Exam 3 SG

Question 1

1. What are the implications for nurses that were published in the IOM’s report The future of nursing?

Answer 1

Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Nurses should be full partners, with physicians and other healthcare professionals, in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and information infrastructure.
- See more at: http://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx#sthash.a4bWk5Hd.dpuf
a. Recommendation 1: Remove scope-of-practice barriers.
b. Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
c. -Recommendation 3: Implement nurse residency programs.
d. -Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
e. -Recommendation 5: Double the number of nurses with a doctorate by 2020.
f. -Recommendation 6: Ensure that nurses engage in lifelong learning.
g. -Recommendation 7: Prepare and enable nurses to lead change to advance health.
-Recommendation 8: percent Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

Question 2

2. What is Magnet recognition?

Answer 2

The only national designation built on and evolving through nursing research that is designed to recognize nursing excellence of healthcare organizations through a self-nominating, appraisal process.

• It is important for RNs to understand and be able to use motivation techniques.
• Research has shown that the higher a person’s educational level, the higher the motivation to learn (Catalano, 2013).
• The higher the desire to learn, the greater the motivation will be to adopt the learned changes.

Question 3

3. What is professional identity in nursing?

Answer 3

(Nursing Now, chapter 1, pages 5-10)

1. High intellectual level
2. Technological
3. pharmacology
4. physical sciences
5. Assessment skills
6. reasoning skills
7. routine judgements
8. High level of individual responsibility and accountability
9. Primary care provider
10. can no longer state that the provider ordered it so I did it.
11. Specialized body of knowledge
12. Public service and altruistic activities
13. Well organized and strong representation
14. Nurses code of ethics
15. Competency and professional license

Question 4

Who determines laws and rules for nurses?

Answer 4

1. A state nurse practice act is a state legislation regulating the practice of nurses that protects the public, defines the scope of practice, and makes nurses accountable for their actions
2. Nurse practice acts establish state boards of nursing (SBNs) and define specific SBN powers regarding the practice of nursing within the state
3. Rules and regulations written by the SBNs become statutory laws under the powers delegated by the state legislature
4. State Board of Nursing:
5. focus primarily on the licensure of nurses w/in their own state (each individual state has its own Nurses Practice Act)

Question 5

What role do nurses play in informed consent?

Answer 5

• Confirm the pt. understands the info provided by the doctor.
• notify provider if pt has any questions or doesn’t understand the procedure.
• verify pt is competent to give informed consent.
  (pt. is a adult or emancipated minor, not impaired)
• ensure pt. signs consent document voluntarily.

Question 6

4. Understand the concepts of care coordination and collaboration in nursing.

Intraprofessional

Inter-professional

Interorganizational

Answer 6

Intraprofessional
h.	Mentoring
i.	shift reports
Interprofessional
j.	PT
k.	OT
l.	Providers
m.	pharmacy
n.	social workers
Interorganizational
o.	Hospice
p.	Home Health care
q.	Health care consortiums

Question 7

1. Understand the concepts of care coordination and Collaboration in nursing.

How does collaboration occur?

What disciplines and who is involved?

Answer 7

● Through respectful communication
● By being open to new ideas
● Involves everyone in the care of the patient
● Involves the family too

mutual trust and respect among the members
Effective teams participate in effective problem solving, increased creativity, and safe and improved health care

Question 8

5. How is informatics used to promote interdisciplinary care?
   Incorporates nursing, information technology, and communication technology to develop and to support nursing practice and improve patient outcomes.

Answer 8

1. The blending of information and computer science to study processes, management, and retrieval of health-related information.
2. Technologically driven organizations have improved competitive edge

Question 9

How do nurses utilize informatics?

Answer 9

Documentation
Find EBP research
Communication

Question 10

6. Consider all the forms of communication in nursing practice: nurse-patient, nurse-nurse, etc. Know the different styles of communication: assertive, aggressive, submissive, conflictual, & educational.
7. Allows expression in direct, honest and non-threatening ways
8. Does not infringe on other’s rights
9. it accurately expresses a person’s feelings, beliefs, ideas, and opinion
10. Assertive communication is the preferred style in most settings.
11. It involves interpersonal behaviors that permit people to defend and maintain their legitimate rights in a respectful manner that does not violate the rights of others.
12. Assertive communication is honest and direct and accurately expresses the person’s feelings, beliefs, ideas, and opinions.
13. Respect for self and others constitutes both the basis for and the result of assertive communication.
14. It encourages trust and teamwork by communicating to others that they have the right to and are encouraged to express their opinions in an open and respectful atmosphere.
15. Disagreement and discussion are considered to be a healthy part of the communication process, and negotiation is the positive mechanism for problem-solving, learning, and personal growth.

