Flashcards in Chapter 1 Practicing the Science and the Art of Psychiatric Nursing Deck (41)
Three fundamental elements of patient advocacy include:
•To ensure that patients are informed of their rights in a particular situation, including the right to refuse treatment.
•To support patients and decisions they make.
•To protect patients, which includes reporting threats to their well-being
Inherent in the responsibilities of advocating for patients include the following protections:
•Protection in participation in research
•Standards and review mechanisms
•Acting on questionable practices
•Addressing impaired practice
Psychiatric–mental health nursing, a core mental health profession, employs a purposeful use of?
self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science
In psychiatry the evidence-based focus extends to treatment approaches in which there is scientific evidence for psychological and sociological treatment methodologies, as well as?
evidence related to the neurobiology of psychiatric disorders and psychopharmacology. Therefore evidence-based practice strives to decrease the gap between research and practice
The mental health recovery model is more of a social model of disability than a?
medical model of disability. Therefore the focus shifts from one of illness and disease to an emphasis on rehabilitation and recovery
The concept of recovery refers primarily to?
managing symptoms, reducing psychosocial disability, and improving role performance
Holistic interventions are designed to increase recovery as evidenced by?
engagement in work and engagement in community/social life, as well as a reduction of symptoms
The principles of the recovery model have been adopted by a number of countries and states. The focus of the recovery model has the following mandates:
•Mental health care is to be consumer and family driven.
•Care must focus on increasing consumer's ability to be successful in coping with life's challenges, facilitating recovery, and building resilience—not just managing symptoms.
•An individualized plan of care is to be at the core of consumer-centered recovery—recovery-oriented services that allow consumers to realize improved mental health and quality of life.
•Consumers must be partners in decision making in all aspects of care
Her contributions went far beyond what she brought to the field of psychiatric nursing. She introduced the concept of advanced nursing practice and promoted professional standards and regulation through credentialing among a multitude of other contributions to nursing
Hildegard Peplau (1909 to 1999)
The emergence of evidence-based nursing practice in the United States originated from the evidence-based practice movement in the?
medical community in England and Canada during the 1980s and 1990s
The University of Minnesota defines EBP as
“the process by which the best available research evidence (from well-designed studies), clinical expertise, and patient preferences are used for making clinical decisions.”
the 5 A's:
1.Ask a question. Identify a problem or need for change for a specific patient or situation.
2.Acquire literature. Search the literature for scientific studies and articles that address the issue(s) of concern.
3.Appraise the literature. Evaluate and synthesize the research evidence regarding its validity, relevance, and applicability using criteria of scientific merit.
4.Apply the evidence. Choose interventions that are based on the best available evidence with the understanding of the patient's preference and needs.
5.Assess the performance. Evaluate the outcomes, using clearly defined criteria and reports, and document results.
Clinical practice guidelines are systematically developed statements that?
identify, appraise, and summarize the best evidence about prevention, diagnosis, prognosis, therapy, and other knowledge necessary to make informed decisions about specific health problems
3 things that clinical practice guidelines do
(1) identify practice questions and explicitly identify all the decision options and outcomes
(2) identify the “best evidence” about prevention, diagnosis, prognosis, therapy, harm, and cost-effectiveness
(3) identify the decision points at which this “best evidence” needs to be integrated with individual clinical experience and patients’ needs and goals in deciding on a course of action.
Clinical algorithms are?
step-by-step guidelines prepared in a flowchart format
- helpful in deciding what medication to use considering a wide variety of variables related to the patient's personal situation (e.g., age, gender, current medications, ethnic origin, allergies)
Clinical/critical pathways are usually specific to the institution using them. They are most often used in relation to?
hospitalized patients and target a specific population (e.g., suicidal patient, bipolar patient–manic, a depressed patient, an individual with schizophrenia)
Level Ia: Evidence from systematic reviews or meta-analyses of randomized controlled trials
Ib: Evidence from at least one randomized controlled trial
-What is the level type of evidence?
(A) Based on hierarchy I evidence
IIa: Evidence from at least one controlled study without randomization
IIb: Evidence from at least one other type of quasi-experimental study-What level type of evidence?
(B) Based on hierarchy II evidence or extrapolated from hierarchy I evidence
III: Evidence from nonexperimental descriptive studies, such as comparative studies, correlation studies, and case control studies
(C) Based on hierarchy III evidence or extrapolated from hierarchy I or II evidence
IV: Evidence from expert committee reports or opinions and/or clinical experience of respected authorities
(D) Directly based on hierarchy IV evidence or extrapolated from hierarchy I, II, or III evidence
Three areas inherent in the “art” of nursing addressed are?
(1) caring, (2) attending, and (3) patient advocacy
Caring is the?
most natural and the most fundamental aspect of human existence”
A survey by Schoenhofer and colleagues (1998) used a group process method (13 groups of 3 to 5 people each) to synthesize what was meant by caring to the participants. The following three themes emerged from the shared narratives:
1.Caring is evidenced by empathic understanding, actions, and patience on another's behalf.
2.Caring for one another by actions, words, and being there leads to happiness and touches the heart.
3.Caring is giving of self while preserving the importance of self.
Evidence-based practice includes not only evaluating research but also ?
integrating it with input from experts and patients
Examples of uncaring behaviors include?
denying patients’ feelings, responding with indifference to patients’ concerns, and failing to check to see if medications given to relieve discomfort or distress are working. These are examples of behaviors that violate a patient's integrity and dignity and are never justified
Benner (2004) states that comforting includes providing?
social, emotional, physical, and spiritual support for a patient that is consistent with the holistic approach to nursing care
Attending refers to an?
intensity of presence, being there for and in tune with the patient
Attending behaviors may include?
listening, touching, or giving attentive physical care
in nursing, being a patient advocate is not a legal role but rather an ethical one. a patient advocate is one who?
speaks up for another's cause, who helps others by defending and comforting them, especially when the other person lacks the knowledge, skills, ability, or status to speak for himself/herself