Nursing Intro - Exam 4? Flashcards
what does evidence- based care do?
- improves quality, safety, and pt outcomes
- increases nurse satisfaction
- reduces costs
sources of evidence
- textbooks
- articles from nursing and health care literature
- quality Improvement and risk management data
- standards of care
- infection control data
- benchmarking, retrospective, or concurrent chart reviews
- clinicians’ expertise
what are the steps of evidence based practice?
- cultivate a spirit of inquiry
- ask a clinical question in PICOT format
- search for the most relevant evidence
- critically appraise the evidence you gather
- integrate all evidence with your clinical expertise and pt preferences and values
- evaluate the outcomes of practice decisions or changes using evidence
- share the outcomes with others
what do you need to do when asking a clinical question?
develop a PICOT question
what does PICOT stand for?
P = pt population of interest I = intervention of interest C = comparison of interest O = outcome T = time
which letters in PICOT may not be appropriate in every question?
I, C, and T
who are some experts you can ask for help?
- nursing faculty
- advances practice nurses
- staff educators
- risk managers
- librarians
what can a medical librarian help you with?
- identify the databases that are available to you
- identify key words that will provide the best answer to your PICOT question
after critiquing all articles for a PICOT question …
- synthesize or combine the findings
- consider the scientific rigor of the evidence and whether it has application in practice
after critiquing the evidence, you will be able to answer the following questions
- do the articles offer evidence to explain or answer my PICOT question?
- do the articles show support for the reliability and validity of the evidence?
- can i use evidence in practice?
what are the elements of an article?
- abstract (brief summary)
- introduction (contains more info about the purpose of the article)
- literature review or background
- manuscript narrative
what is integrating evidence?
teaching, assessment or documentation tools, clinical practice guidelines, policies and procedures
when applying evidence, consider …
setting, staff support, scope of practice, and resources
a ___ may be conducted when evidence is not strong enough to apply in practice
pilot study
when evaluating the EBP change determine …
- was the change effective?
- are modifications needed?
- should the change be discontinued?
after implementing an EBP change, it is important to communicate the results with …
- clinical staff on the unit
- nursing practice council or the research council
- clinicians
- professional conferences and meeting
nursing research
- a way to identify new knowledge, improve professional education and practice, and use resources effectively
- many professional and specialty nursing organizations support the conduct of research for advancing nursing science.
quantitative
- experimental research
- nonexperimental research
- surveys- frequency, distribution, and interrelation of variables among subjects in the study
- evaluation research- determines how well a program, practice, procedure, or policy is working
qualitative
- ethnography
- phenomentology
- grounded theory
what is the research process?
assessment - identify area of interest or clinical problem
diagnosis - develop research questions/ hypotheses
planning - determine how study will be conducted
implementation - conduct the study
evaluation - analyze results of the study use the findings
what is the institutional review board?
scientists and laypersons who review all studies conducted at the institution
what is the human research terminology?
- informed consent means
- participants receive full and complete information
- they can understand the information
- risks & Benefits
- they have free choice to participate or withdraw
- they understand how their confidentiality will be kept
- confidentiality
what is caring?
a universal phenomenon that influences the way we think, feel, and behave
pt value the affective dimension of nursing care
- connecting with patients and their families-develop rapport!
- being present with a reassuring presence
- all patients are unique
- respecting values, beliefs, and health care choices
- keeping a close and attentive eye on the situation
what is the ethic of care?
relationship between pt and nurse and the attitude of each toward the other
caring in nursing practice
- as you deal with health and illness in your practice, you grow in your ability to care and develop caring behaviors.
- caring is one of those human behaviors that we can give and receive.
- recognize the importance of self-care.
- use caring behaviors to reach out to your colleagues and care for them as well.
- behaviors include being present, providing a caring touch, and listening.
- calms anxiety and fear in stressful situations
- caring is a product of culture, values, experiences, and relationships with others.
how can you provide presence?
- being with the pt
- body language
- listening
- eye contact
- tone of voice
- positive and encouraging attitude
touch
- provides comfort
- creates a connection
- be aware of your pt’s cultural practices
- contact touch
listening
- creates trust
- opens lines of communication
- creates a mutual relationship
what is Benners theory?
caring is highly connected involving each nurse- pt encounter
what is Watson’s Transpersonal Caring theory?
- caring is central focus of nursing
- places caring before curing
- 10 carative factors (pg 81)
what is Swanson’s Theory of Caring
- includes 5 caring processes
- defines caring as a nurturing way of relating to an individual
knowing the pt
- one of swansons 5 caring processes
- develops over time
- the core process of clinical decision making
- aspects of knowing include
- responses to therapy, routines, habits
- coping resources
- physical capabilities and endurance
relieving symptoms and suffering
- performing caring nursing actions that give a patient comfort, dignity, respect, and peace
- providing necessary comfort and support measures to the family or significant others
- creating a physical patient care environment that soothes and heals the mind, body, and spirit
- comforting through a listening, nonjudgmental, caring presence
autonomy
commitment to include pt’s in decisions; freedom from external control
beneficence
taking positive actions to help others
nonmaleficence
avoidance of harm or hurt
justice
being fair
fidelity
agreement to keep promises
what is the code of nursing ethics?
