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Foundations > Foundations Exam 1 > Flashcards

Foundations Exam 1 Flashcards

Study for exam 1

1
Q

nursing- ANA definition

A

protection, promotion, & optimization of health and abilities; prevention of illness & injury; alleviation of suffering through the diagnosis and treatment of human response; advocacy in the care of individuals, families, communities, & populations

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2
Q

independent nursing interventions

A

actions that a nurse initiates w/o an order

ex. elevating an edematous extremity, repositioning a pt. for pain relief, instructing a pt on medication side effects

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3
Q

dependent nursing interventions

A

actions that require a physician’s order or other health care provider, interventions that are based on the healthcare provider’s response to treat or manage a medical diagnosis

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4
Q

nursing care plan

A

includes: nursing diagnosis, goals and/or expected outcomes, specific nursing interventions, and a section for evaluation findings
reduces risk of incomplete, incorrect, or inaccurate care

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5
Q

interdisciplinary care plans

A

includes contributions from all disciplines involved in pt care

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6
Q

critical pathways

A
  • pt care management plans that provide the multidisciplinary health care team w/ the activities and tasks to be put into practice sequentially (over time)
  • main purpose is to deliver timely care @ each phase of the care process for a specific type of pt
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7
Q

consultation

A

process by which you see the expertise of a specialist such as your nursing instructor, a physician, or clinical nurse educator to identify ways to hand problems in pt management or the planning and implementation of therapies

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8
Q

explain the relationship of implementation to the nursing diagnostic process

A

4th step in the nursing process, formally begins when the nurse develops a plan of care based on clear/relevant diagnosis. Nurse initiates interventions to achieve goals and expected outcomes needed to support/improve the pt’s health status

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9
Q

describe the association between critical thinking and selecting nursing interventions (p 254)

A

pt’s conditions can change quickly, always think before you act. Use critical thinking to confirm if the intervention is correct and still appropriate.
Review all possible nursing interventions for the pt’s problem, review all possible consequences w/ each nursing action, determine the probability of those consequences, make a judgement on the value of the consequence to the pt

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10
Q

discuss the difference between protocols and standing orders

A

protocols are systemically developed set of statements to help health care providers made decisions about appropriate care in clinical situations and standing orders are preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific pts w/ identified clinical problems.

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11
Q

identify preparatory activities to use before implementation (p257)

A

reassess the pt (are the proposed actions still appropriate), review and revise the existing nursing care plan (has the pt’s status changed in way that changes the diagnosis and in turn changes the plan), Organize resources, anticipate and prevent complications

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12
Q

discuss the value of Nursing Intervention Classification (NIC) system in documenting nursing care

A
  1. standardization of nomenclature of interventions, 2. expanding nursing knowledge about the connections among nursing diagnoses, treatments, and outcomes 3. developing nursing and health care information systems 4. teaching decision making to nursing students, defining and classifying interventions to teach new nurses how to determine a pt’s need for care and respond appropriately 5. determining the cost of services provided by nurses 6. planning for resources need in all types of practice settings 7. language to communicate the unique fxns of nursing, link with the classification systems of other health care providers
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13
Q

NIC

A

Nursing Intervention Classification

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14
Q

Discuss the steps for revising a plan of care before preforming implementation (258)

A
  1. revise data in assessment column to reflect pt’s current status, date any new data
  2. Revise the nursing diagnoses. Delete diagnoses that aren’t relevant, add and date any new ones
  3. Revise specific interventions that correspond to the new nursing diagnoses and goals. Revisions need to reflect pt’s current status
  4. choose method of eval to determine in you achieved pt outcomes
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15
Q

define the three implementation skills

A
  1. cognitive skills- involve application of critical thinking to nursing process, always think and anticipate to provide individualized care, understand the rationale for therapeutic interventions and understand normal and abnormal
  2. interpersonal skills- develop a trusting relationship, express a level of caring, communicate clearly, be perceptive of verbal and nonverbal communication
  3. psychomotor skills- actual hands on care, performing skills correctly, smoothly, and confidently, integration of cognitive and motor activities
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16
Q

describe and compare direct and indirect nursing interventions

A

direct is w/ the pt while indirect is away from the pt. This is the difference between placing an IV, administering meds, or providing comfort for a grieving pt. vs things that are done away from the pt such as documentation, maintaing the environment through safety and infection control, or collaborating with other health care team members

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17
Q

direct care interventions

A

treatments that are performed through interactions w/ pts

ex. placing an IV, medication administration

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18
Q

indirect care interventions (p 262)

A

treatments that are performed away from the pt but on the pt or group of pt’s behalf
ex. actions for managing the pt’s environment (e.g. safety and infection control), documentation, interdisciplinary collaboration, and delegation

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19
Q

select the appropriate interventions for the assigned pt

A

c

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20
Q

nursing process

A 
Assessment
Diagnosis
Planning
Implementation
Evaluation (reassess)
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21
Q

nursing intervention

A

any treatment based on clinical judgement and knowledge that a nurse performs to enhance pt outcomes
interventions are indirect and direct care measures aimed at individuals, families, and/or the community

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22
Q

clinical practice guideline or protocol

A

systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for clinical situations (e.g. protocols for admission and discharge, pressure ulcer care, and incontinence management

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23
Q

ANA

A

American Nurses Association

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24
Q

standing orders

A

preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific pts w/ identified clinical problems (e.g. specifying a drug for irregular heart rhythm, after assessing and finding irregular heart rhythm, nurse can administer drug w/o 1st consulting doc). Often seen in critical care setting and in specialized practice settings. The nurse notifies the doc after completing the standing order.

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25
Q

activities of daily living (ADLs)

A

activities usually performed throughout a normal day (eg. walking, eating, dressing, bathing, and grooming)

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26
Q

nurse initiated interventions

A

are determined by state Nurse Practice Acts

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27
Q

Instrumental Activities of Daily Living (IADLs)

A

skills such as shopping, preparing meals, house cleaning, paying bills, taking meds
OTs work w/ pts to adapt to perform IADLs

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28
Q

lifesaving measure

A

physical care technique used when a pt’s physiological or psychological state is threatened
purpose is to return homeostasis
ex. emergency medications, CPR, psych hold

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29
Q

counseling

A

direct care method that helps the pt use a problem solving process to recognize and manage stress and facilitate interpersonal relationships
ex. pts facing terminal cancer or chronic disease
includes-emotional, intellectual, spiritual, and psychological support

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30
Q

adverse rxn

A

harmful or unintended effect of a medication, diagnostic test, or therapeutic intervention and can occur after any intervention. know what to expect and be able to recognize & intervene
ex. when apply a moist heat compress you don’t want to burn the pt’s skin so inspect the area where apply treatment and then reassess every 5 min after starting therapy

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31
Q

preventive nursing actions

A

promote health and prevent illness to avoid acute or rehabilitative care
primary prevention- aimed at health promotion, health educations programs, immunizations, physical & nutritional fitness activities
secondary prevention- aimed at persons w/ a disease who are at risk for complications or worsening conditions, includes screening techniques and treating early stages of a disease
tertiary preventions-minimizing effects of long-term illness or disability including rehab measures

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32
Q

patient adherence

A

means that pts and families invest time in carrying out required treatments

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33
Q

discuss the relationship between critical thinking and evaluation

A

critical thinking directs you to analyze the findings from evaluation. Has the pt’s condition improved? is the pt able to improve, or are there physical factors preventing recovery? Does the pt’s motivation or willingness impact recovery?

