Test 1 Flashcards
Tanners four domains of clinical judgement
- Noticing
- interpreting
- responding
- reflecting
Noticing
background of nurse, nurse relationship with pt, context of care. step one. know expectations of pt and medical staff before step 2.
Interpreting
- includes reasoning, patterns, analytic, intuitive and narrative-use data plus theoretical knowledge plus experience to make sense. interpret all data before next step
responding
- actions/ outcomes/ reflection in action
reflecting
- challenges one to use critical thinking to examine presented information, question validity, and draw conclusions based on the resulting ideas. reflection can lead to greater self awareness.
hypothetico-deductive
a reasoning pattern might be triggered, through which interpretive or diagnostic hypotheses are generated. Additional assessment is performed to help rule out hypotheses until the nurse reaches an interpretation that supports most of the data collected and suggests an appropriate response
to arrive at conclusions in clinical judgement process need
reflection in action AND reflection on action
IN- how is client responding,do i need to change what I’m doing
ON-final outcome, how did my actions influence outcome, what might i have done differently and in what part of process could my thinking have been more clear
preoperative nurse responsibilities
consents signed (and witness) Hx and P in chart and signed Dx and radiologic test in chart prophylactic antibiotic is give if ordered
time out
correct pt (2 ID) correct procedure (orders and consent same) Correct site (marked and initialed) Correct client position, correct diagnostic radiology tests, prophylactics given? RN and Surgen verbal verify visual of site, safety precautions, RN docs time out
Circulating RN pre op room
ID pt, confirm orders, consent, verify site marked, verify client position, equipment availability and test result availability, communicate all drug related issues and antibiotic admin prior to surgery.
core measure
evidence based, scientifically researched standard of care which has been shown to result in improved clinical outcomes. reduces morbidity, mortality complications and readmissions
heart failure measures
complete discharge instructions
Left ventricular systolic function assessment
ace inhibitor or ARB for LVS dysfunction
smoking cessation counseling
heart failure discharge instructions
activity level, diet/fluid
med reconciliation, follow up with dr
worsening sxs, weight monitoring
acute MI measures arrival
ASA (75-325mg) on arrival or before
EKG timing (with in 10 mins)
Thrombolysis (within 30 mins)
Percutaneous Coronary Intervention within 90
acute MI measures discharge
beta blocker prescribed
ace inhibitor/ carb prescribed for left ventricular systolic dysfunction
ASA prescribed and adult smoking cessation counseling
pneumonia prevention
antibiotic timing within 6 hrs of arrival, blood culture before antibiotic
influenza and pneumonia vaccine- given, refused or contraindicated, smoking cessation
surgical infection prevention
antibiotic 1 hour prior to surgery
antibiotic DC’d w/in 24 after end of surgery
appropriate hair removal (no razors)
urinary cath removal on pod1 or2
Surgical venous thromboembolism prophylaxis
pharmacologic and mechanical phrophylaxis ordered and administered within 24 hrs end of surgery. if pt takes beta blockers daily, need to take day prior to, day of, pod1and2
Donning PPE
hand hygiene, gown, mask, eyes, gloves
removing ppe
gloves, mask, gown, eyes, hand hygiene
use avoidance when
time is needed to collect additional data before decision is made. prolongs resolution which can worsen prob
competitive conflict strategy
use when making an unpopular decision that needs to be implemented. hostility from losing side. result is goal oriented and quick
collaborative conflict strategy
when time available compromise, creative solution acceptable to everyone, integrates ideas from all
harmonizing conflict strategy
used in pt service- if safe do it patient’s way instead of nurses, puts relationship before conflict, allows relationship to remain positive
compromising conflict
each party giving up something they want, best for issues of mild to moderate importance and when both parties are equal and there is no simple solution
core measure
evidence based, scientifically researched standard of care which has been shown to result in improved clinical outcomes- protocols- if this then do x, y, z. TJC mandates organizations to track to monitor quality care
group process
2 or more persons in face-to-face interaction. aware in a group, aware of others and of positive collaboration . example surgical team function as a single unit- trust cooperation, understanding and consideration of other team members
Background
What is the background or circumstances leading up to the situation? State pertinent background information related to the situation that may include
• Admitting diagnosis and date of admission
• List of current medications, allergies, IV fluids
• Most recent vital signs
• Date and time of any laboratory testing and results of previous tests for comparison. Synopsis of treatment to date
• Code status (Lewis 15)
Assessment
State what you think the problem is:
Changes from prior assessments
Patient condition unstable or worsening
Situation
I am Jackie, I just assessed pt so and so in room number_ I am concerned about_ov
Recommendation
What should we do to correct the problem? What is your recommendation or request? State your request.
Specific treatments
Tests needed
Patient needs to be seen now (Lewis 15)
documented benefits of collaboration
shorter length of stays, increased job retention and less job turnover, increased job satisfaction and increase in problem solving skills
8 national pt safety goals
improve effectiveness of communication
improve safety of using meds
improve accuracy of pt ID
reduce risk of harm from falls
accurate and complete reconciliation of meds across continuum of care
prevent health care related pressure ulcers
organizations ID safety risks to pt (suicide, O2 at home)
Universal Protocol (UP)
preprocedure verification, mark site, perform time out, conduct time out before invasive or surgical, confirm correct pt, procedure, and site
shock
not circulating enough blood low bp, fast irregular heart beat weak rapid absent pulse restlessness, confusion, anxiety cool clay skin, rapid shallow breaths, chest pain nausea, lightheaded
clinical decision process steps
ID, analyze, logical inferences, list all poss actions, evaluate options, select options
critical thinking concepts/behaviors
truth seeking, analyticity, self confidence, maturity, open mindedness, systematically, inquisitiveness
how to manage caring for a group of patients
ID dx for each, find most urgent, how to cluster care, consider help resources (assistants, family), delegate
clinical reasoning is and supports clinical decision process with (3 things)
rule based/ analytical to reach judgment
- guidance (assessment, data collection)
- Selection (discard irrelevant data)
- providing correct decision
commitment level of critical thinking
anticipate when to make choices without assistance and accept accountability
interpretist
uses context of care and what the nurse brings (knowledge of standards or care) and understanding individual client situation-recognize one restricted approach not for all- does not use info from chart
contact precautions
incontinance of stool, drainage of body fluids, skin infection/ rash. wear gloves. wear gown if lots of interaction
droplet precautions
respiratory viruses, rsv, influenza, bordetella, first 24 hours of strep a. facemark. also gown and googles if spraying. pt wear mask out of room
airborn precautions
TB, measles, chicken pox. own special room, disposable n95 respirator
holistic
influenced by complex factors surrounding pt circumstances
process orientation
uses experimental knowledge