Answer 10

Assertive

Question 11

2. How to use assertive communication

Answer 11

1. Maintain eye contact.
2. Convey empathy; stating your feelings does not mean sympathy or agreement.
3. Keep your body position erect, shoulders and back straight.
4. Speak clearly and audibly; be direct and descriptive.
5. Be comfortable with silence.
6. Use gestures and facial expressions for emphasis.
7. Use appropriate location.
8. Use appropriate timing.
9. Focus on behaviors and issues; do not attack the person.

Question 12

1. Used to humiliate, control, or embarrass the other person
2. Used to lower person’s self esteem
3. creates and I win, you lose situation
4. The other person may perceive aggressive behavior or communication as a personal attack.
5. Aggressive behavior and communication are viewed by some psychologists as a protective mechanism that compensates for a person’s own insecurities, and others view it as a form of bullying.
6. By demeaning someone else, aggressive behavior allows the person to feel superior and helps inflate his or her self-esteem.
7. Aggressive communication can take several different forms, including screaming, sarcasm, rudeness, belittling jokes, and even direct personal insults.
8. It is an expression of the negative feelings of power, domination, and low self-esteem. Although aggressive people may seem outwardly to be in control, in reality they are merely reacting to the situation to protect their self-esteem.

Answer 12

Aggressive

Question 13

1. Communicating in a way that is aggressive and starts a conflict using words like you did this this, what were you thinking.
2. Knowing when a person is at a breaking point and ignoring that or putting someone in that breaking point
3. Arguing for the sake of argument.
4. conflictual communication is often productive, avoiding conflict only defers it and fails to move toward success

Answer 13

Conflictual

Question 14

1. Being respectful but giving an opportunity to learn
2. Being able to learn when a person needs to communicate about something and allowing them to do so.
3. Usually a two-way conversation where someone asks a question and someone tells the answer
4. Can involve collaboration with others

Answer 14

Educational

Question 15

?

Answer 15

Submissive

Question 16

7. What is SBAR and why/how is it used?

Answer 16

Situation

Background

Assessment

Recommendation

Question 17

What are the barriers to effective communication?

Answer 17

1. Distractions
2. Unclear Directions
3. Differences in Perceptions about what should be done
4. Stressful Situations at home or workplace

Question 18

8. Understand teamwork in healthcare. What makes an effective team? How does the appropriate use of interdisciplinary care affect patient outcomes?

Answer 18

Multiple health disciplines with diverse knowledge and skills who share an integrated set of goals and who utilize interdependent collaboration that involves communications, sharing of knowledge and coordination of services to provide services to patients and their caregiving systems

Question 19

What is Health Promotion? How does culture impact the patient’s understanding of the nurses’ teachings?

Answer 19

What about the use of Alternative medical/herbal therapies (do not need to know specifics about each type of therapy)
Nursing is a multifaceted process that includes a range of activities such as the promotion and maintenance of health through education, the restoration of health through care of the sick and injured, and preparation for death through care of the dying.

Question 20

10. What is Tele-health and how is it impacting health care?

Answer 20

Delivery of health care through technology vs in person. This is particularly helpful in rural areas, where there is lack of specialty care services.

Health care at a distance

Providers able to treat clients from alternative locations using video cameras and phones

Question 21

What are the basic concepts needed for nurses, as knowledge workers, to use Informatics and Electronic Medical Records (EMR?)

Answer 21

1. Good decision making for patient care requires good information.
2. Nurses are knowledge workers, who need data and information to provide effective and efficient patient care.
3. Knowledge work is not routine or repetitive but, instead, requires considerable cognitive activity and critical thinking

Question 22

11. What is Informatics? What are the applications for its use in health care?

How does technology impact health care?

Answer 22

The blending of information and computer science to study processes, management, and retrieval of health-related information.
Technologically driven organizations have improved competitive edge

Question 23

12. Review the tenets of safe prioritization and delegation of care.

Answer 23

• E-A-T [do not delegate what nurse can: evaluate, assess, teach]
• is transferring the authority or responsibility to perform selected tasks in a selected situation to a competent individual
• Delegation involves at least two people, a delegator and a delegatee, with the transfer of authority to perform some type of task or work.
• A working definition could be that delegation is the transfer of responsibility for the performance of an activity from one individual to another, with the delegator retaining accountability for the outcome.
• In other words, delegation involves the transfer of responsibility for the performance of tasks and skills without the transfer of accountability for the ultimate outcome.
• Assignment is the transfer of both the accountability and the responsibility from one person to another. This is typically what happens between professional staff members.
• The nurse manager assigns patient care responsibilities to other professional nurses working in the same unit of the institution or community healthcare setting.
• The level of accountability for the nurse manager who assigns as opposed to delegates is fairly obvious, although there can be some accountability in both instances

Question 24

What cannot be delegated by the RN?