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34
Q

describe the standards of professional nursing practice for evaluation (p 267)

A

defined by the ANA- standards are authoritative statements of the duties of all RNs, regardless of role, pt. population they serve, or specialty, are expected to perform competently
competencies for evaluation- being systematic, using criterion-based evaluation, using ongoing assessment data to revise the plan, and communicating results to pts and families

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35
Q

explain the relationship among goals of care, expected outcomes, and evaluative measures when evaluating nursing care

A

goals and outcomes are objective criteria that are needed to judge a pt’s response to care
outcomes are statements of progressive, step-by-step physical, emotional, or behavioral responses that the pt needs to accomplish to achieve the goals of care
evaluation is not a description of achievement but is observation of the pt’s behavior (e.g. facial expression during interview) and evaluative measure are how we measure evaluations (e.g. observations, physiological measurements). They’re the same as assessment techniques but are performed when you make decisions about a pt’s status and progress

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36
Q

give examples of evaluation measures for determining a pt’s progress towards outcomes

A

observations, vital signs, pt interview, mobility

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37
Q

evaluate the outcomes of care for a patient

A

evaluation is continuous and should be based on the pt’s care plan

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38
Q

describe how evaluation leads to discontinuation, revision, or modification of a plan on care

A

evaluations allows you to see if goals/outcomes have been met which allows your to discontinue a all/portion of a care plan, evaluation also lets you determine if plans needs to be modified due to changes in the pt’s condition but when a goal isn’t met you start over with the nursing process

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39
Q

evaluation

A

final step in the nursing process, is crucial to determine whether, if after application of the nursing process, the pt’s condition or well being improves
evaluation is ongoing. if outcomes are met, pt. goals are met
evaluation is to determine if known problems have remained the same, improves, worsened, or otherwise changed

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40
Q

evaluative measure

A

assessment skills and techniques (e.g. observations, physiological measurements, pt interview)

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41
Q

nursing-sensitive outcome

A

a measurable pt or family state, behavior, or perception largely influenced by and sensitive to nursing interventions
ex. reduction in pain frequency, incidence of pressure ulcers, and incidence of falls

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42
Q

standard of care

A

minimum level if care accepted to ensure high quality of care to pts. They define the types of therapies typically used for defined problems or needs

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43
Q

criterion-based standards

A

standards for evaluation are the physiological, emotional, and behavioral responses that are a pt’s goals and expected outcomes

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44
Q

goal

A

expected behavior or response that indicates resolution of a nursing diagnosis or maintenance of a healthy state

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45
Q

expected outcome

A

end result that is measurable, desirable, and observable, and translates into observable pt behaviors

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46
Q

NOC

A

Nursing Outcomes Classification
1. identify, label, validate, and classify nurse-sensitive pt outcomes 2. to field test and validate the classification 3: to define and test measurement procedures for the outcomes and indicators using clinical data

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47
Q

interpreting evaluation findings

A

compare the pt’s behavioral responses and physiological signs and symptoms that you expect to see with those actually seen from your evaluation and judge the degree of agreement

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48
Q

two factors examined by evaluation

A

the appropriateness of the interventions selected and the correct application of the of the intervention

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49
Q

PES

A

Problem- NANDA-I diagnosis
Etiology or related factor
Symptoms of defining characteristics
ex- impaired physical mobility related to incisional pain as evidenced by restricted turning and positioning

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50
Q

MSU Denver

A

Metro State College- 1965, renamed MSCD in 1990, MSUD- July 1, 2012

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51
Q

MSUD Nursing

History

A

1967- associates program, part of Dept. Nursing & Allied Health, then Nursing and Health Care Management, then Health, Professions, on July 1 2002, Dept. Nursing
1973- RN to BSN (BRNCO)
2004- ANO

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52
Q

MSUD Nursing Accreditation

A

BRNCO- accredited by National League for Nursing 1976

National League for Nursing Accreditation Commission (NLNAC) for ANO in 2004, warning 2011, came back Fed 2013

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53
Q

Dept of Nursing- Mission

A

to provide a high quality, accessible, enriching education to students pursuing a BSNlearning community cultivates graduates who are prepared with the knowledge, skills and competencies to advance professional nursing practice in a diverse, global and technological society. The Department of Nursing is committed to academic excellence, collaborative community involvement and promotion of scholarly achievement.

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54
Q

Dept- Philosophy of Nursing Education

A

nursing education is a dynamic, intellectual process that prepares students for professional nursing practice in a changing healthcare delivery system. Baccalaureate nursing education incorporates knowledge from the natural sciences, social sciences and nursing. The goal of the nursing program is to prepare a generalist professional nurse to practice in current and future healthcare delivery systems
4 concepts of nursing paradigm for basing curriculum- pt, nursing, health, and environment

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55
Q

Dept- Philosophy of Nursing Education

foundational documents for curriculum development

A

The Essentials of Baccalaureate Education for Professional Nursing Practice published by The American Association of Colleges Nursing, and the Quality and Safety Education for Nurses (QSEN)

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56
Q

Dept- Philosophy of Nursing Education

Patient

A

Individuals, families, groups, communities or populations who are the recipients of nursing care. Patients are diverse and complex with unique characteristics and health needs. Patients may function in independent, interdependent or dependent roles and may seek or receive nursing care related to disease prevention, health promotion, or health maintenance as well as illness and end of life care

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57
Q

Dept- Philosophy of Nursing Education

Nursing

A

An interactive process involving the provision of care to patients by nurses. Nursing is a professional discipline that integrates both theory and clinical practice. Nursing is both an art and a science. The science of nursing is based upon an evolving body of knowledge that is derived from evidence-based practice. The art of nursing is evidenced by nursing care that is ethical, person-centered, compassionate and caring

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58
Q

Dept- Philosophy of Nursing Education

Health

A

A dynamic state defined by the patient at any given point in time. Health is influenced by a constantly changing environment. Health encompasses the physical, psychosocial, cultural and spiritual dimensions of the patient.

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59
Q

Dept- Philosophy of Nursing Education

Environment

A

The external and internal physiological, psychological, sociocultural and spiritual factors affecting patients. Patients are in constant interaction with the environment. Professional nurses consider the impact of the local, regional, national and global environment when nursing care is delivered.

