T2 Pt Centered Care

Question 1

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values and needs.

Answer 1

Client centered cared

Question 2

Care must be what to be patient centered?

Answer 2

In its landmark book Crossing the Quality Chasm (2001, p. 40), the Institute of Medicine (IOM) defined patient-centered as:

Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Care must be equitable and not vary due to gender, ethnicity, or socioeconomics.

Question 3

6 Dimensions of patient centered care

Answer 3

1.Respect for Patients’ Values, Preferences, and Expressed Needs
Respect is evident in the sharing of desired information with the patients and families, the active partnering with them to determine care priorities and a plan, tailoring their level of involvement according to their preferences, not those of the care providers, and re-formulating the plan as the situation changes.

2. Coordination and Integration of Care
   As care becomes more complex due to the co-existence of multiple chronic conditions, an increasing number of care providers, numerous care sites, and shorter episodes of care, the need for creating smooth transitions across the episodes of care becomes even more vital. Creating “care between the care” should be the goal.
3. Information, Communication, and Education
   Some individuals prefer comprehensive explanations, while others prefer none. Some people learn best visually, while others favor the personal experience. Adjusting the message and its delivery according to the individual patient’s preferences is a major challenge, yet a cornerstone to patient-centered care. What is common to all situations is that patients want to be able to trust what they are being told, and to receive it in a manner that makes sense to them, at a level they can understand.
4. Physical Comfort
   Ensuring that patients will be comfortable and free from pain is a basic expectation of patient-centered care.
   However, for a variety of reasons, this is often not adequately addressed and must form the basis for any personalized plan of care.
5. Emotional Support
   Patients and their families may experience anxiety and distress from a number of sources; the underlying factors need to be identified and dealt with.
   This is nursing’s work and enables us to make unique contributions to the patient/family experience.
6. Involvement of Family and Friends
   For more than 40 years, research has indicated that children need their parents nearby. Patient-centered care requires that visiting hours, and engagement of family and friends in all aspects of the process as defined by the family, are structured to meet the patients’ needs.

Question 4

Do better educated patients have better outcomes?

Answer 4

Be prepared to answer these questions. According to the literature, the higher the patient’s educational level, the more likely he is to comply with patient teaching.
How does Nursing, then, impact his health care experience, teaching, LEARNING, and thus his outcomes?

Then, think about your last clinical rotation. Choose one patient with which to answer these questions:
Was the patient the source of control?
Was the care compassionate, coordinated, and reflective of the patient preferences, values and needs?
What were the patient directed aspects of care?
What were missed opportunities to meet patient needs?

Question 5

Expectations of patients and family and what they want?

Answer 5

The IOM listed the expectations as including:
“Being listened to and respected as a care partner, being told the truth, having care and information sharing coordinated with all members of the teach, and partnering with staff who are able to provide both technically and emotionally supportive care”

30 years of research of patients and the care experience (critical care). Results include:
need for information
to be near the patient
need for reassurance and support.

Despite this extensive body of evidence, many critical care units continue to struggle with finding ways to implement patient-centered policies. Nurses need to identify barriers and champion the changes that patients and families want.

Question 6

Patients and families have been engaged for decades in various activities that have equipped them to be partners in their care.

Examples include:

Answer 6

receiving pre-operative and home instructions
learning to take medications and perform treatments (e.g., dressing changes, catheter care, blood sugar testing)
monitoring vital signs
watching for complications
Interactive patient care activities including internet based activities
-When to call the doctor
-Patient/Family Involvement when making a careplan.

Hospitals are now including patients and/or families as members of patient safety committees, interview teams and participants in new employee orientation.

Question 7

Activity: What would be the first step in planning discharge instructions for your patient?

Answer 7

?

Question 8

a group’s acceptance of a set of attitudes, values, beliefs, and behaviors that influence the way that the members of the group express themselves.

