FINAL EXAM

Question 1

Interprofessional Collaboration:

Answer 1

Six competency domains highlight the knowledge, skills, attitudes and values that together shape the judgments that are essential for interprofessional collaborative practice. These domains are:

• Role clarification;
• Team functioning;
• Patient/Client/Family/Community-Centered care;
• Collaborative leadership;
• Interprofessional communication;
• Interprofessional conflict resolution.

Question 2

Learning Styles:

Answer 2

Nurses progress through five stages gradually as they gain more experience in patient care and become more competent:
-Novice, advanced beginner, competent practitioner, proficient practitioner, expert practitioner.

Teaching is an interactive process that involves learning.
Effective communication is essential to the teaching-learning interchange: listen empathetically, observe astutely, speak clearly.
Interpersonal variables are important-attitudes, values, culture, emotions, knowledge, motivation to teach and learn, personal learning style.

Question 3

Domains of learning:

Answer 3

-Cognitive:
Intellectual learning: mind based-requires thinking and understanding: knowledge, comprehension, application, synthesis, and evaluation.
-Affective:
Feelings and acceptance of attitudes, opinions, and values: receiving, responding, valuing, organizing, characterizing.
-Psychomotor:
Motor skills: perception, set, guided response, mechanism, complex overt response, adaptation, origination.

Question 4

Appropriate teaching methods based on domains of learning:

Answer 4

Cognitive: Discussion (one-on-one or group), lecture, question-and-answer session, role play and discovery, independent projects and field experience.
Affective: Role play, discussion (one-on-one or group).
Psychomotor: Demonstration, practice, return demonstrations, independent projects and games.

Question 5

A profession exists to?

Answer 5

meet the needs of society. It provides services that are essential and desired by society.

Question 6

A profession enters into a contract with society:

Answer 6

The profession promises to meet a set of identified needs better than any other group

Society gives the profession monopoly over the services it promises to provide

Transparency is important

Question 7

A profession results in:

Answer 7

A monopoly over the services provided
Public recognition
Prestige; power; authority

Question 8

Characteristics of a Profession

Answer 8

Education:
That is prolonged and specialized:
-Provides exclusive knowledge pertinent to the role that will be performed
-Fosters expertise – having a high level of specialized skill and knowledge
Expertise:
Is gained through ongoing education and research, and by practicing skills
Accountability:
Members of a profession are accountable for proving to society that they are faithful to the promises their profession makes
Competency and accountability in nursing imply
responsibility for all conduct and actions –
even collaborative ones
Means being answerable to someone for your actions
Society trusts nurses and gives us the right to self-regulation (autonomy), thus we are responsible and accountable for our actions
High levels of accountability= high levels of public trust in a profession

Question 9

What are two mechanisms of accountability:

Answer 9

1.Codes of ethics
Are one of the criteria of a profession
Support professional members’ autonomous decision making and responsibility
Nurses are always responsible for their actions
2.Standards of practice
Are written documents that outline the minimum expectations for safe practice
Standards are used to guide and evaluate practice
Internal standards: developed within the profession e.g. the College of Nurses of Ontario’s Compendium of Standards of Practice
External standards: developed outside of the profession e.g. the Regulated Health Professions Act (RHPA) of Ontario

Question 10

Accountability

Answer 10

Codes of ethics and standards of practice are accessible to the public
The courts are guided by a profession’s standards of practice and its code of ethics when a member’s conduct is questioned

Question 11

What is autonomy?

Answer 11

Means self-governing (self-regulating)
Individual autonomy in professional practice
Professional autonomy – e.g. self-regulating
Means the profession runs and governs its professional colleges
Self-regulation provides professional autonomy
One mechanism of regulation is title protection:
oImportant for the public because it implies that anyone who says they are a member of the profession has the basic level of competency to practice in the manner identified by the regulating body

Question 12

What is Autonomy in nursing?

Answer 12

Nurses are both ethically and legally required to practice autonomously
This provides a safeguard for the public
The purpose of autonomy in any profession is to protect the public – in nursing’s case, to keep the patient safe from harm
Does not mean we have complete control over every aspect of our practice
Autonomous practice is professional practice and is an ethical imperative – doing something simply “because the doctor said so” is unsafe practice

Question 13

What is Authority?

Answer 13

Refers to government granting power to a profession to have the autonomy to conduct its affairs:
E.g. determining educational requirements
E.g. granting a license to practice
E.g. disciplining a member

Question 14

What is Unity?

Answer 14

Means a sense of belonging, of sharing the same professional values, beliefs and worldviews
Members come together to fulfill the profession’s promises to the public
Members form professional relationships / associations to promote, nurture and support professional goals

Question 15

What is Interprofessional education (IPE):

Answer 15

Is when “two or more professionals learn with, from, and about each other across the spectrum of their life-long professional educational journey to improve collaboration, practice, and quality of client-centered care”.

Question 16

What is intraprofessional education (IPE):

Answer 16

IPE is the most recent health human resources education reform initiative in Canada (Health Canada, n.d.; Oandasan & Reeves, 2005).