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60
Q

Dept- Educational Philosophy

A

focused on learner-centered educational experiences, incorporate Principles of Adult Learning Theory, students valued for prior life and learning experiences

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61
Q

Baccalaureate Generalist Graduate

A

practice from a holistic, caring framework;

  • practice from an evidence base;
  • promote safe, quality patient care;
  • use clinical/critical reasoning to address simple to complex situations;
  • assume accountability for one‟s own and delegated nursing care;
  • practice in a variety of healthcare settings;
  • care for patients across the health-illness continuum;
  • care for patients across the lifespan;
  • care for diverse populations;
  • engage in care of self in order to care for others; and
  • engage in continuous professional development.
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62
Q

Curriculum Framework

A

Communication, Critical Thinking and Clinical Reasoning, Patient Safety, Leadership and Management, and Professionalism and Professional Values.
Course content is sequenced from simple to complex with a progressive focus on the individual, families, groups, communities and populations. Beginning courses in the curriculum provide foundational theory for application in clinical practice settings

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63
Q

Curriculum Framework

Communication

A

process of exchanging information between individuals using a common language, symbols or behavior. Communication occurs in several forms, including verbal, written and non-verbal. Effective communication is characterized by active listening, accurate interpretation and appropriate responses. Therapeutic communication is the hallmark of communication between the patient and the nurse

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64
Q

Curriculum Framework

Critical Thinking and Clinical Reasoning

A

Professional nurses must possess excellent critical thinking and clinical reasoning skills in providing quality healthcare to patients. The American Association of Colleges in Nursing defines critical thinking as: All or part of the process of questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity. Critical thinking underlies independent and interdependent decision making

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65
Q

Curriculum Framework

Patient Safety

A

Professional nurses play a critical role to provide for patient safety. The Quality and Safety Education for Nurses project (QSEN) developed six competencies to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve quality and safety for patients (www.qsen.org). The six QSEN competencies are: patient centered care, team work and collaboration, evidence based practice, quality improvement, informatics, and safety (www.qsen.org). The baccalaureate nursing graduate implements safety principles and works with others on the healthcare team to create a safe environment for care delivery

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66
Q

Curriculum Framework

Leadership & Management

A

Organizational and systems leadership and management skills are critical to promoting high quality patient care. According to AACN (2008, p. 13), “leadership skills are needed that emphasize ethical and critical decision making, initiating and maintaining effective working relationships, using mutually respectful communication and collaboration within interprofessional teams, care coordination, delegation, and developing conflict resolution strategies. Basic nursing leadership includes an awareness of complex systems, and the impact of power, politics, policy and regulatory guidelines on these systems.”
The baccalaureate generalist nurse manages care transitions, is an active participant on the interprofessional team and develops working skills in delegation, prioritization and oversight of care

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67
Q

Curriculum Framework

Professionalism and Professional Values

A

Professionalism is defined as “both having a unique or special knowledge and the self-imposed obligation to serve the community” (Bryan-Brown & Dracup, 2003, p. 394). Professionalism involves accountability for one‟s self and nursing practice, including continuous professional engagement and lifelong learning. Baccalaureate education includes the development of professional values and value based behavior

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68
Q

Mid-Program Outcomes

Communication

A

Analyze the effectiveness of written, verbal, non-verbal and electronic communication.
Examine the effectiveness of therapeutic communication skills when providing nursing care to patients (individuals, families, groups, communities and populations).

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69
Q

Mid-Program Outcomes

Critical Thinking and clinical reasoning

A

Assess the use of critical thinking and clinical reasoning skills when providing nursing care to patients (individuals, families, groups, communities and populations).
Appraise current evidence and compare it with institutional policy.
Evaluate the impact of the environment on the health of the patient (individuals, families, groups, communities and populations) and the delivery of nursing care.

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70
Q

Mid-Program Outcomes

Leadership and Management

A

Analyze the impact of power, politics, policy and regulatory guidelines on the health of patients
(individuals, families, groups, communities and populations).
Integrate management principles in planning and delivering nursing care to patients (individuals, families, groups, communities and populations)

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71
Q

Mid-Program Outcomes

Patient Safety

A

Integrate the QSEN competencies into the delivery of nursing care.
Evaluate the effectiveness of processes related to maintaining patient safety in the clinical setting.

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72
Q

Mid-Program Outcomes

Professionalism and Professional Values

A

Assess the professionalism of interactions with faculty, student colleagues, health care team members and patients (individuals, families, groups, communities and populations).
Evaluate personal development of professional values and value based behavior.

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73
Q

Quality and Safety Education for Nurses (QSEN) competencies

A

patient centered care, team work & collaboration, EBP, quality improvements, informatics, and safety

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74
Q

ANA

A

American Nurses Association

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75
Q

Florence Nightingale

A

1860- 1st school of nursing- Nightingale Training School for Nurses at St. Thomas’ Hospital in London, saw nursing as charge of somebody’s health based on the knowledge of how to put the body in a state to be free from disease or to recover from disease
1st practicing nurse epidemiologist, showed connection between poor sanitation and disease
improved battlefield hospitals in Crimean War, 1853, lady w/ the lamp- fresh air, hygiene, nutrition

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76
Q

Clara Barton

A

founder of American Red Cross, ARC ratified by Congress in 1882 after 10yrs of lobbying by CB, tended wounded soldiers in Civil War

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77
Q

Dorothea Lynde Dix

A

superintendent of the female nurses of the Union Army

organized hospitals, appointed nurses, oversaw and regulated supplies to troops

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78
Q

Mother Bickerdyke

A

organized ambulance service, and walked abandoned battlefields at night looking for wounded soldiers

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79
Q

Harriet Tubman

A

active in the Underground Railroad movement, helping 300+ to freedom

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80
Q

Mary Mahoney

A

1st professionally trained African American nurse, noted for bringing forth the awareness of cultural diversity and respect for the individual regardless of background, race, color, or religion

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81
Q

Isabel Hampton Robb

A

helped found the Nurses’ Associated Alumnae of the US & Canada in 1896- became the ANA in 1911
wrote- Nursing: It’s Principles and Practice for Hospital & Private Use, Nurse Ethics, and Educational Standards for Nurses and was 1 of the founders of the AJN

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82
Q

Mary Adelaide Nutting

A

helped move nursing education into universities

1906- 1st professor of nursing at Columbia University Teachers College

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83
Q

Army Nurse corps

A

established 1901

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84
Q

Navy Nurse corps

A

established 1908

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85
Q

Mary Adelaide Nutting, Lillian Ward, Annie Goodrich

A

Goldmark Report- concluded that nursing education needed increased financial support and suggested that university schools of nursing received $, 1920, pub. 1923

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86
Q

specialty areas of nursing

A

emerged in 1920s, organizations began in 940s and 1950s

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87
Q

Societal Influences are Nursing

Demographics

A

: people moving from rural to urban centers, increased lifespan, increase in patients living with chronic illnesses (we have better drugs and therapy available), increases in alcoholism, lung cancer (and other cancers)

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88
Q

Societal Influences are Nursing

Women’s Health

A

Women are demanding equality, especially in the areas of economic, political, occupational, and educational needs. Because women are demanding that they receive better care, new advances are continually being made in obstetrics, oncology, and research.

