RS old exam 2, new exam notes towards bottom page 100% practice docs

RS old exam 2, new exam notes towards bottom page 100% practice docs Question 1 0 out of 1 points Identify the primary purpose for the development of the Quality and Safety Education for Nurses (QSEN) project. ...

RS old exam 2, new exam notes towards bottom page 100% practice docs Question 1 0 out of 1 points Identify the primary purpose for the development of the Quality and Safety Education for Nurses (QSEN) project. Question 2 1 out of 1 points The Robert Wood Johnson Foundation has recommended the following: (Select all that apply). Question 3 0 out of 1 points Identify the health-care area in which the use of computers has improved the efficiency of care. Question 4 1 out of 1 points Identify what a new graduate nurse who is having unresolved role conflicts may experience. Question 5 0.33333 out of 1 points Which element(s) is (are) a QSEN competency? SELECT ALL THAT APPLY. Question 6 1 out of 1 points What are rules of conduct that protect the community and society overall? Question 7 1 out of 1 points What may cause some people to make responses that seem inappropriate or over emotional? Question 8 1 out of 1 points Which is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement for client education? Question 9 1 out of 1 points What is an important role that the nursing process fulfills in professional nursing? Question 10 0 out of 1 points Identify the most appropriate political activities for nurses at the state level. Question 11 0 out of 1 points Statistically, which factor is most likely to increase a client’s motivation to learn? Question 12 1 out of 1 points Identify the most important element in nursing’s attempt to gain full autonomy of practice. Question 13 0 out of 1 points After assessing an older adult client in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the client is dying. What are the nurse manager’s decision and actions based on? Question 14 1 out of 1 points Which step of the nursing process identifies the success or failure of the plan of care developed by a nurse? Question 15 1 out of 1 points What is a recommended method for nurses to prepare for future professional practice? Question 16 1 out of 1 points The nurse manager decides to involve those to be affected by change early in the change management process. What can positively result in? Question 17 1 out of 1 points The oxygen saturation for a client with acute infective bronchitis drops to 84%, and the client develops severe dyspnea. There is a standing order for a handheld nebulizer (HHN) treatment PRN for shortness of breath. The respiratory therapy department is designated to give all respiratory treatments in the facility. When the nurse calls the respiratory therapist, he states that he has several more treatments to give but he should be there in 10 or 15 minutes. Which action by the nurse is most appropriate at this time? Question 18 1 out of 1 points Which activity tends to increase nurses’ satisfaction during work? Question 19 0 out of 1 points What is the primary concern that some health-care providers have in the use of computers in client care? • Question 20 0 out of 1 points Nurses must understand which principle of the Nurse-Family Partnership? • Question 21 1 out of 1 points Identify the primary position advocated by the 1965 ANA Position Paper on Education for Nurses. • Question 22 1 out of 1 points As nurses achieve increased professional autonomy, what must they also accept? • Question 23 1 out of 1 points Identify the underlying premise for evidence-based practice. • Question 24 1 out of 1 points Identify the element that is the best indicator of increasing accountability in the profession of nursing. • Question 25 1 out of 1 points A leader with a low relationship/low task orientation presents a leadership style that is most similar to which leadership approach? • Question 26 1 out of 1 points You overhear a newly graduated nurse telling one of your colleagues that leadership and management belong to the unit manager and not to her. Your response demonstrates understanding that the what about the perception of the new graduate? • Question 27 1 out of 1 points Which statement by a nurse manager during a staff meeting best demonstrates use of an assertive style of communication? • Question 28 0 out of 1 points The CEO asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-client ratio? • Question 29 1 out of 1 points Why do many new nurses ignore the signs of burnout? • Question 30 What role does anger play in communication? • Question 31 What statement is true regarding the relationship between nurses and legislators? SELECT ALL THAT APPLY. Question 32 During a staff meeting, an elderly physician is very negative about recent changes on the unit. He indicates that the nurses are not working hard enough. How can the unit manager most appropriately deal with this situation? • Question 33 Why is the term healing preferred to medicine when referring to alternative and complementary methods of care? • Question 34 1 out of 1 points As the head of a nursing program, you always invite the ideas of your team about innovations in teaching and