Module 01: Aspects of Nursing Flashcards
This aspect of nursing is learning to deliver care with compassion, caring and respect for patient dignity and individuality.
Nursing as an Art
This gist of nursing is based on body of knowledge and evidence-based practices that are continually changing.
Nursing as a Science
In the gist of nursing as a profession, this is known as the center of the nursing practice.
The patient - individuals, families or communities
How is nursing defined under nursing as a profession?
Nursing is not simply a collection of specific skills and a nurse is not simply a person trained to perform specific tasks.
How should nurses act professionally?
To act professionally, the nurse must use critical thinking, administer high- quality, evidence-based patient-centered care in a safe, prudent and knowledgeable manner. The nurse is responsible and accountable to self, patients and peers
According to this, Nursing incorporates the art and science of caring and focuses on the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.
American Nurses Association (ANA), 2021
According to them, Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.
International Council of Nurses (ICN), 2021
According to this law, A person shall be deemed to be practicing nursing within the meaning of RA No. _____when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, adulthood and old age. As member independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of cares, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.
REPUBLIC ACT NO. 9173, 2002 ARTICLE VI: NURSING PRACTICE & PRC Board Resolution No. 425, 2003
How should the nurse provide nursing care through the utilization of the nursing process?
(1) Traditional and innovative approaches
(2) Therapeutic use of self
(3) Execute health care techniques and procedures
(4) Essential primary health care
(5) Comfort measures
(6) Health teaching
(7) Administration of written prescription for treatment, therapies, oral, topics and parenteral medications
(8) Internal examination during labor (no antenatal bleeding)
(8) Suturing of perineal laceration with special training
What are the duties of the nurse?
(1) Provide nursing care through the utilization of the nursing process
(2) Establish linkages with community resources and coordination with health team
(3) Provide health education
(4) Teach, guide and supervise students in nursing education programs, undertake consultation services, engage in activities that require the utilization of knowledge and decision-making skills
(5) Undertake nursing and health human resource development training and research to include development of advance nursing practice
What does the scope of nursing?
(1) Observe the Code of Ethics and upholds standards of Practice
(2) Continual learning through continuing professional education provided by accredited professional organization
What is the beginning or preceding role of the nurse in client care?
(1) Practices in accordance with legal principles and the code of ethics in making personal and professional judgment
(2) Utilizes the nursing process in the interdisciplinary care of clients that empowers the clients and promotes safe quality care
(3) Maintains complete, accurate and up-to-date recording and reporting system
(4) Establishes collaborative relationship with colleagues and other members of the team to enhance nursing and other health care services
(5) Promotes professional and personal growth and development
What is the beginning or preceding role of the nurse in management and leadership?
(1) Demonstrates management and leadership skills to
provide safe and quality care
(2) Demonstrates accountability for safe nursing practice
(3) Demonstrates management and leadership skills to deliver health programs and services effectively to specific client groups in the community setting
(4) Manages a community/village based health facility/component of a health program or a nursing service
(5) Demonstrates ability to lead and supervise nursing
support staff
(6) Utilizes appropriate mechanism for networking, linkage building and referrals
What is the beginning or preceding role on research?
(1) Engages in nursing or health related research with or under the supervision of an experienced researcher
(2) Evaluate research study/ report utilizing guidelines in the conduct of written research critique
(3) Applies the research process in improving patient care in partnership with a quality improvement/ quality assurance/ nursing audit team
This delineated as a statement of philosophical ideals of right and wrong that define the principles the nurse will use to provide care to clients
Code of Ethics
What is the code of ethics that nurses adhere too?
PRC BON BOARD RESOLUTION NO. 220, SERIES OF 2004
What are the professional responsibilities and roles of a nurse?
(1) Autonomy and accountability
(2) Caregiver
(3) Patient advocate
(4) Educator
(5) Communicator
(6) Manager
What are the trends in the nursing profession?
(1) Importance of nurses’ self-care (burnout, compassion fatigue, work-life balance, experience of grief and loss)
(2) Health care reform and costs
(3) Demographic changes
(4) Evidence-based practice
(5) Quality and safety education for nurses
(6) Emerging information technologies
(7) Genomics
(8)Health policy
This is the organization of people, institutions, and resources to deliver health care services to meet the health needs of a target population, whether a single provider practice or a large health care system. This is the totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems and concerns of the people
Health Care Delivery System
In the US, this is termed which were developed with a focus on improving health care quality and decreasing overall health care costs
Integrated Health Care Delivery
In the Philippines, this is termed which were redefined to suit Universal Health Care or Kalusugang Pangkalahatan
Service Delivery Network
This level of health care services and disease prevention is based on the notion of maintaining an optimum level of wellness.
Primary Prevention (Health Promotion and Illness Prevention)
What are the activities under Primary Prevention (Health Promotion and Illness Prevention)?