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89
Q

Societal Influences are Nursing

Human Rights

A

Nurses have always placed patients at the center of care and been strong advocates for patient care needs. Therefore, it is not surprising that nurses are among the strongest advocates of recognizing patients needs, special and normal. Nurses can be proud that they created bills of rights for dying, hospitalized, and pregnant clients.

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90
Q

Societal Influences are Nursing

medically underserved

A

Nurses have always cared for patients inside and outside of the medical system. We promote the rights of minorities, immigrants, the underinsured, and the uninsured to receive high-quality health care. The rising rates of unemployment, mental illness, and homelessness makes our advocacy more important than ever

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91
Q

Societal Influences are Nursing

threat of bioterrism

A

As disturbing events unfold, threats are increasing and everyone is concerned. To prepare, nursing curriculum as well as health care agencies are training future and practicing nurses to deal with nuclear, chemical, and biological

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92
Q

influences of nursing today

A

rising cost of health care, EBP, nursing and biomedical research, nursing shortages, demographics

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93
Q

code of ethics

A

the philosophical ideals of right and wrong that define the principles you will use to provide care for you pts

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94
Q

Standards of Practice

A

a competent level of nursing care. use critical thinking model know as the nursing process to include- assessment, diagnosis, outcomes identification and planning, implementation, and evaluation

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95
Q

Standards of Professional Performance

A

describe a competent level of behavior in the professional role
provide guidelines for nurses to be accountable for their actions, their pts, and their peers
standards include- education, professional practice evaluation, collaboration, ethics, resource utilization, leadership

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96
Q

registered nurse (RN)

A 
either associates (2yr) or BSN (4yr)- can take the National Council Licensure Exam for Registered Nurses (NCLEX-RN) 
both programs focus on basic sciences, theoretical & clinical courses. BSN also focuses on social sciences, arts & humanities to support nursing theory
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97
Q

masters degree education

A

provides the advanced clinician w/ strong skills in nursing science and theory w/ emphasis on basic sciences and research
important for nurse educators and nurse administrators, also required for advanced practice registered nurse (APRN)

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98
Q

doctoral preparation

A

: a DSN or DSC prepares you to apply research findings to clinical nursing. A PhD emphasizes basic research and theory .

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99
Q

continuing education

A

involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions
updates your knowledge about latest research, helps you specialize, teaches you new skills and techniques

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100
Q

in-service education programs

A

are instruction or training programs by a health care agency or institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution

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101
Q

Nurse Practice Acts

A

overseen by the State Boards of Nursing, regulate the scope of nursing practice and protect the public health, safety, and welfare

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102
Q

nurse licensure

A

RN candidates must past the NCLEX-RN which is administered by individual State Boards of Nursing
provides a standardized minimum knowledge base for nurses

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103
Q

nurse certification

A

minimum practice requirements for certification in a specific area (e.g. oncology, peds, gerontology). After initial exam- maintain certification w/ continuing ed, and clinical or administrative practice

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104
Q

professional responsibilities & roles of a nurse

A

autonomy and accountability, caregiver, advocate, educator, communicator, manager, career development

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105
Q

professional responsibilities & roles of a nurse

autonomy and accountability

A

autonomy involves the initiation of independent nursing interventions w/o medical orders (e.g. implementing coughing and deep breathing exercises for a recent surgery pt, actively collaborating w/ other health professionals to pursue best treatment plan)
accountability- responsible both professionally and legally for type & quality of care provided, need to keep current
greater autonomy leads to increased accountability

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106
Q

professional responsibilities & roles of a nurse

caregiver

A

you help pts maintain and regain health, manage disease and symptoms, and attain a maximal level of fxn and independence through the healing process
you help the pt and family set goals and assist them w/ meeting these goals w/ minimal cost, time, and energy

107
Q

professional responsibilities & roles of a nurse

advocate

A

protect your pt’s human and legal rights and provide assistance in asserting these rights if the need arises
e.g. providing additional info to help a pt decide to or not accept a treatment, find an interpreter if needed

108
Q

professional responsibilities & roles of a nurse

educator

A

explain concepts and facts about health, describe reason for routine care activities, demonstrate procedures (e.g. self care, injections, wound cleaning), reinforce learning or pt behavior, and evaluate the pt’s progress in learning

109
Q

professional responsibilities & roles of a nurse

communicator

A

central to nurse/pt relationships
allows you to know your pt, including strengths, weaknesses, & needs
communicate w/ pts & families, other nurses, other health care providers

110
Q

professional responsibilities & roles of a nurse

manager

A

coordinates the activities of nursing staff in delivering care, has personnel policy and budgetary concerns for the unit
works to provide an environment for collaborative pt centered care to provide safe, quality care w/ + outcomes

111
Q

professional responsibilities & roles of a nurse

types of careers

A
  • Provider of Care- bedside RN
  • Advanced Practice RN (APRN)-most independently functioning nurse, has prescriptive authority- includes clinical nurse specialist (CNS), certified nurse practitioner (CNP), certified nurse midwife (CNM), and certified RN anesthetist (CRNA)
  • Nurse Educator
  • Nurse Administrator
  • Nurse Researcher
112
Q

Clinical Nurse Specialist

A

CNS, is an APRN who is an expert clinician in a specialized area (e.g. geriatrics(population), critical care(setting), diabetes(specific disease), rehab (type of care), or pain(type of problem))
has prescriptive authority

113
Q

Nurse Practitioner

A

NP, is an APRN who provides comprehensive care for pts w/ complex problems and use a more holistic approach than physicians
care for healthy pts and pts w/ chronic health problems
has prescriptive authority

114
Q

Certified Nurse Midwife

A

CNM, is an APRN who is educated in midwifery and certified by the American College of Nurse Midwives. practice involves- care of women during normal pregnancy, L&D, and care of the newborn, also routine gynecology services (paps, family planning, treatment of minor vaginal infections)
has prescriptive authority

115
Q

Certified Registered Nurse Anesthetist

A

CRNA, is an APRN who has advanced education in a nurse anesthetist program, CRNAs provide surgical anesthesia under the guidance and supervision of an anesthesiologist
has prescriptive authority

116
Q

Nurse Educator

A
  • schools of nursing- usually have advance degrees, specific clinical, admin, or research specialty and advanced clinical experience
  • staff development depts of health care agencies- provide educational programs to nurses w/i their institution (e.g. orientation, critical care courses, clinical skill competency, safety training, new equipment or procedure training), often involved in development of new policies and procedures
  • pt education depts- teaches pts who are ill or disabled and families how to self-manage, usually specialized and certified (e.g. ostomy care, certified diabetes educator) and only see a specific population of pts
117
Q

Nurse Administrator

A

manages pt care and the delivery of specific nursing services w/i a health care agency
often have MBA or masters in hospital admin, pubic health, or health service admin (e.g. Brenda, Tracy)
needs to be skilled in business and management. Fxns include budgeting, staffing, strategic planning of programs & services, employee evaluations, & employee development

118
Q

Nurse Researcher

A

investigates problems to improve nursing care and further define and expand the scope of nursing practice, usually works in an academic setting, hospital, or independent professional or community service agency
at least a master’s, prefer doctoral degree