curriculum design, and invite participation in decisions. Many of these ideas have been implemented, and your staff members are keen to try other new ideas. You are employing what type of leadership? • Question 35 Which personality characteristics would make a person more susceptible to burnout? • Question 36 0 out of 1 points Identify the term defined as systems of valued behaviors and beliefs. • Question 37 1 out of 1 points Which is not true of the Change of Shift SBAR report? • Question 38 0 out of 1 points What is the first step in the process of critical thinking? • Question 39 1 out of 1 points Provision number 7 of the 2001 Code of Ethics for Nurses states: “The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.” On which ethical principle is this statement primarily based? • Question 40 0 out of 1 points A family is keeping vigil at a critically ill client's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action? • Question 41 1 out of 1 points Which characteristic is required in a person who is able to resolve difficult crises? • Question 42 1 out of 1 points After her first week working on a busy medical/surgical unit, a new charge nurse notes that the nurses, although highly competent, are unable to function productively as a team. What can she do to facilitate team-building on her unit? • Question 43 1 out of 1 points Select an important principle that guides managers who use a democratic leadership style. What is the primary reason a nurse should develop learning objectives for all client teaching? • Question 45 1 out of 1 points What is a type of nursing education program that is conducted in junior and community colleges that is typically two years in length? • Question 46 1 out of 1 points What is the most common emotion experienced by nurses who are developing burnout? • Question 47 1 out of 1 points What makes a problem an ethical dilemma? • Question 48 1 out of 1 points Which contribution of Florence Nightingale had the greatest impact on nursing education? • Question 49 1 out of 1 points The manager of an intensive care unit wants to add nurse assistants or unlicensed persons to feed, bathe, and assist in some unit tasks. The nurses are very resistant to this idea. What is the best initial approach for the nurse manager to take to get buy-in of the nurses? • Question 50 1 out of 1 points Provision number 1 of the 2001 Code of Ethics for Nurses states: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health-care problems.” On which ethical principle is this statement primarily based? Why is the input of nurses vital to legislators? What is the document that provides nurses with the right to practice and specifies the parameters of professional practice? What comprises the branches found in the government at the federal level? A client with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What would be your best action in this situation? Administration is renovating the nurse's lounge. The department asks the nursing staff to make a wish list of everything that they would like in the new lounge. This process is an example of which part of the decision-making process? What is the most important reason why nurses should be familiar with health-care reimbursement methods? If all of these goals were appropriate for a client, which would have the highest priority? Which demographic factor has the most significant effect on the health-care delivery system of the future? Which action is in compliance with Crossing the Quality Chasm? It is important to the future of nursing research that clinical practice areas find ways to support scientific inquiry. What has been identified as a significant barrier to the implementation of research findings in client care? What is one of the primary goals of the Affordable Care Act of 2010? What is the best way for nurses to influence the legislative process at the federal level? What is true about the translation of research into practice? What approach may gain nursing support of adopting evidenced-based care related to family-centered care? Identify the term that best describes the act of science of influencing public policy A mediator noticed that tension was still evident between the nurse manager and staff members. To begin team-building what would be important for the chief nursing officer to encourage with the team? The nurse manager has had an increase in incident reports about medication errors during the evening shift. What is the best way for the nurse manager to resolve the problem? Before the IOM report was issued, "to err is human" adverse events were considered to be what? An RN is assigned to a step-down coronary care unit with 20 clients in various stages of recovery. What is the primary consideration in assigning the units staff that includes 2 RN's, 2 LPN's, and one CNA? What is a characteristic of a good nursing decision maker? What is a true statement regarding nursing judgement? A nurse manager noticed poor morale and grumbling among his staff. He decided to award them a few more days off in the upcoming schedule. Two of the staff nurses approached him and said that the problem was not scheduling, but rather the charge nurse and the