Exam 2

Question 1

Systems theory

Answer 1

defined as a set of interrelated parts, in which each part is necessary to the whole; comprised of input, throughput, output, evaluation, feedback.
systems in nursing practice consists of person, environment, and health.
ie. family, cultural, social, community, nation, and world systems.

Question 2

Members of the healthcare team

Answer 2

physicians>physician assistants>patient care technicians (unlicensed member of nursing staff)>licensed practical nurses>dieticians>pharmacists>technologists>respiratory therapists>social workers>physical therapists>occupational therapists>administrative support personnel

Question 3

Healthcare delivery system

Answer 3

categories of health care services: health promotion and maintenance, illness prevention, diagnosis and treatment, and rehabilitation and long-term care
classification of health care agencies: government, state, local, voluntary, not-for-profit, and for-profit agencies

Question 4

Organizational structures in health care

Answer 4

board of directors>chief executive officer>medical staff>medical staff governance>chief nursing officer>nursing staff>nursing staff governance

Question 5

Health beliefs model

Answer 5

evaluation of one’s vulnerability to, and seriousness of, a condition
individuals/groups perception of how effective the health behavior might be
the presence of a trigger event that precipitates the health maintenance behavior

Question 6

JCAHO

Answer 6

formed in 1992
joint commission on accreditation of healthcare organizations
nonprofit; serving as the nation’s predominant standard-setting and accrediting body in U.S. health care

Question 7

IOM five core competencies

Answer 7

to promote patient safety

1. provide patient-care vs. focus on disease/illness
2. work in interdisciplinary teams
3. employ evidence-based practice
4. apply and make effective quality improvement
5. use informatics

Question 8

IOM report on the future of nursing

Answer 8

nurses should practice to the full extent of their education/training
nurses should achieve higher levels of education
nurses should be full partners with physicians and other health care professionals
effective workforce planning and policy require better data collection

Question 9

3 ways humans fail

Answer 9

perception (ie. perceive we’ve picked up the correct dose of medication)
assumption (ie. assume the other RN correctly programmed the heparin infusion)
communication (ie. forget to relay key information when giving patient report to the next RN)

Question 10

Collaboration of team members

Answer 10

collaboration is working jointly with other professionals which involves civil behavior, willingness to work together, supportive attitude and behaviors of the organization

Question 11

The collaborative process

Answer 11

identify stakeholders
identify problems to be solved
identify barriers or roadblocks to solutions
clarify desired outcomes
clarify the process that will be sued to accomplish task
identify who will be responsible for each step in the task
evaluate the degree of success in meeting the goals and generating a solution

Question 12

Therapeutic use of self

Answer 12

originated from Hildegard Peplau (theory of nursing)
3 phases:
orientation- introduction and development of trust
working- accomplishes tasks towards goals
termination- ends the relationship therapeutically and constructively

Question 13

Communication theory

Answer 13

communication is the exchange of thoughts, ideas, or information at the heart of all relationships
levels of communication: verbal, nonverbal, congruent and noncongruent

Question 14

Operations in the communication process

Answer 14

3 factors:
perception>evaluation>transmission
these factors are influenced by many variables

Question 15

Criteria for successful communication

Answer 15

feedback, appropriateness, efficiency, flexibility

Question 16

Quality improvement/assurance

Answer 16

ensures the delivery of quality client care
demonstrates the efforts of health care provider to deliver quality care
focuses on assessing/measuring performance
ensures that performances meets standards
takes action for change when care does not meet standards

Question 17

FMEA

Answer 17

failure mode effect analysis
a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change
steps: failure modes (how?), failures causes, failure effects (consequences?)

Question 18

Sentinel events

Answer 18

a type of FMEA
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof and they signal the need for immediate investigation and response

Question 19

Failure to rescue

Answer 19

a type of FMEA
refers to cases where caregivers fail to notice or respond when a patient is dying of preventable complications in a hospital

Question 20

Rapid response

Answer 20

a type of FMEA

purpose is to identify and treat patients before the patients’ condition deteriorates to the point that CPR is needed

Question 21

Root cause analysis

Answer 21

a method of problem solving that tries to identify the root causes of faults or problems that if eliminated , could reduce the risk of similar errors in the future.
data on errors should be compiled, disseminated, and assessed periodically.

Question 22

Acute illness

Answer 22

characterized by:
severe symptoms
relatively short-lived in duration
could become fatal if left untreated
usually return to previous state of health
complications may result in chronic conditions

Question 23

Chronic Illness

Answer 23

characterized by:
gradual development
on-going treatment
continuation throughout pt.’s life
varying severity and outcomes of conditions
no usual return to previous state of health
may occur as periods of exacerbation and remission
in U.S.:
increase of chronic illness r/t sedentary lifestyles, obesity, and aging population
more people die from chronic rather than acute illnesses

Question 24

Stages of adjustment to illness

Answer 24

disbelief and denial
irritability and anger
attempting to gain control
depression and despair *due to disruption of normal routine
acceptance and participation

a person may not hit all stages

Question 25

Influences on illness behavior

Answer 25

``` internal: dependence vs. independence coping ability resistance of body to give up resilience spirituality external: past experiences culture communication patterns personal space norms role expectations values reaction to prescribed medications ethnocentrism ```

Question 26

Families and illness

Answer 26

``` characterized by: behavioral and emotional changes changes in family roles disturbed family dynamics results in increased patient and family stress ```

Question 27

Stress

Answer 27

``` may results in the development and/or prolongation of illness interventions: recognize stressors eliminated as many stressors as possible relaxation techniques patient education ```

Question 28

Open system

Answer 28

promotes exchange of matter, energy, and information with other systems and the environment ie. all living systems

Question 29

Homeostasis

Answer 29

dynamic balance within and between systems | when adaptation is unsuccessful, disequilibrium sets the stage for illness/disease

Question 30

Maslow's human needs hierarchy

Answer 30

``` Level 1: physiological survival Level 2: safety and security needs Level 3: needs for love and belonging Level 4: self-esteem needs Level 5: self-actualization ```

Question 31

Level of health care services provided

Answer 31

primary: care rendered at the point at which a patient first enters the health care system ie. health promotion secondary: involves the prevention of complications from disease ie. surgical centers tertiary: those requiring long-term care or rehabilitation services ie. burn center

Question 32

IOM

Answer 32

created in 1970 to serve as a source of science-based advice on matters of biomedical science, medicine, and health focus is on healthcare professions education that emphasizes interdisciplinary care rather than working in isolation, not on specific healthcare professions

Question 33

To err is human

Answer 33

this IOM report fueled a systems approach to improving healthcare with nurses identified as key stakeholders 98,000 deaths/year due to unnecessary medical errors

Question 34

IOM safety initiatives

Answer 34

``` medication administration patient identification surgical time-outs electronic medical records communication: SBAR ```

Question 35

Types of program evaluation

Answer 35

formative: evaluation for purpose of assessing whether objectives are met or planned activities are completed (progress); during program; may be on-going summative: evaluation to assess program outcomes or as a follow-up of program activities (efficiency); after program.

Question 36

Key to evaluation

Answer 36

documentation

Question 37

Hope

Answer 37

a multidimensional concept that provides comfort while enduring life threats and personal challenges

Question 38

Variations of grief

Answer 38

normal- process of coping complicated- prolonged, difficult grieving process anticipatory- letting go before lost occurs disenfranchised- unsupported grief