Final Exam: Flashcards
Teamwork:
A STRONG Nursing Team works together to achieve the best outcomes for patients
Effective team development requires team building and training, trust, communication, and a workplace that facililtates collaboration
Leadership Qualities and skill:
charismatic
dynamic
enthusiastic
poised
confident
self-directed
flexible
knowledgeable
politically aware
leadership Skills:
commitment to excellence
problem solving skills
commitment to and passion for ones work
trustworthiness and integrity
respectfulness
accessibility
empathy and caring
responsbility to enhance personal growth of all staff
Five Model components of Magnet Status:
transformational leadership
structural empowerment
exemplary professional practice
new knowledge, innovation, and improvements
empirical quality results
Conflict Resolution strategies:
avoiding
collaborating
competing
compromising
cooperating/accommodating
smoothing
Lewins Theory of change:
Unfreezing: the need for change is recognized
Moving: change is initiated after a careful process of planning
Refreezing: change becomes operational
Reasons for resistance to change:
threat to self
lack of understanding
limited tolerance for change
disagreement about the benefits of change
fear of increased responsibility
Overcoming resistance to change:
explain proposed change to all affected
list the advantages of the change
relate the change to the person existing beliefs and values
provide opportunites for open communication and feedback
indicate how change will be evaluated
introduce change gradually
provide incentives for commitment to change
Achieving self-knowledge:
identify your strengths
evaluate how you accomplish work
clarify your values
determine where you belong and what you can contribute
assume responsibility for relationships
developing leadership responsibilities:
Mentorship
Preceptorship
Nursing Organizations
Continuing education
Steps for using time effectively:
establish goals and priorities for each day
evaluate goals in terms of your ability to meet needs of patients
establish a time line
evaluate your success or failure in managing time
use these results to direct your day priorities and time line
Priorities setting:
determine which patient needs should address first:
High priority: immediate threat to patient survival or safety
Intermediate priority: nonemergent, non-life threatening
Low priority: actual or potential problems may or may not be directly related to patient illness or disease
Considerations when delegating Nursing Care:
patient condition
complexity of the activity
potential for harm
degree of problem solving and innovation necessary
level of interaction required with the patient
capabilities of the UAP
avaliability of professional staff to accomplish workload
ANA Principles for delegating Care:
the nursing profession determines the scope of nursing practice
the nursing profession defines and supervises UAP involved in providing direct nurse care
the RN is responsible and accountable for nursing practice
the RN supervises any assistant providing direct patient care
the purpose of UAP is to work in supportive role to the RN
Factors to consider prior to delegating patient care:
qualifications and capabilites of the UAP
stability of the patient condition
complexity of the activity to be delegated
the potential for harm
the predictability of the outcome
the overall context of other patient needs
Time Management:
remain goal oriented
identity priorities
establish personal goals
make to do list
delegate
anticipate
Purpose of patient record:
communication
diagnostic and therapeutic orders
care planning
quality process and performance improvement
research; decision analysis
education
credentialing, regulation, legislation
reimburesement
legal and historical documentation
characteristics of effective documentation:
Factual:
subjective data: pt yelling “ I want to kill my boyfriend”
Objective data:
Descriptive: what the nurse sees, hears, feels, and smells
do not write pt is agitated, write pt is pacing back and forth in his room yelling loudly
Accurate and concise:
facts only, exact measurement, only approve abbreviations
Complete and accurate:
timely: never pre-chart
Organized: communicate in a logical sequence
consistent with health laws and facility standards
legally prudent
confidential
Confidentiality:
all information about patient written on paper, spoken aloud, saved on computer
name, address, phone, fax, social security number
Reason the person is sick
treatment patient receives
information about past health conditions
potential breaches in patient confidently:
displaying information on a public screen
sending confidential e-mail messages via public networks
sharing printers among units with differing functions
discard copies of patient information in trash cans
holding confidential information to unauthorized persons
sending confidental messages overheard on pagers
documentation tips
be accurate
avoid late entry: always date, time and signature/title
prioritize legibility
black, non-erasable ink
use the right tools
follow policy on abbreviations
document physician consultantion
chart the symptom and the treatment
avoid opinions and hearsay
chart only for yourself
do not leave black spaces, line or boxes on chart
write enough to convince a reader that the patient was adequately cared for
do not use correction fluid, erase, scratch out, or blacken out errors, make line through and sign
Common Nursing Documentation Errors:
medication, allergy or pertinent health omission
failing to record nursing action
failing to record that medications have been given
recording on the wrong chart
blank items on a chart
unclear orders, transcribe order improperly
failure to communicate and monitor
failure to record drug reactions or changes in the patient condition
failure to document a discontinued medication
writing illegible
failure to date, time, and sign medical entry
document subjective data
using the wrong abberviations
8 behaviors of purposeful rounding:
use opening key words (C-I-CARE) with PRESENCE
accomplish scheduled task
address four Ps
address additional personal needs, questions
conduct enviromental assessment
Ask is there anything else I can do for you? I have time.