Answer 8

Culture

Question 9

Language
Spirituality
Art and Music
Customs and traditions
Food preferences
Response to illness, stress, pain, grief, anger, and sorrow; 
Decision-making

Answer 9

Cultural expression

Question 10

Behaviors, beliefs, and attitudes are transmitted from one generation to the next.
Expressions of culture are primarily unconscious.
They have a profound effect on an individual’s interactions and response to the health-care system.

2000 census: approximately 30% of the U.S. population was composed of minority groups.
By 2044, the white population will actually be a minority group, constituting 44% of the total population of the United States.
In some states, the white population will be a minority much sooner.

Answer 10

Cultural Orientation:

Question 11

Who will be able to provide competent and culturally sensitive care for clients from all cultural backgrounds?

Answer 11

Nurses who understand the essential characteristics of transcultural nursing

Question 12

explains the differences between cultures.

Answer 12

Diversity

Question 13

characteristics are those that are more obvious, such as nationality, race, color, gender, age, and religious beliefs.

Answer 13

Primary

Question 14

characteristics are harder to identify, such as socioeconomic status, education, occupation, length of time away from the country of origin, gender issues, residential status, and sexual orientation.

Answer 14

Secondary

Question 15

The percentage of minority nurses does not reflect the national population trends.

How can we recruit minority students into the Nursing field?

How can a nurse manager effectively manage a culturally diverse staff?

Answer 15

The percentage of minority nurses does not reflect the national population trends.

In 2000, Minority nurses have remained constant at approximately 10% of RNs.
The number of minority students enrolled in basic nursing programs was about 15%.

Respect for others
Positive reinforcement
Knowledge about the staff

Question 16

What is Cultural competence as it relates to nursing is the

Answer 16

effective care for clients who belong to diverse cultures, based on the nurse’s knowledge and understanding of the values, customs, beliefs, and practices of the culture.
Primary skills required
Communication
Understanding
Sensitivity
Recognize that the nurse comes from a particular culture that has its own set of health-care values.
Identify the culture of the client and recognize specific health-care practices.

Question 17

Barriers to communication

Answer 17

Lack of a common language 
Not understanding nonverbal cues
Not understanding where men and women “fit” in the society
Using loud or aggressive tone of voice
Being confrontational

Question 18

When do nurses develop cultural awareness

Answer 18

Nurses develop cultural awareness only when they can recognize and value all aspects of a client’s culture, including beliefs, customs, responses, methods of expression, language, and social structure.

Merely learning about another person’s culture does not guarantee that the nurse will have cultural awareness. Work with the client’s beliefs and cultural values to make changes that will improve health.

Question 19

The concept of Health Literacy is comprised of two components:

Answer 19

a capacity within the individual to understand words, phrases and concepts

and the nature or clarity of the health information that is being conveyed.

Question 20

health literacy is dynamic and situational.

It includes what communication?, as well as the ability to act upon the information.

Theaverage reading levelofAmericanadults is about ???????gradelevel.

A readability score is given as a “gradelevel,” but a score doesn’t tell us whether an adult with a specificlevelof education will be able toreadthe text. In 2016, the United States had a larger percentage of adults performing at both the top and bottom of the distribution. Thirteen percent of U.S. adults performed at the highest proficiency level, but 18% perform at the lowest proficiency level. Clearly, we have a divide.

Answer 20

oral and written communication

7thto 8thgradelevel

Question 21

The ability to access computers and the internet has become increasingly important to completely immerse oneself in the economic, political, and social aspects of not just America, but of the world.

However, not everyone has access to this technology.

The idea of the “digital divide” refers to who or what ??

Answer 21

the growing gap between the underprivileged members of society, especially the poor, rural, elderly, and handicapped portion of the population who do not have access to computers or the internet;

and the wealthy, middle-class, and young Americans living in urban and suburban areas who have access.