Question 17

Demands on health care are increasing in Canada related to:

Answer 17

• Increases in chronic diseases e.g. diabetes, mental illness, heart disease, respiratory disease
• Improved chronic disease management
• An aging population
• Longer life expectancy

Question 18

At the same time, health care organizations are

asked to provide:

Answer 18

• High quality, safe, and timely patient care
• Care that is decided upon in partnership with patients and families
• All of the above within finite human and financial resources

Question 19

What is Interprofessional collaboration (IPC)

Answer 19

Is the provision of comprehensive health services to patients by multiple health caregivers who work collaboratively to deliver quality care within and across settings

Question 20

IPC is a care model offering a team based approach to care:

Answer 20

-Members include everyone who has contact with the patient:
-Regulated and unregulated care providers
Housekeeping and dietary staff, porters
The patient’s family
-The patient is central and is the most important team member

Question 21

IPE sows the seeds for effective IPC:

Answer 21

• Provides opportunities to learn about one another’s roles and scopes of practice
• Provides you with an understanding of one another’s similarities and differences
• It exposes myths and misunderstandings about one another
• Lays the groundwork for development of mutual respect and trust among team members
• Fosters effective communication and working partnerships
• Very importantly, encourages you to acknowledge, honour and respect the client as the expert knower of self

Question 22

What are the four stages of group development?

Answer 22

1.Forming
2.Storming
3.Norming
4.Performing
No set time for the stages. May seem that some
group members move back and forth between two or
more stages.

Question 23

What is forming?

Answer 23

1.Forming: coming together for the first time
New introductions: polite but impersonal – getting to know each other – cautious
Learning more about the work – needs and deadlines
Forming group goals
Organizing the work and getting to know one another’s strengths/skills
Forming group relationships - “figuring out where I fit”

Question 24

What is storming?

Answer 24

2.Storming: conflict
Resistance to teamwork and collaboration
May be overt - e.g. open verbal hostility; negative body language; bullying; power struggles, impatience
May be covert – e.g. not sharing information, not including all members in decision making, re-doing another member’s work, frustration
Some members may be absent, others may be apathetic

Question 25

What is Norming?

Answer 25

3.Norming: cohesion, collaboration, commitment Confront issues and problems constructively The work is the primary focus - the group organizes itself around the work Develop rules for effective group work and clarify goals  Firm up/ establish member roles and responsibilities Increased feeling of comfort within/with the group

Question 26

What is Preforming?

Answer 26

4.Performing: getting the work done Group members are productive Members are flexible in their roles, and support one another in getting the work done Members are collaborative – respect one another Group pride in what is being achieved together Group pride in quality work

Question 27

Effective group development requires three conditions. All group members must?

Answer 27

1. Trust one another 2. Have a sense of group efficacy: A “yes we can - yes we will” attitude about the group’s ability to work well together 3.Believe the group as a whole performs better on the project/assignment than individuals working on their own

Question 28

What is not helpful to group process?

Answer 28

* The agressor/dominator – destroys others self-esteem * Miss/Mr. Negative – finds fault with everything * The blocker – could fill a book with reasons against * The recognition seeker – “focus on me” * The self-confessor – seeking group therapy * The silent one – non contributor * The know it all – “I’m right as usual” * The playboy/playgirl - group work as a means of developing flirting skills * The latecomer – no respect for the group * The gossip – undermines group cohesion * The scapegoater – “I thought you were doing it”

Question 29

Establish rules from the outset:

Answer 29

–To demonstrate common manners and show consideration toward one another –For decision making –For member roles and responsibilities –For a timeframe to re-visit all of the above

Question 30

Recognize who group members are:

Answer 30

–The extrovert | –The introvert

Question 31

What are extroverts?

Answer 31

Extroverts are the talkers •They think out loud – form thoughts as they talk •May share partially formed ideas •Often move quickly from one thought to the next •Gain energy from past paced conversations •May share an idea just to get a reaction – doesn’t necessarily mean they believe what they say •Extroverts usually do their best work when they can think and talk and work all at the same time.

Question 32

What are introverts?

Answer 32

Introverts are the quiet ones •They think before talking •Want to give their best answer so take their time answering •Prefer to share only fully formed ideas •Use fewer words and choose their words •Introverts usually do their best work in a quieter environment that allows them to think “in their heads”.

Question 33

What are strategies for getting along: | Introvert?

Answer 33

Allow extroverts time to process thoughts out loud – recognize what the extroverts are doing. They aren’t just “yammering” •Ask for a minute to think •Take the initiative to make sure you are heard

Question 34

What are strategies for getting along: | Extrovert:

Answer 34

* Allow introverts time to process thoughts in their heads. Recognize silence does not mean consensus * Practice listening skills – take time to hear what’s said * Be conscious of the need to slow down - ask one question at a time, and wait for a response

Question 35

What are thinking styles?

Answer 35

–Intuitive | –Sensory

Question 36

What does the Intuitive style thinker include?

Answer 36

Intuitive style thinker: •Focuses on the big picture (i.e. end result/product) •Is OK if a few steps get skipped in the process •May jump to conclusions – may not weigh all the evidence •Trusts intuition and often uses it to help solve problems

Question 37

What does the Sensing style thinker include?

