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NURS320 > Module 7 > Flashcards

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
Clinical Outcome
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
26
Functional Outcomes
describes the person's ability to function in relation to the desired usual activities
27
Quality of Life Outcomes
Focus on key factors that affect someone's ability to enjoy life and achieve personal goals
28
Common Errors when writing patient outcomes?
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
29
Types of Nursing Interventions
Nurse Initiated Physician Initiated Collaborative
30
Nurse Initiated Intervention
Actions performed by the nurse without a physician's order
31
Physician Initiated Intervention
Action initiated by a physician in response to a medical diagnosis but carried out by a nurse under doctor's orders
32
Collaborative Intervention
treatments initiated by other providers and carried out by a nurse
33
Under a nursing intervention, include...
explanation of rationale with evidence based reasoning
34
Actions commonly performed in nurse-initiated interventions
Monitoring health status reducing risks resolve, prevent, manage problems Facilitate independence with assistance Promote optimum sense of phys, psych, spirit well being
35
Structured Care Methodologies
These can help make nursing care plans for specific situations: Procedure Standards of Care Algorithm Clinical Practice Guidelines
36
Procedure
Set of how to action steps
37
Standards of Care
Description of acceptable level of patient care
38
Algorithm
set of steps used to make a decision
39
Clinical Practice Guideline
statement outlining appropriate practice for clinical condition or procedure
40
Types of Institutional Plans of Care
Computerized Plans of Care Concept Map Plans of Care Change of Shift Reports Multidisciplinary (collaborative) Plans of Care Student Plans of Care
41
NIC and NOC
Nursing Intervention/Outcomes Classification
42
What are the benefits of using NIC/NOC standardized languages?
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
Purpose of the Implementation Stage of the Nursing process
Helps patients achieve valued health outcomes promotes health and prevents illness restores health facilitates coping with altered fxning
44
Aims for Nursing Outcome Classification Research
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
Implementing involves...
carrying out the plan continued data collection and plan modification documentation of care
46
How is clinical reasoning used with implementing
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
Alfaro's Rule
Assess, Reassess, Revise, and Record *do these things when implementing care plans
48
Types of Nursing Interventions
Those providing direct and indirect care Those aimed at individuals, family, and community Those for nurse-initiated and other provider-initiated treatments
49
How do you implement guidelines into the nursing care plan implementation?
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
How to implement the care plan
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
What to keep in mind when reassessing the patient and reviewing the care plan
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
Variables Influencing Outcome Achievement
Patient Variables Nurse Variables Health Care System Variables
53
Patient Variables that may influence outcome achievement
development stage psychosocial background and culture
54
Nursing Variables that may influence outcome achievement
Resources Current Standards of Care Research Findings Ethical and legal guides to practice
55
Common Reasons for Patient Noncompliance
Lack of Family Support Lack of Understanding Benefits Low perceived value Adverse physical/emotional effects Inability to afford Limited Access
56
When a patient is noncompliant..
we should investigate the why (they may not want to say they cannot afford it)
57
Five Rights of Delegation
Right Task Right Circumstances Right Person Right Direction of Communication Right Supervision and Evaluation
58
Checklist for organizing STUDENT clinical responsibilities
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
Evaluation step of the nursing process involves..
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
Possible Actions based on the patients response to the are plan
Termination Modifications Continuation
61
5 Elements of Evaluation
ID Evaluative Criteria Collect Data to see if criteria are met Interpret and Summarize findings Document Judgment Terminating, Continuing, or Modifying Care Plan
62
Criteria
Measurable qualities that specify skills, knowledge, or health status they describe acceptable level of performance by stating expected behaviors of nurse or patient
63
Standards
level of performance accepted and expected by the nursing stage established by authority, custom, or consent
64
Difference between Criteria and Standards
Criteria are measurable while standards are what we expect
65
4 Types of Patient Outcomes
Cognitive - increased knowledge Psychomotor - achieve new skills Affective - changes in value, belief, attitude Physiologic - physical change
66
How to evaluate cognitive outcomes?
ask patient to repeat info or apply new knowledge
67
How to evaluate psychomotor outcomes
ask patient to demonstrate new skills
68
How to evaluate affective outcomes
observing patient behavior and conversation
69
How to evaluate physiologic outcomes
using physical assessment skill to collect and compare data
70
When doing evaluating statements...
describe how well the outcome was met and list patient date or behavior to support this decisions
71
When describing evaluation statements on short term goals we use...
Met, Partially Met, Not Met
72
When describing evaluation statements on long term goals we use...
the word "ongoing"
73
When describing evaluation statements on nursing interventions we use...
the word "done"
74
What things can be done in revision of the care plan?
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
How to ensure adequacy of evaluation in your nursing process?
Evaluate patient achievements of desired outcomes Review how the process is used Revise care plan as necessary Participate in quality assurance programs
76
IOM's 10 Rules to Redesign and Improve Care
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
4 Steps to Improving Nursing Process Performance
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
How to improve professional performance among nurses?
``` Peer Review Quality Assurance Programs Structure Evaluations Process Evaluation Outcome Improvement Nursing Audit Concurrent and Retrospective Evaluation ```
79
QSEN
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
Elements of a Healthy Work Environment
Skilled communication True collaboration effective decision making appropriate staffing meaningful recognition authentic leadership
81
7 Critical Conversations to have About the Health care System
Broken Rules Mistakes Lack of Support Incompetence Poor Teamwork Disrespect Micromanagement
82
Which of the 7 critical conversations to have about health care impact and put patient care at risk the most?
Poor Teamwork Disrespect Micromanagement

NURS320 (12 decks)

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