Module 7 Flashcards

1
Q

Outcome Identification is essentially..

A

a goal

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2
Q

Steps of Outcome Identification / Planning

A
  1. Establish priorities
  2. ID and write expected patient outcomes
  3. Select EBP nursing interventions
  4. Communicate care plan
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3
Q

What things does a formal care plan allow the nurse to do?

A

Individualize Care

Facilitate Communication

Set Priorities

Give high quality care

Have coordinated care

Evaluate patient response

Create a record

Promote professional development

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4
Q

To Clinically Reason in the Planning (Outcome ID stage) you must…

A

Be familiar with policies

Keep patient at the center

Keep the “big picture” in mind

Trust clinical judgment, but do not fear asking for help

Trust your intuitions

Recognize biases and keep an open mind

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5
Q

What standards must be applied to planning and outcome ID?

A

The Law

National Practice Standards

Specialty Professional Organization

Joint Commission

AHRQ

Employer Standards

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6
Q

3 Elements/Types of Comprehensive Planning

A

Initial

Ongoing

Discharge

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7
Q

Initial Planning

A

Done by nurse who does health history and phys assessment on admission

Comes up with priority problems and identifies appropriate patient goals and related nursing care - puts nursing plan together to achieve goals

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8
Q

Ongoing Planning

A

Non-admission nurses continue care plan and might add something to the diagnosis, keep it up to date, manage risks, promote function, and state the diagnosis and new diagnosis more clearly

Makes outcomes realistic and develops new ones as needed

ID’s nursing interventions to accomplish goals

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9
Q

Discharge Planning

A

Carried out by nurse working closely with patient

Begins on admission and teaches/counsels them in effective skills and knowledge to ensure home care behaviors are done competently

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10
Q

Prioritizing Nursing Diagnoses

A

High Priority > Medium > Low

Greatest threat to well being > non threatening diagnosis > diagnoses not specifically related to current health problem

Keep maslows in mind while prioritizing

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11
Q

Maslow’s Hierarchy Levels

A

Physiologic Needs > Safety > Love and Belonging > Self-Esteem > Self-Actualization

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12
Q

When clinically reasoning and establishing priorities, what things should be kept in mind?

A

What problems need immediate attention

What is my responsibility and what to refer to others

Which problem can use standard plans

Which problems don’t have protocols or standard plans but need addressing

Has the health status changed?

Have changes in patient changed ability of the diagnosis to address the problem?

Are there diagnoses relationships that have a hierarchy of which to work on first?

Can several problems be dealt with at once?

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13
Q

Long-Term Outcomes

A

require longer periods to be achieved

Maybe used as discharge goals

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14
Q

Short Term Outcomes

A

may be accomplished in a specified time period

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15
Q

The parts of a measurable outcome can be determined by using ____

A

S M A R T

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16
Q

What does SMART stand for

A
Specific
Measurable
Attainable
Relevant
Time
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17
Q

Decker Care Plan Outlines Include

A

Nursing Diagnosis
Long Term Goal
2 Short Term Goals
2 Evidence Based Interventions

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18
Q

IOM

A

Institute of Medicine

They have stated 6 goals to be met by healthcare systems to reach quality of care

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19
Q

6 IOM Goals Regarding Quality of Care

A
Safe Care
Effective Care
Patient Centered Care
Timely Care
Efficient Care
Equitable Care
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20
Q

Categories of Outcome Goals

A

Cognitive
Psychomotor
Affective

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21
Q

Cognitive Outcome

A

Described increases in patient knowledge or intellectual behaviors

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22
Q

Psychomotor Outcomes

A

Described patient’s achievement of new skills

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23
Q

Affective Outcomes

A

Described changes in patient values, beliefs, and attitudes

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24
Q

3 Types of Outcomes

A

Clinical
Functional
Quality of Life

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25
Q

Clinical Outcome

A

describe the expected status of health issues at certain points in time, after treatment is complete.

They address whether the problems are resolved or to what degree they are improved

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26
Q

Functional Outcomes

A

describes the person’s ability to function in relation to the desired usual activities

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27
Q

Quality of Life Outcomes

A

Focus on key factors that affect someone’s ability to enjoy life and achieve personal goals

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28
Q

Common Errors when writing patient outcomes?

