Exam 3 Flashcards
evidence-based practice- what
back/ scientific justification for actions
AACN
action putting current evidence into practice
evidence-based p- purpose
guide interventions and clinical decision making
traditional v authoritative v scientific knowledge
traditional- way always done it
authoritative- expert knowledge
scientific- evidence based (research studies)
national institute goals research
prevent dis, build scientific foundation, manage symptoms
evidence based goals- people v nursing process
education, policy dev, ethics, nursing history
qualitative v quantitative
quality v quantity (numbers) b/ include population and data
health
state complete physical, mental, and social wellbeing in addition to absence of disease or infirmity (weakness)
illness
reponse to dis, abnorm process involving changed lvl of funct
wellness
state being healthy by living lifestyle promoting good physical, mental and emotional health
does healthy = problem free
no
person can still have problems and considered healthy
health dimensions
iessep
intellectual, environmental, spiritual, sociocultural, emotional, physical
dimensions of health- physical, environ, intellectual
physic- genetics, age, dev lvl
environ- housing, sanitation, climate, nutritional access
intellect- cog abilities, education
dimensions of health- sociocul, emotional, spiritual
socio- economic lvl, lifestyle, family cul
emotional- body responce to changing conditions
spiritual- beliefs/values
acute illness
rapid onset
brief length
ex. flu, gi bleed, pancreatitis, food poisoning, pneumonia
chronic illness
permanent, irreversible changes
2-3 months, long time
ex. heart dis, lung dis, diabetes, kidney dis, arthritis
remission
pat have dis but sympt not present
exacerbation
sympt of dis present/ and or exaggerated
morbidity
freq. of dis/illness
mortatily
number deaths due specfic dis/illness
illness beh- stage 1
symptoms appear- do not affect ADLs
illness beh- stage 2
sick role
decide if need to take action
go to doctor
impede norm activity func.
illness beh- stage 3
dependent role
take prescrip or hospitalized
illness beh- stage 4
IV recovery and rehab
risk factors for illness
genetic factors, age, physicological, environ, health habits
purpose health illness continuum
measure lvl of health
stages range frm death to high lvl wellness
illustrates dynamic state of health
primary health promotion
weight loss
diet, exercise, smoking cessation
(modifiable, used to prevent dis)
most important
secondary health promotion
screenings, exam, family counseling
(ID illness early on)
performing stage
tertiary health promotion
intervention based
ex. meds, surgery, OT/PT
aging adult objectives
descr, id, compare, desc, id
describ theories of aging
id health problems/illne common in middle age to older
compare myths to realities
desc possible physiological changes occur w/ age
id nursing intervent to promote health
leading cause death in middle to older age
malignant neoplasms (cancer) cardiovasc dis (heart dis) unintent dis (falls, accidents) diabetes mellitus cerebrovascular accidents (stroke)
major health problems in middle to older age
cardiovasc and pulm dis cancer rheumatoid arth diab. mell obesity alcholism depression
myths abt older adults
incontin is expected aggressive treatment is not appropriate not interested in sex lonely appearance not important mental deterioration common always live in nursing homes ageism occurs at 65
integumentary changes in older
alopecia, less elasticity, thickening nails, thinning skin, altered pigmen
musculoskel changes in older
brittle bones, dec ROM, less musc mass and strength
neruo changes in older
slowed response/reflex, alt temp reg (colder), alt pain perception
sensory changes in older
visual and hearing dec
taste and smell alt
cardiopulm changes in older
dec elasticity of blood vess and lung tissue
gastrointestinal changes in older
dec absorp and motility
genitourinary changes in older
frequency, retention, dec kidney func
risks assoc w/ chronic dis
inc ability to have o/ problems
risks w/ age
falls mental impairments (not occur as a result of e/o) have own occurance maltreatment (abuse, neglect, abandonment, and exploitation)
nursing care goals for older
promote indep. func support indiv. strengths prevent complications of illness secure safe/comfort environ promot return health
five prts communication (berlo)
stimulus of referent (why need comm in first place)
sender/ source message (encoder)
message itself (content)
medium or channel of comm (verbal v visual)
receiver (decoder)
four lvls comm
intrapersonal (self talk)
interpersonal (btw 2+ ppl w/ goal exchange info)
group
small group, organizational communication, group dynamics
chara effecting effectivenss of comm
group id cohesiveness patterns of interaction decision making (hierarchical?) responsibility leadership power
factors influc comm
dev lvl, gender, sociocul differences, roles/ responsibilities (charge nurse v cna), space and territory, physical, mental and emotional state, values, environ
factors affecting interpretation of message
body lang
current mood
background of decoder
electronic comm- regulated by, email and text protocol
reg- ANA and NCSBN rules for social media
email- risk violating hippa rules privacy and confidentiality
helping relationship
not occcur right away
strength relationship= effectiveness of care
characterized by unequal sharing of info
built on pat needs
nurse= helper, pat is person being helped
used establish rapport
charac helping relationship
dynamic, purposeful, time limited, helper accountable for outcomes and interventions
phases helping relationship
orientation
working
termination (end shift or goal met)
orientation phase goals
pat descr participants in relationship (name, role and purpose)
pat and nurse agree goals relationship, location, freq, duration of contact, and duration of relationship
goals working phase
pat actively particip in relationship
pat coop in act to achieve goals
pat express feelings and concerns to nurse
goals termination phase
pat particip in id goals accomplished or progress made
pat express feelings abt termination of relationship
*bed side report important
as if pat has anything to add
dispositional traits
promote effective comm
ex. eye contact, tone, empthy, openness, respect, caring, competence
rapport builders
privac and confiden, optimal pacing, comfortable environ, patient v task focus (asure care abt well being and remember purpose of task)
SBAR purpose
hand off comm used if calling provider situation (why calling) background assessment (what think issue is) reccomendation
good conversational skills
be knowledgeable abt topic control tone be clear and concise be truthful flexible and open mind avoid words could have diff interpretations
good listening skills
alert eye contact approp facial express and body gestures think before responding listen for themes in pat comments *meet people where they are, think what do I not know, validate!!