Adequate and proper nutrition, weight control and exercise, Stress reduction, smoking cessation campaigns, environmental programs
This level of health care services and disease prevention requires emergency, intensive, and around the clock acute care.
Secondary Prevention (Diagnosis and Treatment)
What are the activities under Secondary Prevention (Diagnosis and Treatment)?
Early detection and screening, diagnostic and treatment facilities, outpatient surgical units
This level of health care services and disease prevention helps individuals move to their previous level of health.
Tertiary Prevention - Rehabilitation, Health Restoration and Palliative Care
What are the activities under This level of health care services and disease prevention?
End of life care Rehabilitation services
This framework of care is centered on healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improve outcomes to group of clients
Managed Care
This framework of care involves multidisciplinary teams that assume collaborative responsibility for care for groups of clients. Uses critical pathways to track client’s progress
Case Management
This framework of care is narrowed on the system which utilizes the best possible use of nursing personnel based on education preparation and skill sets
Differentiated Practice
This framework of care occurs when one nurse is assigned to and responsible for the comprehensive care of a group of
clients during a shift
Case Method – (total care)
This framework of care focuses on jobs to be completed, based on production and efficiency model
Functional Method
This framework of care is narrowed down on the delivery of nursing care to individual clients by a group of providers led by a professional nurse
Team Nursing
This framework of care transpires when one nurse is responsible for overseeing the total care of a number of hospitalized client 24 hours a day, 7 days a week
Primary Nursing
This is a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician’s expertise, patient preferences and values and available heath care resources in making decisions about patient care
Evidence Based Practice (EBP)
What constitutes Evidence Based Practice (EBP)?
(1) Evidence from research, evidence based theories, clinical experts, and opinion leaders
(2) Evidence from assessment of patient’s history and physical and available health care resources
(3) Clinical Expertise
(4) Information about patient preferences and values
What are the steps for executing and procuring evidence-based practice?
(1) Cultivate a spirit of inquiry within an EBP culture and environment.
(2) Ask a clinical question in PICOT format.
(3) Search for the most relevant and best evidence.
(4) Critically appraise the evidence you gather.
(5) Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision.
(6) Evaluate the outcomes of practice changes based on evidence.
(7) Communicate the outcomes of EBP decision or changes
What does the PICOT format of a research question stand for?
(1) Population
(2) Intervention
(3) Comparison
(4) Outcome
(5) Time Frame
Under the the PICOT format of a research question, this answers what specific patient population is of interest?
Population
Under the PICOT format of a research question, this answers what intervention or policy is being studied?
Intervention
Under the PICOT format of a research question, this answers what is the main alternative?
Comparison
Under the PICOT format of a research question, this answers the question of what should be measured?
Outcome
Under the PICOT format of a research question, this answers the question of what is the appropriate time period to assess outcomes?
Time Frame
This level of evidences is a s systematic review of meta analysis of randomized controlled trials (RCTs) along with evidence- based clinical practice guidelines based on systematic reviews.
Level I
This level of evidence is delineated as a well-designed RCT.
Level II
This level of evidence is delineated as a controlled trial without randomization (quasiexperimental study)
Level III
This level of evidence is delineated as a single non experimental study (case control, correlational and cohort studies).
Level IV
This level of evidence is based on systematic reviews of descriptive and qualitative studies.
Level V
This level of evidence is delineated as a single descriptive or qualitative study.
Level VI
This level of evidence is narrowed down on the opinion of authorities and/or reports of expert committees.
Level VII
This is a key communication strategy that produces a written account of pertinent patient data, clinical decisions and interventions and patient responses.
Documentation
What is the purpose of the health care record under the informatics and documentation?
(1) Facilitating interprofessional communication
(2) Legal record of care provided
(3) Justification for financial billing and reimbursement of care
(4) Audit, monitor and evaluate care provided for quality improvement
(5) Resource for education and research
What are the legal guidelines for documentation?
(1) Do not document retaliatory or critical comments about a patient or care provided by another healthcare professional. Quote all patient statements
(2) Correct all records promptly.
(3) Record all facts
(4) Document discussions with providers that you
initiate.
(5) Document only for yourself
(6) Avoid using generalized, empty phrases such as status unchanged, had good day
(7) Begin each entry with date and time and end with your signature and credentials
(8) Protect security of your password
(9) Do not erase or scratch out errors while recording
(10) Do not leave blank spaces or lines in a written progress note
(11) Record all written entries legibly using black ink.
What are the different approaches or formats of nursing documentation?
(1) Narrative
(2) PIE (P-Nursing problem or diagnoses, Interventions and Nursing Evaluation)
(3) FDAR (Focus, Data (Subjective and Objective), Action or nursing intervention, Response of the patient)
(4) SOAP (Subjective, Objective, Assessment and Plan)
Under PIE, this pertains to the lack of Knowledge related to inexperience with disease condition
Nursing Problem
Under PIE, this pertains to the approach that will be used to address the problem-Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves.