Answer 37

Sensing style thinker: •Focuses on the details •Believes every step of the process is important •Categorizes and organizes data and summarizes key points •Wants to explore and weigh all options •Solves problems by collecting facts - can never have too much information – may lead to “analysis paralysis”

Question 38

What are Strategies for getting along with | Intuitive style thinkers?

Answer 38

Strategies for getting along: Intuitive style thinkers •Be more patient with attention to detail •Slow down – address each step •Take time to learn the key facts •Focus on the task at hand and be thorough with it

Question 39

What are Strategies for getting along with | Sensing style thinkers?

Answer 39

Strategies for getting along: Sensing style thinkers •Take time to hear the ideas posed by intuitive thinkers •Be open to listening to your own “gut” •Set boundaries around data collection – be cognizant of how your work affects the timelines of others

Question 40

Tools for effective group meetings As an individual are?

Answer 40

* Take responsibility for your share of the work - come prepared * Take responsibility for making sure that what you mean to say is what is heard * Practice your manners – please and thank you and common courtesy are appreciated by everyone * Be open to different opinions and viewpoints * Be an active participant * Be committed to the group’s goals * Be open to constructive criticism and be willing to give the same to others * Never use feedback as a means to “settle a score” or make a point * Respect other people’s work * Never re-do or take over someone’s work * Be patient during the storming stage – recognize it as part of a natural group process * Demand respect * Give respect * Own your mistakes * Know when laugh at yourself * Walk your talk

Question 41

Tools for effective group meetings As an group are?

Answer 41

As a group: •Create ground rules at the outset Write them down Pull them out at every meeting Use them!! Revise them periodically Hold everyone to them •Identify three top priorities at the start of each meeting Write them down Use the list to stay on topic Treat the meeting as business – leave socializing for another time Strive to hear what each group member has to say: Ask each member in turn if they have anything to add Summarize and confirm discussions Clarify until everyone has the same understanding

Question 42

Benner’s 5 Stages of Nursing Proficiency are?