interview techniques
open ended, closed validate or clarify reflective sequencing directing questions/comments
charac of assertive self-presentation
confident, concise i statements effectively share feelings and thoughts calm under supervision, ask for help when necessary, give and accept complements admit mistakes (accountable) *acknowledge when people do things right
agressive beh ex
assert ones rights in neg manner violates rights of o/ verbal, physical tensions and anger ppl like to win at all costs make accusations, demostr intolerance
communication blocks
not listen, use closed questions, nontherapeutic comments, judgemental, false assurance, disruptive interpersonal beh, gossip, changing subject
disruptive interpersonal beh
incivilty
bullying- horizontal, nurse and physician
how organization responds to disruptive beh
goals teaching/counseling
maintaining / promoting health
prevent illness
restore health
facilitate coping (family and personal)
patient education
prep to receive care (what to expect, discuss goals)
pre before discharge
document pat. education act (verbal, or motor)
teaching acronym
t- tune into patient (body lang and attention lvl)
e- edit patient infro
a- act on every teaching moment
c- claify
h- honor patient as partner in ed process
learning domains (3)
cog- recall and verbalize learned info
psychomotor- demonstrate physical skill
affective- change attitude, values and feelings (why is education important)
factors affecting patient learning
age, dev lvl family support financial resources cul influences lang deficiet (don't use family as translator) health literacy lvl (don't assume know)
critical dev areas
physical maturation/abilities psychosocial cog capacity emotional maturity moral/spiritual dev
cope model
method for ed delivery c- creativity o- optimism p- planning e- expert info
assessment parameters
affective, cog, and psychomotor
readiness to learn
ability learn (can depend dev lvl)
learning strengths (visual v auditory)
inc compliance
goals are understandable and realistic
inc patient and family
use interactive teaching
dev rapport w/ pat and family
culturally competent patient education
dev understanding of cul and values
be aware bias, assumptions
use material in preferred language
four assumptions abt adult learners (knowles)
inc independence w age
previous experiences alter perceptions
readiness to learn depends on dev lvl
most only want to learn material that is useful
teaching plans for older adults
id learning barriers (hearing and vision) allow extra time plan short teaching sessions reduce environ distractions relate new info to familiar activities
teaching strategies
audiovisual, written mat, discussion, lecture, demonstration, discovery, role-playing
factors that effect communication
distraction, environment tone, vocab used, ask questions clear and concise don't interrupt
nurse coaching
empower pt reach goals
create structure
id opportunities and concerns
id readiness for education
feedback about learning
celebrate learning
eval teaching
revise plan
how to document teaching-learning process
summary of learning need
the plan
implementation of plan
eval results
types counseling
short term- situational (pain)
long term- developmental crisis (ambulation)
culture
group w shared beh patterns learned through socialization
inc- location, sexual orientation, religion, race
cultural humility
subjective- ongoing
cultural competence
objective view, you are the expert
health disparity
preventable differences of disadv populations
subculture
group w/ characteristics not common to larger group
cultural assimilation
minorities lose characteristics to dominant group
culture shock
discomfort when placed in alt culture
cultural imposition
belief everyone should conform to majority belief
cultural conflict
ppl aware of cul differences and feel threatened
ethnicity
based on heritage
share beh, and beliefs
dev through day to day life
ethnocentrism
belief that ideas are superior to all o/
cul influences on healthcare
reactions to pain, mental health, gender roles, language, family supp, nutrition, socioeconomic
care considerations for pain
not assume
respect right to response of pain
respect beliefs about pain
sensitive to nonverbal cues
culture of poverty
need gov aid, unstable family structure, dec community involvement
feelings of despair
factors affect cul interactions
pt prev hx
dominant cul of environment
expectations about care
purpose of documentation
legal, reimbursement, education, research, performance improvement, diag, comm, care planning
documentation components
content, timing, format, accountability, confidentiality
policy for verbal orders
record in chart, read back to verify accuracy, date/ time, record physicians name
personal health records (PHR)
standalone
tethered/connected
benefits health info exchange
improve quality and safety
stim pt education/ involvement
inc community in public health
methods of documenting
chart (focus, exception, pie), source/problem oriented, case management, electronic health record
documentation formats
flow chart, term summary, progress notes, med record, care plan
flow sheet types
24 input/output
MAR
acuity record
24hr pt care record
requirements for home health
rehab pot is good or hospice
pt not stabilized
pt making progress
ISBARR
hand off communication
intro, situation, bckgrnd, assessment, recommendation, read back orders
components in change of shift report
appraisal of health status, new orders, abnormal things during shift, unfufilled orders, family concerns
pt care discussion
rounds
interdisciplinary conferences
referrals
