Granded A NUR3294 Summer 2019 Exam 1 Focused Review

NUR3294 Summer 2019 Exam 1 Focused Review • Characteristics of the Nursing Profession • Respond to needs of patients • Actively participate in policy • Respond and adapt to challenges • Make clinical judgments ...

NUR3294 Summer 2019 Exam 1 Focused Review • Characteristics of the Nursing Profession • Respond to needs of patients • Actively participate in policy • Respond and adapt to challenges • Make clinical judgments and decisions about patients’ health care needs based on knowledge, experience, and standards of care • Purpose and components of nursing's standards of practice • To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice • Assessment • Diagnosis • Outcomes identification • Planning • Evaluation • Purposes of Code of Ethics • To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice • Differentiate between Educational programs for professional RN • Professional Registered Nurse • 2-year associate degree • 4-year baccalaureate degree • Graduate Education • Master’s degree, advanced practice RN • Doctoral degrees • Continuing and in-service education • CEUs • In-service • Definition of Registered Nurse practice • Protect, promote, and optimize our patients’ health • Prevent illness and injury • Advocate for the care of our patients • Alleviate suffering through the diagnosis and treatment of human responses • Nursing professional responsibilities • For obtaining and maintaining specific knowledge and skills • To provide care and comfort • To emphasize health promotion and illness prevention • Examples of nursing professional roles • Caregiver • Advocate • Educator • Communicator • Manager • What is the importance of Quality and Safety Education for Nurses (QSEN)? • Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics • What are reason for studying theories and theorists? • Gain understanding of what occurred in the past and events that have shaped what have gotten us to the point we are at today. • Provide research to postulate fresh ideas to gain new insights and advance new technologies. • What are examples of interdisciplinary theory used to guide nursing practice? • Basic human needs • Developmental • Psychosocial • Systems • What are the relationships among nursing theory, the nursing process and patient needs? • The nursing theory drives the process, which in turn directs the care taken to properly address the patient’s needs. • Define theory based nursing practice? • Generate nursing knowledge for use in practice • Can direct how to use nursing process • Are adaptable to different patients and all care settings • The goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. • Importance of theory based nursing practice important? • Is a conceptualization of some aspect of nursing • Describes, explains, predicts, and/or prescribes nursing care • Know the differences between preventive care, primary care, secondary care, tertiary care, and restorative care (and different types of restorative care) • Preventive care focuses on reducing and controlling risk factors for disease through activities such as occupational health programs. • Primary health care focuses on improved health outcomes for an entire population. It includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of diseases. • Requires collaboration among health professionals, health care leaders, and community members. • Health promotion programs lower the overall costs of health care by reducing the incidence of disease, minimizing complications, and reducing the need to use more expensive health care resources. • Secondary and Tertiary Care • Disease management is the most common and expensive service of a health care delivery system. • Chronic illness causes disability, decreased quality of life, and increased health care costs. • Hospitals • Work redesign • Discharge planning • Intensive care • Psychiatric facilities • Rural hospitals • Restorative Care • Serves patients recovering from an acute or chronic illness/disability • Helps individuals regain maximal function and enhance quality of life • Restorative Care: Home Health Care • Provision of medically related services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation. • Involves coordination of services. • Focuses on patient and family independence. • Usually reimbursed by government (such as Medicare and Medicaid in the United States), private insurance, and private pay. • Restorative Care: Rehabilitation • Includes physical, occupational, and speech therapy, and social services • Begins on admission • Focuses on preventing complications • Maximizes patient function and independence • Restorative Care: Extended Care • Extended care facility • Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities • Intermediate care/skilled nursing facility • Provides care for patients until they can return to their community or residential care location • Know the difference between hospice, respite care, assisted living, and skilled nursing • Nursing centers or facilities • Assisted living • Long-term care setting • Home environment • Greater resident autonomy • No fee caps • Respite care • Respite care provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. • Settings include home, day care, or health care institution with overnight care. • Trained volunteers enable family caregivers to leave the home for errands or social