Answer 42

``` Novice Advanced Beginner Competent Practitioner Proficient Practitioner Expert Practitioner ```

Question 43

Interpersonal variables are important how?

Answer 43

Interpersonal variables are important – attitudes, values, culture, emotions, knowledge, motivation to teach and to learn, personal learning style

Question 44

What are the Domains of Learning?

Answer 44

Cognitive Intellectual learning: mind based - requires thinking & understanding Affective Expressions of feelings, acceptance of attitudes, opinions, values Psychomotor Motor skills based - involves acquiring skills that require the integration of mental & muscular activity Learning may involve one or more (or all) domains

Question 45

Cognitive learning: Includes all intellectual behaviours and requires thinking: the simplest behaviour is acquiring knowledge, whereas the most complex is evaluation. Cognitive learning includes the following:

Answer 45

- Knowledge: the learning of new facts or information and the ability to recall them. - Comprehension: the ability to understand the meaning of learned material. - Application: the use of abstract, newly learned ideas in a practical situation. - Analysis: the breaking down of information into organized parts. - Synthesis: the ability to apply knowledge and skills to produce a new whole. - Evaluation: a judgement of the worth of information given for a specific purpose.

Question 46

Affective learning: Concerns expressions of feelings and acceptance of attitudes, opinions or values. Values clarification is an example of affective learning. The simplest behaviour in the affective learning hierarchy is receiving, and the most complex is characterizing.

Answer 46

- Receiving: the willingness to attend to another person's words. - Responding: active participation through listening and reacting verbally and nonverbally. - Valuing: attachment of worth to an object, concept, or behaviour, demonstrated by the learner's actions. - Organizing: development of a value system by identifying and organizing values and resolving conflicts. - Characterizing: action and response with a consistent value system.

Question 47

Psychomotor learning: Involves acquiring skills that require the integration of mental and muscular activity, such as the ability to walk or to use an eating utensil. The simplest behaviour is perception and the most complex is origination.

Answer 47

- Perception: awareness of objects or qualities through the use of sense organs. - Set: a readiness (mental, physical, or emotional) to take a particular action. - Guided response: the performance of an act under the guidance of an instructor, involving imitation of a demonstrated act. - Mechanism: a higher level of behaviour by which a person gains confidence and skill in performing a behaviour that is more complex or involves several more steps than does a guided response. - Complex overt response: the smooth and accurate performance of a motor skill that requires a complex movement pattern. - Adaptation: the ability to change motor response when unexpected problems occur. - Origination: use of existing psychomotor skills and abilities to perform a highly complex motor act that involves creating new movement patterns

Question 48

What is collaboration?

Answer 48

Collaboration is the process of working together to build consensus on common goals, approaches and outcomes. It requires an understanding of own and others’ roles,mutual respect among participants, commitment tocommon goals, shared decision making, effective communication, relationships, and accountability for both the goals and team members.

Question 49

What is essential to Collaboration

Answer 49

Shared goals Joint venture Willing participants in joint planning and decision making

Question 50

What are the Antecedents?

Answer 50

A good understanding of self: Knowing who you are Knowing hat you believe and value Knowing your strengths and challenges Knowing what “pushes your buttons” and how you respond Self-confidence and self-esteem A good understanding of your discipline and its professional boundaries A good understanding of the knowledge, skills and perspectives of other disciplines and other categories in your own discipline Effective (i.e. assertive) communication Effective communication nurtures trust, respect, and sharing Mutual respect for group members. Includes respect for one another’s: Expertise Roles Disciplinary knowledge Talents and skills Mutual trust among group members. Requires members to: Take the time to get to know one another through communication and sharing Trust takes time and is earned over time Willingness to share with group members. This includes sharing: Power Knowledge and expertise Responsibility Planning and decision making Outcomes Vision A united commitment to working together An environment that: Has a flat organizational structure (i.e. non-hierarchal) Supports autonomy Rewards group efforts over individual work Supports cooperation and consensus rather than competition Supports and nurtures all previously mentioned antecedents

Question 51

What are the Consequences?

Answer 51

Improved client care: Quality of care Continuity of care Client satisfaction Client outcomes A more holistic approach Improved group cohesion and personal satisfaction: “Win-win” attitude among all group members “All for one and one for all” attitude Sense of pride and accomplishment in collective work Increased self-confidence and self-esteem Increased respect and collegiality among group members Increased respect for other disciplines and other categories within your own discipline

Question 52

What is nursing research?

Answer 52

Nursing research is a systematic examination of phenomena important to the nursing discipline…to nurses, their clients, and families. Its purpose is to expand the knowledge base for practice by answering nurses’ questions”. “ Research links education, theory and practice.”

Question 53

What are nurses accountable for?

Answer 53

Nurses are accountable for the quality of the client care we provide. Knowledge gained through research helps us meet this requirement.

Question 54

Why should you read research articles?

Answer 54

Part of continuous life-long learning. Gain up-to-date scientifically sound information in a timely manner. May help you solve clinical problems and helps you provide the best possible client care. Improve client outcomes. May reveal cost effective practices. Learn about new technologies, ideas, diseases Better understand client perspectives.

Question 55

What should you be aware of when reading scholarly journals?

Answer 55

That are not research articles: E.g. opinion piece E.g. literature review E.g. concept analysis These articles are also valuable sources of information and should be part of your readings. Is the article published in a scholarly nursing journal? What are the authors’ credentials? What is the year of publication? Are there references? Are the references cited throughout the article? Is the article a primary source: Written by the researcher(s) who conducted the study (e.g. research study) OR Is the article a secondary source: Written by someone other than the researcher(s) (e.g. literature review)

