1/12/21 lecture Flashcards


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1

basis of all other nursing areas

medical-surgical

2

med-surg focuses on the

management of acutely ill adult patients

3

what is the orders of steps for evidence-based practice?

  1. develop the question
  2. search and collate the best evidence
  3. evaluate the quality of the evidence
  4. integrate evidence into practice
  5. evaluate outcomes of practice change
  6. disseminate the evidence
4

what is level 1 of the levels of evidence?

evidence from systematic reviews of randomized controlled studies (RCTs)

5

includes assessment, diagnosis, planning, implementation, and evaluation and ultimately guides patient care

nursing process

6

foundation of professional nursing practice

evidence-based nursing practice

7

what are the parts of patient-centered care

benchmark of evaluation of nursing care

  • effective communication skills
  • empathy
  • caring
  • compassion
8

focuses on treating patients and families with dignity and respect and engaging patients and families in decision making about care decisions

patient-centered care

9

a survey that provides a standardized approach to collecting data from patients about their experiences in hospitals

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

10

independent, not-for-profit organization that accredits and certifies approximately 77% of hospitals in the U.S., accreditation and certification from this organization are recognized as the standard of patient care, effectiveness, and safety and foster continuous process improvements

The Joint Commision (TJC)

11

organization that fosters patient-centered care through the "patient experience" that is influenced by all the interactions and experiences encountered, based on the organization's culture and practices

The Beryl Institute

12

goals aimed at improving patient safety through goals that focus on potential problems in the healthcare setting

National Patient Safety Goals

13

helps to decrease communication barriers, enhance communication with healthcare providers, & report changes in patient conditions

SBAR

14

what are the 4 parts of the SBAR?

  • situation
  • background
  • assessment
  • recommendations
15

what does the situation consist of?

brief statement of the problems or issue being addressed

16

what does the background consist of?

data related to the current situation

17

what does the assessment consist of?

summary of causes, significance, severity of situation

18

what does the recommendation consist of?

specific actions needed to address the situation

19

when might a "hand-off" be necessary?

  • change of shift reports
  • receiving a patient
  • transferring a pt to another department
20

requires all personnel involved in the procedure to stop to make sure that the pt is identified, the correct anatomical site is identified, and all equipment is in working order

time-out

21

designed to prepare nurses with the required knowledge, skills, and attitudes to foster continuous improvement of quality and safety in healthcare settings

Quality and Safety Education for Nurses (QSEN)

22

What does QSEN consist of?

  • patient-centered care
  • teamwork and collaboration
  • evidence-based practice (EBP)
  • quality improvement (QI)
  • safety
  • informatics
23

Institute of Medicine's Competencies for Health Professionals:

  • provide patient-centered care
  • work in interdisciplinary teams
  • employ evidence-based practice
  • apply quality improvement
  • utilize informatics
24

nurse-led multidisciplinary program that was developed by Mary Naylor, an APRN @ the University of Pennsylvania

transitional care model (TCM)

25

manage patients as they transition across the care continuum from inpatient setting to other settings, including skilled nursing facilities and home

transitional care nurses (TCNs)

26

two or more coexisting medical conditions or disease processes

comorbidities

27

employs nurses as "transition coaches" to manage chronically ill or seriously ill patients as they transition between healthcare settings

Care Transitions Program

28

are national programs that also seek to improve care as patients transition from acute care settings to post-acute care settings by improving the discharge processes

Project RED (Re-engineered Discharge) and Project BOOST (Better Outcomes for Older Adults Through Safe Transitions)

29

an enhanced model of primary care that engages ICTs to address and care for patients with multiple comorbidities

patient-centered medical home (PCMH)

30

an example of a PCMH that has improved pt outcomes and quality and reduced costs through nursing interventions

Guided Care Program

31

project implemented in 2003 to address the recommendations related to improving the quality and safety or patient care on medical-surgical units

Transforming Care at the Bedside (TCAB)

32

the development of ________ also grew as a result of TCAB efforts

rapid response teams

33

are in acute care settings and are composed of clinicians who provide critical care expertise at the patient's bedside or point of care and typically include a critical care provider or intensivist, critical care registered nurse, pharmacist and respiratory therapist

rapid response teams

34

an essential component of IC and all care models striving for effective in-hospital and transitional care is

pt education

35

patient education strategy that involves imparting knowledge and then asking for the information to be restated to ensure patient understanding; this teaching should be accompanied by written material for the patient to use as an ongoing resource

teach-back

36

occurs when two or more professionals work together to solve problems or coordinate care

interprofessional collaboration (IC)

37

was developed by the American Academy of Ambulatory Care Nursing (AACN) to standardize the practice of ambulatory nurses as well as acute, subacute, and home health nurses in care-coordination and transition-management roles

Care Coordination and Transition Management (CCTM)

38

what are the 5 rights of delegation?