Tell the patient when you will be back
document the round
Conferring about care:
consultations and referrals
nursing and interdiscipinary team care conferences
nursing care round
purposeful rounding
HIPPA:
Health insurance portability and accountability act
security and privacy of medical records and protected health information (PHI)
Protecting patient Privacy:
tips for safeguarding PHI:
Paper:
never leave a medical record or other printed or written PHI where other can access it
shred any printed or written patient information for reporting or patient care after use
properly dispose of document in a confidental waste container
Electronic:
log off from computer before leaving the workstation
make sure computer screens cannot be viewed by the public
never share a user ID or password with anyone
Social Media Precautions:
know the implications of HIPAA before using social networking sites for school or work related communication
many organizations, it will be against the code of conduct when taking pictures in an hospital
become familiar with your facility policy regarding the use of social networking
do not use or view social networking media in clinical setting
do not post information about your facility, clinical sites, clinical experience, patient or other health care staff
do not take pictures that show patient or family members
Patient Rights
patient have the right to:
see and copy their health record
update their health record
get a list of disclosures
request a restriction on certain uses or disclosures
choose how to recieve health information
Change of Shift/Hand- off reports:
basic identifying information about each patient: name, room number, bed designation, diagnosis, and attending and consulting physicans
current appraisal of each patient health status
current orders (esp any new changed orders)
abnormal occurrences during shift
any unfilled orders that need to be continues onto next shift
patient/family questions, concern, needs
report on transfers/discharge
Telephone/Telemedicine Reports:
identify yourself and the patient, state relationship to patient
report concisely and accurately the change in the patient condition that is of concern and what has already been done in reponse to this condition
report patient vital signs and clinical manifestations
have patient record at hand to make knowledgeable responses to any physcian inquiries
concisely record time and date of the call, what was communicated and physicians response
Formats for Nursing Documentation:
initial nursing assessement
care plan; patient care summary
critical collaborative pathway
progress notes
flow sheets and graphic records
medication record
acuity record
discharge and transfer summary
long-term care and home health care documentation
Method of documentation:
computerized documentation/ electronic health records (EHRs)
source- oriented records
problem-oriented medical records
PIE charting (problem, intervention, evaluation)
focus charting
charting by exception
case management model
Duties of RN receiving Telephone Orders (TO)
record the orders in patient medical record
read orders back to practitioner to verify accuracy
date and note the time orders were issued
record telephone records, and full name and title of physician or nurse who issued orders
sign the orders with name and title
Verbal Orders:
review orders for accuracy
sign orders with name, title, and pager number
date and note orders signed
Protected Health Information (PHI)
HIPAA has defined 18 identifiers that compose individually identifiable health information:
names, including initials
street address, city, county, zip code
all elements of date
telephone number
fax number
email address
social security number
medical record number
Health plan ID number
account numbers
certificate/lisense number
vehicle identifer and serial number
device identifiers/serial number
web addresses
Internet IP address
biometric identifers
full face photographic and comparable images
any other unique identifying characterisitc or code
7 Basic Tenets of bill of rights for RNS registered:
practice in a manner that fulfills obligations to society and to those who receive nursing care
practice in environments that allow them to act in accordance with professional standards and legally authorized scope of practice
work in environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurse
freely and openly advocate for themselves and their patient, without fear of retribution
receive fair compensation for their work, consistent with their knowledge, experience, and professional resonsibilites
practice in a work environment that is safe for themselves and their patient
negotiate the conditions of their emplyment, either as individuals or collectively, in all practice setting
Basic Terms in Health Ethics:
Autonomy: commitment to include patient in decisions
Beneficence: taking positive actions to help others
Nonmaleficence: avoidance of harm or hurt
Justice: being fair
Fidelity: agreement to keep promises
Values:
Value: personal belief about the worth of a given idea, attitude, custom or object that sets standards that influence behavior
Value Clarification:
ethical dilemmas almost always occur in the presence of conflicting value
to resolve ethical dilemmas, one needs to distinguish among value, fact and opinion
Professional Value:
Altruism: concern for welfare and well-being of others
Autonomy: right to self-determination
Human dignity: respect for inherent worth and uniqueness of individuals and populations
Integrity: acting according to code of ethics and standard of practice
Social Justice: upholding moral, legal, and humanistic rights
Processing an ethical dilemma:
Assess the situation (gather data)
diagnose (identify) the ethical problem
Plan:
identify options
think ethical problem though
make a decision
Implement your decision
evaluate your decision
Institutional Resources:
ethics committee are usually multidiscipinary and serve several purpose; education, policy, recommendation, case review, and consultation, occasionally research
any person involved in an ethical dilemma, including nurse, physicians, health care providers, patient, and family member, can request access to an ethic committee
Professional and Legal regulation of nursing practice:
nurse practice acts
standards
credentialing
accreditation
lisensure
certification
Ethical Issues:
paternalism
deception
privacy
confidentiality
allocation of scarce nursing resources
valid consent or refusal