Question 56

Design: This is the plan for how the research question was answered or how the research hypothesis was tested. You need to determine the type of design:

Answer 56

Is it quantitative, qualitative, or both?

Question 57

What are Quantitative studies?

Answer 57

detailed information about statistical analysis is provided.

Question 58

What are Qualitative studies?

Answer 58

descriptive themes are thoroughly addressed.

Question 59

Implications, limitations, and recommendations

Answer 59

There may be a separate heading for one or more of these elements. Limitations refers to the aspects of the study that had a potential negative effect on the outcome of the study.

Question 60

Paradigm: | A way of thinking – world view based on values and beliefs.

Answer 60

Qualitative research reflects a more recent interpretive paradigm. Subjective and objective data are valued, and multiple truths and ways of knowing are accepted

Question 61

What does Quantitative Designs involve?

Answer 61

Involve analyzing numbers in order to answer the research question. Have variables and hypotheses (prediction about the relationship between two or more variables that will be tested in the study). E.g.: smoking during pregnancy is related to decreased birth weight. Are used to verify and justify data, test theories, identify cause and effect, predict and prescribe. Three common designs: Experimental 1.Non-experimental Quasi experimental Experimental: Randomized control trial 2. Non-experimental: Survey Correlational Experimental and non-experimental designs have three main characteristics: a)Randomization of the sample (random assignment of subjects [.e. sample] into groups) b)A control group for comparison with the experimental group. c)Manipulation of a variable. E.g. self referral versus physician referral. 3.Quasi-experimental designs are missing one of the three main characteristics found in experimental and non-experimental designs (i.e. randomization). This is usually due to ethical considerations or the need to avoid confusion. E.g.: It is not ethical to randomly assign someone to smoke. It would be confusing to randomly assign the same protocol to clients in the same room. Quasi-experimental: Pretest- post test control group (no randomization). Sample size (number of subjects) is usually large because large #s are needed for statistical analysis. Involves objective observation; deductive reasoning (moving from the general to the particular); use instruments to collect data (e.g. Likert Scale).

Question 62

What does Qualitative Designs consist of

Answer 62

Analyze words or pictures. The aim is to describe their meanings in order to answer the research question. Are used to discover meaning, generate theories, and increase understanding and knowledge about lived reality. Sample size is small – there is no statistical analysis and narratives are time consuming to analyze. The sample is purposive (not random) or nominated (recommended by others). Involves subjective and objective observation; inductive reasoning (moving from the particular to the general); interpretation – looking for themes and meaning. Phenomenology – used to describe lived experience. Grounded theory – used to develop theory. Ethnography – used to examine cultures.

Question 63

Quantitative and qualitative designs might | both use participatory action research.

Answer 63

Participatory action research (PAR) aims to change society. The researcher studies a particular setting. Problems are identified, solutions are formulated, and action is taken to implement changes.

Question 64

Both qualitative and quantitative research are valuable to nursing:

Answer 64

The choice of design will depend on what the study hopes to achieve. Some research is best answered through quantitative research (validating claims regarding nursing care for example). “What nurse/patient ratios provide the best health outcomes?” Some research is best answered through qualitative research (where you can never truly know what an experience is like for another person). E.g. “How do family members experience living with a teenager who has diabetes?” Researchers may combine both qualitative and quantitative designs in the same study.

Question 65

What does rigor refer to?

Answer 65

Rigor refers to the quality of the study. Researchers take strict measures to ensure that their studies are not biased. In quantitative research, internal and external validity refers to rigor. In qualitative research discussions about credibility, dependability, confirmability, and transferability refer to rigor.

Question 66

Ethical considerations are important to both qualitative and quantitative research:

Answer 66

Research must meet ethical standards in ways that respect and preserve human dignity and well-being. Informed participant consent is essential. All research articles should have a statement regarding how the researchers met ethical standards of ethical review boards.

Question 67

What is the Systematic Review?

Answer 67

A synthesis or integration of research studies that is done in an objective, rigorous way. A thorough search for all relevant research is conducted. Uses detailed methods for combining data from multiple different studies. This may include using meta-analysis (a statistical method). Uses specific criteria for excluding evidence that is of inadequate quality. Cites the evidence that has been excluded from the review. Summarizes the results of multiple studies to determine whether the experimental treatment had an effect. The Cochrane Collaboration is one international resource that publishes the results of meta-analyses. Ovid and other electronic libraries draw from the Cochrane Collaboration.

Question 68

What are the Best Practice Guidelines (BPGs):

Answer 68

Are written by a group of research and clinical experts on the topic. Usually include a synthesis of all of the available evidence on a specific topic and state recommendations for practice. There are a number of on-line BPG sites. Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines Canadian Nurses Association (CNA) Canadian Health Network Joanna Briggs Institute for Evidence Based Nursing and Midwifery (Australia) Canadian Task Force on Preventative Health Care Agency for Healthcare Research and Quality (USA)

Question 69

What is Evidence Informed (Based) Practice?

Answer 69

Evidence informed practice “is the integration of the most informative research evidence with evidence from expert clinical practice and other sources to produce the best possible care for clients”. Stresses the use of research findings and other data as well: The consensus of the opinions of nurses in clinical practice (i.e. expert opinions) Practice trends Individual client preferences Quality improvement data De-emphasizes nursing care based on “the way we always do it” (ritual or tradition) De-emphasizes ungrounded opinions, and isolated and unsystematic clinical experiences.