- a set of guiding principles that all members of a profession accept
- helps professional groups settle questions about practice or behavior
- includes advocacy, responsibility, accountability, and confidentiality
social networking
- presents ethical challenges for nurses
- risk to pt privacy is great
- friendship with a pt can cloud your ability to remain objective
advocacy
refers to the support of a particular cause
responsibility
refers to a willingness to respect one’s professional obligations
accountability
refers to ability to answer for one’s actions
confidentiality
HIPAA
value
- a value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
- as a nurse, you agree to provide care to your pt’s solely on the basis of their need for your services
values clarification
- ethical dilemmas almost always occur in the presence of conflicting values
- to resolve ethical dilemmas, one needs to be distinguished among values, facts, and opinions
deontology
defines actions as right or wrong
utilitarianism
proposes that the value of something is determined by its usefulness; main emphasis is on the outcome or consequence of an action
feminist ethics
focuses on the inequality between people
ethics of care
emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
casuistry
case- based reasoning; focuses on an “intimate understanding of particular situations”
nursing point of view
- nurses generally engage with patients over longer periods of time than other disciplines.- patients may feel more comfortable revealing information to nurses.
processing an ethical dilemma
Step 1: Ask if this is an ethical dilemma.
Step 2: Gather all relevant information.
Step 3: Clarify values.
Step 4: Verbalize the problem.
Step 5: Identify possible courses of action.
Step 6: Negotiate the outcome.
Step 7: Evaluate the action.
institutional resources
- ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation.
- any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee.
- moral distress can occur when ethical problems are not processed well
quality of life
central to discussions about end of life care, cancer therapy, physician assisted suicide, and DNR
disabilities
antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges
care at the end of life
interventions unlikely to produce benefit for the pt
health care reform
facilitated access to care for millions of uninsured Americas
nurses must keep current with nurse practice act & changing laws
nurse practice acts - describe and define the legal boundaries of nursing practice within each state
standards of care
the knowledge and skill ordinarily possessed and used by nurses including
- legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care
- best known comes from the American Nurses Association (ANA)
- set by state and federal laws that govern where nurses work
- joint Commission requires policies and procedures (P&Ps).
advances directives
- PSDA
- living wills/durable power of attorney
- health care proxies or durable power of attorney for health care
- DNR
Uniform Anatomical Gift Act
individual at least 18 years of age has the right to make an organ donation
HIPAA
- limits who is able to access a pt’s record
- provides confidentiality of a pt’s medical information
HITECH
PHI is not inadvertently conveyed on social media
restraints
there are now standards for reducing the use of all types of restraints in health care settings
licensure
NCLEX; BON suspends or revokes a license if a nurse’s conduct violates the Nurse Practice Act
good samaritan laws
limit liability and offer legal immunity for nurses who help at the scene of an accident
public health laws
protect populations, advocate for the rights of people, regulate health care and health care financing, and ensure professional accountability for care provided
the uniform determination of death act
the cardiopulmonary standard; the whole-brain standard
autopsy
when a pt’s death is not subject to a medical examiners review, consent must be obtained
death with dignity or physician assisted suicide
know your state’s laws to ensure your practice falls withing the laws requirements
what are torts?
- civil wrongful acts or omissions made against a person or property
- intentional torts
assault
intentional threat toward another person that places the person in reasonable fear that harmful, imminent, or unwelcome cotact
battery
intentional offensive touching without consent
false imprisonment
unjustified restraint of a person without a legal reason
quasi- intentional torts
acts which intent is lacking but volitional action and direct causation occur
- invasion of privacy
defamation of character
publication of false statements that result in damage to a persons reputation
slander
when one speaks falsely about another
libel
written defamation of character
unintentional torts
includes negligence and malpractice
negligence
conduct that falls below the generally accepted standard of care
malpractice
often referred to as professional negligence. certain criteria are necessary to establish malpractice
a consent form must be …
signed
informed consent
- agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal
- must be obtained and witnessed when the patient is not under the influence of medication such as opioids
the nurse’s signature as a witness to the consent means that the patient voluntarily gave consent, the patient’s signature is authentic, and the patient appears to be competent to give consent - parents usually sign consent for pediatric patients
- patients with mental illnesses must also give consent; they retain the right to refuse treatment until a court has determined legally that they are incompetent
nursing students
- as a nursing student in a clinical setting, you are expected to perform as professional nurse would in providing safe patient care.
- you are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university.
- you are expected to perform as a professional when rendering care.
- you must separate your student nurse role from your work as a certified nursing assistant (CNA).
malpractice insurance
- a contract between nurse and the insurance company
- provides a defense when a nurse is in a lawsuit involving negligence or malpractice
- nurses covered by institutions insurance while working at their place of employment
short staffing
- legal problem occur if an inadequate number of nurses will provide care
- CHAP
- registered nurse safe staffing act
floating
- based on census load and pt acuities
- must inform the supervisor of any lack of experience in caring for the type of pts
health care providers orders
nurses follow orders unless they believe an order is given in error or is harmful
risk management and quality assurance
a system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs
steps involved in risk management
- identify possible risks
- analyze risks
- act to reduce risks
- evaluate steps taken
occurence reporting
- serves as a database for further investigation
- alerts risk management to a potential clean situation
- separate from the medical record
documentation
a nurses documentation is evidence of care
TJC’s Universal Protocols
time out