A

Expressing patient outcome as a nursing intervention

Using verbs that are not observable or measurable

Including more than 1 patient behavior/manifestation in short term outcomes

Writing vague outcomes

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29
Q

Types of Nursing Interventions

A

Nurse Initiated
Physician Initiated
Collaborative

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30
Q

Nurse Initiated Intervention

A

Actions performed by the nurse without a physician’s order

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31
Q

Physician Initiated Intervention

A

Action initiated by a physician in response to a medical diagnosis but carried out by a nurse under doctor’s orders

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32
Q

Collaborative Intervention

A

treatments initiated by other providers and carried out by a nurse

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33
Q

Under a nursing intervention, include…

A

explanation of rationale with evidence based reasoning

34
Q

Actions commonly performed in nurse-initiated interventions

A

Monitoring health status

reducing risks

resolve, prevent, manage problems

Facilitate independence with assistance

Promote optimum sense of phys, psych, spirit well being

35
Q

Structured Care Methodologies

A

These can help make nursing care plans for specific situations:

Procedure
Standards of Care
Algorithm
Clinical Practice Guidelines

36
Q

Procedure

A

Set of how to action steps

37
Q

Standards of Care

A

Description of acceptable level of patient care

38
Q

Algorithm

A

set of steps used to make a decision

39
Q

Clinical Practice Guideline

A

statement outlining appropriate practice for clinical condition or procedure

40
Q

Types of Institutional Plans of Care

A

Computerized Plans of Care

Concept Map Plans of Care

Change of Shift Reports

Multidisciplinary (collaborative) Plans of Care

Student Plans of Care

41
Q

NIC and NOC

A

Nursing Intervention/Outcomes Classification

42
Q

What are the benefits of using NIC/NOC standardized languages?

A

Demonstrate impact nurses have

Defines knowledge base for nursing

Facilitates selection of approp interventions

Facilitates communication of nursing treatments to others

Enables research to examine effectiveness and cost of care

assists educators in developing curricula

Facilitates teaching of clinical decision making

assists administrators in planning

promotes development and use of nursing info systems

communicates nature of nursing in the public

43
Q

Purpose of the Implementation Stage of the Nursing process

A

Helps patients achieve valued health outcomes

promotes health and prevents illness

restores health

facilitates coping with altered fxning

44
Q

Aims for Nursing Outcome Classification Research

A

ID, Label, Validate, Classify Nursing Sensitive Patient outcomes and indicators

Evaluate validity and usefulness of classification

Define and test measurement procedures for outcomes and indicators

45
Q

Implementing involves…

A

carrying out the plan

continued data collection and plan modification

documentation of care

46
Q

How is clinical reasoning used with implementing

A

Reassesses when change in status that may need new interventions occurs

Helps find research to support best interventions

Monitors the patients responses to intervention so you can modify when needed

Alfaros Rule

47
Q

Alfaro’s Rule

A

Assess, Reassess, Revise, and Record

*do these things when implementing care plans

48
Q

Types of Nursing Interventions

A

Those providing direct and indirect care

Those aimed at individuals, family, and community

Those for nurse-initiated and other provider-initiated treatments

49
Q

How do you implement guidelines into the nursing care plan implementation?

A

Act in partnership with patient

Before implementing, reassess if action still needed

Approach patient competently and caringly

Modify interventions according to patient factors

check that interventions are consistent with standard of care and in legal/ethical guides of practice

Question if intervention is the best one to use

Develop repertoire of skilled nursing interventions

50
Q

How to implement the care plan

A

Determine patients new or cont need for assistance

promote self care (teaching, counseling, advocacy)

assist patient to achieve valued outcomes

reassess and review care plan

clarify prerequisite nursing competencies

organize resources

anticipate unexpected situations

prevent errors and omissions

assist patients to meet outcomes

51
Q

What to keep in mind when reassessing the patient and reviewing the care plan

A

Be sure each nursing intervention has scientific rationale

Be sure each intervention is consistent with professional standards

Be sure the actions are safe for the patient and individualized to their preferences

Clarify questionable orders

52
Q

Variables Influencing Outcome Achievement

A

Patient Variables
Nurse Variables
Health Care System Variables

53
Q

Patient Variables that may influence outcome achievement

A

development stage

psychosocial background and culture

54
Q

Nursing Variables that may influence outcome achievement

A

Resources

Current Standards of Care

Research Findings

Ethical and legal guides to practice

55
Q

Common Reasons for Patient Noncompliance

A

Lack of Family Support

Lack of Understanding Benefits

Low perceived value

Adverse physical/emotional effects

Inability to afford

Limited Access

56
Q

When a patient is noncompliant..