Question 70

What are good sites for research findings?

Answer 70

Canadian Institute for Health Information (CIHI) Statistics Canada Health Units (epidemiology department) Cancer Care Ontario

Question 71

What is the term informatics used to describe?

Answer 71

“The term informatics is used to describe all aspects of computers and information systems

Question 72

What are examples of health informatics?

Answer 72

Electronic order entry systems, reporting and recording systems (pharmacy, laboratory, diagnostic imaging, medicine, nursing, all other health providers, admitting areas, day surgery, etc.) Client scheduling Clinical support tools – computerized equipment, library databases, internet, intranet, computer workstations/areas, blackberries, smartphones, tablets, etc. E.g. fetal heart monitors E.g. glucometers

Question 73

Where would you apply nursing informatics?

Answer 73

1.In clinical practice E.g. Electronic charting E.g. Capturing workload 2.In education E.g. Computer technology assisted distance learning (e.g. Blackboard) E.g. Power point, smart boards, smart phones, laptops, tablets, facebook, email E.g. Electronic libraries; video streaming 3.In research E.g. Evaluating nurse sensitive outcomes using a standard minimum data set 4.Administration E.g. Analyzing computer generated management information systems (MIS) reports

Question 74

Nursing Informatics Competencies and Sample Indicators are?

Answer 74

1. Able to use relevant information and knowledge to provide evidence-informed patient care 2. Uses information and computer technologies in accordance with professional and regulatory standards and workplace policies 3. Uses information and communication technologies in the delivery of patient/client care

Question 75

What are Standards in Health Care Informatics?

Answer 75

Standards are formally established and endorsed protocols and criteria for storing, recording, and sharing health information. In health care informatics, standards shape health care data in several ways. E.g. consistency in: Terminology; documentation Packaging; symbols Accessing and securing health information Coding Much of the work nurses do is invisible – it is not captured in health policy decisions, in descriptions of health care, or in workplace/workload design Standardized nursing language and charting systems may help make our work visible to others if nurses have control over developing nursing informatics standards

Question 76

What is Minimum Nursing Data Set (MNDS)? | ***

Answer 76

MNDS is the minimum number of essential nursing data elements required for effective decision making and evaluation The Canadian version of MNDS is referred to as Health Information: Nursing Components (HI:NC) HI:NC identifies the most important data about the nursing care provided to a client Canadian nurses agree that HI:NC comprise five categories of elements: 1.Client status 2.Nursing interventions 3.Client outcomes 4.Nursing resource intensity 5.Primary nurse identifier (a means of anonymously linking data from several sources to an individual nurse) Many of the clinical information systems in Canada have incorporated the HI:NC elements into their structure This allows the nursing data that is important to nurses to be captured This helps make nurses’ work visible

Question 77

What is ICNP Classification?

Answer 77

The International Council of Nurses (ICN) developed the International Classification for Nursing Practice (ICNP) a)To improve the visibility of nurses’ work b)To standardize nursing data for comparison and analysis purposes c)To promote evidence informed practice ICNP provides a unified international terminology for recording nursing practice and enables electronic communication among the various global nursing information systems ICNP is the foundational classification system for nursing practice in Canada ICNP generates information about nursing diagnoses, nursing actions, and nursing outcomes

Question 78

What is Global Informatics?

Answer 78

SNOMED CT: systematized nomenclature of medicine-clinical terms - outlines clinical terminology used to describe multidisciplinary practice SNOMED CT is the terminology of choice for the pan Canadian electronic health record project Of note: the ICNP remains Canadian nurses’ preferred terminology for nursing Electronic health records The 10th revision of the WHO’s clinical diagnoses standard, the International Classification of Diseases (ICD – 10), used internationally to report clinical diagnoses

Question 79

What is Informatics in Canada?

Answer 79

* Electronic health records systems * CIHI (Canadian Institute for Health Information) – records, analyses and disseminates information about Canada’s health system and Canadians’ health status * CIHI developed the Canadian classification for health interventions (CCI) – consistent with concepts and terminology contained in the ICNP * CIHI enhanced the ICD – 10 for Canada (ICD10-CA) to track morbidity, mortality, injuries, poisoning, and risk factors for health in Canada * Canada Health Infoway Inc. (Infoway) Established in 2001 National body Mandate is threefold: 1)Establish national standards for health information 2)Create a national electronic health record 3)Act as a liasion to international standards development organizations The Canadian Organization for Advancement of Computers in Health (COACH) Is Canada’s health informatics association Multidisciplinary health care provider, information technology, and communication technology membership

Question 80

What are Canadian Nursing Informatic Initiatives?

Answer 80

2006 – the Canadian Nurses Association (CNA) released the E-Nursing Strategy for Canada Will coordinate the integration of technology into nursing practice Hopes to completely integrate information and communication technologies NurseONE (formerly the Canadian Nurses Portal) is part of Canada’s E-Nursing Strategy http://www.nurseone.ca/ The Canadian Nursing Informatics Association (CNIA) is a national special interest group for nurses interested in nursing informatics CNIA established the Canadian Journal of Nursing Informatics (online journal)

Question 81

What is teaching?

Answer 81

Teaching is the purposeful, directed actions one person takes to intentionally facilitate another person’s learning.

Question 82

What is learning?

Answer 82

Learning is the change that takes place in a person’s thinking and behaviours as a result of gaining knowledge from an experience

Question 83

What is Important to remember for teaching and learning?

Answer 83

Nurses provide client-centred care. Client-centred care is more than simply delivering services the client needs. Client-centred care views the client as a whole person and “involves empowerment, advocacy and respect for the client’s autonomy, voice, self-determination and participation in decision-making” Client education is part of every nurse’s role. Effective teaching and learning depends on effective communication and mutual respect, trust and confidence. Nurses have an ethical responsibility to teach their clients.