Answer 24

1. Because the RN is always accountable for assessment, diagnosis, planning, and evaluation, it is important that UNPs understand what elements of implementation they may carry out and why the RN is responsible for analyzing data gathered.
2. Thus RNs are accountable for an initial assessment and then intermittent evaluations. Both elements must be present to ensure effectiveness in entrusting an element of care to someone else.
3. Even if the nurse had trained the person to do the task, if they do not feel comfortable with giving the task to the unlicensed personal they cannot delegate the task
4. Any skills, tasks that the person has not been trained on cannot be delegated
5. Anything that is not within the job description, cannot be delegated.

Question 25

13. Recognize the goals of conflict management.

Is conflict always avoidable or even negative?

Answer 25

• When anger is used in a positive, productive manner, it can promote change and release tension.
• Anger can be used positively to increase others’ attention, initiate communication, problem-solve, and energize the change process.
• Sensitivity to internal anger can warn individuals that something is wrong either within themselves or with someone or something in the external environment.
• Anger that is used negatively is very destructive. It hinders communication, makes coworkers fearful, and erodes relationships with others.
• Anger expressed by abusive behaviors, such as pounding on nursing station counters, throwing charts or surgical instruments, verbal outbursts, or even violent physical contact, is never acceptable and may lead to civil or criminal action against the perpetrator.
• There are many things in life and the environment that contribute to conflicts. These can range from a difference of opinion about how a job should be done to major underlying beliefs such as culture, religion, and politics.
• The focus here is on resolving conflicts that affect the work environment, primarily emotional issues, insecurity, lack of skills, and diversity issues. Understanding the underlying elements of all types of conflict is a key in preventing and resolving many of the issues.
• Professional nurses need to be assertive and feel comfortable when handling conflict and confronting others.
• The conflict situations that nurses may encounter range from uncooperative clients and lazy coworkers to hostile, insecure, but influential physicians and administrators.
• Practicing assertiveness skills during confrontational situations helps increase the nurse’s confidence in handling daily work-related conflicts and allows the honest but respectful expression of opinion and ideas.
• Keep in mind that unresolved conflicts never really go away. Ignoring a conflict situation may postpone it, sometimes for a long time, but it will not resolve the issue. Unresolved conflicts often fester until they either reach the boiling point or are manifested in negative behaviors or feelings.
• Some of the feelings and behaviors that are symptoms of unresolved conflicts include the following
  r. Tension and anxiety manifested as sudden angry outbursts
  s. Generalized distrust among the staff members
  t. Gossiping and rumor spreading
  u. Intentional work sabotage
  v. Backstabbing and lack of cooperation
  w. Isolation of certain staff members
  x. Division and polarization of the staff
  y. Low-rated peer evaluation reports
• collaboration is used to solve a conflict, the energies of all parties are focused on solving the problem versus defeating the opposing party.

Question 26

Understand power, health care organizations, HIPAA, Medicare, and U.S. Health care (How does it differ from other first world countries?)

Answer 26

● HIPAA
○ The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific healthcare information and providing the patient with control over how this information is used and distributed
● Medicare
○ Largest and most influential health insurance program
○ Enacted in 1965: provided, under Social Security, for federal subsidies to pay for the hospitalization of sick people age 65 and over.
1. U.S. healthcare system
1. has become increasingly competitive.
2. As managed care plans compete for business primarily on their rate structures, these plans emphasize controlling patient access to care and lowering payments to providers while increasing patient co-pays and deductibles.
3. As payments to hospitals are reduced, access to care for the uninsured is eroded because these hospitals have less financial capacity to provide charity care.

Question 27

. Why do nurses need to understand these policies?

Answer 27

1. As advocates, nurses must ensure that clients are informed of their rights and have the correct information on which to base health care decisions.
2. Understand how our patients are affected by them
   Advocate for changes

Question 28

15. Understand the similarities and differences in types of nursing degrees: LPN, A.D.N., BSN.

Answer 28

LPN- 1 year
ADN – 2 year
BSN-4 year

Question 29

16. Review all Safety PPT, JC recommendations and goals for patient safety, medication safety

Answer 29

Goal One. Identify patients correctly.
Goal Two. Improve effective communication.
Goal Three. Improve the safety of high-alert medications.
Goal Four. Ensure safe surgery.
Goal Five. Reduce the risk of health care-associated infections.
Goal Six. Reduce the risk of patient harm resulting from falls.

Question 30

17. Review information for Delegation principles and Delegation in relation to Assistive Personnel

Answer 30

ADL’s, bathing, grooming, dressing, toileting, ambulating, feeding (without swallowing issues/precautions), positioning, routine tasks, bed making, specimen collection, intake and output, vital signs for stable clients. Basic CPR
Right task
Right circumstance
Right person
Right direction/communication
Right supervision/evaluation

Question 31

18. Review Leadership and Management principles

Answer 31

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