Test #3 Flashcards
What if a pt comes in with a bag a pills? What do we do with them?
Give them to pharmacy or have them take them home
What should go into discharge education 7
- Written instructions in pts language and reading level
- Specific diet at home - educate on what they should and should not eat
- How to perform home procedures (like tube feedings)
- Precautions that they may need to take when performing procedures (like wound care) or when administering medications (like taking certain medications before meals)
- Symptoms or complications to report.
- Name and numbers of who to call with questions or concerns.
- What follow-up care they will have
What method can we use to see if pt understands their discharge educations
Use the teach back method
What goes into discharge documentation
- We need a provider prescribed order for discharge or an AMA
- Date, time and who went with pt for transportation
- How they were transported (wheelchair to car, gurney, etc)
- Where the pt is going (destination)
- Summary of the pts condition at the time of discharge
- Description of any unresolved difficulties and procedures for follow-up
- Return their valuables and medications
What are our responsibilities for an outbound transfer 7
- On day of transfer, confirm that the receiving facility or unit is expecting the pt, and that the room/bed is available.
- Communicate the time pt will transfer
- Complete all documentation
- Give a transfer report to receiving party
- Confirm mode of transportation the pt will use to get there (car, wheel chair, ambulance).
- Pt should be appropriately dressed
- Account for clients valuables
What are our responsibilities for an inbound transfer
- Have any specialized equipment ready
- Inform other healthcare team members of the pt’s arrival and needs
- Meet with the pt and family on arrival to complete the admission process and orient them to new facility/unit
- Assess how the pt tolerated the transfer
- Review transfer documentation
- Implement appropriate nursing interventions in a timely manner
What are critical pathways (look up in book)
Referrals (look up in book)
Why is a hospital on the hook for readmissions within 30 days of discharge
Because Medicare will not pay for readmissions within 30 days of discharge - which means the hospital will not get reimbursed
How does the American Nurses Association (ANA) define nursing
- Integrates the art and science of caring
- Protects, promotes, and optimizes health and human functioning
- Prevents illness and injury
- Facilitates healing
- Alleviates suffering through compassionate presence
What does the ANA state nursing is for
The diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.
How does ANA define the standards of practice of nursing
“The Standards of Practice describe a competent level of nursing practice demonstrated by the critical thinking model known as the nursing process. The nursing process encompasses significant actions completed by registered nurses and forms the foundation of the nurses’ decision-making.”
What are the ANA Standards of Practice
- Std 1: Assessment (The RN collects pertinent data and information relative to the healthcare consumer’s health or the situation)
- Std 2: Diagnosis (The RN analyzes assessment data to determine actual or potential diagnoses, problems, and issues)
- Std 3: Outcomes Identification (The RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation)
- Std 4: Planning (The RN develops a collaborative plan encompassing strategies to achieve expected outcomes)
- Std 5: Implementation (two parts:)
The RN implements the identified plan.
Std 5A: Coordination of Care: The RN coordinates care delivery.
Std 5B: Health Teaching and Health Promotion: the RN employs strategies to teach and promote health and wellness. - Std 6: Evaluation (The RN evaluates progress toward attainment of goals and outcomes)
What does the Scope of Nursing Practice describe
The who, what, where, when, why, and how associated with nursing practice and roles.
What are the who, what, where, when, why, and how of the RN scope of practice
- Who: all RNs that have been educated, titled, and maintain active licensure to practice nursing.
- What: definition of Nursing - The diagnosis and treatment of human responses and
advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. - Where: any environment where there is a healthcare consumer in need of care, information, or advocacy.
- When: anytime & anywhere there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education.
- Why: in “response to the changing needs of society to achieve positive healthcare consumer outcomes in keeping with nursing’s social contract and obligation to society.”
- How: all ways, means, methods, & manners that RNs use to practice PROFESSIONALLY.
What is the purpose of OSBN
To protect the public by regulating nursing educations, licensure, and practice.