time. • Adult day care centers • Provide a variety of health and social services to specific patient populations who live alone or with family in the community • May be associated with a hospital or nursing home or may operate independently • Hospice • Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. • Focuses on palliative (not curative) care • Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family. • What is performance improvement? • an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions. • What are some examples of quality improvement processes? • Patient Self-Determination Act (PSDA) • Six Sigma or Lean • Rapid-cycle improvement or rapid-improvement event (RIE) • How does technology affect nursing? • Review Institute of medicine nurse competencies • Provide Patient-Centered Care • Recognize and respect differences in patients' values, preferences, and needs. • Relieve pain and suffering. • Coordinate continuous care. • Effectively communicate with and educate patients. • Share decision making and management. • Advocate for disease prevention and health promotion. • Work in Interdisciplinary Teams • Cooperate, collaborate, and communicate. • Integrate care to ensure that it is continuous and reliable. • Use Evidence-Based Practice • Integrate best research with clinical practice and patient values. • Participate in research activities as possible. • Apply Quality Improvement • Identify errors and hazards in care. • Practice using basic safety design principles. • Measure quality in relation to structure, process, and outcomes. • Design and test interventions to change processes. • Use Informatics • Use information technology to communicate, manage knowledge, reduce error, and support decision-making. • Components of achieving magnet status • Transformational leadership • Structural empowerment • Exemplary professional practice • New knowledge, innovation, and improvements • Empirical quality results • What does public health nursing require the understanding of vs community health nursing? • Needs of a population • Factors that influence health promotion and health maintenance • Trends and patterns influencing disease within populations • Environmental factors contributing to health and illness • Political processes used to affect public policy • Community health nursing vs community-based nursing • Community health nursing • Nursing practice in the community • Primary focus: health care of individuals, families, and groups within the community • Goal: preserve, protect, promote, or maintain health • Community-based nursing • Health Promotion • Disease Prevention • Restorative Care • Goals of Healthy People 2020 • Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services • Vulnerable populations • Individuals living in poverty • Older adults • People who are homeless • Immigrant populations • Individuals in abusive relationships • Substance abusers • People with severe mental illnesses • Skills and talents of nurses in community-based nursing • Caregiver • Case manager • Change agent • Collaborator • Counselor • Educator • Epidemiologist • Patient advocate • Models of care delivery including case management, total patient care, primary nursing, and team nursing • Traditional models • Team nursing • Primary nursing • Today’s models • Patient-centered care - mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered • Respect and dignity • Information sharing • Participation • Collaboration • Total patient care • Registered nurse works directly with patient, family, and health care team members. • RN is responsible for patients during shift of care, although care can be delegated. • Approach may not be cost-effective owing to high number of RNs needed. • Patient satisfaction is high • Case management - care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality • Collaborative process of assessing, planning, facilitating, and advocating for options and services to meet an individual’s health needs. • Clinicians oversee the management of patients with specific, complex health problems and are usually held accountable for some standard of cost management and quality. • Often the case manager is an advanced practice nurse (APN), who helps improve patient outcomes via specific interventions. • Decentralized decision making • Decentralized management means that decision making occurs at the level of the staff. • Responsibility, autonomy, authority, and accountability- be able to recognize examples of each • Responsibility: duties and activities an individual is employed to perform • Autonomy: independent decisions about patient care • Authority: legitimate power to give commands and make final decisions specific to a given position • Accountability: answerable for the actions • Clinical care coordination • Clinical decision making • Apply the nursing process • Know your patient • Use clinical decision making practices • Accurate clinical decision-making keeps you focused on the proper course of action • Priority setting • Determine which patient’s needs should be addressed first: • High priority: immediate threat to patient survival or safety • Intermediate priority: nonemergent, non–life threatening • Low priority: actual or potential problems may or may not be directly related to patient’s illness or disease • Organizational skills • Do the right things. • Do things right. • Inform and prepare patient. • Clean