119
Q

profesional Organization

A

deals with issues and concerns to those practicing in the profession
in the US- the NLN (National League for Nursing) and the ANA (American Nurses Association)

120
Q

NLN

A

National League for Nursing- advances excellence in nursing education to prepare nurses to meet the needs of a diverse population and changing health care environment
sets standards for excellence and innovation in nursing education

121
Q

ICN

A

International Council of Nurses- objectives parallel ANA
promoting national associations of nurses, improving standards of nursing practice, seeking a higher status for nurses, and providing an international power base for nurses

122
Q

ANA

A

American Nurses Association- purpose is to improve standards of health and the availability of health care, to foster high standards for nursing, and to promote professional development and general and economic welfare of nurses
part of the ICN

123
Q

patient-centered care

A

recognize the pt or designee as a source of control and full partner in providing compassionate and coordinated care based on respect for pt’s preferences, values, and needs

124
Q

teamwork and collaboration

A

fxn effectively w/i nursing and interprofessional teams, fostering open communications, mutual respect, and shared decision making to achieve quality pt care

125
Q

evidence-based practice

A

integrate best current evidence w. clinical expertise and pt/family preferences and values for delivery of optimal health care

126
Q

quality improvement

A

use data to monitor the outcomes of care processes and use improvement methods to design & test changes to continuously improve the quality & safety of health care systems

127
Q

safety

A

minimize the risk of harm to pts & providers through both system effectiveness & individual performance

128
Q

informatics

A

use information and technology to communicate, manage knowledge, mitigate error, and support decision-making

129
Q

QSEN

A

Quality and Safety Education for Nurses- an initiative to respond to reports about safety and quality pt care and includes competencies of- pt centered care, teamwork & collaboration, EBP, quality improvement, safety, & informatics

130
Q

Genomics

A

term that describes the study of all the genes in a person and the interactions of these genes with one another and the person’s environment
using genomic info allows providers to determine how genomic changes contribute to pt conditions & influences treatment options

131
Q

Societal Influences are Nursing

health care reform

A

affects how health care is paid for and delivered, greater emphasis on health promotion, disease prevention, and illness management
more services will be community based (e.g. more schools, community care centers) which will require nurses to be more adept at assessing for resources, service gaps, and how the pt adapts to returning to the community

132
Q

Societal Influences are Nursing

rising cost of health care.

A

increased cost challenges the profession, the consumer, and the health care delivery systems. As a nurse you’re responsible for providing best-quality care in an efficient and economically sound manner, challenge is to use health care and pt resources wisely

133
Q

PICOT

A 
Pt. Population of interest
Intervention of interest
Comparison of interest
Outcome
Time
helps identify key words for literature search
not all questions need I, C, &/or T
134
Q

evidence-based practice (EBP)

A

a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination w/ a clinician’s expertise & pt preferences and values in making decisions about pt care

135
Q

discuss benefits of EBP

A

EBP works as a guide to help nurses make effective, timely, and appropriate clinical decisions in response to broad political, professional, and societal forces
best evidence is transformed into best practice at the bedside

136
Q

5 steps of EBP

A
  1. ask a clinical question
  2. collect the most relevant & best evidence
  3. critically appraise the evidence you gather
  4. integrate all evidence w/ one’s clinical expertise & pt preferences & values in making a practice decision of change
  5. evaluate the practice decision or change
  6. share the outcomes of EBP changes w/ others
137
Q

problem-focused trigger

A

one you face while caring for a pt or a trend you see on a nursing unit
e.g. How can I reduce the # of falls on my unit?

138
Q

knowledge-focused trigger

A

a question regarding new information available on a topic

e.g. What is the current evidence to improve pain management in pts w/ migraine headaches?

139
Q

PICOT example 1

A

Do patients who have abdominal surgery (P) and who rock in a rocking chair (I) have a reduced incidence of postoperative ileum (O) during hospitalization (T) when compared to pts who receive standard nursing care following surgery (C)?

140
Q

PICOT example 2

A

Is and adult patient’s (P) blood pressure more accurate (O) when measuring with the patient’s legs crossed (I) verses the patient’s feet on the floor (C)?

141
Q

peer-reviewed article

A

has been reviewed by a panel of experts familiar w/ the topic or subject matter of the article

142
Q

levels of evidence available in the literature

A

level of rigor/amount of confidence decreases as you go down

  • systematic reviews and metaanalysis of randomized controlled trials (RCTs)
  • one well designed RCT
  • well-designed controlled trials w/o randomization
  • well-designed case control studies
  • systematic reviews of descriptive and qualitative studies
  • singe descriptive or qualitative study
  • opinions of authorities or expert committees
143
Q

elements of an EBP article

A

abstract, introduction, literature review or background, manuscript narrative, methods or design, results or conclusion, clinical implications

144
Q

elements of an EBP article

abstract

A

brief summary that quickly tells you if it’s research or clinical based, summarizes the purpose, includes major themes or findings, and implications

145
Q

elements of an EBP article

introduction

A

contains more info about the topic of the paper, usually has info about why it’s an important topic
intro and abstract let you decide if you want to continue to read the article

146
Q

elements of an EBP article

literature review or background

A

a good author offers a detailed background on the level of science or clinical info that exists about a topic
important section b/c even if it does’t help w. your PICOT question, it may lead to more useful articles

147
Q

elements of an EBP article

manuscript narrative

A

differs according to type of EBP article.
Clinical article- often includes a description of the pt. pop., the nature of a certain disease of health alteration, how pts are affected, and appropriate nursing therapies
research article- includes subsections w/i the narrative including- purpose statement which has a hypotheses

148
Q

elements of an EBP article

methods or design

A

explain how research study was organized and conducted to answer research question or test the hypothesis (e.g. RCT, case control study, qualitative)

149
Q

elements of an EBP article

results or conclusions

A

found in clinical article, detailed results of the study w/ statistical analysis if it was a quantitative study, explains how the hypothesis is supported or how the research question is answered, limitations should also be included

150
Q

elements of an EBP article

clinical implications

A

explains if the findings have clinical implications and if they do- how to apply findings in a practice setting for the type of subjects studied

151
Q

hypotheses

A

predictions made about the relationship or differences between study variables

152
Q

variables

A

concepts, characteristics, or traits that vary within or among subjects

153
Q

meta-analyses or systematic review

A

state-of-the-art summaries from an individual researcher or panel of experts
perfect answers to PICOT questions b/c they rigorously summarize the current evidence

154
Q

discuss ways to apply evidence in practice

A

if the evidence is strong & applicable- first step may be to apply research in your plan of care for your pts, meet w/ practice committee to recommend new protocol, evaluate the practice decision or change- evaluate if changes work, are needed, or need to be d/c, then share the outcomes w/ others, changes are often shared at profession conferences and meetings
when applying evidence- consider setting, support from staff, and available resources

155
Q

Steps of the Research Process

A

problem identification, study design, conducting the study, data analysis, use the findings

156
Q

Steps of the Research Process

Problem Identification

A 
Identify are of interest of clinical problem
review the literature
formulate theoretical framework
identify study variables
devise research question(s)/hypotheses
157
Q