way she does client assignments. What was the unit manager's first missed step in problem solving? The nurse manager wants to implement a revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care? A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The client speaks very little English and looks worried. What is your best response? Which type of information obtained by a nurse during the assessment step in the nursing process is considered subjective data? Identify a typical response for a manager who uses laissez-faire approach to leadership when faced with a difficult decision What has been identified as a significant factor in moving EBP into client care? As a result of the Joint Commission assessment, a healthcare facility loses its accreditation. What is the primary consequence for this institution? Which step of the nursing process identifies the success or failure of the plan of care developed by a nurse? Considering that research is typically new knowledge, which would be considered research? In designing a quality, safe, healthcare environment, what should be the primary emphasis? What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program? What best describes evidence-based nursing? Select the statement by a unit manager to the vice president for nursing during a budget meeting that would be most effective in decreasing the staffing ratio on her unit from one nurse for every 9 patients to one nurse for every7 patients. "this proposed change will..." There has been an increase in incident reports about clients falling during the 11-7 shift. What is the nurse manager's best way to resolve the problem? Which statement is most accurate regarding evidence-based practice? What is most accurate regarding evidence-based practice? Identify the best sources of support for nurses beliefs about health care As a client care advocate, what should you regularly coach clients about as to how to stay safe at home and in the health care setting? Select the most effective method that nurses can use to gain power over their practice. What is the first step in the process of critical thinking? Identify the best and most inclusive definition of nursing research Identify a valuable source of information about political issues that affect the profession of nursing The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. What should the manager do to make a high-quality decision? Identify the statement that capsulizes every nurse's responsibility to clients in regards to research What is a function of the parish nurse? The nurse manager understands that what is the most important problem-solving step? What is the best strategy to be used by a small hospital with limited resources to develop an evidence-based nursing practice program? Which assignment is most appropriate for a CNA floated to the medical/surgical unit from the outpatient clinic? How can nurses best deal with the value systems of clients for whom they are providing care? 25 Examples of sentinel events include S/A C short staffing on the unit 26 A nurse wants to utilize the best source of support for nurse’s belief about healthcare where can these be found A opinion and stereotypes B new programs and documentaries C written reports and published surveys D discussions and informal feedback from clients 27 the nurse manager of a rehab unit wants to purchase a new anti-embolic stocking to make a high quality decision the nurse manager would A involve the rehab staff in the decision B involve the sales rep C make the decision alone D involve administration in the decision 28 during a fire drill several psychiatric clients became agitated the nurse manager quickly assigned a staff manager to each patient this autocratic style is most appropriate for A a routine problems B crisis situations C manager who prefer a telling style D followers who cannot agree on a solution 29 the nurse manager on a unit is asked by a family member of a dying Native American patient if it is possible to have a member of the patients 8 member family recite the rosary by the bedside the manager responds affirmatively the nurse is most likely exhibiting behavior related to A acculturation B ethnocentricity C cultural diversity D cultural sensitivity 30 in caring for a patient from an east Indian culture the staff expresses frustration that many family members are in the room which often interferes with care as the nurse manager you provide leadership and understanding that this behavior of the family and friends network reflects A lack of understanding of the seriousness of the patient’s illness B lack of communication between family members C the social organization of friendship and family networks of the east indian culture D lack of caring of the hospital environment by the friends and families 31a nurse belongs to several professional organizations serving at a state level committee of 1 group and on 2 task forces at work the nurse is committed to a range of health issues this nurse exemplifies which level of professional action in nursing A vigilante B by end behavior C self activist D political activism 32 a nurse is participating in a baccalaureate course for the class she has to