Question 84

Teaching is?

Answer 84

* Is more than simply giving information. * Aims to inspire the learner to absorb what is being taught and use it to improve his/her life. * Is interactive. Both teacher and learner must be open, attentive, and receptive to one another’s communication strategies.

Question 85

What are the 3 main goals of client education?

Answer 85

1) Maintain and promote health and prevent illness. 2) Restore health. 3) Cope with impaired functioning.

Question 86

You Assess the client’s needs by?

Answer 86

* Asking questions * Observing the client * Determining the client’s interests

Question 87

What Factors That Affect Learning?

Answer 87

*The physical learning environment: e.g. temperature, lighting, noise, ventilation, etc. *Emotional capacity/readiness: e.g. anxiety level, emotional upset, depression. *Intellectual capacity: e.g. mental ability to learn the material. *Learning disabilities *Literacy level *Physical ability: e.g. the strength and stamina to perform a skill; sufficient energy level to attend to what is being taught (fatigue); coordination; intact sensory system (no visual, auditory, olfactory or tactile limitations). *External factors (e.g. job loss; family concerns) Other: e.g. hunger, pain *The learner’s stage of development *Learning styles and preferences (e.g. visual, auditory, tactile) *Motivation Whose idea is it to learn? Is it the client’s, yours, someone else’s? What does the client want? “Just tell me what I need to do/ need to know” “I want to learn everything I can about this.” A relationship of mutual trust, confidence, and respect between the teacher and learner (i.e. you and your client).

Question 88

What do Effective Teachers Do

Answer 88

* Consider the client’s age. E.g. you will use different approaches for a child, a teenager, or an adult. * Determine what kind of learner the client is. Don’t be afraid to ask. * Use a variety of teaching methods: narrative, audiovisual, diagrams, demonstrations, etc. * Are aware of the different factors that can affect a person’s ability to learn. What things facilitate the client’s learning? What things are barriers to the client’s learning? *Realize they may need to help the client find ways of removing barriers. E.g. you may be able to make changes to the physical environment where learning takes place. E.g. you might inform your client about community resources for literacy, or ask the doctor to order a dietitian consult *Have reasonable expectations about the client’s ability to learn. Always consider the client within the context of his lifestyle and resources. E.g. You shouldn’t expect a client who doesn’t own a vehicle and lives in an area without reliable public transportation to regularly attend prenatal classes. E.g. You shouldn’t expect a client with a low literacy level to understand written instructions. *Develop a therapeutic nurse-client relationship before attempting to teach the client anything: This type of relationship is built on mutual respect and trust. Other components of this relationship are empathy, power (the nurse-client relationship is one of unequal power) and professional intimacy (you are aware that you have privileged access to personal client information and you perform care that involves exposing the client’s private physical body and mental health). *Work with the client to negotiate learning objectives and activities. E.g. Your client has just been diagnosed with Type 1 diabetes. Your mutual objective is for her to be able to give herself insulin. You are ready to teach her how to do this. She doesn’t feel ready yet. However, she is willing to learn how to draw up the insulin. *Incorporate the client’s previous learning in the new learning activity. E.g. Your client has been diagnosed with angina. He felt heaviness in his chest several times when doing yard work, but didn’t realize what it meant. You can help him learn to recognize this pain as a symptom of angina, and teach him what to do when it occurs. * Share the same understanding your client does about what is said (clear and concise communication is essential). E.g. Your client needs to bathe and needs to provide a urine sample. You help her prepare for her bath, hand her a specimen container, and remind her to bring you a sample of her “water”. What could happen * Hear what the client says (verbal communication) Observe what the client’s body is telling you (body posture, facial expressions, wound drainage, lab results, etc) Speak in plain language that the client can understand (but be careful; you must also clearly get your message across). Try to engage the client in using two or more senses. This enhances learning. E.g. When teaching a family member how to change a dressing, you explain the procedure (hearing), demonstrate a dressing change (sight), and show her what healthy granulation looks like (sight). *Depending on the presence of infection, you might also ask her to smell the drainage (smell). * Know self (i.e. know what your own values and beliefs are and how they influence your understanding of the client) * Have awareness and knowledge about the ways in which your culture, and the client’s culture influences teaching-learning. * Be willing to learn from the client.

Question 89

Adult learners have particular characteristics, what are they?

Answer 89

*They are autonomous and self-directed: *They want a voice in decisions that affect them. *They want to actively participate in learning. *They are willing to take responsibility for their learning. *They are practical: The material has to be useful and relevant to them in their everyday lives / fields of work. Learning knowledge for its own sake is not generally a goal of adult learners. *They demand respect: They expect you to show them respect and acknowledge the expertise and knowledge they bring forward. They have life experience and knowledge: They want to link this to their learning. Drawing from their own experiences to provide examples of what is being learned helps them better understand what is being taught.

Question 90

Don’t forget about your own learning needs:

Answer 90

* Ongoing health care research is continually generating new knowledge. * New drugs are continually coming on to the market. * Advances in health care technology continually result in new pieces of equipment and new ways of performing procedures.

Question 91

What is an absolute necessity throughout your career.

Answer 91

*As nurses, you are responsible for continuing to learn so that you can keep your knowledge and skills up to date: *It is also a requirement of the College of Nurses of Ontario and every other nursing licensing body in Canada.

Question 92

What is the FIRST STEP IN THE LEARN CONCEPT?

Answer 92

LOOK BACK and recall everything

Question 93

What is the SECOND STEP IN THE LEARN CONCEPT?

Answer 93

ELABORATE & DESCRIBE events

Question 94

