or failure to apply an accepted strategy or prevention
What is an ameliorable adverse event?
while not preventable, could have been less harmful if care had been different
how do we start the process of initiating evidence based practice?
asses the patient and identify a clinical problem
then ask a question
Why don’t we like to report errors?
we fear being punished
What is TeamSTEPPS?
Team Strategies and Tools to Enhance Performance and Patient Safety is a program that emphasizes improving patient outcomes by improving communication in a health care team using EBP
Biases and understanding our own biases
bias: slant toward a particular belief
understanding your own biases starts with self-awareness and cultural awareness, understand intrinsic biases
Define therapeutic communication
The purposeful use of communication to build and maintain helping relationships with clients’ families, and significant others. Therapeutic communication is client-centered, purposeful, planned, and goal directed.
What are the most important parts of therapeutic communication?
client-centered
partnership
professional boundaries
involvement/active participation
use of self
client centered
includes the clients individual preference, values, beliefs, and needs
partnership
honors the clients right to self-determination, giving the client and family maximum control over health care decisions
advocate for the client and encourage independence
professional boundaries
protect functional integrity of alliance between the nurse and client
involvement/active participation
degree of the nurse’s attachment and active participation on clients care
use of self
authenticity: requires admitting mistakes, recognizing vulnerabilities
self-awareness: reflective process seeking to understand one’s one values, feelings attitude, motivations, strengths and limitations
presence: in the moment
Define safe, quality care
QSEN definition: the minimization of risk for harm to patients and to providers (doctors and nurses) through both system effective ness and individual performance
What do we do to clarify communication?
paraphrase
restate
reflect
explore
paraphrase
Restating in fewer words what was said
restate
Echoing feelings; saying the same KEY WORDS that the client used
reflect
may be a question or mirroring back to the clients feelings
explore
A way to elicit more information such as “tell me more, describe, give me an example”
Therapeutic vs non therapeutic communication
therapeutic: use of silence, active listening, clarifying techniques, verbal, nonverbal
non therapeutic: excessive questioning, giving advice, giving approval or disapproval, asking “why” questions, changing the subject
What does “advise” mean from a nursing perspective?
RECOMMEND what a client should do (ex: take a shower or instruction after discharge)
Electronic records and what they have to do with nurses. Are they good or bad?
Technology oriented solutions, such as electronic records, barcodes and IDs help nurses perform safer practices when caring for a patient
what are some safer practices that nurses can implement?
use of check lists
timely documentation
standardized tools (SBAR) for better communication
technology oriented solutions
understanding interdisciplinary roles relationships and nursing role relationship changes
EBP research and promotion of safer policies/procedures
What are the various theoretical concepts of a person, concepts of illness, concept of environment- nursing etc.?
There external factors that play into a client’s condition.
The clients view on illness, environment (where they live), previous experiences, nationality, ethnicity, how they were raised, etc. will play a role how a person views their experience in a hospital setting
What is SBAR?
SBAR is a standardized communication tool commonly used between two people during handoff.
Situation
Background
Assessment
Recommendation
Situation
Introduce yourself
Patient name, age, room #
Attending physician/consulting physician involved in care
Diagnosis and admission date
Description of patient’s current situation
Background
Basically a head to toe assessment
Pertinent procedures and tests completed
Allergies, code status, most recent VS, BS, labs
Vascular access, fluids, drip/rate, patency and site- changes due or last changed
Oxygen flow if oxygen was ordered
Hearing, visual, cognitive, language barriers
Patient mobility/fall risk status
Isolation/infection control precautions
Current medications/relationship to condition
Comorbidities affecting client’s status
Cardiac status
Assessment
Any changes in respiratory, physical, or mental status
What happened in today’s shift
Last pain medication given
Any medications held and the rationale
Recommendation
Suggestions of actions to be taken (plan of care, what does the patient need and when, pending procedures and tests to be scheduled)
Recommendations for discharge
Ask if receiving nurse has any questions
What is Maslow’s hierarchy of needs?