attend the legislative session regarding the new rules of medications assistance nurses should be involved in shaping public policy primarily because A involvement will enable nurses to take over the healthcare system at some point in the future B other healthcare professionals are less concerned about essential needs of a client C such activities are important career builders for nurses who seek top level executive positions D they are closest to the frontline of healthcare and see how it affects clients and families 33 a charge nurse is making a shift assignment what is the primary consideration in assigning the unit staff includes RNs 2 LPNs and 1 CNA A proximity of clients room to the nurses station B scope of practice of each staff member C staff preferences for favorite client D developmental needs of clients 34 what is the most likely reason that nurses have traditionally avoided joining unions and participating in elective bargaining A the union had little to offer nurses as far as pay and working conditions are concerned B unions were largely male dominated organization and wanted little to do with nurses C joining a union seems to contradict nursing image of dedication service and selflessness D nurses already had a great deal of control over their working condition salaries and benefits 35 a newly licensed RN is signing an employment contract with an employer identify the most important factor in the initial negotiation of that contract A discussion of important issues B posturing and negotiation of power C resolution of key conflicts D lack of willingness to work extra hours 36 a nurse is using research and science to influence public health policies at the state level this best known as A power B nursing C politics D ethics 37 a group of nurses want to influence the legislative process at the federal level the nurses can best do this by A organizing demonstrations outside the Whitehouse when important healthcare issues are discussed *B sending telegrams and letters to their congress members and senators C having the main nurse organization nurse speaks with a unified voice when presenting their concerns D joining and actively participating in hospital committees on healthcare 38 a new nurse manager wants to incorporate evidenced based practices into her new unit she recognizes that A she will need to hire a professional nurse researcher B successful use of evidence based practice depends on how practical and useful the information is to the nurses C nurses cannot possibly understand the perplexities of the changing evidence in their practices D job description for all open positions needs to include research competencies 39 a nurse wants to be effective in managing a culturally diverse staff WOTF nurse manager attributes would assist the nurse in addressing the cultural needs of the staff S/A A stereotyping of others B respect for others C positive reinforcement D knowledge about the staff E age biases F disapproval of others 40 a novice nurse wants to be a good nurse advocate for clients on the unit the nurse realizes that being a client advocate is A important but not essential to competent care B necessary only when the nurse agrees with the client’s choices C is one of the most important roles of a nurse D mandatory for diffusing litigious circumstances 41 a nurse is serving as preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate WOTF illustrates advocacy role S/A A verifying that a client understands what is done during a cardiac cauterization B discussing treatment options for a terminal diagnosis C informing members of the healthcare team that the client has DNR status D reporting that a health team member on the previous shift did not provide care as prescribed E assisting a client to make a decision about his care based on the nurses recommendation 42 a nurse is teaching a class about safe medication administration the nurse should include in the teaching that WOTF references are acceptable for safe medication administration S/A A a website that ends in .com B published journals C physicians’ desk reference D pharmaceutical sales reps E pharmacists 43 a charge nurse suspects that a staff nurse is diverting opioids analgesics WOTF is an effect of opioid medication A euphoria B rhinorrhea C hallucinations D dilated pupils 44 a nurse manager on the floor hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care when discussing the issue WOTF statement by the nurse manager is most helpful and appropriate A why didn’t you voice your concerns before the new policy was implemented B being open to change is an expectation of the nurses who are on this unit C you should support this policy change because it was based on evidenced based practice D lets talk about your concern about the new policy 45 ANIC for a 16 year old client who is experiencing a relapse of leukemia and is refusing treatment the clients mother insists that the client receives treatment WOTF actions should the nurse take A initiate the IV per the parents request B notify the provider of the situation C administer a sedative to calm the client D offer the client an antiemetic 46 ANIC for a client who falls in his room after the nurse