What is the THIRD STEP IN THE LEARN CONCEPT?

Answer 94

ANALYZE the outcomes and recall if they are positive or negative.

Question 95

What is the FOURTH STEP IN THE LEARN CONCEPT?

Answer 95

REVISE YOUR APPROACH. Think about what you liked and what you would continue to do or what you weren't comfortable with or should have done differently.

Question 96

What is the FIFTH STEP IN THE LEARN CONCEPT?

Answer 96

NEW TRIAL, plan for the future and how you will use what your learned. • What are you going to do the next time you are faced with a similar situation?

Question 97

Paradigms are important for?

Answer 97

They answer the important questions a discipline has about itself. They also shape the way researchers “do science”. Paradigms provide a framework for conducting research, developing theories, and resolving problems

Question 98

What are the two main paradigms in nursing science

Answer 98

positivist (empiricist) and naturalistic (interpretive). These paradigms have opposing views of knowledge development and reality

Question 99

Quantitative Research Positivist Paradigm (Natural Science) is associated with?

Answer 99

Associated with mechanism (biomedical approach). Behavioural, social and biomedical models of human health. The nursing process and nursing diagnoses reflect the positivist paradigm.

Question 100

Qualitative Research Naturalistic Paradigm (Interpretive/ Human Science) is associated with?

Answer 100

Carper’s fundamental patterns of knowing reflect the naturalistic paradigm.

Question 101

Ontology (ways of being; the nature of reality) Ontology asks: What is the nature of being human and of reality? Quantitative Research Positivist Paradigm (Natural Science)

Answer 101

Human beings are: machines; the sum of their parts; closed systems. Mind and body are separate entities. The body can be reduced to parts that can be studied, isolated and treated independently from the other parts.

Question 102

Ontology (ways of being; the nature of reality) Ontology asks: What is the nature of being human and of reality? Qualitative Research Naturalistic Paradigm (Interpretive/ Human Science)

Answer 102

Humans are unique individuals bound up in their social-historical-cultural environment. They are open systems, free-willed and intentional, and they actively participate in life. Human beings are wholes (unitary). The body and the mind are inseparable and the body cannot be separated into isolated parts because all parts are interdependent.

Question 103

Ontology seeks to answer how human beings live in and relate to their world. Quantitative Research Positivist Paradigm (Natural Science)

Answer 103

There is only one reality. Reality is what you can verify by your senses. If you can’t see, touch, smell, hear or feel it, it doesn’t exist. When research is conducted, the researcher is objective. The researcher does not participate in the process.

Question 104

Ontology seeks to answer how human beings live in and relate to their world. Qualitative Research Naturalistic Paradigm (Interpretive/ Human Science)

Answer 104

Each person is unique, therefore there are multiple realities. A person’s reality is constructed from everything that he/she experiences. When research is conducted, the researcher is a co-participant in the process. Therefore, the researcher is never objective.

Question 105

Epistemology (ways of knowing) Epistemology asks: What is the nature of the relationship between the knower and what can be known? Epistemology seeks to learn what determines and constitutes knowledge about human experience. Qualitative?

Answer 105

There are multiple truths. Knowledge comes from experience. Knowledge can be both qualitative and quantitative. The meanings and understandings one has about a topic / issue / concept are context dependent. The focus is on the lived experience of the unitary (whole) individual: values, relationships, patterns, themes. Subjectivity is fundamental. Intuition and other ways of knowing are valued. The essential data is the lived experience as told by the person who lives it. The person’s narrative is respected: “the person is the expert knower of self”. The narrative is not compared against objective data or predefined norms. Behaviour is considered unpredictable.

Question 106

Epistemology (ways of knowing) Epistemology asks: What is the nature of the relationship between the knower and what can be known? Epistemology seeks to learn what determines and constitutes knowledge about human experience. Quantative?

Answer 106

There is one truth. Knowledge comes from objective, quantifiable, concrete data. The focus can be on the whole or on a part. Objectivity is essential. Subjective data is not considered. Behaviour is considered predictable and linear.

Question 107

What is Conflict Management?

Answer 107

Conflict: tension between two or more people related to incompatible goals or needs, or the actions of others impeding ability to achieve goals. The CNO defines conflict as "a power struggle in which a person intends to harass, neutralize, injure, or eliminate a rival". - Is part of everyday living and can take place in any setting. - We naturally become emotional when we experience conflict-frustrated, upset, anxious, tearful, angry. - Is a natural part of human relationships: recognized in the stages of group development-storming stage. - Working through conflict can lead to improved relationships. - Conflict that is not addressed can grow and lead to burn out, apathy and disengagement

Question 108

Conflict response styles: | Competition:

Answer 108

Power struggle-a winner and loser outcome; characterized by aggression and a lack of compromise-only concerned with self; demoralizing for other group members; ultimately a lose-lose situation for everyone.

Question 109

Avoidance:

Answer 109

Pretend the source of the conflict doesn't exist-ignore it or change the subject. - Accommodation: Band aid approach-a quick fix temporary solution-giving in. - Collaboration: Solution-oriented, co-operative problem solving approach; a win-win situation.

Question 110

Top two ways to avoid conflict:

Answer 110

- Prevent it from happening in the first place. | - Address conflict the minute it happens

Question 111

Principles of conflict resolution:

Answer 111

- Identify the conflict issue. - Know your own responses to conflict. - Stay focused on the issue. - Identify options. - Use standards/criteria. - Separate the issue from the person/people.

Question 112

Think Win/Win:

Answer 112

Create an effective atmosphere: choose a private place that is non-threatening to all parties involved; consider timing. - Collaborate. - Apply therapeutic skills like empathy, nonjudgmental approach, seek clarification, reflect, listen.

Question 113

Consider your personal safety:

Answer 113

- Never engage someone you suspect might become violent or who you know has a history of violence. - Maintain an open exit/proximity to alarm bells. - Pay close attention to non- verbal body language. - Leave immediately if you are verbally threatened.