Steps of the Research Process

Study Design

A

design study protocol

  • select the research design/methodology
  • identify sample pop.: #, recruitment, assignment to groups
  • select the instrumentation: questionnaires, physiological measures, interviews, treatments
  • formulate proposed analysis: statistical methods to answer research question/hypotheses
158
Q

Steps of the Research Process

Conducting the study

A 
obtain necessary approvals
recruit subjects
implement the study protocol/collect data:
  pilot study may be done initially
  continually assess study methodology,
159
Q

Steps of the Research Process

Data Analysis

A

Analyze the results of the study:
interpret demographics of study pop.
analyze each research question/hypothesis
interpret results, including conclusions & limitations

160
Q

Steps of the Research Process

use the findings

A
  • formulate recommendations for further research
  • determine implications for nursing
  • disseminate the findings: presentations, publications, research use in practice
161
Q

Nursing Research

A

way to identify new knowledge, improve professional education & practice, & use resources effectively. The knowledge provides a scientific basis for nursing practice and validates the effectiveness of nursing interventions

162
Q

example of nursing sensitive outcomes

A

-pt falls, w/ and w/o injury
-nursing hrs/ pt and skill mix
-peds pain assessment, intervention, & reassessment cycle
- peds peripheral IV infiltration rate
-pressure ulcer prevalence
-psych physical/sexual assault rate
-restraint prevalence
-RN education, certification, & satisfaction
-voluntary nurse turnover & vacancy rate
-nosocomial infections:
catheter associated UTI
central line cath. assoc. blood stream infection (CABSI)
vent. assoc. pneumonia (VAP)

163
Q

historical research

A

studies designed to establish facts and relationships concerning past events (e.g. study examining societal factors that led to acceptance of APRNs by pts.)

164
Q

exploratory research

A

initial study designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about relationships among phenomena (e.g. pilot study testing the benefits of a new exercise program for older adults w/ dementia)

165
Q

evaluation research

A

study that tests how well a program, practice, or policy is working (e.g. study measuring the outcomes of an info campaign designed to improve parents’ ability to follow immunization schedules for their children

166
Q

descriptive research

A

study that measures characteristics of persons, situations, or groups & the frequency w. which certain events or characteristics occur (e.g. study to examine RNs’ biases toward caring for obese pts)

167
Q

experimental research

A

study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable (e.g. smoking cessations info vs. info + support group)

168
Q

correlational research

A

study that explores the interrelationships among variables of interest w/o any active intervention by the researcher (e.g. study examining the relationship between RNs’ educational levels and their satisfaction in the nursing role)

169
Q

quality improvement (QI)

A

an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of pts & others & inform health care policy (e.g. medication delivery, fall prevention)

170
Q

performance improvement (PI)

A

when an organization analyzes & evaluates current performance & uses the results to develop focused improvement actions

171
Q

PDSA

A

model for QI & PI
Plan-review available data to understand existing practice conditions or problems to identify need for change
Do-select an intervention on the basis of the data reviewed & implement the change
Study- study the results of the change
Act- if successful, incorporate them into daily performance

172
Q

relationship between EBP & QI

A

when implementing an EBP project, !st review for new evidence and QI data, info helps understand the extent of a problem in practice and w/i your organization. QI data inform about how processes work w/i organization & thus offer info about how to make EBP changes.
both are internal process, funded by the health care agency, IRB approval sometime needed for QI

173
Q

relationship between EBP & QI

EBP

A

purpose- use of info from research, professional experts, personal experience, & pt. preference to determine safe and effective nursing care w/ goal of improving pt. outcomes
focus-implementation of evidence already know into practice
data sources- multiple research studies, expert opinion, personal experience, pts
who conducts-practicing nurses & other team members

174
Q

relationship between EBP & QI

QI

A

purpose- improves work process to improve pt outcomes & efficiency of health systems
focus-measures effects of practice and/or practice change on specific pt. pop.
data source- data from pt. records or pts who\ are in a specific area (e.g. pt care unit, certain hospital)

175
Q

critical thinking

A

a continuous process characterized by open-mindedness, continual inquiry, and perseverance combined w/ a willingness to look at each unique pt. situation & determine which identified assumptions are true & relevant
involves recognizing that an issue exists, analyzing info and the issue, evaluating info, & making conclusions

176
Q

evidenced-based knowledge

A

knowledge based on research or clinical expertise

177
Q

critical thinking skills (p 193)

A

interpretation, analysis, inference, evaluation, explanation, self-regulations

178
Q

characteristics of a critical thinker

A
  • considers what is important in each situation
  • observes and examines info
  • imagines & explores alternatives
  • makes informed decisions
179
Q

concepts for a critical thinker (p 194)

A

truth seeking, open-midedness, analyticity, systematicity, self-confidence, inquisitiveness, maturity

180
Q

critical thinking competencies (p195)

A

scientific method, problem solving, decision making, diagnostic reasoning and inference, clinical decision making

181
Q

problem solving

A

involves evaluating the solution over time to make sure it is effective and trying different options if the problem reoccurs

182
Q

decision making

A

product of critical thinking that focuses on problem resolutions
following a set of criteria helps make a thorough & thoughtful decision
to make a decision, an individual has to recognize, & define the problem or situation, & assess all options, weigh each option against a set of personal criteria, test possible options, consider the consequences & make a final decision

183
Q

diagnostic reasoning

A

analytical process for determining a pt’s health problems

184
Q

inference

A

process of drawing conclusions from related pieces of evidence & previous experience w/ evidence

185
Q

clinical decision making

A

requires careful reasoning (i.e. choosing the options for the best pt outcomes on the basis of the pt’s condition & priority of the problem)
improved by knowing your pts, allows you to set priorities for the interventions to implement 1st

186
Q

What is the purpose of the nursing process?

A

to diagnose & treat human responses to actual or potential health problem
human responses include pt symptoms & physiological rxns to treatments, the need for knowledge when health care providers make a new diagnosis or treatment plan, and a pt’s ability to cope w/ loss

187
Q

discuss clinical experience and critical thinking

A
  • knowledge combined w/ clinical expertise from experience defines critical thinking
  • clinical learning experiences help to acquire clinical decision-making skills
  • clinical experience is the lab for testing nursing knowledge
188
Q

components of critical thinking in nursing

p 199

A 
I. specific knowledge base
II. experience
III. critical thinking competencies
 a.general critical thinking
 b. specific critical thinking
 c. specific critical thinking in nursing-nursing process
IV. attitudes of critical thinking
confidence, independence, fairness, responsibility, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility
V. standards of critical thinking
 a. intellectual standards
 clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate (for purpose), fair
 b. profesional standards
  1.ethical for nursing judgement
  2. criteria for evaluation
  3. profesional responsibility
189
Q

discuss how professional standards influence nurse’s clinical decisions

A

promote the highest level of quality of nursing care
allows a nurse to be able to focus on pt’s values & beliefs & helps you make clinical decisions that are just, faithful to the pt’s choices, & beneficial to the pt’s wellbeing

