Week 1: Synergy Model, Professional Issues & Trends, & Care of the Hospitalized Patient Flashcards
What is the synergy model?
- describes nursing practice based on the needs and characteristics of patients
- when the competencies of both the patient and the nurse are matched and are “synergized”, the outcomes for the patient are optimized
- each characteristic or competency exists on a continuum from low (level 1) to high (level 5)
Patient characteristics of the synergy model
Resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability
Synergy model: resiliency
The capacity to return to a restorative level of functioning compensatory or coping mechanisms, their ability to “bounce back”
Synergy model: vulnerability
How likely a patient is to cave to stressors or adverse effects, susceptibility to stressors or adverse effects
Synergy model: stability
Ability to maintain status quo
Synergy model: complexity
Entanglement of two or more systems (doesn’t always have to be body systems)
Synergy model: resource availability
The extent of resources
Synergy model: participation in care
The extent to which a patient or family engages in care
Synergy model: participation in decision making
The extent to which the patient or family engages in decision making
Synergy model: predictability
A characteristic that allows one to expect a certain course of events or course of illness
Synergy model call nurse competencies include…
Clinical judgment, advocacy and moral agency, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitator of learning
Synergy model: clinical inquiry
Ongoing process of questioning and evaluating practice and providing informed practice
Synergy model: clinical judgment
Clinical reasoning, which includes clinical decision making, critical thinking, and a global grasp of the situation
Synergy model: facilitation of learning
The ability to facilitate learning for patients and/or families, nursing staff, other members of healthcare, and community
Synergy model: collaboration
Working with others in a way that promotes or encourages each person’s contribution
Synergy model: systems thinking
There is a body of knowledge or tools that allows the nurse to manage environmental or system and resources exist for the patient and/or family
Synergy model: advocacy and moral agency
Working on another’s behalf and presenting the concerns of the patient and/or family
Synergy model: caring practices
Constellation of nursing activities that create a compassionate, supportive, and therapeutic environment for patients and staff
Synergy model: response to diversity
Ability to recognize, appreciate, and incorporate differences into the provision of care
Synergy model outcomes include…
Satisfaction of patients and their families, rate of adverse incidents, complication rate, adherence to the discharge plan, mortality rate, and each patient length of stay
Fundamentals of AIDET
A - acknowledge I - introduce D - duration E - explanation T - thank you
What is a living will?
States types of interventions of patient would want in a critical illness (artificial nutrition/hydration, life-support and intubation, names surrogate decision maker)
What is a guardianship?
A legal process used to protect individuals who are unable to care for their own well-being due to infancy, incapacity, or disability
Emancipation
- A minor who is emancipated do not need parents permission to sign a legally binding contract, get medical care, enroll in vocational school, or engage in other activities that otherwise require a parent permission
- also includes minors who are married or in the military
Strategies for resolution: collaboration
Step one: understand the cognitive and emotional perspective; listen, mutual respect, no power and balances, set ground rules
Step two: engage all parties
Step three: make decision and make a plan
Strategies for resolution: compromise
- compromise is used when parties in conflict are committed to maintaining the relationship
- parties each possess high moral certainty about opposing courses of action
- each party relinquishes some control
Strategies for resolution: accommodation
- used when the issue is seen as minimally important
- only one party is committed to preserving the relationship
- May not preserve integrity for all parties
Strategies for resolution: coercion
- reflects a strong commitment to a particular position
- generally encourages a power imbalance
Strategies for resolution: avoidance
- used when a moral issue is seen as unimportant or the situation is highly emotionally charged
- The conflict is not addressed or discussed
What is negligence?
The failure to exercise the care that a reasonably prudent person would exercise in the same situation
What is medical malpractice?
When a hospital, doctor, or other healthcare professional, through a negligent act or omission, causes an injury to a patient
What four factors must be present for a malpractice suit to exist?
- Duty of care must be owed
- Breech - The excepted standard of care is breached
- Patient must have sustained an injury
- Causation - injury caused by your actions
What is claims made liability insurance?
In order to be covered, the claim has to be made during the time of that the insurance was active for you to be covered
What is tail coverage insurance?
Extended reporting period endorsement, offered by a provider’s current malpractice insurance carrier, which allows an insured provider the option to extend coverage after the cancellation or termination of a claims made policy
What are the components of decision making capacity?
- The ability to understand the options
- The ability to understand the consequences of choosing each of the options
- The ability to evaluate the personal costs and benefits of each of the consequences and relate them to your own instead of values and priorities
What are informed consent components?
- nature of treatment
- consequences of treatment
- risks and hazards
- known side effects and complications
- alternative treatments available
What is the Stark Law?
Prohibits physicians from referring patients to certain services in which they have a “financial relationship”
What is the anti-kickback statute?
Cannot get kickbacks or money for referrals
What is the National Practitioner Data Bank (NPDA)?
- A web-based repository of reports containing information on medical malpractice payments related to healthcare practitioners, providers, and suppliers
- prevents practitioners from living state to state without disclosure or discovery previous damaging performance
- Mission is to improve healthcare quality, protect the public, and reduce healthcare fraud and abuse in the US
- Not visible to the public
What is defense medicine?
- often the reason why providers order too many tests
- A way providers protect themselves against lawsuits
Characteristics of the synergy model
- when the competencies of both patient and nurse are matched they are synced, the outcomes for the patient are optimized
- each characteristic or competency exists on a continuum from low (level 1) to high (level 5)
Components of a therapeutic relationship
- Mutual trust: depend on each other to reach a common goal, don’t plan for but with the patient
- professional boundaries: maintain patient/provider relationship
- confidentiality: patient feels vulnerable especially when they are an inpatient
- cultural respect: know yourself and your biases, don’t stereotype
Ethical principles: autonomy, nonmaleficence, beneficent, formal justice, veracity, Fidelity, confidentiality, and privacy
- autonomy: ability to make own decisions
- Nonmaleficence: do no harm
- beneficence: do good
- formal justice: have equality
- veracity: to tell the truth
- Fidelity: do what you say you’re going to do
What is credentialing?
Represents the verification of a persons education, training, and experiences; as in “to verify a persons credentials“
What is privileging?
Permission to provide medical and other patient care services in the granting institution based on the individuals education, professional license, experience, competence, ability, health, and judgment
Medicare
- An insurance program that primarily serves people 65 and older, regardless of income
- medicare is a federal program
- can also get Medicare if a younger person has disabilities and/or certain diseases, including end-stage renal disease, Lou Gehrig’s disease, etc.
Medicaid
- available in every state to those with income below the poverty line
- Federal government makes the guidelines, but the program is administered by states so eligibility requirements vary
Licensure
A formal recognition by a regulation agency that someone has proficient on a scale to practice in an area, often a state
Ordering diagnostics
- don’t just order because you can
- Think about risk versus benefit
- is the diagnostic going to change your treatment plan
- what do you ultimately want to find out
Medical futility
Interventions that are unlikely to have significant benefit to the patient