Interventions
Under PIE, this is where the Patient states, “I’m worried about the blood clot, but I understand how it is being treated.” Able to teach back and verbalize that the heparin infusion will be stopped when PT/INR tests are “normal.” Also statesate Windows that he expects to take warfarin for about 6 months until clot in leg dissolves.
Nursing Evaluation
Under FDAR, this is when the Patient states, “My leg is so swollen. I’m worried about this blood clot. Do you know how they are going to treat it?”
Data
Under FDAR this pertains to the provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level.
Action or nursing intervention
Under FDAR, this pertains to the ability to teach back and verbalized that heparin infusion will be stopped when PT/INR reaches “normal level” and that he can expect to take warfarin for 6 months after discharge until clot is fully resolved.
Response of the patient
Under SOAP, this is when the patient states, “My leg is so swollen. I’m worried about this blood clot. Do you know how they are going to treat it?”
Subjective
Under SOAP, this is when the patient asking question about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction.
Objective
Under SOAP, this is when the patient lacks knowledge regarding anticoagulation therapy, seeking information about therapy.
Assessment
Under SOAP, this section discusses the importance of bed rest and the reason for treatment with heparin infusion. Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves.
Plan
In this, all standards for normal assessment findings or for routine care activities are met unless otherwise documented
Charting by Exception
Under Charting by exception, it incorporates standards of care and use clearly, predefined statements for nursing documentation of ___________________.
”Within Define Limits (WDL) or “Within Normal Limits” (WNL)
This helps determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours. This is not part of the patient’s health record
Acuity Rating Systems
Under the acuity of rating systems, this rating pertains to independent in all but one or two aspects of care, almost
ready for discharge.
1
Under Acuity Rating Systems, this pertains to totally dependent in all aspects of care, requiring intensive care
5
What is the acuity rating systems?
A classification that compares one or more patients with another group of patients from 1 (independent in all but one or two aspects of care, almost ready for discharge) to 5 (totally dependent in all aspects of care, requiring intensive care)
This is know as the use of information systems and other information technology to record, monitor, and
deliver patient care, and to perform managerial and organizational functions in health care
Healthcare Information Technology (HIT)
This is defined as a “large, computerized database management system that is used to access patient data needed to plan, implement, and evaluate care.”
Clinical Information System
This is defined “computer hardware and software dedicated to the collection, storage, processing, retrieval, and communication of patient care information in a healthcare agency”
Healthcare information system
This “contains rules and logic statements that link information required for clinical decisions to generate tailored recommendations for individual patients; the recommendations are presented to health care providers as alerts, warnings, or other information for consideration”
Clinical Decision Support Systems
This Is a universal phenomenon influencing the ways in which people think, feel and behave in relation to one another.
Caring
Through caring, how can nurses help patients?
Through caring, nurses help patients recover in the face of illness, give meaning to their illness and maintain or reestablish connection
This is used to probe into and evaluate patient’s perception of caring
Caring Assessment Tool
Based on the gist of caring in the nursing practice, how is caring and compassion represented?
Our patients tell us that a simple touch, a simple phrase or a promise to remain at the bedside represent caring and compassion.
What does caring in the nursing practice include?
(1) Providing Presence - person-to-person encounter conveying a closeness and sense of caring. Eye contact, body language, voice tone, listening and a positive and encouraging attitude act together to create openness and understanding
(2) Touch – comfort measure that reaches out to patients to communicate concern and support. It may be contact touch, caring touch, protective touch, therapeutic touch
(3) Listening – silence yourself and listen with an open mind
(4) Knowing the patient - based on Swanson theory of caring
(5) Spiritual Caring
(6) Relieving symptoms and suffering
Patient safety requires this among all members of the health care team as patient move from one caregiver to another.
effective communication
Why is communication essential?
Communication is essential to establish nurse-patient relationships and deliver high quality patient-centered care
What are the challenging situations?
(1) People who speak and or understand little English
(2) People who are silent or withdrawn and have difficulty expressing feelings or needs
(3) People who are sad and depressed
(4) People who require assistance with visual or speech disabilities (special needs)
(5) People who are angry or confrontational and cannot listen explanations
(6) People who are uncooperative and resent being asked to help others
(7) People who are talkative or lonely and want someone to be with them all the time
(8) People who are demanding and expect others to meet their requests
(9) People who are frightened, anxious, and having difficulty coping
(10) People who have cognitive disorders such as dementia or are confused and disoriented
(11) People who are flirtatious or sexually inappropriate
What are the five (5) levels of communication?