190
Q

reflection

A

the process of purposefully thinking back or recalling a situation to discover its purpose or meaning

191
Q

discuss how reflection improves clinical decision making

A

critical thinking becomes more deliberate through reflection b/c it allows you to think about your previous thinking to make your future thinking better

192
Q

discuss relationship of critical thinking and nursing assessment

A

critical thinking allows you to see the big picture when you form conclusions about a pt’s health condition, while gathering data you synthesize relevant knowledge, recall prior clinical experiences, apply critical thinking standards & attitudes, & uses standards of practice to direct you assessment in a meaningful & purposeful manner

193
Q

two steps of nursing assessment

A
  1. collection of info from a primary source (the pt.) and secondary sources (e.g. family members, health professionals, medical records)
  2. interpretation and validation of data to ensure a complete database
194
Q

database

A

found through assessment, determines the pt’s perceived needs, health problems, and responses to these problems as well as related experiences, health practices, goals, values, and expectations about the health care system

195
Q

Data Collection

A

info comes from:

  • the pt, through interview, observations, and physical examination
  • family members or significant others’ reports & response to interviews
  • others members of the health care team (e.g. OT, PT, RT, docs, nutritionists, etc.)
  • medical records info (e.g. pt history, lab work, x-rays)
  • scientific literature (evidence about assessment techniques & standards)
196
Q

two approaches to comprehensive assessment

A

11 functional health patterns or problem-oriented approach

197
Q

health perception-health management pattern

A

describes pt’s self-report of health & well-being; how a pt manages health (e.g. frequency of health care provider visits, adherence to therapies @ home); knowledge of preventative health practices

198
Q

nutritional-metabolic pattern

A

describes pt’s daily/weekly pattern of food & fluid intake (e.g. food preferences or restrictions, special diet, appetite); actual weight; weight loss or gain

199
Q

elimination pattern

A

describes fxn of excretory fxn (bowel, bladder, and skin)

200
Q

activity-exercise pattern

A

describes patterns of exercise, activity, leisure, and recreation; ability to perform ADLs

201
Q

sleep-rest pattern

A

describes patterns of sleep, rest, and relaxation

202
Q

cognitive-perceptual pattern

A

describes sensory-perceptual patterns; language adequacy, memory, decision-making ability

203
Q

self-perception-self-concept pattern

A

describes pt’s self-concpt pattern and perception of self (e.g. self-concept/worth, emotional patterns, body image)

204
Q

role-relationship pattern

A

describes pt’s patterns of role engagements and relationships

205
Q

sexuality-reproductive pattern

A

describes pt’s patterns of satisfaction and dissatisfaction w/ sexuality pattern; pt’s reproductive patterns; premenopausal and postmenopausal problems

206
Q

coping-stress tolerance pattern

A

describes pt’s ability to manage stress; sources of support; effectiveness of the patterns in terms of stress tolerance

207
Q

value-belief pattern

A

describe patterns of values, beliefs (including spiritual practices), and goals that guide pt’s choices or decisions

208
Q

problem oriented approach

A

you focus on the pt’s presenting situation & begin w/ problematic areas such as incisional pain or limited understanding of postoperative recovery
you ask questions to clarify and expand your assessment so you can understand the full nature of the problem

209
Q

subjective data vs objective data

A

subjective data is what the pt says, their verbal description of of their health problems and what the family says
objective data is info the nurse collects (e.g. vital signs, lab results, breath sounds, heart sounds, etc)

210
Q

sources of data

A 
patient
family/significant other(s)
health care team
medial records
other records and scientific literature
nurse's experience
211
Q

patient-centered interview

A

an approach for obtaining data that is needed to foster a caring nurse-pt role, adherence to interventions, & treatment effectiveness

212
Q

steps to patient-centered interview

A
  1. set the stage-intro of self and role
  2. set the agenda-such as collecting an assessment or history, ask for pt’s concerns or problems
  3. collect the assessment or nursing health history
  4. terminate the interview-summarize discussion, check for accuracy
213
Q

interview techniques

A

open-ended questions
back channeling
probing
close-ended questions

214
Q

open-ended questions

A

prompts pt’s to describe a situation in more than one or two words
leads to a discussion in which the pt actively describes their health status

215
Q

back channeling

A

includes active listening prompts such as “all right,” “go on,” or “uh-huh”
indicates that you have heard what the pt says & are interested in hearing the whole story

216
Q

probing

A

encourages full description w/o trying to control the direction the story takes
open-ended questions such as “Is there anything else you can tell me?” or “What else is bothering you?”

217
Q

closed-ended questions

A

require short answers and clarify previous info or provide additional info
helps to acquire specific info such as symptoms, precipitating factors, or relief measures

218
Q

concomitant symptoms

A

symptoms other than the primary symptom

e.g. pain accompanied by nausea (nausea is concomitant)

219
Q

nursing health history (p 214)

a comprehensive health history covers all health dimensions

A

-biographical info- age, sex, address, working status, occupation, marital status, insurance status
-reason for seeking health care
-pt expectations
-present illness or health concerns-OPQRST
-health history- previous illness, surgery, hospitalization, medication history, allergies, habits & lifestyle patterns (smoking, illegal drugs)
-family history
-environmental history- home/working environments, focusing of pt. safety
psychosocial history- pt’s support system, coping behaviors
-spiritual health
-review of systems
-documentation of history findings-clear & concise w/ appropriate terminology

220
Q

Review of Systems (ROS)

A

a systematic approach for collecting a pt’s self-reported data on all body systems

221
Q

validation

A

comparison of data w/ another source to determine data accuracy

222
Q

discuss relationship of interpretation & validation

A

successful interpretation & validation of assessment data ensure that you have collected a complete database
interpreting assessment data- allows you to determine abnormal findings, recognize that further observations are needed to clarify info and begin to identify pt’s health problems
validation-ensures accuracy, ask a pt to validate/clarify any unclear info obtained during an interview & history

223
Q

discuss critical thinking and nursing diagnosis

A

includes critical analysis & synthesis/interpretation of assessment data that reveal a pt’s response to health problems w/ the goal of identifying pt needs and formulating a nursing diagnosis

224
Q

medical diagnosis

A

the identification of a disease condition based on specific evaluation of physical signs, symptoms, the pt’s medical history & the results of diagnostic tests & procedures

225
Q

nursing diagnosis

A

is a clinical judgement about individual, family, or community responses to actual or potential health problems or life processes that nurses are licensed & competent to treat

226
Q

collaborative problem

A

an actual or potential physiological complication that nurses monitor to detect the onset of of changes in a pt’s status
nurses intervene in collaboration w/ other health care disciplines (e.g. managing hemorrhage, infection, & paralysis w/ medical, nursing,& allied health (e.g. PT, OT) interventions

227
Q

data cluster

A

a set of signs or symptoms gathered during assessment that you group together in a logical way

228
Q

defining characteristics

A

the clinical criteria that are observable & verifiable

229
Q

clinical criterion

A

an objective or subjective sign, symptom, or risk factor that when analyzed w/ other criteria , leads to a diagnostic conclusion