assesses the client, notifies the clients provider and completes an incident report WOTF actions should the nurse take A make a copy of the incident report for the patient B make a copy of the incident report for the provider C submit the incident report to the risk manager D document in the chart that an incident report has been filed 47 an assistive personnel reports to the nurse that a client who is 3 days post-op following an abdominal hysterectomy has a dressing that is saturated with blood WOTF tasks should the nurse delegate to the AP A change the clients dressing B obtain VS C palpate for bladder extension D observe the incision site 48 a systematic but subjective approach implemented to describe life experiences and give them meaning is which type of research A qualitative B quantitative C quantified D random 49 the RN is observing the new LPN giving medication which was ordered as amoxicillin 7.5ml q8hrs on hand is 125mg/ml the LPN draws up 195ml what should he RN do A nothing the dosage is correct of 195ml….this is an ati question B stop her and the dosage should be 185ml C stop her the dosage should be 562.5ml D correct the dosage should be 165ml 50 the RN is observing a graduate nurse as he gives medication to 126lb adult the order reads 20mg/kg for 24hrs to be give POq6hrs how many mg will be administered per dose A 1500mg B 275.5mg C 286.5mg D 280.4mg BELOW IS MOD 4 from VEST WEBEX Improvement of nursing practice in Preoperative teaching Pain management Assessment of children’s behavior Falls prevention Pressure ulcer risk Incontinence care Family centered care in intensive care part of the evaluation is Deciding on whether to implement the research -Quantitative research uses numbers to determine things -Qualitative research uses people. -Some decisions -should not be based upon the results of quantitative data alone. -Needs to be integrated with data from qualitative research to be applied. Requirements for the development of an evidence-based practice -A clearly written clinical question -More thorough search of literature -Review of single studies, meta-analyses, critically appraised topics, systemic reviews, and/or clinical guidelines -Appraising evidence -Placing evidence in the context of patient, family, and community values research utilization -focuses on using a particular research finding in practice Evidence based practice includes -focuses on solving a clinical problem with a research based solution -includes consideration of patient’s reference translation science Government and private agencies are placing increasing emphasis on translation science Institute of Medicine • To Err is Human (2000): Defined the number of deaths attributed to patient safety issues o Moved safety issues from the incident report level to an integrated patient safety report for the organization • Crossing the Quality Chasm (2001): Identified the six major aims in providing health care (see Box 2-1) o Moved care from discipline-centric foci to patient-centered foci o Reinforced the disparities that occur within health care, which, in turn, led to a focus on best practices (and reinforced the need to be patient centered) o Addressed issues such as healing environments, evidence-based care and transparency, which led to a more holistic environment that was built on evidence and that was transparent • Health Professions Education: A Bridge to Quality (2003): Addressed the issue of silo education among the health professions in basic and continuing education (see Box 2-2) o Attempted to shrink the chasm between education and practice so that interprofessional teams would work more effectively together o Increased expectation for participation in lifelong learning • Keeping Patients Safe: Transforming the Work Environment of Nurses (2004): Identified many past practices that had a negative impact on nurses and thus on patients o Focused on direct care nurses, supporting their involvement in decision making related to their practice o Supported the concept of shared governance o Provided a framework for considering how nurses could determine staffing requirements o Moved the Chief Nursing Officer into the boardroom as a key spokesperson on safety and quality issues • Improving the Quality of Health Care for Mental and Substance-Use Conditions (2005): o Addressed issues related to this patient population, including those who can be found among a general care population o Provided a focus on mental health needs of patients who were not admitted for the primary reason of mental health issues • Preventing Medication Errors (2006): Addressed many of the issues surrounding the use of medications o Validated the complexity of providing medications to patients • Future of Nursing: Leading Change, Advancing Health (2010): Identified 8 recommendations based on evidence that the profession must attend to (See Box 2-3) o Created state coalitions focused on improving nursing o Created nursing/community/business coalitions to accomplish the work o Moved the issue of nurses as leaders to a more visible level Agency for Healthcare Research and Quality (AHRQ) • Federal agency devoted to improving quality, safety, efficiency, and