  1. right task
  2. right circumstances
  3. right person
  4. right directions and communication
  5. right supervision and evaluation
39

professional who utilizes the nursing process to care for the patient: to assess, plan, implement, and evaluate

registered nurse

40

where is the Nurse Practice Act found at?

ASBN (Arkansas State Board of Nursing)

41

nurses serve as patients':

  • advocates
  • protectors
  • confidants
42

ethical principles guide the

moral traditions, values, and behaviors of professional nursing

43

Code of Ethics for Nurses provides a

standard of nursing practice

44

both a concept and a movement that considers our past missteps as well as the breadth and consequences of our technological advances; just because we can, should we?

bioethics

45

The Belmont Report describes three basic ethical principles to be applied to any research involving human subjects:

  • respect for persons
  • beneficence
  • justice
46

to "do good"

beneficence

47

to do no harm

nonmaleficence

48

individual right to choose for oneself

autonomy

49

reflects the social contract that nursing has with the public, encompassing the moral traditions, values, and trust that the public has come to associate with nursing

American Nurses Association Code of Ethics

50
  • generic level of competency common to all practicing nurses
  • uses nursing process as framework

ANA Scope and Standards or Practice

51
  • promotes ethical nursing practice throughout the world
  • descries nurses' accountability to core values

International Nursing Council Code of Ethics

52

ethical principles:

  • beneficence
  • autonomy
  • justice
  • fidelity
  • nonmaleficence
  • veracity
  • confidentiality
  • paternalism
53

requires fair and equal treatment for everyone regardless of race, religion, or gender

justice

54

involves the individual's personal right to make decisions concerning him- or herself

autonomy

55

concerns people acting positively on behalf of the perceived well-being of others

beneficence

56

expects the nurse to be accountable for commitments made to others, to the self, and to the profwession, bsed on the virtue of caring

fidelity

57

examines issues related to who may be harmed by actions and how any harm can be minimized or averted

nonmaleficence

58

the requirement to tell the truth and to refrain from intentionally misleading or deceiving a pt to influence decisions

veracity

59

requires that information is not shared beyond those who have a need to know

confidentiality

60

the inappropriate intention to protect individuals from their own involuntary actions or choices in the name of beneficence, which actually violates their right to self-determination (autonomy)

paternalism

61

ethical theories to support nurses in decision making:

  • common good
  • sanctity of life
62

considers what decision will be most beneficial for the greatest number of people and relates to the theory of utilitarianism

common good

63

what are some examples that can be ethical dilemmas?

  • informed consent
  • DNR directives
  • advanced directives
  • living wills
  • withdrawal of fluids and nutrition
  • pain control
  • genetic testing, reproductive technology, selective abortion
  • experimental therapies
  • inability to afford prescribed care
  • organ and tissue donation
64

document that is designed to communicate the final wishes of patients in the event they cannot speak for themselves and is created when the pt is competent and in open communication with the provider

advance directive

65

legal document created by a competent person that provides the person's desires for medical care in the event the person is unable to independently make decisions regarding care

living will

66

what is one of the most challenging ethical dilemmas that a nurse may confront?

withdrawal of fluids and nutrition

67

ethical issues in professional practice:

  • moral courage
  • discernment
  • nurse-pt communication
  • social media, computers, and HIPPA
  • duty to warn
  • workplace incivility and horizontal violence
68

civil or personal wrong, compared with a crime, which is a public wrong

tort

69

what are the types of torts?