(1) Intrapersonal Communication
(2) Interpersonal Communication
(3) Small group Communication
(4) Public Communication
(5) Electronic Communication
Elements of the Communication Process
(1) Channel
(2) Sender
(3) Receiver
(4) Message
(5) Feedback
(6) Channel (Medium)
These are important aspects such as vocabulary, denotative and connotative meanings, pacing, intonation, clarity and brevity
Verbal Communication
This includes personal appearance, posture and gait, facial expression, eye contact gestures, sounds and territoriality and personal space
Nonverbal Communication
What is zone 1?
Intimate distance zone (0-18”) - Appropriate for parents and children, lovers, spouses or partners
What is zone 2?
Personal distance zone (18” - 4’) - Appropriate for close friends
What is zone 3?
Social distance zone (4’ - 12’) - Appropriate for co-workers, social gatherings, friends, work situations
What is zone 4?
Public distance zone (12’+) - Appropriate for actors, total strangers, and important officials
What are the different zones of touch?
(1) Social Zone
(2) Consent Zone
(3) Vulnerable Zone
(4) Intimate Zone
In this zone of touch, permission is usually not needed.
Social Zone
In this zone of touch, permission is needed.
Consent Zone
In this zone of touch, special care is needed.
Vulnerable Zone
In this zone of touch, permission and great sensitivity is greatly needed.
Intimate Zone
Which areas of the body falls under the social zone?
Hands, arms, shoulders and back
Which areas of the body falls under the consent zone?
Mouth, Wrists, Feet
Which areas of the body falls under the vulnerable zone?
Face, neck, front of the body
Which areas of the body falls under the intimate zone?
Genitalia and rectum
What are the six (6) elements of professional communication?
(1) A professional is expected to be clean, neat, well groomed, conservatively dressed and odor free
(2) Courtesy
(3) Use of Names
(4) Trustworthiness
(5) Autonomy and responsibility
(6) Assertiveness
In this NCHC standard, immediately acknowledge the importance of every patient/family/customer/coworker, confirm their presence by making eye contact* or smiling and greeting them. “Hello” “How may I help you?”. “I will be with you shortly” “Culturally appropriate eye contact
Acknowledge
In this NCHC standard, introduce yourself with name and title to each patient/family/customer/coworker and identify the type of care you are providing. To reduce patient anxiety, manage up your skills and experience as well as those of other team members and departments. Encourage others by using genuine compliments and praise; look for ways to preserve and build others’ self-esteem
Introduction
In this NCHC standard, by providing information about time, we set clear expectations with the patient/family/customer/coworker. How long before the test, procedure, visit or admission takes place? How long will the test, procedure, appointment or admission actually take? How long until the test results are available? * How long it will take you to complete the task or follow-up?
Duration
In this NCHC standard, explain to every patient what they can expect. Where the patient is going next? * Who is taking the patient to their destination? What will happen once they arrive? Include the patient in decisions regarding their care by providing explanations before beginning a procedure and asking the patient if they have any questions. Use easily understood and appropriate language when giving patients information about health, special diets, tests, procedures or medication. What’s the process for the task.
Explain
In this NCHC standard, All patient/family/customer/coworker are worth our effort-they are the reason we’re here! Take the time to thank them and let them know you’re happy to serve them. VS “Thank you for letting me care for you” “It was my pleasure to help” “Thank you for choosing North Country Health Care”. “I’m glad I can support your department”
Thank
These are specific responses that encourage expression of feelings and ideas and convey acceptance and respect
Therapeutic Communication Techniques
This disruptive behavior under communication among health professionals are behaviors that are disrespectful, rude, impolite and promote conflict while increasing stress
Incivility
This disruptive behavior under communication among health professionals are repeated, health-harming mistreatment of one or more persons by one or more perpetrators
Bullying
This disruptive behavior under communication among health professionals is any act tor threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the worksite
Workplace Violence
What falls under workplace violence?
(1) Criminal Intent
(2) Customer or client
(3) Worker on worker
(4) Personal Relationship
Under the Framework for nurse-healthcare provider communication, what does SBAR stand for?
(1) Situation
(2) Background
(3) Assessment
(4) Recommendation
Under SBAR in the Framework for nurse-healthcare provider communication, this refers to “What is the situation you are calling about? Provide your name, health agency, client name, and brief information about the problem.”
Situation
Under SBAR in the Framework for nurse-healthcare provider communication, this provides information pertinent to the current situation, such as admitting diagnosis, date of admission, and important clinical information that relates to the call.
Background
Under SBAR in the Framework for nurse-healthcare provider communication, this refers to the current condition of the client (e.g., vital signs, oxygen saturation, pain scale, level of consciousness) and any change in the assessment since the previous communication. Indicate the severity of the problem
Assessment
Under SBAR in the Framework for nurse-healthcare provider communication, this refers to “What is your recommendation for resolving the problem, or what do you need from the healthcare provider (e.g., come see the client, transfer to another unit, or an order for a medication)?”
Recommendation