effectiveness (2008) o Outcomes research sections provide resources for nurses. o Source of Five Steps to Safer Health Care (www.ahrq.gov/consumer/5step.htm) (see Box 2-4) o Source of Stay Healthy checklists for men and women o Source of Team STEPPS National Quality Forum (NQF) o Membership-based organization related to quality measurement and reporting o Source for Centers for Medicare & Medicaid’s never events o Resource for Healthcare Facilities Accreditation Program (a CMS-deemed authority) (uses NQF’s Safe Practices) o Source of nurse-sensitive care standards The Joint Commission o Not-for-profit organization that accredits healthcare organizations internationally o Focused on outcomes redirected accreditation processes and thus nurses’ roles with the process o Changed to unannounced visits and thus changed the way organizations prepared for accreditation o Issues annual patient safety goals o Issues sentinel event announcements Det Norske Veritas/National Integrated Accreditation for Healthcare Organizations o Internationally based organization that accredits many fields, including health care o Based on an internationally understood set of standards known as ISO (International Organization for Standardization) o Visits annually and thus changed the way accreditation is viewed Magnet Recognition Program o A designation built on and evolving through research o Emphasizes outcomes o Created unified approaches to seek this designation o Redirected focus to outcomes, including data and efforts related to patient safety Institute for Healthcare Improvement (IHI) o Independent, not-for-profit o Source of TCAB (Transforming Care at the Bedside) o Provides rapid cycle change projects designed to improve care rapidly o Organization designed to improve health by advancing quality and the value of healthcare Quality and Safety Education for Nurses (QSEN) o Comprehensive resource, including references and video modules o Created knowledge, skills, and attitudes for students and graduates related to safety The National Institutes of Health (NIH) (2011) NIH Roadmap o created a roadmap to harness scientific discovery to improve the health of all people. The roadmap has three major themes:  (1) new pathways to discovery,  (2) research teams of the future,  (3) reengineering the clinical research enterprise. o “New pathways to discovery” is focused on new strategies for diagnosing, treating, and preventing disease. o It includes building blocks, biological pathways and networks, molecular libraries and imaging, structural biology, bioinformatics and computational biology, and nanomedicine. o “Research teams of the future” focuses on high-risk research, interdisciplinary teams, and public-private partnerships. o “Reengineering the clinical research enterprise” focuses on clinical research networks, policy analysis and coordination, dynamic assessment of patient-reported chronic disease outcomes, and translational research. o The goal is to foster high-risk/high-reward research, develop transformative tools and methodologies, fill knowledge gaps, and foster collaboration in order to get research into the hands of practitioners so they can improve patient care. The Leapfrog Group o a consortium of employers and organizations that buys health care, works to prevent mistakes in health care and improve the quality and affordability of health care. o It supports informed healthcare decisions by those using and paying for health care and promoting high-value health care through incentives and rewards o Hospitals and other healthcare organizations will increasingly be called upon to provide value for their services. Steps in evidence based practice -asking the relevant clinical question -searching for best evidence -Critically appraising evidence -Integrating evidence with clinical expertise, patient preferences, values in making a practice decision or change -Evaluating the practice decision or change PICO Patient population Intervention / interest area Comparison Outcome Roger’s diffusion of innovations theory -Innovations spread through society Diffusion of innovation Knowledge -jounals, conferences, educational programs and media are used as well as literature reviews. -think about subscribing to nursing research journals -think about practice journals with a research column -can a nurse provide an example of research finding -can u bring journal with example of research report -go to a conference -recall research in media Persuasion -communication networks, can be a nurse on the unit or charge nurse -positive or negative attitudes -find someone who has served as a champion “leader” or someone interested in the research - Decision -Commitment to adoption -what factors would facilitate the adoption of innovation? -what would make it difficult? Implementation -Application of practice -Confirmation -Direct application -exactly as done in research -Reinvention -modify it to work -Indirect application -modify it according to the needs and values of the staff Evaluate -what worked -what didn’t -what helped motivate the staff to continue with the innovation -what reinforcement worked best -patient perspective -nurse perspective -what value was