Who is on the OSBN board
The OSBN is comprised of 9 state residents appointed by the Governor, confirmed by the state senate: 5 RNs, 1 LPN, 1 CNA, and 2 members of the public otherwise not eligible for appointment to the board.
What comprises the Oregon Nurse Practice Act
Comprised of Oregon Revised Statutes: Chapter 678.010-678.445 (laws) and Oregon Administrative Rules: Chapter 851 (Divisions 1-70).
How to we read or find a statute
They go by chapter - division - rule
(For example: 851-045-0040 corresponds to Scope of Practice Standards for All Licensed Nurses)
If you are not COMPETENT at something - do not do it
Know who to assign tasks to (like what can LPNs do, what CNAs can do)
Know what you need to do for a discharge (ie go over meds,
Can LPN handle chemo drugs
No
If a question asks you “which pt can you assign to an LPN”, don’t select someone who just arrived and needs an initial assessment - RNs need to perform the initial assessment.
Can LPNs perform assessments and create plans of care
No - this is the RNs job
What is interesting about assessments for LPNs versus RNs
LPNs can perform assessments (like listening for bowel sounds) but they can’t evaluate those sounds and qualify them as hypoactive, normal, or hyperactive
Is it within an LPNs scope of practice to provide patient teaching
No
Can LPNs administer blood
No
Can LPNs administer tube feedings
Yes
Can LPNs delegate tasks
Yes, but they also are accountable for that task
Define community
Groups of individuals (can be grouped based on location, or something that pulls them together, like being a part of a church)
What is population
often refers to a geographic area; can also mean a particular group of people with shared characteristics. Examples: homeless population, worker population, Latinx population
What is aggregate
Aggregate is a group of people with at least one shared personal characteristic. Example: Female teens of childbearing age
- “toddlers”, “infants”
- basically one group that shares a common thing
Define health
State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity
What is an example of a structure
Refers to the general characteristics of a community - Demographics and data about healthcare services
“like Lebanon”
What is status
Described by a variety of health indicators
- Biological: Morbidity/mortality rates, life expectancy, risk factors for age groups, prevalence of lifestyle choices (i.e. nicotine)
- Emotional: Mental health and consumer satisfaction with certain community markers (how people feel about things)
- Social: Crime rates, community involvement, leadership capacity
What is process
Process: Describes the overall effectiveness of the community
- Do groups perceive a common purpose?
- Do community members gather and interact?
- Is there an established mechanism for conflict resolution?
What is community health nurse
Providing care OUTSIDE of the acute care setting
What does it mean when we say community health nursing is autonomous
These community health nurses have more independence to make decisions and lookout for the WELFARE of their clients (they can be independent - they can provide education, explain the diagnosis, help people access care, etc)
What is the goal of community health nursing
Promote, preserve and maintain the health of a population by bringing services to individuals, families, and groups – continuity and improved access to care
Where might we see community health nurses
- Senor center
- Soup kitchens
- Schools
- Work
- Faith community
What is the difference between direct and indirect care
- Direct care: provide care to that individual, this is community-BASED nursing (providing wound care to a pt in their home, school nurse teaching a student who has asthma about medications)
- Indirect care: provide care upstream, like developing an intervention program to teach a group, this is community - ORIENTED nursing
What is the focus of care for community oriented nursing? What is the primary goal? What might these nursing activities look like?
- Focus: aggregates, communities, populations
- Goal: health promotion and disease prevention
- Activities: Indirect care - program management, might include direct care for at-risk individuals and populations
What is the focus of care for community based nursing? What is the primary goal? What might these nursing activities look like?
- Focus: individuals and family
- Goal: management of acute and chronic conditions
- Activities: Direct care - where community nurses are working to help individuals manage their acute or chronic conditions
What are examples of community-based care
Includes healthcare or rehab services performed OUTSIDE of the acute care hospital facility
Examples:
Clinics, mobile care units
Surgery centers
Outpatient rehabilitation centers
Skilled nursing facilities
Assisted living communities
Consumer’s home
What is community health nursing
Focus on the health of an individual, family or group in order to impact the entire health of the community