- Physiological needs
- Safety and Security needs
- Love and Belonging Needs
- Self esteem
- Self actualization
Helps nurses prioritize nursing actions
infant
totally dependent on caregiver
communicate through CRYING OR SMILING
provide for infants physical and emotion needs, by 12 months, infants say 3-words with meaning swaddle and hold infant in arms
Take time to listen and address caregiver
toddler
Regress to infantile behaviors when stressed (they think its safer)
LITERAL with interpretation of word (take BP, they think you are actually taking something from them)
Use consistency; routines are important, explain using very basic words, approach slowly
preschooler
Follow simple commands but only ONE AT A TIME
LITERAL with interpretation of words
Eye contact, sit down at their level, approach slowly
school age
Transition from home to school
Use terms understandable to child, give choices, provide encouragement and praise, be honest
adolescent
Transitioning from childhood to adulthood
-fight for independence
-need comfort and security difficult time
-demands from family school peers society body changes (puberty need something to feel good about acne difficult time for parents
-transition
-opposing views
adults
Recognize characteristics
-working toward career goals
-earning a living
-establish primary relationships
-making a place in their community
-raising a family STRESS
-info and assistance in parenting and daily living
-extended psychological adolescent period
-still pursuing education
-still living with parents (boomerang generation)
older adults
Fewer acute illnesses (chronic illness management) more freedom (empty nest, retirement) final stage (no longer needed, bored, lack of energy to participate in activities, fear off loss) interests in younger years tend to remain the same (active vs non active social vs nonsocial)
fidelity
faithfulness; loyalty; obligation to client
virtue centric
this theory centers on the CHARACTER of the person acting
deontology
this theory asks “what is one obligated to do?” It focuses on the MORAL VALUE MINDEDNESS where everyone has inherit dignity and worth
utilitarianism
this theory places emphasis on the OUTCOME of the situation - greatest good for the greatest number
advanced directive
document where written instructions are recognized under state law related to the provision of medical care when an individual is incapacitated and unable to state desired care
advocate
someone who speaks up for or acts on behalf of clients
clients rights
right to autonomy, beneficence, nonmalficience, justice, informed consent
informed consent
A person’s agreement to allow something to happen based upon a full disclosure and explanation of facts needed fro a client to make an intelligent decision. May include information about procedures, treatments, options and consequences of refusal
Statutory vs Common Law
statutory: established through the legislative process
common law: established by previous court decisions
What can the boards of nursing do?
can only limit to deny a nursing license
What are the 6 competencies of QSEN?
patient centered care
teamwork & collaboration
EBP
Quality improvement
safety
informatics
just culture
recognizes human error and faulty systems that causes a mistake and encourages investigation so that the system can be fixed
makes workers feel more at ease to report problems
Agency for Healthcare Research and Quality (AHRQ)
U.S. Department of Health and Human Services involved in patient safety by FUNDING RESEARCH and complying evidence to publish best evidence based standards of practice
young old
65-74
old
74-84
oldest old
85+
centenarians
100+
paternalism
a concept where health care providers believe there know more about what is best fir the clients than the clients themselves
ethnicity
a membership of a person in a particular cultural group.. common racial, geographic, ancestral, religious of historical bonds
ethnocentrism
the belief that ones own culture is superior to another culture
cultural relativism
a concept where each culture is determined to be unique and only judged on its own values, standards or beliefs
health disparities
can exit where there are margins of society that are undeserved for medical care being given (healthcare may be unavailable or person may not have the awareness)
acculturation
where a person from a different culture learns behaviors and values of the dominant culture and adopts the norms and values including language
communication principles
Listen carefully
Explain what the client needs to understand
Acknowledge cultural differences
Recommend what the client should do
Negotiate mutually agreeable strategies
hispanic/latino
strong family loyalty father head of household and primary decision makerreligion: Roman Catholic believe illness id falling out of favor w God high incidence of diabetes not uncommon fro these clients to share meds LOOKING FOR WARMTH RESPECT AND FRIENDLINESS FROM HCP
African american
value “caring for ones own”women often head of household, backbone, assume responsibility for parents and children history of oppression , HTN, stroke, diabetes, heart disease history of suffering from health care disparities especially w lower income groups TRUST MUST BE ESTABLISHED so that clients will participate in their own treatment males tend to use recommended preventivce services and suffer more health issues because of it
asian American
very hard working and education is high valued metal respect and honesty male with male and female with female nurses smile in agreement even if hey disagreereligion: hinduism, buddhism, muslim- rituals for prayer, modest, dietary restrictions use herbal medicines and treatments like accupunctr eSTOIC less likely to request pain meds DO NOT believing mental health illness, as it brings shame to family and can result in suicide
Native American
health practicies are ties into spiritual practices value nature and earth blue respect, story telling and humor direct eye contact is disrespectful private shoe little to no emotion will not participate in teaching back
culture of poverty
associated with health disparities DESERVE SAME RESPECT AS OTHERS