conflict concerning new technologies
unprofessional, imcompetent, unethical, or illegal physicican practice
unprofessional, imcompetent, unethical, or illegal nurse practice
short staffing and whistle blowing
beginning of life issue
end of life issue
Reasons for suspending or revoking a license:
drug or alcohol abuse
fraud
deceptive practice
criminal acts
previous displinary actions
gross or ordinary negligence
physical or mental impairment including age
Standards of Care:
Internal Standards:
Job description
education
expertise
institutional polices and procedures
4 Elements of Liability:
duty
breach of duty
causation
damages
Nursing Students and Liability:
you are liable if your action cause harm to patients, as is your instructor, hospital, and college/university
never perform a task that you dont feel prepared to safely complete
you are expected to perform as a professional when rendering care
you must separate your student nurse role from your work as certified nursing assistant (CNA)
Incident Reports:
complete name of person and name of witness
factual account of incident
date, time, and place of incident
pertinent characteristics of person involved
any equipment or resources being used
any other important variables
documentation by physician of medical exam of person involved
Legal Safeguards for nurse:
adequate staffing
whistle-blowing
professional liability insurance
risk management programs
just culture
incident, variance, or occurance reports; sentinel events and never events
patient rights
good samaritian law
student liability
competent practice
informed consent/ refusal
contracts
collective bargaining
patient education
executing physican orders
delegating nursing care
documentation
appropriate use of social media
Elements of Informed consent:
disclosure
comprehension
competence
voluntariness
Safeguards to competent Practice:
developing interpersonal communication skill
respecting legal boundaries of practice
following institutional procedures and policy
owning personal strengths and weakness
evaluating proposed assignment
keeping current in nursing knowledge and skills
respecting patient rights and developing rapport with patient
keeping careful documentation
working within agency for management policy
Categories of Negligence that result in malpractice:
failure to follow standards of care
failure to use equipment in a responsible manner
failure to communicate
failure to document
failure to assess and monitor
failure to act as a client advocate
Aims of teaching and counseling:
maintaining and promoting health
preventing illness
restoring health
facilitating coping
Teaching Outcome:
high level wellness and related self care practice
disease prevention or early detection
quick recovery from trauma or illness with minimal or no complication
enhanced ability to adjust to developmental life changes and acute, chronic, and terminal illness
patient and family acceptance of lifestyle necessitated by illness or disability
Basic Learning Principles:
Motivation to learn: addresses the patient desire or willingness to learn
Ability to learn: depends on physical and cognitive abilities, developmental level, physical wellness, thought processes
Learning Environment: allows a person to attend to instruction
Factors affecting Patient learning:
age and developmental level
family support networks
financial resources
cultural influences
language deficits
health literacy level
Critical development areas:
physical maturation and abilities
psychosocial development
cognitive capacity
emotional maturity
moral and spiritual development
Four assumptions about adult learners:
as a person matures, one self- concept is likely to move from dependence to independence
the previous experience of the adult is a rich resource for learning
an adult readiness to learn if often related to a developmental task or social role
most adult orientation to learning is that material should be useful immediately, rather than at some time in the future
COPE MODEL
C: creativity
O: optimism
P:planning
E: expert information
Providing culturally competent patient education:
develop an understanding of the patient culture
work with multicultural team
be aware of personal assumptions, biases, and prejudices
understand the core cultural value of the patient or group
develop written material in patient preferred language
Teaching plan for older adults:
identify learning barrier
allow extra time
plan short teaching sessions
accommodate for sensory deficits
reduce environmental distractions
relate new information to familiar activities or information
Health literacy: ask me 3 questions
what is my main problem
what do i need to do?
why is it important for me to do this?
Three learning domains:
cognitive: storing and recalling of new knowledge in brain
psychomotor: learning a physical skill
affective: changing attitude, value, feeling
Assessment Parameters:
knowledge, attitude, and skills needed to be independent
readiness to learn
ability to learn
learning strengths
Consideration for successful patient teaching:
forming contractual agreement
considering time constraints
scheduling
group vs. individual teaching
formal vs informal teaching
manipulating the physical enviroment
Key points to effective communication:
be sincere and honest
avoid to much detail and stick to basics
ask for questions
be a cheerleader for the patient
use simple vocab
vary tone of voice
keep content clear and concise
listen and do not interupt
ensure that the environment is conducive to learning and free of interuptions
be sensitive to the timing of teaching sessions
Documentation of the teaching- learning process:
Learner: patient, family, caregiver
How: verbal, demonstration, written, video, TV translator, group, class
Barrier to learning: communication difficulties, physical impairment, cognitive impairment, sensory impairment, cultural barriers, denies/resists, emotional barrier, religious barrier, language, readiness/motivation, no barrier
Evaluation: verbalized understanding, demonstrates ability, needs reinforcement, not able (explain)
Teach Back:s
start with most important message
focus on 2-4 key points
use plain language no medical jargon
Nurse Coaching Process
establishing relationship and identifying readiness for change
identifying opportunities, issue, and concern
establishing patient- centered goals
creating structure of the coaching interaction
empowering and motiviating patient to reach goal
assisting the patient to determine progress toward goal