  • negligence
  • intentional torts
  • strict liability torts
70

failure of a person to exercise the degree of care that an ordinary prudent person would have exercised under similar circumstances

negligence

71

failure of a professional person to act as other prudent professionals with the same knowledge and education would have acted under similar circumstances

malpractice

72

wrongful act that was intended to cause harm

intentional torts

73

examples of intentional torts:

  • assault and battery
  • false imprisonment
  • defamation: libel and slander
  • invasion of right of privacy
  • fraud
  • intentional torts against property (trespass, conversion)
74

tort liability imposed when the defendant acted neither negligently nor with intent to cause harm; may be applied in cases involving dangerously defective products-medical devices, use of unlicensed medicines

strict liability torts

75

if a party to a contract does not perform as promised, the other party can sue for money damages or seek the remedy of specific performance

breach of contract

76

one party assumes the liability of another party for damage in situations in which the first party would not otherwise be liable

Hold Harmless or Indemnity Agreements

77

to establish legal liability-malpractice-the injured client must prove the following 4 elements:

  1. a duty of care was owed to injured party
  2. there was a breach of that duty
  3. the breach of the duty caused the injury
  4. actual harm or damages were suffered by the plaintiff
78

nurse managers have a duty to:

  • train
  • orient
  • evaluate the ability of nursing staff to perform specific functions and tasks
79

healthcare organizations have a duty to:

  • monitor the competence and ability of nursing and medical professionals
  • inquire about credentials
80

how do you know how to delegate correctly?

Nurse Practice Act found on ASBN

81

4 principles forming the cornerstone of biomedical ethical decision making:

  1. autonomy
  2. beneficence
  3. nonmaleficence
  4. justice
82

the client's right of self-determination and freedom of decision making

autonomy

83

doing good for clients and providing benefit balanced against risk

beneficence

84

doing no harm to clients

nonmaleficence

85

the norm of being fair to all and giving equal treatment, including distributing benefits, risks, and costs equally

justice

86

provide guidance in dealing with ethical dilemmas:

  • fidelity
  • veracity
  • confidentiality-HIPAA
  • privacy
87

standards of nursing practice & provides autonomy

code of ethics

88

fundamental aspect of a nurse's role; the process for a nurse to direct another person to perform nursing tasks and activities

delegation

89

________________ viewed delegation as a critical skill

Florence Nightingale

90

delegation issues have become connected to issues of:

  • overload
  • safety and quality of care
  • mix of staff
  • job security and turf
  • nurse's job satisfaction
91

process of delegation:

  • assess and plan
  • communicate
  • surveillance and supervision
  • evaluation and feedback
92

5 factors to assess when making a decision about delegating nursing tasks:

  1. potential for harm
  2. complexity of task (stable vs unstable pt)
  3. problem solving and innovation required
  4. unpredictability of the outcome
  5. level of pt interaction
93

what are the 5 rights of delegation?

  1. right task
  2. right circumstance
  3. right person
  4. right direction and communication
  5. right supervision and evaluation
94

what is the #1 factor to consider when delegating?

safety

95

what are the 8 principles for RN delegation?

  1. delegate tasks only within the RN's scope of practice, expertise, and knowledge
  2. assess the patient's condition and stability
  3. only the delegate tasks that the UAP is competent to perform and within his/her educational preparation/ability
  4. provide direction and assistance
  5. do not delegate tasks requiring complex nursing skill/judgement
  6. supervise, observe, and monitor UAPs
  7. evaluate the effectiveness of the delegated task
  8. document the delegation
96

what are the steps of the nursing process?

  • assessment/data collection
  • analysis/data collection
  • planning
  • implementation
  • evaluation
97

what are the sources of data collection and assessment?

primary and secondary (objective and subjective from both)

98

what is primary subjective data?

what the client tells the nurse

99

what is primary objective data?

data the nurse obtains through observation and examination

100

what is secondary subjective data?

what others tell the nurse based off what the client has told them

101

what is secondary objective data?

data the nurse collects from other sources (family, friends, caregivers, healthcare professionals, literature review, medical records)

102

use of critical thinking skills to identify client's health statuses or problem(s), recognition of patterns or trends, compare data w/ expected standards or reference ranges, & arrive @ conclusions to guide nursing care

analysis/data collection

103

the nurse establishes priorities and optimal outcomes of care they can readily measure and evaluate, work w/ clients to identify goals & outcomes, & identify actions & interventions that help achieve optimal outcomes

planning

104

the nurse bases the care they provide on assessment data, analyses, and the plan of care in the previous steps and use problem solving, clinical judgement, and critical thinking

implementation

105

the nurse uses evidence-based rationale for selection and implementation of therapeutic interventions and perform nursing actions, delegate tasks, supervise other health care stuff, and document care and clients' responses

implementation

106

the nurse evaluates clients' responses to nursing interventions and form a clinical judgement about extent to which clients have met goals and outcomes

evaluation