Question 22

A 2016study inJournal of Medical Internet Researchfound that the use of health IT, such as fitness and nutrition apps, activity trackers, and patient portals, are significantly associated with what?

Answer 22

improved health literacy,

but patients with low health literacy were less likely to use health IT tools or perceive them as easy or useful.

Question 23

as more people become connected, the problem becomes even more acute for those left out.

Not only are they are out of the mainstream of all the communication and transactions taking place online, but that this exclusion is likely to lead to them where?

Answer 23

becoming even more marginalized within society.

Question 24

Strategies to enhance health literacy

Answer 24

Use simple words
Speak slowly
Small bits of info
Reinforce the teaching

There are a number of strategies that can be employed to enhance an individual’s health literacy.
For oral communication:
use plain language, no “Med Speak”
speak slowly and be sure to enunciate, especially if speaking with someone who does not speak English as his first language
provide small amounts of material at a time…this is difficult, but is imperative for someone who may not understand the teaching.
reinforce with written materials with key points circled or highlighted. When possible, provide written information is in the patient’s preferred language.

As the Internet plays a greater role in our daily life, health professionals in particular need to be aware that their clients or target audiences may not be able to take advantage of this medium.
Nursing must heed the call for those health professionals working in the community to seek out collaborations with public libraries and other non-profit agencies that do provide computer access and support, particularly among the disadvantaged.

Question 25

Assessing patient satisfaction is challenging for many reasons.
What is being measured? The quality of the service experience or the technical aspects of the care?
How can patients evaluate the technical aspects of care?
What is the relationship between patient satisfaction and quality of care?
What is it that patients really want from a care experience?
Is measuring patient satisfaction the same as measuring patient-centered care?
.
It is the first tool to help consumers compare hospitals nationally on 27 key variables that include, among other things, communication, responsiveness, cleanliness, noise and pain management??

Answer 25

The federal government uses its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure patients’ perceptions of their hospital experience and posts public results

Question 26

National regulatory agencies are increasingly becoming involved in stipulating expectations and monitoring performance:

?? is a voluntary consensus standards setting body that has endorsed more than 500 measures of quality and safety.

Answer 26

The Joint Commission (JC)
National Committee for Quality Assurance (NCQA)
Centers for Medicare and Medicaid Services (CMS)

The National Quality Forum (NQF)

Question 27

How can charge nurses provide support to staff nurses and identify underlying causes of problems in clinical judgment, time-management and prioritization early?

As the charge nurse, what if you were having an increase of falls on your unit on the evening shift?

As the charge nurse, what would you do if your unit had low morale? How would that affect productivity?

As the charge nurse, What would you do if heard a rumor that a nurse was using diverting opioids during her shift?
As the charge nurse, what would you do if you heard that a staff nurse was complaining about policy changes?

Answer 27

?

Question 28

Patient Satisfaction:

Answer 28

Competence
Quick treatment
Comfortable & effective
Feel better

Research also shows people have high satisfaction with:
Competent staff
Treatment that is fast and Not uncomfortable
Effective care….That the patient will be out quickly and feel better.

Question 29

Health care organizations invest extensive resources internally in assessing patient/family satisfaction, and many use the services of external vendors to benchmark their performance against that of competitor organizations, often tapping into slightly different concepts.

The Picker Institute defines a patient-centered environment of care as one that is what??

At the heart of the environment of care,

however, are the human interactions that occur within the physical structure to calm, comfort, and support those who inhabit it. Who’s duty is this to provide?

Answer 29

1.safe and clean, and that guards patient privacy.

It also engages all the human senses with color, texture, artwork, music, aromatherapy, views of nature, and comfortable lighting, and considers the experience of the body, mind and spirit of all who use the facility.

Space is provided for loved ones to congregate, as well as for peaceful contemplation, meditation or prayer, and patients, families, and staff have access to a variety of arts and entertainment that serve as positive diversions”.

2.This is the function and duty of the Registered Nurse.