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106 notecards = 27 pages (4 cards per page)

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1/12/21 lecture

front 1

basis of all other nursing areas

back 1

medical-surgical

front 2

med-surg focuses on the

back 2

management of acutely ill adult patients

front 3

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

back 3

  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

front 4

what is level 1 of the levels of evidence?

back 4

evidence from systematic reviews of randomized controlled studies (RCTs)

front 5

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

back 5

nursing process

front 6

foundation of professional nursing practice

back 6

evidence-based nursing practice

front 7

what are the parts of patient-centered care

back 7

benchmark of evaluation of nursing care

  • effective communication skills
  • empathy
  • caring
  • compassion

front 8

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

back 8

patient-centered care

front 9

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

back 9

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

front 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

back 10

The Joint Commision (TJC)

front 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

back 11

The Beryl Institute

front 12

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

back 12

National Patient Safety Goals

front 13

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

back 13

SBAR

front 14

what are the 4 parts of the SBAR?

back 14

  • situation
  • background
  • assessment
  • recommendations

front 15

what does the situation consist of?

back 15

brief statement of the problems or issue being addressed

front 16

what does the background consist of?

back 16

data related to the current situation

front 17

what does the assessment consist of?

back 17

summary of causes, significance, severity of situation

front 18

what does the recommendation consist of?

back 18

specific actions needed to address the situation

front 19

when might a "hand-off" be necessary?

back 19

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

front 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

back 20

time-out

front 21

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

back 21

Quality and Safety Education for Nurses (QSEN)

front 22

What does QSEN consist of?

back 22

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

front 23

Institute of Medicine's Competencies for Health Professionals:

back 23

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

front 24

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

back 24

transitional care model (TCM)

front 25

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

back 25

transitional care nurses (TCNs)

front 26

two or more coexisting medical conditions or disease processes

back 26

comorbidities

front 27

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

back 27

Care Transitions Program

front 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

back 28

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

front 29

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

back 29

patient-centered medical home (PCMH)

front 30

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

back 30

Guided Care Program

front 31

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

back 31

Transforming Care at the Bedside (TCAB)

front 32

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

back 32

rapid response teams

front 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

back 33

rapid response teams

front 34

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

back 34

pt education

front 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

back 35

teach-back

front 36

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

back 36

interprofessional collaboration (IC)

front 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

back 37

Care Coordination and Transition Management (CCTM)

front 38

what are the 5 rights of delegation?

back 38

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

front 39

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

back 39

registered nurse

front 40

where is the Nurse Practice Act found at?

back 40

ASBN (Arkansas State Board of Nursing)

front 41

nurses serve as patients':

back 41

  • advocates
  • protectors
  • confidants

front 42

ethical principles guide the

back 42

moral traditions, values, and behaviors of professional nursing

front 43

Code of Ethics for Nurses provides a

back 43

standard of nursing practice

front 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?

back 44

bioethics

front 45

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

back 45

  • respect for persons
  • beneficence
  • justice

front 46

to "do good"

back 46

beneficence

front 47

to do no harm

back 47

nonmaleficence

front 48

individual right to choose for oneself

back 48

autonomy

front 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

back 49

American Nurses Association Code of Ethics

front 50

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

back 50

ANA Scope and Standards or Practice

front 51

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

back 51

International Nursing Council Code of Ethics

front 52

ethical principles:

back 52

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

front 53

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

back 53

justice

front 54

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

back 54

autonomy

front 55

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

back 55

beneficence

front 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

back 56

fidelity

front 57

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

back 57

nonmaleficence

front 58

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

back 58

veracity

front 59

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

back 59

confidentiality

front 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)

back 60

paternalism

front 61

ethical theories to support nurses in decision making:

back 61

  • common good
  • sanctity of life

front 62

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

back 62

common good

front 63

what are some examples that can be ethical dilemmas?

back 63

  • 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

front 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

back 64

advance directive

front 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

back 65

living will

front 66

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

back 66

withdrawal of fluids and nutrition

front 67

ethical issues in professional practice:

back 67

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

front 68

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

back 68

tort

front 69

what are the types of torts?

back 69

  • negligence
  • intentional torts
  • strict liability torts

front 70

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

back 70

negligence

front 71

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

back 71

malpractice

front 72

wrongful act that was intended to cause harm

back 72

intentional torts

front 73

examples of intentional torts:

back 73

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

front 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

back 74

strict liability torts

front 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

back 75

breach of contract

front 76

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

back 76

Hold Harmless or Indemnity Agreements

front 77

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

back 77

  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

front 78

nurse managers have a duty to:

back 78

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

front 79

healthcare organizations have a duty to:

back 79

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

front 80

how do you know how to delegate correctly?

back 80

Nurse Practice Act found on ASBN

front 81

4 principles forming the cornerstone of biomedical ethical decision making:

back 81

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

front 82

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

back 82

autonomy

front 83

doing good for clients and providing benefit balanced against risk

back 83

beneficence

front 84

doing no harm to clients

back 84

nonmaleficence

front 85

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

back 85

justice

front 86

provide guidance in dealing with ethical dilemmas:

back 86

  • fidelity
  • veracity
  • confidentiality-HIPAA
  • privacy

front 87

standards of nursing practice & provides autonomy

back 87

code of ethics

front 88

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

back 88

delegation

front 89

________________ viewed delegation as a critical skill

back 89

Florence Nightingale

front 90

delegation issues have become connected to issues of:

back 90

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

front 91

process of delegation:

back 91

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

front 92

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

back 92

  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

front 93

what are the 5 rights of delegation?

back 93

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

front 94

what is the #1 factor to consider when delegating?

back 94

safety

front 95

what are the 8 principles for RN delegation?

back 95

  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

front 96

what are the steps of the nursing process?

back 96

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

front 97

what are the sources of data collection and assessment?

back 97

primary and secondary (objective and subjective from both)

front 98

what is primary subjective data?

back 98

what the client tells the nurse

front 99

what is primary objective data?

back 99

data the nurse obtains through observation and examination

front 100

what is secondary subjective data?

back 100

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

front 101

what is secondary objective data?

back 101

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

front 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

back 102

analysis/data collection

front 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

back 103

planning

front 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

back 104

implementation

front 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

back 105

implementation

front 106

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

back 106

evaluation