A

we should investigate the why (they may not want to say they cannot afford it)

57
Q

Five Rights of Delegation

A

Right Task

Right Circumstances

Right Person

Right Direction of Communication

Right Supervision and Evaluation

58
Q

Checklist for organizing STUDENT clinical responsibilities

A

Patient Profile and name they are to be addressed by

Patient chief complain and reason for admission

Routine assistance to meet basic human needs

Priorities for nursing care and special daily events

Special teaching, counseling, or advocacy needs

Special family needs

59
Q

Evaluation step of the nursing process involves..

A

the nurse and patient measuring how well achievement of outcomes has occurred

Nurse ID factors contributing to ability to achieve outcomes, and when needed, modified care plan

Purpose of evaluation is to allow the patients achievement of expected outcomes to direct future nurse patient interactions

60
Q

Possible Actions based on the patients response to the are plan

A

Termination

Modifications

Continuation

61
Q

5 Elements of Evaluation

A

ID Evaluative Criteria

Collect Data to see if criteria are met

Interpret and Summarize findings

Document Judgment

Terminating, Continuing, or Modifying Care Plan

62
Q

Criteria

A

Measurable qualities that specify skills, knowledge, or health status

they describe acceptable level of performance by stating expected behaviors of nurse or patient

63
Q

Standards

A

level of performance accepted and expected by the nursing stage

established by authority, custom, or consent

64
Q

Difference between Criteria and Standards

A

Criteria are measurable while standards are what we expect

65
Q

4 Types of Patient Outcomes

A

Cognitive - increased knowledge

Psychomotor - achieve new skills

Affective - changes in value, belief, attitude

Physiologic - physical change

66
Q

How to evaluate cognitive outcomes?

A

ask patient to repeat info or apply new knowledge

67
Q

How to evaluate psychomotor outcomes

A

ask patient to demonstrate new skills

68
Q

How to evaluate affective outcomes

A

observing patient behavior and conversation

69
Q

How to evaluate physiologic outcomes

A

using physical assessment skill to collect and compare data

70
Q

When doing evaluating statements…

A

describe how well the outcome was met and list patient date or behavior to support this decisions

71
Q

When describing evaluation statements on short term goals we use…

A

Met, Partially Met, Not Met

72
Q

When describing evaluation statements on long term goals we use…

A

the word “ongoing”

73
Q

When describing evaluation statements on nursing interventions we use…

A

the word “done”

74
Q

What things can be done in revision of the care plan?

A

Deletion or Modification depending on how goals turned out

Make outcome statements more realistic

Increase complexity of outcome statement

Adjust time criteria in outcome statement

Change the nursing intervention

75
Q

How to ensure adequacy of evaluation in your nursing process?

A

Evaluate patient achievements of desired outcomes

Review how the process is used

Revise care plan as necessary

Participate in quality assurance programs

76
Q

IOM’s 10 Rules to Redesign and Improve Care

A
  1. Care based on cont healing relationships
  2. Patient based customization
  3. Patient is source of control
  4. Shared knowledge and free info flow
  5. EBP decision making
  6. safety as priority
  7. the need for transparency
  8. anticipation of patient’s needs
  9. continuous decrease in waste
  10. cooperation among clinicians
77
Q

4 Steps to Improving Nursing Process Performance

A
  1. Discover a Problem
  2. Plan a strategy via indicators
  3. Implement change
  4. assess change and/or plan a new strat if outcomes not met
78
Q

How to improve professional performance among nurses?

A
Peer Review
Quality Assurance Programs
Structure Evaluations
Process Evaluation
Outcome Improvement
Nursing Audit
Concurrent and Retrospective Evaluation
79
Q

QSEN

A

Quality and Safety Education for nurses

The purpose of this initiative is to prep nurses with info, skills, and attitudes needed to continuously improve quality and safety of health care systems

80
Q

Elements of a Healthy Work Environment

A

Skilled communication

True collaboration

effective decision making

appropriate staffing

meaningful recognition

authentic leadership

81
Q

7 Critical Conversations to have About the Health care System

A

Broken Rules

Mistakes

Lack of Support

Incompetence

Poor Teamwork

Disrespect

Micromanagement

82
Q

Which of the 7 critical conversations to have about health care impact and put patient care at risk the most?

A

Poor Teamwork

Disrespect

Micromanagement