and organize work area. • Keep patient’s needs at the center of attention. • Use of resources • Appropriate use of resources is an important aspect of clinical care coordination. • Administration of patient care occurs more smoothly when staff members work together. • Time Management • Remain goal oriented. • Identify priorities. • Establish personal goals. • Evaluate • The process • Patient response • Therapy efficacy • Patient and expected outcomes • Team communication • Respect other’s ideas • Share information • Stay informed • Strive to improve communication • Share expectations of communications • Use structured communication techniques • Delegation • Transfers responsibility while remaining accountable for outcomes • Requires knowing which skills are transferable • Results in improved quality, safe patient care, improved efficiency, increased productivity, an empowered staff, and skill development of others • Assess the knowledge and skills of the delegatee. • Match tasks to the delegatee’s skills. • Communicate clearly: • Task, outcome, time • Listen attentively. • Provide feedback. • Knowledge building • Remain competent. • Pursue lifelong learning. • Share the knowledge. • To become a leader, actively pursue learning opportunities, both formal and informal, and learn to share knowledge with the professional colleagues you encounter. • 5 rights of delegation • Right Task • Right Circumstance • Right Person • Right Direction • Right Supervision • What tasks can and cannot be delegated to unlicensed assistive personnel? • Do not delegate the steps of the nursing process of assessment, diagnosis, planning, and evaluation because these steps require nursing judgment. • Patient teaching is also the responsibility of an RN and should not be delegated. • As an RN, you are always responsible for the assessment of a patient’s ongoing status; but if a patient is stable, you delegate vital sign monitoring to the NAP. • Appropriate delegation begins with knowing which skills you are able to delegate. Know your state’s Nurse Practice Act. • As a professional nurse you cannot simply assign the NAP tasks without considering the implications. Assess the patient and determine a plan of care before identifying which tasks someone else is able to perform. • Globalization • Evidence-based practice • When does discharge planning start? At admission • Differentiate between ethics and values • Ethics - The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large. • Values - Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. • What are examples of ethical principles? • Define Risk Management • A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs • Liability and Nursing Students issues • You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. • You are expected to perform as a professional when rendering care. • Examples of negligent acts • Failure to assess and/or monitor, including making a nursing diagnosis • Failure to notify the health care provider of problems • Failure to follow orders • Failure to convey discharge instructions • Failure to follow policies and procedures • Failure to properly delegate and supervise • Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative • Failure to monitor in timely fashion • Failure to use proper equipment to monitor the patient • Failure to document the monitoring • What are examples of Federal statutory issues in nursing practice • Americans with Disabilities Act • Emergency Medical Treatment and Active Labor Act • Mental Health Parity Act • Uniform Anatomical Gift Act • Living Wills, Durable Power of Attorney • Health Insurance Portability and Accountability Act • Advance Directives • Restraints • Differences and similarities in living will, advance directives, durable power of attorney • What are issues related to Ethics of Care? • Quality of life: central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNR • Genetic screening: What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available? • Care at the end of life: interventions unlikely to produce benefit for the patient • Access to care: As a nurse, you will certainly deal with ethical issues related to access to care. • Examples. Definition, processing of ethical dilemmas • Step 1: Ask if this is an ethical dilemma. • Step 2: Gather all relevant information. • Step 3: Clarify values. • Step 4: Verbalize the problem. • Step 5: Identify possible courses of action. • Step 6: Negotiate a plan. • Step 7: Evaluate the plan. • Basic philosophies of health care ethics • Deontology - Defines actions as right or wrong • Utilitarianism - Proposes that the value of something is determined by its usefulness • Feminist Ethics - Focuses on the inequality between people • Ethics of Care - Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives • Role of ethics in professional nursing • The Code is written by nurses to express their understanding of their professional commitment to society. It describes the profession’s values, obligations, duties, and professional ideals. • Legal obligations and role of nurse regarding federal laws • Any competent individual 18 years of age or older for himself or herself • Any parent for his or her unemancipated minor • Any guardian for his or her ward • Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) • Any grandparent for a minor grandchild (if an emergency, and parents are not present)