230
Q

related factor

A

a condition, historical factor, or etiology that gives a context for the defining characteristic s & shows a type of relationship w/ the nursing diagnosis

231
Q

3 types of nursing diagnoses

A

actual nursing diagnosis
risk nursing diagnosis
health promotion nursing diagnosis

232
Q

actual nursing diagnosis

A

describes human responses to health conditions or life processes that exist in an individual, family, or community
(e.g. acute pain, wandering, impaired social interaction, stress urinary incontinence)

233
Q

risk nursing diagnosis

A

describes human response to health conditions or life processes that MAY develop in a vulnerable individual, family, or community (e.g. risk for loneliness, risk for acute confusion, risk for infection)
-do not have related factors or defining characteristics b/c they haven’t happened yet

234
Q

health promotion nursing diagnosis

A

clinical judgement of a person’s, family’s, or community’s motivation, desire, & readiness to increase well-being & actualize human health potential as expressed in their readiness to enhance specific health behaviors such as nutrition & exercise (e.g. readiness for enhanced nutrition, readiness for enhanced family coping)

235
Q

components of a nursing diagnosis

A

usually a 2 part format- the NANDA-I diagnostic label followed by a statement of a related factor
sometimes 3 part PES- diagnostic label, the related factor, & the defining characteristics

236
Q

diagnostic label

A
  • the name of the nursing diagnosis as approved my NANDA-I
  • describes the essence of a pt’s response to health conditions in as few words as possible
  • has a definition that describes the characteristics of the human response identified which help when deciding between 2 diagnoses w/ similar defining characteristics
237
Q

etiology

A

(or related factor) is always w/i the domain of nursing practice & a condition that responds to nursing interventions (e.g. acute pain related to prostatectomy is incorrect b/c nursing actions don’t change the medical diagnoses, should be acute pain related to trauma)

238
Q

PES format

A

diagnostic label consisting of the NANDA-I label, the related factor, and the defining characteristics
P-problem
E-etiology or related factor
S- symptoms or defining characteristics
e.g. impaired physical mobility related to incisional pain, evidenced by restricted turning & postioning

239
Q

sources of diagnostic error

A

collecting, interpreting, clustering, labeling, documentation & informatics

240
Q

sources of diagnostic error

collecting

A
  • lack of knowledge or skill
  • inaccurate data
  • missing data
  • disorganization
241
Q

sources of diagnostic error

interpreting

A
  • inaccurate interpretation of the clues
  • failure to consider conflicting cues
  • using an insufficient # of cues
  • using unreliable or invalid cues
  • failure to consider cultural influences or developmental stage
242
Q

sources of diagnostic error

clustering

A
  • insufficient cluster of cues
  • premature or early closure
  • incorrect clustering
243
Q

sources of diagnostic error

labeling

A
  • wrong diagnostic label selected
  • evidence that another diagnosis is more likely
  • condition a collaborative problem
  • failure to validate nursing diagnosis w/ pt
  • failure to seek guidance
244
Q

History of Nursing Diagnosis

A
  • 1st introduced in 1950
  • 1953, Fry proposed formulation of nursing diagnosis
  • 1973, 1st national conference was held
    1. NANDA was founded
245
Q

NANDA-I

A

North American Nursing Diagnosis Association-International

-nursing diagnoses are listed according to NANDA-I

246
Q

Diagnostic Statement Guidelines

A
  1. Identify the patient’s response, not the medical diagnosis.
  2. Identify a NANDA-I diagnostic statement rather than the symptom.
  3. Identify a treatable cause or risk factor rather than a clinical sign or chronic problem that is not treatable through nursing intervention.
  4. Identify the problem caused by the treatment or diagnostic study rather than the treatment or study itself.
  5. Identify the patient response to the equipment rather than the equipment itself
  6. Identify the patient’s problems rather than your problems with nursing care.
  7. Identify the patient problem rather than the nursing intervention.
  8. Identify the patient problem rather than the goal of care.
  9. Make professional rather than prejudicial judgments.
  10. Avoid legally inadvisable statements.
  11. Identify the problem and its cause to avoid a circular statement.
  12. Identify only one patient problem in the diagnostic statement.
247
Q

nursing diagnosis- application to care planning

A

By learning to make accurate nursing diagnoses, your care plan will help communicate the patient’s health care problems to other professionals.
A nursing diagnosis will ensure that you select relevant and appropriate nursing interventions

248
Q

priority setting

A

the ordering of nursing diagnoses or pt. problems using determinations of urgency and/or importance to establish a preferential order for nursing actions
order of priorities changes as the pt’s condition changes

249
Q

priority setting- high priority

A

nursing diagnoses that , if left untreated, result in harm to the pt or others (e.g. those related to airway status, circulation, safety, pain)

250
Q

priority setting- intermediate priority

A

nursing diagnoses that involve non-emergent, nonlife-threatening needs of pts

251
Q

priority setting- low priority

A

not always directly related to a specific illness or prognosis but affect the pt’s future well-being
many low priority diagnoses focus on the pt’s long term health care needs

252
Q

planning

A

involves setting priorities, identifying pt-centered goals & expected outcomes, & prescribing individualized nursing interventions

253
Q

goal

A

is a broad statement that describes a desired change in a pt’s condition or behavior

254
Q

expected outcome

A

is a measurable criterion to evaluate goal achievement

sometimes several outcomes must be met for a single goal

255
Q

SMART goals

A 
S- specific
M- measurable
A- attainable
R- realistic or reasonable
T- timely
256
Q

patient-centered goal

A

a specific & measurable behavior or response that reflects a pt’s highest possible level of wellness and independence in fxn

257
Q

short-term goal

A

an objective behavior or response that you expect the pt to achieve in a short period of time (hrs to week)

258
Q

long-term goal

A

an objective behavior that you expect the pt to achieve over a longer period (days, wks, months)

259
Q

nursing sensitive pt outcome

A

is a measurable pt, family, or community state, behavior, or perception largely influenced by and sensitive to nursing interventions

260
Q

Nursing Outcomes Classification (NOC)

A

The Iowa Intervention Project published the Nursing Outcomes Classification (NOC) and linked the outcomes to NANDA International nursing diagnoses.
NOC outcomes provide a common nursing language for continuity of care and measuring the success of nursing interventions.

261
Q

6 important factors when choosing interventions

A
  1. characteristics of the nursing diagnosis
  2. goals & expected outcomes
  3. evidence base (research or proven practice) for the interventions
  4. feasibility of the intervention
  5. acceptability to the pt
  6. your own competency
262
Q

student care plans

A

6 columns, left to right

  1. assessment data relevant to corresponding diagnosis
  2. goals
  3. outcomes identified for the pt
  4. implementation for the plan of care
  5. a scientific rationale
  6. a section to evaluate care
263
Q

scientific rationale

A

the reason that you chose a specific nursing action, based on supporting evidence

263
Q

Critical thinking attitudes

A

eleven: confidence, thinking independently, fairness, responsibility and authority, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility

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