placed on each perspective? SHE SAID THIS COULD BE ON TEST BELOW.. The characteristics of innovation Adopters…… Innovators -active in seeking new info, they are visionaries Early adopters -opinion leaders who learn about innovation and apply it to practice, can be effective in communicating the value of innovation, fast to jump on board Early majority- won’t bring forth an innovation, BUT will readily adopt it when given the chance by others, not fast to jump on board but will if opportunity given Late majority- they are skeptical, wont adopt something unless pressure is applied. Might backlash Lagers- most secure in holding onto the past, they are okay with an idea failing STETLER’s Research Utilization Model to Facilitate Evidence-Based Practice -1976, gives direction for individuals and members of group, scientific method and nursing process Preparation Validate Evaluate/Decision making Translation/application Evaluation Individual Strategies for EBP -BASICALLY find out what the challenges are, what are the practices, why are they used. -identify challenges from providing care -ask questions about agency practices -ask for the evidence underlying practices -use PICO to find problems in practices Collaboration in EBP -Partner with researchers at local colleges and universities Stakeholders -can be anyone on unit, nurse manager, other workers, community may be involved in process, client, families -involve as many people -who can be involved -partner with faculty and students to gather info -publicize any research that worked NURSING NOW CH24 SLIDE NOT COVERED IN MY STUDYGUIDE. BELOW IS MOD 5 FROM VEST WEBEX She said she writes test from “Lesson Content - objectives” in the modules in each week. She is not going to review “Clinical Reasoning and Clinical Judgment Chapter 4” Clinical Judgment -interpretation and interferences that influence actions in the clinical setting -need to happen an opinion -looking at opinion and applying it to a clinical setting -experience helps but isn’t reliable Clinical Reasoning -type of thinking and u reach a clinical judgment -defined as a way of noticing and interpreting and responding the patient and how pt responds to interaction -must recognize that each pt is different -understand each contribution and care is different TWO APPROACHES -STANDARD- -puts nurse and pt needs outside of care -involves maps, decision trees, policies, procedure manuals, -clear-cut directions -using what you’ve learned using policies and procedures Interpretivist Approach -life experiences are culturally bound -each pt will interpret their experience on basis of their culture -one set approach is not all right for each pt -not clear cut answer -clinical judgment becomes very specific to the pt -FOCUSES on pt culture 3 ATTRIBUTES of Clinical Judgment -Holistic view of pt situation- consider all factors in care, include characteristics of nurse and pt -Process orientation- understand pt situation and nurses own personal knowledge, background and values and beliefs -reasoning and interpretation- 3 types of reasoning required; analytic, intuitive and narrative, -usually novice nurse uses analytic reasoning in unfamiliar situations. -Expert nurse uses intuitive. -Some nurses use narrative “tales of the patient’s prior experience with illness to understand pt needs Problem solving -know facts, separate from other interpretations -ADPIE -add critical thinking skills Patient Centered Care -requires empowerment of patients to become more active in their plan of care -need communication skills -helps pts advocate for themselves -basically, does the patient know wtf is going on so they can make decisions for themselves since we cant make decisions for them -IOM – Crossing the chasm 2001, SIX aims for healthcare improvement; -patient care must be safe, effective and patient centered, -healing environment, individualized care, autonomy, EBP and transparency -AHRQ – healthcare evolving from disease-centered model to patient centered model Role of Leader and Manager in solving problems Decision making-goal-directed effort using a systematic process to choose among options. Problem solving-make choice to take make best available option, not just settling on one option Critical thinking- subject, content, problem, improves quality of thinking by thinking about it REALLY hard lol, analyzing assessing and reconstructing it Creativity- be creative about the approach to the problem, be flexible and think independently Decision Models Satisficing (good enough) “im satisfied” Optimizing (best possible) “im optimistic that’s the best” Paternalistic – mangers decide whats best “mother knows whats best” Informative- offers staff to make decision after giving them info “inform them then decide” Shared – staff talks about options and what they want to make the decision, interactive! “lets share this issue and talk about it” TOOLS to make decisions -decision grid -SWOT Group decision making -higher quality -function more better -takes ownership Consensus“can we make a conclusion” -more committed group -need to be able to all agree -DOESN’T mean it is made by their “first choice” so can they live with that decision at the end of the day